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Question 1

Ach-like muscarinic agonists are inhibited by this drug

Answer 1

atropine

(phentolamine competitively blocks a-adrenergic receptors, but does not directly interact with the muscarinic receptors on smooth muscle cells)

Question 2

intoxication of ??? causes fever, dry skin/mouth, flushing, blurred vision, AMS

Answer 2

atropine (Jimson weed)

-note the anticholinergic effects

Question 3

?? should be considered when a genetic mutation is identified in the offspring but not the parent

Answer 3

germline mosaicism: the presence of multiple, genetically different gamete cell lines

Question 4

?? is a cytokine produced exclusively by T lymphocytes

Answer 4

IL-2: functions to stimulate the growth and differentiation of T, B, NK cells and macrophages
IL-1: produced by mononuclear phagocytes
TNF-a: prod. by activated macrophages–>sepsis, shock, cachexia
IFN-a: monos, macros, B cells, NK cells–>antiviral
GM-CSF: macros, T cells, NKs, mast cells, endothelial cells, fibroblasts–>stem cell production of granulos and monos

Question 5

?? bind epithelial cells together in tissues (adherens junctions and desmosomes)

Answer 5

Cadherins- Ca2+ dependent

hemidesmosomes (BM) rely on integrins
fibronectin and laminins are extracellular matrix glycoproteins that bind cell surface integrins

Question 6

umbilicated, flesh-colored papules on skin and mucous membranes think ??
what will be seen on biopsy ?

Answer 6

molluscum contagiosum (poxvirus)

eosinophilic cytoplasmic inclusions

Question 7

Ligand binding to a tyrosine kinase receptor results in ??

Answer 7

formation of receptor dimers and a conformational change that exposes tyrosine kinase-active sites

(receptor mediated endocytosis happens with clathrin coats, i.e. LDL: ligand-receptor complex into a vesicle)
(translocation to nucleus happens with steroid, retinoid, or EPO (STAT)–>gene transcription)

Question 8

pancreatic exocrine secretions changes in response to flow, what ion increases during high flow? what decreases? what maintains the inverse relationship?

Answer 8

high flow: HCO3- increases and Cl- drops

opposite in low flow

Cl-/HCO3- exchanger on the apical surface of ductal cells

Question 9

ileal secretions tend to be ??

Answer 9

slightly alkaline: HCO3-&raquo_space;Cl- during high flow, K+ secretion is also increased

Question 10

Relative risk example

Answer 10

% of pts with cancer who have the mutation DIVIDED BY (not subtracted from!) the % of pts w. cancer who do not have the mutation (risk factor) (used in cohort studies)

Question 11

what heme problem ??: intermittent episodes of abdominal pain w. neuro manifestations following exposure to offending medication, darken upon sun exposure but not photosensitive

Answer 11

acute intermittent porphyria: deficiency of porphobilinogen deaminase (porphobilinogen–>hydroxymethylbilane)

Question 12

S4 sound heard in ??

Answer 12

HTN heart disease, aortic stenosis, HOCM (reduced ventricular compliance/distensibility)

Question 13

S3 heard in ??

Answer 13

chronic sev. mitral regurg, chronic aortic regurg, heart failure assoc. with DCM (sudden limitations of ventr. movement during rapid passive diastolic filling, suggests ventricular enlargement)

Question 14

exudates demontrate ?? (vs transudates)

Answer 14

^protein (>0.5), ^LDH (>0.6, >2/3 serum)
caused by infection, cancer, PE due to increased cap perm and reduced “sieving” of proteins

transudate is cause by hypoalbuminema, CHF

Question 15

splenectomy will result in reduced risk of ??

Answer 15

bilirubin gallstones

Question 16

My. gravis can present with difficulty chewing and diplopia. there is a common association between myasthenia gravis and ??

Answer 16

thymomas

Question 17

does DKA present with hypernatremia or hyponatremia?

Answer 17

hyponatremia; osmotic activity of glucose in serum causes Na+ to drib 1.6 mEq/L for every 100 mg/dL rise in glucose (osmotic diuresis–>H2O, Na+ loss)
other findings: ^K+ (H+ into cells, K+ out), ^NH3 (proteolysis)

Question 18

external female genitalia with vagina ending in blind pouch, think ??

Answer 18

genotypic male (phenotypic female): complete androgen insensitivity
^testosterone, ^LH, normal FSH

Question 19

premie presenting with decrebrate posturing and bilateral thrombi in lateral ventricles, think ?? due to ??

Answer 19

intraventricular hemorrhage due to germinal matrix fragility (matrix involutes by term)

Question 20

carboxyl tails of protein receptors can be anchored to plasma membranes via ??

Answer 20

palmitoylation (increases protein hydrophobicity)

Question 21

low Ca2+, ^PTH, ^Phos

think ??

Answer 21

pseudohyperPTH: end organ resistance to PTH: Albright hereditary osteodystrophy: short stature and finger/toe bones

IN CONTRAST: vitamin D deficiency: low Ca2+, ^PTH, LOW Phos (PTH trashes Phos)

Question 22

hepatomegaly, DM, arthropathy, pit hormone deficiencies (hypogonadism)m hyperpigmentation, RCM, infections, think ??

Answer 22

hereditary hemochromatosis

classic triad: cirrhosis, DM, hyperpigmentation- “bronze DM”

Question 23

preproinsulin–>proinsulin happens where ??

Answer 23

edge of RER, N-terminal signal peptide goes to cytoplasm, proinsulin to RER

• proinsulin then cleaved to insulin and C-peptide, packed in secretory granules in RER
• vesicles travel to Golgi
• vesicles secreted out into EC space

Question 24

maple syrup urine disease is a deficiency of ?? which requires this cofactor ?

Answer 24

branched chain a-keto acid dehydrogenase

requires vitamin B1 (thiamine)

Question 25

a-thalassemia seen in this population?
what seen on smear?
most severe would result in?

Answer 25

Asian
hypochromic, microcytic cells
HbBarts (4 y chains): hydrops fetalis: anasarca, ascities, plerual/pericaridial effusions, incompatible with life

Question 26

the seminiferous tubules and epididymis must maintain ^testosterone relative to circulation. this is accomplished by ?? which are synthesized by ??

Answer 26

androgen binding protein (ABP) synthesized by Sertoli cells

Question 27

ablation of ?? can reduce armpit sweating

Answer 27

thoracic sympathetic trunk

Question 28

PE: PaO2? PaCO2? pH?

Answer 28

decreased PaO2 (hypoxemia, V/Q mismatch), decreased PaCO2 (hyperventilating), ^pH (respiratory alkalosis)

Question 29

red man syndrome with vancomycin tx is worsened with ?? and is due to ??

Answer 29

worsened with rapid administration, it is a result of histamine release due to nonspecific mast cell degranulation, NOT an IgE mediated allergic reaction

Question 30

right ventricular heart failure and hypertrophy, what changes in lung?

Answer 30

pulmonary endothelial dysfunction (pulm. arterial HTN)

In contrast, alveolar hyaline membrane formation is seen in ARDS, which is not typically assoc. w. pulm. HTN

Question 31

heavy menstrual bleeding, anemia, distortion of uterus size think ??

Answer 31

leiomyoma

In contrast: endometriosis is typically outside uterus and will not present with endometrial bleeding, endometrial polyps can cause bleeding but not uterine enlargement

Question 32

hypoglycemia after fasting, inappropriately low ketone bodies, think ??

Answer 32

impaired Beta-oxidation of FAs: medium-chain acyl CoA dehydrogenase deficiency (most common)

Question 33

increasing amount of enzyme available will alter Km and Vmax how?

Answer 33

Vmax will increase, but no change in Km

Question 34

how to deal with ammonia in hepatic encephalopathy

Answer 34

“trap” ammonia in the GIT by acidification w. lactulose (NH3–>NH4+)
also: Rifaximin to decrease􏰂 colonic ammoniagenic bacteria
Benzoate, phenylacetate, or phenylbutyrate to bind to NH4+ and lead to excretion

Question 35

impaired mineralization of ?? is seen in osteomalacia (Vit D def)
?? in osteoporosis
?? in Paget’s

Answer 35

osteomalacia: osteoid
osteoporosis: compact and trabecular

Paget’s: abnormal formation of lamellar bone

Question 36

the recurrent laryngeal nerve innervates all the intrinsic muscles of the larynx responsible for sound production EXCEPT for the ??

Answer 36

cricothyroid (external laryngeal nerve)

Question 37

In general, DNA viruses replicate in the ?? (except poxvirus)

RNA viruses replicate in the ??

Answer 37

nucleus

cytoplasm

Question 38

nerve fibers that are unmyelinated include ?

Answer 38

those responsible for slow pain, heat sensation, and olfaction

most efferents are myelin ate EXCEPT postganglionic autonomic neurons

Question 39

acute tubular necrosis (ATN) can be due to ?

characterized by ?

Answer 39

toxins or ischemia (frequently affecting the medullary regions)
-focal necrosis of tubular epithelium in renal medulla, tubular cell detachment from BM, and tubular lumen occlusion w. cellular debris and casts

Question 40

intersitial nephritis may present like ATN with interstitial inflammation and edema w. possible tubular damage but will also have ??

Answer 40

an intense leukocytic infiltrate