block 1

Question 1

common cutanous findings of crohns

Answer 1

erythema nodosum and pyoderma gangrenosum

Question 2

Gilberta

Answer 2

reduced bilirubin UDP glucoronosyltransferase activity and presents with muld unconjugated hyperbilirubinemia provoked by hemolysis, fasting, physical exertion, fever, stress or fatigue

Question 3

peutz-jaghers syndrome inheritance pattern?

Answer 3

autosomal dominant

Question 4

sympathetic innervation of the eye

Answer 4

1. the first order neuron descends from the hypothalamus to the cervical spinal cord where it synapses on a second order neuron in the lateral horn
2. the seoncd order neuron then exists the cord into the sympathetic trunk and ascends to enter the superior cervical ganglion where it synapses on the third order neuron.
3. the third order neuron ascends along the internal carotid artery and joins the branches of the opthalmic division of the trigeminal nerve V

Question 5

water deprivation test under normal circumstances (no DI)

Answer 5

The kidneys should produce a more concentrated urine in order to conserve water. If the urine is not concentrated but dilute this would eliminate psychogenic polydipsia. Possible a diagnosis now of DI (polydispsia, polyuria, urine specific gravity below 1.006)

Question 6

What kind of ectopic tissue can be found in a meckel diverticulum?

Answer 6

ileal mucosa, ectopic gastric, pancreatic, jejunal or colonic tissue

Question 7

Hypertrophic cardiomyopathy can lead to sudden cardiac death in young patients

Answer 7

• autosomal dominant
• mutations in the beta myosin heavy chain protein
• inappropriate hypertrophy of the LV
• coronary arteries not affected
• systolic crescendo-decresendo murmur heard between the apex and the left sternal border, radiating to the suprasternal notch due to LV outflow obstruction. It can be come louder with decreased preload and after load (standing for decreased preload)

Question 8

Prokaryotic DNA pol I

Answer 8

is responsible for the removal of the RNA primers and the synthesis of new DNA in their place

Question 9

Ovarian cancer 80% of woman have increased serum levels of gylcoprotein cancer antigen 125 (CA 125)

Answer 9

50% sensitivity in detecting stageI and 90% in stage II

Question 10

increased alphafetoprotein

Answer 10

• hcc

- non-seminomatous germ-cell tumors –> endodermal sinus (yolk sac) tumors

Question 11

CEA carcinoembryonic antigen

Answer 11

• solid tumors

- colorectal cancer, breast and pancreatic cancers

Question 12

CA 19-9

Answer 12

adenocarcinoma of the pancreas

Question 13

B-hCG levels are associated with pregnancy (multiple pregnancy, pregnancy with down syndrom fetus), hydatidiform mole, choriocarcinoma and some testicular cancers

Answer 13

b-hcg

Question 14

anti-rehection regimens include:

Answer 14

• calcineurin inhibitors: cyclosporine, tacrolimus, sirolimus
• gluticorticoid (prednisone)
• de novo purine synthesis inhibitors (T-lymphocyte proliferation inhibitors such as Azathiprine and mycophenolate mofetil

Question 15

cyclosporine

Answer 15

anti-rejection treatment for solid organs
-also used for severe psoriasis
causes a dose and duration dependent rise in serum BUN and creatinine levels – nephrotoxic

Question 16

Metoclopramide is a D2 anatagonist do not use in Parkinons disease patients!!

Answer 16

• used for diabetic and post surgery gastroparesis and an antiemetic
• it increases resting tone, contractility. it increased LES tone,motility. It does not influence colon transport time

Question 17

Gastroenterities

Answer 17

vomiting, fever, diffuse abdominal tenderness without rebound

treat vomiting or gastirc stasis: metoclopramide

Question 18

alkaptonuria, autosomal recessive

Answer 18

homogentisic acid accumulates within in the skin and cartilage throughout the body as dark deposits called ochronotic pigment. Deposition of ochronotic pigment in join cartilage results in a debilitating arthritis in the 3rd and 4th decade

Question 19

Tissue ischemia causes reduced functionality of membrane Na/KATPase

Answer 19

• K leakage from cells
• may reduct extracellular Ca, Na, HCO3
• cytoplasic Ca2+ accumulation is a hallmark of ischemic injury

Question 20

lipophillic molecules can cross the placenta

Answer 20

unconjucated bilurubin is lipophilic so it can cross, so is warfarin

but conjugated bilirubin is water soluble and so is heparin

Question 21

Who has a capsule neisseria meningitidis or gonorrhoeae?

Answer 21

meningitidis!!!

Question 22

n. gonorrhoease

Answer 22

• gram negative, kidney bean shaped diplococcus
• binds to host eiptithelial cells by means of their pili
• pili have phase variation and antigenic variation

Question 23

treat CMV retinitis with ganciclovir

Answer 23

inhibits DNA chain elongation both by incorporating into viral DNA and inhibiting viral DNA polymerase

Question 24

Genetic reassortment in influenza virus

Answer 24

• Hemagglutinin HA
• neuraminidase NA
• two distinct influenza virus invade one cell, like maybe one human and one animal. One Ha from one and NA from the other could get packed in the same virion. this can then lead to a new novel strain!!!
• note viral HA, NA are coded by separate RNA segments, inviting mispackaging

Question 25

phenotypic mixing

Answer 25

occurs when two viruses infect the same cell and progeny viruses exhibit coat or envelope proteins not coded for by the genetic material packaged within them

Question 26

Mcardles disease

MUSCLE glycogen phosphorylase deficienc

Answer 26

• liver enzymes are fine
• in the muscle cant degrade gylcogen into g1p subunits
• since liver is ok no hypoglycemia
• patients typically present in early adulthood with muscle pain on exertion and exercise tolerance, rhabdomyolysis may occur following significant exercise and can result in myoglobinuria and renal failure

Question 27

hypokalemia EKG

Answer 27

• QT interval prolongation
• appearance of U-waves and ST segment depression
• severe –> torsades de pointes

Question 28

hyperkalemia EKG

Answer 28

peaked T waves

Question 29

Graces ophtalmopathy (proptosis, exopghthalmos)

Answer 29

• lymphocytes infiltrated orbital tissues and secrete cytokines that stimulated fibroblasts to secrete increasing amounts of glycosaminoglycan ground substances such as hyaluronic acid.
• the increased hyaluronic acid draws water into the orbit resulting in EOM EDEMA
• combined with interstitial edema, this process pushes the globe outward (proptosis)

Question 30

tetrology of fallot

Answer 30

VSD, overriding aorta, pulmonic stenosis, RVH
VSD and pulmonic stenosis will cause a R to L shunting. –> cyanosis
Children squat to increase venous return to the heart and restore circulation to the lungs

Question 31

Parinaud syndrome is from mass effect of a pineal tumor

Answer 31

affects the dorsal midbrain in the region of the superior colliculus.
-affected patients experience upward gaze palsy, absent pupillary light relax, failure of convergence and a wide-based gait.

Question 32

Alcoholic cerebellar atrophy/degeneration

Answer 32

• thiamine deficiecy
• loss of purkinge cells in the anterior lobes and cerebellar vermis
• ataxia that progresses over weeks to months
• wide based gait ataxia, truncal instability, intention tremor of the hands and fingers and rhythmic postural parkinsonian tremor of the fingers and hands

Question 33

clonidine

Answer 33

alpha 2 andrenergice receptor agonist

-decreases BP by decreasing central sympathetic outflow

Question 34

phenylephrine

Answer 34

selective alpha 1 adrenergic receptor agonist
-arterial vasoconstriction, but can cause baroreceptor mediated relux –> increase vagal tone –> decreased stroke volume and slow HR

Question 35

Both the CAAT box and TATA box promote initiation of transcription

Answer 35

by acting on binding sites of RNA pol II

Question 36

vitamin C deficiency

Answer 36

-vitamin C is needed for hydroxylation of lysine and proline residues in the procollagen molecule
scurvy can cause easy bruising, perifollicular hemorrhage, and hemorrhage in other locations due to defective collagen synthesis and weakness of the tissue supporting blood vessels.

Question 37

radioimmuneassay RIA

Answer 37

uses specific antibodies and a known quantitiy of radiolabeled antigen to determine the amount of antigen present in an unknown sample.
-this is done by using a known measured amount of radiolabled antigen and then seeing how much it gets displaced from antibodis in the system as you add the unknown sample. You should see a decline in radioactivty as you add unlabeled antigen as it will not be radioactive.
but if you see no changed that means the substance you added cannot bind to the available antibodies because they share no epitodes with the radiolabled antigen