5

Question 1

Improved survival (decompensated systolic heart failure)

Answer 1

ACE Inhibitors, ARBs, aldosterone antagonists (spironolactone, eplerenone) and Beta blockers (carvedilol, metoprolol)

Question 2

Beta blockade in decompensated HF helps by:

Note used in stable HF

Answer 2

1) decreasing afterload (decreases circulating levels of vasoactive hormones (NE, renin, endothelin).
2) slow ventricular rate (decrease cardiac work)

Question 3

Mayer-Rokintansky-Kuster-Hauser (MRKH) syndrome (aka Mullerian aplasia or vaginal agenesis)

Answer 3

Variable uterine development and no upper vagina (short vagina)

Question 4

Short vagina, normal ovaries secreting estrogen–>regular secondary sexual characteristics, hypoplastic or absent uterus = primary amenorrhea (can’t menstruate)

Answer 4

Mullerian aplasia

Question 5

All females with Mullerian defects should undergo what?

Answer 5

Renal ultrasound (50% will have coexisting urologic anomaly)
Ex: unilateral renal agenesis

Question 6

Kallman syndrome occurs due to?

Answer 6

decreased synthesis of GnRH in the hypothalamus (hypogonadotropic hypogonadism)

Question 7

47 XXX

Answer 7

• Tall
• Decreased IQ (minor)
• Physically normal including sex development

Question 8

Huntingtons Disease

Answer 8

loss of neurons in the caudate and putamen

Question 9

Damage to the nucleus ambiguous of the medulla

Answer 9

produces myoclonus

Question 10

Lesions of subthalamic nucleus or lacunar infarcts in that area lead to

Answer 10

hemiballism (flinging movements of contralateral extremities)

Question 11

FGF gene (apical ectodermal ridge)

Answer 11

lengthen limbs

Question 12

sonic hedgehog

Answer 12

holoprosencephaly

Question 13

Encode DNA-binding transcription factors that play an important role in the segmental organization of the embryo along the cranio-caudal axis

Answer 13

Homeobox- HOX genes

Question 14

Homebox-Hox gene disruptions

Answer 14

skeletal abnormalities and improper positioned limbs and appendages

Question 15

Colchicine decreases NEUTROPHIL migration and phagocytosis by interfering with ______

Answer 15

microtubule formation.

Colchicine also decreases tyrosine phosphorylation–> decreased neutrophil activation

Question 16

Irreversible gynecomastia and testicular atrophy due to increased __________ levels due to anabolic steroid abuse

Answer 16

androstenedione

Question 17

Testicular germ cells tumors (firm rapidly growing testicular mass) can cause ________ do to excessive B-hCG

Answer 17

gynecomastia

Question 18

Uremia and High creatine in Chronic renal insufficiency. High uremia is toxic to

Answer 18

your balls

Question 19

Haloperidol induced gynecomastia =

Answer 19

increased prolactin

Question 20

Alcoholic liver cirrhosis gynecomastia=

Answer 20

Impaired hepatic degradation of estrogen and ethanols direct inhibition of testosterone production

Question 21

Originates on the anterior aspect of the sacrum and occupies most of the space in the greater sciatic foramen. Inserts on greater trochanter of the femur

Answer 21

Piriformis (sciatic nerve runs below)

Question 22

Piriformis action

Answer 22

• Externally rotate the thigh when extended

- abduct the thigh when flexed

Question 23

Piriformis syndrome

Answer 23

Pain tingling and numbness in the buttocks and along the nerve distribution due to hypertrophy or muscle injury compressing the sciatic nerve in the foramen

Question 24

Smallest of 3 gluteal muscles; works with gluteus medius to stabalize the hip and abduct the thigh when the limb is extended

Answer 24

gluteus minimus

Question 25

Passes through the greater sciatic foramen and is involved in external hip rotation

Answer 25

piriformis muscle

Question 26

Patient with FH of sudden death, recurrent syncope, and ion channel defect

Answer 26

congenital long QT

Question 27

LQT 1 and LQT 2 are due to

Answer 27

mutations in K+ channel that contribute to the outward-rectifying potassium current

Question 28

Recurrent palpitations, syncope, seizures, or sudden cardiac death

Answer 28

Torsades de pointes

Question 29

Two most common mutations in in hypertrophic cardiomyopathy (AD)

Answer 29

1) myosin-binding protein C gene | 2) cardiac beta-myosin heavy chain gene

Question 30

Secondary Infection with a different viral serotype can cause a more sever illness, possibly due to antibody-dependent enhancement of the infection, enhanced immune complex formation, and/or accelerated T-lymphocyte response

Answer 30

DHF (Dengue hemorrhagic fever) | -increased capillary permeability

Question 31

Lesion on lateral foot

Answer 31

LAD in both popliteal and inguinal

Question 32

Lesion on medial foot

Answer 32

LAD in inguinal

Question 33

Receive lymph drainage from: - Lower extremity - scrotum (not testes) - perineum - Anterior ab wall (inferior to umbilicus) - butt - skin of penis (except glans)

Answer 33

superficial inguinal lymph node

Question 34

Non-motile, unencapsulated, gram-positive rods. Found in clumps (chinese characters) or joined in V or Y shape chains. Cytoplasm contains metachromic granules that stain with aniline dyes (meth blue)

Answer 34

Corynebacterium diphtheriae (classic 2-subunit AB exotoxin)

Question 35

Most common cause of calcium kidney stones

Answer 35

Idiopathic hypercalciuria

Question 36

Toxin used in torticollus and cosmetic hoes

Answer 36

Clostridium botulinum toxin B (inhibits presynaptic release of Ach)

Question 37

Selective vasodilators used to cause coronary steal in people too fat to exercise stress test

Answer 37

Adenosine and dipyridamole

Question 38

coincides with atrial contraction and is produced by the resultant onrush of blood striking a stiff left ventricle

Answer 38

S4 (low frequency)

Question 39

S4 is associated with

Answer 39

Restrictive cardiomyopathy and left ventricular hypertrophy

Question 40

Serotonin receptor blockade

Answer 40

appetite stimulation and weight gain

Question 41

surface marker for monocyte-macrophage cell linage

Answer 41

CD 14

Question 42

Multi-chain complex T-cell marker

Answer 42

CD 7

Question 43

How does NaHCO3 (sodium bicarb) reverse TCA overdose

Answer 43

1) increase serum pH--> favors neutral form of drug--> cant bind Na channels 2) Also increases extracellular sodium to help overcome competitive rapid (fast) sodium channel blockade induced by TCAs

Question 44

Neurophysin II point mutation --> abnormal folding at ER and removal from ER along with bound vasopressin=

Answer 44

Autosomal Dominant Hereditary Hypothalmic diabetes insipidus

Question 45

Hamartomatous polyps (disorganized mucosal glands, smooth muscle, connective tissue)

Answer 45

Peutz-Jeghers syndrome or juvenile polyposis | bleeding and intussusception

Question 46

Hyperplastic (well differentiated mucosal cells that form glands and crypts)

Answer 46

NOT DYSPLASTIC and usually asymptomatic

Question 47

Villous adenomas

Answer 47

can secrete large quantities watery mucus leading to secretory diarrhea, hypovolemia, and electrolyte abnormalities

Question 48

Stimulation of detrusor muscle contraction and internal urethral spincter relaxation

Answer 48

Parasympathetic (S2-S4)

Question 49

MS urge incontinence due to loss of CNS inhibition of detrusor contraction.

Answer 49

as disease progresses bladder can become atonic leading to overflow incontinence

Question 50

The presence of colloid containing microfollicles suggest a benign

Answer 50

follicular adenoma

Question 51

What does the hindgut give rise to?

Answer 51

Distal third of transverse colon, descending and sigmoid colon, rectum, and upper part of anal canal

Question 52

Cyclosporine extensively metabolized by liver and GI tract

Answer 52

CYP3A isoenzymes

Question 53

Furocoumarins (inhibit CYP)

Answer 53

found in grapefruit juice

Question 54

Collections of SQUAMOUS CELL debris that form a round pearly mass behind the tympanic membrane in the middle ear

Answer 54

Cholesteatomas (can be congenital or may occur as an acquired primary lesion or following infection, trauma, or surgery of the middle ear)

Question 55

Cholesteatomas can cause _______ via production of lytic enzymes that often erode through the auditory ossicles

Answer 55

Conductive hearing loss

Question 56

Envelope glycoprotein sequences also contain a hypervariable region prone to frequent genetic mutation

Answer 56

HEP C virus

Question 57

Does the QRS complex duration increase or decrease during exercise?

Answer 57

decrease slightly (do to faster cardiac conduction via increased HR)

Question 58

Use-dependence: sodium blocking effects intensify as heart rate increases due to less time between action potentials for medication to dissociate from the receptor

Answer 58

Class 1C (slowest class 1 agents to dissociate from sodium channel)

Question 59

Weird use of tamoxifen (selective estrogen receptor modulator)

Answer 59

prevent gynecomastia

Question 60

Increased estrogen to androgen ratio increase risk for gynecomastia. Histo?

Answer 60

Ductal epithelial hyperplasia surrounded by dense stromal fibrosis

Question 61

Crohns

Answer 61

Th1 (IL-2, INF-Y, TNF)