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1

pulling sensation in groin with..
ascites, hydrothorax, &..

ovarian fibroma: meig's syndrome

2

hCG & LDL are elevated in what ovarian neoplasm

dysgerminoma

3

AFP is elevated in what ovarian neoplasm

yolk sac tumor, endodermal sinus

4

presentation of yolk sac tumor

in ovaries/testes or saccrococcegeal region

has schiller-duval bodies

5

drug eluting stents elute..

clopidogrel

6

paclitaxel

taxol

stabilizes MT, preventing mitosis

7

schiller-duval bodies

endodermal sinus, yolk sac tumor

8

call-exner body

granulosa cell tumor (malignant ovarian neoplasm)

resembles primitive follicle

9

CA-125

monitor progression of all ovarian neoplasms, but not good for screening

10

most common malignant ovarian neoplasm

serous cystadenocarcinoma

11

most common benign ovarian

serous cystadenoma

12

what is the cornea composed of

1. endothelial layer: cellular, mitochondrial rich, translucent
2. descement's membrane (location of Cu2+ deposition
basement membrane

13

probenicid on uric acid? on penicillin?

LOWERS uric acid (inhibits reabsorption)
INCREASES penicillin (inhibits secretion)

14

input to cerebellum?

cortex -> MCP (contralateral) via ipsilateral pontine nuclei
spinal cord (proprioception) -> ICP (ipsilateral)

via climbing and mossy fibers

15

output from cerebellum

purkinje fiber -> deep cerebellar nuclei (DEGF) -> contralateral cortex superior cerebellum peduncle

16

lateral lesions to cerebellum

voluntary movements of extremities; tendency to fall ipsilaterally

17

medial lesions to cerebellum?

midline structures;

truncal ataxia, nystagmus, head tilting.
wide-based (cerebellar) gait & defective truncal coordination

usu bilateral

ALCOHOLICS (thiamine-deficiency linked)

18

alcoholic wide based gait based on..

midline cerebellar defects; thiamine deficiency linked!

19

xanthomas are most characteristic of..
tendinous more specific for..

increased cholesterol (tendinous more specific)

severely increased triglycerides

20

urease breath test?

drink radiolabeled urease
H. ployri converts to CO2 + NH3
will breath out radiolabeled CO2

the NH3 raises the pH around bacteria & protects it

21

low-pitched, rumbling, mid-diastolic murmur in apex LLD

mitral stenosis

22

most common cause of mitral stenosis

rheumatic heart disease

23

cardiac manifestation of TB?

tuberculosis pericarditis

24

peutz-jeghers syndrome

autosomal dominant.
STK11 (serine/threonine kinase chr. 19) mutation

1. pigmented mucocutaneous macules
- lips, buccal muscosa (pathognomonic) hands & feet
2. numerous hamaratomatous polyps in GI tract

usu benign
can: abdominal pain, GI bleed (intussuception, obstruction, malignant transformation)

develop during first few years of life

25

blue nails & dyspigmentation of lower legs

consider Wilson's disease (hepatolentincular degeneration)

26

enzyme deficiency in gilbert's syndrome

reduced activity of UDP-gluconornyl transferase

27

atrophic glossitis, megaloblastic anemia, shuffling gait in elderly women of Northern European descent

pernicious anemia presentation

gait: due to degeneration of dorsal column proprioception to cerebellum

28

liposarcoma vs. lipoma

liposarcoma: LIPOBLAST: nonmembrane bound cytoplasmic lipid characterestically causing nuclear indentations & scalloping of nuclear membrane

lipoma: mature fat cells, without pleomorphism

both present as slow growing, painless masses in deep connective tissue

29

most common malignant soft tissue tumor in adults? children?

adults: liposarcoma
children: rhabdomyoscarcoma

30

FAP
osteoma in skull
fibroma (desmoid tumor)
congenital hypertrophy of retinal pigmented epithelium

gardener syndrome (autosomal dominant)

31

FAP + malignant CNS tumor

turcot syndrome

32

dermoepidermal junction autoantibodies (against type VII collagen)

epidermolysis bullosa acquisita

33

basement membrane IgG auto-antibodies in skin

bullous pemphigoid

34

lung surfactant maturation screen

L/S
lecithin/sphingomyelin 2:1

note: lecithin = DPPC = dipalmitoyl phosphatidyl choline

35

purpose of surfactant

decrease surface tension of alveoli
reduce pressure needed to keep alveoli inflated

(increased compliance)

36

sympathetic innervation to eye

3 neuron system
1. hypothalamus -> descend to lateral horn spinal cord
2. enters sympathetic trunk & ascends to superior cervical trunk
3. superior cervical trunk, along internal carotid, joins branches of opthalmic division of CN V

go to pupil dilators & superior tarsal

37

bulbar vs. pseudobulbar

bulbar:
- LOWER motor neuron
- cranial nuclei from medulla (CN IX, X, XI, XII) & nerves

pseudobulbar:
- UPPER motor neuron
- corticobulbar tracts in mid pons
- for these lesions to be apparent, must be bilateral, as these nuclei receive bilateral input

38

bromocriptine

dopamine receptor agonist
rx: prolactinoma

39

clomiphene

SERM
-blocks estrogen receptors in hypothalamus (blocks negative feedback)
-increase release of pituitary gonadotropins

40

what can be used to trigger ovulatory cascade when follicles are mature? (i.e. in an oocyte donor)

hCG therapy, triggers ovulation

41

can a person w/ turner have a baby?

w/ IVF
ovaries don't work, but uterus is fine

42

lithium side effects

LMNOP

motor (tremors)
nephrogenic diabetes insipidus
hypothyroidism
pregnancy: teratogen: ebstein anomaly

43

mood disorder history

THINK LITHIUM

44

3 problems in hypertrophic cardiomyopathy

1. diastolic dysfunction: rigid, less volume
2. LVOT: increased afterload
3. increased cardiac work: MI

45

2 causes of renal artery stenosis

1. atherosclerosis
2. fibromuscular dysplasia (females)

46

when giving blood to patient w/ IgA deficiency..

must be blood from someone else w/ IgA deficiency!

if IgA is in blood, they will have anaphylaxis (they'll make anti-IgA)

could be in: RBC, platelet, FFP, IVIG

47

DNA Pol III? DNA Pol I?

DNA Pol III: continues from RNA primer
DNA Pol I: removes primer (5'-3' exonuclease), & places new DNA

48

receiver operating characteric ROC curve? measure of accurary?

sensitivity vs. 1-specificity

want rectangular test
area under curve: accuracy!

true positive rate vs. false positive rate

49

accuracy formula

TP + TN / all observations

50

false positive rate

1-specificity

specificity: without disease, test negative
false positive rate: without disease, test negative

51

true positive rate

sensitivity

with disease, test positive

52

false negative rate

1-sensitivity

with disease, test negative

53

CA-125

high specificity,
low sensitivity

(low false + rate, low PPV)

54

17-hydroxyprogresterone elevation

CAH due to 21-hydroxylase deficiency

55

PTHrP

squamous cell carcinoma of lung
hypercalcemia

56

CA-19-9

pancreatic adenocarinoma

57

cyclosporine

calcineurin inhibitor (binds CYCLOphilin)

prevents IL-2 transcription

-- can't convert NFAT-P to NFAT
[NFAT is TF for IL-2 gene]

use:
transplant rejection prophylaxis
psoriasis
rheumatoid arthritis

58

tacrolimus

calcineurin inhibitor (binds FKBP)

prevents IL-2 transcription

--can't convert NFAT-P to NFAT
[NFAT = TF for IL-2 gene)

59

oprelvekin

IL-11

good for thrombocytopenia

60

filgrastim

G-CSF (recover bone marrow)

61

sargramostin

GM-CSF (recover bone marrow)

62

aldesleukin

IL-2

63

IFN-a

rx:
chronic hep B
chronic hep C
hairy cell leukemia
condyloma acuminatum
renal cell carcinoma
malignant melanoma

64

IFN-b

multiple sclerosis

65

IFN-c

chronic granulomatous disease

66

IL-2 transcription

calcineurin
NFAT-P -> NFAT

NFAT -> transcription factor for IL-2 gene

67

cyclosporine toxicity

NEPHROTOXIC
HTN
hyperlipidemia
hyperglycemia
tremor
hirsuitism
gingival hyperplasia

68

-limus drugs (tacrolimus & sirolimus)

binds FKBP

69

calcineurin inhibitors (cyclosporine & tacrolimus) are both..

nephrotosix

70

tacrolimus toxicity

like cyclosporine: MAIN: NEPHROTOXIC
MORE risk of diabetes & neurotoxicity
LESS risk of hirsuitism & gingival hyperplasia

nephrotoxic
hyperlipidemia
tremor

71

sirolimus (rapamycin)

binds FKBP
mTOR inhibitor
(TF for proliferation genes)

blocks T cell activation & B cell differentiation

prevents IL-2 signal transduction

NON-NEPHROTOXIC

72

basiliximab

monoclonal Ab to IL-2

(like sirolimus / rapamycin, blocks IL-2 reception)

73

immunosuppressant effects of glucocorticoids

inhibits NF-kB
inhibits cytokine transcription

74

NFAT & NFkB

both transcription factor for IL-2 (cytokine)

75

azathiopurine blocks

blocks rapidly dividing T & B cells
like 6-MP

PRPP amidotransferase
(rate limiting step for purine synthesis)

converts PRPP -> 5-phosphoribosylamine
(then add base + carbon)

cleared by xanthine oxidase
(increase w/ allopurinol rx)

76

mycophenolate mofetil

like azathiopurine, blocks rapidly dividing T & B cells

blocks IMP dehydrogenase (can't make de novo GMP)

77

muromonab

Ab against CD3 on T cells
immunosupressants

78

gingival hyperplasia (4)

verapamil
phenytoin
cyclosporine
nifidipine

79

drug induced parkinson's (3)

anti psychotics
reserpine
metoclopromaide

cog-wheel ARM

80

metoclopromide

rx: nausea & gastroparesis

D2 receptor antagonist
increase resting tone, contractility, LES tone, motility.

does not influence colonic transport time.

contraindicated in parkinsons

81

alkaptonuria (ochronosis)

autosomal recessive, bengin.
deficiency of homogentisate oxidase
can't break down tyrosine -> fumarate

major problem: debilitating arthralgia
(homogentisic acid = toxic to cartilage)

urine black on standing
dark blue/grey on sclerae & ear

(no mental retardation)

82

major long-term consequence of alkaptonuria?

debilitating arthralgia (3-4th decade)

knee, hip, shoulder, intervertebral joints

83

parkinsons symptoms mnemonic

TRAPS

resting Tremor
Rigiditiy (cogwheel)
Akinesia (or brady)
Postural instability
Shuffling (festinating) gait

degradation of neurons in substantia nigra pars compacta

84

location of substantia nigra pars compacta

ventral midbrain
near cerebral peduncles (corticobulbar tracts)
'mickey mouse' ears

85

lesion to occipital lobe? lesion to PCA

if occipital lobe: homonymous hemianopsia

if PCA: homonymous hemianopia w/ MACULAR SPARING

can be quadrants if only lingual / cuneate lobe of cortex involved

86

where are juxtaglomerular cells located

modified smooth muscle cells in afferent arteriole, near glomerulus

in close contact w/ macula densa of DCT

87

3 stimuli for renin release

1. decrease tubular NaCl in macula densa
2. B1 receptor sympathetics
3. decreased pressure in afferent arteriole

88

Tamm-Horsfall glycoprotein

exclusively secreted by renal tubular epithelial cells of TAL

if low urine flow, can form hyaline casts

89

normal albumin excretion in urine

< 30mg/day

90

amniotic fluid acetylcholinesterase AChE

open neural tube defect
(bc its present in blood cells, muscle, and nerve tissue)

91

neural tube defect, elevated..

AFP and AchE

92

thyroxine deficiency on bone

usu NOT fracture

instead: pain, ache, stiff

93

presentation of cystathione-beta-synthase deficiency (3)

homocysteinuria from methionine breakdown.
cysteine becomes essential amino acid.

1. ectopia lentis (downward lens displacement)
2. osteoperosis
3. mental retardation
3. thin, fair hair & skin: marfanoid
4. propensity for arterial & venous thromboelmbolism

94

presentation of phenylketonuria? (4)

1. fair pigmentation
2. mousy odor
3. seizures
4. mental retardation

mutation in phenylalanine hydroxaylase, can't make tyrosine

95

presentation of maple syrup urine disease

mutation in branched-chain alpha-keto acid dehydrogenase

can't decarboxylate the alpha-keto acid derivatives of leucine, isoleucine, valine.

96

proline synthesized from..

glutamate

97

level of pancreas

L2

98

what types of drugs cross placenta? what types of drugs do not?

CROSS: lipid soluble

DO NOT CROSS: water soluble

99

why can heparin be given during pregnancy but not warfarin

heparin sulfate: charge: water soluble, will not cross placenta

warfarin: lipophilic: will cross palcenta

100

what type of bilirubin can cross placenta

unconjugated can cross: lipid soluble

conjugated = water soluble = won't cross

101

differentiating gonorrhea vs. chlamydia infection

often, treat for both

gonorrhea:
-purulent discharge
-microscopy: multiple WBC w/ intracellular gram - cocci

chlamydia
-microscopy: neutrophils w/ NO pathogens
(bc chlamydia lacks muramic acid, won't gram stain)
- also causes epididmyitis!

102

common cause of epididymitis?

chlamydia

103

unique feature of neisseria (gonococcal & meningococcal LPS

lack repeating O antigen in LPS!

104

which neisseria ferments maltose & has capsule

meningococcus

gonococcus: NO capsule, NO maltose, NO vaccine

105

difference between..
acyclovir, famciclovir & ganciclovir
vs.
zidovudine, cytarabine, vidarabine

acyclovir, famciclovir & ganciclovir
activated by viral kinase first (then host)

zidovudine, cytarabine, vidarabine
activated by host cell kinase

106

CMS retinitis T cell count

<50

107

PCP pneumonia T cell count

<200

108

chloroquine mechanism

blocks detoxification of heme into hemozin
heme accumulates & is toxic to plasmodia

note: most falciparium -> resistant

109

rx for p. falciparium

artemether/lumefantrine
or
atovaquone/proguanil

life threatening, use quinidine or atesunate

110

what enzyme does ribavarin block

IMP dehydrogenase, can't make GMP

111

cidofovir & foscarnet

do not need viral kinase activation

112

tenovovir

only NRTI that does not need to be phosphorylated by host kinases

is a nucleoTIDe

113

smoking cessation on lung functoin

will stop further damage, but does not IMPROVE.

WILL decrease risk of lung cancer

is associated w/ weight gain (food to replace smoking)

114

recidivism

resumption of harmful activity after abstinence / rehab

115

what allows chicken virus to infect humans

often: genetic reassortment

116

genetic reassortment

responsible for sudden shifts

2 distinct influenza strains (ie that infect diff animals) infect same cell, HA from 1 and NA from other packaged together --> new virion

novel strain of virus to which we have NO susceptibility

HA and NA are surface proteins, also targets of immune system

117

antigenic drift

point mutations in HA and NA
slightly alters product proteins
can slightly increase infectivity, etc

gradual drift

118

phenotypic mixing

2 viruses infect same cell
progeny have coat or envelope proteins not coded for by genetic material packaged within them

119

hypoglycemia in McArdle?

NO
mutation in muscle glyocgen phosphorylase.

muscle glycogen doesn't release glucose into circulation anyways.

liver glyocgen phosphorylase is fine --> no hypoglycemia

120

presentation of McArdle

deficiency muscle glycogen phosphorylase

no hypoglycemia (bc liver fine)
muscle pain on exertion, exercise intolerance
can have myoglobinuria / renal failure

121

hyperkalemia on EKG

1. peaked T waves
2. loss of P
3. prolonged PR
4. wide QRS

slow HR

122

hypokalemia on EKG

1. flattening T waves
2. appearance of U waves
3. ST segment depression

can cause Tdp

123

hypocalcemia on EKG

QT prolongation

124

hypercalcemia on EKG

QT interval shortening
T-wave flattening or inversion in severe cases

125

peaked T wave

earliest EKG sign of hyperkalemia

126

T wave flattening

in hyPO K+

and

hyPER Ca2+

127

graves disease proptosis/exopathalmosis

1. TSH antibodies stimulate fibroblasts to make GAG
2. draws in water --> extraocular muscle EDEMA

note: NOT extraocular muscle hypertrophy

128

communication between suprachiasmatic nucleus & pineal gland

SCN -> NE -> pineal -> melatonin

129

parinaud syndrome (4)

pinealoma

1. upwave gaze palsy,
2. absent pupillary light reflex,
3. failure of convergence,
4. wide-based gait

superior colliculus
oculomotor & trochlear n.
edinger westphal

all involved (mass effect)

130

where are stem cells located in GI system

crypts of Lieberkuhn

131

coarse, rhythmic, postural tremor in fingers & arms of alcoholic

thiamine deficiency --> alcoholic cerebellar degeneration

132

alcoholic cerebellar degeneration pathology

loss of Purkinje cells in anterior lobe & vermis

presentation:
- wide-based gait ataxia
- intention tremor of hands & fingers
- rhythmic parkinsonian tremor of fingers & hands too
- truncal instability

133

medial medullary lesions cause

1. contralateral spastic paralysis
2. contralateral paresis
3. ipsilateral CN XII (tongue) problems

134

korsakoff syndrome specifically refers to

temporal lobe damage w/ alcoholics

135

phenylephrine

alpha-1 agonist

increases PVR
increases systolic BP
decreases PP
decreases HR (reflex)

136

dobutamin

B1 agonist

increase HR
increase contractility

no effect on SVR

137

isoproterenol

nonselective B agonist

increase HR
increase contractility
increase pulse pressure
decrease PVR
decrease diastolic BP

138

epinephrine

both alpha & beta agonist

increase HR
increase pulse pressure
decrease PVR (dominant effect on beta 2 over alpha 1)

139

clonidine

alpha 2-agonist

decreases sympathetic outflow
decreases BP

140

CAAT & TATA box

both promote transcription intiation
RNA pol II binding

CAAT: 80 bp upstream
TATA: 25 bp upstream

141

lysyl hydroxylase deficiency

kyphoscoliosis variant of Ehlers-Danlos
autosomal recessive

hypermobile, hyperextensible, fragile joints

similar to vitamin C deficiency (scurvy)

142

sublimation

convert unacceptable feelings or drives into more socially acceptable

murder -> surgeon

143

stellate cells in liver

perisinusoidal space, store beitamin A

can differentiate into myofibroblast upon injury -> help produce fibrosis

144

lambert-eaton associated w/

paraneoplastic syndrome of small cell lung cancer

145

genetic association w/ small cell lung cancer (note 4 A's)

ACTH, ADH, Autoimmune (lambert-eaton)
Amplification of myc

146

genetic associated w/ adenocarcinoma

k-Ras, eGFR, ALK

147

3 C's of squamous cell carcinoma

cavitation, cigarretes, hyperCalcemia (PTHrP)

148

BMI calculation

weight / height^2

149

what antibiotic binds to 23sRNA

macrolides & clindamycin

maCROlides binds to twenty-THREE

150

mechanism of chloramphenicol

binds to 50S subunit, blocks peptidyl-transferase

[does not bind to 23s)

151

mechanism of macrolide & clindamycin

bind 23sRNA in 50S subunit
block translocation

macRO blocks transLOcation
binds to twenty-THREEsubunit

152

resistance to macrolides

mutation in 23s rRNA subunit of 50s

153

resistance to chloramphenicol

acetylation of antibiotic

154

what topoisomerase do fluoroquinolones blocks?

topo II (DNA gyrase
topo IV

(like etoposide)

155

what topoisomerase dose etoposide block?

topo II (like fluoroquinolone)

156

what topoisomerase does irinotecan, topotecan block

topo !

157

presentation of cystic hydroma? association!

loose areolar tissue of head and neck, often left side

painless, compressible mass that transilluminates

when lymphatics don't connect to venous, bud abnoramlly, or retain embryonic growth potential & expand into adjacent structures along facial planes.

associated w/ turner, trisomy 12, 13, 21!

NOT JUST TURNER

158

what type of patients can have cystic groma (2)

turner
trisomies (13,18, 21)

159

what ultimately determines amplitude of AP in neurons?

Nernst equation equilibrium potential for Na+

increase: w/ increase extracellular Na+ decrease intracellular Na+

160

how can amplitude of AP be altered?
how can likelihood of firing be altered?

amplitude: equilibrium potential for Na+ (increase extracellular, decrease intracellular

likelihood of firing: bring membrane potential closer to threshold
- since K+ determines resting potential, decrease intracellular K+

161

linear erythematous rash after hiking

suggests poisin ivy -- hypersensitivity
type IV HSR

162

drug-induced photosensitivity

SAT For Photo

sulfonamides
amiodarone
tetracylcin
5-FU

163

presentation of rocky mountain spotted fiber

rash BEGIN: at ankles/wrists,
---->
SPREAD to TRUNK & PALM

dermacentor ticks

164

where do rickettsiae live

obligate intracellular: need CoA and NAD+, cannot synthesize ATP

165

ehrlichiosis

monocytes w/ morula
tick vector

166

anaplasmosis

granulocytes w/ morulae
tick vector

167

Q fever

no arthropod vector!
coxiella burnetti

tick feces & cattle placenta, aerosol

present: pneumonia + hepatitis