classic presentations Flashcards

Question 1

Q

Abdominal pain, ascites, hepatomegaly

Answer

A

Budd chiari syndrome ( post hepatic venous thrombosis)

Question 2

Q

abdominal pain, diarrhea, leukocytosis, recent antibiotic use

Question 3

Q

achilles tendon xanthoma

Answer

A

Familial hypercholesterolemia (decreased LDL receptor signaling)

Question 4

Q

adrenal hemorrhage, hypotension, DIC

Answer

A

waterhouse-Friderchsen syndrome (meningococcemia)

Question 5

Q

Anaphylaxis following blood transfusion

Answer

A

IgA deficiency

Question 6

Q

anterior drawer sign

Answer

A

anterior cruciate ligament injury

Question 7

Q

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

Answer

A

marfan syndrome (fibrillin defect)

Question 8

Q

Athlete with polycythemia

Answer

A

secondary to EPO injections

Question 9

Q

back pain, fever, night sweats

Answer

A

Pott disease (vertebral TB)

Question 10

Q

Bilateral acoustic schwannomas

Question 11

Q

Bilateral hilar adenopathy, uveitis

Answer

A

sarcoidosis

Question 12

Q

black eschar on face of patient with DKA

Answer

A

Mucor or rhizopus infectgion

Question 13

Q

Blue sclera

Answer

A

osteogenesis imperfect (defect in type 1 collagen synthesis)

Question 14

Q

bluish line on gingiva

Answer

A

burton line lead poisoning

Question 15

Q

Bone pain, bone enlargement, arthritis

Answer

A

Paget disease of the bone (increased osteoblast and osteoclast activity

Question 16

Q

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

Answer

A

aortic regurgitation

Question 17

Q

butterfly rash and raynaud phenomenon in a young female

Question 18

Q

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

Question 19

Q

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

Answer

A

Mccune albright syndrome (mosaic G protein signaling mutation)

Question 20

Q

Calf psuedohypertrophy

Answer

A

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

Question 21

Q

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

Answer

A

kawasaki disease (treat with IVIG and aspirin)

Question 22

Q

cherry red spots on macula

Answer

A

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

Question 23

Q

chest pain on exertion

Answer

A

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

Question 24

Q

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

Answer

A

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

Question 25

Q

Chest pain with St depression of EKG

Answer

A

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

Question 26

Q

child uses arms to stand up from squat

Answer

A

Duchenne muscular dystrophy gower’s sign

Question 27

Q

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

Answer

A

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

Question 28

Q

chorea, dimentia, caudate degeneration

Answer

A

Huntington disease. (autosomal dominant CAG repeat expansion)

Question 29

Q

chorioretinitis, hydrocephalus, intracranial calcifications

Answer

A

congenital toxoplasmosis

Question 30

Q

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

Answer

A

McArdle disease (skeletal muscle glycogen phosphorylase deficiency)

Question 31

Q

Cold intolerance

Answer

A

Hypothyroidism

Question 32

Q

conjugate horizontal gaze palsy, horizontal diplopia

Answer

A

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

Question 33

Q

continuous machine like heart murmur

Question 34

Q

cutaneous/dermal edema due to connective tissue deposition

Answer

A

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

Question 35

Q

cutaneous flushing, diarrhea, bronchospasm

Answer

A

carcinoid syndrome (right sided valvular lesion)

Question 36

Q

Dark purple skin/mouth nodules in a person with aids

Answer

A

kaposi sarcoma HHV-8

Question 37

Q

deep, labored breathing/ hyperventilation

Answer

A

kussmaul respirations in DKA

Question 38

Q

dermatitis, dementia, diarrhea

Answer

A

pellagra from a niacin (Vit B3 deficiency)

Question 39

Q

dilated cardiomyopathy, edema, alcoholism or malnutrition

Answer

A

Wet berriberri vitamin B1 deficiency

Question 40

Q

Dog or cat bite resulting in infection

Answer

A

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

Question 41

Q

dry eyes, dry mouth, arthritis

Answer

A

sjoren syndrome (autoimmune destruction of exocrine gland)

Question 42

Q

Dysphagia (esophageal webs), glossitis, iron deficiency anemia

Answer

A

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

Question 43

Q

elastic skin, hyper mobility of joints, increased bleeding tendency

Answer

A

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

Question 44

Q

Enlarged left supraclavivular node

Answer

A

virchow node (abdominal metastasis)

Question 45

Q

Episodic vertigo, Tinitus, hearing loss

Answer

A

Meniere disease

Question 46

Q

erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells

Answer

A

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

Question 47

Q

Facial muscle spasm upon tapping

Answer

A

chvostek sign (hypocalcemia)

Question 48

Q

Fat, female, forty, and fertile

Answer

A

cholelithiasis

Question 49

Q

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

Answer

A

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

Question 50

Q

fever, cough, conjuctivitis, coryza, diffuse rash

Question 51

Q

Fever, night sweats, weight loss

Answer

A

B symptoms of lymphoma

Question 52

Q

Fibrous plaque in soft tissue of penis with abnormal curvature

Answer

A

Peyronie disease (connective tissue disease)

Question 53

Q

Golden brown rings around peripheral cornea

Answer

A

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

Question 54

Q

Gout, intellectual disability, self mutilating behavior in a boy

Answer

A

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

Question 55

Q

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

Answer

A

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

Question 56

Q

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

Answer

A

Gaucher disease (glucocerebrosidase deficiency)

Question 57

Q

Heriditary nephritis, Sensineural hearing loss, cataracts

Answer

A

Alport syndrome (mutation in collagen IV)

Question 58

Q

Hyperphagia, hypersexuality, hyperorality, hyperdocility

Answer

A

Kluver-Bucy syndrome (bilateral amygdala lesion)

Question 59

Q

Hyperreflexia, hypertonia, babinski sign present

Answer

A

UMN damage

Question 60

Q

Hyporeflexia, hypotonia, atrophy, fasciculations

Answer

A

LMN damage

Question 61

Q

hypoxemia, polycythemia, hypercapnia

Answer

A

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

Question 62

Q

Indurated, ulcerated genital lesion

Answer

A

nonpainful: chancre (primary syphilis, treponema pallidum)

Painful with exudate: chancroid (hemophilus ducreyi)

Question 63

Q

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

Answer

A

Patau syndrome (trisomy 13)

Question 64

Q

cinfant with hypoglycemia, hepatomegaly

Answer

A

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

Answer 59

A

Edwards syndrome (trisomy 18)

Answer 60

A

courvoiser sign (distal malignant obstruction of biliary tree)

Answer 61

A

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

Answer 62

A

epidural hematoma (middle meningeal artery rupture)

Answer 63

A

bruton disease (X-linked agammaglobulenemia)

Answer 64

A

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

Answer 65

A

beck triad of cardiac tamponade

Answer 66

A

Gardner syndrome

Answer 67

A

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

Answer 68

A

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

Answer 69

A

Sheehan syndrome (pituitary infarction

Answer 70

A

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

Answer 71

A

raynaud phenomenom (vasospasm in extremities)

Answer 72

A

osler nodes (infective endocarditis, immune complex deposition)

Answer 73

A

Janeway lesions (infective endocarditis, septic emboli/microabscesses)

Answer 74

A

cancer of the pancreatic head obstructing bile duct

Answer 75

A

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

Answer 76

A

Men 1 (autosomal dominant)

Answer 77

A

nephrotic syndrome

Answer 78

A

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

Answer 79

A

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

Answer 80

A

Lichen planus

Answer 81

A

Horner Syndrome (sympathetic chain lesion)

Answer 82

A

neurosyphilis (argyll robertson pupil

Answer 83

A

Guillain Barre syndrome (acute inflammatory demyelinating polyradiculopathy subtype)

Answer 84

A

Coxsackie A, secondary syphilis, Rocky mountain spotted fever

Answer 85

A

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

Answer 86

A

Klebsiella pneumoniae pneumonia

Answer 87

A

Acute mesenteric ischemia (adults), intussusception (children)

Answer 88

A

paget disease of the breast (sign of underlying neoplasm

Answer 89

A

Paroxysmal nocturnal hemoglobinuria

Answer 90

A

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

Answer 91

A

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

Answer 92

A

Roth spots (bacterial endocarditis)

Answer 93

A

crigler najjar syndrome (congenital unconjugated hyperbilirubinemia

Answer 94

A

Rovsing sign (acute appendicitis)

Answer 95

A

McBurney sign (acute appendicitis)

Answer 96

A

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

Answer 97

A

Down syndrome

Answer 98

A

Kartagener syndrome (dynein arm defect affecting cilia)

Answer 99

A

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

Answer 100

A

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

Answer 101

A

koplik spots (measles [rubeola] virus)

Answer 102

A

condylomata lata (secondary syphilis)

Answer 103

A

bacterial endocarditis

Answer 104

A

scarlet fever, Kawasaki disease

Answer 105

A

turner syndrome (45, XO)

Answer 106

A

gout/podagra (hyperuricemia)

Answer 107

A

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

Answer 108

A

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

Answer 109

A

aortic stenosis

Answer 110

A

Osler-Weber-rendu syndrome

Answer 111

A

MEN 2A (autosomal dominant RET mutation)

Answer 112

A

MEN 2B (autosomal dominant RET mutation)

Answer 113

A

babinski sign (UMN lesion)

Answer 114

A

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

Answer 115

A

reactive arthritis associated with HLA-B27

Answer 116

A

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

Answer 117

A

Mallory weiss syndrome (alcoholic and bulemic patients)

Answer 118

A

Whipple disease (tropheryma whipplei)

Answer 119

A

subarachnoid hemorrhage

Answer 120

A

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

Answer 121

A

scleroderma (CREST)

Answer 122

A

pemphigus vulgaris

Answer 123

A

Goodpasture syndrome (glomerulonephritis and hemoptysis

Answer 124

A

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

Answer 125

A

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

Answer 126

A

primary biliary cirrhosis (female, cholestasis, portal HTN)

Answer 127

A

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

Answer 128

A

SLE ( type III hypersensitivity)

Answer 129

A

idiopathic thrombocytopenic purpura

Answer 130

A

diffuse systemic scleroderma

Answer 131

A

celiac disease (diarrhea, weight loss)

Answer 132

A

colorectal cancer (usually left sided)

Answer 133

A

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

Answer 134

A

sensitive is S. pyogenes resistant is S. agalactiae

Answer 135

A

Ankylosing spondylitis (chronic infammatory arthritis HLA-B27)

Answer 136

A

howell jolly bodies (due to splenectomy or nonfunctional spleen)

Answer 137

A

Lead poisoning or sideroblastic anemia

Answer 138

A

subarachnoid hemorrhage

Answer 139

A

tetralogy of fallot (due to RVH)

Answer 140

A

actinomyces israeli. treat with penicillin

Answer 141

A

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

Answer 142

A

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

Answer 143

A

Chagase disease (T cruzi)

Answer 144

A

rapidly progressive crescentic glomerulonephritis

Answer 145

A

endometriosis (frequently involved both ovaries)

Answer 146

A

Homer-Wright rosettes (neuroblastoma, medulloblastoma)

Answer 147

A

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

Answer 148

A

Down syndrome or other chromosomal abnormalaties

Answer 149

A

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

Answer 150

A

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

Answer 151

A

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

Answer 152

A

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

Answer 153

A

direct arteriolar vasodilator;;

AE: andrigenic lopecia and severe refactory hypertension

Answer 154

A

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

Answer 155

A

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

Answer 156

A

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

Answer 157

A

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)

Answer 158

A

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

Answer 159

A

Koilocytes (HPV: predisposes to cervical cancer)

Answer 160

A

pericardial tamponade

Answer 161

A

Owl eye appearance of CMV

Answer 162

A

orphan annie eyes nuclei – papillary carcinoma of the thyroid

Answer 163

A

mallory body (alcoholic liver disease)

Answer 164

A

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

Answer 165

A

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

Answer 166

A

negri bodies of rabies.

Answer 167

A

senile plaques (alzheimer disease)

Answer 168

A

Reed sternberg Cells (Hodgkin lymphoma)

Answer 169

A

Schiller duval bodies (yolk sac tumor)

Answer 170

A

beta thalassemia, sickle cell disease (marrow expansion)

Answer 171

A

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

Answer 172

A

Aschoff bodies (rheumatic fever)

Answer 173

A

infectious mononucleosis

Answer 174

A

bronchial asthma (charcot leyden crystals: eosinophilic granules)

Answer 175

A

DVT, PE, DIC

Answer 176

A

Ghon complex (primary TB)

Answer 177

A

interstitial pulmonary fibrosis

Answer 178

A

Troissseau syndrome (adnocarcinoma of the lung or pancreas

Answer 179

A

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

Answer 180

A

primary aldosteronism (conn syndrome)

Answer 181

A

iron deficiency anemia, lead poisoning, thalassemia

Answer 182

A

cowdry type A bodies (HSV or VZV)

Answer 183

A

ferriginous bodies (asbestosis: increases chance of mesothelioma)

Answer 184

A

squamous cell carcinoma

Answer 185

A

chediak higashi disease (congenital failure of phagolysosome formation)

Answer 186

A

Ulcerative colitis (loss of haustra)

Answer 187

A

Goodpasture syndrome

Answer 188

A

wilson disease (hepatolenticular degeneration)

Answer 189

A

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

Answer 190

A

Multiple myeloma

Answer 191

A

Fibrocystic change of the breast

Answer 192

A

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

Answer 193

A

signet ring (gastric diffuse type carcinoma)

Answer 194

A

string sign (chron disease)

Answer 195

A

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

Answer 196

A

gout (monosodium crystals

Answer 197

A

kimmestiel wilson nodules (diabetic nephropathy)

Answer 198

A

Sensitive: S epidermidis; resistant: S saprophyticus

Answer 199

A

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

Answer 200

A

ewing sarcomma

Answer 201

A

s pneumoniae sensitive

s viridans resistant

Answer 202

A

Minimal change disease (child with nephrotic syndrome

Answer 203

A

Eburnation (osteoarthritis resulting in bony sclerosis

Answer 204

A

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

Answer 205

A

Meningiomas, papillary thyroid carcinoma, mesothelioma,

papillary serous carcinoma of the endometrium and ovary

Answer 206

A

Glioblastoma multiforme

Answer 207

A

Aggressive bone lesion (eg, osteosarcoma, Ewing sarcoma,

osteomyelitis)

Answer 208

A

Glomerulonephritis

Answer 209

A

Reinke crystals (Leydig cell tumor)

Answer 210

A

Wiskott-Aldrich syndrome

Answer 211

A

Intrinsic renal failure (eg, ischemia or toxic injury)

Answer 212

A

Pseudogout (calcium pyrophosphate dihydrate crystals)

Answer 213

A

Coarctation of the aorta

Answer 214

A

Toxoplasma gondii, CNS lymphoma

Answer 215

A

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

Answer 216

A

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

Answer 217

A

Giant cell tumor of bone (generally benign)

special because it occurs in the diaphysis

Answer 218

A

Membranous nephropathy (nephrotic syndrome)

Answer 219

A

Rouleaux formation (high ESR, multiple myeloma)

Answer 220

A

Croup (parainfluenza virus)

Answer 221

A

“Clue cells” (Gardnerella vaginalis

Answer 222

A

Colon cancer

Answer 223

A

Birbeck granules (Langerhans cell histiocytosis)

Answer 224

A

Familial adenomatous polyposis (autosomal dominant,

mutation of APC gene)

Answer 225

A

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

Answer 226

A

Epiglottitis (Haemophilus influenzae)

Answer 227

A

Chronic pyelonephritis (usually due to recurrent infections)

Answer 228

A

Membranoproliferative glomerulonephritis

Answer 229

A

Fatty liver disease (alcoholic or metabolic syndrome)

Answer 230

A

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

Answer 231

A

Chronic end-stage renal disease

Answer 232

A

Acute pyelonephritis

Answer 233

A

CLL (almost always B cell)

Answer 234

A

Diffuse proliferative glomerulonephritis (usually seen with

lupus

Answer 235

A

Xanthochromia (eg, due to subarachnoid hemorrhage)s

Answer 236

A

ethosuximide

Answer 237

A

NSAIDs, colchicine, glucocorticoids

Answer 238

A

All-trans retinoic acid

Answer 239

A

Methylphenidate, CBT, atomoxetine, guanfacine, clonidine

Answer 240

A

Disulfiram, acamprosate, naltrexone, supportive care

Answer 241

A

Long-acting benzodiazepines

Answer 242

A

Nutrition, psychotherapy, mirtazapine

Answer 243

A

Class IB antiarrhythmic (lidocaine, mexiletine)

Answer 244

A

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

Answer 245

A

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

Answer 246

A

Aromatase inhibitor (anastrozole)

Answer 247

A

Smoking cessation

Answer 248

A

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

Answer 249

A

Octreotide

Answer 250

A

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

Answer 251

A

Xanthine oxidase inhibitors (eg, allopurinol, febuxostat);

pegloticase; probenecid

Answer 252

A

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

HCV

Answer 253

A

Antitoxin

Answer 254

A

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

Answer 255

A

Antitoxin

Answer 256

A

Ganciclovir, foscarnet, cidofovir

Answer 257

A

Corticosteroids, infliximab, azathioprine

Answer 258

A

if systemic amphoteracin B and flucytosine and ketocanazole for maintenance

Answer 259

A

SSRIs (first-line)

Answer 260

A

Desmopressin (central); hydrochlorothiazide, indomethacin,

amiloride (nephrogenic)

Answer 261

A

Dietary intervention (low carbohydrate) + insulin replacement

Answer 262

A

Dietary intervention, oral hypoglycemics, and insulin (if

refractory)

Answer 263

A

Fluids, insulin, K+

Answer 264

A

Vancomycin, aminopenicillins/cephalosporins

Answer 265

A

Sildenafil, tadalafil, vardenafil

Answer 266

A

Tamoxifen

Answer 267

A

Fomepizole (alcohol dehydrogenase inhibitor)

Answer 268

A

Rifampin (prophylaxis)

Answer 269

A

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

Answer 270

A

Cyclophosphamide, corticosteroids

Answer 271

A

Protamine sulfate

Answer 272

A

Trastuzumab

Answer 273

A

Spironolactone

Answer 274

A

Statin (first-line)

Answer 275

A

Leuprolide, GnRH (pulsatile), clomiphene

Answer 276

A

Oseltamivir, zanamivir

Answer 277

A

IVIG, high-dose aspirin

Answer 278

A

Macrolides (eg, azithromycin)

Answer 279

A

Warfarin, dabigatran, rivaroxaban and apixaban

Answer 280

A

Chloroquine, mefloquine, atovaquone/proguanil (for blood

schizont), primaquine (for liver hypnozoite)

Answer 281

A

Dantrolene

Answer 282

A

Mifepristone

Answer 283

A

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

Answer 284

A

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

for acute flares, use IV steroids

Answer 285

A

RIPE (rifampin, isoniazid, pyrazinamide, ethambutol)

Answer 286

A

Ceftriaxone (add doxycycline to cover likely concurrent

C trachomatis)

Answer 287

A

Penicillin/ceftriaxone, rifampin (prophylaxis)

Answer 288

A

prenatal folic acid

Answer 289

A

Vitamin D supplementation

Answer 290

A

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

Answer 291

A

Close with indomethacin; keep open with PGE analogs

Answer 292

A

α-antagonists (eg, phenoxybenzamine)

Answer 293

A

TMP-SMX (prophylaxis and treatment in immunosuppressed

patients)

Answer 294

A

Cabergoline/bromocriptine (dopamine agonists)

Answer 295

A

Leuprolide, GnRH (continuous

Answer 296

A

flutamide

Answer 297

A

Antipseudomonal penicillins, aminoglycosides, carbapenems

Answer 298

A

Sildenafil, bosentan, epoprostenol

Answer 299

A

Doxycycline, chloramphenicol

Answer 300

A

Atypical antipsychotics

Answer 301

A

Typical and atypical antipsychotics

Answer 302

A

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

Answer 303

A

Hydroxyurea (increases fetal hemoglobin

Answer 304

A

Itraconazole, oral potassium iodide

Answer 305

A

Sublingual nitroglycerin

Answer 306

A

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

Answer 307

A

Penicillin prophylaxis; evaluation for colon cancer if linked to
endocarditis

Answer 308

A

Penicillin/cephalosporin (systemic infection, pneumonia),

vancomycin (meningitis)

Answer 309

A

Penicillin prophylaxis

Answer 310

A

High-dose steroids

Answer 311

A

Levetiracetam, phenytoin, valproate, carbamazepine

Answer 312

A

Sulfadiazine + pyrimethamine

Answer 313

A

peniccilin

Answer 314

A

Metronidazole (patient and partner

Answer 315

A

Carbamazepine

Answer 316

A

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

infliximab, colectomy

Answer 317

A

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

Answer 318

A

Precursor to squamous cell carcinoma

Answer 319

A

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

Answer 320

A

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

Answer 321

A

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

45–85

Answer 322

A

Skip lesions (Crohn disease)

Answer 323

A

Atherosclerosis

Answer 324

A

3° syphilis (syphilitic aortitis), vasa vasorum destruction

Answer 325

A

Marfan syndrome (idiopathic cystic medial degeneration)

Answer 326

A

Hypertension

Answer 327

A

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

Answer 328

A

Sickle cell disease (hemoglobin S)

Answer 329

A

S pneumoniae

Answer 330

A

Group B streptococcus/E coli (newborns),

S pneumoniae/N meningitidis (kids/teens)

Answer 331

A

Krukenberg tumor (mucin-secreting signet ring cells)

Answer 332

A

Bernard-Soulier syndrome (defect in platelet adhesion to von

Willebrand factor)

Answer 333

A

Supratentorial: metastasis, astrocytoma (including

glioblastoma multiforme), meningioma, schwannoma

Answer 334

A

Infratentorial: medulloblastoma (cerebellum) or
supratentorial: craniopharyngioma

Answer 335

A

Invasive ductal carcinoma

Answer 336

A

Fibrocystic change, carcinoma (in postmenopausal

women)

Answer 337

A

Fibroadenoma

Answer 338

A

Rhabdomyoma, often seen in tuberous sclerosis

Answer 339

A

Marantic/thrombotic endocarditis (nonbacterial)

Answer 340

A

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

Answer 341

A

Chiari II malformation

Answer 342

A

Atrial fibrillation (associated with high risk of emboli)

Answer 343

A

Predisposition to gastric carcinoma (can also cause pernicious
anemia)

Answer 344

A

DES exposure in utero

Answer 345

A

21-hydroxylase deficiency

Answer 346

A

Dubin-Johnson syndrome (inability of hepatocytes to secrete

conjugated bilirubin into bile)

Answer 347

A

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

world)

Answer 348

A

LAD > RCA > circumflex

Answer 349

A

Iodine deficit/congenital hypothyroidism

Answer 350

A

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

Answer 351

A

Tetralogy of Fallot, transposition of great vessels, truncus

arteriosus

Answer 352

A

Blast crisis

Answer 353

A

Lupus nephropathy

Answer 354

A

Alzheimer disease, multiple infarcts vascular dimentia

Answer 355

A

Multiple sclerosis

Answer 356

A

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

Answer 357

A

Zenker diverticulum (diagnosed by barium swallow

Answer 358

A

Aortic stenosis

Answer 359

A

Squamous cell carcinoma (worldwide); adenocarcinoma (US)

Answer 360

A

S aureus, B cereus

Answer 361

A

Adenocarcinoma

intestinal vs diffuse type

Answer 362

A

Berger disease (IgA nephropathy)

Answer 363

A

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

Answer 364

A

Mitral valve prolapse

Answer 365

A

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

abuse)

Answer 366

A

Enterobius vermicularis, Ascaris lumbricoides

Answer 367

A

Rupture of middle meningeal artery (trauma; lentiform

shaped)

Answer 368

A

Rupture of bridging veins (crescent shaped)

Answer 369

A

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

Answer 370

A

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

Answer 371

A

von Willebrand disease

Answer 372

A

Gilbert syndrome (benign congenital unconjugated
hyperbilirubinemia)

Answer 373

A

Psoriatic arthritis, ankylosing spondylitis, IBD-associated

arthritis, reactive arthritis (formerly Reiter syndrome)

Answer 374

A

Diabetes mellitus type 1, SLE, Graves disease, Hashimoto

thyroiditis, Addison disease

Answer 375

A

Diabetes mellitus type 1, rheumatoid arthritis, Addison

disease

Answer 376

A

VSD, tricuspid regurgitation, mitral regurgitation

Answer 377

A

Virchow triad (increased risk of thrombosis)

Answer 378

A

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

Answer 379

A

Accidental excision during thyroidectomy

Answer 380

A

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

Answer 381

A

Hepatitis C

Answer 382

A

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

Answer 383

A

Down syndrome, fragile X syndrome

Answer 384

A

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

Answer 385

A

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

Answer 386

A

Alcoholic cirrhosis

Answer 387

A

Gaucher disease

Answer 388

A

Prostatic carcinoma

Answer 389

A

Hodgkin lymphoma

Answer 390

A

ALL, medulloblastoma (cerebellum

Answer 391

A

Prostate, breast > lung > thyroid

Answer 392

A

Lung > breast > genitourinary > melanoma > GI

Answer 393

A

Colon&raquo_space; stomach, pancreas

Answer 394

A

Iron deficiency

Answer 395

A

Disease occurs in both males and females, inherited through

females only

Answer 396

A

Rheumatic heart disease

Answer 397

A

Amyotrophic lateral sclerosis

Answer 398

A

Coxsackie B

Answer 399

A

Focal segmental glomerulosclerosis

Answer 400

A

Minimal change disease

Answer 401

A

Kallmann syndrome (hypogonadotropic hypogonadism and
anosmia

Answer 402

A

S aureus, Pseudomonas, other enteric gram ⊝ rods

Answer 403

A

Mitral stenosis

Answer 404

A

Pneumocystis jirovecii pneumonia

Answer 405

A

S aureus (most common overall)

Answer 406

A

Salmonella

Answer 407

A

Pseudomonas, Candida, S aureus

Answer 408

A

Serous cystadenoma

Answer 409

A

Gallstones, alcohol

Answer 410

A

Alcohol (adults), cystic fibrosis (kids)

Answer 411

A

C trachomatis, N gonorrhoeae

Answer 412

A

CML (may sometimes be associated with ALL/AML)

Answer 413

A

Prolactinoma, somatotropic adenoma

Answer 414

A

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

Answer 415

A

Multiple myeloma

Answer 416

A

Adenoma of adrenal cortex

Answer 417

A

Adenomas, hyperplasia, carcinoma

Answer 418

A

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

Answer 419

A

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

Answer 420

A

Buerger disease (strongly associated with tobacco)

Answer 421

A

Zollinger-Ellison syndrome (gastrinoma of duodenum or

pancreas), associated with MEN1

Answer 422

A

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

Answer 423

A

Cor pulmonale

Answer 424

A

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

Answer 425

A

Stiff/hypertrophic ventricle (aortic stenosis, restrictive

cardiomyopathy)

Answer 426

A

Hypocalcemia of chronic kidney disease

Answer 427

A

C trachomatis (usually coinfected with N gonorrhoeae)

Answer 428

A

Small cell carcinoma of the lung

Answer 429

A

Sigmoid colon

Answer 430

A

Abdominal aorta > coronary artery > popliteal artery

> carotid artery

Answer 431

A

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

Answer 432

A

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

Answer 433

A

Philadelphia chromosome, CML (BCR-ABL activation,

tyrosine kinase oncogene)

Answer 434

A

Risk of ipsilateral blindness due to occlusion of ophthalmic

artery; polymyalgia rheumatica

Answer 435

A

Seminoma (malignant, radiosensitive), increased placental ALP

Answer 436

A

Papillary carcinoma (childhood irradiation)

Answer 437

A

Leiomyoma (fibroids)(estrogen dependent, not precancerous)

Answer 438

A

Strawberry hemangioma (grows rapidly and regresses
spontaneously by childhood)

Answer 439

A

Pheochromocytoma (usually benign)

Answer 440

A

Neuroblastoma (malignant)

Answer 441

A

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

Answer 442

A

Diffuse large B-cell lymphoma

Answer 443

A

E coli, Staphylococcus saprophyticus (young women)

Answer 444

A

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

man or woman)

Answer 445

A

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

Answer 446

A

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

Answer 447

A

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

Answer 448

A

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

Answer 449

A

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

Answer 450

A

transposition of the great vessels, caudal regression syndrome

Answer 451

A

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

Answer 452

A

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

Answer 453

A

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

Answer 454

A

hemosiderin laden macrophages

Answer 455

A

bacterial endocarditis septic emboli from tricuspid valve into lung

Answer 456

A

in left PCWP is increased in right PCWP is decreased

Answer 457

A

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

Answer 458

A

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

Answer 459

A

IL-6 monoclonal antibody

Answer 460

A

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.

Answer 461

A

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

Answer 462

A

GHRH analog used to treat HIV associated lipodistrophy

Answer 463

A

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

Answer 464

A

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

Answer 465

A

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

Answer 466

A

correction of hypernatremia too quickly

Answer 467

A

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.

Answer 468

A

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

Answer 469

A

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.

Answer 470

A

Progressive multifocal leukoencephalopathy

Answer 471

A

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

Answer 472

A

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.

Answer 473

A

negative regulator of RAS. mutated in NF-1

chromosome 17

Answer 474

A

hemangioblastomas
angiomatosis
bilateral RCCs
pheochromocytomas.

Answer 475

A

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

Answer 476

A

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

Answer 477

A

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

Answer 478

A

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

Answer 479

A

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.

Answer 480

A

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

Answer 481

A

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

Answer 482

A

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

Answer 483

A

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

Answer 484

A

usually occurs in the fragile germinal matrix

Answer 485

A

nimodipine

Answer 486

A

12-48 hours after ischemic event

Answer 487

A

24-72 hrs post ischemic event

Answer 488

A

1-2 weeks. closer to 2 weeks.

Answer 489

A

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

Answer 490

A

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.

Answer 491

A

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

Answer 492

A

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

Answer 493

A

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.

Answer 494

A

Genes: MSH2, MLH1, MSH6, and PMS2

associated neoplasms: colorectal cancer, endometrial cancer, ovarian cancer

Answer 495

A

gene: APC

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

Answer 496

A

Sarcomas 
breast cancer 
brain tumors 
adrenocortical carcinoma 
leukemia

Answer 497

A

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

Answer 498

A

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

Answer 499

A

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

Answer 500

A

autosomal dominant
normal intellect
aortic root dilation
upward lens dislocation

Answer 501

A

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

Answer 502

A

heparin is more water soluble.

Answer 503

A

crypts of lieberkuhn.

Answer 504

A

regenerative spherical nodules of proliferating hepatocytes.

Answer 505

A

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

Answer 506

A

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.

Answer 507

A

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

Answer 508

A

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

Answer 509

A

osteomyelitis, discitis, abscess- recent infection or IVDU

fever spine tenderness

Answer 510

A

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.

Answer 511

A

increase in CVP, decrease in CO and increase SVR

Answer 512

A

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.

Answer 513

A

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.

Answer 514

A

schwann cells.

the nodules are known as neuro fibromas

Answer 515

A

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

Answer 516

A

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

Answer 517

A

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

Answer 518

A

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

Answer 519

A

severe hyperammonemia and neurological damage.

Answer 520

A

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

Answer 521

A

GOAT HAG:

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

Answer 522

A

PIGGLET

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

Answer 523

A

primary decreased cortisol and increased ACTH

secondary decreased cortisol and ACTH.

Answer 524

A

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

Answer 525

A

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

Answer 526

A

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

Answer 527

A

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

Answer 528

A

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.

Answer 529

A

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

Answer 530

A

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

Answer 531

A

thyrotoxicosis if a patient with iodine deficiency becomes iodine replete

Answer 532

A

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.

Answer 533

A

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

Answer 534

A

osteoclasts and deposited hemosiderin from hemorrhages.

Answer 535

A

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

Answer 536

A

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

Answer 537

A

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

Answer 538

A

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

Answer 539

A

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

Answer 540

A

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

Answer 541

A

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

Answer 542

A

Gq

CNS, enteric Nervous system

Answer 543

A

Gi

decrease heart rate and contractility of atria.

Answer 544

A

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.

Answer 545

A

Gs

relaxes renal vascular smooth muscle

Answer 546

A

Gi

modulates transmitter release, especially in brain

Answer 547

A

Gq
increases nasal and bronchial mucus production
increases vascular permeability

Answer 548

A

Gs

increases gastric acid secretion

Answer 549

A

Gq

increases vascular smooth muscle contraction

Answer 550

A

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

Answer 551

A

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

Answer 552

A

less condensed. transcriptionally active

Answer 553

A

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

Answer 554

A

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

Answer 555

A

leflunomide, MTX, trimethoprim, pyrimethamine and 5-Fu

Answer 556

A

6-MP, mycophenolate and ribavirin

Answer 557

A

UGA
UAG
UAA

Answer 558

A

AUG. is methionine.

Answer 559

A

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

Answer 560

A

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.

Answer 561

A

occurs predominantlyin G2

Answer 562

A

rRNA
mRNA
tRNA and 5s rRNA.

Answer 563

A

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

Answer 564

A

inhibits RNA pol in both prokaryotes and eukaryotes

Answer 565

A

mixed connective tissue disease

Answer 566

A

5’ GU 3’AG

Answer 567

A

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

Answer 568

A

ATP in tRNA charging and GTP in protein translation

Answer 569

A

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

Answer 570

A

muscle contraction cytokinesis

actin microvilli

Answer 571

A

maintain cell structure

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

Answer 572

A

movement. cell division.

Answer 573

A

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

Answer 574

A

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

decreased production in osteogenesis imperfecta type I

Answer 575

A

cartilage, vitreous body, nucleus pulpus.

Answer 576

A

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

Answer 577

A

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

Answer 578

A

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

Answer 579

A

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

Answer 580

A

one gene contributes to multiple phenotypic effects.

Answer 581

A

hetero implies miosis one defect

iso meiosis II

Answer 582

A

autosomal dominant myotonic type 1 CTG repeat

Answer 583

A

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

Answer 584

A

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

Answer 585

A

glutamine phosphoribosylpyrophospahte

negative regulators are AMP, IMP and GMP.

Answer 586

A

carbamoyl phosphate synthetase II.

regulators ATP and PRPP positively and UTP negatively.

Answer 587

A

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

Answer 588

A

failure of cell migration

Answer 589

A

dichorionic diamniotic
monochorionic diaminiotic
monochorionic monoamniotic
monochorionic monoamniotic conjoined.

Answer 590

A

synthesizes hormones

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

Answer 591

A

associated with congenital and chromosomal anomalies.

Answer 592

A

allantois.

Answer 593

A

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.

Answer 594

A

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

Answer 595

A

proximal part of pulmonary arteries and ductus arteriosus.

Answer 596

A

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.

Answer 597

A

micrognathia, glossoptosis, cleft palate, airway obstruction.

Answer 598

A

neural crest dysfunction –> mandibular hypoplasia, facial abnormalities.

Answer 599

A

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

Answer 600

A

dorsal wings–> inferior parathyroids

ventral wings–> thymus

Answer 601

A

dorsal wings–> superior parathyroids

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

Answer 602

A

mesonephric duct degenerates and paramesonephric duct develops.

Answer 603

A

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

Answer 604

A

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

Answer 605

A

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

Answer 606

A

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

Answer 607

A

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

Answer 608

A

glans penis and corpus cavernosum and spongiosum in males.

glans clitorus and vestibular bulbs in females

Answer 609

A

bulbouretheral glands of cowper and prostate gland in males

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

Answer 610

A

ventral shaft of penis in males

labia minora in females

Answer 611

A

hypo- failure of urethral folds to fuse

epi faulty positioning of genital tubercle.

Answer 612

A

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

Answer 613

A

external iliac nodes

Answer 614

A

deep inguinal nodes

Answer 615

A

connects ovaries to the lateral pelvic wall

contains the ovarian vessels

Answer 616

A

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

Answer 617

A

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

Answer 618

A

medial pole of ovary to lateral uterus.

Answer 619

A

membranous urethra prone to injury

urine to leak into retropubic space

Answer 620

A

bulbar and penile urethra at risk

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

Answer 621

A

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.

Answer 622

A

maintains local levels of testosterone.

Answer 623

A

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

Answer 624

A

arrested in meiosis I prophase I until ovulation

arrested in meiosis II metaphase II until fertilization.

Answer 625

A

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

Answer 626

A

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

Answer 627

A

spermatids loss of cytoplasmic contents and gain of acrosomal caps.

Answer 628

A

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

Answer 629

A

membrane rupture, painless vaginal bleeding, and fetal bradycardia.

Answer 630

A

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

Answer 631

A

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

Answer 632

A

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

Answer 633

A

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

Answer 634

A

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

Answer 635

A

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

Answer 636

A

in cytosol.
oxaloacetate to PEP.
requires GTP

Answer 637

A

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

Answer 638

A

periods of growth

Answer 639

A

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

Answer 640

A

–>porphyrin–>heme

Answer 641

A

creatinine, urea, and nitric oxide

Answer 642

A

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.

Answer 643

A

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

Answer 644

A

niemann pick disease AR
deficient sphingomyelinase
accumulation of sphingomyelin

Answer 645

A

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

Answer 646

A

Krabbe disease AR
deficiency of galactocerebrosidase
galactocerebroside and psychosine accumalation

Answer 647

A

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

Answer 648

A

inherited defect in transport of LCFAs into mitochondra

causes hypotonia, weakness and hypoketotic hypoglycemia.

Answer 649

A

inhibited by malonyl CoA

Answer 650

A

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.

Answer 651

A

paroxysmal nocturnal hemoglobinuria. 
treatment ecilizumab (terminal complement inhibitor)

Answer 652

A

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)

Answer 653

A

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

Answer 654

A

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

Answer 655

A

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

Answer 656

A

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

Answer 657

A

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

Answer 658

A

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

Answer 659

A

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

Answer 660

A

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

Answer 661

A

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

Answer 662

A

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

Answer 663

A

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.

Answer 664

A

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

Answer 665

A

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

Answer 666

A

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

Answer 667

A

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

Answer 668

A

Brenner tumor

Answer 669

A

meigs syndrome

variant of a ovarian fibroma- bundles of spindle shaped fibroblasts

Answer 670

A

meigs syndrome

variant of a ovarian fibroma- bundles of spindle shaped fibroblasts

Answer 671

A

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

Answer 672

A

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

Answer 673

A

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

Answer 674

A

aggressive contains fetal tissue, neuroectoderm

immature embryonic like neural tissue.

Answer 675

A

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

Answer 676

A

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

Answer 677

A

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

Answer 678

A

A beta amyloid and neuritic processes

Answer 679

A

pale infarcts

Answer 680

A

hemorrhagic infarct

Answer 681

A

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

Answer 682

A

spongy degeneration (spongiform encephalopathy)

Answer 683

A

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.

Answer 684

A

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

Answer 685

A

transposon

Answer 686

A

bacillus and clostridium

spores have dipicolinic acid

Answer 687

A

inactivate the 60s ribosome by removing adenine from rRNA

Answer 688

A

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

Answer 689

A

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

Answer 690

A

hand infection in aquarium handlers

Answer 691

A

cervical lymphadenitis in

children

Answer 692

A

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

Answer 693

A

inhibit

phagolysosomal fusion

Answer 694

A

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

Answer 695

A

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

Answer 696

A

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

Answer 697

A

PERCH
polio virus
enterovirus
rhino virus
coxsackie virus
hep A

Answer 698

A

Hep C
west nile
st louis
dengue
yellow fever
zika

Answer 699

A

chukinguya
rubella virus
EEE WEE VEE

Answer 700

A

ebola/marbug

Answer 701

A

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

Answer 702

A

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.

Answer 703

A

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

Answer 704

A

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.

Answer 705

A

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

Answer 706

A

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

Answer 707

A

frontal eye field lesion produces gazes toward lesion side

PPRF produce gaze away from lesion side

Answer 708

A

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

Answer 709

A

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

Answer 710

A

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

Answer 711

A

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).

Answer 712

A

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

Answer 713

A

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

Answer 714

A

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

Answer 715

A

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

Answer 716

A

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

Answer 717

A

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

Answer 718

A

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

Answer 719

A

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

Answer 720

A

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”

Answer 721

A

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

Answer 722

A

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

Answer 723

A

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

Answer 724

A

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

Answer 725

A

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

Answer 726

A

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

Answer 727

A

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

Answer 728

A

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.

Answer 729

A

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.

Answer 730

A

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

Answer 731

A

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

Answer 732

A

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.

Answer 733

A

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.

Answer 734

A

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.

Answer 735

A

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.

Answer 736

A

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

Answer 737

A

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.

Answer 738

A

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.

Answer 739

A

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.

Answer 740

A

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.

Answer 741

A

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.

Answer 742

A

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

Answer 743

A

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).

Answer 744

A

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.

Answer 745

A

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.

Answer 746

A

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.

Answer 747

A

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.

Answer 748

A

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.

Answer 749

A

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

Answer 750

A

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.

Answer 751

A

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.

Answer 752

A

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.

Answer 753

A

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.

Answer 754

A

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

Answer 755

A

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

Answer 756

A

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.

Answer 757

A

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.

Answer 758

A

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.

Answer 759

A

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

Answer 760

A

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

Answer 761

A

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.

Answer 762

A

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.

Answer 763

A

First-trimester pregnancy screen shows 􀁲 free

β-hCG, 􀁲 PAPP-A.

Answer 764

A

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

Answer 765

A

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

Answer 766

A

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)

Answer 767

A

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

Answer 768

A

vitamin B2

used in the succinate dehydrogenase reaction

Answer 769

A

pantothenic acid

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

Answer 770

A

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.

Answer 771

A

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)

Answer 772

A

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.

Answer 773

A

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

Answer 774

A

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).

Answer 775

A

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.

Answer 776

A

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

Answer 777

A

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

Answer 778

A

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

Answer 779

A

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

Answer 780

A

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.

Answer 781

A

Xanthogranulomatous pyelonephritis

Answer 782

A

Associated with obstetric catastrophes (eg,

abruptio placentae), septic shock.

Answer 783

A

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

Answer 784

A

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.

Answer 785

A

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

Answer 786

A

Numerous cysts in cortex and medulla

Answer 787

A

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

Answer 788

A

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.

Answer 789

A

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

Answer 790

A

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)

Answer 791

A

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

Answer 792

A

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

Answer 793

A

terminal bronchioles

Respiration impossible, incompatible with life.

Answer 794

A

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

Answer 795

A

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).

Answer 796

A

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

Answer 797

A

RV
TLC
FRC

Answer 798

A

increase

decrease

Answer 799

A

increase in RV, decrease in FVC and unchanged TLC

Answer 800

A

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

Answer 801

A

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

Answer 802

A

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

Answer 803

A

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

Answer 804

A

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.

Answer 805

A

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

Answer 806

A

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.

Answer 807

A

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.

Answer 808

A

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

Answer 809

A

normally inhibits vascular smooth muscle proliferation.

inactivated in hereditary PH

Answer 810

A

pleural effussion and atelectasis.

atelectasis can cause tracheal deviation towards side of the lesion

Answer 811

A

consolidation (lobar pneumonia, pulmonary edema)

Answer 812

A

-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

Answer 813

A

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

Answer 814

A

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

Answer 815

A

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

Answer 816

A

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

Answer 817

A

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

Answer 818

A

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

Answer 819

A

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

Answer 820

A

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

Answer 821

A

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

Answer 822

A

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

Answer 823

A

into but not over the the muscularis mucosa.

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

Answer 824

A

meissner is in the submucosa

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

Answer 825

A

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

Answer 826

A

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

Answer 827

A

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

Answer 828

A

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

Answer 829

A

kuppfer cells which are macrophages

Answer 830

A

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

Answer 831

A

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

Answer 832

A

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

Answer 833

A

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

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