April 7

Question 1

Increased NE release form peripheral autonomic nerve endings will affect what?

Answer 1

Sympathetic NS–Cardiac and smooth muscle, gland cells, nerve terminals

Sympathetic NS also has ACh release on M3 sweat glands, D release on D1 renal vasculature smooth muscle and ACh release onto the adrenal medulla causing NE and EPI release

Question 2

What 2 watershed areas are most susceptible to nonocclusive ischemia occurring in the colon?

Answer 2

Splenic flexure–Border btw SMA and IMA supply

Rectosigmoid junction–Border btw sigmoid artery and superior rectal artery

Question 3

Pt with recurrent bacterial and enteroviral infections that occurs after 6 months of age with + antigen response is caused by what?

Answer 3

X-linked (Bruton) agammaglobulinemia–defect in BTK, tyrosine kinase gene–no B-cell maturation

Absent B cells in peripheral blood, decreased Ig of all classes with absent/scanty lymph nodes and tonsils —lacking germinal centers because no B-cells

Question 4

What component of the LPS of gram - bacteria contribute to gram - sepsis and endotoxic septic shock?

Answer 4

Lipid A –activates macrophages and granulocytes –widespread release of IL-1 and TNF-a

Also has O antigen and core polysaccharide

Question 5

What are the 3 TNF-a inhibitors and what disease should be check for prior to their use?

Answer 5

Etanercept–fuse protein–TNF decoy receptor

Infliximab and adlimumab– Anti-TNF-a monoclonal antibody

Always check for TB prior to use

Question 6

What is the role of leptin?

Answer 6

Decreases the production of neuropeptide Y –potent appetite stimulant located in the arcuate nucleus of the hypothalamus

Also stimulates the production of POMC in the arcuate nucleus –a-MSH is produced by cleavage of POMC and inhibits food intake

Therefore, block the action of leptin and you will increase food intake as well as leptin release causing obesity and if you have problem with leptin release there will also be obesity but with low leptin levels

Question 7

Osteocytes are connected by…

Answer 7

Gap junctions–they sense mechanical stress and send signals to modulate activity of the surface osteoblasts
–helps to regulate bone remodeling

Question 8

What drug used to treat insomnia and at high does can be an antidepressant can, on rare occasions, cause priapism?

Answer 8

Trazodone–primarily blocks 5-HT2, a1-adrenergic and H1 receptors

Question 9

When does a Ghon complex occur with TB?

Answer 9

Initial infection

–lower lobe lung lesion and ipsilateral hilar adenopathy

Question 10

What pharmacotherapy is 1st line for PTSD?

Answer 10

SSRIs and venlafaxine (SNRI)

Trauma focused CBT can be used

Question 11

Aortic regurgitation leads to what cardiac pathology allowing for CO to be maintained?

Answer 11

Eccentric hypertrophy–increases compliance of the LV increasing SV and maintaining CO

Question 12

Ancanthosis nigricans is associated with what?

Answer 12

Hyperpigmented velvety plaques in axilla and neck

Associated with gastric adenocarcinoma and other visceral malignancies

However–more commonly associated with obesity and insulin resistance

Question 13

What hormone increases the most after ovulation?

Answer 13

Progesterone –corpus luteum secretes progesterone which thickens the endometrium and prepares it to receive and nourish a blastocyst

Question 14

What are the major side effects of theophylline toxicity?

Answer 14

Seizures and tachyarrhythmias

MOA–causes bronchodilation by inhibiting phosphodiesterase–increasing cAMP levels due to decreased cAMP hydrolysis

Question 15

What cells are important for prevention of superficial candida infection and what cells are important for hematogenous spread of candida?

Answer 15

T-lymphocytes–Th cells are important for prevention of topical –seen with HIV pts

Neutrophils–important to prevent hematogenous spread–seen with pt who are immunocompromised/neutropenic—getting chemo and pts with inherited impairments of phagocytosis

Question 16

What ratio is used to measure lung maturity of a fetus?

Answer 16

Lecithin/sphingomyelin ratio

Lecithin also known as phosphatidylcholine

The ratio is relatively the same until about 35 weeks when lecithin increases when the type II pneumocytes begin to secrete surfactant
–Lecithin increases dramatically and sphingomyelin stays the same–indicating lung maturity

Question 17

What supplies blood to the proximal ureter and the distal ureter is supplied by what artery?

Answer 17

Proximal—Branch from the Renal artery

Distal–Vesical artery –a branch off the internal iliac

Question 18

What is the name of the benign vascular tumor found in childhood that are found within the 1st week of life, grow rapidly and regress btw the ages of 5-8?

Answer 18

Strawberry (capillary) hemangioma –composed of capillaries separated by connective tissue

Question 19

What are the characteristic histological findings seen with Reye syndrome?

Answer 19

microvesicular steatosis of hepatocytes without inflammation

Question 20

What cells within the lungs have the ability to proliferate during lung damage?

Answer 20

Type II pneumocytes

–act as a progenitor cell for type I pneumocytes

Question 21

How does Riboflavin (it B2) deficiency present and what important function does it have?

Answer 21

Cheilosis–inflammation of lips, scaling and fissures at the corners of the mouth
Corneal vascularization

Component of flavins FAD and FMN–used as cofactors in redox reactions
–The succinate dehydrogenase section in the TCA cycle–Succinate–> Fumarate

Question 22

What are the 2 most important factors for osteoclastic differentiation?

Answer 22

Macrophage colony stimulating factor M-CSF
Receptor for activated nuclear Kappa-B ligand–RANKL

Produced by osteoblasts and bone marrow stream cells

• -OPG is a decoy receptor that decreases binding of RANK-L to RANK and decreases the differentiation and survival of osteoclasts
• -results in decreased bone turnover and increased bone density

Question 23

What is Ankylosing spondylitis and what HLA does it have a strong association with?

Answer 23

Seronegative spondyloarthritis–symmetric involvement of spine and sacroiliac joints–ankylosis (joint fusion), uveitis, aortic regurgitation
–Bamboo spine on XRAY

Associated with HLA-B27–MHC class I serotype

Question 24

Synchronization of skeletal muscle contractions with glycogen degradation is due to what?

Answer 24

Release of Ca from the SR following neuromuscular stimulation
–increased intracellular calcium causes activation of phosphorylase kinase–stimulating glycogen phosphorylase to increase glycogenolysis

Question 25

What deficiency presents with recurrent bacterial skin and mucosal infections, absent of pus (purulence) formation, impaired wound healing, delayed separation of umbilical cord and what is defective with this disease?

Answer 25

Leukocyte adhesion deficiency–defect in LFA-1 integrin (CD18) protein on phagocytes
–impaired migration and chemotaxis

Increased neutrophils–persistent leukocytosis seen with absence of neutrophils at infection sites

Most commonly seen bugs–S. aureus and gram - bacilli

Question 26

What are the complications seen with succinylcholine?

Answer 26

Hypercalcemia
Hyperkalemia–especially in pts with burns/myopathies/crush injuries/denervation
Malignant hyperthermia

Question 27

What two chemo agents inhibit thymidylate formation and which one can be overcome by N5-formyl-tetrahydrofolate (folinic acid/Leucovorin)

Answer 27

5-FU–myelosuppression will worsen with admin of leucovorin because it will cause tighter bond

Methotrexate–which can be overcome

Question 28

What increases in the venous blood with aerobic exercise?

Answer 28

CO2 content due to the increased skeletal muscle CO2 production

Question 29

Prostate cancer spreads to the spine via?

Answer 29

Vertebral venous plexus which communicates with the prostate by prostatic venous plexus

Question 30

What type of growth medium is used that favors growth of particular organism while preventing growth of other organisms–used for growth of Neisseria?

Answer 30

Selective media

Thayer-Martin agar–contains antibiotics that allow the selective growth of Neisseria by inhibiting the growth of other sensitive organisms

Question 31

What is the marker for HCC?

Answer 31

aFP

Question 32

Acute nausea after the administration of chemo is caused by stimulation of what within the brain?

Answer 32

Chemoreceptor trigger zone (CTZ)–lies in the area postrema of the dorsal medulla near the 4th ventricle

Question 33

What amino acid is a precursor of serotonin?

Answer 33

Tryptophan

Question 34

What is used for the tx of serotonin syndrome?

Answer 34

Cyproheptadine–5-HT2 receptor antagonist

Question 35

What do metalloproteinases do?

Answer 35

Released from macrophages to cause tissue remodeling by degrading collagen

Question 36

How does HepB cause destruction of hepatocytes?

Answer 36

Presence of viral HBsAg and HBcAg on the cell surface stimulate host cytotoxic CD8+ T cells to destroy the infected hepatocytes

Question 37

What is the cause of Alkaptonuria?

Answer 37

Congenital deficiency of homogentisate oxidase in the degradative pathway of tyrosine to fumarate

Question 38

What is the most notable side effect seen with Ethambutol used for the tx of TB?

Answer 38

Optic neuropathy–red-green color blindness

Question 39

Where is the highest osmolarity within the nephron?

Answer 39

Bottom of the loop of henle

Question 40

What is seen on histology of subacute granulomatous thyroiditis (de Quervain)?

Answer 40

Granulomatous inflammation–lymphocytic infiltrates with macrophages and multinucleate giant cells

Question 41

Myelination of an axon ________ the length constant and _______ the time constant.

Answer 41

Increases–how far AP can travel

Decreases

Question 42

Damage to the VPL and VPM nuclei will cause loss of what?

Answer 42

Complete sensory loss to the contralateral limbs (spinolthalamic tract and dorsal column) and face (Trigem)

Question 43

Postive Trendelenburg sign is indicative of damage to what nerve innervating what muscles?

Answer 43

Superior gluteal–innervates gluteus medius/minimus and tensor fasciae latae

+ trendelenburg = stand on affected leg and the opposite leg sags

Question 44

What two drugs are used for opioid withdrawal and tx of addiction?

Answer 44

Methadone–full mu agonist with high bioavailability

Buprenorphine–partial mu agonist–less likely to cause respiratory depression and mortality in overdose

Question 45

What cells are involved in the pathogenesis of centriacinar emphysema?

Answer 45

Neutrophils and macrophages that release proteases–elastases, cathepsins, matrix metalloproteases
–degrade extracellular matrix and generate free radicals that impair the function of protease inhibitors–a1-anthytrpsin

Question 46

What are the symptoms seen with VIPoma?

Answer 46

Pancreatic tumor that secretes VIP

-Watery Diarrhea, Hypokalemia, and Achlorhydria (WDHA)

Question 47

What 3 substances/meds works through activation of cGMP?

Answer 47

ANP/BNP, nitric oxide, and PDE-5 inhibitors

Question 48

What is the presentation of Gaucher disease and what is the cause?

Answer 48

Hepatosplenomegaly, pancytopenia, osteoporosis, aseptic necrosis of femur, bone crises, Gaucher cells–lipid-laden macrophages resembling crumpled tissue paper

Caused by Glucocerebrosidase (B-Glucosidase) deficiency