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1

Histology of GBM

Necrosis, Hemorrhage, Pallisading pattern

2

Histology of Meningioma

Psammoma bodies (also papillary thyroid carcinoma, serous papillary ovarian adenocarcinoma)

3

Histology of Oligodendroglioma

Fried egg appearance

4

PCNSL Histology

Uniform atypical lymphocytes

5

Lingual Thyroid

Thyroid tissue fails to migrate --> Removal cause hypothyroid

6

dx of asthma after Methacholine challenge

Decr in FEV1 of >20%

7

Cutaneous Neurofibromas -->

NF1 --> Autosomal Dominant (Chr 17)

8

Widened QRS converts to narrow during tachyarrhythmia in WPW b/c

accessory pathway no longer pre-excites but instead forms re-entrant circuit

9

EKG Triad for WPW

Shortened PR, Delta wave, Wide QRS

10

Linear deposits of Ig along glomerular basement membrane

Anti-GBM disease (Goodpasture) = Type 1 RPGN = Crescents on LM

11

Basement membrane splitting in kidney bx

Alport and MPGN Type 1

12

Uniform, diffuse wall thickening in kidney bx

Membranous Glomerulopathy

13

B6 is an essential cofactor for

Transamination and Decarboxylation of Aas, Gluconeogenesis

14

OAA + Glutamate -->

Aspartate and a-KG

15

Transamination reactions

AA and a-keto acid --> Amine transferred to a-keto acid, which becomes AA

16

Most common form of Galactosemia

Galactose-1-P uridyl transferase deficiency

17

What to check before initiating metformin therapy?

Serum Creatinine --> Lactic Acid accumulation (also contraindicated in hepatic dysfunction, CHF, alcoholism, sepsis)

18

Bloom syndrome is characterized by

General chromosomal instability

19

Ataxia Telangiectasia is characterized by

DNA hypersensitivity to ionizing radiation

20

Cardiac Output equation

1. SV x HR; 2. (O2 consumption) / (AV O2 difference)

21

TCA cause what heart manifestation

Quinidine-like effect: QRS and QT prolongation by inhibiting fast Na channels

22

Treatment for cardiac TCA overdose

Hypertonic NaHCO3: Corrects QRS prolongation, Reverses hypotension, Treats ventricular dysrhythmias

23

What accounts for awakening from barbiturate anesthesia

Redistribution (not elmination)

24

MOA of Oxybutynin

M3 antagonist --> Decr IP3 --> Decr Ca (urge incontinence)

25

Common causes of myopathy with elevated CK

Hypothyroid, Muscular Dystrophy, Inflammatory Muscle Disease, HMG-CoA Reductase inhibitor

26

Fatiguability, Weight gain, and Myoedema -->

Hypothyroid

27

CK levels in Steroid-induced myopathy

Normal

28

Ciprofloxacin is NOT effective for

Anaerobic infections

29

Ceftriaxone has poor activity against

Anaerobes

30

Azithromycin is used for

Chlamydia, Mycoplasma, H flu, Moraxella

31

Permissive effects of cortisol

Incr vascular and bronchial smooth muscle reactivity to catecholamines

32

Valproate causes what birth defect

Neural Tube defects

33

PYR positive

GAS

34

What molecule is upregulated to mediate Transmigration

PECAM-1

35

Caspofungin is most active against

Candida and Aspergillus (not against Mucor or Rhizopus)

36

Selective Proteinuria

Albumin loss with minimal loss of more bulky proteins (IgG, Macroglobulin)

37

Most selective derminant for size in glomerulus

GBM and slit diaphragm (4nm)

38

Barrier to albumin loss in urine

charge selectivity

39

Tubular proteinuria

Presence of low molecular weight proteins in urine that should have been reabsorbed

40

Overload pronteinuria

Normally reabsorbed, smaller proteins exceed reabsorption capacity

41

Functional proteinuira

change in blood flow through glomerulus

42

Histologic features of Acute Viral Hepatitis

Ballooning degeneration, Mononuclear infiltrates, Councilman bodies

43

Anorexia, nausea, and low grade fever followed by bilirubinuria and R upper quadrant tenderness

Acute Hepatitis - most commonly caused by HAV in young adults

44

Pulmonary Vascular Resistance is lowest when

At Functional Residual Capacity (after casual exhalation)

45

Require cholesterol for growth in acellular media

Mycoplasma

46

MacConkey agar contains ___ to inhibit growth of contaminant

Bile

47

Virulence factor of E coli in neonatal meningitis

K1 capsular antigen

48

Virulence factor of E coli in non-bloody gastroenteritis

Heat stable/labile

49

Virulence factor of E coli in UTI's

P (pyelonephritis) Fimbriae

50

Na channel binding strength among Class I Anti-arrhythmics

1C > 1A > 1B (correlates to use dependence)

51

MOA of BNP

Incr cGMP via GC

52

Slow acetylation affects which drugs

INH, Dapsone, Hydralazine, Procainamide

53

MOA of Rifampin

DNA-dependent RNA synthesis inhibition

54

Rifampin vs Isoniazid

Rifampin is not specific for mycobacteria

55

99mmTc-pertechnetate scan detects

presence of gastric mucosa

56

Digestive effects after sub-total pancreatectomy

Deficient in all digestive enzymes normally secreted by pancrease into duodenum

57

D-xylose absorption

Monosaccharide that can be absorbed direct w/out pancreatic enzymes

58

oral administration of fixed dose D-xylose

Differentiate b/t malabsorption of pancreatic vs GI mucosal etiology

59

Langhans Cells

Multinucleated giant cell with role in Granulomatous inflammation

60

Raquet-shaped intracytoplasmic granule

Birbeck granule in Langerhans cells

61

Merkel Cells

Basal layer neuroendocrine cells with role in touch

62

Portal triad runs in

Hepatoduodenal ligament

63

Which part of heart injured in stab wound to left 4th intercostal space

Right Ventricle

64

Two important steps in workup of metabolic alkalosis

Volume Status, Urine Chloride

65

Treatment of Vomiting/NG suction Metabolic Alkalosis

Isotonic saline for volume and Cl repletion

66

What leads to metabolic alkalosis that is saline unresponsive

Hyperaldosteronism or Hypercortisolism

67

Low blood-gas partition coefficient means

Poor solubility --> Blood saturates quickly --> Fast rise in partial pressure --> Faster brain saturation --> Faster onset time

68

High blood-gas partition coefficient means

High solubility --> Blood saturates slowly --> Delayed rise in partial pressure --> Slow brain saturation --> Slow onset time

69

Function of BRCA1/2

Double strand DNA break repair

70

Heritability of BRCA mutations

Autosomal dominant

71

Dysfunction in Alkaptonuria

Homogentisate Oxidase - Tyrosine to Fumarate

72

What in urine in Alkaptonuria imparts black color if oxidized

Homogentisic Acid

73

Ochronosis

Blue-black pigmentation in Alkaptonuria

74

Tx for combined absence and tonic clonic

Valproate

75

Tx for Absence Seizures

Valproate, Ethosuximide

76

Ethosuximide is not effective for

Tonic Clonic

77

Chronic effects of Obstructive Sleep Apnea

Reflexive systemic and pulmonary vasoconstriction and sympathetic cardiac stimulation --> Pulmonary HTN and Right Heart Failure

78

Hepatic Angiosarcoma is associated with

Arsenic, Thorotrast, Polyvinyl Chloride

79

CD31

PECAM1 --> Leukocyte migration thru endothium

80

IF microscopy in PSGN

Granular deposits of IgG, IgM, C3 = Starry Sky

81

EM in PSGN

Subepithelial humps = Antigen-antibody complexes

82

Longer menstrual cycles and irregular bleeding in adolescent

Anovulatory cycles due to immature HP-Ovarian axis

83

Transports ammonia from peripheral tissues to kidneys

Glutamine --> Glutamate + Free Ammonia Ion

84

Function of N-acetylglutatmate

Active Carbamoyl Phosphate Synthetase I in urea cycle

85

Nitrogen atoms in urea cycle are derived from

NH3 and Aspartate

86

Rate limiting enzyme in urea cycle

Carbamoyl Phosphate Synthetase I (activated by N-acetylglutamate)

87

Causes of HIV esophagitis

Candida, HSV1, CMV - Clinically indistinguishable, need endoscope

88

Endoscopic findings in Candidal Esophagitis

Patches of adherent gray-white pseudomembranes

89

Endoscopic findings in HSV-1 Esophagitis

Small vesicles that evolve into typical "punched out" ulcers

90

Endoscopic findings in CMV Esophagitis

Linear ulceration

91

Isospora belli

Profuse, watery diarrhea in HIV patients

92

Fever, Generalized LAD, Facial Edema, and Diffuse Morbilliform skin rash 2-8 weeks after drug exposure

DRESS!!!

93

Common drugs associated with DRESS

Anticonvulsants, Allopurinol, Sulfonamides

94

Drug-induced Anti-neutrophil cytoplasmic antibodies

Hyperthyroidism meds, Hydralazine

95

Mixed cryoglobulinemia is typically associated with

Chronic inflammatory states (SLE, HepC)

96

Purpose of squatting in Tetralogy of Fallot

Incr SVR/PVR ratio to prevent bypass of lungs

97

Synthesize dextrans from sucrose? Purpose?

Strep viridans --> Adherence to fibrin

98

Why does Strep viridans only bind to damaged endothelium

Adheres to fibrin, which is only deposited at sites of damage

99

Colistin kills

Gram negatives other than Neisseria

100

Reducing media

Used to culture organisms that reduce iron or sulfur

101

Result of incr in Hb saturation at lower oxygen mmHg

Erythrocytosis

102

Activated macrophages are necessary for

Delayed hypersensitivity reactions, Cytotoxicity against intracellular organisms

103

IL-12 receptor deficiency

Severe mycobacterial infections with inability to mount strong cell-mediated granulomatous immune response --> Tx with IFN-g

104

Infused citrate in packed RBCs can cause

Hypocalcemia (occurs with 5-6 liters of blood given over 24 hours)

105

6-MP and 6-TG are converted to active metabolites by

HGPRT

106

Degradation of activated 6-MP and 6-TG is done by

Xanthine Oxidase, Thiopurine Methyltransferase

107

Why give Allopurinol with 6-MP

Prevents inactivation by Xanthine Oxidase and greatly reduces needed dose

108

First line treatment for gestational diabetes

Diet then Insulin

109

Korsakoff syndrome is associated with damage to

Anterior and Dorsomedial Thalamic Nuclei --> Memory loss and Confabulation

110

Role of microglia in post-infarct repair

Move into area 3-5 days after onset of ischemia and phagocytize fragments of neurons, myelin, and necrotic debris

111

How does leptin regulate appetite, metabolism

Decr NPY in arcuate nucleus; Stimulates POMC/a-MSH in arcuate nucleus

112

EML4-ALK is seen in ___? Targeted therapy?

Non-Small Cell Lung Carcinoma (often nonsmokers with adenocarcinoma) --> Crizotinib

113

Sensorineural hearing loss, Tinnitus, Paralysis of facial muscles, Loss of corneal reflex -->

Vestibular Schwannoma affectiing V, VII, VIII --> Cerebellopontine angle

114

Specific symptoms of iron-deficiency anemia

Dysphagia, Koilonychia

115

Most common cause of Hydatid Cysts in humans

Echinococcus granulosus

116

beta adrenergic activity in coronaries

vasodilation

117

Oxygen content in Pulmonary Artery vs Coronary Sinus

Lower in coronary sinus because much more O2 used in myocardium than systemically

118

Prior strep infections are evidenced by

Anti-Streptolysin, Anti-DNaseB, Anti-Hyaluronidase

119

PYR Positive vs negative

GAS, Enterococci are PYR+; GBS, Bovis are PYR-

120

Etiologic agent of scrofula

Mycobacterium scrofulaceum

121

MOA of Nacetylcysteine

Glutathione substitute, Provides sulfhydryl groups to enhance non-toxic sulfation elimination of acetaminophen

122

Effect of glucocorticoids on liver protein synthesis

Incr Gluconeogenic and Glycolytic enzyme synthesis

123

Used to stimulate peristalsis in post-op ileus

Bethanechol, also to treat non-obstructive urinary retention

124

Effect of cholinergic agonist on glaucoma

Miosis causes iris to move further from cornea --> Widens anterior chamber and allows for better outflow of acqueous humor

125

Kidney histology in chronic transplant rejection

Vascular wall thickening, Luminal narrowing, Interstitial fibrosis, Parenchymal atrophy

126

What causes activation of RAS

GTP binding

127

NADPH is required as cofactor for

FA, Cholesterol, Steroid synthesis

128

MOA of Anastrozole

Aromatase inhibitor (+ Letrozole, Exemestane)

129

Bones associated with First Pharyngeal Arch

Maxilla, Zygoma, Mandible, Vomer, Palatine, Incus, Malleus

130

Bones associated with Second Pharyngeal Arch

Styloid, Lesser Horn of Hyoid, Stapes

131

Muscles associated with Second Pharyngeal Arch

Facial Expression, Stylohyoid, Stapedius, Posterior Digastric

132

Neonatal manifestations of Erythroblastosis Fetalis

Anemia, Jaundice, Edema, Nucleated RBCs, Extramedullary Hematopoiesis

133

Who gets oral thrush

Dentures, DM, Immunosuppressed, HIV

134

What causes problem with Fragile X expansion

Hypermethylation (not breakage)

135

What is unique to the duodenum

Brunner's Glands - Located in SUBMUCOSA and secreted bicarb

136

3rd Aortic Arch Derivatives

Common Carotid, Prox internal carotid

137

4th Aortic Arch Derivatives

True Aortic Arch, Subclavian Arteries

138

6th Aortic Arch Derivatives

Pulmonary arteries, Ductus arteriosus

139

Effect of DKA on K

Incr excretion, Decr total stores, But increased extracellular

140

Homeless man with increased fatiguability and exertional dypnea, LE edema, decr sensation in periphery + cardiac dilation and incr CO

B1 deficiency (Beriberi)

141

Laryngeal edema and difficulty breathing after ACEi is due to

Kinin accumulation

142

Long acting benzodiazepines

Chlordiazepoxide, Chlorazepate, Diazepam, Flurazepam (Carefully Choose Due to Falls)

143

What are the dimorphic fungi?

Blasto, Histo, Paracoccidiodies, Coccidiodes, Sporothrix - Body Heat Purportedly Changes Shape

144

Removal of apical ectodermal ridge from newly formed limb bud

Shortened length, Abnormal ventral dorsal

145

Which aortic arch becomes Ductus Arteriosus

Sixth

146

Refsum's disease

Myelin synthesis due to FA oxidation/synthesis disorder

147

Findings in Sarcoidosis

GRAIN - Globulinemia, RA, elevated ACE, Interstitial fibrosis, Noncaseating granulomas

148

pregnant woman hypotensive when supine

IVC compression --> lay on left side at night

149

Especially effective CT agent for Hodgkin

Vincristine

150

Location of the CTZ

Area postrema of the medulla

151

CV manifestations of Turner's

Bicuspid Aortic Valve, Preductal Coarction of Aorta

152

Where is stratified squamous epithelium found in respiratory tract?

Oropharynx, Laryngopharynx, Anterior epiglottis, Upper half of posterior epiglottis, True vocal cords

153

MOA of Alpha-Glucosidase inhibitors

Prevent disaccharide breakdown in intestine, thus absorption

154

Role of adiponectin in T2DM

Low, increased by TZDs

155

Annular pancrease is caused by

Abnormal migration (not apoptosis) of ventral pancreatic bud

156

Bilateral lens subluxation, Massive stroke, Old renal infarcts

Homocysteinuria

157

Most patients with Homocysteinuria respond dramatically to

B6 supplementation

158

Fluoxetine overdose

Tachycardia, Drowsiness, Tremor, Vomitting, Nausea

159

Physical exam finding in AV fistula

Pulsative mass with thrill on palpation, Auscultation reveals bruit over site

160

SST decreases

Secretin, CCK, Glucagon, Insulin, Gastrin

161

AA's that are metabolized to Propionyl CoA

Isoleucine, Valine, Threonine, Methionine

162

L-asparaginase

Antineoplastic by lowering circulating asparagine levels (leukemic cells collect asparagine from serum)

163

Symptoms, Signs of congenital hypothyroidism

Poor feeding, Prolongued jaundice, Constipation, Hypotonia, Hoarse Cry, Macroglossia, Myxedema, Umblical hernia

164

Which diuretic is used to decrease urine calcium

Thiazides

165

Most common cause of SVC syndrome

Bronchogenic Carcinomas

166

Most important HLA association with RA

HLA-DR4

167

HLA associated with SLE

HLA-DR2/3

168

HLA-A3 associated with

Primary Hemochromatosis

169

Lambert Eaton vs MG

LE doesn not improve with AChEi's, Strength improves with repeated testing, Enhanced neurotransmission with repetitive stimulation

170

Limited vs Systemic Sclerosis Ab's

Limited associated with Anti-centromere; Systemic with Anti-Topo 1

171

Kernicterus is most likely to affect which parts of CNS

Basal ganglia, Thalamus, Cerebellum, Cerebral gray matter, Spinal cord

172

Which hepatitis type is associated with PAN

Hep B (Hep C associated with Mixed Cryoglobulinemia)

173

Symptoms of Acute Intermittent Porphyria

Abdominal pain, N/V, Peripheral neuropathy, Paralysis, Psychiatric

174

Anti-mitochondrial Ab is a marker for

Primary Biliary Cirrhosis

175

Treatment of Lithium-induced DI

Amiloride - Blocks channel that lithium uses to enter principal cell

176

SLE on prednisone long term - what vitamin to supplement?

VITAMIN D

177

Toxicity of Nitrosureas

Carmustine --> pulmonary fibrosis

178

Accumulated intermediate in Acute Intermittent Porphyria vs Prophyria Cutanea Tarda

AIP = Porphobilinogen, PCT = Uroporphyrinogen

179

MOA of Bacitracin

Inhibits transfer of mucopeptides to growing cell wall

180

When do Red Neurons appear after cerebral ischemia?

12-24 hours

181

When does liquefactive necrosis appear after cerebral ischemia?

1-2 weeks

182

What can minors consent to when pregnant?

Prenatal care, Dx and Tx of STD's, Drug and Alcohol Rehab; NOT abortions (or elective non-emergency procedures)

183

Acute transplant rejection is mediated by

T cell response against HLA/MHC antigens

184

Symptoms of Systemic Mastocytosis are induced by

Histamine releas

185

What is pulsus paradoxis

Decr systemic blood pressure during inspiration (incr venous return deviates IV septum toward left and blocks outflow)

186

When does Pulsus Paradoxis occur

Acute cardiac tamponade, Constrictive pericarditis, Severe obstructive lung dz, Restrictive CM

187

Most significant factor in Shigellosis

Mucosal invasion, not toxin

188

Confusion, Fever, Nausea, Elevated LFT's four days after anesthesia

Massive hepatic necrosis from Halothane

189

Hepatic Granulomatosis is associated with

Methyldopa, Hydralazine, Quinidine

190

MOA and use of Primidone

First line for benign essential tremor; MOA unknown but metabolizes to phenobarbital

191

Activation of Intrinsic vs Extrinsic pathway

Intrinsic by damaged vessel (XII), Extrinsice by tissue damage (TF, VII)

192

Defect and major manifestations of Type 1 Dyslipidemia

LPL, ApoC --> Chylomicrons --> Acute pancreatitis, Xanthomas, HSM

193

Defect and major manifestations of Type 2a Dyslipidemia

LDL, ApoB-100 --> LDL --> CAD, Corneal Arcus, Tendon Xanthomas

194

Defect and major manifestations of Type 3 Dyslipidemia

ApoE --> Chylomicron, VLDL remnants --> CAD, PVD, Xanthomas

195

Defect and major manifestations of Type 4 Dyslipidemia

ApoA-V --> VLDL --> Pancreatitis, Obesity, Insulin resistance

196

Purine Antimetabolites

6-MP, 6-GP, Fludarabine, Cladribine

197

Use of Cladribine

Hairy Cell Leukemia - Resistant to Adenosine Deaminase

198

Bupropion is contraindicated with

Anything that can lower seizure threshold (eg electrolyte disorders from bulemia)

199

Good samaritan law

Standard of care must be met (meant to protect people, including off duty medical professionals, who help in accidents/emergencies)

200

Laplace's Law

P=2T/r

201

Uptake of unconjugated bililrubin occurs via

Organic Anion Transporting Polypeptide (OATP) - passive

202

Conjugated bilirubin is secreted from hepatocytes via __? This is blocked in __?

MRP2 (active organic anion transporter) - Criggler-Najjar, Rotor

203

Concentration of Bicarb along Proximal Tubule

Actively reabsorbed due to Carbonic Anhydrase --> Acetazolamide causes excretion

204

How to differentiate MAC from MTB in HIV patient

MAC has anemia, HSM, incr ALP/LAD due to widespread involvement of RES; Also grows well at 41degC

205

Prophylaxis and treatment of MAC

Proph with Azithromycin; Tx with Azith + Ethambutol or Rifampin

206

Absence of ganglion cells in colonic wall causes

affected segment to narrow (can't relax)

207

Which parts of GI tract are always involved in Hirschprung

Since NCC's migrate caudally, rectum always involved

208

How does metabolism of drug relate to drug-induced lupus?

Slow acetylators more likely (hydralazine, procainamide)

209

Most liver hydrolysis involve what enzymes

Amidase, Esterase

210

When is Exenatide used?

(GLP-1) Suboptimal glucose control in patients already on Metformin and Sulfonylureas

211

Ventricular response to AF is dependent on

Transmission through AV node

212

What types of viral genomic material can be individually infective?

Positive Linear ssRNA

213

Interstitial pneumonia in transplant patient

CMV

214

Treatment of C. diphtheria

Antitoxin --> Penicillin or Erythromycin --> DPT vaccine

215

Most common cause of death from C diph

Cardiomyopathy

216

Features of Cutaneous Neurofibromas

Rubbery, Buttonholing

217

Features of Wiskott-Aldrich

Thrombocytopenic Purpura, Eczema, Recurrent infections

218

Acute Narrow Angle Glaucoma is often precipitated by

Anticholinergics --> Anterior chamber narrows, obstructing trabecular meshwork

219

Confirmatory test for calculus cholecystitis

HIDA scan (not ultrasound)

220

Stool osmotic gap? What increase?

Colonic fermentation products --> Increased when poorly absorbable substances present (lactose)

221

Nonpolar Aliphatic Hydrophobic AA

VIP GAL - Valine, Isoleucine, Proline, Glycine, Alanine, Leucine

222

Aromatic Hydrophobic AA

Try Trippin w/ Phenytoin - Tyrosine, Tryptophan, Phenilalanine

223

Basic/Positive AA's

Shallow HAL is positive - Hystidine, Arginine, Lysine

224

Acidic/Negative AA's

Glutamate, Aspartate

225

Hydrophilic uncharged AA's

Come, Take My GAS! - Cysteine, Threonine, Methionine, Glutamine, Asparaine, Serine

226

When is Arginine essential?

During + nitrogen balance

227

Non-lactose fermenting, Oxidase negative organism in Sickle Cell Osteomyelitis

Salmonella

228

Oxidase Positive bugs

Vibrio, Pseudomonas, Campylobacter, Helicobacter, Neisseria, Moraxella, Legionella

229

Main virulence factor of S aureus in osteomyelitis

Adhesion to collagen

230

Apo E4 predisposes to

Late-onset familial Alzheimer's

231

Hypertrophic CM trait

AD - Beta myosin heavy chain

232

MOA and use of Dezrazoxane

Iron chelating agent to prevent cardiotoxicity from Anthracyclines

233

Location of 5-HT3 receptors implicated in chemo n/v

Peripherally in presynaptic nerve terminals of vagus in GI, Centrally in CTZ and Solitary nucleus/tract

234

Loop diuretics stimulate release of

Prostaglandins --> incr renal BF

235

Most common benign tumor of breast

Fibroadenoma (<35, often bilateral, cyclinc)

236

Fibroadenoma histology

Cellular, often myxoid stroma that encircles and sometimes compresses epithelium-lined glandular and cystic spaces

237

Function of vWF

Platelet adhesion by crosslining GpIb with exposed collagen underneath damaged endothelium

238

Secondary role of vWF

Carrier protein for factor VIII

239

Proteins C and S act to inactivate

V and VIII

240

Thrombin is produced from Prothrombin by

Activated Factor X

241

Growth Hormone binds to a __ receptor

JAK-STAT

242

Lecithin-Sphingomyeline Ratio is a marker for

Lung maturity (>1.9 = mature)

243

Mechanism of methicillin resistance

Alterations in PBP2a (also affects cephalosporins)

244

Immunity to reinfection by influenza is mediated by

Circulating antibodies against Hemagluttinin

245

Tumor originating from collecting duct cells

Renal Oncocytoma

246

Transitional cell tumors of pelvis are often what morphology

Papillary

247

Niacin-induced flushing is mediated by

Prostaglandins

248

___ reduces pain by decreasing level of substance p in PNS

Capsaicin

249

Clinical uses of Valproate

Anticonvulsant (absence, myoclonic, grand mal) AND mood stabilizer (acute mania, bipolar)

250

Anticonvulsants used as mood stabilizers in bipolar

Valproate, Carbamazepine, Lamotrigene

251

Carbamazepine indications

Trigeminal Neuralgia, Manic episodes, Partial and generalized seizures

252

MOA and use of Olanzapine

second gen antipsychotic

253

QT interval reflects

Myocyte AP duration

254

Two congenital syndromes that cause QT prolongation

1. Jervell Lange-Nielson (AR, neurosensory deafness); 2. Romano-Ward (AD, no deafness)

255

Mutations affecting cardiac cell cytoskeletal proteins or mitochondrial enzymes of ox phos are though to cause

Genetic Dilated CM's

256

Mutations of calcium-binding SR protein might underly

Arrhythmogenic RV Cardiomyopathy --> Progressive fibrofatty replacement of RV

257

Extramedullary hematopoesis is most frequently associated with

Chronic Hemolytic Anemias (eg beta thal)

258

Pentazocine

Opioid narcotic designed to produce analgesia with little to no abuse potential (weak antagonist at mu)

259

Short-acting benzos

ATOM - Alprazolam, Triazolam, Oxazepam, Midazolam

260

Long-acting benzos

Choose Carefully Due to Falls - Chlordiazepoxide, Chlorazepate, Diazepam, Flurazpam

261

Malabsorption, Diarrhea, PAS-positive granules in intestinal macrophages

WHIPPLES DISEASE - Tropheryma whippelii

262

Recurrent infections with Strep pneumo, H flu, and Moraxella indicate

Humoral immunodeficiency

263

Pneumocystis and chronic mucocutaneous candidiasis indicate

T cell deficiency

264

Immotile cilia syndrome presents in newborn period with

Respiratory distress --> Recurrent Otitis Media, Bronchitis, Sinusitis (opprotunistic infections like PCP unusual)

265

Agammaglobulinemia means susceptible to

Extracellular, encapsulated bacteria

266

Exchange of viral dna in coinfection by non-segmented viruses

Recombination

267

Viral phenotypic mixing

Coinfection leads to one virus with nucleocapsid protein from another

268

AE's of TZD's

Weight gain, edema, CHF

269

Damage to the Caudate is associated with

Transient hemiparesis and frontal lobe symptoms such as inattentiveness, abulia, forgetfulness

270

Compression fracture in elderly woman --> Calcium and PTH?

Normal

271

Driver of respiratory function in COPD vs normal

pO2 in COPD vs pCO2 normally --> Supplementary O2 in COPD will lead to respiratory suppression and coma

272

Main toxin of C perf

Lecithinase (phopholipase C, alpha toxin)

273

Insular cortex is associated with

Integrating body states w/ emotions (limbic); ANS control; Conscious experience of visceral sensations

274

Damage to internal vs external Globus Pallidus

Internal --> Excessive movement; External --> Decreased

275

Role of D arm of tRNA

Dihydrouracil residues --> Helps facilitate correct tRNA recognition by proper Aminoacyl tRNA synthetase

276

Role of T arm of tRNA

Binding tRNA to ribosomes

277

Only RNA that contains thymidine

T RNA

278

NE to Epinephrine requires

SAM - PNMT enzyme

279

BH4 is required for synthesis of

Tyrosine, DOPA, Serotonin, Prolactin

280

Winter's Formula

PaCO2 = (1.5*HCO3) + 8 +/- 2

281

Media for growing V cholerae

Alkaline - extremely acid sensitive organism

282

Mechanism of hepatocyte damage in Hep B

CD8 response to viral antigens on cell surface

283

Regulatory HIV genes required for replication

Tat, Rev

284

Structural HIV genes

Gag, Pol, Env

285

Products of Gag, Pol, Env genes in HIV

Gag - p24, p7; Pol - RT, Integrase, Protease; Env - gp120, gp41

286

Function of HIV nef gene? Rev? Tat?

Nef - Downregulate CD4 and MHC 1; Rev - Transport of unspliced viral transcripts out of nucleus; Tat - Protein that transcriptionally activates other viral genes

287

Features of Colitis-associated CRC vs sporadic

(1) younger; (2) Flat or non-polypoid dysplastic precursor; (3) Mucinous and/or signet ring morphology; (4) early p53 and late APC - opposite of sporadic; (5) proximal colon; (6) Multifocal

288

MOA of Varenicline

Partial agonist at nicotinic ACh receptor

289

Pentamidine is used for

Prophylaxis and tx of PCP

290

Nifurtimox is used for

Chagas treatment

291

Normal alveolar pO2

104 mmHg (if higher, poor perfusion)

292

When is O2 equilibration diffusion-limited

Emphysema, Fibrosis, Very high blood flow (ie exercise)

293

A, I, and H bands

A is thick myofilament, I is Actin only, H is Myosin only

294

Pharmacodynamic Drug Antagonism

Drug can antagonize or prevent effect of another drug or endogenous substance

295

Pharmacokinetic drug interaction

eg CYP inducers

296

Treatment of recurrent C diff colitis

Fidaxomicin

297

MOA of Fidaxomicin

Inhibits sigma subunit of RNA polymerase; Less effect on normal flora; Poor oral

298

Most common cystic fibrosis mutation and result

dF508 --> Impaired post-translational processing and results in proteasome degradation

299

AA's with three titratable protons

Acidics, Basics, CT = Glutamate, Aspartate, Histidine, Arginine, Lysine, Cysteine, Tyrosine

300

Salicylate acid base disorder

(1) Rapid respiratory depression causing alkalosis; (2) A few hours later metabolic acidosis

301

Effect of ANP on kidney, Adrenals, BVs

Dilates afferent arterioles, Inhbitis Na reabsorption, Restrict aldosterone secretion, cGMP-mediated veno- and arteriodilation

302

Type of MI usually associated with Bradycardia

Inferior - SA/AV nodal branch block

303

ANS drug that can cause Glaucoma

Atropine --> Midriasis --> Narrowing of anterior chamber

304

Anti-mitochondrial Ab's

Primary biliary cirrhosis

305

Anti-Smith Ab's

Anti-snRNP = Specific for SLE

306

Rapid atrophy and shrinkage of liver on autopsy

Halone-induced liver failure

307

Shortest half life pro-coagulant factor

Factor VII (PT)

308

What enzyme produces urea in Urea cycle

Arginase (Arginine --> Urea + Ornithine)

309

Excessive amounts of Orotic acid are usually found in

OTC deficiency, Citrullinemia, Arginosuccinate aciduria

310

Low levels of C1 esterase inhibitor

Hereditary Angioedema

311

Mechanisms of C1 esterase inhibitor

Inhibit C1 --> Activated C1; Inactivates Kallikrein (which converts Kininogen to Bradykinin)

312

16S rRNA function

Component of 30S subunit --> Expresses sequence complementary to Shine-Dalgarno in all prokaryotic mRNA

313

23S rRNA function

Peptidyltransferase - Peptide bond formation

314

Pontiac Fever

Legionella --> Acute, flu-like, self-limited disease

315

Features of Legionnaire's Disease

Recent expsoure to contaminated water, Pneumonia, High Fever; Sometimes GI, Relative bradycardia, neurologic

316

Most common lab finding in Legionnaire's

Hyponatremia

317

Bilateral ACA occlusion

LE motor, Behavioral (abulia), Urinary incontinence

318

Spread of H flu vs N meningitidis to meninges

H flu uses lymphatics, N men is hematogenous, Both from Pharynx

319

MOA of Organophosphates

AChE inhibitors

320

Bromoacetylcholine MOA

Inhibits Choline Acetyltransferase

321

Nicotininc receptor antagonists

Pancuronium, Tubocurarine

322

Hemicholinium MOA

Choline import into presynaptic terminal

323

Train of Four seen in Non-depolarizing blockade

eg Tubocurarine - Slanted within group, Group increases each 4

324

Train of Four seen in Depolarizing blockade

Equal within group, Group increases each four (phase 1) --> Resembles slanting of non-depolarizing in phase 2

325

Neostigimine in Phase 1 vs 2 of Succinylcholine NMB

Augments blockade in Phase 1, Reverses it in Phase 2

326

Duration of Succinylcholine action depends on

Diffusion out of NMJ and metabolism by plasma cholinesterase

327

Nitrate with best bioavailability

Isosobide Mononitrate

328

Hep B Window Period

Time lag betwee HBsAg disappearing and Anti-HBs appearing

329

Most specific marker for diagnosis fo acute Hep B

Anti-HBc IgM --> Present in window period

330

Vitamin E deficiency manifestations

Neuromuscular disease (myopathy, ataxia, pigmented retinopathy, dorsal column) and Hemolytic anemia

331

Vitamin E primarily serves to

Protect fatty acids from oxidation --> Neurons and erythrocytes most susceptible

332

Vitamin C excess

Nausea, Abdominal pain, Diarrhea, Stones

333

Physostigmine vs Neostigmine and Edrophonium

Neostigimine and Edrophonium are Quaternary Amines and can't cross BBB

334

Tarry stool and fatigue are seen with what CT agents

Alkylating agents (upper GI bleed)

335

Abdominal pain and jaundice may be seen with what CT agent

Mercaptopurine (cholestasis and hepatitis)

336

Flagellate skin discoloration is seen with what CT agent

Bleomycin (along with pulmonary fibrosis)

337

Nitroblue Tetrazolium testing

Properly functioning PMNs produce ROS that reduce yellow NBT to dark blue formazan that precipitates within the cells

338

DHR flow testing

NADPH oxidase shows decr fluorescence

339

NBT and DHR testing in MPO deficiency

Normal

340

Pyruvate kinase deficiency is a common cause of

Chronic Hemolytic Anemia

341

Ortner Syndrome

Mitral Stenosis --> LA enlargement --> Impingement on Recurrent Laryngeal N

342

Location of Glut-2

Regulation of Insulin Release --> Hepatocytes, Beta cells, Renal tubular cells, Small intestine

343

Location of Glut-3

Placenta, Neurons

344

What is commonly found regarding uterus on vaginal vaginal examination in Endometriosis

Nodularity of uterosacral ligaments, Fixed retroversion of uterus

345

Ectopic endometrial tissue secretes

PG's --> Interfere with ovulation and tubal function --> Infertility

346

Adenomyosis

Presence of endometrial glands w/in uterin myometrium (presents with bleeding, painful menses, and enlarged uterus unlike endometriosis)

347

When to give Ribavirin with RSV?

Confirmed, severe RSV at risk for dz progression (immunodeficiency, prematurity, cardiopulmonary disease)

348

Mechanism of Shiga-like toxin

AB - A subunit prevents binding of tRNA to 60S ribosomal subunit

349

Bactrim is drug of choice for

Pneumocystis jiro, Toxoplasma, Nocardia

350

Hyoscyamine

Anti-muscarinic to counteract AChEi in Myasthenia Gravis

351

Side effects of Thiazide Diuretics

Hyper Glycemia Lipidemia Uricemia Calcemia

352

Medication-induced fat redistribution

Corticosteroids, HAART (Protease inhibitors)

353

Chronic Eosinophilic Bronchitis in asthmatics involves

Bronchial wall infiltration by numerous activated eosinophils in response to IL-5 by allergen-activated TH2 cells

354

Class 3 Anti-arrhythmics

Amiodarone, Ibutilide, Dofetilide, Sotalol

355

Which vitamin supplement should be given to child with Measles

Vitamin A - Reduces time to recovery from pneumonia and diarrhea, as well as risk of death

356

Which HIV drug to give to pregnant women

Zidovudine

357

Protein secondary structure is due to

Hydrogen bonds (Tertiary due to ionic bonds, hydrophobic interactions, hydrogen bonds, and disulfide bonds)

358

E coli aquired ability to form pili via

Conjugation

359

Strep pneumo aquired capsule via

Transformation

360

Function of Thyroid Peroxidase

Oxidize inorganic iodide to organic iodine; Formation of monoiodotyrosine and diiodotyrosin; Coupling of these to iodotyrosines

361

Lab studies in HUS

Only bleeding time elevated

362

Bacitracin MOA

Prevents mucopeptide transfer into growing cell wall

363

Trimpethroprin, Methotrexate, and __ inhibit DHFR

Pyrimethamine

364

Important Bactrim AE's

Hyperkalemia, Megaloblastic Anemia

365

Serotonin Syndrome effects

HARM - Hyperthermia, ANS instability, Rigidity, Myoclonus

366

Drugs that precipitate Serotonin Syndrome

TTYL - Tramadol, Triptans, trYcyclics, Linezolid

367

Features of Myotonic Dystrophy

Frontal balding, Gonadal atrophy, Arrhythmia (My toupe, my testicles, my ticker); sustained grip, type 1 fiber loss

368

Most important signalers in Coronary autoregulation

Adenosine, NO

369

What causes NO release in coronaries

Pulsatile stretch, Flow shear stress

370

What subtype not stimulated by NE

Beta 2

371

Skeletal Muscle Depolarization -->

L-type channel-RyR mechanical coupling (no significant flux of Ca across L-type Ca channel) --> RyR1 opening --> Binds Troponin C

372

Cardiac Muscle Depolarization -->

L-type Ca influx on PM --> RyR2 opening

373

Smooth Muscle Depolarization -->

v-gated L type Ca influx --> Calmodulin (no troponin) --> Myosin light chain kinase --> P-lation of myosin

374

Nonselective beta blocker with a1 blocking activity

Labetolol

375

Systemic sequelae with Diphtheria

Myocarditis, Heart Failure, Neurotoxicity

376

EKG leads for LAD

V1-V3

377

Type 3 collagen is found in

Granulation tissue, Skin, Lungs, Blood vessels

378

Bell vs Diaphragm

Bell = Low freq; Diaphragm = High

379

S3 on end expiration

More audible, Heart closer to chest wall

380

Localized amyloidosis confined to cardiac atria

ANP-derived (elderly)

381

Prolyl Hydroxylase -->

Proline on Procollagen --> Stable triple helix

382

Lysyl Hydroxylase -->

Stronger

383

Bepridil

CCB - Second line anti-anginal drug

384

Loud P2 =

Pulmonary hypertension

385

Kussmaul =

Paradoxical rise in JVP during inspiration

386

Don't use DPH-CCB with

Acute Coronary Syndrome (reflex tachycardia)

387

Digoxin toxicity

Hyperkalemia, Vision, N/V/D

388

Afib with RVR: tx -->

CCBs, BBs, then Digoxin second line

389

Lidocaine is for what arrhythmias

Ventricular, not Atrial

390

Mechanism of Fibrates

Peroxismal Proliferator-Activated Receptor Alpha --> LPL activity increase --> Decr TB, Raise HDL

391

How do assess severity of Mitral Regurg

Presence of S3 gallop

392

Defect in Chediak-Higashi

Phagosome-Lysosome fusion --> Recurrent pyogenic infections with Staph and Strep

393

Features of Chediak-Higashi

Immunodef, Albinism, Neurologic (nystagmus, cranial neuropathies)

394

Phosphorylation of NRTI's vs NNRTI's

NRTI's must be phosphorylated

395

Most important mechanism of lead poisoning

Affinity for sulfhydryl groups --> Inhibition of d-ALA dehydratase and ferrochetolase

396

Formation of d-ALA

Succinyl-CoA and Glycine via Pyridoxal Phosphate cofactor

397

Cause and manifestation of acute serum sickness

Type 3 (IC deposition) --> Fever, Pruritic skin rash, Arthralgias, Fibrinoid necrosis, Hypocomplementemia

398

Serum sickness can be caused by

Chimeric monoclonal Ab's, Nonhuman Ig's, Nonprotein drugs (eg penicillin, cefaclor, bactrim)

399

Osteolytic phase of Paget's is due to excess

RANK signaling, NFKB activation

400

Pattern of bone in Osteoblast phase of Paget's

Dense, hypovascular, mosaic pattern of lamellar bone with irregular, haphazardly oriented sections separated by prominent cement lines

401

What stimulates Inhibin B secretion

FSH stimulation of Sertoli cells

402

MOA of trihexyphenidyl

centrally-acting anti-muscarinic

403

Anti-cholinergics such as benztropine and trihexyphenidyl should be avoided in elderly patients, esp with

BPH, Angle-Closure Glaucoma

404

S-100 protein function

Homodimeric calcium-binding proteins, important for protein p-lation, cell growth, and differentiation

405

S-100 marks what cells

Neural Crest (melanocytes, Schwann), Langerhans and other dendritic

406

DLCO depends on

Thickness and total SA of alveolar capillary membrane, Hematocrit, Total volume of pulmonary capillary blood

407

DLCO in emphysema vs chronic bronchitis

Reduced in Emphysema, Normal in CB

408

Mechanism of Bohr effect

CO2 --> H+ and HCO3+ --> H+ binds histidine side chains of Hb --> Stabilize deoxygenated form of Hb

409

What happens to H+ and HCO3 in RBC from CO2

H+ binds Hb; HCO3 exchanged for Cl (Cl enters)

410

Which step of Glycolysis utilizes NAD+

G3P --> 1,3-BPG

411

When is FADH2 produced

During conversion of succinate to fumarate

412

Synthesis of Carnitine

Lysine + Methionine via Vit C cofactor

413

Citrate is formed from

Condensation of Acetyl CoA w/ OAA

414

Heart Failure definition

(1) Cannot pump enough blood to meet demand; or (2) Can onliy do so from elevated ventricular filling pressure

415

Diarrhea in pellagra results from

Columnar epithelium atrophy

416

NAD functions as a coenzyme for

Dehydrogenases involved in metabolism of fats, carbs, and amino acids

417

Niacin can be synthesized endogenously from

Tryptophan

418

Populations that primarily subsist on __ are prone to developing pellagra

Corn (niacin in corn is bound and unabsorbable)

419

Pellagra is less commonly seen in what patient populations

Carcinoid, Prolonged INH, Hartnup (more commonly in alcoholics and chronic disease)

420

Arginine is a precursor of

NO, Urea, Ornithine, Agmatine, Creatine

421

Orotic acid is a precursor of

Pyrimidine

422

Ab-dependent cellular cytotoxicity is defense against

Virus, Parasite

423

Function of MPO

Hypochlorite from H2O2 and Chlorine

424

Testicular feminization syndrome =

Complete Androgen Insensitivity = Absent Wolffian and Mullerian structures

425

Pulmonary hypertension is usually found in patients with

Scleroderma

426

H1 receptors are found in

Vascular endothelium, Bronchial smooth muscle

427

5 important classes of meds with Anti-muscarinic effects

Atropine, TCA's, H1 blockers, Neuroleptics, Anti-Parkinson - NATHA

428

MOA of Ribavirin

Nucleoside antimetabolite - (1) Lethal hypermutation, (2) Inhibit RNA polymerase and IMP DH (depleting GTP), (3) Defective 5'-cap formation on viral mRNA, (4) Modulating a more effective immune response

429

Bone turnover is regulated by ratio of

RANKL to OPG - incr when RANK-L high and OPG low

430

How does PTH activated Osteoclasts

Stimulates Osteoblasts to upregulate RANKL and secrete M-CSF --> Osteoclast maturation

431

Function of Osteoprotegrin

Decoy RANK-L receptor

432

Arachnodactyly, Scoliosis, and Aortic Root Dilatation are signs of

Marfan

433

Macroorchidism, Large Jaw, and Intellectual disability are signs of

Fragile X

434

Top 3 causes of meningitis in neonates

GBS, E coli, Listeria

435

Courses between Biceps brachii and Coracobrachialis

Musculocutaneous

436

Courses between Flexor Carpi Ulnaris and Flexor Digitorum Profundus in forearm

Ulnar

437

Courses between Flexor Digitorum Profundus and Flexor Digitorum Superficialis

Media N

438

Substrate for PRPP synthetase

Ribose-5-Phosphate

439

Gout occurs with increased frequency in patients with activating mutations of

PRPP Synthetase

440

First line for Acute Gouty Arthritis

NSAIDs (Colchicine second)

441

How does pregnancy affect gallstones?

Estrogen-induced cholesterol hypersecretion (HMG CoA Reductase); Progesterone reduces bile acid secretion and slows gallbladder emptying

442

Fluid-filled cavitiy in liver + Fever, Chills, RUAbdominal Pain

Most likely bacterial abscess in developed nation

443

Pyogenic bacteria most commonly gain access to liver via

Biliary tract, Portal vein pyema, Hepatic artery

444

How does RBC carry CO2

15% as carbamate on Hb, Remained as bicarb ion w/in RBC

445

Diuretic often used in management of Cerebral edema and Incr ICP

Mannitol

446

Overaggressive treatment with osmotic diuretic therapy

Excessive volume depletion and eventual hypernatremia

447

Osmotic diuretics should be used cautiously in what patients

CHF, Pre-existing pulmonary edema

448

Spironolactone side effects

Hyperkalemia, Gynceomastia, Decr libido, Erectile dysfunction

449

The risk of statin myopathy is increased when

Fibrates and/or Niacin also used

450

Drugs that can cause myopathy

SGFC PHIN - Statins, GC's, Fibrates, Colchicine, Penicillamine, Hydroxychloroquine, IFNa, Niacin

451

MOA of Fenodolpam

Benazepine derivative of DA --> Selective DA-1 agonist with no effect on alpha or beta receptors

452

Stimulation of DA receptors in kidneys

Improves RBF and Na and Water excretion

453

Fenoldopam is indicated for

Short term management of severe HTN

454

Use and risk of Nitroprusside

Most effective agent for most cases of HTN emergency --> Cyanide toxicity

455

Vimentin is a marker for

Mesenchyme

456

Chromogranin A

Neuroendocrine tumors

457

Imperforate anus is most commonly associated with

GU malformation - VACTERL (vertebral, anal atresia, cardiac anomalies, TE fistula, esophageal atresia, renal anomalies, limb anomalies)

458

Fibrinous pericarditis is most commonly caused by

MI, RF, Uremia; Also viral

459

Pericardial knock

Brief, high frequency, precordial sound heard shortly after S2 in constrictive (chronic) pericarditis

460

Heme in the liver is synthesized for

CYP450 system

461

Acute Intermittent Porphyria can be precipitated by

Phenobarbital, Griseofulvin, Phenytoin, Low calorie diet, Alcohol --> All decr hepatic heme --> Incr ALA synthase activity

462

Heme synthesis enzymes inhibited by lead

ALA dehydratase, Ferrochetolase

463

Influenza vaccine induces

Neutralizing antibodies against Hemagglutinin

464

Why don't killed vaccines stimulate CD8 response

They don't enter host cell for MHC Class 1 presentation

465

Sensory nerve to parietal pleura

Phrenic to Diaphragmatic and Mediastinal; Intercostal to remainder

466

Superficial Inguinal Nodes drain

Nearly all cutaneous lymph from umbilicus to feet, including external genitalia and anus

467

Lymph from Glans penis and cutaneous portion of posterior calf drain into

Deep inguinal lymph directly (bypassing superficial)

468

Effect of cyanide poisoining

Inhibits cytochrome C oxidase - SaO2 of venous blood increases due to failure of oxygen unloading

469

Crescents of RPGN are composed of

Proliferated glomerular parietal cells, Monocytes, Macrophages, Fibrin

470

Inactivated HFE increases iron by

(1) Incr DMT1 on enterocytes; (2) Decr hepcidin --> Incr ferroportin expression

471

Atypical antipsychotics most and least likely to cause EPS

Clozapine least likely, Risperidone most likely

472

Top 3 risk factors for Coronary Heart Disease

Noncoronary Athersclerotic Disease, Diabetes Mellitus, CKD

473

Pineal Tumors most commonly cause

Parinauds, Precocious puberty, Obstructive hydrocephalus

474

Short acting insulins

Lispro, Aspart, Glulisine

475

When to use regular insulin

DKA

476

What accounts for delayed onset of regular insulin

Dimer and hexamer formation (short acting are monomers)

477

NPH insulin works by

Crystalline suspension with protamine and zinc --> Delays absorption

478

Detemir insulin works by

FA bound to lysine --> Binds albumin and slowly dissociates

479

MAOi's

MAO Takes Pride In Shanghai = Tranylcypromine, Phenelzine, Isocarboxazid, Selegline (B selective)

480

SSRI's

Flashbacks Paralyze Senior Citizens = Fluoxetine, Paroxetine, Sertraline, Citalopram

481

SNRI's

Venlafaxine, Duloxetine

482

How quickly after ischemia does loss of contractility occur in cardiomyocytes?

60 seconds

483

At what timepoint is myocardial ischemia irreversible

30 minutes

484

Ligands for Receptor Tyrosine Kinase vs JAK/STAT

Growth Factors bind RTKs; JAK/STAT bound by Cytokines, Growth Hormone, Prolactin, IL-2, EPO

485

Microscopy of Membranous Glomerulopathy

LM - Mesangial proliferation; IF - Ig and C3; EM - Spike and Dome

486

T-ALL is most likely to present

Anterior Mediastinal mass that compresses great vessels and esophagus

487

EKG progression of Acute Transmural Infarct

Peaked T waves --> STE --> Q waves

488

Imaging in Gallstone Ileus shows

Intestinal gas (obstruction), Air in biliary tree

489

Boerhaave Syndrome

Transmural tear (vs Mallory Weiss which is mucosal)

490

Cricopharyngeal motor dysfunction occurs due to

Diminished relaxatin of pharyngeal muscles during swallowing

491

Renal consequences of Ethylene Glycol ingestion

Oxalate crystals, Tubular epithelial damage (ballooning and vacuolar degeneration mostly in PCT)

492

FA vs Glucose oxidation in ATP generation and O2 use

FA oxidation produces more ATP, but uses more O2 per ATP

493

Receptor mediating Mydriasis

Alpha 1

494

Receptor mediating uterine relaxation

Beta 2 (tocolysis = Terbutaline, Ritodrine)

495

Mom and infant sequelae of rubella

Mom = Polyarthritis/Polyarthralgia; Infant = Sensorineural deafness, Cataracts, Cardiac malformations (PDA)

496

Intracellular pyrophophate granules in a bug

C diph (methylene blue staining)

497

Conus Medullaris Syndrome

L2 lesion = Flaccid paralysis of bladder and rectum, impotence, saddle anesthesia

498

Cauda Equina Syndrome

Radiating back pain, Saddle anesthesia, Loss of anocutaneous reflex, Bowel and bladder dysfunction, Loss of ankle-jerk reflex w/ plantar flexion weakness