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Board questions > Combank 3 > Flashcards

Combank 3 Flashcards

1
Q

sirolimus MOA

A

creates a complex with intracellular immunophilins (FKBP) and binds to mTOR inhibiting T cell proliferation in response to IL-2

usually giving with cyclosporine and corticosteroids after a kidney transplant to suppress organ rejection

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2
Q

An XR of small bowel obstruction appears the way it does because…

what is tx for SBO?

A

smooth muscle contraction pushing against an area of resistance

NPO, insert nasogastric tube, place on suction

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3
Q

What are gelatin containing vaccines?

A

MMR, influenza, rabies, varicella, and yellow fever

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4
Q

male between 15 and 35 yo with testicular enlargement and gynecomastia

A

choriocarcinoma

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5
Q

MC testicular neoplasm in infants and children; present with a painless and bulky testicular mass

dx?

what is seen histologically?

pathognomonic?

A

yolk sac tumor/ endodermal sinus tumor

honeycomb pattern is seen in which a reticular network is formed by the vacuolated cytoplasm of tumor cells

Schiller Duvall bodies - take the appearance of a central vessel that is rimmed by fibrous tissue and surrounded by malignant epithelial cells in a cystic space

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6
Q

Lab findings associated with PCOS are

A
  • elevated serum androgens (total T, and DHEAS)
  • elevated LH (LH:FSH >2) due to pituitary oversecretion and leads to decreased synthesis of FSH and increased androgen production
  • elevated serum antimullerian hormone (AMH)
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7
Q

anemia, spleonomegaly, teardrop-shaped RBCs on peripheral smear, and bone marrow fibrosis

dx?

due to?

A

Primary myelofibrosis

due to a mutation in the cytoplasmic tyrosine kinsase janus kinase 2, which leads to a constituitively active TK with increased phosphorylation activity that induces erythrocytosis and eventually leads to fibrosis

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8
Q

bone marrow aspiration and biopsy or peripheral blood containing at least 20% myeloid blasts or equivalents

dx?

A

acute myeloid leukemia

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9
Q

Sickle cell mutation

A

single point mutation on the hemoglobin gene in which glutamic acid is replaced with valine

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10
Q

Why can you tx Sickle cell disease with hydroxyurea?

A

increases fetal hemoglobin

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11
Q

Adult with PCKD has what inheritence type?

A

autosomal dominant

(ADults)

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12
Q

What is commonly associated with the adult form of PCKD?

A

subarachnoid hemorrhages

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13
Q

What is the MC characteristic of toxocariasis?

What type of pathogen is toxocara canis?

A

eosinophilia

dog roundworm

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14
Q

detrusor muscle receives blood supply from

A

anterior division of the internal iliac artery

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15
Q

How does PTH work on the kidney?

A
  • inhibiting Na/P cotransport
  • increasing phosphate excretion
  • increasing urinary excretion of cAMP
  • increasing calcium resorption
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16
Q

Gentamicin concerns

A

aminoglycoside that could be toxic to the kidney

2 most common AE are ototoxicity and nephrotoxicity

admin IV once per day to minimize toxic effects

binds to 30s and 50s subunits in prokaryotes to interfere with formation of initiation complex for protein synthesis

requires oxygen as a cofactor to enter cells, thus anaerobes are intrinsically resistant to bactericidal effects

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17
Q

What nerve passes through the foramen lacerum?

what does it carry and what would happen if injured?

A

nerve of the pterygoid canal

contains parasympathetic neurons to the lacrimal gland and sympathetic neurons to blood vessels in the face

disruption of this nerve would result in anhidrosis and deficits in tear production

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18
Q

What nerve goes through the foramen ovale?

A

mandibular division of the trigeminal nerve (CN V3)

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19
Q

What nerve goes through the foramen rotundum?

A

maxillary branch of trigeminal (CN V2)

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20
Q

name of disease with deficiency in functional UDP-glucuronosyltransferase (UGT) activity

A

Gilbert Disease

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21
Q

pt with menorrhagia and family hx of menorrhagia

A

von Willebrand Disease

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22
Q

triad representative of DiGeorge syndrome

A
  • “Conotruncal” cardiac anomalies
  • hypoplastic thymus (T cell deficits)
  • subsequent hypoplastic parathyroid glands (resulting in hypocalcemia)
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23
Q

Zidovudine characteristics

A

aka Azidothymidine (AZT) - NRTI

can incorportate itself into the growing DNA chain, synthesized by viral reverse transcriptase, causing chain termination

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24
Q

-navir suffix

A

protease inhibitors, can be part of HAART

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25
Q

drug class of efavirenz

A

NNRTI

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26
Q

What is the most extreme issue associated with Ehlers-Danolos syndrome?

A

berry aneurysm in circle of Willis

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27
Q

tumor cells with scanty cytoplasm and rings around little masses of nerve fibers

A

small blue cells forming Homer Wright rosettes

neuroblastoma

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28
Q

neuroblastomas especially tend to produce …. and the classic marker is its breakdown product in urine….

A

dopamine

homovanillic acid (HVA)

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29
Q

young child with a nontender, firm abdominal mass

tumor is extrarenal, and likely to cross midline and have calcifications

A

neuroblastoma

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30
Q

What apolipoprotein is necessary for LPL to act on associated lipoprotein?

What is it found on?

A

apo C II

found on chylomicrons, VLDL, and HDL

responsible for the removal of triglycerides and fatty acids from chylomicrons and VLDL for transport into extrahepatic tissues

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31
Q

presentation with osteogenesis imperfecta

A
  • blue sclerae
  • slightly protruding eyes
  • early hearing loss
  • frequent fx
  • slight spinal curvature
  • poor muscle tone
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32
Q

MC bacterial cause of sinusitis

A

S. pneumoniae

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33
Q

What is the MC AE of SSRIs?

what is an alternative tx to avoid this AE?

A

sexual dysfunction

bupropion

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34
Q

tumor growth along intact alveolar septae/lepidic growth pattern

A

bronchioalveolar carcinoma

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35
Q

A decrease in disease prevalence will do what to the PPV?

A

results in a decreased PPV

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36
Q

MCC of death in ADPKD?

what do the mutations in PKD1 or PKD2 cause?

A

cardiac disease

abnormal levels of polycystin-1 and polycystin-2

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37
Q

acute dystonic manifestations of extrapyramidal symptoms (EPS) are treated with what?

A

rx with anticholinergic properties like diphenhydramine or benztropine

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38
Q

recurrent oral aphthous ulcers, genital ulcers, and uveitis

can also have joint arthropathy and panniculitis/erythema nodosum

A

Behcet syndrome

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39
Q

What do paired bones of the skull do when the sphenobasilar symphysis goes into flexion?

A

external rotation

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40
Q

What is the acute phase of Chagas disease treated with?

how does this work?

A

nifurtimox - kills trypomastigotes in the blood, but is less effective against amastigotes in tissue

decreases the probablity of chronic disease

when nifurtimox is reduced in the trypanosome, a nitro anion radical is formed and undergoes auto-oxidation, resulting in the generation of the superoxide anion O2-, H2O2, HO2, and other highly reactive moleules, killing the organism

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41
Q

trazadone drug info

A

atypical antidepressant

weak inhibitor of 5-HT2A receptor, blocking serotonin reuptake; also causes sedation (inhibit H1 receptor)

tx for sleep disturbances and depression

AE: priapism (predisposed if multiple myeloma, leukemia, and SCA)

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42
Q

What is 5-HIAA?

A

5-hydroxyindoleacetic acid measured in a 24 hour urine collection test that measures the main metabolite of serotonin and can point to the dx of carcinoid syndrome

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43
Q

What type of cells are in carcinoid tumors?

A

neuroendocrine cells

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44
Q

succinylcholine drug info

A
  • acetylcholine agonist at NMJ
  • cause depolarization of the membrane
  • initially causes depolarization that leads to fasciculations, continued exposure results in the Na channels entering an inactivated state and are blocked
    • muscle no longer responds to stimulation
  • known trigger of malignant hyperthermia
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45
Q

What does baclofen do?

A

GABA b receptor agonist, used to decrease muscle spasms

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46
Q

How does PTH work?

A

stimulating adenylate cyclase and generating cAMP

increased cAMP promotes increased bone resorption of calcium and phosphate, increased renal reabsorption of calcium, and decreased renal absorption of phosphate (in PCT)

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47
Q

In normal pregnancy, what happens to thyroid function tests?

A

rising estrogen during pregnancy induces the hepatic synthesis of TBG, a binding protein for T4

  • TBG levels increase
  • total serum T4 increase
  • free T3 and T4 are normal
  • TSH is normal (but was decreased in first trimester in response to the elevated hCG, and elevates at term due to increases in renal iodine clearance and the placental degradation of thyroid hormone
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48
Q

a lesion of the MLF produces nystagmus due to the resulting palsy of what muscle?

A

medial rectus muscle

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49
Q

OMM tx for post op ileus

A

inhibitory pressure of the lower thoracic and lumbar paravertebral muscles to the point of tissue relaxation to promote down-regulation of the sympathetic nervous system

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50
Q

What is “sodium escape” phenomenon?

A

chronically elevated sodium levels lead to a chronically high systemic BP and stimulate cells of the R atrium to release ANP

ANP allows the renal tubule to decrease Na+ absorption, and serum Na+ levels normalize

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51
Q

tx of MG and major AE of this tx?

A

pyridostigmine bromide (anticholinesterase)

AE: diarrhea, increased salivation and bronchial secretions, nausea, sweating, bradycardia, and hypotension

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52
Q

X linked congenital immunodeficiency characterized by recurrent pyogenic infections and eczema due to IgM deficiency and IgA excess

dx?

mutation?

A

Wiskott-Aldrich syndrome (WAS)

WASp gene on X chromosome

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53
Q

multiple severe infections in the first month of life, often in different systems; deficient in both T and B cells

dx?

how?

tx?

A

Adenosine deaminase deficiency (SCID)

CBC with differential and further advanced tests including lymphocyte function tests and molecular studies to identify known genetic defects

bone marrow transplant is curative if done before 3 months of life

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54
Q

Dx of DiGeorge syndrome confirmed with

A

reduced number of CD3+ T cells and chromosomal analysis

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55
Q

mutation of STAT3 gene on chromosome 17 leads to

A

hypergammaglobulinemia E syndrome or Job syndrome

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56
Q

two primary external rotators of the shoulder are…

What nerve innervates the accessory external rotator muscle?

A

infraspinatus and teres minor

axillary nerve innervates the teres minor and the deltoid

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57
Q

What nerve innervates the supraspinatus and the infraspinatus?

A

suprascapular nerve

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58
Q

Clomiphene MOA

A

SERM that inhibits negative FB of estrogen in the HT on gonadotropin release causing an increased release of LH and FSH from the anterior pituitary gland, which stimulates ovulation

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59
Q

unilocular or multilocular cyst with an associated tumor nodule; histo shows Rosenthal fibers, which are elongated corkscrew shaped eosinophilic fibers that stain positively for glial fibrillary acidic protein (GFAP)

dx?

A

pilocytic astrocytoma

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60
Q

benign CNS tumors located in the sella turcica and most commonly occur in children aged 5-10 yo

dx?

what do they arise from?

presenting ssx?

A

craniopharyngiomas

Rathke’s pouch

increased ICP, HA, projectile vomiting, papilledema, decrease in visual acuity, blurred vision, or bitemporal hemianopsia

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61
Q

Where do ependymomas most commonly occur?

What do pts present with?

what does histo look like?

A

commonly found in 4th ventricle

avg age at dx is 4 yo

insidious onset of lethargy, headache, nausea, vomiting due to increased ICP from obstructive hydrocephalus

histo: perivascular pseudorosettes, cells with periph nuclei that form a halo around an empty lumen; blepharoplasts, which are rod-shaped intracytoplasmic eosinophilic inclusions can also be found near the nucleus

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62
Q

9 yo with brain tumor midline cerebellum

dx?

histo?

A

medulloblastoma

Homer-Wright pseudorosettes, which are elongated tumor cells that are arranged concentrically around an eosinophilic central space devoid of any blood vessels

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63
Q

What lab will you see in hereditary hemochromatosis?

A

increased transferrin saturation due to high Fe concentration

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64
Q

TSS is characterized by…

A

high fever, rash, hypotension, multiorgan failure (3+ organs involved), and desquamation, typically of palms and soles 1-2 weeks s/p onset of acute illness

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65
Q

TSST-1 works by…

A

binds MHC II and T cell receptors outside of the antigenic groove, nonspecifically activating large numbers of T cells to stimulate release of IFN-y and IL-2

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66
Q

tx of Loa loa infection and MOA

A

diethylcarbamazine (DEC) is an antihelminthic drug that acts by inhibiting arachidonic acid metabolism in filarial microfilaria, which disrupts their membranes and makes them more susceptible to immune attack

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67
Q

hydrostatic pressure will …. while oncotic pressure ….

A

hydrostatic pressure pushes away from self while oncotic pressure pulls to self

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68
Q

first line tx for actinomyces israelii

A

penicillin

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69
Q

obligate anaerobes lack what enzymes?

ex of such bacteria

A

lack catalase and superoxide dismutase

clostridium, bacteroides, actinomyces

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70
Q

MC AE of amiodarone?

A

pulmonary fibrosis

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71
Q

isometric muscle contraction occurs when the forces applied between the physician and pt are equal. this results in increased muscle tension with no…

A

approximation of origin and insertion

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72
Q

Why would tardive dyskinesia occur with typical antipsychotics?

A

result from increased dopamine receptor synthesis in response to long-term receptor blockade; leads to increased sensitivity of dopamine at its receptors in the basal ganglia, altering the balance between cholinergic and dopamine input responsible for voluntary movement

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73
Q

Major AE of phenytoin… and how this occurs

A

megaloblastic anemia secondary to folate deficiency

specifically, phenytoin inhibits intestinal conjugase, which is needed to convert folate into an absorbable form

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74
Q

phenytoin MOA

A

decreasing sodium influx into neurons, thereby decreasing their ability for depolarization

does so for neurons in resting and depolarization states

also decreases influx of calcium during depolarization

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75
Q

Why is someone with folate deficiency megaloblastic anemia at risk for vessel thrombosis?

A

because of elevated levels of homocysteine, which leads to hypercoagulability

homocysteine causes destruction of arteries, does so by injuring the structural proteins elastin, collagen, and proteoglycans

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76
Q

Lowenstein-Jensen medium will grow

A

mycobacterium

appears as brown, granular colonies

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77
Q

the presence of Howell-Jolly bodies most frequently indicates

A

either absence of the spleen or splenic hypofunction secondary to repeated splenic infarctions

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78
Q

the only deficit seen in conduction aphasia (arcuate fasciculus) is…

A

inability to repeat simple phrases

may also present with inability to write and be localized to the superior temporal gyrus or inferior parietal region adjacent to the temporal lobs

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79
Q

Poor suckling and swallowing in a neonate could be due to…

A

dysfunction of CN IX, X, XII - found in jugular foramen (IX and X) and hypoglossal canal (XII) both of which are made up by the occipital bone of the cranium

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80
Q

what ligament is most often involved in ovarian torsion?

what is within this ligament?

A

infundibulopelvic ligament (suspensory ligament of the ovary)

ovarian artery (coming off the abdominal aorta) and ovarian vein

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81
Q

Crohn disease pts have serum antibodies that are positive for

A

the yeast Saccharomyces cerevisiae (ASCA)

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82
Q

MC AE of lidocaine use when used for arrhythmias

A

CNS effects

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83
Q

pattern of behavior in which they are socially detached and lack desire for personal relationships

A

shizoid personality disorder

84
Q

at least one month hx of two or more of the following ssx: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, and/or negative symptoms PLUS full diagnostic criteria for either a mania or depressive episode

A

shizoaffective disorder

85
Q

What is the only thenar muscle not innervated by the median nerve and what is it innervated by?

A

adductor pollicis innervated by ulnar nerve

86
Q

21-hydroxylase deficiency leads to the inability of the adrenal cortex to produce…..

this is the MC form of ….

leading to….

A

glucocorticoids and mineralocorticoids

CAH

hypotension/salt-wasting and thus activation of the renin-angiotensin system

87
Q

clinical findings of primary biliary cirrhosis

A

pruritis (due to bile salt deposition in the skin), hepatomegaly, jaundice, and cirrhosis with portal hypertension; Alkaline phosphatase elevated and of hepatic origin;

88
Q

MC cardiovascular manifestation of syphilis?

A

thoracic aneurysm formation in the ascending aorta due to obliterative endarteritis of the vasa vasorum, leading to dilation of the aorta and valve ring

89
Q

Write out DNA viruses

A
90
Q

write out RNA viruses

A
91
Q

rib classification based on morphology

A

Ribs 1, 2, 11, and 12 are considered atypical ribs bc of structure

ribs 3-10 are considered typical

ribs 1-7 are considered true ribs bc of attachment to sternum through costal cartilages

ribs 8-10 are false

ribs 11-12 are floating and have unique motion called caliper motion since they have no anterior attachment

more pump handle motion in upper ribs and moving down the ribs more bucket handle motion occurs

92
Q

What is the MC primary CNS malignancy in adults?

A

glioblastoma multiforme (GBM)

93
Q

genetic disease presenting with kidney failure and hearing loss; dx?

defect?

A

Alport syndrome

defect in the production of type IV collagen, the predominant collagen found in the basement membrane, making filtering by the kidney suboptimal, pt gets hematuria and proteinuria

94
Q

drug of choice for Mycoplasma pneumoniae causing CAP

A

second gen tetracyclines (doxy) and macrolides (azithro)

95
Q

MOA of azithromycin

A

binds 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA from ribosomes

RNA dependent protein synthesis to arrest

96
Q

MOA of fluoroquinolones

A

inhibit DNA topoisomerase/gyrase

97
Q

rifampin MOA

A

inhibits DNA-dependent RNA polymerase by binding to beta-subunit, which in turn blocks RNA transcription

98
Q

Acetozolamide AE

A

RTA type 2 from impaired bicarb reabsorption (PCT)

99
Q

K+ sparing diuretics work where?

A

collecting tubule, just distal to the end of the DCT

100
Q

Pathology s/p MI in hours, days, and weeks

A
  • 0-4 hours no change
  • 2-4 hours - neutrophils
  • after 4 hours - early coagulative necrosis
  • 5-10 days - macrophages replace neutrophils
  • 7-10 days - granulation tissue, type III collagen
  • 7-8 weeks - dense type I collagen replaces type III
101
Q

What does 5-alpha-reductase do?

presentation in pt with deficiency?

inheritance pattern?

A

converts testosterone to DHT, a more potent androgen

born with ambiguous genitalia, clitoral-like phallus, bifid scrotum, pseudovaginal perineoscrotal hypospadias, and a rudimentary prostate

autosomal recessive; internal genitalia are normal and LH may be normal or increased; testicles descend at puberty and some pts require HRT

102
Q

What is the most common type of osteoporotic fracture? how do they present and what are they associated with?

A
  • vertebral compression fractures (at midthoracic or throacolumbar junction)
  • present with acute back pain after sudden minor trauma such as bending or lifting
  • XR characteristics are commonly a/w anterior wedging of one or more vertebrae, ‘codfish’ (biconcave) deformities, and compression fx
103
Q

rare cystic masses filled with cholesterol crystals and viscous fluid, calcifications may be present in this tumor

MC childhood supratentorial tumors, benign

A

Craniopharyngiomas

104
Q

biopsy of brain tumor shows solid sheets of basophilic cells surrounding eosinophilic, circular zones devoid of cells

dx?

A

medulloblastoma

105
Q

noncaseating granulomas of sarcoidosis can produce..

A

secrete 1,25 vitamin D, potentially causing hypercalcemia and hypervitaminosis D in affected individuals

106
Q

rocuronium MOA

A

paralyze skeletal muscle through competitive antagonism of acetylcholine receptors; decreases the size of the end plate potential (EPP)

alternative to succinylcholine

107
Q

hemiballismus is a lesion…

A

in the CL subthalamic nucleus due to structural or metabolic dysfunction

damage results in decreased production of glutamate; glutamate would normally stimulate the globus pallidus internus to release GABA and inhibit movement through the direct pathway; inhibition of this pathway will increase movement

108
Q

inherited syndrome in which affected individuals are at risk for development of bilateral multifocal kidney cancer as well as various dermatologic and pulmonary lesions

A

Birt-Hogg-Dube syndrome

109
Q

X linked disease caused by a deficient breakdown of mucopolysaccharides from lack of iduronate sulfatase activity

A

Hunter syndrome

110
Q

how does dopamine interact with prolactin release?

A

dopamine binds D2 receptors on lactotrophic cells of anterior pituitary inhibiting the release of prolactin

111
Q

What is the normal CRI rate?

A

10-14 cycles/min

112
Q

radiograph shows concentric formation of new bone layers in the periosteum of the femur diaphysis in 13 yo male

dx?

genetics?

A

Ewing sarcoma

t(11:22) translocation

113
Q

pioglitazone MOA

A

increases the sensitivity of tissues to insulin be increasing the transcription of insulin responsive genes

114
Q

autosomal dominant disease characterized by angiomyolipomas of the skin, brain, kidneys, and other organs

A

tuberous sclerosis

115
Q

donepezil MOA

A

acetylcholinesterase inhibitor

116
Q

myontonic muscular dystrophy due to…

A

CTG repeat

an expansion tinucleotide within the dystrophyia myotonica-protein kinase (DMPK) gene

117
Q

conivaptan MOA

A

vasopressin receptor antagonist which prevents the action of ADH in the collecting duct, allowing free water diuressis and correction of hyponatremia

118
Q

CSF from LP shows increased lymphocytes, mildly decreased glucose, markedly increased protein and opening pressure

etiology?

A

fungal

119
Q

At the start of menopause, what hormone will be increasing?

A

FSH

ovarin follicles become less functional, production of serum estrogen begins to decline

estrogen exhibits FB inhibition of pituitary gonadotropins, the levels of FSH an LH are relatively increased during menopaue; however, the levels of FSH generally are the first to increase

120
Q

What is the predominant form of estrogen in post-menopausal women?

A

estrone

121
Q

Where is estradiol created?

What happens to estradiol production in menopause?

A

estradiol is produced by the granulosa cells of ovarian follicles;

in menopause, the ovarian follicles begin to decline in function, and thus product relatively lower levels of estradiol

122
Q

How do you treat aspirin toxicity?

A

IV sodium bicarb, hemodialysis, and volume resuscitation

123
Q

Whats the difference between placenta accreta, increta, and percreta?

A
  • accreta - placental villi attach to the surface of teh myometrium
  • increta - chorionic villi penetrate into the myometrium
  • percreta - chorionic villi penetrate through the myometrium to the uterine serosa or adjacent organs
124
Q

When treating hepatic encephalopathy with lactulose, what is actually happening?

A

lactulose is nonabsorbable and is broken down by gut bacteria to lactic acid; this acidification of the gut lumen leads to the conversion of ammonia to ammonium ions and increases movement of ammonia from tissues into the gut lumen

125
Q

anti-DNA-topoisomerase (anti-Scl-70) antibody

A

systemic sclerosis

126
Q

Someone who has missed multiple days of dialysis is at risk for….

On an EKG this would present as…

A

uremic pericarditis

diffuse ST elevations with PR depression (most prominently in lead II) and PR elevation in aVR

127
Q

What is CRP?

A

C- reactive protein

acute-phase reactant produced in the liver during an acute inflammatory process; also important in assisting the binding of complement to damaged cells and microbial pathogens, thus aiding in the defense against acute infections

cirrhosis of the liver would complicate the production and release of CRP

128
Q

What is responsible for shifting gaze from one stationary object to another (saccades)?

A

frontal eye fields are primarily responsible

129
Q

for smooth pursuit/tracking a moving object, what structure is involved?

A

cortical eye fields in multiple lobes of the brain are involved

130
Q

for voluntary horizontal gaze to the left, what gets activated in order to activate the L abducens nucleus?

A

right cortical eye fields activate the L paramedian pontine reticular formation (PPRF)

131
Q

how do corticosteroids work?

A

diffuse through the plasma membrane and bind to intracellular receptors; receptor-hormone complex then enters the nucleus as a dimer, binds to the glucocorticoid response element, and regulates gene transcription

this produces mRNA which travels to the cytoplasm and encodes for new DNA, which inhibits the transcription of pro-inflammatory cytokines

132
Q

What is the equation for calculating t1/2?

A

T1/2 = 0.693 x (Vd/CL)

133
Q

periarticular tophi only occur in gout if…

A

it is a result of chronic, long-standing gout

134
Q

sickle cell anemia is an AR disorder caused by what kind of mutation located where?

A

point mutation of the hemoglobin B gene on chromosome 11p15.5

subs valine for glutamic acid on the B-globulin gene

135
Q

micro exam of exudate shows aggregates of bacilli, shaped like safety-pins, inside macrophages; they are intracellular aggregates highlighted by bipolar stain and have been named…

etiology?

A

Donovan bodies

Klebsiella granulomatis

136
Q

by light microscopy, this bacteria forms clumps and long parallel strands, producing a “school of fish” appearance

etiology and description on gram stain

A

Haemophilus ducreyi

gram negative coccobacillus

137
Q

Pts with dermatomyositis will likely have elevated biomarkers of what?

which is most reliable in monitoring disease process and severity?

A

elevated levels of CK-MM (creatine kinase muscle isoform), aldolase, AST, ALT, and LDH

CK-MM most reliable

138
Q

What percent chance does offspring have of getting an autosomal recessive disease?

A

25% chance (punnet square)

139
Q

virus in southwest US a/w rodent feces/urine

how does this present?

A

hantavirus

severe, rapidly progressing pneumonia - moderate to severe respiratory symptoms that quickly (within 24 hours) worsen into ARDS, with possible hemorrhage and renal failure; severe disease is characterized by a cardiopulmonary syndrome where fluid accumulation in the lungs puts pressure on the heart that can lead to CHF

140
Q

palpitations, syncope, seizures

A

congenital long QT syndrome

141
Q

Huntington disease mutation on chromosome 4 results in

A

excessive nucleotide CAG repeats, which results in a longer than normal string of glutamine residues (polyQ expansion) in the N-terminal region of the protein huntingtin

142
Q

What does the huntingtin protein do?

A

plays a role in vesicle and organelle transport along axons, and increasing the length of the polyQ region disrupts this function

143
Q

How do you identify Isospora belli that can present like giardiasis?

A

like C. parvum, I. belli will stain positive with an acid fast stain, revealing ellipsoid-shaped cysts

144
Q

distinguishing feature of methanol toxicity is

A

visual alterations, typically scintillations (flashes of light), scotomas, and eventually blindness if left untreated

145
Q

court case that established that patients, and patient surrogates, have the right to refuse life-sustaining treatment, including artificial nutrition and hydration

A

Cruzan v Director

146
Q

What established that HHS is the primary agency for the Emergency Support Function and covers public health and medical response, including mass care, emergency assistance, housing, and human services

A

Public Health Service Act, 1944

147
Q

What court case established a legal precedent for informed consent?

A

Schloendorff v Society of New York Hospital

148
Q

What Act authorizes the President to issue a disater or an emergency declaration in response to an event (or threat) that overwhelms the state or local government?

A

Stafford Act

149
Q

What court case resulted in the determination that mental health professionals have a duty to protect individuals who are being threatened by a patient?

A

Tarasoff v Regents of the University of California

150
Q

In a pt with kidney damage, what form of vitamin D will accumulate?

A

25-hydroxycholecalciferol (calcidiol) will accumulate because kidney is where it gets hydroxylated by 1-alpha-hydroxylase to 1,25-dihydroxycholecalciferol (calcitriol)

151
Q

What congenital heart change is seen in Edwards syndrome?

what does it clinically present as?

A

ventricular sepatl defect

holosystolic murmur at the mid to lower left sternal border; normal S2 often appreciated

152
Q

What is the correct management of a pt with cervical adenocarcinoma in situ?

A

hysterectomy, esp for pt who have complicated childbearing, as it allows the greatest reduction in risk of developing invasive adenocarcinoma

153
Q

malformation of the bladder, lower abdominal wall, genitaliua, anus, and pelvic bones; clinical presentation includes a bladder, urethra, and genitalia that are open through the lower abdominal wall throughout their entire length

A

bladder exstrophy

154
Q

the most severe presentation of EEC, includes the features of bladder exstrophy and herniation of the large intestine through the lower abdominal wall

A

cloacal exstrophy

155
Q

irregular acanthosis, a band of lymphocytes below the epidermis, and a damaged basal layer describes

A

lichen planus

156
Q

Pt is able to speak fluently and with comprehension, but have some difficulty finding specific words; repitition ability is lost; often aware of language difficulties – what area of the brain is affected?

A

conduction aphasia - lesion in arcuate fasciculus

157
Q

What are the Brodmann areas that correlate with Wernickes and Brocas areas?

A

Brocas = Brodmann 44 and 45

Wernicke = Brodman 22

158
Q

Where does the posterior scalene attach? What OMM tx is this associated with?

A

attaches to the superior surface of the second rib and can be used to correct exhalation dysfunctions of the second rib with muscle energy

159
Q

What is the vector for cutaneous leishmaniasis?

A

sandfly

inoculation results in a cutaneous, nontender ulceration and regional LAD; skin lesions initially manifest as painless, erythematous papules, which can evolve into pruritic painless, oozing ulcers

160
Q

What is the primary tx of nephrogenic DI?

A

low-solute diet and rx of hydrochlorothiazide, indomethacin, or amiloride

161
Q

potent natural toxin that can cause lethal pulomonary edema and destruction

How would you tx this?

A

ricin

supportive wiht airway support and adequate ventilation

162
Q

Cocaine use in pregnancy is correlated with

A

placental abruption, IUGR, and increased risk for pre-term labor and delivery;

infants exposed deliver earlier, have lower birth weights, are more prone to resp distress syndrome and congenital syphilis, and have longer hospital stays

increased risk for CNS complications and developmental delay

163
Q

Pts with carnitine palmitoyltransferase deficiency will clinically have…

what labs will you notice?

A

rhabdomyolysis and/or myoglobinuria

elevated CK and urine myoglobin

164
Q

A high V/Q ratio is consistent with a …. while a low ratio is consistent with…

A

PE

airway obstruction

165
Q

In a person standing upright, where will be the greatest V/Q ratio?

A

apex of the lung has greatest V/Q ratio

166
Q

Where in the lung of an upright person is pulomonary compliance greatest?

A

greater at the base than the apex

167
Q

bosentan MOA

A

txs pulmonary htn by competitively antagonizing endothelin-1 receptors, thus decreasing pulmonary vascular resistance

168
Q

PAS positive stain with otherwise celiac symptoms

A

Whipple disease

169
Q

Common type II hypersensitivity reactions

A

ABP mismatch, Goodpastures, Rh hemolytic disease of the newborn, myasthenia gravis

170
Q

Pt with vWD would show what type of blood tests?

What can help make the dx?

A

normal platelet count

increased BT

normal PT

PTT can be normal or slightly elevated

Ristocetin-induced platelet agglutination (RIPA) assay can help make the diagnosis

171
Q

How do you treat vWD?

A

mild cases tx’d with desmopressin acetate, raises the pts own plasma lavels of vWF by inducing release of vWF in the Weibel-Palade bodies in the endothelial cells

women with heavy periods - OCPs

172
Q

deletion of the MECP2 gene on the X chromosome

dx?

what does this gene normally do?

how does the disease present?

A

Rett syndrome

MECP2 gene is translated into methyl-CpG binding protein 2, which is responsible for regulating expression of other genes through methylation.

present at 1-4 yo with regression of social interaction, inability to speak, and characteristic midline hand movements such as wringing or clapping; in early infancy signs are nonspecific and include hypotonia and lack of interaction; later signs include sz, rigidity, and loss of ambulation

173
Q

10 yo male with acroparesthesias, non-blanching reddish-blue capillary lesions (angiokeratomas), telangiectasias of the groin and hip, and LV hypertrophy

dx?

deficiency?

A

Fabry disease

X linked recessive lysosomal storage disease due to a deficiency in the lysosomal enzyme alpha-galactosidase A

accumulation of ceramide trihexoside

174
Q

neuropraxia of the upper trunk of the brachial plexus

A

Erbs palsy

175
Q

acid fast oocysts in stool sample

A

Cryptosporidium parvum

176
Q

MC organism in acute bacterial parotitis

A

S. aureus

177
Q

MCC of dental caries?

What else can this cause?

A

S. mutans

if leaked into blood stream, can cause endocarditis

178
Q

MEN1 presentation

A

menin mutation - affects histone regulation

tumors in parathyroid, pituitary, GI neuroendocrine tissues (gastrinomas, insulinomas, and carcinoid tumors) and the skin (angiofibromas and collagenomas)

179
Q

MEN2 presentation

A

mutation in RET oncogene

medullary thyroid cancer and pheo

MEN2A: parathyroid hyperplasia

MEN2B: mucosal neuromas and Marfanoid habitus

familial medullary thyroid carcinoma

180
Q

What nerve innervates the adductor pollicis muscles?

A

ulnar nerve

181
Q

What kind of staining would confirm the presence of a leiomyosarcoma?

A

desmin staining in a retroperitoneal mass

vimentin, h-caldesmon, and actin (will be positive but don’t always confirm)

182
Q

Ciprofloxacin MOA

A

fluoroquinolone derivative that inhibits bacterial DNA topoisomerase II (DNA gyrase)

183
Q

Where is parasympathetic innervation to the kidneys from?

A

vagus through OA, C1, and C2

184
Q

niacin tx of hypercholesterol MOA

A

decreasing the amount of VLDL secreted by hepatocytes into the circulation; also blocks lipolysis in adipose tissue, reduces plasma fibrinogen levels, and has been shown to raise HDL-C by 30% by reducing lipid transfer of cholesterol from HDL to VLDL

185
Q

What are spider naevi/angiomas caused by in pts with cirrhosis?

what is another dermatologic manifestation due to this cuase?

A

increased level of estrogen from decreased metabolism of estrogen by the liver; estrogen stimulates arteriole dilation and impaires arteriole sphincter function - this allows small veins to carry away free-flowing blood, creating the distinct “spider leg” appearance

hyperestrinism can also lead to palmar erythema

186
Q

How would an isolated interosseous injury present?

A

inability to make an O with the thumb and forefinger

187
Q

What nerve innervates the interosseous muscles?

A

ulnar nerve

188
Q

How would you treat hemophilia A if pt was planning on going into a minor surgery?

A

Desmopression - can promote the release of factor VIII, vWF, and t-PA by binding to V2 receptors which facilitate their endothelial release

useful for minor bleeding episodes and surgical prophylaxis only and will decrease PTT

189
Q

What is the first step in heme synthesis?

what is the catalyst?

what would inhibit its formation?

A

formation of delta-aminolevulinic acid from combination of glycine and succinyl CoA

catalyzed by ALAS and cofactor B6

hemin

190
Q

What is the first step in the Krebs cycle?

A

addition of oxaloacetate and acetyl-CoA forming citrate

191
Q

ssx: painful abdomen, pink urine, polyneuropathy, and psychological disturbances

accumulation of porphobilinogen

dx?

defect in?

A

acute intermittent porphyria

defect in porphobilinogen deaminase

192
Q

accumulation of uroporphyrin in pt’s urine

dx?

defect in?

A

porphyria cutanea tarda

defect in uroporphyrinogen decarboxylase enzyme

193
Q

triad of ovarian fibroma with ascites and pleural effusion

A

Meigs’ syndrome

194
Q

HMG-CoA reductase inhibitors ultimately reduce the rate of

A

mevalonate production

195
Q

What do you use to treat inhaled anthrax if recommended cipro and doxy are unavailable?

A

raxibacumab

binds and neutralizes the Bacillus anthracis toxin by binding to the free protective antigen component

can be used as adjuvant or as prophylaxis in pts with high risk of exposure

196
Q

indication for eculizumab

A

PNH to prevent formation of MAC on hemoglobin molecules; mab binds to C5 and blocks cleavage of C5 into C5a and C5b, which is required for formation of MAC

197
Q

What do the different serotypes of Chlamydia cause?

A
    • A, B, C
      • trachoma - chronic keratoconjunctivitis that is commonly seen in areas of poor sanitation
  • D-K
    • variety of STIs - non-gonococcal urethritis, mucopurulent cervicitis, salpingitis, neonatal conjunctivitis, and neonatal pna
  • L1-L3
    • lymphogranuloma venereum (LGV)
198
Q

presents in childhood, but is highly variable; affects many organ systems including brain, skin, kidneys, heart, lung, and liver

pts develop benign tumors in these various organs

most pts will have a cutaneous manifestation of the disease including Shagreen patches, ash leaf spots, and angiofibromas

cardiac rhabdomyoma, tumors in the brain (tubers) resulting in seizures

mild mental retardation

A

tuberous sclerosis

199
Q

What is the MC manifestation of tuberous sclerosis in the kidneys?

A

angiomyolipoma

typically asymptomatic but can increase in size until there are symptoms or bleed

200
Q

How can epi prolong the duration of anesthetic action?

A

induce vasoconstriction thus limiting the diffusion of the local anesthetic from the site of injection

in particular alpha-1 receptor binding stimulates a Gq protein signaling pathway that causes increased vascular smooth muscle contraction, increased pupillary dilator muscle contraction and increased intestinal and bladder sphincter muscle contraction

201
Q

B1 stimulation causes

A

increase in HR, contractility, renin release, and lipolysis

202
Q

What do alpha-2 agonists do?

A

stimulates alpha 2 and imidazoline receptors located primarily in the rostral and ventolateral medulla; leads to decreased sympathetic outflow from the CNS and reduced plasma NE levels, lowering BP

203
Q

Stimulation of beta 2 receptors does what?

A

vascular and nonvascular smooth muscle relaxation

204
Q

a decreased carrying angle in the arm is consistent with what ulnar dx?

A

adducted ulna

205
Q

Biopsy of temporal arteritis shows

A

granulomas with giant cells

Board questions (24 decks)

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