U world High Yields Flashcards
(780 cards)
1
Q
what drug blocks iodine uptake by the thyroid
A
Perchlorate; Pertechnetate
2
Q
conversion of t4-t3
A
propythiouracil, beta blockers and Ipodate
3
Q
erythematous papulovesicular weeping lesion
A
eczematous dermatitis (eczema)
4
Q
histologic appearance of spongiosis refers to what
A
eczematous dermatitis (eczema) spongiosis is the accumulation of edema fluid in the intercellular spaces of the epidermis
5
Q
thickening of stratum spinosum is referred to as
A
acanthosis
6
Q
thickening of the stratum corneum
A
hyperkeratosis
7
Q
dyskeratosis is associated with what layer of the skin
A
stratum granulosum
8
Q
hypergranulosis is the thickening of stratum granulosum and is associated with what skin conditions
A
lichen planus
9
Q
what is the MOA of PCP
A
an (N-Methyl-D-Aspartate) NMDA receptor antagonist
it works secondary to inhibit reuptake of NE, dopamine & Serotonin
PCP binds to sigma opiod
SE: loss of coordination, VERTICAL NYSTAGMUS, poor judgement, memory loss
10
Q
a single point missense mutation in the genes for beta-myosin heavy chain and myosin binding protein refers to what pathology
A
Hypertrophic cardiomyopathy
11
Q
mutation of DYSTROPHIN GENE refers to what three pathology
A
Linked Familial Dilated cardiomyopathy
DUchene muscular dystrophy
Beckers muscular dystrophy
12
Q
Mutation in Transthyretin gene refers to what pathology
A
Hereditary form of Cardiac amyloidosis causing infiltrative cardiomyopathy (present with dyspnea, peripheral edema and ascites)
13
Q
AD mutations affecting cardiac sarcomere genes refers to what disease
A
Hypertrophic cardiomyopathy.
14
Q
selenium deficiency can lead to what cardio path
A
dilated cardiomyopathy
15
Q
Patient develop Fever , pruritic rash and athralagia 7- 14 days after drug use/antigen exposure is an example of
A
serum sickness causes dec C3 levels (Type 3 hypersensitivity)
16
Q
serum levels of anti Hbc AB and Anti HBs antibodies with no antiHBs antigen means what
A
recovery of HB
17
Q
what type of vaccine do cholera patient use
A
killed vaccines (RIP A cholera)
18
Q
what type of vaccine do TB and oral typhoid vaccine use
A
live attenuated bacterial vaccines
19
Q
low voltage QRS despite refers to
A
restrictive cardiomyopathy
20
Q
superficial scotum abscess drained by
A
Superficial inguinal lymph nodes
21
Q
Testes and ovaries abscess drains by
A
Para-aortic nodes
22
Q
lateral epicondyle (tennis elbow) damages the extensor carpal radialis brevis
A
Radial nerve damage
23
Q
shingles causing local pain on single dermatome for many months
A
VZV
24
Q
what another name for tras2tumab
A
Herceptin
25
a proteasome inhibitor that is used in Multiple myeloma, waldenstrom and induces cell apoptosis
Bortezomib
26
which med cause steven johnson syndrome
lamtrogine (for focal seizures)
27
SE of valproic acid
hepatotoxicity & neural tube defect
28
S.E of lithium
D.I, hypothyroidism, abstain bar anomaly, tremor
29
valporic acid function is
for tonic clonic, myoclonic, absence seizure, manic episodes
MOA= blocks voltage gated sodium channels enhancing gaba synthesis and release
30
drug of choice for myoclonic seizure
vampiric acid
31
s.e of carbamazepine
agranulocytosis
32
SE of Olanzipine
weight gain, metabolic syndrome(dyslipidemie, hyperglycemia,HTN)
33
SSRI (sertraline) induces mania so avoid in patient taking what drug
lithium (bipolar)
34
short stature, broad neck, shortened fourth metacarpals refers to what disease
Turner syndrome
35
what is the sound of bicuspid aortic valve and what other heart disease can it cause
early systolic, high frequency click heard over the right second interspace
bicuspid aortic valve high risk of infective endocarditis
36
Lab finding of aminoaciduria refers to what pathology
Hartnups (treat with high protein diet) and fanconi syndrome
37
fever and sore throat in a patient with hyperthyroidism such as graves disease taking medication should raise what concern
thuonamide induced agranulocytosis
38
what is the preferred drug in a patient taking PTU due to high risk of hepatic failure(hepatotoxicity)
methimazole (s.e aplastic cutis)
note methimazole and PTU both cause agranulocytosis (neutrophil count
39
aspirin and ibuprofen can displace thyroid hormones from binding protein and should be avoided in what patients?
hyperthyroidism patients
40
the region of the sarcomere containing only thick filament is
H-Band( myosin only)
41
unusual flexion of the left wrist and thumb and extension of the fingers are observed on cuff Blood pressure measurement refers to
Carpopedal Spasm in Digeorge syndrome (Catch 22, micro deletion)
decrease soft tissue attenuation in the right anterior mediating refers to thymic shadow
42
failure of anterior neurpore
ananecephaly
43
cryptococus neoformins occurs in the yeast form and found in soil and pigeon droppings infect Immunocompromised through
respiratory system and LUNGS( the primary site of entry)
44
what is the mose effective treatment of a specific phobia (fear of heights, cars, elevators)
behavioral therapy (exposure systemic desensitization is the treatment of choice)
45
MOA of Escitalopram
selective serotonin reuptake inhibitor
treats generalized anxiety disorder, social anxiety disorder and panic disorder
46
what is the formulA for net filtration pressure
Net filtration pressure=(Hydrostatic pressure in capillaries- Hydrostatic pressure in the interstitium) --- (oncotic pressure in capillaries-- oncotic pressure in the interstitium)
47
the resting membrane potential of a cell is generally composed of
RMP= High COnc of K+ & Low Conc of NA+
the difference is maintained via Na, K ATPAse pump
48
within the true pelvis, surgeons can palpate the right ureter immediately anterior to which of the following structures?
Internal Iliac artery
49
what vessels is at risk during pelvis and abdominal surgery
ureters
50
what is formed by the common iliac veins at level of L4
IVC
51
Budding yeast with latex agglutination detects polysaccharide capsular antigen refers to
cryptococus neoformins
cultured on sabouraud agar
52
Non septet hyphea refers to
rhizopus and Mucor
53
Budding yeast that forms Germ tubes refers to
Candida (pseudohyphae at 20degrees and germ tubes at 37 degrees)
54
An elderly man with New back pain, urinary symptoms, osteoblastic lesions in lumber spine refers to
prostate cancer
55
double stranded RNA activates interferons
interferons half protein synthesis except for interferon gama which activate macrophage
56
the most common elbow injury in children
present with injured arm held close to the body with elbow extended and forearm pronated.
annular ligament tear (radial head subluxation)
57
penicillin and cephalosporin works by irreversible binding on
penicillin binding proteins such as transpeptidase
58
cellular myxoid storm that encircles and compress epithelium-lined granular and cystic spaces on histology
Fibroadenoma
59
what kind of medication causes dec HR, flushing, diaphoresis and nausea
cholinergic agonist e.g.bethanecol (atonic bladder)
60
what is the pathophysio of TEF (symptoms : drooling, choking and vomiting during feeding)
failure of the primitive gut to separate airways
Esophageal atresia with distal TEF
diagnosis: inability to pass nasogastric tube into the stomach.
61
cystic or partially cystic(containing cholesterol crystals) with solid areas brown yellow fluid that resemble machine oil in a kid
craniophrangyioma (Ratkes pouch) from surface ectoderm
cholesterol crystals found in motor oil like fluid
62
triptans act on
post synaptic serotonin receptors (5HT1b) (1 big damn headache)
used for migraine
Other drugs CCB, topiramate, valproate BB.
63
Bilateral headache that is > 30 min with steady pain, no photophobia No aura
Cluster headache, NSAIDS acetaminophen , amitriptyline
64
beta endorphin acting on Mu receptors which is derived from
POMC which is a pentapeptide which makes ACTH and MSH and beta endorphins
65
Hep B pathophysio?
due to integration of virus into patient genome
| inhibiting tumor suppressor and activating oncogenes which help in Viral DNA integration
66
what electrolyte is the most affected in cystic fibrosis?
Sodium due to defective chloride channel which regulate flow of sodium chloride and water
excessive salt wasting due to a lot of sweat causing (HYPONATREMIA) due to excessive loss of salt via sweat
67
recurrent pulmonary infection in C.F patients in infancy is due to what bug
staf aureus
68
recurrent pulmonary infection in C.F patient in adolescent is cause by what bug
pseudomonas aeuriginosa
69
muscurinic antagonist causes
anticholinergic side effects is common in what age group
DUMBBELLS diarrhea, urination, miosis, bronchospasm, bradycardia, excitation, lacrimation, sweat and salivation
Elderly patients
70
volatile fluorinated inhaled anesthetic (ISOFLURANE) usually cause what organ and why?
cause decrease vascular resistance therefore increasing cerebral blood flow due to inc CO2 causing vasodilation
all anesthetic except NO cause respiratory depression causing hypercapnia.
71
what get reabsorbed in the jejenum
folate and vit K from gut bacteria
72
prob;lem with dna excision repair is
xeroderma pigmentosa
73
problem with non homologous end joining
ataxia talengasteia and falconi anemia
74
what does E coli use to infect urinary tract
Fimbraie
75
the process of administration of anti toxin of corny bacterium diphtheria is referred to as
passive immunity
76
human placental lactogen cause
resistant to insulin to increase glucose level to the baby in a pregnant woman
produced from the placenta (Synthchioblast) and it is the reason for gestational diabetes and usually goes away in pregnant women after delivery but in obese patient leads to DM type 2
77
how do you kill spores
autoclave (1000degrees)
78
lesion to the vermis causes
truncal ataxia and dysarthria
79
dysmetria( finger to nose test) is due to damage to
cerebellum
80
what joint is more prone to destruction in RA
atlantoaxial joint is more prone to subluxation( fracture of C1)
extension of the neck worsens the subluxation by compressing on C1 compress the spinal cords and vertebral arteries
joint finding: osteophytes (bone spurr)
fingers also have ulnar deviation
cervical spine is involved in RA
81
what enzyme is deficient in I-cell disease
N-acetylglucosaminyl-1-phosphotransferase
82
I-cell disease aka inclusion cell disease is also called what
mucolipidosis type 2
83
what is the formula for attributable risk
AR = 1 - Relative Risk percentage
i.e if RR=5 then RR%= 1/5 therefore RR%= 1/5* 100% = 20%
then Attributable risk = 1 - relative risk percentage
AR= 100% - 20% = 80%
84
multinucleated cell with iintranuclear inclusion (cowdry body type A) is associated with what pathology
VZV
85
damaged intermediate filament within the hepatocyte
mallory bodies
86
Nuclear factor Kappa B
present in cytoplasm and its not activated, but activated by Toll Like Receptor that is bound to antigen. then it activates acute phase reactant like IL1, IL6 & TNF alpha
it binds to IKb
87
what is the antidote for serotonin syndrome ( hypereflexia, rigidity, clonus, myoclonus), hyperthermia and cardiovascular collapse
cryptoheptadine (a first generation histamine antagonist with non specific 5HT1 & 5HT2 receptor antagonist properties
88
Biopsy reveals nest of uniform cells with inconspicuous nuclei and a few mitotic figures involving the basal portion of the epidermis and upper dermis refers to what skin pathology
Compound melanocytic nevus
89
a collapsed lung occurs due to
obstruction in main stem bronchus lesion (e.g. central lung tumors in chronic smokers)
90
patient with Sickle cell disease are prone to what type of vitamin deficiency and why?
Folic acid deficiency (causing microcytic anemia) due to increased erythrocyte turnover
91
how does a splenic vein thrombosis cause gastric varies only in the fundus of the stomach
the splenic vein increase the pressure of the short gastric vein causing gastric varices
the short gastric vein usually drain blood from the gastric fundus into the splenic vein
pancreatic inflammation or pancreatic cancer causes blood clot into the splenic vein which causes the increase pressure in the short gastric vein causing gastric varices only in the fundus
92
what stimulate the adrenal medulla
acetylcholine released from preganglionic neurons and secrets catecholamines
93
Most common risk factor for developing calcium stones in the kidney (nephrolithiasis) in adult is
HYPERCALCURIA and it is usually idiopathic with a NORMOCALCEMIA due to intact regulation of vit D and parathyroid hormone
symptoms of nephrolithiasis (right flank pain that radiates to the groin), gross hematuria and no fever and no costovertebral angle tenderness
94
Hyperuricosuria with normouricemia is cause by
High protein diet
95
Hyperoxaiuria is as a result from a diet high in what
oxalate (chocolate, spinach and nuts)
| seen in Crohn disease
96
what pathway in the brain is responsible for positive symptoms of schizophrenia
Increase Dopamine in the MESOLIMBIC PATHWAY is the cause for Positive symptoms of schizophrenia
schizophrenia is inc risk of suicide.
97
what pathway in the brain is responsible for negative symptoms of schizophrenia
decrease dopamine in the MESOCORTICAL TRACT may cause the negative schizophrenia symptoms
98
psychotic symptoms for at least 2weeks in the absence of mood disorder + a time period with both psychosis and a major mood disorder episode at the same time
schizoaffective disorder (primary psychosis with a little bit of mood disorder)
if primary problem is major depression with a little bit of psychosis then it will be major depressive disorder with psychotic features.
99
what is the major defense mechanism for paranoid disorder (always suspicious, lack of trust)
projection
100
tx of psychosis from parkinson meds
quetiapine cuz of lowest side effect
101
role of eosinophils in parasitic infection
Eosinophil play a role in host defense against parasitic infection by inducing antibody dependent cell mediated cytotoxicity with enzymes from their cytoplasmic granules
102
what is MOA of entacapone
A catechol-o-methyl transferase COMT inhibitor increasing the bioavailability of levodopa by inhibiting its peripheral methylation and decrease peripheral levodopa degradation
used in parkinson patient who experience end of dose wearing off periods
103
what is the blood supply for the proximal ureter in the kidney
branch of renal artery
104
distal ureter blood supply is
superior vesicular artery
105
increase bile acid supplementation causes
dissolve gall stones
106
MOA of metformin
inhibit hepatic gluconeogenesis via inhibiting the mitochondria isoform of glycerophosphate dehydrogenase in the liver.
107
cafe au last spots (shoulder, neck and buttocks), endocrine abnormalities (e.g precocious puberty(onset of secondary sexual characteristics in females before the age 8 in girls), hyperthyroidism) and fibrous dysplasia (multiple osteolytic appearing lesion of the hip and pelvis) refers to what pathology
McCune-Albright Syndrome (mutation in the GNAS gene encoding the stimulatory alpha subunit of G protein)
108
what muscles occupy most of the space of the greater sciatic foramen
piriformis (externally rotates the hip)
109
routes of meningeal contamination in nesieria meningitis (bean shaped gram negative cocci in pairs
(Mode of transmission Respiratory droplets) seen in new military recruits, college freshmen)
pharynx----blood-----choriod plexus------meninges
110
route of meningeal infection in H influenza
pharynx---lymphatics----meninges
infants and young children commonly affected
111
route of meningeal infection strep pneumonia
middle ear----contigious tissues-----meninges
112
route of meningeal infection or CNS Abscess by staph aureus
traumatic wound (bacterial from skin)---- leaking CSF----- meninges
113
route of meningeal infection in mycobacterium tb
primary lung focus---blood---meninges
114
What other structure has a similar chemical structure to Bisphosphonate
Pyrophosphate disrupt osteoclast function by attaching to hydroxyapatite binding sites on bony surfaces.
115
why are patient advised to take bisphosphonate on an empty stomach with plenty of water?
due to poor gastrointestinal absorption and remain upright for 30 mins due to risk esophageal erosions
116
the marker for osteoclastic activity in osteoporosis
urinary hydroxyproline
117
in a newly born suffering flaccid lower extremities and absent ankle reflexes bilaterally and poorly developed lumber and sacrum is caused by
uncontrolled diabetes
118
neurologic defects, lactic acidosis and inc alaninine in infancy refers to
pyruvate dehydrogenase deficiency
Treatment: High fat content, lysine (Ketogenic a.a) and leucine (ketogenic a.a)
119
FSH stimulates sertolic cells to produce
inhibin A, (inhibit have a negative feedback blocking FSH release)
FSH helps in spermatogenesis and inhibin production
120
Estrogen up regulate gap junction which contains
connexions
121
spontaneous pneumothorax with apical blebs affecting the pulmonary system is seen in what other pathology apart from spontaneous pneumothorax
Marfan syndrome
122
IN the spleen of a sickle cell patient that is firm and brown (hemosiderosis) is most likely due to
vascular occlusion
123
Cheyne-strokes breathing is seen in what pathology
CHF
124
what contributes to the formation of gallstones
High Serum triglyceride
| this inc production of free fatty acid in the capillaries by pancreatic lipase
125
what is androgenic alopecia and what is the mode of inheritance
made up of hormonal and genetic factors and varies between males and females
Mode of inheritance is polygenic inheritance with variable expressibility
126
cervicitis is detected using nucleic acid amplification testing has what presentation
Vaginal spotting and yellow vaginal discharge
cervicitis is caused by Gonnorhea and CHlamidia causing PID which leads to Infertility and ectopic pregnancy if not treated.
tx: ceftriaxone + azithromycin/doxycyline
127
what drug do you use due to their anti inflammatory properties to treat graves Opthalmopathy
High dose Steroids
128
kisslback plexus (anterior) most common cause of epistaxis occur on due to damage on
Nasal septum.
tx: pinch the nasal alae and give Cautery Silver nitrate for severe form
three major arteries branches at kisselback plexus
1) septal branch of anterior ethmoidal artery
2) Lateral nasal branch of sphenopalatine artery
3) Septal branch of superior labial artery (branch of facial artery)
129
posterior part of the external auditory canal is innervated by
the small auricular branch of the vagus
130
what organism can cause liver abscess
staph aureus
131
elevated alkaline phosphatase means that there is a problem with what organs
liver, gall bladder and bOnes
132
what antidepressant drugs causes orthostatic hypotension & a painful erection unrelated to sexual events (priapism) and used to treat OCD, depression and insomia
Trazodone post synaptic serotonin receptors and inhibit serotonin reuptake with minimal effect on NE and dopamine
133
primaquine is added to the hypnozoites in the liver and it is responsible for
responsible for relapse
134
what is used to treat TCA associated toxicity(antidote) and works by increasing serum pH and extracellular sodium
Sodium bicarbonate
135
which BPH medication is used to decrease prostate volume?
Finasteride
136
influenza virus undergo genetic shift using their segmented genome which other virus have a similar mechanism
Rotavirus & orthomyxovirus
137
what leads to insulin resistance in type 2 DM
Elevated free fatty acid levels
138
why do we have the symptoms in Normal pressure hydrocephalus
due to distortion of periventricular white matter
the bladder control (urinary issues) is due to STRETCHING OF THE DESCENDING CORTICAL FIBERS
139
what accumulates when a patient is on methotrexate
dihydrofolate polyglutamate
140
a prolong PTT and a false-positive rapid plasma reagin in a woman with SLE is at greatest risk of
Disease( Antiphospholipid syndrome) secondary to SLE
Greatest risk for Recurrent Misscarage & venous/arterial thromboembolism
141
what drug worsens/precipitate opioids withdrawer
Buprenorphine (partial opiod agonist that prevent other opiod frm binding.
142
propofol is an anesthetic that when used perfuses to highly vascularized organs like kidney brain heart and then goes to poorly vascularized organs like
skeletal muscles, Fats and bones
143
Neutropenia is a significant SE of Ganciclovir, what two drugs can increase its toxicity
TMP/SMX & zidovudine also cause Neutropenia worsening the bone marrow suppression
144
IN mitochondria inheritance disease, the reason for the variable expressibility among individuals is called
Heteroplasmy (random distribution of normal and mutated mitochondria)
145
supracondylar fracture resulting in anterolateral displacement of the proximal fracture fragment causes what nerve injury
Radial nerve
146
Supracondylar fracture resulting in anteromedial displacement of the proximal fracture segment
Median nerve and brachial artery injury
147
Superior Vena cava syndrome is mostly as a result of
Mediastinal mass
148
MOA of bisphosphonate
Inhibits osteoclast activity inducing osteoclast apoptosis
Bisphosphonate has a similar chemical structure as pyrophosphate (attaching to hydroxyapatite binding sites on bony surfaces)
149
A recombinant formulation identical to the 34 amino acid sequence at the N -terminal portion of endogenous PTH refers to what drug
teriparatide
150
what drug inhibits osteoclast differentiation
raloxifen
151
a monoclonal antibody that binds to Rank L (on nuclear factor kappa B) and blocks the interaction between RANKL & Rank receptor which decrease bone resorption is
DENOSUMAB
152
acute painless monocular vision loss is due to
Retinal artery occlusion
(presents as a cherry red spot on the macula with retinal whitening in patients with history of coronary artery disease, HTN and DM)
Internal Carotid artery are the most common cause of retinal artery occlusion due to thromboembolic complications.
travels from internal carotid artery------opthalmic artery------retinal artery
153
In patient with lactate dehydrogenase deficiency in strenuous exercise you stop glycolysis why?
NO NAD+ to be converted to NADH
154
What type of hernia is due to weakness of transversals fascia
Direct hernia ( in older men)
155
weakness of proximal femoral canal is what pathology
femoral Hernia
156
methadone overdose can cause
methadone is used to whin off opiod euphoric effects
long QT interval and respiratory depression
methadone ( a Mu receptor agonist) has a long half life, high bioavailability, high potency
157
facial pain, headache and nasal eschar is dedicative of mucor and rhyzopus suggesting of DKA . the procedure for diagnosis is
Mucosal Biopsy
158
what is the pathogenesis of rabies virus
Rhabdoviridae (rabies) are single stranded RNA virus enveloped by a bullet shaped capsule. that binds to nicotinic acetylcholine receptors.
(Retrograde transport) using DYnein
Clinical presentation: agitation, disorientation, pharyngospasm and photophobia leading to Coma and death
159
most common cause of osteomyletis(Pain in joint) in children is
Staph aureus
affect mostly long bones (tibia, fibula and femur)
160
what is the cause of a vertebral osteomyelitis after a UTI infection
Enterococcus Faecalis
161
upper extremity numbness, tingling and weakness refers to
thoracic outlet syndrome ( compression of the lower truck of brachial plexus)
most commonly occur within the scalene triangle affecting the scalene muscles (anterior, middle scalene and first rib makes the triangle)
repeated overhead arm movement and trauma worsen it
162
Infertility due to a bling vaginal pouch and lack of mullein structure is
Mayer-Rokitansky-Kuster-Hauser syndrome (due to complete genesis of paramesonephric duct)
163
Recurrent pregnancy loss is due to
```
Bicornuate Uterus (failure of lateral fusion of the paramesonephric duct to fuse)
characterized by indentation in the center of the fundus
```
164
Elevated AFP is seen in what pathology
open wall defects (open neural tube), omphalocele, gastroschisis
165
mylomeningocele is associated with what trisomy
Trisomy 18 (edwards syndrome)
166
omphalocele is associated with what trisomy
trisomy 13 (PAtau) & 18 (edwards)
167
flank pain, gross hematuria, elevated lactate dehydrogenase is what pathology
Renal vein thrombosis,
| URinary loss of Antithrombin 3 predispose this patient to acute condition
168
the mechanism of gallstone formation in cRohns disease is
due to decrease bile acid absorption and increase bile acid wasting
169
what another name for anterior drawer test
lachman test
170
what is congenital Torticollis
it is typically noted by 2 to 4 weeks of age after the child hold his head tilted to one side
due to malposition of the head in utero or birth trauma
can resolve with conservative therapy and stretching exercises.
171
what test can be used to detect fructose in the urine
copper reduction test
172
what pathology is due to loss of paternal chromosome X
turner syndrome
173
what inhibit thyroid hormone release
iodide
174
what is MOA of zolpidem and uses
bind on GABA-a receptor and enhance the inhibitory action of GABA on CNS (SAME MOA AS BENZODIAPAMS)
Zolpidem is Used for short term treatment of Insomnia with a rapid onset of action (15mins) and metabolized by p450 microsomal oxidases
elimination half-life is 3hrs but prolong in liver disease
175
an autosomal codominant genetic disorder that present with pan acing emphysema and liver disease is
alpha-1-antitrypsin deficiency
176
growth retardation, microcephaly(abnormal facies), photosensitive rash, immunodeficiency (recurrent infection)
Bloom syndrome (BLM gene of helices deficiency)
177
primary structure of protein is by what type of bond
peptide bond
178
conformational change in secondary structure of protein such as alpha helix and beta sheet is due to what type of bond
hydrogen bond
179
in tertiary structure, helps protein fold what bond helps
ionic bond
180
subacute sclerosing panencephalities (ataxia, myoclonus and visual problems) caused by what virus affecting kids
```
Measles virus (Rubeola) (enveloped single stranded RNA virus)
codes for membrane bound hemagluttinin (surface adhesion) and matrix protein (important for viral assembly)
```
conjunctivitis, coryza, cough and koplik spot
oligoclonal bands of measles virus antibodies are found on Cerebrospinal Fluid of the patient
tx; live attenuated measles vaccine
181
brain biopsy showing spongiform transformation of the cerebral cortex refers to
creutfieldt-Jakob Disease (due to abnormally folded protein))
182
brain biopsy showing focal demyelinated plaques with relative axonal sparing refers to
Multiple sclerosis
183
Progressive multifocal leukoencephalopathy is caused by
JC virus (a double stranded DNA virus in the polyomavirus family) usually in immunocompromised patients
184
a from of parkinsonism resulting from neurodegnerating of midbrain and frontal subcortical white matter that presents as rapid gait dysfunction, falls executive function loss and vertical gaze palsy refers to
progressive supra nuclear palsy
Biopsy shows deposit of abnormal phosphorylated tau proteins
185
physical examination shows coalescing erythematous lesion with crusting and scaling at the borders and central areas of bronze color induration refers to
glucagonoma
biopsy shows superficial necrolysis (elevated painful and pruritic rash typically affecting the face, groins and extremities)
other symptoms hyperglycemia (DM) & nonspecific GI Symptoms with normocytic normochromic anemia
186
presentation of abdominal pain, gall stones, constipation, hyperglycemia and steatorrhea refers to
somatostatinoma
187
water diarrhea, hypokalemia and achlorydia refers to
VIPOMA (high level of vasoactive intestinal polypeptide)
188
skin lesion with pustules and vesicles without a central clearing, hypogonadism, azoospermia, hair loss, impaired taste, night blindness and impaired wound healing refers to
ZINC DEFICIENCY
189
noise induced hearing loss result from trim to the sterocilliated hair cells in the
organ of corti
190
sounds reaches the middle ear by vibrating .....
the tympanic membrane
191
what part of the ear registers low frequency sound
cochlear cupula
192
type 1 fibers (slow twitch) mostly by aerobic metabolism has high myoglobin, high mitochondria, glycogen poor fibers an example is postural muscles such as
Soles & paraspinal muscles which are postural muscles mostly made up of slow twice fibers (type 1)
seen in marathon runners
193
type 2 fibers (low myoglobin, low mitochondria, glycogen rich fibers) produce rapidly forceful arm movement and they are type two fibers which are fast twitch examples are
latismus dorsi, pectorals major, biceps brachia, deltoid
seen in 100M race (short distances)
194
over expression of what protooncogene is associated with breast and ovarian cancer
ERB-B2 genes (has tyrosine kinase activity related to epidermal growth factor receptor)
195
what is responsible for differentiation of fibroblast into myofibroblast
transformation growth factor Beta (TGF-B)
196
what is the diff btw keloid and hypertrophic scar
Keloid extend beyond the borders of the original wound and are raised, painful and pruritic.
Keloid is seen in remodeling phase in wound healing
(seen in ear piercing, trauma and prominent in (ASIANS/AFrican ethnicity)
Hypertrophic scar are limited to the wound area and regress spontaneously
197
mutation of type 5 collagen
Ehlers Danlos syndrome
198
MOA of phenytoin
block voltage gated sodium (NA+) channels in neurons
how does phenytoin cause gingival hyperplasia?
phenytoin causes increases expression of PDGF (platelet derived growth factor) causing gingival hyperplasia
199
how is propofol cleared in the body creating rapid recovery from the anesthesia
tissue redistribution of the drugs
200
SE of acyclovir
nephrotoxicity and neurotoxicity
201
Lamivudine (NRTI) SE
peripheral neuropathy and lactic acidosis
202
what drug blocks nonstructural protein 5B (NS5B) an RNA dependent RNA polymerase used for hep c viral replication
SOFOSBUVIR
203
SE of FOrscarnet
Electrolyte imbalance
204
what drug inhibit the incorporation of D-alanine into the UDP-MUrNAc-oligopeptide during bacterial cell wall synthesis
cycloserine
SE: HIGH LEVEL OF OTOTOXICITY that is why it is RARELY USED
205
explain pseudomonas resistance to aminoglycoside such as amikacin
it decreases antibiotic entry into the bacterium creating resistance
206
chlorothalidone is an example of what type of drug
thiazides
SE: incr cholesterol and triglyceride levels
207
Best treatment for Post traumatic stress disorder (a solider remembering horrific experiences)
SSRI (selective serotonin reuptake inhibitor)
208
in mallory weise Syndrome( tear at Gastroesophageal junction) causes what acid base disorder
metabolic alkalosis due to repetitive vomiting and loss of gastric secretion
209
trachoesophageal fistula with esophageal atresia is due to
failure of the primitive forgut to appropriate divide into separate trachea and esophageal structures
presentation: drooling due to inability to swallow saliva(polyhydramnious), choking, cyanosis during feeds
diagnosis: via xray due to inability to pass a nasogastric tube into the stomach.
210
what drug do you give for recurrent seizure activity
phenytoin (blocks Na+ channels) & its long acting
211
A soluble receptor decoy protein refers to what drug
Etanercept (Tumor necrosis factor alpha (TNF-A) inhibitor)
| used to treat RA who have failed by methotrexate therapy
212
peu d orange sign and dimpling of the breast is due to
malignant infiltration of the SUSPENSORY LIGAMENT of the Breast.
213
severe depression, suicidal thoughts, fatigue, hypersomnia, hyperphagia, vivid dreams refers to
cocaine withdrawer
214
what test should be ordered before a patient begins Canagliflozin therapy in DM2
BUN & Creatinine test (Asses RENAL FUNCTION Before starting this drug)
Canagliflozin and DApagliflozin is an (SGLT2 inhibitor)
increases renal glucose excretion
SE: hypotension, UTI
215
w drug that inhibit RANK/RANKL activity increasing bone density to treat osteoporosis is
DENOSUMAB
216
edwards syndrome is associated with what GI pathology
Malrotation and Mockers diverticulum
VSD & PDA
217
Palau syndrome is associated with what GI path
Omphalocele/umbilical hernia
218
How does Morphin terminate pain in a physiological stand point
Morphine is an opiod agonist that acts on Mu receptor( family of G protein)
It causes G-protein activation of potassium channels to increase potassium efflux leading to hyper polarization and termination of pain
it also inhibit adenycyclase, inhibit calcium conductance and inhibit transmission release.
219
a systolic murmur at the cardiac apex that decreases with squatting refers to
hypertrophic cardiomyopathy
220
patient sudden onset of syncope with QT prolongation in an otherwise healthy individual refers to
Cardiac arrithmias (due to Membrane potassium channel proteins)
221
mutation of a calcium binding sarcoplasmic reticulum protein refers to what pathology
ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY
222
in duodenal ulcer, H-pylori colonizes mainly what area
The antrum of the stomach in the PREPYLORIC AREA (where there are few acid secreting parietal cells) & duodenal bulb( which is the most exposed to increase acid production)
223
sickness in farm workers as a result of inhalation of animal waste (mostly cattle and sheep) is caused by
coxiella Burneti cause Q fever
Fever > 10 days fatigue, myalgia and rtetroorbital headache associated with photophobia
cause inc liver enzymes and thrombocytopenia
224
MOA OF RIFAXIMIN
inhibits bacteria RNA synthesis through binding with DNA-dependent RNA polymerase
non absorbable antibiotic that alters GI flora decreasing intestinal production and absorption of ammonia.
Rifaximin (dec intraluminal ammonia production) used in travelers diarrhea, Hepatic encephalopathy with lactulose (which increase conversion of ammonia to ammonium)
225
lateral ankle sprain is due to Inversion of a plantar flexed foot damaging what muscle
anterior talofibular ligament (most damaged)
226
eversion of the ankle damage what ligament
Deltoid ligament (not easily sprained)
227
hypercalcemia with no focal lytic bone lesion suggests
humoral hypercalcemia of malignancy which is caused by parathyroid hormone related protein.
228
Left sided heart failure causing Pulmonary Hypertension is due to
Vasoconstriction due to pulmonary venous congestion
229
right sided heart failure causing pulmonary HTN is due to
Hypoxic induced pulmonary vasoconstriction via Cor Pulmonale
230
ANASTROZOLE AND EXEMESTANE MOA
Blocks the conversion of androgen to estrogen
| AKA Decrease ANDROGEN AROMATIZATION
231
what decrease VLDL production
triglycerides, Fibrates and fish oil
232
what reduce LDL receptor degradation of the liver
Pro protein convertase subtilisin Kexin (PCSK 9 inhibitor)
233
what is the MOA of Cinacalcet
allosteric activator of calcium sensing receptor in parathyroid gland, decreasing parathyroid hormone release
234
what drug decrease phosphate absorption in the GI tract
SEVELAMER used to treat hyperphosphatemia in dialysis patients
235
treatment of atropine overdose
physostigmine
236
Hiatal hernia is a strong predisposing factor to
GERD and Mallory Weis syndrome
237
Acanthosis affect the stratum spinosum , what disease displays this condition
psoriasis, seborrheic dermatitis and acanthosis nigrans
238
dyskeratosis is found in what disease
squamous cell carcinoma
239
uticararia is a transient hypersensitivity disorder seen after administering a drug and the patient develop Rash edema of posterior pharynx and tonsils exudate, what is the most likely finding on biopsy?
Dermal EDEMA via mast cell degranulation
240
what cytokine have anti-inflammatory properties in IBD
IL-10 inhibition th1 cells reducing MHC2 expression and suppression of activated macrophages and dendritic cells
IL10 reduces inflammation
241
what is claudication?
intermittent muscle pain reproducibly caused by exercise and relieved by rest and it is due to athelersclerosis of large arteries
the obstruction is due to atheroma which are lipid filled intimal plaques that bulge into the arterial lumen. this prevent increase blood flow to exercising muscles resulting in ischemic muscle pain
242
an example of a protein that can bind cDNA is
N-MYC protein (can be detected by DNA probes)
243
chalky white lesion in mesentery with fat cell destruction (necrosis) and calcium deposition and intestinal edema seen on light microscopy refers to
Acute pancreatitis
244
Aeromonas hydrophilia
oxidative +ve non lactose fermenting, Gram negative rod cause gastroenteritis, wound infection and bacteremia due to exposure to contaminated water.
245
signs of opiod withdrawer in a neonate
persistent crying, tremors, tachypnea, sneezing and diarrhea and Jittering movements
TX: Methadone/ morphine
246
what is the MOA of Repaglinide
inc insulin secretion by inhibiting beta cell K(atp) channels
SE: hypoglycemia, weight gain
247
middle cerebral artery and ophthalmic artery is a branch of
internal carotid artery
248
skull fracture at the pterion (where frontal, parietal, temporal and sphenoid bone meet ) can cause what pathology and what artery
middle menininggeal artery damage causing epidural hematoma,
middle meningeal artery is a branch of the maxillary artery
249
what venus structure does internal hemmoriods drain
superior and middle rectal vein, which communicates with internal iliac & inferior mesenteric vein
250
what venus structure does external hemmoriods drain
inferior rectal vein into the internal pedestal vein which communicates with internal iliac vein
251
branches of the deep external pedestal artery supplies
the scrotum
252
superior vesicular artery supply
urinary bladder and ductus deferens
253
what area of the body do angiotensin 1 converts to angiotensin 2
lungs
254
analog version of ANP
Neprilysin inhibitor (Sacubitril) prevents degradation of ANP enhancing its hemodynamic effects in heart failure patients
255
AML contain auer rods and they stain for
MYELo-peroxidase (pinkish color)
AML presentation is Anemia (fatigue, weakness), thrombocytopenia (petechiae, hemorrhages), neutropenia(fever, opportunistic infections)
256
what are the presentation of hairy cell leukemia
Splenomegaly, fatigue and pancytopenia
Tartrate resistant acid phosphate (TRAP)
b-lymphocyte precursors and are CD20
257
what medication should be started infall Heart failure patients with left ventricular systolic dysfunction to improve survival?
Carvedilol, Metoprolol. ACE inhibitors and aldosterone antagonists
258
what medication do you use to treat supra ventricular and ventricular arrhythmias?
Amiodarone
259
enzymes that require Biotin (also seen in raw eggs (Avidin) ) as a cofactor include
pyruvate carboxylase (pyruvate to oxaloacetate)
Acetyl CoA carboxylase (acetyl coA to malonyl coA for fatty acid synthesis)
Propionyl CoA carboxylase
(Propionyl-CoA to Methyl Malonyl CoA) (Fatty Acid Oxidation)
260
describe the rash in measles(rubeola) & german Measles (rubella)
maculopapular rash that starts in the face and chest and spreads to trunk and extremities.
usually have post auricular lymphadenopathy
Fetus with Rubella is at risk of what congenital defects?
Cataracts, PDA, Polyarthralgia & sensorineural Deafness
261
what occurs in the stages of acute tubular necrosis
initial stage (ischemic injury to renal tubules precipitated by hemorrhage, acute MI, sepsis, surgery)
Maintenance stage (dec urine output, fluid overload, increase creatinine/BUN, hyperkalemia)
Recovery phase: gradual increase in urine output leading to high volume diuresis, electrolyte abnormalities decrease concentration of K, Mg, PO4 and Ca due to slowly recovering tubular functions
Clinical features of acute tubular necrosis is oliguria, brown granular/muddy cast, inc bun:creatinine ratio, hyperkalemia (due to dec resale excretion) with metabolic acidosis.
262
what is the requirement for referring a patient for Hospice care?
Patient has a prognosis less than or equal to 6 months.
Hospice model: focus on quality of life, not cure
they are services provided at home, assisted living facility /dedicated facility
263
abdominal distention and bloody stool in an infant, what is the diagnosis
necrotizing enerocolitis
as bacteria is introduced during feeding, the bacterial proliferate excessively due to compromised immune clearance.
AIR in the bowel wall confirms the diagnosis
264
gastric erosions are a mucosal defect that do not completely extend through what layer
muscular mucosa (i.e. erosion are limited to the mucosal layer.
265
what enzyme is responsible for part of interconversion of of ribose 5 phosphate and fructose 6 phosphate in the reversible step
transketolase
266
what do you use to study the difference between 2 or more independent group
analysis of variance (ANOVA) used to find the difference between the means of 2 or more group.
267
what do you use to check the difference between two category variables (e.g diff btw sexes regarding smoking)
Chi-square
268
what do you use to compare the means of two group
2-sample t-test
269
Neonatal meningitis that is resistance to third generation cephalosporins (Cefotaxime) is most likely caused by
Listeria monocytogenes
resistance to cephalosporin is due to alteration to penicillin binding proteins
however it is susceptible to ampicillin
DOC for listeria is AMPICILLIN
270
what type of gastric cancer infiltrates the stomach wall
```
Diffuse type (limits plastica)
signet ring cells
```
271
what type of gastric cancer projects into the stomach lumen and is composed of glandular forming cuboidal/columnal cells
Intestinal type
272
what do you use to treat nausea and vomitting under chemotherpay
ODANSETRON (INhibits serotonin (5HT3) receptors and block vagus nerve too
273
what area is suscessitble to ischemic damage during hypotension in the colon
rectosigmoid junction in the watershed area
274
a test in which a patient serum is mixed with a solution of cardiolipin, cholesterol and lecithin. aggregation/flocculation of the sample present of cadiolipin antibodies refers to
Rapid plasma Reagin (RPR) test for treponema pallidum (SPirochetal antibodies) & VDRL are screening test
confirmatory test is
FTA-ABS
275
carcinoembryonic antigen (CEA) assay in a patient with colorectal cancer is used to measure
colorectal cancer recurrence
CEA is higher in smokers than non-smokers
NOTE: CEA levels is not used to diagnose colon cancer , it is only used for RECURRENCE
276
a bifid carotid pulse with brisk upstroke (Spike and dome is characteristics of
Hypertrophic cardiomyopathy
| due to LV outflow obstruction
277
what is the most common manifestation of osteoporosis
vertebral fracture
278
microabsesses containing fibrin and neutrophil at the dermal papillate tips refers to
```
dermatitis Herpetiformis (involve formation of IgA antibodies against gliadin
which is associated with Celiac disease which is characterized by INCREASE INTRAEPITHELIAL LYMPHOCYTE, Flattened villi, and hyperplasia of crypts which causes the malabsorption (Steatorrhea)
```
associated with small bowel cancer & t-cell lymphoma
duodenal biopsy to confirm diagnosis
279
shoulder pain, hypotension and tachycardia after a traumatic event such as car crash suggest
Splenic laceration
shoulder pain is due to referred pain due to peritoneal irritation
phrenic nerve irritation cause hiccups due to spasmodic diagrammatic contraction pulling hair against a closed larynx
280
a patient with persistent fluctuating lymphadenopathy that was initially treated with antibiotics for pharyngitis most likely has
follicular lymphoma
present as painless lymph node enlargement or abdominal discomfort from an abdominal mass
281
a tremor of the hands that worsen while maintaining a certain posture e.g holding an object and subside a little with alcohol use and presence of a family history refers to??? treatment??
Essental tremor, treat with propranolol
282
giving clavulinic acid with amoxicillin is
decrease amoxicillin cleavage by bacterial cells increase it scope to kill beta lactamase organism
283
whats the MOA of capscaicin
reduce pain by reducing substance P in PNS + CNS
284
Water shed areas (2areas)
SMA+ IMA
| IMA+ HYPOGASTRIC
285
tinnitus, vertigo, sensoruinear earring loss
menieres disease (due to inc pressure + Volume of endolymph in inner ear)
286
weakness of dorsiflexion of the foot due to involvement of the common perineal nerve refers to what disease
Charcot-Marie-Tooth disease due to mutation of a myelin protein
287
inability to sense a full bladder and incomplete emptying in a type 1 DM can be confirmed by
PostVOid Residual testing with ultrasound or Catheterization can confirm inadequate bladder emptying.
288
what type of benzodiaepans are preferred in patient with impaired hepatic metabolism
LOT (lorazepam,oxazepam, temazepam)
289
what drug can be used for short term anxiety as needed
Lorazepam
290
what stores and transport Surfactant
Lamellar bodies (organ containing parallel stacks of membrane lamellae)
Surfactant deficiency : NRDS(neonatal respiratory distress syndrome)
291
a Dry TAP in hairy cell leukemia means
an unsuccessful bone marrow aspiration aka no marrow is aspirated.
present as pancytopenia and spleenomegally that crosses the midline or extend to the left lower quadrant
292
two biggest SE of tamoxifen is
Endometrial hyperplasia and endometrial carcinoma
293
spaghetti and meatball appearance on light microscopy with the hyphae been short and having a cigar-butt appearance treated with potassium hydroxide refers to
Pityriasis vesicular caused by MALASSEZIA GLOBOSA
294
clostridium difficle work by what method
disrupting actin cytoskeleton structure and intracellular signaling thereby disrupting cytoskeleton integrity
295
glycogen synthesis in hepatocyte by insulin is mediated by what enzyme
protein phosphatase
296
what is MOA of MiLRinone and Inamrinone?
Phosphodiesterase 3 inhibitor used to treat Heart failure by causing VASODILATION by decreasing the rate of CAMP degradation in cardiac tissues therefor increasing CAMP LEVELS promoting calcium influx into cardiac myocyte
Contraindication: do not give drug in severely hypotensive patients
297
strawberry type capillary hemangioma
First increase in size and then regress
298
protein deficient in atomic dermatitis affecting the component of the epidermis is
Filaggrin
299
for POST_EXPOSURE to Nesierria Meningitis and to prevent meningitis a patient should be giving what medication?
RIFAMPIN CHEMOPROPHYLAXIS
300
how does a bacteria become resistance to Isoniazid
by blocking bacteria catalase peroxidase
301
MOA of BUTAPHYNOL
kappa receptor agonist and cause less respiratory depression
302
what is Cholesteatomas
collection of SQUAMOUS CELL DEBRIS that forms PeARL MASS BEHIND THE TYMPANIC MEMBRANE in the middle ear causing CONDUCTING HEARING LOSS
303
chest pain, diaphoresis, history of arteriolosclerosis and type 2 diabetes suggest
acute coronary syndrome
Most common SE of ALTEPLASE is Hemorrhage which presents as loss of consciousness, asymmetric pupils and irregular breathing.
304
list drugs that are VEGF inhibitors
bevacizumab, Ranibizumab
305
Epidermal growth factor receptor inhibitor (EGFR) is
Erlotinib,Gefitinib
306
periodic sudden-onset of involuntary Jerking movement involving both arms with no loss of consciousness refers to
Myoclonic seizure (first line Valporic acid)
307
motor tics with stereotyped movement
Tourette syndrome
Tx: Fluphenazine, pimozide
308
extended spectrum beta lactamases e-coli how do they render betalactamase antibiotic inactive
by transmission through Plasmid conjugation
309
what amino acid is propionyl coA derived from
VALine, ISoleucin, Met, THroninee
310
igG3 antibodies to phospholipase A2 receptor (PLA2R) a transmembrane protein abundant on podocyte refers to what pathology
membranous nephropathy
311
list what is present in REVERSIBLE myocardial injury
```
Myofibril relaxation
Diasagregation of polysomes
disaggregation of nuclear granules
triglyceride droplet accumulation
glycogen loss
```
312
what is an example of IRREVERSIBLE myocardial injury
Mitochondrial vacuolization (damage causes ATP DEPLETION)
313
what is the MOA of the drug used to treat ALS
Riluzole: dec glutamate release
314
in RIght Ovarian vein thrombosis if not treated the thrombus have a risk of extension into what vessel
IVC
note: Right ovarian vein drains into IVC (MOST THROMBOSES IS RIGHT SIDED)
Left ovarian vein drains into left renal vein
315
what type of walking pneumonia causative agent requires cholesterol to grow on artificial media?
Mycoplasma pneumonia
316
what is the next best step management of a patient with septic arthritis
ATHROCENTESIS ( synovial fluid analysis)
317
Damage to the brainstem at/below the level of the red nucleus (Mid brain tegmenjtum and Pons) results in
Decerebrate(extensor) posturing (Check picture on ur phone) due to loss of descending excitation to the upper limb flexors (Via rubrospinal tract) and predominance of the extensors (controlled by vestibulospinal tract)
318
in vertical gaze palsy what part of the brain is damaged?
Midbrain tectum ( superior colliculus damage causing paranoid syndrome)
319
contralateral loss of sensory/motor deficit is as a result of damage to
Internal capsule
320
what is hyper somnolence disorder
excessive daytime sleepiness that cannot be explained by another sleep disorder
UNLike NAcolepsy, this patients do NOT feel refreshed after Naps
321
spindle cells with hair-like glial process that is associated with micro cysts refers to what brain tumor
pilocystic astrocytoma (rosenthal fibers)
322
yellow spot on the inner surface of the abdominal aorta describes
(Lipid laden macrophages aka Foam cells) FATTY STREAKS is the EARLIEST presentation of atherosclerosis and on light microscopy comprised mostly of MACROPHAGES (LIPID LADEN FOAM CELLS)
323
what is the function of the overexpreesion of c-myc oncogene in burritos lymphoma
promotes cell growth, differentiation aka A TRANSCRIPTION ACTIVATOR
324
what drug is used for painful diabetic neuropathy
Gabapentin
325
what is the cause of black liver in dubin johnsejn disease
due to impaired excretion of epinephrine metabolite which appear on histology as dense pigment within lysosomes
326
fatigue, pruritic, hepatomegaly and elevated alkaline phosphatase suggest what disease
cholestatic liver disease and if not treated incr risk of FAT SOLUBLE VITAMINS DEFICIENCY (A,D,E & K) due to reduction in bile flow
327
what drug inhibit topoisomerase 1
Topotecans (TECANS)
328
what drug inhibit topoisomerase 2
Etoposide "POSIDES"
treats testicular cancer and small cell lung cancer
cause chromosomal breaks to accumulate in dividing cells
329
what drug is used to treat genital warts
podophyllin
330
what drug is used to treat RESTLESS LEG SYNDROME
ROPINIROLE
331
what drug is used to reduce premature uterine contaction
Terbutaline
332
what substances run through the cavernous sinus
CN 3, 4 V1, V2, Cn6, internal carotid artery
333
which alpha blocker is used to treat BPH with No HTN
tamsulosin
334
dot or flame-shaped hemorrhage in the eye on fundoscopy examination refers to
hypertensive retinal hemorrhage which is due to HYPERTENSION
patient complains of a shadow developing in the eye
335
cheery red spot on the macula die to diffuse retinal ischemia without hemorrhage refers to
central retinal artery occlusion due to ATHEROSCLEROSIS (Giant cell arteritis)
present with acute monocular vision loss
336
increase phosphoribosyl pyrophosphate (PRPP ) synthase gene is most likely to affect what organ
"the Joints" causing Gout. (increase purine synthesis causes hyperuricemia)
337
in acute gout arteritis, drug blocks which type of cell types?
Neutrophils (swelling, erythema and tenderness) which is responsible for intense inflammatory response in gout patient which is inhibited by NSAIDS
NSAIDS are contraindicated in patients with peptic ulcer and renal impairment. GIVE COLCHICINE in such patients and it inhibits NEUtrophil CHEMOtaxis and PHAGOCYTOSIS by preventing microtubule formation
338
hemadsorption in cell culture is associated with what virus
influenza and parainfluenza virus
339
what type of cells are activated in RA?
CD4+ t cells
340
Recurrent miscarriage, inc PTT and hypercaogulability state refers to
Antiphospholipid syndrome
341
large gram postive rods that form medusa head/serpentine colonies on standard media refers to
Anthrax caused by bacillus anthraces which is an aerobic organism (antiphagocytic D-glutamate capsule)
Chest xray: widened midiasternum
seen in people who works in goat wool processing center causing woosorters disease (pulmonary anthrax )
GOAT HAIR/HIDES is the most common cause and enters alveoli and taken up by macrophages through lymph nodes causing medistinitis
342
what bacteria grows on Loeffler medium and stains with methylene blue
coryneabcterium diphtheria (INTRACELLULAR PHOSPHATE GRANULES ARE CHARACTERISTICS)
343
which part of the brain contains respiratory centers
The Brainstem
Locked in syndrome (cause brainstem Injury)
344
which cranial nerve is unique that it carries only motor fibers
C1
345
AN history of alcohol consumption for years in a patient that develops Tremors of the hand bilaterally, agitation, anxiety, high BP, high pulse 48 hours after admission to the hospital suggests
Alcohol withdrawer
alcohol is a CNS suppressant and bind to Gaba-a receptor complex enhancing inhibitory action on Gaba.
48-96 hours cause delirium tremens (disorientation, severe agitation, fever)
Benzodiazepines are FIRST LINE THERAPY for psychomotor agitation associated with ALCHOL WITHDRAWER
(DIAZEPAMS/CHLORDIAZEPOXIDE are preferred due to self tapering effects resulting in smoother cause of withdrawer)
Note: if this patient have liver disease use benzodiazepams that do not undergo oxidative metabolism and have no active metabolites (Lorazepam, oxazepam & Temazepam (LOT) are preferred)
346
MOA of baclofen and its use
agonist of Gaba B
| treats spastic conditions
347
poorly developed lumber and sacral spine with flaccid paralysis in lower extremities and absent ankle reflex in an infant is as a result of
UNCONTROLLED MATERNAL DIABETES
| which caused Caudal Regression SYndrome
348
what are the effect of cocaine on a newborn
spontaneous abortion, intrauterine growth retardation, placental abruption and prematurity
349
VIT A overdose in pregnancy can cause
craniofacial abnormalities, Posterior Fossa CNS Defects, auditory defects and abnormalities of great vessels (similar to DiGeorge syndrome)
350
what is the reason why you give PIPERACILLIN-TAZOBACTAM therapy together?
pipercilin has a beta lactam ring so it can easily be inactivated by beta-lactamase so giving betalactamase inhibitor such as TAZOBACTAM can help avoid piperacillin destruction by beta lactamases thereby INCREASING antimicrobial spectrum of activity
351
red reflex on physical examination refers to
Retinoblastoma
352
most common non-specific symptoms in a patient with Multiple sclerosis is
Fatigue (occurs after taking hot showers/after strenuous exercise in heated environment)
also cause unilateral sensation loss in the arms
MS: optic neuritis, intranuclear opthamoplegia, and sensory loss and symptoms worsen with heat exposure
353
pruritic in polycythemia after hot showers is due to
histamine release from basophils
354
to reach a 95% steady state concentration, how many half-lifes is needed
4 to 5 half lifes
355
what has the highest risk of colorectal cancer
Pancolitis
356
antibodies against cutaneous basement membrane proteins
epidermolysis bulls acquista (from tense aural bull) and cicatricial pemphigoid (cause chronic conjunctivitis and scaring)
357
scalp rash, lytic skull defects, DI, exompthalmus in a child greater than 3 years
Hand-Schiller-Christian Disease (type of Langherans cell histocytosis)
358
Skin rash and skeletal defects in an infant less than 2 years old
LetterSiwe-Disease
359
what is the MOA of the drug for melanoma
Vemurafenib (A BRAF kinas inhibitor to treat Melanoma)
| BRAF V600E mutation substitute lysine to glutamate
360
what is a reliable earlier indicator of menopause
Increase FSH levels confirms the diagnosis of Menopause
361
chronic malabsorption leading to signs of severe vit def
| Retinal degeneration, ataxia, motor dysfunction+ acanthocytosis+ low cholesterol
Abetalipoproteinnemia (APOB100 and APo b48)
Absence of VLDL and LDL
362
exposure to paint thiner cause anion gap metabolic acidosis + Opthalmoplagia, neurological symptoms
due to methanol exposure which is metabolized via formaldehyde dehydrogenase
(Methanol = paint thinner
methanol-------formaldehyde----- blindness and death
363
what leads to defective intracellular killing of mycobacteria by macrophage what def?
interferon gama receptor deficiency
| Recurrent mycobacteria infection
364
decrease esophageal paristalysis and decrease esophageal tone
scleroderma
365
dec esophageal parystalysis and inc esophageal tone
achalasia
366
hepatic encephalopathy
Lactulose
367
cytoplasmic bleb, shrunken nucleus, fragmented nuclei
apoptosis
368
MOA of ALbendazole
inhibit tubular depolarization and impairs glucose uptake
369
MOA of PRaziquantel
inc calcium influx raising the threshold, causing paralysis in trematodes and cestodes
370
diethycarbamazeine MOA
sensitization of microfiliarie to phagocytosis which mobilizes them by an unknown mechanism
371
ivermectin
bind to glutamate gated chloride ion channels increasing chlorine permeability which depolazrisez them resulting in paralysis via hyper polarization
372
what drug stimulate IL11 that stimulate hemopoietic stem cells production
OPRELVEKIN
373
what drugs cause pupillary dilation
CAL is dilated
| cocaine, amphetamines, LSD
374
persistent of colonization of pseudomonas in an individual is due to
biofilm formation in the lower respiratory tract giving them resistant
375
What MHC complex is associated with HLA-B27
MHC class 1 is associated with the disease
376
taking a patient for unnecessary procedure causing body harm
violation of non-malificience (which is Do no harm)
377
knowing a drug will benefit a patient and you did not prescribe it you violating what
violation of beneficence (DO GOOD to all)
378
what is used to alleviate(make better) the symptoms of pulmonary hypertension in infants with methemoglobinemia
Nitric OXIDE not NITROUS oxide
379
aseptic/avascular necrosis is a complication of what drug
corticosteroids
380
tx of carpal tunnel
lidocaine dec permeability of sodium
381
what is the mode of inheritance of AIP
Autosomal dominant
382
what is the first line treatment for Narcolepsy (daytime sleepiness)
Modafinil (a non-amphetamine stimulant ) that has become the first line agent and MOA is it enhance dopaminergic signaling and drug abuse is rare.
amphetamine and methylphenidate is second line SE: HTN, arrhythmia, psychosis
383
what is zolpidem used for
Insomnia
| zolpidem is a non benzo drug
384
what is use to treat Jet-Lag and age related Insomnia
Melatonin
385
what kind of examination do you use to identify Kayer-flescher ring (brownish color surrounding the eye) of wilson disease
Slit-lamp examination
the rings are form with copper deposition on the DESCEMET membrane of the cornea
basal ganglia atrophy is also present in wilson disease
386
Agitation, mental status change, problem with sleeping, psychosis
delirium
tx: Haloperidol
387
what medication is used to treat drug induced parkinson
antimuscurinic (trihexyphenidyl, benztropine)
drug induced parkinson symptoms are: rigidity(muscle stiffness), tremor (shaking of the hand), flat faces
388
the only recombinant insulin without any amino acid modification used in type 1 DM patient is
Regular Insulin( start working within 30 mins) & neutral Protamin Hagedorn (NPH) (NPH has protamine and Zinc , intermediate start working within 2 hours)
389
post auricular and occipital lymphadenopathy behind the ears with maculopapular rash starting at the face and spread to extremities
Toga virus (rubella)
MMR (measles & Rubella rash start on the face and spread to the rest of the body)
390
the word ZUMAB in monoclonal antibody are all
"ZUMAB" are ALL HUMANIZED ANTIBODY thats why it works despite it being a foreign antibody
391
beta endorphin is derived from
POMC
| it make B-endorphins, ACTH and MSH
392
how does carbonic anhydrase cause orthostatic hypotension
due to hypovolemia and blood pulling down
393
what are the histologic findings in GERD
basal zone hyperplasia, elongation of lamina propria papillae, scattered eosinophils and neutrophils within the squamous epithelium
394
glycine replaced by larger amino acid side chains, budge in colony complex and blocks intermolecular interactions therefore interfering cross linking is
osteogenesis imperfecta
395
problems with pro-collagen peptidase and faulty collagen synthesis refers to
Ehler Danlos syndrome
396
backpain, not relieved by rest or position change
neoplastic bone disease (prostate metastasis to Bone)
397
injecting needle to inferior medial side of the butt, what nerve is damaged
sciatic nerve
398
injecting needle superior medial side of the butt what nerve is damaged
superior gluteal nerva damage
399
in a lung abscess, the abscess formation is primary caused by what?
lysosomal enzymes released from neutrophils and macrophages.
400
Keratin is from what lineage? what amino acid makes up keratin
Epithelial linage
Alanine and Glycine makes up Keratin
401
what is vimentin?
an intermediate filament present in mesenchymal tissue.
402
A 185 kD transmembrane glycoprotein that has intracellular tyrosine kinase activity refers to what protein and what is its function?
HER2/neu oncogene
Inc risk of Breast, ovarian, gastric and endometrial cancer.
function: accelerates cell proliferation.
403
defective collagen synthesis which causes pro collagen peptidase deficiency which impairs N-terminal peptide removal is what disease
Ehler Danilo syndrome (inadequate cross-linking)
404
Dark Red non-blanching macule and papule over the buttocks groin and umbilicus is
Angiokeratomas present in Fabry disease
405
what type of vitamins comes from the sun?
7-dehydrocholesterol
406
SE of methylphenidate
Weight loss, dec appetite, insomnia
407
what fungal drugs inhibit cell wall synthesis
caspofungins inhibit 1,3 beta D glucans
| CASPOFUNGINS are the most active against Candida species and ASPERGILLUS
408
what fungi drug inhibits cell membrane
Amphotericin B, Nystatin which bind to Ergosterol, Azoles which inhibits synthesis of Ergosterol
409
which fungi drug plays a role in DNA and RNA synthesis
Flucytosine
410
which Fungi drugs inhibit microtubule polymerization
Griseofulvin
| accumulates in keratin containing tissues
411
drug used to treat dermatophytosis and inhibits squalene epoxidase is
Terbinafine
412
an example of atrophy is
adrenal glands during prolonged glucocorticoid therapy
| this can lead to adrenal insufficiency if glucocorticosteriod is abruptly stopped
413
kryphoscolosis, foot deformities, Diabetes mellitus Hypertrophic cardiomyopathy (depend on LV filling) collapse of LV septum on the mitral valve due to pushing of the LV septum is associated with what disease
Friedrich Ataxia (GAA repeat)
414
CGG repeat is referred to
```
Fragile X (it has a CPG repeat which undergo Hypermethylation of the cysteine bases leading to decrease expression and no transcription
the "P" between CPG denote the phosphodiesterase bond and is the signal for methylation
Methylation= Mute
Acetylation = turned on
```
415
what disease is associated with hypermethylation of histones
Huntington disease
416
what is degenerate in biochemistry ?
having 20 amino acid and coding for 61 diff codons
417
SE of what drug that dec peripheral vasoconstriction causes cold extermeites (hands & feet)
B-Blockers
418
cerebellar ataxia, telangiectasis (Superficial blanching nest of distended capillaries on sun exposed area of the skin) and inc sinupulmonary infection
ataxia telangiectasia (DNA break repair deficiency) mutation of ATM gene responsible for DNA break repair
419
defect in expressing HLA class 2 on surface of antigen presenting cell is called
Bare Lymphocyte syndrome
420
tyrosine, dopa, serotonin, Nitric oxide ( NO STD) needs a specific cofactor, what is it?
Dihydrobiopterin reductase (BH4) deficiency causing advanced PKU.
421
what step does DNASE when added to the petri dish block
Transformation
why? because it only works due to lysis of already dead cells and exposed DNA being taking up by another living cells. i.e DNASE only breaks down DNA that is naked
422
P27 protein act on which phase of the cell cycle
G1 phase inhibiting cyclin dependent kinases (CDKs)
423
Cross shaped intraerythrocyte inclusion (Maltese cross) in a history of recent travel to Connecticut
Lyme disease (borrielia burgdorferi)
Maltese cross is also seen in Babesia
424
Ringed shaped intraerythrocytic inclusion on blood smear refers to
Plasmodium falciparum (malaria)
425
IN obstructive sleep apnea decrease oxygen to which of the following organs is responsible for increase hematocrit
Kidneys..why?
| peritubular cells in the renal cells sense hypoxia and respond by releasing erythropoietin
426
aneurysm may cause bilateral loss of lateral visual fields, what artery is damaged?
Anterior communicating artery (berry aneurysm ) optic chasm damaged
427
broca or wernicke aphasia, what artery is damaged.
Middle cerebral artery damage
428
unilateral lower extremity sensory and motor loss what artery is damaged
anterior cerebral artery stroke
429
unilateral facial and arm sensory/motor loss, what artery?
midle cerebral artery stroke
430
cord factors creates "Serpentine Cord" appearance on enriched media in what bacteria
TB
induce release of TNF
431
requires an acidic environment and used for intracellular organism what drug?
pyrazinamide
432
campylobacter jejuni entamoeba histolytica, giardia, do they cause diarrhea with a lot of innoculum or less?
cause diarrhea with a small inoculum
433
most common cause of sinusitis in children
Nontypeal H.infleunza
434
most common cause of bacteria conjunctivitis in children
moraxella catarhralis
435
ampicillin is used to treat
Listeria and enterococcus
436
what bacteria affects smokers and what lab values do yo see
legionella
see hyponatremia
437
back pain and thigh pain that worsen with walking is referred to as
neurogenic claudication aka SPINAL STENOSIS
walking up hill or leaning on a stroller relieves the pain
the thickening of the ligament contributing to this patient symptom is the LIGAMENTUM FLAVUM ( a strong ligament supporting the spinal canal), Intervertebral disk herniation and osteophyte formation of affecting the facet joint.
438
what is the most common elbow injury in children
Radial Head Subluxation due to TEAR OF THE ANNULAR LIGAMENT.
affected children present with the injured arm held close to the body with the elbow extended and forearm pronated
439
A BASeball thrower (pitcher) normally hurts what ligament
ulnar collateral ligament
440
what drug inhibit 11-B hydroxylase that converts 11-deoxycortisol to cortisol
metyrapone
441
most enveloped virus acquire their lipid bilayer enveloped by budding except----------- which acquire their nuclear enveloped from host cell nuclear membrane
Herpes viruses (HSV 1,2 VZV, CMV)
442
what medication is giving to an elderly patient for insomnia short term with fewer side effects
RAMelteon (melatonin agonist at the suprachiasmatic nucleus) demonstrate safety and efficacy in OLDER ADULTS
NOTE:
TCAS, ANTIHISTAMINES, BENZodiaepine such as ALPRAZOLAM for insomnia should be avoided in elderly patient due to the risk of Falls, fractures and cognitive impairment
443
berry aneurysm is associated with what heart anomaly
coarctation of the aorta and this is due to hypertension in the branches of the aortic arch proximal to the coarctation hence leading to subarachnoid hemmorahge
444
light & electron microscopy of the intestinal/bowel mucosa of a patient with lactose intolerance will show
NORMAL intestinal mucosa
445
what the treatment for psoriasis that activate a nuclear transcription factor
vit d analog (calcipotriene), calcitriol, tacalcitol inhibiting keratinocyte proliferation and stimulate keratinocyte differentiation
cyclosporin also treat psoriasis but it inhibits nuclear factor of activated T cells (NFAT)
what monoclonal antibody used for psoriasis targets IL-12 & IL-23 and inhibiting differentiation and activation of CD4+th1 & Th-17 cells?
USTEKINUMAB
446
headache, retro-orbital pain, muscle pains, thrombocytopenia, high grade fever and episode of epistaxis with maculopapular rash after a trip to brazil
Dengue fever by Aedes Aegypti mosquito (mostly in tropics, southeast Asia, pacific islands, carribeans, Americas)
Aedes Aegypti also transmits the virus causing Chikungunya (flulike symptoms, polyarhralgia/arthritis (hands, wrist, ankles) and diffuse macular rash
447
Pulmonary TB spread through air borne contact, what type of area is the patient placed in
Negative-pressure isolation room and specific mask are worn by all visitors and contacts
448
what is the formula for volume of distribution
Vd=amount of drug/concentration in plasma
449
what is the formula for the clearance
Clearance = Rate of elimination/plasma concentration
Clearance = (0.7 x Vd) / (half-life)
450
what is the formula for loading dose
LD = (concentration @ steady state(Css)) x Vd
451
what is the formula for maintenance Dose
MD=Css (concentration @ stay state) X Clearance
452
what is the formula for half life
t1/2= (0.693 X vd) / clearance
453
pulmonary vascular resistance is lowest at------------ in the lungs
FRC (functional residual capacity)
454
whats another name for angiosarcoma
Stewart -Treves Syndrome
455
compulsive consumption of a nonfood/non-staple food such as ICE common in pregnancy and associated with iron deficiency anemia causing unexplained weight loss
PICA
456
spotty hepatic necrosis and a history of travel refers to
Hepatitis A (symptoms Fever, anorexia and dark colored urine)
you see councilman bodies
457
Ipilimumab MOA
bind cytotoxic t lymphocyte associated antigen 4 (CTLA-4) used to treat metastatic melanoma
458
treatment for toxoplasmosis
Pyrimethamine and sulfadiazine (inhibit dihydrofolate reductase)
drugs that inhibit dihydrofolate reductase are trimethoprim, methotrexate and pyrimethamine
459
liquifactory necrosis is present on
ABSCESS(PUS FORMATION) & BRAIN due to activity of neutrophils
460
blood vessels surrounded by numerous spindle cells & high nuclear to cytoplasmic ratio in a patient that works in a chemical plantsrefers to
Angiosarcoma (vinyl chloride)
CD31 aka PECAM is the tumor marker for blood vessels
461
what kind of cancer does Cadmium (found in batteries) cause
Prostate Cancer
462
Benzene cause what cancers
Leukemia and Hodgkin Lymphoma
463
what kind of Cancer is Nickel cause
Cancer of Lungs and Nose
464
what is the most important POOR prognostic factor for Post-streptococcal glomerulonephritis (PSGN)
INCREASE AGE
only 60% of adult cases resolve completely while the rest develop htn, recurrent proteinuria, chronic renal insufficiency
PRE-EXISTING KIDNEY DISEASE is also an IMPORTANT PROGNOSTIC FACTOR.
465
patient with cariogenic shock and evidence of wedge shaped strips of necrosis over the cerebral convexity suggest what pathology
Hypoxic-Ischemic Encephalopathy
466
what drugs stimulates dopamine receptors in the brain
ERGOST COMPOUND from Ergost Fungi : BRomocriptine (dopamine agonist)
NONERGOST Compounds: Pramipexole and Ropinirole (DOPAMINE AGONIST)
both help treat Parkinson disease
467
which organ is the least vulnerable to infarction? and why?
Liver because it has dual blood supply, hepatic vein and portal artery
468
what medication increases the FREQUENCY of chloride channel opening?
BEnzodiazepames
469
what medication increases the DURATION of opening of opening of GABA-A Chloride channel in CNS
Barbiturates
470
what medication do you use to treat Restless Leg syndrome
Dopamine agonist (Pramipexole & Ropinirole)
471
for diphtheria infection what is the treatment
Administer antitoxin (process of administering antitoxin is PASSIVE IMMUNIZATION
then penicillin/erythromycin and then DPT vaccine (ACTIVE IMMUNIZATION)
THE GREATEST EFFECT ON SURVIVAL IS ANTITOXIN AKA PASSIVE IMMUNIZATION
what is the most common cause of death in Diphtheria patients ?
Cardiomyopathy
472
what are they signs of congenital hydrocephalus
macrocephaly , poor feeding, HYPERREFLEXIA and MUSCLE HYPERTONICITY
473
fever, skin flushing and altered mental status by Ecoli is as a result of what virulence factor
SEPTIC SHoCK By Ecoli (GRAM -ve sepsis) and its as a result of LIPID A (part of LPS)
474
what is the first line treatment for Major depressive disorder and does not cause sexual dysfunction
BUPROPION
contraindicated in Bulimia Nervosa,Anorexia Nervosa and seizure disorder due to lowering of seizure threshold
475
what is the treatment for Arsenic Poisoning
NOTE INSECTICIDE IS A COMMON SOURCE FOR ARSENIC
Dimercaprol and SUccimer
GLAM (GOLD, LEAD, ARSENIC, MERcury) Poisoning
"GLAM FOR SUCCESS AND DIAMONDS"
ANTIDOTe: SUCCIMER & DIMERCAPROL
476
How does sodium thiosulfate treat cyanide poisoning
sodium thiosulfate treat cyanide poisoning by donating sulfur to Liver RODANASE to enhance conversion of cyanide to thiocyanate
note: thiocyanate is a safe form for excretion
477
antidote for doxorubicin overdose
Dexrazoxane
478
what is DYSTONIA
Neurological movement disorder characterized by sustained involuntary muscle contraction, which forces certain parts of the body into ABNORMAL and PAINFUL movement and postures
due to impaired function of BASAL GANGLIA
479
what part of the brain gets damaged first during an ISCHEmic event?
Hippocampus(pyramidal cells) , neocortex, and purkinji cells of the cerebellum
480
methanol--------- formaldehyde causes
Ethylene glycol(antifreeze)------- oxalic acid
acidosis, retinal damage, blindness (blocked by FOmepizole)
causes acidosis, kidney damage, CNS problems, Heart/lung toxicity,
blocked by Fomepizole or give Ethanol to compete for the enzyme
481
what drugs cause disulfarm-like effect
Metronidazole, Procarbazine, 1st generation sulfonylureas, cephalosporins
tell patient to avoid alcohol
482
drugs that cause cutaneous flushing
Vancomycin, Niacin, Adenosine, Dihydropyridine CCBs
483
what drugs causes Coronary Vasospasm
Cocaine, Amphetamines, Methamphetamines, Triptans, Ergotamines
484
what drugs cause Dilated cardiomyopathy
doxorubicin and Daunorubicin
485
drugs that cause thrombocytopenia
Heparin, Cimetidine (H2 blockers)
486
drugs that causes agranulocytosis
clozapine, carbamazepine, colchicine, methimazole, Propythiouracil, Dapsone
487
drugs that cause APlastice Anemia
Chloramphenicol, Benzene, NSAIDS, PTU, Methimazole
488
what drugs cause Gray baby syndrome
Chloramphenicol
presentation: limp muscles, cyanosis, hypotension and cardiovascular collapse
occurs cause the UDP glucourantransferase enzyme is immature
489
drugs that cause G6PD deficient patient
Isoniazid, Sulfonamides, primazuine, High dose Aspirin, Ibuprofen, Nitrofurantoin, Dapsone, Fava beams, Naphthalene
490
what causes thrombosis
OCPS
491
what meds causes Pulmonary Fibrosis
Amiodarone, bleomycine, bulsulfan, Methotrexate
492
what drugs cause pseudomembranous collitis
clindamycin, amoxicilin, ampicillin
493
what drug causes Massive Hepatic necrosis
Halothane, Acetaminophen, Vampiric acid, Amanita Phalloides (mushroom toxin)
494
what drug causes hepatitis
INH (isoniazid)
495
what drugs causes gout
Furosemide, Thiazides, Niacin, Cyclosporin, Pyrazinamide
496
what drug cause Gingival hyperplasia
Phenytoin, cyclosporin, verapamil
497
what drug causes osteoporosis
Corticosteroids, Heparin
498
what drug causes photosensitivity
SAT 5FU----Sulfonamides, Amiodarone, Tetracycline , 5 Fluorouracil
499
what drug causes Steven Johnson Syndrome
Seizure drugs (Ethosuximide, Carbamazepine, Lamotrigine, Phenytoin, Phenobarbital) Sulfa Drugs, Penicillin, Allopurinol
"SSPA"
500
Drug Induced SLE
SHIPPE (Sulfonamide, hydralazine, Isoniazid, Procainamide, Phenytoin
501
what drug causes Tendon Rupture/Cartilage damage
FLuoroquinolones
502
drugs that cause of Interstitial Nephrities
NSAIDS, Furosemide, Antibiotics
503
drugs that cause Fanconi syndrome
Expired Tetracycline, Heavy Metal exposure
504
dug that cause hemorrhagic cystitis
cyclophosphamide, IFOsfamide
505
what drug causes parkinson-like syndrome
Metoclopramide (used for Gastroparesis), Antipsychotics, Reserpine
506
what drugs causes Cinchonism (dizziness with headache, vision changes, Tinnitus)
Quinidine, Quinine
507
drugs that cause seizures
Bupropion, Imipenem/Cilastatin, Tramadol, Metclopramide, Benzodiazepine or alcohol withdrawer
508
drugs that cause Nephrotoxicity + neurotoxicity
Aminoglycosides, Cisplatin, Polymyxin
509
drugs that cause Nephrotoxicity + Ototoxicity
Amino glycosides, Vancomycin, Loop Diuretics Cisplatin
510
Drugs that cause Anticholinergic effects
Atropine, TCAs, H1 blockers, Thioridazine, CHloropromazine
511
treatment for Hepatic encephalopathy
Lactulose and Rifaximin
Hepatic Encephalopathy refers to reversible decline in neurological functions that occurs due to failure of the liver to metabolize waste products such as ammonia
512
Bitter Almond odor is what type of posioning
Cyanide poisoning
| antidote: nitrite, thiosulfate
513
positive Sodium cyanide nitropruside test is used to detect ?
Cysteine stones aka AminoACiduria
detect excess cysteine in the urine
tx: acetazolamide
cystinuria is due to defect in BASIC Amino acid (COLA) in proximal renal tubular epithelial cells
514
Hemolytic Uremic syndrome caused by 057:H7 strain decreases and increase what levels in the blood
Dec Hemoglobin and Haptoglobin levels
Increases Lactate dehydrogenase and Increase Unconjugated/INDIRECT Bilirubin levels
515
what test do you use to detect antibodies against Group A strept
Streptozyme test
516
what 4 occupation are prone to developing Lead poison
Lead paint, batteries, ammunition and CONSTRUCTION WORKERS
Basophilic stippling on blood smear
517
what is the characteristics of Villous adenoma
"cauliflower like projections"
Malignant transformation
518
what is Ortner syndrome
Mitral stenosis can cause left atria dilation sufficient to enough to compress the left recurrent laryngeal nerve causing hoarseness
519
what is the complication of varicose veins
Skin Ulcers due to fluid build up
520
What are the drugs that inhibit P450 1A2
Quinolone, Macrolides
521
transforming growth factor induce
Apoptosis and cell differentiation
522
what do you use to screen for antibody that bind to protein
immunochemistry and Western blot
523
In Botulism
dec End plate potential (low acetylcholine), MEPP (miniature end plate potential) (relax muscles) = 1(never changes, its the leak from the presynaptic cleft and it is NEVER Affected by botulinum toxin) and Response to ACh
524
Pathophysiology of HUS is what?
Mocrothrombi in small blood vessels
525
what is the lab value for thrombocytopenia
platelet count
526
what cause dilated Pupil
Dilated pupil caused by (CAL)- cocaine, amphetamine, LSD
Constricted pupil -LSD
527
parasympathetic fibers running through the ganglia in the head are only 4
COPS-- cilliary, otic, pterygopalantine and submandibular ganglion
ganglionic layer is what is damaged in central retinal occlusion
528
50& of castleman disease is associated with
HHV8 and also Kaposi
529
Thyroid acts as a steroid in the nucleus so in graves disease it will be associated with
nuclear/retinoid x Binding to DNA
530
when serine/threonine kinase when phosphorylated is the way to inactivate what?
INSULIN
531
iN osteoporosis what effect do you see on Rank/RankL receptor
Inc RANK/RankL receptor activity
532
in blood transfusion in combined immunodeficiency what kind of blood do you give
Irradiated packed red blood cells(Radiate the blood cells) to kill to the T-cells so it does not affect the host and prevent GRAFT vs Host Disease
533
whole blood contain
Red cells, white cells and platelets and everything.
if they have pancytopenia patients (give whole blood cells)
534
packed red blood cells contains
contain only RBC
give patient that have low RBC
535
washed red blood cells give them
for IgA deficiency give Washed backed red blood cells to get rid of immunoglobulins
536
what is moa of ethernacept
functions as a Decoy of TNF-alpha
other TNF-alpha is Infliximab and Adalimumab
you give ethernacept when patent do not respond to methotrexate therapy for RA
so before giving Eternacept DO A Tuberculosis TEST cuz
NOTE TNF-alpha is needed to promote reactivation of latent TB
537
what is the long time effect of using hydroxychloroquine
IRREVERSIBLE RETINAL DAMAGE
SO a Follow-UP Ophthalmologic examination
538
where do you see Kerley B lines
pulmonary edema
539
where do you see lines of zahns
Pulmonary Embolus
found ONLY in thrombi
540
Primaquine is used to Kill
Hypnozoites (sleeping) for vivid and oval
541
list the beta lactase resistance bugs
Ecoli, staph aureus, epidermis, klebsiella
They all produce Beta-lactamase
drugs u give to treat beta lactase resistance:
aztreonem/carbapenem, sulbactam, tazobactam, clavulanic acid
542
slipped strand misprint is associated with what type of mutation
Frame shift mutation (either due to insertion or deletion)
543
what increase the amount of aortic regurgitation
Hypervolemia
544
what are the organ for graft and host disease
Skin, Liver and G.I transplant
Early signs of graft versus host disease is diffuse maculopapular rash that affect palms and soles
545
PROTEASE INHIBITORS (AVIRS) ritonavir blocks specific what steps
Protein Processing
546
in a starvation stage what enzyme is responsible for maintaining a normal glucose level and increase Ketones in the blood
Hormone sensitive Lipase. converts triglycerides to glycerol (undergo glucoeneogenesis in the liver to make glucose) + Fatty acids (forms ketone bodies)
Hormone sensitive lipase is inhibited by Insulin
547
fever, hypotension and altered mental status in an elderly refers to
Septic shock
UTI its the most common cause of sudden disorientation and confusion in the Elderly.
548
what is mesoblastic nephroma?
kidney tumor found before birth by ultrasound or within the first 3 months of life
TUMOR IS BILATERAL
contains fibroblastic cells (connective tissue cells)
more common in MALES
Note: Rhabdoid tumor: 1- 3 years of age
Clear cell sarcoma of the kidney: from 2-3 years of age
WILMS tumore: over 3 years of age
549
a kidney mass on top of the upper pole of the kidney in 10 months
Nephroblastoma
UNILATERAL TUMOR
550
list non germ cell/sex cord tumors
leydig cell tumors, sertoli cells, testicular lymphoma
551
pancreatic enzymes also breaks down
fats
552
a congenital absence of the gyri is known as
Lissencephaly (agyria)
symptoms: mental retardation and seizures
on gross examination: Brain surface has a smooth appearance
553
widespread epidermal sloughing of the skin with gentle pressure (+ve Nikolsky sign) refers what disease
scaled skin syndrome by staph aureus
mechanism of Exfoliative toxin: exotoxin mediated skin damage.
554
large obstructing intensely eosinophilic cast suggest what disease?
```
Multiple myeloma (CRAB)
Fried egg appearance produce IgG(55%) & IgA (25%)
in elderly (40-50 years)
```
Most common cause of death is : susscibility to infectn
HyperCalemia is due to IL1 & TNF alpha
Renal insufficiency----excess antibody that forms cast (EOSINOPHILIC CAST)
ANEMIA--plasma cell in bone marrow interfering with other cell lines
Bone Lytic Lesions/Back pain
Monoclonal M protein
tx: Bortezomib: a Boronic acid dipeptide associated with PROTEOSOMES.
MOA is Cause APOPTOSIS
on XRAY: Punched out lytic bone lesion and IgG light chains in urine
555
intracytoplasmic Donovan Bodies are diagnostic for what bug
Klebsiella granulomatis
cause painless genital papule the ulcerates
556
What is Pickwickian syndrome/Obesity Hypoventilation syndrome
restricted expansion of chest wall due to severe obesity
| cause hypoventilation, with elevated PCo2 and reduced Po2
557
what is the confirmatory test for Lactase deficiency
STOOL pH (
558
what test do you use to differentiate between pancreatic from intestinal malabsorption
D-Xylose test
| unaffected in lactase deficiency
559
compression of what organnel gives rise to craniopharngyioma
compression of the PITUITARY STALK
560
for an Anesthestheic to be potent what must happen to the minimal alveolar concentration
Inc Potency = Low MAC(minimal alveolar concentration)
Note arteriovenous concentration gradient influences the rate of induction
arteriovenous concentration reflects overall tissue solubility of anesthetic
INC tissue Solubility = Large Arteriovenous Concentration = SLOWER ONSET OF ACTION
561
how does Penicillin used to treat syphilis work? and what other drug does Penicillin have a structural similarities too?
works by covalently binding to and inhibiting Transpeptidase: this enzyme catalyze the final cross -linking step in peptidoglycan cell wall formation and bind to D-alanine- D-alanine of another peptidoglycan molecule
Penicillin has a STRUCTURAL SIMILARITIES TO VANCOMYCIN (binds to D-Alanine- D-Alanine Residue) preventing incorporation of new subunits into the cell wall
562
what is carnitine deficiency
Impairment ofr fatty acid transport from the cytoplasm into mitochondria preventing B-oxidation of fatty acid into acetyl coA
Unable to synthesize Ketone bodies (such as acetoacetate)
presentation: myopathy, inc CK, weakness, hypoketotic hypoglycemia, S3 gallop
563
Damage to the MLF is located in what area in the brain
DORSAL PONS
564
absent of upward gaze, absent pupillary light reflex and impaired convergence
Parinaud syndrome (damage to superior colliculus)
565
what are the presentation of pheochromocytoma
Episodic HTN, Flushing, palpitation, HEADACHES and Diaphoresis
566
a mass in the kidney composed of Fat, smooth muscles and blood vessels refers to
ANgiomyolipoma of the Kidneys and associated with Tuberous Sclerosis
567
what is uniparental disomy and what disease are associated with it?
occurs when a person receives two copies of a chromosome from the same parents and none from the other parents. Example is Prader-Willi syndrome and Angelman syndrome
568
what murmur is known to increase during INSPIRATION
Tricuspid Regurgitation
569
What murmur increases in INTensity During Expiration
Mitral Regurgitation
570
during late stages of pregnancy what prevents lactation by prolactin (milk production) in a woman
Progesterone by inhibiting anterior pituitary, hence inhibiting Prolactin
although PROLACTIN levels increases as Pregnancy Progresses, Progesterone keeps PROLACTIN IN-CHeCK till delivery
it also suppreses FSH and LH
After delivery, there is a massive drop in PROGEsterone thereby allowing Prolactin to stimulate Lactation
571
what increases the risk of cholelithiasis in women who are pregnant or using OCPS
Estrogen Induced cholesterol Hypersecretion and progesterone induced gall bladder hypomotility
572
hemorrhage on head CT in the occipital and parietal areas and bleeding in parietooccipital lobe in an elderly suggests
Cerebral amyloid angiography
573
occipital lobe lesion causes what type of hemianopia
Homonymous hemianopsia
574
what is the most common cause of intracranial hemorrhage in children and tends to be a single lesion
arteriovenous malformation
575
trabecular thinking with fewer interconnections refers to what pathology
```
OSTEROPOROSIS
Osteoporotic Bone (usually affect trabecular bone of the vertebrae and neck of the femur
```
presenting as vertebral fractures and fracture of neck of femur
576
unmineralized spongiosa in the medullary canal refers to
Osteopetrosis
577
the findings of squamous metaplasia in the pancreatic duct that causes extensive exocrine gland atrophy and fibrosis in s Cystic fibrosis patient is due to deficiency of what specific FAT soluble vitamins?
VITAMIN A
help in differentiation of epithelial and mucous secreting columnar epithelial cells of the conjunctiva, pancreas, and other exocrine ducts
578
Right sided weakness with a history of HTN and a Lake-like cavity lesions in the Left Internal capsule refers to what disease
Hypertensive arteriolar sclerosis
579
progressive headache, nausea and vomitting following confusion refers to what pathology
hypertensive encephalopathy
580
during neuronal death proliferation of what cells do you see in the brain
Astrocyte in area of neuron degeneration is called gliosis
581
treatment for Hep C
Interferon alpha, RIbavirin (also treat RSV)
RIbavirin pairs with either uracil or cytosine and causes hypermutation during RNA-dependent RNA replication
also inhibit IMP Dehydrogenase (same MOA as MOFITIL)
RIBAVIRIN MOA is MULTIFACTORIAL
582
Peribronchial Cuffing on chest xray refers to
Asthma
583
Budesonide , what is it used for?
Chronic Asthma
584
in anaphylaxis reaction mast cells and basophils releases inflammatory mediators what are they?
Histamine, TRYPTASE, PGE
| IgE receptors cross-link with each other causing RECEPTOR AGGREGATION causing Mast Cell and Basophil Degranulation
585
ultrasound revealing a stenosis of subclavian artery proximal to the origin of the vertebral artery and a retrograde(caudal) flow instead of normal integrate flow is called
Subclavian steal syndrome
is severe stenosis of the proximal subclavian artery which leads to reversal in blood flow from the contralateral vertebral artery to the ipsilateral vertebral artery, e.g dizziness and vertigo.
presents with symptoms as Exercise induced fatigue, paresthesias OR vertebrobasillar insufficiency (e.g dizziness, vertigo)
(look at ur phone for pictures)
due to atherosclerosis and Takayasu Arteritis and heart surgery complication (aortic coarctation repair)
presents as ARM ISCHEMIA A(e.g arm hurting after playing table tennis) or Vertbrobasilar insufficiency (e.g Dizziness, vertigo, drop attacks).
586
what is the most likely target of Timolol in the eyes
what other drug has the same MOA as Timolol
what drugs decrease intraoculare pressure by increasing outflow of aqueous humor
Ciliary epithelium
non selective beta blockers that diminish aqueous humor by the CiLiary epithelium
Another drug that decrease aqueous humor by the colliery epithelium is a carbonic anhydrase inhibitor Acetazolamide.
so Acetazolamide and Timolol DECREASE production of aqueous humor dec Glaucoma
Pilocarpine, carbachol, prostaglandin F2alpha (e.g Latanprost and travoprost), MOA is by INCREASE OUTFLOW OF AQUEOUS HUMORE dec Glaucoma
587
what is used to transport fatty acid through the mitochondria membrane and is a necessary component in fatty acid oxidation
Carnitine
588
what inhibits beta oxidation of newly formed fatty acids
Malonyl CoA
| by inhibiting the action of mitochondria carnitine acetyltransferase
589
how does TCA such as amitriptyline cause Cardiac arrhythmia which causes death
They inhibit Fast sodium Channels slowing down myocardial depolarization causing arrhythmias
TCAs also inhibit NE and serotonin reuptake
590
what is responsible for the skin necrosis after warfarin therapy
Warfarin induced skin necrosis which is due to a transient hyper coagulable state
Protein C has the shortest half life so its activity is reduced quickly when warfarin therapy is initiated.
the Risk of Skin Necrosis is seen in patient that have pre-existing protein C deficiency
591
what are the clinical features of PCP
Violent and bizarre behaviors
NYSTAGMUS (Vertical and Horizontal Nystagmus)
ATAXIA
592
What is the clinical features of LSD
Visual Hallucination and vivid dreams
593
what is the clinical features of cocaine
Chest pain and seizures, Pupillary dilation
594
what is the clinical features of Methamphetamine
Tooth decay, Violent behavior, CHoreioform Movement
595
what is the clinical feature of Heroin
Depressed mental status, Miosis, Respiratory depression
596
what is the histo pathogenesis of HIV associated Dementia
involves the activation of microglial cells
597
what the relationship between primary billiary cirrhosis and graft vs host disease
both lead to the destruction of small and medium sized intrahepatic bile ducts
598
Urine smelling like caramelizing sugar/burntsugar/ maple syrup requires dietary restriction of leucine, isoleucine and valine. what other substance needs to be supplemented?
Maple syrup disease,
deficiency of branched chain alpha ketoacid dehydrogenase complex (isoleucine, leucine and valine is deficiency)
Note: leucine is the most involved.
Supplement THiAMINE (Vit B1)
599
what is the essential amino acid in UREA cycle
ARGININE
600
what medication is responsible for the redistribution of fat from the extremities to the abdomen? whats the term called for fat redistribution of fat?
HAART therapy (antiretroviral medication) causing Lipodystrophy/Lipoatrophy
drugs like stavudine and Zidovudine
601
what alternative medication can you give to a patient for cardiovascular disease that is allergic to aspirin and is as effective as aspirin for cardiovascular disease
Clopidogrel (blocks P2Y 12 component of ADP receptors)
602
a phosphodiesterase inhibitor that is used for peripheral vascular disease such as Claudication, what drug?
CIlostazole
603
what other drug is used that inhibits glycoprotein 2b/3a apart from abixcimab
Eptifibatide
604
what pathology is associated with overproduction of TGF-alpha resulting in mucosal call hyperplasia with gastric fold enlargement
Menetrier disease
TGF-alpha stimulator of epithelial growth which is secreted by carcinomas, macrophages and epithelial cells
605
what is the major virulence factor in group A strep that inhibit phagocytosis and the activation of complements
M Protein aka Protein M
606
what is another name for Central pontine myelinolysis ( caused by rapidly correction of hyponatremia)
Osmotic Demyelination syndrome
607
what metabolizes cyanide in the tissues
Rhodanese
608
sodium nitroprusside induced cyanide toxicity and sodium thiosulfate can be used to reverse it by acting as a donor to what element?
Sulfur
Sodium thiosulfate act as a donor for sulfur to promote hepatic rhodanese to convert canide to thiocyanate which is excreted into the urine.
Hydroxycobalamine can revers cyanide poison by directly binding to cyanide ions
Sodium Nitrite convert Hb to methemoglobin then thiosulfate to thiocyanate which then is excreted in the urine
609
what is a common extra dermal manifestation of scleroderma
Pulmonary HTN
610
what urinary problem is seen in an MS patient
bladder hypertonia/spastic bladder few weeks after lesion to spinal cord
presenting with increase urinary frequency and urge incontenance
611
what type of phenomena is paraneoplastic syndromes
autoimmune phenomena
612
inspissated green fecal mass obstructing the DISTAL ILIEUM in a 2 day old boy with abdominal distention and dark green emesis suggests
Meconium Ilieus ( obstruction is at the iLIEUM and associated with CYSTIC FIBROSIS and most common complication is PNEUMONIA, Bronchectasis and Cor PUlmonale are most common cause of death in C.F patients) NOT Hirghsprung disease (in Hischsprungs obstruction is at the Rectosigmoid and its associated with down syndrome and ENTEROCOLITIS IS THE MOST COMMON CAUSE OF DEATH IN HISCHSPrUNGS disease
613
Pretrial subcutaneous fat inflammation seen in sarcoidosis refers to what
Erythema Nodosum
614
what drug is used prophylactics for PCP
DAPSONE
615
which antibiotics is giving for meningitis prophylaxis ( you don't know what the bug is)
ceftrixone, vancomycin and ampicillin
616
what is the stimulation test that you use to confirm adrenal insufficiency
metyrapone stimulation test
617
Neutropenia with fever is also refered to as
Agranulocytosis
618
what do u use for thyroid storm
proponolol, pTU, predinosone,
619
abdominal pain out of proportion to physical findings , Diagnosis?
acute mesenteric ischemia
620
crampy abdominal pain followed by hematochezia
Colonic Ischemia/ISchemic colitis
621
what is the cause of obstructive sleep apnea in adult and in children?
what is the treatment for central sleep apnea
In adult: caused by excess parapharyngeal tissue in adults
In children: caused by adenotonsillar hypertrophy in children
tx: weight loss, CPAP(continuous positive airway pressure) and surgery
tx for central sleep apnea is CAFFEINE
622
in a neonate, diffuse airspace interstitial opacities in the bronchogram also called ground glass appearance, whats the diagnosis
neonatal respiratory distress syndrome
623
Dementia frequently associated with frequent falls and syncope
Lewy Body dementia
624
dementia plus visual hallucination
Lewy body dementia
625
Endoneural inflammatory infiltration refers to
Gillian-Barre syndrome by campylobacter jejuni
paralysis of respiratory muscles may occur and CN7 damage (bells palsy)
on light microscopy: segmented demyelination of peripheral nerve is seen
626
toxin penetration through blood-nerve barrier refers to
Peripheral neuropathy by DIPhtheria
627
endoneurial arteriole hyalinization is associated with
Diabetic micro angiopathy
628
a high leukocyte alkaline phosphatase refers to what? and what do you see?
Leukemoid Reaction (inc ALP) compared to CML with (low ALP)
Leukocytosis > 50,000/mm3 that occurs due to conditions such as severe infection, hemorrhage, malignancy, or acute hemolysis, peripheral blood smear shows increase band cells, neutrophil precursors (melocyte0, granules (DOhle bodies) in the neutrophil.
Leukeomoid reaction you see DOHLE BODIES (are light blue basophilic peripheral granules in neutrophils)
the blue color is due to ribosome bound to RER
you see inc bands, toxic granulation and cytoplasmic vacuoles
629
prolong prothrombin time (PT), hypoalbuinemia, and high bilirubin levels suggest what organ dysfunction
liver dysfunction
prolong prothrombin time indicate poor prognosis in this patients
630
what values indicate billiary injury
Increase alkaline phosphatase (ALP) and Gamma-glutamyl transpeptidase (exclude bone disease)
631
patient with untreated ulcerative colitis that experience shock (hypotension, tachycardia) is most likely suffering from what
why don't you do colonoscopy and barium
toxic megacolon involve large intestine and it is associated with clostridium difficile
a PLAIN ABDOMINAL X-ray need to be done
barium and colonoscopy is contraindicated due to risk of PERFORATIONS
632
what are the two bugs that cause sepsis in a sickle cell patient
Streptococcus pneumonia and Homophiles Influenza
633
what are the two bugs that cause sepsis in a sickle cell patient
Streptococcus pneumonia and Homophiles Influenza
OSteomyletits in sickle cell patient is by salmonella
634
the conversion of NE to epinephrine is one by
Phenylethanolamine-N-methyltransferase (PNMT) and SAM which is turned on by Cortisol
635
3 choices for antibiotics
dicloxacilin, nafcilin, oxacillin
636
what is demecylclociline
ADH ANTagonist
637
skin lesion in the legs look orange peel appearance
Hypertheriodisim (pretrial myxedema)
638
patient receiving blood transfusion get hypocalcemia by loosing calcium during blood transfusion, what can you give and why?
give citrate and it act as a calcium chelator and prevents hypocalcemia
639
most sensitive enzyme for M.I
Myoglobin (nonspecific)
640
constipation, dec flatus, tympanic abdomen, dec bowel sounds, what is diagnosis?
iLieus
641
which bacteria cause lobar pneumonia and a typical
Legionella
642
Jaundice, fever and RUQ pain
ascending CHolangitis
643
effect of low calcium on EKG
QT prolongation
644
A UNILATERAL ADnexial mass with a yellow and firm mass in the ovary that has a small cuboidal cells in sheets with gland like structures that contains acidophilic material refers to
Granulose cell tumor
a large unilateral adnexal mass
Secretes INCREASE ESTROGEN and also increase inhibin
Call-Exner bodies( cuboidal granulose cells in a rosette pattern with coffee bean nuclei) and yellow theca cells with lipid on Histology
645
what is responsible for closure of the ductus arteriosus after delivery
Inc Infant breathing------ increase oxygenated blood in the aorta------decrease prostaglandin-----closure of ductus arterioles
646
what cause the closure of the foramen ovale
infant breathing---dec pulmonary vascular resistance---inc LA pressure----pushes septum premium against septum secundum
647
what qualifies for systemic inflammatory response syndrome (SIRS)
More than 2 of the criteria
Fever, Increase HR, leukocytosis , tachypnea
648
what is the first sign of shock
Tachycardia (RAPID HEART RATE)
649
the pathophysiology of NRDS is the same as which other lung pathology
Atelectasis in that there is decrease surfactant and leads to lung collapse
650
severe shortness of breath when running or in the cold suggest what pathology? what drug causes it too?
Asthma
Asthma sensitive asthma is also called Samter's triad: nasal polyps + asthma + aspirin sensitivity
Aspirin
for aspirin induced asthma give Montelukast and zafrilukast
651
decrease diffusion of oxygen in the alveolar walls due to destruction of the alveoli wall is associated with what pathology
Emphysema (diffusion limited)
652
what is the structure of the virus genome that predispose to subsequent bacteria pneumonia in an otherwise healthy individual that develops lobar pneumonia
INFLUENZA VIRUS (enveloped, segmented, single-stranded RNA virus)
653
ELISA of Nasal washing is used to diagnose bronchiolitis in a children less than 2 years , what virus?
RSV
present with nasal flaring, grunting, respiratory distress, low grade fever and crackles
ELISA of nasal flaring is used to detect RSV, rhinovirus and coronavirus
654
what is the virulence factor for legionere disease from contaminated water
ANK protein is virulence factor for Legionella
655
what is the virulence factor for staph aureus
Protein A
656
dyspnea (shortness of breath) on exertion, dry cough for more than 3 months and bilateral rales on examination with clubbing of the nails suggest
pulmonary fibrosis
Honeycomb lungs on CT
657
for sarcoidosis what is an alternate treatment apart from glucocorticoids
Methotrexate
hydroxychloroquine can also be used to control the symptoms of sarcoidosis
658
for good pasture disease what tx?
steroids, cyclophosphamide and azathioprine
659
why does the thorax shift away from the collapsed lungs during tension pneumothorax
it is due to the positive pressure from the pleural space
660
RSV is from paramyxovirdae virus and it is a
single stranded NEGATIVE SENSE, LINEAR enveloped RNA virus with a NONSEGMENTED genome
other virus included in paramyxoviridae family is PARAINFLUENZA VIRUS causing Croop(Barking cough, inspiratory stridor),
Measles (cough, coryza,kopek spot) and Mumps (bilateral parotid gland)
661
Chronic obstructive sleep apnea present has Respiratory acidosis that is compensated by metabolic alkalosis, what happens to the Bicarb?
Increase renal bicarb reabsorption/retention (METABOLIC ALKALOSIS COMPENSATION)
662
what are the two major risk factors for goodpastures disease
exposure to hydrocarbon solvent such as does found in dry cleaning industry and Cigarette smoking
type 2 hypersensitivity
treatment: plasmapheresis
663
segmental necrotizing glomerulonephritis with granuloma in the lungs refers to
Wegners
CXR: larger nodular densities/bilateral nodular infiltrates
cANCA/antiproteinase3
tx: cyclophosphamide and steroids
664
Hep E belongs to what virus family
CaLiciviruses (Single stranded, Positive sense, linear non-segmentted RNA virus)
665
influenza virus belong to what family type
Orthomyxoviruses (Single stranded, Negative sense Linear Segmented RNA virus)
666
what enzymes are used in the catabolism of NE
COMT(catechol-o-methyltransferase
| MAO (monoamine oxidase)
667
what is the whole purpose of the Chloride Shift?
IT occurs when the patient is havin a HIGH RISE In CO2(aka Hypercapnia)
so the bicarb created by carbonic anhydrase in response to rising CO2 leaves RBC in exchange for chloride
668
what medication respond well to gram negative rods such as klebsella
Aztreonam (a monobactam antibiotic)
669
what is the name of the beta lacatamase inhibitor that prevents the degradation of beta lactam
clavulanic acid
670
a serine protease inhibitor that is deficient in emphysema
alpha-1- antitrypsin (A serine protease inhibitor)
671
what is the most common symptom for Panacinar emphysema
Worsening shortness of breath (worsen dyspnea)
672
what is both common to both obstructive and restrictive lung disease
Decrease Vital capacity
673
what type of histamine receptor is responsible for allergic reaction and which one is responsible for gastric acid secretion? histamine 1? and histamine 2?
seasonal allergies are a result of
Histamine -1-receptor activation which present with (pruritis, bronchoconstriction, increase nasal and bronchial mucous production
activation of Histamine-2- receptor leads to increase gastric acid production and located in the stomach.
674
what are the drugs that improve survival rate in a CHF patient
Ace inhibitors, ARBS, aldosterone blockers, beta blockers
675
BLURRY YELLOW VISION, vomitting , hyoerjakenuadiarrhea, arrhythmias, nausea are all signs of what drug toxicity
Digoxin toxicity
Most common Digioxin EKG abnormality is Bradycardia (dec HR)
TX; gradually correct Hypokalemia, Magnesium, anti-digoxin Fab Fragments, Cardiac pacer
676
what drug are used to treat chronic CHF
ACE inhibitors, ARBS, Aldosterone antagonist, Betablockers, Nitrates DIgioxin
677
what drugs are used to treat acute CHF
NMenonice: NO LIP
N----- Nitrates
O----- Oxygen
L------Loop diuretics
I-------Inotropic Drugs (e.g. dobutamine)
P------ Positioning (allow blood to flow to the legs instead of the lungs to protect against lung failure)
678
which central lines have the highest risk of Pneumothorax
The subclavian vein
679
for a central line, which site is the easiest site with the least risk
Femoral Nerve
680
swan-Ganz catheter preferred site arre
RIGHT internal Jugular vein or the Left subclavian vein is the most common site for a swan-Ganz Catheter
Right Internal Jugular> Left subclavian > Right Subclavian > Left Internal Injugular
681
in the cardiac cycle what specific disease is affected the Dicrotic notch
Tertiary SYphilis (tree backing of the aorta) cuz of decreasing elasticity
682
what leukotrienes worsen asthma symptoms?
LTC4, LTD4, LTE4
683
which drug when giving to a RA patient reactivates latent TB
Ethernacept
684
what is the relationship of the arteries to airways in broncho pulmonary segment
bronchial arteries and pulmonary arteries run with the airways in the center of the segments
685
what is the relationship of the veins and lymphatics of airways in broncho pulmonary segment
veins and lymphatics drain together along the edge of the segments
686
pandemics are the result of genetic/antigenic shift. which of the following characteristics of the influenza virus makes the pandemic possible?
occurs when viruses with segmented genome exchange segments. mostly hemagluttinin and neuraminidase antigen
687
TENSION pneumothorax can lead to
Jugular Venous Distention
688
pursed lips is a method emphysema patient use to breath, how it works
inc pressure in small airways thereby preventing airway trapping
689
list the three cephalosporins used to treat Pseudomonas (MUST KNOW)
cefoperazone, ceftazidime (more commonly used, 3rd generation)) and cefepime (4th generation)
ceftriaxone used for meningitis and gonnorhea
Ceftazidime --used for pseudomonas
690
what are the medication that is used for RATE CONTROL in patients with A-Fib?
Digoxin, calcium channel blockers, beta blockers
691
what are the medication that is used for RHYTHM CONTROL for A-FIB?
(SAF)
Sotalol
Amiodarone
Flecainide
692
a shifting sinusoidal waveforms on ECG is treated with?
Magnesium sulfate (treats Torsade De Pointes)
693
abdominal bruit suggest
renal artery stenosis
694
how does surfactant decrease surface tension and prevention lung collapse
it disrupt liquid intermolecular forces in the alveoli aka it breaks the hydrogen bonds between molecules of water.
this prevent alveoli collapse and increase compliance.
695
what drug inhibits Renin
Aliskiren
696
Histology showing a diffuse interstitial infiltrate of LYMPHOCYTES with MYOCYTE NECROSIS , whats the diagnosis?
Myocarditis (generalized inflammation of the myocardium)
Most common cause Coxsackie B virus
697
a bitter almond taste refers to cyanide poisoning, what type is it? respiratory acidosis, metabolic acidosis, etc
A increase metabolic acidosis ( due to an increase in Lactic acidosis)
High anion-gas metabolic acidosis (MUDPILES)) L-lactic acidosis
698
what describes diffusion limited exchange in emphysema
decrease surface area due to destruction of alveoli
699
Cadmium is associated with what type of cancer and where is it found?
Prostate cancer and found in batteries and metal coating
700
Benzene is associated with what type of cancers and where are they found?
Leukemia and Hodgkin Lymphoma
found in light oil and gasoline
701
what element is found in glass, ceramics and electronics
Silica
702
what substances increases ADH production
Nicotine, Opiates
703
What substances Decrease ADH production
Ethanol, atrial natriuretic factor and decrease Serum osmolarity
704
Osteocyte connecting to each other by
GAP Junction
705
hepatitis A is associated with what type of food
Steamed food and contaminated water (e.g. Shell fish)
706
the most common cause of abscess in the liver is
Staph aureus via hematogenous spread
707
what is the most likely cause of the urinary symptom in a multiple sclerosis patients
URGE INCONTENANCE
UNInhibited Bladder contraction (so UNINHIBITED DETROUSER muscle
so detrouser overactivity
708
why do MI pain, radiate to shoulder and left arm
Afferent pain fibers enters the spinal cord at the POSTERIOR HORN in the SAME Level as the Spinal Cord. causing pain perceived in the neck and shoulders
709
Greatest to lowest affinity(highest Km) for sodium channel in antiarhythmis
class 1C > 1A > 1B
710
most side effect of Opiod therapy
Constipation and Miosis (dilated pupil)
711
partial deletion is associated with what disease?
Cru-DU-Chat
712
cells that lack sorbitol dehydrogenase and are sensitive to osmotic damage by sorbitol
SLRK (schwann cells, Lens, Retina & Kidneys)
713
what is lipodystrophy? and what care the causes?
abdominal fat with a buffalo hump and THIN EXTREMITIES.
what are the causes of lipodystrophy?
Leptin Deficiency
HIV Medications (e.g. Protease Inhibitors)
Ventromedial nuclei is stimulated by Leptin which causes increase Satiety
Lateral Hypothalamus stimulates Hunger and its Inhibited by Leptin
714
what is metabolic syndrome
3 of the following to make the diagnosis
1) abdominal Obesity
2) Increase Triglyceride > 150
3) decrease HDL
715
what drug blocks 3 beta hydroxysteriod dehyrogenase
Trilostane
716
what is Killan triangel and pathology associated with it?
thryophrangeal, cricopharngeal and inferior pharyngeal constrictor
disease associated is Zenker diverticulum
717
what drug ? blocks detoxification of heme into hemozine
Chloroquine
718
what drug do you use to treat hypnozoite which is dormant in RBC
Primaquine
719
for INH to work it needs what
Catalase peroxidase to work
720
to amplify signal what do you need
DNA polymerase, primer and base
721
where do you do a femoral nerve block
Inguinal Crease at lateral border of femoral artery
722
what are the artery that anastomostose in kissle back plexus
septal branch of anterior ethmoidal artery
Lateral nasal branch of sphenopalatine artery
septal branch of superior labial artery
723
what is responsible for green color of Pus in bacterial infection
Myeloperoxidase
724
what is responsible for the green color in bruises several days after an injury?
Billiverdin (green color in Bruises)
Heme convert to Biliverdin via the enzyme HEME OXYGENASE
725
what amino acids are the stimulators of gastric secretions
Phenylalanine, tryptophan and calcium
| PTC stimulate gastrin
726
List the G.I pathology that is associated with down syndrom
Duodenal atresia, hirschsprung disease, annular pancreas and celiac disease
727
what is the microscopic presentation of Kaposi Sarcoma
spindled cells with slit like vasculature
728
hearing loss in one ear in an elderly refers to damaged to what nucleus?
Cochlear Nucleus
sensourinearal hearing loss below the trapezius body
729
which are the FIRST NODE TO receive lymphatic node from the lateral breast?
Pectoral Nodes
730
what do you see on histology on endometrial cancer
well differentiated epithelial cells with glandular epithelium
731
Slit-light examination is in what pathology
Wilson disease
732
what is the MOA of the drug used to treat primary billiary cirrosis
URSODIOL (dec synthesis of cholesterol in the liver)
Changes the composition of Bile.
delays progression of Primary billiary cirrhosis
733
jaundice, fever, RUQ pain refers to
CHolangitis
734
Jaundice, fever, RUQ pain, Hypotension and altered mental status refers to
REYNOLDS PENTAD
735
what drugs causes intrahepatic damage
Chlorpromazine and Arsenic
736
what is the problem with aortic stenosis in terms of the cardiac cycle
aortic stenosis is due to delayed opening of the aortic valve so you will have a PROLONGED isovolumetric Contraction and DECREASE the period of systolic ejection
737
Defect in erythroid progenitor cells refers to what pathology
Diamond-Blackfan Anemia
a form of megaloblastic anemia
inc in HBF (dec in total Hb)
Presentation:
Short stature, craniofacial abnormalities and upper extremity abnormality with triphalangeal thumb in up to 50% of cases
738
Defect in DNA Repair refers to what pathology
Fanconi Anemia (pancytopenia, aplastic anemia, Hypoplastic thumb)
739
Defect in DNA synthesis refers to
Megaloblastic Anemia
740
Metastasis to Bones
Primary Relocated Tumors Like Bones
```
Prostate cancer
Renal cell carcinoma
testes cancer
Lung cancer
Breast Cancer
```
741
Metastasis of Cancer to Brain
Lots of Bad Stuff Kills Glia
```
Lungs
Breast
Skin (melanoma)
Kidneys (renal cell carcinoma)
G.I tract (colon cancer)
```
742
Metastasis to Liver
Cancer Sometimes Penetrates Benign Liver
```
Colon
Skin
Prostate cancer
Breast
Lung cancer
```
743
treatment for testicular cancer
"ERADICATE BALL CANCER"
| EToposide, Bleomycin, Cisplatin
744
what are the SE of steroid use
Cushion syndrome
"BAM CUSHINGOID"
Bufalo hump
Ammenorhea
Moon facies
```
Crazy (psychosis, agitation)
Ulcers
Skin Changes
HTN
Infection
Necrosis of Femoral head
Glaucoma and cataracts
Osteoporosis
Immunosupresion
Diabetes
```
745
by what mechanism does lithium cause thyroid dysfunction
by blocking thyroid hormone release by an unknown mechanism
746
what is the electron carrier needed to make steroid synthesis
NADPH From HMP shunt
747
what type of cells is present in the pancreas of type 1 diabetes? i.e is it granulomas, monocyte, lymphocyte
LYMPHOCYTE
type 1 DM is auto immune so Lymphocyte present
748
negative symptoms of schizophrenia is by what tract
Mesocortical tract
749
positive symptoms of schizophrenia is by what tract
Mesolimbic tract
750
what do you use to treat vancomycin resistance staph aureus
Linezoid and DAPTOMYCIN (cause myopathy and increase CCK)
751
methicillin resistance staph aureus is used for
Ciprofloxacin
752
elevated level of diphosphogylcerol and glucose 6 phosphate refers to what blood pathology
Pyruvate Kinase Deficiency (echinocytes will be seen which is Burr cells)
753
what gland is found between the thalamic bodies on an MRI
PINEAL GLAND (PRODUCING MELATONIN)
MASS IN THIS REGIONS IS PINEOBLASTOMA (Symptom is a HEADACHE and Drowsiness and vivid dreams due to excessive melatonin production)
754
in a patient with an Ileal/Ilieum Resection, what bacteria can't affect this patient?
Shigella because it infects the M cells in Payers patches in the Ilieum. Since no Ilieum , Shigella cannot invade through M-Cells
M-Cells Produce IgA
Other bacteria that use payers patches for invasion include salmonella, Yersinia, certain strains of E-coli and mycobacterium avium
755
what is the treatment for Hep B infection
Lamivudine and Interferon alpha
756
what is the treatment for Hep C infection
Ribavirin and interferon alpha
757
sickness as a result of bear meat is as a result of what parasite
Trichinella spiralis
758
list the aromatase inhibitor drugs
Letrozole, anastrozole, exemestane
759
what antibiotics cause clostridium deficile
clindamycin, ampicillin and cephalosporin
760
High Fever, black vomit, aching pain and Jaundice refers to
Yellow Fever ( councilman bodies which are eosinophilic globules believed to be the result of apoptosis)
761
what drug worsen raynaud phenomena
phenelphrine
762
which amino acid are modified in the golgi aparatus
SAG (serine, threonine and Asparagine)
763
what is responsible for extra ocular movement during REM Sleep
PPRF (paramedian pontine reticular formation)
764
what is marcus Gunn Pupil
Optic nerve injury or Retinal detachment in which leads to an inability of both eyes to constrict when eye is shone into the affected eye
765
what drug causes an increases in coronary blood flow 1-2 mins after NE infusion
Adenosine
766
what causes weight loss in a patient with small cell carcinoma of the lungs
Cytokine effect
767
6-year-old boy with 5-day history of intermittent vomiting and 3-month hx of progressive clumsiness. Can no longer ride bicycle and difficulty getting out of car. Funduscopic exam shows bilateral papilledema. Neuro exam shows impaired upward gaze and pupil response to light. Walks shuffling gait. CT shows enlarged lateral and third ventricles and a 2-cm mass. Location of mass?
Pineal Gland
768
Herniated lumbar intervertebral disc asking for most appropriate location for surgical entrance to neural canal?
for this lamina is the answer because this is the only place which doesnt lie directly on a nerve or spinal cord. i dont remember the option number
769
what enzyme is responsible for digesting triglyceride
Colipase
770
Workbench wiped down with alcohol, successfully inactivates viruses with which characteristic?
Enveloped virion
771
6-year-old girl with 15-minute history of severe shortness of breath. Diagnosed with throat tumor 3 years ago. RR 32. PE nasal flaring. Laryngoscopy shows multiple raised, finger-shaped lesions from vocal cords and epiglottis. Lesions excised and shows finger-shaped fibrovascular cores lined with benign squamous epithelium. Causal virus?
Human papillomavirus, type 6
772
unilateral lower extremity sensory and motor loss, what artery?
ACA
773
unilateral facial and arm sensory and motor loss, what artery?
MCA
774
where does the dorsal column, lateral corticospinal tract cross?
medulla
Caudal medulla
775
what antipsychotics drugs are associated with blood dyscartias
Carbamazepine and ethisuoximide
776
Pink round bacteria in pairs in a 24 year old refers to what bacteria
Neiseeria Gonnorhea
777
RUQ pain and inflammation of the liver capsule refers to what pathology
Fitz-Hugh-Curtis Syndrome
778
unilateral left lower abdominal pain on ovulation due to rupture of the mature follicle is called
Mittelschmerz
779
what is the most significant risk factor for endometrial cancer
Obesity
780
Fever, RUQ Abdominal Pain and Vaginal discharge and on Laparoscopy ,
Violin-String adhesions are present, Diagnosis?
Fitz-Hugh-Curtis Syndrome ( infection of the LIVER CAPSULE and VIOLIN STRING ADHESION ON PERITONEUM to LIVER)
its a complication of PID
