5/9 Mixed

Question 1

Acute rejection of endomyocardial biopsy (cardiac transplant rejection)

Answer 1

Dense infiltrate of mononuclear cells, usually composed primarily of T lymphocytes

Primarily cell-mediated

Question 2

Autosomal recessive inheritance (if both parents are carriers)

Answer 2

25% chance of inheriting 2 normal alleles (AA)
50% chance of inheriting one normal and one mutant allele (Aa or aA)
25% chance of inheriting 2 mutant alleles
75% chance of inheriting one or more mutant alleles

Question 3

Treatment of Bulimia nervosa

Answer 3

SSRI (fluoxetine)
Nutritional rehab
Cognitive-behavioral therapy

Question 4

Bacteroides

Answer 4

Gram negative anaeroic rods
Produce B lactamase
Rx: piperacillin-tazobactam

Question 5

Class III antiarrhythmic drugs (amiodarone, sotalol, dofetilide)

Answer 5

Block K channels, inhibit the outward K currents during phase 3 of cardiac action potential, prolonging repolarization and total action potential duration

Question 6

Location of the AV node

Answer 6

Endocardial surface of the right atrium, near the insertion of the septal leaflet of the tricuspid valve and the orifice of the coronary sinus

Radiofrequency ablation of AV node

Question 7

Parvovirus B19 infection

Answer 7

Nonspecific viral syndrome
erythema infectiosum (fifth disease) in children
Acute arthropathy in adults

Question 8

Precipiating factors to hepatic encephalopathy

Answer 8

Drugs (sedatives, narcotics)
Hypovolemia (diarrhea, vomiting)
Excessive nitrogen load (GI bleeding, constipation)
Metabolic disturbances (hypokalemia, metabolic alkalosis, hypoglycemia)
Infections (pneumonia, urinary tract infection, spontaneous bacterial peritonitis)
Portosystemic shunting

Question 9

Rx hepatic encephalopathy

Answer 9

Lower blood ammonia levels
Oral administration of disaccharide (lactulose)
Converts absorbable ammonia into nonabsorbable ammonium ions, trapping ammonia in the stool and increasing nitrogen excretion

Question 10

Fourth heart sound (S4)

Answer 10

Atrial gallop sound (before S1)

Heard immediately after atrial contraction phase as blood is forced into a stiff ventricle

Question 11

Dermatomyositis as a paraneoplastic syndrome

Answer 11

(can occur alone or as pn syndrom)

Most commonly associated cancers include ovarian, lung, colorectal, non-Hodgkin lymphoma

Question 12

Final common pathway for HCL section

Answer 12

H/K ATPase proton pump on parietal cells
Stimulated by Ach, histamine, gastrin
Proton pump inhibitors= lansoprazole, omeprazole

Question 13

Bacterial vaginosis

Answer 13

Grayish-white vaginal discharge with "fishy" odor
Overgrowth of gardnerella vaginalis, an anaerobic gram-variable rod 
Clue cells (squamous epithelial cells covered with bacterial organisms) seen on wet mount microscopy or cytology

Question 14

Beta-endorphin

Answer 14

Endogenous opioid peptide that is derived from proopiomelanocortin (POMC)
POMC= polypeptide percursor that goes through enzymatic cleavage and modification to produce beta-endorphins, ACTH, MSH

Question 15

Primary anti-ischemic effect of nitrates

Answer 15

Systemic vasodilation with a decrease in left ventricular end-diastolic volume/wall stress, results in decreased myocardial oxygen demand

Question 16

Drug induced lupus erythematosus

Answer 16

Abrupt onset: fever, fatigue, arthralgia, arthritis, rash, serositis
Predilection for slow acetylators
Anti-histone antibodies
Implicated drugs: procainamide, hydralazine, isoniazid, minocycline, TNF-a inhibitors (etanercept)

Question 17

MI scar

Answer 17

Type I collagen

Also seen in: dermis, bone, tendons, ligmanets, dentin, cornea, blood vessels, scar tissue

Question 18

Leukotriene B4

Answer 18

Stimulates chemotaxis of neutrophils to sites of inflammation

Other important chemotactic agents include 5-HETE (leukotriene precursor), complement component C5a, and IL-8

Question 19

Osteocytes remain connected to each other by

Answer 19

Gap junctions

Question 20

Trendelenburg gait

Answer 20

Hip drops down as the ipsilateral foot is lifted off the ground
Observed when there is injury to the contralateral superior gluteal nerve
Injections to the superomedial quadrant of the buttock have a high probability of injuring the superior gluteal nerve

Question 21

Obstructive sleep apnea

Answer 21

Due to neuromuscular weakness of the oropharnyx

Rx: Electrical stimulation of the hypoglossal nerve increases the diameter of the oropharyngeal airway and decreases the frequency of apneic events

Question 22

Epistaxis

Answer 22

Commonly caused by irritation of the highly vascular mucosa at the anterior nasal septum

Anterior nasal septum contains the Kiesselbach plexus

The anterior ethmoidal, sphenopalatine, and superior labial arteries anastomose in this region

Question 23

Dubin-Johnson Syndrome

Answer 23

Benign AR disorder characterized by defective hepatic excretion of bilirubin glucuronides due to a mutation in the canalicular membrane transport protein

Episodes of jaundice, otherwise asymtomatic

Grossly, the liver appears black due to impaired excretion of EPI metabolites, which histologically appear as dense pigments within lysosomes

Question 24

Selective proteinuria

Answer 24

Albumin loss with minimal loss of more bulky proteins (such as IgG and macroglobulin)

Question 25

Crossover study

Answer 25

Subjects are randomly allocated to a sequence of 2 or more treatments given consecutively. A washout (no treatment) period is often added between treatment intervals to limit the confounding effects of prior treatment.

Question 26

Highest osmolarity in the nephron

Answer 26

At the bottom of the loop of Henle

Question 27

Postpartum Ovarian Vein Thrombosis

Answer 27

Persistent fever after delivery, localized abdominal/flank pain, no response to ABX

Left ovarian vein drains into the left renal vein and the right ovarian vein drains directly into the IVC

Most thrombosis is right sided

Question 28

Neural tube defects

Answer 28

Failure of fusion of neural tube during 4th week of fetal development
Occurs in the region of the neuropores
If neuropore does not fuse, opening exists between the neural tube and the ambiotic cavitiy
AFP, achetylcholinesterase appear in the amniotic fluid (due to CSF leakage)= prenatal dx of NTDs

Question 29

Hepatic abscess

Answer 29

Undeveloped countries: Entamoeba hisolytica
Developed countries: bacterial infection (ex. Staph aureus via hematogenous seeding of the liver)

Enteric bacteria (E. coli, Klebsiella, enterococci) can cause hepatic abscesses by ascending the biliary tract (ascending cholangitis), portal vein pyemia, or direct invasion from an adjacent area (cholecystitis).

Question 30

Giant Cell Arteritis

Answer 30

Cell-mediated immunity is primary mechanism
Production of cytokines, in particular Interleukin-6 is an important driver of this process and closely correlates with severity of symptoms

Rx: Monoclonal Ab against IL-6 (tocilizumab)

Question 31

B-blockers lower BP via 2 mechanisms:

Answer 31

Reducing myocardial contractility and heart rate

Decreasing renin release by the kidney

Question 32

Trimethoprim (in bacteria)
Methotrexate (in human cells)
Pyrimethamine (in some protozoa)

Answer 32

All prevent the reduction of folic acid to tetrahydrofolate (THF) by inhibiting dihydrofolate reductase (DHFR)

Question 33

Clostridium tetani

Answer 33

Prevents release of inhibitory neurotransmitters glycine and gamma-aminobutyric acid (GABA)

Question 34

Rx for cerebral vascular spasm following SAH

Answer 34

Calcium channel blockers, specifically Nimodipine

Question 35

What should be assessed prior to initiation of metformin therapy?

Answer 35

Renal function by serum creatinine measurement

Increased risk of lactic acidosis

Question 36

Nitrate Administration

Answer 36

Must provide nitrate-free interval every day in pts using long acting nitrates to avoid the development of tolerance