5/10 Mixed

Question 1

Drug interactions with Lithium causing toxicity

Answer 1

Thiazide diuretics (Hydrocholothiazide)
NSAIDs
ACE inhibitors

Lithium Toxicity: ataxia, tremors/fasciculations

Question 2

TB Ghon complex

Answer 2

A lower lung lesion (Ghon focus) + ipsilateral hilar adenopathy = Ghon complex

Occurs during initial infection with M. tuberculosis

Question 3

Ventricular fibrillation

Answer 3

Most frequent mechanism of sudden cardiac death in the first 48 hours after acute MI and is related to electrical instability due to lack of perfusion in the ischemic myocardium

Question 4

Cystinuria

Answer 4

AR disorder caused by defective transportation of cystine, ornithine, arginine, and lysine across the intestinal and renal tubular epithelium.
Recurrent nephrolithiasis is the only clinical manifestation.
Urinalysis shows pathognomonic hexagonal cystine crystals.

Question 5

CXR anatomy, structures near the right middle lobe

Answer 5

On PA CXR, the right middle lobe is seen adjacent to the right border of the heart, which is primarily formed by the right atrium.

Question 6

Internal hemorrhoids

Answer 6

Above the dentate line
Venous component drains into the middle and superior rectal veins, which communicate with the internal iliac and inferior mesenteric veins, respectively.

Question 7

Which agent will decrease the effects of radiotherapy due to competitive inhibition of iodine transportation?

Answer 7

Perchlorate (Potassium perchlorate) and pertechnetate ions (as well as all iodide isotopes) are absorbed into the thyroid gland via the sodium-iodide symporter. High levels of any one substance will significantly reduce the uptake of the others due to competitive inhibition.

Question 8

Persistent depressive disorder (dysthymia)

Answer 8

Chronic depressed mood and at least 2 other depressive symptoms lasting for at least 2 years

Question 9

Where is aldosterone secreted in the adrenals?

Answer 9

Zona glomerulosa

GFR> aldosterone, cortisol, androgens

Question 10

Rx of myoclonic seizures

Answer 10

Myoclonic seizure: no loss of consciousness or postictal state; brief jerking movements involving both hemispheres at onset

Rx: Lamotrigine, Levetiracetam, Topiramate, Valproic acid

Question 11

Bisphosphonate (Risedronate) MOA

Answer 11

Inhibits mature osteoclast-mediated bone resorption

Chemically similar to pyrophosphate, attach to hydroxyapatite on body surfaces

Question 12

Translocation Down Syndrome

Answer 12

Inherited from an unaffected parents with a balanced translocation between 2 acrocentric nonhomologous chromosomes (14 and 21) > unbalanced Robertsonian translocation with 46 chromosomes and 3 effective copies of chromosome 21 [46 XX, t (14;21)]

Epicanthal folds, upslanthing palpebral fissurs, a protruding tongue, excessive skin at the nape of the neck; birth weight and length are below average, hypotonia and weak startle reflex, cardiac defects (VSD)

Question 13

Internal capsule stroke

Answer 13

Pure motor weakness affecting the contralateral arm, leg, and lower face
Contralateral spasticity/ increased tone (Clasp-knife spasticity), hyperreflexia, and a positive Babinski sign are also present

Question 14

Compound melanocytic nevi

Answer 14

Round, uniform melanocytes (nevus cells), mitotically quiescent,

Question 15

complete AV canal septal defect

Answer 15

Most common type of cardiac defect in patients with Down syndrome (autosomal trisomy)

Question 16

Histopathologic manifestation of chronic hep B

Answer 16

Hepatocellular cytoplasm fills with hepatitis B surface antigen. Highly specific for Hep B.

Finely granular, dull eosinophilic, “ground glass” appearance.

vs. Hep C will have lymphoid aggregates within the portal tracts and focal areas of macrovesicular steatosis

Question 17

Normal tracheal pO2 is 150 mmHg
Normal alveolar pO2 is 104 mm Hg
Normally perfusion-limited
Situations were O2 equilibration can become diffusion limited

Answer 17

Emphysema, pulmonary fibrosis, exercise

Question 18

Hyperammonenmia and the brain

Answer 18

Ammonia crosses the BBB and causes excess glutamine to accumulate within astrocytes
Decreases the amount of glutamine available for conversion to glutamate in the neurons, resulting in disruption of excitatory neurotransmission

Question 19

Bipolar II

Answer 19

Major depressive and hypomanic episodes

Less severe, do not involve psychosis, cause a lesser degree of functional impairment

Question 20

Three cytogenic abnormalities can lead to down syndrome:

Answer 20

Meiotic nondisjunction
Unbalanced Robertsonian translocations
Mosaicism

Question 21

Chronic renal allograft rejection

Answer 21

Months to years after transplantation
Worsening HTN and slowly progressive rise in serum creatinine
Mediated by chronic, indirect immune response against donor alloantigens and results in obliterative intimal thickening, tubular atrophy, interstitial fibrosis

Question 22

Amiodarone

Answer 22

40% iodine by weight

Can cause hypo/hyperthyroidism

Question 23

Hereditary nonpolyposis colon cancer (HNPCC)/ Lynch syndrome

Answer 23

AD genetic predisposition to colon cancer

Colon adenocarcinoma occurs at a young age

Question 24

Osgood-Schlatter Disease (OSD)

Answer 24

Injury of secondary ossification center of the tibial tubercle
Common cause of knee pain in young adolescent athletes
Repetitive quad contraction and chronic avulsion cause the proximal patellar tendon to separate from the tibial tubercle

Question 25

Effect of prolactin on GnRH

Answer 25

Prolactin suppresses GnRh, leading to a reduction in release of LH from the pituitary and decreased testicular testosterone production

Question 26

Prevention of neonatal tetanus

Answer 26

Hygienic delivery and immunization of women who are pregnant or may become pregnant
Immunized moths provide passive immunity via transplacental IgG

Question 27

Which pancreatic structure is derived from the ventral pancreatic primordium?

Answer 27

Main pancreatic duct

Question 28

Raloxidene

Answer 28

SERM, binds to estrogen receptors
Prevents osteoporosis
Prevents estrogen receptor positive breast ca

Question 29

Class I antiarrhythmic drugs

Answer 29

Block sodium channels, inhibit initial depolarization and prolong QRS duration (Phase 0)

Question 30

Paraneoplastic cerebrallar degeneration

Answer 30

Small cell lung cancer, breast, ovarian, uterine
Progressively worsening dizziness, limb and truncal ataxia, dysarthria, visual disturbances
Immune response against tumor cells that cross-react with Purkinje neuron antigens
Anti-Yo, anti-P/Q, and anti-Hu

Question 31

Course of the median nerve

Answer 31

Between the humeral and ulnar heads of the pronator teres, then runs between the flexor digitorum superficialis and the flexor digitorum profundus, before crossing the wrist within the carpal tunnel

Question 32

Thiazide diuretics

Answer 32

Block Na-Cl symporters in the distal convoluted tubules > enhanced Na, Cl, water excretion
SE: hypokalemia, hyponatremia, hypomagnesemia, hypotension, volume depletion, hypercalcemia

Question 33

Chronic bronchitis

Answer 33

Thickened bronchial walls, lymphocytic infiltration, mucous gland enlargement, patchy squamous metaplasia of the bronchial mucosa

Cigarette smoking is the leading cause of chronic bronchitis

Question 34

Most common complication of statin use

Answer 34

Myopathy

Myalgia/myopathy with/without myonecrosis (elevated CK)

Question 35

Statins

Answer 35

Inhibit intracellular cholesterol biosynthesis via competitive inhibition of HMG-CoA reductase. Leads to enhanced hepatic LDL receptor recycling and increased LDL clearance from circulation.