UWorld 1st time incorrects

Question 1

Pheochromocytoma

Answer 1

can cause paroxysmal hypertension and is a tumor of the adrenal medulla (derived from neural crest cells)

Question 2

neural crest gives rise to

Answer 2

1. sensory neurons of spinal and cranial nerves
2. autonomic postganglionic neurons
3. melanocytes
4. leptomeninges (arachnoid and pia mater)
5. cartilage, ligaments, and bones of branchial arch origin

Question 3

endoderm gives rise to

Answer 3

1. Epithelial linining of GI and respiratory tracts
2. thyroid and parathyroid glands
3. thymus
4. liver and gall bladder epithelium
5. pancreas
6. epithelial lining of urinary bladder and urethra
7. epithelial lining of tympanic cavity and auditory tube

Question 4

mesoderm gives rise to

Answer 4

1. adrenal cortex (not medulla)
2. connective tissue
3. cartilage
4. bone
5. muscle
6. blood cells and blood and lymph vessels
7. spleen
8. kidneys
9. gonads
10. serous membranes of lining body cavities

Question 5

neuroectoderm gives rise to

Answer 5

1. central nervous system
2. somatic motor neurons of spinal and cranial nerves
3. preganglionic autonomic neurons
4. posterior pituitary

Question 6

surface ectoderm gives rise to

Answer 6

1. epidermis of the skin
2. hair, nails, sweat and sebaceous glands
3. parotid gland
4. anterior pituitary (Rathke’s pouch)
5. lens of the eye

Question 7

notochord gives rise to

Answer 7

nucleus pulposus

Question 8

Hirschsprung disease

Answer 8

congenital cause of constipation

• absence of ganglion cells in submucosal and myenteric plexuses of colon segment
• due to neural crest migration defect
• lack of peristalsis here
• distal rectum always involved

Question 9

greater sciatic foramen

Answer 9

occupied by piriformis muscle
-superior gluteal nerve, artery, and vein exit through the greater sciatic foramen above piriformis muscle (major hip abductors lie here)

Question 10

lots of fractured bones and bluish tinge to sclerae leads to what likely finding

Answer 10

• osteogenesis imperfecta
• AD collagen type 1 defect
• impaired osteoid production by osteoblasts
• decreased production of normal type 1 collagen
• example of pleiotropy (multiple often seemingly unrelated physical effects caused by a single genotype)

Question 11

duchenne muscular dystrophy

Answer 11

x-linked recessive disorder caused by dystophin mutations

complication includes cardiomyopathy

Question 12

patients with nonallergic bronchospastic conditions (emphysema and chronic bronchitis)are not prescribed what

Answer 12

non-selective beta blockers (ex: metoprolol) due to bronchoconstriction

Question 13

beta blockers and pts with chronic respiratory disorders

Answer 13

• not recommended

- if they must be prescribed then use a beta1 selective blockers should be used (like metoprolol)

Question 14

foul-smelling putrid rust colored sputum mixed in aspiration is seen with…

Answer 14

aspiration pneumonia caused by bacteroides species

• less likely but still possible is strep pneumo
• lung abscess usually occur in individuals with episodes of impaired consciousness (alcohol/drug abuse, dementia) or decreased ability to swallow (esophageal strictures)
• generally caused by aspiration of anaerobic and aerobic bacteria from oral cavity into the lower respiratory tract

Question 15

which NSAID contains sulfa in it

Answer 15

celecoxib (selective COX2 inhibitor)

Question 16

mixed connective tissue disease

Answer 16

autoimmune condition
high antibody titers to U1-ribonucleoprotein

• joint pain
• myalgias
• pleurisy
• esophageal dysmotility
• raynauds phenomenon

Question 17

primary toxic agent in lipopolysaccharide in gram-negative organisms

Answer 17

lipid A (also causes septic shock)

Question 18

what should be cut to relieve pressure in a patient with carpal tunnel?

Answer 18

flexor retinaculum (aka. transverse carpal ligament) –> compresses the median nerve

Question 19

as part of an intake the patient should always be asked…

Answer 19

about advanced directives including the patients end of life care

Question 20

Fragile X symptoms

Answer 20

x-linked (LOF)
long narrow face, prominent forehead and chin, large testes, hyperlaxity of joints, developmental delay (speech and motor), and neuropsychiatric features

Question 21

klinefelter syndrome

Answer 21

47, XXY

• primary hypogonadism (low testosterone, elevated FSH and LH, elevated estradiol)
• tall stature, gynecomastia, small testes (often undescended), and infertility

Question 22

analysis of variance (ANOVA)

Answer 22

used to determine whether there are any significant differences between the means of several independent groups

Question 23

spironolactone

Answer 23

aldosterone antagonist

-anti-androgenic effects: gynecomastia

Question 24

most cardiac venous blood drains into the right atrium via the…

Answer 24

coronary sinus
-anything that causes right atrial pressure to increase (like pulmonary hypertension) will also cause the coronary sinus to dilate

Question 25

interstitial lung disease (restrictive pulmonary) causes

Answer 25

airway widening due to increased outward pulling (radial traction) by the surrounding fibrotic tissue -radial traction is increased in restrictive pulmonary disease

Question 26

what happens to the following 3 in isolated diastolic heart failure 1. LV end-diastolic pressure 2. LV end-diastolic volume 3. LV ejection fraction

Answer 26

1. Increased 2. Normal 3. Normal *Conditions that reduce ventricular compliance lead to increased LV end-diastolic pressures and the same LVED volumes (upward shift in PV curve)

Question 27

early group A strep pharyngitis treatment

Answer 27

penicillin -- early treatment is good -prevents acute rheumatic fever and can cause CV death

Question 28

what three enzymes can act on pyruvate

Answer 28

1. lactate dehydrogenase (anaerobic) 2. pyruvate dehydrogenase (aerobic) 3. pyruvate carboxylase--> to form oxaloacetate which is used to regenerate glucose via gluconeogenesis

Question 29

what would a chest stab wound hit if its in the lateral fifth intercostal space

Answer 29

left lung

Question 30

what would a left stab wound to the anterior chest wall hit?

Answer 30

right ventricle

Question 31

drug-induced lupus erythematosus

Answer 31

- can be due to hydralazine, procainamide, quinidine, minocycline and isoniazid (metabolized via phase II liver acetylation) - anti-histone antibodies, arthralgias, and pleuritic chest pain

Question 32

lateral medullary (wallenberg) syndrome

Answer 32

PICA injury/obstruction which is a branch off the vertebral artery usually due to acute ischemia (due to trauma) in a vertebral artery branch presenting with ataxia (fall toward side of lesion), loss of pain/temp on ipsi face and contra body

Question 33

leprosy (hansen disease)

Answer 33

deforming infection primarily of skin and nerves (infect schwann cells) caused by Mycobacterium leprae - usually via armadillo - tuberculoid leprosy is least severe form and usually self-limited

Question 34

amiodarone

Answer 34

- class III antiarrhythmic drug - potassium channel blockers - prolongs QT - LOW risk of TDP - must start by checking TSH then continue to check it while they are on the drug

Question 35

pyridoxine (vitamin B6)

Answer 35

- necessary for transamination and decarboxylation of amino acids (used in gluconeogenesis) - nitrogen involved

Question 36

nystatin

Answer 36

drug used for oral thrush (candida fungi) - note neutrophils typically prevent hematogenous spread of candida (you will see BOTH pseudohyphae and budding yeast) - t lymphocytes prevent superficial candida infection

Question 37

dexamethasone

Answer 37

positive impact on fetal survival - corticosteroids have the greatest effect on increasing surfactant production by accelerating maturation of type II pneumocytes (note that surfactant is stored in the lamellar bodies--> organelles containing parallel stacks of membrane lamellae) - as surfactant is degraded it is recycled back into the same type II pneumocytes via endocytosis for reprocessing

Question 38

diabetic nephropathy

Answer 38

- earliest test for it is to see albumin in the urine - can be manifested as a diffuse or nodular glomeruloscerlosis (aka. Kimmelstiel-Wilson) - KW--> characterized by PAS+ deposits (hyaline) of mesangial matrix, thickened basement membranes, and nephrotic syndrome - ovoid hyaline masses in the periphery of the glomerulus

Question 39

Respiratory vs metabolic acid/alkylosis

Answer 39

``` respiratory 40 (increase, decrease) metabolic 24 (decrease, increase) ```

Question 40

how to treat acute cholecystitis

Answer 40

third-generation cephalosporin (cefotaxime or ceftriaxone) + metronidazole

Question 41

choledocholithiasis

Answer 41

gallstone impaction in the common bile duct -results in elevated direct bilirubin in blood, leading to jaundice and colicky right upper quadrant pain

Question 42

what is tertiary vs quaternary prevention

Answer 42

3 --> reduces likelihood of disease recurrence or exacerbation in people already diagnosed with disease 4 --> methods to mitigate or avoid consequences or unnecessary or excessive interventions in the health system

Question 43

secondary prevention

Answer 43

identifies disease at pre-clinical state

Question 44

primary prevention

Answer 44

reduces number of new cases by eliminating risk factors or through immunization

Question 45

systemic vascular resistance (SVR)

Answer 45

SVR = deltaP/CO deltaP = mean arterial pressure - right atrial pressure

Question 46

what can cause syndrome of inappropriate antidiuretic hormone secretion? SIADH can cause hyponatremia, osmolarity, which can result in a seizure

Answer 46

- CNS disorders - chronic pulmonary disease - drugs - ectopic ADH secretion by small cell carcinoma of lung

Question 47

ulceroglandular tularemia

Answer 47

caused by francisella tularensis - gram-neg coccobacillus - begins with rupturing pustule followed by ulcer and regional lymph nodes

Question 48

what type of sperm are in seminiferous tubules

Answer 48

spermatogonia

Question 49

what can result in septic arthritis

Answer 49

neisseria gonorrhoeae

Question 50

what connects osteocytes to each other?

Answer 50

gap junctions

Question 51

fenoldopam

Answer 51

short-acting, selective, peripheral dopamine-1 receptor agonist that causes renal vasodilation, arteriolar dilation, and increased natriuresis

Question 52

most common cause of fatal sporadic encephalitis or inflammation of brain parenchyma

Answer 52

HSV-1 - presents with fever, headache, seizures, aphasia, mental status/behavior changes - temporal lobe hemorrhage/edema on brain imaging - cerebrospinal fluid PCR for HSV - treat with acyclovir

Question 53

familial erythrocytosis

Answer 53

B-globin mutation resulting in reduced binding of 2,3-BPG and increased hb oxygen affinity -most of their blood is fetal hemoglobin

Question 54

what level of the spinal cord is the lateral horn (intermediolateral cell column) located

Answer 54

T1-L2 -sympathetic preganglionic neurons

Question 55

how to treat urge incontinence/overactive bladder syndrome/detrusor instability

Answer 55

anticholinergic medications

Question 56

what hole in the skull does the mandibular nerve (V3) come out of?

Answer 56

foramen ovale

Question 57

pineal gland mass

Answer 57

causes - obstructive hydrocephalus (nonbloody/nonbilious emesis) - dorsal midbrain (Parinaud) syndrome (blurry vision)

Question 58

hypoxemia + reasons for elevated alveolar to arterial gradient

Answer 58

1. right to left shunt 2. ventilation/perfusion mismatch 3. impaired diffusion

Question 59

hypoxemia + reasons for normal alveolar to arterial gradient

Answer 59

1. hypoventilation | 2. low inspired fraction of oxygen

Question 60

zika virus

Answer 60

- single-stranded RNA flavivirus - microencephaly, craniofacial disproportion - neurological abnormalities (ex: spasticity, seizures) - ocular abnormalities - infects and destroys fetal neural progenitor cells causing fetal death - dx via calcifications, ventriculomegaly, cortical thinning

Question 61

DiGeorge syndrome and what defects are common

Answer 61

maldevelopment of 3rd and 4th pharyngeal pouch derivatives -immunodeficiency can result from thymic aplasia which causes deficiency of T cells (mainly found in the paracortex) -thymic aplasia, hypocalcemia, tetralogy of fallot, truncus, arteriosus, transposition of great arteries ``` CATCH Conotruncal cardiac defects Abnormal facies Thymic aplasia/hypoplasia Cleft palate Hypocalcemia ```

Question 62

clostridium perfringens

Answer 62

- gas gangrene due to penetrating injury - can also cause transient watery diarrhea and abdominal discomfort - can also cause late onset food poisoning

Question 63

anticholinergic toxicity

Answer 63

1. hot as a hare 2. dry as a bone 3. red as a beet 4. blind as a bat 5. mad as a hatter 6. full as a flask 7. fast as a fiddle

Question 64

tertiary amines

Answer 64

physostigmine (helps with anticholinergic toxicity)

Question 65

increased % of O2 saturation causes unloading of what from blood?

Answer 65

protons

Question 66

mechanism of action of fenofibrate

Answer 66

reducing hepatic VLDL production by inhibiting 7-alpha-hydroxylase

Question 67

neutrophil elastase released by PMNs and Macrophages ... what does it do?

Answer 67

responsible for extracellular elastin degradation - major serum inhibitor of alpha-1 antitrypsin - causes panacinar emphysema

Question 68

cardiac output equation

Answer 68

``` CO = SV x HR CO = rate of O2 consumption / arteriovenous O2 content difference ```

Question 69

clues to lead to arteriosclerosis

Answer 69

- isolated systolic hypertension | - decreased arterial compliance

Question 70

if giving a drug for a drug company and they offer to pay you for time explaining the drug you should...

Answer 70

give the drug if you think its the right fit BUT DO NOT ACCEPT THE MONEY AT ALL

Question 71

positive vs negative predictive value

Answer 71

amount of true positives vs negatives

Question 72

mechanism of action of macrolides

Answer 72

binding to P site of 50S ribosomal subunit and also decreases the elimination of warfarin via CYP450 ex: clarithromycin and erythromycin

Question 73

if the patient is on hemodialysis what type if amyloid deposits are most likley

Answer 73

Beta-2 microglobulin is too large and does not pass through all of the dialysis membranes

Question 74

how to test for pneumocystis jirovecci and who usually gets this and first line treatment

Answer 74

direct fluorescent antibody test or stained with methenamine silver stain AIDS pts usually get P.jirovecci first line treatment: TMP-SMX

Question 75

how to calculate total lung capacity

Answer 75

FRC + IC

Question 76

what is associated with pernicious anemia (antibodies to intrinsic factor/destruction of parietal cells)

Answer 76

atrophic gastritis - hypochlorhydria --> compensatory increase in gastrin - loss of parietal cells --> loss of IF and low B12

Question 77

Test used to compare two mean values

Answer 77

Two sample t test

Question 78

What does RNA polymerase I do?

Answer 78

Form essential ribosomal components ---> works exclusively in the nucleolus

Question 79

What does the posterior descending artery come off of on the heart?

Answer 79

Right coronary sinus

Question 80

What does hypocretin do?

Answer 80

Aka orexin. Produced in the lateral hypothalamus and promotes wakefulness and inhibits REM -too little in CSF causes cataplexy and narcolepsy (treat narcolepsy with modafinil--- nonamphetamine stimulant to promote wakefulness)

Question 81

Fracture of pterion part of skull does what?

Answer 81

Can cause laceration of middle meningeal artery (branch of maxillary) which can cause epidural hematoma

Question 82

pagets disease

Answer 82

deformity of long bones + hearing loss (increased hat size and messed up hearing) - look for receptor factor NFk-B ligand - osteocytes in pagets are typically large and can have over 100 nuclei (normal have 2-5) - serum ca, phosphorous, and PTH are noraml and alkphos is increased

Question 83

pregnant woman with HPV genital warts... what can be affected in the baby?

Answer 83

true vocal cords cause of its stratified squamous epithelium

Question 84

budding spherical yeast with thick polysaccharide capsules

Answer 84

cryptococcus neoformans and causes meningoencephalitis (mainly in AIDS pts) - you get it from bird droppings then gets inhaled into the alveoli of lungs - seen via india ink staining - also stains red with mucicarmine

Question 85

apical holosystolic murmur going to axilla

Answer 85

suggests mitral regurgitation

Question 86

Henosch-Sholein purpura (palpable purpura on thighs and butt which can lead to blood in urine and stool)

Answer 86

due to IgA-immune complexes circulating around | -usually in children and can also cause joint pain

Question 87

pulmonary arterial hypertension

Answer 87

hereditary AD | -can also cause smooth muscle proliferation

Question 88

losartan mechanism of action

Answer 88

angiotensin II receptor blocker

Question 89

internuclear ophthalmoplegia

Answer 89

conjugate horizontal gaze where ipsilateral lesion/eye is unable to adduct and contralateral eye abducts with nystagmus -this can be seen in pts with multiple sclerosis (CD4+T lymphocytes activated by myelin basic protein)

Question 90

pneumonia that requires cholesterol to grow cause of cell membrane

Answer 90

mycoplasma pneumoniae

Question 91

Fas pathway

Answer 91

activation-induced t lymphocyte death/apoptosis

Question 92

cystic fibrosis

Answer 92

CFTR gene mutation. impared post-translational processing (deltaF508)--> causes improper folding and glycosylation of CFTR if a young child is always getting respiratory infections (pseudomonas/staph) and has pancreatic insufficiency then think CF!

Question 93

enterococcus

Answer 93

component of normal colon flora - grows in saline and bile and PYR positive - cathetar or anything in gu tract can cause enterococcus endocarditis

Question 94

what is needed for PCR amplification?

Answer 94

nucleotide sequence of regions flanking target exon

Question 95

scabies

Answer 95

mite and eggs - rapidly spreading rash - spread via person to person contact

Question 96

midazolam

Answer 96

benzodiazepine (works by binding GABA-A receptors causing an increase in the frequency of chloride channels opening in the presence of GABA) -note that barbiturates increase duration of chloride channels opening

Question 97

odds ratio

Answer 97

-measure of strength of association b/w exposure and outcome OR = ad/bc -dont use total amount but how many did/didnt respond to the drug or whatever it is

Question 98

how can rheumatoid arthritis cause flaccid paralysis

Answer 98

involving cervical spine and vertebral malalignment subluxation -endotracheal intubation can worsen this

Question 99

inheritance of androgenetic alopecia

Answer 99

polygenic inheritance

Question 100

trochlear nerve (CN 4) palsy

Answer 100

vertical diplopia (double vision)-- trouble walking down stairs -innervates superior oblique muscle

Question 101

how to measure potency of inhaled anesthetic

Answer 101

minimal alveolar concentration

Question 102

diabetic ketoacidosis

Answer 102

polydipsia, polyuria, and fruity odor to breath/urine (metabolic acidosis) hyperglycemia, low bicarb, high anion gap, decreased serum sodium

Question 103

strongyloides stercoralis infection youll see what

Answer 103

rhabditiform larvae in stool | eggs and adult parasites only seen in intestinal biopsies

Question 104

continuous infusion of drug eliminated by first order kinetics... when do you hit steady state? and... what is the formula for half-life

Answer 104

4-5 half-lives Vd x 0.7 / CL

Question 105

bupropion

Answer 105

antidepressant similar to amphetamines -work by inhibiting reuptake of norepi and dopamine (no weight gain or sexual dysfunction) -side effects: stimulant effects (tachy and insomnia), headache, seizures in bulimic pts

Question 106

amphotericin B

Answer 106

treatment for systemic mycoses -preferentially binds ergosterol of fungal cell membranes and also binds slightly to cholesterol causing all the bad side effects -known for renal toxicity

Question 107

damage to waht can cause contralateral hemiballism (LARGE flinging movements of proximal limbs on one side of body)

Answer 107

subthalamic nucleus (part of basal ganglia) -if they are small flinging movements then it would be more like huntingtons which is from caudate atrophy

Question 108

lithium induced diabetes insipidus

Answer 108

lithum antagonizes action of vasopressin on principal cells in collecting duct

Question 109

what is associated with cutaneous small vessel vasculitis

Answer 109

medication (penicillin and cephalosporins) usually you see leukoclastic vasculitis

Question 110

janeway lesions

Answer 110

seen in infective endocarditis with mitral regurg as well

Question 111

major antibody associated with mucosal immunity

Answer 111

secretory IgA (from the duodenum)

Question 112

gout

Answer 112

disease caused by tissue deposition of monosodium urate crystals. a risk factor is increased purine metabolism and PRPP (phosphoribosyl pyrophosphate synthetase) is response for this -neutrophils cause the intense inflammation and pain TREATMENT first line: NSAIDs second line: Colchicine

Question 113

nutcracker effect

Answer 113

increased pressure of left renal vein cause of compression where vein crosses aorta under SMA... can cause elevated left gonadal vein leading to varicocele formation

Question 114

how old do pts realize death is final

Answer 114

age 7

Question 115

vitamin A deficiency can cause

Answer 115

night blindness, thickened and dry skin | -can occur due to prolonged biliary obstruction (diffuse itchiness)

Question 116

guyon canal syndrome (ulnar trap)

Answer 116

pins and needles, mild weakness, flattened hypothenar eminence

Question 117

hydrocephalus

Answer 117

intracranial calcifications and chorioretinitis -usually due to congenital toxoplasmosis in utero

Question 118

serotonin syndrome

Answer 118

altered mental status, autonomic hyperactivity, neuromuscular excitation -antidote: cyproheptadine (antihistamine)

Question 119

anaplastic tumors

Answer 119

1. loss of cell polarity 2. nuclear pleomorphism 3. large nuclie/hyperchromatic 4. mitotic figures 5. giant, multinucleated tumor cells *dont look like tissue of origin

Question 120

neuroleptic malignant syndrome

Answer 120

adverse reaction to antipsychotic meds with lead pipe rigidity, hyperthermia, sympathetic hyperactivity, mental status changes treatment: dantrolene (ryanodine receptor blocker that inhibits calcium release from SR) or bromocriptine if refractory

Question 121

aflatoxin-induced p53 mutations to G --> T due to moldy food is due to what

Answer 121

aspergillus (increased risk of liver cancer)

Question 122

scurvy

Answer 122

- all the symptoms are due to decreased connective tissue strength - perifollicular hemorrhages - myalgias - subperiosteal hematoma - gingivitis - due to deficiency of ascorbic acid (vitamin c) - abnormal proline and lysine hydroxylation

Question 123

reasons for holosystolic murmur

Answer 123

tricuspid regurg, mitral regurg, ventricular septal defects

Question 124

pt with fever, headache, delirium, petechial rash, and meningismus has what?

Answer 124

meningococcal meningitis

Question 125

disseminated gonorrheal infection triad

Answer 125

arthritis dermatitis tenosynovitis -all in sexually active woman due to neisseria gonorrheae

Question 126

how to treat androgenetic alopecia

Answer 126

- 5a reductase inhibitors (finasteride) | - this is NOT autoimmune but polygenic inherited loss of hair

Question 127

olanzapine and clozapine

Answer 127

2nd gen antipsychotic -metabolic adverse effects -clozapine (indicated in treatment resistant schizophrenia and when its associated with suicidal ideations) causes fatal neutropenia and agranulocytosis

Question 128

tricyclic antidepressants

Answer 128

give to pts with treatment resistant depression - work by inhibiting reuptake of norepi and serotonin as well as inhibiting fast sodium channel conduction (slowing myocardial depolarization leading to arrhythmias) - strong anticholinergic properties - side effects include urinary retention, confusion - if you overdose the cause of death is due to inhibitory properties of Na channels

Question 129

prostacyclin

Answer 129

= prostaglanin I2 -inhibits platelet aggregation and causes vasodilation locally

Question 130

most common adverse effect of fibrinolytic therapy

Answer 130

hemorrhage

Question 131

nissl substance

Answer 131

corresponds to rough ER

Question 132

pathogenesis cells in COPD

Answer 132

- neutrophils - macrophages - CD8+Tcells

Question 133

deficiency of B1 (thiamine) causes what clinical problems

Answer 133

beriberi (peripheral neuropathy and heart failure) wernicke korsacoffs --> occulomotor, ataxia, encephalopathy chronic can lead to korsakoffs syndrome --> memory impairment, confabulation, and apathy -MOST SUSCEPTIBLE AREA = MAMMILLARY BODIES

Question 134

most frequent CNS tumor in immunosuppressed pts and associated with EBV

Answer 134

primary CNS lymphoma

Question 135

what to give for PTSD

Answer 135

SSRI, SNRI, prazosin for nightmares along with CBT

Question 136

raloxifene and tamoxifin

Answer 136

selective estrogen receptor modulators - inhibit the effects of estrogen on breast tissue and can reduce risk of gynecomastia in pts - adverse effects: hot flashes and venous thromboembolism -adverse effects of tamoxifen only: endometrial hyperplasia and carcinoma

Question 137

drugs that can cause aplastic anemia

Answer 137

carbamazine, chloramphenicol, sulfonamides, and radiation

Question 138

which enzyme in the CTA cycle uses FAD

Answer 138

succinate dehydrogenase

Question 139

ventromedial nucleus does what

Answer 139

center of satiety

Question 140

parts of HIV cell fusion

Answer 140

gp41 and gp120, cd4 receptor, and chemokine receptor

Question 141

rapid hyponatremia correction can lead to what

Answer 141

osmotic demyelination syndrome of axons in central pons (spastic quadrapalegia and psuedobulbar palsy)

Question 142

blastomyces dermatitidis

Answer 142

lung, skin, and bone involvement | -dimorphic fungus with thick walls

Question 143

what two muscles flank the median nerve

Answer 143

flexor digitorum superficialis and flexor digitorum profundus

Question 144

rat poison works in the body like...

Answer 144

kinda acts like a super warfarin

Question 145

how to treat heparin overdose

Answer 145

protamine sulfate

Question 146

lung apex tumors (superior sulcus)--> pancoast tumors cause what

Answer 146

invasion/compression of surrounding structures - hoarseness --> recurrent laryngeal nerve - horner syndrome (ipsilateral ptosis, miosis, anhidrosis) --> stellate ganglion - SVC syndrome --> superior vena cava - brachiocephalic syndrome (unilateral) --> brachiocephalic vein - sensorimotor deficits --> brachial plexus *Note the pt can present with rib destruction and atrophy of hand muscles as well

Question 147

clopidogrel

Answer 147

irreversibly blocks P2Y12 component of ADP receptors on platelet surface and prevents platelet aggregation. -as effective as aspirin for prevention of CV events and should be used in pts with aspirin allergy

Question 148

ankylosing spondylitis

Answer 148

chronic inflammatory disease of axial skeleton - progressive pain and stiffness of spine, sacroiliitis - can also cause reactive arthritis (cant see, cant pee, cant climb a tree) - HLA-B27 positive serology - look at degree of chest expansion (you will see limited chest expansion and spinal mobility) --> this can eventually lead to hypoventilation

Question 149

southern blots test for

Answer 149

DNA

Question 150

northern blots detect what?

Answer 150

target mRNA to assess gene expression

Question 151

x-linked sideroblastic anemia

Answer 151

due to gamma-aminolevulinate synthase mutation | -histology: ring sideroblasts

Question 152

HIV-1 vs HIV-2

Answer 152

1: worldwide, high viral load 2: west-africa, low viral load

Question 153

gancyclovir vs acyclovir

Answer 153

they are structurally similar but gancyclovir has a greater activity against CMV DNA polymerase -if the person has gancyclovir-resistant CMV you can use foscarnet (can cause hypocalcemia and hypomagnesmia)

Question 154

ocular disease in pts with untreated HIV

Answer 154

cytomegalovirus retinitis

Question 155

schizotypal personality disorder

Answer 155

- eccentric behavior - odd beliefs - perceptual distortions - social anxiety

Question 156

schizoid personality disorder

Answer 156

tends to struggle in realtionships and is socially detached

Question 157

genetic defect in NADPH oxidase

Answer 157

chronic granulomatous disease - impaired intracellular killing - more sensitive to catalase positive organisms

Question 158

paradoxical embolism

Answer 158

venous thrombosis crosses into arterial circulation via abnormal connection b/w right and left cardiac chambers (youll see a wide splitting of S2)

Question 159

mhc class I vs II structure

Answer 159

I: heavy chain and Beta2 microglobulin II: alpha and beta polypeptide chains

Question 160

Trazadone

Answer 160

sedating antidepressant that can cause priaprism (long standing erection)

Question 161

zolpidem

Answer 161

nonbenzo hypnotic used in insomnia treatment

Question 162

imipramine and clomipramine

Answer 162

tricyclic antidepressants used as second line therapy cause of cardiotoxicity

Question 163

what does a positive babinski sign show

Answer 163

upper motor neuron sign - abnormal plantar flexion - spastic paralysis - increased muscle tone - clasp knife rigidity - hyperreflexia - pronator drift - pyramidal weakness

Question 164

lower motor neuron signs

Answer 164

- flaccid paralysis - weakness - hypotonia - muscle atrophy - fasciculations - suppressed/absent reflexes

Question 165

colchicine mechanism of action

Answer 165

- treatment of acute gouty arthritis in pts who cant take NSAIDs - inhibits leukocyte migration and phagocytosis by blocking tubulin polymerization

Question 166

coronary dominance

Answer 166

depends on which gives blood to the PDA right coronary artery --> right dominant (70%) left circumflex artery --> left dominant (10%) 20% are both

Question 167

difference between free ribosomes and ribosomes attached to ER

Answer 167

- free ribosomes: in cytosol and translate proteins found in cytosol - attached ribosomes: bind to RER after protein translation begins. synthesize secretory proteins, integral membrane proteins of nucleus and cell membrane and parts of organelles

Question 168

edrophonium

Answer 168

- short acting acetylcholinesterase inhibitor - used to treat myasthenia gravis - reduces heart rate, cardiac conduction, and cardiac contractility

Question 169

esmolol

Answer 169

cardioselective beta1 blocker (short acting) - decreases heart rate, myocardial contractility, and cardiac contraction without affecting renal blood flow - beta blockers prolong PQ interval cause they decrease AV conduction

Question 170

phenylephrine

Answer 170

selective a1-adrenergic receptor agonist that causes a generalized increase in peripheral vascular resistance and blood pressure -significant renal, splanchnic, and mesenteric vasoconstriction

Question 171

statin mechanism of action

Answer 171

inhibit HMG CoA reductase (rate limiting step in hepatic cholesterol synthesis) -before you give a statin make sure to check their liver transaminase levels because statins are hepatotoxic and show muscle toxicity as well

Question 172

cholestyramine mechanism of action

Answer 172

increases hepatic cholesterol and bile acid synthesis cause it binds to bile acid and prevents it from being taken back up in the terminal ileum -they also increase hepatic production of triglycerides and can cause hypertriglyceridemia

Question 173

myeloperoxidase

Answer 173

key component of respiratory burst of neutrophils and is released into phagocytic vacuole and extracellular space as part of immune response to bacteria/pathogens

Question 174

methylmalonic acidemia

Answer 174

- AR organic acidemia - methylmalonyl-CoA mutase deficient - lethargy, vomiting, and tachypnea in newborn - hyperammonemia, ketotic hypoglycemia, and metabolic acidosis - elevated urine methylmalonic acid and propionic acid

Question 175

what to suspect when you have a pregnant woman with alpha-fetoprotein and/or acetylcholinesterase in the amniotic fluid

Answer 175

neural tube defects due to neural folds not fusing in pregion of anterior or posterior neuropores

Question 176

what is the main factor driving lung abceses

Answer 176

neutrophils releasing lysosomal content | -a sign someone has these is copious sputum (foul-smelling) as well as x-ray of cavitation with air-fluid level

Question 177

anterior pons infarct

Answer 177

contralateral hemiparesis, babinski sign, contra lower facial palsy, dysarthria -trigeminal nerve involvement if they have sparing of forehead muscles

Question 178

how does having hep b give you a chance of getting hep d

Answer 178

the b surface antigen virus coats hep d antigen of hep d virus before it can infect hepatocytes and multiply

Question 179

TTN gene mutation

Answer 179

- AD with incomplete penetrance, likely a familial inheritance - encodes sarcomere protein titin and when mutated causes dilated cardiomyopathy

Question 180

mu opioids cause what

Answer 180

contraction of smooth muscles in sphincter of oddi (leading to spasm and increase in common bile duct pressures)

Question 181

pt has cyanotic spells that improve with squatting and a systolic murmur

Answer 181

tetralogy of fallot -abnormal neural crest migration leading to anterior and cephalad deviation of infundibular septum (malaligned VSD and overriding aorta)

Question 182

4 characteristics of tetralogy of fallot and what is the most important factor in degree of intracardiac shunting and cyanosis

Answer 182

PROVe 1. Pulmonary infundibular stenosis (most important determinant for prognosis) --> right ventricular outflow tract obstruction 2. Right ventricular hypertrophy (RVH) --> boot shaped heart on chest X-ray 3. Overriding aorta 4. VSD

Question 183

failed fusion of superior and inferior endocardial cushions

Answer 183

- defects of av septum and values (tri and bi) | - initially left to right shunting then becomes r to left and causes delayed cyanosis

Question 184

porphyria cutanea tarda

Answer 184

enzyme deficiency in late porphyrin synthesis steps (Uroporphyrinogen decarboxylase)

Question 185

in post strep glomerulonephritis what immunofluorescence stains will be seen

Answer 185

- granular deposits of IgG, IgM, and C3 | - discrete subepithelial humps on electron microscopy

Question 186

first line treatment for trigeminal neuralgia

Answer 186

carbamazepine: neuroleptic medication that inhibits neuronal high frequency firing by reducing the ability of soium channels to recover from inactivation - can cause bone marrow suppression

Question 187

clasp-knife spasticity

Answer 187

- initial resistance then sudden release | - internal capsule stroke can cause this due to the upper motor neuron lesion

Question 188

maraviroc

Answer 188

targets CCR5 to stop HIV from infecting macrophages

Question 189

Enfuviritide

Answer 189

HIV fusion inhibitor (blocks gp41)

Question 190

eplerenone

Answer 190

aldosterone antagonist -can be used in Conn syndrome

Question 191

what do you think of when someone has cataracts and no other symptoms or when a diabetic has cataracts

Answer 191

galactokinase deficiency if its a diabetic you can assume that they have cataracts due to aldose reductase converting glucose to sorbitol faster than sorbitol can be metabolized

Question 192

pathologic features of hiv-associated dementia

Answer 192

microglial nodules and multinucleated giant cells

Question 193

patient with symmetric bilateral lower extremity pitting edema and tortuous abdominal veins....

Answer 193

interior vena cava obstruction

Question 194

what heart defect is associated with turner syndrome

Answer 194

bicuspid aortic valve and aortic coarctation -you will also see a shield chest, decreased femoral pulse, shortened 4th metacarpals, high-arched palate, streak ovaries/amenorrhea/infertility, cystic hygroma (fluid filled sac due to lymphatic blockage), and horseshoe kidney

Question 195

first line treatment for essential tremor

Answer 195

propranolol -pts say symptoms improve with alcohol consumption

Question 196

epidural hematoma

Answer 196

- pt with fracture of. temporal bone and rupture/tear of middle meningeal artery - pt loses consciousness, wakes up, then loses consciousness again

Question 197

Jervell and Lange-Nielsen syndrome

Answer 197

- AR - bilateral sensorineural hearing loss and congenital long QT syndrome - mutation in voltage gated K channels - mutation in KCNQ1 and KCNE1 genes

Question 198

Huntingtons disease findings

Answer 198

chorea, dementia, behavioral changes - loss of neurons in caudate and putamen - NMDA associated toxicity - AD- CAD trinucleotide repeats

Question 199

atropine

Answer 199

- treats bradycardia - decreases vagal influence on SA and AV node - side effect: increased intraocular pressure can cause acute closed-angle glaucoma

Question 200

peau d'orange

Answer 200

erythematous, itchy breast rash with skin texture changes analogous to an orange peel -usually due to inflammatory breast cancer and is caused by cancerous cells obstructing lymphatic drainage due to spread to dermal lymphatic spaces

Question 201

horse/sheep erythrocytes in monospot test

Answer 201

this is done and positive in pts with EBV -if its mono and not from EBV it could be due to CMV

Question 202

how is nitric oxide synthesized and what does it do

Answer 202

arginine + O2 along with stress/Ca increase which then makes NO + Citrulline -causing vasodilation

Question 203

kartagener syndrome

Answer 203

-form of primary ciliary dyskinesia (AR) 1. situs inversus 2. chronic sinusitis 3. bronchiectasis *infertility can also occur due to sperm tails or cilia in fallopian tubes

Question 204

where is the most common location for an anal fissure?

Answer 204

posterior midline --> likely due to decreased blood flow

Question 205

what type of cells are in the adrenal medulla

Answer 205

chromaffin cells --> modified neuroendocrine cells derived from neural cresta nd are stimulated by acetylcholine to secrete catecholamines

Question 206

propionyl-CoA is made from what... and if you have excess how does it present

Answer 206

odd chain fatty acids, branched-chain amino acids, methionine, and threonine -presents as propionic acidemia --> lethargy, poor feeding, vomiting, hypotonia 1-2 weeks after birth

Question 207

anticholinergic toxicity

Answer 207

- hot as a hare - dry as a bone - red as a beet - blind as a bat - mad as a hatter - full as a flask - fast as a fiddle -GIVE THE PT PHYSOSTIGMINE (cholinesterase inhibitor)

Question 208

anticholinergiic drugs

Answer 208

atropine and scopolamine

Question 209

ACE inhibitor side effects

Answer 209

cough hyperkalemia decreased GFR initially cause of actions on efferent tubules of glomerulus -angioedema is rare but can occur (increase in bradykinin increases vascular permeability) --> any pt on these with swelling or difficulty breathing should have the drug discontinued

Question 210

lead time bias

Answer 210

apparent increase in survival time when there actually isnt one. -detecting it earlier makes people think that pts lived longer when in reality you just found out they had is sooner

Question 211

where are most things reabsorbed (including water) in the nephron

Answer 211

proximal tubule

Question 212

how is isoniazid metabolized

Answer 212

via acetylation and there are fast and slow acetylators so it depends what grup people are in to see how quickly the drug will work -its also directly hepatotoxic

Question 213

what bacterial pathogens are most likely to occur after influenza virus

Answer 213

-the following pathogens are more likely due to the loss of cilia from influenza - strep pneumo - staph aureus - haemophilus influenzae

Question 214

cilostazol

Answer 214

pde inhibitor that inhibits platelet aggregation

Question 215

nitrate moa and adverse effects

Answer 215

get converted to NO, activate guanylate cyclase and increase intracellular cGMP leads to myosin light chain dephosphorylation leading to vascular smooth muscle relaxation headaches, flushing, light headedness, hypotension -due to veinodilation (systemic dilation)

Question 216

what characterizes Alzheimer disease

Answer 216

decfreased acetylcholine in nucleus basalis of meynert and hippocampus caused by diminished activity of choline acetyltransferase

Question 217

COPD exacerbations usually occurs due to which infections

Answer 217

viral: rhinovirus, influenza, parainfluenza bacterial infection: haemophilus influenzae, moraxella catarrhalis, streptococcus pneumoniae

Question 218

what does cyanide poisoning look like and how do you fix it

Answer 218

- reddish skin discoloration , lactic acidosis, narrowing of venous-arterial PO2 gradient - give nitrates (amyl nitrite) so iron is converted to ferric iron in the blood so it binds the cyanide and stops it from blocking cytochrome c oxidase

Question 219

zidovudine (drug)

Answer 219

nucleoside reverse transcriptase inhibitor -blocks phosphodiester bond so reverse transcriptase cant be made

Question 220

what predisposes someone to infective endocarditis to a native valve

Answer 220

mitral valve prolapse with regurg -rheumatic heart disease is common only in developing nations

Question 221

if a patient has malaria from africa it is likely to be chloroquine resistant... which drugs should you give?

Answer 221

atovaquone-proguanil or artemisinins

Question 222

pts with malaria p vivax or p ovale have...

Answer 222

dormant liver forms (hypnozoites) that require the addition of primaquine therapy

Question 223

funtion of detrusor muscle

Answer 223

to squeeze the bladder so you can completely empty during urination

Question 224

struvite kidney stones

Answer 224

usually seen in pt with upper urinary infection by urease-producing organisms (proteus, klebsiella). hydrolysis of urea yields ammonia which alkalinizes urine and facilitates precipitation of magnesium ammonium phosphate. urinalysis shows hematuria and elevated urine ph

Question 225

why cant sheep blood agar support haemophilus growth

Answer 225

insufficient nutrients. it needs X factor (hematin) and V factor (NAD+) -it can get V factor (NAD+) when grown alongside S aureus cause its Beta-hemolytic --> called satellite phenomenon

Question 226

follicular lymphoma cytogenetic analysis

Answer 226

BCL-2 overexpression and t(14;18)

Question 227

does carbon monoxide poisoning affect PaO2

Answer 227

no, it only increases carboxyhemoglobin (which represents levels of CO-bound hemoglobin) -it decreases the O2 carrying capacity of of blood cause CO binds stronger than O2

Question 228

constant vomiting leads to what acid-base disturbance

Answer 228

metabolic alkalosis due to net loss of acid gastric secretions

Question 229

what enzymes breaks down triglycerides

Answer 229

hormone sensitive lipase -- found in adipose tissue, allowing for glycerol to be used in glucose production and fatty acids to be used in ketone body formation during times of starvation lipoprotein lipase -- on endothelial cells that function to degrade triglycerides found in chylomicrons and VLDL, works in bloodstream to form FFAs that are then transported into adipocytes storage or used by tissues for energy production

Question 230

hemolytic uremic syndrome

Answer 230

acute renal failure in children - microangiopathic hemolytic anemia - microthrombi in small vessels - thrombocytopenia - acute kidney injury

Question 231

if portal hypertension leads to esophageal varicies... where is the portal blood shunted to?

Answer 231

left gastric vein

Question 232

most important mediator in sepsis

Answer 232

TNF-alpha (acute phase cytokine produced by activated macrophages) -also IL-1 and IL-6

Question 233

what causes intestinal atresia of the midgut in newborns? "apple peel atresia" occurs when superior mesenteric artery is obstructed

Answer 233

vascular occlusion in utero and the first sign of this is bilious emesis

Question 234

neurophysins

Answer 234

carrier proteins for oxytocin and vasopressin (produced in paraventricular and supraoptic nuclei) are released from posterior pituitary

Question 235

DIC pathogenesis in pregnant women

Answer 235

placental damage --> release of tissue factor from placenta into maternal circulation --> activation of intravascular coagulation --> circulating microthrombi --> platelet/factor consumption --> bleeding

Question 236

preferred antihypertensives in pts with diabetic nephropathy

Answer 236

ACE inhibitors and angiotensin II receptor blockers... due to antiproteinuric effects

Question 237

patients with sickle cell disease and chronic splenic infarctions lead to BLANK and require BLANK

Answer 237

fibrosis and atrophy of spleen they require increased folic acid due to erythrocyte turnover --HbS allows for hydrophobic interactions among hemoglobin molecules

Question 238

orotic aciduria

Answer 238

rare autosomal recessive disorder of de novo pyrimidine synthesis that occurs due to defect in UMP synthase - physical and mental retardation - megaloblastic anemia - large amounts of urinary orotic acid give uridine supplementation

Question 239

where is the apex of the lung located on the anterior side of the body

Answer 239

above the clavicle and the first rib through superior aperature in the neck

Question 240

broad spectrum anticonvulsants for generalized seizures

Answer 240

lamotrigine, levetiracetam, topiramate, valproic acid

Question 241

grayish white vaginal discharge with fishy odor

Answer 241

``` overgrowth of gardnerella vaginalis (anaerobic gram variable rod) clue cells (squamous epithelial cells covered with bacterial organisms) are seen on wet mount microscopy or cytology treat with metronidazole or clindamycin ```

Question 242

septic shock

Answer 242

facial flushing and altered consciousness + positive for bacteria due to LPS toxin--> Lipid A

Question 243

Terbinafine uses and mechanism of action

Answer 243

dermatophytosis (by tinea corporis) and suppresses enzyme squaline epoxidase to block synthesis of fungal membrane ergosterol

Question 244

renal ammoniagenesis

Answer 244

renal epithelial cells metabolize glutamine (generating ammonia and bicarb) which buffers acids in the blood

Question 245

what is strep gallolyticus associated with (aka s bovis)

Answer 245

colonic cancer

Question 246

sphingomyelinase deficiency (Niemen-Picks disease)

Answer 246

accumulation of lipid sphingomyelin, hepatosplenomegaly, neurologic regression, cherry red macular spot in infancy

Question 247

how does glucagon work

Answer 247

via adenylyl cyclase and protein kinase A

Question 248

where does the lymph of the testis drain to vs the scrotum lymph

Answer 248

testis --> para-aortic | scrotum --> superficial inguinal lymph nodes

Question 249

what is HAART therapy associated with

Answer 249

fat redistribution (increases abdominal girth)

Question 250

what do pelvic floor strength exercises do

Answer 250

target levator ani to improve support around urethra and bladder

Question 251

how do you tell if a pt is taking exogenous thyroid hormone or if they have graves

Answer 251

graves will have an elevated thyroglobulin and exogenous use will have undetectable thyroglobulin

Question 252

what deficiency causes maternal virilization

Answer 252

aromatase, also causes ambiguous genetalia in baby

Question 253

cancers of the pelvis (including prostate) spread to where via the vertebral venous plexus/prostatic venous plexus

Answer 253

lumbosacral spine

Question 254

where is the breast tumor if you have dimpling of the skin

Answer 254

suspensory ligament

Question 255

testicular torsion is when BLANK wraps around the BLANK leading to ischemia

Answer 255

twisting of testis around spermatic cord (containing gonadal artery), leading to ischemia .... note that the gonadal artery arises from the abdominal aorta

Question 256

what to give for C.diff treatment

Answer 256

oral vancomycin or metronidazole | fidoximicin --> macrolide against RNA polymerase

Question 257

what do studies show in a pt with lactose intolerance?

Answer 257

increased breath hydrogen test reduced stool ph elevated stool osmolaltiy

Question 258

what do you see on xray for necrotizing enterocolitis

Answer 258

thin curvilinear areas of lucency that parallel the bowel wall lumen

Question 259

where does heme synthesis occur and what are the precursors ?

Answer 259

partly in the mitoC and partly in erythrocytes made from glycine and succinyl-CoA

Question 260

recombination

Answer 260

gene exchange occurs through the crossing over of 2-double stranded DNA molecules mixing of genome segments in segmented viruses that infect the same host cell

Question 261

what drugs are guanosine analogs

Answer 261

acyclovir, famciclovir, and valacyclovir... also gancyclovir

Question 262

what do thiazide diuretics do to ion levels in the body?

Answer 262

raises calcium, uric acid, glucose, cholesterol, and triglycerides lower sodium, potassium, and magnesium

Question 263

minimal change disease

Answer 263

- mostly in children - proteinuria - hypoalbuminemia - edema (reversible with corticosteroids) - may be triggered by recent URI - foot process effacement

Question 264

what can increased nsaid use do to the kidneys?

Answer 264

chronic interstitial nephritis and papillary necrosis

Question 265

what is a sign for meckel diverticulum

Answer 265

-includes mucosa, submucosa, and muscularis layers spontaneous and painless lower gi bleeding 99m-TC-pertechnetate localizes ectopic gastric mucosa and increased uptake in the lower right quadrant * most common vitelline duct anomaly: results from partial closure of vitelline duct with patent portion attached to ileum (a fibrous band my connect tip of diverticulum to the umbilicus) - failure of obliteration of vitelline duct (omaphalomesenteric duct) --> painless GI bleeding

Question 266

pts with severe mitral regurgitation

Answer 266

holosystolic murmur at apex with radiation to the axilla audible S3 gallop -pts with severe mitral regurg develop left-sided volume overload with an S3 gallop due to the large volume of regurgitant flow reentering the ventricle during mid-diastole. The absence of an S3 gallop excludes severe chronic MR

Question 267

first line treatment for pts with ADHD

Answer 267

stimulant medications: increase availability of norepinephrine and dopamine in the prefrontal cortex

Question 268

what heart defect is common in pts with down syndrome and what are possible causes of down syndrome Also list the As of down syndrome

Answer 268

complete atrioventricular defect causes: trisomy 21 or 46 XX (14;21) robertsonian translocation or mosaicism (nondisjunction during mitosis) 5As 1. Advanced maternal age 2. Atresia (duodenal) 3. AV septal defect 4. Alzheimers 5. AML/ALL

Question 269

number needed to treat equation

Answer 269

number needed to treat = 1 / absolute risk reduction absolute risk reduction = control event rate - experimental event rate

Question 270

what virus is common in pts with lung transplants?

Answer 270

cytomegalovirus

Question 271

staph aureus

Answer 271

is on the normal skin flora and intravascular catheters are causing an increase in the incidence of their bloodstream infections

Question 272

Abacavir

Answer 272

HIV/AIDS medication that can cause an allergic reaction in pts with HLA-B*57:01 molecule causes delayed (type 4) hypersensitivity reaction

Question 273

what laboratory findings do you see in rheumatoid arthritis

Answer 273

anti-cyclic citrullinated peptide antibodies -rheumatoid factor is an antibody (typically IgM) specific for the Fc component of IgG soft tissue swelling and bony erosions C reactive protein and ESR correlate with disease activity -fibrinoid necrosis with palisading histiocytes/epithelioid cells

Question 274

severe retrosternal pain that radiates to the back

Answer 274

aortic dissection (intimal tearing)

Question 275

pleiotropy

Answer 275

multiple phenotypic manifestations from single genetic mutation (diff organs)

Question 276

what to think of in a child who has pemphigus vulgaris

Answer 276

staph scalded skin syndrome and causes exotoxin mediated skin damage (exfoliatin exotoxin)

Question 277

key clinical features of tay-sachs vs niemann-pick disease

Answer 277

Tay-Sachs Beta-hexoaminidase A deficiency resulting in GM2 ganglioside accumulation -progressive neurodegeneration, cherry red macular spot and no heptaosplenomegaly Niemann-Pick - sphingomyelinase deficiency - same as tay-sachs BUT WITH HEPATOSPLENOMEGALY

Question 278

metalloproteinases

Answer 278

zinc containing enzymes that degrade extracellular matrix | participate in normal tissue remodeling and in tumor invasion through basement membrane and connective tissue

Question 279

what noise is heard with aortic regurg

Answer 279

decrecendo with diastolic murmur with maximal intensity just after closure of aortic valve -more noticeable when pt leans forward on exam table -aortic regurg causes fall in diastolic aortic pressure and a rise in systolic aortic pressure

Question 280

gertsmann syndrome

Answer 280

- damage to angular gyrus of the dominant parietal lobe - agraphia - acalculia - finger agnosia - left/right disorientation

Question 281

haloperidol

Answer 281

high potency first generation antipsychotic risk of acute harm used for delerium to treat behavioral and psychotic manifestations

Question 282

chemoreceptor trigger zone

Answer 282

- chemotherapy goes here and triggers vomiting - on dorsal surface of MEDULLA at caudal end of fourth ventricle (area postrema) - to help with chemo induced n/v you can use serotonin antagonists and neurokinin 1 antagonists

Question 283

malignant hyperthermia

Answer 283

after administration of inhalation anesthetics or succinylcholine to genetically susceptible individuals -treated with dantrolene that blocks ryanodine receptors and prevents release of Ca into cytoplasm of skeletal muscle fibers

Question 284

what medications can you give for manic features

Answer 284

valproate and carbamazepine

Question 285

systemic mastocytosis

Answer 285

abnormal proliferation of mast cells and increased histamine which causes hypersecretion of gastric acid by parietal cells in stomach as well as a variety of other symptoms (hypotension, flushing, pruritus)

Question 286

what do these lead to believe as a dx - microcytic anemia - construction worker - constipation/abdominal pain - mental status changes

Answer 286

lead poisoning - inhibits heme synthesis pathway - leads to basophilic stippling first line treatment --> edetate calcium disodium (increases urinary excretion of lead) IN CHILDREN - lead poisoning will present with: - loss of milestones/cognitive impairment, behavioral problems, encephalopathy - constipation, abdominal pain, decreased vitamin D metabolism - interstitial nephritis - anemia

Question 287

how to treat beta blocker overdose

Answer 287

glucagon because it increases heart rate and contractility independent of adrenergic receptors glucagon activates G-protein coupled receptors on cardiac myocytes activating adenylate cyclase and raising intracellular cAMP ---> increase SA firing

Question 288

side effect of omeprazole

Answer 288

lower calcium absorption | prolonged use can increase risk of osteoporosis

Question 289

abnormally slow relaxation of muscles

Answer 289

AD increased number of trinucleotide repeats myotonia (myotonic dystrophy)

Question 290

what causes a transudate vs exudate pleural effusion

Answer 290

both are due to some type of heart/vascular failure EXUDATE --> inflammatory increase in vascular membrane permeability: infection (pneumonia), malignancy, rheumatologic disease TRANSUDATE --> pressure changes (hydrostatic or oncotic pressure): heart failure, cirrhosis, nephrotic syndrome

Question 291

adenoma to carcinoma sequence

Answer 291

firing order of events is AK-53 (normal ---> at risk ---> adenoma ---> carcinoma) normal colon --- (APC inactivation/B-catenin accumulation)--> hyperproliferative epithelium (methylation abnormalities and COX-2 overexpression) -- (KRAS activation)--> adenoma --(p53 inactivation)--> carcinoma

Question 292

lamotrigine

Answer 292

- treats partial and generalized seizures (anticonvulsant mood stabilizer) also used in depressed phase/maintenance of bipolar disorder - blocks voltage gated sodium channels - benign rash that can progress to SJS and toxic epidermal necrolysis are rare but life threatening adverse effects

Question 293

what lab tests are used to check the status of the biliary tract

Answer 293

alk phos and gamma-glutamyl transferase

Question 294

histology of adenocarcinoma of the lung

Answer 294

invasive glandular cells with abundant cytoplasm -most common lung cancer among non-smokers and women

Question 295

pure red cell aplasia is associated with what 3 pathologies?

Answer 295

1. thymoma 2. lymphocytic leukemia 3. parvovirus B19

Question 296

neurofibromatosis 1 (aka. vonRecklinghausen's disease)

Answer 296

- AD, NF1 tumor suppressor - PNS tumor syndrome - cafe-au-lait spots - pigmented iris nodules - cutaneous neurofibromas (made of schwann cells)

Question 297

what are schwann cells embryologically derived from

Answer 297

neural crest

Question 298

heteroplasmy

Answer 298

clinical variability of mitochondrial diseases (presence of both normal and mutated mtDNA, resulting in variable expression in mitochondrially inherited disease)

Question 299

neurologic deficits and megaloblastic anemia... what is deficient and what should you measure to check?

Answer 299

B12 (cobalmin) is deficient and you should measure methymalonic acid which will be increased

Question 300

abusive head trauma

Answer 300

subdural hemorrhage, posterior rib fractures, and retinal hemorrhages

Question 301

damage to brainstem at level of red nucleus or below results in what type of stuck posturing

Answer 301

extensor

Question 302

damage to brainstem above red nucleus results in what type of stuck positioning

Answer 302

flexed

Question 303

fever, stiff neck, altered mentation

Answer 303

bacterial meningitis

Question 304

how to treat essential tremors

Answer 304

beta blockers

Question 305

ethosuximide

Answer 305

treats absence seizures and blocks type T calcium channels

Question 306

onset of gas anesthetic depends on what

Answer 306

solubility in blood (blood/gas partition coefficient)

Question 307

name the first generation anti-histamines and their associated side effects

Answer 307

chlorpheniramine and diphenhydramine -meant to block histamine released from mast cells -also blocks alpha adrenergic, serotonergic, and cholinergic receptors (cholinergic blocking can cause blurriness when looking at things close up cause of the ciliary muscles impaired accomodation)

Question 308

how do volatile anesthetics alter cerebral blood flow

Answer 308

they increase it. this is undesireable side effect as it increases cerebral vascular pressure

Question 309

edrophonium

Answer 309

used in the tensilon test to see if a pt with myasthenia gravis is undertreated. if the pt gets better with edrophonium (a short acting ace inhibitor) then you need to increase the pts dosage of their med

Question 310

pentapeptide

Answer 310

is a beta-endorphin thats made from the POMC precursor... the same one that makes ACTH and melanin

Question 311

what nerves come off of the sciatic nerve?

Answer 311

branches into the common peroneal (wraps around medially to the anterior side and branches into the deep and superficial peroneal nerves) and the tibial nerve (stays posterior)

Question 312

what innervates each of the eye muscles

Answer 312

CN III (oculomotor): SMILI (superior, medial, inferior rectus, lateral palpebrae superioris, and inferior oblique) CNIV (trochlear): superior oblique CNVI (abducens): lateral rectus

Question 313

what nerve becomes problematic in pts with crutches

Answer 313

proximal radial nerve injury - weakness in extensor muscles of arm and no triceps reflex * radial nerve injury can also cause wrist drop (no wrist extension

Question 314

von Hipple Lindau disease

Answer 314

AD cerebellar hemangioblastoma and congenital cysts in kidney, liver, and pancreas

Question 315

NF2

Answer 315

AD nervous sytem tumor | -bilateral cranial nerve 8 schwannomas and multiple meningiomas

Question 316

sturge-weber syndrome

Answer 316

rare congenital neurocutaneous disorder - cutaneous facial angiomas - leptomeningeal angiomas - V1 and V2 distributions of trigeminal nerve - mental retardation, seizures, hemiplegia, skull radiopacities - tram-trak calcifications

Question 317

tuberous sclerosis

Answer 317

AD - cortical and subependymal hamartomas - cutaneous angiofibromas (adenoma sebaceum) - visceral cysts - renal and cardiac problems as well - seizures are major complication

Question 318

osler-weber-rendu syndrome

Answer 318

hereditary hemorrhagic telangiectasia -AD

Question 319

friedreich ataxia

Answer 319

- AD - progressive gait ataxia - hypertrophic cardiomyopathy - DM - kyphoscoliosis - pes cavus degeneration of.... lateral corticospinal tract (spastic paralysis) spinocerebellar tract (ataxia) dorsal columns (decrease in vibratory sense and proprioception) dorsal root ganglia (loss of DTRs)

Question 320

clostridium tetani with tetanus toxin

Answer 320

due to puncture wound usually - blocks gaba and glycine - locked jaw - only grows at inoculation site - clinical diagnosis (dont really test for it usually) - give diazepam and do wound debridement/antitoxin/vaccine booster/antibiotics

Question 321

uncal herniation

Answer 321

ipsilateral oculomotor nerve palsy with fixed dilated pupil

Question 322

cholinergic toxicity and what to give the pt as a result

Answer 322

DUMBELS ---> give the pt an antimuscarinic agent (glycopyrrolate/hyoscyamine/propantheline) ``` Diarrhea/diaphoresis Urination Miosis Bronchospasm, bronchorrhea, bradycardia Emesis Lacrimation Salivation ```

Question 323

decrease in compound muscle action potential

Answer 323

botulinum toxin

Question 324

cavernous hemangiomas cause increased risk of what

Answer 324

intracerebral hemorrhage and seizures

Question 325

what does the iliohypogastric nerve supply blood to

Answer 325

sensation to suprapubic and gluteal regions | motor function to anterolateral abdominal wall muscles

Question 326

restless leg syndrome (causes and treatments)

Answer 326

- idiopathic, iron deficiency, uremia, diabetes | - avoid triggers and use dopamine agonists (pramipexole)

Question 327

what is the most common cause spontaneous lobar hemorrhage

Answer 327

cerebral amyloid angiopathy and these usually occur in the occipital and parietal lobes

Question 328

what is the problem with using halogenated inhaled anesthetics

Answer 328

they can cause acute hepatitis due to their reactive intermediates (....ane drugs)

Question 329

what artery supplies the occipital lobe of the brain

Answer 329

PCA

Question 330

what happens if. you give a pt with alcoholism glucose without thiamine?

Answer 330

hemorrhage and necrosis of mammillary bodies

Question 331

myeloperoxidase

Answer 331

found in neutrophils and converts hydrogen peroxide to hypochlorous acid (bactericidal compound causes oxidative damage to host cells)

Question 332

NADPH oxidase

Answer 332

catalyzes reduction of molecular oxygen to superoxide free radicals (destroys bacteria) ---> deficiency of this causes chronic granulomatous disease and pts cant destroy catalase positive organisms

Question 333

superoxide dismutase

Answer 333

neutralizes reactive oxygen species (preventing cell injury)

Question 334

two most common causes of toxic shock syndrom

Answer 334

-essentially shoving something in a hole for too long - tampon use - nasal packing after epistaxis ``` superantigens bind to mhc class II and no antigen processing needed (T cell receptors bind to bacterial secretory products) -due to macrophages and T lymphocytes ```

Question 335

both bactrim and tenofovir can cause acute interstitial nephritis... what is the the key difference in the kidney damage they do?

Answer 335

tenofovir also causes focal damage to the proximal tubule

Question 336

symptoms of chronic alcoholic pancreatitis

Answer 336

abdominal pain, chronic diarrhea, and recent weight loss -due to digestive enzyme deficiency

Question 337

what is the most common complication of bicuspid valves

Answer 337

aortic stenosis (usually in their 50s)

Question 338

gomori trichrome stain

Answer 338

characteristic of mitochondrial myopathies (red ragged fiber disease)

Question 339

milrinone

Answer 339

PDE3 enzyme inhibitor that reduced cAMP to provide 2 beneficial effects for treating systolic heart failure causes vasodilation and decreases preload and afterload

Question 340

mechanism of action of opiate analgesics

Answer 340

increased potassium efflux out of cells to cause hyperpolarization of the post-synaptic cell

Question 341

why would a pt have an S4 heart sound?

Answer 341

decreased left ventricular compliance and associated with restrictive cardiomyopathy and left ventricular hypertrophy

Question 342

what does a pulmonary artery balloon measure

Answer 342

left atrial pressure

Question 343

ectopia

Answer 343

its like metaplasia but you are born with it so its congenital rather than metaplasia which is developed during adult life

Question 344

what two enzymes in the process of atp production require thiamine as a co-factor

Answer 344

1. pyruvate dehydrogenase | 2. alpha-ketoglutarate dehydrogenase

Question 345

new diabetes (hyperglycemia) and a rash (necrolytic migratory erythema --> blistering with erythematous plaques and central clearing), what do you think?

Answer 345

glucagonoma

Question 346

elevated methionine, marfanoid habitus, lens subluxation, thrombosis/stroke/MI, kyphosis, and intellectual disability

Answer 346

its probably homocysteinuria and you should supplement B6, increase cysteine in diet, increase methionine in diet and increase folate in diet

Question 347

what are the two parts of the lesser omentum

Answer 347

hepatogastric and hepatoduodenal ligaments

Question 348

two major symptoms of hyperaldosteronism (Conn syndrome)

Answer 348

Paresthesias and muscle weakness | -you also get a metabolic alkalosis

Question 349

aspirin intoxication

Answer 349

fever, tinnitus, and tachypnea also... RESPIRATORY ALKALOSIS with increased respiration and loss of CO2 then METABOLIC ACIDOSIS

Question 350

sick sinus syndrome

Answer 350

you will see the p wave disappear and is due to age related degeneration of the sinoatrial node located on the right atrial wall causing reduced cardiac output

Question 351

if gastrin levels rise in response to secretin, what is that suggestive of?

Answer 351

zolinger-elison syndrome which is a gastrin secreting tumor

Question 352

what two tests can you do when comparing qualitative data

Answer 352

chi-square and logistic regression

Question 353

what do you need to check before starting a patient on metformin

Answer 353

renal activity because if its decreased the patient will be at greater risk for lactic acidosis

Question 354

treatment of hepatic encephalopathy after eating a lot of smoked meats and having cirrhosis

Answer 354

increase in blood ammonia levels lactulose (increased conversion of ammonia to ammonium) rifaximin (decrease intraluminal ammonia production)

Question 355

grayish pharyngeal exudate

Answer 355

corynebacterium diphtheriae - conversion from nontoxigenic to toxigenic C.Diphtheriae occur due to infection with lysogenic bacteriophage called corynephage beta --> this inserts the tox gene into its genome which results in bacterial expression of diphtheria AB toxin (PHAGE CONVERSION PERMITTING EXOTOXIN PRODUCTION) - stains deeply with aniline dyes - irreversibly halts protein synthesis due to ADP-ribosylation of EF-2

Question 356

alpha 1 blockers

Answer 356

can help with BPH and decreasing peripheral vascular resistance -doxazosin, prazosin, and terazosin

Question 357

ecological study

Answer 357

population level as unit of analysis (instead of individual level)

Question 358

tibial nerve problems

Answer 358

- tibial nerve is the one that follows on the back of the leg from the sciatic nerve - problems with this will cause difficulty in plantar flexion and decreased sensation over the sole of the foot

Question 359

common peroneal nerve problems

Answer 359

foot drop and trouble everting ankle as well as toe extension

Question 360

phenoxybenzamine

Answer 360

``` irreversible a1 and a2 blocker prevents catecholamine (hypertensive) crisis ```

Question 361

Low serum sodium and normal urine osmolality after deprivation test and no change with vasopressin being added.... what do you think?

Answer 361

primary polydipsia

Question 362

pringle maneuver

Answer 362

clamp the hepatoduodenal ligament to see if bleeding stops (common bile duct, hepatic artery, and hepatic portal vein are all in this ligament)

Question 363

primary central nervous sytem lymphoma

Answer 363

second most common cause of ring enhancing lesions (first is toxoplasma gondii) which is usually as a result of EBV which infects B cells primarily and is seen on biopsy of the brain T cell abnormalities can be seen on blood smear

Question 364

inheritance pattern of achondroplasia

Answer 364

AD with full penetrance and homozygosity is lethal

Question 365

mechanism of action of all hepC drugs

Answer 365

inhibit viral genome replication and assembly

Question 366

how to treat cardiac toxicity of tricyclic antidepressants

Answer 366

sodium bicarbonate | -works by increasing serum pH and extracellular sodium (alleviating fast sodium channel blockade)

Question 367

nonseptate hyphae that branch at wide 90degree angles

Answer 367

mucor, rhizopus, and absidia (all fungi)

Question 368

pts with small cell lung cancer could have what major paraneoplastic syndrome

Answer 368

lambert-eaton myasthenic syndrome: autoantibodies to presynaptic Ca2+ channels and decreased ACh release - proximal muscle weakness and dry mouth/impotence - histo shows small, round/oval cells with scant cytoplasm and large hyperchromatic nuclei (chromogranin+)

Question 369

hallmark of acute acute graft rejection

Answer 369

dense interstitial lymphocyte infiltration

Question 370

most common cause of acute pericarditis

Answer 370

viral etiology

Question 371

what causes most oral DM drugs to be contraindicated?

Answer 371

impaired kidney function

Question 372

side effect of doxorubicin

Answer 372

-dilated cardiomyopaty and its a chemotherapeutic drug

Question 373

where does steroidogenesis occur?

Answer 373

mitochondria then smooth endoplasmic reticulum

Question 374

gallstone ileus

Answer 374

passage of large gallstone and it gets stuck usually at the ileocecal valve - small bowel obstruction - gas in gallbladder and biliary tree as seen on x-ray - high pitch bowel sounds

Question 375

how does hep b immunization work?

Answer 375

when you actually get infected the immunity stops the virus from being able to infect any cells

Question 376

what are the teoxic alcohols

Answer 376

ethylene glycol and methanol -give pt fomepizole (competative alcohol dehydrogenase inhibitor)

Question 377

extended spectrum beta lactamases

Answer 377

- render penicillins and cephalosporins inactive - on plasmids - transmitted via conjugation

Question 378

thromboxane

Answer 378

increases platelet aggregation and vasoconstriction

Question 379

what medication do you give to a pt who suffered from a subarachnoid hemorrhage

Answer 379

nimodipine (calcium channel blocker) | -prevents cerebrovascular spasm

Question 380

what are the extrapyramidal adverse effects of taking a typical antipsychotic medication

Answer 380

``` ADAPT AD --> acute dystonia (muscle spasm/stiffness) A --> akathisia (restlessness) P --> parkinsonism (bradykinesia) T --> Tardive dyskinesia ```

Question 381

endemic location for histoplasmosis and path

Answer 381

mississippi and ohio river valley , in macrophages

Question 382

endemic location for blastomycosis and path

Answer 382

eastern and central US, as well as great lakes, broad based budding yeast

Question 383

endemic location for coccidioidomycosis and path

Answer 383

southwestern US and california, spherule filled with endospores

Question 384

endemic location for para-coccidioidomycosis and path

Answer 384

latin america, budding yeast with captains wheel formation

Question 385

guillan barre syndrome

Answer 385

immune mediated, demyelinating polyneuropathy (molecular mimicry), cross reacts with myelin of spinal roots and peripheral nerves.... causing demyelination -you will see inflammatory infiltrate in the endoneurium

Question 386

what are the differentials for pulsus paradoxus

Answer 386

1. cardiac tamponade 2. pericarditis 3. asthma/COPD 4. obstructive sleep apnea 5. croup

Question 387

what do alcohol based disinfectants target

Answer 387

lipid bilayer membranes and then they denature proteins after

Question 388

how can you tell the difference between PTSD and acute stress disorder

Answer 388

acute stress disorder occurs for more than three days but less than 1 month PTSD is the same thing but it lasts for longer than 1 month acute stress disorder just changes to PTSD after the one month mark

Question 389

hemagluttinin and neuraminidase

Answer 389

HA: binds sialic acid and promotes viral entry NA: promotes progeny virion release (inhibited by oseltamivir)

Question 390

maintenance dose

Answer 390

CPss x CL / bioavailability fraction

Question 391

loading dose

Answer 391

Vd x CPss / bioavailability fraction

Question 392

what is the drug of choice in a pt in cardiogenic shock

Answer 392

dobutamine due to the increase in CO and increase in end-organ perfusion

Question 393

how to treat an SSRI/SNRI/MAOI/TCA overdose

Answer 393

cyproheptadine (serotonin antagonist)

Question 394

how to treat a benzo overdose and what are the signs of benzo withdrawal

Answer 394

flumazenil (benzo competitive antagonist) W/D - rebound anxiety - tremor - insomnia - sympathetic hyperactivity (diaphoresis and palpitations) - severe cases: psychotic symptoms, seizure, death

Question 395

whatre the most common causes of acute pancreatitis

Answer 395

1. gall stones | 2. alcohol abuse (you will also see macrocytosis)

Question 396

if a patient has bulemia nervous, where does her BMI usually stand?

Answer 396

in normal range (this is the main distinguishing factor compared to anorexia where BMI is below 18.5) -they also may have bilateral painless parotid gland enlargement and hypokalemia

Question 397

equation of the PPP?

Answer 397

oxidative/irreversible part: glucose-6-phosphate --> ribulose-5-phosphate -enzyme used is G6PD

Question 398

what causes hypertrophic cardiomyopathy

Answer 398

AD mutation in genes encoding sarcomeric proteins like myosin binding protein C and beta-myosin heavy chain - can cause sudden cardiac death - avoid vasodilators and diuretics in these pts cause you need to make sure enough blood is getting to their heart

Question 399

how do right sided colon cancers typically present

Answer 399

iron deficiency anemia (fatigue and pallor) | occult blood loss (not visible in the poop yet)

Question 400

adverse effect of permanent pacemaker

Answer 400

tricuspid regurg which can lead to right sided heart failure (edema, hepatomegaly, distended jugular veins)

Question 401

how to help with hypoglycemia

Answer 401

mild: eat candy bar or juice severe (pt passed out): emergency glucagon IM injection (will work w/i 10-15mins) and if you cant find this then put something sweet on buccal mucosa but this may not work and if so it will work slowly

Question 402

rotavirus pathologic finding

Answer 402

blunting of villi in duodenum and proximal jejunum

Question 403

hepatic angiosarcoma

Answer 403

associated with: arsenic, thorotrast, and polyvinyl chloride tumor cells express CD31 (endothelial cell marker)

Question 404

future mother with pain in both knees and feet then stillbirth probably has what

Answer 404

parvovirus B19 (non-enveloped single stranded DNA)

Question 405

most common location of traumatic aortic rupture

Answer 405

aortic isthmus (directly after the arch)--> tethered by the ligamentum arteriosum (relatively fixed and immobile due to adjacent descending aorta) - usually due to a motor vehicle accident/sudden deceleration - you will also see a widened mediastinum on x-ray

Question 406

where do acoustic shwannomas (aka. acoustic neuroma) usually occur

Answer 406

cerebellar pontine angle, due to vestibulocochlear nerve problem (CN8)

Question 407

what allows viruses to go through a genetic shift mutation

Answer 407

reassortment is due to segmented nature of genomes

Question 408

inositol triphosphate and its second messenger system

Answer 408

-binds to receptor on ER and causes increase in cytoplasmic Ca2+ ---> increases smooth muscle contraction phospholipase C cleaves PIP2 into IP3 (causes Ca2+ release from ER) and DAG (activates PKC to phosphorylate proteins and cause smooth muscle contraction)

Question 409

recurrent sinopulmonary and gi infections as well as failure to thrive and lack of proper signaling b/w CD4 Tcells and B lymphocytes...

Answer 409

hyperimmunoglobulin M syndrome (defective class switiching) problem with or absence of CD40 or CD40L could cause this (so you have lots of IgM and not much of the other ones)

Question 410

someone normally at sea level is hiking up a mountain, what do you think?

Answer 410

possible high altitude sickness. most cases subside within two days but it can cause cerebral/pulmonary edema - pt starts hyperventilating--> respiratory alkalosis (blowing off too much CO2) - hypobaric hypoxia

Question 411

Wiskott-Aldrich vs Chediak-Higashi

Answer 411

Wiskott-Aldrich - mutation is WAS gene (defective antigen presentation cause leukocytes and platelets are unable to reorganize actin cytoskeleton) - WATER (wiskott-aldrich, thrombocytopenia, eczema, recurrent infections) - fewer and smaller platelets Chediak-Higashi - defect in LYST (lysosomal trafficking regulator gene)--> microtubule dysfunction in phagosome-lysosome fusion - PLAIN (progressive neurodegeneration, lymphohistiocytosis, albinism, recurrent pyogenic infections, peripheral neuropathy) - giant granules in granulocytes and platelets

Question 412

how do you determine the power of a study

Answer 412

``` power = chance of detecting difference power = 1 - B B = probability that there is no difference ```

Question 413

what part of neisseria meningitis can cause septic shock

Answer 413

lipooligosaccharide (LOS) --> endotoxin (like LPS) that causes toxicity when released into plasma via shedding of outer membrane or bacterial lysis *contrast with lipoteichoic acid found in gram + bacteria and acts as a regulator of of autolytic cell wall enzymes

Question 414

overuse injury caused by repetitive strain and chronic avulsion of secondary ossification center of WHAT

Answer 414

- proximal tibial tubercle | - called Osgood-Schlatter disease (traction apophysitis)

Question 415

first line treatment for panic disorder

Answer 415

SSRI | -for an acute attack you can give a benzo

Question 416

pyrrolidonyl arylamidase positivity leads you to think what

Answer 416

strep pyogenes or enterococcus

Question 417

what does enterococci grow in

Answer 417

bile and hypertonic solutions

Question 418

how to test for fat malabsorption

Answer 418

stool microscopy with sudan III stain

Question 419

where is airway resistance highest in the respiratory tract

Answer 419

highest in the medium-sized bronchii then goes down from there

Question 420

linkage disequilibrium

Answer 420

when respective alleles are inherited together in the same gamete (haplotype) more or less frequently than expected at random --> this is usually because the alleles are in close proximity

Question 421

aTTrition bias

Answer 421

form of selection bias (they are ASSes and dont follow up again) -disproportionate loss to follow-up b/w exposed and unexposed groups

Question 422

caseating granulomas with centra necrosis is what type of tb and what do you look for ... how are they formed

Answer 422

secondary--> look for CD14+ cells at periphery (monocyte/marcophage lineage) -you will also see langhans giant cells caseating granuloma formation - form after macrophages come into contact with something they cant eat fully/degrade - IL-12 is released by macrophage--> Th1 differentiation (CD4 lymphocytes) - Th1 goes to site and releases IFN-gamma to activate more macrophages - then TNF-a gets released to call for even more help from macrophages/monocytes - macrophages differentiate into epitheliod and langhans giant cells to wall off the area to limit bacterial spreading

Question 423

if you are not absorbing (gastrectomy) or are not taking in (strict vegan diet) enough B12

Answer 423

this would take 4-5 years to develop because body stores SO MUCH OF IT

Question 424

list the torch infections

Answer 424

``` Toxoplasma OTHER --> strep agalactiae, ecoli, listeria, and parvob19 Rubella CMV HIV/herpes Syphilis ```

Question 425

altered level of consciousness, pinpoint pupils, and central respiratory depression

Answer 425

opioid overdose: acute respiratory acidosis (low pH and high PaCO2) due to hypoventilation bicarb is still near normal

Question 426

rotator cuff muscles

Answer 426

supraspinatus--> abduction (suprascapular nerve) infraspinatus--> external rotation (suprascapular nerve) teres minor--> adduction and external rotation (axillary nerve) subscapularis--> adduction and internal rotation (upper and lower subscapular nerve)

Question 427

rotator cuff syndrome

Answer 427

tendon impingement trauma of supraspinatus between humeral head and acromion problems/pain with abduction of arm

Question 428

krabbe disease defect

Answer 428

lysosomal storage disease: deficiency of galactocerebrosidase -destroys myelin sheath (oligodendrocytes)

Question 429

metachromatic leukodystrophy defect

Answer 429

arylsulfatase A deficiency | -impaired myelin production

Question 430

adrenoleukodystrophy

Answer 430

peroxisomal disorder: VLCFA CoA synthetase defect - dementia, hearing loss, seizures - gray discoloration of white matter/severe demyelination/perivascular inflammation

Question 431

what do proteosomes do?

Answer 431

degradation of ubiquitinated proteins

Question 432

name the three peroxisomal diseases

Answer 432

1. Adrenoleukodystrophy 2. Zellweger syndrome 3. Infantile refsum disease

Question 433

prevalence dependent values

Answer 433

positive and negative predictive values

Question 434

around what age is it acceptable to diagnose ADHD

Answer 434

around 4-5years old

Question 435

what are the 5Ps of acute intermittent porphyria and how do you treat it

Answer 435

1. Painful abdomen 2. Port-wine-colored urine 3. Polyneuropathy 4. Psychological disturbances 5. Precipitated by drugs (cytochrome P-450 inducers), alcohol, starvation -porphobilinogen deaminase defect (excess porphobilinogen and ALA) Treated with hemin and glucose

Question 436

if pt comes in with blistering cutaneous photosensitivity and hyperpigmentation

Answer 436

- Porphyria cutanea tarda: most common porphyria - uroporphyrinogen decarboxylase defect (increase in uroporphyrin) - causes tea-colored urine - exacerbated with alcohol consumption and associated with hep C - treated with phlebotomy, sun avoidance, antimalarials

Question 437

weakness of quadriceps muscle, loss of patellar reflex, and loss of sensation over anterior and medial thigh and medial leg

Answer 437

femoral nerve injury (can be due to trauma, compression, stretch injury, or ischemia)

Question 438

if hematin (factor 10) and nicotinamide (factor 5) adenine dinucleotide (NAD+) are in a question what should you automatically think about

Answer 438

haemophilus influenzae -major virulence factor is the polysaccharide capsule (polyribosylribitol phosphate (prp)) by binding to factor H and stopping complement by degrading C3b

Question 439

mild renal insufficiency, normocytic anemia, hypercalcemia, bone pain, osteolytic radiolucent bone lesions

Answer 439

multiple myeloma --> plasma cell malignancy associated with excessive IgG gamma gap: serum protein - serum albumin > 4 myeloma cells replicate in the bone marrow and release cytokines that stimulate osteoclasts (by secreting RANKL and destroying osteoprotegrin) and inhibit osteoblasts - M spike due to IgG, rouleaux formation, bence jones protein - decreased PTH, normal PTH-related protein, increased urinary calcium, decreased 1,25vitD ``` CRAB hyperCalcemia Renal involvement Anemia Bone lytic lesions/Back pain ```

Question 440

list two DNA-binding proteins that are transcription factors and how do you look for them

Answer 440

c-Jun and c-Fos (leucine zipper motif) --> transcription factors -southwestern blots look for these as well as nucleases, and histones----IF YOU SEE DOUBLE STRANDED DNA BEING USED ITS SOUTHWESTERN

Question 441

what does the latissimus dorsi do and what innervates it

Answer 441

extension, adduction, and medial rotation of humerus | thoracodorsal nerve

Question 442

how does mycoplasma pneumoniae cause anemia

Answer 442

IgM cold agglutanins cross react and cause clumping and lysis of RBCs -anemia decreases with fading of immune response against bacteria

Question 443

neprilysin

Answer 443

responsible for the breakdown of natriuretic peptides (ANP and BNP--> released due to cardiac stretch) and angiotensin II

Question 444

methotrexate vs trimethoprim and pyrimethamine

Answer 444

all block dihydrofolate reductase --> so it blocks rapidly dividing cells - methotrexate does it humans - trimethoprim does it in bacteria - pyrimethamine does it in protazoa adverse effects: stomatitis, bone marrow suppression, liver function abnormalities

Question 445

eosinophilia, winter months, proximal bronchiectasis

Answer 445

aspergillus fumigatus

Question 446

the PPD skin test, patch test, and candida skin test are testing what?

Answer 446

T cell immune function, so they are causing type IV hypersensitivity reactions

Question 447

do platelets express COX1 or COX2

Answer 447

COX1 so if you dont wanna mess with platelet aggregation then you can give celecoxib which is selective for COX 2 COX enzymes block prostaglandin synthesis 1--> in areas of platelets and gi system 2--> in areas of acute inflammation (by IL-1 and TNF-a)

Question 448

pts with new or worsening back pain, fever, and recent endocarditis or bacteremia (especially staph aureus)

Answer 448

vertebral osteomyelitis -get MRI of spine for dx

Question 449

what does the body do in response to fatty foods

Answer 449

the pancreas secretes CCK from acinar cells

Question 450

what acid base disorder does a pulmonary embolism cause

Answer 450

respiratory alkalosis due to hyperventilation (hypocapnia)

Question 451

what to think when the scapula lifts off the thoracic wall and becomes prominent (winged scapula)

Answer 451

paralysis of serratus anterior due to long thoracic nerve injury --> serratus anterior is along surface of first 8 ribs and inserts on the medial boarder of the scapula -causes impaired abduction of shoulder past horizontal

Question 452

BRAF V600E

Answer 452

melanoma (usually metastasizes)

Question 453

how to determine true negatives and false positives with specificity

Answer 453

true negatives = (specificity) x (number of pts confirmed w/o disease) false positives = (1 - specificity) x (number of pts confirmed w/o disease)

Question 454

coughing spells that last a very long time even after your sickness gets better

Answer 454

pertussis (esp. in pt who hasnt had booster shots)

Question 455

how to remember ECG waveforms during wake/sleep cycle

Answer 455

BATSDB (BATS Drink Blood) ``` B: awake eyes open A: awake eyes closed T: n1 S/K: n2 --> TWOoth grinding D: n3 --> parasomnias B: REM ```

Question 456

primary cytokines involved in pathogenesis of RA

Answer 456

IL-1 and TNF-alpha

Question 457

multiple myeloma vs waldenstroms macroglobulinemia

Answer 457

MM has CRAB findings and M spike due to IgG WM has M spike due to IgM and hyperviscosity syndrome (blurred vision, raynaud phenomenon), no CRAB findings

Question 458

when is PTH-related protein increased

Answer 458

malignancy

Question 459

heart problems mixed with bibasilar crackles and S3

Answer 459

left sided heart failure so fluid is backing up into the lungs and causing a decrease in heart compliance

Question 460

P bodies

Answer 460

in cytoplasm only | -play a role in mRNA translation, regulation, and mRNA degradation ... also maybe storage

Question 461

migraine therapy: abortive and preventative

Answer 461

abortive: NSAIDs, triptans, dihydroergotamine preventative: lifestyle changes, b-blockers, amitriptyline, topiramate, valproate, botox injections

Question 462

glaucoma medications

Answer 462

increase trabecular outflow--> carbachol, pilocarpine (M3 agonists) increase uveoscleral outflow--> lantanoprost, bimatoprost (prostaglandin agonists) decrease aqueous humor synthesis--> timolol (beta blocker), brimonidine (a2 agonist), and acetazolamide (carbonic anhydrase inhibitor)

Question 463

typical bruise is called what

Answer 463

ecchymosis (cutaneous or subcutaneous collection of extravasated blood at least 1cm in diameter)

Question 464

lentigines

Answer 464

on a little old mans head --> brown sunspots

Question 465

fanconi syndrome

Answer 465

generalized reabsorption defect in all of proximal tubule (increase excretion in pretty much everything) -leads to metabolic acidosis, hypophosphatemia, osteopenia

Question 466

how does ALL present

Answer 466

mediastinal mass - lymphadenopathy and hepatosplenomegaly - hypercellularity of bone masses

Question 467

homeobox genes typically code for what

Answer 467

transcription factors

Question 468

how to tell the difference between a left or right sided colon adenocarcinoma

Answer 468

right sided --> bleeding, iron deficiency anemia, left sided --> obstructing symptoms like constipation, abdominal distension, nausea, and vomiting

Question 469

what can trigger erythema multiforme

Answer 469

mycoplasma pneumoniae and HSV sulfa drugs, beta-lactams, and phenytoin you will see a targetoid rash (target lesions) -cytotoxic T cell mediated rash

Question 470

when the clavicle breaks, what causes the two ends to go in each direction

Answer 470

medial fragment--> displaced superiorly due to sternocleidomastoid lateral fragment--> displaced inferiorly due to weight of arm and pectoralis major

Question 471

if someones rheumatoid arthritis drugs arent working well what the first line drug to add

Answer 471

methotrexate

Question 472

fulminant hepatitis in pregnant women

Answer 472

HepE - high mortality rate - patchy necrosis on liver biopsy - enteric and epidemic - fecal oral transmission - ssRNA - unenveloped

Question 473

waxing and waning lymphadenopathy

Answer 473

Follicular lymphoma - indolent course - t(14;18) - translocation of heavy chain Ig with BCL-2(18)

Question 474

regardless of lipid levels what lipid related drug should you give to decrease risk of cardiovascular events

Answer 474

always give a statin (hmg-coa reductase inhibitor)

Question 475

when diagnosing a metabolic alkalosis what can you look at next to help with the differential

Answer 475

urine chloride and pts volume status

Question 476

medial hypertrophy, intimal fibrosis, luminal narrowing of pulmonary arteries

Answer 476

pulmonary arterial hypertension -give pt Bosentan (endothelin receptor competitive antagonist)--> causes vasodilation and decreases progression of vascular remodeling and right ventricular hypertrophy

Question 477

mechanism of action of sulfonylureas and meglitinides

Answer 477

close K+ channel in pancreatic B-cell membrane --> cell depolarizes --> insulin release via increase Ca2+ influx

Question 478

interscalene nerve block

Answer 478

- anesthetizes the brachial plexus as it passes through the scalene triangle - anesthetic for shoulder and upper arm - nearly all pts develop transient ipsilateral diaphragmatic paralysis due to involvement of phrenic nerve roots

Question 479

ulcers where in the gi tract are not likely to be malignant

Answer 479

duodenum -gastric ones should be biopsied

Question 480

bone pain in a young boy with systemic symptoms

Answer 480

hematogenous osteomyelitis - common in metaphysis of long bone due to slower blood flow and capillary fenesrae - w/o proper treatment can progress to chronic suppurative osteomyelitis

Question 481

cardiac description: decreased LV cavity, sigmoid shaped ventricular septum, increased collagen in ventricular wall, brownish perinuclear cytoplasmic inclusions (lipofucsin pigment) what is this?

Answer 481

normal aging heart

Question 482

what do interferon alpha and beta do?

Answer 482

type 1 interferons are synthesized due to viral infections andincrease MHC I and transcribe enzymes to HALT protein synthesis Note these are only active with dsRNA to selectively target virally infected cells only - RNase L: endonuclease to degrade all RNA - protein kinase R: block eIF-2 to stop translation initiation

Question 483

what to suspect with back pain that wont get better no matter what and is worse at night

Answer 483

malignancy/metastasis

Question 484

if a pt has back pain when they walk but feels better leaning forward on something while they walk... what do you think?... shopping cart sign

Answer 484

LUMBAR PAIN/PROBLEM spinal stenosis usually caused hypertrophied ligamentum flavum and can cause those symptoms

Question 485

three causes of narrowing of spinal canal

Answer 485

1. disc herniation 2. ligamentum flavum hypertrophy 3. osteophyte formation affecting facet joints

Question 486

other name for end-diastolic volume

Answer 486

preload

Question 487

most common trigger of afib

Answer 487

aberrant electrical foci in the pulmonary veins near their ostia into the left atrium

Question 488

post MI: gross, microscopic, problems

Answer 488

1 day: none, coag necrosis, arrhythmias 3 days: hyperemia, PMN and coag necrosis, fibrinous/inflammatory pericarditis 2 weeks: yellow/brown softening, macrophages/granulation tissue, pseudoaneyrism of inferior wall/free wall rupture/papillary muscle rupture/septal (VSD) rupture >2weeks: recancalized artery/gray-white scar, contracted scar, aneurysm of anterior wall/Dressler (immune pericarditis)

Question 489

pt presents with proximal muscle weakness, gottron papules, photodistributed facial erythema, darkening and thickening of facial tips, increased risk of occult malignancy -perimysial inflammation and atrophy with CD4+T cells

Answer 489

dermatomyositis (autoimmune) --> may occur alone or as paraneoplastic syndrome due to underlying adenocarcinoma treat with glucocorticoids -if they have all these symptoms without the skin problems its polymyositis and involves CD8T cells and endomysial inflammation both are a problem with autoantibodies against tRNA synthetase

Question 490

how does fibromuscular dysplasia look

Answer 490

alternating areas with aneuyrsmal dilation (string of beads appearance) and loss of internal elastic lamina

Question 491

midshaft humerus break... which artery/nerve is affected?

Answer 491

deep brachial artery and radial nerve

Question 492

where is the most common location for epistaxis

Answer 492

anterior NASAL SEPTUM which includes Kiesselbachs plexus

Question 493

distal humerus break... which artery/nerve is affected?

Answer 493

pinches median nerve and brachial artery

Question 494

congenital torticollis

Answer 494

- noted by 2-4 weeks of age - after this the child prefers to hold their head to one side - usually results from malposition of head in utero or birth trauma - usually resolve with stretching it out over time

Question 495

why should you not administer high O2 to a pt with COPD

Answer 495

you could cause a COPD exacerbation due to increased CO2 retention (O2 induced hypercapnia) resulting in confusion and lethargy ---> ventilation/perfusion mismatch

Question 496

what nerve, artery, and vein are in the anterior compartment of the leg

Answer 496

deep peroneal nerve, anterior tibial artery and vein

Question 497

what nerve is in the lateral compartment of the leg?

Answer 497

superficial peroneal nerve

Question 498

whats in the posterior compartment of the leg?

Answer 498

tibial nerve, posterior tibial artery and vein, peroneal artery and vein

Question 499

whats the best way to avoid a fall for an elderly person, whats the first thing the physician should do?

Answer 499

look at their medications -psychotropic (aripiprazole, sertraline, amitriptyline, and benzos) and cardiovascular drugs (calcium channel blockers, beta blockers, and diuretics) can cause an increased falling risk

Question 500

what infection causes hypo/hyperpigmented areas of the skin specifically seen in sun exposed areas and in hot/humid weather -just found in stratum corneum of skin

Answer 500

``` Pityriasis versicolor (tinea versicolor) --> Malassezia globosa) -can dx via KOH preparation ```

Question 501

etanercept mechanism of action

Answer 501

TNF-alpha inhibitor that acts as a decoy receptor -this drug is added onto methotrexate fro those with bad RA

Question 502

what type of MHC class is on an antigen presenting cell?

Answer 502

MHC class II -MHC class I is found mainly on most of the human nucleated cells that present either self or antigen and are never lysosomed

Question 503

dog bite that becomes erythematous and grows gram negative coccobacilli with the culture having a mouse-like odor

Answer 503

pasteurella multocida

Question 504

why would you have an enlarged coronary sinus?

Answer 504

elevated right sided heart pressure (anything that can cause this like pulmonary hypertension)

Question 505

thickening of pleura and what is seen on histology

Answer 505

mesothelioma - may result in hemorrhagic pleural effusion (exudative), pleural thickening - psammoma bodies, calretinin positive

Question 506

honeycomb appearance of lung

Answer 506

idiopathic pulmonary fibrosis - loss of type 1 pneumocytes and hyperplasia of type 2 pneumocytes - traction bronchiectasis and digital clubbing

Question 507

what happens to someones kidney after they drink ethylene glycol

Answer 507

toxic alcohol found in antifreeze - acute kidney injury causing acute tubular necrosis - vacuolar degeneration with ballooning of proximal tubular cells overall symptoms --> altered mentation, renal failure, high anion gap metabolic acidosis, increased osmolar gap, and calcium oxalate crystals in urine

Question 508

two major adverse effects of theophylline

Answer 508

seizures and tachyarrhythmias

Question 509

plummer vinson syndrome

Answer 509

PLUMBERS DIE 1. Dysphagia 2. Iron deficiency anemia --> leads to koilonychia (spoon shaped nails) and shiny red tongue secondary to atrophy of lingual papillae 3. Esophageal web -treat with iron supplementation

Question 510

what to expect if someone has lead poisoning on peripheral blood smear

Answer 510

basophilic stippling of hypochromatic RBCs

Question 511

Hibernating myocardium

Answer 511

-state of chronic myocardial ischemia presence of left ventricular systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization

Question 512

positive trendelenburg gait, what nerve is affected?

Answer 512

superior gluteal nerve -make sure to give injections in the superiolateral quadrant of the butt, not the superiomedial quadrant cause you can mess up this nerve

Question 513

what does thymidylate synthase do?

Answer 513

converts dUMP into dTMP and its important cause its a dihydrofolate reductase U --> T (important to make DNA without apoptosis due to incorporation of uracil)

Question 514

first line treatment for generalized/social anxiety disorder

Answer 514

ssri and snri

Question 515

majority of overdose deaths are due to what

Answer 515

opioids

Question 516

what finding is pathognomonic for pyelonephritis

Answer 516

WBC casts

Question 517

explain noise induced hearing loss

Answer 517

damage to stereociliated hair cells of organ of corti - due to shearing forces against tectorial membrane - high frequency hearing is lost first regardless of damaging noise frequency

Question 518

noncaseating granuloma formation

Answer 518

-usually seen in autoinflammatory conditions - chronic t-lymphocyte and macrophage activation - macrophages secrete TNF-alpha, IL-1, IL-6, and IL-12 - IL-12 causes Th1 differentiation - Th1 produces IL-2 and IFN-gamma (more macrophages/giant cells)

Question 519

most common reason to have a COPD exacerbation

Answer 519

viral or bacterial respiratory infections

Question 520

manifestations of arsenic poisoning and how to treat

Answer 520

- garlic breath, watery diarrhea, vomiting, prolonged QTc | - give dimercaprol or DMSA

Question 521

marker of mast cell activation

Answer 521

tryptase is a specific marker

Question 522

what reaction does G6PD catalyze?

Answer 522

glucose-6-P --------> 6-phosphogluconolactone

Question 523

what type of damage is caused by CCl4

Answer 523

free radical injury -its oxidized by cp450 in the liver forming free radical CCl3 which reacts to structural lipids of the cell membrane leading to hepatocyte necrosis

Question 524

what medications do you give to someone who had a TIA (transient ischemic attack)?

Answer 524

statin and low dose aspirin (predominantly inhibiting cox-1/blocking platelet aggregation)

Question 525

peripheral neuropathy (wrist/foot drop), asthma, sinusitis, skin nodules/purpura can also involve heart, GI, kidneys

Answer 525

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss) - granulomatous, necrotizing vasculitis with eosinophilia - MPO-ANCA/p-ANCA, increased IgE level

Question 526

interruption of what dopaminergic pathway can lead to galactorrhea and amenorrhea

Answer 526

tuberoinfundibular pathway

Question 527

artery with the lesser curvature of the stomach causes bleeding what could it be?

Answer 527

left or right gastric arteries

Question 528

painless, solid testicular mass in man age bw 15-35

Answer 528

testicular cancer

Question 529

what makes elastin so elastic?

Answer 529

cross linking of lysine residues

Question 530

bilateral acoustic neuromas

Answer 530

NF2

Question 531

what enzymes require B1 (TTP) as a cofactor?

Answer 531

Be APT Branched-chain ketoacid dehydrogenase Alpha-ketoglutarate dehydrogenase Pyruvate dehydrogenase Transketolase

Question 532

flattening of deltoid muscle with acromial prominence suggests what

Answer 532

anterior humerus dislocation

Question 533

Rb mutation causes what two types of cancer

Answer 533

retinoblastoma and osteosarcoma

Question 534

what causes peripheral neuropathy

Answer 534

endoneural arteriole hyalinization

Question 535

explain the metyrapone stimulation test

Answer 535

- sensitive indicator of the HPA-axis - metyrapone blocks cortisol synthesis so you dont have feedback so you should have a surge in ACTH being released and 17-hydroxysteroids will accumulate in the urine

Question 536

what is associated with hirschsprung disease vs meconium ileus?

Answer 536

H: down syndrome, rectosigmoid obstruction, normal meconium, positive squirt sign M: cystic fibrosis, ileus obstruction, inspissated mass(dehydrated meconium), negative squirt sign

Question 537

what is messed up/inhibited if you eat poison mushrooms

Answer 537

RNA polymerase II (mRNA)

Question 538

c-ANCA (cytoplasmic staining antineutrophil cytoplasmic antibodies)

Answer 538

pathognomonic for granulomatosis with polyangiitis (Wegener) -may target neutrophil proteinase 3

Question 539

what causes varicose veins (dilated, torturous veins in superficial leg)

Answer 539

chronically increased intraluminal pressure and/or loss of tensile strength in vessel wall ---> leading to incompetent venous valves complications - edema - skin ulcerations - stasis dermatitis - poor wound healing - infections

Question 540

post-prandial epigastric pain with food aversion and weight loss associated with generalized atherosclerosis

Answer 540

chronic mesenteric ischemia

Question 541

MEN type 1 vs type 2a vs type 2b

Answer 541

1: primary hyperpara, pituitary tumor, and pancreatic tumors 2a: primary hyperpara, medullary thyroid cancer, pheochromocytoma 2b: medullary thyroid cancer, pheochromocytoma, mucosal neuroma/marfanoid habitus

Question 542

what does alcohol inhibit that can lead to hypoglycemia

Answer 542

gluconeogenesis

Question 543

blue-black spots on connective tissue and osteoarthropathy later in life

Answer 543

Alkaptonuria: congenital deficiency of homogentisate oxidase elevated HGA treat with dietary restriction of tyrosine and phenylalanine

Question 544

common cause of eccentric hypertrophy

Answer 544

chronic aortic regurg which can be due to aortic root dilatation

Question 545

immune mediated noncaseating granulomas, hypercalcemia, elevated ACE african american female enlarged lymph nodes hilar and mediastinal adenopathy involves: lungs (most common), skin, eyes, heart -can also cause weight loss what is this and what is it associated with?

Answer 545

sarcoidosis - large number of CD4+ T lymphocytes release IFN-gamma and TNF-alpha to drive macrophage activation and granuloma formation - bronchoalveolar lavage fluid in pulmonary sarcoidosis demonstrates high CD4/CD8 ratio assoiated with Bell palsy, Uveitis, Granulomas, Lupus pernio, Interstitial fibrosis, Erythema nodosum, Rheumatoid arthritis-like arthropathy a FACIAL DROOP is UGLIER hypercalcemia is due to increase 1alpha-hydroxylase mediated vitamin D activation in macrophages CD4+ T cell mediated

Question 546

severe constant middle or left chest pain that may radiate to neck and shoulders pain increases on inspiration relieved by sitting up and leaning forward

Answer 546

acute pericarditis

Question 547

hyperphosphatemia can lead to what with calcium

Answer 547

hypocalcemia

Question 548

hypertensive crisis

Answer 548

- blood pressure >180/120 with end organ damage - malignant nephrosclerosis in the kidney--> fibrinoid necrosis of small arteriolar walls and hyperplastic arteriosclerosis (onion skin appearance) - maha can occur due to erythrocyte fragmentation and platelet consumption at narrowed arteriolar lumen

Question 549

false positive VLDR/RPR with prolonged PTT due to lupus anticoagulant

Answer 549

antiphospholipid syndrome treat with systemic anticoagulation

Question 550

if you see a young woman with rash, joint pain, and fever (and sometimes proteinuria) what should you think?

Answer 550

systemic lupus erythematosus -hypocomplement, ANA+, anti-dsDNA, anti-smith

Question 551

lateral prefrontal corte vs orbitofrontal cortex

Answer 551

lateral prefrontal --> executive functioning, organization, motivation, planning, and purposeful action orbitofrontal --> personality and inhibition

Question 552

how to beta blockers affect the R-A-A axis

Answer 552

they block the formation of renin so none is made

Question 553

breast carcinoma with human epidermal growth factor 2 (HER2) positivity

Answer 553

you can give Trastuzumab --> monoclonal antibody that targets tyrosine kinase receptors (these receptors are commonly overexpressed in breast cancer pts) - major adverse effect is cardiotoxicity (reducing cardiomyocyte contractility with no fibrosis) - blocking these receptors downregulates cellular proliferation and promotes apoptosis - HER2+ is associated with aggressive disease

Question 554

what can predispose someone to develop angiosarcoma

Answer 554

Stewart-Treves Syndrome --> chronic lymphedema

Question 555

selegiline mechanism of action

Answer 555

MAO-B inhibitor

Question 556

amorphous extracellular matrix with scattered stellate or globular myxoma cells within abundant mucopolysaccharide ground substance

Answer 556

myxoma tumor (usually found in left atrium) - mobile and small - tumor plop sound - glycosaminoglycans - breath worse when sitting/better when lying down

Question 557

explain the difference between pemphigus vulgaris and bullous pemphigoid

Answer 557

pemphigus vulgaris - autoantibodies against desmosomes - painful flaccid bullae - erosions affecting skin and MUCOSAL membranes - bullae spread laterally with pressure and new blisters may form with gentle rubbing - mucosal involvement is common - positive nikolsky sign bullous pemphigoid - autoantibodies against hemidesmosomes - tense/firm bullae - separates entire dermis from epidermis - no mucosal involvement and negative nikolsky sign

Question 558

tumor grade vs tumor stage

Answer 558

grade --> differentiation stage --> tumor expansion**** this is more important for prognosis

Question 559

azathioprine metabolism

Answer 559

azathioprine --> 6-MP 6-MP --HGPRT--> active metabolites block purine synthesis 6-MP --TPMP/Xanthine Oxidase--> inactive metabolites Note: allopurinol blocks xanthine oxidase

Question 560

what do alveolar hyaline membranes in the lungs represent

Answer 560

acute respiratory distress syndrome (restrictive) | -macrophages and neutrophils involved in initial part

Question 561

axonal reaction and wallerian degeneration

Answer 561

changes made in the neuron after the axon is severed/damaged - increased protein synthesis to facilitate axon repair - enlarged rounded cells with peripherally located nuclei and dispersed finely granular nissl substance (everything pushed to periphery) Wallerian degeneration is essentially just the axon/myelin breaking down and macrophages remvoing the debris all distal to the site of injury - this occurs much faster in the PNS b/c you dont have the BBB - in the CNS you could have axonal debris for years, suppressing axonal growth via myelin associated inhibitory factors also note that glial scars can inhibit axonal growth/regeneration

Question 562

whats the one part of the body that cannot use ketone bodies for energy

Answer 562

erythrocytes

Question 563

what type of anemia does a pt have with chronic kidney disease and why

Answer 563

normocytic anemia because the kidneys cannot make enough EPO (epo is made and released from the peritubular interstitial cells/fibroblasts in renal cortex) -also chronic kidney disease causes decreased Ca and increased phosphate leading to secondary hyperparathyroidism which can cause osteitis fibrosa cystica

Question 564

what is the single most important measure to to reduce the risk of transmission of hospital acquired infections

Answer 564

hand hygiene

Question 565

common precipitating factors of G6PD deficiency anemia

Answer 565

1. infections 2. drugs (dapsone, antimalarials, sulfonamides) 3. DKA 4. favism (eating fava beans)

Question 566

pt eats cheese then gets meningitis, what causes this?

Answer 566

listeria monocytogenes -can also cause meningitis in baby and has intrinsic resistance to cephalosporins due to PBPs -use ampicillin to treat

Question 567

tinitis, vertigo, sensoryneural hearing loss

Answer 567

menire disease | -pathogenesis related to increased volume and pressure of endolymph in vestibular apparatus

Question 568

why would pus/sputum have a green discoloration

Answer 568

due to presence of myeloperoxidase (blue-green-heme-based enzyme that is released from neutrophil azurophilic granules and forms hypochlorous acid/bleach)

Question 569

hemorrhage and subsequent hypotension can do what to the kidneys?

Answer 569

acute tubular necrosis (3 phases) 1. initiation (24-36hrs) --> initial ischemic or toxic insult 2. maintenance (1-2weeks) --> fully established tubular damage with oliguria, fluid overload, electrolyte abnormalities, low GFR, high serum creatinine 3. recovery --> re-epithelialization of tubules (electrolyte wasting-- decrease K, phosphorous, mg, ca)

Question 570

diffuse medium sized lymphocytes and high proliferation index indicated via Ki-67 fraction (approaching 100%)

Answer 570

Burkitt lymphoma - strong association with EBV - starry sky appearance (due to macrophages) - 8;14 translocation --> c-myc acts as transcription activator controlling proliferation, differentiation, and apoptosis

Question 571

symptoms of schizophrenia and mood disorders together (pt must have >2wks of psychotic symptoms without a manic or depressive episode)

Answer 571

schizoaffective disorder

Question 572

immature defense mechanism. I actually feel mad but i dont want to admit it so im gonna think that youre mad

Answer 572

projection

Question 573

get yelled at by the boss so you go home and yell at your neighbor

Answer 573

displacement

Question 574

what nerve is around the posterior wall of the external auditory canal

Answer 574

small auricular branch of vagus nerve

Question 575

explain muscle loss in cancer related cachexia

Answer 575

ubiquidine -proteosome pathway mediates protein degradation -MAINLY DUE TO TNF-A (suppresses appetite and increases basal metabolic rate) - rapid disposal of unneeded intracellular proteins - high levels of proinflammatory cytokines lead to increased ubiquidination of sarcomeric muscle proteins --> extensive skeletal muscle loss

Question 576

digoxin mechanism and toxicity

Answer 576

MECHANISM - used in a pt with afib that decreases conduction through the AV node and increases contractility in pts with heart failure - blocks Na/K ATPase TOXICITY -one of the ways it works is by slowing down heart rate via increasing parasympathetic tone color vision alterations nausea, vomiting, abdominal pain, fatigue, confusion, weakness -most serious complication = life threatening ventricular arrhythmias

Question 577

what stains positive for GFAP (glial fibrillary acidic protein)

Answer 577

neoplasms of glial origin: astrocytoma, ependymoma, and oligodendroglioma -gfap is essentially just staining for astrocytes

Question 578

what gives reticulocytes their blue-ish color

Answer 578

blue-ish cytoplasm and reticular precipitates of residual ribosomal RNA

Question 579

if you see a serum calcium of over 13, what should you be suspicious of

Answer 579

underlying malignancy and secretion of PTHrP (causes hypercalcemia and loss of phosphate usually seen with squamous cell carcinomas

Question 580

if you see nail clubbing what should you automatically think of

Answer 580

the pt has had prolonged hypoxia - large cell lung cance - TB - cystic fibrosis - suppurative lung diseases: empyema, bronchiectasis, and chronic lung abscesses

Question 581

pt with severe long-bone and/or pelvic fractures who develops acute onset neurologic abnormalities, hypoxemia, and a petechial rash

Answer 581

fat embolsim syndrome --> occlusion of pulmonary microvessels by fat globules (early histological finding)

Question 582

octreotide

Answer 582

synthetic analog of somatostatin given to help the symptoms of carcinoid syndrome

Question 583

wheezing, facial flushing, diarrhea | -associated with ileal tumor with hepatic metastasis

Answer 583

carcinoid syndrome

Question 584

intracellular protazoa with rod shaped kinetoplasts

Answer 584

cutaneous leishmaniasis (enlarging pinkish papule at site of bite then eventually develops into a nodule or plaque) - infected from sand flies - obligate intracellular protazoa that mature in macrophages

Question 585

what drugs should you not give to someone on lithium

Answer 585

thiazide diuretics, ACE inhibitors, and NSAIDs -volume depletion and drug interactions

Question 586

what are you likely to see on histological examination from the bowel of an individual with Crohns disease vs UC

Answer 586

Crohns: patchy transmural inflammation and noncaseating granulomas, mouth to anus, strictures (due to bowel wall edema, fibrosis, thickening of muscularis mucosae), fistulas (penetration of ulcers through intestinal wall), and abscesses UC: involves mucosa and submucosa in the colon only,

Question 587

gross hematuria, acute flank pain, and passage of tissue fragments in the urine -usually seen in pts with sickle cell or sickle trait, DM, analgesic nephropathy, or severe obstructive pyelonephritis

Answer 587

renal papillary necrosis

Question 588

CREST SYNDROME

Answer 588

limited scleroderma and anti-centromere antibodies - calcinosis - raynauds - esophageal dysmotility - sclerodactyly - telangiectasias

Question 589

physician burnout vs fatigue

Answer 589

burnout --> emotional exhaustion, cynicism, depersonalization, decreased sense of personal accomplishment that can result in suboptimal pt care and medical errors fatigue --> caused by sleep deprivation resulting in cognitive impairment and medical errors

Question 590

musculocutaneous nerve injury

Answer 590

usually due to trauma or overuse (C5-C9) innervated forearm flexors (biceps brachii and brachialis), corachobrachialis (flexes and adducts arm), and sensory innervation to lateral forearm

Question 591

painless genital ulcer

Answer 591

with lymphadenopathy: syphilis without lymphadenopathy: klebsiella granulomatis

Question 592

what part of the brain does the pupillary light reflex go to?

Answer 592

afferent limb: optic nerve (CN2) efferent limb: occulomotor (CN3) upper midbrain: pretectal nucleus --> Edinger-westphal nuclei (via CN3) *if a pt has no direct or indirect pupillary constriction this means its likely a CN3 problem

Question 593

diphenoxylate

Answer 593

opioid antidiarrheal drug - binds mu opiate receptors in gut to slow motility - overuse can lead to euphoria and physical dependence -usually combined with atropine to discourage abuse by inducing adverse effects if taken in high doses

Question 594

leser trelat sign

Answer 594

- usually a sign of internal malignancy (typically GI cancer) - seborrheic keratosis all over frontal trunk of body

Question 595

alendronate, ibandronate, risedronate, and zoledronate

Answer 595

bisphosphonates - pyrophosphate analogs that bind hydroxyapatite in bone, inhibiting osteoclast activity - used in osteoporosis, hypercalcemia, paget disease of bone, metastatic bone disease, and osteogenesis imperfecta - may cause esophagitis and kinda a pain to take cause you have to take with water and remain upright for 30 mins after, can also cause osteonecrosis of jaw, and atypical femoral stress fractures - if taken IV can cause flu-like symptoms

Question 596

what can cause foamy frothy urine

Answer 596

proteinuria or bile salts in urine

Question 597

ezetimibe mechanism of action

Answer 597

blocks cholesterol absorption on brush boarder of small intestine

Question 598

what causes wrinkles?

Answer 598

decrease in collagen fibril production - this is due to UVA penetration causing photoaging due to the reactive oxygen species activating inflammatory cell receptors and nuclear transcription factors (leading to decreased production) - metalloproteinases and collagenases are upregulated to degrade type I and III collagen and elastin

Question 599

where are uva and uvb light absorbed?

Answer 599

UVB --> upper dermis and contribute to sunburn and increased risk of malignancy UVA --> deeper into skin and cause photoaging (leads to decreased collagen fibril production and upregulation of metalloproteinases) that degrade type I and III collagen and elastin Note: photoaging is first seen with thinning of epidermis and increased crosslinking of collagen with a deposition of collagen breakdown products

Question 600

explain the difference between brief psychotic disorder, schizophreniform, schizophrenia, schizoaffective, and delusional disorder

Answer 600

BPD --> one day to one month of sudden onset psychosis, full return to function schizophreniform --> one month to 6 months of schizophrenia, functional decline not required schizophrenia --> more than 6 months with included functional decline schizoaffective disorder --> mood disorder + schizophrenia delusional disorder --> more than 1 month of delusion(s) with no other psychotic symptoms

Question 601

what type of infectyions should you be most worried about in a neutropenic pt?

Answer 601

pts own endogenous bacterial flora (fever is only sign of infection)

Question 602

diffusely homogenous pale eosinophilic cytoplasm in hepatocytes

Answer 602

hepatits B (ground glass appearance)

Question 603

pathogenesis of diffuse esophageal spasm

Answer 603

impaired neural inhibition

Question 604

markers for chronic lymphocytic leukemia

Answer 604

b cell markers: CD 19,20,23 with smudge cells seen on peripheral blood smear

Question 605

chronic myeloid leukemia, what cells are increased?

Answer 605

increased number of granulocytes (neutrophils at different ages of maturation) -low leukocyte/neurtrophil alk phos

Question 606

arthritis, diarrhea, fever and maybe sometimes hyperpigmentation of skin

Answer 606

tropheryma whippelii (whipple disease)

Question 607

most susceptible cells in the brain to ischemia

Answer 607

CA1 pyramidal neurons of the hippocampus (can cause anterograde amnesia and disorientation to place and time)

Question 608

what to think of with a new onset of left varicocele associated with flank pain and hematuria

Answer 608

renal vein thrombosis possibly due to hypercoagulable state (in nephrotic syndrome for example) -loss of anticoagulant factors can increase the risk of thrombotic and thromboembolic complications

Question 609

what is the cause of acute appendicitis?

Answer 609

obstruction of the lumen of the appendix | -then a bacterial infection can result from the backing up of the poop

Question 610

prostate cancer that metastasizes to the spinal cord and causes compression

Answer 610

results from local extension of vertebral metastases into the epidural space

Question 611

pilocytic astrocytoma

Answer 611

cystic tumor usually in kids and you will see rosenthal fibers and granular eosinophilic bodies

Question 612

pancytopenia, hepatosplenomegaly (extramedullary hematopoiesis), dry tap, and teardrop cells (aka dacryocytes) -associated with clonal expansion of megakaryocytes --> secrete cytokine TGF-beta

Answer 612

primary myelofibrosis

Question 613

what causes actinic keratosis and what is it a precursor for

Answer 613

sun exposure and squamous cell carcinoma

Question 614

what medication can you give to a pt with spasticity

Answer 614

baclofen (gaba-b agonist) --> also used for dystonia and multiple sclerosis, acts on the BACk tizanidine (alpha2 agonist)

Question 615

if someone has a foreign object stuck in their throat like a fishbone or something where is this and what problem can it cause if the nearby nerve is messed up

Answer 615

gets lodged in the piriform recess and may cause damage to the superior/internal laryngeal nerve (affects afferent limb of cough reflex) --> CN10

Question 616

bone metastases can be osteoblastic, mixed, or osteolytic

Answer 616

Osteoblastic (SCLEROTIC): prostate, small cell lung cancer, hodgkin lymphoma Mixed: GI and breast Osteolytic (LUCENT): MM, non-small cell lung cancer, non-hodgkin lymphoma, renal cell carcinoma, melanoma

Question 617

rhabdomyolysis

Answer 617

granular muddy brown casts seen due to skeletal muscle necrosis causing acute tubular necrosis - direct cytotoxicity and renal vasoconstriction - can be due to crush injury, prolonged muscle activity (seizure, marathon), drugs (tatins, amphetamines, heroin)

Question 618

what property of a drug makes it more likely to be metabolized and cleared by the liver rather than the kidney

Answer 618

liver = more lipophilic drugs

Question 619

lidocaine and mexiletine

Answer 619

- class 1B antiarrhythmic drug - binds inactivated sodium channels and rapidly dissociates --> preferentially binds to rapidly depolarizing and ischemic ventricular myocardial fibers - suppresses v.tach induced by rapidly depolarizing and ischemic myocardium

Question 620

explain the high dose dexamethasone suppression test

Answer 620

ectopic sources will show no difference in cortisol or ACTH levels

Question 621

what type of cancer can you treat with vitamin A derivatives

Answer 621

APL/AML (treated with all-trans-retinoic acid)

Question 622

what type of cells line the ventricles?

Answer 622

ependymal cells

Question 623

lateral displacement of proximal fracture fragment during supracondylar humeral fractures

Answer 623

radial nerve injury

Question 624

in a pt with mitral stenosis why would the left recurrent laryngeal nerve become impinged and what would this cause

Answer 624

this causes left atrial enlargement which can cause too much compression on the nerve causing hoarseness and left vocal cord paresis

Question 625

avoidant personality disorder

Answer 625

they WANT to be with people but avoid it due to fear of criticism and rejection

Question 626

two possible diagnoses when seeing an increase in endogenous insulin

Answer 626

1. insulinoma | 2. sulfonylurea medication (increases endogenous insulin release)

Question 627

what do you see on IF in goodpasatures?

Answer 627

linear IgG and C3 deposits - also antibodies to alpha 3 chain to type IV collagen - treat with plasmapheresis

Question 628

whats the first step of tertiary syphillus?

Answer 628

vasa vasorum endarteritis

Question 629

here is the problem, list the nerve involved 1. weakness in knee flexion 2. weakness in dorsiflexion and numbness on dorsal foot and posterolateral calf 3. weakness in plantar flexion and inversion, absent ankle reflex

Answer 629

1. sciatic nerve 2. common peroneal nerve 3. tibial nerve

Question 630

what type of neoplasm can a blue-ish tumor under the nail be?

Answer 630

glomus tumor/glomangioma (thermoregulation) melanoma (pigmentation)

Question 631

most common benign vascular tumors in adults

Answer 631

cherry hemangiomas (small, bright red, papular lesions)

Question 632

whats the purpose of Protein A

Answer 632

virulence factor on staph aureus that binds to Fc of IgG leading to impaired complement activation, opsonization, and phagocytosis

Question 633

indole + (what bacteria)

Answer 633

ecoli

Question 634

signet ring on histology slide of stomach, what do you think? -kinda looks like a circle with two darker sides (nucleus pushed to the side)

Answer 634

GASTRIC ADENOCARCINOMA - no glands formed, just abundant mucin droplets that push nucleus to one side - diffuse involvement of stomach wall due to loss of E-cadherin - leather bottle stomach --> linitis plastica

Question 635

how do you treat rickettsia species

Answer 635

doxycycline--> blocks 30S ribosomal subunit

Question 636

rapidly progressive dementia, myoclonus, death within a year of symptom onset spongiform changes in brain (uniform intracellular vaculoes throughout gray matter), widespread neuronal loss and no inflammatory response

Answer 636

creutzfeldt-jakob disease (alpha helix to beta sheet) | -most cases are sporadic but they can also be inherited or iatrogenic

Question 637

flulike illness, conjunctival suffusion (noninflammatory), corkscrew shaped organism

Answer 637

leptospira (via water sports and being in contact with contaminated water)

Question 638

IgE-dependent vs independent mast cell degranulation

Answer 638

dependent --> due to environmental exposure/food/beta-lactam/sulfonamide antibiotics independent --> due to opiods, radiocontrast agents, and vancomycin (work by activating PKA and PI3 kinase)

Question 639

renal cell carcinoma | -risk factors and what gets obstructed

Answer 639

- smoking, hypertension, obesity, toxin exposure - inferior vena cava gets obstructed - also note that the tumor can sometimes make EPO which causes erythrocytosis

Question 640

mannitol

Answer 640

osmotic diuretic (increases plasma or tubular fluid osmolality) - causes extraction of water from interstitial spaces around the body to go be peed out - this can reduce edema and intracranial pressure in pts with cerebral edema - severe toxicity is pulmonary edema

Question 641

main causes of toxic megacolon and how will the pt present

Answer 641

ulcerative colitis and c.diff abdominal pain/distension, bloody diarrhea, ever, shock (hypotension and tachypnea) best way to see this is via x-ray

Question 642

black vs brown gallstone pigments

Answer 642

brown --> biliary tract infection | black --> chronic hemolytic anemia, increased cycling of bilirubin

Question 643

tumor in metaphyses of long bone, worsening pain and soft tissue swelling, lytic bone lesion

Answer 643

osteosarcoma (pleomorphic spindle shaped tumor that generate osteoid and thin trabeculae of neoplastic bone) - malignant proliferation of osteoblasts - risk factors: familial retinoblastoma, paget disease, and radiation exposure

Question 644

what type of ALL causes a mediastinal mass making it difficult to breath, swallow, or it can also cause superior vena cava syndrome

Answer 644

T-cell ALL

Question 645

pathogenesis in diabetic gastroparesis

Answer 645

destruction of enteric neurons due to chronic hyperglycemia leading to impaired peristalsis

Question 646

how do heparin and enoxaparin work and how do they differ?

Answer 646

they bind to antithrombin III to activate it so it can go bind to factor 10a and stop it from converting prothrombin into thrombin (preventing coagulation) heparin is a high molecular weight so it can also bind to factor 10a and facilitate binding

Question 647

anicteric

Answer 647

no jaundice accompanied. this is usually seen in a pt who had hepA as a child and grows up with IgG titer but no active symptoms

Question 648

trabecular thinning with fewer interconnections of bone is seen in what disorder?

Answer 648

osteoporosis

Question 649

subperiosteal resorption with cortical thinning of bone is seen in what disorder?

Answer 649

hyperparathyroidism leading to osteoporosis but since the cause is different its pathogenesis differs as well

Question 650

what bone structure is seen in someone who has osteopetrosis?

Answer 650

"marble bone disease" | -spongiosa filling medullary canals with no mature trabeculae

Question 651

how does bone look in vitamin D deficiencty

Answer 651

osteoid matrix accumulation around trabeculae

Question 652

lamellar bone structure with mosaic pattern is associated with what disease?

Answer 652

pagets disease of bone

Question 653

hamartoma

Answer 653

common benign tumor made of cartilage, fibrous/fatty tissue -most common benign tumor of lung

Question 654

what can you use to check if someone has osteitis deformans (paget disase of bone)

Answer 654

increased alk phos | -increased osteoclasts followed by increased osteoblasts

Question 655

tick-bite that leads to mulberry shaped intracytoplasmic inclusions in monocytes

Answer 655

Ehrlichiosis (Ehrlichia chaffeensis) | -transmitted by the Ixodes tick (same as lyme disease tick) or the lonestar tick

Question 656

dancing eyes and dancing feet tumor in children with elevated catecholamine metabolites

Answer 656

neuroblastoma (normotensive) | N-myc oncogene = poor prognosis

Question 657

what two substances promote angiogenesis

Answer 657

VEGF and FGF2

Question 658

what type of cancers are usually associated with glandular cells

Answer 658

adenocarcinoma

Question 659

facial edema/plethora and venous distension in neck veins and upper abdomen

Answer 659

superior vena cava syndrome (most common causes are lung cancer and non-hodgkin lymphoma) --> some mediastinal mass is most common but another reason could be due to superior sulcus tumor (less common)

Question 660

biceps and brachioradialis reflex

Answer 660

C5-C6

Question 661

what does a bruit mean

Answer 661

that you have turbulent blood flow and possible stenosis of whatever blood vessel youre listening to

Question 662

vitiligo

Answer 662

partial or complete loss of epidermal melanocytes

Question 663

risperidone

Answer 663

2nd gen. atypical antipsychotic - used for schizophrenia and bipolar disorder - can cause hyperprolactinemia (amenorrhea, galactorrhea, gynecomastia)

Question 664

painless unilateral visual disturbances with a flame like hemorrhage in the eye... underlying cause?

Answer 664

hypertension (hypertensive renal hemorrhage)

Question 665

two main causes of acute pancreatitis and if those are negative whats the next test you should run and why

Answer 665

1. gall stones 2. alcoholism (macrocytosis and AST:ALT ratio > 2 are indirect indicators of chronic alcohol consumption) test for triglycerides cause if they are over 1000 they can cause direct injury to pancreatic acinar cells

Question 666

painless blood int he urine and and peeing out malignant cells with no kidney abnormalities

Answer 666

urothelial transitional cell bladder cancer major risk factors: cigarette smoking, occupational exposure to rubber plastics, aromatic amine-dyes, textiles, and leather -cyclophosphamide therapy also increases risk

Question 667

causes of primary vs secondary spontaneous pneumothorax

Answer 667

primary --> apical subpleural blebs (in tall thin men) secondary --> diseased lung (bullae in emphysema, infections), mechanical ventilation with use of high pressures leading to barotrauma

Question 668

rising fever, abdominal pain, rose spots on trunk and abdomen, hepatosplenomegaly -possible intestinal bleeding and perforation

Answer 668

salmonella typhi (typhoid fever)

Question 669

what causes hydatid cysts "eggshell calcification" in the liver and what can happen to it?

Answer 669

echinococcus granulosis via ingestion of eggs in food contaminated with dog feces and the cyst can rupture and cause anaphylaxis

Question 670

spike and dome appearance on EM in kidney

Answer 670

membranous nephropathy

Question 671

what medication can you give to CF pts with phe508 deletion?

Answer 671

lumacaftor (corrects misfolded proteins and improves their transport to cell surface) ivacaftor (opens Cl- channels to improve chloride transport)

Question 672

whats the most common mechanism of sudden cardiac death in a pt within the first 48hrs of a MI?

Answer 672

v. fib

Question 673

inflammation of what causes acne vulgaris

Answer 673

pilosebaceous follicles

Question 674

compare and contrast psoriasis to atopic dermatitis in an adult

Answer 674

psoriasis --> scaly (on back of arm/elbow), erythematous plaques, neutrophilic infiltration, positive auzputzs sign, dilated blood vessels atopic dermatitis (eczema) --> itchy dry skin (on flexure surfaces), eosinophilic infiltration both have hyperkeratosis

Question 675

pt presents with increased neutrophils and what seems like a cold or something bacterial but only alk phos is slightly elevated

Answer 675

leukemoid reaction | -expect to see PMN with Dohle bodies (basophilic granules in the PMNs)

Question 676

list the class 1A antiarrhythmics

Answer 676

quinidine, procainamide, and disopyramide

Question 677

cardiac ischemia, when does that part of the heart stop beating and when does the damage become irreversible

Answer 677

stops beating after 1min | becomes irreversible after 30mins

Question 678

painless obstructive jaundice (elevated bilirubin, dark urine, pale stool)

Answer 678

PANCREATIC ADENOCARCINOMA - smoking is the most important risk factor - other risk factors include advanced age, chronic pancreatitis, and genetic predisposition (Peutz-Jeghers syndrome)

Question 679

hemeangioma on the butt of an infant that is slowly growing in size

Answer 679

strawberry (capillary) hemeangioma

Question 680

absence of CD55 on red blood cells

Answer 680

paroxysmal nocturnal hemoglobinuria - compliment mediated hemolysis due to mutated PIGA (helps synthesize GPI) - hemolytic anemia (hemoglobinuria), pancytopenia, and thrombosis at atypical sites - chronic hemolysis can cause iron deposition in the kidney (hemosiderosis)

Question 681

what is the pathogenesis of the problem when a child has nonbilious vomiting

Answer 681

pyloric stenosis which is due to smooth muscle cell hypertrophy

Question 682

infant doesnt develop social smile and fails to track objects

Answer 682

infantile cataracts due to galactokinase deficiency

Question 683

leucovorin

Answer 683

aka. folinic acid - can reverse toxicity of methotrexate in non-cancerous cells in gastric mucosa and bone marrow - serves as reduced form of folic acid that does not require dihydrofolate reductase

Question 684

whats a secondary cause someone would develop pulmonary hypertension

Answer 684

prolonged untreated obstructive sleep apnea