classic presentations

Question 1

Abdominal pain, ascites, hepatomegaly

Answer 1

Budd chiari syndrome ( post hepatic venous thrombosis)

Question 2

abdominal pain, diarrhea, leukocytosis, recent antibiotic use

Answer 2

C diff

Question 3

achilles tendon xanthoma

Answer 3

Familial hypercholesterolemia (decreased LDL receptor signaling)

Question 4

adrenal hemorrhage, hypotension, DIC

Answer 4

waterhouse-Friderchsen syndrome (meningococcemia)

Question 5

Anaphylaxis following blood transfusion

Answer 5

IgA deficiency

Question 6

anterior drawer sign

Answer 6

anterior cruciate ligament injury

Question 7

arachnodactlyly, lens dislocation (upward), aortic dissection, hyperflexible joints

Answer 7

marfan syndrome (fibrillin defect)

Question 8

Athlete with polycythemia

Answer 8

secondary to EPO injections

Question 9

back pain, fever, night sweats

Answer 9

Pott disease (vertebral TB)

Question 10

Bilateral acoustic schwannomas

Answer 10

NF-2

Question 11

Bilateral hilar adenopathy, uveitis

Answer 11

sarcoidosis

Question 12

black eschar on face of patient with DKA

Answer 12

Mucor or rhizopus infectgion

Question 13

Blue sclera

Answer 13

osteogenesis imperfect (defect in type 1 collagen synthesis)

Question 14

bluish line on gingiva

Answer 14

burton line lead poisoning

Question 15

Bone pain, bone enlargement, arthritis

Answer 15

Paget disease of the bone (increased osteoblast and osteoclast activity

Question 16

Bounding pulses, wide pulse pressure, diastolic heart murmur, head bobbing

Answer 16

aortic regurgitation

Question 17

butterfly rash and raynaud phenomenon in a young female

Answer 17

SLE

Question 18

Cafe au lairt spots, Lish nodules (iris hamartoma), cutaneous neurofibromas, pheochromocytomas, optic gliomas.

Answer 18

NF-1

Question 19

cafe-au lait spots (unilateral), Polyostotic fibrous dysplasia, precocious puberty, multiple endocribe abnormalaties

Answer 19

Mccune albright syndrome (mosaic G protein signaling mutation)

Question 20

Calf psuedohypertrophy

Answer 20

muscular dystrophy (most commonly duchenne, due to X-linked recessive frameshift mutation of dystrophin gene)

Question 21

cervical lymphadenopathy, desquamating rash, coronary aneurysms, red conjuctivae and tongue, hand foot changes

Answer 21

kawasaki disease (treat with IVIG and aspirin)

Question 22

cherry red spots on macula

Answer 22

Tay Sachs (GM2 ganglioside accumalation) or Nieman-pick disease (sphingomyelin accumalation).. central retinal artery occlusion

Question 23

chest pain on exertion

Answer 23

Angina (stable: with moderate exertion;unstable: with minimal exertion or rest)

Question 24

chest pain, pericardial effusion/friction rub, persistant fever following MI

Answer 24

Depending on time line fibrinous pericarditis 1-3 days post or dressler syndrome 2 weeks or more post Mi (Autoimmune mediated)

Question 25

Chest pain with St depression of EKG

Answer 25

Unstable angina (negative troponins) or NSTEMI (positive troponins)

Question 26

child uses arms to stand up from squat

Answer 26

Duchenne muscular dystrophy gower’s sign

Question 27

child with fever later develops red rash on face that spreads to body

Answer 27

erythema infectiosum/fifth disease (slapped cheeks appearence, caused by parvo B19)

Question 28

chorea, dimentia, caudate degeneration

Answer 28

Huntington disease. (autosomal dominant CAG repeat expansion)

Question 29

chorioretinitis, hydrocephalus, intracranial calcifications

Answer 29

congenital toxoplasmosis

Question 30

chronic exercise intolerance with myalgia, fatigue, painful cramps, myoglobinuria

Answer 30

McArdle disease (skeletal muscle glycogen phosphorylase deficiency)

Question 31

Cold intolerance

Answer 31

Hypothyroidism

Question 32

conjugate horizontal gaze palsy, horizontal diplopia

Answer 32

Internuclear opthalmoplegia (damage to MLF; may be unilateral or bilateral)

Question 33

continuous machine like heart murmur

Answer 33

PDA

Question 34

cutaneous/dermal edema due to connective tissue deposition

Answer 34

myxedema (caused by hypothyroidism, graves disease (pretibial))

Question 35

cutaneous flushing, diarrhea, bronchospasm

Answer 35

carcinoid syndrome (right sided valvular lesion)

Question 36

Dark purple skin/mouth nodules in a person with aids

Answer 36

kaposi sarcoma HHV-8

Question 37

deep, labored breathing/ hyperventilation

Answer 37

kussmaul respirations in DKA

Question 38

dermatitis, dementia, diarrhea

Answer 38

pellagra from a niacin (Vit B3 deficiency)

Question 39

dilated cardiomyopathy, edema, alcoholism or malnutrition

Answer 39

Wet berriberri vitamin B1 deficiency

Question 40

Dog or cat bite resulting in infection

Answer 40

pasturella multicoda (cellulitis at infection site or may spread deeper causing osteomyelitis)

Question 41

dry eyes, dry mouth, arthritis

Answer 41

sjoren syndrome (autoimmune destruction of exocrine gland)

Question 42

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

Answer 42

plummer vinson syndrome (may progress to esophageal squamous cell carcinoma )

Question 43

elastic skin, hyper mobility of joints, increased bleeding tendency

Answer 43

Ehlers-Danlos syndrome (type V collagen defect, Type III collagen defect seen in vascular subtype of ED)

Question 44

Enlarged left supraclavivular node

Answer 44

virchow node (abdominal metastasis)

Question 45

Episodic vertigo, Tinitus, hearing loss

Answer 45

Meniere disease

Question 46

erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells

Answer 46

Mycosis fungoides (cutaneous T cell lymphoma ) or sezary syndrome (mycosis fungoides + malignant T cells in blood)

Question 47

Facial muscle spasm upon tapping

Answer 47

chvostek sign (hypocalcemia)

Question 48

Fat, female, forty, and fertile

Answer 48

cholelithiasis

Question 49

fever, chills, headache, myalgia following antibiotic treatment for syphilis

Answer 49

jarisch Herxheimer RXN (rapid lysis of spirochetes results in endotoxin release)

Question 50

fever, cough, conjuctivitis, coryza, diffuse rash

Answer 50

measles

Question 51

Fever, night sweats, weight loss

Answer 51

B symptoms of lymphoma

Question 52

Fibrous plaque in soft tissue of penis with abnormal curvature

Answer 52

Peyronie disease (connective tissue disease)

Question 53

Golden brown rings around peripheral cornea

Answer 53

Wilson disease (kayser-Fleischer rings due to copper accumulation)

Question 54

Gout, intellectual disability, self mutilating behavior in a boy

Answer 54

Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)

Question 55

harmatomatous GI polyps, hyperpigmentation of mouth/feet/hands/genitalia

Answer 55

Peutz-Jeghers syndrome (inherited benign polyposis can cause bowel obstruction; increased cancer risk mainly GI)

Question 56

Hepatomegaly, pancytopenia, osteoporosis, aseptic necrosis of femoral head, bone crisis

Answer 56

Gaucher disease (glucocerebrosidase deficiency)

Question 57

Heriditary nephritis, Sensineural hearing loss, cataracts

Answer 57

Alport syndrome (mutation in collagen IV)

Question 58

Hyperphagia, hypersexuality, hyperorality, hyperdocility

Answer 58

Kluver-Bucy syndrome (bilateral amygdala lesion)

Question 59

Hyperreflexia, hypertonia, babinski sign present

Answer 59

UMN damage

Question 60

Hyporeflexia, hypotonia, atrophy, fasciculations

Answer 60

LMN damage

Question 61

hypoxemia, polycythemia, hypercapnia

Answer 61

Chronic bronchitis (hyperplasia of mucous cells “blue boater”)

Question 62

Indurated, ulcerated genital lesion

Answer 62

nonpainful: chancre (primary syphilis, treponema pallidum)

Painful with exudate: chancroid (hemophilus ducreyi)

Question 63

Infant with cleft lip/palate, microcephaly or holoprosencephaly, polydactyly, cutis aplasia

Answer 63

Patau syndrome (trisomy 13)

Question 64

cinfant with hypoglycemia, hepatomegaly

Answer 64

Cori disease (debraching enzyme deficiency) or von Gierke disease (glucose 6 phosphatase deficiency, more severe)

Question 65

Infant with microcephaly, rocker bottom feet, clenched hands and sructural heart defect

Answer 65

Edwards syndrome (trisomy 18)

Question 66

Jaundice, palpable distended non-tender gallbladder

Answer 66

courvoiser sign (distal malignant obstruction of biliary tree)

Question 67

large rash with bulls eye appearance

Answer 67

Erythema chronicum migrans from ixodes tick bite (Lyme disease borrelia)

Question 68

Lucid interval after traumatic brain injury

Answer 68

epidural hematoma (middle meningeal artery rupture)

Question 69

Male child, reccurent infections, no mature B cells

Answer 69

bruton disease (X-linked agammaglobulenemia)

Question 70

mucosal bleeding and prolonged bleeding

Answer 70

glanzmann thrombasthenia (defect in platelet aggregation due to lack of GPIIb/IIIa)

Question 71

Muffled heart sounds, distended neck veins, hypotension

Answer 71

beck triad of cardiac tamponade

Question 72

Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth

Answer 72

Gardner syndrome

Question 73

Myopathy (infantile hypertrophic cardiomyopathy), exercise intolerance

Answer 73

Pompe disease (lysosomal alpha 1,4-glucosidase deficiency)

Question 74

neonate with arm paralysis following difficult birth

Answer 74

Erb-duchenne palsy 9superior trunk {C5-C^}brachial plexus injury “waiter’s tip”

Question 75

No lactation postpartum, absent menstruation, cold intolerance

Answer 75

Sheehan syndrome (pituitary infarction

Question 76

Nystagmus, intention tremor, scanning speech, bilateral internuclear opthalmoplegia

Answer 76

M.S

Question 77

painful blue fingers/toes, hemolytic anemia

Answer 77

cold agglutinin disease (autoimmune hemolytic anemia caused by mycoplasma pneumoniae, infectious mononucleosis, CLL)

Question 78

painful fingers/toes changing color fro, blue to white to red with cold or stress

Answer 78

raynaud phenomenom (vasospasm in extremities)

Question 79

painful, raised red lesions on pads of fingers/toes

Answer 79

osler nodes (infective endocarditis, immune complex deposition)

Question 80

Painless eythematous lesions on the palms and soles

Answer 80

Janeway lesions (infective endocarditis, septic emboli/microabscesses)

Question 81

painless jaundice

Answer 81

cancer of the pancreatic head obstructing bile duct

Question 82

Palpable purpura on buttocks/legs, joint pain, abdominal pain (child), hematuria

Answer 82

Henoch-Schonlein purpura (IgA vasculitis affecting skin and kidneys)

Question 83

Pancreatic, pituitary, parathyroid tumors

Answer 83

Men 1 (autosomal dominant)

Question 84

Periorbital and/or peripheral edema, proteinuria (>3.5g/day), hypoalbuminemia, hypercholesterolemia)

Answer 84

nephrotic syndrome

Question 85

pink complexion, dyspnea, hyperventilation

Answer 85

emphysema (pink puffercentriacinar smoking or pan acinar alpha 1 trypsin deficiency

Question 86

polyuria, renal tubular acidosis type II, growth failure, electrolyte imbalances, hypophosphatemic rickets

Answer 86

Fanconi syndrome (multiple combined dysfunction of the proximal convuluted tubule)

Question 87

Pruitic, purple, polygonal, planar papules and plauqes

Answer 87

Lichen planus

Question 88

ptosis, miosis, anhidrosis

Answer 88

Horner Syndrome (sympathetic chain lesion)

Question 89

Pupil accommodates but doesnt react

Answer 89

neurosyphilis (argyll robertson pupil

Question 90

Rapidly progressive limb weakness that ascends following GI/ upper respiratory infection

Answer 90

Guillain Barre syndrome (acute inflammatory demyelinating polyradiculopathy subtype)

Question 91

Rash on palms and soles

Answer 91

Coxsackie A, secondary syphilis, Rocky mountain spotted fever

Question 92

reccurent cold (noninflammed) abscesses, unusual eczema, high serum IgE, coarse fascies, retained primary teeth

Answer 92

Hyper IgE syndrome (job sndrome neutrophil chemotaxis abnormality) (deficiency of Th17 due to STAT 3 mutation

Question 93

red currant jelly sputum in alcoholic or diabetic patients

Answer 93

Klebsiella pneumoniae pneumonia

Question 94

red currant jelly stools

Answer 94

Acute mesenteric ischemia (adults), intussusception (children)

Question 95

Red Itchy swollen rash of nipple/ areola

Answer 95

paget disease of the breast (sign of underlying neoplasm

Question 96

red urine in the morning, Fragile RBCs

Answer 96

Paroxysmal nocturnal hemoglobinuria

Question 97

Renal cell carcinomas (bilateral), hemangioblastomas, angiomatosis, pheochromocytoma

Answer 97

Von hippel-lindau disease (dominant tumor suppressor gene mutation)

Question 98

Resting tremor, rigidity, akinesia, postural instability, shuffling gait

Answer 98

parkinson disease (loss of dopaminergic neurons in substantia nigra pars compacta)

Question 99

Retinal hemorrhages with pale centers

Answer 99

Roth spots (bacterial endocarditis)

Question 100

severe jaundice in neonate

Answer 100

crigler najjar syndrome (congenital unconjugated hyperbilirubinemia

Question 101

Severe RLQ pain with palpation of LLQ

Answer 101

Rovsing sign (acute appendicitis)

Question 102

Severe RLQ pain with deep tenderness

Answer 102

McBurney sign (acute appendicitis)

Question 103

Short stature, cafe au lait spots, thumb/ radial defects, increase incidence of tumors/ leukemia, aplastic anemia

Answer 103

Fanconi anemia (genetic loss of DNA cross link repair; often progresses to AML)

Question 104

single palmar crease

Answer 104

Down syndrome

Question 105

Situs inversus, chronic sinusitis, bronchiectasis, infertility

Answer 105

Kartagener syndrome (dynein arm defect affecting cilia)

Question 106

skin hyperpigmentation, hypotension, fatigue

Answer 106

primary adrenocortical insufficiency (addison disease) causes increase ACTH and increase alpha MSH production

Question 107

slow progressive muscle weakness in boys

Answer 107

becker muscular dystrophy (X-linked missense mutation in dysrophin; less severe than duchenne)

Question 108

small, irregular red spots on buccal/lingual mucosa with blue white centers

Answer 108

koplik spots (measles [rubeola] virus)

Question 109

smooth, moist, painless wart like white lesions on genitals

Answer 109

condylomata lata (secondary syphilis)

Question 110

splinter hemorrhages in finger nails

Answer 110

bacterial endocarditis

Question 111

strawberry tongue

Answer 111

scarlet fever, Kawasaki disease

Question 112

streak ovaries, congenital heart disease, horseshoe kidney, cystic hydroma at birth, short stature, webbed neck, lymphedema

Answer 112

turner syndrome (45, XO)

Question 113

sudden swollen/painful big toe joint, tophi

Answer 113

gout/podagra (hyperuricemia)

Question 114

swollen gums, mucosal bleeding, poor wound healing, petechiae

Answer 114

scurvy (vitamin C deficiency: cant hydroxylate proline/ lysine for collagen synthesis)

Question 115

swollen hard painful finger joints

Answer 115

osteoarthritis (osteophytes on PIP [Bouchard nodes], DIP[herberden nodes]

Question 116

systolic ejection murmur (crescendo decrescendo)

Answer 116

aortic stenosis

Question 117

telangiectasias, reccurent epistaxis, skin discoloration, arteriovenous malformations, GI bleeding, hematuria

Answer 117

Osler-Weber-rendu syndrome

Question 118

thyroid and parathyroid tumors, pheochromocytoma

Answer 118

MEN 2A (autosomal dominant RET mutation)

Question 119

thyroid tumors, pheochromocytoma, ganglioneuromatosis

Answer 119

MEN 2B (autosomal dominant RET mutation)

Question 120

Toe extension/fanning upon plantar scape

Answer 120

babinski sign (UMN lesion)

Question 121

Unilateral facial drooping involving forehead

Answer 121

LMN facial nerve (CN VII) palsy; UMN lesions spare the forehead

Question 122

urethritis, conjuctivitis, arthritis in a male

Answer 122

reactive arthritis associated with HLA-B27

Question 123

vascular birthmark (port wine stain) of the face

Answer 123

Nevus flammeus (benign, but associated with sturge Weber syndrome)

Question 124

vomiting blood following gastroesophageal lacerations

Answer 124

Mallory weiss syndrome (alcoholic and bulemic patients)

Question 125

weight loss, diarrhea, arthritis, fever, adenopathy

Answer 125

Whipple disease (tropheryma whipplei)

Question 126

worst headache of my life

Answer 126

subarachnoid hemorrhage

Question 127

increase in AFP in amniotic fluid

Answer 127

dating error, anencephaly, spina bifida (neural tube defects)

Question 128

anticentromere antibodies

Answer 128

scleroderma (CREST)

Question 129

anti-desmoglein (anti-desmosome)antibodies

Answer 129

pemphigus vulgaris

Question 130

ant-glomerular basement membrane antibodies

Answer 130

Goodpasture syndrome (glomerulonephritis and hemoptysis

Question 131

antihistone antibodies

Answer 131

drug induced SLE (hydralazine, isoniazid, phenytoin, procanimide)

Question 132

Anti- IgG antibodies

Answer 132

rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity)

Question 133

anti-mitochondrial antibodies

Answer 133

primary biliary cirrhosis (female, cholestasis, portal HTN)

Question 134

ANCA

Answer 134

microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (ghurg strauss syndrome) (MPO ANCA/ p-ANCA); granulomatosis with polyangiitis (wegner; PR3-ANCA/c-ANCA)

Question 135

antinuclear antibodies (ANAs: anti smith and anti-dsDNA

Answer 135

SLE ( type III hypersensitivity)

Question 136

antiplatelet antibodies

Answer 136

idiopathic thrombocytopenic purpura

Question 137

anti-topoisomerase antibodies

Answer 137

diffuse systemic scleroderma

Question 138

anti-transglutaminase/anti-endomysial antibodies

Answer 138

celiac disease (diarrhea, weight loss)

Question 139

apple core lesion on barium enema x-ray

Answer 139

colorectal cancer (usually left sided)

Question 140

atypical lymphocytes

Answer 140

EBV

Question 141

azurophilic peroxidase positive granular incusions in granulocytes and myeloblasts

Answer 141

Auer rods (AML, especially the promyelocytic [M3] type

Question 142

Bacitracin response

Answer 142

sensitive is S. pyogenes resistant is S. agalactiae

Question 143

bamboo spine on x-ray

Answer 143

Ankylosing spondylitis (chronic infammatory arthritis HLA-B27)

Question 144

basophilic nuclear remnants in RBCs

Answer 144

howell jolly bodies (due to splenectomy or nonfunctional spleen)

Question 145

Basophilic stippling of RBCs

Answer 145

Lead poisoning or sideroblastic anemia

Question 146

Bloody or yellow tap on lumbar puncture

Answer 146

subarachnoid hemorrhage

Question 147

Boot shaped heart on X-ray

Answer 147

tetralogy of fallot (due to RVH)

Question 148

Branching gram positive rods with sulfur granules

Answer 148

actinomyces israeli. treat with penicillin

Question 149

bronchogenic apical lung tumor on imaging

Answer 149

Pancoast tumor (can compress cervical symathetic chain and cause horner syndrome)

Question 150

Brown tumor of Bone

Answer 150

Hyperparathyroidism or osteitis fibrosa cystica (deposited hemosiderin from hemorrhage gives brown color)

Question 151

cardiomegaly with apical atrophy

Answer 151

Chagase disease (T cruzi)

Question 152

Cellular cresencts in Bowman capsule

Answer 152

rapidly progressive crescentic glomerulonephritis

Question 153

chocolate cysts of ovary

Answer 153

endometriosis (frequently involved both ovaries)

Question 154

circular grouping of dark tumor cells surrounding pale neurofibrils

Answer 154

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

Question 155

colonies of mucoid psuedomonas in lungs

Answer 155

cystic fibrosis (autosomal recessive mutations in CFTR gene–> fat soluble vitamin deficiency and mucus plugs)

Question 156

decreased AFP in amniotic fluid/maternal serum

Answer 156

Down syndrome or other chromosomal abnormalaties

Question 157

degeneration of dorsal column fibers

Answer 157

Tabes dorsalis (tertiary syphylis), subacute combined degeneration (dorsal columns, lateral corticospinal, spinocerebellar tracts affected)

Question 158

Delta wave on EKG, short PR interval, supraventricular tachycardia

Answer 158

Wolf-parkinson-white syndrome (Bundle of kent bypasses AV node)

Question 159

depigmentation of neurons in substantia nigra

Answer 159

parkinson disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)

Question 160

Desquamated epithelium casts in sputum

Answer 160

curshman spirals (bronchial asthma; can result in whorled mucous plugs)

Question 161

minoxidil

Answer 161

direct arteriolar vasodilator;;

AE: andrigenic lopecia and severe refactory hypertension

Question 162

Diazoxide

Answer 162

a potassium channel opener with hyperglycemic effects; used for emergency HTN

Question 163

bivalirudin

Answer 163

directly inhibits free and clot associated thrombin;; can be used in HIT

Question 164

clopidogrel, prasugrel, ticagrelor (reversible), ticlopidine

Answer 164

Inhibit platelet aggregation by irreversibly blocking ADP receptors. Prevent expression of glycoproteins IIb/IIIa on platelet surface.

Question 165

Sjoren syndrome

Answer 165

Anti SSA (anti-ro), Anti ssB (anti La) are anti ribonuclear proteins. keratoconjunctivitis sicca, xerostomia, bilateral parotid enlargement and can lead to MALT lymphoma (B cell)

Question 166

Disarrayed granulosa cells arranged around collections of eosinophilic fluid

Answer 166

call exner bodies (granulosa cell tumor of the ovary). can cause different presentations based on increased estrogen production in different age groups

Question 167

dysplastic squamous cervical cells with raisinoid nuclei and hyper chromasia

Answer 167

Koilocytes (HPV: predisposes to cervical cancer)

Question 168

electrical alternans (alternating amplitude on EKG)

Answer 168

pericardial tamponade

Question 169

enlarged cells with intranuclear inclusion bodies

Answer 169

Owl eye appearance of CMV

Question 170

Enlarged thyroid cells with ground glass nuclei with central clearing

Answer 170

orphan annie eyes nuclei – papillary carcinoma of the thyroid

Question 171

eosinophilic cytoplasmic inclusion in liver cell

Answer 171

mallory body (alcoholic liver disease)

Question 172

Eosinophilic cytoplasmic inclusion neuron

Answer 172

Lewy body (parkinson disease and lewy body dimentia) composed of alpha synuclein

Question 173

eosinophilic globule in liver

Answer 173

councilman body (viral hepatitis, yellow fever), represents hepatocyte undergoing apoptosis

Question 174

Eosinophilic inclusion bodies in cytoplasm of hippocampal and cerebellar neurons

Answer 174

negri bodies of rabies.

Question 175

extracellular amyloid deposition in gray matter of brain

Answer 175

senile plaques (alzheimer disease)

Question 176

Giant B cells with bilobed nuclei with prominent inclusions (owl’s eye)

Answer 176

Reed sternberg Cells (Hodgkin lymphoma)

Question 177

Glomerulus like structure surrounding vessel in germ cells

Answer 177

Schiller duval bodies (yolk sac tumor)

Question 178

Hair on end (crew cut appearance on X-ray

Answer 178

beta thalassemia, sickle cell disease (marrow expansion)

Question 179

hCG elevated

Answer 179

choriocarcinoma, hydatidiform mole (occurs with and without embryo, and multiple pregnancy)

Question 180

heart nodules granulomatous

Answer 180

Aschoff bodies (rheumatic fever)

Question 181

Heterophile antibodies

Answer 181

infectious mononucleosis

Question 182

hexagonal, double pointed, needle like crystals in bronchial secretions

Answer 182

bronchial asthma (charcot leyden crystals: eosinophilic granules)

Question 183

high level of D dimers

Answer 183

DVT, PE, DIC

Question 184

Hilar lymphadenopathy, peripheral granulomatous lesion in middle or lower lung lobes (can calcify)

Answer 184

Ghon complex (primary TB)

Question 185

honey comb lung on X-ray or CT

Answer 185

interstitial pulmonary fibrosis

Question 186

Hypercoagubility (leading to migrating DVTs and vasculitis)

Answer 186

Troissseau syndrome (adnocarcinoma of the lung or pancreas

Question 187

Hypersegented neutrophils

Answer 187

Megaloblastic anemia (B12 deficiency: neurologic symptoms; folate deficiency no neurologic symptoms)

Question 188

HTN, hypokalemia, metabolic alkolosis

Answer 188

primary aldosteronism (conn syndrome)

Question 189

hypochromic microcytic anemia

Answer 189

iron deficiency anemia, lead poisoning, thalassemia

Question 190

intranuclear eosinophilic droplet like bodies

Answer 190

cowdry type A bodies (HSV or VZV)

Question 191

iron containing nodules in alveolar septum

Answer 191

ferriginous bodies (asbestosis: increases chance of mesothelioma)

Question 192

keratin pearls on skin biopsy

Answer 192

squamous cell carcinoma

Question 193

large granules in phagocytes immunodeficiency

Answer 193

chediak higashi disease (congenital failure of phagolysosome formation)

Question 194

Lead pipe appearence of colon on abdominal imaging

Answer 194

Ulcerative colitis (loss of haustra)

Question 195

linear appearence of IgG deposition on glomerular and alveolar basement membranes

Answer 195

Goodpasture syndrome

Question 196

low serum ceruloplasmin

Answer 196

wilson disease (hepatolenticular degeneration)

Question 197

lumpy bumpy appearence of glomeruli on IF

Answer 197

PSGN, (due to deposition of IgG, IgM, and C3)

Question 198

Lytic punched out bone lesions on X-ray

Answer 198

Multiple myeloma

Question 199

mammary gland (blue domed) cyst

Answer 199

Fibrocystic change of the breast

Question 200

Monoclonal antibody spike

Answer 200

multiple myeloma (usually IgG or IgA)
monoclonal gammopathy of undetermined significance (MGUS)
waldenstrom (M protein= IgM) macroglobulinemia 
primary amyloidosis

Question 201

mucin filled cell with peripheral nucleus

Answer 201

signet ring (gastric diffuse type carcinoma)

Question 202

Narrowing of bowel lumen of barium X-ray

Answer 202

string sign (chron disease)

Question 203

Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis

Answer 203

granulomatosis with poliangiitis (wegner, PR#-ANCA/c-ANCA) and goodpasture syndrome (anti-basement membrane antibodies)

Question 204

needle shaped, negatively birefringent crystals

Answer 204

gout (monosodium crystals

Question 205

nodular hyaline deposits in glomeruli

Answer 205

kimmestiel wilson nodules (diabetic nephropathy)

Question 206

Novobiocin response

Answer 206

Sensitive: S epidermidis; resistant: S saprophyticus

Question 207

“Nutmeg” appearance of liver

Answer 207

Chronic passive congestion of liver due to right heart failure or budd chiari syndrome

Question 208

onion skin periostal reaction

Answer 208

ewing sarcomma

Question 209

optochin response

Answer 209

s pneumoniae sensitive

s viridans resistant

Question 210

Podocyte fusion or “effacement” on electron microscopy

Answer 210

Minimal change disease (child with nephrotic syndrome

Question 211

Polished, “ivory-like” appearance of bone at cartilage erosion

Answer 211

Eburnation (osteoarthritis resulting in bony sclerosis

Question 212

Protein aggregates in neurons from hyperphosphorylation of

tau protein

Answer 212

Neurofibrillary tangles (Alzheimer disease) and Pick bodies
(Pick disease)

Question 213

Psammoma bodies

Answer 213

Meningiomas, papillary thyroid carcinoma, mesothelioma,

papillary serous carcinoma of the endometrium and ovary

Question 214

Pseudopalisading tumor cells on brain biopsy

Answer 214

Glioblastoma multiforme

Question 215

Raised periosteum (creating a “Codman triangle”)

Answer 215

Aggressive bone lesion (eg, osteosarcoma, Ewing sarcoma,

osteomyelitis)

Question 216

RBC casts in urine

Answer 216

Glomerulonephritis

Question 217

Rectangular, crystal-like, cytoplasmic inclusions in Leydig cells

Answer 217

Reinke crystals (Leydig cell tumor)

Question 218

Recurrent infections, eczema, thrombocytopenia

Answer 218

Wiskott-Aldrich syndrome

Question 219

Renal epithelial casts in urine

Answer 219

Intrinsic renal failure (eg, ischemia or toxic injury)

Question 220

Rhomboid crystals, ⊕ birefringent

Answer 220

Pseudogout (calcium pyrophosphate dihydrate crystals)

Question 221

Rib notching (inferior surface, on x-ray)

Answer 221

Coarctation of the aorta

Question 222

Ring-enhancing brain lesion on CT/MRI in AIDS

Answer 222

Toxoplasma gondii, CNS lymphoma

Question 223

Sheets of medium-sized lymphoid cells with scattered pale,

tingible body–laden macrophages (“starry sky” histology

Answer 223

Burkitt lymphoma (t[8:14] c-myc activation, associated with
EBV; “starry sky” made up of malignant cells)

Question 224

Silver-staining spherical aggregation of tau proteins in

neurons

Answer 224

Pick bodies (Pick disease: progressive dementia, changes in
personality)

Question 225

“Soap bubble” in femur or tibia on x-ray

Answer 225

Giant cell tumor of bone (generally benign)

special because it occurs in the diaphysis

Question 226

Spikes” on basement membrane, “dome-like” subepithelial

deposits

Answer 226

Membranous nephropathy (nephrotic syndrome)

Question 227

Stacks of RBCs

Answer 227

Rouleaux formation (high ESR, multiple myeloma)

Question 228

“Steeple” sign on frontal CXR

Answer 228

Croup (parainfluenza virus)

Question 229

Stippled vaginal epithelial cells

Answer 229

“Clue cells” (Gardnerella vaginalis

Question 230

Streptococcus bovis bacteremia

Answer 230

Colon cancer

Question 231

“Tennis racket”-shaped cytoplasmic organelles (EM) in

Langerhans cells

Answer 231

Birbeck granules (Langerhans cell histiocytosis)

Question 232

Thousands of polyps on colonoscopy

Answer 232

Familial adenomatous polyposis (autosomal dominant,

mutation of APC gene)

Question 233

Thrombi made of white/red layers

Answer 233

Lines of Zahn (arterial thrombus, layers of platelets/RBCs)

Question 234

“Thumb sign” on lateral neck x-ray

Answer 234

Epiglottitis (Haemophilus influenzae)

Question 235

Thyroid-like appearance of kidney

Answer 235

Chronic pyelonephritis (usually due to recurrent infections)

Question 236

“Tram-track” appearance of capillary loops of glomerular

basement membranes on light microscopy

Answer 236

Membranoproliferative glomerulonephritis

Question 237

Triglyceride accumulation in liver cell vacuoles

Answer 237

Fatty liver disease (alcoholic or metabolic syndrome)

Question 238

increased uric acid levels

Answer 238

Gout, Lesch-Nyhan syndrome, tumor lysis syndrome, loop
and thiazide diuretics
niacin

Question 239

“Waxy” casts with very low urine flow

Answer 239

Chronic end-stage renal disease

Question 240

WBC casts in urine

Answer 240

Acute pyelonephritis

Question 241

WBCs that look “smudged”

Answer 241

CLL (almost always B cell)

Question 242

“Wire loop” glomerular capillary appearance on light

microscopy

Answer 242

Diffuse proliferative glomerulonephritis (usually seen with

lupus

Question 243

Yellowish CSF

Answer 243

Xanthochromia (eg, due to subarachnoid hemorrhage)s

Question 244

absence seizure

Answer 244

ethosuximide

Question 245

Acute gout attack

Answer 245

NSAIDs, colchicine, glucocorticoids

Question 246

Acute promyelocytic leukemia (M3)

Answer 246

All-trans retinoic acid

Question 247

ADHD

Answer 247

Methylphenidate, CBT, atomoxetine, guanfacine, clonidine

Question 248

Alcoholism

Answer 248

Disulfiram, acamprosate, naltrexone, supportive care

Question 249

Alcohol withdrawal

Answer 249

Long-acting benzodiazepines

Question 250

Anorexia

Answer 250

Nutrition, psychotherapy, mirtazapine

Question 251

Arrhythmia in damaged cardiac tissue

Answer 251

Class IB antiarrhythmic (lidocaine, mexiletine)

Question 252

Benign prostatic hyperplasia

Answer 252

α1-antagonists, 5α-reductase inhibitors, PDE-5 inhibitors

Question 253

Bipolar disorder

Answer 253

Mood stabilizers (eg, lithium, valproic acid, carbamazepine),
atypical antipsychotics

Question 254

Breast cancer in postmenopausal woman

Answer 254

Aromatase inhibitor (anastrozole)

Question 255

Buerger disease

Answer 255

Smoking cessation

Question 256

Bulimia nervosa

Answer 256

SSRIs

Question 257

Candida albicans

Answer 257

Topical azoles (vaginitis); nystatin, fluconazole, caspofungin
(oral/esophageal); fluconazole, caspofungin, amphotericin B

Question 258

Carcinoid syndrome

Answer 258

Octreotide

Question 259

Chlamydia trachomatis

Answer 259

Doxycycline (+ ceftriaxone for gonorrhea coinfection), erythromycin eye drops (prophylaxis in infants)

Question 260

Chronic gout

Answer 260

Xanthine oxidase inhibitors (eg, allopurinol, febuxostat);

pegloticase; probenecid

Question 261

Chronic hepatitis B or C

Answer 261

IFN-α (HBV and HCV); ribavirin, simeprevir, sofosbuvir

HCV

Question 262

Chronic myelogenous leukemia

Answer 262

Imatinib

Question 263

Clostridium botulinum

Answer 263

Antitoxin

Question 264

Clostridium difficile

Answer 264

Oral metronidazole; if refractory, oral vancomycin or fidaxomicin if refactory

Question 265

Clostridium tetani

Answer 265

Antitoxin

Question 266

CMV

Answer 266

Ganciclovir, foscarnet, cidofovir

Question 267

Crohn disease

Answer 267

Corticosteroids, infliximab, azathioprine

Question 268

Cryptococcus neoformans

Answer 268

if systemic amphoteracin B and flucytosine and ketocanazole for maintenance

Question 269

Cyclophosphamide-induced hemorrhagic cystitis

Answer 269

Mesna

Question 270

Depression

Answer 270

SSRIs (first-line)

Question 271

Diabetes insipidus

Answer 271

Desmopressin (central); hydrochlorothiazide, indomethacin,

amiloride (nephrogenic)

Question 272

Diabetes mellitus type 1

Answer 272

Dietary intervention (low carbohydrate) + insulin replacement

Question 273

Diabetes mellitus type 2

Answer 273

Dietary intervention, oral hypoglycemics, and insulin (if

refractory)

Question 274

DKA

Answer 274

Fluids, insulin, K+

Question 275

Drug of choice for anticoagulation during pregnancy

Answer 275

Heparin

Question 276

Enterococci

Answer 276

Vancomycin, aminopenicillins/cephalosporins

Question 277

Erectile dysfunction

Answer 277

Sildenafil, tadalafil, vardenafil

Question 278

ER ⊕ breast cancer

Answer 278

Tamoxifen

Question 279

Ethylene glycol/methanol intoxication

Answer 279

Fomepizole (alcohol dehydrogenase inhibitor)

Question 280

Haemophilus influenzae (B)

Answer 280

Rifampin (prophylaxis)

Question 281

Generalized anxiety disorder

Answer 281

SSRIs, SNRIs (first line); buspirone (second line)

Question 282

Granulomatosis with polyangiitis (Wegener)

Answer 282

Cyclophosphamide, corticosteroids

Question 283

Heparin reversal

Answer 283

Protamine sulfate

Question 284

HER2/neu ⊕ breast cancer

Answer 284

Trastuzumab

Question 285

Hyperaldosteronism

Answer 285

Spironolactone

Question 286

Hypercholesterolemia

Answer 286

Statin (first-line)

Question 287

Hypertriglyceridemia

Answer 287

Fibrate

Question 288

Immediate anticoagulation

Answer 288

Heparin

Question 289

Infertility

Answer 289

Leuprolide, GnRH (pulsatile), clomiphene

Question 290

Influenza

Answer 290

Oseltamivir, zanamivir

Question 291

Kawasaki disease

Answer 291

IVIG, high-dose aspirin

Question 292

Legionella pneumophila

Answer 292

Macrolides (eg, azithromycin)

Question 293

Long-term anticoagulation

Answer 293

Warfarin, dabigatran, rivaroxaban and apixaban

Question 294

Malaria

Answer 294

Chloroquine, mefloquine, atovaquone/proguanil (for blood

schizont), primaquine (for liver hypnozoite)

Question 295

Malignant hyperthermia

Answer 295

Dantrolene

Question 296

Medical abortion

Answer 296

Mifepristone

Question 297

Migraine

Answer 297

Abortive therapies (eg, sumatriptan, NSAIDs); prophylaxis
(eg, propranolol, topiramate, CCBs, amitriptyline)

Question 298

Multiple sclerosis

Answer 298

Disease-modifying therapies (eg, β-interferon, natalizumab);

for acute flares, use IV steroids

Question 299

Mycobacterium tuberculosis

Answer 299

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

Question 300

Neisseria gonorrhoeae

Answer 300

Ceftriaxone (add doxycycline to cover likely concurrent

C trachomatis)

Question 301

Neisseria meningitidis

Answer 301

Penicillin/ceftriaxone, rifampin (prophylaxis)

Question 302

Neural tube defect prevention

Answer 302

prenatal folic acid

Question 303

Osteomalacia/rickets

Answer 303

Vitamin D supplementation

Question 304

Osteoporosis

Answer 304

Calcium/vitamin D supplementation (prophylaxis);
bisphosphonates, PTH analogs, SERMs, calcitonin,
denosumab (treatment)

Question 305

Patent ductus arteriosus

Answer 305

Close with indomethacin; keep open with PGE analogs

Question 306

Pheochromocytoma

Answer 306

α-antagonists (eg, phenoxybenzamine)

Question 307

Pneumocystis jirovecii

Answer 307

TMP-SMX (prophylaxis and treatment in immunosuppressed

patients)

Question 308

Prolactinoma

Answer 308

Cabergoline/bromocriptine (dopamine agonists)

Question 309

Prostate adenocarcinoma/uterine fibroids

Answer 309

Leuprolide, GnRH (continuous

Question 310

Prostate adenocarcinoma

Answer 310

flutamide

Question 311

Pseudomonas aeruginosa

Answer 311

Antipseudomonal penicillins, aminoglycosides, carbapenems

Question 312

Pulmonary arterial hypertension (idiopathic)

Answer 312

Sildenafil, bosentan, epoprostenol

Question 313

Rickettsia rickettsii

Answer 313

Doxycycline, chloramphenicol

Question 314

Schizophrenia (negative symptoms)

Answer 314

Atypical antipsychotics

Question 315

Schizophrenia (positive symptoms)

Answer 315

Typical and atypical antipsychotics

Question 316

SIADH

Answer 316

Fluid restriction, IV hypertonic saline, conivaptan/tolvaptan,
demeclocycline

Question 317

Sickle cell disease

Answer 317

Hydroxyurea (increases fetal hemoglobin

Question 318

Sporothrix schenckii

Answer 318

Itraconazole, oral potassium iodide

Question 319

Stable angina

Answer 319

Sublingual nitroglycerin

Question 320

Staphylococcus aureus

Answer 320

MSSA: nafcillin, oxacillin, dicloxacillin (antistaphylococcal
penicillins); MRSA: vancomycin, daptomycin, linezolid,
ceftaroline

Question 321

Streptococcus bovis

Answer 321

Penicillin prophylaxis; evaluation for colon cancer if linked to
endocarditis

Question 322

Streptococcus pneumoniae

Answer 322

Penicillin/cephalosporin (systemic infection, pneumonia),

vancomycin (meningitis)

Question 323

Streptococcus pyogenes

Answer 323

Penicillin prophylaxis

Question 324

Temporal arteritis

Answer 324

High-dose steroids

Question 325

Tonic-clonic seizures

Answer 325

Levetiracetam, phenytoin, valproate, carbamazepine

Question 326

Toxoplasma gondii

Answer 326

Sulfadiazine + pyrimethamine

Question 327

Treponema pallidum

Answer 327

peniccilin

Question 328

Trichomonas vaginalis

Answer 328

Metronidazole (patient and partner

Question 329

Trigeminal neuralgia (tic douloureux)

Answer 329

Carbamazepine

Question 330

Ulcerative colitis

Answer 330

5-ASA preparations (eg, mesalamine), 6-mercaptopurine,

infliximab, colectomy

Question 331

UTI prophylaxis

Answer 331

TMP-SMX

Question 332

Warfarin reversal

Answer 332

Fresh frozen plasma (acute), vitamin K (non-acute)

Question 333

Actinic (solar) keratosis

Answer 333

Precursor to squamous cell carcinoma

Question 334

Acute gastric ulcer associated with CNS injury

Answer 334

Cushing ulcer (􀁱 intracranial pressure stimulates vagal gastric
H+ secretion)

Question 335

Acute gastric ulcer associated with severe burns

Answer 335

Curling ulcer (greatly reduced plasma volume results in
sloughing of gastric mucosa)

Question 336

Age ranges for patient with ALL/CLL/AML/CML

Answer 336

ALL: child, CLL: adult > 60, AML: adult ∼ 65, CML: adult

45–85

Question 337

Alternating areas of transmural inflammation and normal

colon

Answer 337

Skip lesions (Crohn disease)

Question 338

Aortic aneurysm, abdominal

Answer 338

Atherosclerosis

Question 339

Aortic aneurysm, ascending or arch

Answer 339

3° syphilis (syphilitic aortitis), vasa vasorum destruction

Question 340

Aortic aneurysm, thoracic

Answer 340

Marfan syndrome (idiopathic cystic medial degeneration)

Question 341

Aortic dissection

Answer 341

Hypertension

Question 342

Atrophy of the mammillary bodies

Answer 342

Wernicke encephalopathy (thiamine deficiency causing
ataxia, ophthalmoplegia, and confusion)

Question 343

Autosplenectomy (fibrosis and shrinkage)

Answer 343

Sickle cell disease (hemoglobin S)

Question 344

Bacteria associated with gastritis, peptic ulcer disease, and
gastric malignancies (eg, adenocarcinoma, MALToma)

Answer 344

H pylori

Question 345

Bacterial meningitis (adults and elderly)

Answer 345

S pneumoniae

Question 346

Bacterial meningitis (newborns and kids)

Answer 346

Group B streptococcus/E coli (newborns),

S pneumoniae/N meningitidis (kids/teens)

Question 347

Bilateral ovarian metastases from gastric carcinoma

Answer 347

Krukenberg tumor (mucin-secreting signet ring cells)

Question 348

Bleeding disorder with GpIb deficiency

Answer 348

Bernard-Soulier syndrome (defect in platelet adhesion to von

Willebrand factor)

Question 349

Brain tumor (adults)

Answer 349

Supratentorial: metastasis, astrocytoma (including

glioblastoma multiforme), meningioma, schwannoma

Question 350

Brain tumor (kids)

Answer 350

Infratentorial: medulloblastoma (cerebellum) or
supratentorial: craniopharyngioma

Question 351

Breast cancer

Answer 351

Invasive ductal carcinoma

Question 352

Breast mass

Answer 352

Fibrocystic change, carcinoma (in postmenopausal

women)

Question 353

Breast tumor (benign, young woman)

Answer 353

Fibroadenoma

Question 354

Cardiac 1° tumor (kids)

Answer 354

Rhabdomyoma, often seen in tuberous sclerosis

Question 355

Cardiac manifestation of lupus

Answer 355

Marantic/thrombotic endocarditis (nonbacterial)

Question 356

Cardiac tumor (adults)

Answer 356

Metastasis, myxoma (90% in left atrium; “ball and valve”)

Question 357

Cerebellar tonsillar herniation

Answer 357

Chiari II malformation

Question 358

Chronic arrhythmia

Answer 358

Atrial fibrillation (associated with high risk of emboli)

Question 359

Chronic atrophic gastritis (autoimmune)

Answer 359

Predisposition to gastric carcinoma (can also cause pernicious
anemia)

Question 360

Clear cell adenocarcinoma of the vagina

Answer 360

DES exposure in utero

Question 361

Congenital adrenal hyperplasia, hypotension

Answer 361

21-hydroxylase deficiency

Question 362

Congenital cardiac anomaly

Answer 362

VSD

Question 363

Congenital conjugated hyperbilirubinemia (black liver)

Answer 363

Dubin-Johnson syndrome (inability of hepatocytes to secrete

conjugated bilirubin into bile)

Question 364

Constrictive pericarditis

Answer 364

TB (developing world); idiopathic, viral illness (developed

world)

Question 365

Coronary artery involved in thrombosis

Answer 365

LAD > RCA > circumflex

Question 366

Cretinism

Answer 366

Iodine deficit/congenital hypothyroidism

Question 367

Cushing syndrome

Answer 367

• Iatrogenic (from corticosteroid therapy)
• Adrenocortical adenoma (secretes excess cortisol)
• ACTH-secreting pituitary adenoma (Cushing disease)
• Paraneoplastic (due to ACTH secretion by tumors

Question 368

Cyanosis (early; less common)

Answer 368

Tetralogy of Fallot, transposition of great vessels, truncus

arteriosus

Question 369

Death in CML

Answer 369

Blast crisis

Question 370

Death in SLE

Answer 370

Lupus nephropathy

Question 371

dementia

Answer 371

Alzheimer disease, multiple infarcts vascular dimentia

Question 372

Demyelinating disease in young women

Answer 372

Multiple sclerosis

Question 373

DIC

Answer 373

Severe sepsis, obstetric complications, cancer, burns, trauma,
major surgery, acute pancreatitis, APL

Question 374

Diverticulum in pharynx

Answer 374

Zenker diverticulum (diagnosed by barium swallow

Question 375

Ejection click

Answer 375

Aortic stenosis

Question 376

Esophageal cancer

Answer 376

Squamous cell carcinoma (worldwide); adenocarcinoma (US)

Question 377

Food poisoning (exotoxin mediated)

Answer 377

S aureus, B cereus

Question 378

Gastric cancer

Answer 378

Adenocarcinoma

intestinal vs diffuse type

Question 379

Glomerulonephritis (adults)

Answer 379

Berger disease (IgA nephropathy)

Question 380

Gynecologic malignancy

Answer 380

Endometrial carcinoma (most common in US); cervical
carcinoma (most common worldwide)

Question 381

Heart murmur, congenital

Answer 381

Mitral valve prolapse

Question 382

Heart valve in bacterial endocarditis

Answer 382

Mitral > aortic (rheumatic fever), tricuspid (IV drug

abuse)

Question 383

Helminth infection (US)

Answer 383

Enterobius vermicularis, Ascaris lumbricoides

Question 384

Hematoma—epidural

Answer 384

Rupture of middle meningeal artery (trauma; lentiform

shaped)

Question 385

Hematoma—subdural

Answer 385

Rupture of bridging veins (crescent shaped)

Question 386

Hemochromatosis

Answer 386

Multiple blood transfusions or hereditary HFE mutation
(can result in heart failure, “bronze diabetes,” and 􀁱 risk of
hepatocellular carcinoma)

Question 387

Hepatocellular carcinoma

Answer 387

Cirrhotic liver (associated with hepatitis B and C and with
alcoholism)

Question 388

Hereditary bleeding disorder

Answer 388

von Willebrand disease

Question 389

Hereditary harmless jaundice

Answer 389

Gilbert syndrome (benign congenital unconjugated
hyperbilirubinemia)

Question 390

HLA-B27

Answer 390

Psoriatic arthritis, ankylosing spondylitis, IBD-associated

arthritis, reactive arthritis (formerly Reiter syndrome)

Question 391

HLA-DR3

Answer 391

Diabetes mellitus type 1, SLE, Graves disease, Hashimoto

thyroiditis, Addison disease

Question 392

HLA-DR4

Answer 392

Diabetes mellitus type 1, rheumatoid arthritis, Addison

disease

Question 393

Holosystolic murmur

Answer 393

VSD, tricuspid regurgitation, mitral regurgitation

Question 394

Hypercoagulability, endothelial damage, blood stasis

Answer 394

Virchow triad (increased risk of thrombosis)

Question 395

Hypertension, 2°

Answer 395

Renal artery stenosis, chronic kidney disease (eg, polycystic
kidney disease, diabetic nephropathy), hyperaldosteronism

Question 396

Hypoparathyroidism

Answer 396

Accidental excision during thyroidectomy

Question 397

Hypopituitarism

Answer 397

Pituitary adenoma (usually benign tumor), sheehan syndrome, empty sella syndrome, pituitry apoplexy..

Question 398

Infection 2° to blood transfusion

Answer 398

Hepatitis C

Question 399

Infections in chronic granulomatous disease

Answer 399

S aureus, E coli, Aspergillus (catalase ⊕), candida, B cepacia…

Question 400

Intellectual disability

Answer 400

Down syndrome, fragile X syndrome

Question 401

Kidney stones

Answer 401

• Calcium = radiopaque
• Struvite (ammonium) = radiopaque (formed by urease
  ⊕ organisms such as Klebsiella, Proteus species, and
  S saprophyticus)
• Uric acid = radiolucent
• Cystine = radiolucent

Question 402

Late cyanotic shunt (uncorrected left to right becomes right

to left)

Answer 402

Eisenmenger syndrome (caused by ASD, VSD, PDA; results
in pulmonary hypertension/polycythemia)

Question 403

Liver disease

Answer 403

Alcoholic cirrhosis

Question 404

Lysosomal storage disease

Answer 404

Gaucher disease

Question 405

Male cancer

Answer 405

Prostatic carcinoma

Question 406

Malignancy associated with noninfectious fever

Answer 406

Hodgkin lymphoma

Question 407

Malignancy (kids)

Answer 407

ALL, medulloblastoma (cerebellum

Question 408

Metastases to bone

Answer 408

Prostate, breast > lung > thyroid

Question 409

Metastases to brain

Answer 409

Lung > breast > genitourinary > melanoma > GI

Question 410

Metastases to liver

Answer 410

Colon&raquo_space; stomach, pancreas

Question 411

Microcytic anemia

Answer 411

Iron deficiency

Question 412

Mitochondrial inheritance

Answer 412

Disease occurs in both males and females, inherited through

females only

Question 413

Mitral valve stenosis

Answer 413

Rheumatic heart disease

Question 414

Mixed (UMN and LMN) motor neuron disease

Answer 414

Amyotrophic lateral sclerosis

Question 415

Myocarditis

Answer 415

Coxsackie B

Question 416

Nephrotic syndrome (adults)

Answer 416

Focal segmental glomerulosclerosis

Question 417

Nephrotic syndrome (kids)

Answer 417

Minimal change disease

Question 418

Neuron migration failure

Answer 418

Kallmann syndrome (hypogonadotropic hypogonadism and
anosmia

Question 419

Nosocomial pneumonia

Answer 419

S aureus, Pseudomonas, other enteric gram ⊝ rods

Question 420

Obstruction of male urinary tract

Answer 420

BPH

Question 421

Opening snap

Answer 421

Mitral stenosis

Question 422

Opportunistic infection in AIDS

Answer 422

Pneumocystis jirovecii pneumonia

Question 423

Osteomyelitis

Answer 423

S aureus (most common overall)

Question 424

Osteomyelitis in sickle cell disease

Answer 424

Salmonella

Question 425

Osteomyelitis with IV drug use

Answer 425

Pseudomonas, Candida, S aureus

Question 426

Ovarian tumor (benign, bilateral)

Answer 426

Serous cystadenoma

Question 427

Pancreatitis (acute)

Answer 427

Gallstones, alcohol

Question 428

Pancreatitis (chronic)

Answer 428

Alcohol (adults), cystic fibrosis (kids)

Question 429

Pelvic inflammatory disease

Answer 429

C trachomatis, N gonorrhoeae

Question 430

Philadelphia chromosome t(9;22) (BCR-ABL)

Answer 430

CML (may sometimes be associated with ALL/AML)

Question 431

Pituitary tumor

Answer 431

Prolactinoma, somatotropic adenoma

Question 432

1° amenorrhea

Answer 432

Turner syndrome (45,XO or 45,XO/46,XX mosaic)

Question 433

1° bone tumor (adults)

Answer 433

Multiple myeloma

Question 434

1° hyperaldosteronism

Answer 434

Adenoma of adrenal cortex

Question 435

1° hyperparathyroidism

Answer 435

Adenomas, hyperplasia, carcinoma

Question 436

1° liver cancer

Answer 436

Hepatocellular carcinoma (chronic hepatitis, cirrhosis,
hemochromatosis, α1-antitrypsin deficiency, Wilson disease)

Question 437

Pulmonary hypertension

Answer 437

Idiopathic, heritable, left heart disease (eg, HF), lung disease
(eg, COPD), hypoxemic vasoconstriction (eg, OSA),
thromboembolic (eg, PE)

Question 438

Recurrent inflammation/thrombosis of small/medium vessels

in extremities

Answer 438

Buerger disease (strongly associated with tobacco)

Question 439

Refractory peptic ulcers and high gastrin levels

Answer 439

Zollinger-Ellison syndrome (gastrinoma of duodenum or

pancreas), associated with MEN1

Question 440

Renal tumor

Answer 440

Renal cell carcinoma: associated with von Hippel-Lindau and
cigarette smoking; paraneoplastic syndromes (EPO, renin,
PTHrP, ACTH)

Question 441

Right heart failure due to a pulmonary cause

Answer 441

Cor pulmonale

Question 442

S3 heart sound

Answer 442

increased ventricular filling pressure (eg, mitral regurgitation, HF),
common in dilated ventricles

Question 443

S4 heart sound

Answer 443

Stiff/hypertrophic ventricle (aortic stenosis, restrictive

cardiomyopathy)

Question 444

2° hyperparathyroidism

Answer 444

Hypocalcemia of chronic kidney disease

Question 445

Sexually transmitted disease

Answer 445

C trachomatis (usually coinfected with N gonorrhoeae)

Question 446

SIADH

Answer 446

Small cell carcinoma of the lung

Question 447

Site of diverticula

Answer 447

Sigmoid colon

Question 448

Sites of atherosclerosis

Answer 448

Abdominal aorta > coronary artery > popliteal artery

> carotid artery

Question 449

t(14;18)

Answer 449

Follicular lymphomas (BCL-2 activation, anti-apoptotic
oncogene)

Question 450

t(8;14)

Answer 450

Burkitt lymphoma (c-myc fusion, transcription factor
oncogene)

Question 451

t(9;22)

Answer 451

Philadelphia chromosome, CML (BCR-ABL activation,

tyrosine kinase oncogene)

Question 452

Temporal arteritis

Answer 452

Risk of ipsilateral blindness due to occlusion of ophthalmic

artery; polymyalgia rheumatica

Question 453

Testicular tumor

Answer 453

Seminoma (malignant, radiosensitive), increased placental ALP

Question 454

Thyroid cancer

Answer 454

Papillary carcinoma (childhood irradiation)

Question 455

Tumor in women

Answer 455

Leiomyoma (fibroids)(estrogen dependent, not precancerous)

Question 456

Tumor of infancy

Answer 456

Strawberry hemangioma (grows rapidly and regresses
spontaneously by childhood)

Question 457

Tumor of the adrenal medulla (adults)

Answer 457

Pheochromocytoma (usually benign)

Question 458

Tumor of the adrenal medulla (kids)

Answer 458

Neuroblastoma (malignant)

Question 459

Type of Hodgkin lymphoma

Answer 459

Nodular sclerosing (vs mixed cellularity, lymphocytic
predominance, lymphocytic depletion)

Question 460

Type of non-Hodgkin lymphoma

Answer 460

Diffuse large B-cell lymphoma

Question 461

UTI

Answer 461

E coli, Staphylococcus saprophyticus (young women)

Question 462

Vertebral compression fracture

Answer 462

Osteoporosis (type I: postmenopausal woman; type II: elderly

man or woman)

Question 463

Viral encephalitis affecting temporal lobe

Answer 463

HSV-1

Question 464

Vitamin deficiency (US)

Answer 464

Folate (pregnant women are at high risk; body stores only 3- to
4-month supply; prevents neural tube defects)

Question 465

congenital rubella

Answer 465

classic triad of eye (cataract), ear (deadness), and congenital heart disease (PDA, pulmonary stenosis.
blueberry muffin rash

Question 466

congenital CMV

Answer 466

hearing loss, seizures, petechial rash(blueberry muffin), periventricular calcifications.

Question 467

congenital syphilis

Answer 467

often results in stillbirth, hydrops fetalis, if child survives presents with facial (notched teeth, saddle nose, short maxilla), saber shins, CN VIII deafness

Question 468

sofosbuvir vs simepevir

Answer 468

both used for HCV. inhibits RNA dependent RNA Pol acting as chain terminator (NS5B) vs HCV protease inhibitor

Question 469

Infant of a diabetic mother

Answer 469

transposition of the great vessels, caudal regression syndrome

Question 470

williams syndome

Answer 470

microdeletion of long arm of chromosome 7. 
elfin facies
hypercalcemia
intellectual disability 
extreme friendliness to strangers
supravalvular aortic stenosis

Question 471

restrictive/infiltrative cardiomyopathy

Answer 471

sarcoidosis, amyloidosis, postradition fribrosis
endocardial fibroelastosis (thick fibroelastic tissue in endocardium of young children)
Loffler syndrome (endomyocardial fibrosis with a prominent eosinophilic infiltrate)

diastolic dysfunction ensues. can have a low voltage ECG despite thick myocardium

Question 472

Hypertrophic cardiomyopathy

Answer 472

hereditary cases involve beta-myosin heavy chain… can be associated with friedrich ataxia.

Question 473

golden cytoplasmic granules in macrophages that turn blue with prussian blue staining

Answer 473

hemosiderin laden macrophages

Question 474

IVDU with sudden pulmonary symptoms

Answer 474

bacterial endocarditis septic emboli from tricuspid valve into lung

Question 475

Pulmonary capillary wedge pressure in cardiogenic shock due to left heart failure vs right

Answer 475

in left PCWP is increased in right PCWP is decreased

Question 476

dystrophic calcification

Answer 476

considered a hallmark of cell injury and death occuring in all types of necrosis in the setting of normal calcium lvls

Question 477

cytokine involved in Giant cell (temporal) arteritis

Answer 477

IL-6 appears to closely correlate with the severity of the disease

Question 478

tocilizumab

Answer 478

IL-6 monoclonal antibody

Question 479

polyarteritis nodosa

Answer 479

typically involves renal and visceral vessels, not pul arteries
immune complex mediated
transmural inflammation of the arterial wall with fibrinoid necrosis
different stages of inflammation may coexist in different vessels.

Question 480

henoch schonlein purpura

Answer 480

most common childhood systemic vasculitis. 
often follows URI.
triad: 
skin-palpable purpura on buttocks/legs
arthralgias
GI:abdominal pain

Question 481

tesamorelin

Answer 481

GHRH analog used to treat HIV associated lipodistrophy

Question 482

fronto temporal dementia

Answer 482

early changes in personality and behavior or aphasia
may have associated movement disorders
frontal temporal lobe degeneration
inclusions of hyperphosphorylated tau or ubiquitinated TDP-43

Question 483

lewy body dementia

Answer 483

initially dementia and visual hallucinations followed by parkinsonian features
intracellular lewy bodies

Question 484

osmotic demyelination syndrome

Answer 484

massive axonal demyelination in pontine white matter. secondary to osmotic changes–> overly rapid correction of hyponatremia

Question 485

cerebral edema

Answer 485

correction of hypernatremia too quickly

Question 486

agents used to treat MS

Answer 486

glatiramer- mix of 4 amino acids which are antigenically similar to myelin basic protein
natalizumab- antibody against the alpha-4 subunit of intergrin molecules. limits adhesion and transmigration
IV corticosteroids.
baclofen-Gaba b receptor agonist for spasticity.

Question 487

acute disseminated (postinfectious) encephalomyelitis

Answer 487

multifocal periventricular inflammation and demyelination after infection or vaccination. presents with rapidly progressive multifocal neurologic symptoms, AMS.

Question 488

Charcot marie tooth disease (heriditary motor and sensory neuropathy)

Answer 488

defective production in the proteins involved in the structure and function of peripheral nerves or the myelin sheath.
autosomal dominant
associated with foot deformities (pes cavus), lower extremity weakness and sensory deficits.

Question 489

natalizumab and rituximmab increase risk of

Answer 489

Progressive multifocal leukoencephalopathy

Question 490

adrenoleukodystrophy

Answer 490

X-linked genetic disorder typically affecting males. disrupts metabolism of very long fatty acids–> excessive buildup in nervous system adrenal glands testes. progressive disease that can lead to longterm coma/death and adrenal crisis

Question 491

tuberous sclerosis

Answer 491

harmatomas of in CNS and skin
angiofibromas
mitral regurg
ash leaf spots
rhabdomyoma
autosomal dominant
mental retardation
renal angiolipomas
seizures and shagreen patches 
increased incidence of subependymal astrocytomas and ungual fibromas.

Question 492

neurofibromin

Answer 492

negative regulator of RAS. mutated in NF-1

chromosome 17

Question 493

von hippel lindau disease

Answer 493

hemangioblastomas
angiomatosis
bilateral RCCs
pheochromocytomas.

Question 494

middle cerebral artery

Answer 494

contralateral paralysis and sensory loss- face and upper limb
aphasia if in dominant (usually left) hemisphere.
hemineglect if in non dominant.

Question 495

anterior cerebral artery

Answer 495

contralateral sensory loss lower limb.

also most common location for a berry aneurysm in the CNS is at intersection with Acomm can lead to bitemporal hemianopsia

Question 496

lenticulostriate artery

Answer 496

contralateral paralysis and or sensory loss- face and body.
absence of cortical signs
common location of lacunar infarcts, secondary to unmanaged HTN.

Question 497

anterior spinal artery

Answer 497

contralateral paralysis of upper and lower limbs.
decreased contralateral proprioception
ipsilateral hypoglossal dysfunction (tongue deviates ipsilaterally)
medial medullary syndrome

Question 498

Posterior inferior cerebellar artery

Answer 498

vomiting, vertigo nystagmus (vestibular nuclei)
decreased pain and temperature sensation from ipsilateral face and contralateral body
dysphagia, hoarseness and decreased gag reflex
ipsilateral horner syndrome
ataxia dysmetria
nucleus ambiguus effects are specific to PICA lesions.

Question 499

anterior inferior cerebellar artery

Answer 499

vomiting vertigo nystagmus
paralysis of face, decreased lacrimation, salivation and decreased taste from anterior 2/3s of mouth
ipsilateral decrease in pain and temp of the face, contralateral decreased pain and temp of the body
ataxia dysmetria
facial droop means AICAs pooped

Question 500

basillar artery

Answer 500

locked in syndrome
preserved conciousness, vertical eye movement, blinking,
quadraplegia, loss of voluntary facial, mouth, and tongue movements.
reticular formation is spared

Question 501

central post stroke pain syndrome

Answer 501

neuropathic pain due to thalamic lesions. initial paresthesias followed in weeks to months by allodynia.

Question 502

lacunar infarctions

Answer 502

result of small vessel occlusion (due to lipohyalinosis and microatheroma formation) in the penetrating vessels supplying the deep brain structures.

Question 503

neonatal interventricular hemorrhage

Answer 503

usually occurs in the fragile germinal matrix

Question 504

prevent vasospasm 4-10 after SAH with

Answer 504

nimodipine

Question 505

red neurons

Answer 505

12-48 hours after ischemic event

Question 506

necrosis + neutrophils in brain matter

Answer 506

24-72 hrs post ischemic event

Question 507

macrophages in brain post ichemic event

Answer 507

3-6 days

Question 508

reactive gliosis + vascular proliferation timeline

Answer 508

1-2 weeks. closer to 2 weeks.

Question 509

risk factors for idiopathic intracranial HTN (psuedotumor cerebri)

Answer 509

woman of childbearing age, Vitamin A excess, danazol and tetracycline

Question 510

Liposarcoma

Answer 510

soft tissue malignancy. contain numerous lipoblasts, which are cells that produce non membrane bound cytoplasmic lipid. this well demarcated lipid shifts within the cell causing nuclear indentation and scalloping of the nuclear membrane.

Question 511

Meckel diverticulum

Answer 511

derived from the omphalomesenteric (vitelline) duct which connects the midgut to yolk sac
most common congenital abnormality of the small intestine.
heterotopic gastric mucosa or pancreatic tissue may be seen .
anemia can occur due to brisk but painless lower GI bleeding.
complications such as volvulus, intussusception or obstruction can occur which would be painful

Question 512

volvulus

Answer 512

presents with billious emesus, abdominal pain, and bloody stools.
increased incidence in people with malrotation

Question 513

intussusception

Answer 513

the proximal portion of the bowel telescopes into the distal portion. may present with severe intermittent abdominal pain, vomiting, bloody stools and palpable abdominal mass.

Question 514

lynch syndrome

Answer 514

Genes: MSH2, MLH1, MSH6, and PMS2

associated neoplasms: colorectal cancer, endometrial cancer, ovarian cancer

Question 515

Familial adenomatous polyposis

Answer 515

gene: APC

associated neoplasms: colorectal cancer, desmoids and osteomas, brain tumors

Question 516

Li fraumeni syndrome

Answer 516

Sarcomas 
breast cancer 
brain tumors 
adrenocortical carcinoma 
leukemia

Question 517

Calcineurin inhibitors

Answer 517

tacrolimus and cyclosporine.
cause nephrotoxicity that is dose related and manifests as a rise in serum BUN and creatinine levels as well as increased BP
the above is thought to be a result of afferent and efferent arteriolar vasoconstriction leading to systemic HTN. and long term use can also lead to obliterative vasculopathy, tubular vacuolization and glomerular scarring

Question 518

Tamm-horsfall glycoprotein

Answer 518

exclusively secreted by renal tubular epithelial cells of the ascending limb of the loop of henle.

Question 519

foam stability test

Answer 519

index evaluates surfactant functionality.
or
lecithin:sphingomyelin ratio >2

Question 520

Marfan syndrome

Answer 520

autosomal dominant
normal intellect
aortic root dilation
upward lens dislocation

Question 521

homocystinuria

Answer 521

Autosomal recessive
intellectual disability
thrombosis
downward lens dislocation
megaloblastic anemia
fair complexion

Question 522

heparin vs warfarin use in pregnancy

Answer 522

heparin is more water soluble.

Question 523

Bowel epithelial stem cells are located in

Answer 523

crypts of lieberkuhn.

Question 524

spherical nodues within the confines of sibrous septa in liver cirrhosis

Answer 524

regenerative spherical nodules of proliferating hepatocytes.

Question 525

stellate (ito) cells

Answer 525

store vitamin A and support the sinusoids. can differentiate into a myofibroblast upon injiry to the liver and plays a large role in the production of fibrosis in cirrhosis

Question 526

cystic hygromas

Answer 526

commonly associated with chromosomal aneuploidy. manifest as soft, compressible masses that transilluminate. they are most commonly found on the head and neck and typically on the left side.

Question 527

Musculoskeletal causes of lower back pain.

Answer 527

Mechanical (muscel strain)-normal neuro exam and paraspinal tenderness
radiculopathy- radiation below the knee, positive straight leg raise, neuro deficits.
spinal stenosis- psuedoclaudication relieved by leaning forward.(old man leaning on shopping cart or stroller)
compression fracture- osteoporosis

Question 528

Malignant causes of lower back pain

Answer 528

metastatic cancer - age > 50
worse at night.
not relieved with stress

Question 529

infectious causes of lower back pain

Answer 529

osteomyelitis, discitis, abscess- recent infection or IVDU

fever spine tenderness

Question 530

tardive kinesis

Answer 530

commonly associated with long term use of first generation antipsychotic meds.
involuntary movements include rhythmic movements of the face, lips, and tongue.
mechanism is believed to be upregulation of postsynaptic dopamine receptors due to longterm blockade leading to supersensitivity.

Question 531

saddle pulmonary embolus central venous pressure, cardiac output and SVR

Answer 531

increase in CVP, decrease in CO and increase SVR

Question 532

xerosis

Answer 532

itchy rash and dry cracked skin.common in older patients during the winter months when indoor heaters lower the relative humidity of the ambient air.
these patients usually have defects in the stratum corneum permeability barrier.

Question 533

Cough syncope

Answer 533

typically occurs in overweight overweight male patients with COPD.
increased intrathoracic pressure during a coughing episode decreases venous return to the heart thereby transiently decreasing cardiac outputand cerebral perfusion.

Question 534

composition of fleshy skin nodules in NF-1 aka neurofibromas

Answer 534

schwann cells.

the nodules are known as neuro fibromas

Question 535

primary ovarian insufficiency

Answer 535

amenorrhea in women age <40 with eevated gonadotropins (FSH) and low estrogen levels. the pathophysiology is likely inadequate supply of ovarian follicles or a premature depletion of these follicles.
–apoptosis

Question 536

agglutination inhibition reactions

Answer 536

competition between soluble antigens and particle affixed antigens for antibody binding sites.

Question 537

complications of stent placement

Answer 537

scute stent thrombosis and restonosis due to intimal hyperplasia.
drug coated stents have reduced both of these complications. paclitaxel for intimal hyperplasia.

Question 538

Ornithine transcarbamyolase deficiency

Answer 538

result in accumalation of carbomyl phosphate which is converted to orotic acid by the pyrimidine biosynthetic pathway and congenital hyperammonemia

Question 539

Carbamoyl phosphate I synthetase deficiency

Answer 539

severe hyperammonemia and neurological damage.

Question 540

endocrine hormones that increase cAMP

Answer 540

FLAT ChAMP:
FSH, LH, ACTH, TSH, CRH, hCH, ADH(V2 receptor), MSH, PTH,
calcitonin, GHRH

Question 541

endocrine hormones that increase IP3

Answer 541

GOAT HAG:

GnRH, oxytocin, ADH (V1), TRH, Histamine (H1), angiotensin II, Gastrin

Question 542

endocrine hormones that activate nonreceptor tyrosine kinase

Answer 542

PIGGLET

prolactin, immunomodulators (cytokines), GH, G-CSF, erythropoeitin, and thrombopoetin

Question 543

primary vs secondary/tertiary adrenal insufficiency cortisol and ACTH levels

Answer 543

primary decreased cortisol and increased ACTH

secondary decreased cortisol and ACTH.

Question 544

primary adrenal insufficiency

Answer 544

hypotension (hyponatremic volume contraction), hyperkalemia, metabolic acidosis skin and mucosal hyperpigmentation .

Question 545

secondary adrenal insufficiency

Answer 545

decreased pituitary ACTH production, no skin/mucousal hyperpigmentation, no hyperkalemia (aldosterone synthesis preserved).

Question 546

tertiary adrenal insufficiency

Answer 546

seen in patients with chronic exogenous steroid use; precipitated by abrupt withdrawal. aldosterone synthesis unaffected.

Question 547

hyperaldosteronism clinical features

Answer 547

HTN, decreased or normal K+, metabolic alkalosis, (no edema due to aldosterone escape mechanism).

Question 548

neuroblastoma

Answer 548

most common tumor of the adrenal medulla in children
originates from neural crest cells.
presents as abdominal distention and a firm, irregular mass that can cross the midline
can present with opsoclonus myoclonus syndrome
increase HVA and VMA in urine,
homer wright rossettes
bombesin and NSE positive.
associated with over expression of N-myc.

Question 549

riedel thyroiditis

Answer 549

thyroid replaced by fibrous tissue with inflammatory infiltrate. fibrosis may extend into local structures mimicking anaplastic carcinoma.
1/3 are hypothyroid.
considered a manifestation of IgG4 related systemic disease (autoimmune pancreatitis, retroperitoneal fibrosis, nininfectious aortitis)
fixed hard painles goiter

Question 550

infiltrative opthalmpathy

Answer 550

edema and infiltration of lymocytes into the extraocular muscles and connective tissue. retroorbial fibroblaasts thatn stimulated by cytokines

Question 551

Jod basedow phenomenom

Answer 551

thyrotoxicosis if a patient with iodine deficiency becomes iodine replete

Question 552

associations of thyroid cancers:
papillary
follicular
medullary

Answer 552

papillary- orphan annie eyes and increased risk with RET and BRAF mutations.
follicular- uniform follicles. hematogenous spread common Ras mutations
medullary- sheets of cells in amyloid stroma. MEN2a and 2b.

Question 553

psuedohypoparathyroidism

Answer 553

albright hereditary osteodystrophy.
unresponsive kidney to PTH.
defective Gs protein alpha subunit
short stature and sortened 4th and 5th digits.

Question 554

brown bown tumor in osteitis fibrosa cystica consists of

Answer 554

osteoclasts and deposited hemosiderin from hemorrhages.

Question 555

glucagonoma

Answer 555

tumor of pancreatic alpha cells. presents with dermatitis (necrolytic migratory erythema), diabetes, DVT, declining weight, depression

Question 556

carcinoid syndrome

Answer 556

neuroendocrine cells. prominent rossettes.
secrete serotonin.
if mets to liver results in diarrhea, cutaneous flushing, asthmatic wheezing, right sided valvular heart disease (tricuspid regurg, pulm stenosis)
increased 5-HIAA in urine, niacin deficiency

Question 557

alpha 1 receptors

Answer 557

act through Gq.
increase vascular smooth muscle contraction
increase pupillary dilator muscle contraction (mydriasis), increase intestinal and bladder sphincter muscle contraction.

Question 558

alpha 2

Answer 558

act through Gi. 
decrease sympathetic (adrenergic) outflow
decrease insulin release
decrease lipolysis
increase platelet aggregation
decrease acqueous humor production

Question 559

beta 1

Answer 559

act through Gs
increase heart rate
increase contractility
increase renin release 
increase lipolysis

Question 560

beta 2

Answer 560

act through Gs
vasodilation
bronchodilation
increase lipolysis
increase insulin release
decrease uterine tone (tocolysis)
ciliary muscle relaxation
increase aqueous humor production

Question 561

beta 3

Answer 561

acts through Gs
increase lipolysis.
increase thermogenesis in skeletal muscle.

Question 562

M1

Answer 562

Gq

CNS, enteric Nervous system

Question 563

M2

Answer 563

Gi

decrease heart rate and contractility of atria.

Question 564

M3

Answer 564

Gq
increase exocrine gland secretions (lacrimal, sweat, salivary, gastric acid), increase gut peristalsis, increase bladder contraction, bronchoconstriction, increase pupillary sphincter muscle contraction (miosis), ciliary muscle contraction.

Question 565

D1

Answer 565

Gs

relaxes renal vascular smooth muscle

Question 566

D2

Answer 566

Gi

modulates transmitter release, especially in brain

Question 567

H1

Answer 567

Gq
increases nasal and bronchial mucus production
increases vascular permeability

Question 568

H2

Answer 568

Gs

increases gastric acid secretion

Question 569

V1

Answer 569

Gq

increases vascular smooth muscle contraction

Question 570

V2

Answer 570

increases h20 permeability and reabsorption in collecting tubules of kidney (V2 is found in the 2 kidneys).

Question 571

heterochromatin

Answer 571

condensed. appears darker in EM,
transcriptionally inactive
sterically in accesible
barr bodies. 
heterochromatin=highly condensed

Question 572

euchromatin

Answer 572

less condensed. transcriptionally active

Question 573

Telomerase

Answer 573

reverse transcriptase (RNA dependent) tha to the 3’end. it lengthens telemores by adding TTAGGG

Question 574

purines vs pyrimidines

Answer 574

purines 2 rings. pyrimidine 2 rings.
deamination of cytosine makes uracil
thymidine has a methyl

Question 575

disrupt pyrimidine synthesis

Answer 575

leflunomide, MTX, trimethoprim, pyrimethamine and 5-Fu

Question 576

dusrupt purine synthesis

Answer 576

6-MP, mycophenolate and ribavirin

Question 577

stop codons

Answer 577

UGA
UAG
UAA

Question 578

start codon

Answer 578

AUG. is methionine.

Question 579

nucleotide excision repair.

Answer 579

repair pyrimidine dimers.
endonuclease release oligonucleotides and DNA polymerase and ligase fill and reseal the gap
predominantly occurs in G1

Question 580

base excision repair

Answer 580

important in repair of spontaneous/toxic deamination
base specific glycosylase removes altered base. AP endonucleus and lyase cleave 5’ and 3’ sides respectively. DNA pol beta fills in gap and DNA ligase seals it
occurs throughout cell cycle.

Question 581

Mismatch match repair

Answer 581

occurs predominantlyin G2

Question 582

RNA pol I
RNA pol II
RNA pol III

Answer 582

rRNA
mRNA
tRNA and 5s rRNA.

Question 583

alpha amantin

Answer 583

found in amnita phalloides (death cap mushrooms). inhibits RNA pol II.
causes severe hepatotoxicity if ingested.

Question 584

Actinomycin D

Answer 584

inhibits RNA pol in both prokaryotes and eukaryotes

Question 585

anti-U1 RNP antibodies

Answer 585

mixed connective tissue disease

Question 586

intron splice sites

Answer 586

5’ GU 3’AG

Question 587

microRNAs

Answer 587

small, noncoding RNA molecules that post transcriptionally regulate protein expression. introns can contain miRNAs

Question 588

energy use in tRNA charging vs translocation in protein synthesis

Answer 588

ATP in tRNA charging and GTP in protein translation

Question 589

what catalyzes the peptide bond in the ribosome between amino acids

Answer 589

ribozyme

Question 590

shortest phase of the cell cycle

Answer 590

M phase.

Question 591

signal recognition particle

Answer 591

abundant cytosolic ribonucleoprotein that traffics from the ribosome to the RER. absent or dysfunctional SRP–> proteins accumalate in the cytosol.

Question 592

microfilaments

Answer 592

muscle contraction cytokinesis

actin microvilli

Question 593

intermediate filaments

Answer 593

maintain cell structure

i.e vimentin, desmin, cytokeratin, lamins, glial fibrillary acid proteins, neurofilaments.

Question 594

microtubules

Answer 594

movement. cell division.

Question 595

oubain

Answer 595

inhibits binding to K+ site on Na+/K+ atpase

Question 596

type 1 collagen

Answer 596

bone, skin, tendon, dentin, cornea, late wound repair.

decreased production in osteogenesis imperfecta type I

Question 597

type II collagen

Answer 597

cartilage, vitreous body, nucleus pulpus.

Question 598

type III collagen

Answer 598

reticulin- skin, blood vessels, uterus, fetal tissue, granulation tissue
deficient in the uncommon vascular type ehlors danlos

Question 599

type Iv collagen

Answer 599

basement membrane, basal lamina, and lens
defective in alport syndrome
autoantibodies in good pasture.

Question 600

requirements and defects in the hydroxylation, glycosylation and cross linking of collagen

Answer 600

hydroxylation- requires vitamin C (deficiency leads to scurvy)
glycosylation- formation of procollagen via hydrogen and disulfide bonds (triple helix of 3 collagen alpha chains)
problems forming triple helix osteogensis imperfecta.
cross linking- reinforcement of many staggered tropocollagen molecules by covalent lysine-hydroxylysine cross linkage. (by copper containing lysyl oxidase) problems lead to ehlers danlos and menkes disease

Question 601

blue sclarae, hearing loss and multiple fractures.

Answer 601

osteogensis imperfecta
COLA1 and COLA2
autosomal dominant most common.
bone matrix formation issue

Question 602

pleiotropy

Answer 602

one gene contributes to multiple phenotypic effects.

Question 603

uniparenty disomy: hetero disomy vs isodisomy

Answer 603

hetero implies miosis one defect

iso meiosis II

Question 604

myotonia, muscle wasting, cataracts, frontal balding, testicular atrophy and arrhythmias

Answer 604

autosomal dominant myotonic type 1 CTG repeat

Question 605

trinucleotide repeast expansion diseases

Answer 605

fragile X CGG (methylation leads to decreased expression; X linked dominant)
huntington chromosome 4 CAG repeats
myotonc type 1 CTG repeats
friedrichs ataxia GAA

Question 606

rate limiting enzyme of fatty acid synthesis

Answer 606

acetyl coA carboxylase
regulators include insulin and citrate positively
glucagon and palmitoyl coa negatively

Question 607

rate limiting enzyme of de novo purne synthesis

Answer 607

glutamine phosphoribosylpyrophospahte

negative regulators are AMP, IMP and GMP.

Question 608

rate limiting enzyme of denovo pyrimidine synthesis

Answer 608

carbamoyl phosphate synthetase II.

regulators ATP and PRPP positively and UTP negatively.

Question 609

dysplastic nevus syndrome

Answer 609

manifests w numerous dysplastic nevi in a young person who has a family history of melanoma in more than 3 first degree relatives. this syndrome is associated w/ mutations in the CDKN2A gene on chromosome 9p21

Question 610

fetal alcohol syndrome leads to congenital defects by

Answer 610

failure of cell migration

Question 611

monozygotic identical twins cleavage timeline:
0-4 days
4-8 days
8-12 days
>13 days

Answer 611

dichorionic diamniotic
monochorionic diaminiotic
monochorionic monoamniotic
monochorionic monoamniotic conjoined.

Question 612

Syncytiotrophoblast

Answer 612

synthesizes hormones

lacks MHC-I expression-decreases chance of attack by maternal immune system.

Question 613

single umbilical artery

Answer 613

associated with congenital and chromosomal anomalies.

Question 614

umbilical arteries and veins are derived from

Answer 614

allantois.

Question 615

urachus

Answer 615

is derived from the yolk sac. isa connection between the bladder and the umbilicus
if patent can lead to pee coming out the umbilicus.
partial failure–> fluid filled cavity lined with urothelium can lead to infection and adnocarcinoma.

Question 616

4th aortic arch derivative

Answer 616

on left aortic arch. on right proximal part of subclavian artery.

Question 617

6th aortic arch derivative

Answer 617

proximal part of pulmonary arteries and ductus arteriosus.

Question 618

branchial clefts/grooves.

Answer 618

dervied from ectoderm.
1st cleft develops into external auditory meatus.
2nd-4th clefts form temporary vervical sinuses, which are obliterated by proliferation of 2nd arch mesenchyme.
if 2-4 persis leads to a branchial cleft cysts on lateral neck anterior to SCM.

Question 619

pierre robin sequence

Answer 619

micrognathia, glossoptosis, cleft palate, airway obstruction.

Question 620

Treacher collins syndrome

Answer 620

neural crest dysfunction –> mandibular hypoplasia, facial abnormalities.

Question 621

brachial arch derivatives

Answer 621

refer to page 569
chew 
smile
smile
stylishly swallow
simply swallow 
speak

Question 622

3rd branchial pouch

Answer 622

dorsal wings–> inferior parathyroids

ventral wings–> thymus

Question 623

4th branchial pouch

Answer 623

dorsal wings–> superior parathyroids

ventral wings–> ultimobranchial body–> parafollicular (C) cells of thyroid.

Question 624

default development of an embryo

Answer 624

mesonephric duct degenerates and paramesonephric duct develops.

Question 625

mullerian inhibitory factor

Answer 625

secreted by serotoli cells and suppresses the development of the paramesonephric duct

Question 626

paramesonephric duct

Answer 626

develops into female internal structures-fallopian tubes, uterus, upper portion of vagina.

Question 627

primary amenorrhea in females with fully developed secondary sexual characteristics

Answer 627

mullerian agenesis (mayer-rokitansky-kuster-hauser syndrome)

Question 628

mesonephric duct

Answer 628

develops into SEED–> seminal vesicle, epididymis, ejaculatory duct, ductus deferens

Question 629

no serotoli cells or lack of mullerian inhibitory factor?

Answer 629

develop both male and female internal genitalia and male external genitalia.

Question 630

genital turbercle

Answer 630

glans penis and corpus cavernosum and spongiosum in males.

glans clitorus and vestibular bulbs in females

Question 631

urogenital sinus

Answer 631

bulbouretheral glands of cowper and prostate gland in males

and greater vestibular glands and urethral and paraurethral glands in females.

Question 632

urogenital folds

Answer 632

ventral shaft of penis in males

labia minora in females

Question 633

hypo spadia vs epi spadia

Answer 633

hypo- failure of urethral folds to fuse

epi faulty positioning of genital tubercle.

Question 634

gubernaculum

Answer 634

band of fibrous tissue
in males anchors testes within scrotum
in females it is the ovarian ligament + the round ligament of uterus

Question 635

body of uterus/cervix and superior bladder drain to

Answer 635

external iliac nodes

Question 636

glans penis drains to

Answer 636

deep inguinal nodes

Question 637

infundibulopelvic ligament (suspensory ligament of the ovary)

Answer 637

connects ovaries to the lateral pelvic wall

contains the ovarian vessels

Question 638

cardinal ligament

Answer 638

connects the cervix to side wall of pelvis
contains the uterine vessels.
ureter at risk of injury during ligation of uterine vessels in hysterectomy

Question 639

round ligament of the uterus

Answer 639

uterus fundus to the labia majora.
travels through the round inguinal canal.
above the artery of sampson.

Question 640

ovarian ligament

Answer 640

medial pole of ovary to lateral uterus.

Question 641

pelvic fracture

Answer 641

membranous urethra prone to injury

urine to leak into retropubic space

Question 642

perineal straddle injury

Answer 642

bulbar and penile urethra at risk

cause urine to leak beneath deep fascia of buck. if torn urine leaks into superficial perineal space

Question 643

male sex response

Answer 643

erection - parasympathetic
emission- sympathetic (hypogastric nerve)
ejaculation-(pudendal nerve)
the internal urethral sphincter contracts during ejaculation to prevent retrograde flow of semen from the urethra to the bladder.

Question 644

serotoli secretion of androgen binding protein

Answer 644

maintains local levels of testosterone.

Question 645

estrogen

Answer 645

increases transport proteins, SHBG, increases HDL, decreases LDL.

Question 646

oogensis arrest ohases

Answer 646

arrested in meiosis I prophase I until ovulation

arrested in meiosis II metaphase II until fertilization.

Question 647

low birth weight complications

Answer 647

increased risk of SIDS
complications include respiratory distress syndrome, necrotizing enterocolitis, interventricular hemorrhage, and persistant fetal circulation

Question 648

menopause

Answer 648

diagnosed by amenorrea for atleast 12 months.
increased FSH
causes hot flashes, atrophy of the vagina, osteoporosis, coronary artery disease, sleep disturbances

Question 649

spermiogenesis

Answer 649

spermatids loss of cytoplasmic contents and gain of acrosomal caps.

Question 650

severe acne, very tall, learning disabilities, autism spectrum disorders.

Answer 650

xyy

Question 651

Kallman syndrome

Answer 651

failure to complete puberty; defective migration of GnRH cells and formation of olfactory bulb. anosmia.
decreased GnRH, FSH, Lh, testosterone.
color blindness.

Question 652

vasa previa triad

Answer 652

membrane rupture, painless vaginal bleeding, and fetal bradycardia.

Question 653

congenital torticollis

Answer 653

typically develops by 2-4 weeks of age
caused by birth trauma or mal position of the head in utero
may include hip dysplasia, metatarsus aductus, and talepes equinovarus

Question 654

congenital torticollis

Answer 654

typically develops by 2-4 weeks of age
caused by birth trauma or mal position of the head in utero
may include hip dysplasia, metatarsus aductus, and talepes equinovarus

Question 655

phsophofructokinase

Answer 655

rate limiting step of glycolysis
AMP and fructose-2,6-bisphosphate postive regulators
ATP and citrate negative regulators.

Question 656

pyruvate kinase

Answer 656

PEP–> to pyruvate
fructose-1,6-BP postive regulator
ATP and alanine negative regulators

Question 657

neurologic defects, lactic acidosis, increase serum alanine starting infancy

Answer 657

pyruvate dehrodrogenase deficiency
X-Linked.
increase intake of ketogenic nutrients lysine and leucine.

Question 658

pyruvate carboxylase

Answer 658

in mitochondria.
pyruvate to oxaloacetate
requires biotin and ATP. activated by acetyl CoA

Question 659

PEP carboxykinase

Answer 659

in cytosol.
oxaloacetate to PEP.
requires GTP

Question 660

propionyl coa

Answer 660

generated from odd chain fatty acids and can enter TCA as succinyl CoA, undergo gluconeogenesis, and serve as a glucose source.

Question 661

arginine and histidine are required during

Answer 661

periods of growth

Question 662

treatment of hyperammonemia

Answer 662

lactulose to acidify the GI tract and trap NH4+ for excretion.
rifaximin to decrease colonic ammoniagenic bacteria
benzoate, phenylacetate, or phenylbututyrate to bund NH4+ and lead to excretion

Question 663

glycine derivatives

Answer 663

–>porphyrin–>heme

Question 664

arginine derivatives

Answer 664

creatinine, urea, and nitric oxide

Question 665

maple syrup urine disease

Answer 665

blocked degradation of branched amino acids (Isoleucine, Leucine, Valine) due to decreased branched chain alpha ketoacid dehydrogenase
piss smells like burnt sugar
treatment restriction on branched amino acids and thiamine supplementation.

Question 666

episodic peripheral neuropathy, angiokeratomas, hypohidrosis. late progressive renal failure and cardiovascular problems

Answer 666

fabry disease XR
deficient alpha galactosidase
accumulation of ceramide trihexoside (globotriacyl ceramide)

Question 667

progressive neurodegeneration, hepatpsplenomegaly, foam cells and cherry spot on macula

Answer 667

niemann pick disease AR
deficient sphingomyelinase
accumulation of sphingomyelin

Question 668

progressive neurodegeneration, developmental delay, cherry spot on macula, lysosomes w onion skin

Answer 668

tay-sachs disease AR
hexosamindase A deficiency
GM2-ganglioside accumalation

Question 669

peripheral neuropathy, developmental delay, optic atrophy, globoid cells.

Answer 669

Krabbe disease AR
deficiency of galactocerebrosidase
galactocerebroside and psychosine accumalation

Question 670

hurler syndrome

Answer 670

developmental delay, gargoylism, airway obstruction, corneal clouding, hepatosplenomegaly.
deficient alpha L iduronidase
accumalation of heparin sulfate and dermatan sulfate

Question 671

systemic primary carnitine deficiency

Answer 671

inherited defect in transport of LCFAs into mitochondra

causes hypotonia, weakness and hypoketotic hypoglycemia.

Question 672

carnitine acetyl transferase

Answer 672

inhibited by malonyl CoA

Question 673

medium chain acyl CoA dehydrogenase deficiency

Answer 673

autosomal recessive
accumalation of 8-10 carbon fatty acyl carnitines in the blood and hypoketotic hypoglycemia.
present in early infancy as lethargy, seizures, coma, and liver dysfunction.
acetyl coA dehydrogenase.

Question 674

triad of coombs (-) hemolytic anemia, pancytopenia, and venous thrombosis

Answer 674

paroxysmal nocturnal hemoglobinuria. 
treatment ecilizumab (terminal complement inhibitor)

Question 675

Diamond blackfan anemia

Answer 675

rapid onset anemia within 1st year of life due to intrinsic defect in erythroid progenitor cells
short stature, cranio facial abnormalaties, and upper extremity malformations (triphalangeal thumbs)

Question 676

achondroplasia

Answer 676

FGFR3 mutation (constitutive activation which inhibits chondrocyte proliferation).
autosomal dominant
problem with endochondrial ossification leading to shortened limbs and normal sized head.

Question 677

thickened dense bones prone to fracture.

Answer 677

failure of normal bone resorption due to defective osteoclasts–> thickened dense bones that are prone to fracture.
bone fills marrow space –> pancytopenia, extramedullary hematopoeisis
carbonic anyhydrase II mutations can be seen.–> impair ability of osteoclast to generate acidic environment necessary for bone resorption
cranial nerve impingement and palsies as a result of narrowed foramina.
bone marrow transplant potentially curative

Question 678

Pagets disease of bone

Answer 678

caused by increase osteoclastic activity followed by increased osteoblastic activity that forms poor quality bone.
serum calcium, phosphorus and PTH lvls normal ALP increased.
mosaic pattern of woven and lamellar bone.
increased blood flow from increased arteriovenous shunt formation may cause high output cardiac failure
increased risk of osteogenic sarcoma.
increase hat size
hearing loss

Question 679

osetonecrosis causes

Answer 679

corticosteroids, alcoholism, sickle cell disease, Trauma, the Bends (caisson/decompression disease), Legg-Calve perthes disease, Gaucher disease, slipped capital femoral epiphysis.

Question 680

osteoma

Answer 680

benign tumor of bone aries on surface of facial bones. associated with gardner syndrome (FAP+osteoma)

Question 681

osteoid osteoma

Answer 681

benign tumor of osteoblasts (produce osteoid) surrounded by rim of reactive bone ; bone pain that resolves with aspirin. bony mass less than 2 CM on imaging

Question 682

osteoblastoma

Answer 682

similar to an osteoid osteoma but on vertebrae and larger than 2 CM and does not respond to aspirin.

Question 683

Chondroma

Answer 683

benign tumor of cartilage. arises in medulla of small bones of hands and feet.
olliers syndrome and maffuci’s syndrome.

Question 684

lichen sclerosis

Answer 684

thinning of epidermis and fibrosis of dermis. leukoplakia with parchment like vulvar skin.
most commonly seen in postmenopausal women.
associated with slightly increased risk of SCC

Question 685

risk factors for CIN

Answer 685

multiple sexual partners, smoking, starting sexual intercourse at a young age, HIV infection (immunodeficiency)

Question 686

PCOS

Answer 686

hyperinsulenemia and or insulin resistance.
increased LH:FSH ratio
anovulation
enlarged bilateral cystic ovaries
amenorrhea/oligorrhea, hirsutism acne, decreased fertility. associated with obesity
increased risk of endometrial cancer.

Question 687

follicular cyst

Answer 687

distention of unruptured graafian follicle.
may be associated with hyperestrogenism, endometrial hyperplasi.
most common ovarian mass in young women.

Question 688

ovarian neoplasm risk factors

Answer 688

advanced age, infertility, endometriosis, PCOS, genetic predisposition.

Question 689

factors decreasing risk of ovarian neoplasms

Answer 689

previous pregnancy, history of breast feeding, OCPs, tubal ligation.

Question 690

mature cystic teratoma

Answer 690

Germ cell tumor, most common ovarian tumor in females (10-30YO)
cystic mass containing elements of all 3 germ layers
present with pain secondary to ovarian enlargement or torsion.
monodermal form struma ovarii (presents with hyperthyroidism).
somatic malignancy-SCC

Question 691

ovarian tumor looks like bladder

Answer 691

Brenner tumor

Question 692

ovarian fibroma, ascites, hydrothorax. pulling sensation in groin

Answer 692

meigs syndrome

variant of a ovarian fibroma- bundles of spindle shaped fibroblasts

Question 693

ovarian fibroma, ascites, hydrothorax. pulling sensation in groin

Answer 693

meigs syndrome

variant of a ovarian fibroma- bundles of spindle shaped fibroblasts

Question 694

granulosa cell tumor

Answer 694

most common malignant stromal tumor.
often produces estrogen or progesterone and produces postmenpausal bleeding, sexual precocity (in pre adolescents), breast tenderness.
histology shows call exner bodies

Question 695

serous cystadenocarcinoma

Answer 695

most common malignant ovarian neoplasm, frequently bilateral. Psamomma bodies.

Question 696

mucinous cusadenocarcinoma

Answer 696

psuedomyoma peritonei-intraperitoneal accumulation of mucinous material from ovarian or appendiceal tumor.

Question 697

immature teratoma

Answer 697

aggressive contains fetal tissue, neuroectoderm

immature embryonic like neural tissue.

Question 698

dysgerminoma

Answer 698

most common in adolescents
sheets of uniform friend egg cells.
hCG LDH

Question 699

yolk sac (endodermal sinus tumor)

Answer 699

sacrococcygeal area in young children
most common tumor in male infants
yellow friable (hemorrhagic), solid mass. 
schiller duval bodies.
AFP

Question 700

lichen simplex chronicus

Answer 700

hyperplasia of vulvar squamous epithelium.
leukoplakia with thick leathery vulvar skin. associated with chronic irritation and scafolding.
benign

Question 701

neuritic plaques

Answer 701

A beta amyloid and neuritic processes

Question 702

layers where pyramidal neurons are located

Answer 702

3,5,6

Question 703

thombotic stroke

Answer 703

pale infarcts

Question 704

embolic stroke

Answer 704

hemorrhagic infarct

Question 705

lewy bodies in parkin disease vs lewy body dimentia

Answer 705

in parkinson’s they are located in the neuron of the substantia nigra pars compacta
in lewy body disease they are located in the cortical neurons
hence early dimentia in lewy body and late in parkinson’s

Question 706

histology in prion disease

Answer 706

spongy degeneration (spongiform encephalopathy)

Question 707

normal pressure hydrocephalus causes stretching of the

Answer 707

corona radiata
This sheet of both ascending and descending axons carries most of the neural traffic from and to the cerebral cortex. The corona radiata is associated with the corticospinal tract, the corticopontine tract, and the corticobulbar tract.

Question 708

genes transferred by specialized transduction

Answer 708

ABCDS
group A strep erythrogenic toxin
botulinum toxin
cholera toxin
diptheria toxin
shiga toxin

Question 709

Van A gene from VRE to staph aureus is an example of

Answer 709

transposon

Question 710

spore forming bacteria

Answer 710

bacillus and clostridium

spores have dipicolinic acid

Question 711

Shiga and shiga like toxin

Answer 711

inactivate the 60s ribosome by removing adenine from rRNA

Question 712

heat labile vs heat stabile toxins

Answer 712

heat labile increase cAMP leading to an increase in Cl- secretion
heat stabile toxin increases cGMP leading to decreased NA reabsorption

Question 713

two toxins that degrade cell membranes

Answer 713

alpha toxin from clostridium perfringens and streptolysin O from group A strep

Question 714

M marinum

Answer 714

hand infection in aquarium handlers

Question 715

M scrofulaceum

Answer 715

cervical lymphadenitis in

children

Question 716

Cord factor

Answer 716

creates a “serpentine cord”
appearance in virulent M tuberculosis
strains; activates macrophages (promoting
granuloma formation) and induces release of
TNF-α.

Question 717

Sulfatides (surface glycolipids)

Answer 717

inhibit

phagolysosomal fusion

Question 718

leprosy

lepromatous vs tuberculoid form

Answer 718

lepromatous mainly TH2 response leading to leonine like facies and is communicable
tuberculoid mainly TH1 response limited to few hypoesthetic hairless skin plauqes
Treatment: dapsone and rifampin for tuberculoid form; clofazimine is added for lepromatous form

Question 719

Lymphogranuloma venereum

Answer 719

small, painless
ulcers on genitals 􀁰 swollen, painful inguinal
lymph nodes that ulcerate (buboes). Treat with
doxycycline.

Question 720

receptors used by viruses:
CMV 
EBV 
HIV 
Parvovirus B19 
Rabies Nicotinic 
Rhinovirus

Answer 720

intergrins (heparin sulfate)
CD21 
CD4, CXCR4, CCR5
P antigen on RBCs
AchR
ICAM-1

Question 721

Picornoviruses

Answer 721

PERCH
polio virus
enterovirus
rhino virus
coxsackie virus
hep A

Question 722

FLaviviruses

Answer 722

Hep C
west nile
st louis
dengue
yellow fever
zika

Question 723

togaviruses

Answer 723

chukinguya
rubella virus
EEE WEE VEE

Question 724

fillovirus

Answer 724

ebola/marbug

Question 725

negative strand viruses

Answer 725

always bring polymerase or fail replication
arena virus
bunyavirus
paramyxovirus
orthomyxovirus
filoviruses
rhabdovirus

Question 726

yellow fever virus

Answer 726

Aedes mosquitoes. Virus has a monkey or
human reservoir.
Symptoms: high fever, black vomitus, and
jaundice. May see Councilman bodies
(eosinophilic apoptotic globules) on liver
biopsy.

Question 727

segmented viruses

Answer 727

BOAR
bunyavirus- 3 segments
orthomyxovirus- 8 segments
arenavirus- 2 segments
riovirus 11 segments

Question 728

influenza virus

Answer 728

Contain
hemagglutinin (binds sialic acid and promotes
viral entry) and neuraminidase (promotes
progeny virion release) antigens. Patients at
risk for fatal bacterial superinfection, most
commonly S aureus, S pneumoniae, and
H influenzae.

Question 729

Warthin-

Finkeldey giant cells

Answer 729

(fused lymphocytes) in
a background of paracortical hyperplasia.
sign of measles

Question 730

Dorsal motor nucleus

Answer 730

Sends autonomic (parasympathetic) fibers to
heart, lungs, upper GI
vagus

Question 731

frontal eye field lesion vs PPRF

Answer 731

frontal eye field lesion produces gazes toward lesion side

PPRF produce gaze away from lesion side

Question 732

hyperopia

Answer 732

Also known as “farsightedness.” Eye too short for refractive power of cornea and lens –> light
focused behind retina. Correct with convex (converging) lenses.

Question 733

myopa

Answer 733

Also known as “nearsightedness.” Eye too long for refractive power of cornea and lens –> light
focused in front of retina. Correct with concave (diverging) lens

Question 734

astigmatism

Answer 734

Abnormal curvature of cornea 􀁰 different refractive power at different axes. Correct with
cylindrical lens.

Question 735

presbyopia

Answer 735

Aging-related impaired accommodation (focusing on near objects), primarily due to decreased lens
elasticity, changes in lens curvature, decreased strength of the ciliary muscle. Patients often need “reading
glasses” (magnifiers).

Question 736

greenstick fracture

Answer 736

Incomplete fracture extending partway through
width of bone A following bending stress;
bone is bent like a green twig.

Question 737

torus fracture

Answer 737

Axial force applied to immature bone 􀁰 simple
buckle fracture of cortex B . Can be very
subtle.

Question 738

Iliohypogastric

T12-L1

Answer 738

Sensory—suprapubic region
Motor—transversus abdominis
and internal oblique
injury: Abdominal surgery 
Burning or tingling pain in
surgical incision site radiating
to inguinal and suprapubic
region

Question 739

Genitofemoral nerve

L1-L2

Answer 739

Sensory—scrotum/labia
majora, medial thigh
Motor—cremaster
Laparoscopic surgery
 decreased anterior thigh sensation
beneath inguinal ligament;
absent cremasteric reflex

Question 740

Lateral femoral

cutaneous (L2-L3)

Answer 740

Sensory—anterior and lateral
thigh
Tight clothing, obesity,
pregnancy
decrease thigh sensation (anterior and
lateral)

Question 741

Obturator (L2-L4)

Answer 741

Sensory—medial thigh
Motor—obturator externus,
adductor longus, adductor
brevis, gracilis, pectineus,
adductor magnus
Pelvic surgery 
decreased thigh sensation (medial) and
adduction

Question 742

Femoral (L2-L4)

Answer 742

Sensory—anterior thigh,
medial leg
Motor—quadriceps, iliopsoas,
pectineus, sartorius
Pelvic fracture 􀁲 thigh flexion and leg
extension

Question 743

Sciatic (L4-S3)

Answer 743

Sensory—posterior thigh
Motor—semitendinosus,
semimembranosus, biceps
femoris, adductor magnus
Herniated disc 
Splits into common peroneal
and tibial nerves

Question 744

Common peroneal

L4-S2

Answer 744

Sensory—dorsum of foot
Motor—biceps femoris, tibialis
anterior, extensor muscles of
foot
Trauma or compression of
lateral aspect of leg, fibular
neck fracture
PED = Peroneal Everts and
Dorsiflexes; if injured, foot
dropPED
Loss of sensation on dorsum
of foot
Foot drop—inverted and
plantarflexed at rest, loss of
eversion and dorsiflexion;
“steppage gait”

Question 745

Tibial (L4-S3)

Answer 745

Sensory—sole of foot
Motor—triceps surae, plantaris,
popliteus, flexor muscles of
foot
Knee trauma, Baker cyst
(proximal lesion); tarsal
tunnel syndrome (distal
lesion)
TIP = Tibial Inverts and
Plantarflexes; if injured, can’t
stand on TIPtoes
Inability to curl toes and loss of
sensation on sole; in proximal
lesions, foot everted at rest
with loss of inversion and
plantarflexion

Question 746

Superior gluteal (L4-
S1)

Answer 746

Motor—gluteus medius, gluteus
minimus, tensor fascia latae
Iatrogenic injury during
intramuscular injection to
upper medial gluteal region
Trendelenburg sign/gait—
pelvis tilts because weightbearing
leg cannot maintain
alignment of pelvis through
hip abduction
Lesion is contralateral to the
side of the hip that drops,
ipsilateral to extremity on
which the patient stands
Choose superolateral quadrant
(ideally the anterolateral
region) as intramuscular
injection site to avoid nerve
injury

Question 747

Inferior gluteal (L5-S2)

Answer 747

Motor—gluteus maximus Posterior hip dislocation Difficulty climbing stairs, rising
from seated position; loss of
hip extension

Question 748

Pudendal (S2-S4)

Answer 748

Sensory—perineum
Motor—external urethral and
anal sphincters
Stretch injury during childbirth 􀁲 sensation in perineum and
genital area; can cause fecal
or urinary incontinence
Can be blocked with local
anesthetic during childbirth
using ischial spine as a
landmark for injection

Question 749

nerve and artery associated with these locations:
Axilla/lateral thorax
Surgical neck of humerus 
Midshaft of humerus 
Distal humerus/ cubital fossa 
Popliteal fossa
Posterior to medial

Answer 749

• long thoracic and lateral thoracic
• axillary and posterior circumflex
• radial and deep brachial
• median and brachial
• tibial and popliteal
• tibial and posterial tibial

Question 750

transferance

Answer 750

Patient projects feelings about formative or other important persons onto physician (eg, psychiatrist
is seen as parent).

Question 751

countertransferance

Answer 751

Doctor projects feelings about formative or other important persons onto patient (eg, patient
reminds physician of younger sibling).

Question 752

displacement

Answer 752

Redirection of emotions or impulses to a neutral
person or object (vs projection).
A teacher is yelled at by the principal. Instead of
confronting the principal directly, the teacher
goes home and criticizes her husband’s dinner
selection.

Question 753

Dissociation

Answer 753

Temporary, drastic change in personality,
memory, consciousness, or motor behavior to
avoid emotional stress. Patient has incomplete
or no memory of traumatic event.
A victim of sexual abuse suddenly appears numb
and detached when she is exposed to her
abuser.

Question 754

Identification

Answer 754

A resident starts putting his stethoscope in his
pocket like his favorite attending, instead of
wearing it around his neck like before

Question 755

Isolation (of affect)

Answer 755

Separating feelings from ideas and events. Describing murder in graphic detail with no
emotional response.

Question 756

Projection

Answer 756

Attributing an unacceptable internal impulse to
an external source (vs displacement).
A man who wants to cheat on his wife accuses
his wife of being unfaithful.

Question 757

Rationalization

Answer 757

Proclaiming logical reasons for actions actually
performed for other reasons, usually to avoid
self-blame.
After getting fired, claiming that the job was not
important anyway.

Question 758

Reaction formation

Answer 758

Replacing a warded-off idea or feeling by an
(unconsciously derived) emphasis on its
opposite (vs sublimation).
A patient with libidinous thoughts enters a
monastery.

Question 759

Repression

Answer 759

Involuntarily withholding an idea or feeling
from conscious awareness (vs suppression).
A 20-year-old does not remember going to
counseling during his parents’ divorce 10 years
earlier.

Question 760

Sublimation

Answer 760

Replacing an unacceptable wish with a course
of action that is similar to the wish but does
not conflict with one’s value system (vs
reaction formation).
Teenager’s aggression toward his father is
redirected to perform well in sports

Question 761

Suppression

Answer 761

Intentionally withholding an idea or feeling from
conscious awareness (vs repression); temporary.
Choosing to not worry about the big game until
it is time to play.

Question 762

Vulnerable child

syndrome

Answer 762

Parents perceive the child as especially susceptible to illness or injury. Usually follows a serious
illness or life-threatening event. Can result in missed school or overuse of medical services.

Question 763

Rett syndrome

Answer 763

X-linked dominant disorder seen almost exclusively in girls (affected males die in utero or shortly
after birth). Majority of cases are caused by de novo mutation of MECP2. Symptoms usually
become apparent around ages 1–4, including regression characterized by loss of development, loss
of verbal abilities, intellectual disability, ataxia, stereotyped hand-wringing. No longer a solitary
diagnosis within DSM-5.

Question 764

Tourette syndrome

Answer 764

Onset before age 18. Characterized by sudden, rapid, recurrent, nonrhythmic, stereotyped motor
and vocal tics that persist for > 1 year. Coprolalia (involuntary obscene speech) found in only
10–20% of patients. Associated with OCD and ADHD. Treatment: psychoeducation, behavioral
therapy. For intractable and distressing tics, high-potency antipsychotics (eg, haloperidol,
fluphenazine, pimozide), tetrabenazine, α2-agonists (eg, guanfacine, clonidine), or atypical
antipsychotics may be used.

Question 765

Disruptive mood dysregulation disorder

Answer 765

Onset before age 10. Severe and recurrent temper outbursts out of proportion to situation. Child
is constantly angry and irritable between outbursts. Treatment: psychostimulants, antipsychotics,
CBT.

Question 766

Depersonalization/derealization disorder

Answer 766

Persistent feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and
actions (depersonalization) or one’s environment (derealization).

Question 767

delusional disorder

Answer 767

Fixed, persistent, false belief system lasting > 1 month. Functioning otherwise not impaired
(eg, a woman who genuinely believes she is married to a celebrity when, in fact, she is not).
Can be shared by individuals in close relationships (folie à deux).

Question 768

Schizoaffective disorder

Answer 768

Meets criteria for
schizophrenia in addition to major mood
disorder (major depressive or bipolar). To
differentiate from a major mood disorder
with psychotic features, patient must have
> 2 weeks of hallucinations or delusions
without major mood episode.

Question 769

Bipolar disorder (manic depression)

Answer 769

Bipolar I defined by presence of at least 1 manic episode +/− a hypomanic or depressive episode.
Bipolar II defined by presence of a hypomanic and a depressive episode.
Patient’s mood and functioning usually return to normal between episodes. Use of antidepressants
can precipitate mania. High suicide risk. Treatment: mood stabilizers (eg, lithium, valproic acid,
carbamazepine, lamotrigine), atypical antipsychotics.
Cyclothymic disorder—milder form of bipolar disorder lasting at least 2 years, fluctuating
between mild depressive and hypomanic symptoms.

Question 770

major depressive disorder

Answer 770

Episodes characterized by at least 5 of
the 9 diagnostic symptoms lasting ≥ 2
weeks (symptoms must include patientreported
depressed mood or anhedonia).
Treatment: CBT and SSRIs are first line.
SNRIs, mirtazapine, bupropion can also be
considered. Antidepressants are indicated if
bipolar disorder is ruled out. Electroconvulsive
therapy (ECT) in select patients.
Persistent depressive disorder (dysthymia)—
depression, often milder, lasting at least
2 years.

Question 771

Depression with atypical features

Answer 771

Characterized by mood reactivity (being able to experience improved mood in response to positive
events, albeit briefly), “reversed” vegetative symptoms (hypersomnia, hyperphagia), leaden
paralysis (heavy feeling in arms and legs), long-standing interpersonal rejection sensitivity. Most
common subtype of depression. Treatment: CBT and SSRIs are first line. MAO inhibitors are
effective but not first line because of their risk profile.

Question 772

Maternal (postpartum) “blues”

Answer 772

50–85% incidence rate. Characterized by depressed affect, tearfulness, and fatigue starting 2–3
days after delivery. Usually resolves within 10 days. Treatment: supportive. Follow up to assess for
possible postpartum depression.

Question 773

Postpartum depression

Answer 773

10–15% incidence rate. Characterized by depressed affect, anxiety, and poor concentration for ≥ 2
weeks. Treatment: CBT and SSRIs are first line.

Question 774

Postpartum psychosis

Answer 774

0.1–0.2% incidence rate. Characterized by mood-congruent delusions, hallucinations, and
thoughts of harming the baby or self. Risk factors include history of bipolar or psychotic disorder,
first pregnancy, family history, recent discontinuation of psychotropic medication. Treatment:
hospitalization and initiation of atypical antipsychotic; if insufficient, ECT may be used.

Question 775

Adjustment disorder—

Answer 775

disorder—emotional symptoms (anxiety, depression) that occur within 3 months of
an identifiable psychosocial stressor (eg, divorce, illness) lasting < 6 months once the stressor has
ended. If stressor lasts > 6 months and causes continual impairment, it is GAD. Treatment: CBT,
SSRIs.

Question 776

obsessive compulsive disorder

Answer 776

Recurring intrusive thoughts, feelings, or sensations (obsessions) that cause severe distress;
relieved in part by the performance of repetitive actions (compulsions). Ego-dystonic: behavior
inconsistent with one’s own beliefs and attitudes (vs obsessive-compulsive personality disorder).
Associated with Tourette syndrome. Treatment: CBT, SSRIs, and clomipramine are first line.

Question 777

post traumatic stress disorder

Answer 777

Exposure to prior trauma (eg, witnessing death, experiencing serious injury or rape) 􀁰 persistent
Hyperarousal, Avoidance of associated stimuli, intrusive Reexperiencing of the event (nightmares,
flashbacks), changes in cognition or mood (fear, horror, Distress) (having PTSD is HARD).
Disturbance lasts > 1 month with significant distress or impaired social-occupational functioning.
Treatment: CBT, SSRIs, and venlafaxine are first line. Prazosin can reduce nightmares.
Acute stress disorder—lasts between 3 days and 1 month. Treatment: CBT; pharmacotherapy is
usually not indicated.

Question 778

borderline personality disorder

Answer 778

Unstable mood and interpersonal relationships,
impulsivity, self-mutilation, suicidality, sense
of emptiness; females > males; splitting is a
major defense mechanism.
Treatment: dialectical behavior therapy

Question 779

histrionic

Answer 779

Excessive emotionality and excitability,
attention seeking, sexually provocative, overly
concerned with appearance.

Question 780

factitious disorder imposed on self

Answer 780

Also known as Munchausen syndrome. Chronic factitious disorder with predominantly physical
signs and symptoms. Characterized by a history of multiple hospital admissions and willingness to
undergo invasive procedures. More common in women and healthcare workers.

Question 781

somatic symptom disorder

Answer 781

Variety of bodily complaints (eg, pain, fatigue) lasting for months to years. Associated with
excessive, persistent thoughts and anxiety about symptoms. May co-occur with medical illness.
Treatment: regular office visits with the same physician in combination with psychotherapy.

Question 782

Conversion disorder(functional neurologic symptom
disorder)

Answer 782

Loss of sensory or motor function (eg, paralysis, blindness, mutism), often following an acute
stressor; patient is aware of but sometimes indifferent toward symptoms (“la belle indifférence”);
more common in females, adolescents, and young adults.

Question 783

Illness anxiety
disorder
(hypochondriasis)

Answer 783

Excessive preoccupation with acquiring or having a serious illness, often despite medical
evaluation and reassurance; minimal somatic symptoms.

Question 784

Refeeding syndrome

Answer 784

(increased insulin –> hypophosphatemia –> cardiac complications) can occur in
significantly malnourished patients.

Question 785

down syndrome first and second semester ultrasound and serologies

Answer 785

First-trimester ultrasound commonly shows
􀁱 nuchal translucency and hypoplastic nasal
bone; decrease serum PAPP-A, increase free β-hCG.
Second-trimester quad screen shows
decrease α-fetoprotein, increase β-hCG, decrease estriol, increase inhibin A.

Question 786

edward’s syndrome serologies

Answer 786

PAPP-A and free β-hCG are decreeased in first trimester.
Quad screen shows decrease α-fetoprotein, decrease β-hCG,
decrease estriol, decrease or normal inhibin A.

Question 787

patau syndrome

Answer 787

First-trimester pregnancy screen shows 􀁲 free

β-hCG, 􀁲 PAPP-A.

Question 788

genetic disorders asociated with chromosomes 3-7

Answer 788

3 von Hippel-Lindau disease, renal cell carcinoma
4 ADPKD (PKD2), achondroplasia, Huntington disease
5 Cri-du-chat syndrome, familial adenomatous polyposis
6 Hemochromatosis (HFE)
7 Williams syndrome, cystic fibrosis

Question 789

genetic disorders associated with chromosomes 9,11,13,15

Answer 789

9 Friedreich ataxia
11 Wilms tumor, β-globin gene defects (eg, sickle cell disease, β-thalassemia, MEN1)
13 Patau syndrome, Wilson disease, retinoblastoma (RB1), BRCA2
15 Prader-Willi syndrome, Angelman syndrome, Marfan syndrome

Question 790

genetic disorders associated with chromosomes 16, 17,, 18, 21, 22, X

Answer 790

16 ADPKD (PKD1), α-globin gene defects (eg, α-thalassemia)
17 Neurofibromatosis type 1, BRCA1, p53
18 Edwards syndrome
21 Down syndrome
22 Neurofibromatosis type 2, DiGeorge syndrome (22q11)
X Fragile X syndrome, X-linked agammaglobulinemia, Klinefelter syndrome (XXY)

Question 791

In thiamine pyrophosphate (TPP), a cofactor for

several dehydrogenase enzyme reactions:

Answer 791

Pyruvate dehydrogenase (links glycolysis to
TCA cycle)
α-ketoglutarate dehydrogenase (TCA cycle)
Transketolase (HMP shunt)
Branched-chain ketoacid dehydrogenase

Question 792

riboflavin

Answer 792

vitamin B2

used in the succinate dehydrogenase reaction

Question 793

vitamin B 5

Answer 793

pantothenic acid

used as a cofactor for fatty acid synthase and Co enzyme A(CoA)

Question 794

vitamin B6

Answer 794

pyridoxine Converted to pyridoxal phosphate (PLP), a cofactor used in transamination (eg, ALT and AST),
decarboxylation reactions, glycogen phosphorylase. Synthesis of cystathionine, heme, niacin,
histamine, and neurotransmitters including serotonin, epinephrine, norepinephrine (NE),
dopamine, and GABA.

Question 795

vitamin B7 is a Cofactor for

Answer 795

Cofactor for carboxylation enzymes (which add
a 1-carbon group):
􀂃 Pyruvate carboxylase: pyruvate (3C)
–> oxaloacetate (4C)
􀂃 Acetyl-CoA carboxylase: acetyl-CoA (2C)
–> malonyl-CoA (3C)
􀂃 Propionyl-CoA carboxylase: propionyl-CoA
(3C) –> methylmalonyl-CoA (4C)

Question 796

vitamin C

Answer 796

Antioxidant; also facilitates iron absorption
by reducing it to Fe2+ state. Necessary
for hydroxylation of proline and lysine in
collagen synthesis. Necessary for dopamine
β-hydroxylase, which converts dopamine to
NE.

Question 797

Glucose-6-

phosphatase

Answer 797

In ER. Glucose-6-phosphate –> glucose.

Question 798

Renal oncocytoma

Answer 798

Benign epithelial cell tumor arising from
collecting ducts well circumscribed
mass with central scar).
Large eosinophilic cells with abundant
mitochondria without perinuclear clearing
B (vs chromophobe renal cell carcinoma).
Presents with painless hematuria, flank pain,
abdominal mass.
Often resected to exclude malignancy (eg, renal
cell carcinoma).

Question 799

Nephroblastoma

Wilms tumor

Answer 799

Most common renal malignancy of early childhood (ages 2–4). Contains embryonic glomerular
structures. Presents with large, palpable, unilateral flank mass A and/or hematuria.
“Loss of function” mutations of tumor suppressor genes WT1 or WT2 on chromosome 11.

Question 800

WAGR complex

Answer 800

Wilms tumor, Aniridia (absence of iris), Genitourinary malformations, mental
Retardation/intellectual disability (WT1 deletion)

Question 801

denys drash

Answer 801

Wilms tumor, early-onset nephrotic syndrome, male pseudohermaphroditism
(WT1 mutation)

Question 802

beckwith-wiedeman syndrome

Answer 802

Wilms tumor, macroglossia, organomegaly, hemihyperplasia (WT2
mutation)

Question 803

Most common tumor of urinary tract system
(can occur in renal calyces, renal pelvis,
ureters, and bladder)

Answer 803

transitional cell carcinoma
can be suggested by painless hematuria.
smoking, phenacetin, anyline dyes and cyclophosphamide

Question 804

Squamous cell
carcinoma of the
bladder

Answer 804

Chronic irritation of urinary bladder –> squamous metaplasia –> dysplasia and squamous cell
carcinoma.
Risk factors include Schistosoma haematobium infection (Middle East), chronic cystitis, smoking,
chronic nephrolithiasis. Presents with painless hematuria.

Question 805

grossly orange nodules that can mimic tumor
nodules; characterized by widespread kidney damage due to granulomatous tissue containing
foamy macrophages

Answer 805

Xanthogranulomatous pyelonephritis

Question 806

Diffuse cortical

necrosis

Answer 806

Associated with obstetric catastrophes (eg,

abruptio placentae), septic shock.

Question 807

Acute interstitial nephritis(tubulointerstitial nephritis)

Answer 807

Acute interstitial renal inflammation. Pyuria
(classically eosinophils) and azotemia
occurring after administration of drugs that
act as haptens, inducing hypersensitivity
Associated with fever, rash, hematuria, and
costovertebral angle tenderness, but can be
asymptomatic
􀂃 Pee (diuretics)
􀂃 Pain-free (NSAIDs)
􀂃 Penicillins and cephalosporins
􀂃 Proton pump inhibitors
􀂃 RifamPin

Question 808

Acute tubular necrosis

Answer 808

Can be caused by ischemic or nephrotoxic injury:
􀂃 Ischemic—2° to decreased renal blood flow (eg, hypotension, shock, sepsis, hemorrhage, HF). Results
in death of tubular cells that may slough into tubular lumen B (PCT and thick ascending limb
are highly susceptible to injury).
􀂃 Nephrotoxic—2° to injury resulting from toxic substances (eg, aminoglycosides, radiocontrast
agents, lead, cisplatin, ethylene glycol), crush injury (myoglobinuria), hemoglobinuria. PCT is
particularly susceptible to injury.

Question 809

Renal papillary

necrosis

Answer 809

Sloughing of necrotic renal papillae A 􀁰 gross
hematuria and proteinuria. May be triggered
by recent infection or immune stimulus.
SAAD papa with papillary necrosis:
Sickle cell disease or trait
Acute pyelonephritis
Analgesics (NSAIDs)
Diabetes mellitus

Question 810

Autosomal dominant
polycystic kidney
disease

Answer 810

Numerous cysts in cortex and medulla

Question 811

Autosomal recessive
polycystic kidney
disease

Answer 811

Cystic dilation of collecting ducts
associated with congenital
hepatic fibrosis. Significant oliguric renal failure in utero can lead to Potter sequence

Question 812

Medullary cystic

disease

Answer 812

Inherited disease causing tubulointerstitial fibrosis and progressive renal insufficiency with inability
to concentrate urine. Medullary cysts usually not visualized; shrunken kidneys on ultrasound.
Poor prognosis.

Question 813

choriocarcinoma

Answer 813

malignancy of trophoblastic tissue (cytotrophoblasts and syncytiotrophoblasts).
no chorionic villi present.
shortness of breath hemoptysis and increase in beta hCG
hematogenous spread to lungs.
Hematogenous spread to lungs
–> “cannonball” metastases

Question 814

androgen insensitivity syndrome (46XY)

Answer 814

defect in androgen recepto resulting in normal appearing female.
female external genitalia with scant sexual hair, rudimentary vagina
develop normal functioning testes
increased testosterone, estrogen, LH (vs sex chromosome disorders)

Question 815

placental aramotase deficiency

Answer 815

inability to synthesize estrogens from androgens.
masculinization of female
increase serum testosterone and androstenedione
can present with maternal virilization during pregnancy

Question 816

lung development embryonic weeks 4-7

Answer 816

lung-> tertiary bronchi
Errors at this stage can lead to
tracheoesophageal fistula

Question 817

lung development psuedoglandular 5-17

Answer 817

terminal bronchioles

Respiration impossible, incompatible with life.

Question 818

Respiratory zone

Answer 818

Lung parenchyma; consists of respiratory bronchioles, alveolar ducts, and alveoli. Participates in gas
exchange.
Mostly cuboidal cells in respiratory bronchioles, then simple squamous cells up to alveoli. Cilia
terminate in respiratory bronchioles

Question 819

conducting zone

Answer 819

Large airways consist of nose, pharynx, larynx, trachea, and bronchi. Small airways consist of
bronchioles that further divide into terminal bronchioles (large numbers in parallel -> least airway
resistance).
Warms, humidifies, and filters air but does not participate in gas exchange 􀁰 “anatomic dead
space.”
Cartilage and goblet cells extend to end of bronchi
Airway smooth muscle cells extend to end of terminal bronchioles (sparse beyond this point).

Question 820

Inspiratory Capacity
FRC
VC
TLC

Answer 820

Inspiratory capacity IRV + TV
Air that can be breathed in after normal exhalation
Functional residual capacity
RV + ERV. Volume of gas in lungs after normal expiration
Vital capacity TV + IRV + ERV. Maximum volume of gas that can be expired
after a maximal inspiration
Total lung capacity IRV + TV + ERV + RV
Volume of gas present in lungs after a maximal
inspiration

Question 821

Lung volumes that cannot be measured on spirometry.

Answer 821

RV
TLC
FRC

Question 822

changes in FRC with
COPD
fibrosis

Answer 822

increase

decrease

Question 823

aging cganges in respiratory system

Answer 823

increase in RV, decrease in FVC and unchanged TLC

Question 824

cyanosis and chocolate colored blood

Answer 824

methemoglobia
nitrates and benzocaine and can lead to this
treat with methylene blue and vitamin C.

Question 825

confusion, headache and almond breathe

Answer 825

cyanide poisoning
treat with sodium thisulfate and nitrate
poisons cytochrome c and increases anaerobic metabolism.

Question 826

asbestosis

Answer 826

Associated with shipbuilding, roofing,
plumbing. “Ivory white,” calcified,
supradiaphragmatic and pleural plaques
are pathognomonic of asbestosis.
affects lower lobes
increases  risk of pleural effusions.

Question 827

berryllioses

Answer 827

Associated with exposure to beryllium in
aerospace and manufacturing industries.
Granulomatous (noncaseating) on histology
and therefore occasionally responsive to
steroids.
affects upper lobes

Question 828

silicosis

Answer 828

Associated with foundries, sandblasting,
mines. Macrophages respond to silica
and release fibrogenic factors, leading to
fibrosis. It is thought that silica may disrupt
phagolysosomes and impair macrophages,
increasing susceptibility to TB.
Affects upper lobes.
“Eggshell” calcification of hilar lymph nodes on
CXR.

Question 829

Acute respiratory

distress syndrome

Answer 829

Endothelial damage –> increases alveolar
capillary permeability –> protein-rich leakage
into alveoli –> diffuse alveolar damage and
noncardiogenic pulmonary edema (normal
PCWP)
Initial damage
due to release of neutrophilic substances
toxic to alveolar wall and pulmonary capillary
endothelial cells, activation of coagulation
cascade, and oxygen-derived free radicals

Question 830

sleep apnea

Answer 830

Repeated cessation of breathing > 10 seconds during sleep –> disrupted sleep –> daytime
somnolence. Diagnosis confirmed by sleep study. Normal Pao2 during the day.
Nocturnal hypoxia –> systemic/pulmonary hypertension, arrhythmias (atrial fibrillation/flutter),
sudden death.
Hypoxia – increased EPO release –> increased erythropoiesis.

Question 831

obstructive sleep apnea

Answer 831

Respiratory effort against airway obstruction. Associated with obesity, loud snoring. Caused by
excess parapharyngeal tissue in adults, adenotonsillar hypertrophy in children. Treatment: weight
loss, CPAP, surgery.

Question 832

obesity hypoventiallation syndrome

Answer 832

Obesity (BMI ≥ 30 kg/m2) –> hypoventilation increased PaCO2 during waking hours (retention); decreased PaO2 and increased PaCO2 during sleep. Also known as Pickwickian syndrome.

Question 833

BMPR2

Answer 833

normally inhibits vascular smooth muscle proliferation.

inactivated in hereditary PH

Question 834

decreased breath sounds, decreased fremitus and dull percussion

Answer 834

pleural effussion and atelectasis.

atelectasis can cause tracheal deviation towards side of the lesion

Question 835

Bronchial breath sounds; late inspiratory crackles, egophony, bronchophony, whispered pectoriloquy, increased fremitus and dull percussion

Answer 835

consolidation (lobar pneumonia, pulmonary edema)

Question 836

pleural effusions

• transudate
• exudate
• lymphatic

Answer 836

-decrease protein content. Due to increased hydrostatic pressure (eg, HF) or decreased oncotic pressure (eg, nephrotic syndrome, cirrhosis).
- increased protein content, cloudy. Due to malignancy, pneumonia, collagen vascular disease, trauma
(occurs in states of increased vascular permeability). Must be drained due to risk of infection.
- Also known as chylothorax. Due to thoracic duct injury from trauma or malignancy. Milkyappearing
fluid; increased triglycerides

Question 837

Cryptogenic organizing pneumonia

Answer 837

Formerly known as bronchiolitis obliterans organizing pneumonia (BOOP). Noninfectious pneumonia characterized by inflammation of bronchioles and surrounding structure. Etiology unknown. Secondary organizing pneumonia caused by chronic inflammatory diseases (eg, rheumatoid arthritis) or medication side effects(eg, amiodarone). ⊝ sputum and blood cultures,
no response to antibiotics

Question 838

Congestion
Red hepatization
Gray hepatization
Resolution

Answer 838

• 1-2 Red-purple, partial consolidation of parenchyma
  Exudate with mostly bacteria
• 3-4 Red-brown, consolidated Exudate with fibrin, bacteria, RBCs, and WBCs
  -5-7 Uniformly grayExudate full of WBCs and fibrin
  -8+ Enzymes digest components of exudate

Question 839

pancoast tumor

Answer 839

Compression of locoregional structures may cause array of findings:
􀂃 Recurrent laryngeal nerve –> hoarseness
􀂃 Stellate ganglion –> Horner syndrome (ipsilateral ptosis, miosis, anhidrosis)
􀂃 Superior vena cava –> SVC syndrome
􀂃 Brachiocephalic vein –> brachiocephalic syndrome (unilateral symptoms)
􀂃 Brachial plexus –> sensorimotor deficits

Question 840

duodenal atresia

Answer 840

failure to recanalize. Associated with “double bubble” (dilated stomach, proximal duodenum) on x-ray ). Associated with Down syndrome.

Question 841

jejunal and ileal atresia

Answer 841

disruption of mesenteric vessels –> ischemic necrosis 􀁰–>segmental resorption (bowel discontinuity or “apple peel”).

Question 842

ventral and dorsal pancreatic buds

Answer 842

Ventral pancreatic buds contribute to uncinate process and main pancreatic duct.
The dorsal pancreatic bud alone becomes the body, tail, isthmus, and accessory pancreatic duct. Both the ventral and dorsal buds contribute to pancreatic head

Question 843

hepatoduodenal ligament

Answer 843

Liver to duodenum
Portal triad: proper hepatic artery, portal vein, common
bile duct

Question 844

gastrohepatic ligament

Answer 844

Liver to lesser curvature of stomach Gastric arteries Separates greater and lesser sacs
on the right

Question 845

ligaments of the greater curvature of the stomach

Answer 845

gastrocolic Greater curvature and transverse colon
Gastroepiploic arteries
gastrosplenic- Greater curvature and spleen Short gastrics, left gastroepiploic vessels Separates greater and lesser sacs on the left

Question 846

splenorenal ligament

Answer 846

Spleen to posterior abdominal wall Splenic artery and vein, tail of pancreas

Question 847

erosions vs ulcerations

Answer 847

into but not over the the muscularis mucosa.

ulcers can extend into the subucosa, inner or outer muscular layer

Question 848

location of meissner plexus and myenteric (auerbach plexus)

Answer 848

meissner is in the submucosa

myenteric (auerbach) is in the muscularis between outer and inner muscular layers

Question 849

transjugular intrahepatic portosystemic shunt

Answer 849

between the portal vein and hepatic vein relieves portal hypertension by shunting blood to the systemic circulation, bypassing the liver. Can precipitate hepatic encephalopathy

Question 850

Above pectinate line

Answer 850

internal hemorrhoids, adenocarcinoma. Arterial supply from superior rectal artery (branch of IMA).
Venous drainage: superior rectal vein –> inferior
mesenteric vein –> splenic vein –> portal vein
Lymphatic drainage to internal iliac lymph
nodes.
not painful

Question 851

below pectinate line

Answer 851

external hemorrhoids, anal fissures, squamous cell carcinoma. Arterial supply from inferior rectal artery (branch of internal pudendal artery).
Venous drainage: inferior rectal vein –> internal
pudendal vein –> internal iliac vein –> common
iliac vein –> IVC.
External hemorrhoids receive somatic
innervation (inferior rectal branch of pudendal
nerve) and are therefore painful if thrombosed.
Lymphatic drainage to superficial inguinal nodes

Question 852

anal fissure

Answer 852

tear in the anal mucosa below the Pectinate line. Pain while Pooping; blood on toilet Paper. Located Posteriorly because this area is Poorly Perfused. Associated with lowfiber diets and constipation

Question 853

lining of sinusoids

Answer 853

kuppfer cells which are macrophages

Question 854

Zone I, II and III of liver

Answer 854

Zone I—periportal zone:
􀂃 Affected 1st by viral hepatitis
􀂃 Ingested toxins (eg, cocaine)
Zone II—intermediate zone:
􀂃 Yellow fever
Zone III—pericentral vein (centrilobular) zone:
􀂃 Affected 1st by ischemia
􀂃 Contains cytochrome P-450 system
􀂃 Most sensitive to metabolic toxins
􀂃 Site of alcoholic hepatitis

Question 855

femoral triangle

Answer 855

Contains femoral nerve, artery, vein. Venous near the penis

Question 856

femoral sheath

Answer 856

Fascial tube 3–4 cm below inguinal ligament.
Contains femoral vein, artery, and canal (deep
inguinal lymph nodes) but not femoral nerve

Question 857

femoral triangle bordered by

Answer 857

bordered by the inguinal ligament (superiorly), adductor longus muscle (medially) and sartorius muscle (laterally)