UWorld Incorrects

Question 1

What is the antidote for severe Serotonin Syndrome?

Answer 1

Cyproheptadine: 1st gen Antihistamine with nonselective serotonin antagonist (5-HT1 and 5-HT2)

Question 2

How can you inhibit a shorter growth spurt in a child who is female who has Idiopathic precocious puberty?

Answer 2

Inhibit estrogen effects on long bone epiphyseal plate.

Question 3

Describe Strep Agalactiae (GBS)
5 points

Answer 3

• Catalase negative
• beta hemolytic
• PYR negative (Pyrrolidony Arylamidase)
• CAMP positive (Christie, Atkins and Much- Petersen test)
• Causes neonatal sepsis, meningitis, UTI

Question 4

Describe the E Coli virulence factor: P. Fimbriae

Answer 4

• allows adhesions to urothelium
• Presents as UTI

Question 5

Gram negative bacilli, cannot ferment lactose, is not oxidase-positive, and can produce H2S:

Answer 5

Proteus and Salmenella

Question 6

Gram negative bacilli, slow lactose fermenter:

Answer 6

Citrobacter and Serratia

Question 7

Describe Strep Viridans

Answer 7

• Catalase negative
• Alpha- hemolytic (partial green hemolysis)
• Optochin-resistant
• Bile insoluble
• Found in dental carries
• Responsible for subacute endocarditis

Question 8

Describe Strep Pneumoniae

Answer 8

• catalase negative
• optochin- sensitive
• bile soluble
• alpha hemolytic (partial green hemolysis)
• causes meningitis, otitis media, Pneumonia, Sinusitis

Question 9

Describe Strep Pyogenes (GAS)

Answer 9

• catalase negative
• beta hemolytic
• PYR positive (Pyrrolidonyl Arylamidase)
• Bacitracin Sensitive
• Causes Scarlet fever, Rheumatic fever, and PSGN

Question 10

Describe Enterococcus

Answer 10

• Catalase negative
• Gamma hemolytic
• Growth in Bile and 6.5% NaCl
• causes UTI, Cholecystitis, and subacute endocarditis

Question 11

Describe Strep Gallolyticus
5 points

Answer 11

• catalase negative
• gamma hemolytic
• growth in bile, not in NaCl
• PYR-Negative
• responsible for Bacteremia associated with colorectal cancer

Question 12

Describe the features of MHC II:

Answer 12

Structure: Alpha and Beta polypeptide chains
Location: APC’s (B-cells, macrophages, dendritic cells, langherans cells)
Type of Ag: Bacterial from lysosomes.
Antigen Presentation: Activates TH cells, when stimulated results in the humoral and cell-mediated immune response.

Question 13

Describe the erythematous childhood rash: German Measles (Rubella)

Answer 13

• Caused by Rubella Virus ( Enveloped, ssRNA positive sense, Togaviridae family, Rubivirus genus)
• Clinical presentation: Maculopapular rash starting on head, progressing to trunk and extremities, also occipital and post-auricular lymphadenopathy.
• Complication: Congenital Rubella Syndrome

Question 14

Dermatology Pathology:
Describe the Erythamatous rash in childhood: Roseola Infantum

Answer 14

• Caused by HHV 6 (Enveloped dsDNA, Icosahedral shape, Herpesviridae family)
• High fever for 3-5 days with rash after fever subsides. Macules and papule initially at truck that spreads to extremeties.
• Complications are self limited.

Question 15

Describe Actinomyces Israelli

Answer 15

• gram positive bacterium that grows in filaments.
• causes a cervicofacial infection that slowly evolves into multiple abscesses and draining sinus tracts with yellow “sulfur” granules.
• Histopath: chronic inflammatory granulation tissue surrounding dense fibrosis.

Question 16

Describe Statin Myopathy:

Answer 16

Myocyte Necrosis caused by increase concentration of Statin drugs, mostly due to Cyp450 inhibition. Severe cases rhabdomyolysis and AKI (elevated BUN and creatinine), dark urine.
Cyp450 inhibitors: Cyp3A4
- Non-dihydropyridine CCBs: Verapamil, diltiazem.
- Macrolides: Erythromycin, Clarithromycin.
- Protease Inhibitors: Ritonavir, Soquinavir)
- OATP inhibitors: Cyclosporine
- Corticosteroids, Fibrates, Colchicine, Ketoconazole
Statin of choice to prevent this is Pravastatin.

Question 17

Describe Lichen Planus

Answer 17

Clinical findings:
- 5 ‘p’s’: pruritic, purple/pink, polygonal, papule, plaques
- Lacy, white network (Wickman Striae)
- Locations: Skin (e.g. wrist, ankles), oral mucosa/white papule and plaques and erythema, (mucosal cetrophy ulcers), Geritalia
*Path. findings: Hyperkeratosis, Lymphocytic interface dermatitis, Eosinophilic colloid (civatte) bodies, thickened stratum granulosum, sawtooth ridges Rete
*Hx: Chronic symptoms. Form. of Lesions at sites of trauma (Köbner phenom.) Resolve 2 yr. Mucosal recur./persist.

Question 18

Describe the pathway of CSF

Answer 18

• Lateral Ventricles
• Interventricular foramina of Monro
• 3rd Ventricle
• Cerebral aqueduct of Sylvius
• 4th Ventricle
• Lateral foramina of Lusaka or midline of Magendie
• Subarachnoid space

Question 19

Describe Syringomyelia:

Answer 19

• Formation of a cavity (syrinx) in the cervical region of the spinal cord.
• The syrinx damages the ventral white commissure, leading to BL loss of pain and temperature of the affected levels (typical arms and hands), distal sensation is preserved.
• Destruction of ventral horns results in flaccid paralysis and atrophy of the intrinsic muscles of the hand.

Question 20

Describe Aplastic Anemia:

Answer 20

-Pathogenesis: Multipotent hematopoietic stem cells destroyed by cytotoxic T cells or direct cytotoxic injury –> bone marrow aplasia/hypoplasia –> lack of circulating peripheral blood cells.
*Common triggers: Autoimmune, drugs: cytotoxic chemotherapy, immunosuppresants, idiosyncratic reactions. Ionizing radiation and toxins. Viral infections (eg. viral hepatitis, HIV)
*Manifestations: anemia, thrombocytopenia, leukopenia.

Question 21

Describe pure red cell aplasia:

Answer 21

Rare form of bone failure characterized by severe anemia with reticulocytopenia and morphologically normal platelets and leukocytes. Most common with Thymoma, Lymphocytic leukemia, and parvovirus B19 infection.

Question 22

Describe IgA Vasculitis (Henoch-Schönlein purpura):

Answer 22

*Pathogenesis: Deposition of IgA immune complex in small vessels
- activates compliment.
- Neutrophillic inflame and vascular damage.
- often follows a URI
*Clinical Manifestations:
- Palpable purpura/petichiae on the lower extremities and
buttocks.
- Arthritis/arthralgia, abdominal pain, GI bleed intersusception,
renal disease (hematuria w/ w/o protein)
*Dx: Usually clinical
- Skin Bx: Leukoclastic vasculitis, IgA deposition in vessel walls

Question 23

List the anomalies associated with Trisomy 21:

Answer 23

• Neuro: Intellectual disability, Early onset Alzheimer Disease
• Cardiac: Complete AV Septal Defect, VSD, ASD
• GI: Duodenal Atresia, Hirschsprung Disease
• Endo: Hypothyroidism, T1DM, Obesity, Short Stature
• Oncologic: Acute Leukemia (ALL)
• Orthopedic: Atlantoaxial instability

Question 24

Describe Hereditary Angioedema:

Answer 24

• Recurrent episodes of cutaneous or mucosal swelling due to C1
  inhibitor deficiency.
• C4 levels are low due to inhibited cleavage of C4 by excess activated
  C1
• Elevated bradykinin causes vasodilation and increase vascular
  permeability resulting in edema.

Question 25

Describe how chronic pancreatitis cause vitamin B12 deficiency: What are the symptoms of chronic pancreatitis?

Answer 25

- Decreased production of pancreatic proteolytic enzymes (exocrine insufficiency), needed to release vitamin B12 from the R protein. - Symptoms: chronic epigastric pain, weight loss, and steatorrhea

Question 26

Describe Alkaptonuria:

Answer 26

- Autosomal Recessive - Deficiency in Homogentisic Acid Deoxygenase, involved in tyrosine metabolism - Excess homogentisic acid causes black-blue deposits in connective tissues => sclerae and ear cartilage hyperpigmentation and osteoarthropathy of the spine and large joints

Question 27

What are the triggers for Reactive Arthritis?

Answer 27

*Preceding infection: - GU: Chlamydia trachomatis - GI: Salmonella, Shigella, Yersinia, Campylobacter, Clostridiodes difficile *MSK: Asymmetric Oligoartitis, Enthesitis, Dactylitis. Associated with HLA-B27 *Extraarticular symptoms: Ocular conjunctivitis, anterior uveitis, genital-urethritis, cervicitis, prostatitis, dermal-keratoderma (psoriasis-like bumps), blennorrhagicum, circinate balantis (red flat rash on penis), oral ulcers

Question 28

Describe the Erythematous Childhood rash: Erythema Infectiosum

Answer 28

- Caused by Parvovirus B19 (NE ssDNA) - Malar rash with 'slapped cheek' appearance - Complications: aplastic crisis in sickle cell and immunocompromised patients

Question 29

Describe the Erythematous Childhood rash: Scarlet fever

Answer 29

- Agent: Strep Progenies (GAS) - Sandpaper like rash that begins on the neck and upper trunk and then generalizes. - Associated with fever and sore throat - Complications: Rheumatic fever, glomerulonephritis

Question 30

What comprises the arterial supply of the ureters?

Answer 30

- Renal artery supplies the proximal ureter - Superior vesical artery supplies distal ureter

Question 31

Describe the Erythematous Childhood rash: Measles (Rubeola)

Answer 31

- Agent: Measles virus (Enveloped ssRNA negative sense, Paramyxoviridae family) - Macularpapular rash starting at the head, the spreads to the trunk and extremities. - Rash precedes by cough, coryza, conjunctivitis, and Koplic Spots. - Complications: Bronchopneumonia, Encephalitis

Question 32

Describe the E. coli virulence factor K1 capsular polysaccharide: What can it cause?

Answer 32

- Mechanism: prevents phagocytosis and compliment-mediated lysis - Presents as Neonatal Meningitis

Question 33

What does an increase in acetylcholinesterase on amniocentesis suggest?

Answer 33

Leakage of CSF into the amniotic cavity. Suggestive of an open neural tube defect. Occurs from failed fusion of the edges of the neural plate.

Question 34

List the antibiotics effective against Pseudomonas Aeruginosa:

Answer 34

- PCNs: Ticarcillin, Piperacillin - Cephalosporins: Ceftazidine (3rd gen), Cefepime (4th gen) - Aminoglycosides: Amikacin, Gentamicin, Tobramycin - Fluoroquinolones: Ciproflaxicin, Levofloxacin - Monobactams: Aztreonam - Carbapenems: Imipenem, Meropenem *Hint: Burn patients

Question 35

What is the pathogenesis in Ehlers-Danlos Syndrome?

Answer 35

Defective collagen synthesis due to deficient procollagen peptidase. Impairs removal of N-terminal propeptide.

Question 36

Describe Tuberous Sclerosis:

Answer 36

*Pathogenesis: - Autosomal dominant - TSC1/TSC2 tumor supressor gene mutation => Defective tubers- hemartin complex => unrestricted cellular proliferation Classic finding: - Skin: Ash-leaf spots, facial angiofibromas, Shagreen Patches - Neuro: CNS Hemartomas, Seizures, Intellectual disabilities - Cardiac: Rhabdomyomas - Renal: Angiomylipomas

Question 37

What structures are derived from Endoderm?

Answer 37

- GIT, Liver, Pancreas - Lungs - Thymus, parathyroids, thyroid follicular cells - Middle ear epithelium - Bladder and urethra - Parafollicular (C) cells

Question 38

Describe Pompe Disease:

Answer 38

Type 2 Lysosomal Storage disease *Deficiency in acid alpha-glucosidase - normal glucose levels - severe cardiomegaly - glycogen accumulate in lysosomes

Question 39

Describe the MOA of Azole antifungals:

Answer 39

Blocks fungal enzyme Lanosterol 14-alpha-demethylase (Cyp450 dependent) for Lanosterol => ergosterol conversion. - Mutation in genes => fungal resistance

Question 40

Describe Vitamin E deficiency:

Answer 40

Etiology: - Fat malabsorption: Cystic Fibrosis, pancreatitis, cholestasis - Genetic: abetalipoproteinemia Clinical features: - Hematologic: hemolytic anemia - Neuromuscular: Spinocerebellar tract: ataxia, Dorsal columns: Loss of vibration and proprioception, Peripheral nerves: decreased strength and sensation hyporeflexia. - Muscles: Myopathic weakness *Tx: High dose Vitamin E

Question 41

What would you expect in a patient with aortic regurgitation caused by infective endocarditis?

Answer 41

- Rapid loss of aortic pressure during diastole - Eccentric hypertrophy due to increase EDV - Increase in SV and CO - High amplitude, rapid rise- rapid fall pulsation => widened pulse pressure - Corrigan sign: rapid distention and collapse of carotids - Duroziez sign: 'to-and-fro' bruit appreciated at the Femorals. - Aortic pressure: 160/60; LV pressure: 160/20. -Reduced aortic diastolic pressure and elevated LVDP (diastolic back flow). Aortic and LVSP increased from compensation.

Question 42

Describe Turner Syndrome:

Answer 42

- Loss of a paternal X chromosome (45, XO) - Physical Features: Short stature, broad chest, and webbed neck. May have a narrow, high-arched palate, low hairline, cubits vulgarus (elbows with a weird angle). - Cardiac: Bicuspid AV, Aortic Coarctation in which causes an increased risk of aortic dissection - Renal: Collecting system malformation (Ureter Duplication), Horseshoe kidney (fusion of lower poles) presented as Recurrent UTIs. - Repro: Streak Ovaries (amenorrhea, infertility)

Question 43

Describe the Latissimus dorsi:

Answer 43

- Contributes to forceful movement of the humerus - Innervated from the thoracodorsal nerve (C6-C8) - Extension, adduction, and internal rotation of the humerus - injured from forceful downwards movement of the humerus, throwing, climbing, or swinging

Question 44

Describe Narcolepsy:

Answer 44

DSM 5 Criteria: - Dx: recurrect lapses into sleep or naps (> 3/wk for 3 months) - more than or equal to 1 of the following: *Cataplexy: Brief loss of muscle precipitated by strong emotion (laughter or excitement) * Low CSF levels of hypocretin-1 (orexin-secreting hormone) * Shortened REM latency - Associated features: Hypnagogic/hypnopompic hallucinations, sleep paralysis

Question 45

Describe Pierre Robin Sequence:

Answer 45

*Single developmental defect causes a cascade of additional malformations => micrognathia, glossoptosis (small mandible displaces tongue posteriorly), U-shaped cleft palate (posterior displacement of the tongue prevents palatal fusion)

Question 46

Describe Mucormycosis:

Answer 46

- Opportunistic infection caused by Rhizpus, Mucor, and Absidia species. - Paranasal sinus involvement in DM and Immune suppressed patients. - Broad nonseptate hyphae that branch at right angles

Question 47

What are the primary cells involved in hepatic fibrosis?

Answer 47

- Stellate (Ito) cells - Hepatic injury => stellate cells activated => Myofibroblasts proliferate, promote chemotaxis, and producing lots of collagen. - Masson trichome stain

Question 48

What is equation for relative risk?

Answer 48

RR= (a/a+b)/(c/c+d)

Question 49

Describe the effect of chronic glucocorticoid use on the HPA axis for cortisol:

Answer 49

Decreased Corticotropin Releasing Hormone (CRH) -> Decreased ACTH -> Decreased Cortisol

Question 50

Describe Leishmaniasis:

Answer 50

-Intracellular protozoa with rod-shaped kinetoplasts causing cutaneous lesions. - Endemic in Middle East and Central/South America - Transmitted through bites of infected sand flies - Protozoa mature in macrophages

Question 51

What virus has lifelong latent infection of the sensory ganglia, has periodic viral replication leading to cycling flares that resolve over time?

Answer 51

HSV- Latent infection within neuronal cell bodies.

Question 52

Describe the antipsychotic side effect: Neuroleptic Malignant Syndrome

Answer 52

Fever, rigidity, mental status changes, autonomic instability

Question 53

What structures are derived from the neural tube (ectoderm)?

Answer 53

Brain, spinal cord, posterior pituitary, pineal gland, retina

Question 54

What structures are derived from the surface ectoderm? Mneumonic: A LINE

Answer 54

1. Anterior Pituitary (Rathke pouch) 2. Lens and Cornea 3. Inner ear sensory organs, olfactory epithelium 4. Nasal and oral epithelial lines, salivary glands 5. Epidermis, sweat and mammary glands

Question 55

What is the key feature in congenital HSV?

Answer 55

vesicular/ulcerative rash

Question 56

Describe Congenital Toxoplasmosis:

Answer 56

Infection acquired in utero that can present with hydrocephalus, intracranial calcification, and chorioretinitis due to CNS inflammation

Question 57

Describe Measles Virus (Rubeola)

Answer 57

- Clinical Presentation: Prodrome (Cough, coryza, conjunctivitis, fever, Koplik spots), maculopapular exanthem - Cephalocaudal and centrifugal spread - Spares palms and soles - Complications: - Primary Measles pneumonia - Secondary bacterial infections (pneumonia and otitis media) - Neurologic: Encephalitis (days), Subacute sclerosing encephalomyelitis (weeks), Subacute sclerosing Panencephalitis (years) - Prevention: Live Attenuated Vaccine *Increase risk with Vitamin A deficiency

Question 58

What can a patient develop preceding Panic Disorder?

Answer 58

Agoraphobia: avoidance of multiple situations where they may feel trapped and helpless. Can be dx w/ for w/o panic disorder.

Question 59

Gram negative bacilli, cannot ferment lactose, is not oxidase positive, and cannot produce H2S?

Answer 59

Shigella and Yersinia

Question 60

MSK Anatomy: What are the hip flexors?

Answer 60

1. Rectus femoris (also does knee extension) 2. Iliopsoas 3. Sartorius (also does knee flexion)

Question 61

Drug(s) of choice for HIT?

Answer 61

Direct thrombin inhibitors: Hirudin, Lepirudin, Argatroban. Does not require ATIII.

Question 62

Antidote for Warfarin overdose:

Answer 62

FFP and Vitamin K

Question 63

Antidote for Heparin overdose:

Answer 63

Protamine

Question 64

Homozygous for the apolipoprotein E4 allele. What is the most likely pathology to develop?

Answer 64

Late onset Familial Alzheimer's Disease

Question 65

Describe Transudate Pleural Effusion:

Answer 65

- Light Criteria: Excudate criteria not met - Pathophysiology: Change in hydrostatic or oncotic pressure. - Common causes: Heart failure, cirrhosis (hepatic hydrothorax), nephrotic syndrome

Question 66

What structures are derived form the mesoderm?

Answer 66

- Muscles - connective tissue, bone, and cartilage - Cardiovascular and lymphatic systems - Spleen and hematopoietic cells - Kidneys and ureters, internal ganglia - Adrenal cortex

Question 67

Prolonged exposure to loud noises causes hearing loss due to damage to what?

Answer 67

Stereocilliated hair cells of the organ of Corti

Question 68

Describe the mechanism of action of patiromer?

Answer 68

- Exchanges calcium for potassium in the intestine. Decreases Potassium excreted in the feces. - AE: Diarrhea, hypokalemia, hypercalcemia, and hypomagnesemia

Question 69

Of the respiratory tree, what is the last to disappear?

Answer 69

Cilia, persists up to the respiratory bronchioles.

Question 70

Describe the Abducens Nerve:

Answer 70

- CN VI, innervated Lateral rectus. Function to abduct the eye. - Lesion would cause medial deviation. Horizontal diplopia

Question 71

What are the components of a maternal serum quadruple screen?

Answer 71

AFP, estriol, beta hCG, and inhibin A

Question 72

What conditions cause an increase in Maternal serum AFP?

Answer 72

1. Open neural tube defects (eg, anencephaly, open spina bifida) 2. Ventral wall defects (eg, omphalocele, gastroschisis) 3. Multiple gestation

Question 73

What conditions cause a decrease in Maternal serum AFP?

Answer 73

Aneuploidies (eg, trisomy 18 and 21)

Question 74

Describe the features of fragile X syndrome:

Answer 74

- Pathogenesis: X-linked disorder caused by a trinucleotide (CGG) repeat expansion in the FMR1 gene (fragile X messenger ribonucleoprotein). Repeats with more that 200 causes hypermethylation, which silences the gene and prevents transcription of the associciated ribonucleoprotein. - Physical features: Long, narrow face, a prominent forehead and chin; and large testes. Most apparent after puberty. Hyperlaxity of the joints in the hand can also occur. - Cognitive and Developmental: Developmental delay (speech and motor) common in infancy. Intellectual disability can vary. - Neuropsychiatric: features of ADHD (eg, inattention, impulsivity) and autism spectrum disorder (eg, poor eye contact, social deficits) are common.

Question 75

Vignette mentions a skin nodule that stains dark-blue, basaloid keratinocytes in the dermis with peripheral palisading and cleft formation. Cells are crowded, have scan cytoplasm, and have a high N:C ratio. What is the Dx and what is the most likely outcome?

Answer 75

Dx: Basal cell carcinoma Outcome: Local growth with progressive tissue destruction.

Question 76

Neuroanatomy: List the most common causes of Spinal stenosis: 3

Answer 76

- Intervertebral disc herniation - Ligamentum flavum hypertrophy - Osteophyte formation affecting the facet joints

Question 77

Describe Holoprosencephaly:

Answer 77

- Embryology: Incomplete division of the forebrain (prosencephalon) - Etiologies: Genetic: Trisomy 13, Sonic Hedgehog gene mutations; Environmental: maternal alcohol use, retinoic acid deficiency - Clinical features: CNS abnormalities: range from asymptomatic to seizures, severe intellectual disability, death. Midface abnormalities: range from mild hypotelorism (distance between the eyes) and cleft lip/palate to cyclopean, primitive nose, facial cleft.

Question 78

Describe Permissiveness:

Answer 78

Occurs when a hormone has no direct effect on a physiologic process but allows another hormone to exert its maximal effect on that process. Example: Cortisol exerts a permissive effect on catecholamines to potentiate vasoconstriction and bronchodilation; it also has a permissive effect on glucagon to increase glucose release from the liver.

Question 79

An increase in which of the following features best explains the presence of Target cells?

Answer 79

Increase in Surface area-to-volume ratio. Occurring from either a reduced erythrocyte cell volume from deficient hemoglobin synthesis (thalassemia, iron deficiency) or structural mutation to hemoglobin (eg, sickle cell) Or excessive erythrocyte cellular membrane due to greater cholesterol-to-phospholipid ratios (eg, Obstructive liver disease) or splenectomy.

Question 80

Describe Pappenheimer bodies:

Answer 80

Aggregated iron deposits in erythrocytes that are often seen in patients with sideroblastic anemia. They appear as dark blue inclusions.

Question 81

Describe Howell-Jolly bodies:

Answer 81

Clusters of DNA remnants in erythrocytes due to hyposplenism or asplenism (the spleen usually removes the DNA remnants). They appear as peripheral, round, dark purple, blue, or red inclusions.

Question 82

Describe Heinz bodies:

Answer 82

Aggregates of denatured hemoglobin that may be present in erythrocytes when patients have Glucose-6-phosphate DH deficiency or thalassemia. Cannot be seen on routine screening.

Question 83

Describe Basophilic stippling:

Answer 83

Blue granules dispersed within the cytosol of erythrocytes due to precipitated ribosomes. - thalassemias - alcohol use disorder - lead/heavy metal poisoning

Question 84

Describe the immunosuppressants in transplant patients Cyclosporine and Tacrolimus:

Answer 84

Inhibit calcineurin activation. Calcineurin is an essential protein in the activation of IL-2, which promotes the growth and differentiation of T cells.

Question 85

What medication is know to have a lower incidence of tornado de pointes than other QT-prolonging agents?

Answer 85

Amiodarone

Question 86

Which cells control a Tuberculosis infection?

Answer 86

CD4 T lymphocytes and macrophages

Question 87

ST elevations in (lateral) leads I and aVL, which cardiac artery is affected?

Answer 87

Left circumflex artery

Question 88

Which leads have ST elevations when it affects the Left Anterior Descending Artery (LAD)?

Answer 88

Proximal: anterior leads V1-V4 Distal segment may spare V1-V2.

Question 89

Which leads have ST elevations when the Left Main Coronary Artery is affected? (giving rise to the LAD and LCX)

Answer 89

Anterior V1-V4 and lateral V5-V6 and aVL leads.

Question 90

What additional tests should be considered during a workup for acute pancreatitis?

Answer 90

Serum Triglycerides (more than 1000 mg/dL

Question 91

Describe the three treatment of cyanide (CN-) toxicity:

Answer 91

1. Sodium thiosulfate: sulfur donor that facilitates CN- binding to form thiocyanate, which is excreted in the urine. 2. Hydroxocobalamin: Cobalt binds to CN- to form cyanocobalamin, which is excreted in the urine. Prevents cyanide binding to ferric ions. 3. Sodium Nitrite: Nitrites promote formation of methemoglobin, which binds CN- with greater affinity than cytochrome C oxidase, reducing CN- toxicity. Take with caution because Methemoglobinemia is toxic in excess.

Question 92

Describe Campylobacter Jejuni:

Answer 92

- Epidemiology: Motile, curved, gram-negative rod, oxidase-positive. Transmission: contaminated food (undercooked poultry) and pets (dogs). Common cause of food borne gastroenteritis. - Manifestations: Fever, abdominal pain, diarrhea w/ w/o blood/mucus. Usually self-limited (<7days) - Complications: Guillain-Barré syndrome (cross-reacting antibody to myelin gangliosides) Reactive arthritis.

Question 93

What is impaired in Osteogenesis Imperfecta?

Answer 93

Osteoid production by osteoblasts.

Question 94

Formula for Odds Ratio:

Answer 94

Odds of dx of cases/ odds of dx of control. OR= (a/c)/(b/d) or (ad)/(bc)

Question 95

Levels of which of the following substances will be higher in the pulmonary vein compared to the pulmonary artery in Decompensated heart failure? (exertion dyspnea, orthopnea, JVD, cardiac heave, and peripheral edema)

Answer 95

Angiotensin II

Question 96

Describe Dysplasia type of congenital anomaly?

Answer 96

- Abnormal organization of cells within a tissue (often genetic) - Ex: Skeletal dysplasia (eg, achondroplasia)

Question 97

What is responsible for internuclear ophthalmoplegia (impaired adduction with CL eye gaze) and optic neuritis (transient blur in vision and eye pain with movement)? What is the dx?

Answer 97

Demyelination of CNS (reduced saltatory conduction) in AI-Multiple Sclerosis

Question 98

Describe Intraductal Papilloma

Answer 98

Epithelial and myoepithelial cells lining fibrovascular cores in a cyst was or duct. Causes bloody nipple discharge and typically present without breast masses or skin changes.

Question 99

What is the difference between factor X (hematin) and factor V (NAD+) in Haemophilus influenza?

Answer 99

- X factor Hematin responsible for beta-hemolysis-induced erythrocyte lysis - V Factor (NAD+) is responsible for growth

Question 100

Describe the Trochlear Nerve:

Answer 100

- CN IV, innervates the superior oblique Fx to abduct, internally rotate, depress the eye while adducted - Lesion cause upward deviation, vertical and torsional diplopia

Question 101

List the key features of congenital syphillis?

Answer 101

Rhinorrhea, Skeletal anomalies, Desquamating rash (palms/soles)

Question 102

Which inhibitors block binding of platelet glycoprotein IIb/IIIa with fibrinogen and fibronectin?

Answer 102

- GpIIb/IIIa inhibitors: Abciximab, Eptifibatide, Tirofiban *Useful in percutaneous intervention (PCI) in ACS

Question 103

Formula for oral bioavailability:

Answer 103

AUC of PO dose/ AUC of IV dose

Question 104

Describe E coli virulence factor Lipopolysaccharide: How does it present?

Answer 104

- Mech: Activates macrophages -> widespread release of IL-1, IL-6 and TNF-alpha - Presentation: Bacteremia and septic shock

Question 105

Which nerve roots is responsible for perianal anesthesia?

Answer 105

- S2-S4, aka saddle anesthesia

Question 106

What plays an important role in mRNA translation and mRNA degradation?

Answer 106

Cytoplasmic P bodies

Question 107

Describe the effects of Phenylephrine:

Answer 107

- alpha 1 - BP: Increase - HR: decrease

Question 108

Describe Hep B marker: HBsAg

Answer 108

- Hep B virus surface glycoproteins - Detectable during acute infection - Persistence >6 mo = chronic infection

Question 109

What would you expect with UV radiation damage?

Answer 109

Endonuclease nicking of the damaged DNA => Xeroderma pigmentosum

Question 110

If the rectus abdomens muscle is incised laterally, what structure is at greater risk of injury?

Answer 110

Inferior epigastric artery

Question 111

Describe the Hep B marker: HBeAg

Answer 111

- Hep B virus polypeptide - Detectable during acute infection - Indicates increase replication and infectivity

Question 112

GI Pathology: Elevated unconjugated bilirubin, intermittent scleral icterus, normal PE and vitals. What is Dx?

Answer 112

Gilbert Syndrome. Icterus upon a stressor. Pathophysiology: Dec. activity of UDP Glucoronosyltransferase

Question 113

The presence of a central vascular catheter and receipt of parenteral are risk factors for what?

Answer 113

Candida in the blood -> candademia *Pseudohyphae with blastoconidia

Question 114

Where is type 3 collagen found, and what is its association?

Answer 114

Location: Skin, lungs, intestines, blood vessels, bone marrow, lymphatics, and granulation tissue. Associated with Vascular Ehlers-Danlos Syndrome type 4

Question 115

Where is type 4 collagen found, and what is its association?

Answer 115

Location: Found in basement membrane Associated with Alport Syndrome

Question 116

Cannulation above the inguinal ligament can significantly increase the risk for what?

Answer 116

Retroperitoneal Hemorrhage

Question 117

Lesion where in the brain would cause contralateral sensory deficits and cortical sensory signs?

Answer 117

The somatosensory cortex, located posterior to the central sulcus

Question 118

Describe Persistent Vitelline Duct:

Answer 118

- Complete duct closure failure - Results in a patient connection between intestinal line and the umbilicus. - Causes meconium discharge from the umbilicus after birth

Question 119

Describe Exudative Pleural Effusion:

Answer 119

Light Criteria: - Pleural protein/serum protein > 0.5, or - Pleural LDH/ serum LDH >0.6, or - Pleural LDH >2/3 upper limit of normal Pathophysiology: Inflammation increase in membrane permeability Common Cause: - Infection (eg, pneumonia, TB), malignancy, Rheumatologic disease

Question 120

Describe Small Cell Carcinoma of the Lung:

Answer 120

Clinical features: - Risks: Smoking, male> female. Highly aggressive, centrally located. - Histology: sheets of small blue cells with scant cytoplasm. - Neuroendocrine markers: neural cell adhesion molecule (NCAM), neuron-specific enolase, chromogranin, synaptophysin. Associated Paraneoplastic Syndromes: - SIADH - Cushing Syndrome - Lambert-Eaton Syndrome

Question 121

Describe the Hep B marker: Anti-HBc IgG

Answer 121

Present in both acute and chronic infection. Not present after vaccination.

Question 122

What is responsible for vaccine reactogenicity?

Answer 122

Macrophages and IL-6, and Mast cells and IL-1. Look for warmth, swelling, edema, fatigue. fever, and headache.

Question 123

Gram negative bacilli, fast lactose fermenter, indole negative:

Answer 123

Klebsiella, Enterobacter

Question 124

What would be contained in Meckel Diverticulum?

Answer 124

Heterotopic/Ectopic Gastric Mucosa

Question 125

What nerve is in close proximity to the crust terminals of the right atrium?

Answer 125

Right Phrenic nerve -> elevation of right hemidiaphragm

Question 126

Which cytokines are responsible for cachexia?

Answer 126

TNF-alpha, IL-1 beta, IL-6

Question 127

Cardiovascular Pathology: In Mitral Stenosis, how do the Left ventricular hemodynamics look during rest?

Answer 127

Normal Diastolic pressure, after load, and contractility

Question 128

What nerve is responsible for adducting the thigh?

Answer 128

Obturator Nerve

Question 129

Describe the effects of Dobutamine:

Answer 129

Beta 1 > Beta 2 receptor binding. BP: -/decrease HR: Increase

Question 130

What are the complication of Hereditary Spherocytosis?

Answer 130

Pigmented gallstones, Aplastic crisis with Parvovirus B19 infection

Question 131

Describe the effects of Isoproterenol:

Answer 131

Beta 1 = Beta 2 receptor binding BP: -/decrease HR: increase

Question 132

Describe the 1st line Tx for Schizophrenia:

Answer 132

D2 receptor antagonists- antipsycotics

Question 133

Where would suspect an ectopic foci in a patient with AFib?

Answer 133

Pulmonary Veins

Question 134

List the key features for congenital Cytomegalovirus?

Answer 134

- Periventricular calcifications - Microcephaly - Sensorineural hearing loss

Question 135

What is the effect of surfactant on Functional Residual Capacity?

Answer 135

Increase

Question 136

What is released from mast cells and basophils during anaphylaxis?

Answer 136

Histamine and Tryptase respectively

Question 137

Describe Hep B marker: Anti-HBs

Answer 137

Seen with cleared infection or vaccination. Confers long-term immunity

Question 138

Which drugs inhibit ADP mediated platelet aggregation. Useful in PCI, tx in unstable angina, and non-Q wave MI?

Answer 138

Ticlodipine and Clopidogrel

Question 139

What is deficient and what is accumulated in Tay-Sacks Disease?

Answer 139

Deficient in Beta-hexosamidase A Accumulates GM2 ganglioside

Question 140

Gram negative diplococci, aerobic, can utilize maltose?

Answer 140

N. Meningitidis

Question 141

Which host factors are primarily responsible for mediating the response to Trastazumab?

Answer 141

Natural Killer cells and granzymes

Question 142

Withdrawal of what substance causes anxiety, tremor, insomnia, and sympathetic hyperactivity (eg, diaphoresis, palpitations). Severe cases cause psychosis, seizures, and death?

Answer 142

Benzodiazepines eg, Lorazepam

Question 143

What causes nonpitting edema in neonates with Turner Syndrome?

Answer 143

Lymphatic network dysgenesis

Question 144

What causes cleft palate?

Answer 144

Palatine shelves fail to fuse

Question 145

Describe Cryptosporidium parvum:

Answer 145

Pathogenesis: - A parasite spread via fecal-oral transmission (eg, contaminated water, animal contact) - Oocyte ingestion -> sporozoite attachment to intestinal epithelium -> intraluminal merino formation -> fecal oocyte shedding. Clinical manifestations: - immunocompetent: self-resolving, watery (noninflammatory) diarrhea < 2 weeks - Immunosuppressed (eg, AIDS, transplant recipient): prolonged, severe diarrhea with weight loss/ malabsorption. Dx: - Stool PCR testing - Stool microscopy: acid-fast staining oocytes or immunofluorescent assay. Histology: - basophilic Cryptosporidium organisms on intestinal brush border, small intestine villous blunting, lamina propria inflammation

Question 146

What organism has a narrow zone of clear hemolysis with zone enhancement in the presence of Staph. Aureus?

Answer 146

Streptococcus agalactiae (GBS)

Question 147

Describe a Glomangioma:

Answer 147

A benign tumor of the modified smooth muscle cells of a glomus body. Glomus bodies are numerous small, encapsulated neuromuscular organs found in the dermis of the nail bed, pads of the fingers and toes, and the ears. Rich vasculature shunts blood away as a form of thermoregulation.

Question 148

Describe Pertussis:

Answer 148

Pathophysiology: - Bordetella pertussis (gram-negative coccobacilli) - Major virulence factors: pertussis toxin (AB toxin), adenylate cyclase toxin, tracheal cytotoxin Clinical stages: - Catarrhal (1-2 wks): mild cough, rhinitis - Paroxysmal (2-6 wks): severe coughing spells with inspiratory whoop, posttussive emesis; w/ w/o apnea/cyanosis (infants) - Convalescent (weeks to months): gradual resolution Treatment: - Macrolide antibiotic (eg, azithromycin) (50S, inhibits protein synthesis) - Prevention: Acellular pertussis vaccine.

Question 149

Describe the 6 Pharyngeal and Aortic arches with associations:

Answer 149

1. Trigeminal (CN V), Maxillary artery 2. Facial (CN VII), Stapedial artery (regresses) 3. Glossopharyngeal (CN IX), Common carotid artery and proximal internal carotid artery. 4. Superior laryngeal branch of vagus ( CN X), True aortic arch, subclavian arteries. 5. Obliterated 6. Recurrent laryngeal branch of CN X, Pulmonary arteries, ductus arteriosus

Question 150

Describe the step involved in Base excision repair:

Answer 150

1. Glycosylase: Cleaves the altered base, leaving an AP site 2. Endonuclease: cleaves the 5' end 3. Lyase: Cleaves the 3' sugar phosphate 4. Polymerase: Fills the single nucleotide gap 5. Ligase: Seals the nick

Question 151

What you expect to decrease in Wernicke encephalopathy?

Answer 151

Erythrocyte transketolase activity

Question 152

Describe the clinical features of early congenital syphillis: 4 category involvement

Answer 152

Perinatal: - Prematurity - Intrauterine fetal demise - low birth weight - Focal necrosis of the umbilical cord Mucocutaneous: - Snuffles: copious rhinorrhea, often purulent or seroanguineous - Desquamating, maculopapular rash involving palms/soles - fissures near orifices (eg, anal, oral) - jaundice Musculoskeletal: - Long bone abnormalities (eg, periosteal thickening, metaphyseal erosion) Reticuloendothelial: - Hepatomegaly w/ w/o splenomegaly - Lymphadenopathy - Anemia, thrombocytopenia, leukopenia/leukocytosis

Question 153

Describe a patent ductus arteriosus:

Answer 153

- Allows blood from the aorta to flow directly into the pulmonary artery => decreasing the SVR. - Increase in blood return to the LA and LV, LV compensates by increasing SV and CO.

Question 154

Virology: Describe Conjugation:

Answer 154

Form of horizontal gene transfer that involved the formation of the pilus and the direct passing of genetic material from one bacterium to another. Common source of antibiotic resistance and environmental adaptation. Particular about Shigella tx resistance.

Question 155

Describe Hemophilia:

Answer 155

XLR Bleeding disorder due to decreased levels of factor VIII (Hemophilia A) or factor IX (hemophilia B). Decreased levels cause a failure to convert prothrombin into thrombin and deficient thrombus formation. Typically present as bleeding after a tooth extraction and a hx of hemarthrosis (bleeding into the joints).

Question 156

What is the pathophysiology behind 3rd degree AV block?

Answer 156

Degenerative changes involving the atrioventricular node.

Question 157

What organ like deep to the tip of the 12th rib?

Answer 157

Left Kidney

Question 158

Describe the Glossopharyngeal nerve:

Answer 158

- Somatic motor: Stylopharyngeus muscle only (elevates larynx during swallowing) - Parasympathetic: Inferior salivary nucleus -> CN IX -> otic ganglion -> travels along auriculotemporal nerve (CN V3) -> parotid gland secretion. - General sensory: Tympanic membrane (inner surface), Eustachian tube, posterior third of tongue, tonsillar region, upper pharynx (afferent portion of gag reflex), carotid body, and carotid sinus - Special sensory (taste): posterior third of tongue

Question 159

HML Pathology: What normal value would you expect to see in a patient with Methemoglobinemia (Nitrites)?

Answer 159

PaO2

Question 160

Microbiology: Describe Ehrlichia chaffeensis:

Answer 160

Harbored in white-tailed deer and transmitted to humans by tick bite. It replicates in vacuoles within monocytes and forms mulberry-shaped, intraleukocytic inclusions (morale. Manifestations usually include nonspecific symptoms (eg, fever, chills, myalgia), maculopapular rash, and significant laboratory abnormalities, paricularly lymphopenia.

Question 161

Describe Syndrome of inappropriate antidiuretic hormone (SIADH):

Answer 161

Pathophysiology: - Uncontrolled secretion of ADH. - Leads to water retention and impaired urinary water excretion Causes: - CNS disturbances (stroke, hemorrhage, trauma) - Medications (eg, carbamazepine, SSRIs, NSAIDs) - Lung disease (eg, pneumonia) - Malignancy (eg, small-cell lung cancer) Clinical findings: - nausea, forgetfulness (mild hyponatremia) - seizures, coma (severe hyponatremia) - Euvolemia (eg, moist mucous membranes, no edema, no JVD) Laboratory findings: - hyponatremia, Low serum osmolality, High urine osmolality, high urine sodium

Question 162

Patients with severe aortic stenosis are at high risk for mucocutaneous and colonic bleeding due to what?

Answer 162

Acquired von Willebrand deficiency

Question 163

Pathway for Neisseria Meningitidis to reach the CNS:

Answer 163

Pharynx -> Blood -> choroid plexus -> meninges

Question 164

Describe Meckel Diverticulum:

Answer 164

The most common vitelline duct anomaly, resulting from partial closure of the vitilline duct, with the patent portion attached to the ileum. A fibrous band may connect the tip of the diverticulum with the umbilicus. Patients classically have painless hematochezia due to intestinal ulceration from heterotopic gastric mucosa contained within the diverticulum.

Question 165

Describe the findings of Opioid Intoxication:

Answer 165

- Pupillary constriction (ie, mitosis), - depressed mental status - Hypothermia - Hypotension - Decreased tidal volume

Question 166

Describe the MOA of Digoxin on the heart:

Answer 166

Slows AV node conduction by increasing parasympathetic tone. Works to treat Afib at rest, not so much during exercise because of increased sympathetic tone.

Question 167

What virulence factor of Staph. Aureus is responsible for necrotizing pneumonia (pulmonary cavitations/ abscesses)?

Answer 167

Panton- Valentine Leukocidin

Question 168

How is gastric acid neutralized in the GI tract?

Answer 168

1. Bicarbonate from the submucosal (Brunner) glands of the 1 part of duodenum. 2. Pancreatic secretions emptied into the duodenum at ampulla.

Question 169

Describe Hep B marker: Anti-HBcIgM

Answer 169

Detectable during acute infection. Present during window phase (between HBsAg and anti-HBs

Question 170

Inhibition of Neprilysin and Angiotensin Receptor is important why?

Answer 170

Increase ANP and BNP --> vasodilation, diuresis --> increased urinary Na+ excretion

Question 171

Gram negative bacilli, fast Lactose fermenter, indole positive

Answer 171

E. Coli

Question 172

Which organisms are responsible for recurrent infections in patients with Chronic Granulomatous disease?

Answer 172

*Catalase positive organisms: - Bacteria: Staph Aeureus, Barkholderia, Serratia, Nocardia - Fungi: Aspergillus

Question 173

Where is type 2 collagen found and what pathology is it associated with?

Answer 173

Found in carriage, vitreous humor, and nucleus pulposus. Associated with skeletal dysplasias

Question 174

How would you describe Aspergillous Fumigates?

Answer 174

Fungus found in decaying vegetables causing rhinosinusitus. Septate Hyphae with acute 45 degree angle branching More commonly effect immunocompromised individuals

Question 175

Describe Chikunguny Virus infection

Answer 175

Epidemiology: - Tropical/subtropical of Caribbean, Central/South America, Africa and Asia. - Vector: Aedes mosquito (also transmits dengue, yellow fever, and Zika) - Manifestations: Incubation: 3-7 days. High fever and severe polyarthralgia (almost always present), headache, myalgia, conjunctivitis, maculopapular rash. Lymphopenia, thrombocytopenia, transaminitis. - Manage: Supportive (initial symptoms resolve 7-10 days), Chronic arthralgia/arthritis frequently occurs (may require Methotrexate)

Question 176

Elevated AFP with ultrasound shows open neural tube defect, presented with a cystic lesion overlying the lumbosacral spine, ventriculomegaly, and hindbrain herniation), What is the defect?

Answer 176

Primary neurulation

Question 177

What are the muscles of the quadriceps? Where do they insert? What is the pathologic association?

Answer 177

Muscles: Rectus femoris, Vastus intermedius, vastus medialis, vastus lateralis. Inserts at the tibial tubercle. Association: Osgood-Schlatter disease.

Question 178

Describe Vitelline sinus

Answer 178

Results from partial closure of the vitelline duct, with the patent portion at the umbilicus; serous umbilical drainage may occur.

Question 179

Describe the effects of Norepinephrine:

Answer 179

alpha 1 > beta 1 > beta 2 BP: increase HR: - / reflexive bradycardia

Question 180

Describe the different Adrenergic Agonists:

Answer 180

alpha 1: peripheral VC, increase SVR beta 1: Increase HR and Contractility, increase CO beta 2: peripheral VD, decrease SVR D1: Renal arteriolar VD

Question 181

Describe Vitellin Duct Cyst:

Answer 181

Forms when peripheral portions of the duct obliterate but the central part remains. Patients are asymptomatic.

Question 182

Describe Trendelenburg Gait:

Answer 182

Injury to the superior gluteal nerve -> weakness in the gluteus medius. Example: injection to superomedial quadrant. Hip drop of the contralateral side of the lesion.

Question 183

Describe the Hep B marker: Anti-HBe

Answer 183

Develops in cleared infection and later in chronic infection. Indicated decrease viral replication and infectivity

Question 184

Gram negative diplococci, aerobic, cannot utilize maltose?

Answer 184

N. Gonorrhoea, Moraxella

Question 185

Which drugs inhibit platelet aggregation by inhibiting phosphodiesterase activity and increasing cAMP?

Answer 185

Dipyridamole and cilostazol. Cilostazol also acts as a direct arterial dilator.

Question 186

Describe Androgen insensitivity syndrome:

Answer 186

- Dysfunctional androgen receptors - Genotypical male: XY - Testes present, absent external and internal genitalia

Question 187

Describe Fludrocortisone:

Answer 187

Synthetic mineralcorticoid 1. Increase Na+ reabsorption in DCT and collecting duct -> fluid retention and circulation blood volume -> decrease urine sodium 2. Increase vascular sensitivity to multiple endogenous vasoconstrictors (eg, ATII, NE) causing a potentiation of their pressor effects

Question 188

What is the inheritance pattern of Hemophilia A or B?

Answer 188

X-Linked Recessive 1/2 * 1/2 * 1/2 (for the chance of having a boy)

Question 189

Describe Trisomy 18 (Edwards Syndrome)

Answer 189

- 47, XX, +18 (Meiotic Nondysjunction) - Micrognathia (small mandible) - Prominent occiput - Low set ears - Heart defects, kidney defects - Limited hip abduction - Rocker bottom feet - Clenched hands either overlapping fingers

Question 190

What are the primary mediators in COPD?

Answer 190

Neutrophils, macrophages, and CD8 T cells

Question 191

Describe the muscarinic effects of Cholinergic Toxicity (Organophosphate poisoning) ?

Answer 191

DUMBELS - Diarrhea/ diaphoresis - Urination - Miosis - Bronchospasm, bronchorrhea (watery sputum), and Bradycardia - emesis - lacrimation - salivation Treat with Atropine

Question 192

Describe the nicotinic effects of Cholinergic Toxicity (Organophosphate poisoning) ?

Answer 192

Muscle weakness, paralysis, fasciculation Treat with Pralidoxime

Question 193

Describe the E coli virulence factor: Shiga Toxin

Answer 193

Inactivated 60S ribosomal subunit, halting protein synthesis and causing cell death Presentation: Blood gastroenteritis Particular with E Coli 0157:H7

Question 194

Cardiovascular Pathology: Holosystolic murmer at the apex with radiation to the axilla with audible S3 to determine severity

Answer 194

Mitral regurgitation

Question 195

Describe Cerebral Arteriovenous malformation

Answer 195

Vascular malformations histologically characterized by a tangle of abnormal vessels, including large veins with thickened walls and irregular arteries. Intracranial hemorrhage, headache, +/- seizures 'Bag of worms' appearance and dark flow voids on radiograph. Refer to picture taken.

Question 196

Microbiology: List key feature of congenital Rubella:

Answer 196

Cataracts Heart defects (eg, PDA) Sensorineural hearing loss

Question 197

Gram negative bacteria, cannot ferment lactose, but is oxidate positive?

Answer 197

Pseudomonas, common UTI cause with indwelling catheters

Question 198

What is a consequence of chronic corticosteroid use applied topically?

Answer 198

Dermal/ Cutaneous Atrophy, as well as telengiectasias and acne.

Question 199

What 2 main arteries supply the small and large intestines?

Answer 199

SMA and IMA Connected by the marginal artery of Drummond.

Question 200

Describe the E Coli virulence factor Heat-stable/ Heat labile enterotoxins:

Answer 200

Mechanism: Promotes fluid and electrolyte secretion from intestinal epithelium. Presentation: watery gastroenteritis

Question 201

HML: Pathology Patient with pancytopenia, inappropriate low reticulocyte count, normal cell lines on PBS, no splenomegaly. What is the dx, how to dx?

Answer 201

Dx: Aplastic Anemia Bx: hypocellular marrow with abundance of stratal and fat cells. 'Dry tap.'

Question 202

Gram negative coccobacilli?

Answer 202

H. Influenzae B. Pertussis Pasteurelia Brucella F. Tularensis

Question 203

What is the inheritance pattern for Phenylketonuria? Symptoms?

Answer 203

Autosomal Recessive 1/2 * 1/2 Symptoms: Intellectual disability, gait abnormality, musty body odor, Eczema - Deficiency in phenylalanine hydroxylase (PAH)

Question 204

What nerve is affected with a Fibular neck fracture, what are the deficits?

Answer 204

Common fibular nerve (perineal) -> loss of sensation of the dorsal of the foot. Deep Fibular nerve: dorsiflexion weakness. Superficial fibular nerve: eversion weakness

Question 205

What drug inhibits inosine 5'-monophosphate dehydrogenase?

Answer 205

Mycophenolate: Inhibits IMP -> GMP conversion primarily in lymphocytes. Used to prevent rejection in transplants. Process in denote purine synthesis. Prevents lymphocytes from proliferating.

Question 206

Describe Arsenic poisoning

Answer 206

Mechanism: - Binds to sulohydryl groups - Disrupts cell respiration and glucogensis Sources: - Pesticides/insecticides - contaminated water (wells mostly) - Pressure treated wood Manifest: - Acute: Garlic breath, vomitting, watery diarrhea, QTc prolongation - Chronic: Hyper/hypopigmentation, hyperkeratosis, stocking-glove neuropathy Treatment: - Dimercaprol and DMSA

Question 207

Describe the 5 types of cell junctions?

Answer 207

Gap Junctions: Connexins, fx to communicate intercellular Tight junctions: Claudin and Occludin, fx paracellular barrier Adherens: Cadherins, fx to anchor cells Desmosomes: Cadherins (desmogleins/plakins), fx to anchor cells Hemidesmosomes: Integrins, fx to anchor cells

Question 208

Describe Prevalence

Answer 208

existing cases/ population Affected by immigration and emigration of both healthy and sick

Question 209

What is tetrahydrobiopterin (BH4) an important cofactor for?

Answer 209

1. Phenylalanine hydrocylase: Phe-> Tyr; phenylketonuria (microcephaly, developmental delay, seizures). Hypopigmentation too via tyrosinase competitive inhibition 2. Tyrosine hydroxylate: catecholamine production 3. Tryptophan hydroxylate: Serotonin production

Question 210

What is the risk taking Eculizumab, what is the prophylaxis?

Answer 210

Eculizumab target C5, an essential for the MAC complex. Treatment option for Paroxysmal Nocturnal hemoglobinuria. Needs vaccination for encapsulated bacteria eg, Neisseria Meningitidis, Strep. Pneumonia, etc. Also PCN prophylaxis.

Question 211

Abrupt-onset unilateral headache, eye pain with nausea and visual halos. What is the dx? Tx? Mechanism?

Answer 211

Dx: Angle-closure glaucoma: impaired drainage of aqueous humor. Tx: Carbonic anhydrase inhibitor eg, Acetazolamide decreases pressure. Also affects the PCT of the kidney causing an increase in urine pH and mild metabolic acidosis.

Question 212

List the causes of QT prolongation:

Answer 212

1. Acquired: Medications Macrolides and Fluoroquinolones. Antiemetics (eg, ondansetron), Azoles (Fluconazol), Antipsychotics, TCAs, SSRIs, some opioids (eg, methadone, oxycodone), Class 1a antirrhythmics: eg, quinidine, Class III antirrhythmics eg dofetilide, sotalol. 2. Electrolyte Imbalance: Decrease Magnesium, Decrease Potassium, Decrease Calcium 3. Congenital: Romano-Ward syndrome (AD), Jerrell & Lange-Nielsen Syndrome (AR) associated with sensorineural hearing loss. All have common Volted gated potassium channels

Question 213

Describe the effects of Dopamine:

Answer 213

Low dose: - D1 > beta 1 > alpha 1 receptor binding - BP: - / decrease - HR: increase High Dose: - alpha 1 > beta 1 > D1 - BP: increase - HR: - / decrease (reflexive)

Question 214

How is protein synthesis terminated?

Answer 214

Stop codons (UGA, UAA, UAG) are recognized by releasing factors that hydrolyze the bond between the polypeptide chain and the tRNA in the P site

Question 215

Pt with ringed trophozoites traveled to an endemic area? What is the dx, what is the treatment?

Answer 215

Dx: Malaria, Plasmodium species. Giemsa staining positive Tx: - Non African origin -> Chloroquine - Endemic Africa: Atovaquone & proguinal combo, or artemisinins. - For Hypnozoites (Liver forms of P Vivax and P ovals) -> Primaquine

Question 216

Explain the causes of Hypoxemia:

Answer 216

1. Reduced PiO2; High altitude; Normal A-a 2. Hypoventilation; CNS Depression, Morbid obesity; Normal A-a 3. Diffusion limitation; Emphysema, ILD; Increase A-a 4. V/Q mismatch; PE, Pneumonia; Increased A-a

Question 217

Describe malformation type of congenital anomaly?

Answer 217

- Defect in organogenesis (eg, genetic or teratogenic) - Ex: Spinal Bifida, Holoprosencephaly

Question 218

Which medical conditions are considered polygenic inheritance?

Answer 218

Mneumonic AGE THIS - Androgenetic alopecia - Glaucoma - Epilepsy - T2DM - HTN - IHD - Schizophrenia

Question 219

Describe disruption as a congenital anomaly?

Answer 219

Destruction of a structure that was previously developing normally. Ex: Amniotic bands, triggered by interuption of the blood supply, forms fibrous bands that encircle and contracts without external pressure

Question 220

Describe the physiologic changes of pregnancy:

Answer 220

1. Cardiovascular: Increase blood volume (plasma > RBC mass), decrease SVR, increase HR and CO. 2. Pulmonary: Increase central respiratory drive (hyperpigmentation) decrease PaCO2 (resp. alk.), increase PaO2. 3. Renal: Increase in RBF, urine output, increase GFR, decrease in BUN and Serum creatinine. Increase HCO3- excretion (metabolic compensation). Decrease Na+ concentrate (Increase ADH) 4. Hematologic: Increase in prothrombotic coagulation factors, decrease concentrations (dilution anemia)

Question 221

Phases of Acute Respiratory Distress syndrome:

Answer 221

1. Week 1: Exudative: hyaline membranes, acute inflammation. 2. Week 2: Proliferative: interstitial inflammation; proliferation of pneumocytes, endothelial cells, fibroblasts for collagen deposition. ***Prolonged period causes a reduced diffusion capacity resulting in an Increased A-a gradient. 3. Week 3: Fibrosis, not with all patients

Question 222

Which part of the aorta is susceptible to injury in rapid decelerating injury?

Answer 222

Dx: Blunt aortic injury Location: Aortic Isthmus Symptoms: chest pain, SOB, widened mediastinum, pulse discrepancy between upper and lower extremities (similar to aortic coarctation) intrascapular murmur (aortic impingement).

Question 223

Describe von Gierke Disease:

Answer 223

Type 1 GSD - hepatomegaly and steatosis - fasting hypoglycemia - lactic acidosis - hyperuricemia and hyperlipidemia - deficiency in Glucose- 6- phosphatase

Question 224

Describe Oculocutaneous Albinism:

Answer 224

Pathophysiology: - AR Tyrosinase. mutation. Impaired melanin synthesis. Abnormal optic nerve and foveal development. - Eye finding: Photophobia, reduced visual acuity, strabismus, Nystagmus, Light colored, translucent iris - Skin findings: White.light skin and hair, Increase propensity for sunburn, increase risk of skin cancer

Question 225

What respiratory pathologies can manifest from rheumatoid arthritis?

Answer 225

Pulmonary fibrosis (bilateral reticular modular opacities on CXR. PFTs show restrictive pattern. Can occur from the disease or meds -> interstitial lung disease

Question 226

Dermatology Pathology: What skin finding can you find after a bony fracture, ligamentous rupture, or muscular injury. Does not blanch under pressure as the RBCs are not in the vessel and undergoes a color change that can estimate the age of injury.

Answer 226

Ecchymoses

Question 227

MSK Pathology: Describe the features of Drug-induced lupus erythematosus:

Answer 227

Clinical features: - Abrupt onset of symptoms: Fever/fatigue, arthralgias/arthritis, rash, serositis - increase risk in slow acetylators Laboratory findings: - Antihistone antibodies present in >95% of patients - Anti-dsDNA antibodies rarely seen (Specific for SLE) Implicated drugs: - Procainamide, Hydralazine, Isoniazid, Minocycline, TNF-alpha inhibitors (eg, etanercept)

Question 228

What do you avoid in a patient with Aldolase B deficiency or hereditary fructose intolerance (AR)?

Answer 228

Fructose or sucrose Aldolase B deficiency can result in fructose-1-phosphate accumulation; this toxic metabolite depletes intracellular phosphate and inhibits the activation of hepatic phosphorylase and gluconeogenesis.

Question 229

List the major muscles responsible for flexion of the hip:

Answer 229

Iliopsoas, Rectus femoris, Tensor fascia lata

Question 230

MSK Anatomy: List the major muscles responsible for extension of the hip:

Answer 230

Gluteus maximus, Semitendinosus, Semimembranosus, Biceps femoris (long head)

Question 231

MSK: Anatomy List the major muscles responsible for abduction of the hip:

Answer 231

Gluteus medius, Gluteus minimus

Question 232

List the major muscles responsible for adduction of the hip:

Answer 232

Adductor brevis, Adductor longus, Adductor Magnus

Question 233

Describe Selective IgA deficiency:

Answer 233

Clinical features: - usually asymptomatic - recurrent sinopulmonary and GI infections - autoimmune disease - anaphylaxis during transfusions Diagnosis: - low or absent serum IgA levels - Normal IgG and IgM levels

Question 234

Psych Pharmacology: What do you give a patient suffering alcohol withdrawal? Name 3 meds

Answer 234

Benzodiazepines: acts on GABA receptors, preventing alcohol withdrawal. Eg, lorazepam, diazepam, chlordiazepoxide.

Question 235

Describe Sexual performance anxiety/psychogenic erectile dysfunction:

Answer 235

Causes and risk factors: - marital/ relational stress, conflict - major psychosocial trauma (loss of job or loved one) - severe medical illness (stroke, myocardial infarction) - mood, anxiety disorders Features: - abrupt onset, clear precipitating event or stressor - situational ED (normal nocturnal/nonsexual erections) - impaired or premature orgasm Management: - CBT, couples/relational therapy

Question 236

What site is the primary infection in a patient with Cryptococcus neoformans?

Answer 236

Organism resides in cold contaminated by bird droppings, and Human exposure primarily occurs due to inhalation into the lungs.

Question 237

List the common medication associated with constipation:

Answer 237

Opioids: - Centrally acting (eg, oxycodone, morphine) - Peripherally acting (eg, loperamide) Anticholinergic agents: - antihistamines (eg, diphenhydramine) - Tricyclic antidepressants (eg, amitriptyline) - antispasmodics (eg, dicyclomine) - 1st generation antipsychotics (Eg, haloperidol) Cation- containing agents - iron tablets - aluminum (eg, antacids) Non-dihydropyridine CCBs: - diltiazem, verapamil 5HT3 antagonists: - Ondansetron, granisetron

Question 238

What agent is responsible for Tinea corporis?

Answer 238

- Trichophyton rubrum - most common cause and infects keratinized matter in the stratum corneum of the superficial epidermis but does not invade the dermis or subcutaneous tissues.

Question 239

Describe the Plague:

Answer 239

Microbiology: - Yersinia pestis - gram negative coccobacillus - Bipolar (safety-pin) appearance on Wright or Giemsa staining Epidemiology: - Zoonotic: transmitted primarily by rodent fleas - endemic to South and North America, Africa, Asia, Russia Manifestations: - painful regional lymphadenopathy with overlying erythema (buboes) - chills, fever, headache, weakness - disseminated intravascular coagulation and death when not treated

Question 240

Which common colonic polyps are neoplastic?

Answer 240

- Sessile serrated polyp - Adenomatous (Villous > tubular)

Question 241

Which common colonic polyps are nonneoplastic?

Answer 241

- Hyperplastic - Inflammatory - Hamartomatous

Question 242

Describe Reye Syndrome:

Answer 242

Pathophysiology: - ASA use in children during viral infection (eg, influenza, varicella) - Mitochondrial toxicity -> impairs fat metabolism - Microvesicular fat deposits in the lever (steatosis) - Hepatic dysfunction 0> hyperammonemia - Diffuse astrocyte swelling (ie, cerebral edema) Clinical features: - acute liver failure: hepatomegaly, elevated transaminases; coagulopathy. - rapid progressive encephalopathy: vomitting, lethargy, seizures, coma Rx: Supportive

Question 243

Describe Cori disease:

Answer 243

Type 3 GSD - deficiency in debranching enzyme - hepatomegaly - ketotic hypoglycemia - hypotonia and weakness - abnormal glycogen with very short outer chains

Question 244

Describe Paranoid Personality Disorder:

Answer 244

Distrust and suspiciousness - Believes being exploited and deceived by other - interprets benign comments and events as threats; reacts angrily - bears judgment - questions loyal of partner without justification

Question 245

During pregnancy what hormone contributes to insulin resistance?

Answer 245

Human Placental Lactogen (hPL) - a peptide hormone released from syncytiotrophoblast during the 2nd and 3rd trimester => Increase maternal glucose levels, maternal proteolysis, and maternal lipolysis - stimulated pancreatic beta-cell proliferation to increase insulin production, if cannot overcome -> gestational diabetes

Question 246

Describe the features of MHC-I:

Answer 246

Structure: - heathy chain and beta 2 micro globulin Location: - all nucleated cells Function: - present antigen to CD8+ cytotoxic T cells Type of antigen - viruses, tumor proteins, antigens are processed in the cytoplasm Ag presentation results in apoptosis of the presenting cells

Question 247

MSK Development What causes cleft lip?

Answer 247

Failed fusion of the left or right maxillary prominence with the intermaxillary segment

Question 248

Describe McArdle Disease:

Answer 248

Type 5 GSD - muscle phosphorylase deficiency (glycogen phosphorylase - weakness and fatigue with exercise - no rise in lactate levels post exercise

Question 249

Describe Vasospastic angina:

Answer 249

Pathogenesis: - Hyperactivity of coronary smooth muscle due to endothelial dysfunction and autonomic imbalance Clinical Presentation: - <50 yo, minimal CAD risk factors other than smoking - recurrent chest discomfort at rest or during sleep - spontaneous resolution Diagnosis: - ECG: ST-elevation during episodes

Question 250

Explain the antipsychotic effect: Extrapyramidal side effects

Answer 250

Acute dystonic reaction: - sudden-onset, sustained muscle contractions Akathisia: - subjective restlessness with inability to sit still Drug-induced Parkinsonism: - tremor, rigidity, bradykinesia, masked facies

Question 251

Explain the Warburg Effect:

Answer 251

A method to produce energy through anaerobic glycolysis in rapidly dividing cells ie stem cells and cancer cells. Produces lots of lactate.

Question 252

Describe deformations a congenital anomaly:

Answer 252

Definition: mechanical forces alter shape/position of a structure that was previously developing was previously developing normally. Ex: Clubfoot (Talipes equinovarus)

Question 253

Explain the anti-psychotic side effect: Tardive dyskinesia

Answer 253

Involuntary movements after chronic use (eg, lip smacking, choreathetoid movements)

Question 254

Patient with a Porcelain gallbladder is at increased risk of what? What precedes, and what is the association?

Answer 254

Gallbladder adenocarcinoma, Chronic cholecystitis precedes, associated with multiple gallstones. Refer to photo taken.

Question 255

Failure of which of the embryologic processes is most like associated with Spina Bifida Occulta?

Answer 255

- Vertebral arch fusion, a closed neural tube defect - Typically L5-S1

Question 256

Describe Ankylosing Spondylitis:

Answer 256

- Inflammatory Back Pain: Chronic, insidious back and buttock pain. Onset at <40 yo. Worse with rest, relieved with warmth. - Examination findings: Decreased motion of the torso. Stiff/stooped pasture, tenderness, Dactylics (swelling fingers/toes), Uveitis - Pathophysiology: Increase osteoclast activation because of increased production of IL-17, TNF-alpha, and prostaglandins - Labs: Elevated ESR and CRP, HLA-B27 - Imaging: - Sacroiliitis: bone erosions, subchondral sclerosis, eventual bony fusion (ankylosis) - Bridging syndesmophytes: ossification at vertebral body margins (bamboo spine)

Question 257

What type of collagen is found in mature scars (eg, remote myocardial infarction)? What diagnosis is associated?

Answer 257

Type 1 collagen normally found in bones, tendons, ligaments, skin, and dentin (teeth). Associated with osteogenesis imperfecta

Question 258

What structures are derive from neural crest cells- ectoderm?

Answer 258

- Neural ganglia, adrenal medulla - Schwann cells, Pia and arachnoid matter - Aorticopulmonary septum and endocardial cushions - Brachial arches (bones and cartilage) - Skull bones - Melanocytes

Question 259

CVS Pharmacology: Describe the effects of sublingual nitroglycerin

Answer 259

Nitrates decrease the preload by causing venodilation, causing a decrease in LV EDV and wall stress, resulting in decreased myocardial oxygen demand

Question 260

What muscle arises from the sacrum, passes through the greater sciatic foramen, and inserts on the greater trochanter.

Answer 260

The Piriformis muscle - Acting to externally rotate the thigh when extended and adducts the thigh when flexed. Also causes compression to the sciatic nerve when hypertrophied.

Question 261

Pain + limited hip extension and knee flexion + ischial avulsion fractures affects what group of muscles?

Answer 261

The hamstrings: composed of the biceps femoris (long and short heads), semitendinosus, and semimembranosus

Question 262

What nerve is vulnerable to injury in a posterior hip dislocation causing the leg to be shortened and internally rotated, with the hip held in flexion and adduction?

Answer 262

The sciatic nerve

Question 263

What can cause an anterior displacement of the vertebral body ie spondylolisthesis?

Answer 263

Fracture of the posterior vertebral arch often occurring at the pars interarticularis ie spondylolysis, mostly bilateral

Question 264

Describe Greater trochanteric pain syndrome:

Answer 264

- Overuse tendinopathy of the gluteus medius and gluteus minimus at their insertion on the greater trochanter of the femur. - Exam will show tenderness over the greater trochanter - pain is reproduced by resisted hip abduction and internal rotation (when the hip is flexed)

Question 265

What structure(s) are contained in the anterior compartment of the leg?

Answer 265

- Deep perineal nerve - Anterior tibial artery and veins

Question 266

What structure(s) are contained in the lateral compartment of the leg?

Answer 266

- Superficial peroneal nerve

Question 267

What structure(s) are contained in the deep posterior compartment of the leg?

Answer 267

- Tibial nerve - Posterior tibial artery and veins - Peroneal artery and veins

Question 268

What is the mnemonic for the bones of the wrist?

Answer 268

"Some Lovers Try Positions That They Can't Handle" - Lower row starting from the thumb: Scaphoid, Lunate, Triquetrum, Pisiform - Top row starting from the thumb: Trapezium, Trapezoid, Capitate, Hamate

Question 269

What is the MOA of Zidovudine (ZDV)?

Answer 269

A nucleoside reverse transcriptase inhibitor used to prevent maternal to fetal transmission of HIV during labor (when the mother is not suppressed). It is a thymidine analogue without a hydroxyl group. Causes chain termination.

Question 270

Describe the guidelines for Clozapine:

Answer 270

Indications: - treatment-resistant schizophrenia - Schizophrenia associated with suicide ideations Adverse effects: - agranulocytosis - seizures - myocarditis - metabolic syndrome

Question 271

Describe Clostridioides difficile colitis:

Answer 271

Risk factors: - recent antibiotic use - hospitalization - gastric acid suppression (eg, PPI) Pathogenesis: - disruption of intestinal flora -> C difficile overgrowth - Toxins A and B disrupt cytoskeleton integrity and stimulate inflammation - Pseudomembrane formation Clinical presentation: - profuse watery diarrhea (most common) - Leukocytosis (around 15k/mm^3) - Fulminant colitis/toxic megacolon Diagnosis: - Stool PCR for C difficult genes (specific for toxigenic strains) - Stool EIA for C diff. toxin and glutamate dehydrogenase antigen Treatment: - Oral fidaxomicin (inhibits the RNA polymerase sigma subunit) or oral vancomycin - IV metronidazole added for fulminant (sudden and severe) disease

Question 272

What antibiotic is effective in clostridial skin infections eg, Clostridium perfringens, Clostridium septicum?

Answer 272

Doxycycline: Binds to the 30S ribosomal subunit (tetracycline)

Question 273

Describe Abruptio Placentae

Answer 273

Definition: - premature placental separation from uterus Risk factors: - hypertension, preeclampsia - abdominal trauma - cocaine or tobacco use - prior abruptio placentae Clinical features: - sudden-onset vaginal bleeding - abdominal pain - high-frequency contractions - tender, firm uterus

Question 274

Vignette mentions proximal stomach herniating through the esophageal hiatus, what's the defect, what's the dx?

Answer 274

Hiatal hernia, a common disorder where abdominal cavity herniate through the diaphragm into the thoracic cavity at the esophageal hiatus. Due to laxity (looseness) of the phrenoesophageal membrane, usually caused by stresses like coughing, vomiting.

Question 275

What effect occurs when the tendency of study subjects to change their behavior as a result of their awareness. that they are being studied?

Answer 275

Hawthorned effect (observer effect)

Question 276

What gene is inactivated in Hereditary Pulmonary Arterial hypertension? What is the inheritance pattern?

Answer 276

- BMPR2 - Autosomal dominant - predisposes for excessive endothelial injury and smooth muscle cell proliferation.

Question 277

Which cells and mediators cause noncaseating granulomas in cases like Sarcoidosis?

Answer 277

APCs -> IL-12 -> Th1 (CD4) -> IL-2 and interferon gamma -> Th1 cells proliferate and macrophage activate respectively.

Question 278

What is the significance of Malonyl-CoA?

Answer 278

- Product of rate limiting step in de novo fatty acid synthesis - where Cystolic acetyl-CoA carboxylase converts acetyl-CoA to malonyl-CoA - inhibits the action of mitochondrial carnitine acyltransferase, therefore inhibiting beta-oxidation of newly formed fatty acids.

Question 279

Describe the Rotator cuff muscle: Supraspinatus

Answer 279

- Origin on scapula: supraspinous fossa - attachment on humerus: superior aspect of greater tubercle - function on arm: abduction (primarily <15 degree) - innervation: suprascapular nerve

Question 280

Describe the Rotator cuff muscle: Infraspinatus

Answer 280

- origin on scapula: infraspinous fossa - Attachment on humerus: posterolateral aspect of greater tubercle - function on arm: External rotation - innervation: suprascapular nerve

Question 281

MSK Anatomy: Describe the Rotator cuff muscle: Teres minor

Answer 281

- origin on scapula: lateral border - attachment on humerus: posterolateral aspect of greater tubercle - function on arm: adduction and external rotation - innervation: axillary nerve

Question 282

Describe the Rotator cuff muscle: Subscapularis

Answer 282

- Origin on scapular: sub scapular fossa - Attachment on humerus: lesser tubercle - function on arm: adduction and internal rotation - innervation: Upper and lower subscapular nerve

Question 283

What affect does T3 have on bone?

Answer 283

Activate osteoclasts the bone resorption.

Question 284

What infection is associated with gastric MALT lymphoma?

Answer 284

Helicobacter pylori.

Question 285

Describe the 1st line drugs for neuropathic pain:

Answer 285

- First line: TCAs, SNRIs, and Anticonvulsants. - TCAs (nortriptyline, amitriptyline) modulate pain transmission by inhibiting VG Na channels in sensory nerves and increasing NE signaling in CNS. - SNRIs (duloxetine, venlafaxine) alter central transmission of pain by increasing NE in the central synapses. - Anticonvulsants (gabapentin, pregabalin) inhibit the release of excitatory neurotransmitters by binding to VG Ca modulators on nerve terminals.

Question 286

Describe the histopathologic examination of syphilitic lesions (at all stages):

Answer 286

Intense plasma cell-rich infiltrate with proliferative endarteritis (inflammation of the inner lining of an artery).

Question 287

Describe the causes of Gout:

Answer 287

1. Increased urate production: - Primary gout (idiopathic) - Myeloproliferative/lymphoproliferative disorders - tumor lysis syndrome - Hypoxanthine-guanine phosphoribosyltransferase (HGPRT) deficiency 2. Decreased rate clearance: - CKD, Thiazide/loop diuretics

Question 288

What is the inheritance patter of Cystic Fibrosis:

Answer 288

Autosomal recessive

Question 289

Compare HIV-1 and HIV-2 respectively:

Answer 289

Geographic location: - Worldwide vs West africa Viral load: - high vs low Progression to AIDS: - 7-10 years vs 10-25 years Intrinsic resistance: - limited vs NNRTIs, fusion inhibitors

Question 290

What are the causes of a Paradoxical embolism?

Answer 290

Abnormal connection between the right and left chambers eg patent foramen ovale, atrial septal defect, or ventricular septal defect.

Question 291

How is it possible for the Hep D virus to infect hepatocytes and multiply?

Answer 291

The hepatitis B surface antigen of hep B virus must coat the hepatitis D antigen. Hep D itself is considered replicative defective.

Question 292

Which occupations are associated with asbestos?

Answer 292

Insulation installation, shipbuilding, pipe work

Question 293

What do you give to a premature baby (<32 wks) to prevent NRDS?

Answer 293

Corticosteroids to increase surfactant production by accelerating maturation of type II pneumocytes, eg betamethasone, dexamethasone.

Question 294

Describe the pathogenesis of Acute Promyelocytic leukemia:

Answer 294

- t(15;17) involving PML and RARA -M PML-RAR alpha oncoprotein -> myeloid differentiation inhibited - RAR alpha: nucelar receptor involved in myeloid differential - PML: fusion forms receptor with dominant negative activity

Question 295

HML Pathology: Describe the pathogenesis Burkitt lymphoma:

Answer 295

- t(8;14) involving MYC and IGH -> MYC over expression -> cell growth - MYC: transcription factor regulating cell growth - IGH: Immunoglobulin heavy chain (high expression in B cells)

Question 296

Describe the pathogenesis Chronic myeloid leukemia:

Answer 296

- t(9;22) involving ABL1 and BCR -> BCR-ABL1 oncoprotein -> cell proliferation - ABL1: non receptor tyrosin kinase - BCR: fusion leads to activation

Question 297

Describe the pathogenesis Follicular lymphoma:

Answer 297

- t(14;18) involving IGH and BCL2 -> BCL2 over expression -> apoptosis evasion - BCL2: antiapoptotic protein

Question 298

Describe the pathogenesis Mantle cell lymphoma:

Answer 298

- t(11;14) involving CCND1 and IGH -> cyclin D1 over expression -> cell cycle progression - Cyclin D1: regulated cells cycle

Question 299

Describe Internuclear ophthalmoplegia:

Answer 299

Disorder of impaired horizontal gaze caused by a lesion in the medial longitudinal fascicles (MLF). The affected ipsilateral eye is unable to adduct while the CL eye able to abduct (often associated with nystagmus). Convergence and pupillary light reflex are preserved because the pathways bypass the MLF.

Question 300

What structure is at risk for damage if there a laceration at the posterior vaginal opening through the vaginal mucosa and submucosa?

Answer 300

Perineal body

Question 301

Describe a Subgaleal hemorrhage:

Answer 301

A potentially fatal neonatal bleed that occurs during delivery when emissary veins between the dural sinuses and scalp are sheared. The accumulation of blood between the periosteum and galea aponeurosis present with a diffuse, fluctuant scalp and neck swelling; high risk for shock and death.

Question 302

Lesion to what part of the brain results in contralateral hemiballism?

Answer 302

Subthalamic Nucleus

Question 303

What can pregnant women with severe preeclampsia develop?

Answer 303

HELLP Syndrome: - Hemolysis, elevated liver enzymes, low platelet count - also at risk for seizure, renal insufficiency, disseminated intravascular coagulation (DIC) due to endothelial dysfunction

Question 304

What does the Ulnar nerve innervate and what motions is it responsible for?

Answer 304

- Sensory for fifth digit, medial half of the fourth digit, and the hypothenar eminence - responsible for wrist flexion and adduction - injury leads to claw hand (ring and picky finger cannot extend with rest of the hand) - Loss of MCP flexion and IP extension by lubrical III and IV

Question 305

Describe wrist drop: what nerve is affected, what 3 muscles are effected?

Answer 305

- Injury to the radial nerve - inability to extend the wrist - Loss of wrist extension by ECRB, and ECRL, and ECU

Question 306

Describe Median claw:

Answer 306

- Injured nerve: distal median - Lateral 3.5 digits cannot extend - Loss of MCP flexion and IP extension by lumbricals I and II

Question 307

MSK Pathology: Describe hand of benediction:

Answer 307

- injured nerve: Proximal median - content: attempting to a fist - Loss of DIP flexion by FDP to index and middle fingers - Loss of PIP flexion and FDS - Loss of IP flexion by FPL (flexor pollicus longus) - Intact FDP to ring and little fingers preserves flexion

Question 308

What transverses through the Cribriform plate of the anterior cranial fossa?

Answer 308

CN I olfactory bundles

Question 309

What transverses through the optic canal of the middle cranial fossa?

Answer 309

CN II, Ophthalmic artery, central retinal vein

Question 310

What transverses through the Superior orbital fissure of the middle cranial fossa?

Answer 310

CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers

Question 311

What transverses through the Foramen rotundum of the middle cranial fossa?

Answer 311

CN V2 (maxillary)

Question 312

What transverses through the Foramen ovale of the middle cranial fossa?

Answer 312

CN V3 (mandibular)

Question 313

What transverses through the internal acoustic meatus of the posterior cranial fossa?

Answer 313

CN VII (facial), VIII (vestibularcochlear)

Question 314

What transverses through the Jugular foramen of the posterior cranial fossa?

Answer 314

CN IX, X, XI, jugular vein

Question 315

What transverses through the hypoglossal canal of the posterior cranial fossa?

Answer 315

CN XII

Question 316

Neuro Anatomy: What transverses through the Foramen magnum of the posterior cranial fossa?

Answer 316

Spinal roots of CN XI, brain stem, vertebral arteries

Question 317

MSK Pathology: What surgical maneuver is needed to relieve the pressure in Carpal Tunnel syndrome?

Answer 317

Longitudinal incision of the transverse carpal ligament aka the flexor retinaculum

Question 318

What can you expect in Brown-Séquard syndrome?

Answer 318

- IL paralysis due to corticospinal tract injury - IL loss of vibratory, proprioceptive, and light touch sensation (dorsal columns) - CL loss of pain, temperature, and crude touch sensation (spinothalamic tract) below the level of the injury - results from hemisection of the spinal cord

Question 319

Describe the musculocutaneous nerve:

Answer 319

- derived from the upper trunk of the brachial plexus (C5-C7) - Innervates the coracobrachialis which flexes and adducts the arm - innervated the major elbow flexors (eg, biceps brachia, brachial) - provides sensory innervation to the lateral forearm

Question 320

Describe the hypothalamic nuclei: Ventromedial

Answer 320

Signals satiety; destruction leads to hyperphagia

Question 321

Describe the hypothalamic nuclei: Lateral

Answer 321

Signals hunger; destruction leads to anorexia

Question 322

Describe the hypothalamic nuclei: Anterior

Answer 322

Mediates heat dissipation; destruction leads to hyperthermia

Question 323

Describe the hypothalamic nuclei: Posterior

Answer 323

signals to conserve heat; destruction leads to hypothermia

Question 324

Describe the hypothalamic nuclei: Arcuate

Answer 324

Secretion of Dopamine (inhibits prolactin), GHRH

Question 325

Describe the hypothalamic nuclei: Medial preoptic

Answer 325

Secretion of GnRH, regulates sexual behavior

Question 326

Describe the hypothalamic nuclei: Paraventricular

Answer 326

Secretion of oxytocin, CRH, TRH, and small amounts of ADH

Question 327

Describe the hypothalamic nuclei: Supraoptic

Answer 327

Secretion of ADH and small amounts of oxytocin

Question 328

Describe the hypothalamic nuclei: Suprachiasmatic

Answer 328

Circadian rhythm regulation and pineal gland function

Question 329

What structure is twisted in an Ovarian torsion?

Answer 329

Infundibulopelvic ligament

Question 330

What is muscle is involved in painful external rotation of the arm against resistance?

Answer 330

Infraspinatus

Question 331

What is the relation between the femoral nerve, artery, vein?

Answer 331

Lateral to medial respectively

Question 332

What is the importance of L2-L4 nerve roots?

Answer 332

- Patellar reflex - lesion can cause sensory deficiency to anteromedial thigh and medial shin - Lesion affects hip flexion (iliopsoas), hip adduction, knee extension (quadriceps)

Question 333

What is the importance of the S1 nerve root?

Answer 333

- Achilles reflex - lesion can cause sensory deficiency to posterior calf, sole and lateral part of the foot - lesion can also affect hip extension (gluteus Maximus), knee flexion (hamstrings), and foot plantar flexion (gastrocnemius)

Question 334

Describe lumbosacral radiculopathy of L5 nerve root:

Answer 334

- no reflex affected - sensory loss of lateral shin and dorsal of the foot - weakness in foot dorsiflexion and inversion (tibialis anterior), foot eversion (peroneus), and toe extension (extensor hallucis and digitorum)

Question 335

Head and neck squamous cell carcinomas typically first spread where?

Answer 335

Anterior cervical/jugular lymph nodes via the lymphatics

Question 336

If you had to anesthetize the nerves supplying the quadriceps, wha nerve is it, and where should you inject?

Answer 336

Femoral nerve, below the inguinal ligament ie in the inguinal crease

Question 337

Which lymph nodes drain the testis?

Answer 337

Para-aortic

Question 338

Which lymph nodes drain the scrotum?

Answer 338

Superficial inguinal

Question 339

What is contained in the Kiesselbach plexus of the Nasal septum?

Answer 339

- septal branch of the anterior ethmoidal artery - lateral nasal branch of the sphenopalatine artery - septal branch of the superior labial artery (branch of the facial artery)

Question 340

How can patients be at increased risk of recurrent encapsulated bacterial infection like Neisseria Meningitidis?

Answer 340

Terminal compliment deficiency C5-C9.

Question 341

What risk is increased with coarctation of the aorta?

Answer 341

Cerebral Aneurysm which can rupture into a subarachnoid hemorrhage.

Question 342

Explain the tubular fluid/plasma ultra filtrate graph:

Answer 342

- Upward (positive) slope indicated an increasing concentration of that substance as fluid moves toward distal parts of the tubule, results of secretion or non reabsorption - A downward slope indicates active reabsorption of that substance in the proximal tubule - Order: Top to bottom Positive slope: 1. Creatinine, 2. Urea No slope: 3. Sodium or Potassium Negative slope: 4. Bicarbonate, 5. Glucose or Amino Acids

Question 343

Describe Nocardiosis/Nocardia

Answer 343

Microbiology: - Gram positive rod (beaded or branching) - Partially acid- fast - Aerobic Epidemiology: - Endemic in soil - disease from spore inhalation or traumatic inoculation into skin - Immunocompromised or elderly patients Clinical features: - Pneumonia: similar to TB - CNS involvement: brain abscess - Cutaneous involvement Treatment: - Trimethoprim-sulfamethoxazole - Surgical drainage of abscesses

Question 344

Describe the MOA of Echinocandins eg Caspofungin, Micafungin:

Answer 344

- blocks synthesis of 1,3-beta-D-glucan, suppressing fungal cell wall synthesis.

Question 345

Describe a pericardial effusion:

Answer 345

- Enlarged, globular silhouette - chest tightness or fullness an dyspnea on exertion (due to decreased diastolic ventricular filling that leads to decreased stroke volume - Tachycardia to compensate for decreased ventricular filling - Low voltage QRS and diminished heart sounds - Electrical alternans dues to the swinging motion of the heart in the fluid-filled pericardial cavity, causing a beat-to-beat variation in the QRS axis

Question 346

Describe Cataracts:

Answer 346

Pathogenesis: - Oxidative damage and opacification of the lens Risk factors: - age >60 - Diabetes mellitus - Chronic sunlight exposure - tobacco use - immunosuppression (eg, HIV, corticosteroids) Clinical features: - painless, progressive, bilateral vision loss - difficulty with nighttime driving - loss of red reflex - opacified lens Treatment: - Artificial lens implantation

Question 347

What site of the brain is responsible for vomiting?

Answer 347

Chemoreceptor trigger zone, aka the Area postrema. Located at the caudal end of the fourth ventricle.

Question 348

What benign disorder is characterized by low total thyroxine (T4) and normal free T4 and TSH?

Answer 348

Thyroxine-binding globulin deficiency, patients are euthyroid and do not require treatment.

Question 349

Describe the respiratory tract infections in children: Nasopharyngitis (common cold)

Answer 349

Presentation: - nasal congestion and discharge, sneezing, cough and sore throat Common etiologic agents: - Rhinovirus, Influenza virus, coronavirus

Question 350

Describe the respiratory tract infections in children: Laryngotracheitis (croup)

Answer 350

Presentation: - Upper respiratory tract symptoms followed by hoarseness, barking cough, stridor, and respiratory distress Common etiologic agents: - Parainfluenza virus

Question 351

Describe the respiratory tract infections in children: Diphtheria

Answer 351

Presentation: - sore throat, cervical lymphadenopathy, coalescing pseudomembrane Common etiologic agents: - Corynebacterium diphtheriae (club shaped, gram positive baccilus)

Question 352

Describe the respiratory tract infections in children: Epiglottitis

Answer 352

Presentation: - sore throat, dysphagia, drooling, and respiratory distress - thumb print sign on X-ray Common etiologic agents: - Haemophilus influenzae

Question 353

Describe the respiratory tract infections in children: Bronchiolitis

Answer 353

Presentation: - upper respiratory tract symptoms followed by wheezing, cough, and respiratory distress Common etiologic agents: - Respiratory syncytial virus

Question 354

Describe Nontyphoidal Salmonella:

Answer 354

Epidemiology: - Poultry/eggs, exotic pet contact - industrialized regions - S. Enteritidis, S. Newport, S. Typhumirium Pathophysiology: - invasion of enterocytes - neutrophil-mediated inflammatory response localized to lamina propria/ Peyer patches Manifestations: - Gastroenteritis: Self-limited, watery diarrhea (can be bloody). Rarely invasive: osteomyelitis, endocarditis, mycotic aneurysm (a life-threatening condition that occurs when a blood vessel wall becomes infected and weakens, causing the vessel to swell or balloon)

Question 355

Describe Typhoidal Salmonella:

Answer 355

Epidemiology: - water/food contamination - resource-limited regions - S. Typhi, S Paratyphi Pathophysiology: - Invasion of enterocytes - blunted neutrophil response due to capsular antigen Vi - extensive intracellular replication in macrophages -> spread through lymphatics and RES Manifestation: - Typhoid fever: Progressive fever (pulse-temperature dissociation), Rose spots, abdominal pain, hepatosplenomegaly, GI bleeding, perforation

Question 356

Describe the MOA Fibrates:

Answer 356

Lower triglyceride levels by activating peroxisome proliferator-activated receptor alpha (PPAR- alpha), which leads to decreased hepatic VLDL production and increased lipoprotein lipase activity.

Question 357

Describe the effects of taking Omega-3 fatty acids:

Answer 357

Lower triglycerides by decreasing production of VLDL and apolipoprotein B

Question 358

How can you localize the heterotopic gastric mucosa in Meckel diverticulum?

Answer 358

99mTc-pertechnetate

Question 359

What can you expect damaging the anterior and posterior vagal trunks that pass through esophageal hiatus? eg, esophageal hiatal hernia repair aka fundoplication

Answer 359

-Delayed gastric emptying - gastric hypochlorhydria

Question 360

Where can you expect a neoplastic spinal cord compression to spread?

Answer 360

Epidural space causing severe back pain, motor weakness, and/or sensory deficits. Urinary and fecal retention or incontinence are common late-stage findings/

Question 361

What is strong evidence of malignancy?

Answer 361

Monoclonal lymphocytic proliferation

Question 362

Describe the characteristics of the left ventricle: 5 points

Answer 362

- High muscle mass - High resting oxygen extraction - Coronary perfusion during diastole only - collateral circulation less developed - Low ischemic preconditioning

Question 363

Describe the characteristics of the right ventricle:

Answer 363

- Low muscle mass - Low resting oxygen extraction - Coronary perfusion throughout cardiac cycle - Collateral circulation more developed - High ischemic preconditioning (protective)

Question 364

Describe Chédiak-Higashi Syndrome:

Answer 364

- Autosomal recessive - affects lysosomal trafficking - Immunodeficiency, albinism, neurological abnormalities (eg, nystagmus) - Giant cytoplasmic granules are seen within neutrophils

Question 365

Describe Myoglobin

Answer 365

- Monomeric containing only one globin therefor carries one oxygen molecule - Graphically is hyperbolic

Question 366

Where do internal hemorrhoids originate?

Answer 366

Above the pectinate line Nonpainful

Question 367

Where do external hemorrhoids originate?

Answer 367

Below the pectinate line Painful

Question 368

Where do internal hemorrhoids drain?

Answer 368

Superior rectal vein, which communicates with the inferior mesenteric vein.

Question 369

MSK Anatomy: Where do external hemorrhoids drain?

Answer 369

Drains via the inferior rectal vein into the internal pudendal vein, which communicates with the internal iliac veins.

Question 370

What does the superior vesicle artery supply?

Answer 370

Bladder and ductus deferens

Question 371

What does the left colic artery supply?

Answer 371

Branching off the inferior mesenteric artery. Supplying the transverse and descending colon.

Question 372

What does the external iliac vein drain?

Answer 372

- inferior epigastric (anterior abdominal wall) - deep circumflex iliac veins (iliac crest)

Question 373

What does the external pudendal artery supply?

Answer 373

- Scrotum (male) - Labia majora (females) - Perineum

Question 374

What labs consider polycythemia as a dx?

Answer 374

Hematocrit: - >48% for females - >52% males

Question 375

What are the takeaways of Absolute Polycythemia?

Answer 375

Polycythemia Vera: - true increase in RBC - Polycythemia Vera cause all 3 cell lines increase Secondary erythrocytosis: - Only RBC increases - Normal WBC and platelets - Hypoxia, erythropoietin producing tumors

Question 376

What are the takeaways of Relative Polycythemia?

Answer 376

- Relative has normal RBC mass - Causes include dehydration and excessive diuresis

Question 377

Describe Histoplasma Capsulatum:

Answer 377

Epidemiology: - Dimorphic fungus - mold in environment, yeast at body temperature - endemic to Ohio and Mississippi River Valleys - Soil contaminated by bird or bat droppings Pathophysiology: - Inhaled -> phagocytosed by alveolar macrophages -> escapes lysosome destruction -> spreads to hilar/ mediastinal lymph nodes - controlled by cell-mediated immune response (granulomas) Disease course: - Immunocompetent: asymptomatic (primarily) or self- limited pneumonia with mediastinal/hilar lymphadenopathy - Immunocompromised: disseminated disease through liver, spleen, or bone marrow Diagnosis: - urine antigen testing - Biopsy with histopathology- granulomas and macrophages with intracellular ovoid/round yeast

Question 378

Pulmonary Pharmacology and Embryology: What do you give to an infant suffering from NRDS?

Answer 378

Corticosteroids, infant is most like premature <32 weeks and has a surfactant deficiency.

Question 379

Immunology: How is serum sickness resolved?

Answer 379

Mononuclear phagocytes continue to remove the excess ICs.

Question 380

GI Embryology: What is the pathogenesis of a congenital diaphragmatic hernia?

Answer 380

Failure of the pleuropertinoneal folds to close

Question 381

Behavioral science: How long does it take for an adequate antidepressant response?

Answer 381

4-6 weeks

Question 382

Biochemistry: Triglyceride metabolism How are triglycerides converted into glucose?

Answer 382

Liver and kidney enzyme Glycerol kinase phosphorylates producing DHAP, further producing energy and Glucose

Question 383

Cardiovascular Pharmacology: Which drugs would most likely cause drug induce lupus erythematosus? 5 points

Answer 383

- Hydralazine - Procainamide - Isoniazid - Minocycline - Quinidine

Question 384

Microbiology: What drug is Mycobacterium Tuberculosis most likely resistant to if there are reductions in the catalase-peroxidase enzyme?

Answer 384

Isoniazid INH, an inhibitor of mycolic acid synthesis, a crucial component to the cell wall

Question 385

Cardiovascular Pathology: What hemodynamics measurements are you expected to see in a pt with Hypovolemic shock?

Answer 385

- CVP (Right-sided preload); Decrease - PCWP (Left-sided preload: Descrease - Cardiac index (LV output): decrease - SVR: increase - SvO2 (mixed venous oxygen saturation): Decrease

Question 386

Cardiovascular Pathology: What hemodynamics measurements are you expected to see in a pt with cardiogenic shock?

Answer 386

- CVP (Right-sided preload); increase - PCWP (Left-sided preload: increase - Cardiac index (LV output): decrease - SVR: increase - SvO2 (mixed venous oxygen saturation): Decrease

Question 387

Cardiovascular Pathology: What hemodynamics measurements are you expected to see in a pt with obstructive shock?

Answer 387

- CVP (Right-sided preload); increase - PCWP (Left-sided preload: decrease (CTamp*) - Cardiac index (LV output): decrease - SVR: increase - SvO2 (mixed venous oxygen saturation): Decrease

Question 388

Cardiovascular Pathology: What hemodynamics measurements are you expected to see in a pt with distributive shock?

Answer 388

- CVP (Right-sided preload): decrease - PCWP (Left-sided preload: decrease - Cardiac index (LV output): Increase - SVR: decrease - SvO2 (mixed venous oxygen saturation): Increase**