UWorld second half Flashcards

Question

Indications for clozapine

Answer 1

**Treatment resistent schizophrenia or schizophrenia associated with suicidal ideation** Remember side effect of agranulocytosis need to **monitor clozely with clozapine**

Answer 2

Predominantly cause a hepatocelluar pattern of liver injury. Can range from mild to fulminent hepatitis with 50% mortality rate. Liver looks very atrophied on exam at autopsy Lab: **elevated serum aminotransferases, prolonged PT (due to failure of production of factor VII),** leukocytosis, eosinophilia

Answer 3

**Alkaptonuria** Problem with **Tyrosine --\> Fumarate** **No Homogentisic Acid Dioxygenase** **Ochronosis=black urine** **(could be acute intermittent porphyria too if turned port wine colored --\> black overnight)**

Answer 4

Celiac patients have excessive diarrhea that is fatty. This means a **decrease in ADEK vitamins**. Thus, these pts will have a **decrease in Vitamin D**. If D is low, then Ca and Phosphate are not being brought in from the gut. As a compensation mechansim, PTH will be high. **PTH: HIGH** **Ca: LOW** **Phosphate: LOW**

Answer 5

**Systemic: Neutrophils** prevent the systemic spread of candidiasis. Disseminiated Candidiaisis is more common in pts who are neutropenic **Local: T Lymphocytes** are important for prevention of superficial candidial infections (oral/esophageal) Thus, HIV pts suffer from local candida infections but rarely suffer from systemic infections. If they are neutropenic for whatever reason they are at risk for both local and systemic

Answer 6

5-14 days post MI

Answer 7

**Bone marrow suppression** Gancyclovir itself puts pts at risk for **neutropenia**, anemia, thrombocytopenia, impaired renal fxn. Used for cytomegalovirus in HIV pts often

Answer 8

**Enterovirus** (cocksackie, echo, polio) responsible for \>90% of cases CSF: normal glucose, marginally elevated protein, pleocytosis with a **LYMPHOCYTIC** predominance. This pattern suggests aseptic meningitis, which is viral in etiology

Answer 9

Warfarin blocks epoxide reductase so you cannot gamma carboxylate 2,7,9,10,C,S factors. It turns out that **C and S have short half lives (VII is the shortest** and reason why you can measure PT and not PTT) of any of these factors and thus run out first. These are inhibitory factors, so if they are gone you are in a **hypercoagulable** state (WHEN YOU WANT TO BE ANTICOAGULATED). This can lead to **warfarin induced skin necrosis** Tx: fresh frozen plasma, protein C concentrate

Answer 10

This is a classic example of eczema, specifically, the patient has an acute allergic contact dermatitis that is mediated by a type 4 hypersensitivity reaction to an antigen on the skin surface (cream). The antigen was taken up and presented to the Langerhan cells and presented to CD4 cells in the lymph nodes Histologically, this is characterized by **spongiosis**, accumulation of edema fluid in the intracellular spaces of the epidermis

Answer 11

Stratum spinosum --\> acanthosis Stratum corneum --\> hyperkeratosis (**psoriasis, calluses)** Stratum granulosum --\> hypergranulosis (**seen in lichen planus**) Dyskeratosis --\> premature keratinization of individual keratinocytes below the stratum granulosum **(squamous cell carcinoma)** Separation epidermal cells --\> acantholysis **(pemphigus vulgaris)**

Answer 12

Results in lower extremity pain, numbness/parasthesias Symptoms often worsen when standing up tall and get better when leaning forward (shopping cart) Degenerative arthritis of the spine is the most common type of spinal stenosis. The disc degenerates and begins to portrude and lose height. This places a large load on the POSTERIOR aspect of the spinal column leading to hypertrophy of the **ligamentum flavum**

Answer 13

Pregnancy Rapid weight loss High spinal cord injuries Prolonged TPN Octreotide Biliary stasis --\> bile concentration --\> bile ppt --\> biliary sludge (a precursor to stone formation)

Answer 14

**Mitral valve regurgitation** Often accompanied by S3 (increased LV filling rate during mid diastole) Often times treatment with a diuretic to decrease total fluid decreases the S3 (or makes it go away entirely). This happens via a decrease in LV preload and therefore decrease in LV EDV

Answer 15

Clindamycin

Answer 16

**Valproate good for BOTH** Ethosuximide would be good for the absent seizure but NOT for the tonic-clonic Phenytoin would be good for tonic-clonic but NOT the absent seizures Carbamezapine is drug of choice for complex partial seizures and is also effective in generalized tonic-clonic seizures but has side effect of agranulocytosis and aplastic anemia

Answer 17

**Splenic congestion** --\> can be seen in infants (10-15% mortality), which occurs due to vasoocclusion and splenic pooling of erythrocytes. Would see rapidly enlarging spleen and hypovolemic shock **Fibrosis/atrophy**

Answer 18

**1. Macrocytic megaloblastic anemia due to folic acid** deficiency due to increased erythrocyte turnover **2. Extramedullary erythropoesis** can occur in SCD and lead to elevated MCV (as the RBCs are larger). Also, this tends to make only a slightly elevated MCV \*\*The reticulocyte index would help decide which is happening. If the index is low, it is folic acid, if high, then extramedullary\*

Answer 19

**1. extracellular domain:** respinsible for ligand binding **2. transmembrane domain:** made up on **NON-POLAR HYDROPHOBIC AA (alanine, valine** leucine**, isoleucine,** phenylalanine**,** tryptophan**,** methionine**,** proline**,** glycine). The hydrophobic aspect is arranged OUTWARD to **anchor** the transmembrane region in the phospholipid bilayer **3. Intracellular domain:** coupled with heterotrimeric G-proteins

Answer 20

Retinoblastoma presents with white pupillary reflex in children \<5 years old **Familial retinoblastoma occurs due to a germline mutation in the Rb gene on chr 13** (remember that an active Rb does not allow a cell to go from G1 --\>S via inhibiting EF2, inactive Rb permits cell division) Likely to develop **osteosarcoma** later in life

Answer 21

**=erythroblastosis fetalis** Results in **destruction of fetal red blood cells by maternal antibodies directed against fetal erythrocyte antigens.** These antibodies are IgG antibodies (the only cass that can cross the placenta G=go) **1st preg:** Rh-mom/Rh+dad Rh+ kid --\> these fetal Rh antibodies enter the maternal blood stream and the mother generates anti-D antibodies **2nd preg:** Rh-mom/Rh+dad Rh+kiddo. Now the Anti-Rh-D antibodies cross the placenta and cause lysis of fetal RBC. This results in a **positive coombs test,** profound **anemia**, **jaundice** (possibly leading to kernicterus) and generalized edema (hydrops fetalis due to accumulation of interstitial fluid). Also see **extramedullary hematopoeisis** in liver, spleen and other tissue

Answer 22

**True:** Meckel's, Normal appendix. Contain mucosa, submucosa, and muscularis **Pseudo:** Zenker, diverticula. Contain ONLY mucosa and submucosa

Answer 23

Genetic defect in glycoprotein **fibrillin-1,** resulting in abnormal skeleton **Cardiac:** see **mitral valve prolapse** and **cystic medial degeneration of the aorta** --\> resulting in aneurysmal dilation in 70% of cases. This can cause death if untreated and is the most common cause of death in Marfan pts

Answer 24

**Tetrology of Fallot (VSD, overriding aorta, pulmonary artery stenosis, RVH**) Due to abnormal neural crest cell migration leads to anterior and cephalad deviation of the infundibular septum Squatting increases systemic vascular resistance without changing pulmonary vascular resistance which increases the ratio of SVR:PVR. This decreases Right to left shunting, thereby increasing pulmonary blood flow and improving oxygenation status

Answer 25

Can cause **contraction of smooth muscle cells in the sphincter of oddi**, leading to spasm and an increase in common bile duct pressure. Although uncommon, pressures can increase and cause biliary colic. Management includes discontinuing of opioids

Answer 26

Can enter into TCA cycle and make energy OR can enter into gluconeogenesis and make glucose Know that Acetyl CoA acts to increase the opposite pathway and stop its own pathway (negative feedback). This prevents the cell from being energy starved

Answer 27

Presence of **cord factor correlates with virulence**. Mycobacteria that do NOT have cord factor are NOT able to cause disease It is responsible for inactivating neutrophils, damaging mitochondria, and inducing release of TNF-Alpha

Answer 28

Behavioral therapy is the treatment of choice for specific phobia Can use short acting benzos acutely Beta blocker is used to treat performance anxiety but is NOT indicated for phobias

Answer 29

Sudan III Stain

Answer 30

Feedback stystem that monitors and maintains muscle force. GTO are exquisetly sensitive to increases in muscle tension but are insensitive to passive stretch Innervated by group Ib sensory axons Connected in SERIES with the extrafusal skeletal muscle fibers **Negative feedback system that regulates and maintains muscle tension**

Answer 31

**sudden standing, nitro, valsalva (thus all 3 are contraindicated in these pts)** These pts have LV outflow tract obstruction (25% of HCM pts) Basically, **mechanisms that decrease preload (venous return) or decrease afterload, reduce LV chamber size**, which decreases the separation between the mitral valve and the interventricular septum, increasing obstruction **These actions INCREASE THE MURMUR**

Answer 32

Refers to a sta**te of chronic myocardial ischemia in which function and metabolism are decreased to match a concomminant reduction in coronary blood flow.** This new equilibrium prevents necrosis This leads to decreased contractility and LV systolic dysfunction Upon revascularization, the heart muscle can leave its hibernation state and improve contractility and LV function

Answer 33

Target lesions with a dusky central area This is a cell-mediated immune process that is brought on by CD-8 T cells Most frequently associated with HSV and mycoplasma but can be associated with sulfa drugs, B-lactams, phenytoin \*\*not to be confused with erythema MIGRANS which is seen in lymes disease\*\*

Answer 34

**wrinkles = decrease in collagen fibril production** UVA damage causes photoaging via production of ROS leading to a decrease in collagen fibril production along with upregulation of MMPs Photoaging may be visable by age 30-35 and results in thinning of the epidermis There is **INCREASED CROSSLINKING of collagen**

Answer 35

**poorly soluble gas has decreased blood/gas coefficient** **highly soluble gas has a high blood/gas coefficient** **Nitrous oxide is poorly soluble gas with blood/gas coefficient of 0.47** (meaning that it saturates quickly, leading to a fast rise in partial pressure, this also enters the brain quickly. The speed of anesthetic induction is equal to the speed at which the brain tissue takes up the agent **WANT A POORLY SOLUBLE DRUG**

Answer 36

**Abnormal neural crest cell migration leads to anterior and cephalad deviation of the infundibular septum** resulting in malaligned VSD and overriding aorta

Answer 37

As a result of the LV hypertrophy and decreased LV diastolic compliance, the left side of the heart begins to fail. This leads to higher diasolic filling pressures to maintain SV and CO. This **increase in pressure is transmitted backwards to the left atrium and pulmonary veins where it can cause pulmonary HTN** and subsequent R sided HF The pathogeneisis of PHTN begins with passive increase in pulmonary capillary and arterial pressure **due to pulmonary venous congestion.** This results in endothelial damage and decreased release of NO. Over time, see remodeling of the pulmonary vasculature with increased smooth muscle cell proliferation

Answer 38

1. can lead to acute pancreatitis 2. Can lead to premature coronary artery disease 3. Can also lead to premature coronary artery disease 4. obesity and insulin resistance

Answer 39

**Vincristine specifically: Peripheral neuropathy and neurotoxicity,** also can cause paralytic ileus and constipation also cause alopecia These drugs **bind beta tubulin and inhibit its polymerization into microtubules --\> prevent mitotic spindle formation** **\*Arrests in M phase\***

Answer 40

Receives contributions from **C5-T1**. Courses **with brachial artery** in groove **between biceps brachii and brachialis muscle**. Courses **between humeral and ulnar heads of pronator teres**. Then travels **BETWEEN flexor digitorum profundus and superficialis** before entering the wrist within the **flexor retinaculum**

Answer 41

The first one covers 95% of the population (1 standard deviation) The second one covers 99% of the population (2 standard deviations) the 1.96 and 2.58 represent Z-scores for 95% and 99% of the population respectively Standard error is SD/sqrt n and is a way to account for variability in the sample

Answer 42

Hydrocephalus is enlargement of the ventricles (with or without elevated pressure) **1. central neuronal volume loss (hydrocephalus ex-vacuo)**. Pts with neurogegenerative disease such as AIDS, dimentia can develop this due to significant cortical atrophy, which allows the ventricles to expand without increased CSF pressure **2. excessive CSF accumulation.** Typically occurs due to obstruction (noncommunicating) or absorption (communicating) 2 types below 2a. normal-pressure hydrocephalus: chronic reduction in CSF absorbtion at arachnoid villi (wet, wobby, wacky) 2b. high-pressure hydrocephalus. This is more acute, from cerebral venous sinus thrombosis, change in mental status, seizure, HA

Answer 43

Type 1 DM: fasting glucose \>126, or A1C Gestational DM: oral glucose tolerance test

Answer 44

**Sulfonureas** (inhibit the K channel, cause depolarization, cause insulin release). Specifically, glyburide glipizide, glimepride Arcabose NOT associated hypoglycemia (decrease intestinal glucose absorption) Metformin NOT associated hypoglycemia (increase gluconeogenesis) Pioglitazone NOT associated hypoglycemia (increase insulin sensitivity) Staglipton NOT associated hypoglycemia (DDP-4 inhibitor)

Answer 45

**Candida albicans!** Candida fungi exist in yeast single cell form. They appear as budding yeast with pseudohypahe. The germ tube test is diagnostic of candida albicans and allows differentiation from other types of candida **These growing hyphae are called germ tubes**

Answer 46

**Used to prevent disease relapse of Ovale and Vivax**, which are unique in the fact that they can establish a l**atent hepatic infection i**n the form of **hypozonites**, responsible for relapses **Chloroquine** is effective against cloroquine-sensitive plasmodium but has **NO activity against latent infection established by vivax and ovale**

Answer 47

**"dancing eyes dancing feet"** Associated with **neuroblastoma** in children and small cell lung cancer in adults nonrhythmic conjugate eye movements This is a paraneoplastic syndrome associated with neuroblastoma. This tumor has increased copies of N-myc amplifciation

Answer 48

This would be seen in the LUNGS and is called hypoxic vasoconstriction so that blood flow is diverted away from underventilated areas. This is reverse in the rest of the system where hypoxic tissues receive increased blood flow

Answer 49

the major AA responsible for transporting nitrogen to the liver for disposal. During the catabolism of proteins, amino groups are transferred to alpha-ketoglutarate to form glutamate. Glutamate is then processed in the liver to form urea

Answer 50

strep pneumo is the most common cause of bacterial meningitis in adults of all ages

Answer 51

reversibility Dysplasia refers to abnormal cell growth that is confined to the epithelium. Does not necessarily mean a precursor to cancer (if low grade) if high grade (carcinoma in-situ) is a precursor to invasive carcinoma

Answer 52

UAG (U Are Gone) UAA (U Are Away) UGA (U Go Away) The **codon RIGHT BEFORE** the stop codon will be the last protein added

Answer 53

Block sodium channel and inhibit phase 0 of the cardiac action potential (vertical line), thereby slowing conduction \*Remember that class Ia have moderate potassium channel blocking activity

Answer 54

Direct and indirect are both located above the inguinal ligament

Answer 55

anticholinergic (anti-muscarinic), alpha adrenergic, serotonergic Examples are chloramphenamine and diphenhydramine **Can cause accomodation and blurring of the eyes for close objects**

Answer 56

This is cystinuria, with the hexagonal shaped crystals in the urine. If found in 16 year old, would be indicative of cystinuria, AR disorder that does **not allow cystine, ornithiene, lysine, arginine (NO _COAL_) to be reabsorbed in the proximal renal tubules** leading to urine supersaturation with cystine **Dx: aminoaciduria.** The sodium cyanide nitroprusside test is a qualitative test used Treatment involves alkalinizing the urine with acetazolamide

Answer 57

This pt has **mitral valve stenosis** (since diastolic). This plot shows an elevated pressure gradient between the left atrium and left ventricle. Hear high pitch opening snap followed by low pitched diastolic rumble best heard at the apex. **This corresponds to C in the first diagram when LA pressure is highest and the mitral valve is opening**

Answer 58

1. Na/Ca exchanger pumps calcium out of cell entirely 2. Calcium ATPase pump (SERCA) pumps Ca back into the sarcoplasmic reticulum

Answer 59

AR mutation in BLM gene that encodes for DNA helicase Presents with growth retardation, photosensitivity, facial anomalies, immunodeficiency (recurrent infections)

Answer 60

This is a thiazide diuretic, works by inhibiting Na/Cl resorption in DCT Side effects are **Hyper GLUC** **hyperGlycemia** **hyperLipidemia** **hyperUricemia** **hyperCalcemia**

Answer 61

**Non-selective Beta blocker** Used for open-angle glaucoma. Glaucoma is usually associated with increased IOP due to increased production or decreased draining of aqueous humor Aqueous humor is produced by the epithelial cells of the ciliary body **timolol works to decrease secretion of aqueous humor by the epithelial cells of the ciliary body** **NO pupillary or vision changes seen with timolol**

Answer 62

CO=SVxHR ## Footnote **CO=rate of O2 consumption/arteriovenous O2 content difference** **This second equation is determined by the Swan-Ganz catheter, by applying the fick principle**

Answer 63

**1. Destroying aged and abnormal erythrocytes** (like spherocytes) and serving as an emergency store of blood cells and platelts that can be put into circulation if necessary **2. Clearance of circulating bacteria** that become lodged in the cords. Macrophages then present the captured antigens to B and T cells that reside in the splenic WHITE pulp **\*nearly 1/2 of the body's total immunoglobulins are produced by splenic B-lymphocytes. Splenic opsonizing antibody is of particular importance in clearance of encapsulated bacteria**

Answer 64

1. loss of gag reflex 2. loss of general sensation in the upper pharynx, posterior tonsils, middle ear 3. loss of taste to posterior 1/3 tongue

Answer 65

Taste ant 2/3 --\> chorda tympani Sensation ant 2/3 --\> Trigeminal V3 Taste posteior 1/3, sensation posterior 1/3 Glossopharyngeal

Answer 66

**Glioblastoma with necrosis and vascular proliferation**. This is the most common primary brain tumor in adults. Causes typical butterfly distribution as it crosses the midline. From astrocytes ## Footnote **\*\*Pseudopalisading necrosis (focal necrosis surrounded by tumor cells)**

Answer 67

All SSRI (sertraline) Esp if the pt has a family hx Most pts commonly present with just depression sx and no manic sx so they are started on a SSRI and then come back a few weeks later in a manic state that was induced by the SSRI.

Answer 68

**umbilical hernia** This is a defect at the linea alba that is covered in skin Associated with Down syndrome, hypothyroidism and Beckwith-Wiedemann syndrome (WT2 mutation with wilms tumor, macroglossia, organomegaly) Most are asymptomatic and resolve in first few years of life

Answer 69

Estogen increases the Thyroid Binding Globulin levels (which accounts for roughly 70% of thyroid binding levels with the other coming from albumin) The increase in estrogen causes an increase in TBG which causes a decrease in free T3 T4 (since more is bound up). This negatively feeds back to the pituitaty and causes an increase in TSH and increase in T3/T4 until the additional TBG is bound and free T3/T4 levels are restored. **Therefore an increase in estogen --\> increase TBG --\> increased in TOTAL T4 (bound T4 + free T4) however level of free is normal so pt remains euthyroid**

Answer 70

Trigeminal nerve mandibular branch (think O for mouth) This provides sensory innervation to the face and motor innervation to muscles of mastication

Answer 71

Same as bacitracin sensitivity (essentially) ## Footnote **Group A strep is bacitracin sensitive, PYR +** **Group B strep is bacitracin resistant, PYR -** **Enterococcus is PYR sensitive but no mention of bacitracin (onlt differnece)**

Answer 72

Seen primarily in hyperthyroidism due to Graves What happens is that there is an autoimmune response to the TSH receptor Stimulate dermal fibroblasts. Infiltration of retroorbital space by activated T-cells leading to increased cytokines (TNF-a, INF-Y) to increase fibroblast secretion of hydrophilic GAGs --\> increased osmotic swelling

Answer 73

Basically, just know the big categories and when the line is moved left or right it either increases or decreases that exact value

Answer 74

p+q=1 P2+2pq+q2=1 They gave us q2= disease frequency so take srt and get 1/200 and can assume other parent's contribution is essentially zero so p=0 so then you have 2pq=2 x 1/200 = 1/100 **Then in sum, the probablility of having another child that is affected is 1/4 x 1/100 = 1/400**

Answer 75

**Hyperacusis (increased sensitivity to certain frequencies of sound)** This is a **middle ear problem** The stapedius muscle arises from the wall of the tympanic cavity and inserts on the neck of the stapes. It is innervated by the stapedius nerve, a branch of the **facial nerve** **Note, ipsilateral hyperacusis is a common finding associated with Bells Palsy**

Answer 76

Persistently **elevated transforming growth factor Beta (TGF-B)**. It is critical for stimulating connective tissue synthesis and remodeling of the extracellular matrix If TGF-B is elevated, can **lead to increased fibroblast proliferation and activity and eventual increase in collagen deposition** **=keloid scar**

Answer 77

a rare form of marrow failure characterized by severe hypoplaisa of erythroid elements in the setting of normal granulopoeisis and thrombocytopoesis ## Footnote **associated with thymomas** **Can also result from Parvovirus B19**

Answer 78

**Failure of fusion of the maxillary prominence at the intermaxillary segment** to form the upper lip and the primary palate. If one of the maxillary prominences fails to fuse, bilateral cleft lip ensues

Answer 79

The vector is the **Ixodes Tick** and the disease is **Babesiosis**. The NE USA exposure and summer is indcative of Babesiosis (notice pt did not travel to Africa to obtain Malaria although images look similar) This is the **same vector for Borelli Burgdorferi (Lymes)** \*Remember that Malaria is spread by **Anopheles**\* **Aedes** spreads Chikungunya and Dengue\*

Answer 80

CCK It functions to increase pancreatic enzyme secretion (by acinar cells) AND gallbladder contraction, and to decrease gastric emptying

Answer 81

**Increased triglyceride breakdown in adipose tissue due to insulin deficiency.** TG are broken down by **hormone sensitive lipase** to glyerol and FFA. **\*Remember that adipocytes are unable to metabolize glycerol (kinda like they cant do gluconeogenesis b/c no glucose-6-phosphatase)\*** Therefore, they transport to liver where it is phosphorylated by **glycerol kinase\*\***

Answer 82

This is porcelain gallbladder (can see the thickening walls) These pts present with RUQ pain but can be largely asymptomatic with findings discovered on PE or imagine Potential manifestation of chronic cholecystitis and is often found with multiple gallstones **These pts have an increased risk of ADENOCARCINOMA of the gallbladder** **Think of gallbladder as gland-like, so get gland like cancer**

Answer 83

Acetylchoninesterase inhibitor (**irreversibly inhibit AChE)** Need to **give them an Achetylcholinesterase**s that increase ACh (atropine, pralidoxime)

Answer 84

Recurrent, **unexpected** panic attacks. Ususally there is concern about another attack occuring. Usually have CP, SOB tachycardia, GI distress. ## Footnote **Key is that some events are spontaneous with no obvious trigger**

Answer 85

This can happen with pts who have granulomatous disease (sarcoidosis, TB) due to expression of 1-alpha hydroxylase in macrophages This leads to increased intestinal calcium absorption with subsequent hypercalcemia and hypercalciuria

Answer 86

**Non-steroid agent that acts as a competitive testosterone receptor inhibitor** This blocks the stimulatory effect of androgens on the primary tumor and metastasis and leads to **REDUCTION IN THEIR SIZE, which improves sx such as bone pain and urinary obstruction**

Answer 87

Inactivate the 60S subunit leading to an inhibition of protein synthesis and eventual cell death

Answer 88

The **ureter runs UNDER the gonadal vessels** (WATER UNDER THE BRIDGE) and then **runs OVER the internal iliac** and then **UNDER the uterine artery** **The ONLY OVER IS THE INTERNAL ILIAC**

Answer 89

**Hyperplastic arteriolosclerosis** presents as an **onion-like concentric thickening** of the walls of arterioles as a result of laminated smooth muscle cells and reduplicated basement membranes

Answer 90

**1. Hand hygeine with alcohol sanitizer or soap and water** 2. Maximal barrier precautions 3. Preparation of the sterile site with chlorhexidine 4. Use of subclavian or jugular (NOT femoral, has higher rate of infection) \*Catheter replacement at scheduled dates is NOT effective

Answer 91

An AD disorder of the heme synthesis pathway caused by **porphobilinogen deaminase deficiency.** The symptoms are the 5 P's...P**ainful abdomen, port wine- colored urine, polyneuropathy, psychological disturbances, precipitated by drugs** (cytochrome cyp450 INDUCERS), alcohol, starvation Treatment: **GLUCOSE** or heme to downregulate ALA synthase

Answer 92

This patient has a family hx of **LYNCH SYNDROME!! = HNPCC** The genes affected are **MSH2, MLH1, MSH6, PMS2** Colon cancer occurs in ages \<50 due to inherited mutation in mismatch repair **Mismatch Repair = MSHhhmash**

Answer 93

Pituitary apoplexy (problem originally was pituitary adenoma : sudden hemorrhage of pituitary gland, often in the presence of an existing pituitary adenoma.

Answer 94

Triad of: **confusion, opthalmoplegia (paralysis of muscles in eye), ataxia** Due to **damage of medial dorsal nucleus of thalamus, MAMMILLARY BODIES** Thiamine deficiency is the ultimate cuase of this. IF treat with **glucose BEFORE thiamine, can make worse**. Thiamine is a cofactor for the enzymes responsible for glucose metabolism. Infusion of glucose will exacerbate pre-existing thiamine deficiency -----\> precipitating Weknicke

Answer 95

These are **normal flora of the mouth.** If these are found in a lung abscess, it is likely they were **aspirated**. There are several thoughts here, either the patient is an **alcoholic** and they aspirated, or they have a **seizure** disorder, or **drug overdose,** or severe **neurologic disorder**

Answer 96

These are **auer rods** in myeloblast (large cells with abundant cytoplasm) These are seen in **acute myelogenous leukemia** They stain for **peroxidase**

Answer 97

**Annular Pancreas:** ventral pancreatic bud abnormally encircles 2nd part of duodenum: forms ring of pancreatic tissue that may cause duodenal narrowing and NON-billious vomiting. This rotation behind the duodenum by the vental pancreatic bud happens during the 7th week of development Ventral pancreatic bud --\> uncinate process portion of the head and main pancreatic duct

Answer 98

**Adenosine, _Dipyridamole_, and Regadenoson** preferentially vasodilate coronary vessels. These drugs can r**educe collateral blood flow.** Areas of ischemia are already maximally dilated. These drugs cause vasodilation in other nonischemic regions and thus leads to decreased perfusion pressure within the collateral microvessels, diverting blood from ischemic areas to non-ischemic areas and can make ischemia worse **--\> often used in myocardial imaging and perfusion studies to stimulate coronary vasodilation that occurs during exercise =Coronary steal phenomenon**

Answer 99

Medial circumflex artery Injury to this vessel can lead to osteonecrosis of the femur head

Answer 100

This is a **glioblastoma** that is the most common primary cerebral neoplasm in adults. They **arise from astrocytes** and typically located in **cerebral hemispheres**. May occasionally cross the corpus callosum (**butterfly)** They also can **cause midline shift** which is seen in the third ventricle

Answer 101

Pellagra is deficiency in B3=niacin. Sx are 3D's: diarrhea, dermatitis, dementia (overdose causes facial flushing) **_Hartnup Disease_** is autosomal recessive deficncy of neutral amino acid transporters in proximal renal tubular cells and on enterocytes. Get pallagra-like symptoms and **treat with high protein diet and nicotinic acid (daily niacin)**

Answer 102

Use in **Hepatitis C therapy and RSV** (although palivizumab is preferred in children) ## Footnote **Interferes with duplication of viral genetic material**

Answer 103

Patau, 13 NOT EDWARDS (eddy does not have a cleft lip/palate)

Answer 104

**A and E are nonenveloped** (n**A**k**E**d). Since they lack an envelope, they are not destroyed by the gut Vowels hit your Bowels (A and E, not B,C,D) The only two that are spread fecal/orally Also have **NO hepatocellular carcinoma risk**

Answer 105

**B-blockers INHIBIT renin release via B1 blockage on JGA cells** They have NO effect on ACE and therefore do NOT affect bradykinin levels

Answer 106

**Use sodium Bicarb** Have prolonged QT and wide QRS can lead to torsades Can present with delerium, seizures Symptoms are caused by blockage of cardiac fast sodium channels **Wide QRS or ventricular arrhythmia is an indication for sodium bicarb therapy**

Answer 107

**Decorticate** (protect the CORE): **see flexion of the upper limb.** Here, the lesion is **BEFORE** the red nucleus. Due to loss of descending inhibiton of the red nucleus and subsequent hyperactivity of the upper limb flexors. **This would be damage in cerebral hemispheres, internal capsule** **Decerebrate:** see **extension of the upper limb** predominate. Here, the lesion is **AFTER** the red nucleus leading to loss of descending excitation to the upper limb flexors (via rubrospinal tract) and extensor predomiance (due to unopposed vestibulospinal tract). **This would be damage in midbrain, tegmentum, pons. This is WORSE PROGNOSIS**

Answer 108

Subjects randomly assigned to one of two groups. Take med first then placebo or placebo first and then med. Essentially, the subjects act as their own control

Answer 109

They did not receive their MMR vaccine. They have Rubella (german measles). Rash starts on face and spreads to extremities. **Mom --\> polyarthralgia** **Infant --\> sensorineural deafness, cataracts, PDA**

Answer 110

**Membranous Nephropathy:** remember this is the most common cause of primary NEPHROTIC (can be nephritic too though) syndrome in Caucasian males. **See spike and dome appearance with subepithelial deposits** This is caused by HBV, HCV, solid tumors, SLE, NSAIDS penicillamine (Wilson)

Answer 111

-First, it is a **substrate in the synthesis of fatty acids** (palmitate, specifically) Since it is involved in the SYNTHESIS of fatty acids, it makes sense that it also **INHIBITS the enyme responsible for breakdown of Fatty-Acyl CoA (which is carnitine acetyltransferase)** Do not want to break down the FA that you JUST synthesized

Answer 112

**Use bed only for sleep and sexual activity** **Go to bed only when sleepy** **Leave bed when unable to sleep and go to another room** **Fixed wake-up time, even on weekends** --\>these are different from sleep hygeine which includes regular sleep schedule, no caffeine after lunch, no alcohol or meals near bedtime, do NOT exercise right before bedtime

Answer 113

The herpesviruses do this (including cytomegalovirus, EBV, HSV, VZV, HHV8...)

Answer 114

Right sided **brachiocephalic vein obstruction**. May be the result of external compression of apical lung tumor or thrombotic occlusion as can occur when a central catheter has been placed for a significant amount of time

Answer 115

This would be do to **contralateral optic tract lesion** Remember the optic nerve goes back from the eye itself and then crosses at the optic chiasm and then turns into the optic TRACT

Answer 116

Caused by **decreased hypocretin (orexin)** production in the lateral hypothalamus. This is **detected in the CSF** **Cataplexy** is loss of all muscle tone following strong emotional stimulus such as laughter or joking \*\*Note that the level of melatonin is NOT decreased in these pts. The level of melatonin IS decreased in Alzheimer pts

Answer 117

Alveolar hyperventilation. PaCO2 is inversely related to and considered to be the main indicator of total alveolar ventilation **hypocapnia --\> alveolar hyperventilation** Can result from a V/Q mismatch resulting in decreased CO2 and O2 exchange leading to hypoxemia stimulating resp drive centers above normal levels. This leads to excessive CO2 excretion resulting in hypocapnia

Answer 118

This pt has a **Bells Palsy (Facial nerve palsy)** These pts present with sudden onset unilateral facial paralysis with **mouth being drawn to UNAFFECTED** SIDE. Pts also have **DECREASED tearing**, and **hyperacusis** (increased sensitivity to certain frequency sounds)

Answer 119

**Oxygen induced hypercapnia** in COPD In a COPD exacerbation, these pts need O2, but NOT high levels of O2. High oxygen concentrations can lead to increased CO2 retention resulting in confusion and lethargy. There are three mechanisms resonsible for this phenomenon. 1. The first is that you are chronically pulmonary vasoconstricted with hypoxia and now this is reversed, and you increase physiologic dead space. 2. The second is due to the high affinity of CO2 for Hb. With high O2, get Haldane effect where you decrease Hb affinity for CO2 and it gets dumped into plasma. 3. The third is that the chemoreceptors sense O2 and then decrease the need for ventilation, so the CO2 builds up

Answer 120

**NE is a potent alpha-1 agonist** (**a1\>a2\>b1, NO b2)** leading to potent vasoconstriction, which can lead to local tissue necrosis Thus, it would be logical to given alpha-1 antagonist. **Phentolamine** is a great example, as this would block the alpha receptor **\*\*Remember that phentolamine is the same med that you give to pts on MAO-I who eat tyramine-containing foods\*\***

Answer 121

This is **Rifampin** The mechanism is it **binds bacterial DNA dependent RNA polymerase** thereby preventing transcription and leading to a deficiency of proteins necessary for TB survival

Answer 122

This pt was given mannitol, an osmotic diuretic used in the management of cerebral edema and increased ICP. It works by increasing plasma osmolality, which causes fluid to move from the intravascular space into the vessels. Overagressive treatment can lead to excess volume depletion and eventual hypernatremia Additionally, this rapid increase in vascular volume can lead to PULMONARY EDEMA

Answer 123

This baby has **Volvulus,** which is **twisting of a portion of the bowel around its mesentery.** This **can lead to obstruction and infarction.** Initially get 90 degree couterclockwise rotation outside of gut. --\> stays outside and grows for 8-10 weeks --\> returns and rotates another 180 degreees counterclockwise (**for total of 270**). Incomplete rotation will result in midgut malrotation. The cecum will rest in the RUQ and the fibrous bands that connect the RUQ to the retroperitoneum (Ladd's bands) will pass over the duodenum and compress it. **Additionally, the mesentary is vulnerable to twisting around the superior mesenteric artery**

Answer 124

**1. Pulsus paradoxicus** **2. Distended neck veins** **3. Hypotension** This is due to cardiac tamponade (compression of the heart by fluid)

Answer 125

It is derived from the **third pharyngeal pouch**. This is the same as the **inferior parathyroid glands.** **Myasthinia Gravis** is often associated with thymomas

Answer 126

Hydralizine and Minoxidil are two examples They lower blood pressure by reducing systemic vascular resistance (via their arterial vasodilaiton). This effect is limited by subsequent stimulation of baroreceptors leading to sympathetic activation. This leads to increased HR, contractility, and CO. This ALSO increases activation of RAAS system, which would increase Na and water reabsorption For this reason, they are rarely used in management of HTN, but can be used acutely for malignant HTN (esp if given with diruetics and sympatholytics)

Answer 127

nonselective beta blockers inhibit NE/Epi mediated compensatory reactions to hypoglycemia. Blocking B2 also inhibits gluconeogenesis and peripheral glygogenolysis Nonselective beta blockers should be used in caution in pts with diabetes as these can increase the risk of hypoglycemia and reduce patients awareness of hypoglycemia **Selective B1 bblockers are preferred (A--\>M)**

Answer 128

Treat with **Sulfadiazene and Pyrimethamine along with Leucovorin (folinic acid)**

Answer 129

Inhibitor of MAO, used in parkinsons disease to delay the progression Can also be used to treat MPTP (street drug) since the active metabolite MPP+ once broken down by MAO is what is actually causing the damage

Answer 130

N-terminal peptide removal by N and C procollagen peptidases occurs OUTSIDE of cells Collagen molecules then spontaneously assemble Covalent cross links are then formed by lysyl oxidase

Answer 131

1. Diet (deficient in populations who eat primarily corn, alcoholics, chronic illness) 2. Synthesized endogenously from **tryptophan** It is a essential component of the enzymes NAD and NADP, which participate in redox metabolism

Answer 132

Left Gastric

Answer 133

**Length constant:** measure of how far along an axon a signal can propagate. A low length constant reduces the distance an impulse can travel. Myelin increases the length constant and decreases the time constant (improving axonal speed) \*Note, the time constant is the time it takes to get from one spot to another spot. This number is INCREASED in MS since the signal takes a longer time to get from A to B

Answer 134

**Iatrogenic Cushing Syndrome** Can suppress the entire HPA axis leading to low levels of ACTH cortisol. Prolonged suppression of ACTH can lead to **bilateral atrophy of adrenal cortices** Sudden cessation of glucocorticoids can cause adrenocortical insufficiency and adrenal crisis (reason why need to taper!)

Answer 135

**_ELEVATED CK_** 1. Statin Induced 2. Inflammatory myopathy (dermatomyositis, polymyositis) 3. Hypothyroid myopathy (muscle pain and cramps and weakness involving proximal muscles **_NORMAL CK_** 1. Glucocorticoid induced myopathy 2. Polymyalgia Rheumatica

Answer 136

1. NSAID 2. Colchisine 3. Glucocorticoids (only if cannot tolerate first two). Esp contraindicated if pt has DM since it will increase his glucose levels

Answer 137

Since the ACTH levels are increased, it is either pituitary adenoma or ectopic producer. Since the cortisol was suppressed with the Dex test, we know that it cannot be ectopic because it actually responded to treatment. Thus, we know it must be a **pituitary adenoma**

Answer 138

**Xanthine oxidase _INACTIVATES_ it** **HGPRT activates the drug** This effect is so significant that chemo pts must reduce their dose of 6-MP by 70% if they are taking allopurinol. This is because the coadministration can lead to high levels of 6-MP metabolites **This drug is a purine analog that decreases de novo purine synthesis from PRPP --\> IMP, so there would be decreased AMP and GMP. It is used in preventing organ rejection, RA, IBD, SLE, and ALL. Side effects are myelosuppression, hepatotoxicity**

Answer 139

This kiddo has **necrotising enterocolitis**, more specifically he has pneumatosis intestinalis (air in the small bowel). In an infant, these findings on X-ray would be consistent with necrotising enterocolitis It affects predominantly preterm infants secondary to GI and immunologic immaturity. Impaired mucosal barrier allows the bacteria to invade the intestinal wall causing inflammation and ischemic necrosis. **Becomes gangrenous and gas develps** 30% of neonates die, esp when disease is complicated by intestinal perforation

Answer 140

This pt has **Trypanosoma Cruzi, which can cause Chagas Disease (caused by Reduviid, kissing bug)** It produces a neurotoxin that destroys the myenteric plexus and causes intramural parasympathetic enervation of smooth muscle

Answer 141

Neurological movement disorder characterized by sustained, involuntary muscle contractions

Answer 142

Tumor of **pancreatic alpha cells** --\> overproduction of glucagon Sx: **dermatitis (necrolytic migratory erythema), DM, Diarrhea, declinging weight, depression** **ALL D's** Dx: look at glucagon levels

Answer 143

KRAS mutation making the anti-EGFR ineffective. KRAS is a proto-oncogene that encodes a GTP binding protein involved in regulating cell division via transduction of extracellular signals such as those from EGFR KRAS mutations are found in a lot of metastatic colon cancers

Answer 144

**Smooth muscle cells** The infiltrating macrophages and T-lymphocytes release cytokines (PDGF, fibroblast growth factor, endothelin-1, interleukin-1) that attract migration and promotion of vascular smooth muscle cells (VSMC) within the intima. These are stimulated and synthesize extracellular matrix proteins (collagen) that form the fibrous cap typical of mature atheromas

Answer 145

Vesicoureteral reflex (VUR) Pts with this are at much higher risk of chronic pyelonephritis. Ongoing injury leads to renal scarring most commonly at the upper and lower poles. If untreated, can lead to HTN

Answer 146

This patient has a **pineal gland mass = Pinealoma** Clincally, they present with **Parinaud syndrome** (compression of tectum --\> vertical gaze palsy: only want to look down) **See B-hCG production** Most common pineal gland mass is a **germinoma**, a malignant midline tumor that is thought to develop from embryonic germ cells A. Pituitary B. Thalamus C. Pineal Gland

Answer 147

It has **5'--\>3' exonuclease activity** (removes RNA primer and repair damaged DNA)

Answer 148

Broad based budding --\> Blastomyces Pseudohyphae with blasoconida --\> Candida (central venous catheter with TPN is a high risk factor for this) Right angle --\> Rhizopus species

Answer 149

coronary artery that provides blood to the **posterior descending artery** (posterior interventricular artery) The PDA originates from one of the following: 1. Right coronary artery (70% people, Right heart dominant) 2. Left circumflex artery (10% of people, Left heart dominant) 3. Both left and right circumflex in 20% of population (codominant) **\*Note, the AV node blood supply usually is derived from the dominant coronary artery\***

Answer 150

neurologic symptoms incompatable with any known neurologic disease. Often acute onset associated with stress (pt breaks up with boyfriend and then has strange leg pain with all tests coming up negative. This patient DISLIKES doctors and does not want to be there, which differentiates it from factitious disorder where the patient WANTS to be the sick patient)

Answer 151

**Femoral nerve, block using femoral nerve block** and the best place to do so is the **inguinal crease** at the lateral border of the femoral artery NOT in the femoral ring, the upper opening of the femoral canal (too high)

Answer 152

ARPexposed=100 x ((risk in exposed-risk in unexposed)/risk in exposed)) ARP exposed =100 x ((RR-1)/RR) so if RR was 5, it would be =100 x (5-1)/5) = 80%

Answer 153

PECAM1 (platelet endothelial adhesion molecule), this indicates the tumor has arisen from vascular endothelial cells

Answer 154

Most common childhood tumor can cause bitemporal hemianopia. Derived from remnants of Rathke's Pouch --\> anterior pituitary Calcification is common, Cholesterol crysals found in "motor oil"- like fluid within tumor.

Answer 155

Increased risk for osteoperosis

Answer 156

Cimetidine Ritonavir Amiodarone Ciprofloxacin Ketoconazole Acute Alcohol Abuse Macrolides Isoniazid Grapefruit juice Omeprazole Sulfonamides Gemfibrozil Quinidine

Answer 157

Barbituates St. John Wort Carbamezapine Rifampin Alcohol chronic (chronically induce cirrhoris) Phenytoin Griseofulvin Phenobarbitol Sulfonurea

Answer 158

Pt has **sideroblastic anemia from INH** **Decreased activity of ALA synthase** INH directly **inhibits pyridoxine phosphokinase**, which normally convers pyridoxine (vit B6) to its active form), which is a cofactor with ALA synthase in the heme synthesis pathway

Answer 159

often due to inactivating mutation **in BMPR2** (normally **inhibits vascular smooth muscle proliferaiton.** Transmitted AD with variable penetrance

Answer 160

The difference between B and C depicts the volume of blood ejected With the dotted lines, this patient has increased contractility with a larger volume of the blood ejected. as a reult there will be an increase in stroke volume or ejection fraction

Answer 161

**Give them Vitamin A.** (think measles/weasles with vitamin A hats) Acute measles infection depletes Vitamin A stores and giving supplemental Vitamin A. Vitamin A helps prevent and treat these ocular complicaitons. It reduces length of hospital time and recovery time NO OTHER VITAMIN IS LINKED TO MEASLES

Answer 162

Translocation Down Syndrome --\> can be inherited from a noninfected parent with a balanced translocation This robertsonian translocation occurs between chromosomes 21 and 14. The result is a fusion of 2 long arms and fusion of two short arms (nonessential genetic material) The resulting fetus has an unbalanced robertsonian translocation with 46 chromosomes and 3 effective copies of 21 (46 XX, t(14;21))

Answer 163

overuse injury of the second ossification center (apophysis) of the tibial tubercle VERY COMMON knee pain in young adults after a recent growth spurt **\*\*Pain and swelling at the tibial tubercle, the intsertion point of the patellar ligament\*\*** Repetitive contraction of the quadriceps (jumping) results in avulsion fractures causing the proximal patellar tendon to separate from the tibial tubercle

Answer 164

The **memory loss and impairment of learning is usually perminent** The ataxia, confusion, occulomotor dysfunction are all reversible with **THIAMINE +Glucose** **\*\*\* Remember, thiamine must be given at same time or before glucose, or will worsen the whole shebang\*\***

Answer 165

The enzyme responsible for converting arginene into urea and ornithiene at the end of the uric acid cycle. If deficienct, there would be a buildup of arginine (seen in blood) and can present as bilateral leg stiffness and abnormal involuntary movements, and growth delay This pt will NOT present with hyperammonemia Treatment includes arginine free, low protein diet

Answer 166

**Hawthorne effect:** The tendency for subject studies to change their behavior because they know they are being studied **Pygmalian effect:** this is the tendency that physicians/researchers's beliefs in the efficacy of a treatment can potentially affect the outcome **Berkson Bias:** refers to a selection bias chosing hospital patients as a control group (less healthy than general population, will skew results)

Answer 167

**Clopidogrel**: reversibly blocks P2Y12 component of ADP receptor on the surface of platelet Clopidogrel is as effective as ASA for prevention of CVA events The pt is unable to tolerate ASA due to exacerbation of preexisting respiratory sx

Answer 168

This is a characteristic of RUBELLA (German Measles), a togavirus ## Footnote **Germans get neck swelling**

Answer 169

Gastric varicies can be seen in splenic vein thrombosis due to chronic pancreatitis, pancreatic cancer and abdominal tumors The **SHORT GASTRIC VEIN** drains the fundus into the **splenic vein**

Answer 170

**Superoxide dismutase** converts superoxide to hydrogen peroxide Note: NADPH oxidase converts O2 to O2- (superoxide), and myeloperoxidase converts H2O2 to HClO (

Answer 171

Carb: 4 Fat: 9 Protein: 4 ETOH: 7

Answer 172

This patient has **Actinic Keratosis:** small scaly erythematous lesions with a sandpaper texture occuring on sun exposed areas AKs do NOT invade the dermis and are considered to be premalignant lesions --\> **invasive squamous cell carcinoma**

Answer 173

May be a **Glomus Tumor or a Subungal Melanoma** In this example, Gloumus is more likely choice since no hyperpigmentation was seen This is a tumor of modified smooth muscle cells of a glomus body. A glomus body is part of the dermis layer of the skin involved in body temperature regulation. Each glomus body is attached to an arteriovenous anastamosis. The role is to shunt blood away from skin in cold temperatures and direct blood to surface in hot temperatures to facilitate the disipation of heat **TEMPERATURE REGULATION**

Answer 174

**gamma-glutamyl transpeptidase (GGTP)** This is increased in various liver and biliary diseases (just as ALP) but NOT in bone **\*\*Good way to distinuish if the elevated ALP is from bone origin or liver origin\*\***

Answer 175

Neuronal cell It is a transmembrane glycoprotein found in the presynaptic vesicles of neurons, neuroectodermal, and neuroendocrine cells

Answer 176

This is a **chronic AV fistula**. Increased CO (increase in height of cardiac function curve), and decreased TPR (increased slope of both) and an increase in mean systemic pressure (right shift of venous curve along x-axis)

Answer 177

Glycogenolysis for first 12-18 hours of fasting Then gluconeogenesis takes over The first committed step of gluconeogenesis is the conversion of pyruvate to oxaloacetate by pyrvuvate carboxylase

Answer 178

**Familial Hypocalciuric Hypercalcemia.** This is an AD condition where there is a defect in the calcium sensing receptors in multiple tissues (CaSR). This requires higher than normal levels of calcium to suppress PTH These are transmembrane G-protein receptors that help to regulate secretion of PTH in response to changing serum calcium levels

Answer 179

hypertrophic cardiomyopathy

Answer 180

This is a trochlear nerve palsy. This innervates the superor oblique muscle, which causes the eye to intort and depress while adducted

Answer 181

A protein tetramer produced in the liver that acts as a carrier of thyroxine and retinol Mutations in the gene cause a misfolded protein that results in an amyloid protein that infiltrates the myocardium (infiltrative cardiomyopathy)

Answer 182

Black: chronic hemolysis (sickle cell, spherocytosis), increased enterohepatic recycling of bilirubin (ileal disease) Brown: E. Coli, liver fluke (chlonorchis sensilis)

Answer 183

Epi by itself decreases insulin secretion Stim of B2 promotes insulin exretion Stim of A2 inhibits insulin secretion Since epi acts on both of these receptors, it would have to be an A2 blocker if epi was now all of a sudden increasing insulin secretion

Answer 184

MEN2A Medullary thyroid cancer, Pheochromocytoma, parathyroid hyperplasia MEN2B: Medullary thyroid cancer, pheochromocytoma and mucosal neuromas Medullary thyroid cancer is a neuroendocrine tumor that arises from parafollicular Calcitonin secreting C-cells. These show up as nests of polygonal cells with Congo-red positive deposits

Answer 185

This should raise suspicion for visceral cancer (adenocarcinomas of the pancreas, colon, lung)

Answer 186

Hippocampus is the first area damaged (also the purkinje cells of the cerebellum)

Answer 187

Mixture with deoxygenated blood Blood in the left atrium has a slightly lower O2 content than blood in the capillaries. This is due to mixing of deoxygenated blood with oxygenated blood from the pulmonary veins. \*This deoxygenated blood comes from: 1. bronchial arteries carry blood to the bronchi and bronchioles (most of this blood returns via the pulmonary vein) 2. small cardiac (thesbian veins) that drain into the LA and ventricle and contribute to normal anatomic shunting

Answer 188

A bile acid binding resin that binds bile acid in the GI tract thereby interfering with the enterohepatic circulation of bile acid and therefore cause increased bile acid excretion. This results in synthesis of new bile acid, a process that consumes liver cholesterol stores

Answer 189

**used to detect and quantify levels of mRNA in sample** Uses reverse transcription to create complementary DNA template that is then amplified using the normal PCR mechanism

Answer 190

Neural tube defects (myelomeningocele, meningocele)

Answer 191

non alpha, non beta islet cell pancreatic tumor that secretes VIP This results in Watery Diarrhea, Hypokalemia, Achlorhydria (WDHA syndrome) This can be treated with somatostatin (octreotide), which inhibits VIP production

Answer 192

Usually indicates the presence of erosive esophagitis and the formation of an ulcer

Answer 193

This pt has **Phenylketonuria**, and a deficiency in **phenylalanine hydroxylase.** This enzyme requires cofactor with **BH4.** Excess phenylalanine is what causes **neurological damage** in these pts See **hypopigmentation** due to decreased synthesis of melanin The **musty body odor** is due to accumulation of phenylalanine

Answer 194

**Calcium** Glycogen in the skeletal muscles is used to provide energy for muscle contraction Increased Calcium is a powerful activator of muscle phosphorylase kinase When Ca is released from the SR, there is synchronyous muscle contraction (via binding troponin...) as well as glycogen breakdown via activation of PK to increase glygogenolysis

Answer 195

When there is failure of endocardial fusion, this results in: **1. osteum primum atrial septal defect** **2. ventricular septal defect** **3. single AV valve** This results in significant L --\> R shunting and AV valve regurg leading to excess pulm blood flow and sx of heart failure This is commonly seen in **DOWN SYNDROME**

Answer 196

The new drug will be approved if its associated recurrence rate is decreased by at least 40% compared to recurrence rate on std therapy alone, which is 8%. so 40% of 8% is 0.4 x 8% =3.2%. The maximal acceptance rate would be 8%-3.2% =4.8% Basically, you are looking for a Relative Risk Reduction (RRR) RRR=(ARcontrol-ARtreatment)/AR control RRR=0.4 and ARcontrol is 0.08

Answer 197

Classic triad for **botulinism poisoning** (cleave SNARE in presynaptic terminal leading to flaccid paralysis)

Answer 198

The SA node is located near where the superior vena cava enters the heart in the RA (junction of RA and SVC)

Answer 199

G6PD test because see hemolysis if give and dont check \*\*If have G6PD, could also see anemia if give: antimalaria drugs, TMP-SMX, DKA, Ingestion of fava beans

Answer 200

Individuals with signs and symptoms of cortisol excess have Cushing Syndrome Cushing DISEASE is a type of cushing syndrome that is caused by excess ACTH from pituitary adenoma. Pts with Cushing disease usually develop **HYPERPLASIA** of the zona **fasiculata** and zona **retiularis**

Answer 201

These drugs are used as antiemetics The are postrema in the 4th ventricle has a chemoreceptor trigger zone that can respond to drugs, toxins, NT The nucleus tractus solitaris receives signals from the area postrema to cordinate the vom process **NK1 receptor antagonists prevent substance P release (aprepitant, fosaprepitant)**

Answer 202

Digoxin toicity --\> cardiac arrhythmias, nonspecific GI sx, neurological and visual sx (seeing yellow) as well as hyperkalemia (via inhibiton of Na/K ATPase

Answer 203

Stimulates 5HT-1a receptors Used in Generalized Anxiety Disorder **\*\*Takes 1-2 weeks to take effect so NO ACUTE USE\*\***

Answer 204

1. fibrous dysplasia 2. precocious puberty 3. Cafe-au-lait spots This is a somatic mutation in GNAS gene encoding the stimulatory alpha-subunit of G-protein, get constituitive activation of AC

Answer 205

Compression of LOWER trunk of brachial plexus as it passes through the thoracic outlet, presents as upper extremity numbness, tingling, weakness ALSO see compression of subclavian vein can cause upper extremity swelling OR compression of subclavian artery causing exertional arm pain This usually occurs in the SCALENE TRIANGLE...can be due to cervical rib, scalene muscle anomalies, injury (repetitive overhead use)

Answer 206

This pt has G6PD and this is not an uncommon way for this to present. This is hemolysis induced by the TMP-SMX G6PD is an X-linked disorder that affects mostly males and is more common in pts of African, Asian, and Med descent. it is an enzyme of the Pentose pathway and eventually results in decreased NADPH and inability to maintain glutathione in reduced state

Answer 207

1. Abdominal artery 2. Coronary arteries 3. popliteal 4. Internal carotid 5. Circle of willis

Answer 208

This is a rupture of saccular aneurysm Clinically the acute onset of HA is characteristic of subarachnoid hemorrhage and the CT confirms the dx. Focal neuro deficits are usually NOT seen Berry aneurysms are the MOST common cause of SAH with the anterior communicating artery being the most common site

Answer 209

of new cases/total population at risk

Answer 210

Carrier protein for oxytocin and vasopressin (ADH). Neurophysin bind and act like chaperone protein

Answer 211

This is a classic Reed Sternberg cell (Owl Eye) of Hodgkins Lymphoma. These cells are derived from germinal center B-lymphocytes and are the neoplastic cells of Hodgkins \*\*They are necessary for dx\*\*

Answer 212

This is an AR acidemia from parial or complete deficiency of methylmalonyl-CoA mutase Leads to **buildup of methylmalonic acid** leading to metabolic acidosis. Hypoglycemia results from overall increased metabolic activity leading to increased glucose utilization and direct toxic inhibition of gluconeogenesis --\> **KETOGENESIS**. The organic acids also inhibit urea cycle leading to **HYPERAMMONIA**

Answer 213

First, achlorhydria is decreased gastric acid production to maintain normal gastric pH \<4 Predisposed to things like Cholera infection at lower innoculation dose. Normally, killed by stomach acid, but if have less acid you need less bacteria to infect. Could be low due to chronic omeprazole therapy or a result of gastritis

Answer 214

Thrombin will make up for the deficiency and lead to blood clotting \*Remember that in hemophilia, the bleeding time and platelet count are normal (those would be low in things like VWF, Glanzmann..). Also the PT would be normal since it really just tests Factor VII.

Answer 215

**Depersonalization** --\> experiencing surround as unreal. Feelings of detachment **Dissociative amnesia --**\> inability to recall important personal information **Dissociative identity** --\> associated with severe trauma/abuse

Answer 216

JGA --\> DECREASE Cardiomyocyte --\> DECREASE Vascular smooth muscle --\> NO CHANGE \*\*\*Remember that Atenolol is a SELECTIVE B1 blocker that acts on cardiac myocytes and JGA cells. There are NO B1 on vascular smooth muscle cells

Answer 217

Cholestasis The causes can be intrahepatic or extrahepatic When it is prolonged, the reduction in bile flow results in malabsorption of fats and fat soluble vitamins (ADEK), which REQUIRE bile salts for digestion

Answer 218

This pt will not be able to reabsorb BILE ACIDS leading to an inability to absorb ADEK vitamins. Also inability to reabsorb B12 leading to megaloblastic anemia The K deficiency will result in decreased Factor 2,7,9,10,C,S which will lead to easy bruising and large hematomas

Answer 219

This can happen through sites of uterine trauma or cervical lacerations. Fetal squamous cells and mucin are seen on autopsy. When this arrives at the lung, it causes an anaphalactoid reaction causing occlusion and vasospasm of the maternal pulmonary circulation and can lead to DIC. Tissue factor (thromboplastin) is also released from amniotic fluid

Answer 220

Clavulonic Acid is a beta-lactamase inhibitor that inhibits beta lactamase that was made by the bacteria in an attempt to thward the antibiotics. Other beta-lactamase inhibitors are sulbactam and tazobactam It expands the spectrum of action to bacteria that are beta-lactamase synthesizing

Answer 221

This pt has Neisseria Meningititis (know because of the neck stiffness with concurrent petechial rash all over the trunk and DIC presentation. This is highly associated with Waterhouse-Fredreichson syndrome which is bilateral adrenal hemorrhage

Answer 222

It can affect any tissue but is classically associated with lips, tongue, eyelids. Laryngeal edema and difficulty breathing may also occur When taking an ACE-I, bradykinin is accumulated. NORMALLY, ACE is responsible for bradykinin breakdown. Bradykinin is a potent vasodilator, causing significant angioedema

Answer 223

1. ACE-I 2. Spironolactone, Eplerenone (3. Beta Blockers) \*Both block deleterous effects of Aldosterone on the heart

Answer 224

1. Palpable Purpura 2. colicky abd pain 3. polyarthralgia IgA and C3 deposition seen

Answer 225

Defective migration of GnRH secreting neurons from their origin in the olfactory placode to their location in the hypothalamus Most often due to mutation in KAL-1 gene or FGFR-1 gene Classically have central hypogonadism and anosmia. Most often these present with delayed puberty

Answer 226

**RPF: Decreased** due to a decline in circulating volume leading to a systemic vasoconstriction, including renal vasoconstriction **GFR: Reduced** RBF causes perfusion pressure to drop, this the GFR drops as well. This decreases distal tubule Na delivery, thus we see an **increase in RENIN --\> RAAS** **FF:** Remember this is a ratio of GFR/RPF. The RPF decreased more than the GFR, thus, this the FF **INCREASED**

Answer 227

This is asking the progression of the **Ademona--\>Carcinoma sequence** The FIRST mutation is an **APC mutation** (tumor supressor mutation) Incidentally, this mutation is found in all pts with FAP (COcked) AK 53: APC inactivation, COX-2 overexpression, KRAS activation, p53 inactivation

Answer 228

The clot that goes to the lung causes a V/Q mismatch. The Q part of this equation decreases causing ischemia to the portion downstream of the clot. This causes a redistribution of blood to poorly ventilated regions. This worsens the V/Q mismatch and causes significant intrapulmonary R --\> L shunting The ensuing HYPOXIA stimulates the respiratory drive, however hyperventilation cannot compensate for the PE fully. This does lead to RESPIRATORY AKLALOSIS. The bicarb will remain the same acutely, but will decrease within 48 hours So pH is INCREASED (7.5), PaCO2 (24) is DECREASED, PaO2 is DECREASED (65) and Bicarb is unchanged (23)

Answer 229

TNF-alpha is a cytokine that cuases necrosis of some tumors in vitro and produces symptoms of cachexia in experimental animals ## Footnote **\*\*\*TNF-alpha --\> Causes cachexia in malignancy\*\*\***

Answer 230

**Cryptococcus Neoformans:** a yeast that has a THICK antiphagocytic polysaccharide capsule that is its virulence factor The capsule appears as a clear UNSTAINED zone on India Ink stain and stains RED with mucicarmine. Methanamine silver stain can also be used to identify it

Answer 231

**Concentric (**add sarcomeres in parallel)--\> chronic HTN, Aortic stenosis **Eccentric** (sarcomeres added in series) --\> aortic or mitral regurgitation, MI, dilated cardiomyopathy **\*Think eCCentric (the C's are in series)\***

Answer 232

Drug induced hyperprolactinemia due to **Risperidone** (an antipsychotic drug used in management of schizophrenia) **-Inhibits D1 and D2** -Loss of normal tonic inhibition of prolactin release leading to **hyperprolactinemia** --\> decreased LH/FSH --\> amenorrhea

Answer 233

Familial Dysbetalipoproteinemia is characterized by xanthomas and premature cardiac dz Defect is in APOE3 and APOE4 found on chylomicrons and VLDL that are responsible for binding hepatic apoliporotein receptors Without these two receptors, the liver cannot remove chylomicrons and VLDL from the circulation

Answer 234

Redistribution of fat from extremities to central adiposity is a common adverse effect of HAART therapy (**antiretroviral therapy)** Can be lipoatrophy (loss of subcutaneous fat esp from face) or central adiposity (similar to cushings)

Answer 235

Hematochromatosis!!! Abnormally high iron absorption that causes iron overload particularily in heart, liver, pancreas See hepatomegaly, abd pain, SKIN PIGMENTATION, DM, impotence, and pigment cirrhosis Usually see \>50% saturation of transferrin and elevated serum ferritin, and elevated serum iron

Answer 236

Patent Ductus Arteriosus Heard best in L infraclavicular region with maximal intensity at S2

Answer 237

**B-Cell ALL** is 70-80% of cases **CD10, 19, 20** **T-Cell ALL** is 15-17% of cases. Often presents as a mediastinal mass that presents with SVC symptoms, resp sx, dysphagia **CD2,3,4,5,7,8**

Answer 238

proinflammatory transcription factor that increases **cytokine production** In Crohns, there is a NOD2 mutation that DECREASES expression of NF-KB, which impaires the innate immune response in the intestinal mucosa

Answer 239

**Long-standing RA** can affect the cervical spine causing vertebral malalignment (subluxation) that can affect the alantoaxial joint This can be worsened by intubation as the pts head is leaned backwards leading to acute compression of spinal cord

Answer 240

This pt has **congenital long QT syndrome** Prolonged QT predisposes to development of life threatening ventricular arrhythmias (torsades) and can present as recurrent palipitations, syncope, or sudden cardiac death

Answer 241

**Osteoblastic:** prostate, small cell lung cancer, hodgkins **Mixed:** GI, Breast **Osteolytic:** Multiple myeloma, non-small cell lung cancer, non-hodgkins, Renal cell carcinoma, Melanoma

Answer 242

It is **actively filtered** from the blood in the glomerulus and **secreted** by the cells lining the proximal tubule. Thus the calculated clearance can be used to estimate Renal Plasma Flow **\*\*It is filtered and secreted but NOT reabsorbed\*\*** This **filtration process cannot be saturated** (thus neither can excretion) The **secretion** is a **carrier protein mediated process** therefore is able to be saturated. The maximum value of PAH secretion is 80mg/min

Answer 243

t=(0.693 x Vd)/CL

Answer 244

Caused by parathyroid adenoma in 85% of cases and by parathyroid hyperplasia in the remaining cases Sx: bone pain, renal stones, GI disturbances (bones stones, abdominal groans and psych overtones) The skeletal findings most often involve the corcial (compact) bone in the apendicular skeleton \*\*Subperiosteal resorption with cystic dilation\*\* This shows up like a salt and pepper skull

Answer 245

**Peripheral edema**, lightheadedness, flushing, gingival hyperplasia

Answer 246

**pulmonary hypertension and Right sided HF** Most pts with OSA develop **systemic HTN** due to chronic sympathetic stimulation and elevated plasma norepi levels, also leads to **arrhythmias** (Afib/Aflutter)

Answer 247

This is what is deficienct in MSUD, resulting in accumulation of the branched chain amino acids (Isoleucine, Leucine, Valine), resulting in neurotoxicity that includes seizures, irritability, lethargy and poor feeding Requires 5 cofactors: Thiamine, Lipoate, Coenzyme A, FAD, NAD (Tender Loving Care For Nancy) ...therefore some pts with MSUD improve with high dose thiamine treatment

Answer 248

Bethanechol (cholinergic agonist)

Answer 249

Happens in the endothelium Arginine + O2 --\> NO + Citruline Nitric Oxide Synthase is the enzyme responsible This then diffuses into the smooth muscle where it activate guanylyl cyclase and increases cGMP

Answer 250

seen in microangiopathic anemias and MECHANICAL damage of RBC ## Footnote **Schistocyte example is Helmet Cell**

Answer 251

This pt has **Kleinfelter Syndrome (47; XXY)** These pts usually have atrophied, hyalinized seminiferous tubules (resulting in low inhibin levels) and damaged Leydig cells ( resulting in low testosterone levels). The lack of feedback causes **excess gonadotrophs (FSH, LH), which also causes increased ESTROGEN** These pts also have increased gynecomastia (and thus increased risk for male breast cancer)

Answer 252

**_A neurologic disorder characterized by:_** Agraphia Acalculia Finger Agnosia Left/Right Dissociation **\*\*Affects the dominent parietal lobes\*\*\***

Answer 253

This is a pancreatic pseudocyst These walls consist of **granulation tissue and NO epithelial lining** Found in **acute pancreatitis** (ususally caused by alcohol and gallstones but can also be from trauma, steroids, mumps, protease inhibitors, NRTIs)

Answer 254

Caused by Gastrin secreting neuroendocrine tumor (gastrinoma) Commonly located in small intestine or pancreas Presents with multiple peptic ulcers that can be located beyond the duodenal bulb Associated with MEN1

Answer 255

Given the difference in pressure between the aorta and left ventricle, this patient must have Aortic Stenosis. This would be heard loudest during the peak of LV contraction (crescendo-decrescendo), which would correspond to B on the graph

Answer 256

Apoptotic hepatocytes form round acidophilic bodies (pink staining on H&E) that are seen in Hepatitis (most likely C) and Yellow Fever

Answer 257

Congenital hypothyroidism is one of the most common causes of preventible intellectual disability. Most cases are due to thyroid dysgenesis or iodine deficiency -Neonates initially have no sx since there is maternal T4, then as this weanes, the sx will get progressively worse T4 is essential for brain development and can result in severe and irreversible intellectual disability Treatment with levothyroxine by age 2 can normalize cognitive and physical development \*The screening of hypothyroidism is performed in the US but NOT all other countries\*\*

Answer 258

This is due to a Parvovirus B19 (single stranded DNA virus) infection of erythroid precursors in the bone marrow. This is an aplastic CRISIS just RBC decrease (unlike aplastic ANEMIA that is pancytopenic)

Answer 259

The end product is **NADPH** and this is then used in **Fatty Acid Synthesis** and also the glutathione antioxidant mechanism

Answer 260

The pyruvate dehydrogenase complex and the alpha-ketoglutarate dehydrogenase complex \*If give glucoseto the alcoholic that does not have thiamine, cause rapid depletion of the small amount of thiamine that these pts have and worsen sx. Need to give at SAME TIME\*

Answer 261

This pt has Typhoid Fever! This is caused by Salmonella Typhi Salmonella is able to penetrate the gut wall via phagocytosis of M cells and bacteria mediated endocytosis by enterocytes. The bacteria are then able to survive and proliferate within macrophages found in the submucosal region (Peyers Patch) causing severe inflammation and ensuing bacteremia **\*\*See Salmon colored rose spots on abd\*\***

Answer 262

This is **CMV esophagitis** which can occur in immunocompromised pts CMV can be transmitted to transplant recepients from the donor CMV esophagitis presents with odynophagia or dysphagia **On tissue bipsy would see enlarged cells with basophilic or eosonophilic intranuclear inclusions**

Answer 263

Listeria, usually comes from contaminiated food. Can multiply in cold temperatures (so grows well in refrigerated food) Found in milk products and unwashed raw veggies Tx: ampicillin

Answer 264

1C\>1A\>1B 1A: quinidine, procainamide, dysopyramide 1B: lidocaine, phenytoin, mexilitine 1C: flecainide, propanephone **Think CAB!**

Answer 265

Torsion that happens when the **ovary wraps around the infundibulopelvic ligmanet** (suspensory ligament of the ovary). This houses the ovarian blood and nerve supply The main risk factor is having a large ovarian mass (cyst, neoplasm). The weight of the mass causes the ovary to twist and oclude the vessels and nerves Usually present with sudden onset unilateral pain

Answer 266

Dilated cardiomyopathy caused by viral myocarditis Myocardial inflammation leads to dilation and enlargement of the heart chambers (eccentric hypertrophy) with decreased ventricular contractility (systolic dysfunction)

Answer 267

**Meniere's Disease** is a common cause of vertigo due to increased pressure and volume of endolymph. Leads to recurrent vertigo, ear fullness/pain, unilateral hearing loss and tinitis ## Footnote **=endolymphatic hydrops**

Answer 268

Usually caused continuation of spread by infection from the medial third of the face, sinus or teeth by S. Aureus but can also be caused by strep, mucor, rhizopus This results in paralysis of III, IV and VI CN III palsy may also result in ptosis and mydriasis

Answer 269

First gen antihistamine that blocks central and peripheral H1 receptors

Answer 270

Highly conserved DNA sequence that is usually 180 BP in length. These genes encode for **transcription factors** that bind to regulatory regions on DNA

Answer 271

The Locus Ceruleus produces NE It is a pigmented brainstem nucleus located in the posterior rostral pons near the lateral floor of the fourth ventricle It involves mood, arousal (reticular activating system(, sleep-wake cycles, autonomic function (BP control)

Answer 272

He has paroxysmal supraventricular tachycardia (PSVT), which is almost always due to a reentrant impulse traveling between the slowly and rapidly conducting segment of the AV node VAGAL maneuvers such as carotid sinus massage, dumping head in cold ice bucket can be used to actively terminate PSVT This works by increasing afferent firing from the carotid sinus, which increases vagal parasympathetic tone. This SLOWS conduction through AV node and prolongs AV node refractory period

Answer 273

ONLY GLUT 4 is responsive to insulin\*\* this is expressed in skeletal muscle and adipocytes GLUT1 --\> erythrocytes GLUT2 --\> hepatocytes, pancreatic B-cells, basolateral membrane renal tubules GLUT3 --\> placental, neuronal GLUT5 --\> fructose transporter

Answer 274

1. Pheochromocytoma 2. Medullary carcinoma thyroid 3. Mucosal neuromas (oral/intestinal ganglioneuromatosis) **\*\*Marfanoid body habitus** Mutation in RET gene

Answer 275

months of the year backwards

Answer 276

Histoplasmosis oval cells within macrophages

Answer 277

These are effective for schitzophrenia and psychosis **Low potency --\> (chlorpromazine, thioridazine)** cause non-neurological side effects (histaminergic, cholinergic, noradrenergic) **High potency --\> (haloperidol, flufenazine)**cause neurological side effects (extrapyradimal) due to potent D2 antagonism in nigrostriatal pathway

Answer 278

**Primary Biliary Cirrhosis** characterized by destruction of small bile ducts in the liver. Pts with PBC develop malabsorption of fat soluble vitamins ADEK This pt also has Vitamin A deficeincy which Can dx PBC with anti-mitochondrial antibody

Answer 279

This is caused by E. Coli infection or Helminthic (ascaris lumbricoides, clonorchis (liver fluke)) --\> leads to release of **microbial B-glucuronidase** by injured hepatocytes and bacteria These stones are comprised of calcium salts and unconjugated bilirubin

Answer 280

**alpha-1--**\> increase IP3 --\> peripheral vasoconstriction **alpha-2** --\> decrease cAMP --\> decrease release NE and insulin **Beta-1 -**-\> increase cAMP --\> increase cardiac contractility **NOT REALLY any action at B2 for NE**

Answer 281

inflammatory activation of microglial cells Should be expected in AIDS pts with cognitive decline

Answer 282

**Irreversible cell injury** This becomes visable 12-24 hours post injury and followed by death of the neuron Remants are then phagocytosed by microglia and then see astrocyte proliferation into a glial scar

Answer 283

**Phyostigmine** --\> tertiary amine that can cross BBB, used to treat atropine overdose **Pyridostigmine** --\> used for myasthinia gravis **Pralidoxime** --\> used for organophosphate OD (reverses BOTH muscarinic + nicotinic effects but does NOT enter CNS) **Atropine** --\> competitive inhibitor of AChE-I, used in organophosphate OD, enters CNS to reverse muscarinic side effects

Answer 284

This is best heard when the pt is in the l**eft lateral decubitus position** at the **end of expiration**. This makes the sound even more audible by decreasing lung volume and bringing the lung closer to the chest wall

Answer 285

Nitrates are primarily venodilators that increase peripheral venous capacitance, thereby reducing cardiac preload and LV end diastolic volume and pressure. Also have a modest effect on arteriolar dilation LV End Diastolic Pressure --\> DECREASE Peripheral venous capacitance --\> INCREASE Systemic Vascular Resistance --\> DECREASE

Answer 286

Intimal Tear

Answer 287

Enveloped viruses (the envelope is made up of the NUCLEAR membrane, and thus is weak as shit) NON-enveloped viruses are generally resistent to the actions of ether

Answer 288

She can not tell her parents about the prenatal care but NOT if she gets an abortion She could also get STD tx without telling her parents, contraception, drug/alcohol tx programs

Answer 289

**very indicative of GERD** these are considered extraesophageal symptoms (nocturnal cough and hoarsness) in the ABSENCE of heartburn **=silent GERD**

Answer 290

These are NNRTI (nonnucleoside reverse transcriptase inhibitors) that do NOT require activation via intracellular phosphorylation

Answer 291

OVERACTIVITY! sudden overwelming need to empty the bladder The detrusor muscle remains relaxed to fill the bladder and then constricts to contract the bladder and urinate

Answer 292

Cough Angioedema Teratogen Increased creatinine HYPERkalemia Hypotension

Answer 293

Radial head subluxation The annular ligament tears from its periosteal attachment to the radial neck. The ligament slips over the radial head into the joint where it becomes trapped

Answer 294

mid systolic click followed by mid-late systolic murmur heard at cardiac apex. Heard less when squatting (increased LV volume pulls valve into more anatomical position) Caused by pathologic **deterioration of the connective tissue** affecting the mitral valve leaflets and cordae tendenae Can also be secondary to Marfans, Elers Danlos, Osteogenesis

Answer 295

erythrocytes! NO mitochondria

Answer 296

Prostacyclin --\> INHIBITS platelet aggregation and adhesion to vascular endothelium and vasodilates Thromboxane A2 --\> enhances platelet aggregation

Answer 297

These are the -**glitazone** T2 DM meds they reduce insulin resistance by binding PPAR-Y The main side effect is fluid retention due to increased Na reabsorption in the collecting tubules They also cause adipose wt gain (increased fat storage and increased number of adipocytes)

Answer 298

**Dermatitis herpetiformis:** erythematous pururitic papules that often occur on extensor surfaces (they look kinda like herpes simplex breakout) Characterized by microabscesses containing fibrin and neutrophils at the dermal papillae tips Pathogenesis is formation of **IgA antibodies against gliadin in intestine that cross react with epidermal tissue transglutaminase**

Answer 299

Most commonly identified DNA binding domain in humans (trancription factor motif) Only intracellular receptors located in the nucleus can act directly on transcription factors The molecules that act on these zinc fingers would be ones that act intracellulary **THYROID HORMONE** is an example (also estrogen, aldosterone, cortisol, fat soluble vitamins)

Answer 300

Hydrocephalus is either due to overproduction or under-excretion Congenital is due to a structural disorder that causes impaired CSF drainage (aqueduct stenosis, Dandy Walker Malformation, Chiari Malformations) Infants with congenital hydrocephalus develop macrocephaly and muscle hypertonicity and hyperreflexia from UPPER motor neuron lesion

Answer 301

Methylphenidate and amphetamines and they increase DA and NE and block NE and DA reuptake at synapses in prefrontal cortex

Answer 302

They have **Fragile-X syndrome**, the most common inherited cause of intellectual disability Caused by mutation in long arm of the X-chromosome A "Full Mutation" is characterized by **\>200 CGG** trinucleotide repeats which causes **FMR1 HYPERMETHYLATION**

Answer 303

Shine light into eye and see response in that eye (direct) and in the opposite eye (consensual) The OPTIC nerve is responsible for the AFFERENT loop of this reflex The OCCULOMOTOR nerve is responsible for the EFFERENT loop of this reflex

Answer 304

A somatic component innervates inferior, superior, and middle rectus, inferior oblique and levator palpebrae muscles **Ptosis** occurs due to paralysis of the levator palpebrae muscle **Down and Out** occurs due to the unopposed lacteral rectus (VI) and superior oblique (IV)

Answer 305

**Light into L eye --\> NO change in R pupil, NO change in R pupil** **Light into R eye --\> Constrict L pupil, Constrict R pupil** Remember that the AFFERENT pathway is the optic nerve and the EFFERENT pathway is the occulomotor nerve. In this pt, there is damage to the optic nerve but not anything else **(motor pathways are intact, sensory are not)**

Answer 306

hippocampus

Answer 307

**-shortened PR interval** **-Wide QRS** **-delta wave** There is a pre-excitation pathway that excites the ventricles before the AV node, this results in a shortened PR interval with an early upslope at the start of each QRS, thus making each QRS wider than normal

Answer 308

This pt has Pagets Disease of the bone Initially high osteoclast then high osteoblast (common to see hearing issues). See high bone turnover in these pts Osteoclasts in pagets tend to be very large and can have \>100 nuclei The two most important factors for osteoclast differentiation is: 1. macrophage colony stimulating factor (M-CSF) 2. receptor for activated nuclear factor Kappa-B ligand (RANK-L) \*note that osteoprotegrin competatively binds RANK-L and prevents its binding to RANK

Answer 309

**Myopathy** This is made worse with **gemfibrozil** (impair hepatic clearance of statins and lead to excessive blood levels)

Answer 310

Glutamic acid --\> Lysine (very basic POLAR) mutation in beta globulin. There is NO hydrophobic interaction (like seen in sickle cell glu --\> val, so NO sickling) Causes extravascular hemolysis See target cells on smear Pts with HbSC have milder disease than HbSS

Answer 311

cherry red spot NO hepatosplenomegaly accumulation of GM2 ganglioside due to B-hexosaminidase A deficiency progressive neurologic deterioration as these glycolipids accumulate in the brain pts die by age 2-5

Answer 312

Right lateral foot

Answer 313

This is an xanthelasma, a cutaneous lesion found on the eyelid that contains lipid-layden macrophages Classically associated with primary or secondary hyperlipidemia Chronic cholestatic processes such as obstructive biliary lesions and primary biliary cirrhosis result in hypercholesterolemia and result in xanthelasma

Answer 314

Toxoplasmosis infection (caused by cat poo) It is a TORCH infection but the fetus is only affected if the mother is infected within the first 6 months of pregnancy

Answer 315

family of transmembrane protein receptors that interact with the extracellular matrix by binding to specific proteins such as COLLAGEN, FIBRONECTIN, and LAMININ

Answer 316

posterior midline distal to dentate line likely due to poor blood supply anal fissures are due to stretching of the mucosa and are characterized by longitudinal tears in the anal canal distal to the dentate line Most are due to high anal pressures and passage of hard stool, or MSM, or diarrhea

Answer 317

block calcium channels in the cardiac slow-response tissues, which SLOWS phase 4 diastolic depolarizaiton and conduction velocity and the SA and AV nodes Verapamil and Diltiazam are used to prevent PSVT

Answer 318

ONLY K would flow out if allowed to and if the resting membrane potential was -70

Answer 319

There are delta waves, which indicate **Wolf Parkinson White syndrome** where there is an AV accessory pathway The triad is: **short PR** **wide QRS** **delta wave**

Answer 320

X-linked recessive

Answer 321

**Tardive dyskinesia** associated with long term dopamine antagonist medications (antipsychotics)

Answer 322

They have loss of atrial contraction due to the AFIB, which can lead to decreased PRELOAD in the LV. This can also lead to backwards flow into the lungs leading to acute pulm edema

Answer 323

The LEFT lateral geniculate body in the thalamus The left temporal hemiretina receives visual information from the nasal visual field of the LEFT eye

Answer 324

This is a MAO-I that are antidepressants that work by blocking the breakdown of NA, DA, 5HT Useful in treatment-resistent depression (atypical subtype of major depression) Atypical depression --\> mood reactivity, leaden paralysis, rejection sensitivity, increased sleep and appetite

Answer 325

This is Chovstek sign (hypocalcemia) due to thyroid surgery where they accidently removed the parathyroid glands and thus decreased PTH, thus do not have adequate calcium levels

Answer 326

This pt has hemolytic uremic syndrome caused by shiga-like toxin of e.coli 0157:H7 The smear shows shistocytes which are indicative of **--\> microangiopathic hemolytic anemia** (HUS, TTP, DIC, malignant HTN) \*NOTE that HUS and TTP lie on a spectrum \*\*THIS IS NOT AN AUTOIMMUNE PROCRESS\*\*

Answer 327

Prolong PR interval (the period from the beginning of atrial depolarization (start P) to the beginning of ventricular depolarization (start QRS) Beta blockers have NO effect on QRS or QT interval duration

Answer 328

=hives, caused by transient hypersensitivity characterized by intensely pruritic, raised, erythemartous plaques =wheals Most often caused by IgE mediated degranulation of mast cells The **uticaria itself is due to increased permeability of the microvasculature leading to edema of the superficial dermis** **If the deep dermis and subcutaneous tissue was involved, this would be called ANGIOEDEMA**

Answer 329

Glitazones ...also increase fatty acid uptake, increase adiponectin production, increase insulin sensitivity

Answer 330

A selective **phosphodiesterase-3 inhibitor** that is occasionally used as an **inotropic agent** in pts with refractory heart failure due to left ventricular systolic dysfunction ALSO has PDE-3 inhibiton in the **vascular smooth muscle** can also cause systemic **arterial and venous dilation**, leading to decreased BP

Answer 331

Hepatitis HAV is most likely would see hepatocyte necrosis if did liver biopsy. This is characterized by cellular swelling and cytoplasmic emptying (ballooning degeneration) likely caused by ATP depletion This is different from Hepatocyte apoptosis where you see councilmann bodies --\> cellular shrinkage and nuclear fragmentation with intense eosinophilia (likely caused by mitochondrial oxidative damage)

Answer 332

tyrosine (tyrosine hydroxylase) DOPA (DOPA decarboxylase) DA Dopamine B-hydroxylase) NE (PNMT) EPi

Answer 333

Calcinosis, Raynauds, Esophageal dysmotility, Sclerodactylitis, Telangectasias this can be detected with **anti-centromere antibody** This is due to increased COLLAGEN deposition in the tissue trigggered by increase in monoclonal T-cells that secrete variety of cytokines including TGF-beta **See intimal thickening of pulmonary arterioles**

Answer 334

the most common disorder of heme synthesis causes photosensitivity, which is thought to be due to the accumulation of porphyrinogens that react with oxygen on excitation by UV light Due to deficiency in urophorinogen decarboxylase see tea colored urine too along with the blistering cutaneous photosensitivity

Answer 335

this is an abdominal aortic aneurysm that occurs BELOW the renal artery Risk factors are age \>60, smoker, male, fx Leads to oxidative stress, vascular smooth muscle apoptosis, and **chronic transmural inflammation** of the aorta

Answer 336

COX2, no effect on gastric mucosal protection (COX 1 makes prostaglandins that protect gastric mucosa)

Answer 337

Aromatase inhibitor This slows the progression of ER positive tumors

Answer 338

benign tumor comprised of blood vessels, smooth muscle, and fat Associated with **Tuberous Sclerosis** **--\> get brain hammartomas and ash-leaf skin patches**

Answer 339

releasing factor. they facilitate the release of the polypeptide chain from the ribosome and dissolution from the ribosome mRNA complex

Answer 340

bile acid supplmementation (ursodeoxycholic acid) This pt has a cholesterol gallstone, the most common type of gallstone Administration of hydrophilic bile acid reduce cholesterol secretion and increase biliary acid bile concentration. This improves cholesterol solubility and increases gallstone disolution

Answer 341

Nucleotide excision repair disorder the thiamine dimers made by UV damage are normally repaired by UV endonucleases (this is deficient in these pts)

Answer 342

This patient has carotid sinus hypersensitivity, triggered by pressure on the carotid sinus by the tight neck The carotid body chemoreceptors have a **afferent** limb that travels to the medulla via the Herring nerve, a branch of the **glossopharyngeal** nerve. The **EFFERENT** limb carries its signal by the **vagus** nerve

Answer 343

production of circulating **IgG antibodies** against the exotoxin B subunit, effectively preventing disease ## Footnote **--\> IgG against circulating proteins**

Answer 344

hepatic macrophages that line the walls of the sinusoids and participate in RBC breakdown

Answer 345

Part of the meglitglinide class of T2DM drugs. Binds to the K channels on B-cell membrane (at different site than sulfonureas) and cause release of insulin. These can also lead to hypoglycemia along with sulfonureas They bind and close the ATP dependent K channel

Answer 346

manic episode, if they had this they do NOT get an SSRI. This means they have bipolar disorder ## Footnote **If the SSRI is started, can ppt MANIA**

Answer 347

Adrenal crisis is characterized by severe hypotension and refractory shock ## Footnote **In addition to aggressive fluids and glucocorticoids (hydrocortisone or dexamethasone)**

Answer 348

**Pilocytic astrocytoma:** these are low grade tumors that arise from astrocytes. The cerebellum is the most common location, but they can also develop within the cerebral hemispheres. Usually appears on MRI as mass with **both solid and cystic components** This is **NOT a medulloblastoma**, the second most common tumor in a child. Although these are the most common malignant tumor in children. They are located exclusively in the cerebellum. These tumors **ARE ALWAYS SOLID ON IMAGING**

Answer 349

Defieincy in Vitamin A may cause squamous metaplasia of the epithelial lining of the pancreatic exocrine duct

Answer 350

increased endothelial protein release (increased vWF)

Answer 351

DECREASED ALL The increased prolactin decreases GnRH, which decreases all of the rest downstream

Answer 352

**lowers VLDL and raises HDL**

Answer 353

autophosphorylates, activates tyrosine kinase, then can go down two pathways P13K pathway --\> glycogen, lipid,

Answer 354

Inhibition or deficiency of ADAMTS13 (vWF metalloprotease) ## Footnote **\*von-Wilebrand cleaving factor\***

Answer 355

Thiazide, ACE-I, and NSAIDS

Answer 356

TNF-alpha...also IL-1 and IL-6

Answer 357

Segment of axon that has lost contact with the cell body First swelling and irregularity are noted in the distal segment of the axon The changes seen on the neuronal body after the axon is severed is called **axonal reaction** and the cell body becomes swollen and round, with nucleus displacement to the periphery. Nissl substance becomes fine, granular and dispursed throughout the cytoplasm

Answer 358

The chemoreceptor trigger zone is located on the dorsal surface of the medulla at the **caudal end of the 4th ventricle** in the area known as the **area postrema** This area receives blood from the fenestrations in the BBB, which allows it to sample chemicals circulating in the blood

Answer 359

Excessive bleeding is common in pts with significant renal dysfunction due in part to the accumulation of uremic toxins in the circulation. These toxins impair platelet aggregation and adhesion resulting in a qualitative platelet disorder characterized by **PROLONGED BLEEDING TIME** **PT, PTT, platelet count all NORMAL** **Can be improved with dialysis as it removes the toxins and partially reverses the bleeding abnormality**

Answer 360

The pt has **hereditary spherocytosis** Spherocytes demonstrate increased osmotic fragility These pts would be at **higher risk for pigmented gallstones (a complication of any hemolytic anemia)** Pts with HS also present with aplastic crisis due to Parvovirus B19 infection

Answer 361

Bipolar 1 is manic episode +/- hypomanic and depressive Bipolar 2 has hypomania and depressive episode \*Remember that mood usually returns to baseline between episodes Cyclothymic: milder form of bipolar lasting \> 2 years

Answer 362

He is just getting IV fluid

Answer 363

alpha 1 antagonists that can cause orthostatic hypotension (used to treat BPH, HTN)

Answer 364

**When it is bound to GTP** It is inactive when it is bound to GDP Activated RAS then begins a phosphorylation cascade that results in the activation of MAPkinase, which enters the nucleus and causes transcription

Answer 365

Blastomyces Blasto Buds Broadly

Answer 366

His glom is hypercellular typical of PSGN **hematuria, proteinuria, and urine RBC casts --\> PSGN** This pt would have a LOW C3 in the serum (IgM, IgG, C3)

Answer 367

this is skin mottling that if seen following an invasive vascular procedure is sugestive of atheroembolic disease If you took a look at this patient's kidneys, would see cholesterol clefts in the arterial lumen

Answer 368

superficial cervical fascia, and cricothyroid membrane \*\*DO NOT CUT CARTILAGE\*\*\*

Answer 369

This is called **subclavian steal** and is caused by severe stenosis or occlusion of the CONTRALATERAL subclavian artery symptoms are arm ischemia and bouts of vertebrobasillar insuffiency leading to occasional bouts of dizziness

Answer 370

This has a V-wave that is indicative of **mitral regurgitaiton**. The left atrium pressure is higher than it normally. In that diagram we see a 10 mmhg increase in LA pressure that should not be there normally to to backflow leak

Answer 371

blocks thyroid peroxidase which then inhibits coupling of iodotyrosines

Answer 372

**Methotrexate** side effects: - hepatotoxicity - mucositis (mouth ulcers) - pulm fibrosis - myelosuppression (reversible with Leucovorin)

Answer 373

antithyroid used to treat hyperthyroidism competitive inhibitor of Iodine at the sodium-iodine symporter

Answer 374

ASA (specifically, COX-2) Remember in the adenoma to carcinoma sequence, increased COX-2 overexpression helps this process progress COCKED AK 53 COX2 --\> APC --\> KRAS --\> p53

Answer 375

clamping the **hepatoduodenal ligament** --\> thus clamping the portal triad (common bile duct, hepatic artery, hepatic portal vein)

Answer 376

Alzheimers --\> neuritic plaques (picutre) also have excecutive dysfunction and visuospatial impairment Classic neuritic plaques and neurofibrilary tangles (in the neuronal cytoplasm with aggregates of hyperphosphorlyated tau, which normally mediates microtubule stabilization)

Answer 377

The enlarged cells are Reticulocytes, which are enlarged RBC. It lacks a nucleus but retains a reticular (mesh-like) network of residual ribosomal RNA

Answer 378

nondisjunction that occurs during Maternal Meiosis 1

Answer 379

cholestitis in the absence of a stone. Happens in critically ill pts and is a very poor prognosis

Answer 380

Calcium stones represent 75-80% of all renal stones hypercalciuria is seen These pts remain normocalcemic due to intact regulation of calcium by Vitamin D and PTH

Answer 381

Want a high sensitivity so that you cast a broad net and that a negative test rules out the possibility. Then could do a more specific test Sensitivity, a Negative result rules OUT a dx **(SnNOUT)**

Answer 382

starting around age 40-50 individuals stop being able to focus on close up objects This is caused by progressive denaturation of the lens proteins and changes in lens curvature causing the lens to become less elastic and lose its accomodating power

Answer 383

Bicuspid aortic valve

Answer 384

This is caused by decrease venous return It is called supine hypotension syndrome Supine --\> compression of IVC --\> reduced venous return --\> reduced preload --\> decreased CO --\> hypotension \*predominently occurs in women \>20 weeks and is due to gravid uterus compressing on the IVC

Answer 385

Bladder cell carcinoma arise from transitional epithelial cells lining the bladder Present as painless gros hematuria **\*Tumor stage is the most important factor determining prognosis and depends on degree of invasion into bladder wall\*\***

Answer 386

Glucagon Can be injected intramuscularly or subcutaneously

Answer 387

Campy can be from domestic animals or contaminated foods

Answer 388

This pt has clubbing, and this can be caused by bronchiectasis Clubbing can be seen in: CF, large cell carcinoma, TB, broniectasis, pulmonary hypertension, all the classical congenital heard disorders (esp Tet), bacterial endocarditis, Crohns, UC

Answer 389

binge eat, compensatory behavior (vomit or exercise or stop eating for period of time), excessive worry about body shape and wt, MAINTAINS NORMAL body wt \*IF super skinny, probably anorexia

Answer 390

Increases release of **vWF** and **Factor VIII** from endothelial cells Also can be used to treat enuresis (but this is a CNS effect)

Answer 391

Presents very similar to B12 defieincy (but without the megaloblastic anemia) Also presents very similar to Fredreich ataxia (GAA trinucleotide repeat) Often occurs in pts with fat malabsorption or abetalipoproteinemia See hemolysis and neurologic dysfunction (posterior column and spinocerebellar tract demylination)

Answer 392

Candida when grown at 37 degrees C Note that if an immunocompromised pt has fever, night sweats, wt loss (ie picutre of TB) and performs a sputum stain that shows Candida, this came from the ORAL CAVITY Systemic candida is seen in immunosuppressed pts (neutropenic), unlike esophageal that is seen in T-cell mediated immunosuppressed pts like an HIV pt

Answer 393

**PCT** 60% (ADH and aldo and those other things play a role, but the majority of water reabsorption comes from the PCT)

Answer 394

mouth to anus skip lesions cobblestones fistulas transmural inflammation perianal skin tags

Answer 395

Asthma/COPD breath at lower rate (slow deep breaths) Restrictive lung dieases as well as ARDS, pulm edema breath at rapid and shallow breaths \*Pts with stiff lungs (restrictive) do best breathing at rapid, shallow breaths to minimize the work of breathing. These pts have incresed elastic resistance **Restrictive --\> higher elastance --\> increase RR**

Answer 396

CD4 cell mediated immune response against parietal cells (autoantibodies against parietal cells also seen) See loss of parietal cell mass due to auto-destruction **Decreased INTRINSIC FACTOR** **IMPAIRED B12 absorption** Decreased acid secretion by these parietal cells causes a feedback on the gastric cells to **increase secretion of gastrin** (which are supposed to increase acid release by parietal cells)

Answer 397

Remember that moving rostrally, the amount of white matter increases and the sections become more ovoid Also remember that a feature unique to thoracic is the presence of lateral horns

Answer 398

**blocks toposiomerase II** induces transient breaks in BOTH strands of DNA used in testicular cancer and small cell carcinoma of lung **STAY IN S phase or G2 phase**

Answer 399

This drug **competitively antagonizes ENdothelin-1 receptors --\> decreased pulmonary vascular resistance** USED to treat pulmonary hypertension (also can use sildenafil, epoprostenol, iloprost)

Answer 400

This is used in chronic bronchitis to assess the thickness of the mucosal gland layer to the thickness of the wall between epithelium and cartilage The Reid index is normally 0.4 The higher the number, the worse the bronchitis In the image below, the reid index would be B/(A+B+C)

Answer 401

**Arnold Chiari Type 1** is the most common. It is mostly asymptomatic. It is the downward displacement of cerebellar tonsils thru Foraman magnum. Since this is mild, some people are not aware they have this. **Arnold Chiari Type 2** This is the downward displacement of cerebellar vermis and medulla thru Foraman magnum. Also compression of iv ventricle leading to obstructive hydrocephaly. Frequent assoication with syringomelia. Frequent lumbar mengingomyelocele.

Answer 402

1. **junctional** --\> **flat** macules. Limited to dermoepithelial junction. **FLAT** **2. compound** --\> both dermal and epidermal components. **GOES DOWN INTO DERMIS** **3. intradermal --**\> **papular**. lose tyrosinase activity and lose pigment

Answer 403

C3-C5 Lung cancers can frequently invade the phrenic nerve Irritation of the phrenic nerve causes DYSPNEA, HICCUPS, referred pain to the shoulder

Answer 404

When new O2 arrives in an RBC, it binds to a heme group, this causes increased CO2 and H+ unloading from the RBC \*\*The actual heme is releasing H+

Answer 405

calcium pyrophosphate The knee joint is involved in \>50% of pseudogout cases The crystals are Rhomboid Shaped Calcium Shaped Pyrophosphate

Answer 406

Peroxisomes metabolize very long fatty chain acids by beta-oxidation

Answer 407

**Primary:** sequence of AA linked by covalent bonds **Secondary:** Alpha or Beta linked by HYDROGEN BONDS. In alzheimers, lose beta amyloid loses its alpha helical structure and forms beta pleated sheets, which are less soluble and prone to aggregation. Aggregates of beta pleated sheets are the primary component of the extracellular (neuritic) plaques seen in Alzheimer. **Tertiary:** 3D protein made up of many secondary

Answer 408

melatonin agonist

Answer 409

**Minimum alveolar concentration** is the percentage of anesthetic that renders 50% of patients unresponsive to painful stimuli. Corresponds to ED50 on the dose-effect curve Potency is INVERSELY PROPORTIONAL to MAC The lower the MAC, the more potent the drug

Answer 410

- Otitis EXTERNA - Pneumonia (esp in Cystic Fibrosis pts) - Infections in burn and neutropenic pts - Hot Tub Folliculitis - Ecthyma Gangrenosum **\*Remember, this is a MOBILE, gram - rod that is aerobic, and NON-lactose fermenting, oxidase-positive, that produces pyocyanin pigment and produces endotoxin A that inhibits EF-2**

Answer 411

**Alpha 1 AGONIST** **Phenelephrine** (used to dilate eyes before eye appts) this stimulates pupillary dilator muscles, resulting in mydriasis

Answer 412

Hepatic parenchymal cells produce HEPCIDIN, an acute phase reactant that acts as the central regulator of iron hemostasis High iron --\> increase hepcidin Hepcidin works via action at ferroportin either on ENDOTHELIAL CELLS or MACROPHAGES

Answer 413

This is a lesion of the anterior cerebral atery. Each ACA supplies the medial region of the ipsilateral hemisphere Lesions here would affect the contralateral FOOT and LEG

Answer 414

the Ineratrial septum near the opening of the coronary sinus

Answer 415

The interval from the A2 to the OPENING SNAP As this interval gets SHORTER, the mitral stenosis is WORSE because the valve is opening more forcefully,

Answer 416

Serum Creatinine Can cause lactic acidosis, need to check serum creatinine before starting

Answer 417

Atrophy, thinning of the dermis that is associated with loss of collagen, drying, cracking, tightening of the skin, telangectasias, ecchymosis

Answer 418

AR lysosomal storage disorder, occurs due to defects in protein targeting Failure of golgi to phosphorylate mannose residues (decreased mannose-6-phosphate) Proteins are secreted extracellularly instead of secreted to lysosymes Results in Coarse facial features, Corneal Clouding, Restricted joint movement, and high plasma level of lysosomal enzymes

Answer 419

In the heart see Libman-Sacks endocarditis that is that is thickened valve leaflets with vegetations on BOTH surfaces In the kidney see diffuse proliferative glomerulonephritis, characterized by proliferative and necrotising lesions with crescent formations. See basemement membrane thickening with "Wire-loop" changes

Answer 420

Pregnancy hypothyroidism DM RA **BILATERAL!**

Answer 421

**Right sided --\>** They grow as exophytic masses. The ascending colon has a large caliber opening so pts usually do **NOT develop obstruction.** -Usually present with **features of IRON deficiency** anemia due to occult blood loss **Left Sided --\>** tend to infiltrate the intestinal wall and encircle the lumen, causing **constipation** and symptoms of intestinal **obstruction**

Answer 422

This patient has **idiopathic aplastic anemia** defined by the pancytopenia with bone marrow hypocellularity. The bone marrow biopsy shows an abundance of fat cells and scattered clusters of normal WBC \*this is different from a crisis from a parvovirus B19, which would cause a red cell aplasia only (not pancytopenia)

Answer 423

S4 is considered an atrial kick. It is heard in late diastole so would be apparent right before the mitral valve closes

Answer 424

**1. Galactokinase deficiency --\> deficiency in galactokinase.** **2. Classic Galactosemia --\> galactose-1-phosphate uridyltransferase.** Symptoms are failure to thrive, jaundice, hepatomegaly, infantile cataracts, intellectual disability. BOTH are AR **Classic is WORSE.** Due to accumulation of Galictatol

Answer 425

thorn prick. dimorphous fungus spreads along lymphatics commonly seen in gardeners Itraconazole is tx of choice

Answer 426

occurs when the medial temporal lobe herniates between the crus cerebri and tentorium Often leads to occulomotor lesions (fixed and dilated pupil) with "down and out pupil"

Answer 427

These are **Charcott-Leyden crystals** largely in response to **IL-5** released by **TH2 cells**

Answer 428

Intussuseption

Answer 429

Wegner's Granulomatos (granulomtosis with polyangitis)

Answer 430

1st --\> maxillary artery (max=first) 2nd --\> stapedial artery and hyoid artery (s=second) 3rd --\> Common Carotid artery and prox part of internal carotid (C is 3rd letter) 4th --\> aortic arch, prox part of right subclavian 6th --\> prox part of pulm arteries and ductus arteriosus

Answer 431

urge to move the legs treat with DOPAMINE AGONIST (ropinerole, pramipexole --\> non-ergots)

Answer 432

seuqence directly upstream from AUG This sequence helps initiate translation at the methionine start codon (AUG) Beta thalassemia can be caused by globin gene mutaitons in this region

Answer 433

Granulomatous inflammation of the MEDIA and involves medium to smaller branches of the carotid artery, esp the temporal artery

Answer 434

phosphodiesterase III inhibitor that **INHIBITS PLATELET AGGREGATION and VASODILATES** \* used in internmittent claudication, coronary vasodilation, prevention of stroke or TIA **\*\*Dipyridamole is another drug in this class\*\***

Answer 435

neutrophils because of demarigination of neutrophils previously attached to vessel wall

Answer 436

starts as **vague abd pain at umbilicu**s due to **visceral pain that enters at T10** As the appendix becomes more inflammed, it irritates the **parietal peritoneum** and abdominal wall and becomes a more **somatic pain** that shifts to mcburneys point

Answer 437

right sided heart failure due to PULMONARY HYPERTENSION

Answer 438

segmental transmural inflammation with fibrinoid necrosis medium sized arteries 30% associated with Hep B Rest are idiopathic

Answer 439

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UWorld second half Flashcards

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