CBSSA 15

Question 1

Muscle pain and weakness, tender bones, low serum calcium and high PTH levels indicate?

Answer 1

Osteomalacia (usually due to dec. vitamin D)

Question 2

Osteomalacia vs. Osteoporosis

Answer 2

In osteoporosis you get dec. bone mass DESPITE normal mineralization and lab values!
Serum Ca, Phosphorus, Alk phosph, and PTH are all normal.

Question 3

Phosphocreatine aka creatine phosphate

Answer 3

Phosphorylated creatine molecule that serves as a rapidly mobilizable reserve of high-energy phosphates in skeletal muscle and the brain.

During a contraction, each myosin cross-bridge breaks down ATP, producing ADP and a phosphate group. The energy stored in creatine phosphate is then used to “recharge” ADP, converting it back to ATP

Question 4

Lupus hematologic association

Answer 4

Thrombocytopenia

Question 5

Resistance to ampicillin

Answer 5

via beta-lactamase production by bacteria - can inhibit by administering beta-lactamase inhib. with the Ab (ex: clavulanic acid, sulbactam, tazobactam)

Question 6

How does surface tension affect the lung?

Answer 6

Surface tension generates a force that favors the collapse of the alveolus and opposes lung distension
P(alveoli)=2T/r
Air at high pressure will move to sites of low pressure (alveoli with larger radii). The consequence of this, in a lung without sufactant, is that small alveoli would collapse as larger alveoli expand. This effect is referred to as alveolar instability and can be largely prevented by surfactant.

Question 7

Optic tract located in which lobe of brain

Answer 7

Parietal

Question 8

DiGeorge malformation

Answer 8

3rd & 4th branchial POUCHES

Question 9

Why use primaquine along with chloroquine?

Answer 9

Chloroquine will get rid of blood infection (sporozoites) of P. vivax & ovale but primaquine will get rid of hepatic dormant organisms (Hyponozoites)

Question 10

Will pupil dilate/constrict with light if it has a dense central scotoma impacting the entire visual field?

Answer 10

NO. Retinal ganglion cells have been destroyed

Question 11

Slipped-strand mispairing

Answer 11

In genetics, an insertion (also called an insertion mutation) is the addition of one or more nucleotide base pairs into a DNA sequence. This can often happen in microsatellite regions due to the DNA polymerase slipping

Question 12

Lentigo maligna can lead to

Answer 12

can lead to Lentigo maligna melanoma

Question 13

Normal neutrophil percentage

Answer 13

40-60/70% of total leukocytes!!!

Question 14

What component of Gm - bacteria is responsible for inducing hypotension?

Answer 14

LPS layer - induces TNF & IL-1 - can cause shock, fever, vascular leak

Question 15

Trichomonas vaginalis

Answer 15

Motile trophozoites on wet prep (with flagella)
Green/yellow frothy discharge
Doesn’t have to be (can be) foul smelling
Itching/burning sensation

TREAT WITH METRONIDAZOLE

Question 16

Sarcoidosis

Answer 16

Non-caseating granulomas
Bilateral hilar adenopathy
Paratracheal node enlargement

ASSOCIATE WITH AFRICAN AMERICANS

Question 17

What could cause hypokinesis of posterior left ventricle

Answer 17

Stenosis of RCA (gives off the posterior descending artery - PDA)

Question 18

Zanamivir MOA

Answer 18

Neuraminidase inhibitor - treat influenza A & B; same mechanism as oseltamivir

Decreases release of progeny virus

Question 19

Appropriate lab method to identify specific CD variant

Answer 19

Immunohistochemistry: process of detecting antigens (e.g., proteins) in cells of a tissue section

Question 20

Intermittent painless episodes of mild jaundice often precipitated by periods of stress/fasting/infection

Answer 20

Gilbert syndrome - due to decreased conjugation of bilirubin

Reduced activity of the enzyme glucuronyltransferase

Question 21

Blood supply of AV node

Answer 21

Posterior descending artery (PDA) - usually comes off RIGHT coronary but in a left dominant heart, will come off circumflex/LCA

Question 22

Acute intermittent porphyria

Answer 22

Porphobilinogen deaminase def.
Porphobilinogen + Delta-ALA + uroporphyrin accumulate
5 P’s: painful abdomen, wine urine, polyneuropathy,psychosocial disturbances, precipitated by drugs (ex: TMP/SMX)

Question 23

Porphyria cutanea tarda

Answer 23

Uroporphyrinogen decarboxylase def.
Uroporphyrin accum.
Most common porphyria
Blistering cutaneous photosensitivity
Tea/wine urine

Question 24

Enzymes that can lead to lead poisoning

Answer 24

Ferrochelatase
ALA dehydratase (ALAD)

Accumulate protoporphyrin & delta-ALA

Question 25

ALAS def.

Answer 25

Sideroblalstic anemia (X-linked) - rate limiting step
Requires B6 to function

Question 26

Glutathione and acetaminophen

Answer 26

Excess acetaminophen depletes glutathione stores (which prevents toxic metabolite) - causes toxic metabolite to build up (NAPQI)

Question 27

Lymphatic drainage for ovarian cancers

Answer 27

Lumbar/paraortic nodes

Question 28

Think someone is surreptitiously using insulin - how to check?

Answer 28

Measure C-peptide levels - this is found in endogenous insulin synth pathways so if they are taking excess insulin injections, endogenous insulin synt. will be INHIB and thus you will have LOWER THAN NORMAL c-peptide levels

Question 29

Causes of hypoxemia

Answer 29

Decreased ventilation
High altitude
V/Q mismatch
Diffusion limitation
R-L shunt

Question 30

Glycine receptor

Answer 30

INHIBITORY NT
The glycine receptor, or GlyR, is the receptor for the amino acid neurotransmitter glycine. GlyR is an ionotropic receptor that produces its effects through chloride current. It is one of the most widely distributed inhibitory receptors in the central nervous system

Question 31

Cardiogenic vs. hypovolemic shock

Answer 31

BOTH: low output, cold/clammy, inc. TPR, low CO
Cardiogenic: increased LVEDV - will see JVD, hear crackles in lung bases (fluid overload due to inefficient pumping)
Hypovolemic: low LVEDV

Question 32

Idiopathic pulmonary fibrosis

Answer 32

Abnormal pulmonary function tests with evidence of restriction (reduced vital capacity) and impaired gas exchange

Bibasilar reticular abnormalities with minimal ground glass on high-resolution CT scans

Transbronchial lung biopsy or bronchoalveolar lavage (BAL) showing no features to support an alternative diagnosis

Finger clubbing