Uworld Part 2

Question 1

What bacterial factor of E coli causes Septic Shock?

Answer 1

Lipid A

(part of LPS, heat-stable ENDOTOTOXIN.

Question 2

SSRI work on which part of the brainstem?

Answer 2

Raphe Nucleus

Question 3

Where do SNRI’s work in brain?

The question asks that where can we find serotinin and NE-releasing neurons in the brain?

Answer 3

Raphe Nucleus in whole of the brainstem (i.e Midbrain, Pons and Medulla)

NE releasing neurons are found in the LOCUS CERULEUS of dorsal Pons.

Question 4

Apixaban is a Factor Xa inhibitor, so which of the following will it directly affect when given as therapy?

1) Conversion of factor X to Xa
2) Conversion of prothrombin to thrombin

Answer 4

The correct answer is it affects the conversion of prothrombin to thrombin.

It is a DIRECT factor Xa inhibitor, it doesn’t inhibit the conversion of factor X to factor Xa. It binds to factor Xa to inhibit it.

Question 5

Story of Retinoblastoma, the security guard of G1/S transition?

Answer 5

Retinoblastoma is just like a security guard. He is always active and dephosphorylated binding tightly to its gun(E2F)

But when Cyclin Kinases come to rob the building, they PHOSPHORYLATE Rb i.e. shoot him. Shooting is phosphorylation because ammunition contains phosphorous. And it gets down, releases E2F from it hand and the thieves progress i.e cell cycle continues.

Question 6

Typical age for Schizophrenia is?

Answer 6

In men, early 20’s. And women, late 20’s.

Question 7

Another name for septic shock is?

Answer 7

Fluid refractory hypotension because of sepsis

Question 8

ACA stroke causes?

Answer 8

C/L leg and foot weakness, urinary incontinence.

Question 9

MCA stroke causes?

Answer 9

C/L Face and upper limb paralysis and sensory loss.
Haath kay kaam nahyin ker sakay ga jaisay gripping, aur mu kay bhee jaisay whistling and swallowing.

Aphasia agar dominant lobe ho jaata hai damage, aur agar non dominant lobe damage ho tou hemineglect ho jaata hai.

Question 10

Spinal muscular atrophy in a child, SMN1 gene affected. What protein is defective?

Answer 10

snRNPs in lower motor neurons.

Question 11

When snRNPs are defective, which cellular element doesn’t work?

Answer 11

Spliceosomes

Question 12

Diseases caused by splice site mutation and what does a splice site mutation cause?

Answer 12

Gaucher, B thalassemia and Marfans are a result of splice site mutation.

In a splice site mutation, intron retained in the mRNA when it should have been cleaved.

Question 13

Splice sites of introns have what specifications?

Answer 13

GU———————AG

Question 14

Defective SnRNPs and antibodies against snRNPs are seen in which diseases respectively?

Answer 14

Defective snRNPs are seen in Spinal Muscular Atrophy.

Antibodies against snRNPS are seen SLE. The anti-smith Antibodies are actually against snRNPs.

Question 15

Amazing fact about snRNPs?

Answer 15

Have lots of Uridine in them so are also called U-RNA.

Question 16

Treatement of Nesserio Gonorrhea?

Answer 16

Macrolide (Azithromycin) and a third generation cephalosporin (Ceftriaxone)

Question 17

Why does acute salicylate intoxication cause primary anion gap metabolism?

Answer 17

Increases lipolysis
Uncouple oxidative phosphorylation
Inhibits citric acid cycle.

So there’s accumulation of lactate, ketoacids.

Question 18

You have told the patient that she has pancreatic cancer. She begins to cry while holding her head in her hands. Which of the following is the most appropriate response?
A) “I know this isn’t the news you wanted to hear, let’s talk about the results in a bit more detail”
B) “I wish I had better news to share with you. I imagine this is very upsetting to hear”

Answer 18

B) “I wish I had better news to share with you. I imagine this is very upsetting to hear”

Not A, because we need to give the patient time to process this news and express her emotions. Instead physician should let the patient take the lead and answer the questions that the patient asks.

Question 19

Actinic Keratosis progresses to?

Answer 19

Squamous Cell Carcinoma

Question 20

Characteristics of Actinic Keratosis?

Answer 20

Has a sandpaper texture, occurs on sun-exposed areas.
Hyperkeratosis
Parakeratosis (Retention of nuclei in Stratum Corneum)

DO NOT INVADE DERMIS.

Question 21

Liver Biopsy reveals dilated Bile Canalculi with green-brown plugs and yellowish green accumulations of pigment with the hepatic parenchyma.

What is it?

Answer 21

Cholestasis.

Has a lot of reasons, there’s a table for it in your camera roll. PLEASE GO LOOK.

Question 22

NPH can occur due to decreased absorption of cerebrospinal fluid by _____________________.

Answer 22

Arachnoid Granulations.

Arachnoid Granulations don’t absorb CSF adequately when fibrosed from previous cerebral inflammation or bleeding.

Question 23

Cause of urinary incontinence in NPH?

Answer 23

Lateral Ventricles expand——-> Stretch cortical descending fibres———-> lack of cortical inhibition———> Detrusor Muscle Hyperactivity (Urge Incontinence)

Question 24

What bacterial virulence factor of Staph aureus causes necrotising pneumonia?

Answer 24

Leukocidin is a cytotoxin responsible for tissue necrosis.

Question 25

In BPH treatement, which drug acts on the epithelial components and which drug works on smooth muscle components?

Answer 25

Finasteride (5 alpha reductase inhibitor) works on the epithelial component) Alpha-1 blockers work on smooth muscles.

Question 26

Patient has pheochromocytoma. CT Scan abdomen reveals a mass in right adrenal gland. Which of the following cells have the same embryological origin as the tissue responsible for this patient’s current condition? ``` A) Capillary Endothelial Cells B) Cardiac Myocytes C) Interstitial fibroblasts D) Melanin-producing cells E) Thyroid Follilcular cells. ```

Answer 26

D) Melanin-producing cells. (Pheo Schwann's PNS is dark) ``` Neural Crest derivatives: Neural ganglia, adrenal medulla Schwann cells; pia & arachnoid mater Aorticopulmonary septum & endocardial cushions Branchial arches (bones & cartilage) Skull bones Melanocytes ```

Question 27

1 SD and 2 SD of the normal distribution curve is how much of the total population in percentage.

Answer 27

1 SD is 68% | 2 SD is 95%

Question 28

What’s peculiar about mesothelioma?

Answer 28

Pleural effusions are BLOODY/HEMORRHAGIC/ EXUDATIVE

Question 29

Histo of Mesothelioma?

Answer 29

Proliferation of epitheloid type cells that are joined by desmosomes, Contain abundant TONOFILAMENTS. Studded with very long MICROVILLI.

Question 30

3 symptoms/signs of SIADH?

Answer 30

Hypotonic Hyponatremia (Serum sodium and serum osmolality are decreased) Concentrated Urine (Increased Urine Osmolality, Increased Urina Na) CLINICAL EUVOLEMIA.

Question 31

``` Which of the following drugs can cause SIADH? A) Canagliflozin B)Carbamazepine C) Furesemide D)Lithium E) Spironolactone ```

Answer 31

Carbamazepine. There’s also a table for SIADH, that you SHOULD revise.

Question 32

``` 22 year old comes to you with erectile dysfunction, lack of sexual desire, Bilateral Gynecomastia, small firm testis. What should be given for treatment? A) Aromatase inhibitor B) Gonadotropin C) PDE5 inhibitor D) Selective Estrogen receptor Modulator E) Testosterone ```

Answer 32

E) Testosterone.

Question 33

What will be the levels of following in Klinefelter’s Syndrome? ``` Serum LH Testosterone Serum FSH Inhibin B Sperm count ```

Answer 33

``` Serum LH- INCREASED Testosterone- DECREASED Serum FSH- Increased Inhibin B- Decreased Sperm count- ABSENT. ```

Question 34

In a patient of Klinefelter’s syndrome. 47 XXY——> what is the main pathology?

Answer 34

Dysgenesis of seminiferous tubules

Question 35

Disturbances that increase alveolar-arterial O2 gradient include _________, ____________ and ______________________.

Answer 35

V/Q mismatching ( eg Pulmonary Embolism) Diffusion Limitation Right-to-left shunting (Eg Eisenmenger Syndrome)

Question 36

What causes syncope in a panic attack?

Answer 36

Hyperventilation causes DECREASED ARTERIAL PARTIAL PRESSURE OF CO2—-> the hypocapnia reduces Cerebral blood flow and leads to lightheadedness/ dizziness.

Question 37

Endurance training will result in increase of? A) Anaerobic Glycolytic Enzymes B) Mitochondrial Content C) Proportion of type 2( fast twitch fibres)

Answer 37

Increased Mitochondrial content.

Question 38

What happens to skeletal muscle fibres in Endurance training?

Answer 38

It promotes characteristics of Type 1 fibres—-> increased size and increased mitochondrial content, increase in aerobic oxidative enzymes. Increases capillary density Anaerobic glycolytic enzymes will decrease

Question 39

What happens to skeletal muscles during resistance training?

Answer 39

Enhances characteristics of Type 2 muscle fibres.

Question 40

No matter what kind of exercise you do, what characteristic of skeletal muscles remains unchanged?

Answer 40

Number of muscle fibres within a motor unit Or Endplates per fiber DO NOT CHANGE.

Question 41

21 year old woman comes to office with facial flushing, headache, nausea, vomiting and abdominal cramps after drinking alchohol ar a party. What is she being treated for?

Answer 41

She is taking Metronidazole for treatement of trichomonas vaginitis or Bacterial vaginosis—-> disulfiram reaction occured and accumulation of acetaldehyde dehydrogenase is causing all of these symptoms.

Question 42

Mechanism of action of Clostridium difficile toxins on colon?

Answer 42

The toxins affect the colonic mucosa. These toxins disrupt the cellular cytoskeletons and intercellular TIGHT junctions leading to COLONOCYTE APOPTOSIS.

Question 43

What will you see on histo of colon when infected by clostidium difficile?

Answer 43

There’s going to be DENUDED colonic epithelium/Necrotic epithelium.—-> That’s why there’s formation of white/gray pseudomembranes seen grossly. There’s also going to be inflammatory infiltrate over this which includes FIBRIN AND NEUTROPHILS.

Question 44

Reactive lymphocytes are seen in?

Answer 44

Intracellular infections like HIV, CMV, Toxoplasmosis and infectious mononucleosis caused by EBV

Question 45

Reactive Lymphocytes are large, ____________ and have abundant cytoplasm.

Answer 45

SCALLOPED.

Question 46

Reactive lymphocytes are effector cells that contain __________ (You did this wronggg)

Answer 46

Perforins and granzymes.

Question 47

Cytotoxic granules in reactive lymphocytes are released in response to foreign antigens on the surface of (MHC Class I receptors/ MHC class II receptors.)

Answer 47

MHC Class I receptors

Question 48

Which of the following steps involving the processing and handling of pre-mRNA/HnRNA occur only in the cytoplasm of cells? A) Interation with snRNP B) Methylation of 5’terminal guanine C) Multiple Adenine nucleotide attachment to the 3’ end. D) interaction with P bodies

Answer 48

interaction with P bodies P bodies interact with mRNA once it is out of the nucleus after being all finalized with the Poly A tail and splicing done in the NUCLEUS. P bodies are responsible for fundamental role in translational repression and mRNA decay.

Question 49

What is acute retroviral syndrome? You

Answer 49

When HIV infected people develop mononucleosis like symptoms (Sore throat, headache, diffuse lymphadenopathy, OROPHARYNGEAL ULCERS AND DIFFUSE MACULOPAPULAR RASH) This period is after 2-4 weeks of inoculation. The labs will show NEGATIVE SEROLOGY i.e ‘o antibodies.

Question 50

Person with megaloblastic anemia, has low Vitamin B12 levels but normal folate levels. What’s the diagnosis? And what will be the levels of the following? Gastrin (Elevated, Reduced, Normal) Gastric PH (High, Low, Normal) Parietal Cell Mass ( Increased, Decreased, Normal)

Answer 50

This means intrinsic factor problem. And that indicates autoimmune gastritis/Pernicious anemia. CD4+ T cells attacking parietal cell, cause a DECREASED parietal cell mass. Resulting in decreased gastric acid (caused HIGH gastric PH), and decreased production of intrinsic factor (causing low vitamin B12 and hence megaloblastic anemia) The high PH, stimulates more gastrin to be released, so ELEVATED GASTRIN.

Question 51

What is the effect on GFR and FF if efferent arteriole constricts?

Answer 51

Efferent arteriole constricts so because of back pressure or in short increased capillary hydrostatic pressure and causes INCREASED GFR. However, efferent arteriolar constriction causes DECREASED RPF. So this causes, INCREASED FF.

Question 52

Which gonadal cells are responsible formation of internal reproductive organs in a male?

Answer 52

Sertoli cells. In lack sertoli cell function, the kid will have BOTH male and female internal reproductive organs.

Question 53

What is needed for the following to happen in a male fetus for the development of reproductive gonads? 1) Involution of paramesonephric ducts——> 2) wolfian duct/mesonephric duct into male internal reproductive organs—-> 3) Development of external male reproductive organs——->

Answer 53

1) Involution of paramesonephric ducts——> MIF from Sertoli cells needed 2) wolfian duct/mesonephric duct into male internal reproductive organs—-> Testosterone from Leydig cells. 3) Development of external male reproductive organs——-> DHEAT.

Question 54

Due to increase in which clotting factors during pregnancy and pierperium there is risk of thrombosis?

Answer 54

Factor 7,8 and 10 | vWF and Fibrinogen are also increased.

Question 55

Ovarian vein drain into what on each side?

Answer 55

Right ovarian vein drains into IVC | Left ovarian vein drains into left renal vein.

Question 56

Which intracellular signalling pathway is stimulated with the medication used to treat Turner’s syndrome in a 6 year old girl?

Answer 56

JAK-STAT pathway activated by growth hormone.

Question 57

Growth hormone induced the production of _____________ by __________.

Answer 57

IGF-1 (Insulin Like growth factor) by hepatocytes.

Question 58

What is another name for JAK-STAT pathway?

Answer 58

Non-receptor tyrosine Kinase

Question 59

Which hormones use JAK-STAT pathway?

Answer 59

Prolactin, Growth Hormone, Erythropoietin, Cytokines like IL-6, IL-2, IFN. Also G-CSF.

Question 60

IP3-calcium-calmodulin pathway and DAG- Protein Kinase C are the same pathways. They start from?

Answer 60

Gq receptors that activate Phospholipase C

Question 61

Hormones that work via IP3 pathway?

Answer 61

Mnemonic is GOAT HAG. GnRh, Oxytocin, ADH (V1 receptor), TRH, Histamine, Angiotensin 2, Gastrin.

Question 62

3 diseases in which pulse-temperature dissociation is seen?

Answer 62

Typhoid, Tularemia, Yellow Fever.

Question 63

Antibodies seen in SLE?

Answer 63

Positive ANA, Anti-dsDNA, Anti-smith ( that are actually antibodies against snRNPs)

Question 64

Lab abnormalities seen in SLE:

Answer 64

Mnemonic is SAB KAM HOTA HAI. Anemia, leukopenia, thrombocytopenia, low complement levels. But INCREASED LEVELS OF IMMUNE COMPLEXES.

Question 65

Anti-cyclic cittrulinated peptide antibodies are seen in?

Answer 65

Rheumatoid Arthritis.

Question 66

Anti-mitochondrial antibodies are seen in?

Answer 66

Primary Biliary Cirrhosis.

Question 67

60 year old man comes with enlarged vertebral bodies with cortical thickening, what is the diagnosis and how will you diagnose the patient?

Answer 67

Paget’s disease, diagnosed by presence of ELEVATED ALK PHOS LEVELS.

Question 68

On gross examination of a signet ring carcinoma, characteristirized by diffuse involvement of the stomach wall due to loss of _____________.

Answer 68

Cell Adhesion protein E-cadherin.

Question 69

2 types of acute pancreatitis and their pathology?

Answer 69

Acute interstitial pancreatitis——-> Fat cell destruction and calcium deposition (because of duct obstruction—-> Stasis of Pancreatic secretions leads to digestion of adipose cells by lipase and causes precipitation of insoluble calcium salts) Acute necrotic Pancreatitis ——> autodigestion of pancreatic tissue due to Trypsin activating all the proteolytic enzymes. Destruction of blood vessels causes areas of Hemorrhage. Macroscopically, it is seen an AREAS OF WHITE CHALKY FAT NECROSIS AND BLACK AREAS OF HEMORRHAGE.

Question 70

Reddish Urine that darkens on exposure, which disease is it?

Answer 70

Acute intermittent porphyria. | Deficiency of prophonilinogen deaminase deficiency.

Question 71

What is patiromer?

Answer 71

Nonabsorbable cation exchanger that binds phosphate and gives up its calcium in the intestine.

Question 72

_____________ prevent the hematogenous spread of candida.

Answer 72

Neutrophils

Question 73

Disseminated candidiasis presents as?

Answer 73

Candidemia, endocarditis.

Question 74

The (Sympathetic/Parasympathetic) Nervous System is responsible for physiological adaptations of vessels in hypothermia

Answer 74

Sympathetic

Question 75

The medication works by inhibiting metalloprotease to prolong the action of endogenous polypeptides. These polypeptides are most likely secreted by which cells?

Answer 75

Cardiomyocytes releasing ANP, BNP. | The medication is neprilysin inhibitor (sacubitril)

Question 76

Cause of hypercalcemia in Multiple Myeloma?

Answer 76

IL-1 and TNF-alpha liberating calcium from bones leads to lytic lesions of bones and hypercalcemia.

Question 77

``` There are four major diseases with hypercalcemia: Multiple Myeloma Primary Hyperparathyroidism Tertiary Hyperparathyroidism Familial hypocalciuric hypercalcemia. ``` What the mnemonic/story for their differences?

Answer 77

In Multiple Myeloma, increase in calcium occurs sab sey pehlayyy. So PTH is decreased and then 1,25 OH-Vit D is also decreased. In Primary Hyperparathyroidism, pehlay PTH increases and then it causes an increase Calcium. So there will also be HYPERCALCIURIA. In familial Hypocalciuric hypercalcemia——> same as Primary hyperparathyroidism, normal to increased PTH, INCREASED CALCIUM, but HYPOCALCIURIA.

Question 78

Why is the real problem in instussusception is compromised blood supply?

Answer 78

Impaired venous return from the invaginated segment of the bowel.

Question 79

Pseudodiverticula had which particular layer missing?

Answer 79

Muscularis propria

Question 80

___________________ is the essential pathogenic mechanism for Shigella infection.

Answer 80

Mucosal invasion

Question 81

Pathogen most commonly associated with cat and dog bite infection?

Answer 81

Pasteurella Multicoda. | It is indole positive so the infection produces a mouse like odour.

Question 82

What causes lymphangitis in immunocompetent hosts?

Answer 82

Bartonella henselae via cat bite (Lymphogranuloma Venereum caused by Chlamydia L1-L3 occurs in immunocompetent hosts---> Mixed granulomatous and neutrophilic infilteration with epithelial cells and inflammatory cells having chlamydial intracellular inclusion bodies. The painless ulcers----> Buboes (painful lymphadenopathy)--> causes STELLATE ABSCESS. Stellate shaped granuloma/abscesses--> are also called suppurative granulomas because they are granulomas and abscesses too.---> Occur in Bartonella. Lymphogranuloma venerum, and tularemia.

Question 83

3 types of pathogens responsible for skin infection after human bite?

Answer 83

Anaerobes Strep Eikenella corrodens

Question 84

Entameba histolytica histopathology will show?

Answer 84

Flask-shaped colonic ulcers with FOAMY trophozoites that resemble macrophages.

Question 85

How is the word actin related to Shigella and Clostridium?

Answer 85

Shigella induces apoptosis of host cells and spread to adjacent cells via protrusions created through host cell actin polymerization. Clostiridium difficile toxin INACTIVATE RHO-REGULATORY PROTEINS, involved in signal transduction and actin cytoskeletal structure maintenance. Thus, there’s disruption of intercellular TIGHT junctions.

Question 86

Ribosomal protein synthesis is inhibited by

Answer 86

Shiga and Shiga-like toxin( EHEC).

Question 87

What is the pathogenic mechanism of cholera exotoxin?

Answer 87

Apical ion transport affected——-> increased transport of Na and Cl out of the gut mucosa cells leading to watery diarrhoea.

Question 88

Roseola infantum caused by HHV-6,7 | Jo meeru ko hua tha, what are its signs/symptoms?

Answer 88

Pehlay buhat taez bukhaar hota hai————> phir rash hota hai, aur rash starts on the TRUNK. (Rosy-Ola)---> Rosy later! (Rash appearing after fever has subsided also occurs in Parvovirus)

Question 89

Erythema infectiosum is caused by which pathogen and what are its signs and symptoms?

Answer 89

It is caused by Parvovirus B19. Pehlay flu hota hai, phirrr slapped cheek rash aur reticular truncal rash (cheeky smile---> because the kid feels better)

Question 90

Axonal reaction?

Answer 90

Neuronal body becomes round, swollen and the nucleus is displaced to periphery. Nissl substances become fine, granular, and dispersed throughout the cytoplasm. This is called CENTRAL CHROMATOLYSIS.

Question 91

6 year old boy is brought to the ER due to confusion and intractable vomiting after taking Aspirin. This is Reye’s syndrome. What will we see in the light microscopy of his liver specimen?

Answer 91

Microvesicular steatosis. | (presence of small fat vacuoles in the cytoplasm of hepatocytes.

Question 92

Labs in Reye Syndrome?

Answer 92

Increased LFTs, Increased ammonia, Increased bilirubin, Prolonged PT and PTT

Question 93

Chest Tube placement to drain left sided pleural effusion. | Incision is at the 5th intercostal space in the mid axillary line. Which muscle will mostly likely by dissected?

Answer 93

Serratus Anterior

Question 94

What do leprosy skin lesions demonstrate?

Answer 94

Increased IL-2 and interferon-gamma in skin lesions.

Question 95

The cavitary lesion in TB, is formed due to which of the following mechanism? A) Aggregation of activated leukocytes B) Intraelveolar bacterial overgrowth

Answer 95

Aggregation of activated leukocytes

Question 96

Culture on sabouraud agar can be done for detection of which pathogen?

Answer 96

Cryptococcus Neoformans.

Question 97

Embryological cause of omphalocele or gastroschisis?

Answer 97

Failure of extraembryonic gut to return to the abdominal cavity.

Question 98

Embryological Cause of congenital umbilical hernia associated with Down’s Syndrome?

Answer 98

Incomplete closure of the umbilical ring

Question 99

Fate of umbilical hernia?

Answer 99

Spontaneous closure. Elective surgery around age 5.

Question 100

Gross appearance of the following: Umbilical Hernia—-> Gastroschisis———> Omphalocele——>

Answer 100

Umbilical Hernia—-> Large midline abdominal protrusion, covered by skin that is more pronounced when he cries. The umbilical stump is at the center of protrusion. Gastroschisis———> Eviscerated bowel with no covering membrane, beside umbilical cord. Omphalocele——> Sac containing multiple organs. Umbilical cord at apex.

Question 101

What is the pathway of heart failure because of systemic hypertension?

Answer 101

Systemic Hypertension——-> causes concentric LV Hypertrophy, ie. uniformly thickened left ventricular walls and a small LV cavity——-> leads to IMPAIRED DIASTOLIC FILLING AND HEART FAILURE WITH PRESERVED EJECTION FRACTION———> Elevated diastolic filling pressures are transmitted back to LA and cause left atrial dilatations predisposing it to Atrial fibirillation.

Question 102

________________ can lead to dramatic reduction in left ventricular filling in patients of Diastolic HF and can precipitate ACUTE DECOMPENSATION. (Pathological mechanism of acute decompensation in diastolic HF due to HTN)

Answer 102

Loss of Atrial contraction.

Question 103

Cardiac amyloidosis and Concentric hypertrophy due to HTN————> Both cause impaired diastolic function, but what’s the difference?

Answer 103

In cardiac amyloidosis, the diastolic filling is impaired because of VENTRICULAR WALL STIFFENING. In concentric hypertrophy, the diastolic filling is impaired because of VENTRICULAR WALL THICKENING.

Question 104

Receptor X upon activation, cause immediate change in transmembrane Calcium, Sodium and Potassium flow secondary to opening of the channel. Receptor X is most likely which type of receptor?

Answer 104

Nicotinic cholinergic receptors found at motor end plate. These receptors are ION channels. One receptor has 2 Ach binding sites and will only open if both the sites are bound bu Ach. Then the ion channel opens, and causes: Sodium and Calcium INFLUX Potassium EFFLUX.

Question 105

Which monosaccharide has the fastest rate of metabolism in the glycolytic pathway? And why?

Answer 105

FRUCTOSE-1-PHOSPHATE, because it bypasses phosphofructokinase enzyme which is an important regulatory enzyme of glycolysis. Hence, fructose is metabolized by the liver fastest and is rapidy cleared from bloodstream following dietary absorption.

Question 106

The prostatic plexus lies within the fascia of the prostate. It is made up for which nerves?

Answer 106

Inferior hypogastric plexus, with additional input from pelvic and sacral splanchnic nerve.

Question 107

Injury to prostatic plexus results in?

Answer 107

Erectile dysfunction because the cavernous nerves coming from this plexus carry post-ganglionic Parasympathetic fibres that facilitate Penile erection.

Question 108

68 year old woman is visiting her kids in Texas when she comes to ED due to confusion and flaccid paralysis of the left lower extremity with preserved sensation. What is the causative organism and what is its mode of transmission?

Answer 108

West Nile Virus causing meningitis/encephalitis and acute ASYMMETRIC flaccid paralysis. Positive sense, single stranded RNA transmitted by mosquito CULEX SPP.

Question 109

18 year old boy is brought to you in clinic, due to increasingly BIZARRE behaviour since the past 2 months. Doesn’t attend classes, doesn’t socialize, believes cafetaria food is poisoned. What is the diagnosis out of the following? A) Brief Psychotic Disorder B) Schizophreniform disorder C) Schizophrenia D) Delusional disorder.

Answer 109

A) Brief Psychotic Disorder- symptoms of schizophrenia for less than 1 month. B) Schizophreniform disorder- CORRECT (symptoms have been there for more than a month, bur less than 6 months) C) Schizophrenia- Symptoms should be for more than 6 months. D) Delusional disorder.- The patient won’t act bizarre, just has a delusion.

Question 110

Most likely mechanism of low serum phosphate in a patient of primary HyperPTH.

Answer 110

Decreased Phosphate reabsorption in proximal tubules.

Question 111

Cause of clinical variability of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes?

Answer 111

Heteroplasmy, the mixture of two types of genetic materials is the cause of clinical variability of mitochondrial diseases.

Question 112

What is low-expression variability?

Answer 112

Variability in severity of autosomal dominant disorders, such as seen in Marfan Syndrome.

Question 113

What down-regulates gastric acid secretion after a meal?

Answer 113

The third phase of stomach acid secretion called intestinal phase. Because of intestinal influences, the food upon reaching the ileum and colon releases PEPTIDE YY. Peptide YY binds to ECLS which inhibit gastrin-stimulated histamine release from ECLs.

Question 114

3 factors that reduce gastric acid secretion after a meal?

Answer 114

Intestinal influences, Somatostatin, Prostaglandins

Question 115

Vitamin C deficiency clinical manifestation?

Answer 115

Normocytic normochromic anemia. | Normal PT, aPTT while bleeding gums and loose teeth are seen. Skin ecchymosis and hemarthrosis are also seen.

Question 116

There is presence of Noncaseating granulomas on intestinal biopsy. What your choice for an effective treatment?

Answer 116

TNF-alpha inhibitors like infliximab, adalimumab are used as first-line therapy in the T/M of Crohn’s disease. Becaused TNF-alpha production by macrophages plays a central role in the pathogenesis of CD.

Question 117

On physical examination, the right pupil is 3 mm and the left pupil is 5 mm. Anisocoria increases in dimmed room. What is the most like location of the lesion?

Answer 117

Right oculosympathetic pathway. If anisocoria increases in dim light, that means sympathetic pathway is affected. Sympathetic is needed to dilate, so smaller pupil is the one with defect. Hence, right sided oculosympathetic pathway is damaged.

Question 118

Chest x-ray shows pulmonary infiltrates and area of cavitation in upper lobe. Sputum microscopy shows acid fast bacilli. What’s the most accurate statement concerning the patient’s pulmonary infection? A) First exposure to bacilli occurred recently. B) Healing of lung lesion would result in Ghon Complex formation. C) It originated from reactivation of an old infection.

Answer 118

A) First exposure to bacilli occurred recently- Primary TB mein focal lesion banti hai mid-to-lower lungs mein jissay kehtay hein Ghon Focus. B) Healing of lung lesion would result in Ghon Complex formation- Ghon Complex formation primary TB infection meim hoti hai jabb Ghon focus bn jaata hai hai and with that there’s also hilar lymphadenopathy. C) It originated from reactivation of an old infection- CORRECT. Cavitation means reactivated of TB.

Question 119

The levels of which antibody will differ the most in two patients who are give Salk and Sabin separately and not both?

Answer 119

Duedenal Luminal IgA response is only seen in Sabin ( the oral polio vaccine). As it is oral, it generates a much more robust and oropharyngeal and intestinal mucosal IgA response than the inactivated Salk poliovirus vaccine.

Question 120

Lab Studies reveal AAT deficiency. What will be the patterns of the following pulmonary function parameters? FEV1/FVC Total Lung Capacity DLCO

Answer 120

FEV1/FVC- obstructive so DECREASED. Total Lung Capacity- EMPHYSEMA of all any sort causes INCREASED TLC because of hyperinflation of lungs. DLCO- DECREASED.

Question 121

Affect of Beta-blockers, other than on B-receptors when given for hyperthyroidism?

Answer 121

Inhibits peripheral conversion of T4 to T3

Question 122

On autopsy, increased pigmentation is noted around the nipple areola and anal and vaginal mucous membranes. Which of the following additional findings are most likely to be seen on autopsy?

Answer 122

A) Atrophy of both adrenal

Question 123

Gomori Trichrome stain for?

Answer 123

Muscle biopsy showing blotchy red muscle fibres are characteristic of mitrochondrial myopathies.

Question 124

EM of mitochondrial myopathy will show?

Answer 124

INCREASED number of enlarged abnormally shaped mitochondria

Question 125

Person with membranous nephropathy comes to you with complains of flank pain, hematuria and left vericocele likely has?

Answer 125

Renal Vein Thrombosis as a result of Nephrotic Syndrome.

Question 126

Why is renal vein thrombosis a complication of nephrotic syndrome?

Answer 126

Due to loss of Anti-thrombin 3—-> hypercoagulable state.

Question 127

Patient comes to you with 10-day history of abdominal pain and loss of appetite. Has a family history of colon cancer. Abdominal examination is significant for tenderness on deep palpation of the LLQ along with an appreciable mass. What is the cause of the abdominal pain? A) Acute Diverticulitis B) Colon Cancer C) Ischemic Colitis

Answer 127

A) Acute Diverticulitis- CORRECT———> Leukocytosis and tenderness with or without palpable mass. B) Colon Cancer- Tumour large enough to be palpated with manifest with more chronic symptoms like weight loss. C) Ischemic Colitis——> common cause of abdominal pain in older patients. So it was a close call, but it presents as hematochezia and post-prandial pain. (You stop the blood supply of organs and they start giving out blood----> renal infarction presents with hematuria, Ischemia colitis presents with hematochezia sometimes when it is being experienced due to low blood supply)

Question 128

45 year old woman with sores and abscesses on her arm, fecal bacteria was found in one of the sores. What’s the most likely cause of patient’s condition? A) Factitious disorder B) Conversion Disorder C) Malingering.

Answer 128

A) Factitious disorder- CORRECT. Coming with facts, real chotein per khud ko lagaayi hon. B) Conversion Disorder- Exxagerate kerna, per patient jhoot nahyin bol raha hota. Dimaghi masla hota hai. C) Malingering- Jhoot bolna, exaggerate kerna symptoms ko.

Question 129

Patient’s cyanosis that does not improve with supplemental oxygen has ____________________.

Answer 129

Acquired Methemglobinemia

Question 130

Acquired methemoglobinemia’s 3 causes?

Answer 130

1. Dapsone. (Cannot be given in G6PD, used for treatment of Dermitis herpetiformis.) 2. Topical/Local Anesthetic——> Benzocaine. (MOA is??--> Inhibition of Na channels/ Na influx) 3. Nitrates/Nitrites (Found in drinking ground water)

Question 131

What do you see on calf biopsy of a patient of Duchenne Muscular Dystrophy? A) Fibrofatty muscle replacement B) Multiple lipid droplets within the muscle fibre

Answer 131

A) Fibrofatty muscle replacement- CORRECT. There’s myonecrosis in this condition, regenerating fibres with variation in shape and size are seen along with INCREASED amounts of Connective Tissue on LM. B) Multiple lipid droplets within the muscle fibre—-> Tricky, but seen in carnitine palmitoyltransferase deficiency.

Question 132

Patient with a cavitary lesion with an air-fluid level on chest x-ray, raising strong suspicion for _________________.

Answer 132

Lung Abscess So, remember: Air fluid level in chest means Lung Abscess, Air fluid level in intestines/abdominal x-ray means---> intestinal obstruction.

Question 133

What is the etiology of Subacute cerebellar degeneration? | Common in small cell carcinoma/oat cell---> so will present with mass in the lung

Answer 133

Autoimmune——-> Anti Yo, Anti Hu antibodies. Anti P/Q antibodies. Paraneoplastic cerebellar degeneration is due to an immune response against tumor cells that cross-reacts with Purkinje neuron antigens, leading to acute-onset rapid degeneration of the cerebellum.

Question 134

Paraneoplastic cerebellar degneration has what signs and symptoms?

Answer 134

Progressively worsening dizziness, limb and truncal ataxia, dysarthria and visual disturbances ( diplopia, oscillopsia)

Question 135

Medication induced esophagitis can be due to which drugs?

Answer 135

Tetracyclines Aspirin, NSAIDS. BISPHOSPHONATES PLISS REMEMBER THISSSS. Potassium Chloride, Iron.

Question 136

Bisphosphonates are C/I in?

Answer 136

Conditions that impair esophageal motility such as stricture, achalasia.

Question 137

What’s a peculiar side effect of bisphosphonates?

Answer 137

Osteonecrosis of jaw and atypical fractures of subtronchanteric zone and femoral shaft.

Question 138

The cause of LVOT in HOCM? A) Ascending aorta and interventricular Septum B) Mitral Valve leaflet and interventricular Septum C) Aortic Valve Cusp and Interventricular septum.

Answer 138

B) Mitral Valve leaflet and interventricular Septum- CORRECT.

Question 139

Which one out of the following will lead to cancer because of an activating mutation? ``` A) APC B) BRCA1 C) KRAS D) RB E) TP53 ```

Answer 139

KRAS because it is a proto-oncogene. | An activating mutation causes cancer.

Question 140

A lesion in Jugular foramen will cause?

Answer 140

Vernet/Jugular foramen Syndrome characterized by 9, 10, 11 dysfunction. Lose of taste from posterior 1/3rd of tongue (CN 9) Loss of Gag reflex and Dysphagia (CN 9,10) Hoarseness, uvula deviating towards the normal side (CN10) Sternocleidomastoid and Trapezius muscle paresis (CN11)—-> question will tell that shoulder is drooper on the affected side, and strength is reduced during shoulder shrug test

Question 141

Hemotympanum in the right ear. The patient is greatest risk for injury involving which cranial nerve?

Answer 141

Hemotympanum can occur in temporal bone fracture and temporal bone also contains the FACIAL NERVE (CN 7)

Question 142

Which tissue cannot utilize ketone bodies for energy?

Answer 142

Erythrocytes ONLY. | Even brain starts using ketone bodies in prolonged starvation

Question 143

Patient comes to you with hypotension, tachycardia and jugular venous distension. Also, pulsus paradoxus after a recent upper respiratory viral infection. A) Cardiac Temponade B) Constrictive Pericarditis

Answer 143

A) Cardiac Temponade- CORRECT. B) Constrictive Pericarditis- Pulsus paradoxus can occur in this too, but this condition takes several weeks to months to develop. Ans kussmaul sign is a MUST mention for us to diagnosse this.

Question 144

28 year old man, comes with muscle weakness and headaches (Hypokalemka and Hypertension). His BP is 190/120. His plasma renin and aldosterone are elevated. What’s the most likely cause? A) Adrenal Cortical Tumour B) Juxtaglomerular cell Tumour

Answer 144

A) Adrenal Cortical Tumour (Conn’s Syndrome) - will cause primary Hyperaldosteronism- Increased Aldo will inhibit Renin production, and Renin will be drecreased. B) Juxtaglomerular cell Tumour- CORRECT——> Renin and Aldosterone both increased.

Question 145

A person with traumatic brain injury during a motor vehicle collision comes to ED. One day later, a repeat head CT scan reveals diffuse cerebral edema. The ventilator respiratory rate is adjusted to achieve a PaCO2 of 26-30 mm Hg. What will be the effect of this ventilation?

Answer 145

Diffuse cerebral edema will cause an INCREASED ICP. Lowering PaCO2 to reduce ICP in mechanically ventilated patients with cerebral edema is a trick/intervention in the ICU because this would cause cerebral vasoconstriction and hence, reduced cerebral blood flow leading to reduced ICP.

Question 146

Mechanism of action of Triamterene?

Answer 146

Blocking renal tubular epithelial Sodium Channels.

Question 147

Cytosine Deamination is repaired by what?

Answer 147

Base Excision repair.

Question 148

Tell the enzymatic sequence of Base Excision Repair?

Answer 148

Glycosylase—->endonuclease——->lyase——-> DNA polymerase——-> Ligase

Question 149

Foot drop is due to which nerve?

Answer 149

Common fibular/peroneal nerve——-> question stem will say weakness in foot dorsiflexion and eversion.

Question 150

How can common peroneal nerve be damaged?

Answer 150

Trauma to knee and tightly applied plaster casts due to its superficial location at the neck of the fibula.

Question 151

Patient who is on sulfonylurea and ACE inhibitor, starts taking a weight loss supplement which she believes is completely herbal and contains caffeine. What do you do?

Answer 151

Offer to review the ingredients with the patient and discuss potential risks of the supplements.

Question 152

What is defective in Androgen insensitivity syndrome?

Answer 152

In AIS, there’s loss of feedback inhibition of GnRH, FSH, LH due to destruction of Androgen receptors in hypothalamus and pituatary.

Question 153

Labs in androgen receptor dysfunction?

Answer 153

Oligosepermia, FSH normal aur baaki Sabb increased ( Testosteron, LH)

Question 154

Delayed Typer HSR in candida is due to which cells?

Answer 154

CD 8+

Question 155

Greatest risk of cavernous hemangioma is the development of? A) Intracerebral Hemorrhage B) Subarachinoid Hemorrhage C) Subdural Hematoma

Answer 155

A) Intracerebral Hemorrhage- CORRECT, as they are so thin-walled they have the tendency to bleed into brain paranchyma. B) Subarachinoid Haemorrhage- caused by ruptured saccular aneurysms. C) Subdural Hematoma- most commonly by head trauma when bridging veins in subdural space are ruptured.

Question 156

Exclusively breastfed childen need the supplementation of which vitamin?

Answer 156

Vitamin D

Question 157

What changes will you see in arteriovenous fistula formation?

Answer 157

Low resistance fistula pathway REDUCES SYSTEMIC VASCULAR RESISTANCE——-> Reduced afterload. Blood passes through quickly in reduced peripheral resistance——-> Increased preload. INCREASED STROKE VOLUME due to reduced afterload and increased preload, helps maintain blood pressure.

Question 158

Arteriovenous malformations cause high-output heart failure, why?

Answer 158

The left ventricle is unable to keep up with the increased venous return despite a sustained increased in cardiac output/Stroke volume.

Question 159

Arteriovenous malformations are found in which conditions?

Answer 159

Osler-Weber-Rendu Syndrome/Heriditary Hemorrhagic telengectasia- Arteriovenous malformations in brain that have a tendency to rupture and cause Subarachnoid Hemorrhage. (These people present with Telengectasia of skin, GI bleeding or Epistaxis, and is AUTOSOMMAL DOMINANT.) Osteitis deformans/Paget’s disease of Bone. Acquired after a traumatic injury. Surgical placement for hemodialysis.

Question 160

If marginal artery from IMA is ligated in a surgery, which artery’s collaterals prevent ischemia of the descending colon?

Answer 160

SMA

Question 161

In a pregnant women, the INCREASE in insulin resistance is primarily due to the action of _____________________ a peptide hormone, secreted by the _________________.

Answer 161

Human placental Lactogen Syncytiotrophoblast.

Question 162

Strep pyogenes causing Glomerulonephritis after cellulitis/Erysiplas——-> The organism responsible for patient’s symptoms would demonstrate which of the following? ``` A) Bile Solubility B) Catalase Positivity C) Growth in hypertonic saline D) Optochin Sensitive E) PYR positive ```

Answer 162

``` A) Bile Solubility B) Catalase Positivity C) Growth in hypertonic saline- Only enterococci, which causes IE after GU procedures. D) Optochin Sensitive E) PYR positive- CORRECT ANSWER. ```

Question 163

Patient injured his leg while operating a motorized watercraft on the ocean near Florida 2 days ago. Dorsum of foot shows a small laceration, surrounding with hemorrhagic Bulla. Wound Culture yields curved gram-negative rods. What is the greatest risk factor for this patient’s infection?

Answer 163

The patient has gotten cellulitis due to Vibrio fulnicus. Vibrio fulnicus lives in salty water and is a curved gram negative rod. Causes wound infection with necrotising fasciitis and HEMORRHAGIC BULLAE. Patients with IRON OVERLOAD are are greatest risk of getting infected, because iron acts as a growth catalyst for this bacteria.

Question 164

The joint destruction in RA is characterised by _____________ and ____________.

Answer 164

Synovial hyperplasia and inflammatory infilteraretes (often containing lymphoid follicles)

Question 165

Early onset Alzheimer’s disease in Down’s syndrome people due to am extra 21 chromosome is due to which gene?

Answer 165

The APP GENE | Amyloid precursor protein

Question 166

H pylori lives in which specific part of the Stomach?

Answer 166

Gastric antrum

Question 167

Mechanism of ulcer formation in H pylori infection?

Answer 167

Colonization of the gastric antrum is associated with DECREASED SOMATOSTATIN———> Causing increased acid production by parietal cells.

Question 168

After 15 minutes, the skin at the site with peanut extract is erythamatous with a raised, itchy bump that improves by the time the family leaves the office. 4 hours later, the parents notice a HARD, RED SWELLING at the puncture site. What is most likely involved in this secondary reaction?

Answer 168

Epithelial damage by major basic protein. | Th2 xells release IL-5 to activate eosinophils——-> eosinophils release major basic protein, eosinophil peroxidase

Question 169

65 year old man is evaluated for HYPOTENSION,SHORTNESS OF BREATH, TACHYCARDIA AND TRACHEAL DEVIATION shortly after placement of subclavian central venous catheter. What is the diagnosis? And the cause of hypotension?

Answer 169

The diagnosis TENSION PNEUMOTHORAX, because of close proximity to the apex of lung, there is risk of lung puncture during the procedure.

Question 170

Which particular pressure changes in tension pneumothorax but stays the same in simple pneumothorax?

Answer 170

In simple, pneuomothorax as air rushes into the pleural space, it leads to LOSS OF INTRAPLEURAL NEGATIVE PRESSURE and pressure equalisation——> i.e. intrapleural pressure is almost equivalent to lung pressures and doesn’t change progressively. In Tension pneumothorax, intrapleural pressure keeps on increasing progressively with each breath.

Question 171

Clinical triad of Fat Embolism syndrome?

Answer 171

1. Confusion/ acute onset neurological abnormalities 2. Hypoxemia (Will present has SOB) 3. Petechial Rash

Question 172

Cause of petechial rash in fat embolism?

Answer 172

Fat emboli-associated microvascular occlusion in dermal capillaries——> extravasation of erythrocytes————> petechial rash

Question 173

Elevated Postassium and Cardiac Arrythmia is a presentation of __________________ in a patient being treated for Atrial Fibrillation and Congestive Heart Failure.

Answer 173

Digoxin toxicity. Digoxin toxicity causes hyperkalemia due to inhibition of Na-K-ATPase pump and that results in increased extracellular potassium.

Question 174

Mother doesn’t agree to som get erythromycin antibiotic as she says she doesn’t have STD. What do you say to her?

Answer 174

Giving Medication to a healthy baby may seem unusual and unnecessary; let’s talk about why this treatment is recommended for all newborns.

Question 175

What do you see on a gross specimen of lung of a CF patient?

Answer 175

Bronchiectasis——> thickened and dilated bronchioles. Mucus plugging.

Question 176

Fatal Hemoptysis in CF, what is the cause?

Answer 176

Rupture of hypertrophied Bronchial arteries.

Question 177

Hemorrhage from a highly vascular endobronchial tree tumour. presents with hemoptysis commonly.

Answer 177

Carcinoid tumour

Question 178

The antigenic target of anti-thyroid peroxidase antibodies is involved in which process?

Answer 178

Thyroglobulin iodination

Question 179

In a mid-clavicular fracture, why is the lateral clavicle pulled downwards?

Answer 179

Deltoid

Question 180

In a mid-clavicular fracture, why is the medial clavicle segment pulled upwards?

Answer 180

Trapezius

Question 181

What changes will Mannitol administration bring to the following: A) Serum Na Conc B) Renal Tubular flow C) Glomerular filterate osmolality

Answer 181

A) Serum Na Conc- DECREASED. The cause is dilutional hyponatremia as warer moves from intracellular space into the plasma. B) Renal Tubular flow- INCREASE as plasma volume expansion occirs. C) Glomerular filterate osmolality- INCREASED. As Mannitol filters freely through the glomerulus, so the glomerular filterate will now by hyperosmolar

Question 182

Pathogenesis of cerebral edema after an ischemic stroke?

Answer 182

Failure of ATP-dependant ion transporters. ( Accumulation of intracellular Na and water in neural and glial cells, along with release of excitatory AA such as glutamate———> causes cerebral edema)

Question 183

The great Saphenous vein should be accessed at which site?

Answer 183

Just inferolateral to the pubic tubercle.

Question 184

Risk of statin-associated myopathy is maximum with which of the following drug combinations? A) Atorvastatin and ezetimibe B) Atorvastatin and gemfibrozil C) Niacin and Ezetimibe

Answer 184

A) Atorvastatin and ezetimibe B) Atorvastatin and gemfibrozil- CORRECT, maximum risk with THIS combination because gemfibrozil impairs hepatic clearance of statins C) Niacin and Ezetimibe

Question 185

DIC labs?

Answer 185

Elevated D-Dimer, prolonged PT, aPTT. Low plasma fibrinogen.

Question 186

Which leukemia is associated with DIC and what is the translocation and abnormal gene involved?

Answer 186

APML/ M3 variant of AML (Acute Promyelocytic Leukemia) T (15; 17) Codes for abnormal Retinoic acid receptor which then inhibits myeloblast differentiation.

Question 187

Tumour cells invade the Basement membrane via enhanced secretion of ________________ and ______________.

Answer 187

Metalloproteinases and Cathepsin D protease.

Question 188

Tumour cells ADHERE to Basement Membrane, that is facilitated by INCREASED expression of ____________.

Answer 188

Laminin.

Question 189

Tobacco smoke is the MOST important risk factor for which 3 cancers?

Answer 189

Pancreas, Renal and Bladder cancer.

Question 190

Bacterial vaginosis treatement? | Tell both drugs and they are bacteriostatic or bacteriocidal?

Answer 190

Clindamycim (Bacteriostatic) and Metronidazole (Bactericidal as damages the DNA of facultative anaerobes)

Question 191

Sorbitol by sorbitol dehydrogenase is converted into?

Answer 191

FRUCTOSE. | YOU DID THIS WRONGGG. WHYYYY

Question 192

Autopsy reveals B/L hemorrhagic necrosis of the inferior and medial TEMPORAL LOBES. What is the most likely cause of the infection?

Answer 192

HSV. | Behan, yeh sketchy mein hai phir bhee ghalat kiya tha tumnay

Question 193

Anti-parkinson drugs have caused a person to have abrupt onset IMPULSE CONTROL DISORDER (Such as gambling, compulsive buying, compulsive sexual behaviour) WHYY?

Answer 193

Stimulating dopamine activity by central dopamine receptors. (Stimulating dopamine activity in ventral striatum, which includes nucleus accumbens which is involved in motivation and reward pathways) and substantia nigra

Question 194

Initiation of allopurinol with which immunosuppressant drug causes increased risk of cellular toxicity?

Answer 194

Azathioprine. (Inhibits conversion of prpp into imp)

Question 195

Commom Side effects associated with drugs prescribed to a kid of ADHD, that parents should he educated about?

Answer 195

Decreased appetite, weight loss and INSOMNIAAAA.

Question 196

Which pathogen is the most common cause of bacterial meningitis in adults of all ages?

Answer 196

Strep pneumoniae

Question 197

Cause of DIC in obstetrics?

Answer 197

In pregnancy, DIC is mediated by release of tissue factor/thromboplastin into maternal circulation. Tissue factor is round in high concentration in placental trophoblast.

Question 198

Which TCA cycle reaction will be defective in an alcoholic?

Answer 198

Alcoholics have thiamine deficiency. And conversion of alpha-ketoglutarate to Succinyl CoA is a thiamine dependant reaction in TCA cycle.

Question 199

Neurological symptoms of __________ closely mimic _________, because there’s loss of dorsal columns, spinocerebellar tracts and loss of deep tendon reflexes due to peripheral nerve degeneration.

Answer 199

Vitamin E deficiency closely mimics Friedreich Ataxia.

Question 200

Wernicke-korsakoff Syndrome, which part of brain is damaged?

Answer 200

Mamillary bodies( with medial temporal lobe), dorsomedial thalamus.

Question 201

What is the dysfunction in wernicke-korsakoff Syndrome that is immediately reversible upon thiamine infusions?

Answer 201

Oculomotor dysfuntion.

Question 202

How does the oculomotor dysfuntion manifest in wernicke-korsakoff syndrome?

Answer 202

Horizontal nystagmus, and B/L abducens palsy. In the vignette, it is described as horizontal nystagmus evoked on lateral gaze with B/L weakness of lateral rectus muscles. (CN 3 and 6 are affected)

Question 203

PDA is associated with a __________ murmur best heard at _______________ with maximal intensity at ____________.

Answer 203

Coninuous machine like murmuer, best heard at left infraclavicular region with the maximal intensity at S2

Question 204

Patient says “Antibiotics always seem to help me feel better fast” What do you say?

Answer 204

Feeling sick can be unpleasant; let’s talk about why antibiotics are not recommended and what treatments can help you feel better.

Question 205

Pheobe’s personality type is? | you did this wrong thrice

Answer 205

Schizotypal personality disorder.

Question 206

Thiazide diuretics cause (Hypercalcemia/Hypocalcemia) and (Hypercalciuria/Hypocalciuria)

Answer 206

Thiazide diuretics increase renal Ca reabsorption leading to Hypercalcemia and Hypocalciuria. (Anjum auntie takes a Thiazide diuretic and she has the strongest bones!!)

Question 207

Cardiogenic shock, What happens to the following? A) Cardiac contractility B) SVR C) Pulmonary artery systolic pressure/ PCWP

Answer 207

A) Cardiac contractility- Decreased. B) SVR- INCREASED- extremities are cold and clammy. C) Pulmonary artery systolic pressure/ PCWP- INCREASEDDDD.

Question 208

Campylobactor jejuni can be caused due to undercooked poultry, but due to one more thing?

Answer 208

Direct contact with domesticated animals, such as puppies from kennels.

Question 209

__________________ withdrawal is characterized by rebound anxiety, tremor, insomnia and sympathetic hyperactivity (diaphoresis, palpitations). In severe cases, it results in hallucinations, delusions and seizures.

Answer 209

Benzodiazepines (eg. Lorazepam)

Question 210

EM of pheochromocytoma?

Answer 210

Shows dense membrane-bound granules containing catecholamines.

Question 211

Multiple myelome patient is at a greatest risk of?

Answer 211

Amyloidosis

Question 212

What is the cause of perinuclear clearing/perinuclear paleness in plasma cells seen in the BM of a multiple myeloma patient?

Answer 212

Well-developed golgi apparatus.

Question 213

What will the brain autopsy of PKU patient show?

Answer 213

Pallor of substantia nigra, locus ceruleus, and vagal nucleus dorsalis.

Question 214

Gastrointestinal adenocarcinoma is associated with which 3 dermal conditions?

Answer 214

Leser-Trélat sign- Sudden onset of multiple seborrheic keratosis ( Due to INCREASED IGF-1 and, FGF) Acanthosis nigricans Dermatomyositis.

Question 215

Two dermal conditions in which the lesions are always on extensor surfaces?

Answer 215

Dermitis herpetiforimis (IgA deposition on the tips of--> dermal papillae---->associated with celiac disease)-->treated with dapsone and psoriasis--> Treated with methotrexate (asked in NBME 16)

Question 216

In which two dermal lesions, NUMBER OF MELANOSOMES is increased?

Answer 216

Freckles, and Café-au-lait spots.

Question 217

Café-au-lait spots are seen in which diseases?

Answer 217

McCune Albright Syndrome (Activating Mutation in Gs protein)- U/L café-au-lait spots seen. NF1 Fanconi anemia (genetic loss of DNA crosslink repair) (Fanconi and BRCA1 mutations are basically mutations in Homologous recombination)

Question 218

Earliest finding of Rheumatoid Arthritis?

Answer 218

Synovial neovascularization!!

Question 219

Story for Acute leukemia. Uworld table is there.

Answer 219

Acute leukemia is characterized by Bone marrow blasts. Now blasts can be of two types, MYELOBLASTS OR LYMPHOBLASTS. Myeloblasts are MPO+/Auer rods seen. (Milo aurrr peenay ko dil chaahta hai) Lymphoblasts are TdT+ in nucleus( DNA polymerase). Lymphoblasts per agar CD number chota hai tou that’s T-cell type, agar barra hai tou that’s B-cell type.

Question 220

Hairy Cell leukemia manifests as?

Answer 220

Massive Splenomegaly in 54 year old. Dry tap on BM aspiration. TRAP+ Treatment is ADA inhibitor CLADRIBINE

Question 221

Bcl-2 and bcl-xl are proapoptotic or antiapoptotic?

Answer 221

Buckles rok kay rakhtay hein bhaee tummy ko. | So ANTI-APOPTOTIC.

Question 222

Bcl-2 overexpression is seen in?

Answer 222

Follicular lymphoma (T 14:18) and Diffuse Large B cell Lymphoma. (Both are neoplasms of mature B cells)

Question 223

Mantle Cell Lymphoma’s translocation and problem?

Answer 223

Overexpression of Cyclin D1 Translocation (11:14) Mazay ki baat, common in Adult males so MAN. CD5+

Question 224

Cardiac temponade on echo?

Answer 224

Right Ventricular Collapse in early diastole is seen. | This is when intracardiac pressure is the lowest.

Question 225

What will be the following echocardiographic findings in a person with amyloid cardiomyopathy? A) Left Atrial Cavity Size B) Left Ventricular Cavity Size C) Left Ventricular wall thickening D) Left ventricular relaxation

Answer 225

A) Left Atrial Cavity Size- DILATED. B) Left Ventricular Cavity Size- NOT DILATED, this is the one with the problem! C) Left Ventricular wall thickening- INCREASED. I knoww weird, stiffening and thickening BOTH. D) Left ventricular relaxation- Impaired.

Question 226

Intense endurance training in an athlete’s heart, will bring about what changes in the following as compared to normal heart: ``` Left Atrium Cavity Size Left Ventricular Cavity Size Left Ventricular Wall Thickness Left Ventricular relaxation Ejection Fraction Maximal Cardiac Output ```

Answer 226

Left Atrium Cavity Size- Normal/Not dilated. Left Ventricular Cavity Size- DILATED. Left Ventricular Wall Thickness- INCREASED. Left Ventricular relaxation- Normal Ejection Fraction- Unchanged Maximal Cardiac Output- Increased

Question 227

What changes will you see in the following in Mitral Stenosis? Left Atrium Cavity Size Left Ventricular Cavity Size Left Ventricular Wall Thickness Left Ventricular relaxation

Answer 227

Left Atrium Cavity Size- DILATED Left Ventricular Cavity Size- NORMAL Left Ventricular Wall Thickness- NORMAL Left Ventricular relaxation- NORMAL

Question 228

What changes will you see in the following in dilated cardiomyopathy? Left Atrium Cavity Size Left Ventricular Cavity Size Left Ventricular Wall Thickness Left Ventricular relaxation

Answer 228

Dilated cardiomyopathy causes CONTRACTILE DYSFUNCTION. So, wall thickness and relaxation will be normal. Left Atrium Cavity Size- INCREASED Left Ventricular Cavity Size- INCREASED. Left Ventricular Wall Thickness-NORMAL Left Ventricular relaxation-NORMAL

Question 229

The best method for determining whether a gene is undergoing transcription is to analyze the presence of it ________ using a ___________ blot.

Answer 229

mRNA, Northern Blot.

Question 230

One month old baby comes with a history of PERSISTENT JAUNDICE, with MUSCLE RIGIDITY AND SEIZURES. What is the disease and the defect?

Answer 230

The disease is Crigler-Najjar. Presents early in life (The baby is so smollllll) There’s unconjugated bilirubin being thrown into blood because of LACK OF UDP-Glucuronosyltransferase.

Question 231

Conjugated hyperbilirubinemia seen in a baby, which two diseases can be the cause?

Answer 231

Dubin-Johnson or Rotor Syndrome.

Question 232

Dubin-Johnson and Rotor Syndrome are due to defective liver excretion of conjugated Bilirubin. And how is that written in uworld?

Answer 232

1) Defective hepatocellular excretion of bilirubin glucoronides due to a mutation in canalicular membrane transport protein. 2) impaired canalicular bile transit

Question 233

Drug of abuse that presents with RAPID IMPROVEMENT OF THE INITIAL SYMPTOMS and perinasal as well as perioral rash?

Answer 233

Inhalants. The dermatitis/ rash is known as Glue Sniffer’s rash.

Question 234

Kid eats Mushroom that has a poision which stimulates muscarinic receptors. Which of the following is a direct effect of this poision? A) NO synthesis B) Pupillary Dilation C) Reduced Salivation.

Answer 234

NO synthesis- CORRECT. M3 stimulation causes Parasympathetic activity and NO synthesis leads to vasodilation!

Question 235

Person gets very mild dengue fever when goes to Mexico 5 years ago. But presents to you with very severe symptoms of Dengue when comes back from Mexico now. What is the mechanism of patient’s current severe illness?

Answer 235

Secondary Infection with a different viral serotype causes more sever illness because of ANTIBODY DEPENDANT ENHANCEMENT OF INFECTION, ENHANCED IMMUNE COMPLEX FORMATION, and ACCELERATED T LYMPHOCYTE RESPONSE.

Question 236

Pathway of embolus causing cherry-red spot in the macula with surrounding retinal whitening?

Answer 236

That means, central retinal artery occlusion. Internal Carotid Artery——-> Ophthalmic artery——> Retinal artery.

Question 237

The patient's serum fails to agglutinate horse erythrocytes.  The agglutination test is repeated a week later and, again, no agglutination is noted. What does this mean?

Answer 237

This means NEGATIVE MONOSPOT test. Infectious Mononucleosis like syndrome due to CMV in characteristic of a negative monospot test.

Question 238

The difference between infectious mononucleosis caused by EBV vs CMV

Answer 238

Infectious Mononucleosis caused by EBV will atleast have ONE POSITIVE MONOSPOT TEST. In the beginnning, sometimes the Monospot test doesn't come positive in EBV. Sore throat and Lymphadenopathy MUST. Infectious Mononucleosis caused by CMV will never have a positive monospot test. Lack of Sore throat and Lymphadenopathy. Can be caused by blood-transfusion because CMV affects leukocytes of granulocyte-macrophage lineage.

Question 239

causes of heterophile antibody-negative mononucleosis-like syndromes include:

Answer 239

CMV, human herpesvirus-6, HIV, and toxoplasmosis.

Question 240

Dependant segments of lung while lying down? Right Lung is more more to aspiration or left lung?

Answer 240

Posterior segment of upper lobe, superior segment of lower lobe. Right Lung is more prone to Aspiration.

Question 241

Erythema Nodosum?

Answer 241

Tender Subcutaneous Nodules on Lower extremities.

Question 242

In which conditions is Erythema Nodosum seen?

Answer 242

Coccidioidomycosis, sarcoidosis, Ulcerative Colitis, Crohn's and BEHCET'S SYNDROME.

Question 243

What is the likely mechanism triggered in Anaphylaxis? A) Anibody dependant Cell-mediated Cytotoxicity B) CD8+ T lymphocytes- mediated Hypersenstivity C) Cell surface-bound antibody bridging by Antigen

Answer 243

A) Anibody dependant Cell-mediated Cytotoxicity- Happens in Type 2 HSR B) CD8+ T lymphocytes- mediated Hypersenstivity- Happens in Type 4 HSR. C) Cell surface-bound antibody bridging by Antigen- CORRECT

Question 244

_________________ the most common type of cardiac defect in patients with Down syndrome

Answer 244

complete atrioventricular (AV) canal defect, the most common type of cardiac defect in patients with Down syndrome

Question 245

Features of complete AV Canal defect?

Answer 245

Failure of endocardial cushion fusion, results in: 1---> Ostium Primium ASD 2----> VSD 3-----> Single AV valve/Common AV Valve.

Question 246

Auscultatory findings of Complete AV Canal defect?

Answer 246

There is AV Valve regurgitation---> So, that will present as holosystolic murmur at apex (The vignette said hyperdynamic precordium) and INCREASED Pulmonary Venous Return------> Presents as Mid diastolic rumble at LSB

Question 247

patients with severe emphysema are expected to have ___________? (You need to stop doing this wronggg) How is their mizaaj when they are talking? (Hint)

Answer 247

Patients with severe emphysema are expected to have chronic respiratory acidosis with metabolic compensation

Question 248

What effects the absorption of levothyroxine?

Answer 248

Soy products Iron Calcium antacids

Question 249

Labs in congenital Hypothyroidism?

Answer 249

INCREASED TSH, but DECREASED free thyroxine/T4

Question 250

Most common benign vascular tumour in children vs most common benign vascular tumour in adults?

Answer 250

In children, it is strawberry (capillary) hemangioma. | In adults, it is cherry hemangioma.

Question 251

Histology of a Cherry Hemangioma?

Answer 251

Dilated capillaries and post-capillary venules are seen in the papillary dermis.

Question 252

Most common cause of sudden cardiac death?

Answer 252

Ventricular fibrillation causing acute MI leads to SCD. You did, embolic stroke. Embolic stroke doesn't typically lead to SCD.

Question 253

2 brain tumours in children that occur in cerebellum, and how do they appear differently on MRI?

Answer 253

Pilocytic Astrocytoma and Medulloblastoma both occur in cerebellum. Pilocytic Astrocytoma is more of CYSTIC AND SOLID, so will appear BLACK AND WHITE on MRI. Medulloblastoma is a SOLID tumor, it appear white on MRI.

Question 254

Dihydrorhodamine flow cytometry testing reveals an absence of the green fluorescence produced by normal neutrophils.  This patient's condition is most likely due to impaired activity of which of enzyme?

Answer 254

NADPH Oxidase.

Question 255

Physical examination shows a laterally directed anterior chest wall stab wound at the fifth intercostal space along the left midclavicular line.  Which of the following structures is most likely to have been injured in this patient

Answer 255

Left lung

Question 256

Global ischemia of the brain for 3 minutes only will damage what in the brain sabb sey pehlay?And how will the patient present?

Answer 256

CA1 pyramidal neurons of the hippocampus, which can be damaged by ischemia in as little as 3 minutes. Inability to make new memories (anterograde amnesia), disoriented to time and place.

Question 257

How does a HepB vaccinated person, fight off future HepB infection upon needle-stick exposure? (What's the mechanism of immunity provided upon a vaccinated person when he gets exposed to needle stick prick of HepB blood?)

Answer 257

Vaccination is upon HBsAG, HepB surface antigen is the glycoprotein on the surface of the virus, that mediates virus attachment and entry into hepatocytes. So, the antibodies produced against new exposure in an already vaccinated person prevent/impair virion entry into Hepatocytes.

Question 258

In patients exposed to HBV, the resolution of acute infection is mediated primarily by a vigorous, polyclonal ______________________ response that destroys infected hepatocytes.

Answer 258

Cytotoxic T-cell response.

Question 259

Procedure of acid-fast staining of Mycobacteria?

Answer 259

Acid-fast staining means that the pathogen holds onto the dye/stead-fast even upon being treated with an acid and alcohol. Mycobacteria and Nocardia once takes up aniline dye (carbolfuschin), doesn't decolorize even when it is treated with Hcl and Alcohol.

Question 260

Truncating mutations (usually nonsense mutations) affecting the _____________ are the most common cause of familial DCM. 

Answer 260

TTN gene, which encodes for the sarcomere protein titin. Titin is an elastic protein, which anchors beta-myosin heavy chains to Z-disks. Titin is the cause of passive myocardial tension.

Question 261

Oral thrush is treated by?

Answer 261

Nystatin

Question 262

Bite cells are found in which disease, and how are they formed?

Answer 262

Bite cells are found in G6PD deficiency as well as Glutathione reductase deficiency. Bite cells are formed when splenic macrophages remove Heinz bodies from erythrocytes.

Question 263

What are Hein bodies?

Answer 263

Heinz bodies are intraerythrocytic inclusions of OXIDIZED HB CONGLOMERATES.

Question 264

Patient says: "Doctor, please don't tell me if the tests say cancer." What would you say to the patient?

Answer 264

Tell me more about your concerns, so I can better understand why you feel this way.

Question 265

Jetlag is due to the release of substannces by which hypothalamic nucleus?

Answer 265

Circadian rhythms are maintained by the suprachiasmatic nucleus (SCN). It releases cortisol (stress-hormone) and melatonin (sleep-inducing hormone).

Question 266

GFR with the help creatinine clearance is measured of two people. The serum creatinine of each one of them is 1.1 mg/dl. GFR estimated via an equation reveals one has a GFR of 118 ml/min and the other has 70 ml/min. What is the cause of this difference in GFR?

Answer 266

Skeletal Muscle mass--> Creatinine is a waste product of muscle breakdown. Therefore, patients with lower muscle mass or reduced dietary meat intake may have significantly lower GFRs for any given creatinine level. Because they have to get less creatinine out the body, so when the equation is used it shows less GFR.

Question 267

Person, has high aldosterone and low rennin. What will be the levels of the following? Serum Potassium Serum Sodium Serum bicarbonate

Answer 267

This scenario is of hypokalemic alkalosis. Serum Potassium- low Serum Sodium- Normal Serum bicarbonate- high

Question 268

A 4-year-old boy is brought to the office with 3 days of fever, irritability, and oral lesions.  His parents are concerned due to his refusal to eat or drink and lack of urination today.  Physical examination demonstrates painful ulcers on the tongue and gingiva, swollen gums, and cervical lymphadenopathy. Which of the following is the cause of patient's condition? A) Latent Infection B) Primary infection C) Virus Reactivation

Answer 268

A) Latent Infection- shows no clinical symptoms B) Primary infection- CORRECT.---> HSV causing gingivostomatitis. C) Virus Reactivation- HSV reactivation causes herpes labialis. In herpes labialis the lesions are mild, unilateral and only on lips.

Question 269

14 year old boy presents with Flesh coloured nodules seen on lips and tongue. Marfanoid Habitus. Had a thyroidectomy 5 years ago.

Answer 269

Men 2B Medullary thyroid cancer (calcitonin) Pheochromocytoma Mucosal neuromas/marfanoid habitus

Question 270

Patient of BPH comes with gross hematuria, what must be the cause?

Answer 270

Microscopic/Gross Hematuria can result in patients of BPH due to formation of new friable blood vessels formed in area of prostatic hyperplasia.

Question 271

Cytoscopy done in a patient of BPH shows

Answer 271

Increased detrusor wall trabeculations due to detrusor muscle hypertrophy.

Question 272

How does interstitial cystitis present as? | What will the cytoscopy show?

Answer 272

More common in females. No hematuria SUPRAPUBIC PAIN, specially when the bladder is full. Pain gets better upon voiding. Cytoscopy shows patchy erythema and petechiae.

Question 273

Pacemaker action potential, depolarization is due to?

Answer 273

Large increase in Calcium Influx.

Question 274

Most common gene mutation associated with Polycythemia Vera and what does it cause?

Answer 274

The mutation is V617F involving the JAK2 gene, which is involved in signal transduction. The mutation makes HEMATOPOEITIC CELLS MORE SENSITIVE TO GROWTH FACTORS LIKE ERYTHROPOEITIN AND THROMBOPOEITIN.

Question 275

Classic labs of primary Polycythemia Vera?

Answer 275

Increased red cell mass, with decreased erythropoetin.

Question 276

18 year old suddenly collapses on the ground while playing Soccer. He has been experiencing fatigue, and exertional dyspnea since the past weeks. Which of the following will be seen on cardiac autopsy? a) Dilatation of all cardiac chambers with flabby ventricular walls b) Myocardial Hypertrophy with patchy interstitial fibrosis

Answer 276

a) Dilatation of all cardiac chambers with flabby ventricular walls- This is also close, and points towards DCM. But a patient of familial DCM also present with orthopnea, leg swelling and they won't be able to participate in strenuous activities like soccer!!! b) Myocardial Hypertrophy with patchy interstitial fibrosis- CORRECT. The person has HCM because it is the most common cause of SCD in young people.

Question 277

Which pathogens produce toxins that increase cyclic cGMP?

Answer 277

Heat stable toxin of ETEC and Yersenia enterolitica.

Question 278

What do Shiga and Shiga like toxin of EHEC do?

Answer 278

Halt protein synthesis by binding to 60S ribosomal units of infected cells.

Question 279

What is the difference between appendicitis causing vague midline pain and appendicitis causing severe pain at a point 2/3 between umbulicus and ASIS?

Answer 279

The vague midline pain in appendicitis is due to visceral pain. Visceral pain is carried by ANS. Because there's activation of ANS, this pain is accompanied by nause, vomiting and sweating. As appendix becomes for inflammed it irritates parital peritoneum and that results in severe pain with rebound tenderness.

Question 280

2 causes of appendicitis presenting as pain with hip extension?

Answer 280

Inflammed appendix lies against right psoas muscle | Retrocecal orientation of appendix.

Question 281

In temporomandibular joint, which nerve causes the jaw joint referred pain to ear?

Answer 281

Mandibular Branch of Trigerminal Nerve. | Why do you always do this wrong?

Question 282

In addition to having endometrial glands with hemosiderin pigment, one of the biopsies contains simple cuboidal epithelial cells.  Which of the following is the most likely site of the biopsy?

Answer 282

This is endometriosis. Ectopic endometrial tissue found in ovary. As ovaries have simple cuboidal epithelium.

Question 283

Patient has increasing neck and lower back pain, most severe in the morning. Her pain improves as the day passes. There's tenderness over lumbosacral area and at the insertion site of the Achilles Tendon. What will be raised in serum?

Answer 283

Pain that improves with exercise and not rest, and tenderness of insertion sites of tendons (enthesitis) is characteristic of Ankylosing Spondylitis. There's upregulation of IL-17, TNF-alpha.

Question 284

Which enzyme degrades heme into green colour substances that causes the bruise to turn green in colour?

Answer 284

Heme Oxygenase converts Heme into Biliverdin which is green in colour.

Question 285

Which enzyme and substance is the cause of yellow colour of a bruise?

Answer 285

Biliverdin Reductase converts Biliverdin into Yellow Pigment Bilirubin.

Question 286

Fever, maculopapular rash, and acute renal failure (eg, elevated creatinine, oliguria) occurring within a few weeks of starting a beta-lactam antibiotic are highly suggestive of _____________________.

Answer 286

Drug Induced Acute Interstitial Nephritis.

Question 287

What will be the lab findings of urine in Acute Interstitial Nephritis?

Answer 287

WBCS AND WBC CASTS IN URINE, RBCS IN URINE. | EOSINOPHILURIA!

Question 288

In which conditions the Renal Papillary Necrosis occurs?

Answer 288

It is common in severe acute pyelonephritis. | Sickle Cell Disease, Diabetes Mellitus, or analgesic Nephropathy.

Question 289

Local vs invasive manifestation of Hib?

Answer 289

Local is---> acute otitis media, sinusitis by unencapsulated strains of H. Influenza or encapsulated Type B causing infection in unvaccinated children. Invasive is-----> Septic arthritis, Meningitis, Bacteremia. The cause of invasive disease is its anti-phagocytic capsule.

Question 290

What is the cause of vaccination failure in an old person?

Answer 290

Decrease in Naive B and CD4+ T lymphocytes.

Question 291

What is the only type of cells that are increased in immunosenescence?

Answer 291

Increased CD8+ memory T cells.

Question 292

What is the etiology of hypothyroid myopathy?

Answer 292

The impaired use of muscle glycogen and triglyceride and increased oxidative stress causes myocyte injury. Will present as elevated creatinine kinase and proximal muscle weakness?

Question 293

What is myoedema?

Answer 293

Occurs in hypothyroidism. It is focal muscle contraction at the site of percussion.

Question 294

What is the cause of myoedema and delayed tendon reflexes seen in the hypothyroidism?

Answer 294

These characteristic findings are caused by impaired reuptake of Calcium by Sarcoplasmic Reticulum

Question 295

What are the changes seen in the following values, in Diabetes Insipidus? Osmolarity: ICF ECF

Answer 295

Osmolarity: INCREASED ICF: DECREASED ECF: DECREASED DI, Dehydration and profuse sweating cause HYPEROSMOTIC CONTRACTION.

Question 296

What are the changes seen in the following values, in Acute GI Bleeding? Osmolarity: ICF ECF

Answer 296

Osmolarity: No change ICF: No change ECF: Decreased This is called iso-osmotic volume contraction, as the osmolarity doesn't change and there's only loss of ECF. This occurs in Diarrhea and GI Hemorrhage.

Question 297

In which two conditions. the figure of osmolarity, ECF and ICF are opposite to one another?

Answer 297

Adrenal insufficiency, pulls it down from upper right corner. Hypertonic Saline infusion, pulls it upwards from upper right corner.

Question 298

What are the changes seen in the following values, in Adrenal insufficiency? Osmolarity: ICF ECF

Answer 298

Osmolarity: decreased ICF: Increased ECF: decreased

Question 299

What are the type of receptors that Cinacalcet works on?

Answer 299

Ca-Sensing receptors that are Gq coupled/ Membrane bound receptors coupled with a G protein. Cinacalcet increases Ca-sensing receptors' sensitivity---> and that reduces PTH.

Question 300

Name 4 Opsonins for body?

Answer 300

IgG, Complement C3b, Mannose Binding Lectin, C-reactive protein.

Question 301

Maximum flow occurring during diastole and minimal flow occurring during ventricular systole. This pattern is unique for the _________________.

Answer 301

Left Ventricular Myocardium. | There's constant Blood flow to the right ventricular myocardium because of low pressures even in systole

Question 302

What are the levels of the following in a person with one testicle in scrotum: FSH LH Inhibin

Answer 302

In these patients, the testicle that is not in the scrotum has DAMAGED SERTOLI CELLS IN SEMENIFEROUS TUBULES. Now, LH causes release of testosterone by Leydig cells. and FSH causes release of Inhibin B by sertoli cells in normal people. However, FSH will be elevated as there's not enough Inhibin produced by damaged sertoli cells. FSH- INCREASED LH-Normal Inhibin B- DECREASED.

Question 303

Patient comes to you with symptoms of hyperthryroidism, when she has been taking levothyroxine after thyroidectomy. What will be the levels in the following? ``` Serum TSH T4 T3 Serum Thyroglobulin Radioiodine uptake ```

Answer 303

``` Case of exogenous thyrotoxicosis. Serum TSH- Low T4- HIGH T3- HIGH (T4 is deiodinated into T3 in the periphery. And if a T3 supplement like liothyronine is used then only T3 will be elevated and not T4) Serum Thyroglobulin- LOW Radioiodine uptake- Low ```

Question 304

What is the first ever step in the pathogenesis of atheroma formation in blood vessels?

Answer 304

Endothelial Cell Injury

Question 305

What is the second step in the pathogenesis of atheroma formation?

Answer 305

Endothelial Cell dysfunction results in monocyte adhesion and migration to intima, while exposure of subendothelial collagen promotes platelets adhesion.

Question 306

Which cells are important for the formation of fatty streaks in vessels?

Answer 306

Macrophages.

Question 307

How does subclavian steal syndrome represent as?

Answer 307

It is mostly asymptomic, but when symptoms occurs they can be: Exercise induced pain, fatigue and parasthesias in the affected extremity. Vertebrobasilar insufficiency causes drop attacks, dizziness, vertigo.

Question 308

How does a vestibular schwannoma manifest as?

Answer 308

Vestibular Schwannoma occurs in cerebellopontin angle, and compresses the following nerves: CN 7: Will cause ipsilateral facial paralysis--> e.g. asymmetric smile. CN 8: will causes sensineural hearing loss, and ringing of ear. CN 5: Ipsilateral facial sensation and loss of afferent limb of corneal reflex.

Question 309

Location of a vestibular schwannoma?

Answer 309

Between lateral pons and cerebellum.

Question 310

What is the CNS manifestation of nocardia and how is treated?

Answer 310

Brain abscess, treated by surgical drainage of the abscess and TMP-SMX.

Question 311

45y old woman comes to you with fracture of the wrist. Dexa scan shows osteoperosis and labs show elevated PTH, mild hypercalcemia. What is the major contributor to bone loss seen in this patient?

Answer 311

This is a vignette of Hyperparathyroidism. Elevated PTH causes increased RANK-L expression, and decreased OPG. This results in LOW opg: rankl ratio-------. INCREASED osteoclast formation and activity. The bone loss is due to Increased Bone resorption due to paracrine stimulation of osteoclasts.

Question 312

How does Biliary atresia present as?

Answer 312

In biliary atresia, the infant is normal at birth as the biliary tree is normal at that time. However, an infant of LESS THAN 2 MONTHS OF AGE, will present as: Jaundiced skin Increased total, and direct bilirubin Dark urine Clay colored stools

Question 313

What the pathology in Biliary Atresia and how can it be diagnosed?

Answer 313

The pathology is obstruction of extra-hepatic bile ducts. Diagnosis can be confirmed on a liver biopsy which shows proliferation of intrahepatic bile ducts, potral tract edema and fibrosis.

Question 314

Which step in Hep B virus cycle is important for the infection?

Answer 314

Reverse transcription of template RNA into Viral DNA.

Question 315

Which step in Hep B virus cycle is important for hepatocarcinogenesis?

Answer 315

Integration of viral genome into host cells.

Question 316

What kind of immune response is responsible for clearing of HepB infection

Answer 316

A robust, polyclonal Cytotoxic T cell response is needed to completely get rid of HepB. People who develop a latent infection of HepB basically have a narrow cytotoxic T cell response.

Question 317

What causes Hepatocyte damage in HepB?

Answer 317

Hepatocyte damage occurs majorly when Cytotoxic T cells recognize HBV antigens on infected cells.

Question 318

What is the major risk factor for developing Barret's esophagus: Alcohol Obesity

Answer 318

Obesity--------> Barret's esophagus------> Adenocarcinoma. ( GERD, ) Alcohol is the risk factor for esophageal squamous cell carcinoma. (Thermal injuries, preservative foods, )

Question 319

What are the shortest acting Benzodiazepines?

Answer 319

Triazolam, Midazolam

Question 320

Which Benzodiazepine will you give to a 911 emergency dispatch operator who has trouble sleeping at night but is supposed to be clear-headed in the morning?

Answer 320

Intermediate acting Benzodiazepine------------> Oxazepam, Lorazepam, alprazolam.

Question 321

Hypoattenuation of an area in Brain CT Scan means?

Answer 321

Hypoattenuation in CT scan means BLACK--------. ischemic infarct

Question 322

What is the cause of splenomegaly in pyruvate kinase deficiency?

Answer 322

Splenomegaly is because of RED PULP HYPERPLASIA, as reticuloendothelial cells in the red pulp are responsible for removing damaged RBCS.

Question 323

Manifestation of pyruvate kinase deficiency?

Answer 323

Often presents as hemolytic anemia of the newborn. Because of decreased pyruvate kinase-----> decreased ATP-------> leading to water and potassium loss-----> rigid RBCs-------> extravascular hemolysis------> increased 2.3 BPG--------> Decreased affinity of hemoglobin for O2.

Question 324

Which intraerythrocytic inclusions are found in pyruvate kinase deficiency?

Answer 324

Burr cells/ Echinocytes.

Question 325

How is trichomoniasis diagnosed?

Answer 325

Wet mount microscopy shows flagellated, motile protozoans. | NAAT is the the gold standard.

Question 326

Which vaginal infection gives positive test with KOH?

Answer 326

KOH when added to Bacterial Vaginosis (Causes by Gardnerella Vaginalis) gives off a charasteritc odour. Also called positive whiff test.

Question 327

For which vaginal infection, the partner has to be treated as well?

Answer 327

For Trichomoniasis, the patient and partner have to be treated with metronidazole.

Question 328

Stop codons?

Answer 328

UAA, UAG, UGA

Question 329

Biopsy findings in CMV pneumonitis?

Answer 329

Intranuclear and intracytoplasmic inclusions that resemble owl's eyes. Because inclusions surrounded by a halo, so looks like owl's eyes.

Question 330

Universal prophylaxis with ______________ is done to prevent CMV pneumonitis in Lung transplant patients.

Answer 330

Valganciclovir

Question 331

What is the prodrug of ganciciclovir? and what is its benfit?

Answer 331

Ganciciclovir's prodrug is valganciclovir and it has better bioavailability.

Question 332

ECG shows diffuse ST elevation. Diagnosis?

Answer 332

Acute pericarditis.

Question 333

Colchicine's mechanism of action?

Answer 333

Colchicin binds to intracellular protein tubulin, inhibits microtubular polymerization. Disrupt cytoskeleton dependant functions like phagocytosis and chemotaxis.

Question 334

A kid who cannot get Hib vaccine, is prone to which infection the most?

Answer 334

Meningitis. The kid without antibodies produced by B-lymphocytes after being vaccinated is prone to INVASIVE diseases caused by Hib. Such as Meningitis, Bacteremia, Pneumonia and Epiglottitis.

Question 335

Antidote for SSRI overdose?

Answer 335

Cyprheptadine

Question 336

Mutation in which gene causes Bare lymphocyte Syndrome?

Answer 336

``` In Bare lymphocyte Syndrome, there's a deficiency of MHC CLASS 2-PEPTIDE COMPLEX formation, which is necessary for activation of B and T lymphocytes. So, a mutation in HLA-DR,DP,DQ causes problems in MHC class 2. ```

Question 337

What will the flow cytometry show for Bare Lymphocyte Syndrome?

Answer 337

Normal levels of CD3+ (Reflects normal levels of circulating T-cells) Normal levels of CD19+ (Reflects normal levels of circulating B cells) Absence of HLA-DR+ cells.

Question 338

What will the flow cytometry show for DiGeorge Syndrome?

Answer 338

Absence/Reduction of CD3+ cells. As the failure of development of thymus, results in deficiency of circulating T cells.

Question 339

CD40L is expressed on _____________.

Answer 339

Activated T-helper cells.

Question 340

A deficiency in CD40L will cause ____________.

Answer 340

Hyperimmunoglobulin IgM Syndrome.

Question 341

A mutation in which gene will show a reduction of CD19+ cells on Flow Cytometry?

Answer 341

BTK gene causes X-linked agammaglobulinemia, because there's problem in signal transduction by Bruton Tyrosine Kinases for maturation of B-cells. Manifests after 3 months of age, when maternal IgG are depleted.

Question 342

Nonbililous Vomiting in the setting of Pyloric Stenosis causes which Acid-base disorder in an infant?

Answer 342

Primary Metabolic Alkalosis with respiratory compensation.

Question 343

Phosphorylation of mannose residues on lysosome-bound proteins, allowing them to _____________ and ultimately be transported to the lysosome, where they serve as catalysts for degradation of cellular components.

Answer 343

Golgi Network. Impaired in I-cell disease.

Question 344

What will mass spectometry analysis show in I-cell disease?

Answer 344

Performed on cultured fibroblasts and reveals deficient phosphorylation of mannose residues on certain glycoproteins in the Golgi apparatus.

Question 345

Which 2 enzymatic deficiencies cause orotic aciduria?

Answer 345

``` Uridine monophosphate synthetase (UMPS)( Nohyperammonemia, patient has megaloblastic anemia) Ornithine transcarbamylase (OTC) deficiency, the most common urea cycle disorder. (OTC deficiency results in excess carbamoyl phosphate, and hyperammonemia) ```

Question 346

Increased insulin sensitivity during exercise can be attributed to?

Answer 346

Translocation of GLUT4 to cell surface membrane.

Question 347

V/Q mismatch vs Alveolar Hypoventilation, because both cause HYPOXEMIA.

Answer 347

Alveolar Hypoventilation cause by opioids, sedatives, hypoventilation syndrome---------> RESPIRATORY ACIDOSIS, Normal A-a gradient with hypoxemia. V/Q Mismatch caused by PE--------> RESPIRATORY ALKALOSIS, INCREASED A-a gradient with hypoxemia.

Question 348

ARDS is typically characterized by 2 things?

Answer 348

1-Progressive hypoxemia refractory to oxygen therapy | 2-diffuse interstitial edema in the absence of cardiogenic causes.

Question 349

Alveolar Hyaline Membrane formation results because of a transudative/exudative process.

Answer 349

Exudative. | Pulmonary edema due to cardiogenic causes is a transudative cause.

Question 350

Which 2 pulmonary function testing values increase with aging?

Answer 350

Residual Volume and FRC.

Question 351

What remains unchanged in PFT in aging?

Answer 351

TLC

Question 352

Drugs used for spasticity act on which receptors?

Answer 352

Drugs that treat spasticity are GABA agonists, because GABA is an inhibitory neurotransmitter. GABA A is ion-gate chloride channels. Benzodiazepines used for muscle relaxation are GABA A agonists. GABA B is G-protein coupled receptors that opens K+ channels. Baclofen is a GABA B agonist.

Question 353

Antagonists of acetylcholine muscarinic receptors are used to treat spasticity in which specific condition?

Answer 353

Benztropine and Trihexyphenidine is used to treate acute dystonia, tremors and rigidity in Parkinson's and Drug-induced Parkinson's. Not used to treat any other spasticity.

Question 354

Acute Viral Hepatitis histology?

Answer 354

Presence of "spotty necrosis" with ballooning degeneration (hepatocyte swelling with wispy/clear cytoplasm), Councilman bodies (eosinophilic apoptotic hepatocytes), and mononuclear cell infiltrates.

Question 355

The major cause of oxygen-induced hypercapnia in COPD is due to?

Answer 355

INCREASED ventilation-perfusion mismatch.

Question 356

Cytokines that are present in high quantities in granulomatous diseases like TB, sarcoidosis?

Answer 356

IL-2 and interferon Gamma.

Question 357

IL-1 and TNF-alpha are important cytokines in which 2 diseases?

Answer 357

Bone loss in Multiple Myeloma, Bony erosions in RA. Hence, RA treatment include TNF-alpha blockers ( adalimumab, etanercept) and IL-1 inhibitors (anakinra)

Question 358

Smudge cells are seen in?

Answer 358

CLL.

Question 359

How does TNF-Alpha induce insulin resistance? | Qid 1326

Answer 359

TNF-alpha activates Serine Kinases----> Serine Kinases phosphorylate serine residues on B-subunit of Insulin Receptor and IRS-1----> this obviously hinders IR causing tyrosine phosphorylation of IRS-1------> resulting in resistance to normal actions of insulin.

Question 360

What is found on histopathology of IPF?

Answer 360

Loss of Type 1 pneumocytes, and hyperplasia of Type 2 pneumocytes.

Question 361

Meningeal irritation can be seen in _____________ as well. | Not meningitis

Answer 361

Subarachinoid Hemorrhage.

Question 362

What does the brain imaging show in SAH?

Answer 362

Blood layering cerebral sulci

Question 363

Advanced Alzheimer's disease is associated with diffuse brain atrophy.  Atrophy is most pronounced in the ______________ and _____________. 

Answer 363

Temporoparietal lobes and Hippocampus.

Question 364

Normal aPTT indicates an intact ____________.

Answer 364

Intrinsic coagulation system.

Question 365

Prolonged PT indicates ____________, and can be due to the deficiency of _______.

Answer 365

defective extrinsic pathway, can be due to deficiency of Factor 7

Question 366

3 characteristics of late-stage radiation dermatitis

Answer 366

Fibrosis, characterized histologically by homogenization of dermal collagen, due to fibroblast activation by transforming growth factor-beta from damaged tissue and responding immune cells Vascular damage, resulting in chronic hypoxia and ulceration Abnormal, dilated microvasculature (ie, telangiectasias

Question 367

Histology of Steven Johnson Syndrome/Toxic epidermal necrolysis widespread blistering?

Answer 367

1) Full thickness epidermal necrosis | 2) Subepidermal bullae

Question 368

What is found histologically in pseudomembranes formed in clostridium difficile infection?

Answer 368

They are basically, white yellow plaques fibrin, inflammatory cells, and cellular debris.

Question 369

Treatment with a medication that alters glucose metabolism within the liver by increasing the concentration of fructose 2,6-bisphosphate within hepatocytes.  Which of the following conversions will be inhibited by high intracellular concentrations of this metabolite?

Answer 369

Alanine----->Glucose. | Because increased Fructose 2,6 BPG inhibits gluconeogenesis

Question 370

Ischemic brain injury results in _________ necrosis.

Answer 370

Liquefactive

Question 371

In irreversible brain injury, necrotic neuronal remnants are then phagocytized by ______, and _______ proliferate at the site of the injury to form a glial scar.

Answer 371

Microglia phagocytose. | Astrocytes make glial scar.

Question 372

Neuronal cells with foamy appearance due to accumulated undigested macromolecules is seen in?

Answer 372

Lysosomal Storage disease like Neimann-Pick, Tay-Sachs

Question 373

Neurons with shrunken nuclei and eosinophilic cytoplasm lacking Nissl bodies.  Which of the following is the most likely cause of these findings? A) Irreversible Ischemic Injury B) Transection injury of the nerve fibre

Answer 373

A) Irreversible Ischemic Injury- CORRECT. B) Transection injury of the nerve fiber- This causes axonal reaction, not red neurons.

Question 374

Treatment of narcolepsy?

Answer 374

Modafinil, it is a nonamphetamine psychostimulant that promotes wakefulness. It enhances dopaminergic signalling. or Nighttime sodium oxybate.

Question 375

5 month old baby boy comes with complete loss of extremity muscle tone. Patient receives formula as a sole source of nutrition except fruits and honey occasionally. Which of the following test will confirm the diagnosis in the patient? a) Blood Test for Liver enzymes b) Stool test for bacterial toxin c) Urine testing for amino acids

Answer 375

a) Blood Test for Liver enzymes- Heriditary fructose intolerance causing hepatocyte damage can be diagnosed in this situation but the symptoms would include hypglycemia, vomiting, hepatomegaly. b) Stool test for bacterial toxin- CORRECT. Patient has infant botulism because of honey, classic symptom is hypotonia. c) Urine testing for amino acids- MSUD can be diagnosed with this, also presents with vomiting and poor feeding but will present in a neonate.

Question 376

Inactivated versions of the influenza vaccine stimulate the formation of neutralizing antibodies against the ___________ of included strains.

Answer 376

Heamagglutinin antigen, which is important for attaching to sialic acid receptor of host epithelial cells for VIRAL ENTRY.

Question 377

Catheter area ablation for atrial flutter is done in which area?

Answer 377

Cavotricuspid isthmucs----> The area between tricuspid valve and IVC in RA.

Question 378

Emergency laprotomy done in a 2 day old boy shows inspissated, green fecal mass obstructing distal ileum. what is going to be the most likely cause of mortality in this patient?

Answer 378

PNEUMONIA The intraoperative finding of a green inspissated mass (dehydrated meconium) in the distal ileum points to the diagnosis of meconium ileus as the source of obstruction.  Meconium ileus is a very specific finding for cystic fibrosis (CF). 

Question 379

Which drugs cause inhibition of androgen synthesis?

Answer 379

``` Ketoconazole Spironolactone ( Also impairs androgen-receptor binding interactions.) ```

Question 380

A deep laceration is present at the proximal aspect of the right cubital fossa, just lateral to the medial epicondyle.  Examination reveals absent sensation in the lateral palm and the palmar surfaces of the first 3½ fingers, inability to flex the proximal interphalangeal joints, and inability to pronate the forearm. Which structure is responsible for patient's bleeding?

Answer 380

Median Nerve Injury and Brachial artery damaged.

Question 381

Most common metastasis sights of colon cancer are?

Answer 381

Liver and Lungs

Question 382

Mechanism of action of finasteride?

Answer 382

inhibits conversion of androgens into DHT in peripheral tissues.

Question 383

Mechanism of action of sitagliptin?

Answer 383

It is a DPP4 Inhibitor. It works by increasing GLP-1 and GIP levels.

Question 384

Peculiar S/E of saxaliptin?

Answer 384

Nasopharyngitis

Question 385

Metyrapone blocks cortisol synthesis by inhibiting __________________, which converts 11-deoxycortisol to cortisol in the zona __________.

Answer 385

11-β-hydroxylase, Zona Fasiculata

Question 386

Why does Metyrapone stimulation test in a normal person shows increase 17-OH Progesterone?

Answer 386

Due to ACTH surge.

Question 387

Metyrapone Stimulation test results? Discuss.

Answer 387

In a normal person, cortisol DECREASED, so ACTH and 11-deoxycortisol INCREASE. In primary Adrenal insufficiency, ACTH INCREASES, but 11-deoxycortisol DECREASES. In secondary/tertiary Adrenal Insufficiency, ACTH might increase or decrease, but 11-deoxycortisol DECREASES GREATLY.

Question 388

Acne vulgaris is the problem of _______________.

Answer 388

pilosabeceous follicles.

Question 389

A 72-year-old woman comes to the office due to persistent headaches, fatigue, and diffuse muscular pain.  She has a history of hypertension and osteoarthritis. She is given prednisone and her symptoms improve considerably. What is the pathology seen?

Answer 389

This is Giant Cell Arteritis, patient may have headache, jaw claudication, polymyalgia rheumatic--> achy pain in shoulder and hip girdle. Pathology is: GRANULOMATOUS INFLAMMATION OF THE MEDIA.

Question 390

Explain vessel histopathology of polyarteretis Nodosa in 2 different ways?

Answer 390

1) Transmural inflammation of the vessel wall with fibrinoid necrosis. 2) Fibrinoid degeneration of the vessel wall with luminal narrowing.

Question 391

The bacteria and fungi responsible for infections in CGD are?

Answer 391

The bacteria and fungi responsible for infections in CGD are catalase-positive organisms that can destroy their own hydrogen peroxide. Staphylococcus aureus, Burkholderia cepacia, Serratia marcescens, Nocardia, and Aspergillus.

Question 392

Which vasculitis causes mononeuritis multiplex?

Answer 392

Churg strauss---> But obviously, why would they let you get through by just remembering that? They want you to remember it as EOSINOPHILIC GRANULOMATOSIS WITH POLYANGITIS. (Late onset-Asthma,sinusitis, mononeuritis multiplex aka assymetic multifocal neuropathy aka wrist drop,foot drop due to involvment of epineural vessels.)

Question 393

Which vasculitis causes mononeuritis multiplex?

Answer 393

Churg strauss---> But obviously, why would they let you get through by just remembering that? They want you to remember it as EOSINOPHILIC GRANULOMATOSIS WITH POLYANGITIS. (Late onset-Asthma,sinusitis, mononeuritis multiplex aka assymetic multifocal neuropathy aka wrist drop,foot drop due to involvment of epineural vessels.)

Question 394

Which vasculitis causes mononeuritis multiplex?

Answer 394

Churg strauss---> But obviously, why would they let you get through by just remembering that? They want you to remember it as EOSINOPHILIC GRANULOMATOSIS WITH POLYANGITIS. (Late onset-Asthma,sinusitis, mononeuritis multiplex aka assymetic multifocal neuropathy aka wrist drop,foot drop due to involvement of epineural vessels.)

Question 395

The __________ is the nerve most commonly injured by anterior shoulder dislocations. 

Answer 395

Axillary nerve, It innervates the deltoid and teres minor muscles and provides sensory innervation to the skin overlying the lateral shoulder.

Question 396

Examples of disease that are Type 3 HSR?

Answer 396

SLE, Polyarteretis Nodosa, PSGN

Question 397

Clinical Presentation of Jarvell Lange-Neilsen Syndrome?

Answer 397

An autosomal recessive disorder characterized by profound bilateral sensorineural hearing loss and congenital long QT syndrome, which predisposes individuals to syncope and sudden cardiac death. This syndrome occurs secondary to mutations in genes (eg, KCNQ1, KCNE1) that encode the alpha and beta subunits of voltage-gated potassium channels.(Asked in uworld specifically)

Question 398

What is a possible manifestation of folate overdose?

Answer 398

Folate antagonizes phenytoin. So, someone on phenytoin might have seizures because folate is not letting phenytoin do its work.

Question 399

Actinic Keratosis vs Seborrheic Keratosis. | They are unrelated, but both have hyperkeratosis--->thickening of stratum corneum

Answer 399

Actinic Keratosis, appears on sun-exposed areas and it non-pigmented. Seborrhein Keratosis, often point towards GI adenocarcinoma. Have Hyperkeratosis as well as keratin cysts. Flat macules with greasy appearance and well-demarcated borders.

Question 400

In Plasmodium falciparum infection, red blood cells have _______________________________________.

Answer 400

In Plasmodium falciparum infection, red blood cells have multiple small rings representing developing trophozoites (arrows) and banana-shaped gametocytes (not shown).

Question 401

What is the treatment of choice for Plasmodium Falciparum, in a chloroquine-resistance area?

Answer 401

Atovaquone and Proguanil.