April 9

Question 1

What is release from steroli cells that allow for male differentiation?

Answer 1

MIF–Mullerian inhibiting factor–causes mullerian duct to involute–stopping formation of female internal genitals

• -Defective steroli cells in male fetus will result in male and female internal genitalia
• –Leydig cells secrete testosterone which allows wolffian ducts to develop into male internal genitalia

Question 2

Midshaft fracture of the humerous can result in damage to what nerve and what artery?

Answer 2

Radial nerve–C5-T1–wrist drop

Deep brachial artery

Question 3

What heart defect is associated with head bobbing?

Answer 3

Aortic regurgitation

Wide pulse pressure results in bounding femoral and carotid pulses with abrupt collapse

Question 4

What is Bosentan used for and with is its MOA?

Answer 4

Used for Pulmonary HTN

–Competitively antagonizes Endothelin-1 receptors–decreasing pulmonary vascular resistance

Question 5

a-Amanitin, found in Amanita phalloides–mushroom inhibits what?

Answer 5

RNA polymerase II–which makes mRNA

–Causes severe hepatotoxicity

Question 6

A humoral response with antibodies directed against _______ is the most important source of protection against influenza.

Answer 6

Hemagglutinin

Question 7

Dopamine is dose dependent, having different effects with increased dosing, what are these effects?

Answer 7

Low doses–Stimulate D1 on renal and mesenteric vasculature –resulting in vasodilation and increased blood flow to these areas

Higher dose–stimulates B1-adrengeric receptors in the heart and increase contractility

Even higher dose–stimulates a1-adrengeric causing vasoconstriction

Question 8

What disease presents with dermatitis (necrolytic migratory erythema), diabetes, DVT, declining weight, depression and normocytic normochromic anemia?

NME–elevated, painful and pruritic rash typically affecting the face, groin, and extremities–crusting and scaling with bronze-colored indurations

Answer 8

Glucagonoma–tumor of pancreatic a-cells causing overproduction of glucagon

Tx: octreotide, surgery

Question 9

What is the MOA of opioid analgesics, such as morphine, fentanyl, codeine, loperamide, methadone?

Answer 9

Act as agonists at opioid receptors to modulate synaptic transmission

• Open K+ channels, close Ca2+ channels–> Decreases synaptic transmission
• -Inhibition of release of ACh, NE, 5-HT, glutamate, substance P

Question 10

Fructose intolerance is a hereditary deficiency of aldolase B causing fructose-1-phosphate accumulation–causing inhibition of glycogenolysis and gluconeogenesis –sym: hypoglycemia, jaundice, cirrhosis and vomiting. What should be avoided in the diet of these pts?

Answer 10

Fructose and sucrose (glucose + fructose) intake

Question 11

What lymphoid neoplasm is seen mostly in adult males and causes marrow fibrosis resulting in a “dry tap” on aspiration of the bone marrow?

Answer 11

Hairy cell leukemia–Mature B-cell tumor

Pts usually present with massive splenomegaly

Question 12

What part of the bronchial tree has the most amount of resistance and which has the least?

Answer 12

Most–med sized bronchi

Least–terminal bronchioles–due to large # in parallel

Question 13

Anterior nose bleeds are most likely caused by damage to what structure located where?

Answer 13

Kiesselbach plexus–located in anterior segment of the nasal septum

Question 14

What is the most common cause of meningitis in adults?

Answer 14

Strep pneumoniae

Question 15

What adverse effects are seen with the 1st generation antihistamines?

Answer 15

Sedation
Antimuscarinic–blockage of ACh
anti-a-adrenergic —hypotension and postural dizziness

Question 16

What is the cause of Osteogenesis imperfecta?

Answer 16

Caused by a variety of gene defects–most commonly COL1A1 and COL1A2—decreased production of otherwise normal type I collagen–leads to impairment of bone matrix formation

Question 17

What ligament is torn with radial head subluxation–nursemaids elbow?

Answer 17

Annular ligament tear from its periosteal attachment at radial neck

Seen in children due to sudden pulling of arm

Question 18

Propranolol is given with hyperthyroidism, what 2 functions does it have?

Answer 18

Reduce HR and anxiety/agitation

Also inhibits iodothyronine deiodinase–reducing the peripheral conversion of T4–> T3
–reduces thyroid hormone action on peripheral tissue

Question 19

What is the surface marker for macrophages?

Answer 19

CD14

Question 20

Phosphoribosyl Pyrophosphate synthetase enzyme (PRPP) excess can cause gout, what is the mechanism?

Answer 20

PRPP–responsible for purine synthesis pathway–> more purine synthesis=more purine degradation–> hyperuricemia–> gout

Question 21

Which aortic arch derivative makes up the proximal part of the pulmonary arteries and ductus arteriosus?

Answer 21

6th arch

4th– Left Aortic arch and proximal part of right subclavian
3rd–Common carotid and proximal part of internal carotid artery
2nd–Stapedial artery and hyoid artery
1st–Part of maxillary artery –branch of external carotid

Question 22

What is produced by S. sanguinis allowing it to cause endocarditis?

Answer 22

Dextrans–bind to fibrin-platelet aggregates on damaged heart valves

Question 23

What is the cause of Hartnup disease?

Answer 23

Autosomal recessive deficiency of neutral amino acid (tryptophan) transporters in proximal renal tubular cells and on enterocytes
–results in neutral aminoaciduria and decreased absorption from the gut–decreased tryptophan for conversion to niacin–> pellagra-like symptoms

Question 24

What meds should be avoided in the elderly for treatment of insomnia?

Answer 24

Benzodiazepines
Antihistamines
Sedating antidepressants

Use–Ramelteon–Melatonin agonist–few side effects

Question 25

Where does parvo B19 replicate?

Answer 25

In the erythrocyte precursors of the bone marrow

Question 26

What occurs in respiratory and gastric glands in CF pts compared to sweat glands?

Answer 26

Respiratory and gastric–Impaired CFTR results in reduced lumen secretion of Cl- and increased luminal absorption of Na+ and H2O

Sweat glands–CFTR mutation results in production of hypertonic sweat with high chloride content

Question 27

Pt has elevated Alkaline phosphatase, what enzyme can be used to differentiate liver vs bone origin?

Answer 27

gamma-glutamyl transpeptidase –found in various liver and biliary disease but NOT in bone disease

–associated with ETOH use

Question 28

Disorder of increased HCT that may present with intense itching after hot shower and is associated with V617F JAK2 mutation?

Answer 28

Polycythemia vera

–Increased RBCs, WBCs, Platelets