April 6

Question 1

What does carotid sinus massage lead to?

Answer 1

Increased afferent firing from the carotid sinus–increasing vagal parasympathetic tone
–slowing conduction through the AV node and prolonging AV nodal refractory period–help to terminate reentrant tachycardias

Question 2

What type of breathing is associated with advanced CHF?

Answer 2

Cheyne-Stokes breathing– cyclic breathing with period of apnea followed by gradual increase in TV until next apnea episode

Question 3

What is the MOA of trastuzumab?

Answer 3

Monoclonal antibody against HER-2 (c-erbB2)–a tyrosine kinase receptor

Question 4

What 2 substances are responsible for taking naive CD4+ T-cells and differentiating them to Th1 cells?

Answer 4

IL-12

IFN-g

Question 5

What substance is responsible for taking naive CD4+ T-cells and differentiating them to Th2 cells?

Answer 5

IL-4

Question 6

What is the hormone that binds an intracellular receptor to maintain normal glucose levels during prolonged fasting?

Answer 6

Cortisol

Question 7

What two antibodies can be present in pts with RA and which one is more specific?

Answer 7

Rheumatoid factor–autoantibodies targeting the Fc portion of human IgG

Anti-cyclic citrulinated peptide antibody–more specific

Question 8

What are hamartomas and where are they most likely to occur?

Answer 8

Excessive growth of tissue type native to the organ of involvement

Most likely to occur in the lungs as well-defined coin lesion with popcorn calcifications
–composed of disorganized cartilage,fibrous and adipose tissue

Question 9

What is the difference btw Schizophrenia and schizophreniform disorder?

Answer 9

Schizophreniform disorder has all the same characteristics as Schizophrenia but has only lasted 1-6 months

Question 10

UV light is involved in the conversion of what to ultimately produce Vit D?

Answer 10

7-dehydrocholesterol —> Vit D3 (cholecalciferol)

1st step in synthesis

Question 11

Infants with hydrocephalus typically develop what?

Answer 11

Macrocephaly
Poor feeding
Muscle hypertonicity
Hyperreflexia

Last 2 are caused by UMN lesion caused by stretching of the periventricular pyramidal tracts

Question 12

What step of the citric acid cycle produces GTP?

Answer 12

Succinyl-CoA—-> Succinate by succinyl-CoA synthetase

Question 13

Pt who is left dominant–what artery is going to feed the AV node?

Answer 13

Circumflex artery—feeding the posterior descending artery

Right dominant pt–MOST COMMON–supplied by RCA

Question 14

What is typically indicative of irreversible cell injury?

Answer 14

Mitochondrial vacuolization

Question 15

What type of collagen is deposited within the myocardium 2 wks into the healing process after MI–the final stages of healing from MI?

Answer 15

Type I collagen

Most abundant collagen in the body and primary collagen of mature scar

Question 16

What fetal vessel has the highest O2 content?

Answer 16

Blood enters the fetus through the umbilical vein via the ductus venous into the IVC–highest O2

Question 17

Pregnant women >20 wks can experience hypotension and syncope–this is caused by what?

Answer 17

When in the supine position the gravid uterus can compress the IVC causing decreased venous return and decreased CO

Question 18

Imprinting involves imprinted/inactivation by ________.

Answer 18

Methylation

Question 19

Horizontal transection of the rectus abdominis can result in injury to what structure?

Answer 19

Inferior epigastric artery –enters this muscle at the level of the arcuate line

Question 20

What drug class can exacerbate hypoglycemia and can mask the adrenergic symptoms mediated by NE an EPI?

Answer 20

Non-selective B-blockers

Question 21

What antipsychotic is the only one that has shown superior efficacy to treatment resistant schizophrenia?

Answer 21

Clozapine

Question 22

What are the products of proinsulin and what happens to each?

Answer 22

Insulin and C-peptide

They are both packaged into secretory granules at the golgi and secreted together when appropriate

Question 23

Positive skew =

Answer 23

Mode median mean to the right

Negative skew= mode median mean to the left

Question 24

What is the S3 heart sound associated with?

Answer 24

Occurs in early diastole during rapid ventricular filling phase–increased LVESV seen with mitral regurgitation or HF

Question 25

What is Jervell and Lange-Nielsen syndrome?

Answer 25

Autosomal recessive congenital long QT syndrome that involves sensorineural deafness

Romano-Ward syndrome–is AD–pure cardiac phenotype (no deafness)

Question 26

What is seen with potter sequence (syndrome)?

Answer 26

POTTER

• Pulmonary hypoplasia
• Oligohydramnios–trigger
• Twisted face
• Twisted skin
• Extremity defects
• Renal failure (in utero)

Low set ears and flattened nose

Causes:
-ARPKD, obstructive uropathy, bilateral renal agenesis, chronic placental insufficiency

Question 27

What do fibrates inhibit that cause a reduction in bile acid synthesis and favors the formation of cholesterol gallstones?

Answer 27

Cholesterol-7a-hydroxylase

–normally catalyzes the rate-limiting step in bile acid synthesis

Question 28

Glucose-6-phosphate dehydrogenase is the rate-limiting enzyme in the _____________a major source of ______ and when deficient reduction of ______ and biosynthesis of ______, ______, ______ can not occur.

Answer 28

Pentose phosphate pathway
NADPH

Glutathione
Cholesterol
Fatty acids
Steroids

Question 29

Cephalic and gastric phase of digestion ______ gastric acid secretion and intestinal phase _____ gastric acid secretion.

Answer 29

Stimulates
Reduces

Cephalic–triggered by smell, thought, taste of food
Gastric–mediated by presence of gastrin –triggered by food entering the stomach
Intestinal–triggered when protein containing food enters the duodenum

Question 30

What is the most common complication that occurs after a VZV infection?

Answer 30

Postherpetic neuralgia–persistant local pain that can be present months after shingles rash occurs

Question 31

Where are H1 histones located and what is there function?

Answer 31

Located outside of the histone core and help to package nucleosomes into more compact structures by binding and linking the DNA btw adjacent nucleosomes

Question 32

Vit D supplementation is recommended babies with what 3 risk factors?

Answer 32

Breastfed
Lack of sunlight exposure
Dark pigmentation

Iron–recommended for preterm/low birthweight

Question 33

Where is the putamen located?

Answer 33

Medial to the lnsula and lateral to the globus pallidus on coronal section

Question 34

Atropine reverses the muscarinic effects seen with organophosphate poisoning, but what muscle be given in order to reverse the nicotinic effects such as muscle paralysis?

Answer 34

Pralidoxime

Question 35

Gross hematuria in otherwise healthy patient with family hx of sickle cell suggests?

Answer 35

Renal papillary necrosis

Acute flank pain and passage of tissue fragments in the urine

SAAD papa with papillary necrosis

• Sickle cell disease or trait
• Acute pyelonephritis
• Analgesics
• DM

Question 36

What lung cancer occurs most commonly in women who are non-smokers?

Answer 36

Adenocarcinoma –located at the periphery and consists of tumor cells of glandular or papillary structures

Squamous cell carcinoma and small cell carcinoma have strong association with smoking

Question 37

What is the major virulence factor for S. pyogenes and what is its function?

Answer 37

Protein M–inhibits phagocytosis and the activation of complement