DIT End of Session Questions

Question 1

What developmental structure matches the following description? 1. Fetal placental structure that secretes hCG 2. Maternal component of the placenta

Answer 1

1. Syncitiotrophoblast 2. Decidua Basalis

Question 2

What are the stages of an embryo between conception and an inner cell mass?

Answer 2

Zygote -> Morula -> Blastocyst (includes trophoblast and inner cell mass)

Question 3

What other findings would you expect to see in a patient with an aganglionic colon and other neural crest derivative deficiencies?

Answer 3

1. Peripheral nervous system abnormalities
2. Autonomic dysfunction
3. Conductive hearing loss
4. Anterior chamber eye problems
5. Dental abnormalities
6. Albinism
7. Heart defects

Question 4

List as many drugs as you can that are contraindicated in pregnancy

Answer 4

1. Methotrexate 2. Valproic Acid 3. Carbamazepine 4. Phenytoin 5. Tetracycline 6. Aminoglycosides 7. Atorvastatin 8. Vitamin A 9. ACE Inhibitors 10. Fluoroquinolones 11. Sulfonamides 12. Metronidazole 13. Warfarin 14. Clarithromycin 15. Diethylstilbestrol 16. Thalidomide

Question 5

What is the relationship between the notochord, the neural plate, the neural tube, and the neural crest cells?

Answer 5

The mesodermal notochord induces overlying ectoderm to form the neural plate, which becomes the neural tube and neural crest

Question 6

What is the embryologic origin of the following adult structures? 1. Anterior Pituitary 2. Cornea 3. Lens 4. Retina 5. Olfactory eptihelium 6. Mammary glands 7. Salivary glands 8. Sweat glands

Answer 6

1. Anterior Pituitary = Surface Ectoderm 2. Cornea = Neural Crest 3. Lens = Surface Ectoderm 4. Retina = Neurectoderm 5. Olfactory eptihelium = Surface Ectoderm 6. Mammary glands = Surface Ectoderm 7. Salivary glands = Surface Ectoderm 8. Sweat glands = Surface Ectoderm

Question 7

What must be present on a protein in order for that protein to gain entry into the nucleus?

Answer 7

Nuclear localization signals

Question 8

Which types of proteins are responsible for fostering the progression through the cell cycle?

Answer 8

Cyclins and cyclin dependent kinases

Question 9

Which cyclin-CDK complexes assist in the progression from G1 to S phase?

Answer 9

1. Cyclin D + CDK4 2. Cyclin E + CDK2

Question 10

Which cyclin-CDK complexes assist in the progression from G2 to M phase?

Answer 10

1. Cyclin A + CDK2 2. Cyclin B + CDK1

Question 11

What molecule targets proteins in the endoplasmic reticulum for lysosomes

Answer 11

Mannose-6-Phosphate

Question 12

What are the different methods that a cell uses to break down proteins?

Answer 12

1. Proteosomal degradation (via ubiquitin) 2. Lysosomal degradation 3. Calcium-dependent degradation

Question 13

Which cell types are rich in smooth ER?

Answer 13

1. Hepatocytes 2. Hormone-producing cells of the adrenal cortex

Question 14

What drugs act on microtubules?

Answer 14

1. Mebendazole & Thiobendazole (antihelminthic) 2. Vincristine & Vinblastine (Anticancer) 3. Colchicine (Microtubules of phagocytes) 4. Griseofulvin (Antifungal) 5. Paclitaxel (Anticancer -> stabilize MT’s)

Question 15

What two fundamental substances are required to make most things work inside the cell?

Answer 15

1. ATP 2. Calcium

Question 16

Which organelle is responsible for the breakdown of very long-chain fatty acids?

Answer 16

Peroxisome

Question 17

What are the intermediate filaments for the following tissue types and cellular structures? 1. Connective tissue 2. Muscle tissue 3. Epithelial tissue 4. Axons

Answer 17

1. Connective tissue = Vimentin 2. Muscle tissue = Desmin 3. Epithelial tissue = Cytokeratin 4. Axons = Neurofilaments

Question 18

What are the defects seen in Kartagener Syndrome?

Answer 18

Immotile cilia causing infertility, bronchiectasis, recurrent sinusitis, and Kartagener syndrome is associated with situs inversus

Question 19

Which arachidonic acid product causes each of the following effects?

1. Increased bronchial tone
2. Decreased bronchial tone
3. Increased platelet aggregation
4. Decreased platelet aggregation
5. Increased uterine tone
6. Decreased uterine tone
7. Increased vascular tone
8. Decreased vascular tone

Answer 19

1. Increased bronchial tone: Thromboxane and Leukotriene
2. Decreased bronchial tone: PGI2 (Prostacyclin) and prostaglandin
3. Increased platelet aggregation: Thromboxane
4. Decreased platelet aggregation: PGI2
5. Increased uterine tone: Prostaglandin
6. Decreased uterine tone: PGI2
7. Increased vascular tone: Thromboxane
8. Decreased vascular tone: PGI2 and prostaglandin

Question 20

What are the two most abundant substances in plasma membranes?

Answer 20

Cholesterol and phospholipids

Question 21

1. What drugs act on the arachidonic acid product pathway? What enzymes do they affect?

FA #404

Answer 21

1. Corticosteroids inhibit phospholipase A2
2. Zileuton inhibits lipoxygenase
3. NSAIDS, Acetaminophen, COX-2 inhibitors, and Aspirin inhibit cyclooxygenase
4. Zafirlukast and Montelukast inhibit leukotriene receptors

Question 22

What substances do cytotoxic T cells and NK cells use to induce apoptosis in the cells infected with virus?

Answer 22

Perforin and Granzyme B

Question 23

What highly damaging events can cause irreversible cell injury?

Answer 23

1. Ca2+ influx causing caspase activation
2. Plasma membrane damage
3. Lysosomal rupture
4. Increasing mitochondrial permeability
5. Nuclear pyknosis - irreversible condensation of chromatin
6. Karyolysis - complete dissolution of chromatin
7. Karyorrhexis - Fragmentation of nucleus

Question 24

What cellular enzymes are responsible for handling oxygen free radicals?

Answer 24

1. Glutathione Peroxidase
2. Superoxide Dismutase
3. Catalase

Question 25

Describe the process of leukocyte extravasation

Answer 25

4 steps:

1. Rolling adhesion - mediated by P and E Selectins
2. Tight adhesion - mediated by ICAM (integrin)
3. Diapedesis - PECAM-1
4. Migration - Bacterial products (chemokines)

Question 26

What findings are associated with Ehlers-Danlos syndrome?

Answer 26

1. Hyperflexible and dislocated joints
2. Aneurysms
3. Stretchy skin
4. Eary bruising/bleeding

Question 27

What are the different types of collagen and where can they be found?

Answer 27

Type I: “Strong” - Skin, tendon, bone, late scar tissue

Type II: “Slippery” - cartilage, nucleus pulposus, and vitreous body

Type III: “Bloody” - Skin, Reticular fibers, fetal tissue, blood vessels, early scar tissue

Type IV: Basement membrane

Question 28

Which amino acids are found in large concentrations in collagen? In elastin?

Answer 28

Collagen: Glycine, Proline, and Hydroxyproline

Elastin: Glycine and Proline

Question 29

What is the role of vitamin C in collagen production?

Answer 29

Vitamin C is involved in the hydroxylation of lysine and proline

Question 30

What cytokine is particularly important in the formation of granulomas

Answer 30

TNF-alpha

Question 31

What cell type plays a role in inflammation by generating fibrinogen and C-reactive protein?

Answer 31

Hepatocytes

Question 32

What cell is most responsible for the acute phase of inflammation?

Answer 32

Neutrophils (chronic inflammation is primarily macrophages and monocytes)

Question 33

Does the compensatory growth of muscle fibers occur primarily as a result of hyperplasia or hypertrophy?

Answer 33

Hypertrophy

Question 34

Does myometrial growth in pregnancy occur primarily as a result of hyperplasia or hypertrophy?

Answer 34

Hypertrophy

Question 35

What can happen to the cells of the lower esophagus in response to chronic acid reflux?

Answer 35

Metaplasia: Squamous -> Columnar

Question 36

What is actually occurring at the cellular level during atrophy?

Answer 36

1. Reduction in the number of organelles 2. Decreased protein synthesis 3. Increased protein degradation-ubiquitin-proteosome pathway 4. Autophagy (“self-eating”)

Question 37

What is a lipofuscin granule?

Answer 37

Residual body within the cell that contains brown pigment. Results from free radical-induced lipid oxidation

Question 38

What abnormalities are often found with an Arnold-Chiari Malformation?

Answer 38

Herniated cerebellar vermis - Hydrocephalus - Stenosis of the aqueduct Syringomyelia Myelomeningocele

Question 39

What are the classic presenting symptoms of syringomyelia

Answer 39

Spinothalamic tract compression - Bilateral loss of pain and temperature sensation in upper extremity Severe cases affects motor neurons of anterior horn - Weakness/atrophy of the hand muscles

Question 40

What amniotic fluid lab abnormality might point you to a diagnosis of anencephaly?

Answer 40

Alpha Fetoprotein (AFP)

Question 41

Which nervous system cell matches each of the following descriptions?

1. Look like fried eggs under histologic staining
2. Form multinucleated giant cells in the CNS when infected with HIV
3. Myelinates multiple CNS axons
4. Myelinates one PNS axon
5. Damaged in Guillain-Barre syndrome
6. Damaged in Multiple Sclerosis
7. Macrophages of the CNS
8. Cells of the blood brain barrier

Answer 41

1. Look like fried eggs under histologic staining: Oligodendrocytes
2. Form multinucleated giant cells in the CNS: when infected with HIV: Microglia
3. Myelinates multiple CNS axons: Oligodendrocyte
4. Myelinates one PNS axon: Schwann cell
5. Damaged in Guillain-Barre syndrome: Schwann cell
6. Damaged in Multiple Sclerosis: Oligodendrocytes
7. Macrophages of the CNS: Microglia
8. Cells of the blood brain barrier: Astrocyte

Question 42

In which neurological diseases is acetylcholine altered?

Answer 42

Huntingtons Chorea: Ach is decreased Alzheimers Disease: Ach is decreased Parkinsons disease: Ach is increased

Question 43

What is the main inhibitory neurotransmitter of the CNS? In which diseases are levels altered?

Answer 43

GABA (Glycine is the main inhibitory neuron in the spinal cord). GABA is decreased in Huntigtons disease and in anxiety

Question 44

What are the components of the blood-brain barrier?

Answer 44

1. Tight junctions 2. Basement membrane 3. Astrocyte

Question 45

Which nucleus of the hypothalamus fits each of the following descriptions?

1. Considered “master clock” for most of our circadian rhythms
2. Regulates the parasympathetic nervous system
3. Destruction results in hyperthermia
4. Regulates the sympathetic nervous system
5. Produces antidiuretic hormone to regulate water balance
6. Receives input from the retina
7. Savage behavior and obesity result from stimulation
8. Savage behavior and obesity result from destruction
9. Stimulation leads to eating and destruction leads to starvation
10. Regulates the release of gonadotropic hormones
11. Responsible for sweating and cutaneous vasodilation in hot temperatures
12. Responsible for shivering and decreased cutaneous blood flow in the cold
13. Destruction results in neurogenic diabetes insipidus
14. Destruction results in inability to stay warm
15. Releases hormones affecting the anterior pituitary

Answer 45

1. Considered “master clock” for most of our circadian rhythms: Suprachiasmatic nucleus
2. Regulates the parasympathetic nervous system: Anterior nucleus & a little from preoptic nucleus
3. Destruction results in hyperthermia: Anterior nucleus & a little from preoptic nucleus
4. Regulates the sympathetic nervous system: Posterior nucleus & a little from Lateral nucleus
5. Produces antidiuretic hormone to regulate water balance: Supraoptic
6. Receives input from the retina: Suprachiasmatic nucleus
7. Savage behavior and obesity result from stimulation: Dorsomedial nucleus
8. Savage behavior and obesity result from destruction: Ventromedial nucleus
9. Stimulation leads to eating and destruction leads to starvation: Lateral nucleus
10. Regulates the release of gonadotropic hormones: Preoptic nucleus
11. Responsible for sweating and cutaneous vasodilation in hot temperatures: Anterior nucleus
12. Responsible for shivering and decreased cutaneous blood flow in the cold: Posterior nucleus
13. Destruction results in neurogenic diabetes insipidus: Supraoptic nucleus
14. Destruction results in inability to stay warm: Posterior nucleus
15. Releases hormones affecting the anterior pituitary: Arcuate nucleus

Question 46

What EEG waveforms correspond to the different stages of sleep?

Answer 46

Awake: Beta (High frequency, low amplitude)

Stage I: Theta

Stage II: Sleep spindles and K complexes Stage

III/IV: Delta (low frequency, high amplitude)

REM: Beta

Question 47

What is the pathway by which retinal information induces the release of melatonin?

Answer 47

Light stimulation of the retina - reduces release of melatonin Dark stimulation of the retina - induces the release of melatonin

Darkness ->Suprachiasmatic nucleus releases NE -> Pineal gland releases melatonin

Question 48

Which cranial nerves have their nuclei located in the medulla?

Answer 48

CN X, XI, XII and IX

Question 49

Which cranial nerves have their nuclei in the pons?

Answer 49

CN V, VI, VII, VIII

Question 50

Which cranial nerves have their nuclei in the midbrain?

Answer 50

CN III and IV

Question 51

A 19 year-old patient presents with a furuncle on his philtrum, and the cavernous sinus becomes infected. What neurological deficits might you see in this patient?

Answer 51

Varying degrees of opthalmoplegia (CN III, IV, VI)

Question 52

What are the muscles of mastication

Answer 52

1. Temporalis: Closes jaw 2. Masseter: Closes jaw 3. Medial pterygoid: Closes jaw 4. Lateral pterygoid: Opens jaw

Question 53

What nerves innervate the branchial arches? Later, what structures are derived from these arches? 1st Arch 2nd Arch 3rd Arch 4th-6th Arches

Answer 53

1st Arch: CN V2 and V3, muscles of mastication, malleus, incus, mylohyoid muscle, mandible, meckel’s cartilage

2nd Arch: CN VII, stapes, muscles of facial expression, stapedius, stylohyoid, styloid process, lesser horn of hyoid, stylohyoid ligament

3rd Arch: CN IX, stylopharyngeus, greater horn of hyoid

4th-6th Arches: CN X, superior laryngeal nerve (swallowing), recurrent laryngeal nerve (speaking), cricothyroid mm, levator veli palatine mm, muscles of the larynx, thyroid cartilage, cricoid cartilage, arytenoids, corniculate cartilage, cuneiform cartilage

Question 54

From which branchial pouch are each of the following structures derived? 1. Middle ear and eustachian tubes 2. Superior parathyroids 3. Inferior parathyroids 4. Epithelial lining of the palatine tonsils 5. Thymus

Answer 54

1. Middle ear and eustachian tubes: 1st 2. Superior parathyroids: 4th 3. Inferior parathyroids: 3rd 4. Epithelial lining of the palatine tonsils: 2nd 5. Thymus: 3rd

Question 55

How does the parasympathetic nervous system affect the following body structures? 1. Heart 2. Eye 3. Salivary glands 4. Bronchiolar smooth muscle 5. Bladder 6. Male GU 7. GI tract

Answer 55

1. Heart: Decreased HR and small decrease in contractility 2. Eye: Contraction of ciliary muscle, miosis 3. Salivary glands: Salivation 4. Bronchiolar smooth muscle: bronchoconstriction 5. Bladder: Contract bladder wall, relax sphincter 6. Male GU: Erection 7. GI tract: Contract intestinal wall, relax sphincter

Question 56

What drug regenerates acetylchoinesterase after organophosphate poisoning?

Answer 56

Pralidoxime

Question 57

What is the antidote for organophosphate poisoning?

Answer 57

Atropine or Pralidoxime

Question 58

Which anticholinesterases are used in the treatment of Alzheimer disease?

Answer 58

1. Donepezil 2. Galantamine 3. Rivastigmine

Question 59

Identify the following drugs as a direct agonist, anticholinesterase, antimuscarinic, or cholinesterase regenerator

1. Pilocarpine
2. Oxybutynin
3. Donepezil
4. Pralidoxime
5. Darifenacin
6. Ipratropium
7. Tropicamide
8. Benztropine
9. Scopalamine
10. Edrophonium
11. Tolterodine
12. Trospium
13. Homatropine
14. Carbachol

Answer 59

1. Pilocarpine: Direct Muscarinic Agonist
2. Oxybutynin: Antimuscarinic
3. Donepezil: Cholinesterase Inhibitor
4. Pralidoxime: Cholinesterase regenerator
5. Darifenacin: Antimuscarinic
6. Ipratropium: Antimuscarinic
7. Tropicamide: Antimuscarinic
8. Benztropine: Antimuscarinic
9. Scopalamine: Antimuscarinic
10. Edrophonium: Cholinesterase Inhibitor
11. Tolterodine: Antimuscarinic
12. Trospium: Antimuscarinic
13. Homatropine: Antimuscarinic
14. Carbachol: Direct Muscarinic & Nicotinic Agonist

Question 60

Which of the muscarinic antagonists could be used to improve FEV-1 in a patient with COPD?

Answer 60

Ipratropium & Tiotropium

Question 61

What substances inhibit the reuptake of norepinephrine?

Answer 61

Tricyclic antidepressants & Cocaine

Question 62

What substances stimulate the release of norepinephrine from neurons?

Answer 62

1. Calcium is the normal trigger for release
2. Amphetamine
3. Ephedrine
4. Tyramine

Question 63

What G protein class does each of the following receptors stimulate?

1. Alpha 1
2. Alpha 2
3. Beta 1
4. Beta 2
5. Muscarinic 1
6. Muscarinic 2
7. Muscarinic 3
8. Dopamine 2

Answer 63

1. Alpha 1: Gq
2. Alpha 2: Gi
3. Beta 1: Gs
4. Beta 2: Gs
5. Muscarinic 1: Gq
6. Muscarinic 2: Gi
7. Muscarinic 3: Gq
8. Dopamine 2: Gi

Question 64

Outline the pathway by which stimulation of a Gs receptor activates Protein Kinase A

Answer 64

Gs -> Adenylate Cyclase -> Increased cAMP -> Protein Kinase A

Question 65

In what part of the cell would you find steroid hormone receptors?

Answer 65

Inside the cell: In the cytoplasm

Question 66

What clinical finding would you expect to find in a man with high sex hormone binding globulin?

Answer 66

Low free testosterone -> Gynecomastia

Question 67

What clinical finding would you expect to find in a woman with low sex hormone binding globulin?

Answer 67

Increased free testosterone -> Hirsutism

Question 68

A patient’s MRI reveals replacement of tissue in the sella turcica with CSF. What is the most likely clinical presentation?

Answer 68

This is Empty Sella syndrome. Its usually asymptomatic (subclinical) but sometimes symptoms can present according to a deficiency in one or more pituitary hormones

Question 69

Which hormones share a common alpha subunit?

Answer 69

1. TSH
2. LH
3. FSH
4. HcG

Question 70

What is the most common presentation of hyperprolactinemia in a female patient?

Answer 70

Premenopausal: Hypogonadism (infertility: oligomenorrhea or amenorrhea)

Postmenopausal: Asymptomatic

Question 71

What are some of the possible clinical features of acromegaly?

Answer 71

1. Large hands and feet
2. Course face (large nose, ears, tongue)
3. Increased spacing of teeth
4. Deep voice
5. Impaired glucose tolerance

Question 72

What are the symptoms of 21 alpha-hydroxylase deficiency?

Answer 72

Blocks the pathways to Aldosterone and Cortisol (these will be absent), shunting production to androgens

Hypotension and masculinization result

Question 73

What are the symptoms of 11 beta-hydroxylase deficiency?

Answer 73

Blocks the pathways of Aldosterone and Cortisol production (these will be absent), and shunts production to Androgens. Deoxycorticosterone builds up though (a mineralcorticoid)

Hypertension and masculinization result

Question 74

What food substance is an essential starting point in the synthesis of adrenal steroids?

Answer 74

Cholesterol

Question 75

An adult male with elevated serum cortisol levels and signs of Cushing Syndrome undergoes a dexamethasone suppression test. 1mg of dexamethasone does not decrease cortisol levels, but 8mg does. What is the diagnosis?

Answer 75

Cushing Disease

Question 76

What effect does cortisol have on bone formation and immune system functioning?

Answer 76

1. Decreased bone formation
2. Immunosuppression

Question 77

What are the potential side effects of glucocorticoid use?

Answer 77

Cushing Syndrome

• Buffalo hump
• Moon facies
• Muscle wasting
• Truncal obesity
• Easy bruisability
• Insomnia
• Psychosis
• Glaucoma
• Acne
• Osteoporosis
• Peptic ulcers
• Glucose intolerance or diabetes

Question 78

What are the clinical manifestations of Addison Disease? What is the cause of Addison Disease?

Answer 78

Hyperpigmentation

Hyperkalemia

Hypotension

Weakness & Malaise

Anorexia & Weight loss

Hyponatremia

Caused by autoimmune destruction of the adrenals (adrenal atrophy, decreased Aldosterone, decreased Cortisol)

Question 79

What tumor locations are associated with the 3 different types of multiple endocrine neoplasia?

Answer 79

1. MEN1: Parathyroid, Pancreas, Pituitary
2. MEN2a: Medullary thyroid tumor, Pheochromocytoma, parathyroid hyperplasia
3. MEN2b: Medullary thyroid tumor, Pheochromocytoma, Mucosal neuromas

Question 80

What might a lab detect in the urine of a patient with pheochromocytoma?

Answer 80

Catecholamine breakdown products

1. Vanillyl mandelic acid (VMA)
2. Homovanillic acid (HVA)
3. Metanephrine
4. Noremetanephrine

Question 81

Which receptors are stimulated by each of the following sympathomimetics?

1. Clonidine
2. Dopamine
3. Phenylephrine
4. Albuterol
5. Norepinephrine
6. Isoproterenol
7. Epinephrine
8. Dobutamine
9. Terbutaline

Answer 81

1. Clonidine: Alpha2
2. Dopamine: D1 & D2 (low dose), B1 & B2 (medium dose), a1 & a2 (High dose)
3. Phenylephrine: a1>a2
4. Albuterol: B2>B1
5. Norepinephrine: a1, a2, B1
6. Isoproterenol: B1 = B2
7. Epinephrine: a1, a2, B1, B2
8. Dobutamine: B1 > B2
9. Terbutaline: B2 > B1

Question 82

Which sympathomimetic matches each of the following statements?

1. Given as a nebulizer for asthma
2. Drug of choice for anaphylaxis
3. Most common first line agent for patients in cardiogenic shock
4. Most common first line agent for patients in septic shock
5. Given SubQ for asthma
6. Used by ENT to vasoconstrict nasal vessels

Answer 82

1. Given as a nebulizer for asthma: Albuterol or levalbuterol
2. Drug of choice for anaphylaxis: Epinephrine
3. Most common first line agent for patients in cardiogenic shock: Dobutamine
4. Most common first line agent for patients in septic shock: Norepinephrine
5. Given SubQ for asthma: Terbutaline
6. Used by ENT to vasoconstrict nasal vessels: Cocaine, Phenylephrine

Question 83

How does blood pressure response to phenylephrine administration change if an alpha-blocker is administered before hand? Why is this different than the change seen when epinephrine is used rather than phenylephrin?

Answer 83

Phenylephrine wont have an effect becuase it cannot activate the alpha receptor, whereas epinephrine will cause vasodilation because it will still be able to exert its B2 effects.

Question 84

What are the common side effects of beta-blockers? Which patient populations should use caution when taking beta-blockers?

Answer 84

1. Bronchospasm - use with caution in asthmatics, COPD
2. Raise blood glucose & mask sympathetic symptoms of hypoglycemia
3. Bradycardia and AV block - use with caution in acute CHF
4. Erectile dysfunction

Question 85

What are the various clinical applications of beta-blockers?

Answer 85

1. MI
2. CHF
3. Hypertension
4. Stage fright
5. Supraventricular tachycardia
6. Angina
7. Glaucoma

Question 86

What is the most common location of salivary gland tumors?

Answer 86

Parotid gland

Question 87

What is the most common salivary gland tumor? What is the histological appearance of this tumor?

Answer 87

Pleomorphic adenoma. Histologically, it has both epithelial and mesenchymal differentiation

Question 88

What is the second most common benign salivary gland tumor?

Answer 88

Warthins tumor

Question 89

What is the most common malignant salivary gland tumor (the second most common tumor overall of the salivary gland)?

Answer 89

Mucoepidermoid Carcinoma

Question 90

What medication is often used in the treatment of allergic rhinitis, nasal polyps, and eustachian tube dysfunction?

Answer 90

Intranasal steroids

Question 91

A 35 year-old woman presents with diffuse goiter and hyperthyroidism. What are the most likely relative values of TSH and thyroid hormones?

Answer 91

1. Decreased TSH
2. Increased Free T3/ T4

Question 92

What would you suspect to be the cause of hyperthyroidism in a patient presenting with symptoms of hyperthyroidism in addition to each of the following findings?

1. Extremely tender thyroid gland
2. Pretibial myxedema
3. Pride in recent weight loss, medical professional
4. Palpation of single thyroid nodule
5. Palpation of multiple thyroid nodules
6. Recent study using IV contrast (iodine)
7. Eye changes (proptosis, edema, injection)
8. History of thyroidectomy or radioablation of thyroid

Answer 92

1. Extremely tender thyroid gland: Subacute (De Quervain) Thyroiditis
2. Pretibial myxedema: Graves disease
3. Pride in recent weight loss, medical professional: Facticious Hyperthyroidism (Thyroid hormone abuse)
4. Palpation of single thyroid nodule: Toxic thyroid adenoma
5. Palpation of multiple thyroid nodules: Toxic multinodular goiter
6. Recent study using IV contrast (iodine): Jod-Basedow Phenomenon (iodine deficient Pt supplied suddenly supplied w/ iodine)
7. Eye changes (proptosis, edema, injection): Graves disease
8. History of thyroidectomy or radioablation of thyroid: Patient taking too much exogenous thyroid hormone

Question 93

What is the most common location for ectopic thyroid tissue?

Answer 93

Tongue

Question 94

How would pregnancy affect serum thyroid hormone levels?

Answer 94

1. Estrogen increases thyroid binding globulin (TBG)
2. Increase in total T4/T3 (increased production of T3/T4 to compensate for unbound TBG)
3. Normal free T4/T3

Question 95

What type of thyroid cancer matches each of the following statements?

1. Most common type of thyroid cancer (70-75%)
2. Second most common type of thyroid cancer (10%)
3. Activation of receptor tyrosine kinases
4. Hashimoto’s thyroiditis is a risk factor
5. Cancer arising from parafollicular C cells
6. Commonly associated with either a RAS mutation or a PAX8-PPAR gamma I rearrangement
7. Commonly associated with rearrangements in RET oncogene or NTRKI
8. Most common mutation in the BRAF gene (serine/threonine kinase)

Answer 95

1. Most common type of thyroid cancer (70-75%): Papillary carcinoma of thyroid
2. Second most common type of thyroid cancer (10%): Follicular carcinoma of thyroid
3. Activation of receptor tyrosine kinases: Papillary & Medullary carcinoma of thyroid
4. Hashimoto’s thyroiditis is a risk factor: B cell lymphoma
5. Cancer arising from parafollicular C cells: Medullary carcinoma of thyroid
6. Commonly associated with either a RAS mutation or a PAX8-PPAR gamma I rearrangement: Follicular carcinoma of thyroid
7. Commonly associated with rearrangements in RET oncogene or NTRKI: Papillary carcinoma of thyroid (Medullary carcinoma only associated with RET)
8. Most common mutation in the BRAF gene (serine/threonine kinase): Papillary carcinoma

Question 96

To which lymph nodes do the sigmoid colon and the rectum drain?

Answer 96

Sigmoid colon: Drains to colic lymph nodes which drain into inferior mesenteric nodes

Rectum (above pectinate line): Drains into internal iliac lymph nodes

Question 97

Where can B and T cells be found in the lymph nodes?

Answer 97

B cells: Follicles of the cortex

T cells: Paracortex

Question 98

Which MHC is recognized by T helper cells? Which MHC is recognized by cytotoxic T cells?

Answer 98

1. Helper T cells: MHC II
2. Cytotoxic T cells: MHC I

Question 99

What characteristic finding would you see on electron microscopy of a dendritic cell with Langerhans cell Histiocytosis?

Answer 99

Birbeck granules (Shaped like tennis rackets)

Question 100

What molecules are expressed on the surface of antigen presenting dendritic cells?

Answer 100

1. MHC I & MHC II
2. B7 co-stimulatory signal (CD80 & CD86)
3. CD40

Question 101

What are 3 cell types that are known for presenting antigens to T cells?

Answer 101

1. Dendritic cells
2. Macrophages
3. B cells

Question 102

Which cytokines are produced by Th1 cells? Which cytokines are produced by Th2 cells?

Answer 102

Th1

1. IL-2 (stimulates CD8 T cells)
2. IFN-gamma (stimulates macrophages, inhibits Th2)

Th2

1. IL-10 (inhibits Th1)
2. IL-4 & IL-5 (stimulates B cells)

Question 103

Which cytokines inhibit Th1 cells? Which cytokines inhibit Th2 cells?

Answer 103

1. Th1 is inhibited by IL-10
2. Th2 is inhibited by IFN-gamma

Question 104

How do cytotoxic T cells kill virus-infected cells and neoplastic cells?

Answer 104

1. Induce apoptosis by releaseing cytotoxic granules (perforin & granzyme B)
2. Apoptosis can be mediated by the Fas-FAS ligand

Question 105

Which cytokine more than any other should be known as the macrophage-activating cytokine?

Answer 105

IFN-gamma

Question 106

What are the acute phase cytokines that are produced by macrophages?

Answer 106

1. TNF-alpha
2. IL-1
3. IL-6

Question 107

What is the function of macrophages in the spleen?

Answer 107

1. Remove encapsulated bacteria
2. Remove dysfunctional cells

Question 108

What name is given to RBCs partially digested by splenic macrophages?

Answer 108

Bite cells (degmacytes)

Question 109

What amino acid frequently has more coding sequences in the mRNA than are represented in the peptide that is created from that mRNA?

Answer 109

Methionine - The start codon codes for methionine which is often removed later on

Question 110

What is the difference between an intron and an exon?

Answer 110

1. Introns are intervening (noncoding) regions of RNA that get spliced out of the mature mRNA and stay within the nucleus
2. Exons are coding regions of RNA that get spliced together to form mature mRNA which leaves the nucleus

Question 111

How is transcription of the lac operon regulated?

Answer 111

1. Lac repressor: Present in the absence of lactose
2. Lac enhancer (Catabolite activating protein <cap>): Present in the absence of glucose and facilitates RNA polymerase binding and production of beta-galactosidase</cap>

Question 112

What enzyme matches amino acids to tRNA?

Answer 112

Aminoacyl-tRNA synthetase

Question 113

What antibiotics are inhibitors of prokaryotic protein synthesis at the 30S ribosome? 50S?

Answer 113

“Buy AT 30, CCELL at 50”

30S

1. Aminoglycosides
2. Tetracycline

50S

1. Chloramphenicol
2. Clindamycin
3. Erythromycin (and other Macrolides)
4. Linezolid
5. Lincomycin
6. Also Streptogramins

Question 114

Which immunoglobulin isotypes fit each of the following statements?

1. Associated with allergies because it is bound by mast cells and basophils and causes them to degranulate and release their histamine
2. Comprises 70-75% of the total immunoglobulin pool
3. Present in large quantities on the membrane of many B cells
4. Crosses the placenta and, additionally, confers immunity to neonates in the first few months of life
5. Can occur as a dimer
6. Largely confined to the intravascular pool and is the predominant early antibody frequently seen in the immune response to infectious organsims with complex antigens
7. Distributed evenly between the intravascular and extravascular pools
8. The predominant immunoglobulin in mucoserous secretions, and genitourinary secretions
9. Can be a pentamer

Answer 114

1. Associated with allergies because it is bound by mast cells and basophils and causes them to degranulate and release their histamine: IgE
2. Comprises 70-75% of the total immunoglobulin pool: IgG
3. Present in large quantities on the membrane of many B cells: IgD & IgM
4. Crosses the placenta and, additionally, confers immunity to neonates in the first few months of life: IgG
5. Can occur as a dimer: IgA
6. Largely confined to the intravascular pool and is the predominant early antibody frequently seen in the immune response to infectious organsims with complex antigens: IgM
7. Distributed evenly between the intravascular and extravascular pools: IgG
8. The predominant immunoglobulin in mucoserous secretions, and genitourinary secretions: IgA
9. Can be a pentamer: IgM

Question 115

Which cellular organelles are particularly important to plasma cell function?

Answer 115

Rough endoplasmic reticulum & Golgi apparatus

Question 116

What initiates recombination of V(D)J sequences?

Answer 116

Recombination Activating Gene Complexes (RAG-1 & RAG-2)

Question 117

Which viral vaccines are potentially dangerous to patients with an egg allergy?

Answer 117

Influenza vaccine & Yellow fever vaccine (MMR vaccine made with a tiny amount of egg that is not a concern for egg allergy)

Question 118

What autoimmune disease is associated with anti-dsDNA antibodies?

Answer 118

SLE (especially SLE with renal disease)

Question 119

What stain is used to identify amyloid microscopically, and how is its appearance described?

Answer 119

1. Congo red stain
2. Amyloid has apple green birefringence under polarized light

Question 120

Which immunosuppressant matches each of the following statements?

1. Precursor of 6-mercaptopurine
2. Can cause nephrotoxicity
3. Antibody that binds to CD3 on T cells
4. Antibody that binds IL-2 receptor on activated T cells
5. Inhibits inosine monophosphate (IMP) dehydrogenase

Answer 120

1. Precursor of 6-mercaptopurine: Azothioprine
2. Can cause nephrotoxicity: Cyclosporine & Tacrolimus
3. Antibody that binds to CD3 on T cells: Muromomab
4. Antibody that binds IL-2 receptor on activated T cells: Daclizumab
5. Inhibits inosine monophosphate (IMP) dehydrogenase: Mycophenolate Mofetil

Question 121

Which immunosuppressant matches each of the following statements?

1. Inhibits calcineurin resulting in the loss of IL-2 production and blockage of T cell differentiation and activation
2. Binds FK-binding protein (FKBP) leading to loss of IL-2 production
3. Binds FKBP12 leading to inhibition of mTOR and T cell proliferation
4. Used for lupus nephritis
5. Metabolized by xanthine oxidase, therefore increasing allopurinol toxicity

Answer 121

1. Inhibits calcineurin resulting in the loss of IL-2 production and blockage of T cell differentiation and activation: Cyclosporine
2. Binds FK-binding protein (FKBP) leading to loss of IL-2 production: Tacrolimus
3. Binds FKBP12 leading to inhibition of mTOR and T cell proliferation: Sirolimus
4. Used for lupus nephritis: Cyclosporine, Azothioprine, Mycophenolate mofetil
5. Metabolized by xanthine oxidase, therefore increasing allopurinol toxicity: Azothioprine & 6-Mercaptopurine

Question 122

What cytokine matches each of the following statements?

1. Promotes B cell growth and differentiation
2. Produced by Th1 cells
3. Produced by Th2 cells
4. Involved in growth and activation of eosinophils
5. Secreted by helper T cells and activates macrophages

Answer 122

1. Promotes B cell growth and differentiation: IL-4 & IL-5
2. Produced by Th1 cells: IL-2 & IFN-gamma
3. Produced by Th2 cells: IL-4, IL-5, IL-10
4. Involved in growth and activation of eosinophils: IL-5
5. Secreted by helper T cells and activates macrophages: IFN-gamma

Question 123

What cytokine matches each of the following statements?

1. Inhibits macrophage activation
2. Pyrogens secreted by monocytes and macrophages
3. Inhibits production of Th1 cells
4. Inhibits production of Th2 cells
5. Mediate inflammation

Answer 123

1. Inhibits macrophage activation:IL-10
2. Pyrogens secreted by monocytes and macrophages: IL-1, IL-6, TNF-alpha
3. Inhibits production of Th1 cells: IL-10
4. Inhibits production of Th2 cells: IFN-gamma
5. Mediate inflammation: IL-1, IL-6, TNF-alpha

Question 124

What cytokine matches each of the following statements?

1. Enhances synthesis of IgE and IgG
2. Enhances synthesis of IgA
3. Released by virus-infected cells
4. Supports growth and differentiation of bone marrow stem cells
5. Supports T cell proliferation, differentiation, and activation

Answer 124

1. Enhances synthesis of IgE and IgG: IL-4
2. Enhances synthesis of IgA: IL-5
3. Released by virus-infected cells: IFN-alpha & IFN-beta
4. Supports growth and differentiation of bone marrow stem cells: IL-3
5. Supports T cell proliferation, differentiation, and activation: IL-2

Question 125

Which type of hypersensitivity is responsible for each of the following clinical problems?

1. Poststreptococcal glomerulonephritis
2. Asthma
3. Rheumatic fever
4. Tuberculosis skin test

Answer 125

1. Poststreptococcal glomerulonephritis: Type III
2. Asthma: Type I
3. Rheumatic fever: Type II
4. Tuberculosis skin test: Type IV

Question 126

Which type of hypersensitivity is responsible for each of the following clinical problems?

1. Allergies, anaphylaxis, and hay fever
2. Polyarteritis nodosa
3. Serum sickness
4. ABO blood type incompatibility

Answer 126

1. Allergies, anaphylaxis, and hay fever: Type I
2. Polyarteritis nodosa: Type III
3. Serum sickness: Type III
4. ABO blood type incompatibility: Type II

Question 127

Which type of hypersensitivity is responsible for each of the following clinical problems?

1. Poison Ivy
2. Eczema
3. Contact dermatitis
4. Goodpastures syndrome

Answer 127

1. Poison Ivy: Type IV
2. Eczema: Type I
3. Contact dermatitis: Type IV
4. Goodpastures syndrome: Type II

Question 128

A patient suffers from recurrent Neisseria infections. What complement proteins are deficient?

Answer 128

Any one of C5-C9

Question 129

Which complement is responsible for neutrophil chemotaxis?

Answer 129

C5a

Question 130

What would you expect to see in a patient with Wiskott-Aldrich Syndrome?

Answer 130

Deficiency of IgM antibodies, and elevated IgA antibodies

“WAITER”

1. Wiskott
2. Aldrich
3. Immunodeficiency
4. Thrombocytopenia
5. Eczema
6. Recurrent pyogenic infections

Question 131

1. What is the cause of chronic granulomatous disease?
2. what infections are these individuals susceptible to?

Answer 131

1. Defective NADPH oxidase - phagocytes cant generate oxygen-free radicals
2. Susceptible to infection by staph aureus, E. coli, Klebsiella, Aspergillus, & candida

Question 132

A young child presents with tetany from hypocalcemia, and candidiasis resulting from immunosuppression. What cell type is deficient in this patient?

Answer 132

1. DiGeorge Syndrome characterized by thymic aplasia resulting in a deficiency of T cells and parathyroid dysfunction resulting in hypocalcemia.

Question 133

When should patient with HIV begin prophylactic medication for opportunistic infections?

Answer 133

CD4 < 200: Pneumocystis Jirovecii prophylaxis with TMP-SMX

CD4 < 100: Toxoplasmosis prophylaxis with TMP-SMX (only in patients with positive IgG titer for PCP)

CD4 < 50: Mycobacterium Avium Complex (MAC) prophylaxis with Azithromycin

In endemic regions - CD4 < 100: Histoplasmosis prophylaxis with Itraconazole

Question 134

What organisms are known to cause infections in the mouth of AIDS patients?

Answer 134

1. Candida Albicans
2. HSV
3. CMV
4. EBV

Question 135

What are the three structural genes that code for HIV proteins?

Answer 135

1. Pol: codes reverse transcriptase
2. Env: gp120 and gp41
3. Gag: p24

Question 136

Categorize the following agents as protease inhibitor, NRTI, or NNRTI:

1. Ritonavir
2. Didanosine
3. Delavirdine
4. Zidovudine
5. Abacavir
6. Lamivudine
7. Nelfinavir
8. Efavirenz

Answer 136

1. Ritonavir: Protease Inhibitor
2. Didanosine: NRTI
3. Delavirdine: NNRTI
4. Zidovudine: NRTI
5. Abacavir: NRTI
6. Lamivudine: NRTI
7. Nelfinavir: Protease Inhibitor
8. Efavirenz: NNRTI

Question 137

What are the two HIV envelope proteins and the drugs that interfere with them?

Answer 137

gp120: Inhibited from binding CCR5 by the drug Maraviroc (which binds CCR5)
gp41: Fusion inhibited by Enfuvirtide

Question 138

Which antiretroviral or antiretroviral class matches each of the following statements?

1. Side Effect - Lactic Acidosis:
2. Side Effect - GI intolerance:
3. Side Effect - Pancreatitis:
4. Side Effect - Peripheral neuropathy:
5. Side Effect - Megaloblastic anemia:

Answer 138

1. Side Effect - Lactic Acidosis: NRTIs
2. Side Effect - GI intolerance: Protease Inhibitors
3. Side Effect - Pancreatitis: Didanosine, Ritonavir
4. Side Effect - Peripheral neuropathy: Didanosine, Stavudine, Zalcitibine
5. Side Effect - Megaloblastic anemia: Zidovudine

Question 139

Which antiretroviral or antiretroviral class matches each of the following statements?

1. Side effect - Rash:
2. Side effect - Hyperglycemia, diabetes mellitus, and lipid abnormalities:
3. Side effect - Bone marrow suppression:
4. Given to pregnant women with HIV:
5. Regime for occupational HIV exposures:
6. A combination of different classes of medication used to attack the HIV at different points in its replication/infection cycle in order to control the infection and avoid resistance

Answer 139

1. Side effect - Rash: NNRTI
2. Side effect - Hyperglycemia, diabetes mellitus, and lipid abnormalities: Protease inhibitors
3. Side effect - Bone marrow suppression: Zidovudine
4. Given to pregnant women with HIV: Zidovudine
5. Regime for occupational HIV exposures: Zidovudine + Lamivudine
6. A combination of different classes of medication used to attack the HIV at different points in its replication/infection cycle in order to control the infection and avoid resistance: HAART

Question 140

A newborn is having trouble feeding. He vomits milk when fed and has a gastric air bubble on X-ray. What kind of fistula is present?

Answer 140

Tracheoesophageal fistula: Most commonly a blind upper pouch of proximal esophagous with a distal esophagous attatched to the trachea

Question 141

What substance is important for relaxing the lower esophageal sphincter?

Answer 141

Nitric oxide

Question 142

What are the names of the diverticula found in the esophagus based on their anatomical locations?

Answer 142

1. Zenker diverticulum: Immediately above the upper esophageal sphincter
2. Traction diverticulum: Near midpoint of the esophagus
3. Epiphrenic diverticulum: Immediately above the lower esophageal sphincter

Question 143

A 60 year-old man with chronic reflux presents with esophageal cancer. What is the most likely diagnosis?

Answer 143

Adenocarcinoma, which is most common in the USA (Squamous carcinoma is most common world wider)

Question 144

1. What is the artery of the foregut?
2. Of the midgut?
3. Of the rectum and distal third of the colon?

Answer 144

1. Celiac artery
2. Superior mesenteric artery
3. Inferior mesenteric artery

Question 145

1. What disorder is characterized by a excess of gastrin?
2. What is the treatment?

Answer 145

1. Zollinger-Ellison Syndrome
2. Proton pump inhibitors +/- Octreotide (an octapeptide that mimics natural somatostatin pharmacologically)

Question 146

What receptors found on gastric parietal cells regulate acid secretion?

Answer 146

1. Histamine (H₂) receptors
2. CCK_B receptors
3. M₃ receptors
4. Prostaglandin receptors
5. Somatostatin receptors

Question 147

What happens to serum pH at the time of gastric acid secretion?

Answer 147

Alkalosis (pH rises)

Question 148

A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L.

What is the half-life of drug X in this patient?

Answer 148

Clearance = [rate of elimination]/[plasma drug concentration]

Or

Clearance = [Volume of distribution]x[elimination constant]

The elimination constant = 0.7/[half-life]

So

Vd = 0.5 L/kg x 60 kg man = 30 L

Clearance is given as 2 L/hr

Clearance = (Vd x 0.7)/(t1/2)

t1/2 = (Vd x 0.7)/[Clearance] = (30 L x 0.7)/(2 L/hr)

t1/2 = 10.5 hrs

Question 149

A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L.

What loading dose could have been used to reach the target concentration of 20 mg/L?

Answer 149

Loading dose (Ld) = Concentration of steady state (Css) x Volume of distribution (Vd)

Vd = 0.5 L/kg x 60 kg man = 30 L

Css given as 20 mg/L

Ld = 20 mg/L x 30 L = 600 mg

Question 150

A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L.

If the patient begins to show signs of toxicity, and the target dose is decreased to 10 mg/L, what would you do to get to this level?

Answer 150

Stop the infusion for 1 half-life

Question 151

A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L.

The patient begins to show signs of toxicity, and the target dose is decreased to 10 mg/L. Assuming 100% bioavailability, what oral dose of drug X would be necessary to maintain the new target level?

Answer 151

Maintainance dose (Md) = Concentration of steady state (Css) x Clearance (CL)

Css given a 10 mg/L

CL given as 2 L/hr

Md = 10 mg/L x 2 L/hr = 20 mg/hr

Question 152

A 60kg man with status asthmaticus is being given an IV infusion of drug X at 60 mg/hr. The clearance of drug X is 2 L/hr, and the volume of distribution is approximately 0.5 L/kg. 48 hours after administration has begun, the asthma attack is under control. At this time, the concentration of drug X in his plasma is 20 mg/L.

If the patient has a kidney disease, and the clearance is reduced to 1 L/hr, but the Vd is unchanged, what effect will this have on loading dose and maintainance dose?

Answer 152

Loading dose will be unchanged

Maintainance dose will be decreased by half

Question 153

What are the two most common underlying causes of a hospital admission for a bleeding peptic ulcer?

Answer 153

1. H. Pylori
2. NSAIDs

Question 154

Which antacid matches each of the following statements?

1. May cause diarrhea
2. May cause constipation
3. Mayc cause rebound hypercalcemia
4. May cause hypokalemia

Answer 154

1. May cause diarrhea: Magnesium Hydroxide
2. May cause constipation: Aluminum Hydroxide
3. Mayc cause rebound hypercalcemia: Calcium Carbonate
4. May cause hypokalemia: All 3 of the above antacids

Question 155

A patient taking NSAIDs for the management of her gout develops anemia, has pain with eating, and is positive on occult blood test. What drug would most directly address the mechanism behind this patient’s current problem?

Answer 155

Misoprostol

Question 156

Where is Virchow’s node located?

Answer 156

Left supraclavicular lymph node

Question 157

What important secretory products are secreted from each of the following cells of the GI tract?

1. G cells
2. I cells
3. S cells
4. D cells
5. Parietal cells

Answer 157

1. G cells: Gastrin
2. I cells: CCK
3. S cells: Secretin
4. D cells: Somatostatin
5. Parietal cells: Gastric acid & Intrinsic factor

Question 158

What GI ligament matches each of the following descriptions?

1. Contains the portal triad and may be compressed to control bleeding
2. Attaches the spleen to the posterior abdominal wall
3. Attaches the spleen to the stomach

Answer 158

1. Contains the portal triad and may be compressed to control bleeding: Hepatoduodenal ligament
2. Attaches the spleen to the posterior abdominal wall: Splenorenal ligament
3. Attaches the spleen to the stomach: Gastrosplenic ligament

Question 159

What is the mechanism of action of metoclopramide?

Answer 159

D2 receptor antagonist and serotonin agonist

Increases contractility of GI tract (prokinetic)

Question 160

Which hormones stimulate pancreatic secretion?

Answer 160

1. CCK: Pancreas & gall bladder
2. Secretin: Stimulates bicarb secretion
3. Acetylcholine (neurotransmitter not a hormone)

Question 161

What enzyme catalyzes the rate-limiting step in carbohydrate digestion?

Answer 161

Oligosaccharide hydrolases found at the intestinal brush border

Question 162

What are the possible etiologies of acute pancreatitis?

Answer 162

“GET SMASHED”

1. Gall stones
2. Ethanol
3. Trauma
4. Steroids
5. Mumps
6. Autoimmune
7. Scorpion Stings
8. Hypercalcemia/Hypertriglyceridemia
9. Endoscopic Retrograde Cholangiopancreatography (ERCP)
10. Drugs

Question 163

1. What is the typical presentation of a patient with pancreatic insufficiency?
2. What is the treatment for pancreatic insufficiency?

Answer 163

1. Diarrhea, steatorrhea, malabsorption, weight loss, deficiency of fat-soluble vitamins (A, D, E, K)
2. Pancreatic enzyme supplementation, fat soluble vitamin supplementation, limit fat intake

Question 164

How is hemoglobin glycosylated in DM to form HgbA1c?

Answer 164

Nonenzymatic glycosylation

Question 165

Which type of diabetes mellitus fits the following descriptions?

1. Associated with obesity
2. May cause ketoacidosis
3. Strong genetic predisposition
4. Associated with HLA DR3 & DR4

Answer 165

1. Associated with obesity: Type II
2. May cause ketoacidosis: Type I
3. Strong genetic predisposition: Type II
4. Associated with HLA DR3 & DR4: Type I

Question 166

In which tissues will you find GLUT-2 receptors?

Answer 166

1. Liver
2. Pancrease (beta cells)
3. Kidney
4. Small intestine

Question 167

Which tissues depend on insulin for glucose uptake?

Answer 167

Skeletal muscle and adipose tissue

Question 168

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Lactic acidosis is a rare but worrisome side effect

Answer 168

Biguanide: Metformin

Question 169

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Most common side effect is hypoglycemia

Answer 169

Sulfonylureas: Glyburide, Glimepiride, Glipizide

Question 170

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Recommended first-line treatment for most patients

Answer 170

Biguanide: Metformin

Question 171

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Also helps lower triglycerides and LDL cholesterol levels

Answer 171

Biguanide: Metformin

Question 172

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Not safe in settings of hepatic dysfunction or CHF

Answer 172

Primarily

Thizolidinediones: Pioglitazone and Rosiglitazone

Also could be

Biguanide: Metformin

Question 173

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Should not be used in patients with elevated serum creatinine

Answer 173

Biguanide: Metformin

Question 174

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Should not be used in patients with cirrhosis, elevated serum creatinine, or inflammatory bowel disease

Answer 174

Alpha-Glucosidase Inhibitors: Acarbose & Miglitol

Question 175

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Hepatic serum transaminase levels should be carefully monitored when using these agents

Answer 175

Thiazolidinediones: Pioglitazone & Rosiglitazone

Biguanide: Metformin

Question 176

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Not associated with weight gain, often used in overweight diabetics

Answer 176

Biguanide: Metformin

Question 177

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Metabolized by the liver; excellent choice in patients with renal disease

Answer 177

Thiazolidinediones: Pioglitazone & Rosiglitazone

Question 178

Which of the oral agents used in the control of type II diabetes has the following characteristic?

Primarily effects prostprandial hyperglycemia

Answer 178

Alpha-Glucosidase Inhibitors: Acarbose & Miglitol

Question 179

Which of the oral agents used in the control of type II diabetes has the following characteristic?

MOA: Closes K channel on beta cells -> Depolarization -> Ca2+ influx -> Insulin release

Answer 179

Sulfonylureas: Glyburide, Glimepiride, & Glipizide

Question 180

Which of the oral agents used in the control of type II diabetes has the following characteristic?

MOA: Inhibits alpha-glucosidase at intestinal brush border

Answer 180

Alpha-Glucosidase inhibitors: Acarbose & Miglitol

Question 181

Which of the oral agents used in the control of type II diabetes has the following characteristic?

MOA: Agonist at PPAR-gamma receptors -> improved target cell response to insulin

Answer 181

Thiazolidinediones: Pioglitazone & Rosiglitazone

Question 182

A 40 year-old man comes to the emergency room for the treatment of DKA. His type I diabetes is normally well controlled, and he doesnt know why his DKA developed this time. What is the differential diagnosis for the development of his DKA?

Answer 182

1. Infection
2. Dehydration
3. Medication omission or reduction
4. Severe mental illness
5. Glucocorticoids
6. Alcohol/drug abuse

Question 183

Describe the process by which B12 is absorbed

Answer 183

1. Pepsin in the stomach releases B12 from protein-bound form
2. In the stomach, B12 binds to salivary vitamin B12 binding proteins (R-binder)
3. In the duodenum, this complex of R-binders and B12 is broken down by pancreatic proteases
4. In the duodenum, unbound B12 binds to intrinsic factor
5. Intrinsic factor plus B12 binds Intrinsic factor receptors on cells of the terminal ileum
6. B12 crosses the mucosal cell membrane and is picked up by plasma protein trans-cobalamin-2

Question 184

What serum antibodies are associated with celiac sprue?

Answer 184

1. Anti-Tissue Transglutaminase Antibody
   Anti-Gliadin Antibody

Question 185

What organism is associated with Whipple disease?

Answer 185

Tropheryma Whippeli

Question 186

What specific organs are involved in the absorption of vitamin B12?

Answer 186

1. Salivary glands
2. Stomach
3. Pancreas
4. Duodenum
5. Distal Ileum

Question 187

What pathology of the small intestine is most closely associated with the following statement?

Small intestinal mucosa laden with distended macrophages in the lamina propria (that are filled with PAS (+) granules and rod-shaped bacilli seen by electron microscopy)

Answer 187

Whipple disease

Question 188

What pathology of the small intestine is most closely associated with the following statement?

Gluten sensitivity

Answer 188

Celiac Disease

Question 189

What pathology of the small intestine is most closely associated with the following statement?

Total or subtotal atrophy of the small bowel villi, plasma cells and lymphocyte infiltration into the lamina propria and epithelium, and hyperplasia/elongation of crypts

Answer 189

Celiac disease

Question 190

What intestinal disorder is common in the NICU to premature babies that receive oral feeds too soon?

Answer 190

Necrotizing enterocolitis

Question 191

What are the common causes of small bowel obstruction?

Answer 191

1. Adhesion
2. Hernia
3. Tumor

Question 192

What are the classic symptoms of carcinoid syndrome?

Answer 192

1. Bronchospasm
2. Flushing
3. Diarrhea
4. Right-sided hear disease/murmur

Question 193

What irreversible enzymes are involved in gluconeogenesis?

Answer 193

1. Pyruvate carboxylase
2. PEP carboxylase
3. Fructose-1,6-bisphosphatase
4. Glucose-6-phosphatase

Question 194

What effect do glucagon and insulin have on glycolysis?

Answer 194

1. Insulin -> decreased cAMP -> decreased PKA -> decreased fructose bisphosphatase 2 & increased phosphofructokinase 2 -> increased stimulation of PFK-1 -> increased glycolysis
2. Glucagon -> increased cAMP -> increased PKA -> increased fructose bisphosphatase 2 & decreased phosphofructokinase 2 -> decreased stimulation of PFK-1 -> decreased glycolysis

Question 195

What is the clinical consequence of a glycolytic enzyme deficiency?

Answer 195

Hemolytic anemia: RBCs cannot maintain Na/K ATPase -> RBC swelling/lysis

Question 196

Which enzyme converts glucose to glucose-6-phosphate?

Answer 196

1. Glucokinase: Liver and beta-cells of pancreas
2. Hexokinase: Everywhere else

Question 197

What is the rate-limiting enzyme for the following metabolic pathway?

1. Glycolysis
2. Gluconeogenesis
3. Glycogenesis
4. Glycogenolysis

Answer 197

1. Glycolysis: Phosphofructokinase 1
2. Gluconeogenesis: Fructose-1,6-bisphosphatase
3. Glycogenesis: Glycogen Synthase
4. Glycogenolysis: Glycogen phosphorylase

Question 198

Which enzyme converts glucose-6-phosphate to glucose?

Answer 198

Glucose-6-phosphatase

Question 199

Which glycogen storage disease matches each of the following phrases?

1. Glycogen phosphorylase deficiency
2. Glucos-6-phosphatase deficiency
3. Lactic acidosis, hyperlipidemia, hyperuricemia (gout)
4. Alpha-1,6-glucosidase deficiency
5. Alpha-1,4-glucosidase deficiency

Answer 199

1. Glycogen phosphorylase deficiency: Type V (McArdle disease)
2. Glucos-6-phosphatase deficiency: Type I (Von Gierke disease)
3. Lactic acidosis, hyperlipidemia, hyperuricemia (gout): Type I (Von Gierke disease)
4. Alpha-1,6-glucosidase deficiency: Type III (Cori disease)
5. Alpha-1,4-glucosidase deficiency: Type II (Pompe disease)

Question 200

Which glycogen storage disease matches each of the following phrases?

1. Cardiomegaly
2. Diaphram weakness leading to respiratory failure
3. Increased glycogen in liver; severe fasting hypoglycemia
4. Hepatomegaly, hypoglycemia, hyperlipidemia (normal kidneys, lactate, and uric acid)
5. Painful muscle cramps, myoglobinuria with strenuous exercise
6. Severe hepatosplenomegaly, enlarged kidneys

Answer 200

1. Cardiomegaly: Type II (Pompe disease - Infantile type)
2. Diaphram weakness leading to respiratory failure: Type II (Pompe disease - Adult type)
3. Increased glycogen in liver; severe fasting hypoglycemia: Type I (Von Gierke disease)
4. Hepatomegaly, hypoglycemia, hyperlipidemia (normal kidneys, lactate, and uric acid): Type III (Cori disease)
5. Painful muscle cramps, myoglobinuria with strenuous exercise: Type V (McArdle disease)
6. Severe hepatosplenomegaly, enlarged kidneys: Type I (Von Gierke disease)

Question 201

What are the possible products of pyruvate?

Answer 201

1. Lactate
2. Oxaloacetate
3. Alanine
4. Acetyl CoA

Question 202

What are the two main nitrogen transporters in the blood?

Answer 202

Alanine & Glutamine

Question 203

What are the major regulatory enzymes of citric acid cycle?

Answer 203

1. Citrate Synthase
2. Isocitrate Dehydrogenase
3. Alpha-Ketoglutarate Dehydrogenase

Question 204

What substances are known to inhibit the complexes of the electron transport chain?

Answer 204

1. Amytal
2. Rotenone
3. MPP
4. Antimycin A
5. Cyanide
6. Azide
7. Carbon monoxide (CO)
8. Hydrogen Sulfide (H₂S)

Question 205

What substances can increase the permeability of the inner mitochondrial membrane, thereby decreasing ATP synthesis but increasing heat generation?

Answer 205

1. Aspirin
2. Thermogenin
3. 2,4-Dinitrophenol

Question 206

What is the rate-limiting step of the pentose phosphate pathway?

Answer 206

Glucose-6-Phosphate Dehydrogenase (G6PD)

Question 207

Which tissues of the body use the pentose phosphate pathway?

Answer 207

1. Liver
2. Red blood cells
3. Adrenal cortex
4. Mammary glands

Question 208

Expalin why a deficiency of the enzyme that is the rate-limiter for the HMP shunt can result in hemolytic anemia

Answer 208

G6PD generates NADPH -> NADPH is used to produce reduced glutathione -> No G6PD = oxidative damage = hemolysis

Question 209

What are the symptoms of classic galactosemia?

Answer 209

1. Failure to thrive
2. Mental retardation
3. Hepatomegaly
4. Jaundice
5. Infantile cataracts

Question 210

What disorder is caused by a deficiency of each of the following enzymes?

1. Galactokinase
2. Aldolase B
3. Lactase
4. Galactose-I-Phosphate Uridyltransferase
5. Fructokinase

Answer 210

1. Galactokinase: Galactokinase deficiency - Galactitol accumulates if galactose is present in diet. Relatively mild condition (Symptoms are galactose appearing in blood and urine, infantile cataracts, may initially present as failure to track objects or to develop a social smile)
2. Aldolase B: Fructose intolerance - Fructose-1-Phosphate accumulates causing a decrease in available phosphate which results in inhibition of glycogenolysis and gluconeogenesis (symptoms are hypoglycemia, jaundice, cirrhosis, vomiting)
3. Lactase: Lactose intolerance - Symptoms are bloating, cramps, osmotic diarrhea
4. Galactose-I-Phosphate Uridyltransferase: Classic Galactosemia - Damage caused by accumulation of toxic substances including galactitol, which accumulates in the lens of the eye (Symptoms are failure to thrive, jaundice, hepatomegaly, infantile cataracts, and mental retardation)
5. Fructokinase: Essential Fructosuria - A benign, asymptomatic condition, since fructose is not trapped in cells (Fructose appears in blood and urine)

Question 211

What is the primary energy source in a patient that has not eaten in two days?

Answer 211

Fatty acids

Question 212

What hormone stimulates the storage of lipids in the fed state?

Answer 212

Insulin

Question 213

What is the rate limiting enzyme in ketone body synthesis?

Answer 213

HMG-CoA Synthase

Question 214

A stressed physician comes home from work, consumes 7 or 8 shots of tequila in rapid succession before dinner, and becomes hypoglycemic. Why did she become hypoglycemic?

Answer 214

Ethanol metabolism generates NADH and drives:

• Pyruvate -> Lactate
• Oxaloacetate -> Malate

No longer have pyruvate and oxaloacetate to undergo gluconeogenesis, causing hypoglycemia

Question 215

What are some of the hallmark features of Kwashiorkor?

Answer 215

1. Protein malnutrition
2. Edema and ascites
3. Anemia
4. Malfunction of the liver (fatty change)
5. Skin lesions
6. Skin and hair depigmentation

Question 216

What are the five categories of criteria for the diagnosis of metabolic syndrome?

Answer 216

1. Abdominal Obesity: Waist >/= 40 inches (Men), 35 inches (Women)
2. Triglycerides >/= 150
3. BP >/= 130/85
4. Fasting Glucose >/= 100
5. HDL = 40 mg/dl (Men), = 50 mg/dl (Women)

Question 217

What liver disease is associated with obesity?

Answer 217

Non-alcoholic Steatohepatitis

Question 218

At what BMI is a patient considered obese?

Answer 218

>/= 30

Question 219

What enzyme is responsible for the conjugation of bilirubin?

Answer 219

UDP-Glucuronyl Transferase

Question 220

Which hereditary hyperbilirubinemia matche each of the following statements?

1. Mildly decreased UDPGT
2. Completely absent UDPGT
3. Grossly black liver
4. Responds to phenobarbital
5. Treatment includes plasmapheresis and phototherapy
6. Asymptomatic unless under physical stress (Alcohol, infection)

Answer 220

1. Mildly decreased UDPGT: Gilbert Syndrome or Type II Crigler-Najjar Syndrome
2. Completely absent UDPGT: Type I Crigler-Najjar Syndrome
3. Grossly black liver: Dubin-Johnson Syndrome
4. Responds to phenobarbital: Type II Crigler-Najjar Syndrome or Gilbert Syndrome
5. Treatment includes plasmapheresis and phototherapy: Type I Crigler-Najjar Syndrome
6. Asymptomatic unless under physical stress (Alcohol, infection): Gilbert Syndrome

Question 221

What are the signs of portal hypertension?

Answer 221

1. Ascites
2. Esophageal varices (Causing Hematemesis and Melena)
3. Hemorrhoids
4. Splenomegaly
5. Caput Medusae

Question 222

1. What is seen in Budd-Chiari Syndrome?
2. What conditions are associated with Budd-Chiari Syndrome?

Answer 222

1. Occlusion of the Inferior Vena Cava or hepatic veins
2. Hepatocellular carcinoma, Polycythemia vera, Pregnancy

Question 223

What is the mechanism by which aspirin can cause Reye Syndrome?

Answer 223

1. Metabolites of aspirin inhibit mitochondrial enzymes
2. Decreased Beta-oxidation

Question 224

A young man presents with ataxia and tremors. He has brown pigmentation in a ring around the periphery of his cornea. What treatment should he recieve?

Answer 224

This is Wilson Disease and it is treated with Penicillamine

Question 225

1. What is the underlying problem in Wilson disease?
2. What are the characteristics of Wilson disease?
3. What is the treatment for Wilson disease?

Answer 225

1. Impaired copper excretion - body does not put copper into the bile appropriately
2. Decreased Ceruloplasmin, Asterixis, Basal ganglia degeneration, Cirrhosis, Kayser-Fleischer rings, Copper accumulation, Dementia, Dyskinesia, Dysarthria
3. Penicillamine

Question 226

1. What is the classic triad of symptoms in hemochromatosis?
2. What lab tests are used to diagnose hemochromatosis?
3. What is the treatment for hemochromatosis?

Answer 226

1. Diabetes, pigmentation, cirrhosis
2. Increase Ferritin*, Increased transferrin saturation, increased serum iron, decreased TIBC
3. Phlebotomy and Deferoxamine

Question 227

What are the risk factors for the development of hepatocellular carcinoma?

Answer 227

1. Hepatitis B and C
2. Hemochromatosis
3. Alpha 1-Antitrypsin deficiency
4. Hepatic Adenoma
5. Alcoholic cirrhosis

Question 228

Identify the hepatitis B status of each of the following patients based on their hepatitis B serologic markers

1. HBsAg (-), HBsAb (+), HBcAb (+)
2. HBsAg (-), HBsAb (-), HBcAb (+)
3. HBsAg (+), HBsAb (-), HBcAb (+ IgM)
4. HBsAg (+), HBsAb (-), HBcAb (+ IgG)
5. HBsAg (-), HBsAb (+), HBcAb (-)

Answer 228

1. HBsAg (-), HBsAb (+), HBcAb (+): Past infection (recovered
2. HBsAg (-), HBsAb (-), HBcAb (+): Window period
3. HBsAg (+), HBsAb (-), HBcAb (+ IgM): Acute infection
4. HBsAg (+), HBsAb (-), HBcAb (+ IgG): Chronic infection
5. HBsAg (-), HBsAb (+), HBcAb (-): Vaccine

Question 229

What medications are used in the treatment of chronic hepatitis B and C?

Answer 229

1. Interferon Alpha* - Chronic hepatitis B and C
2. Ribavirin - Chronic hepatitis C only

Question 230

Which antibodies can be used to help make the diagnosis of autoimmune hepatitis?

Answer 230

1. ANA (+), Anti-Smooth muscle Antibody (+)
2. Anti-liver-kidney microsomal Antibody (+)
3. Anti-mitochondrial (-)

Question 231

What is the fate of bilirubin after it is conjugated and secreted into the GI tract?

Answer 231

1. Bacteria convert it to urobilinogen
2. Most is excreted in the stoll as stercobilin
3. Some is reabsorbed/recycled in bile
4. Tiny amount is excreted in the urine as urobilin

Question 232

What enzyme is functioning suboptimally in newborns with physiologic jaundice?

Answer 232

UDP-Glucuronyl Transferase

Question 233

What are some of the intrahepatic and extrahepatic causes of biliary obstruction?

Answer 233

Intrahepatic

1. Pimary biliary cirrhosis
2. Primary sclerosing Cholangitis
3. Drugs (Chlorpromazine & Arsenic)

Extrahepatic

1. Pancreatic neoplasia
2. Choledocolithiasis
3. Pancreatitis
4. Cholangiocarcinoma

Question 234

What is the difference between primary biliary cirrhosis and primary sclerosing cholangitis?

Answer 234

Primary biliary cirrhosis

1. Positive AMA
2. Middle aged females
3. Autoimmune disease (CREST Scleroderma)

Primary sclerosing cholangitis

1. Positive cANCA
2. Males over 40
3. Ulcerative colitis & cholangiocarcinoma
4. “Beads on a string” on ERCP

Question 235

What are some of the risk factors for the development of cholesterol gallstones?

Answer 235

“4 F’s”

1. Fat
2. Fertile
3. Female
4. > Forty

Question 236

What deficiency causes familial hypercholesterolemia?

Answer 236

Deficiency of LDL receptors

Question 237

Which apolipoprotein matches each of the following statements?

1. Activates LCAT
2. Mediates chylomicron secretion
3. Mediates VLDL secretion
4. Binds to LDL receptor
5. Cofactor for lipoprotein lipase
6. Mediates uptake of remnant particles

Answer 237

1. Activates LCAT: A1
2. Mediates chylomicron secretion: B48
3. Mediates VLDL secretion: B100
4. Binds to LDL receptor: B100
5. Cofactor for lipoprotein lipase: C2
6. Mediates uptake of remnant particles: E

Question 238

What is the rate-limiting enzyme for each of the following metabolic pathways?

1. Hexose monophosphate pathway
2. Fatty acid synthesis
3. Beta-oxidation of fatty acids
4. Ketone body synthesis
5. Cholesterol synthesis

Answer 238

1. Hexose monophosphate pathway: Glucose-6-Phosphate dehydrogenase
2. Fatty acid synthesis: Acetyl CoA Carboxylase
3. Beta-oxidation of fatty acids: Carnitine Acyltransferase
4. Ketone body synthesis: HMG-CoA synthase
5. Cholesterol synthesis: HMG-CoA reductase

Question 239

Which group of medications inhibits the rate limiting enzyme of cholesterol synthesis?

Answer 239

Statins

Question 240

Where in the cell would you find each of the following enzymatic processes taking place?

1. Fatty Acid degradation
2. Fatty Acid synthesis
3. Glycolysis
4. TCA cycle
5. Electron transport chain (oxidative phosphorylation)
6. Gluconeogenesis

Answer 240

1. Fatty Acid degradation: Mitochondria
2. Fatty Acid synthesis: Cytoplasm
3. Glycolysis: Cytoplasm
4. TCA cycle: Mitochondria
5. Electron transport chain (oxidative phosphorylation): Mitochondria
6. Gluconeogenesis: Mitochondria & Cytoplasm

Question 241

What are the essential amino acids?

Answer 241

“PVT TIM HALL”

1. Phenylalanine
2. Valine
3. Threonine
4. Tryptophan
5. Isoleucine
6. Methionine
7. Histidine
8. Arginine - Component of nuclear localization signal
9. Leucine
10. Lysine - Helpful in treatment of viral infections, component of nuclear localization signal

Question 242

Amino acid is a precursor to each of the following molecules?

1. Histamine
2. Porphyrin, heme
3. NO
4. GABA (a neurotransmitter)
5. S-adenosyl-methionine(SAM)
6. Creatine

Answer 242

1. Histamine: Histidine
2. Porphyrin, heme: Glycine
3. NO: Arginine
4. GABA (a neurotransmitter): Glutamate
5. S-adenosyl-methionine(SAM): Methionine
6. Creatine: Arginine

Question 243

Compare carbamoyl phosphate synthetase I to carbamoyl phosphate synthetase II

Answer 243

CPS I

1. Urea cycle
2. Mitochondria
3. Gets nitrogen from ammonium

CPS II

1. Pyrimidine synthesis
2. Cytosol
3. Gets nitrogen from glutamine

Question 244

What is the mechanism of action of lactulose?

Answer 244

1. Digested by bacteria in the colon
2. Creates an acidic environment
3. NH₃ -> NH₄
4. NH₄ excreted in the stool

Question 245

A full-term neonate becomes mentally retarded and hyperactive and has a musty odor. What is the diagnosis?

Answer 245

Phenylketonuria (PKU)

Question 246

A patient with PKU should have diet low in phenylalanine. What other dietary modifications should a patient with PKU make?

Answer 246

Increase Tyrosine in the diet

Replace tetrahydrobiopterin (if this is the cause of PKU)

Question 247

A middle-aged man has dark spots on his sclera and has noted that his urine turns black when left sitting for a period of time. What is the diagnosis?

Answer 247

Alkaptonuria

Question 248

What is the underlying cause of maple syrup urine disease?

Answer 248

Deficiency of Alpha-ketoacid dehydrogenase

Question 249

1. Which hepatic phase of metabolism is lost first by geriatric patients?
2. Which phase is mediated by cytochrome p450?

Answer 249

1. Phase I
2. Phase I

Question 250

Which medication overdose can be treated with sodium bicarbonate?

Answer 250

Weak acids like Aspirin

Question 251

Which medication overdose can be treated with ammonium chloride?

Answer 251

Weak bases like amphetamines

Question 252

What medication inhibits alcohol dehydrogenase

Answer 252

Fomepizole

Question 253

Which medications inhibit acetaldehyde dehydrogenase?

Answer 253

Disulfuram

Question 254

What coagulation factor is deficient in hemophilia A?

Answer 254

Factor VIII

Question 255

What coagulation factor is deficient in hemophilia B?

Answer 255

Factor IX

Question 256

What is the clinical consequence of a deficiency in either protein C or protein S?

Answer 256

Hypercoagulable state

Question 257

What are the treatments for overdose of Heparin and Warfarin?

Answer 257

Heparin: Protamine Sulfate

Warfarin: Vitamin K (Delayed effect) or Fresh frozen Plasma (immediate effect)

Question 258

What is the treatment for heparin induced thrombocytopenia?

Answer 258

Stop heparin

Start Anticoagulation with another drug such as a direct thrombin inhibitor (Lepirudin)

Question 259

What allows RBCs to change shape as they pass through vessels?

Answer 259

Spectrin

Question 260

1. Where does fetal erythropoiesis take place?
2. Inwhich adult bones does erythropoiesis take place?

Answer 260

1. “Young Livers Synthesize Blood”

• Yolk sac (8 weeks)
• Liver
• Spleen
• Bone (28 weeks)

1. Adult bones

• Vertebrae
• Ribs
• Pelvis
• Sternum
• Tibia & Femur

Question 261

What is the name given to immature erythrocytes?

Answer 261

Reticulocyte

Question 262

What are some of the different causes of polycythemia?

Answer 262

1. Excessive Erythropoietin

• Renal cell carcinoma
• Pheochromocytoma
• Hepatocellular carcinoma
• Hemangioblastoma

2. Chronic hypoxia

• COPD
• Obstructive sleep apnea
• High altitudes

3. Polycythemia vera
4. Trisomy 21

Question 263

What pathologic form of RBC would you see in each of the following diseases?

1. Lead poisoning
2. G6PD deficiency
3. DIC
4. Abetalipoproteinemia
5. Asplenia

Answer 263

1. Lead poisoning: Basophilic stippling
2. G6PD deficiency: Heinz bodies & Bite cells
3. DIC: Schistocytes
4. Abetalipoproteinemia: Acanthocytes (Spur cells)
5. Asplenia: Target cells, Howell-Jolly bodies

Question 264

1. What is the structure of HbH?
2. What disease results in HbH production?
3. What is the structure of Hb Bart’s?
4. What disease results in Hb Bart’s production?

Answer 264

1. What is the structure of HbH?: Beta-4
2. What disease results in HbH production?: Alpha-Thalassemia
3. What is the structure of Hb Bart’s?: Gamma-4
4. What disease results in Hb Bart’s production?: Hydrops Fetalis

Question 265

1. What is the rate limiting-step in purine synthesis?
2. In pyrimidine synthesis?

Answer 265

1. Glutamine PRPP Aminotransferase
2. CPS-II

Question 266

1. What are the sources of carbons in the formation of purines?
2. What are the carbon sources in pyrimidine synthesis?

Answer 266

1. Glycine, CO2, and Tetrahydrofolate (Aspartate & Glutamine are essential to provide nitrogen)
2. Aspartate and CO2 (Glutamine is essential to provide nitrogen)

Question 267

Which medication matches each of the following statements?

1. Inhibits ribonucleotide reductase
2. Inhibits dihydrofolate reductase
3. Inhibits thymidylate synthase
4. Inhibits inosine monophosphate dehydrogenase
5. Inhibits PRPP synthetase

Answer 267

1. Inhibits ribonucleotide reductase: Hydroxyurea
2. Inhibits dihydrofolate reductase: Trimethoprim & Methotrexate
3. Inhibits thymidylate synthase: 5-Fluorouracil
4. Inhibits inosine monophosphate dehydrogenase: Mycophenylate
5. Inhibits PRPP synthetase: 6-Mercaptopurine

Question 268

What are the characteristic features of orotic aciduria?

Answer 268

1. Orotic acid in urine
2. Megaloblastic Anemia
3. Failure to Thrive
4. No elevation of ammonia

Question 269

1. What accounts for the positive charge of histones?
2. What accounts for the negative charge of DNA?

Answer 269

1. Lysine & Arginine
2. Phosphate groups

Question 270

How many adenine residues are found in a molecule of DNA if one strand contains A=2000, G=500, C=1500, T=1000

Answer 270

3000

Question 271

What strand of DNA nucleotides opposes this DNA strand: 5’-ATTGCGTA-3’

Answer 271

5’-TACGCAAT-3’

Question 272

How does UV light damage DNA?

Answer 272

UV pairs thymine to thymine on same DNA strand (Thymine dimers)

Question 273

What eukaryotic DNA polymerases matches each of the followin descriptions?

1. Replicated lagging strand, synthesized RNA primer
2. Repairs DNA
3. Replicates mitochondrial DNA
4. Replicates leading strand DNA

Answer 273

1. Replicated lagging strand, synthesized RNA primer: DNA Pol Alpha
2. Repairs DNA: DNA Pol Beta & Epsilon
3. Replicates mitochondrial DNA: DNA Pol Gamma
4. Replicates leading strand DNA: DNA Pol Delta

Question 274

What has been the most common clinical scenario of excess iron ingestion in the last 3 decades?

Answer 274

Infant consuming mom’s iron-fortified vitamins (Prenatal vitamins, vitamin supplements)

Question 275

What are some of the clinical effects of zinc deficiency?

Answer 275

1. Delayed wound healing
2. Decreased immune response
3. Acrodermatitis Enteropathica
4. Anorexia and diarrhea
5. Growth retardation (children)
6. Depressed mental function
7. Impaired night vision
8. Infertility

Question 276

What are some of the signs of hypocalcemia?

Answer 276

1. Trousseau’s sign (a blood pressure cuff is placed around the arm and inflated to a pressure greater than the systolic blood pressure and held in place for 3 minutes. This will occlude the brachial artery. In the absence of blood flow, the patient’s hypocalcemia and subsequent neuromuscular irritability will induce spasm of the muscles of the hand and forearm. The wrist and metacarpophalangeal joints flex, the DIP and PIP joints extend, and the fingers adduct)
2. Chvostek’s sign (When the facial nerve is tapped at the angle of the jaw (i.e. masseter muscle), the facial muscles on the same side of the face will contract momentarily - typically a twitch of the nose or lips - because of hypocalcemia with resultant hyperexcitability of nerves)
3. Tetany and neuromuscular irritability

Question 277

What organs are primarily affected by an excess of cadmium?

Answer 277

1. Increased risk of lung cancer
2. Kidney damage
3. Calcium loss -> Osteoporosis/Osteomalacia

Question 278

What organs are primarily affected by an excess of mercury?

Answer 278

Kidney & Brain

Question 279

What test can be used to diagnose beta-thalassemia minor?

Answer 279

Hb electrophoresis to look for increased HbA2

Question 280

What lab findings allow you to distinguish iron deficiency anemia from microcytic, hypochromic anemia resulting from thalassemia?

Answer 280

Iron deficiency anemia

1. Ferritin: Low
2. Serum Fe: Low
3. TIBC: High

Thalassemia

1. Ferritin: normal
2. Serum Fe: Normal
3. TIBC: Normal

Question 281

What should you rule out in a man over 50 with new-onset iron deficiency anemia?

Answer 281

Colon cancer

Question 282

A patient is diagnosed with a macrocytic, megaloblastic anemia. What is the danger of giving folate alone?

Answer 282

Might be vitamin B deficient - Folate will correct the anemia but not address the B12 deficiency

Question 283

What is the cause of anemia, given each of the following statements?

1. Microcytic anemia + swallowing difficulty + Glossitis
2. Microcytic anemia + >3.5% HbA2
3. Megaloblastic anemia not correctable by B12 or folate
4. Megaloblastic anemia along with peripheral neuropathy

Answer 283

1. Microcytic anemia + swallowing difficulty + Glossitis: Iron deficiency anemia (Plummer-Vinson Syndrome)
2. Microcytic anemia + >3.5% HbA2: Beta-Thalassemia minor
3. Megaloblastic anemia not correctable by B12 or folate: Orotic Aciduria
4. Megaloblastic anemia along with peripheral neuropathy: B12 deficiency

Question 284

What is the cause of anemia, given each of the following statements?

1. Microcytic anemia + Basophilic stippling
2. Microcytic anemia reversible with B6
3. HIV-positive patient with macrocytic anemia
4. Normocytic anemia + red urine in the morning
5. Normocytic anemia and elevated creatinine

Answer 284

1. Microcytic anemia + Basophilic stippling: Lead poisoning
2. Microcytic anemia reversible with B6: Sideroblastic anemia
3. HIV-positive patient with macrocytic anemia: Drug induced anemia (Zidovudine)
4. Normocytic anemia + red urine in the morning: Paroxysmal Nocturnal Hemoglobinuria
5. Normocytic anemia and elevated creatinine: Chronic kidney disease

Question 285

What are the causes of aplastic anemia?

Answer 285

1. Radiation
2. Drugs (Benzene, Chloramphenicol)
3. Alkylating agents
4. Antimetabolites
5. Viruses
6. Fanconi Anemia (a genetic defect in a cluster of proteins responsible for DNA repair. As a result, the majority of FA patients develop cancer, most often acute myelogenous leukemia, and 90% develop bone marrow failure by age 40)

Question 286

A child anemic since birth has now been cured with splenectomy. What is the disease?

Answer 286

Hereditary Spherocytosis

Question 287

What findings are associated with hereditary spherocytosis?

Answer 287

1. Anemia
2. Pigmented gallstones
3. Jaundice
4. Splenomegaly
5. Spherocytes on peripheral smear
6. Positive osmotic fragility test
7. Coombs test negative

Question 288

What is the difference between the hemoglobin S defect and the hemoglobin C defect?

Answer 288

S: Valine substituted for glutamic acid on position 6 of Beta-globin gene

C: Lysine substituted for glutamic acid

Question 289

What is the difference between a warm agglutinin and a cold agglutinin?

Answer 289

1. Warm is IgG
2. Cold is IgM

Question 290

What are schistocytes?

Answer 290

Fragmented RBCs

Question 291

What are two protozoal diseases that can cause hemolytic anemia?

Answer 291

1. Malaria
2. Babesiosis

Question 292

In what hematologic disorder would you find each of the following abnormal tests/findings?

1. Ham’s test
2. DEB test
3. Heinz bodies
4. Basophilic stippling
5. Osmotic fragility test

Answer 292

1. Ham’s test: Paroxysmal nocturnal hemoglobinuria
2. DEB test: Fanconi Anemia (Aplastic anemia)
3. Heinz bodies: G6PD deficiency
4. Basophilic stippling: Lead poisoning (also can be seen in thalassemia)
5. Osmotic fragility test: Hereditary spherocytosis

Question 293

What is the cause of ITP?

Answer 293

Autoimmune reaction to glycoprotein IIb/IIIa on platelets

Question 294

What is the defect in Bernard-Soulier disease?

Answer 294

Glycoprotein Ib deficiency

Question 295

What is the life span of a platelet (Which is also the maximum life of platelets after a transfusion)?

Answer 295

8-10 days

Question 296

What molecule is expressed on the surface of a platelet after it becomes activated?

Answer 296

Glycoprotein IIb/IIIa

Question 297

NSAIDs inhibit the production of which substance important in platelet aggregation?

Answer 297

Thromboxane A₂

Question 298

After normal spontaneous vaginal delivery, the new mom bleeds profusely from her vagina and later from her gums. What abnormal lab values would you suspect?

Answer 298

This is DIC

• Low Platelets
• High PT, PTT, Bleeding time, and D-Dimer

Question 299

What is the mechanism of action of each of the following drugs?

1. Streptokinase
2. Aspirin
3. Clopidogrel
4. Abciximab
5. Tirofiban
6. Ticlopidine
7. Enoxaparin
8. Eptifibatide

Answer 299

1. Streptokinase: Converts Plasminogen to Plasmin
2. Aspirin: Irreversibly inhibits COX-1
3. Clopidogrel: Blocks ADP receptors
4. Abciximab: Monoclonal Ab - Inhibits GP IIb/IIa
5. Tirofiban: Inhibits GP IIb/IIa
6. Ticlopidine: Blocks ADP receptors
7. Enoxaparin: Xa inhibitor
8. Eptifibatide: Inhibits GP IIb/IIa

Question 300

Compare the age distribution of those affected by Hodgkin Lymphoma to those affected by non-Hodgkin lymphoma

Answer 300

1. Hodgkin lymphoma: Bimodal (20s and around 65)
2. Non-Hodgkin lymphoma: Variable

Question 301

1. What is the most common type of non-Hodgkin lymphoma in adults?
2. In children?

Answer 301

1. Diffuse large B cell lymphoma
2. Acute Lymphoblastic lymphoma

Question 302

A patient with anemia, hypercalcemia, and bone pain receives a bone marrow biopsy which reveals plasma cells. What is the diagnosis, and what may be found on urinalysis?

Answer 302

1. Multiple Myeloma
2. Nothing will be seen on urinalysis because Bence Jones proteins dont show up on urinalysis. Urine Protein Electrophoresis must be performed

Question 303

What form of leukemia matches the following statement?

1. Most common leukemia in children
2. Most common leukemia in adults in US
3. Characteristic Auer rods
4. Myelodysplastic syndromes have a tendency to progress to what
5. Myeloproliferative disorders may progress to what

Answer 303

1. Most common leukemia in children: ALL
2. Most common leukemia in adults in US: CLL
3. Characteristic Auer rods: AML (M2 and M3)
4. Myelodysplastic syndromes have a tendency to progress to what: AML
5. Myeloproliferative disorders may progress to what: AML

Question 304

What form of leukemia matches the following statement?

1. More than 20% blasts in marrow
2. Leukemia with more mature cells and <5% blasts
3. PAS (+) Acute leukemia
4. Commonly presents with bone pain
5. Numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase (LAP)

Answer 304

1. More than 20% blasts in marrow: ALL
2. Leukemia with more mature cells and <5% blasts: CLL
3. PAS (+) Acute leukemia: ALL
4. Commonly presents with bone pain: ALL
5. Numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase (LAP): CML

Question 305

What form of leukemia matches the following statement?

1. Always positive for the Philadelphia chromosome t(9;22)
2. Acute leukemia positive for peroxidase
3. Solid sheets of lymphoblasts in marrow
4. PAS (-) acute leukemia
5. Always associated with BCR-ABL gene

Answer 305

1. Always positive for the Philadelphia chromosome t(9;22): CML
2. Acute leukemia positive for peroxidase: AML (M2 and M3)
3. Solid sheets of lymphoblasts in marrow: ALL
4. PAS (-) acute leukemia: AML
5. Always associated with BCR-ABL gene: CML

Question 306

What vitamin in excess can cause hypercalcemia?

Answer 306

Primarily Vitamin D but also vitamin A

Question 307

What are the symptoms of Vitamin A toxicity?

Answer 307

1. Increased intracranial pressure
2. Dry and pruritic skin
3. Hepatotoxicity (Enlarged or possibly cirrhotic liver)
4. Arthralgias (Bone/joint pain)
5. Visual impairment
6. Fatigue
7. Ataxia
8. Alopecia
9. Hyperlipidemia

Remember Vitamin A is teratogenic!!!

Question 308

In which common chronic diseases is vitamin D supplementation particularly essential?

Answer 308

1. Osteoporosis
2. Chronic kidney disease

Question 309

What headache-causing condition can result from an excess of vitamin A?

Answer 309

Pseudotumor cerebri

Question 310

What vitamins have a function similar to reduced glutathione?

Answer 310

Vitamins A, E, and C are all antioxidants

Question 311

What clinical features would lead you to suspect that a patient has scurvy?

Answer 311

1. Loose teeth with sore, spongy gums
2. Fragile blood vessels (Bruising)
3. Poor wound healing
4. Anemia
5. Swollen joints (due to bleeding into the joint spaces)

Question 312

Vitamin C is necessary for the hydroxylation of which amino acids in collagen synthesis?

Answer 312

Proline and lysine

Question 313

What is the other name for Vitamin E?

Answer 313

Alpha-tocopherol

Question 314

A patient presents with convulsions and irritability. What vitamin deficiency is causing these symtpoms in this patient?

Answer 314

Vitamin B6 (Pyridoxine)

Question 315

What type of anemia can be caused by folate or B12 deficiency?

Answer 315

Megaloblastic anemia

Question 316

Where is B12 absorbed into the circulation?

Answer 316

Terminal ileum

Question 317

Which vitamin deficiency matches each of the following descriptions?

1. Increased RBC fragility
2. Peripheral Neuropathy, glossitis
3. Hemorrhagic disease
4. Neural tube defects
5. Dermatitis, diarrhea, dementia

Answer 317

1. Increased RBC fragility: Vitamin E
2. Peripheral Neuropathy, glossitis: Vitamin B12
3. Hemorrhagic disease: Vitamin K
4. Neural tube defects: Folate (Vitamin B9)
5. Dermatitis, diarrhea, dementia: Vitamin B3 (This condition is known as pellagra)

Question 318

Which vitamin deficiency matches each of the following descriptions?

1. Megaloblastic anemia
2. Pernicious anemia
3. Bitot spots, keratomalacia, xerophthalmia
4. Osteomalacia
5. Rickets

Answer 318

1. Megaloblastic anemia: B12 or folate (B9)
2. Pernicious anemia: B12
3. Bitot spots, keratomalacia, xerophthalmia: Vitamin A
4. Osteomalacia: Vitamin D
5. Rickets: Vitamin D

Question 319

Which vitamin matches each of the following statements?

1. Can be used to treat acne and psoriasis
2. Used in oxidation/reduction reactions
3. Used in carboxylation reactions
4. Involved in the hydroxylation of prolyl residues
5. Requires intrinsic factor for absorption
6. Deficiency may result from kidney disease

Answer 319

1. Can be used to treat acne and psoriasis: Vitamin A (Vitamin D can be used to treat psoriasis but not acne)
2. Used in oxidation/reduction reactions: Vitamin B2 & B3
3. Used in carboxylation reactions: Biotin (Vitamin B7) - “Buy-a-tin of CO2”
4. Involved in the hydroxylation of prolyl residues: Vitamin C
5. Requires intrinsic factor for absorption: Vitamin B12
6. Deficiency may result from kidney disease: Vitamin D

Question 320

Which vitamin matches each of the following statements?

1. Used by pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase
2. Given prophylactically to newborns
3. Can be used to elevate HDL and lower LDL
4. Deficiency can be caused by isoniazid use
5. Cobalt is found within this vitamin
6. Critial for DNA synthesis

Answer 320

1. Used by pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase: B1 (TTP from Thiamine), Lipoic Acid, B5 (CoA from pantothenic acid), B2 (FAD from Ribflavin), B3 (NAD from Niacin)- “Tender Loving Care For No-one”
2. Given prophylactically to newborns: Vitamin K
3. Can be used to elevate HDL and lower LDL: Niacin (Vitamin B3)
4. Deficiency can be caused by isoniazid use: Vitamin B6 (but also Vitamin B3)
5. Cobalt is found within this vitamin: Vitamin B12
6. Critial for DNA synthesis: Folate (Vitamin B9) & Vitamin B12

Question 321

What is the classic presentation of appendicitis?

Answer 321

1. Begins with diffuse periumbilical pain that migrates to Right lower quadrant (McBurney’s sign)
2. Nausea
3. Fever

Question 322

A 50 year-old man complains of diarrhea. On exam, his face is plethoric and a heart murmur is detected. What is the diagnosis?

Answer 322

Carcinoid syndrome (location: bronchopulmonary or GI tract with metastasis to the liver)

Question 323

What is the fundamental problem in Hirschsprung disease?

Answer 323

Neural crest cells fail to migrate to the colon. Missing Enteric ganglia/nerve plexuses (Auerbach’s plexus and Meissner’s plexus)

Question 324

What is the most abundant bacteria in the colon of most individuals?

Answer 324

Bacteriodes Fragilis

Question 325

A 40 year-old woman presents with having to defecate 4 times a day for several months along with a constant low-grade abdominal pain that is somewhat relieved by defecation. Colonoscopy is normal. What is the most likely diagnosis?

Answer 325

Irritable bowel syndrome

Question 326

1. Which pathological lesions of the colon are considered precursors to malignancy?
2. Which colon pathology has the most malignant potential?

Answer 326

1. Adenomatous
2. Villous adenomas

Question 327

What are the risk factors for colon cancer?

Answer 327

1. Obesity
2. Smoking
3. High fat/low fiber diet
4. Adenomatous polyps
5. Inflammatory bowel disease
6. Polyposis syndromes

Question 328

What is the classic presentation for diverticulosis?

Answer 328

Usually asymptomatic

If symptoms are present, they may include mild left lower quadrant pain and painless rectal bleeding

Question 329

Which portion of the colon is most commonly affected by volvulus?

Answer 329

1. Sigmoid colon
2. Cecum

Question 330

Where in the distal GI tract does endodermal tissue make an abrupt transition to tissue derived from surface ectoderm?

Answer 330

Pectinate line

Question 331

What problem is most closely associated with each of the following statements?

1. Most common cause of acute right lower quadrant pain
2. Most common cause of acute left lower quadrant pain
3. Most common cause of right upper quadrant pain
4. Colonoscopy reveals very friable (easily crumbled) mucosa extending from the rectum to the distal transverse colon

Answer 331

1. Most common cause of acute right lower quadrant pain: Appendicitis
2. Most common cause of acute left lower quadrant pain: Diverticulitis
3. Most common cause of right upper quadrant pain: Cholecystitis
4. Colonoscopy reveals very friable (easily crumbled) mucosa extending from the rectum to the distal transverse colon: Ulcerative colitis

Question 332

Which form of E. Coli causes hemolytic uremic syndrome (HUS)?

Answer 332

Enterohemorrhagic E. Coli (0157:H7)

Question 333

What medications are commonly used to treat C. Diff colitis?

Answer 333

1. Metronidazole (Most of the time)
2. Oral vancomycin

Question 334

What infectious agent most likely corresponds to each of the following statements?

1. Food poisoning as a result of mayonnaise sitting out too long
2. Diarrhea caused by Gram (-) nonmotile organism that does not ferment lactose
3. Rice-water stools
4. Diarrhea caused by an S-shaped organism

Answer 334

1. Food poisoning as a result of mayonnaise sitting out too long: Staph Aureus
2. Diarrhea caused by Gram (-) nonmotile organism that does not ferment lactose: Shigella
3. Rice-water stools: Vibrio Cholera (also could be enterotoxigenic E. Coli)
4. Diarrhea caused by an S-shaped organism: Campylobacter Jejuni

Question 335

What infectious agent most likely corresponds to each of the following statements?

1. Diarrhea transmitted from pet feces
2. Food poisoning resulting from reheated rice (Chinese food)
3. Diarrhea caused by Gram (-) motile organism that doesn’t ferment lactose
4. Most common cause of “traveler’s” diarrhea

Answer 335

1. Diarrhea transmitted from pet feces: Yersinia Enterocolitica
2. Food poisoning resulting from reheated rice (Chinese food): Bacillus Cereus
3. Diarrhea caused by Gram (-) motile organism that doesn’t ferment lactose: Salmonella
4. Most common cause of “traveler’s” diarrhea: Enterotoxigenic E. Coli

Question 336

What infectious agent most likely corresponds to each of the following statements?

1. Diarrhea after a course of antibiotics
2. Diarrhea caused by gram (-) lactose fermenting bacteria, no fever
3. Diarrhea caused by Gram (-) comma-shaped organism, no fever
4. Diarrhea + recent ingestion of water from a stream
5. Food poisoning from undercooked hamburger meat

Answer 336

1. Diarrhea after a course of antibiotics: Clostridium Difficile
2. Diarrhea caused by gram (-) lactose fermenting bacteria, no fever: E. Coli
3. Diarrhea caused by Gram (-) comma-shaped organism, no fever: Vibrio Cholera
4. Diarrhea + recent ingestion of water from a stream: Giardia (also could be Entamoeba Histolytica)
5. Food poisoning from undercooked hamburger meat: 0157:H7

Question 337

What protozoan matches each of the following statements?

1. Cause of malaria
2. Most common protozoal infection in the U.S.
3. Cause of Chagas disease
4. Amoebic dysentery
5. African sleeping sickness

Answer 337

1. Cause of malaria: Plasmodium species
2. Most common protozoal infection in the U.S.: Toxoplasma Gondii
3. Cause of Chagas disease: Trypanosoma Cruzii
4. Amoebic dysentery: Entamoeba Histolytica
5. African sleeping sickness: Trypanosoma Brucei (Rhodesiense or Gambiense)

Question 338

What protozoan matches each of the following statements?

1. Diarrhea in campers and hikers
2. Transmitted in raw meat or infected cat feces
3. Transmitted by sandflies
4. Causes vaginitis

Answer 338

1. Diarrhea in campers and hikers: Giardia Lamblia
2. Transmitted in raw meat or infected cat feces: Toxoplasma Gondii
3. Transmitted by sandflies: Leishmania Donovani
4. Causes vaginitis: Trichomonas Vaginalis

Question 339

A patien who visited Mexico presents with bloody diarrhea. What infectious form is found in the stool?

Answer 339

Cysts of Entamoeba Histolytica

Question 340

A 32 year-old man went camping in northern California 2 weeks ago, had a 2-day stint of diarrhea, and now presents with symptoms of liver damage and jaundice. What is the infecting organism?

Answer 340

Entamoeba Histolytica

Question 341

What are the names of the following stages in the malaria life-cycle?

1. Looks like a diamond ring
2. Ruptures the cell host
3. Replicating intracellularly
4. Form injected from the Anopheles mosquito
5. Banana-shaped

Answer 341

1. Looks like a diamond ring: Trophozoite
2. Ruptures the cell host: Merozoite
3. Replicating intracellularly: Schizont
4. Form injected from the Anopheles mosquito: Sporozoite
5. Banana-shaped: Gametocyte of plasmodium falciparum

Question 342

A patient returning from a 2-week vacation in West Africa presents with typical malaria presentation and recurrent fever. What is the mechanism responsible for this patient’s recurrent fever?

Answer 342

Hemolysis of RBCs

Question 343

What helminth matches each of the following statements?

1. Most common helminthic infection in the US
2. One-quarter of the world infected with it
3. Snail host, “swimmer’s itch”
4. Most common predisposing factor for bladder cancer in 3rd world countries
5. Contracted by eating undercooked fish and causes an inflammation of the biliary tract

Answer 343

1. Most common helminthic infection in the US: Enterobius Vermicularis
2. One-quarter of the world infected with it: Ascaris Lumbricoides
3. Snail host, “swimmer’s itch”: Schistosoma
4. Most common predisposing factor for bladder cancer in 3rd world countries: Schistosoma haematobium
5. Contracted by eating undercooked fish and causes an inflammation of the biliary tract: Clonorchis Sinensis

Question 344

What helminth matches each of the following statements?

1. Soil->Enters through skin->venous blood supply->lungs->coughed into pharynx->swallowed into the intestines where the reside
2. Hookworm
3. Giant roundworm
4. Contracted by eating undercooked crabmeat and causes inflammation of the lung

Answer 344

1. Soil->Enters through skin->venous blood supply->lungs->coughed into pharynx->swallowed into the intestines where the reside: Strongyloides stercoralis
2. Hookworm: Ancylostoma duodenale & Necator americanus
3. Giant roundworm: Ascaris lumbricoides
4. Contracted by eating undercooked crabmeat and causes inflammation of the lung: Paragonimus westermani

Question 345

What helminth matches each of the following statements?

1. Pork tapeworm
2. Responsible for lymphatic filariasis
3. Adult patient from Mexico with new onset seizures and brain calcifications
4. Hematuria in patient from 3rd world country

Answer 345

1. Pork tapeworm: Taenia solium
2. Responsible for lymphatic filariasis: Wuchereria bancrofti
3. Adult patient from Mexico with new onset seizures and brain calcifications: Taenia solium (Neurocystercercosis)
4. Hematuria in patient from 3rd world country: Schistosoma haematobium

Question 346

What medication is used to treat each of the following parasitic infections?

1. Giardia, Entamoeba, Trichomonas
2. Most malarias
3. Plasmodium vivax or ovale
4. Resistant malarias

Answer 346

1. Giardia, Entamoeba, Trichomonas: Metronidazole
2. Most malarias: Chloroquine
3. Plasmodium vivax or ovale: Chloroquine + Primaquine
4. Resistant malarias: Quinine + Doxycyclin, Mefloquine, Atovaquone-Proguanil, Artemether-Lumefautrine

Question 347

What medication is used to treat each of the following parasitic infections?

1. Most all flukes and tapeworms
2. Hookworm, pinworm, and roundworm
3. Chagas disease
4. Best guess for roundworms
5. Leishmaniasis

Answer 347

1. Most all flukes and tapeworms: Praziquantel
2. Hookworm, pinworm, and roundworm: Benzamidazoles (mebendazole) or Pyrantel Pamoate
3. Chagas disease: Nifurtimox
4. Best guess for roundworms: Benzamidazoles
5. Leishmaniasis: Cutaneous - Sodium Stibogluconate, Visceral - Liposomal Amphotericin B

Question 348

Which 2 agents are usually used in the treatment of pediculosis capitis and pediculosis pubis?

Answer 348

Permethrin or Pyrethrin

Question 349

Why is lindane not the preferred agent in the treatment of lice?

Answer 349

It is neurotoxic and many lice are resistant

Question 350

What type of cancer is associated with the following tumor suppressor genes?

1. Rb
2. DPC
3. p53
4. APC
5. WT1
6. BRCA1 and BRCA2

Answer 350

1. Rb: Retinoblastoma and osteosarcoma
2. DPC: Pancreatic cancer
3. p53: >50% of cancers
4. APC: Familial Adenomatous Polyposis Coli
5. WT1: Wilms tumor
6. BRCA1 and BRCA2: Breast and ovarian cancer

Question 351

What cancers are associated with a mutation of the K-RAS oncogene?

Answer 351

Colon, pancreas, and lung cancers

(H-RAS is associated with bladder and kidney tumors, N-RAS is associated with melanomas and hematologic malignancies)

Question 352

Among men and among women, compare the most common cancers and the most common cancers causing mortality

Answer 352

Men

1. Most common: Prostate > Lung > Colon
2. Cause of death: Lung > Prostate > Colon > Pancreas

Women

1. Most common: Breast > Lung > Colon > Uterus
2. Cause of death: Lung > Breast > Colon > Pancreas

Question 353

What neoplasms are associated with each of the following conditions?

1. Hashimoto Thyroiditis
2. Down syndrome
3. Tuberous Sclerosis
4. Ataxia-Telangiectasia
5. Paget Disease of bone

Answer 353

1. Hashimoto Thyroiditis: Lymphoma
2. Down syndrome: AML & ALL
3. Tuberous Sclerosis: Cardiac Rhabdomyoma, Astrocytoma, and Angiomyolipoma
4. Ataxia-Telangiectasia: Leukemia & Lymphoma
5. Paget Disease of bone: Osteosarcoma and Fibrosarcoma

Question 354

Which neoplasm is associated with each of the following?

1. Nitrosamines
2. Asbestos
3. Naphthalene
4. Arsenic
5. EBV
6. HPV
7. Schistosoma Haematobium

Answer 354

1. Nitrosamines: Esophageal, stomach, and colon cancer
2. Asbestos: Bronchogenic carcinoma, mesothelioma
3. Naphthalene: Transitional cell bladder cancer
4. Arsenic: Squamous cell skin cancer & Angiosarcoma of the liver
5. EBV: Burkitt lymphoma, Hodgkin lymphoma & Nasopharyngeal carcinoma
6. HPV: (types 16 & 18) - Cervial, vulvar, penil, and anal cancer
7. Schistosoma Haematobium: Squamous cell carcinoma of the bladder

Question 355

What type of tumor matches each of the following descriptions?

1. Benign tumor of epithelium
2. Malignant tumor of blood vessels
3. Benign tumor of bone
4. Malignant tumor of smooth muscle

Answer 355

1. Benign tumor of epithelium: Adenoma or Papilloma
2. Malignant tumor of blood vessels: Angiosarcoma
3. Benign tumor of bone: Osteoma
4. Malignant tumor of smooth muscle: Leiomyosarcoma

Question 356

What unique enzyme is normally absent in somatic cells, but is active in stem cells and cancer cells?

Answer 356

Telomerase

Question 357

Which tumor marker would you use to follow each of the following cancers?

1. Hepatocellular carcinoma (Hep B and C)
2. Ovarian cancer
3. Pancreatic cancer
4. Melanoma
5. Colon cancer
6. Astrocytoma

Answer 357

1. Hepatocellular carcinoma (Hep B and C): Alpha-fetoprotein (AFP)
2. Ovarian cancer: CA-125
3. Pancreatic cancer: CEA & CA 19-9
4. Melanoma: S-100
5. Colon cancer: CEA
6. Astrocytoma: S-100

Question 358

1. What is the most common cause of hypercalcemia?
2. What cancers may cause hypercalcemia?

Answer 358

1. Primary hyperparathyroidism
2. Cancers

• Squamous cell lung cancer
• Breast cancer
• Renal cell carcinoma
• Multiple Myeloma
• Metastatic disease to the bone
• Squamous cancer of the head and neck

Question 359

What neoplasm is most commonly responsible for each of the following paraneoplastic syndromes?

1. ACTH->Cushing Syndrome
2. Erythropoietin->Polycythemia
3. ADH->SIADH

Answer 359

1. ACTH->Cushing Syndrome: Small cell lung cancer
2. Erythropoietin->Polycythemia: Renal cell carcinoma, hemangioblastoma, hepatocellular carcinoma, pheochromocytoma
3. ADH->SIADH: Small cell lung cancer or Intracranial neoplasms

Small cell lung cancer also causes Lambert-Eaton Syndrome (autoimmune disorder that is characterised by muscle weakness of the limbs that gets better with use)

Question 360

Which cancers metastasize to bone?

Answer 360

“Permanently Relocated Tumors Totally Love Long Bones”

1. Prostate
2. Renal cell carcinoma
3. Thyroid
4. Testes
5. Lung
6. Lymphoma
7. Breast

Question 361

Which cancers metastasize to brain?

Answer 361

“Lots of Bad Stuff Kill Glia”

1. Lung
2. Breast
3. Skin (Melanoma)
4. Kidney (Renal cell carcinoma)
5. GI tract (Colorectal cancer)

Question 362

Which cancers metastasize to liver?

Answer 362

“Cancer Sometimes Penetrates Benign Liver”

1. Colon
2. Stomach
3. Pancreas
4. Breast
5. Lung

Question 363

What is currently the most effective intervention in the prevention of the following cancers?

1. Lung cancer
2. Cervical cancer
3. Renal cell carcinoma
4. Breast cancer
5. Colon cancer

Answer 363

1. Lung cancer: Stop smoking
2. Cervical cancer: PAP smear/HPV vaccine
3. Renal cell carcinoma: Stop smoking
4. Breast cancer: Screeing mammograms
5. Colon cancer: Colonoscopy

Question 364

What is the only definitive way to prevent ovarian cancer?

Answer 364

Bilateral oopherectomy

Question 365

Which male patients should be screened for prostate cancer with a serum PSA?

Answer 365

Controversial but screeing can beperformed in any male between 50 and 70 who has a 10-year life expectancy

Question 366

What is the primary immune system cell type involved in host tumor immune surveillance?

Answer 366

Cytotoxic T-cells

Question 367

What enzyme present in melanoma generates peptides that are targets for host T cells?

Answer 367

Tyrosinase

Question 368

How can tumor cells evade attack from cytotoxic T cells?

Answer 368

By developing the loss of expression of MHC class I

Question 369

How might tumor cells induce apoptosis of T cells that would antagonized them?

Answer 369

Expressing FasL

Question 370

How does the mechanism of action of methotrexate differ from 5-Fluorouracil?

Answer 370

Both decrease DNA and protein synthesis

1. Methotrexate is a folic acid analog that inhibits Dihydrofolate reductase
2. 5-Fluorouracil is a pyrimidine analog that inhibits thymidilate synthase

Question 371

How does the body metabolize 6-mercaptopurine?

Answer 371

Xanthine oxidase

Question 372

Which anticancer drug is also often used in rheumatoid diseases as well as ectopic pregnancies?

Answer 372

Methotrexate

Question 373

Which anticancer drug fits each of the following descriptions?

1. Forms a complex between topoisomerase II and DNA
2. Alkylates DNA, toxicity -> pulmonary fibrosis
3. Fragments DNA, toxicity -> Pulmonary fibrosis
4. Blocks purine synthesis, metabolized by xanthine oxidase
5. Cross-links DNA, nephrotoxic, ototoxic

Answer 373

1. Forms a complex between topoisomerase II and DNA: Etoposide
2. Alkylates DNA, toxicity -> pulmonary fibrosis: Busulfan
3. Fragments DNA, toxicity -> Pulmonary fibrosis: Bleomycin
4. Blocks purine synthesis, metabolized by xanthine oxidase: 6-Mercaptopurine
5. Cross-links DNA, nephrotoxic, ototoxic: Cisplatin and Carboplatin

Question 374

Which anticancer drug fits each of the following descriptions?

1. Nitrogen mustard, alkylates DNA (electrophile that binds DNA)
2. Folic acid analog that inhibits dihydrofolate reductase
3. Prevents tubulin disassembly
4. Intercalates DNA, produces oxygen free radicals, cardiotoxic
5. DNA alkylating agents used in brain cancer

Answer 374

1. Nitrogen mustard, alkylates DNA (electrophile that binds DNA): Cyclophosphamide
2. Folic acid analog that inhibits dihydrofolate reductase: Methotrexate
3. Prevents tubulin disassembly: Paclitaxel
4. Intercalates DNA, produces oxygen free radicals, cardiotoxic: Doxyrubicin & Daunorubicin
5. DNA alkylating agents used in brain cancer: Nitrosoureas

Question 375

1. Applied topically for AKs and basal cell cancers
2. Treatment for childhood tumors (Ewing sarcoma, Wilms tumor, Rhabdomyosarcoma)
3. Inhibits ribonucleotide reductase
4. SE of hemorrhagic cystitis
5. Inhibitor of the mutated tyrosine kinase produced by the philadelphia chromosome

Answer 375

1. Applied topically for AKs and basal cell cancers: 5-Fluorouracil
2. Treatment for childhood tumors (Ewing sarcoma, Wilms tumor, Rhabdomyosarcoma): Dactinomycin
3. Inhibits ribonucleotide reductase: Hydroxyurea
4. SE of hemorrhagic cystitis: Cyclophosphamide
5. Inhibitor of the mutated tyrosine kinase produced by the philadelphia chromosome: Imatinib

Question 376

What are the equations for sensitivity, specificity, positive predictive value, and negative predictive value?

Answer 376

1. Sensitivity = A/(A+C)
2. Specificity = D/(D+B)
3. PPV = A/(A+B)
4. NPV = D/(D+C)

Question 377

A physician is looking for risk factors for pancreatitis. He interviews 100 hospitalized patients with pancreatitis and 100 hospitalized patients without pancreatitis. What type of study is this?

Answer 377

Case-control study

Question 378

A group of smokers and a group of non-smokers are followed over 20 years. Wvery two years, it is determined who develops cancer and who does not. What type of study is this?

Answer 378

Prospective cohort study

Question 379

A certain screening test has a 1% false-negative rate. What is the sensitivity of the test?

Answer 379

99%

Question 380

What are the equations for odds ratio, relative risk, attributable risk, and number needed to treat?

Answer 380

1. OR = (A/B)/(C/D)
2. RR = (A/(A+B))/(C/(C+D))
3. AR = A/(A+B) - C/(C+D)
4. NNT = 1/ARR

Question 381

The small town of Mickey City (Pop. 8000) is immediately adjacent to factories where asbestos products are produced. During the past year, the prevalence of mesothelioma has been 16 cases. In the town of Donaldville (Pop. 6000) 15 miles upwind of (and theoretically safely distant from) Mickey City, there was a prevalence of 3 cases during the same year: What is the relative risk of mesothelioma for the population of Mickey City?

Answer 381

RR = (A/A+B)/(C/(C+D)) = (16/8000)/(3/6000) = 4

Question 382

A new glucose test arrives and you decide to see how well it works. There is a standard substance provided that has 90 mg/dL of glucose. Your repeated measurements of the substance reveal the following values: 54, 56, 55, 54, 53, 56, 55, and 54. What can you say about the precision and accuracy of your new glucose test?

Answer 382

1. High precision
2. Low accuracy

Question 383

The prevalence of varicella in population A is 2 times the prevalence of varicella in population B. The incidence is the same in populations A and B. What can be assumed about the disease duration in population A versus population B?

Answer 383

Duration of varicella is twice as long in population A as in B

Question 384

Study X show that vitamin C can prevent Coronavirus infections, but 10 other studies show no benefit. What type of error is found in study X?

Answer 384

Type I (alpha)

Question 385

Study Y shows that aspirin administration during an MI offers no improvement in patient morbidity or mortality. What type of error is present?

Answer 385

Type II (beta)

Question 386

What is the difference between the mean, median, and mode?

Answer 386

2. Mean = average
3. Median = Middle value
4. Mode = Most frequent value

Question 387

What does it mean to say that a statistical distribution has a positive skew?

Answer 387

Mean > Median > Mode

Question 388

What is the current recommendation on receiving a meningitis vaccine?

Answer 388

All children 11-12 years old

Booster at 16

For high-risk children, vaccinate as young as 2 months of age

Question 389

When is it important for a patient with a tetanus prone wound to receive a tetanus vaccine?

Answer 389

1. Minor wound - vaccinate if >10 years since last booster
2. High risk wound - Vaccinate if >5 years since last booster
3. If vaccine status is unknown - Vaccinate

Question 390

Which adult populations should receive a pneumococcal vaccine?

Answer 390

Vaccinate after age 65

Vaccinate high risk populations: Residents of long term care facilities, COPD/Asthma, smokers, cardiovascular Dx, diabetes, asplenia, HIV, CSF leaks

Question 391

What are the current indications for the herpes zoster vaccine?

Answer 391

1 dose after age 60

Question 392

At minimum, what four medications should a patient with a prior MI due to atherosclerosis be taking?

Answer 392

1. Aspirin (Clopidogrel if ASA-allergic)
2. Beta-blocker
3. ACE inhibitor
4. Statin

Question 393

What vaginal disorder is common in elderly women?

Answer 393

Vaginal atrophy

1. Thinning of the vaginal mucosa
2. Vaginal dryness causing bleeding with intercourse
3. Urinary incontinence

Question 394

What are the 3 leading causes of death in patients over age 65?

Answer 394

1. Heart disease
2. Cancer
3. Stroke

Question 395

Which patients should be screend for an abdominal aortic aneurysm using an abdominal ultrasound?

Answer 395

Men age 65-75 who have never smoked

Question 396

At what age should every geriatric patinet have had a DEXA bone density scan?

Answer 396

Women

1. All over age 65
2. Younger women whose fracture risk is greater than that of a 65 yo white woman with no additional risk factors

Men

1. USPSTF does not recommend screen
2. National Osteoporosis foundation recommends screen to men 50-70 with risk factors and all men over 70

Question 397

A 60 year old business man complains of a lack of succesful sexual contacts with women and a lack of ability to reach full erection. One year ago, he had a heart attack. What might be the cause of his problem?

Answer 397

1. Atherosclerosis
2. Fear of sudden death during intercourse

Question 398

What is the difference between a premium, co-pay, and deductible?

Answer 398

1. Premium = monthly payment to insurance company
2. Co-pay = Amount paid out-of-pocket at time of service
3. Deductible = Amount that must be paid out-of-pocket before insurance starts paying

Question 399

Which usually offers patients a greater variety of physicians to choose from: HMO or PPO?

Answer 399

PPO

Question 400

What is the difference between being paid by capitation and fee-for-service?

Answer 400

1. Capitation is amount paid for a period of time or number of patients
2. Fee-for-service is amount paid according to the specific service provided

Question 401

What must a hospital submit to a third-party payer in order to receive payment for services?

Answer 401

1. ICD-9 diagnosis codes
2. CPT service/procedure codes

Question 402

What department in a hospital oversees the maximization of the quality of care while minimizing the cost of care?

Answer 402

Utilization Management Department (Utilization Review)

Question 403

What structures traverse the diaphragm, and what vertebral levels do they pass through?

Answer 403

“I Ate Ten Eggs At Twelve”

1. T8: IVC
2. T10: Esophagus and vagus nerve
3. T12: Aorta, thoracic duct, and azygous vein

Question 404

What is the difference between a hiatal hernia and an incisional hernia after an abdominal surgery?

Answer 404

1. Hiatal hernia: Peritoneal contents herniate through the diaphragm into the thorax
2. Incisional hernia: Defect in the abdominal wall resulting in abdominal contents bulgin outward

Question 405

What histological change takes place in the trachea of a smoker?

Answer 405

Metaplasia: Ciliated columnar -> Squamous

Question 406

A patient in the ER is having anaphylaxis. You make an incision beneath thyroid cartilage to establish airway. What structure was cut?

Answer 406

Cricothyroid membrane

Question 407

What cell type proliferates during lung damage?

Answer 407

Type II pneumocytes

Question 408

What amniotic fluid measurement is indicative of fetal lung maturity?

Answer 408

Lecithin:Sphyngomyelin ratio >2

Question 409

A young woman has infertility, recurrent URIs, and dextrocardia. Which of her proteins is defective?

Answer 409

This is Kartagener syndrome caused by a Dynein arm defect

Question 410

The following lung volumes are obtained from an elderly smoker: FRC = 5L, IRV = 1.5L, IC = 2L, VC = 3.5L. What is his total lung capacity?

Answer 410

TLC = FRC + IC = 7L

Question 411

If a lung collapses, what happens to the intrathoracic volume?

Answer 411

It increases

Question 412

What gene mutation can cause primary pulmonary hypertension?

Answer 412

Bone Morphogenetic Protein Receptor 2 (BMPR2) gene

Question 413

What are some of the secondary causes of pulmonary hypertension?

Answer 413

1. COPD
2. Sleep apnea
3. Frequent thrombosis
4. Mitral stenosis
5. Left-to-right shunt

Question 414

What are some of the treatment options available for pulmonary hypertension?

Answer 414

1. Bosentan or Ambrisentan
2. Prostaglandin analogues
3. Sildenafil
4. Dihydropyridine Ca channel blockers (Nifedipine)

Question 415

What is the mechanism of action of bosentan?

Answer 415

Completely antagonize endothelin-1 receptors -> Decreases pulmonary vascular resistance

Question 416

Which form of hemoglobin A has high affinity for oxygen? Which has a low affinity for oxygen?

Answer 416

1. T form (Taut) - Low affinity for O₂
2. R form (Relaxed) - High affinity for O₂

Question 417

1. What substances tend to shift the oxygen-hemoglobin dissociation curve to the right?
2. Does this favor oxygen loading or unloading?

Answer 417

1. Increased CO₂, temperature, 2,3-DPG, H⁺, Exercise/activity
2. Favor unloading

Question 418

What is the treatment for methemoglobinemia?

Answer 418

1. Methylene blue
2. Vitamin C

Question 419

1. What is the normal value for the A-a gradient?
2. What might an elevated A-a gradient indicate?

Answer 419

1. 10-15 mmHG
2. Causes of high A-a gradient include

• High FiO2 (from supplemental O2)
• Shunting of blood
• Pulmonary fibrosis (Impaired gas diffusion)
• V/Q mismatch
• Advanced age

Question 420

A 42 year-old woman with fibroids is chronically tired. What is the most likely diagnosis, and what changes have occured in the oxygen content and saturation?

Answer 420

• She most likely has iron deficiency anemia from excessive uterine bleeding from her fibroids
• There is no change in the O2 saturation but a decrease in total O2 content of her blood

Question 421

A patient is shown to have hypoxia, and CXR reveals an enlarged heart. What is the most likely cause of hypoxia?

Answer 421

Heart failure

Question 422

1. What is the V/Q at the apex of the lung?
2. At the base of the lung?
3. During airway obstruction?
4. During blood flow obstruction?

Answer 422

1. Greater than 1
2. Less than 1
3. Approaching zero
4. Approaching infinity

Question 423

How is CO2 transported from the tissues to the lungs?

Answer 423

1. As bicarbonate
2. Bound to the N terminus of globin (5%)
3. Dissolved in the blood

Question 424

How do CO2 levels in circulation change during exercise?

Answer 424

1. Increase in venous CO2
2. No change in arterial CO2

Question 425

How does the body compensate for hypoxia at high altitude?

Answer 425

1. Increased ventilation
2. Increased renal excretion of bicarb
3. Increased mitochondria in the tissues (better utilization of O2)
4. Increased 2,3-BPG
5. Increased erythropoietin

Question 426

How much does the H&H change in a person that has acclimatized to a hypoxic environment for weeks?

Answer 426

1. Hematocrit: 40-45 -> 60
2. Hemaglobin: 15 g/dl -> 20 g/dl

Question 427

At what positive G force does a visual “black-out” occur? Why does this occur?

Answer 427

1. 4-6 G
2. Centrifugal force pools blood in the legs and abdomen causing insufficient blood to the brain

Question 428

What physiologically is taking place in decompensation sickness?

Answer 428

Nitrogen precipitates out of the blood, forming bubbles that occlude small blood vessels

Question 429

For what conditions is hyperbaric oxygen therapy particularly helpful?

Answer 429

1. Decompression sickness
2. Arterial gas embolism
3. Carbon monoxide poisoning
4. Gas gangrene (due to anaerobic clostridium)
5. Osteomyelitis

Question 430

By what physiological mechanism does acute mountain sickness cause acute cerebral edema and acute pulmonary edema?

Answer 430

Hypoxia-induced vasodilation

Question 431

A patient suffers a stroke after incurring multiple long bone fractures in a skiing accident. What caused the infarct?

Answer 431

Fat embolus to cerebral artery via patent foramen ovale

Question 432

A patient with a recent tibia fracture and no history of COPD or asthma is shown to have hypoxia. CXR is normal. What is the cause of the hypoxia, and what disease process does it mimic?

Answer 432

1. DVT -> Pulmonary embolism
2. Mimics MI

Question 433

A patient presents with asthma attack. What immunological reaction is taking place that is responsible for anaphylaxis in this patient?

Answer 433

Antigen cross linking IgE on pre-sensitized mast cells (type I hypersensitivity)

Question 434

What asthma medication fits each of the following statements?

1. Inhaled treatment of choice for chronic asthma
2. Inhaled treatment of choice for acute exaserbations
3. Narrow therapeutic index, drug of last resort
4. Blocks conversion of arachidonic acid to leukotriene

Answer 434

1. Inhaled treatment of choice for chronic asthma: Inhaled steroid
2. Inhaled treatment of choice for acute exaserbations: Albuterol or levalbuterol (Not salmeterol)
3. Narrow therapeutic index, drug of last resort: Theophylline
4. Blocks conversion of arachidonic acid to leukotriene: Zileuton

Question 435

What asthma medication fits each of the following statements?

1. Inhibits mast cell release of mediators, used for prophylaxis only
2. Inhaled treatment that blocks muscarinic receptors
3. Inhaled long-acting Beta 2 agonist
4. Blocks leukotriene receptors

Answer 435

1. Inhibits mast cell release of mediators, used for prophylaxis only: Cromolyn
2. Inhaled treatment that blocks muscarinic receptors: Ipratropium and Tiotropium
3. Inhaled long-acting Beta 2 agonist: Salmeterol
4. Blocks leukotriene receptors: Montelukast & Zafirlukast

Question 436

A patient has an extended expiratory phase. What is the disease process?

Answer 436

Obstructive lung disease

Question 437

1. What is the hallmark sign of COPD?
2. What is the hallmark sign of a restrictive lung disease?

Answer 437

1. COPD: FEV1/FVC < 0.8
2. Restrictive lung disease: Decreased total lung capacity but FEV1/FVC >/= 0.8

Question 438

How does the emphysema caused by smoking differ from the emphysema caused by alpha-1 antitrypsin deficiency?

Answer 438

1. Smoking: Centriacinar emphysema
2. Alpha-1 Antitrypsin deficiency: Panacinar emphysema

Question 439

A preterm infant has difficulty breathing. An x-ray reveals diffuse air space and interstitial opacities, with air bronchograms. What is the diagnosis, and what could have prevented this condition?

Answer 439

1. Neonatal respiratory distress syndrome
2. Maternal steroids administered 24-48 hrs prior to delivery

Question 440

What are common causes of ARDS?

Answer 440

1. Trauma
2. Shock
3. Sepsis/infection
4. Gastric aspiration
5. Uremia
6. Acute pancreatitis
7. Amniotic fluid embolism
8. Heroin overdose
9. High concentrations of O2 for extended period of time

Question 441

H&E of lung biopsy from a plumber shows elongated structures with clubbed ends in tissue. What is the diagnosis?

What is he at increased risk for?

Answer 441

1. Asbestosis
2. Mesothelioma and Bronchogenic carcinoma

Question 442

What are the manifestations of sarcoidosis?

Answer 442

“GRUELING”

1. Granulomas
2. Rheumatoid Arthritis association
3. Uveitis
4. Erythema Nodosum
5. Lymphadenopathy (bilateral hilar lymphadenopathy)
6. Idiopathic
7. Not TB
8. Gammaglobulinemia

And Increased ACE, Vit D, and Ca

Question 443

What do patients with silicosis need to be worried about?

Answer 443

Increased susceptibility to TB

Question 444

A patient devolops bronchogenic lung cancer but has never smoked. He is a coal miner: Exposure to what substance has put him at risk for developing lung cancer?

Answer 444

Radon

(Coal dust and silica do not increase the risk of cancer and asbestos isnt located in mines)

Question 445

What complications can arise from lung cancer?

Answer 445

1. SIADH (small cell lung cancer)
2. Cushing Syndrome (small cell lung cancer)
3. Lambert-Eaton Syndrome (small cell lung cancer)
4. PTHrP -> Hypercalcemia (squamous cell lung cancer)
5. Carcinoid Syndrome (Carcinoid tumor)
6. Horner Syndrome (Pancoast Tumor)
7. Hoarse voice (Pancoast Tumor)
8. Superior vena cava syndrome (direct obstruction of the superior vena cava)
9. Pleural effusions
10. Dysphagia (esophageal invasion)
11. Laryngeal invasion

Question 446

What are the 3 most common locations of lung cancer metastasis?

Answer 446

Bone, Brain, and Liver

Question 447

Examination of a lung autopsy reveals a peripheral lesion with caseous necrosis. What is the diagnosis?

Answer 447

Tuberculosis

Question 448

A 30 year old comatose man on ventilatory support in the ICU develops an infection and dies. Autopsy reveals a pus-filled cavity in his right lung. What is the likely etiology

Answer 448

Aspiration resulting in an abcess

Question 449

What infectious agent is the cause of pneumonia, based on each of the following lab tests?

1. Gram (+) cocci in clusters
2. Gram (+) cocci pairs
3. Gram (-) rods in 80 year-old
4. Gram (+) cocci in neonate
5. Gram (-) rods in neonate

Answer 449

1. Gram (+) cocci in clusters: Staph Aureus
2. Gram (+) cocci pairs: Strep Pneumoniae
3. Gram (-) rods in 80 year-old: E. Coli
4. Gram (+) cocci in neonate: Group B strep
5. Gram (-) rods in neonate: E. Coli

Question 450

What bacterial structures have the following functions?

1. Mediates adherence of bacteria to the surface of a cell
2. Protects against phagocytosis
3. Provides rigid support to bacterial cell and protects against osmotic pressure differences
4. Space between the inner and outer cellular membranes in Gram (-) bacteria

Answer 450

1. Mediates adherence of bacteria to the surface of a cell: Fimbria or pili
2. Protects against phagocytosis: Capsule
3. Provides rigid support to bacterial cell and protects against osmotic pressure differences: Peptidoglycan layer
4. Space between the inner and outer cellular membranes in Gram (-) bacteria: Periplasm

Question 451

What bacterial structures have the following functions?

1. Motility
2. Bacterial form which provides resistance to dehydration, heat, and chemicals
3. Forms attachment between two bacteria during transfer of DNA material (AKA conjugation)
4. Genetic material within bacteria that contains genes for antibiotic resistance

Answer 451

1. Motility: Flagella
2. Bacterial form which provides resistance to dehydration, heat, and chemicals: Spore
3. Forms attachment between two bacteria during transfer of DNA material (AKA conjugation): Sex pilus (F pilus)
4. Genetic material within bacteria that contains genes for antibiotic resistance: Plasmid

Question 452

What stain is required to see the following organism (or substance)?

1. Cryptococcus neoformans
2. Pneumocystis Jirovecii
3. Chlamydia

Answer 452

1. Cryptococcus neoformans: India ink
2. Pneumocystis Jirovecii: Legionella
3. Chlamydia: Giemsa

Question 453

Which organisms do not take gram stain?

Answer 453

“These Rascals May Microscopically Lack Color”

1. Treponema (too thin to be detected)
2. Rickettsia (intracellular)
3. Mycobacteria
4. Mycoplasma (no cell wall)
5. Legionella Pneumophila (primarily intracellular)
6. Chlamydia (intracellular and lacks muramic acid in cell wall)

Question 454

Which bacteria are encapsulated?

Answer 454

“Even Some Pretty Nasty Killers Have Shiney Bodies”

1. E. Coli
2. Strep pneumo
3. Pseudomonas aeruginosa
4. Neisseria meningitidis
5. Klebsiella pneumoniae
6. Haemophilus influenzae
7. Salmonella typhi
8. Group B strep

Cryptococcus neoformans is a fungi with a capsule

Question 455

By what method are plasmids exchanged between bacteria?

Answer 455

Conjugation

Question 456

What exotoxin matches each of the following characteristics?

1. Inhibits Ach release -> flaccid paralysis
2. Lecithinase that causes gas gangrene
3. Inhibits the inhibitor of adenylate cyclase -> whooping cough
4. Stimulates adenylate cyclase -> Cl- and water into gut -> diarrhea
5. Destroys leukocytes
6. Composed of edema factor, lethal factor, and protective antigen

Answer 456

1. Inhibits Ach release -> flaccid paralysis: Botulin toxin
2. Lecithinase that causes gas gangrene: Alpha-toxin of Clostridium perfringens
3. Inhibits the inhibitor of adenylate cyclase -> whooping cough: Pertussis toxin
4. Stimulates adenylate cyclase -> Cl- and water into gut -> diarrhea: Cholera toxin & heat-labile E. Coli toxin
5. Destroys leukocytes: Leukocidin of Staph Aureus
6. Composed of edema factor, lethal factor, and protective antigen: Cytotoxin of Bacillus Anthracis

Question 457

What exotoxin matches each of the following characteristics?

1. Enterotoxin causing rice-water diarrhea
2. Causes Scarlet fever
3. Causes toxic shock syndrome
4. Inactivates EF-2 -> pseudomembranous pharyngitis
5. Blocks the release of the inhibitory neurotransmitter glycine

Answer 457

1. Enterotoxin causing rice-water diarrhea: Cholera toxin and heat-labile E. Coli toxin
2. Causes Scarlet fever: Erythrotoxin and pyrotoxin of strep pyogenes
3. Causes toxic shock syndrome:TSST-1 of Staph Aureus
4. Inactivates EF-2 -> pseudomembranous pharyngitis: Diptheria toxin
5. Blocks the release of the inhibitory neurotransmitter glycine: Tetanospasmin (tetanus toxin)

Question 458

What 6 bacteria secrete enterotoxins (exotoxin that causes water and electrolyte imbalances of intestinal epithelium resulting in diarrhea)?

Answer 458

1. Vibrio cholera
2. ETEC
3. Staph Aureus
4. Yersinia
5. Salmonella
6. Shigella

Question 459

What is the function of catalase?

Answer 459

Breakdown hydrogen peroxide to H20 and O2

Question 460

What is the most common aerobic skin flora?

Answer 460

Staph Epidermidis

Question 461

What organisms are most commonly implicated in subacute endocarditis?

Answer 461

1. Viridans Strep
2. Enterococci
3. Staph Epidermidis

Question 462

What infections are most commonly caused by Strep. Pyogenes?

Answer 462

Proliferative/Pyogenic

1. Skin infections
2. Pharyngitis
3. Endocarditis
4. Necrotizing fasciitis
5. Bacteremia

Toxin-mediated

1. Toxic shock syndrome
2. Scarlet fever

Autoimmune-antibody mediated but initiated by S. pyogenes

1. Rheumatic fever
2. Acute glomerulonephritis

Question 463

Which gram (+) organism matches each of the following statements?

1. Causes scalded skin syndrome
2. White membrane on pharynx
3. Pharyngitis -> glomerulonephritis
4. Most common cause of meningitis
5. Most common cause of osteomyelitis
6. Serious newborn infections

Answer 463

1. Causes scalded skin syndrome: Staph Aureus
2. White membrane on pharynx: Corynebacterium Diphtheria
3. Pharyngitis -> glomerulonephritis: Strep pyogenes
4. Most common cause of meningitis: Strep pneumoniae
5. Most common cause of osteomyelitis: Staph Aureus
6. Serious newborn infections: Group B strep, Listeria (and the gram (-) E. Coli)

Question 464

Which gram (+) organism matches each of the following statements?

1. Infant with poor muscle tone
2. Diarrhea after using antibiotics
3. Respiratory distress in a postal worker
4. Otitis media in children
5. Cellulitis

Answer 464

1. Infant with poor muscle tone: Clostridium Botulinum
2. Diarrhea after using antibiotics: Clostridium Difficile
3. Respiratory distress in a postal worker: Bacillus Anthracis
4. Otitis media in children: Strep pneumoniae
5. Cellulitis: Strep pyogenes and Staph aureus

Question 465

One hour after eating potato salad at a picnic, an entire family began to vomit. After 10 hours, they were better. What is the organism?

Answer 465

Staph aureus

Question 466

What patients are susceptible to Listeria monocytogenes?

Answer 466

Neonates and immunocompromised

Question 467

Which bacteria are spore formers?

Answer 467

1. Clostridium
2. Bacillus
3. Coxiella burnetii

Question 468

What organism can be treated with ampicillin or amoxicillin?

Answer 468

Effective against the “HEELPSS” organisms

1. H. influenzae
2. E. Coli
3. Enteroccoci
4. Listeria
5. Proteus
6. Salmonella
7. Shigella

Indications

1. URIs: Gram (+) and H. influenzae
2. UTIs and colon infections: E. coli, Proteus, Enteroccoci, Salmonella
3. Neonatal infections: E. coli, Listeria

Question 469

Which of the penicillins can be used to treat pseudomonas infections?

Answer 469

Ticarcillin, piperacillin, carbenicillin

Question 470

What are the two different mechanisms of resistance bacteria use against penicillin agents?

Answer 470

1. Beta-lactamase: Hydrolyzes the beta-lactam ring of penicillins
2. Alteration of Beta-lactam targets - IE the Penicillin Binding Proteins (PBPs)

Question 471

What are the beta-lactamase inhibitors?

Answer 471

1. Clavulanic acid (often combined with Amoxicillin or Ticarcillin)
2. Sulbactam (often combined with Ampicillin)
3. Tazobactam (often combined with Piperacillin)

Question 472

Which generation of cephalosporin would you choose to use for each of the follwoing infections?

1. UTI prevention
2. Serratia UTI
3. N. Meningitidis
4. Pseudomonas
5. Otitis media due to nontypable H. influenzae

Answer 472

1. UTI prevention: 1st or 2nd
2. Serratia UTI: 2nd
3. N. Meningitidis: 3rd
4. Pseudomonas: 4th
5. Otitis media due to nontypable H. influenzae: 2nd

Question 473

Which substances can have a side-effect similar to disulfuram with alcohol consumption?

Answer 473

1. Disulfuram
2. Metronidazole
3. Cephalosporins: Cefotetan, Cefamandole, Cefoperazone
4. Procarbazine (antineoplastic chemotherapy drug for the treatment of Hodgkin’s lymphoma)
5. 1st Generation Sulfonylureas (Tolbutamide)

Question 474

What side effect would you be concerned about if a patient is receiving both ceftriaxone and gentamicin?

Answer 474

Nephrotoxicity can result with concommitant use of a cephalosporin and an aminoglycoside

Question 475

What cell wall inhibitor matches each of the following statements?

1. Can cause “Red Man syndrome”
2. Next step in treatment of otitis media if resistant to amoxicillin
3. Prophylaxis against bacterial endocarditis
4. Increases the nephrotoxicity of aminoglycosides

Answer 475

1. Can cause “Red Man syndrome”: Vancomycin
2. Next step in treatment of otitis media if resistant to amoxicillin: [Amoxicillin + Clavulanic acid] or 3rd gen cephalosporin - Cefdinir
3. Prophylaxis against bacterial endocarditis: Penicillin V, aminopenicillin (amoxicillin), or cephalexin
4. Increases the nephrotoxicity of aminoglycosides: Cephalosporins

Question 476

What cell wall inhibitor matches each of the following statements?

1. Aminoglycoside pretender
2. Inpatient treatment for MRSA
3. Sufficient for the treatment of syphilis
4. Single dose treatment of gonorrhea

Answer 476

1. Aminoglycoside pretender: Aztreonam
2. Inpatient treatment for MRSA: Vancomycin
3. Sufficient for the treatment of syphilis: Penicillin G
4. Single dose treatment of gonorrhea: Ceftriaxone

Question 477

What cell wall inhibitor matches each of the following statements?

1. Hospitalized patient with new Gram (+) cocci clusters in blood
2. Treatment for C. Diff colitis
3. Broad spectrum coverage for appendicitis
4. Cell wall inhibitors effective against Pseudomonas

Answer 477

1. Hospitalized patient with new Gram (+) cocci clusters in blood: Vancomycin
2. Treatment for C. Diff colitis: Oral vancomycin (Tx of choice is Metronidazole but Metronidazole is not a cell wall inhibitor)
3. Broad spectrum coverage for appendicitis: Carbapenams such as imipenem/cilastatin or meropenam
4. Cell wall inhibitors effective against Pseudomonas: Cefepime (4th gen cephalosporin), carbapenams, Aztreonam, Carboxypenicillins (ticarcillin)

Question 478

How does an organism develop resistance to vancomycin?

Answer 478

D-ala-D-ala -> D-ala-D-lac

Question 479

A patient is receiving an IV infusion of an antibiotic and the nurse calls you when his face becomes flushed 15 minutes after the infusion started. What is the treatment for this patient?

Answer 479

Stop the Vancomycin -> Add an antihistamine such as Diphenhydramine -> Restart the Vancomycin at a decreased rate of infusion

Question 480

What is the distinction between a Ghon complex and a Ghon focus? Are these seen in primary or secondary tuberculosis?

Answer 480

1. Ghon focus = Calcified lung scar
2. Ghon complex = Calcified lung scar (Ghon focus) + hilar lymphadenopathy
3. They occur in primary TB

Question 481

What does a positive PPD skin test indicate?

Answer 481

1. Previous TB exposure
2. BCG vaccination
3. Current infection

Question 482

What does a negative PPD skin test indicate?

Answer 482

1. No TB exposure/infection
2. Immunosuppressed (HIV)
3. Sarcoidosis
4. Chronic steroid use
5. Malnutrition

Question 483

A patient is attempting to recall for you what medications he is taking, and there is one medication that he is taking to “keep his lungs healthy” that he also says can “hurt his nerves” unless he takes his B vitamin. To what medication is he referring?

Answer 483

Isoniazid

Question 484

What is the classic presenting symptom in a patient with lyme disease?

Answer 484

Erythema Chronicum Migrans

(Also fatigue, fever, and headache)

Question 485

What pupillary sign might point you to a diagnosis of syphilis?

Answer 485

Argyll Robertson pupils: Not reactive to light but constrict with accomodation

Question 486

What organism is associated with each of the following clues?

1. Lymphadenopathy + a new kitten
2. Dog bite
3. Ixodes tick
4. Rabbit hunter
5. Pet prairie dog

Answer 486

1. Lymphadenopathy + a new kitten: Bartonella
2. Dog bite: Pasteurella multocida
3. Ixodes tick: Borrellia burgdorferi
4. Rabbit hunter: Francisella tularensis
5. Pet prairie dog: Yersinia pestis

Question 487

What is the Rickettsial triad of symptoms?

Answer 487

Headache, fever, rash

Question 488

A 25 year-old with Mycoplasma atypical pneumonia exhibits anemia due to cryoagglutinins. What type of immunoglobulins are responsible for the anemia?

Answer 488

IgM (cold agglutinins)

Question 489

A homeless, alcoholic patient vomited while intoxicated, and subsequently developed foul-smellin sputum. What organism is most likely causing his infection?

Answer 489

Klebsiella pneumonia or anaerobic pneumonia

Question 490

Which embryologic structure of the heart gives rise to each of the following adult structures?

1. Ascending aorta and pulmonary trunk
2. Coronary sinus
3. SVC
4. Smooth parts of the left and right ventricle
5. Smooth part of the right atrium
6. Trabeculated left and right atrium
7. Trabeculated parts of the left and right ventricle

Answer 490

1. Ascending aorta and pulmonary trunk: Truncus arteriosus
2. Coronary sinus: Left horn of sinus venosus
3. SVC: Right common cardinal vein and right anterior cardinal vein
4. Smooth parts of the left and right ventricle: Bulbus cordis
5. Smooth part of the right atrium: Right horn of sinus venosus
6. Trabeculated left and right atrium: Primitive atria
7. Trabeculated parts of the left and right ventricle: Primitive ventricle

Question 491

1. What structure divides the truncus arteriosus into the aortic and pulmonary trunks?
2. What is the cellular origin of this structure?

Answer 491

1. Aorticopulmonary septum
2. Neural crest derivative

Question 492

Which fetal vessel has the highest oxygenation?

Answer 492

Umbilical vein > Ductus venosus > Inferior vena cava > Right atrium

Question 493

What causes the ductus arteriosus to close?

Answer 493

Infant breathing -> Increased oxygenated blood in aorta -> Decreased prostaglandins

Question 494

What causes the foramen ovale to close?

Answer 494

Infant breathing -> Decreased pulmonary resistance -> Increased left atrial pressure

Question 495

What is the most common congenital cardia anomaly?

Answer 495

Ventricular Septal Defect (VSD)

Question 496

What are the components of the Tetralogy of Fallot?

Answer 496

1. Pulmonary Stenosis
2. Right Ventricular Hypertrophy
3. Ventricular Septal Defect
4. Overriding Aorta

Question 497

Explain how the great vessels are attached in a transposition of the great vessels.

Answer 497

1. Right ventrical is attached to the Aorta
2. Left ventrical is attached to the pulmonary trunk

Question 498

A 45 year-old man presents with a BP of 160/90 on the right arm and 170/92 on the left arm. There are no palpable pulses in the feet/ankle. What problem does this patient most likely have?

Answer 498

Coarctation of the aorta

Question 499

Describe the blood flow through a Patent ductus arteriosus

Answer 499

Left to right shunt from aorta to the pulmonary artery via the patent ductus arteriosus

Question 500

What heart defect is associated with each of the following disorders?

1. Chromosome 22q11 deletions
2. Down syndrome
3. Congenital rubella
4. Turner syndrome
5. Marfan syndrome

Answer 500

1. Chromosome 22q11 deletions: (This is a DiGeorge variant) Persistent truncus arteriosus, tetralogy of Fallot
2. Down syndrome: Endocardial cushion defect
3. Congenital rubella: PDA, Pulmonary artery stenosis
4. Turner syndrome: Coarctation of the aorta, bicuspid aortic valve
5. Marfan syndrome: Aortic insufficiency

Question 501

What is the pulse pressure in a patient with systolic BP of 150 and a MAP of 90?

Answer 501

MAP = 90 = 2/3 Diastolic + 1/3 Systolic

90 = 2/3 D + 50

Diastolic = 60

Pulse pressure = Systolic - Diastolic

PP = 150 - 60 = 90

Question 502

What is the basic equation for cardiac output?

What is the Fick principle?

Answer 502

1. CO = SV x HR
2. CO = Rate of oxygen consumption/(arterial O2 content - venous O2 content)

Question 503

How can the myocardial oxygen demand be decreased in circumstances where the heart is ischemic?

Answer 503

1. Decrease contractility
2. Decrease afterload
3. Decrease HR

Question 504

What can make the stroke volume increase for a given preload?

Answer 504

Increased contractility: Sympathetic stimulation, inotropic drugs, increased intracellular Ca, decreased extracellular Na

Question 505

What factors affect stroke volume?

Answer 505

1. Afterload
2. Preload
3. Contractility

Question 506

What is the heart ejection fraction?

Answer 506

EF = SV/EDV

Question 507

What are the signs of right-sided heart failure?

Answer 507

Peripheral signs/symptoms

1. Lower extremity edema
2. Jugular venous distension

Question 508

What are the signs of left-sided heart failure?

Answer 508

Pulmonary signs/symptoms

1. Dyspnea on exertion
2. Orthopnea
3. Paroxysmal nocturnal dyspnea
4. Pulmonary congestion symptoms

Question 509

What medications are used to treat chronic heart failure?

Answer 509

Improve outcomes

1. ACE inhibitors
2. ARBs
3. Aldosterone antagonists (K sparing diuretics like spironolactone)
4. Beta-blockers (Metoprolol and Carvedilol)

Improve symptoms

1. Loop diuretics
2. Digoxin
3. Nitrates

Question 510

What medications are used to treat acute heart failure?

Answer 510

“LMNOP”

1. Loop diuretics
2. Morphine
3. Nitrates
4. Oxygen
5. Positioning and pressors

Question 511

What is the mechanism of action of the cardiac glycosides (eg Digoxin)?

Answer 511

Inhibit Na/K counter transporter -> Increase intracellular Ca

Question 512

How do the following circumstances impact the Starling forces of fluid movement through capillaries?

1. Heart failure
2. Liver failure
3. Renal failure
4. Infections and toxins
5. Nephrotic syndrome

Answer 512

1. Heart failure: Increase capillary pressure
2. Liver failure: Decrease oncotic pressure
3. Renal failure: Decrease in plasma proteins -> Decrease in plasma colloid osmotic pressure
4. Infections and toxins: Increased capillary permeability
5. Nephrotic syndrome: Decrease plasma protein -> Decreased plasma colloid osmotic pressure

Question 513

How do the following circumstances impact the Starling forces of fluid movement through capillaries?

1. Lymphatic blockage
2. Burns
3. Diuretic administration
4. IV infusion of albumin or clotting factors
5. Venous insufficiency

Answer 513

1. Lymphatic blockage: Increased interstitial osmotic pressure -> draw fluid out of capillaries into interstitium
2. Burns: Increased capillary permeability
3. Diuretic administration: Osmotic agent to prevent water reabsorption -> Decreased Hydrostatic pressure
4. IV infusion of albumin or clotting factors: Increased plasma protein -> Increased plasma colloid osmotic pressure
5. Venous insufficiency: Increased capillary pressure

Question 514

How do the vascular resistance and stroke volume differ in hypovolemic shock compared to septic shock?

Answer 514

1. Hypovolemic shock: Increased vascular resistance, decreased SV
2. Septic shock: Decreased vascular resistance, increased SV

Question 515

What are some of the causes of cardiogenic shock?

Answer 515

1. MI
2. Pulmonary embolism
3. Arrhythemia
4. Cardiac tamponade

Question 516

How is the skin of a patient different in cardiogenic shock compared to septic shock?

Answer 516

1. Cardiogenic shock: Less perfused -> Cold/clammy/cyanotic
2. Septic shock: More perfused -> Warm/flushed

Question 517

What other severe problems often coexist with septic shock in ICU patients?

Answer 517

1. DIC
2. Multiorgan failure (Acute pancreatitis, acute renal failure, liver failure, adrenal insufficiency)
3. Acute respiratory distress syndrome
4. Intestinal ileus

Question 518

What serum lab marker is helpful in assessing the appropriate oxygenation of tissues?

Answer 518

Lactic acid

Question 519

When does isovolumetric contraction take place?

Answer 519

After the mitral valve closes but before the aortic valve opens

Question 520

How does an increase in afterload affect the stroke volume of the heart assuming contractility remains the same?

Answer 520

Decreased SV

Question 521

What impact does an increase in contractility have on stroke volume assuming preload and afterload remain constant?

Answer 521

Increased SV

Question 522

1. What heart sound is associated with dilated congestive heart failure?
2. What heart sound is associated with chronic hypertension?

Answer 522

1. S3
2. S4

Question 523

What gives rise to the jugular venous a, c, and v waves?

Answer 523

1. a: Right atrial contraction
2. b: Right ventricular contraction
3. v: Atrial filling

Question 524

Where does the QRS complex fall in relation to valvular dynamics?

Answer 524

Ventricular depolarization -> Mitral valve closure

Question 525

What defect is associated with the following type of murmur?

Crescendo-decrescendo systolic murmur best heard in the 2nd and 3rd interspace close to the sternum

Answer 525

Aortic stenosis

Question 526

What defect is associated with the following type of murmur?

Early diastolic decrescendo murmur heard best along the left side of the sternum

Answer 526

Pulmonic regurgitation

Question 527

What defect is associated with the following type of murmur?

Late diastolic decrescendo murmur heard best along the left side of the sternum

Answer 527

Tricuspid stenosis

Question 528

What defect is associated with the following type of murmur?

Pansystolic (AKA holosystolic or uniform) murmur best heard at the apex and often radiates to the left axilla

Answer 528

Mitral regurgitation

Question 529

What defect is associated with the following type of murmur?

Late systolic murmur usually preceded by a mid-systolic click

Answer 529

Mitral prolapse

Question 530

What defect is associated with the following type of murmur?

Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd left interspaces close to the sternum

Answer 530

Pulmonary stenosis

Question 531

What defect is associated with the following type of murmur?

Pansystolic murmur best heard along the left lower sternal border and generally radiates to the right lower sternal border

Answer 531

VSD or Tricuspid regurgitaion

Question 532

What defect is associated with the following type of murmur?

Rumbling late diastolic murmur with an opening snap

Answer 532

Mitral stenosis

Question 533

What defect is associated with the following type of murmur?

Continuous machine-like murmur (in systole and diastole)

Answer 533

PDA

Question 534

What defect is associated with the following type of murmur?

High-pitched diastolic murmur associated with a widened pulse pressure

Answer 534

Aortic regurgitation

Question 535

What murmurs are heard best in the left lateral decubitus position?

Answer 535

1. Mitral Regurgitation
2. Mitral Stenosis
3. Left sided s3 & s4 heart sounds

Question 536

Describe the flow of ions during a pacemaker action potential

Answer 536

Phase 4: Na in

Phase 0: Ca in

Phase 3: K out

Question 537

What physiology accounts for the automaticity of the AV and SA nodes?

Answer 537

Phase 4 gradual sodium conductance

Question 538

What is the mechanism of action of each class of antiarrhythmic?

Answer 538

“No Bad Boy Keeps Clean”

Class I: Na channel blockers

Class II: Beta-blockers

Class III: K blockers

Class IV: Ca channel blockers

Question 539

Which antiarrhythmic has the side effect of cinchonism?

Answer 539

Quinidine

Cinchonism = headache + tinnitus

Quinidine also causes thrombocytopenia and torsades de pointes

Question 540

What are the potential side effects of amiodarone use?

Answer 540

1. Pulmonary fibrosis
2. Liver toxicity
3. Hyper or hypothyroidsm
4. Blue-grey skin discoloration
5. Photodermatitis
6. Bradycardia
7. Heart block
8. Corneal deposits
9. Neurologic Sx
10. Constipation

Question 541

What is the mechanism of action of adenosine as an antiarrhythmic?

Answer 541

1. Increase outward K current
2. Hyperpolarizes cells
3. Decreases intracellular Ca
4. Stops heart

Question 542

To which class of antiarrhythmics does each of the following agents belong?

1. Sotalol
2. Propranolol
3. Bretylium
4. Quinidine

Answer 542

1. Sotalol: Class III (Beta-blocker but even more of a K channel blocker)
2. Propranolol: Class II
3. Bretylium: Class III
4. Quinidine: Class Ia

Question 543

To which class of antiarrhythmics does each of the following agents belong?

1. Verapamil
2. Procainamide
3. Lidocaine
4. Diltiazem

Answer 543

1. Verapamil: Class IV
2. Procainamide: Class Ia
3. Lidocaine: Class Ib
4. Diltiazem: Class IV

Question 544

How does the cause of a narrow QRS complex differ from the cause of a wide QRS comples?

Answer 544

1. Narrow: Depolarization through AV node and down the purkinje system
2. Wide: Beat originates in the ventricles as a result of a premature ventricular contraction, Ventricular tacchycardia, or bundle branch block

Question 545

What is the ECG axis given the QRS deflections in each of the follwoing scenarios?

1. Positive in lead I, positive in lead II
2. Positive in lead I, Negative in lead III
3. Neagtive in lead I, positive in lead III
4. Positive in lead I, negative in aVR

Answer 545

1. Positive in lead I, positive in lead II: Normal axis
2. Positive in lead I, Negative in lead III: Left axis deviation or normal axis
3. Neagtive in lead I, positive in lead III: Right axis deviation
4. Positive in lead I, negative in aVR: Normal axis

Question 546

How does hyperkalemia affect the shape of T waves?

Answer 546

Hyperkalemia: Tall peaked T waves

Hypokalemia: Flattened T waves

Question 547

What is the initial treatment for ventricular fibrillation?

Answer 547

CPR and shock

Question 548

What is the initial treatment for ventricular tachycardia when there is no pulse?

Answer 548

CPR and shock

Question 549

What is the hallmark of a 3rd degree heart block?

Answer 549

No coordination between P-waves and QRS segments

Question 550

What drugs are known to prolong the QT interval, increasing the likelihood of torsades in those at risk?

Answer 550

1. Anti-infectivess: Macrolides, chloroquine
2. Anti-psychotics: Haloperidol, risperidone
3. Anti-HIV: Protease inhibitors (-navirs)
4. Anti-arrhythmics: Class Ia (quinidine) and Class III (K channel blockers such as sotalol)

Question 551

What are the two different types of second degree AV block? How do they differ?

Answer 551

1. Mobitz I (Wenckebach): Progressively prolonged PR interval followed by a dropped beat
2. Mobitz II: Randomly dropped beats

Question 552

Why is warfarin anticoagulation important in patients with chronic atrial fibrillations?

Answer 552

Blood pools in the atrium during atrial fibrillation, increasing the risk of thrombosis and embolism

Question 553

Outline the mechansim by which the kidneys regulate BP

Answer 553

Juxtoglomerular apparatus senses low BP and synthesizes renin -> Renin converts angiotensinogen (Created by liver) into angiotensin I -> ACE (created in lungs) converts angiotensin I into angiotensin II -> Angiotensin II causes vasoconstriction and also stimulates aldosterone secretion by the adrenal cortex -> Aldosterone promotes Na and H20 retention in the distal convoluted tubule and proximal collecting duct

Question 554

What substances act on smooth muscle myosin light-chain kinase? How does this affect blood pressure?

Answer 554

Dihydropyridine Ca channel blockers inhibit the Calmodulin-Ca complex: The calmodulin-Ca complex normally activates myosin light-chain kinase, resulting in the phosphorylation of myosin and contraction. Thus, Ca channel blockers inhibit contraction and promote relaxation

Epinephrine (beta2 receptors) and prostaglandin E2 receptor binding results in an increase in cAMP: cAMP inhibits myosin light chain kinase. Thus, epinephrine and prostaglandins inhibit contraction and promote relaxation

Question 555

Describe the chain of events in which hypotension causes a reflex tachycardia

Answer 555

Decreased baroreceptor stretch in the carotid sinus (Aortic arch baroreceptors only sense high BP) -> Less stimulation of CN IX and less afferent signaling to the solitary nucleus -> More sympathetic activation and less parasympathetic activation -> Reflex tachycardia

Question 556

1. What BP values mark the diagnosis of hypertension?
2. What values mark prehypertension?

Answer 556

1. Hypertension >/= 140/90
2. Pre-hypertension >/= 120/80

Only systolic or diastolic pressures have to exceed their respective cuttoff in order for the patient to fall in that category

Question 557

What would you most suspect the cause of hypertension to be in a patient with each of the following clinical clues?

1. Paroxysms of increased sympathetic tone - Anxiety, palpitations, diaphoresis
2. Age of onset between 20 and 50
3. Elevated serum creatinine and an abnormal urinalysis
4. Abdominal bruit
5. BP in arms > legs

Answer 557

1. Paroxysms of increased sympathetic tone - Anxiety, palpitations, diaphoresis: Phoechromocytoma
2. Age of onset between 20 and 50: Primary Hypertension
3. Elevated serum creatinine and an abnormal urinalysis: Renal disease
4. Abdominal bruit: Renal artery stenosis
5. BP in arms > legs: Coarctation of the aorta

Question 558

What would you most suspect the cause of hypertension to be in a patient with each of the following clinical clues?

1. Family history of Hypertension
2. Tachycardia, heat intolerance, diarrhea
3. Hyperkalemia
4. Episodic sweating and tachycardia
5. Abrupt onset in a patient younger than 20 or older than 50, and depressed serum K+ levels

Answer 558

1. Family history of Hypertension: Essential hypertension
2. Tachycardia, heat intolerance, diarrhea: Hyperthyroidism
3. Hyperkalemia: Renal failure
4. Episodic sweating and tachycardia: Pheochromocytoma
5. Abrupt onset in a patient younger than 20 or older than 50, and depressed serum K+ levels: Hyperaldosteronemia

Question 559

What would you most suspect the cause of hypertension to be in a patient with each of the following clinical clues?

1. Central obesity, moon-shaped face, hirsutism
2. Normal urinalysis and normal serum K+ levels
3. Young individual with acute onset tachycardia
4. Hypokalemia
5. Proteinuria

Answer 559

1. Central obesity, moon-shaped face, hirsutism: Cushing syndrome
2. Normal urinalysis and normal serum K+ levels: Primary hypertension
3. Young individual with acute onset tachycardia: Cocaine or amphetamine use
4. Hypokalemia: Renal artery stenosis causing hyperaldosteronism
5. Proteinuria: Renal disease

Question 560

What chest x-ray finding is a possible sign for aortic dissection?

Answer 560

Widened mediastinum

Question 561

What category of BP medications is preferred in the treatment of aortic dissection?

Answer 561

Beta-blocker

Question 562

Which antihypertensive class or drug fits each of the following side effects?

1. First dose orthostatic hypotension
2. Ototoxic (especially with aminoglycosides)
3. Hypertrichosis
4. Cyanide toxicity

Answer 562

1. First dose orthostatic hypotension: Alpha-1 Blockers (Prazosin)
2. Ototoxic (especially with aminoglycosides): Loop diuretics
3. Hypertrichosis: Minoxidil
4. Cyanide toxicity: Sodium Nitroprusside

Question 563

Which antihypertensive class or drug fits each of the following side effects?

1. Dry mouth, sedation, severe rebound HTN
2. Bradycardia, impotence, asthma exacerbation
3. Reflex tachycardia
4. Cough

Answer 563

1. Dry mouth, sedation, severe rebound HTN: Alpha-2 agonists (Clonidine)
2. Bradycardia, impotence, asthma exacerbation: Beta-blockers
3. Reflex tachycardia: Any vasodilator (Nitrates, Hydralazine, Dihydropyridines)
4. Cough: ACE inhibitors

Question 564

Which antihypertensive class or drug fits each of the following side effects?

1. Avoid in patients with a sulfa allergy
2. Possible angioedema
3. Possible development of drug-induced lupus
4. Hypercalcemia, hypokalemia

Answer 564

1. Avoid in patients with a sulfa allergy: Loop and thiazide diuretics
2. Possible angioedema: ACE inhibitors and ARBs
3. Possible development of drug-induced lupus: Hydralazine
4. Hypercalcemia, hypokalemia: Thiazide diuretics

Question 565

Which antihypertensives are particularly beneficial to heart failure patients?

Answer 565

1. Beta-blockers
2. ACE inhibitors
3. ARBs
4. Aldosterone antagonists (K sparing diuretics)

Question 566

Which antihypertensives are safe to use in pregnancy?

Answer 566

“Hypertensive Moms Love Nifedipine”

1. Hydralazine
2. Methyldopa
3. Labetalol
4. Nifedipine

Question 567

What are the most common locations for atherosclerosis, and what disorders result from plaques in these locations?

Answer 567

1. Abdominal aorta - Abdominal aortic aneurysm (AAA)
2. Coronary Artery - MI and Angina
3. Popliteal artery - Claudication and peripheral vascular disease
4. Carotid arteries - Transient ischemic attack, strokes, dementia

Question 568

A patient with poorly-managed HTN has acute, sharp substernal pain that radiates to the back and progresses over a few hours. Death occurs in a few hours. Diagnosis?

Answer 568

Aortic dissection

Question 569

What is the most likely cause of chest pain in each of the following scenarios?

1. Acute onset dyspnea, tachycardia, and confusion in the hospitalized patient
2. Rapid onset of sharp pain in the 20-year-old and associated with dyspnea
3. Pain began the day following an intensive new exercise program
4. ST segment elevation only during bried episodes of chest pain
5. Sharp pain lasting hours to days and is somewhat relieved by sitting forward
6. Chest wall tenderness on palpation

Answer 569

1. Acute onset dyspnea, tachycardia, and confusion in the hospitalized patient: Pulmonary embolus
2. Rapid onset of sharp pain in the 20-year-old and associated with dyspnea: Spontaneous pneumothorax
3. Pain began the day following an intensive new exercise program: MSK pain
4. ST segment elevation only during bried episodes of chest pain: Prinzmetal’s angina
5. Sharp pain lasting hours to days and is somewhat relieved by sitting forward: Pericarditis
6. Chest wall tenderness on palpation: MSK pain

Question 570

Which lipid lowering agent matches each of the following descriptions?

1. SE: Facial flushing
2. SE: Elevated LFTs, Myositis
3. SE: GI discomfort, bad taste
4. Best effect on HDL
5. Best effect on triglycerides/VLDL
6. Best effect on LDL/cholesterol
7. Binds C. Diff toxin

Answer 570

1. SE: Facial flushing: Niacin
2. SE: Elevated LFTs, Myositis: Statins & Fibrates
3. SE: GI discomfort, bad taste: Bile acid binding resins
4. Best effect on HDL: Niacin
5. Best effect on triglycerides/VLDL: Fibrates (and omega-3 fatty acids but less effective)
6. Best effect on LDL/cholesterol: Statins
7. Binds C. Diff toxin: Cholestyramine (Bile acid binding resin)

Question 571

A 50 year-old man starts on lipid-lowering medication. Upon his first dose, he develops a rash, pruritis, and diarrhea. What drug is he taking?

Answer 571

Niacin

Question 572

How can the flushing reaction of niacin be prevented?

Answer 572

1. Aspirin or NSAID 30 minutes before niacin
2. Avoid alcohol/hot beverages
3. Take at bedtime
4. Be persistent

Question 573

Which serum lab markers are commonly used to make the diagnosis of MI?

Answer 573

1. Troponin-I
2. CK-MB

Question 574

Which coronary artery is most commonly occluded in an MI?

Answer 574

Left Anterior Descending (LAD)

Question 575

What would cause each of the following findings after an MI?

1. Cardiac tamponade
2. Severe mitral regurgitation
3. New VSD
4. Stroke

Answer 575

1. Cardiac tamponade: Ventricular wall rupture
2. Severe mitral regurgitation: Papillary rupture
3. New VSD: Intraventricular septum rupture
4. Stroke: Mural thrombus -> embolus

Question 576

Which ECG leads will show evidence of ischemia in an anterior wall MI?

Answer 576

V1-V5

Question 577

What medications would you think to prescribe in an ER patient diagnosed with MI?

Answer 577

“MONA”

1. Morphine
2. Oxygen
3. Nitroglycerin
4. Aspirin

Also

Beta-blockers: Decrease O2 demand, decrease infarct size, decrease mortality (They increase risk of acute cardiogenic shock if there is significant Left ventrical dysfunction)

ACE inhibitor of ARB: Decrease afterload, decrease O2 demand, decrease cardiac remodelling, and decrease risk of heart failure and death

Statins: Stabilize atherosclerotic plaques, may decrease inflammation , decrease LDL

MG > 2, K > 4: Reduce the risk of arrhythmia

Question 578

What are the differences between acute and subacute bacterial endocarditis?

Answer 578

Acute

1. Usually caused by Staph Aureus
2. Onset is very rapid
3. Normal valves can be affected

Subacute

1. Usually caused by Viridans strep
2. affects already damaged valves
3. Insidious onset

Question 579

An IV drug user presents with chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely cause?

Answer 579

Bacterial endocarditis with bacterial embolism to the pulmonary arteries

Question 580

A patient in a motor vehicle accident presents with chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely cause?

Answer 580

Tension pneumothorax

Question 581

A post-op patient presents with chest pain, dyspnea, tachycardia, and tachypnea. What is the most likely cause?

Answer 581

Pulmonary embolism from a DVT

Question 582

A young girl with congenital valve disease is given penicillin prophylactically. In the ER, bacterial endocarditis is diagnosed. What is the next step in her management?

Answer 582

IV Vancomycin until the blood culture comes back. Once the culture results come back, you can switch to an antibiotic regimen specific for the bacteria’s susceptibilities

Question 583

Under what circumstances might you see pulsus paradoxus?

Answer 583

1. Cardiac tamponade (mainly)
2. Asthma
3. Croup
4. Obstructive sleep apnea
5. COPD

Question 584

What are the Jones criteria for the diagnosis of acute rheumatic fever?

Answer 584

1. Joints
2. Pancarditis
3. Nodules
4. Erythema marginatum
5. Syndenham’s chorea

Question 585

What heart pathology fits each of the following statments?

1. Diffuse myocardial inflammation with necrosis and mononuclear cells
2. Focal myocardial inflammation with multinucleate giant cells
3. Fever + IV drug abuser + new heart murmur
4. Chest pain and course rubbing heart sounds in patient with creatinine of 5.0
5. Tree-barking of the aorta

Answer 585

1. Diffuse myocardial inflammation with necrosis and mononuclear cells: Myocarditis
2. Focal myocardial inflammation with multinucleate giant cells: Aschoff bodies of Rheumatic heart disease
3. Fever + IV drug abuser + new heart murmur: Infective endocarditis
4. Chest pain and course rubbing heart sounds in patient with creatinine of 5.0: Uremic pericarditis
5. Tree-barking of the aorta: Syphilis heart disease

Question 586

What heart pathology fits each of the following statments?

1. Child with fever, joint pain, cutaneous nodules 4 weeks after throat infection
2. ST elevation in all ECG leads
3. Disordered growth of myocytes
4. ECG shows electrical alterans

Answer 586

1. Child with fever, joint pain, cutaneous nodules 4 weeks after throat infection: Rheumatic fever
2. ST elevation in all ECG leads: Pericarditis
3. Disordered growth of myocytes: Hypertrophic cardiomyopathy
4. ECG shows electrical alterans: Cardiac Tamponade

Question 587

Which disorders are commonly discovered in patients with Raynaud phenomenon?

Answer 587

1. Lupus
2. Buerger’s Dx
3. CREST Scleroderma
4. Mixed Connective Tissue Disease

Question 588

What are the characteristic features of Kawasaki disease?

Answer 588

1. Vasculitis of small and medium vessels in an asian child
2. Coronary aneurysms
3. High fever
4. Conjunctivitis
5. Desquamating rash on palms and soles
6. Bright red inflammation of lips/oral mucosa
7. Strawberry tongue
8. Lymphadenopathy

Question 589

Which type of vasculitis fits each of the following high-yield characteristics?

1. Weak pulses in upper extremities
2. Necrotizing granulomas of lung and necrotizing glomerulonephritis
3. Necrotizing immune complex inflammation of visceral/renal vessels
4. Young male smokers

Answer 589

1. Weak pulses in upper extremities: Takayasu’s arteritis
2. Necrotizing granulomas of lung and necrotizing glomerulonephritis: Wegener’s Granulomatosis (Granulomatosis with polyangiitis)
3. Necrotizing immune complex inflammation of visceral/renal vessels: Polyarteritis Nodosa
4. Young male smokers: Buerger’s disease

Question 590

Which type of vasculitis fits each of the following high-yield characteristics?

1. Young asian women
2. Young asthmatics
3. Infants and young children; involved coronary arteries
4. Most common vasculitis

Answer 590

1. Young asian women: Takayasu’s arteritis
2. Young asthmatics: Churg-Strauss Syndrome
3. Infants and young children; involved coronary arteries: Kawasaki disease
4. Most common vasculitis: Temporal (Giant Cell) arteritis

Question 591

Which type of vasculitis fits each of the following high-yield characteristics?

1. Associated with hepatitis B infection
2. Occlusion of opthalmic artery can lead to blindness
3. Perforation of nasal septum
4. Unilateral headache, jaw claudication

Answer 591

1. Associated with hepatitis B infection: Polyarteritis Nodosa
2. Occlusion of opthalmic artery can lead to blindness: Temporal (Giant Cell) arteritis
3. Perforation of nasal septum: Wegeners granulomatosis (Granulomatosis with polyangiitis)
4. Unilateral headache, jaw claudication: Temporal (Giant Cell) arteritis

Question 592

Which vascular tumor fits each of the following descriptions?

1. Benign, raised, red lesion about the size of a mole in older patients
2. Raised, red area present at birth, increases in size initially then regresses over months to years
3. Lesion caused by lymphoangiogenic growth factors in an infected HIV patient

Answer 592

1. Benign, raised, red lesion about the size of a mole in older patients: Cherry hemangioma
2. Raised, red area present at birth, increases in size initially then regresses over months to years: Strawberry hemangioma
3. Lesion caused by lymphoangiogenic growth factors in an infected HIV patient: Kaposi Sarcoma

Question 593

Which vascular tumor fits each of the following descriptions?

1. Polypoid red lesion found in pregnancy or after trauma
2. Benign, painful, red-blue tumor under fingernails
3. Cavernous lymphangioma associated with Turner Syndrome
4. Skin papule in AIDS patient caused by Bartonella

Answer 593

1. Polypoid red lesion found in pregnancy or after trauma: Pyogenic Granuloma
2. Benign, painful, red-blue tumor under fingernails: Glomus tumor
3. Cavernous lymphangioma associated with Turner Syndrome: Cystic hygroma
4. Skin papule in AIDS patient caused by Bartonella: Bacillary angiomatosis

Question 594

A lesion to which area of the brain is responsible for each of the following clinical scenarios?

1. Hemispatial neglect syndrome
2. Poor repetition
3. Poor comprehension
4. Poor vocal expression

Answer 594

1. Hemispatial neglect syndrome: Non-dominant parietal lobe
2. Poor repetition: Arcuate Fasciculus (Conduction aphasia)
3. Poor comprehension: Wernicke’s area
4. Poor vocal expression: Brocas area

Question 595

A lesion to which area of the brain is responsible for each of the following clinical scenarios?

1. Personality changes
2. Dysarthria
3. Agraphia and acalculia
4. Hyperorality, hypersexuality, disinhibited behavior

Answer 595

1. Personality changes: Frontal lobe
2. Dysarthria: Cerebellar Vermis
3. Agraphia and acalculia: Dominant parietal lobe
4. Hyperorality, hypersexuality, disinhibited behavior: Bilateral Amygdala (Called Kluver-Bucy Syndrome)

Question 596

What typically is the cause of a lesion to the mamillary bodies?

Answer 596

Vitamin B1 deficiency

Question 597

What is the most feared consequence of carotid artery stenosis?

Answer 597

Rupture of atherosclerotic carotid plaque -> Plaque embolus to the brain -> Ischemic embolic stroke

Question 598

What artery is damaged with each of the following presentations?

1. Broca or Wernicke aphasia
2. Unilateral lower extremity sensory and/or motor loss
3. Unilateral facial and arm sensory and/or motor loss

Answer 598

1. Broca or Wernicke aphasia: Middle cerebral artery
2. Unilateral lower extremity sensory and/or motor loss: Anterior cerebral artery
3. Unilateral facial and arm sensory and/or motor loss: Middle cerebral artery

Question 599

What artery supplies the medial lemniscus and medullary pyramid of the medulla?

Answer 599

Anterior spinal artery

Question 600

1. Where does the corticospinal tract decussate in the brainstem?
2. Where does the dorsal column-medial leminiscal pathway decussate?

Answer 600

1. Caudal Medulla prior to medullary pyramids
2. Medulla then ascends as medial lemniscus

Question 601

What artery supplies the following medullary structures: Spinothalamic tract, inferior cerebellar peduncle, nucleus ambiguus, and lateral spinothalamic tract?

Answer 601

Posterior Inferior Cerebella Artery (PICA)

Question 602

How do the symptoms of a lesion to the cortical motor region of the face differ from a lesion of the facial nerve or nucleus?

Answer 602

1. Lesion in cortical motor face region: Paralysis of contralateral lower face
2. Lesion of facial nerve or nucleus: Paralysis of ipsilateral full face

Question 603

A patient has a leftward deviation of the tongue on protrusion, and has a right-sided spastic paralysis. Where is the lesion?

Answer 603

Left medulla

Question 604

What are the signs of Weber syndrome?

Answer 604

PCA infarction

1. Contalateral spastic paralysis
2. CN III palsy (eye looks down and out)
3. Ptosis

Question 605

What are the signs of Wallenberg syndrome?

Answer 605

PICA infarction

1. Contalateral loss of pain and temperature sensation of body
2. Ipsilateral loss of pain and temperature sensation of face
3. Hoarse voice, difficulty swallowing, loss of gag reflex
4. Ipsilateral Horner syndrome
5. Vertigo, nystagmus, nausea/vomiting
6. Ispsilateral cerebella deficits

Question 606

A patient cannot abduct her left eye on lateral gaze and convergence is normal. She is also having difficulty smiling. In what part of the CNS is there a lesion?

Answer 606

Pontine lesion

Question 607

A lesion of what artery can cause a locked-in syndrome?

Answer 607

Basilar artery

Question 608

1. What is the most common site of a berry aneurysm?
2. What diseases are often associated with berry aneurysms?

Answer 608

1. Anterior communicating artery
2. Autosomal dominant polycystic kidney disease & Ehlers-Danlos syndrome

Question 609

An 85 year-old man with Alzheimer disease falls at home and presents 3 days later with severe headache and vomiting. What is the most likely diagnosis and what structures were damaged?

Answer 609

1. Subdural hematoma
2. Bridging veins

Question 610

1. Where is CSF generated?
2. Where is CSF reabsorbed?

Answer 610

1. Choroid plexus of the ventricles
2. Arachnoid granulations in the superior sagittal sinus

Question 611

What is the difference between communicating and noncommunicating hydrocephalus?

Answer 611

1. Communicating: Decreased absorption of CSF at the arachnoid villi
2. Non-communicating: Physical, mechanical obstruction of ventricles

Question 612

What clinical features characterize normal pressure hydrocephalus?

Answer 612

1. Wet: Urinary incontinence
2. Wobbly: Ataxia
3. Wacky: Dementia

Question 613

What are the differences between the 1a afferent motor pathway and the 1b afferent motor pathway?

Answer 613

1a: Intrafusal fibers within muscle spindle that stimulate alpha motor neurons -> contraction
1b: Sensory from the golgi tendon organ that inhibits alpha motor neurons -> inhibits contraction

Question 614

What portion of the thalamus relays the following types of information?

1. Somatosensory from body (via medial lemniscus and spinothalamic)
2. Cerebellum (Dentate nucleus) and basal ganglia -> motor cortex
3. Trigeminothalamic and taste pathways to somatosensory cortex

Answer 614

1. Somatosensory from body (via medial lemniscus and spinothalamic): Ventral Posterolateral Nucleus (VPL)
2. Cerebellum (Dentate nucleus) and basal ganglia -> motor cortex: Ventrolateral Nucleus (VL)
3. Trigeminothalamic and taste pathways to somatosensory cortex: Ventroposteromedial Nucleus (VPM)

Question 615

What portion of the thalamus relays the following types of information?

1. Retina -> occipital lobe
2. Basal ganglia -> prefrontal, premotor; and orbital cortices
3. (Auditory info) brachium of inferior colliculus -> Primary auditory cortex

Answer 615

1. Retina -> occipital lobe: Lateral Geniculate Nucleus (LGN)
2. Basal ganglia -> prefrontal, premotor; and orbital cortices: Ventral Anterior Nucleus (VA)
3. (Auditory info) brachium of inferior colliculus -> Primary auditory cortex: Medial Geniculate Nucleus (MGN)

Question 616

1. What are classic signs of an upper motor neuron lesion?
2. Of a lower motor neuron lesion?

Answer 616

Upper motor neuron lesion

1. Spastic paralysis
2. Hyperreflexia
3. Positive babinski sign

Lower motor neuron lesion

1. Flaccid paralysis
2. Fasciculations
3. Atrophy

Question 617

What is the difference between essential tremor; resting tremor; and intention tremor

Answer 617

Essential tremor

• Occurs with a family history
• Present with or without movement

Resting tremor

• Disappears with voluntary movement

Intention tremor

• Appears with voluntary movement

Question 618

What are the cardinal features of Parkinson disease?

Answer 618

1. Resting tremor, pill rolling tremor
2. Rigidity
3. Hypokinesia
4. Cogwheel rigidity
5. Mask-like facies
6. Festinating gate

Question 619

28 year-old chemist presents with MPTP exposure. What neurotransmitter is depleted?

Answer 619

Dopamine

Question 620

How do each of the following structures normally impact movement?

1. Globus pallidus internal segment
2. Subthalamic nucleus
3. Substantia nigra pars compacta

Answer 620

1. Globus pallidus internal segment: Inhibits movement
2. Subthalamic nucleus: Inhibits movement
3. Substantia nigra pars compacta: Promotes movement

Question 621

A male paitent presents with involuntary flailing of one arm. Where is the lesion?

Answer 621

Subthalamic nucleus on the contralateral side

This is Hemibalism

Question 622

What neurotransmitters are altered in Huntington disease?

Answer 622

1. Decreased Ach
2. Decreased GABA
3. Increased Dopamine

Question 623

Which spinal tract conveys the following types of information?

1. Touch, vibration, and pressure sensation
2. Voluntary motor command from motor cortex to body
3. Voluntary motor command from motor cortex to head/neck
4. Alternate routes for the mediation of voluntary movement

Answer 623

1. Touch, vibration, and pressure sensation: Dorsal column
2. Voluntary motor command from motor cortex to body: Lateral and Ventral Corticospinal tract
3. Voluntary motor command from motor cortex to head/neck: Corticobulbar tract
4. Alternate routes for the mediation of voluntary movement: Reticulospinal and Rubrospinal tracts

Question 624

Which spinal tract conveys the following types of information?

1. Pain and temperature sensation
2. Important for postural adjustments and head movements
3. Proprioceptive information for the cerebellum

Answer 624

1. Pain and temperature sensation: Lateral Spinothalamic tract
2. Important for postural adjustments and head movements: Vestibulospinal tract
3. Proprioceptive information for the cerebellum: Dorsal and Ventral Spinocerebellar tract

Question 625

What are the findings of Brown-Sequard syndrome?

Answer 625

1. Ipsilateral UMN signs below lesion
2. Ipsilateral dorsal column loss of information below lesion
3. Contralateral pain and temperature loss at 2-3 segments below lesion
4. Ipsilateral pain an temperature loss at level of the lesion
5. LMN signs at level of lesion

Question 626

What clinical presentation would lead you to suspect amyotrophic lateral sclerosis as a diagnosis?

Answer 626

Combined UMN and LMN motor loss without sensation loss

Question 627

What are some of the more classic presenting scenarios for multiple sclerosis?

Answer 627

1. Charcot’ Triad
   
   • Scanning speech
   • Intention tremor
   • Nystagmus
2. Bowel or bladder incontinence
3. Internuclear opthalmoplegia
4. Optic neuritis

Question 628

What are the symptoms of a lesion to the C5 and C6 nerve roots?

Answer 628

Erb-Duchenne Palsy

1. Paralysis of upper extremity (Arm hangs at side)
2. Medial rotation of arm with forearm pronation (Waiters tip hand)

Question 629

What are the symptoms of a lesion to the inferior trunk of the brachial plexus?

Answer 629

Klumpke’s Palsy

1. Sensory deficits of the forearm and hand on the medial side
2. Atrophy of the thenar, hypothenar, and interosseous muscles

Question 630

What nerve is damaged when a patient presents with the following symptom (upper extremity)?

1. Claw hand
2. Ape hand
3. Wrist drop
4. Scapular winging
5. Unable to wipe bottom

Answer 630

1. Claw hand: Ulnar or median nerve
2. Ape hand: Median nerve
3. Wrist drop: Radial nerve
4. Scapular winging: Long Thoracic nerve
5. Unable to wipe bottom: Thoracodorsal nerve

Question 631

What nerve is damaged when a patient presents with the following symptom (upper extremity)?

1. Loss of forearm pronation
2. Cannot abduct or adduct fingers
3. Loss of shoulder abduction
4. Weak external rotation of arm
5. Loss of elbow flexion and forearm supination

Answer 631

1. Loss of forearm pronation: Median nerve
2. Cannot abduct or adduct fingers: Ulnar nerve
3. Loss of shoulder abduction: Axillary nerve
4. Weak external rotation of arm: Suprascapular and Axillary nerves
5. Loss of elbow flexion and forearm supination: Musculocutaneous nerve

Question 632

What nerve is damaged when a patient presents with the following symptom (upper extremity)?

1. Loss of wrist extension
2. Trouble initiating shoulder abduction
3. Unable to abduct arm beyond 10 degrees
4. Unable to raise arm above horizontal

Answer 632

1. Loss of wrist extension: Radial nerve
2. Trouble initiating shoulder abduction: Suprascapular nerve
3. Unable to abduct arm beyond 10 degrees: Axillary nerve
4. Unable to raise arm above horizontal: Long thoracic and spinal accessory nerves

Question 633

What nerve is most at risk of injury with the following types of fractures/injury?

1. Fracture of the shaft of the humerus
2. Fracture of the surgical neck of the humerus
3. Supracondylar humerus fracture

Answer 633

1. Fracture of the shaft of the humerus: Radial nerve
2. Fracture of the surgical neck of the humerus: Axillary nerve
3. Supracondylar humerus fracture: Median nerve

Question 634

What nerve is most at risk of injury with the following types of fractures/injury?

1. Fracture of the medial epicondyle
2. Anterior shoulder dislocation
3. Injury to the carpal tunnel

Answer 634

1. Fracture of the medial epicondyle: Ulnar nerve
2. Anterior shoulder dislocation: Axillary nerve
3. Injury to the carpal tunnel: Median nerve

Question 635

A patient falls off a motorcycle and lands on his right shoulder. On physical exam you notice his shoulder has an abnormal configuration. X-rays indicate an anterior dislocation of his shoulder. What artery and nerve are most at risk of being damaged?

Answer 635

Axillary nerve and Posterior Circumflex artery

Question 636

1. A highschool athlete falls on his arm during practice. In the ER, a radiograph shows a midshaft break of the humerus. Which nerve and which artery have the highest risk of being damaged?
2. What muscular actions are affected?

Answer 636

1. Radial nerve and Deep Brachial artery
2. Wrist drop and loss of brachioradialis reflex

Question 637

A patient presents with decreased pain and temperature sensation over the lateral aspects of both arms. Where is the lesion?

Answer 637

Central canal of cervical spinal cord

This is Syringomyelia

Question 638

Exam of a patient reveals decreased prick sensation on the lateral aspect of her foot and leg. What muscular defect would you also expect to be present?

Answer 638

Injury to the common peroneal nerve: Problem with dorsiflexion (causing foot drop) and eversion of the foot

Question 639

A patient fractures her fibula neck. What nerve is most at risk of being damaged?

Answer 639

Deep peroneal nerve

Question 640

Which two muscle receptors are responsible for opening the sarcoplasmic reticulum in response to depolarization?

Answer 640

1. Dihydropyridine receptors
2. Ryanodine receptors

Question 641

What drug prevents the release of calium from the sarcoplasmic reticulum of skeletal muscle?

Answer 641

Dantrolene

Question 642

For what conditions is the drug Dantrolene useful?

Answer 642

1. Malignant hyperthermia
2. Neuroleptic malignant syndrome

Question 643

Which type of muscle would usually be dominant in the gastrocnemius muscle?

Answer 643

Type II muscle fibers (Fast twitch, white muscle)

Question 644

Where does new bone formation take place in growing long bones?

Answer 644

Epiphyseal plate

Question 645

What cell types are most similar to osteoclasts?

Answer 645

Monocytes/macrophages

Question 646

Which bony disease fits each of the following descriptions?

1. Reversible when vitamin D is replaced
2. Excess osteoclastic activity results in disorganized bony architecture
3. Bone is replaced by fibroblasts, collagen, and irregular bony trabeculae

Answer 646

1. Reversible when vitamin D is replaced: Osteomalacia/Rickets
2. Excess osteoclastic activity results in disorganized bony architecture: Paget disease of bone
3. Bone is replaced by fibroblasts, collagen, and irregular bony trabeculae: Polystotic fibrous dysplasia

Question 647

Which bony disease fits each of the following descriptions?

1. Soft bones due to defective mineralization of osteoid
2. Failure of bone resorption -> Thickened and dense bones
3. Genetic deficiency of carbonic anhydrase II

Answer 647

1. Soft bones due to defective mineralization of osteoid: Osteomalacia/Rickets
2. Failure of bone resorption -> Thickened and dense bones: Osteopetrosis
3. Genetic deficiency of carbonic anhydrase II: Osteopetrosis

Question 648

What measures can be taken to prevent osteoporosis?

Answer 648

1. Weight bearing exercise
2. Calcium intake
3. Vitamin D intake
4. Stop smoking
5. Avoid steroid use
6. Avoid chronic use of heparin

Question 649

How would the following lab values be affected in Paget Disease of the bone?

1. Serum Ca
2. Serum Phos
3. Alk Phos
4. PTH

Answer 649

1. Serum Ca: No change
2. Serum Phos: No change
3. Alk Phos: Increase
4. PTH: No change

Question 650

How would the following lab values be affected in Osteomalacia/Rickets?

1. Serum Ca
2. Serum Phos
3. Alk Phos
4. PTH

Answer 650

1. Serum Ca: Decrease
2. Serum Phos: Decrease
3. Alk Phos: Increase
4. PTH: Increase

Question 651

How would the following lab values be affected in Osteitis fibrosa cystica?

1. Serum Ca
2. Serum Phos
3. Alk Phos
4. PTH

Answer 651

1. Serum Ca: Increase
2. Serum Phos: Decrease
3. Alk Phos: Increase
4. PTH: Increase

Question 652

1. How would the following lab values be affected in Osteopetrosis?
2. Serum Ca
3. Serum Phos
4. Alk Phos
5. PTH

Answer 652

2. Serum Ca: No change
3. Serum Phos: No change
4. Alk Phos: No change
5. PTH: No change

Question 653

Which primary bone tumor fits each of the following descriptions?

1. Most common malignant primary bone tumor of children
2. Most common malignant primary bone tumor in adults
3. Most common benign bone tumor

Answer 653

1. Most common malignant primary bone tumor of children: Osteosarcoma
2. Most common malignant primary bone tumor in adults: Multiple myeloma
3. Most common benign bone tumor: Osteochondroma

Question 654

Which primary bone tumor fits each of the following descriptions?

1. 11;22 translocation
2. Soap-bubble appearance on x-ray
3. Onion-skin appearance of bone

Answer 654

1. 11;22 translocation: Ewing sarcoma
2. Soap-bubble appearance on x-ray: Giant cell tumor
3. Onion-skin appearance of bone: Ewing sarcoma

Question 655

Which primary bone tumor fits each of the following descriptions?

1. May actually be a hamartoma
2. Codman’s triangle on x-ray
3. Associated with Gardner syndrome

Answer 655

1. May actually be a hamartoma: Osteochondroma
2. Codman’s triangle on x-ray: Osteosarcoma
3. Associated with Gardner syndrome: Osteoma

Question 656

What are the 3 functions of vitamin D?

Answer 656

1. Increase dietary absorption of Ca
2. Increase dietary absorption of phosphate
3. Increase bone absorption of both Ca and phosphate

Question 657

1. How does PTH affect calcium?
2. How does PTH affect phosphate

Answer 657

1. Increases calcium by increasing bone resorption of Ca and increasing renal reabsorption of Ca
2. Decreases phosphate by taking phosphate in bone and excreting it in the urine

Question 658

1. What cell type produces PTH?
2. What cell type produces calcitonin?

Answer 658

1. PTH is secreted by the chief cells of the parathyroid
2. Calcitonin is secreted by the parafollicular “C cells” of the thyroid

Question 659

What are two signs of hypocalcemia?

Answer 659

1. Chvostek’s sign: Tap cheek = contraction of facial muscles
2. Trousseau’s sign: Tighten BP cuff = carpopedal spasm

Question 660

What are the two most common causes of primary hyperparathyroidism?

Answer 660

1. Parathyroid adenoma (90-95%)
2. Parathyroid hyperplasia (5%)

Question 661

What are some possible causes of hypocalcemia?

Answer 661

1. Hypoparathyroidism
   
   • Accidental parathyroidectomy
   • Autoimmune destruction of the parathyroid
   • DiGeorge syndrome
2. Vitamin D deficiency
3. Low calcium in diet
4. Acute pancreatitis

Question 662

What ligaments are typically injured during an ankle sprain?

Answer 662

Lateral ligaments

1. Anterior talofibular ligament
2. Calcaneofibular ligament
3. Posterior talofibular ligament

Question 663

What is the leading cause of knee pain in patients younger than 45?

Answer 663

Patellofemoral syndrome

Question 664

What is the other name for housemaid’s knee?

Answer 664

Prepatellar bursitis

Question 665

Which muscles of the rotator cuff are responsible for each of the following actions?

1. Initial 15 degrees of arm abduction
2. Lateral rotation of arm
3. Medial rotation of arm

Answer 665

1. Initial 15 degrees of arm abduction: Supraspinatus
2. Lateral rotation of arm: Infraspinatus & Teres minor
3. Medial rotation of arm: Subscapularis

Question 666

Which antibiotic class is known to increase the risk of tendon rupture in adults?

Answer 666

Fluoroquinolones

Question 667

By what mechanism do NSAIDS cause renal disease?

Answer 667

NSAIDS prevent prostaglandin synthesis -> Prostaglandins normally optimize renal blood flow -> Less prostaglandins causes contriction of renal vessels and decreased renal perfusion

Question 668

What medications are used in the treatment of an acute gout exacerbation?

Answer 668

1. NSAIDS (Indomethacin)
2. Colchicine (2nd line)
3. Steroids (real world application but prob not an answer for step 1)

Question 669

What drugs can be used in the treatment of chronic gout?

Answer 669

1. Allopurinol (more common)
2. Probenecid

Question 670

What are the classic symptoms of Sjogren syndrome?

Answer 670

Xerophthalmia (dry eyes)

Xerostomia (Dry mouth)

Arthritis

Question 671

What organism causes painless white patches on the tongue that cannot be scraped off?

Answer 671

Hairy Leukoplakia (Caused by EBV)

Question 672

Which skin disorder matches each of the following statements?

1. Pruritic, purple, polygonal papules
2. Life threatening rash with bullae
3. Pruritis associated with asthma
4. Pruritic vesicles associated with celiac disease
5. Allergy to nickle

Answer 672

1. Pruritic, purple, polygonal papules: Lichen Planus
2. Life threatening rash with bullae: Stevens Johnson Syndrom/Toxic Epidermal Necrolysis
3. Pruritis associated with asthma: Atopic dermatitis
4. Pruritic vesicles associated with celiac disease: Dermatitis Herpetiformis
5. Allergy to nickel: Contact dermatitis

Question 673

Which skin disorder matches each of the following statements?

1. Thickened scar especially around face/chest
2. Antibodies against epidermal basement membrane
3. Antibodies against cell-cell adhesions
4. Parakeratotic scaling
5. Keratin-filled cysts

Answer 673

1. Thickened scar especially around face/chest: Keloid
2. Antibodies against epidermal basement membrane: Bullous Pemphigoid
3. Antibodies against cell-cell adhesions: Pemphigus Vulgaris
4. Parakeratotic scaling: Psoriasis
5. Keratin-filled cysts: Seborrheic Keratosis

Question 674

Which skin disorder matches each of the following statements?

1. Sand-paper; predisposition to squamous cell cancer
2. Skin rash and proximal muscle weakness
3. Honey-crusting lesions common about the nose and lips
4. Hyperkeratosis and koilocytosis
5. Histology shows palisading nuclei

Answer 674

1. Sand-paper; predisposition to squamous cell cancer: Actinic keratosis
2. Skin rash and proximal muscle weakness: Dermatomyositis
3. Honey-crusting lesions common about the nose and lips: Impetigo
4. Hyperkeratosis and koilocytosis: Verrucae
5. Histology shows palisading nuclei: Basal cell carcinoma

Question 675

Which fungus matches each of the following statements?

1. Found in SW U.S including west Texas and California
2. Found in Mississippi and Ohio River basins
3. Causses San Joaquin Valley fever
4. Found in rural Latin America
5. Associated with plant thorns and cutaneous injury

Answer 675

1. Found in SW U.S including west Texas and California: Coccidioides immitis
2. Found in Mississippi and Ohio River basins: Histoplasma capsulatum
3. Causses San Joaquin Valley fever: Coccidioides immitis
4. Found in rural Latin America: Paracoccidioides brasiliensis
5. Associated with plant thorns and cutaneous injury: Sporothrix Schenckii

Question 676

Which fungus matches each of the following statements?

1. Found in states east of the Mississippi River
2. Found in bird and bat droppings
3. Mold form contains barrel-shaped arthroconidia
4. Associated with dust storms
5. Broad-based budding of yeast
6. Multiple budding of yeast form

Answer 676

1. Found in states east of the Mississippi River: Blastomyces dermatitidis
2. Found in bird and bat droppings: Histoplasma capsulatum
3. Mold form contains barrel-shaped arthroconidia: Coccidioides immitis
4. Associated with dust storms: Coccidioides immitis
5. Broad-based budding of yeast: Blastomyces dermatitidis
6. Multiple budding of yeast form: Paracoccidioides brasiliensis

Question 677

Which fungus matches each of the following statements?

1. Causes diaper rash
2. Opportunistic mold with septate hyphae that branch at a 45 degree angle
3. Opportunisitic mold with irregular nonseptate hyphae that branch at wide angles (>90 degrees)
4. Causes thrush in immunocompromised patients and vulvovaginitis in women
5. Known for causing pneumonia in AIDS patients -> start Bactrim prophylaxis when CD4 < 200
6. Yeast known for causing meningitis in AIDS patients

Answer 677

1. Causes diaper rash: Candida albicans
2. Opportunistic mold with septate hyphae that branch at a 45 degree angle: Aspergillus fumigatus
3. Opportunisitic mold with irregular nonseptate hyphae that branch at wide angles (>90 degrees): Mucor or Rhizopus
4. Causes thrush in immunocompromised patients and vulvovaginitis in women: Candida albicans
5. Known for causing pneumonia in AIDS patients -> start Bactrim prophylaxis when CD4 < 200: Pneumocystis jirovecii
6. Yeast known for causing meningitis in AIDS patients: Cryptococcus neoformans

Question 678

What infections are associated with birds?

Answer 678

1. Histoplasma
2. Cryptococcus
3. Chlamydophila psitacci
4. West Nile Virus
5. H5N1 influenza

Question 679

An HIV (+) patient with CSF showing 75/mm^3 lymphocytes suddenly dies. Yeast is identified in the CSF. What is the most likely diagnosis?

Answer 679

Cryptococcal meningitis

Question 680

Which antifungal fits each of the following statements?

1. Interferes with microtubule function
2. “Swish and swallow” for oral candidiasis (thrush)
3. Cell wall synthesis inhibitor used in invasive aspergillosis
4. Binds ergosterol -> membrane pores
5. Inhibits ergosterol synthesis

Answer 680

1. Interferes with microtubule function: Griseofulvin
2. “Swish and swallow” for oral candidiasis (thrush): Nystatin
3. Cell wall synthesis inhibitor used in invasive aspergillosis: Caspofungin
4. Binds ergosterol -> membrane pores: Nystatin and Amphotericin B
5. Inhibits ergosterol synthesis: Azoles and Terbinafine

Question 681

Which antifungal fits each of the following statements?

1. Most common treatment for onychomycosis
2. SE: arrythmias and nephrotoxicity
3. Deposits in heratin-containing tissues
4. Inhibits hormone synthesis and cytochrome P450
5. SE: Liver dysfunction

Answer 681

1. Most common treatment for onychomycosis: Terbinafine, Itraconazole, Fluconazole
2. SE: arrythmias and nephrotoxicity: Amphotericin B
3. Deposits in keratin-containing tissues: Griseofulvin
4. Inhibits hormone synthesis and cytochrome P450: Azoles (particularly Ketoconazole)
5. SE: Liver dysfunction: Azoles and Griseofulvin

Question 682

Which antifungal fits each of the following statements?

1. SE: teratogenic, carcinogenic
2. Used for cryptococcal meningitis in AIDS
3. Converted to fluorouracil, inhibits DNA synthesis
4. Drug of choice for sporotrichosis

Answer 682

1. SE: teratogenic, carcinogenic: Griseofulvin
2. Used for cryptococcal meningitis in AIDS: IV Amphotericin B + Flucytosine
3. Converted to fluorouracil, inhibits DNA synthesis: Flucytosine
4. Drug of choice for sporotrichosis: Itraconazole

Question 683

Which antifungal can be used intrathecally for fungal meningitis?

Answer 683

Amphotericin B

Question 684

What is the clinical use and side effects of Griseofulvin?

Answer 684

1. Used for superficial fungal infections
   
   • Dermatophytes (Ring worm and athletes foot)
   • Tinea capitis
   • Tinea unguium
2. Side effects
   
   • Teratogenic and carcinogenic effects
   • Confusion/headache
   • Cytochrome P450 inducer
   • Hepatotoxicity

Question 685

What 5 drug classes are used in the treatment of glaucoma?

Answer 685

1. Beta blockers
2. Alpha agonists
3. Prostaglandins
4. Diuretics (acetazolamide and Mannitol)
5. Direct or indirect cholinomimetics

Question 686

How does the optic disc appearance differ in glaucoma when compared to hydrocephalus?

Answer 686

1. Glaucoma: Cupping of the optic disk
2. Hydrocephalus: Papilledema

Question 687

Light stimulus in patient’s right eye produces bilateral pupillary constriction. When the light is shown in the left eye, there is a paradoxical bilateral pupillary dilatation. What is the defect?

Answer 687

Afferent pupillary defect

Question 688

What is the treatment for dry age-related macular degeneration?

Answer 688

1. Cessation of smoking
2. Daily supplementation with antioxidant vitamins

Question 689

A patient with vertigo, tinnitus, and hearing loss. What is the diagnosis?

Answer 689

Meniere disease (Endolymphatic hydrops)

Question 690

Which organisms are most commonly responsible for acute otits media?

Answer 690

1. Strep pneumo
2. Haemophilus influenza (non-typeable)
3. Moraxella catarrhalis

Question 691

What organism is most commonly responsible for otitis externa?

Answer 691

Pseudomonas aeruginosa

Question 692

Chronic otitis media can sometimes result in a cystic lesion that is lined by keratinizing squamous epithelium which can be metaplastic, that is filled with amorphous debris. What is the name of this condition?

Answer 692

Cholesteatoma

Question 693

What structure of the brain is responsible for mental alertness?

Answer 693

Reticular activating system

Question 694

What psychosocial crisis are most 25 year-old working through?

Answer 694

Intamacy vs isolation

Question 695

What is the order of human needs as described by Maslow?

Answer 695

1. Physiological needs
2. Safety needs
3. Love and belonging
4. Esteem
5. Self-actualization

Question 696

Which portion of the brain is responsible for delayed gratification?

Answer 696

Prefrontal cortex

Question 697

Which portion of the brain is responsible for memory?

Answer 697

Hippocampus

Question 698

What term applies to the growth of new neurons?

Answer 698

Neurogenesis

Question 699

What name is given to chronic compulsive hair pulling common in young girls?

Answer 699

Trichotillomania

Question 700

What stimulant medications are commonly used in the treatment of ADHD?

Answer 700

1. Methylphenidate
2. Dextroamphetamine

Question 701

Which childhood psychiatric disorder matches each of the following statements?

1. Females only, loss of previously acquired purposeful hand skills between 6-30 months
2. Impairments in social interactions, communications, play, repetitive behaviors
3. Impairment insocial interaction (but not avoidance), no language delay

Answer 701

1. Females only, loss of previously acquired purposeful hand skills between 6-30 months: Rett disorder
2. Impairments in social interactions, communications, play, repetitive behaviors: Autism
3. Impairment insocial interaction (but not avoidance), no language delay: Aspergers

Question 702

Which childhood psychiatric disorder matches each of the following statements?

1. Stereotyped hand movements
2. Ignoring the basic rights of others
3. Characterized by hostility, annoyance, vindictiveness, disobedience, and resentfulness

Answer 702

1. Stereotyped hand movements: Rett disorder
2. Ignoring the basic rights of others: Conduct disorder
3. Characterized by hostility, annoyance, vindictiveness, disobedience, and resentfulness: Oppositional Defiant disorder

Question 703

Which childhood psychiatric disorder matches each of the following statements?

1. Multiple motor and vocal tics
2. Impulsive and inattentive
3. 7-year-old that avoids going to school to stay home with parent

Answer 703

1. Multiple motor and vocal tics: Tourettes syndrome
2. Impulsive and inattentive: ADHD
3. 7-year-old that avoids going to school to stay home with parent: Separation anxiety

Question 704

What is the difference between binge eating disorder and compulsive eating disorder?

Answer 704

Binge eating disorder

1. Negative feelings towards food
2. Binges are and expression of a deeper problem

Compulsive eating disorder

1. Patient is obsessed with food

Question 705

What are the stages of behavioral change?

Answer 705

1. Precontemplation
2. Contemplation
3. Preparation
4. Action
5. Maintainance
6. +/- Relapse

Question 706

What is the mechanism of action of the drug disulfuram?

Answer 706

Inhibit Acetaldehyde Dehydrogenase

Question 707

What other drugs have a disulfuram-like reaction?

Answer 707

1. Metronidazole
2. Cephalosporins
3. 1st generation Sulfonylureas
4. Procarbazine

Question 708

What drug intoxication or withdrawal is causing the following symptoms in each of the following patients?

1. Post-op constipations and/or respiratory depression
2. Severe depression, headache, fatigue, insomnia/hypersomnia, hunger
3. Pinpoint pupils, N/V, seizures

Answer 708

1. Post-op constipations and/or respiratory depression: Opioid use
2. Severe depression, headache, fatigue, insomnia/hypersomnia, hunger: Amphetamine or cocaine withdrawal
3. Pinpoint pupils, N/V, seizures: Opiod overdose

Question 709

What drug intoxication or withdrawal is causing the following symptoms in each of the following patients?

1. Belligerence, impulsiveness, nystagmus, homicidal ideations, psychosis
2. Headache, anxiety/depression, weight gain
3. Anxiety/depression, delusions, hallucinations, flashbacks

Answer 709

1. Belligerence, impulsiveness, nystagmus, homicidal ideations, psychosis: PCP overdose
2. Headache, anxiety/depression, weight gain: Smoking or caffiene withdrawal
3. Anxiety/depression, delusions, hallucinations, flashbacks: LSD intoxication

Question 710

What drug intoxication or withdrawal is causing the following symptoms in each of the following patients?

1. Euphoria, social withdrawal, impaired judgement, hallucinations
2. Rebound anxiety, tremors, seizures, life-threatening
3. Anxiety, piloerection, yawning, fever, rhinorrhea, nausea, diarrhea

Answer 710

1. Euphoria, social withdrawal, impaired judgement, hallucinations: Marijuana intoxication
2. Rebound anxiety, tremors, seizures, life-threatening: Alcohol, benzodiazepine, or barbituate withdrawals
3. Anxiety, piloerection, yawning, fever, rhinorrhea, nausea, diarrhea: Opioid withdrawal

Question 711

What weak opioid agonist is commonly used in chronic pain control prior to prescribing stronger opioids?

Answer 711

Tramadol

Question 712

What is the treatment for a patient that is overly intoxicated with each of the following substances?

1. Alcohol
2. Benzodiazepines
3. PCP
4. Opioids

Answer 712

1. Alcohol: Fluids, respiratory and blood alcohol monitoring, time
2. Benzodiazepines: Flumazenil
3. PCP: Benzodiazepines or Haloperidol
4. Opioids: Naltrexone or Naloxone

Question 713

What are the usual components of a “dementia work-up”?

Answer 713

1. Mini-mental-status exam
2. Syphilis and HIV screen
3. Head MRI/CT
4. Serum TSH
5. Serum vitamin B12

Question 714

Why is Alzheimer disease more common in patients with Down syndrome?

Answer 714

3 copies of the APP gene on chromosome 21

Question 715

What is the mechanism of action of the drugs used in the treatment of Alzheimer disease?

Answer 715

1. Cholinesterase inhibitors: Prolong the action of Ach
2. Memantine: Antagonist at the NMDA glutamate receptor

Question 716

A 72 year-old patient of yours is not able to recall 3 objects on a mini-mental status exam. When asked what he would do if he smelled smoke in a movie theater, he replies that he would yell “fire.” When asked what a table and chair have in common he replies that they both have 4 legs and are made of wood. The family reports that for the past year someone has had to stay with him at all times for his own safety and that he stays awake all day and sleeps well at night. What is the most likely diagnosis in this patient?

Answer 716

Dementia

Question 717

A 72 year old patient of yours is brought into the clinic by his family because of strange behaviors over the past week. She has been very agitated recently, takes many naps during the day, occasionally urinates on herself, and has had a poor appetite. It is difficult for you to administer th MMSE because she is unable to focus her attention on the questions. What is the most likely diagnosis?

Answer 717

Delirium

Question 718

What features allow you to distinguish a migraine from a cluster headache or tension headache?

Answer 718

Migraine

1. Might have an aura
2. Nausea/vomiting
3. Photophobia/phonophobia
4. Unilateral
5. Throbbing
6. Time frame: 24-48 hours

Cluster

1. Might have tearing/rhinorrhea
2. Occur daily at certain clusters of time
3. Timeframe: 30 min - 3 hrs

Tension

1. Frontal/occipital pain
2. Time frame: Long period of time

Question 719

What is the mechanism of action of Sumatriptan?

Answer 719

Serotonin receptor (1B & 1D) agonist

Question 720

What are the contraindications to sumatriptan use?

Answer 720

1. CAD
2. Prinzmetal’s angina
3. Pregnancy

Question 721

What is the usual treatment for migraine headaches in pregnancy?

Answer 721

Opioids

Question 722

What would you suspect as a cause of headache in a patient using topical retinoic acid for acne?

Answer 722

Vitamin A toxicity causing Pseudotumor cerebri (a neurological disorder that is characterized by increased intracranial pressure in the absence of a tumor or other diseases)

Question 723

A 20 year-old woman that has migraine headaches each proceeded by an aura should never be prescribed which medication?

Answer 723

OCP

This does not apply to migraines without aura

Question 724

What are the 3 most common primary brain tumors in adults? What are the 3 most common in children?

Answer 724

Adult

1. Glioblastoma
2. Meningioma
3. Schwanoma

Child

1. Pilocytic astrocytoma
2. Medulloblastoma
3. Ependymoma

Question 725

Which primary brain tumor fits each of the following descriptions?

1. Pseudopalisading necrosis
2. Polycythemia
3. Neruofibromatosis II
4. Associated with von-Hippel-Lindau syndrome

Answer 725

1. Pseudopalisading necrosis: Glioblastoma multiforme
2. Polycythemia: Hemangioblastoma
3. Neruofibromatosis II: Schwannoma
4. Associated with von-Hippel-Lindau syndrome: Hemangioblastoma

Question 726

Which primary brain tumor fits each of the following descriptions?

1. Foamy cells, high vascularity
2. Hyperprolactinemia -> galactorrhea, amenorrhea, anovulation
3. Psammoma bodies

Answer 726

1. Foamy cells, high vascularity: Hemangioblastoma
2. Hyperprolactinemia -> galactorrhea, amenorrhea, anovulation: Pituitary adenoma
3. Psammoma bodies: Meningioma

Question 727

Which primary brain tumor fits each of the following descriptions?

1. Fried-egg appearance
2. Perivascular pseudorosettes
3. Bitemporal hemianopia

Answer 727

1. Fried-egg appearance: Oligodendroglioma
2. Perivascular pseudorosettes: Ependymoma
3. Bitemporal hemianopia: Pituitary adenoma or Craniopharyngioma

Question 728

Which primary brain tumor fits each of the following descriptions?

1. Worst prognosis of any primary brain tumor
2. Child with hydrocephalus
3. Homer-Wright pseudorosettes

Answer 728

1. Worst prognosis of any primary brain tumor: Glioblastoma multiforme
2. Child with hydrocephalus: Medulloblastoma or Ependymoma
3. Homer-Wright pseudorosettes: Medulloblastoma

Question 729

Which anesthetic fits each of the following descriptions?

1. IV, associated with hallucinations and bad dreams
2. IV, most common drug used for conscious sedation
3. Inhaled, side-effect of hepatotoxicity

Answer 729

1. IV, associated with hallucinations and bad dreams: Ketamine
2. IV, most common drug used for conscious sedation: Midazolam + Fentanyl
3. Inhaled, side-effect of hepatotoxicity: Halothane

Question 730

Which anesthetic fits each of the following descriptions?

1. IV, used for rapid anesthesia induction and short duration of action
2. IV, decreased cerebral blood flow (important in brain surgery)

Answer 730

1. IV, used for rapid anesthesia induction and short duration of action: Propofol
2. IV, decreased cerebral blood flow (important in brain surgery): Barbituates (Thiopental)

Question 731

Which anesthetic fits each of the following descriptions?

1. Opioid that does not induce histamine release
2. High triglyceride content increase the risk of pancreatitis with long-term use

Answer 731

1. Opioid that does not induce histamine release: Fentanyl
2. High triglyceride content increase the risk of pancreatitis with long-term use: Propofol

Question 732

What is the mechanism of action of Dantrolene?

Answer 732

Prevents release of Ca from sarcoplasmic reticulum of skeletal muscle

Question 733

1. What is the mechanism of action of local anesthetics?
2. Which nerve fibers are blocked first with local anethesia?

Answer 733

1. Block Na channels
2. Order of blockade
   
   1. Small myelinated fibers
   2. Small unmyelinated fibers
   3. Large myelinated fibers
   4. Large unmyelinated fibers

Question 734

What drugs can be used to reverse neuromuscular blockade?

Answer 734

Acetylcholinesterase inhibitors (neostigmine)

Question 735

In regards to seizures, what do the terms partial, simple, complex, and generalized mean?

Answer 735

1. Partial: Localized to a specific area of the brain (IE temporal lobe)
2. Simple: No alteration in consciousness
3. Complex: Alteration in consciousness
4. Generalized: Over the entire brain

Question 736

What are the most common causes of seizures in children?

Answer 736

1. Genetic/congenital
2. Infection
3. Trauma
4. Metabolic disturbances

Question 737

a 10 year-old child “spaces-out” in class (stops talking midsentence and then continues as if nothing had happened). During the spells, there is slight quivering of lips. What is the diagnosis?

Answer 737

Petite mal (absence seizure)

Question 738

What drugs are known for causing Stevens-Johnson syndrome?

Answer 738

1. Seizure drugs: Phenytoin, Carbamazepine, Phenobarbital, Lamotrigine, Ethosuximide
2. Sulfonamides
3. Penicillins
4. Allopurinol

Question 739

1. How is barbiturate overdose managed?
2. How is benzodiazepine overdose managed?

Answer 739

1. Supportive/symptomatically (no antidote)
2. Flumazenil

Question 740

What side effects are common to most all of the anti-epileptics?

Answer 740

1. Sedation
2. Diplopia
3. Ataxia
4. Stevens-Johnson Syndrome

Question 741

What are the toxic side effects of phenytoin?

Answer 741

1. “More gums”: Gingival hyperplasia
2. “More hair”: Hirsutism
3. “More messed up babies”: Fetal Hydantoin syndrome (Cleft lip/palate, congenital heart defects, mental retardation, developmental delays)
4. Induces P450
5. Can cause Stevens-Johnson Syndrome
6. Can cause drug induced lupus

Question 742

What are some of the positive symptoms of schizophrenia? What are some of the negative symptoms?

Answer 742

Positive symptoms

1. Delusions
2. Hallucinations (especially auditory)
3. Disorganized speech
4. Disorganized/catatonic behavior

Negative symptoms

1. Flat affect
2. Social withdrawal
3. Lack of motivation
4. Lack of speech (alogia)
5. Thought blocking
6. Poor grooming

Question 743

Categorize the following antipsychotics in the appropriate category as neurleptics (low or high potency) or atypical antipsychotics:

1. Olanzapine
2. Thioridazine
3. Quetiapine

Answer 743

1. Olanzapine: Atypical antipsychotic
2. Thioridazine: Low potency neuroleptic
3. Quetiapine: Atypical antipsychotic

Question 744

Categorize the following antipsychotics in the appropriate category as neurleptics (low or high potency) or atypical antipsychotics:

1. Chlorpromazine
2. Haloperidol
3. Fluphenazine

Answer 744

1. Chlorpromazine: Low potency neuroleptic
2. Haloperidol: High potency neuroleptic
3. Fluphenazine: High potency neuroleptic

Question 745

Categorize the following antipsychotics in the appropriate category as neurleptics (low or high potency) or atypical antipsychotics:

1. Loxapine
2. Risperidone
3. Thiothixene

Answer 745

1. Loxapine: High potency neuroleptic
2. Risperidone: Atypical antipsychotic
3. Thiothixene: High potency neuroleptic

Question 746

Categorize the following antipsychotics in the appropriate category as neurleptics (low or high potency) or atypical antipsychotics:

1. Trifluoperazine
2. Clozapine
3. Aripiprazole

Answer 746

1. Trifluoperazine: High potency neuroleptic
2. Clozapine: Atypical antipsychotic
3. Aripiprazole: Atypical antipsychotic

Question 747

What are the clinical features of neuroleptic malignant syndrome?

How is it treated?

Answer 747

Symptoms

1. Delirium and mental status changes
2. Autonomic instability
3. Muscle rigidity
4. Myoglobinuria
5. Hyperpyrexia

Treatment

1. Bromocriptine: Restore Dopamine transmission
2. Dantrolene: Stop muscle contraction

Question 748

What are the criteria for the diagnosis of mania?

Answer 748

“DIG FAST”

1. Distractibility
2. Irresponsibility
3. Grandiosity
4. Flight of ideas
5. Activity/agitation
6. Sleep (decreased need)
7. Talkativeness

Question 749

What mood stabilizers are used in the treatment of bipolar disorder?

Answer 749

1. Lithium
2. Seizure medications: Valproic acid, Carbamazepine, and Lamotrigine
3. Atypical antipsychotics: Risperidone, Aripiprazole, and Olanzapine

Question 750

What are the potential side effects of lithium?

Answer 750

1. Teratogenic (Ebstein Anomaly)
2. Polyuria, possible diabetes insipidus
3. Arrhythmias
4. Hypothyroidism
5. Tremor
6. Sedation
7. Lethargy
8. Dizziness

Question 751

What are the criteria for the diagnosis of a major depressive episode?

Answer 751

“SIG E CAPS”

1. Sleep
2. Interest (anhydonia)
3. Guilt/worthlessness
4. Energy
5. Concentration
6. Appetite
7. Psychomotor agitation/retardation
8. Suicidal ideation
9. Depressed mood
10. Must have 5/9 including depressed mood or anhydonia for a perior of 2 weeks

Question 752

What is atypical depression?

Answer 752

1. Hypersomnia
2. Hyperphagia (weight gain)
3. Mood reactivity
4. Rejection hypersensitivity

Question 753

A patient mentions that he has had thoughts of suicide. What question should you ask to help determine how high-risk he is?

Answer 753

“SAD PERSONS”

1. Sex (male?)
2. AGE (Teenager or elderly?)
3. Depression
4. Previous attempts
5. Ethanol/drug use
6. Rational thought +/-
7. Sickness (medical illness)
8. Organized plan
9. Social/spousal support +/-
10. Stated future intent

Question 754

A patient tries to commit suicide by slitting her wrists. After she is appropriately managed in the ER, what question would you ask the patient in order to determine her level of commitment of trying to take her own life?

Answer 754

“What did you do after the suicide attempt”

Trying to assess how serious the attempt was or if it was more of a cry for help than an actual attempt

Question 755

A 28 year-old woman has symptoms of mild depression for 6 years. What is the diagnosis?

Answer 755

Dysthymia

Question 756

What is the mechanism of action of each of the following medication classes?

1. SSRI
2. SNRI
3. TCA
4. MAOI

Answer 756

1. SSRI: Inhibits the reuptake of serotonin
2. SNRI: Inhibits the reuptake of serotonin and norepinephrine
3. TCA: Inhibits the reuptake of serotonin and norepinephrine
4. MAOI: Inhibits the enzyme (MAO) that metabolizes and inactivates norepinephrine (also Serotonin and Dopamine)

Question 757

Name the 5 SSRIs

Answer 757

“FLashbacks PARalyze SEnior CITizens”

1. Fluoxetine
2. Paroxetine
3. Sertaline
4. Citalopram

also Fluvoxamine

Question 758

Name the 3 SNRIs

Answer 758

1. Venlafaxine
2. Duloxetine
3. Milnacipran

Question 759

Name the 7 TCAs

Answer 759

1. Nortiptyline (less anticholinergic side effects)
2. Clomipramine
3. Imipramine
4. Amytriptyline
5. Desipramine (less sedating and higher seizure threshold)
6. Doxepin
7. Amoxapine

Question 760

Name the 4 MAOIs

Answer 760

“MAO Takes Pride In Shanghi”

1. Tranylcypromine
2. Phenelzine
3. Isocarboxazid
4. Selegiline

Question 761

Name the NDRI (NE and DA reuptake inhibitor)

Answer 761

Bupropion

Question 762

Name the 2 tetracyclic antidepressants

Answer 762

1. Trazodone
2. Mirtazapine

Question 763

Which antidepressant matches each of the following statements?

1. SE: Priapism
2. Lowers the seizure threshold
3. Works well with SSRIs and increases REM sleep

Answer 763

1. SE: Priapism: Trazodone
2. Lowers the seizure threshold: Bupropion & TCAs
3. Works well with SSRIs and increases REM sleep: Trazodone

Question 764

Which antidepressant matches each of the following statements?

1. Appetite stimulant that is likely to result in weight gain
2. Can be used for smoking cessation
3. Can be used for bedwetting in children

Answer 764

1. Appetite stimulant that is likely to result in weight gain: Mirtazapine
2. Can be used for smoking cessation: Bupropion
3. Can be used for bedwetting in children: Imipramine

Question 765

What are the symptoms of TCA overdose?

Answer 765

1. Convulsions (causing hyperpyrexia)
2. Coma
3. Cardiotoxicity
4. Respiratory depression

Question 766

What are the symptoms of serotonin syndrome?

Answer 766

1. Muscle rigidity
2. Hyperthermia
3. Cardiovascular collapse

Question 767

What happens if you ingest tyramine while on MAOIs?

Answer 767

1. Hypertensive crisis
2. Hemorrhagic stroke
3. Cardiac arrhythmias

Question 768

A patient on whom you wish to obtain an MRI tells you that he cannot go through with it because of claustrophobia. What can you do to help this patient?

Answer 768

Give him a benzodiazepine

Question 769

A young woman that is anxious about receiving her first pap smear is told to relax and to imagine foing through the steps of the exam. What does this process exemplify?

Answer 769

Systematic desensitization

Question 770

A woman has flashbacks about her boyfriend’s death one month ago following a hit-and-run accident. She often cries and wishes for the death of the culprit. What is the diagnosis?

Answer 770

Normal bereavement but bordering on post-traumatic stress disorder

Question 771

A nurse has episodes of hypoglycemia. Blood analysis reals no elevation in C-peptide. What is her diagnosis?

Answer 771

Insulin-induced hypoglycemia due to poorly controlled diabetes, Factitious disorder, or Malingering

Question 772

What somatoform disorder matches each of the following descriptions?

1. Unexplained pain
2. Patient with normal anatomy is convinced a part of their anatomy is abnormal
3. Unexplained loss of sensory or motor function (tests and PE are negative)

Answer 772

1. Unexplained pain: Pain disorder
2. Patient with normal anatomy is convinced a part of their anatomy is abnormal: Body dysmorphic disorder
3. Unexplained loss of sensory or motor function (tests and PE are negative): Conversion disorder

Question 773

What somatoform disorder matches each of the following descriptions?

1. Unwavering belief by the patient that she has a specific disease (despite medical reassurance)
2. Unexplained complaints in multiple organ systems
3. False belief of being pregnant

Answer 773

1. Unwavering belief by the patient that she has a specific disease (despite medical reassurance): Hypochondriasis
2. Unexplained complaints in multiple organ systems: Somatization disorder
3. False belief of being pregnant: Pseudocyesis

Question 774

What defense mechanism fits each of the following statements?

1. Voluntarily choosing not to think about a piece of bad news
2. Not acknowledging a piece of bad news, as though it was never said
3. Involuntary withholding of a feeling from conscience awareness

Answer 774

1. Voluntarily choosing not to think about a piece of bad news: Suppression
2. Not acknowledging a piece of bad news, as though it was never said: Denial
3. Involuntary withholding of a feeling from conscience awareness: Repression

Question 775

What defense mechanism fits each of the following statements?

1. A veteran that can describe horrific war details without any emotion
2. A child abuser was himself abused as a child
3. Man yells at his family when he has a bad day at work

Answer 775

1. A veteran that can describe horrific war details without any emotion: Isolation
2. A child abuser was himself abused as a child: Identification
3. Man yells at his family when he has a bad day at work: Displacement

Question 776

A 65 year-old asks her husband to stay in the hospital overnight with her because she is afraid to be alone. What defense mechanism is she exhibiting?

Answer 776

Regression

Question 777

Which defense mechanism underlies all other defense mechanisms?

Answer 777

Repression

Question 778

A 60 year-old man, admitted for chest pain, jumps out of bed and does 50 push-ups to show the nurses he has not had a heart attack. What defense mechanism is he using?

Answer 778

Denial

Question 779

A 40 year-old woman tells you during one of her office visits that she is in love with you. You refer her to someone else, and she attempts suicide. What type of personality disorder does this patient have?

Answer 779

Borderline personality disorder

Question 780

A 30 year-old woman tells you during one of her office visits that you are the best doctor she’s ever had but that your nurse is very disrespectful. On a subsequent visit, she threatens to change doctors because you do not feel a particular lab test is necessary. Additionally, you notice several symmetrical cuts on her left forearm which she attributes to cat scratches. What type of personality disorder does this person have?

Answer 780

Borderline personality disorder

She is also exhibiting splitting (defense mechanism)

Question 781

A 55 year-old woman comes to your office wearing all black including a black miniskirt and black feather boa. She also is wearing an excessive amount of lipstick, and you notice her having conversations with many of the other patients in the waiting room. What type of personality disorder do you suspect in this patient?

Answer 781

Histrionic personality disorder

Question 782

A person demands only the best and most famous doctor in town. What personality disorder does this person have?

Answer 782

Narcissistic personality disorder

Question 783

What are the cluster A personality disorders?

Answer 783

“Weird”

1. Paranoid
2. Schizoid
3. Schizotypal

Question 784

What are the Cluster B personality disorders?

Answer 784

“Wild”

1. Antisocial
2. Borderline
3. Histrionic
4. Narcissistic

Question 785

What are the Cluster C personality disorders?

Answer 785

“Worried”

1. Avoidant
2. Obsessive-Compulsive
3. Dependent

Question 786

What artery prevents a horseshoe kidney from ascending in the abdomen?

Answer 786

Inferior mesenteric artery

Question 787

A 40 year-old patient of yours weighs 100Kg. What is her estimated plasma volume?

Answer 787

60% of body weight is water

2/3s of that is intracellular

1/3 of 60% of 100kg = 20 kg = 20L

25% of that 20L of extracellular fluid is plasma (the rest is interstitial fluid)

25% of 20L = 5L

Question 788

What fundamental problem creates Potter syndrome?

Answer 788

Oligohydramnios

Usually from bilateral renal agenesis

Question 789

What cell type releases renin?

Answer 789

Juxtoglomerular cells

Question 790

What effect will a renal stone that obstructs the ureter have on GFR and FF?

Answer 790

1. Decreased GFR
2. Decreased Filtration fraction

Question 791

What is the maximal serum glucose concentration at which glucose can be absorbed in the tubules?

Answer 791

350 mg/dl

Question 792

What vitamin deficiency results from Hartnup disease?

Answer 792

Deficiency of tryptophan, leading to Niacin (B3) deficiency (Pellagra)

Question 793

1. What substances can be used to estimate GFR?
2. What substances can be used to estimate renal plasma flow?

Answer 793

1. Creatinine, Inulin
2. Para-aminohippurate (PAH)

Question 794

What is the equation for the renal clearance of any substance?

Answer 794

Clearance = UV/P

1. U = urine concentration of substance
2. V = Urine flow rate
3. P = Plasma concentration of substance

Question 795

What segment of the renal tubule matches the following statements?

1. Rebsorbs 67% of the fluid and electrolytes filtered by the glomerulus
2. Segment responsible for concentrating urine
3. Site of secretion of organic anions and cations
4. Always impermeable to water
5. Permeable to water only in the presence of ADH

Answer 795

1. Rebsorbs 67% of the fluid and electrolytes filtered by the glomerulus: PCT
2. Segment responsible for concentrating urine: Collecting duct
3. Site of secretion of organic anions and cations: PCT
4. Always impermeable to water: Thick ascending limb
5. Permeable to water only in the presence of ADH: Late DCT and collecting duct

Question 796

What segment of the renal tubule matches the following statements?

1. Site of the Na/2Cl/K co-transporter
2. Site of isotonic fluid reabsorption
3. Site responsible for diluting urine
4. Only site where glucose and amino acids are reabsorbed
5. Water reabsorption in the loop of Henle

Answer 796

1. Site of the Na/2Cl/K co-transporter: Thick ascending limb
2. Site of isotonic fluid reabsorption: PCT
3. Site responsible for diluting urine: Thick ascending loop
4. Only site where glucose and amino acids are reabsorbed: PCT
5. Water reabsorption in the loop of Henle: Thin descending limb

Question 797

What are the two main cell types of the collecting duct?

Answer 797

1. Principle cells
2. Intercalated cells

Question 798

What affect does aldosterone have on the intercalated cells and principle cells of the collecting duct?

Answer 798

1. Intercalated cells: Increases H⁺ (acid) secretion
2. Principal cells: Increases Na reabsorption (water follows sodium) and K secretion

Question 799

What class of drugs inhibits the Na/2Cl/K symporter in the nephron?

Answer 799

Loop diuretics

Question 800

What type of diuretic is each of the following drugs?

1. Triamterene
2. Acetazolamide
3. Hydrochlorothiazide
4. Bumetanide
5. Spironolactone

Answer 800

1. Triamterene: K sparing
2. Acetazolamide: Carbonic anhydrase inhibitor
3. Hydrochlorothiazide: Thiazide
4. Bumetanide: Loop
5. Spironolactone: K sparing

Question 801

What type of diuretic is each of the following drugs?

1. Chlorthiazide
2. Ethacrynic acid
3. Mannitol
4. Metolazone

Answer 801

1. Chlorthiazide: Thiazide
2. Ethacrynic acid: Loop
3. Mannitol: Osmotic
4. Metolazone: Thiazide

Question 802

What type of diuretic is each of the following drugs?

1. Chlorthalidone
2. Furosemide
3. Amiloride
4. Torsemide

Answer 802

1. Chlorthalidone: Thiazide
2. Furosemide: Loop
3. Amiloride: K sparing
4. Torsemide: Loop

Question 803

What diuretic or class of diuretics would be most useful in each of the following situations?

1. Acute pulmonary edema
2. Idiopathic hypercalciuria (-> calcium stones)
3. Glaucoma
4. Mild to moderate CHF with expanded ECV

Answer 803

1. Acute pulmonary edema: Loop
2. Idiopathic hypercalciuria (-> calcium stones): Thiazide
3. Glaucoma: Acetazolamide or Mannitol
4. Mild to moderate CHF with expanded ECV: Loop (or thiazide since its mild CHF)

Question 804

What diuretic or class of diuretics would be most useful in each of the following situations?

1. In conjunction with loop or thiazide diuretics to retain K
2. Edema associated with nephrotic syndrome
3. Increased intracranial pressure
4. Mild to moderate hypertension

Answer 804

1. In conjunction with loop or thiazide diuretics to retain K: K sparing
2. Edema associated with nephrotic syndrome: Loop
3. Increased intracranial pressure: Mannitol
4. Mild to moderate hypertension: Thiazide

Question 805

What diuretic or class of diuretics would be most useful in each of the following situations?

1. Hypercalcemia
2. Altitude sickness
3. Hyperaldosteronism

Answer 805

1. Hypercalcemia: Loop
2. Altitude sickness: Acetazolamide
3. Hyperaldosteronism: **K sparing direct aldosterone inhibitors (Spironolactone, Eplerenone) **

Question 806

What is the site of action of Mannitol?

Answer 806

PCT

Question 807

What is the site of action of thiazides?

Answer 807

Early DCT

Question 808

A patient with heart failure exacerbation needs medial diuresis but has a sulfa allergy. What diuretic can be used?

Answer 808

Ethacrynic acid

Question 809

What factors/substances cause hyperkalemia?

Answer 809

1. Acidosis
2. Insulin deficiency
3. Beta-blockers
4. Digoxin
5. Cellular lysis
6. Potassium sparing diuretics
7. ACE inhibitors

Question 810

What factors/substances cause hypokalemia?

Answer 810

1. Loops and thiazides
2. Insulin
3. Beta agonists
4. Alkalosis
5. Cell proliferation

Question 811

What are the actions of angiotensin II?

Answer 811

1. Vasoconstriction
2. Stim aldosterone secretion

Question 812

Which electrolyte disturbance fits each of the following presentations?

1. Correcting too rapidly may result in central pontine myelinosis
2. Peaked T waves
3. Tetany

Answer 812

1. Correcting too rapidly may result in central pontine myelinosis: Hyponatremia
2. Peaked T waves: Hyperkalemia
3. Tetany: Hypocalcemia

Question 813

Which electrolyte disturbance fits each of the following presentations?

1. Arrhythmias
2. Decreased deep tendon reflexxes
3. Flattened T waves, U waves on EKG

Answer 813

1. Arrhythmias: Hyper/Hypo-kalemia, Hypomagnesia
2. Decreased deep tendon reflexes: Hypermagnesia
3. Flattened T waves, U waves on EKG: Hypokalemia

Question 814

What are the causes of acidosis with an elevated anion gap?

Answer 814

“MUDPILES”

1. Methanol
2. Uremia
3. DKA
4. Propylene glycol
5. Iron tablets or Isoniazid
6. Lactic acidosis
7. Ethylene glycol
8. Salicylates

Question 815

What are the diagnostic features of diabetes insipidus?

Answer 815

1. Polyuria: Urine has low specific gravity and low urine osmolarity
2. Water deprivation test: Urine osmolality does not rise

Question 816

What are the defining features of nephrotic syndrome?

Answer 816

1. Proteinuria > 3.5 g/day
2. Hyperlipidemia
3. Edema (Due to hypoalbuminemia)

Question 817

Why is it important to treat Strep throat in children or in those that could transmit Strep pyogenes to a child?

Answer 817

To avoid rheumatic fever

You cant really prevent post streptococcal glomerulonephritis

Question 818

Which glomerular disease would you suspect most in a patient with the following findings?

1. Granular pattern of immune complex deposition; LM: Hypercellular glomeruli
2. Linear pattern of immune complex deposition
3. Deposition of IgG, IgM, IgA, and C3 in the mesangium
4. Anti-GBM antibodies, hematuria, hemoptysis

Answer 818

1. Granular pattern of immune complex deposition; LM: Hypercellular glomeruli: Acute poststreptococcal Glomerulonephritis
2. Linear pattern of immune complex deposition: Goodpastures syndrome
3. Deposition of IgG, IgM, IgA, and C3 in the mesangium: IgA nephropathy (Berger’s disease)
4. Anti-GBM antibodies, hematuria, hemoptysis: Goodpastures syndrome

Question 819

Which glomerular disease would you suspect most in a patient with the following findings?

1. Nephritis, deafness, cataracts
2. Crescent formation in the glomeruli
3. Wire-loop appearance
4. Most common nephrotic syndrome in children

Answer 819

1. Nephritis, deafness, cataracts: Alport syndrome
2. Crescent formation in the glomeruli: Rapidly progressive (Crescentic) glomerulonephritis
3. Wire-loop appearance: SLE (Diffuse proliferative glomerulonephritis)
4. Most common nephrotic syndrome in children: Minimal Change disease

Question 820

Which glomerular disease would you suspect most in a patient with the following findings?

1. IF: granular pattern of immune complex depostion; LM: Diffuse capillary thickening
2. Kimmelstiel-Wilson lesions (Nodular glomerulosclerosis)
3. Most common nephrotic syndrome in adults
4. EM: loss of epithelial foot processes

Answer 820

1. IF: granular pattern of immune complex depostion; LM: Diffuse capillary thickening: Membranous glomerulonephritis
2. Kimmelstiel-Wilson lesions (Nodular glomerulosclerosis): Diabetic glomerulonephropathy
3. Most common nephrotic syndrome in adults: Focal segmental glomerulosclerosis
4. EM: loss of epithelial foot processes: Membranoproliferative glomerulonephritis

Question 821

Which glomerular disease would you suspect most in a patient with the following findings?

1. Nephrotic syndrome associated with hepatitis B
2. Nephrotic syndrome associated with HIV
3. EM: Subendothelial humps and tram-track appearance
4. LM: Segmental sclerosis and hyalinosis

Answer 821

1. Nephrotic syndrome associated with hepatitis B: Membranoproliferative glomerulonephritis
2. Nephrotic syndrome associated with HIV: Focal segmental glomerulosclerosis
3. EM: Subendothelial humps and tram-track appearance: Membranoproliferative glomerulonephritis
4. LM: Segmental sclerosis and hyalinosis: Focal segmental glomerulosclerosis

Question 822

Which glomerular disease would you suspect most in a patient with the following findings?

1. Purpura on back of arms and legs, abdominal pain, IgA nephropathy
2. Apple-green birefringence with Congo-red stain under polarized light
3. EM: Spiking of the GBM due to electron dense subepithelial deposits

Answer 822

1. Purpura on back of arms and legs, abdominal pain, IgA nephropathy: Henoch-schonlein purpura
2. Apple-green birefringence with Congo-red stain under polarized light: Renal Amyloidosis
3. EM: Spiking of the GBM due to electron dense subepithelial deposits: Membranous glomerulonephritis

Question 823

Glomerular histology reveals multiple mesangial nodules. This lesion is indicative of what disease?

Answer 823

Kimmelstiel-Wilson lesions indicative of diabetic glomerulonephropathy

Question 824

A teenager presents with nephrotic syndrome and hearing loss. What is the disease?

Answer 824

Alport syndrome

Question 825

What is the WAGR complex?

Answer 825

1. Wilm’s Tumor
2. Aniridia (no iris)
3. Genitourinary malformation
4. Retardation

Question 826

What are the risk factors for transitional cell carcinoma?

Answer 826

1. Smoking (Main risk factor)
2. Phenacetin
3. Aniline dyes
4. Cyclophosphamide

Question 827

What are the classic features of drug-induced acute interstitial nephritis?

Answer 827

1. Fever
2. Rash
3. Eosinophilia
4. Azotemia

Question 828

What changes will be seen in a basic metabolic panel in a patient with renal failure?

Answer 828

1. Increased serum Creatinine
2. Increased serum BUN
3. Increased serum Potassium
4. Increased serum Phosphate
5. Decreased Serum Calcium

Question 829

What urinary pathology fits each of the following descriptions?

1. Most common tumor of the urinary tract
2. Most common renal malignancy of early childhood (ages 2-4)
3. Fever + rash + hematuria + eosinophilia
4. Cancer associated with Schistosoma haematobium

Answer 829

1. Most common tumor of the urinary tract: Transitional cell carcinoma
2. Most common renal malignancy of early childhood (ages 2-4): Wilm’s tumor
3. Fever + rash + hematuria + eosinophilia: Acute interstitial nephritis
4. Cancer associated with Schistosoma haematobium: Squamous cell bladder cancer

Question 830

What infections is Klebsiella pneumoniae known for causing?

Answer 830

1. UTI (particularly nosocomial)
2. Aspiration pneumonia and lung abscess

Question 831

What organisms are the most common causes of UTI?

Answer 831

1. E. Coli
2. Staph saprophyticus
3. Klebsiella
4. Proteus

Question 832

What is the function of the enzyme urease?

Answer 832

Splits urea into 2 molecules of NH3 and 1 molecule of CO2

Proteus mirabilis does this

Question 833

A culture reveals Gram negative, oxidase-positive diplococci. What is the likely organism?

Answer 833

N. Meningitidis or N. Gonorrhoeae

Question 834

A 22 year-old medical student has a burning feeling in his gut after meals. An EGD is performed and biopsy of the gastric mucosa shows spiral-shaped Gram (-) bacteria. What is the organism?

Answer 834

H. Pylori

Question 835

A 50 year-old male smoker presents with a new cough and flu-like symptoms. Grams stain of the sputum shows no organisms but silver stain shows rods. What is the diagnosis?

Answer 835

Legionella pneumophila

Does not gram stain as it is intracellular

Question 836

What Gram (-) organism matches each of the following descriptions?

1. Osteomyelitis in a patient with diabetes mellitus
2. Sepsis, DIC, adrenal hemorrhage
3. 5 year-old with pharyngitis, drooling, and X-ray reveals thumb sign
4. Osteomyelitis in a patient with sickle cell
5. Alcoholic with aspiration pneumonia

Answer 836

1. Osteomyelitis in a patient with diabetes mellitus: Pseudomonas
2. Sepsis, DIC, adrenal hemorrhage: N. Meningitidis
3. 5 year-old with pharyngitis, drooling, and X-ray reveals thumb sign: H. influenzae type B (Epiglotitis)
4. Osteomyelitis in a patient with sickle cell: Salmonella
5. Alcoholic with aspiration pneumonia: Klebsiella

Question 837

What Gram (-) organism matches each of the following descriptions?

1. Child with a new puppy develops severe abdominal pain
2. Burn wound infection
3. Motile organism that causes UTI
4. Most common form of traveler’s diarrhea

Answer 837

1. Child with a new puppy develops severe abdominal pain: Yersinia enterocolitica
2. Burn wound infection: Pseudomonas
3. Motile organism that causes UTI: Proteus mirabilis
4. Most common form of traveler’s diarrhea: ETEC

Question 838

What Gram (-) organism matches each of the following descriptions?

1. Life-threatening meningitis + purpura
2. Common cause of both UTI and pneumonia
3. Corneal infections in contact lens wearers
4. Septic arthritis in young, sexually active patients

Answer 838

1. Life-threatening meningitis + purpura: N. Meningitidis
2. Common cause of both UTI and pneumonia: Klebsiella
3. Corneal infections in contact lens wearers: Pseudomonas
4. Septic arthritis in young, sexually active patients: N. Gonorrhoeae

Question 839

What are the side effects of the aminoglycosides?

Answer 839

“NOT”

1. Nephrotoxicity
2. Ototoxicity
3. Teratogenicity

Question 840

What drugs have photosensitivity reactions?

Answer 840

“SAT for a Photo”

1. Sulfonamides
2. Amiodarone
3. Tetracyclines

Question 841

1. What causes Gray baby syndrome?
2. Gray man syndrome?
3. Red man syndrome?

Answer 841

1. Gray baby syndrome: Chloramphenicol
2. Gray man syndrome: Amiodarone
3. Red man syndrome: Vancomycin

Question 842

What are the clinical uses for macrolides?

Answer 842

“PUS”

1. Pneumonia (Atypical)
2. URIs
3. STDs
4. Also for Gram (+) infections in penicillin-resistant patients

Azithromycin, Arithromycin, and Clarithromycin

Question 843

What agent is used for porphylaxis for each of the following infections?

1. Gonorrhea
2. Syphilis
3. Recurrent UTIs

Answer 843

1. Gonorrhea: Ceftriaxone
2. Syphilis: Penicillin G
3. Recurrent UTIs: TMP-SMX

Question 844

What agent is used for porphylaxis for each of the following infections?

1. Pneumocystis jirovecii pneumonia
2. Exposure to meningococcal or H. influenzae type B meningitis
3. Endocarditis prevention in patient with turbulent flow heart disease

Answer 844

1. Pneumocystis jirovecii pneumonia: TMP-SMX
2. Exposure to meningococcal or H. influenzae type B meningitis: Rifampin
3. Endocarditis prevention in patient with turbulent flow heart disease: Amoxicillin/Ampicillin or Clindamycin

Question 845

What antibiotics should expecially be avoided in pregnancy?

Answer 845

“Countless SAFe Moms Take Really Good Care”

1. Clarithromycin - Embryotoxic
2. Sulfonamides - Kernicterus
3. Aminoglycosides - Ototoxic
4. Fluoroquinolones - Cartilage damage
5. Metronidazole - Mutagenesis
6. Tetracyclines - Discolored teeth, bone growth inhibition
7. Ribavirin - Teratogenic
8. Griseofulvin - Teratogenic
9. Chloramphenicol - Gray baby

Question 846

What type of vaccine uses a live virus that has lost its virulence? What are some examples of live virus vaccines?

Answer 846

Live attenuated virus

1. Small Pox vaccine
2. Yellow fever vaccine
3. Varicella Zoster vaccine
4. MMP vaccine
5. Sabin (Oral) Polio
6. Intranasal Influenza vaccine
7. Rotavirus vaccine

Question 847

What is the DNA structure of most all of the DNA viruses and what are the exceptions? What else is common to most DNA viruses and what are the exceptions?

Answer 847

1. Double-stranded: Except Parvovirus
2. Linear genome: Except Papilloma virus, Polyoma virus, & Hepadnavirus
3. Icosahedral shape: Except Poxvirus
4. Replicate in the nucleus: Except Poxvirus

Question 848

When should live vaccines be considered in HIV positive patients?

Answer 848

1. MMR & Varicella Zoster vaccines when CD4 count is >200
2. No recommendation for or against Shingles vaccine when CD4 count >200

Question 849

Where does herpesvirus acquire its envelope?

Answer 849

Nuclear membrane

Most get envelope from host cell plasma membrane

Question 850

Which viral families do not have an envelope?

Answer 850

Non-enveloped RNA viruses

1. Calicivirus
2. Picornavirus
3. Reovirus
4. Hepevirus

Non-enveloped DNA

1. Parvovirus
2. Adenovirus
3. Papillomavirus
4. Polyomavirus

Question 851

What is the treatment for the different herpes viruses?

Answer 851

1. HSV-1, HSV-2, VZV, and EBV (only a little): Aciclovir, Valacyclovir, and Famciclovir (Tx of choice for VZV)
2. CMV: Ganciclovir or Foscarnet (if resistant to Ganciclovir)

Question 852

What group of patients is prone to esophagitis caused by CMV?

Answer 852

HIV patients with CD4

Question 853

Where is latent herpes infection found in the body?

Answer 853

1. HSV-1: Trigeminal ganglia
2. HSV-2: Sacral ganglia
3. VZV: Dorsal root ganglia or Trigeminal ganglia
4. CMV: Mononuclear cells
5. EBV: B cells

Question 854

What are Downey cells?

Answer 854

1. Activated T cells responding to an EBV infection as in Mononucleosis
2. Cytoplasm has foamy appearance

Question 855

Which DNA virus is associated with each of the following statements?

1. Erythema infectiosum (AKA Fifth disease)
2. Heterophile-positive mononucleosis
3. Can cause conjunctivitis or diarrhea
4. Enlarged cell with owl’s eye inclusions

Answer 855

1. Erythema infectiosum (AKA Fifth disease): Parvovirus B19
2. Heterophile-positive mononucleosis: EBV
3. Can cause conjunctivitis or diarrhea: Adenovirus
4. Enlarged cell with owl’s eye inclusions: CMV

Question 856

Which DNA virus is associated with each of the following statements?

1. Identified with a pap smear
2. Milkmaid’s blisters
3. Burkitt lymphoma and nasopharyngeal carcinoma
4. Gingivostomatitis

Answer 856

1. Identified with a pap smear: Papillomavirus
2. Milkmaid’s blisters: Cowpox (Poxvirus)
3. Burkitt lymphoma and nasopharyngeal carcinoma: EBV
4. Gingivostomatitis: HSV-1

Question 857

Which DNA virus is associated with each of the following statements?

1. Hides in sensory ganglia of S2 and S3
2. Hides in trigeminal ganglia
3. Hides in dorsal root ganglia
4. Viral family of JC virus

Answer 857

1. Hides in sensory ganglia of S2 and S3: HSV-2
2. Hides in trigeminal ganglia: HSV-1 (Could be VZV)
3. Hides in dorsal root ganglia: VZV
4. Viral family of JC virus: Polyomavirus

Question 858

Which DNA virus is associated with each of the following statements?

1. Downey cells
2. Human progressive multifocal leukoencephalopathy
3. Oral hairy leukoplakia
4. Multinucleate giant cells on Tzanck test

Answer 858

1. Downey cells: EBV
2. Human progressive multifocal leukoencephalopathy: Polyomavirus (JC virus)
3. Oral hairy leukoplakia: EBV
4. Multinucleate giant cells on Tzanck test: HSV-1 & HSV-2

Question 859

Which DNA virus is associated with each of the following statements?

1. Only DNA virus that is not double-stranded
2. Roseola
3. Heterophile-negative mononucleosis

Answer 859

1. Only DNA virus that is not double-stranded: Parvovirus
2. Roseola: HHV-6 (Sixth disease)
3. Heterophile-negative mononucleosis: CMV

Question 860

A 45 year-old man with squamous cell carcinoma of the penis had exposure to what virus?

Answer 860

HPV 16 or HPV 18

Question 861

A 20 year-old college student presents with lymphadenopathy, fever, and hepatosplenomegaly. His serum agglutinates sheep red blood cells. What cell type is infected?

Answer 861

His B Cells are infected with EBV

Question 862

What is the #1 cause of fatal infantile gastroenteritis?

Answer 862

Rotavirus of the Reovirus family

Question 863

What virus is commonly associated with outbreaks of gastroenteritis on cruise ships?

Answer 863

Norovirus of the Calicivirus family

Question 864

Which RNA virus matches each of the following statements?

1. Hand, foot, and mouth disease
2. “Break bone fever”
3. “Common cold”

Answer 864

1. Hand, foot, and mouth disease: Coxsackievirus (Picornavirus)
2. “Break bone fever”: Dengue (Flavivirus)
3. “Common cold”: Rhinovirus (Picornavirus) and Coronavirus

Question 865

Which RNA virus matches each of the following statements?

1. Fever, jaundice, black vomit
2. Meningitis in summer months
3. Tourniquet test helps diagnose hemorrhagic disease
4. Infects motor neurons of the anterior horn

Answer 865

1. Fever, jaundice, black vomit: Yellow Fever (Flavivirus)
2. Meningitis in summer months: Echovirus (Picornavirus), Coxsackievirus (Picornavirus)
3. Tourniquet test helps diagnose hemorrhagic disease: Dengue (Flavivirus)
4. Infects motor neurons of the anterior horn: Poliovirus (Picornavirus), West Nile Virus (Flavivirus)

Question 866

Which antivirals match each of the following statements?

1. Prophylaxis for influenza A
2. Used in treatment for chronic hepatitis C
3. First-line for HSV or EBV
4. Inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase

Answer 866

1. Prophylaxis for influenza A: Zanamivir, Oseltemivir
2. Used in treatment for chronic hepatitis C: Ribavirin and IFN-alpha
3. First-line for HSV or EBV: Acyclovir, Valacyclovir, Famciclovir
4. Inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase: Acyclovir, Valacyclovir, Famciclovir

Question 867

Which RNA virus matches each of the following statements?

1. Characteristic barking seal cough
2. Childhood diarrhea in winter months
3. Asthma-sounding infection in infants (Esp. preemies)

Answer 867

1. Characteristic barking seal cough: Croup caused by Parainfluenza virus (Paramyxovirus)
2. Childhood diarrhea in winter months: Rotavirus
3. Asthma-sounding infection in infants (Esp. preemies): RSV

Question 868

What virus (RNA or DNA) fits the following statement?

1. Can cause conjunctivitis or diarrhea
2. Fever + jaundice + black vomit
3. Enlarged cell with owl’s eye inclusions

Answer 868

1. Can cause conjunctivitis or diarrhea: Adenovirus
2. Fever + jaundice + black vomit: Yellow Fever (Flavivirus)
3. Enlarged cell with owl’s eye inclusions: CMV

Question 869

What virus (RNA or DNA) fits the following statement?

1. Identified with a Pap smear
2. Barking Seal cough
3. Brassy cough

Answer 869

1. Identified with a Pap smear: Papillomavirus
2. Barking Seal cough: Croup caused by Parainfluenza virus (Paramyxovirus)
3. Brassy cough: RSV (Paramyxovirus)

Question 870

What virus (RNA or DNA) fits the following statement?

1. Negri bodies
2. Hides in trigeminal ganglia
3. Diarrhea in children during the winter months

Answer 870

1. Negri bodies: Rabies virus (Rhabdovirus)
2. Hides in trigeminal ganglia: HSV-1 (Also could be HSV-2 and VZV but these more commonly lay dormant in the sacral ganglia and dorsal root ganglia respectively)
3. Diarrhea in children during the winter months:** Rotavirus (Reovirus)**

Question 871

What virus (RNA or DNA) fits the following statement?

1. 2 most common causes of common cold
2. Downey cells
3. Aseptic meningitis

Answer 871

1. 2 most common causes of common cold: Rhinovirus (Picornavirus), Coronavirus
2. Downey cells: EBV (these are the activated T-cells of Mononucleosis)
3. Aseptic meningitis: Echovirus, Coxackievirus and Enterovirus (All Picornaviruses)

Question 872

An adolescent presents with cough and rust-colored sputum. What does the gram stain of the sputum show?

Answer 872

Gram (+) diplococci (Strep pneumo)

Question 873

An older male patient has blood in his urine and renal stones. What organism is most likely responsible for the patient’s stones?

Answer 873

Proteus

Question 874

What organism would you suspect as the cause of a septic arthritis in a 20 year-old man?

Answer 874

N. Gonorrhoeae

Question 875

What are the most common causes of pneumonia for each of the following patient populations?

1. 6w-18y
2. 18y-40y
3. 40y-65y
4. Elderly

Answer 875

1. 6w-18y: RSV, Strep pneumoniae, Chlamydia pneumoniae, Mycoplasma
2. 18y-40y: Strep pneumoniae, Mycoplasma, Chlamydia pneumoniae
3. 40y-65y: Strep pneumo, H. influenzae, anaerobes, viruses
4. Elderly: Strep pneumoniae, viruses, G (-) rods

Question 876

What findings would help you distinguish bacterial meningitis from fungal and viral meningitis?

Answer 876

Bacterial

1. Glucose: Down
2. Protein: Up
3. CSF pressure: Up
4. WBCs: Neutrophils

Fungal/TB

1. Glucose: Down
2. Protein: Up
3. CSF pressure: Up
4. WBCs: Lymphocytes

Viral

1. Glucose: Normal
2. Protein: Normal
3. CSF pressure: Normal
4. WBCs: Lymphocytes

Question 877

What CSF findings would you see in a patient with TB meningitis?

Answer 877

1. Glucose: Down
2. Protein: Up
3. CSF pressure: Up
4. WBCs: Lymphocytes

Question 878

What are the TORCH infections?

Answer 878

“TORCHHeS”

1. Toxoplasma (Chorioretinitis, Hydrocephalus, Intracranial calcifications)
2. Other (Parvovirus B19)
3. Rubella (PDA, Cataracts, Deafness)
4. CMV (Unilateral hearing loss)
5. HIV
6. HSV (Temporal lobe encephalitis)
7. Syphillis

Question 879

A 50 year-old patient recovered from abdominal surgery performed 2 days ago and has had an internal catheter in place since that time. He now has a fever of 100 degrees F. What is the most likely cause of fever?

Answer 879

UTI

Question 880

Which STD matches the following statement?

1. Clue cells
2. Painless genital ulcer
3. Flagellated cells
4. Strawberry cervix

Answer 880

1. Clue cells: Bacterial vaginosis
2. Painless genital ulcer: Syphillis
3. Flagellated cells: Trichomonas
4. Strawberry cervix: Trichomonas

Question 881

What medication causes cardiotoxicity and bone marrow suppression?

Answer 881

Doxorubicin and Daunorubicin

Doxorubicin cardiotoxicity is characterized by a dose-dependent decline in mitochondrial oxidative phosphorylation. Reactive oxygen species, generated by the interaction of doxorubicin with iron, can then damage the myocytes (heart cells), causing myofibrillar loss and cytoplasmic vacuolization

Question 882

A patient tries to commit suicide by overdosing on digitalis. What is the most important step in the management of this patient?

Answer 882

1. Stop digitalis
2. Administer anti digitalis antibody fragments
3. Address K and Mg levels

Question 883

An African-American male that goes to Africa develops anemia after taking prophylactic medicine for primary disease prevention. What enzyme is this patient deficient in?

Answer 883

G6PD

Question 884

Which drugs cause gynecomastia?

Answer 884

“Some Drugs Create Awesome Knockers”

1. Spironolactone
2. Digitalis
3. Cimetidine
4. Amantidine
5. Ketoconazole

Question 885

A patient presents with tinnitus, dizziness, headaches, and GI distress. What drug is causing these symptoms?

Answer 885

This is Cinchonism caused by Quinine (2nd line antimalarial) or Quinidine (1a antiarrhythmic)

Question 886

What medications are known for causing drug-induced lupus?

Answer 886

“SHIPP”

1. Sulfonamides
2. Hydralazine
3. Isoniazid
4. Procainamide
5. Phenytoin

Question 887

What cell type lines the uterus?

Answer 887

Columnar epithelium with some tubular glands

Question 888

What ligament of the female pelvis matches each of the following descriptions?

1. Connects the cervix to the pelvic side wall
2. Connects the ovaries to the lateral pelvic wall
3. Connects the uterus, fallopian tubes and ovaries to the pelvic side wall
4. Contains the uterine vessels
5. Contains the ovarian vessels

Answer 888

1. Connects the cervix to the pelvic side wall: Cardinal ligament
2. Connects the ovaries to the lateral pelvic wall: Suspensory ligament of the ovary
3. Connects the uterus, fallopian tubes and ovaries to the pelvic side wall: Broad ligament
4. Contains the uterine vessels: Cardinal ligament
5. Contains the ovarian vessels: Suspensory ligament of the ovary

Question 889

What is the landmark used for the pudendal nerve block?

Answer 889

Ischial spine

Question 890

To where does testicular cancer first metastasize?

Answer 890

Para-aortic lymph nodes

Question 891

What structures develop from the mesonephric duct system?

Answer 891

1. Seminal vesicles
2. Epididymis
3. Ejaculatory duct
4. Vas deferens

Question 892

What is the male homologue to each of the following female structures?

1. Vestibular bulbs
2. Labia minora
3. Bartholin glands
4. Urethral and paraurethral glands (ofSkene)

Answer 892

1. Vestibular bulbs: Corpus spongiosum
2. Labia minora: Ventral shaft
3. Bartholin glands: Bulbourethral glands
4. Urethral and paraurethral glands (ofSkene): Prostate

Question 893

What gene product comes from the SRY gene that underlies male genital development?

Answer 893

Testes-determining factor

Question 894

What structure anchors the testes to the scrotum?

Answer 894

Gubernaculum

Question 895

How many carbon molecules are found on testosterone and on androstenedione?

Answer 895

19 carbons

Question 896

What is the difference between androgen insensitivity and 5-alpha-reductase?

Answer 896

Androgen insensitivity

1. Testicular feminization
2. Defect in Dihydrotestosterone receptor
3. Phenotypically normal female
4. Increased testosterone, LH, and estrogen

5-alpha-reductase deficiency

1. Testosterone cannot be converted to dihydrotestosterone
2. Early defect is ambiguous genitalia
3. Increased testosterone at puberty causes normal male genitalia
4. Normal testosterone, estrogen, and LH

Question 897

What is the role of Sertoli cells and Leydig cells in spermatogenesis?

Answer 897

Sertoli cells

1. Stimulated by FSH
2. Produce inhibin
3. Produce androgen binding protein that maintains high level of concentration of testosteron in seminiferous tubules

Leydig cells

1. Stimulated by LH
2. Produce testosterone

Question 898

A 23 year-old patient presents with one testicle. For what is this patient at risk?

Answer 898

This is likely cryptochordism which is associated with increased risk of germ cell testicular cancer

Question 899

What testicular tumor is described by each of the following statements?

1. Composed of cytotrophoblasts and syncytiotrophoblasts
2. May present initially with gynecomastia
3. Elevated AFP
4. Elevated beta-hCG

Answer 899

1. Composed of cytotrophoblasts and syncytiotrophoblasts: Choriocarcinoma
2. May present initially with gynecomastia: Leydig cell tumor (and possibly Sertoli cell tumor)
3. Elevated AFP: Yolk-sac tumor and Embryonal carcinoma
4. Elevated beta-hCG: Choriocarcinoma and Embryonal carcinoma

Question 900

What testicular tumor is described by each of the following statements?

1. Most common testicular tumor
2. Most common testicular tumor in infants and children up to 3 years of age
3. Most common testicular tumor in men over age 60

Answer 900

1. Most common testicular tumor: Seminoma
2. Most common testicular tumor in infants and children up to 3 years of age: Yolk-sac tumor
3. Most common testicular tumor in men over age 60: Testicular lymphoma

Question 901

What testicular tumor is described by each of the following statements?

1. Histologic appearance similar to koilocytes (cytoplasmic clearing)
2. Histologically may have alveolar or tubular appearance sometimes with papillary convolutions
3. Composed of multiple tissue types

Answer 901

1. Histologic appearance similar to koilocytes (cytoplasmic clearing): Seminoma
2. Histologically may have alveolar or tubular appearance sometimes with papillary convolutions: Embryonal carcinoma
3. Composed of multiple tissue types: Teratoma

Question 902

What testicular tumor is described by each of the following statements?

1. Histologic endodermal sinus structures (Schiller-Duval bodies)
2. 25% have cytoplasmic rod-shaped crystalloids of Reinke
3. Androgen producing and associated with precocious puberty

Answer 902

1. Histologic endodermal sinus structures (Schiller-Duval bodies): Yolk-Sac tumor
2. 25% have cytoplasmic rod-shaped crystalloids of Reinke: Leydig cell tumor
3. Androgen producing and associated with precocious puberty: Leydig cell tumor (and possibly Sertoli cell tumor)

Question 903

What is the mechanism of action of Sildenafil?

Answer 903

It inhibits cGMP-Phosphodiesterase -> Increase in cGMP -> Decrease in smooth muscle contraction

Question 904

What are the side effects of Sildenafil?

Answer 904

1. Flushing
2. Headache
3. Dyspepsia
4. Impaired blue-green color vision
5. Life-threatening hypotension (With nirtrates)

Question 905

What organism is commonly implicated in balantitis?

Answer 905

Candida albicans (Common in diabetes)

Question 906

How does flutamide differ from finasteride in relation to mechanism of action and clinical use?

Answer 906

Finasteride

1. 5alpha-reductase inhibitor
2. Prevents Testosterone conversion fto DHT
3. Used in BPH and Male-pattern-baldness

Flutamide

1. Inhibits testosterone receptors
2. Used in prostate adenocarcinoma

Question 907

A 55 year-old man undergoing treatment for BPH has increased testosterone and decreased DHT as well as gynecomastia and edema. What medication is he being treated with?

Answer 907

5alpha-reductase inhibitors

Question 908

What are the diagnositic symptoms of BPH?

Answer 908

1. Nocturia
2. Hesitancy
3. Difficulty stopping and starting urine stream
4. Frequency
5. Dysuria

Question 909

What is the two-cell theory of estradiol production?

Answer 909

Theca cells produce androstenediones from cholesterol -> Granulosa cells convert the androstenediones into Estrogens (mostly Estradiol)

Question 910

What are the target cells of LH?

What cells respond to FSH?

Answer 910

LH stimulates

1. Theca cells (females)
2. Leydig cells (males)

FSH stimulates

1. Granulosa cells (females)
2. Sertoli cells (males)

Question 911

State whether each of the following statements describes estrogen or progesterone

1. Production of thick mucus that inhibits entry of sperm into the uterus
2. Induces LH surge
3. Uterine smooth muscle relaxation
4. Follicle growth

Answer 911

1. Production of thick mucus that inhibits entry of sperm into the uterus: Progesterone
2. Induces LH surge: Estrogen
3. Uterine smooth muscle relaxation: Progesterone
4. Follicle growth: Estrogen

Question 912

State whether each of the following statements describes estrogen or progesterone

1. Maintainance of pregnancy
2. Hepatic synthesis of transport proteins
3. Withdrawal leads to menstruation

Answer 912

1. Maintainance of pregnancy: Progesterone
2. Hepatic synthesis of transport proteins: Estrogen
3. Withdrawal leads to menstruation: Progesterone

Question 913

When does beta-hCG appear in the urine during pregnancy?

Answer 913

2 weeks after conception

Question 914

What are the pros and cons of oral contraceptive pill use?

Answer 914

Pros

1. Reliable, low-failure rate
2. Decreased risk of ovarian cancer
3. Decreased risk of endometrial cancer
4. Decreased risk of ectopic pregnancy
5. Regulate menses
6. Decrease dysmenorrhea
7. Improve acne

Cons

1. Daily dosing
2. No STD protection
3. Possible elevation of Triglycerides
4. Possible nausea
5. Hypertension
6. Induce hypercoagulable state

Question 915

Why is progesterone used in combination with estrogen during estrogen replacement?

Answer 915

Prevent unopposed estrogen which would otherwise cause endometrial hyperplasia and increase the risk of endometrial cancer

Question 916

What is the best option for birth control in a mentally retarded patient?

Answer 916

IM Medroxyprogesterone

Question 917

What hormonal changes are seen during menopause?

Answer 917

1. Decreased estrogen
2. Increased GnRH
3. Increased FSH and LH

Question 918

A 23 year-old woman is on Rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant. Why?

Answer 918

Rifampin induces P450 -> Increasing the metabolism of birth control pill

Question 919

What are the risk factors for cervical cancer?

Answer 919

1. STDs
2. Multiple sex partners
3. HIV/AIDS
4. No HPV vaccine
5. Smoking

Question 920

What is the classic histological appearance of a vaginal epithelial cell infected with HPV?

Answer 920

Koilocyte: Dysplastic cervical cells with enlarged dark nuclei and perinuclear clearing

Question 921

Who is at risk of clear cell adenocarcinoma?

Answer 921

Individuals who had exposure to diethylstilbestrol in utero

Question 922

What are the risk factors for endometrial carcinoma?

Answer 922

1. Obesity
2. Diabetes
3. Hypertension
4. Exposure to unopposed estrogen
5. Nulliparity
6. Late menopause

Question 923

What uterine pathology matches each of the following descriptions?

1. Excess unopposed estrogen is the main risk factor
2. Menorrhagia with an enlarged uterus and no pelvic pain
3. Pelvic pain that presents only during menstruation
4. Diagnosed by endometrial biopsy in clinic

Answer 923

1. Excess unopposed estrogen is the main risk factor: Endometrial hyperplasia/carcinoma
2. Menorrhagia with an enlarged uterus and no pelvic pain: Leiomyoma
3. Pelvic pain that presents only during menstruation: Endometriosis
4. Diagnosed by endometrial biopsy in clinic: Endometrial hyperplasia/carcinoma

Question 924

What uterine pathology matches each of the following descriptions?

1. Definitive diagnosis and treatment is by laparoscopy
2. Menstruating tissue within the myometrium
3. Malignant tumor of the uterine smooth muscle

Answer 924

1. Definitive diagnosis and treatment is by laparoscopy: Endometriosis
2. Menstruating tissue within the myometrium: Adenomyosis
3. Malignant tumor of the uterine smooth muscle: Leiomyosarcoma

Question 925

How does the dosing of leuprolide affect its physiological impact?

Answer 925

1. Constant dosing: GnRH antagonist
2. Pulstile dosing: GnRH agonist

Question 926

What is the underlying cause of PCOS?

What are the clinical manifestations?

What is the treatment?

Answer 926

What is the underlying cause of PCOS?

1. Increased LH

What are the clinical manifestations?

1. Amenorrhea
2. Infertility
3. Obesity
4. Hirsutism
5. Impaired glucose tolerance

What is the treatment?

1. Weight loss
2. Metformin (Tx diabetes and induce ovulation)
3. Clomiphene (Induce ovulation)
4. Pulsitile Leuprolide
5. Spironolactone (Tx Hirsutism)

Question 927

A patient with PCOS is most at risk for developing which type of cancer?

Answer 927

Endometrial carcinoma

Question 928

Under what circumstances would you expect to see an elevated LH?

Answer 928

1. PCOS
2. Normal surge before pregnancy
3. Menopause
4. Androgen insensitivity syndrome

Question 929

What drug would you give to inhibit prolactin secretion?

Answer 929

Dopamine analog (Bromocriptine)

Question 930

What ovarian tumor matches each of the following statements?

1. Produces AFP
2. Estrogen-secreting, leading to precocious puberty
3. Intraperitoneal accumulation of mucinous material
4. Testosterone-secreting, leading to virilization

Answer 930

1. Produces AFP: Yolk-sac tumor
2. Estrogen-secreting, leading to precocious puberty: Granulosa-Theca cell tumor
3. Intraperitoneal accumulation of mucinous material: Mucinous cystadenocarcinoma
4. Testosterone-secreting, leading to virilization: Sertoli-Leydig tumor

Question 931

What ovarian tumor matches each of the following statements?

1. Call-Exner bodies
2. Resembles bladder epithelium
3. Elevated Beta-hCG

Answer 931

1. Call-Exner bodies: Granulosa-Theca cell tumor
2. Resembles bladder epithelium: Brenner cell tumor
3. Elevated Beta-hCG: Choriocarcinoma (Also Dysgerminoma)

Question 932

What are the risk factors for ovarian cancer?

Answer 932

Increased number of cycles

1. Not being pregnant early in life
2. Late menopause
3. Early menarch

Question 933

An obese woman presents with amenorrhea and increased levels of serum testosterone. What is the most likely diagnosis?

Answer 933

PCOS

Question 934

1. A pregnant woman at 16 weeks of gestation presents with an atypically large abdomen and hypertension.
2. What abnormality might be seen on blood test, and what is the disorder?

Answer 934

1. Increased Beta-hCG on blood test
2. Complete Hydatidiform mole

Question 935

A 15-year-old female patient of yours that normally comes with her parents presents alone this time. She states that she is sexually active but that she knows she is not pregnant because she has never menstruated. What would be the appropriate next step in managing this patient?

Answer 935

1. Check a pregnancy test
2. Work-up for delayed puberty
3. Inform patient about STDs and contraception

Question 936

Monozygotic twins are delivered. One is pale and has a hematocrit of 15%, and the other is flushed with a hematocrit of 55%. What is the cause of these features?

Answer 936

Twin-twin transfusion (They share a placenta and one recieved more blood than the other)

Question 937

What is the difference between placenta previa, abruptio, and accreta?

Answer 937

Placenta previa

1. Placenta overlies the cervical os
2. Painless vaginal bleeding
3. Requires a C-section

Placenta abruptio

1. Painful
2. Placenta separates from the uterus
3. Bleeding inside the uterus
4. Life-threatening to the fetus

Placent accreta

1. Placenta is attached to the myometrium
2. Does not separate from myometrium at birth

Question 938

A pregnant woman with previous c-section is at increased risk for which placental abnormalities?

Answer 938

1. Placenta accreta
2. Placenta previa

Question 939

What are some of the conditions that can result in polyhydramnios?

Answer 939

Esophageal or duodenal atresia

Question 940

What is the mechanism of action of mifeprostone?

Answer 940

1. Competitively binds to progesterone receptors
2. Blocks the effects of progesterone

Question 941

What agents are commonly used as tocolytics (Labor suppressants)?

Answer 941

1. Magnesium sulfate
2. Terbutaline
3. Ritodrine
4. Nifedipine
5. Indomethacin

Question 942

What prenatal ultrasound finding is a clue that the fetus may have Down Syndrome?

Answer 942

Nuchal translucency

Question 943

1. What is the most common event that causes Down syndrome?
2. Second most common?
3. Third most common?

Answer 943

1. Meiotic nondisjunction (95%)
2. Robertsonian translocation (4%)
3. Mosaicism (1%)

Question 944

What gene is affected in Fragile-X syndrome?

Answer 944

FMR1 gene

Question 945

What are the clinical features of Fragile-X syndrome?

Answer 945

1. Autism (Mental retardation)
2. Macro-orchidism
3. Long face and large jaw
4. Large everted ears
5. Mitral valve prolapse

Question 946

What are the clinical features of Williams syndrome?

Answer 946

This is a microdeletion of chromosome 7 (deleted region includes elastin gene)

1. Elfin facies
2. Mental retardation
3. Well developed verbal skills
4. Extreme friendliness with strangers
5. Cardiovascular problems (Valvular defects)

Question 947

What are the possible defects in cases of chromosome 22q11 deletion?

Answer 947

1. Absent Thymus (DiGeorge syndrome)
2. Hypocalcemia
3. Abnormal facies
4. Cleft palate
5. Cardiac defects

Question 948

What are the distinguishing characteristics of Klinefelter syndrome compared to Turner syndrome?

Answer 948

Klinefelter Syndrome

1. 47 XXY Male
2. Tall with long extremities
3. Testicular atrophy
4. Gynecomastia

Turner syndrome

1. 45 XO
2. Webbing of the neck
3. Shield chest
4. Primary amenorrhea
5. Short stature

Question 949

What genetic defect is responsible for achondroplasia?

Answer 949

Cell signaling defect of FGF receptor (FGFR-3 gene)

Question 950

A genetic defect in which proteins results in hereditary spherocytosis?

Answer 950

Spectrin or Ankyrin

Question 951

What autosomal dominant disease fits each of the following statements?

1. Associated with floppy mitral valve, dissecting aortic aneurysm, berry aneurysm
2. Associated with mitral valve prolapse, liver disease, berry aneurysms
3. Neural tumors and pigmented iris hamartomas

Answer 951

1. Associated with floppy mitral valve, dissecting aortic aneurysm, berry aneurysm: Marfan syndrome
2. Associated with mitral valve prolapse, liver disease, berry aneurysms: Autosomal dominant polycystic kidney disease
3. Neural tumors and pigmented iris hamartomas: Neurofibromatosis type I

Question 952

What autosomal dominant disease fits each of the following statements?

1. Very strong association with colon cancer
2. MI before age 20
3. Hemangioblastomas of retina/cerebellum/medulla

Answer 952

1. Very strong association with colon cancer: Familial adenomatous polyposis (FAP)
2. MI before age 20: Familial Hypercholesterolemia
3. Hemangioblastomas of retina/cerebellum/medulla: Von Hippel-Lindau disease

Question 953

What autosomal dominant disease fits each of the following statements?

1. Increased MCHC, Hemolytic anemia
2. Bilateral acoustic neuromas
3. Facial lesions, seizure disorder, cancer risk

Answer 953

1. Increased MCHC, Hemolytic anemia: Hereditary Spherocytosis
2. Bilateral acoustic neuromas: Neurofibromatosis type II
3. Facial lesions, seizure disorder, cancer risk: Tuberous Sclerosis

Question 954

What autosomal dominant disease fits each of the following statements?

1. Caudate atrophy, dementia
2. Cystic medial necrosis of the aorta
3. Defect of fibroblast growth factor (FGF) receptor 3

Answer 954

1. Caudate atrophy, dementia: Huntingtons disease
2. Cystic medial necrosis of the aorta: Marfan syndrome
3. Defect of fibroblast growth factor (FGF) receptor 3: Achondroplasia

Question 955

What are some of the disorders resulting from trinucleotide repeats?

Answer 955

1. Friedrich Ataxia: GAA
2. Huntingtons disease: CAG
3. Fragile-X syndrome: CGG
4. Myotonic Dystrophy: CTG

Question 956

What is the name of the genetic disease that fits each of the following descriptions?

1. Macro-orchidism and autism
2. Endocardial cushion defects are common
3. Recurrent pulmonary infections, steatorrhea

Answer 956

1. Macro-orchidism and autism: Fragile-X syndrome
2. Endocardial cushion defects are common: Trisomy 21 (Downs syndrome)
3. Recurrent pulmonary infections, steatorrhea: Cystic fibrosis

Question 957

What is the name of the genetic disease that fits each of the following descriptions?

1. Multiple fractures, easily confused with child abuse
2. Associated with Alzheimer disease after age 35
3. Excess fibro-fatty tissue deposits amongst muscle

Answer 957

1. Multiple fractures, easily confused with child abuse: Osteogenesis imperfecta
2. Associated with Alzheimer disease after age 35: Down sydrome (Trisomy 21)
3. Excess fibro-fatty tissue deposits amongst muscle: Duchenne muscular dystrophy

Question 958

What gene is defective in Cystic fibrosis?

Answer 958

CFTR gene on chromosome 7

Question 959

What is the traditional test used to diagnose cystic fibrosis?

Answer 959

Sweat Chloride test > 60 meq/L

Question 960

What is the difference between Southern blot, Northern blot, and Western blot?

Answer 960

1. Southern blot: Detect DNA with a DNA probe
2. Northern blot: Detect RNA with a DNA probe
3. Western blot: Detect protein with an antibody probe

Question 961

What type of test uses a known antigen to discern the presence of an antibody?

Answer 961

Indirect ELISA

Question 962

What type of test is performed in order to diagnose chromosomal imbalances?

Answer 962

Karyotyping

Question 963

A male infant is born to a woman that is heterozygous for an X-linked disease. The father is normal. What is the probability that the son will be affected?

Answer 963

50%

Question 964

A female infant is born to a woman that is heterozygous for an X-linked disease. The father is normal. What is the probablity that the daughter is a carrier?

Answer 964

50%

Question 965

What is the probablity that a female carrier of an X-linked disease will have a child with that disease assuming she mates with a normal male?

Answer 965

25%

Question 966

If aa symbolizes a recessive disease, what is the likelihood that parents Aa and Aa will have a phenotypically normal child?

Answer 966

75%

Question 967

Cystic fibrosis is an autosomal recessive disorder. Two parents that are heterozygous for cystic fibrosis have a normal, non-affected child. What is the probability that the child is homozygous normal?

Answer 967

33%

Question 968

Upon examination of a pedigree, you note that both males and females are affected with a disease in every generation. What type of genetic disease is this?

Answer 968

Autosomal dominant

Question 969

What is the frequency of the Aa genotype and the AA genotype if the frequency of allele A is .95?

Answer 969

1. AA = 90.25%
2. Aa = 9.5%

Question 970

If 49% of a particular population is homozygous for a curly hair gene that is dominant to a straight hair gene, what percentage of the population has curly hair?

Answer 970

91%

Question 971

Two patients have the smae mutation on chromosome 15 but have different phenotypic expressions. One patient recieved the mutation form the father while the other recieved the mutation from the mother. What is this an example of?

Differentiate Angelman syndrome from Prader-Willi syndrome

Answer 971

Imprinting

“MAMA and POP”

MAMA

1. Maternal gene
2. Angelman syndrome
3. Mood: Happy with inappropriate laughter
4. Ataxia

POP

1. Prader-Willi
2. Overeating/Obesity
3. Paternal gene deletion

Question 972

What are some of the causes of gynecomastia?

Answer 972

Conditions

1. Klinefelter syndrome
2. Hyperestrogen state
3. Old age
4. Cirrhosis
5. Testicular tumors

Drugs

“Some Drugs Create Awesome Knockers”

1. Spironolactone
2. Digoxin
3. Cimetidine
4. Alcohol
5. Ketoconazole

Question 973

What organism is most commonly responsible for acute mastitis?

Answer 973

Staph aureus

Question 974

What is the classic presenting complaint in a patient with intraductal papilloma?

Answer 974

1. “Straw-colored” (yellowish) nipple discharge
2. +/- bloody discharge

Question 975

What breast pathology fits each of the following descriptions?

1. Most common breast tumor in women under 25
2. Most common breast mass in postmenopausal women
3. Most common breast mass in premenopausal women
4. Most common form of breast cancer

Answer 975

1. Most common breast tumor in women under 25: Fibroadenoma
2. Most common breast mass in postmenopausal women: Invasive ductal carcinoma
3. Most common breast mass in premenopausal women: Fibrocystic change of the breast
4. Most common form of breast cancer: Invasive ductal carcinoma

Question 976

What breast pathology fits each of the following descriptions?

1. Small, mobile, firm mass with sharp edges in 24 year-old woman
2. Histological “leaf-like projections”
3. Signet ring cells

Answer 976

1. Small, mobile, firm mass with sharp edges in 24 year-old woman: Fibroadenoma
2. Histological “leaf-like projections”: Phyllodes tumor
3. Signet ring cells: Lobular carcinoma in situ, Invasive lobular carcinoma

Question 977

What breast pathology fits each of the following descriptions?

1. Loss of e-cadherin cell adhesion gene on chromosome 16
2. Always ER(+) and PR(+)
3. Commonly presents with nipple discharge

Answer 977

1. Loss of e-cadherin cell adhesion gene on chromosome 16: Invasive lobular carcinoma
2. Always ER(+) and PR(+): Lobular carcinoma in situ, Invasive lobular carcinoma
3. Commonly presents with nipple discharge: Intraductal papilloma

Question 978

What breast pathology fits each of the following descriptions?

1. Eczematous patches on nipple
2. Multiple bilateral fluid-filled lesions with diffuse breast pain
3. Firm, fibrous mass in a 55 year-old woman

Answer 978

1. Eczematous patches on nipple: Paget disease of the breast
2. Multiple bilateral fluid-filled lesions with diffuse breast pain: Fibrocystic change of the breast
3. Firm, fibrous mass in a 55 year-old woman: Invasive ductal carcinoma

Question 979

A 58 year-old postmenopausal woman is on tamoxifen. What is she at increased risk of acquiring?

Answer 979

Endometrial cancer

Question 980

What factors are taken into consideration when giving a newborn an Apgar score?

Answer 980

“APGAR”

1. Appearance
2. Pulse
3. Grimace
4. Activity
5. Respiration

Question 981

What is the definition of low birth weight? What complications are associated with low birth weights?

Answer 981

1. < 2500g at birth
2. Complications
   
   • Infections
   • Respiratory distress syndrome
   • Necrotizing enterocolitis
   • Persistent fetal circulation
   • Intraventricular hemorrhage

Question 982

Based on the following milestones, how old are each of the following children?

1. Jumps up, 6 cube tower, eats with spoon, 2-3 word sentences
2. Regards face, responds to sound, not yet able to roll over
3. Stands with support, 1-3 words, stranger anxiety, drinks from a cup
4. Rides tricycle, understandable sentences, plays board-games

Answer 982

1. Jumps up, 6 cube tower, eats with spoon, 2-3 word sentences: 2 years
2. Regards face, responds to sound, not yet able to roll over: < 3 months (Probably 2-4 weeks old)
3. Stands with support, 1-3 words, stranger anxiety, drinks from a cup: 1 year old
4. Rides tricycle, understandable sentences, plays board-games: 3 year old