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AM- STEP1 > DIT- Things to know > Flashcards

DIT- Things to know Flashcards

1
Q 
Loss of pain and temp on C/L body
Loss of pain and temp on ipsl face
Hoarseness
Difficulty swallowing
Loss of gag reflex
Vertigo
Nystagmus
N/V
A

Lateral Medullary syndrome (Wallenberg)

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2
Q

Lateral Medullary syndrome (Wallenberg) (6)

A

Spinothalamic tract damage
- Loss of pain and temp sensation over c/l body

Spinal Trigeminal nucleus damage
- Loss of pain and temp sensation over ipsl face

CN IX and X damage
- Hoarseness, difficulty swallow, loss of gag reflex

Descending sympathetic tract
- Ipsilateral Horner syndrome

Vestibular nuclei damage
- Vertigo, nystagmus, N/V

Inferior cerebellar peduncle damage
- Ipsilateral cerebellar deficits
(ataxia, past pointing)

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3
Q

Vessel occluded in stroke of lateral medulla

A

PICA

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4
Q

Internuclear opthalmoplegia

A

Medial longitudinal fasciculus

Eyes dont track together

Medial rectus palsy (right)
Left eye: horizontal nystagmus

Abducting eye: nystagmus
Adducting eye: unable to adduct

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5
Q

Locked in syndrome

A

Can only move eyes

basilar A. stroke affects both sides of superior pons

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6
Q 
Dysphagia
Dysphonia
Dysarthria
C/L spastic hemiparesis
Ipsl ptosis
Pupillary dilation
Lateral strabismus (down and out)
A

Weber syndrome

Anterior midbrain infarction resulting from occlusion of paramedian branches of the posterior cerebral artery

Oculomotor nerve
Cerebral peduncle lesion

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7
Q

Lumbar puncture layers (9)

A
  1. Skin/ superficial fascia
  2. Supraspinous lig
  3. Interspinous lig
  4. Ligamentum Flavum
  5. Epidural space
  6. Dura mater
  7. Subdural space
  8. Arachnoid membrane
  9. Subarachnoid space
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8
Q

Last place blood from brain travels before exiting cranium through jugular foramen

-becomes

A

Sigmoid sinus

Internal jugular vein

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9
Q

Carotid sheath contains (3)

A

Internal jugular v.
Common carotid A.
Vagus n.

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10
Q

Clinical features of normal pressure hydrocephalus

A

Wet wacky wobbly

Urinary incontinence
Dementia
Gait disturbances

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11
Q

Magnetic gait

A

Normal pressure hydrocephalus

Wet wacky wobbly

Urinary incontinence
Dementia
Gait disturbances

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12
Q

Fetal component that secretes hCG

A

Synctiotrophoblast

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13
Q

Maternal component of the placenta

A

Decidua basalis

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14
Q

Migraines are made worse by foods that contain

A

Tyramine

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15
Q

Jaw muscle pain when chewing

A

Giant cell arteritis

Temporal arteritis

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16
Q

Pt using topical retinoic acid for acne

A

Vit A toxicity –>

Idiopathic intracranial HTN

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17
Q

Elevated ESR headache

A

Giant cell arteritis

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18
Q

Headache + Extraocular muscular palsies

A

Cavernous sinus thrombosis

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19
Q

Scintillating scotomata prior to HA

A

Migraine

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20
Q

Stages that an embryo goes through between conception and development of inner cell mass

A

Zygote –> Morula –> blastocyst

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21
Q

Adult brain tumor pneumonic

A

MGM studios

Metastasis
Glioblastoma
Meningioma
Schwannoma

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22
Q

Pediatric brain tumor pneumonic

A

Animal kingdom
Magic kingdom
EpCot

Prepubescent minds eaten with cancer

Pilocytic astrocytoma
Medulloblastoma
Ependymoma
Craniopharyngioma

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23
Q 
Rapidly progressive primary brain tumor
Irregular necrotic center
Surrounded by edema
GFAP stain
Pseudopalasating pattern "snake like"
A

Glioblastoma

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24
Q

Slow growing primary brain tumor
“Whorled”
Surface of brain
Psammoma bodies

  • originates
  • risk
A

Meningioma

Arachnoid cells

Risk

  • Radiation
  • Neurofibromatous type 2
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25
Q

Benign brain tumor
S-100
Tennitus, hearing loss
Vertigo, unsteady gait

-assoc with

A

Schwannoma

Bilateral assoc w/ NF2

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26
Q

Fried egg brain tumor

A

Oligodendroglioma

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27
Q

Slow growing brain tumor
Frontal lobe
Perinuclear cytoplasmic clearing

A

Oligodendroglioma

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28
Q

Hypogonadism or acromegaly

Bitemporal hemianopia

A

Pituitary adenoma

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29
Q

Things that have fried egg appearance

A

Oligodendroglioma
HPV
Seminoma

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30
Q

Two brain tumors associated with NF-2

A

Meningioma

Schwannoma

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31
Q

Posterior fossa brain tumor
GFAP
Rosenthal fibers

A

Pilocytic astrocytoma

Rosenthal fibers: eosinophilic corkscrew fibers

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32
Q

Rathke’s pouch
Compresses optic chiasm
Supratentorial tumor of childhood

A

Craniopharyngioma

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33
Q

Malignant brain tumor
Cerebellar
Compress 4th ventricle
Homer-wright rosettes

A

Medulloblastoma

Cells circle around tangle of fibers

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34
Q

Compress 4th ventricle

Peri-vascular pseudo-rosettes

A

Ependymona

Circular arrangement of cell around vessel

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35
Q

Eosinophilic corkscrew fibers

A

Rosenthal fibers

Pilocytic astrocytoma

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36
Q

Which cranial nerve relays the following information

1) Hypoxia measure by carotid body
2) Motor information on swallowing
3) BP from aortic arch
4) Salivation from the sublingual glands
5) Salivation from the parotid gland
6) BP from carotid body

A

1) CN IX
2) IX, X
3) X
4) VII
5) IX
6) IX

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37
Q

Which type of collagen abnormal in alport syndrome

Alport syndrome

A

Type IV collagen

BM

Nephritis and kidney failure
Hearing loss
Eye problems (cataracts)

Can see, cant pee, cant hear high C

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38
Q

Which type of collagen abnormal in Classic Ehler Danlos syn

Which type in Vascular EDS

A

Type V and I
(Type 1: bone)

Type III
Type (III: stretchy, blood vessles, uterus)

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39
Q

Collagen synthesis 3*

A

Preprocollagen alpha chains synthesized in rough ER of fibroblast
( glycine-proline- X) or (glycine-x-hydroproline)

Hydroxylation of lysine and proline
(requires Vit C)

Glycosylation of the hydroxylated lysin –> procollagen

Exocytosis

Cleave terminal regions of procollagen –> Tropocollagen (proteolysis)

Crosslink tropocollagen to make collagen fibrils (covalent bond)

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40
Q

What is seen in early onset Alz dis vs late onset

A

Early onset

  • Presenilin 1
  • presenilin 2
  • amyloid precursor protein (APP) chr 21

Late onset
- Apo E4

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41
Q

Dementia w/ Lewy body inclusion

A

Pinkish eosinophilic cytoplasmic inclusions, made up of protein called alpha-synuclein

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42
Q

Inclusions of Tau proteins
Atrophy of frontal and temporal lobe
Dementia and behavioral changes
Dementia and progressive aphagia (inability to understand)

A

Pick’s dis

Frontotemporal dementia

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43
Q 
Rapidly progressive dementia
Personality changes
Muscle spasm
Myoclonus
Weeks to months
A

Creutzfeldt-Jakob disease

Prions

aka spongiform encephalopathy

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44
Q

Dementia plus

1) Visual hallucinations
2) Progressive aphasia
3) Ataxia & loss pupillary light reflex
4) Megaloblastic anemia and peripheral neuropathy
5) Resting tremor and bradykinesia
6) Uninhibited social behavior
7) Urinary incontinence and magnetic gait
8) Syncopal episodes
9) Dysarthria and liver dis
10) Myoclonus

A

1) Lewy body dis
2) FTD (Pick)
3) Tertiary syphilis
4) B12
5) LBD or Parkinsons dis
6) FTD (Pick)
7) Normal pressure hydrocephalus
8) Lewy body dis
9) Wilson dis (copper build up)
10) Creutzfeltd-Jakob dis

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45
Q

Identify pigment inclusion

1) Herpes simplex
2) Rabies
3) Parkinson dis
4) Assoc w/ aging
5) Dark pigment in substantia nigra and locus coeruleus, not seen in parkinson dis
6) Eosinophilic, rod like seen in hippocampus of Alz pts
7) Diagnostic of Alz dis
8) Filamentous inclusion that stain w/ silver, do not survival neuronal death
9) Filamentous inclusion that stain w/ PAS and ubiquitin

A
  1. Cowdry Type A
  2. Negri bodies
  3. Lewy body
  4. Lipofuscin granules
  5. Melanin
  6. Hirano bodies
  7. Neurofibrillary plaques and tangles
  8. Pick bodies
  9. Lewy body
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46
Q

Dementia work up (5)

A 
RPR- syphilis
HIV
B12
TSH
MRI
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47
Q

Dominant parietal lobe lesion (4)

Non-dominant parietal lobe lesion

A

Gerstman syndrome

  • agraphia
  • acalculial
  • Finger agnosia (inability to distinguish fingers)
  • L to R disorientation

Hemispatial neglet
(Ignore c/l side of body)

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48
Q

Cholinergic excess pneumonic

A

DUMBBELSS

Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Excitation of skeletal m./ CNS
Lacrimination
Salivation
Sweating
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49
Q

Ptosis
Diplopia
Worsens as day goes on

A

Myasthenia gravis

Ab to acetycholine receptor
Thymus pathology

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50
Q

Nicotinic receptor and Muscarinic receptor are what type of receptor

A

Nicotonic: Ligand gated Na/K channels

Muscarinic: G protein coupled

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51
Q

Anxiety is assoc with altered levels of neurotransmitters

A

Decrease GABA
Decrease Serotonin
Increase NE

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52
Q

Uvela deviates to right, damage to what 2 things

A

Left vagus n.

Left nucleus ambiguus

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53
Q

What beside alpha feto protein is abnormal in fetus with neural tube defect

A

Increase acetylcholinesterase (amniotic)

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54
Q

Patient can not adduct left eye on lateral gaze, convergence is normal

What is damaged

A

Intranuclear opthalmoplegia

Medial longitudinal fasciculus

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55
Q

Pharyngeal pouches from

A

Endoderm

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56
Q

Sympathetic receptor on vasculature of skeletal m.

on heart

on lungs

A

vasculature of skeletal m.: Alpha 1 Beta2 (more)

Heart: Beta 1

Lungs: Beta 2

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57
Q

alpha 1
alpha 2
Beta 1
Beta 2

A

Alpha 1: vascular smooth m. contraction

  • increase resistance and BP
  • bladder sphincter contraction

Alpha 2: Inhibit NE release

Beta 1: Heart

  • Tachycardia
  • increase contractility
  • release renin

Beta 2: Lungs

  • Vasodilation
  • bronchodilation
  • insulin release
  • decrease uterine tone
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58
Q

Pharyngeal pouches structures

A

1st pouch: mastoid air cells, middle ear cavity, eustacian tubes

2nd pouch: lining of palatine tonsils

3rd pouch: thymus, inferior parathyroid glands

4th pouch: superior parathyroid glands

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59
Q

Structures in cavernous sinus

A 
Oculomotor
Trochlear n.
Abducens
Opthalmic div V1
Maxillary div V2

Internal carotid A.

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60
Q

Catecholamine synthesis

A

Phenylalanine (BH4 -> BH2) –> Tyrosine [Phenylalanine hydroxylase]

Tyrosine (BH4–> BH2) –> DOPA
[Tyrosine hydroxylase)

DOPA (Vit B6) –> Dopamine
[DOPA decarboxylase]

Dopamine (Vit C) –> NE
[Dopamine beta-hydroxylase]

NE –> EPI
[PNMT] (+) Cortisol

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61
Q

Cofactors in metabolism of NE

A

Catechol-o-methyltransferase (COMT)
- methylates NE

Monoamine oxidase (MAO)
- oxidized NE
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62
Q

Damage to which artery would produce each

1) Bilateral loss of lateral visual fields
2) Broca or wernicke aphasia
3) Unilateral lower extremity sensory and/or motor loss
4) Unilateral facial and upper extremity sensory and motor loss

A

1) Anterior communicating A.
2) Middle cerebral A.
3) Anterior cerebral A.
4) Middle cerebral A.

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63
Q

Diuretic used for idiopathic intracranial HTN

A

Acetazolamide

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64
Q

When does implantation of blastocyst take place

A

6 days after fertilization

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65
Q

Therapeutic index (TI)

A

LD50/ED50

Lethal dose/ effictive dose

Higher the TI safer the drug

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66
Q

Low therapeutic index drugs

A

Some Drugs With Low Therapeutic index

Seizure drugs
Digoxin
Warfarin
Lithium
Theophylline
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67
Q

Which regions of the brain compose the limbic system

A 
Amygdala
Septal nucleus
Mamillary bodies
Fornix
Hippocampus
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68
Q

What structure grows to close the opening/ canal between the atrial chamber and ventricular chamber into two smaller openings

A

Superior endocardial cushion

Inferior endocardial cushion

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69
Q

Aortic arches

A

Most likely to be test on 3rd and 4th

1st
- Part of maxillary A.

2nd

  • stapedial A.
  • hyoid A.

3rd

  • common carotid a.
  • proximal part of internal carotid A.

4th

  • Left: arch of adult aorta
  • Right: Proxiaml part of right subclavian a.

6th

  • proximal part of pulmonary A.
  • Ductus arteriosus
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70
Q

R to L shunts

A
  1. Persistant Truncus arteriosus
  2. Transposition of the great vessels (2 vessels)
  3. Tricuspid atresia
  4. Tetralogy of Fallot
  5. Total anamalous pulmonary venous return
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71
Q

Ebstein anomaly

A

Tricupsid leaflets are displaced into right ventricle
Hypoplastic right ventricle

Lithium use

Widely split S2

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72
Q

Tetralogy of Fallot

A

IHOP

Interventriculat septal defect (USD)
Hypertrophy of RV
Overriding aorta
Pulmonic stenosis

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73
Q

Boot shaped heart in infant

A

Tetralogy of fallot

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74
Q

Maternal alcohol use can lead to heart defects

A

Tetralogy of fallot
VSD
ASD

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75
Q

Pregestational diabetes possible heart defect

A

Transposition of great vessels

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76
Q

Congenital Rubella possible heart defect

A

PDA

Pulmonary artery stenosis

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77
Q

DiGeorge syndrome possibe heart defect

A

Tetralogy of fallot

Truncus arteriosus

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78
Q

Turner syndrome possible heart defect

A

Coarctation of the aorta

Bicuspid aortic valve

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79
Q

Trisomy 21 possible heart defect

A

ASD or VSD

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80
Q

Most common congenital cardiac anomaly

A

VSD

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81
Q

Most common congenital cause of early cyanosis

A

Tetralogy of Fallot

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82
Q

Rib notching heart defect

A

Coarctation of aorta

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83
Q

Enzymes involved in catabolism of NE

A 
Catechol-o-methyltransferase (COMT)
Monoamine oxidase (MAO)
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84
Q

Cardiac output is equal to

A

Stroke vol (SV) x HR

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85
Q

Stroke vol is equal to

A

End-diastolic vol minus end-systolic vol

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86
Q

Fick Principle

A

CO= Rate of O2 consumption/ arterial O2 content- venous O2 content

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87
Q

Mean arterial pressure (P) =

A

MAP = Cardiac output (Q) x Peripheral resistance (R)

P= QxR

MAP= 2/3 diastolic pressure + 1/3 systolic pressure

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88
Q

Pulse pressure =

A

systolic pressure - diastolic pressure

The higher the stroke volume the higher the pulse pressure

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89
Q

Digoxin does what

A

Increase contractility

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90
Q

Ejection fraction (EF) =

A

SV/ EDV

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91
Q

CHF does what to capillary hydrostatic pressure (Pc)

A

Increases it

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92
Q

Liver disease does what to starling forces

A

Decreases plasma colloid osmotic pressure

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93
Q

What increased interstitial colloid osmotic pressure

A

Lymphatic obstruction

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94
Q

Affect on starling forces

  1. HF
  2. Liver failure
  3. Oliguric renal failure
  4. Infections
  5. Nephrotic syndrome
  6. Lymphatic blockage
  7. Burns
  8. Diuretic administration
  9. IV infusion of albumin
  10. Venous insufficiency
A
  1. HF= Increase Pc
  2. Liver failure= Decrease TTc
  3. Oliguric renal failure= Increase Pc
  4. Infections= Increase Kf
  5. Nephrotic syndrome= Decrease TTc
  6. Lymphatic blockage= Increase TTi
  7. Burns= Increase Kf
  8. Diuretic administration= Decrease Pc
  9. IV infusion of albumin= Increase TTc
  10. Venous insufficiency= Increase Pc
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95
Q

Drug causes eye dilation

A

Anticholinergic

Atropine

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96
Q

Wide splitting of S2

A

Wider on inspiration

Pulmonic stenosis
RBBB

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97
Q

Fixed splitting of S2

A

Split on both inspiration and expiration equally

atrial septal defect

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98
Q

Paradoxical splitting of S2

A

Split on expiration

Aortic stenosis
LBBB

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99
Q

Which heart sound is associated with dilated congestive heart failure

A

S3

Mitral regurg
L To R shunt

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100
Q

Which heart sound is associated with chronic HTN

A

S4

Hypertrophic cardiomyopathy
Aortic stenosis
LV hypertrophy
Post MI

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101
Q

Inspiration makes what murmur louder

A

Tricuspid

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102
Q

What murmur is louder with expiration

A

Mitral

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103
Q

Hang Grip makes what murmur louder

A

Most quieter except

Hypertrophic cardiomyopathy

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104
Q

Bounding pulses, head bobbing, diastolic murmur

A

Aortic regurg

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105
Q

Underlying mechanism of organophosphate poisoning

A

Inhibit acetylcholinesterase

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106
Q

MOA of N-acetylcysteine for acetaminophen overdose

A

Regenerates glutathione

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107
Q

Equation for 1/2 life

A

T1/2= (0.7 x VD)/ CL

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108
Q

What two antibodies most useful in diagnosing rheumatoid arthritis

A

Rheumatoid factor

Anti-citrullinated protein Ab

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109
Q

How do NSAIDS cause renal disease

A

Block prostaglandin Syn

Constrict renal vessels

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110
Q

Epidermis pneumonic

A

Come Lets Get Sun Burnt

Corneum
Lucideum
Granulosum
Spinosum (only palms and soles) 
Basale
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111
Q

Components of Zona Occludens

A

TIght junction

Claudins
Occludin

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112
Q

Components of Zona adherens

A

Bridge to skeleton

E-cadherin
actin

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113
Q

Components of Macula adherens

A

Desmosomes, resist shearing forces
Simple/ stratified squamous epithelium

Desmoglein

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114
Q

Components of Gap junctions

A

Cardiac cells

Connexon

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115
Q

Components of Hemidesmosomes

A

Connect to BM

Integrins

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116
Q

Auer rods

A

AML

15;17

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117
Q

15;17

A

AML

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118
Q

8;14

A

Burkitt lymphoma

Starry sky
Basophilic cytopasms containing prominenet lipid vacuoles

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119
Q

9;22

A

CML

Blood smear shows leukocytosis with many immature myeloid cells (horseshoe nucleus)

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120
Q

12;21

A

B cell- ALL

Anemia
Thrombocytopenia
Lymphoblasts

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121
Q

14;18

A

Follicular lymphoma

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122
Q

Firm flesh color papules on face with umbilicated center is

A

Molluscum contagiosum from Pox virus

See Molluscum bodies: eosinophilic cytoplasmic inclusions

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123
Q

Ballooning multinucleated giant cells

A

Herpes simplex

Enlarged cells w/ intranuclear inclusions, cell fusion produc giant cells

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124
Q

Basaloid cells with peripheral palisading nuclei

A

Basal cell carcinoma

Slow growing papules, ulceration or rolled border

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125
Q

Cells with enlarged nuclei and perinuclear halos

A

Veruca vulgaris due to HPV

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126
Q

Encapsulated round yeast forms

A

Cryptococcus neoformans

cerebrospinal fluid shows budding encapsulated yeast

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127
Q

What is at risk with an anterior/ posterior knee displaccement

A

Popliteal artery

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128
Q

What is commonly damaged by blunt trauma of lateral knee, vessel

A

Common peroneal nerve

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129
Q

Concentrations of fluids within

  • Ileum
  • Pancreas
  • Salivary gland
  • Sweat gland
A

Ileum

  • Alkaline
  • bicarb > Cl
  • increase K

Pancreas

  • bicarb and chloride change with flow rate
  • high flow: high bicarb low Cl
  • low flow: low bicarb high Cl
  • fixed Na and K concentration

Salivary gland

  • isotonic solution
  • Lower [Na] [Cl]
  • Higher [K]

Eccrine glands

  • hypotonic
  • composed of sodium chloride, some potassium
  • minimal bicarb
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130
Q

Acute stress disorder become PTSD

A

> 1 month

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131
Q

Cerebellar degeneration vs cobalamin deficiency

A

Cerebellar degeneration

  • tremors
  • gait impairment

Cobalamin deficiency

  • Decreased vibration sensation
  • Gait impairment
  • Positive Babinski
  • Hyperactive/ hypo reflexes
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132
Q

Difficulty chewing
Double vision
Ptosis

Associated with

A

Myasthenia gravis

Associated with thymic hyperplasia

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133
Q

Loss of heterozygosity

A

Inherits one mutation and must develop the second one for tumor to form

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134
Q

Defective DNA repair

A

Xeroderma pigmentosum

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135
Q

Parental imprinting

A

Prader-Willi

Angelmann syndromes

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136
Q

Blue green image

A

potassium hydroxide (KOH) mount

Fungi

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137
Q

Low CD3

Normal B cells

A

Di George

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138
Q

Allelic heterogeneity

A

Multiple genes same phenotype

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139
Q

Hereditary hemochromatosis

A

AR
Excessive absorption of iron

Hyperpigmentation (bronze diabetes)
Arthalgia, arthropathy
Hepatomegaly
DM
Progressive weakening
Dry mouth
Hypogonadism (small testes)
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140
Q

COL1A1 mutation

A

Osteogenesis imperfecta

Type I collagen
Short stature
Blue sclerae

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141
Q

Infant suffering from recurrent infections, abnormal gene for cytoplasmic tyrosine kinase

A

Bruton aggammaglobulinemia

Bruton’s tyrosine kinase (BTK)

X linked

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142
Q

Genetic mutations chromosome 7

A

Cystic fibrosis
Ehlers Danlos
Osteogenesis imperfecta

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143
Q

Genetic mutations chromosome 16

A

Polycystic kidney disease

Tuberous sclerosis

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144
Q

Increase in branched chain alpha-keto acid

What can also be deficent

A

Maple syrup urine disease

Alpha ketoacid dehydrogenase require thaimine pyrophosphate (Vit B1) as coenzyme

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145
Q

Pyridoxine order to go with

A

Isoniazid

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146
Q

Previous MI
Crampy abdominal pain
Blood in stool
Elderly

A

Ischemic colitis

Mucosal hemorrhage and patchy areas of necrosis

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147
Q

Not eating for days
Low ketones
Vomiting and lethargy

A

Medium-chain acyl-CoA dehydrogenase deficiency

Hypoketotic hypoglycemia

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148
Q

Glucose 6 phosphatase deficiency

A

Von Gierke disease

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149
Q

Glycogen phosphorylase deficiency

A

McArdle

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150
Q

Warfarin with CYP 450 inducer leads to what Vmax and KM

A

Warfarin metabolism increased

Increased V max

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151
Q

Chromogranin

A

Carcinoid tumor

Secretes serotonin

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152
Q

Diabetes medications

  1. Acarbose
  2. Canagliflozin
  3. Glyburide
  4. Pioglitazone
  5. Repaglinide
A

Acarbose
-intestinal brush border alpha glucosidase inhibitor decreases postprandial hyperglycemia by reducing GI absorption of glucose

Canagliflozin
- sodium glucose cotransporter 2 inhibitors, act on kidney to decrease reabsorption of filtered glucose

Glyburide (sulfonylureas) and Meglitinides (repaglinide)

  • bind to and close ATP sensitive K channels in pancreatic beta membrane
  • depolarize and open L type Ca channel
  • Increase Ca influx, insulin release

Pioglitazone (Thiazolidinediones) peroxisome proliferator-activated receptor gamma (PPAR-y)

  • decrease insulin resistance
  • expression glut 4
  • adiponectin
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153
Q

Celiac disease location

A

Distal duodenum

Proximal jejunum

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154
Q

Chronic diarrhea
Drainage of abscess
Erythema near perineum

A

Crohns

terminal ileum

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155
Q

Abnormal formation of lamellar bone is seen in

A

Paget disease of bone

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156
Q

Autosomal dominant cancer mutations disease

A 
Lynch syndrome
Familial adenomatous polyposis
VHL
Li-Fraumeni
MEN1/2
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157
Q

Laryngeal nerves

-Internal laryngeal supplies

A

Internal laryngeal: Supraglottic

External laryngeal: cricothyroid

L. recurrent laryngeal: posterior cricoarytenoid, lateral cricoarythenoid, oblique arytenoid, transverse arytenoid, thyroarytenoid

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158
Q

DNA virus

A

Papillomaviruses

Poxviruses (replicates in cytosol)

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159
Q

Acute onset anemia
Evidence of hemolysis (icterus, elevated reticulocyte count)
Tx w/ TMP-SMX

A

G6pD deficiency

Erythrocyte enzyme deficiency

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160
Q

Unmyelinated nerve fibers

A

Post ganglionic autonomic nervous system axons

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161
Q

Positive sense ssRNA virus

1) Meningitis
2) common cold

A

Picornavirus

Coronoavirus- cold

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162
Q

negative sense ssRNA virus

A

Arenavirus- hemorrhagic fever

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163
Q

Prader Willi syndrome

A

Loss of paternally inherited allele

Tantrums
Excessive food seeking
Obesity
Small hands
Short stature
Hypogonadism
Intellectual disability
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164
Q

Tantrums
Excessive food seeking behavior
Obesity
Small hands

A

Prader Willi syndrome

Loss of paternally inherited allele

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165
Q

Angelmann syndrome

A

Loss of maternal allele

Epilepsy/ seizures
Ataxic gait
Innappropraite laughter/ smiling

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166
Q

Cobblestone mucosa

A

Crohns disease

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167
Q

Aggressive biting fingers, tongue and lips

A

Hypoxanthine-guanine phosphoribosyltransferase deficiency (HGPRT)

Lesch-Nyhan syndrome
X linked recessive

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168
Q

Stroke blindness

A

Homonymous hemianopsia

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169
Q

acanthosis nigrcans associated iwth

A

velvety hyper pigmented plaques on the skin in axillae and neck

insulin resistance

GI malignancy

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170
Q

Cystic fibrosis type of mutation

A

Frame shift

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171
Q

Hyperflexible joints

Stretchy skin

A

Ehlers danlos

Collagen defect

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172
Q

Drug A. Absolute risk reduction for drug A versus standard therapy 4%. The incidence of recurrent PE in standard therapy group was 6%. There were 24 pts who developed recurrent PE in drug A group. How many total subjects in drug A group?

A

ARR= ER control- ER treatment
(Event rate)

0.4= 0.6- x
ER treatment= 0.2

ER treatment= Number of events/ number of subjects

0.2= 24/ number of subjects

=1200

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173
Q

IFN-y fxn

A

activates macrophages

promotes TH1 differentiation

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174
Q

IL-4

A

produced by TH2

activates B cells

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175
Q

Stimulates neutrophil migration to sites of inflammation

A

Leukotriene B4

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176
Q

Acute pancreatitis is due to activation of waht

A

Trypsin

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177
Q

Elastin composition

A

Nonpolar aminoacids
Not hydroxylated
Lysyl oxidase copper-dep enzyme oxidatively deaminates lysine residues of tropoelastin, facilitating desmosine cross links

[Collagen synthesis

  • Disulfide bridges
  • post translational hydroxylation
  • triple helix assembly]
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178
Q

Reverse T3 (rT3)

A

inactive form of T3 generated by entirely from the peripheral conversion of T4

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179
Q

Diphtheria toxin and Exotoxin A (pseudomonas)

A

Inactivates EF-2 vis ribosylation, thus inhibiting host cell rpotein synthesis

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180
Q

Tc-pertechnetate scan

A

Meckel diverticulum

Failed obliterationo fthe vitelline duct

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181
Q

Promotor regions

-disrupted

A

CAAT
TATA

  • Prevent initiation of transcription
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182
Q

Palpitations
Tachycardia
Irregularly irregular rhythm

A

Atrial fibrillation

No P waves

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183
Q

Neutralizes reactive oxygen species

A

Superoxide dismutase

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184
Q

Kidney biopsy

Green straight lines

A

Anti-glomerular basement membrane disease
(Goodpasture dis)

Collagen IV

Seen glomerular crescents

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185
Q

Origin of melanoma

A

Neural crest

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186
Q

Receptor of T cells to identify tumor cells and induce apoptosis

A

Programmed death ligand 1 (PD-1)

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187
Q

Yellow nodules on palmar creases. Father has MI at 56. Accumulation of lipid laden macrophages
Lack of ApoE3 and ApoE4. What is impaired?

A

Familial dysbetalipoproteinemia
AR

-defect in ApoE

Impaired chylomicron remnant uptake by liver cells

Accumulation cholestesrol and triglyceride levels

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188
Q

Hyperlipoproteinemias types

A

Type I (AR)

  • Familial chylomicroenemia
  • Defect: Lipoprotein lipase
  • Defect: ApoC-2 production
  • Elevated chylomicrons
  • Acute pancreatitits*, Lipemia retinalis, eruptive xanthomas
Type IIA
- Familial hypercholesterolemia
- Defect: LDL receptor
- Defect: ApoB-100
- Elevated LDL*
(Impaired LDL particle uptake by hepatocytes) 
-Premature atherosclerosis*
- Tendon xanthomas, xanthelasmas (yellow deposit around eyes)

Type III

  • Familial dysbetalipoproteinemia
  • Defect ApoE
  • Elevated: chylomicron & VLDL remnants
  • Premature atherosclerosis*
  • Tuboeruptive and palmar xanthomas

Type IV

  • Familial hypertriglyceridemia
  • Defect Polygenic
  • Elevated VLDL
  • Associated with coronary disease, pancreatitis and diabets
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189
Q

Defect in Fibrillin-1

A

Marfan

Microfibrils
Blood vessels (aorta)
Long thin extremities
long fingers
Aortic root dilation
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190
Q

Vit D overdose similar to what condition

A

Sarcoidosis, Tb

Have PTH independent conversion due to expression of 1-alpha-hydroxylse in activated macrophages

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191
Q

Oculomotor (CN III) palsy secondary to a compressive aneurysm located where

A

Posterior communicating artery

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192
Q

Bronchiolitis

A

Rhinorrhea and congestion

Followed by cough, low grade fever and increased work of breathing

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193
Q

Repetitive vomiting leads to what acid-base disturbance

A

Metabolic alkalosis

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194
Q

Conjunctival injection

A

Red eyes

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195
Q

Glucagon mediator responsible for decrease glycogen stores adn glucose

A

Gs

Adenylate cyclase
Protein kinase A

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196
Q

Insulin resistance leads to increase in waht

A

Free fatty acid level

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197
Q

How to measure mean arterial pressure

A

placing an arterial catheter directly in central arterial circulation (common femoral or radial artery) and reflects the average aortic pressure

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198
Q

Measuring pressure in pulmonary artery is also measuring pressure where?

A

Left atrial pressure

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199
Q

Ammonium and bicarbonate generated from AA

Urea and ornithine produced from

pyruvate produced from AA

oxaloacetate produced from AA

A

glutamine

arginine

Alanine

aspartate

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200
Q

Lymphatic drainage

Testis

glans penis

Upper 2/3 vagina, uterus, cervix, prostate

Lower 1/2 vagina, vulva, scrotum

A

Testis: para-aortic

Glans penis: deep inguinal nodes

Upper 2/3 vagina, uterus, cervix, prostate: External iliac nodes, internal iliac nodes

Lower 1/2 vagina, vulva, Scrotom: superficial inguinal nodes

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201
Q

Broad, nonseptate hyphae that branch at wide 90 angles

A

Mucor
Rhizopus
Absidia

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202
Q

Immediate hypersensitivity txn

A

Type 1

Cell surface bound antibody bridging by antigen

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203
Q

Three primary ketones

A

Acetoacetate
Beta-hydroxybutyrate (BHB)
Beta-hydroxybutyric acid

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204
Q

Septic aborption organisms

A

Staph aureus
Ecoli
Group B strep

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205
Q

Intellectual disability
Hx of seizures
Abnormal pallor of substantia nigra, locus ceruleus and vagal nucleus dorsalia

A

Phenylalanine hydroxylase deficiency

PKU

Cant convert phenylalaine to tyrosine

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206
Q

Tennis racquet granules

A

Langerhan cells

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207
Q

9 month old
2 minute general seizures
Fever

3 days later
afebrile
Maculopapular rash on trunk

A

Human herpesvirus 6

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208
Q

Exertional dyspnea
Easy fatigue
Gait unstable when eyes closed
Impaired vibratory sensation of lower extremiteis
Marked pallor of conjunctivae, nail beds and palms

A

Vit B 12 deficency

Co factor for methylmalonyl-CoA

Elevated Serum methylmalonic acid and homocysteine

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209
Q

Increased intracranial pressure in infant

A

Intracranial hemorrhage due to vit K deficiency

Impaired clotting factor carboxylation

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210
Q

Acute compartment syndrome (ACS) affects what in the leg

A

Foot extensors
Anterior tibial A.
Deep peroneal (Fibular) nerve

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211
Q

Pleiotrophy

A

One mutation multiple things wrong w/ person

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212
Q

Power of the study?

A

1- beta

beta= type II error, probability to conducting there is no difference

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213
Q

MHC to CD8 composed of

A 
MHC class I
beta microglobulin
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214
Q

MCH to CD4 composed of

A

MHC class II

alpha and beta chains

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215
Q

Hepatitis B C D vs A E

A

BCD transmitter parenterally (IV, blood)

AE: fecal oral

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216
Q

Hepatitis pregnant women

A

Hep E

unenveloped ssRNA

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217
Q

Takes place in cytosol vs mitochondria

A

Cytosol

  • Glycolysis
  • FA synthesis
  • Pentose phosphate pathway

Mitochondria
- beta oxidation of fatty acids
- citric acid cycle
carboxylation of pyruvate (gluconeogenesis)

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218
Q

Interferon alpha and beta do what

A

halt protein synthesis

Only works on dsDNA

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219
Q

Sorbitol conversion

A

Sorbitol – sorbitol dehydrogenease –> fructose

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220
Q

Start codon

A

AUG

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221
Q

Stop codon

A

UAA
UAG
UGA

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222
Q

OCD tx

A

SSRI

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223
Q 
Fever myalgia
Profound fatigue
Swollen LN in neck and behind ears
Lymphocytosis
Splenomegaly
A

EBV

transferred vis kissing

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224
Q

Splenomegaly
South asia
Anemia
thrombocytopenia

A

Malaria

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225
Q

Splenomegaly
South asia
Progressive splenic enlargement
WL over months

A

Leishmaniasis

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226
Q

scabes tx

A

topical permethrin

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227
Q

Tx for staph aureus cellulitis

A

Topical mupirocin

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228
Q

Anemia
Hypercoagulability
Pancytopenia

A

Paroxysmal nocturnal hemoglobinuria (PNH)

Mutation PIGA
Deficiency: glycosylphosphatidylinositol (GPI) anchor
Deficiency: CD55 CD59

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229
Q

Positive VDRL w/ vulvar lesion

A

Tertiarty syphilis

Gumma

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230
Q

Tx Manic depression

A

Valproic acid
Lithium
Carbamazepine

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231
Q

Tx w/ antibiotic
Proteinuria
Hematuria

A

Acute poststreptococcal glomerulonephritis

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232
Q

HTN
Hematuria
Proteinuria

A

Nephritic syndrome

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233
Q

Breast dimpling signals involvement of

A

Suspensory ligaments

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234
Q

HTN
HA
Adrenal mass

A

Pheochromocytomas

From Neural crest

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235
Q

Narcolepsy caused by

A

hypocretin-1

hypocretin-2

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236
Q

Elevated 14-3-3 protein CSF

A

Creutz-jakob

Prions

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237
Q

Temporal lobe encephalitis

A

Herpes simplex virus

Tx acyclovir
- effects viral DNA polymerase

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238
Q

Meningitis w/ increased protein and normal glucose

A

Viral

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239
Q

Meningitis w/ low glucose and elevated protein

A

Bacterial

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240
Q

CHF leads to increase in what force

A

Capillary hydrostatic pressure (Pc)

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241
Q

Replicative process

1) DS dna –> DS dna template –> ds DNA progeny
2) DS dna -> +RNA template -> partially ds-DNA
3) ssDNA –> ds DNA template –> ss DNA progeny
4) ss +RNA –> ds DNA template –> ss +RNA progeny
5) ss +RNA –> - RNA template –> ss + RNA progeny
6) ss -RNA –> +RNA template –> ss -RNA progeny

A

1) Adenovius, herpesvirus, poxvirus
2) Hepatitis virus
3) Parvovirus B19
4) Retroviruses (HIV)
5) poliovirus
6) Influenza virua, measles virus, rabies virus

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242
Q

Metastatic bone pneumonic

A

Permanently Relocated Tumors That Like Bones

Prostate
Renal cell cancer
Testes
Thyroid
Lung
Breast
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243
Q

Osteopetrosis due to deficient

A

Carbonic anhydrase II

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244
Q

Polyostotic Fibrous dysplasia

associated with

A

Bone replaced by collagen and fibroblast

Assoc with McCune Albright syn

  • Precocious puberty
  • Cafe au lait
  • Fibrous dysplasia bone
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245
Q

Precocious puberty
Cafe au lait spots
Fibrous dysplasia bone

A

McCune albright syndrome

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246
Q

unhappy Triad

A

Anterior cruciate lig
Medial cruciate lig
Lateral/ medial meniscus

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247
Q

Ankle sprain (3)

A

Anterior talofibular lig
Calcaneofibular lig
Posterior talofibular lig

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248
Q

What structures damaged in anterior shoulder dislocation

A

Axillary n.
Posterior circumflex artery
Supraspinatus tendon
Anterior glenohumoral ligaments

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249
Q

What is damaged with posterior dislocation of the hip

A

Medial and lateral circumflex femoral a.
Femoral v
Sciatic nerve
Head of femur

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250
Q

Polymyositis

A

Inflammatory muscle disease
Proximal muscle weakness

CD8 t cells induced injury to muscle fibers

Increase Ck and aldolase

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251
Q

Fibromyalgia

A

Excess tenderness at 11 of 18 sites
Fatigue

Tx. Pregabalin, milnacipran

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252
Q

Duchenne muscular dystrophy

A

X linked frame shift mutation

Absent Dystrophin gene

INcreased creatine kinase

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253
Q

Becker muscular dystrophy

A

Inframe shift mutation

Mutated dystrophin gene

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254
Q

Polymyalgia rheumatica

A

Joint pain
Stiffness in proximal joints
Malaise, fever, WL

No weakness

Tx prednisone

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255
Q

S-100 tumor marker

A

Melanoma

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256
Q

Melanoma histologically

A

Nests of melanocytes that fill dermis and obsecure epithelial dermal junction

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257
Q

Albinism due to

A

Lack of melanin pigment due to lack of tyrosinase enzyme

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258
Q

Vitillago due to

A

Decreased number of melanocytes

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259
Q

Melasma

A

Dark discoloration common in pregnant women those take OCPs or hormone replacement

Patchy cheeks or lip

Due to stimulation of melanocytes by estrogen and progesterone

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260
Q

Cellulitis organisms

looks like

A

Staph. aureus
Strep pyogenes

Painful and tender to touch
rapidly spreads

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261
Q

cellulitis tx

  • MRSA
  • non-MRSA
A

Non-MRSA( no abscess)
- oral dicloxacillin, cephalexin

MRSA:

  • oral trimethoprim/sulfamethoxazole
  • clindamycin
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262
Q

Necrotizing fasciitis organism

Tx

A

Strep. pyogenes
Anaerobic bacteria

Tx: Debridement
IV carbapenem
clindamycin

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263
Q

Painful flaccid blister

biopsy shows
Ab against
test

unique feature

A

Pemphigus vulgaris

acantholysis
Ab desmosomes
Positive Nikolsky sign

oral lesions

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264
Q

Tight raised blister

A

Bullous pemphigoid

Ab to hemidesmosomes
Eosinophils within blister
Negative nikolsky
no oral lesion

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265
Q

Blister IgA in tips of dermal papillae

A

Dermatitis herpetiformis

assoc w/ celiac

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266
Q

Erythema multiforme

A

Deposition of immune complexes
Following infection or drug exposure

Target lesions

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267
Q

Pruritic, purple, polygonal papules and plaques

  • microscopically see
  • assoc with
A

Lichen planus

Sawtooth pattern at dermal-epidermal junction

Hepatitis C

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268
Q

Acanthosis nigricans

  • hyperplasia of
  • assoc w/
A

velvety hyperpigmentation of skin

Stratum spinosum

Hyperinsulinemia and visceral malignancies

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269
Q

Erythema nodosum assoc with

A

Sarcoidosis, histoplasmosis, Tb, leprsy

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270
Q

Pruritic vesicles associated with celiac disease

A

Dermatitis herpetiformis

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271
Q

Ligaments of ovaries/ uterus w/ vessels

A

Cardinal ligament
- uterine vessels
Cervix to pelvic sidewall

Infundibulopelvic ligament (suspensory lig of ovary)

  • ovarian vessels
  • ovary to pelvic side wal

Broad ligament

  • uterus, fallopian tubes, and ovaries to pelvic wall
  • contain ovarian lig, round lig, and suspensory lig of ovary
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272
Q

Ligaments of ovaries/ uterus with no vessels

A

Round ligament of uterus

  • gubernaculum
  • uterus thorugh inguinal canal to labia majorum

Ovarian ligament

  • ovary to uterus
  • gubernaculum
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273
Q

Nerves damaged w/ prostatectomy –> erectile dysfunction

Release
Leads to

A

Cavernous n.

release NO (vasodilation)
Increase cGMP
Decrease Ca

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274
Q

Nervous system components of male sexual response

A

Erection (point)
- parasym

Emission & ejaculation (shoot)
- sympathetic

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275
Q

R ovarian/ testis vein drain to

A

R gonadal v to IVC

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276
Q

L ovarian/ testis vein drin to

A

L gonadal v. to L. renal vein –> IVC

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277
Q

Indirect inguinal hernia

Direct inguinal hernia

A

Indirect inguinal hernia

  • Most common
  • Congenital due to failure of closure of processus vaginalis
  • Protrude through deep inguinal ring, lateral to inferior epigastric vessels and pass through inguinal canal

Direct inguinal hernia

  • Weakening of abdominal wall in Hesselbach’s triangle
  • Increase pressure heavy lifting
  • Directly through abdominal wall medial to inferior epigastric vessel, exit out superficial inguinal ring
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278
Q

Hesselbach’s triangle

A

Inguinal lig
Inferior epigastric vessel
Lateral border of rectus abdominis

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279
Q

Mitral regurg vs Aortic regurg

A

Mitral regurg

  • Left lateral decubitis best heard
  • Enhanced w/ squatting
  • Expiration
  • Holosystolic

Aortic regurg

  • Widening of pulse pressure
  • Diastolic
  • Decrescendo
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280
Q

Epispadias

associated with

A

opening of penis on dorsal surface (top)

Exstrophy of bladder
- exposure of bladder interior to the outside world

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281
Q

Male reproductive development process

A

Mesonephric duct

SRY gene on Y chromosome
Produce testis-determining factor
-Induces gonad differentaition
- Develop of two cells types

Sertoli

  • Produce Mullerian inhibitor factor
  • Paramesonephric duct degenerates

Leydig cells

  • Produce testosterone
  • Mesonephric duct –> internal male (but not prostate)
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282
Q

What induces urogenital sinus and genital tubercle to become male external genitalia

A

DHT

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283
Q

Paramesonephric duct forms

A

Fallopian tube, uterus and upper portion of vagina

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284
Q

What forms the lower portion of the vagina

A

Urogenital sinus –> sinovaginal bulbs –> lower vagina

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285
Q

Genital homologs

1) Glans penis
2) Corpus spongiosum and corpus cavernosum
3) Bulbourethral (Cowper) glas
4) Prostate gland
5) Ventral shaft of penis
6) Scrotum

A

1) Glans penis= glans clitoris
2) Corpus spongiosum and corpus cavernosum= vestibular bulbs
3) Bulbourethral (Cowper) glands= Greater vestibular (Bartholin) glands
4) Prostate gland= Urethral and paraurethral (skene) glands
5) Ventral shaft of penis= Labia minora
6) Scrotum= Labia majora

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286
Q

Genital homologs
1) Glans clitoris

2) Vestibular bulbs
3) Greater vestibular (Bartholin) glands
4) Urethral and paraurethral (skene) glands
5) Labia minora
6) Labia majora

A

1) Glans penis= glans clitoris
2) Corpus spongiosum and corpus cavernosum= vestibular bulbs
3) Bulbourethral (Cowper) glands= Greater vestibular (Bartholin) glands
4) Prostate gland= Urethral and paraurethral (skene) glands
5) Ventral shaft of penis= Labia minora
6) Scrotum= Labia majora

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287
Q

Gubernaculum and Processus vaginalis in males and females

A

Males

  • Gubernaculum: anchors testes to scrotum
  • Processus vaginalis: forms tunica vaginalis

Females
- Gubernaculum: becomes ovarian ligament and round ligament of uterus
(anchors uterus to labia majora)
- Processus vaginalia: obliterated

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288
Q

Sertoli cells stimulated by

secrete (3)

A

Anti-mullerian hormone

Inhibin (FSH feedback)

Androgen binding protein

  • maintain levels testosterone
  • helps mature spermatocytes
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289
Q

Leydig cells

  • located
  • stimulated by
  • secretes
A

Interstitium

LH

Secretes testosterone

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290
Q

Amenorrhea

Loss of smell

A

Kallman syndrome

Defect of X linked KAL chain
Decrease GnRH –> Low LH and FSH

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291
Q

Redness swelling and tenderness of scrotom relieved by support of the testes

  • Organisms
  • Tx
A

Epididymitis

GC/Chlamydia
Anal: E coli

GC/Chlamydia: Ceftrixone (IM) then doxycycline

Ecoli: Fluoroquinolone

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292
Q

Lesions on penis

Gray, solitary, crusty plaque on the penile shaft or scrotum

Red, velvety plaque involving the glans of the penis

Multiple papular lesions, not invasive

A

Bowen disease
- progress to invasive SCC

Erythroplasia of Queyrat
- the tip of the penis

Bowenoid papulosis
-affects younger individuals

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293
Q

95% of penile cancers

A

SCC

assoc w/ HPV

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294
Q

Peyronie disease

A

Angulation of penis
Leading to painful erections
Inflammation of tunica albuginea

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295
Q

Priapism

Lead to

assoc w/

A

Persistent penile erection

Ischemia and clotting of blood retained in penis

Assoc w/ sickle cell disease and spinal cord injuries

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296
Q

Balanitis

  • organism
  • more common
A

Inflammation of glans penis

Candida

Uncircumcised
Diabetes

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297
Q

Prostatitis

  • Organism
  • Tx
A

<35: Gonorrhea, Chlamydia

> 35: E coli, klebsiella, serratia, enterobacter, proteus

Tx: Fluoroquinolone (levofloxacin), TMP-SMX

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298
Q

Estradiol
Estrone
Estriol

A

Estradiol

  • Most potent estrogen
  • Produced ovaries
  • need both granulosa and theca cells to produce

Estrone

  • aromatase conversion
  • adipose tissue

Estriol

  • produced by placenta
  • weakest
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299
Q

hCG

  • fxn
  • alpha and beta subunit
A

Prevents degradation of corpus luteum

Shares alpha subunit with LH, FSH, and TSH

Beta subunit specific for hCG

  • detectable in blood 1 wk
  • detectable in urine 2 wk
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300
Q

Prolactin vs oxytocin

A

Prolactin
- milk production

Oxytocin
- milk ejection (letdown)

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301
Q

Menopause

  • definition
  • labs
A

12 months of amenorrhea

Decrease estradiol
Decrease Inhibin
Increase GnRH, LH, FSH

Estrone is predominant, aromatase still working

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302
Q

Byproducts of MAO and COMT enzymatic activity of dopamine, NE, Epinephrine

A

Dopamine –> homovanillic acid (HVA)

NE –> Vanillylmandelic acid (VMA)

Epi –> Metanephrine

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303
Q

Smooth white plaques on vulva
Parchment paper
Fusion of labia majora and minora

  • due to
  • tx
  • risk of
A

Lichen sclerosus

Thinning of epidermis

Corticosteroids

SCC of vulva

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304
Q

Koilocytosis

A

Enlarged nuclei and perinuclear halo
Fried egg

Seminoma
Dysgerminioma
HPV

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305
Q

Vaginal tumors (3)

A

SCC

Clear cell adenocarcinoma
- DES exposure
- T shaped uterus
- Vaginal adenosis 
(patches of columnar epithelium on ectocervix and vagina)

Sarcoma botryoides
(Embryonal rhabdomyosarcoma)
- infants, <5 y.o
- bunch of grapes out of vagina

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306
Q

HPV 16 and 18 MOA

A

E6 binds p53 –> degradation

E7 binds Rb and inactivates

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307
Q

Post coidal bleeding

Pelvic or low back pain

A

Cervical cancer

Lesion on surface of cervix

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308
Q

Bunch of grapes growing out of vagina

A

Sarcoma botryoides

Embryonal rhabdomyosarcoma

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309
Q

T shaped uterus

Patches of columnar epithelium on ectocervix and vagina

A

(Vaginal adenosis)

Clear cell adenocarcinoma due to DES exposure

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310
Q

Cervical cancer presentation

A

abnormal vaginal bleeding
- post coidal

Vaginal discharge

Pelvic or low back pain

Bowel or bladder symptoms

Ureteral obstruction

  • Pyelonephritis
  • uremia
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311
Q

Endometrium layers

Which are shed

A

Stratum compactum
Stratum spongiosum
Stratum basalis

Basalis only one not shed

Stratum functionalis

  • Stratum compactum
  • Stratum basalis
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312
Q

Endometritis

  • what cells do you see in endometirum
  • tx
A

Plasma cells

Broad spectrum Ab
Post partum
- Gentamicin + clindamycin

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313
Q

Adenomyosis

A

Endometrial tissue extends into myometrium

enlarged globular uterus
tender to palpation

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314
Q

Whorled pattern

A

Leiomyomas

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315
Q

Nontender enlarged uterus

Infertility

A

Leiomyomas

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316
Q

Rapidly enlarging uterus

-from

A

Leiomyosarcoma
Rare malignant

Denovo from myometrium

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317
Q

Dermoid cyst aka

A

Benign cystic teratoma

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318
Q

String of pearls

A

PCOS

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319
Q

PCOS symptoms

  • also see (3)
A

Need 2 of 3

Anovulation/ Oligoovulation

  • menstrual irregular
  • infertility

Hyperandrogenism

  • acne
  • hirsuitism (hair on face)

Polycystic ovarian on US

ALso see

  • Obesity
  • insulin resistance
  • increased risk endometrial hyperplasia
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320
Q

Midcycle pelvic pain associated with ovulation

A

Mittelschmerz

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321
Q

Ascites in otherwise healthy female think

A

ovarian carcinoma

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322
Q

Ovarian tumor

Psamomma bodies

A

Serous tumor

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323
Q

Abundant mucinous ascites

A

appendical cancer

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324
Q

Brenner tumor

A

Benign ovarian tumor

Urinary tract like epithelium

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325
Q

Struma ovarii

A

Teratoma contains functional thyroid tissue –> hyperthyroidism

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326
Q

Rosettes of tumor cells surrounding eosinophilic spaces

A

Call- Exner body

Granulosa cell tumors

yellow
produce estrogen

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327
Q

Meigs syndrome

A

Ovarian tumor
Ascites
Pleural effusion

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328
Q

SIgnet ring cells

A

FIlled w/ mucin
Pushes nucleus to periphery

Metastatic gastric adenocarcinoma to bilateral ovaries

Krukenberg tumor

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329
Q

Swollen hydropic villi

Snow strom appearance

A

Hydatidiform mole

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330
Q

Hydatidiform mole hallmarks

A

Swollen hydropic villi
Look like grape clusters

US: Snowstorm appearance

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331
Q

Bloody brown vaginal discharge

  • arises from
  • metastasizes to
A

Choriocarcinoma

Complete mole, miscarriage, normal pregnancy, ectopic pregnancy

Lung

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332
Q

Triple or quadruple screen in pregnancy

A

AFP
Estriol
hCG
Inhibin

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333
Q

Trisomy 18 lab values

A

Decrease AFP
Decrease estriol
Decrease hCG

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334
Q

Trisomy 21 lab values

A

Decrease AFP
Decrease estriol
Increase hCG
Increase inhibin

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335
Q

Partial mole vs complete mole

A

Partial mole

  • 69 XXX, XXY, XYY
  • Fetal parts
  • Normal size uterus
  • increase hCG
  • No risk choriocarcinoma

Complete mole

  • 46, XX or YY
  • No fetal parts
  • Large uterus
  • BIG increase hCG
  • Risk of choriocarcinoma
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336
Q

Type of ovarian cyst associated with molar pregnancies

A

Increase hCG

Theca-lutein cyst

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337
Q

Cause of placental abruption

A 
Hx prior placental abruption
HTN
Trauma
Smoking
Cocaine use**
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338
Q

HTN
Proteinuria
or end organ dysfunction

A

Preeclampsia

Thrombocytopenia
Renal insufficiency
Increased LFT
Pulmonary edema
Cerebral or visual symptoms
- HA, visual disturbances, seizure
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339
Q

Hemolysis
Elevated liver enzymes
Low platelets

A

HELLP syndrome

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340
Q

Patients who have migraines with aura are at an increased risk for what other neurologic condition?

A

Stroke

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341
Q

Trisomy 21 what happens w/ chromosomes

- gene effect seen

A

Maternal nondisjunction of homologous chromosomes during anaphase of meiosis I

Mosaicism

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342
Q

Rocker bottom feet
Micrognathia
Intellectual disability

A

Trisomy 18

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343
Q 
Rocker bottom feet
Intellectual disability
Microcephaly
Cleft lip and palate
Holoprosencephaly
Polydactyly

labs?
US?

A

Trisomy 13 Patau

Decrease hCG, PAPP-A

US: increase nuchal translucency

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344
Q

Kleinfelter labs

A

Testicular atrophy

Decrease testosterone
Decrease inhibin
Increase FSH

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345
Q

Commonly seen w/ Double Y males

A

Tall
Severe achne
Antisocial behavior

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346
Q

High-pitched crying and newing

also seen (4)

Mutation

A

Cri-du-chat syndrome

Microcephaly
Severe intellectual disability
Epicanthal folds
Cardiac abnormalities

5p deletion

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347
Q

William syndrome

  • characteristics (5)
  • mutation
A 
Elfin facies
Intellectual disability
Hypercalcemia (hypersensitivity to Vit D)
Good verbal skills
Friendly w/ strangers

Microdeletion of long arm of chr 7

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348
Q

What should be suspected as a cause of HA in a patient using topical retinoic acid for tx of acne

A

Idiopathic intracranial hypertension (IIH)

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349
Q

What is associated iwth berry aneurysms

mutation?

A

Autosomal dominant polycystic kidney dis

APKD1 mutation on chr 16

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350
Q

AD disease6

A

1) Achondroplasia
2) Autosomal dominant polycystic kidney dis
3) Familial adenomatous polypopsis
4) Gardner syndrome
5) Familial hypercholesterolemia
6) Hereditary hemorrhagic telangiectasis
7) Hereditary spheocytosis
8) Huntington dis
9) Li-Fraumeni syndrome
10) Marfan syndrome
11) MEN
12) NF1
13) NF2
14) Tuberous sclerosis
15) VHL

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351
Q

Trinucleotide repeat disorders

A

Huntington
Myotonic dystrophy
Fragile X syndrome
Friedreich ataxia

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352
Q

Bilateral acoustic neuroma
Hearing loss
Tinnitus

mutation

A

NF2

Chr 22 AD

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353
Q

Cafe au lait spots
Neural tumor
Lisch nodules (pigment hamartoma in eye)
Scoliosis

mutation

A

NF I

AD mutation chr 17

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354
Q

Huntington mutation

A

Chr 4

CAG repeats

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355
Q

Hereditary spherocytosis defect in

A

Spectrin or ankyrin

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356
Q

MEN syndrome

A

MEN1: MEN 1 gene

  • PPP
  • Parathyroid adenomas
  • Pituitary adenomas
  • Pancreatic tumor

MEN2A: RET gene

  • PPM
  • Parathyroid adenomas
  • Pheochromocytoma
  • Medually thyroid cancer

MEN2B: RET gene

  • PMM
  • Pheochromocytoma
  • Medullary thyroid cancer
  • Mucosal neuromas
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357
Q 
Facial lesions
Hypopigmented ash leaf spots
Cortical and retinal hamartomas
seizures
intellectual diability
A

Tuberous sclerosis

Mutation of hamartin or tuberin gene

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358
Q

Hemangioblastomas of retina, cerebellum, medulla

Phenochromocytomas

A

von Hippel lindau disease

Deletion of VHL
Expression of HIF

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359
Q

Fragile X syndrome

A

X linked trinucleotide repeat

Mutation for FMR1 gene which codes for FMRP cytoplasmic protein

Involved in mRNA translation of axons and dendrites

CGG repeat

Macro-orchidism
Long face
Large jaw
Everted ears
Mitral valve prolapse
Intellectual disability
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360
Q 
Macro-orchidism
Long face
Large jaw
Everted ears
Mitral valve prolapse
Intellectual disability
A

Fragile X syndrome

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361
Q 
AR trinucleotide repeat disorder
Staggering gait
Falling
Nystagmus
Pes cavus 
Kyphoscoliosis
A

Friedreicha ataxia

GAA

Mutation for gene that codes for frataxin (mitochondrial protein that is involved in iron detoxifying and storage)

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362
Q

AD disease fits

1) Associated with mitral valve prolapse, liver disease, berry aneurysms
2) Neural tumors and pigmented iris hamartomas
3) Very strong association with colon cancer
4) MI before age 20
5) Hemangioblastomas of retina/ cerebellum/ medulla
6) Increased MCHC, hemolytic anemia
7) Bilateral acoustic neuromas
8) Facial lesions, seizure disorder, cancer risk
9) Caudate atrophy, dementia
10) Cystic medial necrosis of aorta
11) Defect of FGF receptor 3
12) Assoc w/ floppy mitral valve, dissecting aortic aneurysm

A

1) ADPKD
2) NF1
3) Familal adenomatous polyposis
4) Familial hypercholestrolemia
5) VHL
6) Hereditary spherocytosis
7) NF2
8) Tuberous sclerosis
9) Huntington’s dis
10) Marfan syn
11) Achondroplasia
12) Marfan syndrome

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363
Q

X linked recessive pneumonic

A

Oblivious Females will Give Her Boys Her (x)Linked Disorders

Ocualr albinism
Fabry dis
Wiskott aldrich
G6PD defiency
Hunter syndrome
Bruton agammaglobulinemia
Hemophilia A/B
Lesch-Nyhan syn
Duchenne muscular dystrophy
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364
Q

Lysosomal storage disease

A 
Fabry dis (X linked recessive) 
Gaucher dis
Krabbe
Metachromatic leukodystrophy
Niemann Pick
Tay-sach
Hurler syndrome
Hunter syndrome (X linked recessive)
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365
Q

Painless papules on lower abdomen
peripheral neuropathy
glomerulopathy (renal failure)

A

Fabry disease

Deficient: alpha- galactosidase

Accumulation: ceramide trihexoside; globotriaosylceramide

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366
Q 
Hepatosplenomegaly
Cherry red spot
Painful bony lesions
Anemia
Fatigue
thrombocytopenia

-Microscopically

A

Gaucher disease

Deficient: glucocerebrosidase

Accumulation: Glucocerebroside

Prominent blue cytoplasmic fibrils (crumpled tissue paper)

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367
Q 
Hepatosplenomegaly
Cherry red spot
Thrombocytopenia
Ataxia
Dysarthria
Dysphagia
Gradual worsening of intellectual fxn
  • Mircoscopically
A

Niemann-Pick disease

Deficient: Sphingomyelinase

Accumulation: sphingomyein

Foam cells

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368
Q

Irritability
Regression of motor skills
Macrocepahly
Cherry red spot

A

Tay-Sachs

Deficient: hexosaminidase A

Accumulation: GM2 ganglioside

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369
Q 
Peripheral neuropathy
Seizures
Optic atrophy
Developmental delay
Weakness
A

Krabbe disease

Deficient: galactocerebrosidase

Accumulation: galactocerebroside

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370
Q

Muscle wasting
Weakness
Progressive vision loss
Dementia

A

Metachromatic leukodystrophy

Deficient: arylsulfatase

Accumulation: cerebroside sufate

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371
Q 
Progressive deterioration
Coarse facial features
Hepatosplenomegaly
Intellectual disability
Poor growth (dwarfism)
Corneal clouding
A

Hurler syndrome

Deficient: alpha-L-iduronidase

Accumulation: heparan sulfate and dermatan sulfate

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372
Q 
2 y.o
Progressive deterioration
Coarse facial features
Hepatosplenomegaly
Intellectual disability
Poor growth (dwarfism)
Aggressive behavior
A

Hunter syndrome

Deficient: iduronate sulfatase

Accumulation: heparan sulfate and dermatan sulfate

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373
Q

Hepatomegaly
Hypoglycemia
Seizure
Lactic acidosis

A

Von Gierke

Glycogen storage disease

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374
Q

Cardiomegaly

Severe hypotonia

A

Pompe disease

Lysosomal alpha-1,4, glucosidase deficiency

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375
Q

What type lysosomal storage diseases have myelin sheath pathology leading to peripheral neuropathy

A

Krabbe disease

Metachromatic leukocystrophy

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376
Q

Signet ring cells

ER and PR positive

A

LCIS

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377
Q

Large bulky breast tumor

Leaf like projections on histology

A

Phyllodes tumor

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378
Q

Bloody nipple discharge

A

intraductal papilloma

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379
Q

What is a feature of gram positive bacteria cell wall

A

Lipoteichoic acids

Induce cytokine production

IL-1, TNF-alpha

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380
Q

What is the unique featuers of gram negative bacteria cellw all

A

Outer membrane

  • endotoxin (LPS)
  • induce IL-1, TNF alpha
Periplasmic space (between membranes)
- beta lactamase
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381
Q

Quellung reaction

A

Anti-capsular serum added to bacteria

Capsule appears swollen under microscope

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382
Q

Bacteria w/ capsule pneumonic

A

Even Some Pretty Nasty Killers have Shiny Bodies

E coli
Strep pneumonia
Pseudomonas
Neisseria meningitidis
Klebsiella
Haemophilius influenza type B
Salmonella
Group B strep

Cryptococcus neoformans
- encapsulated yeast

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383
Q

Mycoplasma vs mycobacteria

A

Mycoplasma

  • sterols for plasmsa membrane
  • No cell wall

Mycobacteria

  • Mycolic acid cell wall
  • Rich in lipids, resistant to staining
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384
Q

Bacteria that dont stain well

A

Mycoplasma
Mycobacteria

Treponema

  • due to corkscrew and small
  • dark field microscopy

Legionella pneumophilia
- stain poorly due to unusual branch chain fatty acid in wall

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385
Q

Giemsa stain

A

Giemsa

Chinese Painted wHore Bows To Rich

Chylamydia
Plasmodium
Histoplasma
Borrelia
Trypanosomes
Rickettsiae
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386
Q

PAS stain for

A

Tropheryma whipplei

Whipple disease

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387
Q

Ziehl neelsen stain

A

Acid fast organism

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388
Q

India ink

A

Fungus

Crytococcus neoformans

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389
Q

Silver stain

A

Fungi
-Pneumocystis jirovecii

Legionella

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390
Q

Neurotoxins

A

Interfere with neural transmission

Botulinum toxin
Tetanus toxin

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391
Q

Enterotoxins

A

Affect intestines
Shigella
Vibero cholera

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392
Q

Superantigens

A

Exotoxins that simulatenously bind MHC II receptor and T cell receptor

Polyclonal expansion of T cells

Large amounts of cytokines

Staph Aureus
Strep Pyogenes

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393
Q

Diphtheria toxin

A

Inactivates EF-2

Inhibits protein synthesis

Corynebacterium diphtheriae

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394
Q

Inactivates EF-2

A

Exotoxin A - pseudomonas

Diphtheria toxin

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395
Q

Shiga toxin

A

Cleaves host rRNA at adenine base in 60S ribosomal subunit

Inhibition of protein synthesis

Shigella

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396
Q

Ecoli toxin

A

Verocytotoxin (Shiga toxin)

  • Bloody diarrhea
  • HUS
Heat labile toxin
- stimulates adenylyl cyclase
- Increase cAMP
Heat stabile toxin
-stimulate guanylyl cyclase
- increase cGMP
ETEC
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397
Q

Heat stable toxin

A

ETEC

Yersinia enterocolitica

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398
Q

Pseudoappendicitis

A

Yersinia enterocolitica

Heat stable toxin

Increase cGMP

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399
Q

Anthrax toxin

A

Edema factor (adenylyl yclase)
Lethal factor
Protective antigen

Bacillus anthracis

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400
Q

Vibrio cholerae

A

Cholera toxin

stimulates adenylyl cyclase
increase cAMP
chloride and water cross lumen

rice water stools

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401
Q

Bordetella pertussis

A

Pertussis toxin binds and inactivates inhibitory G proteins –> increase cAMP

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402
Q

Clostridium tetani

A

Tetanospasmin blocks release of inhibitory NT gaba and glycine

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403
Q

Botulinum toxin

A

Exotoxins A->G inhibit release of ACh at NMJ

CLostridium botulinum

Spoiled canned goods
Honey

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404
Q

Clostridium perfringens toxins

A

Alpha toxin (phospholipase)

  • Gas gangrene
  • Myonecrosis

Enterotoxin

  • Food poisoning
  • Food left out too long once cooked
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405
Q

Endotoxin triggers (3)

A
  1. Macrophages
    - IL-1 IL-6= fever
    - TNF= cell death
    - NO= hypotension, development septic shock
  2. Complement
    - C3a= release histamine, hypotension, edema
    - C5a= neutrophil chemotaxis
  3. Tissue factor
    - coagulation cascade –> DIC
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406
Q

Toxic associated with Staph aureus
- hemolysis

  • tissue destruction w/ mRSA affects both neutrophils and macrophages
  • food poisoning
  • release of cytokines, high fever, hypotension, diffuse rash
  • Scalded skin syndrome in newborns
A

Hemolysis

  • alpha-toxin (alpha hemolysin)
  • sphingomyelinase C (beta)
  • leukocidin (gamma)
  • delta-toxin

Panton-Valentine leukocidin

Enterotoxin (superantigen)

Toxic shock syndrome toxin 1 (superantigen)

Exfoliative toxin

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407
Q

Toxins secreted by Strep pyogenes

A

Streptolysin O
- hemolysis (oxygen labile)

Streptolysin S
- hemolysis (oxygen stable)

Streptococcal pyrogenic exotoxins Type A, B, C/ erythrogenic toxins
- red rash (erythro-) and fever (pyro-) of scarlet fever
(superantigen)

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408
Q

Degrades H202 into H20 and O2

A

Catalase

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409
Q

Increases bidning to host tissues, induce coagulation or blood clotting

A

Coagulase

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410
Q

S. epidermidis vs s. saprophyticus

A

S. epidermidis

  • Novobiocin sensitive
  • heart valves

S. saprophyticus

  • Novobiocin resistant
  • UTI
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411
Q

Gram positive diplococci

A

Strep. pneumoniae

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412
Q

Viridans streptococci

A

Colonizer of the oral cavity
Cause infective endocarditis
No capsule

Partial hemolysis

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413
Q

Chronic granulomatous disease

A

NADPH oxidase deficiency

H2O2 easily broken down by catalase (+) organisms

Susceptible in infections by staph

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414
Q

Contaminated deli meat

A

Listeria

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415
Q

meningitis in very young and old

A

Listeria

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416
Q

Potato salad

A

Staphyloccus aureus

Rapid vomiting

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417
Q

Fried rice Reheated rice

A

Bacillus cereus

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418
Q

Pigment producing bacteria (4)

A

Staph aureus
- Large golden colonies

Actinomyces israelii

  • yellow (sulfur) granules
  • yellow sand

Pseudomonas aeruginosa
- blue green pigment

Serratia marcescens (MARsecens)
- red pigment
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419
Q

What ovarian tumor matches each of hte following

1) Estrogen secreting leading to precocious puberty
2) Produces AFP
3) Psammoma bodies
4) Testosterone secreting leading to virilization

A

1) Granulosa theca cell tumor
2) Yolk sac tumor
3) serous cystadenocarcinoma
4) Sertoli-leydig cell tumor

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420
Q

Gram (+) cocci
Catalase negative
Dental plaque

A

S. mutans (most)

S. sanguinis
- preexisting heart flow problems

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421
Q

Common disease caused by Group A strep (pyogenes)

A

Acute pharyngitis
Cellulitis
Invasive infection

Acute post-streptococcal glomerulonephritis

Rheumatic fever

Toxic shock syndrome

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422
Q

Impetigo caused by

A

Staph aureus

Strep pyogenes

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423
Q

Otitis media and sinusitis
Sudden onset chills
Lobular consolidation
Rust colored sputum

A

Streptococcus pneumoniae

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424
Q

Group A Strep immunologic complications

A

Body immune response to bacteria

Jones
Joints
Pancarditis (endo/myo/pericarditis)
Nodules (SQ)
Erthema marginatum
Sydenham chorea
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425
Q

Neonatal sepsis

A

Group B strep
Listeria
Ecoli

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426
Q

Gram positive bacteria associated iwth colon cancer

A

Streptococcus bovis
Group D strep

Endocarditis
Found in gut

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427
Q

Bacteria cause subscute endocarditis

A 
Coagulase neg Staph
Viridans group streptococci
Strep bovis
Enterococci
HACEK organisms
HACEK
- not gram (+)
Haemophilus aphrophilus
Aggregatibacter spp
Cardiobacterium hominis
Eilcenella corrodens
Kingella kingae
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428
Q

Spore forming

A

Clostridium spp
Bacillus anthracis
Coxiella burnetti

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429
Q

Clostiridum difficile

  • toxins
  • diagnosis
  • tx
A

Toxin A (enterotoxin)

  • binds brush border
  • secretion and inflammation
Toxin B (cytotoxin)
- disruption actin cytoskeleton

Pseudomembrnaous colitis

Stool toxin assay (PCR or ELISA)

Tx

  • Metronidazole
  • Oral vancomycin
  • Fidxomicin (recurrent)
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430
Q

Mediastinal widening on CXR

A 
Bacillus anthracis
Aortic dissection
Ruptured esophagus
Lymphoma
Aortic aneurysm due to syphillus
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431
Q

Large painless ulcer w/ central necrosis (eschar)

A

Cutaneous anthrax

Wound

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432
Q

Obligate anaerobes (3)

Tx

A

Clostridium species
Actinomyces (Gram +)
Bacteroides (Gram -)

Tx metronidazole
Clindamycin

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433
Q

Facial infection of jaw/mandible

Sinus tracts draining yellow pus

A

Actinomyces israelii

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434
Q

Decaying vegetation

Infection in immunocompromised

A

Nocardia

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435
Q

Whitish patch on posterior oropharynx, makes greyish membrane, will bleed if scrap off

Tx

A

Corynebacterium diphtheriae

Erythromycin or penicillin
Antitoxin
Vaccinate

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436
Q

Chocolate agar

- requires

A

Haemophilus influenza

Factor V and X

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437
Q

Epiglottitis

A

Haemophilus influenza

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438
Q

Buffered charcoal yeast extract agar

  • requires
  • transmission
  • tx
A

Legionella pneumophila

Iron
Cysteine

Aerosols from water sources

macrolides
Fluoroquinole

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439
Q

Spiral shaped rod
urease positive

causes

tx

A

Helicobacter pylori

Gastric adenocarcioma

Tx:
Triple therapy
- PPI
- Clarithromycin
- Amoxicillin or metronidazole

Quadruple therapy

  • PPI
  • Bismuth
  • Metronidazole
  • Tetracycline
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440
Q

Lactose non-fermenters
Urease producing

-Creates what

A

Proteus spp

Alkaline urine
Struvite stones (Staghorn calculi)
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441
Q

Associated w/ reactive arthrits

A 
Shigella
Salmonella
Campylobacter jejuni
Yersinia
Chlamydia
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442
Q

Question marked shaped
Rodent urine

Phase 1
Phase 2

A

Leptospira interrogans

Phase 1
Fever chills
Body ache
HA

Phase 2
Hyponatremia
Renal failure
Liver damage w/ jaundice

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443
Q 
Bulls eye
Fever
HA
Body ache 
Fatigue

Tx

A

Borrelia burgdorferi

Ixodes tick

Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)

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444
Q

Bilateral facial nerve palsy

Tx

A

Borrelia burgdorferi

Ixodes tick

Tx Doxycycline (early stage)
Amoxicilin (children <8)
Doxycycline or Ceftriaxone (late)

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445
Q

Argyll robertson pupil

A

Pupil constricts with accomodation but doesnt react w/ direct light

Neurosyphilis

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446
Q

Rash involving palms and soles

Maculopapular

A

Kawasaki disease
Coxsackie A virus
Rocky mountain spotted fever
Syphillis

Meningococcemia

You drive Kawaski CARS with your hands and feet

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447
Q

Sensory ataxia
Lancinating pain: sudden stabs of pain in body
Loss of proprioception and vibratory sense

A

Tabes dorsalis

Posterior dorsal columns of SC and dorsal root

Neurosyphilis

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448
Q

Zoonotic bacteria

1) Cat scratch
2) Rodents to Tick
3) Cattle fluids
4) Birds and pigs
5) Birds
6) Infected placenta or contaminated fluid of newborn farm animals
7) Lone star tick
8) Rabbit or squirrel
9) Infected animal urine
10) Nine-banded armadillo
11) dog bit
12) Lice
13) Fleas
14) Tick, rash on palms
15) Fleas, prairie dogs

A

1) Bartonella henselae
2) Borrelia burgdorferi
3) Brucellosis
4) Campylobacter
5) Chlamydophila psittaci
6) Coxiella burneii
7) Ehrlichia chaffeensis
8) Francisella tularensis
9) Leptospira
10) Mycobacterium leprae
11) Pasteurella multocida
12) Rickettsia prowazekii
13) Rickettsia typhi
14) Rickettsia rickettsii (rocky mountain spotted fever)
15) Yersinia pestis

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449
Q

What is the classic presenting symptoms in a patient with Lyme disease

A

Erythema migrans (bulls eye)

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450
Q

Leprosy Hansen disease two types

A

Lepromatous disease

  • weak immune system
  • disfuguring

Tuberculoid disease

  • strong immuen response
  • fewer skin lesions
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451
Q

Clue cell

  • organism
  • characteristic (2)
  • change
  • tx (2)
A

Vaginale pithelial cell covered in coccobacilli

Gardnerella vaginalia

  • gray vaginal discharge
  • fishy smell
  • elevated pH >4.5

Oral metronidazole
Metronidazole cream

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452
Q

Headache
Fever
Rash on wrist and ankles moves to palms soles and trunk

A

Ricketta ricksttsii

Rocky mountain spotted fever

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453
Q

HA

Fever, Rash centrally spreads to extremities

A

Rickettsia prowazekii
-Lice

Rickettsia typhi
- Fleas

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454
Q

Febrile
Non specific
Morulae within monocytes or granulocytes

Vector

Tx

A

Ehrlichia chaffeensis
-Lone star tick

Anaplasma phagocytophilum
- Ixodes scapularis

Tx: Doxycycline

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455
Q

Acute flu like illness w/ pneumoniae
Works on farm

  • chronic assoc w/
A

Coxiella burnetii

  • Q fever
  • Spore forming
  • chronic assoc w/ endocarditis
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456
Q

Chlamydia Types

1) A-C
2) D-K
3) L1-L3

Tx

A

A-C

  • Acute eye infection
  • Can lead to scarring and blindness

D-K

  • Urethritis, cervicitis, PID
  • Neonatal pneumonia and conjunctivitis

L1-L3

  • Lymphogranuloma venereum
  • Genital ulcer
  • Unilateral lymphadenopathy
  • Groove sign
  • Proctitis

Tx: Azithromycin

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457
Q

Atypical pneumonia

A

Legionella pneumophila
Chlamydophila pneumoniae
Mycoplasma pneumoniae

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458
Q 
Malaise, HA
Low grade fever
Nonproductive cough
Diffuse interstitial infiltrates
Coughing for weeks

CXR: patchy reticulonodular infiltrate

Tx

Diagnosis

A

Mycoplasma pneumonia

College kids- dorms
Military recruits

Macrolide (azithromycin)
Doxycycline (empiric)
Fluroquinoles (empiric)

Cold agglutinins
- Nonspecific IgM Ab to erythrocytes

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459
Q

Lymphatic drainage

1) Arm lateral breast
2) Posterior calf, dorsolateral foot
3) Thigh
4) Stomach, upper duodenum
5) Lower duodenum, jejunum, ileum, proximal 2/3 of colon
6) Distal 1/3 of colon, upper rectum
7) Lower rectum (above pectinate line)
8) Anal canal (below pectinate line)
9) Test, ovaries, uterus kidneys
10) Scrotum, vulva
11) Right arm and right side of face
12) Rest of body

A

1) Arm lateral breast
= Axillary LN

2) Posterior calf, dorsolateral foot
= Popliteal LN

3) Thigh
= Superficial inguinal LN

4) Stomach, upper duodenum
= Celiac LN

5) Lower duodenum, jejunum, ileum, proximal 2/3 of colon
= Superior mesenteric

6) Distal 1/3 of colon, upper rectum
= Inferior mesenteric

7) Lower rectum (above pectinate line)
= Internal iliac

8) Anal canal (below pectinate line)
= superficial inguinal

9) Testes, ovaries, uterus kidneys
= para-aortic

10) Scrotum, vulva
= superficial inguinal

11) Right lymphatic duct
12) Thoracic duct –> L subclavian

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460
Q

Peyers patches are located

A

Lamina propria and submucosa of ileum

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461
Q

Which muscles and nerves are derived from the first brachial arch?

A

M & T

Muscles of mastication

  • Masseter
  • Medial pterygoid
  • Lateral pterygoid
  • Temporalis

Mylohyoid

Tensor tympani
Tensor veli palatini

Anterior 2/3 of tongue

Mandibular and maxillary division of Trigeminal n.

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462
Q

What is the cell type in peyer’s patches

A

M (microfold) cells

Take up Ag from lumen of gut and transcytose to other side of cell

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463
Q

Dendritic cell surface markers

A

MHC I
MHC II
B7 protein (CD80 or 86)
CD40

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464
Q

HLA-B27

HLA-DR3, HLA-DR4

A

Seronegative spondoloarthropathies
“PAIR”
Psoriatic arthritis, ankylosing spondylitis, inflammatory bowel disease, reactive arthritis

Type 1 diabetes mellitus

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465
Q

S-100
CD1a
Tennis rackets

A

Langerhans cell histiocytosis

Excessive proliferation of langerhan cells but are poor at presenting Ag

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466
Q

Positive selection

- occurs where

A

Selecting for T cells that can bind to MHC

Loss CD4 or CD8

Cortex of thymus

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467
Q

Negative selection

- occurs where

A

Selectingout T cells w/ receptor for self antigen

Corticomedullary junction

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468
Q

Induces Th1 differentiation

Th1 produces

Functions of those produced

A

IL-12 –> Th1

Th1 –> IL-2, INF-gamma

IL-2: proliferation of T cells induce more Th1

IFN-gamma: activate macrophages, suppress Th2

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469
Q

Induces TH2 differentiation

Th2 produces

Functions of those produced

A

IL-4 –> Th2

Th2 –> IL-4, IL-5, IL-10

IL-4, IL-5= proliferation of B cells, induce production of Th2 cells

Il-10= inhibit production Th1, inhibits macrophages

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470
Q

T cell activation

A

2 signals

TCR and CD4/CD8 binds to MHC II/I

B7 protein (CD80/86) on APC binds to CD28 of T cell

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471
Q

Transcription factor the helps control the development of Treg cells

A

FOXP3
Forkhead Box Protein P3

Found on X chromosome

Mutation: suppress immune system
- condition called IPEX

Immune dysregulation
Polyendocrinopathy
- Type I diabetes
- Thyroiditis
Enteropathy
- Severe diarrhea
- Failure to thrive
X linked
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472
Q

Male infant
Severe chronic diarrhea
Neonatal diabetes or thyroiditis
Eczema

A

IPEX

Mutation of FOXP3

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473
Q

B cell activation

A

1) Th cell activated
2) B cell endocytoses Ag and present to Th cell
3) B cell has CD40 and binds to CD40L on T cell
4) Th2 produce IL-4, IL-5 induce B cell proliferation and class switching

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474
Q

NK cells activity induced by

A

IL-12
IL-2
IFN-alpha
IFN-beta

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475
Q

IFN-alpha and IFN-beta fxn

A

Induce NK cells

Induce near by cells to inhibit viral protein synthesis

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476
Q

CD16

  • does what
  • found on
  • function
A

Binds to Ab (on constant region Ab)

Found on:
NK cells
Macrophages
Monocytes
Neutrophils
Eosinopohils

Antibody dependent cell mediated cytotoxicity (ADCC)
- Enemy cell get coated with IgG antibody, NK cells and other cells w/ CD16 surface marker are able to recognize Ab coated cells and kill them

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477
Q

VDJ recombination begins with

Initated by

A

Breaks in dsDNA at Recombination Signal sequences RSSs

Initiated by RAG-1 and RAG-2

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478
Q

Surface markers

B cells

T cells

T cytotoxic

T helper

NK cells

Macrophages

Dendritic

A

1) B cells
- CD19, 20, 21
- IgG, IgM
- B7
- CD40
- MHC II

2) T cells
- CD3
- TCR
- CD28

3) T cytotoxic
- CD3
- TCR
- CD28
- CD8

4) T helper
- CD3
- TCR
- CD28
- CD4
- CD40 ligand

5) NK cells
- CD16
- CD56

6) Macrophages
- CD14
- MHC II
- B7
- CD40

7) Dendritic
- MHC II
- B7
- CD 40

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479
Q

IgG (5)

IgA (5)

IgE (4)

IgM (4)

IgD (1)

A

1) IgG
- Delayed immune response
- Fixes complement
- Crosses placenta **
- Opsonizes bacteria **
- Neutralize viruses and bacterial toxins

2) IgA
- Secreted by MALT
- Mucous membranes and GI
- Monomor in circulation
- Dimer in secretion
(Mucus, tears, saliva, breast milk)

3) IgE
- Immunity to parasites
- Activates eosinophils
- Mast cells and basophils
- Type I hypersensitivity

4) IgM
- Surface of B cells (monomer)
- Circulation (pentamer)
- Primary immune response
- Does NOT cross placenta

5) IgD
- surface of B cells

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480
Q

Live Virus vaccinations pneumonic

A

Attention! Please Vaccinate Young Infants with MMR Regularly

Attenuated virus vaccines

Polio (sabin, oral)
Varicella
Yellow fever
Intranasal influenza
MMR
Rotavirus
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481
Q

Egg based vaccines

A

Influenza
Yellow fever
(MMR) tiny amount

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482
Q

Bacteria vaccine

  • toxin
  • capsular polysaccharides
  • killed bacteria
  • live attenuated bacteria
A

Toxin
- Tetanus toxoid

Capsular polysaccharides

  • S. pneumoniae
  • H. influenzae

Killed bacteria
- Vibrio cholerae

Live attenuated bacteria

  • Typhoid vaccine
  • BCG vaccine
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483
Q

Amyloidosis types (6)

A

1) Immunologic (primary)
- Ig light chain
- AL fibril

2) Secondary
- SAA (serum amyloid associated protein)
- AA fibril

3) Type 2 diabetes
- Amylin (secreted by pancreas)
- AIAPP

4) Medullary thyroid CA
- Calcitonin
- A-CAL

5) Alzheimer
- beta-amyloid
- APP (amyloid precursor protein)

6) Dialysis associated
- beta2- microglobulin
- Abeta2M

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484
Q

Opsonization

A

C3b

IgG

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485
Q

Stimulates mast cells and basophils (complement)

A

C3a

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486
Q

C5a does what

A

Neutrophil chemotaxis

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487
Q

Deficiency of C1 esterase inhibitor

Deficiency of C3

Deficiency of MAC

Deficiency of DAF

A

1) Def C1 esterase inhibitor
- Hereditary angioedema
- Elevated bradykinin
- Never take ACE inhibitor, also increase bradykinin levels

2) Def C3
- Recurrent pyogenic sinus infections and resp tract infections
- encapsulated organisms
- Strep pneu, Haemophilus influ
- Increased sensitivity to type II infections

3) Neisseria bactermia susceptible

4) Def in DAF (CD55)
- Protect self form spontaneous complement activation through alternative pathway
- Paroxysmal noctural hemogobinuria (PNH)

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488
Q

Paroxysmal nocturnal hemoglobinuria (PNH) deficient in what

clinical (3)

Tx (3)

A

TBC deficient in two surface molecules that protect against MAC

1) Glycosylphosphotidylinositol (GPI) which anchors Decay accelerating factor (CD55) to plasma membrane
2) MAC inhibitory protein (CD59)

Clinical

  • break down RBC intravascular
  • hemosiderinura (red urine)
  • thrombosis (platelets destroyed)

Transfusion
Warfarin
Eculizumab

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489
Q

Which organisms cannot be stained w/ gram stain

A 
Treponema
Rickettsia
Chlamydia
Legionella
Mycoplasma
Mycobacteria
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490
Q

Macrophages secrete

A

IL-1, IL-6, TNF-alpha (acute phase)

IL-12

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491
Q

Neutrophils chemotactic agents

A

IL-8
C5a
Leukotriene B 4

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492
Q

Cytokines functions pneumonic

A

Hot T bone stEAk

IL-1: fever
IL-2: stimulates T cells
IL-3 stimualtes bone marrow
IL-4: IgE adn IgG
IL-5: IgA and eosinophils
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493
Q

Differential diagnosis Eosinophilia pneuonic

A

CANADA P

Collagen vascular disease (PAN, dermatomyositis)

Atopic disease (allergies, asthma)

Neoplasm

Adrenal insufficiency (addison dis)

Drugs (NSAIDS, penicillins, cephalosporins)

Acute interstitial nephritis

Parasites (stronglyloides, ascaris)

HIV
Hyper igE
coccidioidomycosis

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494
Q

Chvostek sign

Trousseau sign

A

Chovstek: tap on cheek, causes facial spasm

Troussseau: blood pressure cuff, leads to spasm of arm

Hypocalemia

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495
Q

6 month old boy
Recurrent bacterial infections
Low immunoglobulins

  • defect
  • inheritence
A

Bruton agammaglobulinemia

Defective tyrosine kinase
X linked

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496
Q

Recurrent candida infections and respiratory infections
Diarrhea
Failure to thrive
No thymus seen on imaging

  • deficiency
  • decrease in
A

Severe combined immunodeficiency (SCID)

Decrease B and T cells

Adenosine deaminase deficiency

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497
Q

Cant follow object
Talangiectasias of face
Recurrent infections

clinical (2)
sensitive (2)
risk (2)
elevated

A

Ataxia-telangiectasia

IgA deficiency
T cell deficiency

Cerebellar ataxia
Telangiectasias after 5 y.o
Radiation sensitivity (avoid x ray)
Increased risk: lymphoma leukemia
-Elevated AFP (8 months)
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498
Q

Ataxia-telangiectasia mneumonic “ATAXIA”

A 
"ATAXIA"
Ataxia
Telangiectasia, tracking eye difficulties
Acute leukemia and lymphoma
Xray sensitivity
IgA deficiency
AFP
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499
Q

Wiskott-Aldrich syndrome mneumonic

A 
WAITER
Wiskott
Aldrich
Immunodeficiency
Thrombocytopenia and purpura
Eczema
Recurrent pyogenic infections

X linked
Low IgM, high IgA

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500
Q

1) Defect tyrosine kinase
2) Elevated AFP
3) Adenosine deaminase deficiency
4) Low IgM, high IgA
5) Lack NADPH oxidase
6) Defect LYST gene
7) STAT3 mutation
8) Abnormal integrins
9) Two rows of teeth
10) Delayed separation umbilical cord

A

1) Bruton agammaglobulinemai
2) Ataxia-telangiectasia
3) SCID
4) Wiskott-Aldrich sydrnome
5) Chronic granulomatous disease (CGD)
6) Chediak-Higashi sydnrome
7) Hyper IgE syndrome (Job syn)
8) Leukocyte adhesion deficiency
9) Hyper IgE syndrome (Job syn)
10) Leukocyte adhesion deficiency

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501
Q

Chronic granulomatous disease (CGD)

A

X linked

Lack of NADPH oxidase

Cant destroy catalase +
Staph aureus, aspergillus

TMP-SMX
Itraconazole

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502
Q

Giant cytoplasmic granules in PMN
Partial albinism
Recurrent respiratory tract and skin infections
Neurologic disorders

A

Chediak- Higashi syndrome

LYST gene defect
(lysosomal transport)

Defective phagocyte lysosomes

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503
Q 
High level IgE and eosinophils
Eczema
Recurrent cold S. aureus abscesses
Coarse facial features
Two rows teeth
A

Hyper IgE syndrome

STAT3 signaling protein mutation

Impaired differentiation of TH12
Impaired recruitment of neutrophils

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504
Q

X linked immunodeficiencies

A

Bruton agammaglobulinemia
Chronic granulomatous disease
Wiskott aldrich syndrome
SCID

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505
Q

Eczema
Recurrent cold abscesses
high serum IgE

A

Hyper IgE syndrome

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506
Q

Large phagosomal vesicles with neutrophils

A

Chediak=Higashi disease

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507
Q

Tuberous sclerosis mutations

- what is the gene for

A

TSC1 or TSC2

TSC1= hamartin protein
TSC2= tuberin protein
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508
Q

Seizures
Intellectual disability
Angiofibromas (tiny bumps/ tumors on nose and cheeks)

  • also seen
A

Tuberous sclerosis

Hypomelanotic macules (white spots)
Retinal hamartomas (white circumscribed tumor of eye)
Cortical tuber (white mass in brain benign)
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509
Q 
Flaccid paralysis
Hyporeflexia
weakness
Faciculations
Fever, HA, malaise
Lymphocytic pleocystois (increase lymphocytes in CSF)
Slightly elevated protein
Normal glucose
A

Polio

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510
Q

Infantile flaccid paralysis

A

Most infants die before 1 year

AR

Werdnig-hoffman

Death of neuron in the anterior horn of Spinal cord

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511
Q 
Rapidly progessive weakness
Muscle atrophy
Fascicultations
Spasticity
Difficulty speaking and swallowing
  • Defect
  • Tx
A

ALS

Superoxide dismutase 1

Riluzole

  • lengthens survival
  • decrease glutamate release
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512
Q

Tabes dorsalis

  • assoc w/
  • affects
  • test
A

Tertiary syphilis

Obliterates dorsal columns

Light tough and proproceptive cant get to CNS

Romberg sign

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513
Q

Bilateral loss of pain and temperature sensation in upper extremities (cape like)
Hand muscle weakness and atrophy

A

Syringomyelia

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514
Q 
Ipsl UMN sign
Ipsl loss tactile vibrtaion and proprioception
C/L pain and temp below lesion
LMN at level of lesion
At lesion ipsl pain /temp
A

Brown sequard syndrome

complete hemisection spinal cord

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515
Q

Brown sequard syndrome

A 
Ipsl UMN sign
Ipsl loss tactile vibrtaion and proprioception
C/L pain and temp below lesion
LMN at level of lesion
At lesion ipsl pain /temp
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516
Q

Deep nuclei of cerebellum from medial to lateral

A

Fast Gerbals Exercise Daily

Fastigial nucleus
Globose nucleus
Emboliform nucleus
Dentate nucleus

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517
Q

Involuntary flailing of one arm

A

Hemiballismus

Subthalamic nucleus

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518
Q

which portions of the hypothalamus are inhibited by leptin ? which are stimulated

A

Inhibits the lateral nucleus

Stimulates teh ventromedial nucleus

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519
Q

Dopamineric signals from the ______ to _______ induce movement

A

Substantia nigra to neostriatum

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520
Q

Parkinson

  • signs
  • seen in brain
  • loss of
A 
Hypokinesia
Festinating gait
Pill rolling tremor
Cogwheel rigidity
Mask like facies

Depigmentation of substantia nigra

Loss of dopamine

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521
Q

Also has parkinsonian features

A

Synthesizing meperidine

Creates MPTP – MAO–> MPP

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522
Q

Athetosis

A

Slow writhing snke like movements in hands and fingers

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523
Q

Akathisia

A

Compulsion to move

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524
Q

Huntingtons Disease

A

Huntington chorea
C’s

CAG trinucleotide repeat
Chromosome cuatro (4)
Cuarenta (age 40)
Chorea
Cognitive decline
Caudate atrophy

Excessive excitation by glutamate –> death of neurons

Increase dopamine
Decrease GABA
Decrease ACh

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525
Q

Fracture to shaft of humerus

Fracture of surgical neck of humerus

A

Radial n.
- Wrist drop

Axillary n.
Posterior circumflex A.

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526
Q

Poststreptococcal glomerulonephritis deposits

A

IgG
IgM
C3

Immune complex deposition

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527
Q

Enteropeptidase activity

A

Trypsin

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528
Q

Gram neg rod
Green metallic sheen on eosin methylene blue agar
Hemolysis on blood agar

A

Ecoli

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529
Q

Green metallic sheen on eosin methylene blue agar

A

Ferments lactose

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530
Q

Pyruvate kinase deficiency

A

Pyruvate kinase needed to convert phosphoenolpyruvate to pyruvate, resulting in generation of ATP

Deficiency means less ATP, less gradient

Disruption of RBC membrane

Splenic red pulp hyperplasia to remove RBCs

Splenomegaly

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531
Q

RAS is usually active when bound to

A

GTP

MAP kinase pathway

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532
Q 
Fever chills, fatigue, dyspnea
Temp
Ring shaped and Maltese cross
Splenectomy
Intraerythrocytic inclusions
A

Babesiosis
Tick borne infection

Babesia microti

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533
Q

Heteroplasmy

A

condition of having different mitochondrial genomes

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534
Q

Frothy foamy urine caused by

Starling forces?

A

Proteinuria or bile salts in urine

Low plasma oncotic pressure

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535
Q

Absence of CD18

A

Leukocyte adhesion deficiency

CD18 needed for formation of integrins

Persistent leukocytosis

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536
Q

Average total body water is

extracellular fluid

Plasma volume

A

41 liters

14 L

3 L (within extracellular)

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537
Q

Posterior duodenal wall ulcer erodes into

A

Gastroduodenal artery

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538
Q

Mass in right temporal love vision problems

A

Affects meyer’s loop

Left homonymous superior quadrantanopia

Left top quadrant of both eyes

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539
Q

Hepatoduodenal ligament contains

A

Common bile duct
Hepatic artery
Portal vein

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540
Q

Amnio acids modified in golgi

A

Tyrosine
Serine
Threonine
Aspargine

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541
Q

Failure of what process results in I cell disease

A

Addition of mannose-6- receptor marker to lysosome enzymes

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542
Q

What develops week 4

Week 8

Week 10

A

Week 4: 4 chamber heart, 4 limb buds

Week 8: fetal movement
8 and “Gait”

Week 10: sex specific genitalia (“ten”italia”)

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543
Q

Neural crest derivitives

A

Magic Cops

Melanocytes
Aorticopulmonary septum
Ganglia (autonomic, dorsal root, enteric)
Iris stroma
Chromaffin cells
Cranial nervs
Odontoblasts/ ossicles
Parafollicular C cells
Sclerae
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544
Q

Emybryonic origin of each

1) Anterior pituitary
2) Posterior pituitary
3) Parotid glands
4) Sublingual glands
5) Sclera
6) Lens
7) Retina
8) Mammary glands
9) Sweat glands

A

1) Anterior pituitary= surface ectoderm
2) Posterior pituitary= neural tube
3) Parotid glands= surface ectoderm
4) Sublingual glands= endoderm
5) Sclera= neural crest
6) Lens= surface ectoderm
7) Retina= Neural tube
8) Mammary glands= surface ectoderm
9) Sweat glands= surface ectoderm

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545
Q

G1 –> S

A

cyclin D binds/ activates CDK4 –> phosphorylation of Rb protein

Rb protein released from E2F

E2F left free to transcribe/ synthesize components needed for progression through S (cyclin E, DNA polymerase, thymidine kinase)

Cyclin E binds/ activates CDK2 –> the cell is allowed into S pahse

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546
Q

G2 –> M

A

Cyclin A - CDK2 complex –> mitotic prophase

Cyclin B- CDK1 complex is activated by cdc25 –> breakdown of nuclear lamins and initiation of mitosis

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547
Q

Trafficking proteins (3)

A

1) COP-11
- antrograde trafficking
- protein from ER to golgi

2) COP-1
- retrograde from golgi to ER

3) Clathrin
- farside of golgi
- helps golgi to form vesicles to transport enzymes called hydrolases to lysosomes

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548
Q

Post translational modifications of proteins and proteoglycans in golgi apparatus

A

1) GLycosylation of core proteins to form proteoglycans
2) Sulfation of proteoglycans and selected tyrosine residues
3) Add O-oligosaccharides to serine and threonine residues
4) Adds mannose-6-phosphate to asparagine residues located on lysosomal enzymes

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549
Q

I cell disease

A

Deficiency of mannose phosphorylation

No mannose-6-phosphate to target lysosomal proteins

Secreted out of cell instead of into lysosomes

Corneal clouding, coarse facies, hepatosplenomegaly, skeletal abnormalities, restricted joint movement

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550
Q

Corneal clouding, coarse facies, hepatosplenomegaly, skeletal abnormalities, restricted joint movement

A

I cell disease

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551
Q

Beta oxidation of very long chain fatty acids and branched chain fatty acids

  • synthesis of
A

Peroxisomes

Synthesis of plasmalogens (phospholipids in myelin)

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552
Q

Retrograde movement on axon

A

Dynein

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553
Q

Antrograd movement on axon

A

Kinesin

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554
Q

Situs inversus
Chronic sinusitis
Bronchiectasis
Infertility

A

Kartagner syndrome

Dynein doesnt work

Immotile cilia

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555
Q

what intermediate filaments are found in each of the following?

Connective tissue
Muscle tissue
Epithelial tissue
Axons
Nuclear envelope and DNA
Schwann cells
A

CT= Vimentin

Muscle tissue= desmin

Epithelial tissue= cytokeratin

Axons= neurofilaments

Nuclear envelop and DNA= Nuclear lamins

Schwann cells= Glial fibrillary acid proteins

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556
Q

Kartagener syndrome

A

Situs inversus
Bronchiectasis
Chronic sinsitis

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557
Q

Which arachidonic acid product causes each of the following effects

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

A

1) LTD4, LTE4, LTC4
2) TXA A2
3) PGL2
4) PGE2, PGF2alpha
5) PGI2
6) TXA A2
7) PGI2, PGE1

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558
Q

Needed for Granuloma formation

A

IFN-gamma: forms granuloma

TNF-alpha: maintains granuloma

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559
Q

Blue sclerae
Hearing loss
Multiple fractures

-inheritence

A 
Osteogenesis imperfecta (OI)
- Autosomal dominant
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560
Q

Cant see
Cant pee
Cant hear high C

A

Alport syndrome

Type IV collagen

Nephritis and kidney failure
Hearing loss
Eye problems (Cataracts)

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561
Q

Role of Vit C in collagen production

A

Hydroxylation of lysine and proline

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562
Q

Damaged in Guillain-Barre syndrome

CSF changes

Classic manifestations

A

Schwann cell

Normal cell count
Increase protein

Symmetric ascending muscle weakness
Bilateral facial paralysis (palsy)
Preceded by infection
No sensory loss

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563
Q

Holoproencephaly

  • conditions
  • mutation
A

Trisomy 13 patau
Fetal alcohol

SHH mutation

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564
Q

Chiari Malformation

A

Herniation of cerebellar tonsils

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565
Q

Enlarged posterior fossa
Cerebellar vermis fails to develop
Dilation of 4th ventricle

A

Dandy Walker

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566
Q

Brocas

A

Language production

Understand
Cant talk

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567
Q

Wernicke’s area

A

Comprehension of language

Can talk in sentences
Doesnt make sense

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568
Q

Lesion to which area of brain is responsible for each of the following

1) Hemispatial neglet syndrome
2) Poor repetition
3) Poor comprehension
4) Poor verbral expression
5) Personality changes and disinhibition
6) Agraphia and acalculia

A

1) Nondominant angular gyrus, parietal
2) Arcuate fasciculus
3) Wernicke
4) Broca
5) Frontal lobe
6) Dominant angular gyrus, parietal

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569
Q

What regulates the progression of the cell cycle from the G1 phase to S phase

A

p53

Rb

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570
Q

Which arachidonic acid product has actions that oppose that of prostacyclin

A

Thromboxane A2

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571
Q

Disease which has abnormal breakdown of elastin

A

Alpha 1 anti-trypsin deficiency

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572
Q

Associated with berry aneurysms

A

ADPKD

Ehler Danlos

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573
Q

Fearless
Curious
Puts things in mouth
Hypersexual

A

Bilateral lesion in amygdala

Kluver-Bucy syndrome

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574
Q

Nystagmus
Ataxia
Encephalopathy
Amnesia

A

Wernicke-Korsakoff syndrome

Thiamine deficiency (Vit B)
- alcoholics

Mamillary body lesion

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575
Q

Located in anterior hypothalamus

  • damage to this neuron causes dilute urine
  • secretes antidiuretic hormone
A

Supraoptic nucleus

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576
Q

Stimulation increases appetite
Damage causes anorexia adn WL
Leptin inhibits this nucleus

A

Lateral nucleus

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577
Q

Regulates teh secretion of TSH
Regulates teh secretion of ACTH
Secretes oxytocin

A

Paraventricular nucleus

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578
Q

Receives input from retina
Controls circadian rhythms
Master clock

A

Suprachiasmatic nucleus

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579
Q

Damage leads to savage behavior
Damage leads to obesity
Stimulated by leptin

A

Ventromedial nucleus

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580
Q

Thermoregulation (cooling)

Damage causes hyperthermia

A

Anterior nucleus

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581
Q

Involved in memory

Damage causes wernicke korsakoff

A

Mamillary nucleus

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582
Q

Regulates appetite
Pulsatile secretion of FnRH
Secretes dopamine
Secretes GHRH

A

Arcuate nucleus

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583
Q

Regulates hunger

Damage leads to obesity and a savage behavior

A

Dorsomedial nucleus

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584
Q 
Does thermoregulation (warming)
Damage causes hypothermia
A

Posterior nucleus

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585
Q

Secretes GnRH

nucleus?

A

Preoptic area nucleus

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586
Q

Which amino acids are found in nuclear localization signals

A

PAL

Proline
Arginine
Lysine

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587
Q

Cavernous sinus becomes infected. What neurological deficits

A

Ophthalmoplegia

  • CN III: down and out
  • CN VI: unable to abduct

Diplopia

Pain/ numbness in upper face

Oculomotor n.
Trochlear n.
Abducens n.
Opthalmic div of CN V1
Maxillary div of CN V2
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588
Q

Nerve for

1) dorsal foot
2) lower leg
3) Sole of foot
4) lateral lower leg

A

1) Common fibular nerve
2) Sciatic n.
3) Tibial n.
4) common fibular n.

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589
Q

Merkel corpuscle

  • adaption
  • sensation
  • location
A

Slow
Static pressure
Superficial

590
Q

Meissner corpuscle

  • adaption
  • sensation
  • location
A

Rapid
Light tough
Superficial

591
Q

Ruffini

  • adaption
  • sensation
  • location
  • shape
A

Slow
Pressure, position sense
Deep
Spindle shaped

592
Q

Pacinian

  • adaption
  • sensation
  • location
  • shape
A

Rapid
Vibration
Deep
Onion-shaped

593
Q

Previous infection
In the last week
-Muscle weakness in legs
-Muscles weakness spread to hands and trunk

  • can also see
A

Guillain-Barre syndrome

Bilateral facial paralysis

no sensory loss

594
Q

Slowly adapting vs fast adapting

A

Slowly adapting

  • sends a continuous electric signal thoughout stimulus
  • Merkel, Ruffini

Fast adapting

  • sends a electrical signal only at the beginning and end of continuous stimulus
  • Meissner, Pacinian
595
Q

Bilateral facial muscle paralysis or weakness

A

Guillain-Barre

Lyme disease with Bells palsy

596
Q 
Abrupt onset of pain
HA at the eyebrow
Colored halos
Rainbows of light
Red teary eye, hazy cornea, fixed
Mid dilated pupil (not reactive to light) 
Firm to palpation
A

Acute angle-closure glaucoma

Lens against iris

597
Q

Patients complains of glare with vision

Eye sight has improved, was near sighted

A

Cataract

598
Q

White or bluish ring on periphery of cornea
Elderly

-due to

A

Arcus senilis

Accumulation of cholesterol

599
Q

Clouding of cornea

A

Mucopolysaccharidosis (hurler syndrome)

Deficient: alpha-L-iduronidase

Accumulation: heparan sulfate and dermatan sulfate

600
Q

Enlarged optic disc > 50% of optic cup

A

Glaucoma

601
Q

Auditory pathway (10)

A

1) Tympanic membrane
2) Middle ear ossicles (malleus –> incus –> stapes
3) Hair cells
4) Spiral (cochlear ganglion)
5) Cochlear nuclei
6) C/L superior olivary nucleus
7) Lateral lemniscus
8) Inferior colliculus
9) Medial geniculate nucleus
10) Primary auditory cortex

602
Q

Intermittent vertigo
Tinnitus
Hearing loss

A

Meniere disease

Imbalance of fluid and electrolyte composition of the endolymph

603
Q

Acute otitis externa organisms

A

S. aureus

Pseudomonas aeruginosa

604
Q

Acute otitis media organisms

A

S. pneumonia
Nontypable Haemophilius influenzae
M. Catrrhalis

605
Q

Facial angiofibromas
Ash-leaf spots of depigmentation
Hx of seizures
Intellectual disability

What neoplasms is this patient at an increased risk of developing

A

Tuberous sclerosis

Cardiac rhabdomyoma
Astrocytomas
Angiomyolipoma

606
Q

Awake (open)
Awake (closed)
Non-REM stages
REM stages

A

Awake (open): beta waves

Awake (closed): alpha

Stage N1: Theta waves

Stage N2: Sleep spindles and K complexes
- Bruxism (teeth grinding)

Stage N3: Delta waves
- Sleepwalking, night terror, bedwetting (enuresis)

REM: Beta waves

607
Q

Upper motor neuron lesion classic signs

LMN classic signs

A

UMN

  • Spastic paralysis
  • Hyperreflexia

LMN

  • Flaccid paralysis
  • Hyporeflexia
  • Atrophy
  • Fasciculations
608
Q

What can be damaged with parotid gland surgery

A

Facial n.

Runs through parotid gland

609
Q

Common infectious organism of tonsils and adenoids

Common infectious organism of salivary gland

A

S. pyogenes

S. aureus, viridans group streptococci

610
Q

Tumor of parotid gland

A

Pleomorphic adenomas

benign

611
Q

Child
Recurrent staphylococcus abscesses
Neutrophils fail to respond because chemotactic stimuli are deficient

A

Leukocyte adhesion deficiency

Hyperimmunoglobulin E syndrome

612
Q

What upper GI problem associated with findings

1) Biopsy of pt with esophagitis reveals large pink intranuclear inclusions and host cells chromatin that is pushed to the nucleus

A

HSV esophagitis

613
Q

What upper GI problem associated with findings

Biopsy of a patient with esophagitis reveals enlarged cells, intranuclear and cytoplasmic inclusions, and a clear perinuclear halo

A

CMV esophagitis

614
Q

An esophageal biopsy reveals a lack of ganglion cells between the inner and outer muscular layers

A

Achalasia

615
Q

Protrusion of the mucosa in the upper esophagus

A

Plummer-vinson syndrome

616
Q

Outpouching of the esophagus found just above the LES

A

Epiphrenic diverticulum

617
Q

Goblet cells seen in the distal esophagus

A

Barrett esophagus

618
Q

A PAS stain on a biopsy obtained from a patient with esophagitis reveals hyphate orgnaisms

A

Candida esophagitis

619
Q

Esophageal pouch found in the upper esophagus

A

Zenker diverticulum

620
Q

Dark urine
Clay stools
Jaundice

  • due to
A

Extrahepatic biliary atresia

Incomplete recanalization of the bile duct during development of the bile duct

621
Q

Non-bilious vomiting
Shortly after birth
Constricting ring around duodenum

-due to

A

Annual pancreas

Failure of ventral pancreatic bud to rotate properly

622
Q

Mega-esophagus

Cardiomegaly

A

Chagas disease

Trypanosoma cruzi infection

623
Q

Dysphagia
Glossitis
And ____

A

Plummer-vinson

Iron deficiency anemia

624
Q

Directly inhibits parietal cells from generating acid

A

Somatostatin

625
Q

Gastrin secreted by

Secretion stimulated by

A

G cells of antrum

Phenylalanine
Tryptophan
Calcium

626
Q

Stomach biopsy reveals neutrophils above the basement membrane, loss of surface epithelium and fibrin-containing purulent exudate

A

Acute gastritis

627
Q

What is seen in chronic gastritis

A

Stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells and atrophy of the glandular structures

628
Q

Spiral shaped bacteria

A

H. pylori

629
Q

A 54 y.o male presents with abdominal pain, diarrhea, bilateral lower extremity edema and 5 lb weight loss over last 3 months. An esophagogastroduodenoscopy is performed and cerebriform rugae are observed throughout the body of the stomach. A biopsy of the region shows an abundance of mucous cells forming glands in the shape of corkscrews, but very few parietal and chief cells. most likely diagnosis is

  • increased risk of
A

Menetrier disease

Gastric adenocarcinoma

630
Q

Menetrier disease 5 things

A
  1. Hypertrophy of mucous producing cells, rugae of stomach hypertrophy look like gyri
  2. Atrophy of parietal cells
  3. Decrease gastric acid production
  4. Enteric protein loss –> hypoalbuminemia –> edema
  5. Increase risk of gastric adenocarcinoma
631
Q

Signet ring cell in ovary

A

Krukenberg tumor gastric cancer metasisi to ovary

632
Q

Non bilious projectile vomiting

Palpable oliver mass in epigastric

A

Pyloric stenosis

  • pylorus is hypertrophied
  • narrowing of gastric outlet
633
Q

What enzymes do obligate anaerobes lack

A

Catalse

Superoxide dismutase

634
Q

WHich mycobacterium species fits each

1) Causes leprosy
2) Causes pulmonary TB-like symptoms in COPD patients
3) Causes cervical lymphadenitis in children
4) Cuases a disseminated disease in AIDS patients
5) Associated iwth hand infection in aquarium handlers

A

1) Myco. leprae
2) Myco. kansasii
3) Myco. scrofulaceum

4) Myco. avium intracellulure (MAI)
Myco. avium complex (MAC)

5) Myco. Marinum

635
Q

Stimulates gallbladder contraction

Faciliates pancreatic HCO3 secretion

Increase insulin release

Inhibits secretion of all GI hormones

Relaxes smooth muscle and sphincter through out GI

Produces peristaltic waves

A

Cholecystokinin (CKK)

  • I cells
  • Gall bladder contraction, decrease gastric emptying, increase pancreatic secretion

Secretin

  • S cells
  • Neutralize gastric acid
  • Decrease gastric acid production

Gastric inhibitory peptide (GIP)

  • K cells
  • Decrease gastric acid production
  • Increase insulin release

Somatostatin

  • D cells in GI tract
  • delta cells in pancreas

Vasoactive intestinal peptide (VIP)

  • Relaxes smooth m and sphincter
  • Increase secretion of electrolytes and water
  • Copious watery diarrhea

Motillin

636
Q

Hepatoduodenal ligament contains

A

Portal triad

  • Hepatic artery
  • portal vein
  • common bile duct
637
Q

Retroperitoneal

A 
SAD PUCKER
Suprarenal (adrenal) glands
Aorta
Duodenum (2nd-->4th part)
Pancreas (not tail)
Ureters
Colon (ascending and descending)
Kidney
Esophagus (lower 2/3)
Rectum
638
Q

Four obligate aerobic bacteria

A

Nagging Pest Must Breathe

Nocardia
Pseudomonas aeruginosa
Mycobacterium tuberculosis
Bacillus

639
Q

Carbohydrate breakdown and transport

A

Carbs
- immediately: salivary amylase in mouth

Carbs –> disaccharides
(pancreatic amylase)

Disaccharides –> monosaccharides
(intestinal brush border)

Sodium dependent transport

  • GLucose
  • Galactose
Faciliate diffusion (GLUT5) 
- Fructose
640
Q

Protein breakdown and transport

A

Protein –> Amino acids & dipeptides, tripeptides
(pancreatic proteases)

Sodium dependent transport
- Amino acids

Hydrogen gradient
- dipeptides, tripeptides

641
Q

Lipid breakdown and transport

A

Lipids –> triacylglycerol
( salivary lipase, stomach)

Triacylglycerol –> Fatty acids, 2-monoacylglycerol
( Pancreatic lipase)

Bile acids emulsify hydrolyzed product
Forms micelles

–> Triglycerides, cholesterol

Gets balled up into chylomicrons, transported to liver

642
Q

Location of absorption

Iron
Folate
Vit B12

A

Duodenum

Duodenum and jejunum

Terminal ileum

643
Q

Bite cell

A

G6PD deficiency

Due to removal of Heinz bodies by macrophages in the spleen

644
Q 
Deficiency ApoB-48, ApoB-100
Malabsorptive
Steatorrhea
Failure to thrive
Ataxia
acanthocyes "spur cell" on microscope
Lipid-laden enterocytes
  • inheritence
  • mutation
  • missing
  • later manifestations
  • tx
A

Abetalipoproteinemia
AR
Mutation in gene that encodes for microsomal transfer protein (MTP)

Chylomicrons, VLDL and LDL absent

Retinitis pigmentosa
progressive ataxia
acanthocytosis

Restriction of long chain fatty acids
Large doses oral Vit E

645
Q 
Defective ApoB-100
Increased LDL, cholesterol, VLDL
Premature atherosclerosis
Tendon xanthomas
Xanthelasmas
A

Familial hypercholesterolemia

  • AD
  • Absent LDL receptors

Defective LDL particle uptake by hepatocytes

646
Q 
Deficiency ApoC-2
Increased chylomicrons
Acute pancreatitis
Lipemia retinalis
Eruptive xanthomas
A

Familial
chylomicronemia
AR

Creamy white retinal blood vessels

Localized lipid deposits in skin, red bumps

647
Q

Deficiency ApoE
Premature atherosclerosis
Lipid droplets in palms of hand
Lipid laden macrophages

What is impaired

A

Familial dysbetalipoprotenemia

Chylomicron remnant uptake by liver cells

Increase chylomicron and VLDL remnants

648
Q

Celiac disease Ab to

A

Gliadin

Tissue transglutaminase

649
Q 
Weight loss 
Lymphadenopathy
Hyperpigmentation
Cardiac symptoms
Arthralgias
Neurlogic symptoms
PAS+ Foamy macrophages in lamina propria
A 
Whippe disease
Tropheryma whipplei (Gram +)

Penicillin
Ampicillin
Tetracycline

650
Q

Small intestinal mucosa laden with distended macrophages in the lamina propria

A

Whipple disease

651
Q

Horrible abdominal pain
Mild tenderness to palpation
Dilated loops of bowel
Bowel wall thickening

A

Intestinal ischemia

652
Q

Blood supply proximal to pectinate line

Blood supply distal to pectinate line

A

Superior rectal artery
from inferior mesenteric artery

Inferior rectal artery (br. of pudendal a.)

653
Q

Peutz-Jeghers syndrome

A

AD
Multiple benign hamartomas in GI tract
Hyperpigmented areas on lips, mouth, hands genitalia
Increase risk of malignancy

654
Q

Colon cancer APC pathway

A 
Loss of APC gene 
K-RAS mutation
Loss of tumor suppressor genes
-p53
- DCC (chr 18q)
655
Q

colon cancer microsatellite pathway

A

Loss common
HNPCC (lynch)
Dysfunction of DNA mismatch repair enzymes

656
Q

LOTs of polyps

A

Familial adenomatous polyposis

AD mutation of the APC gene

657
Q

Gardner syndrome (4)

A

Familial adenomatous polyposis
Bone and soft tissue tumors
Lipomas
Retinal hyperplasia

658
Q

Lynch syndrome

A

HNPCC
Nonpolyposis colorectal cancer
AD
Proximal colon cancer

659
Q

Patient with urinary tract infection caused by Proteus vulgaris is at risk for what type of renal stone

A

Ammoniummagnesium phosphate stones (Staghorn calculi)

660
Q

Chlamydophila psittaci

Chlamydophila pneumoniae

Chlamydia trachomatis

  • A, B, C
  • D-K
  • L1 L2 L3
A

Chlamydophila psittaci

  • bird exposure
  • pneumonia

Chlamydophila pneumoniae

  • interstitial pneumoniae
  • walking pneumonia

Chlamydia trachomatis

  • A, B, C (trachoma eye infxn)
  • D-K (PID, urethritis, conjunctivitis)
  • L1 L2 L3 (lymphogranuloma venerum, primary ulcer and LAD)
661
Q

Ventral pancreatic bud –>

Dorsal pancreatic bud –>

A

Ventral –> uncinate process, part of head of pancreas, proximal portion of main pancreatic duct

Dorsal –> Body and tail, most of head (superior aspect) , small accessory pancreatic duct

662
Q

What tells the pancreas to start secreting

A

CCK
Vagus n.
Secretin

663
Q

Pancreatitis causes

A 
"Pancreatitis"
hyperParathyroidism**
Alcohol**
Neoplasm
Choleithiasis**
Rx (drugs)**
ERCP**
Abdominal surgery
hyperTriglyceridemia **
Infection
Trauma
Idiopathic 
Scorpion sting
664
Q

Sit wont sit down
Severe pain radiates to back

What will be elevated

A

Acute pancreatitis

Increased serum lipase

665
Q

Painless jaundice

-markers

A

Pancreatic adenocarcinoma

CD19-9
CEA

666
Q

Trousseua syndrome

A

Hypercoagulability
Venous thrombosis
Migratory thrombophlebitis
Associated with pancreatic cancer

667
Q

A 59-year-old man with no prior medical history
presents to the physician with marked hyperglycemia,
diarrhea, and weight loss. A CT
scan of the abdomen reveals a pancreatic mass.
A trial period on an oral hypoglycemic agent
has not helped reduce his glucose levels. His
physical examination is signifi cant for the rash
shown in the image. Which of the following is
the most likely diagnosis?

A

Glucagonoma

Tx Octreotide

668
Q

Pancreatic mass
Increased insulin
Hypoglycemia
Elevated C- peptide

A

Insulinoma

669
Q 
Pancreatic mass
Hyperglycemia
Steatorrhea
Gallstones
Decrease hydrocholic acid (achlorhydria)
A

Somatostatinoma

670
Q

Young child has recurrent lung infections and granulomatous lesions. This is most likely due to what underlyign defect in neutrophils

A

Chronic granulomatous disease

Deficiency of NADPH oxidase

671
Q

Spore forming bacteria

A

Bacillus anthracis
Bacillus cereus

Clostridum spp
(perfringens, tetani, botulinum, difficle)

Coxiella burnetti

672
Q

6 month old gets flaccid paralysis after eating honey. Organism? MOA?

A

Clostridum botulinum

Inhibits release of acetylcholine

673
Q 
Jaundice male neonate
Lethargic
Icterus of skin and sclerae
Muscle tone decreased
Liver no enlarged
Total bilirubin high
Normal direct bilirubin

Phenobarbital does not lower bilirubin levels

A

Unconjugated hyperbilirubinemia

Crigler-najjar Syn (type I)

674
Q

hCG stimulates corpus luteum to produce progesterone until placenta takes over at

A

8 weeks

675
Q

Adult vs fetal hemoglobin

A

Adult

  • Two alpha
  • two beta

Fetal

  • two alpha
  • two gamma
676
Q

What allows bilirubin to be taken out of blood

A

UDP-glucuronyl transferase

677
Q

A healthy 25 y.o man comes in to routine examination. His lab tests show a serum bilirubin level of 4 mg/dL and a direct bilirubin of 0.3 mg/dL. Liver fxn tests are nromal. Which of hte following explains the serum and indirect bilirubin levels

A

B. Glucuronosyltransferase deficiency

Gilbert

678
Q

Phenobarbital in Crigler Najjar

A

Phenobarbital

Type II have decrease in bilirubin

Type I no change

679
Q

New born presents with kernicterus, jaundice adn elevation of serum unconjugated bilirubin. Patient dies after 1st birthday. Most likely had a deficiency of?

A

Uridine diphosphate-glucuronsltransferase

Crigler-Najjar tyep I

680
Q

Autopsy of patient has black liver

A

Dubin Johnson

Increase direct bilirubin

681
Q

Increased direct bilirubin

no black liver

A

Rotor syndrome

682
Q

Encapsulated bacteria?

Test for encapsulated bacteria

A

Even Some Pretty Nasty Killers Have Shiny Bodies

E.coli
Strep pneu.
Pseudomonas
Neisseria meningitis
Klebsiella
H. influenza
Salmonella
B Group B strep

Quellung rxn

683
Q

A 39-year-old white woman who suffers from
polycythemia vera presents to the clinic complaining
of severe and constant right upper
quadrant pain over the past 2 days. Physical examination
reveals an enlarged liver. What other finding would most likely be seen at presentation?
(A) Ascites
(B) Asterixis
(C) Esophageal varices
(D) Hyperpigmented skin
(E) Spider angiomata

A

A. Ascites

Budd-chiari

684
Q

A 34-year-old woman who is at 26 weeks of gestation
and who has a history of multiple spontaneous
abortions presents with severe abdominal
pain, jaundice, ascites, and mental status
change. Ultrasonography reveals an obscure
hepatic venous connection to the inferior vena cava and absence of any waveform in the hepatic veins. She has a positive serum antiphospholipid antibody titer. Which of the following
is the most likely diagnosis?
(A) Budd-Chiari syndrome
(B) Congestive heart failure
(C) Polymyalgia rheumatica
(D) Portal vein thrombosis
(E) Veno-occlusive disease

A

A. Budd-chiari syndrome

Complete obstruction to blood flow by acute clot in hepatic veins or inferior vena cava

Hepatomegaly
Pain
Ascites
Jaundice

685
Q

A 57-year-old white man presents to his primary
care physician with dyspnea. He says that
he likes to maintain his yard and garden, but
that he has recently had trouble doing the
work, and becomes short of breath even walking
up the one fl ight of stairs in his house. On
further questioning, he says that sometimes he
wakes up short of breath in the middle of the
night. Physical examination demonstrates pitting
ankle edema. Which of the following fi ndings
would also be expected in this patient?
(A) Decreased sympathetic outfl ow
(B) Decreased venous pressure
(C) Increased aldosterone secretion
(D) Increased effective arterial blood volume
(E) Increased glomerular fi ltration rate

A

C. increased aldosterone secretion

CHF

686
Q

A 26-year-old man presents to the clinic with
bradykinesia, rigidity, and resting tremor. Serum
aminotransferase levels are mildly elevated.
A liver biopsy is shown in the image.
What is the chance that this patient’s sister will
have the same condition?

A

B. 25%

Wilsons disease

687
Q

A 19-year-old woman is bothered by a tremor at rest,
which becomes progressively worse over the next 6 months.
She exhibits paranoid ideation with auditory hallucinations
and is diagnosed with an acute psychosis. On physical examination,
she has scleral icterus. A slit lamp examination shows
corneal Kayser-Fleischer rings. Laboratory findings include
total serum protein, 5.9 g/dL; albumin, 3.1 g/dL; total bilirubin,
4.9 mg/dL; direct bilirubin, 3.1 mg/dL; AST, 128 U/L;
ALT, 157 U/L; and alkaline phosphatase, 56 U/L. Which of
the following additional serologic test findings is most likely
to be reported in this patient?
A Decreased α1-antitrypsin level
B Decreased ceruloplasmin level
C Increased α-fetoprotein level
D Increased ferritin level
E Positive antimitochondrial antibody
F Positive HbsAg

A

B. Decreased ceruloplasmin level

Wilson disease

688
Q 
Cirrhosis
Diabetes
Hyperpigmentation
CHF
Testicular atrophy
A

“Bronze diabetes”

Hemochromatosis

INcreased risk of HCC

AR disease
- HFE gene –> makes hepcidin

Increased ferritin

689
Q

Lung and liver disease

A

Alpha 1 antitrypsin disease
AD

Impaired ability to protect organs for elastase

690
Q

What three bacteria are obligate intracellular bacteria

A

Rickettsia
Coxiella
Chlamydia

691
Q

Hepatitis A

  • type
  • genus
  • family
  • transmission
  • infection type
  • signs
A

ssRNA virus
non-enveloped

Hepatovirus

Picronavirus

Fecal/oral, poor sanitation

Acute

Fever, vomiting, jaundice, RUQ pain

692
Q

Hepatitis E

  • type
  • genus
  • family
  • transmission
  • infection type
  • More likely to cause fulminant hepatic failure in
A

ssRNA

Hepevirdae

Orthohepevirus

Fecal/oral route, contaminated water

Acute

Pregnant women

693
Q

Hepatitis B

  • type
  • genus
  • family
  • transmission
  • infection type
  • Tx
A

ds DNA

Orthohepadnavirus

Hepadnaviridae

Perinatally, sexual contact, blood

Chronic

Tenofovir

694
Q

Hepatitis D

  • type
  • genus
  • family
  • transmission
  • infection type
  • feature
  • Tx
A

ssRNA
deltavirdae
Blood, sexual contact

Infects w/ hepatitis B

Chronic

Pegylated IFN-alpha

695
Q

Hepatitis C

  • type
  • genus
  • family
  • transmission
  • infection type
  • Tx
A

ssRNA

hepacivirus

Flavivirdae

Blood, sexual contact

Chronic

Ledipasvir-sofosbuvir
Ombitasvir-paritaprevir-ritonavir + dasabuvir

696
Q

ANA

anti-smooth muscle Ab

A

Autoimmune hepatitis

Type 1

697
Q

Anti-liver-kidney microsomal Ab

Anti-liver cytosol antibody

A

Autoimmune hepatitis

Type 2

698
Q

Coarse facial features
Abscesses
Eczema

A

Hyper IgE syndrome

T cell

699
Q

Thrombocytopenia
Purpura
Infections
Eczema

A

Wiskott aldrich

B cell disorder

700
Q

Delayed separation of umbilicus

A

Leukocyte adhesion deficiency

701
Q

Neurologic defects, partial albinism

recurrent infections

A

Chediak-Higashi syndrome

702
Q

P450 enzymes in the liver are found in what zone of hepatic lobule

A

Zone 3

703
Q

Beads on a string
+ pANCA

  • due to
  • tx
A

Primary sclerosing cholangitis (PSC)

COncentric fibrosis of bile ducts

liver transplant

704
Q

A 43-year-old man with a 20-year history of ulcerative
colitis presents to the physician with complaints of worsening bloody diarrhea, progressive
fatigue, pruritus, visual disturbances, and arthralgias. On physical examination, he is
found to have icteric sclera, fi nger clubbing, and several small ulcerations with necrotic
edges on both legs. Endoscopic retrograde cholangiopancreatography
(ERCP) shows alternating
strictures and dilations of the bile ducts.
Which of the following conditions is consistent with these ERCP fi ndings?
(A) Cholelithiasis
(B) Pancreatic carcinoma
(C) Primary biliary cirrhosis
(D) Primary hemochromatosis
(E) Primary sclerosing cholangitis

A

(E) Primary sclerosing cholangitis

705
Q
  1. A 46-year-old white woman with rheumatoid arthritis
    presents with severe pruritus. She denies
    any history of alcohol or drug use. On physical
    examination, she is found to have icteric sclera,
    palpebral xanthomas, and hepatomegaly. She
    tests positive for antimitochondrial antibody and
    increased alkaline phosphatase activity. Which
    of the following is most likely responsible for
    this patient’s presentation?
    (A) Destruction of intrahepatic bile ducts
    (B) Hepatic parenchymal destruction
    (C) Obstruction of extrahepatic bile ducts
    (D) Portal vein thrombosis
    (E) Stenosis of extrahepatic and intrahepatic
    bile ducts
A

(A) Destruction of intrahepatic bile ducts

The triad of jaundice
(icteric sclera), hypercholesterolemia (palpebral
xanthomas), and pruritus with positive antimitochondrial
antibody titers and elevated alkaline
phosphatase activity is classic for
primary biliary cirrhosis. Primary biliary cirrhosis
is a cholestatic disease with chronic, progressive,
and often fatal liver injury characterized
by the destruction of medium-sized
intrahepatic bile ducts with eventual liver failure.
Liver transplantation is the defi nitive treatment.

706
Q
  1. A 46-year-old white woman with rheumatoid arthritis
    presents with severe pruritus. She denies
    any history of alcohol or drug use. On physical
    examination, she is found to have icteric sclera,
    palpebral xanthomas, and hepatomegaly. She
    tests positive for antimitochondrial antibody and
    increased alkaline phosphatase activity. Which
    of the following is most likely responsible for
    this patient’s presentation?
    (A) Destruction of intrahepatic bile ducts
    (B) Hepatic parenchymal destruction
    (C) Obstruction of extrahepatic bile ducts
    (D) Portal vein thrombosis
    (E) Stenosis of extrahepatic and intrahepatic
    bile ducts
A

(A) Destruction of intrahepatic bile ducts

The triad of jaundice
(icteric sclera), hypercholesterolemia (palpebral
xanthomas), and pruritus with positive antimitochondrial
antibody titers and elevated alkaline
phosphatase activity is classic for
primary biliary cirrhosis. Primary biliary cirrhosis
is a cholestatic disease with chronic, progressive,
and often fatal liver injury characterized
by the destruction of medium-sized
intrahepatic bile ducts with eventual liver failure.
Liver transplantation is the defi nitive treatment.

707
Q

A 42-year-old woman comes to the physician
with severe itching for the past 4 days. Her
physical examination is signifi cant for hepatomegaly
and three xanthomas on her right lower
extremity. Laboratory studies reveal a normal
total bilirubin level and elevated serum cholesterol
and alkaline phosphatase levels. A liver
biopsy shows granulomatous destruction of medium-
sized intrahepatic bile ducts. Which of
the following autoantibodies is most likely to
be signifi cantly elevated in this patient?
(A) Anticentromere antibodies
(B) Antihistone antibodies
(C) Antimitochondrial antibodies
(D) Antinuclear antibodies
(E) Rheumatoid factor

A

C. anti mitochondrial ab

primary biliary cholangitis (cirrhosis)

708
Q

Granulomas
Cirrhosis
Middle age female
Anti-mitochondrial antibody

  • due to
  • tx
A

Piarmy biliary cholangitis (PBC)

Autoimmune
T cells attack bile ductules within teh liver parenchyma

Ursodiol (ursodeoxycholic acid)
- bile acid that decreases the synthesis of cholesterol in the liver
Liver transplant

709
Q

Lysosomal storage disease

  • accumulation of CM2 ganglioside
  • associated with renal failure
A

Tay-Sach

Fabry disease

710
Q

Inhaled coin goes where

A

Right mainstem bronchus

711
Q

Physiologic dead space equation

A

Vd= Vt x (PaCO2- PeCO2)/ PaCO2

Vd= dead space
Vt= tidal volume
PaCO2= Pco2 arterial
PeCO2= Pco2 expired air
712
Q

Pulmonary vascular resistance equations

P=

R=

A

P= Q x R

Q= perfusion

R= 8 nl/ #R^4
n= viscosity
l= length of vessel
r= radius
#= pie
713
Q

Beta 2 stimulation

A

INcrease radius

Decrease resistance

714
Q

Moves oxygen hemoglobin dissociation curve right (5)

A 
Co2
Acidosis
Increase 2,3 DPG
Increase exercise
Increase temp
715
Q

Form of hemoglobin that has low affinity for oxygen

  • what favors this form
A

Taut (T form)

Favors tissues, give up oxygen readily

Favor the T form

  • Co2
  • H
  • Increased temp
  • 2,3 DPG
716
Q

Hemoglobin with high affinity for oxygen

A

R form (relaxed)

717
Q

Methemoglobin

  • form
  • affinity
  • causes
  • caused by
  • tx
A

Ferric form (3+) of iron
Decreased affinity for oxygen
Increased affinity for cyanide

–> Tissue hypoxia

Nitrates and nitrites
Antimalarial drugs 
(Chloroquine, primaquine)
Dapsone
Sulfonamide
Local anesthetics (lidocaine)
Metoclopramide

Tx

  • Methylene blue
  • Vit C
  • Cimetidine (gradually lowers)
718
Q

Which immunodeficiency matches

1) Neutrophils fail to respond to chemotactic stimuli
2) Adenosine deaminase deficiency
3) Failure of endodermal development
4) Defective tyrosine kinase gene
5) Associated wth high levels of IgE and eosinophils

A

1) Leukocyte adhesion deficiency
2) Hyper IGE syndrome
3) SCID
4) Bruton agammaglobulienmia
5) Hyper IgE syndrome

719
Q

What occurs in COPD with oxygen levels

A

Decrease arterial PO2
Physiologic shunt
Decrease O2 extraction ration
Decreases blood O2 content

720
Q

Alveolar gas equation

A

PAo2= PIo2- PaCo2/ R

PAo2= 150 - PaCO2/0.8

721
Q

CAG

  • cause
  • inheritence
  • signs

CGG

  • cause
  • inheritence
  • signs

CTG

  • cause
  • inheritence
  • signs

GAA

  • cause
  • ineritence
  • signs
A

Huntington disease
- AD
-
-

Fragile X syndrome

  • gene hypermethylation
  • X linked dominant
  • Protruding chin, giant gonads

Myotonic dystrophy

  • AD
  • Cataracts, Toupee (early balding) , gonadal atrophy

Friedreich ataxia

  • AR
  • Ataxic gait
722
Q

Defects in DNA mismatch repair

A

Lynch syndrome

increased risk of hereditary non-polyposis colorectal cancer (HNPCC)

723
Q 
Headache fever inattentiveness
Chemotherapy
Increased opening pressure
Increased protein, low glucose
Image: Cds

Tx.

A

Cryptococal meningoencephalitis

Initial:
Amphotericin B
Flucytosine

Long term maintenance therapy:
Fluconazole

724
Q

Left ventricular myocardial blood supply occurs when

A

During diastole

Ventricle is relaxed

725
Q

Intrapleural pressure when airway pressure is zero

A

-5

–> -7.5 with inspiration

726
Q

Manic vs hypomanic

A

Manic

  • severe
  • 1 week
  • May have psychotic features

Hypomanic
- >= 4 consecutive days

727
Q

Bipolar I
Bipolar II
Cyclothymic disorder

A

Bipolar 1

  • Manic episode
  • Depressive episode common

Bipolar 2

  • Hypomanic
  • > 1 major depressive episode

Cyclothymic
- >2 years fluctuating, mild hypomanic, depressive symptoms

728
Q

1) Parasite eggs in stool
2) Perianal egg deposition
3) Proglottids in the stool
4) Rhabdoitiform larvae in the stool
5) Trophozoites and cysts in the stool

A

1) Schistosoma mansoni or S. japonicum
2) Enterobius vermicularis (pinworms)
3) Intestinal tape worms (Taenia solium, T saginata, Diphyllobothrium latum)
4) Strongyloides stercoralis
5) Protozoal infections (Giardia lamblia, entamoeba histolyticsa)

729
Q 
Conjunctiva pallor
SOB
Constipation
Decreased concentration
Microcytic anemia
- Decreased MCV

What do you see on peripheral smear?

A

Lead poisoning

Basophilic stippling

730
Q

1) Heinz bodies
2) Howell-Jolly bodies
3) RIng sideroblasts
4) Schistocytes
5) Basophilic stippling

A

1) Inclusions of denatured hemoglobin after Oxidant stress in pts w/ G6PD deficiency
2) DNA remnant incusion in peripheral RBC taht are normal removed by spleen, indicates decreased or absent splenic function

3) Formed from precipitation of iron granules in developing erythrocytes due to defect in heme synthesis pathway
(See in bone marrow no peripheral smear)

4) Are fragments of RBC formed from mechanical hemolysis, hemolytic uremic syndrome, thrombocytopenic purpura, and disseminated intravascular coagulation

731
Q

Lactose deficiency see what in intestine

A

Normal

732
Q

Tennis elbow

- muscle

A

Lateral epicondylitis
Wrist extension
Extensor carpi radialis brevis

733
Q

Prophylactic medication
Jaundice
Dark urine
RBC w/ dark inclusions

-inheritence pattern?

A

G6PD deficiency

Heinz bodies

X recessive

734
Q

Relative erythrocytosis

A

aka Relative Polycythemia

Normal RBC mass

Decrease in plasma volume

735
Q 
Fever 
Headache
Nuchal rigidity
Normal glucose
elevated protein
A

Aseptic meningitis

Enteroviruses

  • coxsackievirus
  • echovirus
  • poliovirus
736
Q

Ovarian cancer risk factors

A

Repeat ovulation

- nulliparity

737
Q

Failure to thrive
Developmental delay
Cant lift head
Orotic acid crystals

Supplementation of what is needed?

A

Hereditary orotic aciduria

  • AR
  • disorder of pyrimidine synthesis
  • defect in uridine 5- monophosphate (UMP) synthase

Supplement Uridine

738
Q

Ascorbic acid

A

Vit C

739
Q

Posterior left 12th rib fracture injury

Anterior right rib 8-11 fracture

Anterior left ribs 8-11 fracture

Fracture ribs 1-6

A

L kidney

R liver

Spleen

visceral pleural of lungs

740
Q

Changes what gene expression

1) 14;18
2) 9;22
3) 8;14
4) Breast cancer

A

1) Follicular lymphoma
- Bcl-2 overexpression

2) CML
- Bcr-abl

3) Burkitt lymphoma
- C-myc overexpression

4) Erb-B2 overexpression, HER2

741
Q

Increased hemoglobin=

A

Erythrocytosis

Excess erythropoietin porduction

742
Q

1) Linear IgG and C3 deposits on IF microscopy
2) Glomerular basement membrane splitting
3) Glomerular basement fibrin deposition
4) Subepithelial humps on electron microscopy
5) Diffuse capillary wall thickening on light microscopy
6) Glomerular crescents on LM
7) C3 granular straining along GBM

A

1) Anti-GBM disease
2) Membranoproliferative glomerulonephritis (MPGN) and Alport syndrome
3) Rapidly progressive glomerulonephritis (anti-gbm)
4) Poststreptococcal glomerulonephritis
5) Membranous glomerulopathy
6) Rapidly progressive glomerulonephritis, Anti- GBM disease
7) Poststreptococcal glomerulonephritis

743
Q

Metabolic vs respiratory

compensation

A

Metabolic acidosis

  • Decrease pH
  • Decrease PCo2
  • Decrease HCO2

Respiratory acidosis

  • Decrease pH
  • Increase PCO2
  • Increase HCo2

PCO2= 1.5 [HCO3] + 8 (+-2)

744
Q

Rapid onset sepsis
Altered consciousness
Organ failure
Petechial/ ecchymotic rash

virulence factor

A

N. meningitidis

Lipo-oligosaccharide (LOS)

745
Q

Reaction rate in skeletal muscles is dependent on ____ which is activated by

A

Phosphorylase kinase (PK)

Ca

746
Q

Skeletal pain
Deformity (bowing of legs)
Focal warmth

A

Paget disease

747
Q

How HIV attaches

A

Attaches to host cells using the viral surface glycoprotein gp120

This glycoprotein bins to teh CD4 as the primary receptor and teh chemokine receptor CC45 as the coreceptor

Conformation change in gp120 exposes teh underlying transmembrane glycoprotien gp41 which mediates viral fusion

748
Q

Nef

tat

A

HIV regulatory genes

Nef: downregulates teh expression of class I major histocompatibility complex proteins on teh surface of infected cells, limits immune recognition by cytotoxic T cells

tat: is a transcriptional activator that promotes viral gene expression

749
Q

(+) for
synaptophysin
Chromogranin
neuron-specific enolase

A

Small cell carcinoma of the lung

Carcinoid tumor

750
Q

Temporal hemorrhage affects what nerve

A

Herniation

CN III

751
Q

Missouri caves

A

Histoplasma capsulatum

Macropahges iwth intracellular small yeasts

752
Q

1) Budding yeast with thick capsule
2) Macropahges with intracellular small yeast
3) Round spherules iwth multiple endospores
4) Septate hyphae with dichotomous branching
5) Yeasts with pseudohyphae and blastoconidia

A

1) Cryptococcus neoformans
- bird droppings
- immunocompromised
- meningoencephalitis

2) Histoplasma capsulatum
- Missouri caves
- fever nonproductive cough

3) Coccidioides immitis
- pulmonary disease

4) Aspergilus fumigatus
- V shaped branching
- AIDS

5) Candida species
- immunocompromised

753
Q

Pig farmer

A

Loeffler syndrome
Ascaris infection

Eosinophilic invasion due to parasitic infection

754
Q

Most common cause of viral conjunctivitis

A

Adenovirus

Ds non enveloped linear DNA virus

755
Q

Listeria is acquired how

A

Contaminated food

Unpasteurized milk
Uncooked meats

756
Q

Decrease in RPF causes what in GFR and FF

A

Decrease in GFR

Increase FF

757
Q

Anti cholinergic effects

A 
Hot as a hare
Dry as a bone
Red as a beet
Blind as a bat
Mad as a hatter
Full as a flask
Fast as a fiddle
758
Q

Alpha 1 agonist effects

A

increase smooth muscle tone of iris dilator (mydriasis)
Blood vessel constriction
Vasoconstriction reduce nasal congestion

759
Q

DNA binding protein

A

c-Jun c-Fos

760
Q

Chalky white lesions in mesentery, fat cell destruction and calcium depositions

Abdominal pain

A

Acute pancreatitis

761
Q

Infection from puppy

A

Campylobacteri jejuni

762
Q

Exertional shortness of breath
Progressive dyspnea
Lightheadness during exertion
Tricuspid regurg

A

Pulmonary hypertension

763
Q

Glucagon MOA

A

Increases hepatic glucose production via glycogenlysis and gluconeogenesis

764
Q

What can you suffer from if to quick nitroprusside infusion

tx

A

cyanide toxicity

tx sulfur

765
Q

Nissl substance

A

Normal axonal injury reaction

766
Q

VSD sign

A

holosystolic murmur over left sternal border

767
Q

Fundal varices

A

splenic vein thrombosis

768
Q

COPD exacerbation due to

A

virus: rhinovirus, influenza virus, parainfluenza (most common)
bacterial: h. influenza, moraxella catarrhalis, strep. pneumoniae

769
Q

Hyperventilation results in

A

Decrease in arterial partial pressure of CO2

770
Q

Wrinkles due to

A

Decrased collagen fibril production

771
Q

Increase RBC

Intense itching after showering

A

Polycythemia vera
Mutation Jak2
Hematopoietic cells more sensitive to growth factors

Decrease EPO

772
Q

Projection

A

Think wife is cheating cause they are

773
Q

Displacement

A

Mad at boss yells at wife

774
Q

Transference

A

See psychiatrist as parent

775
Q

5 y.o difficulty breathing
dysphagia
drooling fever
Swollen and cherry red epiglottis

sign

A

H. influenzae type B

thumb sign

776
Q

Child sticking nose in air

A

Esophagitis

H. infuenzae type B

777
Q

Cyst in brain
Not IC
Seizures

A

Taenia solium
Pork tapeworm
Feces contaminated food

778
Q

Mutations in pol gene in HIV patient

A

Inconsistent use of antiretroviral–> antiretroviral resistance

779
Q

Patient in shocks gets IV fluids causes

A

increase in preload
Stretches myocardium
Increases the end-diastolic sarcomere length

780
Q

Levothyroxine supplement
TSH <0.01
Risk

A

Too high supplement

Atrial fibrillation

781
Q

Copper is eliminated

A

hepatic excretion into bile

782
Q

Corynebacterium diphtheriae is virulent how

A

phage conversion permitting exotoxin production

783
Q

Permissive effect

A

One hormone allows another to exert it s maximal effect

784
Q 
Lethary confusion
Persistent atrial fibrillation
CHF
Nauseas and decreased appetitie, vomiting
Vision difficulties

Hyperkalemic

A

Digoxin toxicity

785
Q

Nitrates MOA

A

Venodilators
(large veins)

Increase peripehral venous capacitance
–> reducing cardiac preload and left ventricular end-diastolic pressure adn volumne

786
Q

Release of NE from peripheral autonomic nerve terminals will effect

A

sympathetic output to the detrusor muscle
Most organs
Smooth muscle
glands

787
Q 
Fever
Lethargy
urinalysis: positive for proteinuria and hematuria
Decreased hemoglobin
Elevated reticulocyte count 
Decreased platelet
GI illness
scattered petechial rash

renal biopsy

A

Thrombocytopenic thrombotic purpura-hemolytic uremic syndrome

Platelet rich thrombi in glomeruli and arterioles

788
Q

Crescent- shaped mass of cellular proliferation and leukocytes

A

RPGN
macroscopic hematuria
HTN
Progressive renal failure

Good pasture

789
Q

Diffuse proliferation and subepithelial immunoglobulin deposits

A

Post streptococal glomerulonephritis

790
Q

Mesangial IgA deposition and proliferation

A

Henoch-Schonlein purpura

Palpable purpura
arthritis

791
Q

Patchy necrosis of tubular epithelium and loss of basement membrane

A

Acute tubular necrosis

Rising creatinine
Muddy brown granular casts on urinarlysis

792
Q

RB mutation

BRAF

HER2

KRAS

RET

A

RB: Retinoblastoma, osteosarcoma

BRAF: Hairy cell luekemia, melanoma

HER2: breast cancer

KRAS: colorectal cancer, non-small cell lung cancer

RET: MEN2

793
Q

Calculate False positives

Study enrolled 300 patients, 100 have a UTI by urinalysis. New dipstick test 70% sensitive and 90% specific

A 
0.9= D/ 200
TN= 180

False positive= 200-180= 20

794
Q

Diarrhea
HIV patient
Hemorrhagic nodules or polypoid masses
Spindle cells

A

Kapsoi sarcoma

-HHV8

795
Q

What can not be metabolized to pyruvate and cause more lactic acid if pyruvate dehydrogenase deficiency

A

Lysine
Leucine

Ketogenic AA

796
Q

Myeloid cells

A 
Myeloblast
Metamyelocyte
Band
Neutrophils
Basophils
Eosinophils
797
Q

UV damage

A

formation of abnromal covalent bonds between adjacent thymine or cytosine rediues (pyrimidien dimers)

798
Q

Hemosiderin laden macrographes

A

Chronic passive lung congestion in setting of heart failure (left ventricular systolic dysfunction

799
Q

Collagen synthesis occurs when

A

RER

proline and lysine residues are hydroxyalted

Vit C cofactor here

800
Q

Internal hemorrhoid above pectinate line drain into

External hemorrhoids drain

A

Superior rectal vein
from inferior mesenteric vein

External drain via inferior rectal vein into internal pudendal vein which communicates with internal iliac veins

801
Q

Branches of deep external pudendal artery supply the

External iilac vein receives drainage from

Left colic artery branches off, supplies

The superior vesical artery supplies

A

Supply the scrotum and labia majora

External iliac vein receives drainage from the inferior epigastric and deep circumflex iliac veins, serve the anterior abdominal wall and iliac crest respectively

Branches of inferior mesenteric a. to supply the transverse and descending colon

portions of the urinary bladder and ductus deferens

802
Q

Complications of herpes zoster

A

long term residual pain

postherpetic neuralgia

803
Q

Beta 1 receptor found

A

Cardiac tissue
Renal JC cells
Not vascular smooth muscle

Nonselective beta blocker who affect all three

804
Q

Vit B12 deficiency
Type 1 DM
Hashimoto thyroiditis

A

Pernicious anemia

CD4 mediated immune response against parietal cells

Loss of parietal cells mass

  • decrease in intrinsic factor
  • decreased secretion of hydrochloric acid

Elevated pH that stimulates gastrin secretion

805
Q

Tx for alcohol wanting to quit with help

A

Naltrexone

806
Q

Apolipoprotein E4 allele

A

At risk Alz disease

807
Q

Oval budding yeast forms germ tubes at 37 C

A 
Candida albicans 
(true hyphae at 37)

Normal commensal of skin and GI

808
Q

Small ovoid yeast in lungs

A

Histoplasma capsulatum

  • dimorphic
  • inhaled as microconidia
  • pneumonia
809
Q

Noncardiogenic pulmonary edema can be distinguished from cardiogenic pulmonary edema by a

A

normal pulmonary capillary wedge pressure

810
Q

Pancreatitis
SOB adn hypoxemia
New bilateral opacities

A

Acute respiratory distress syndrome

Indirect pulmonary insults cause excessive cytokine release leading to endothelial activation, neutrophilic migration to the lungs, degranulation with release of toxic mediators

Increase capilalry permeability
Formation of hyalien membrane

811
Q

Exercise effect on PaO2, PaCO2, CO and HR

A

Increase HR and CO

No change PaO2, PaCO2

812
Q

Crescent formation 3 types

A

Rapidly progressive glomerulonephritis (RPGN)

1) Antiglomerular basement membrane

2) Immune complex RPGN
- post-streptococcal glomerulonephritis, SLE, IGA, henoch schonlein purupra
- decrease C3 C4

3) Pauci-immune RPGN
- no immunoglobulin or complement deposits
- elevated antineurtrophil cytoplasmic antibodies (ANCA)

813
Q 
SOB
Cough
Exacerbated when lay down
MI
Bilateral crackles at lung base
S3
A

Left sided heart failure

–> elevation of end-diastolic pressure

–> decrease lung compliance

814
Q

zollinger-Ellison syndrome associated with

also at risk for

A

MEN 1

primary hyperparathyroidism ( hypercalcemia, constipation, kidney stones) 
Recurrent nephrolithiasis

Pituitary adenomas

815
Q

Calcifications in epigastric area
abdominal pain
Chronic diarrhea
Consumes alcohol

A

Chronic pancreatitis

Digestive enzyme deficiency –> diarrhea

816
Q

Vomiting/ nausea due to

A 
GI irritation (infections chemotherapy, distention)
- increase serotonin release and activation of 5HT
Central nausea (migraines)
- use dopamine receptor antagonist to stop

Vestibular nausea

  • dopamine receptor stimulation and H1 stimulation
  • promethazine tx both
817
Q

Seen in hashimoto on biopsy

A

Intense lymphoplasmacytic infiltrate with active germinal centers

Hurthle cells

818
Q

Thyroid biopsy

1) Branching papillae with cells containing empty -appearing nuclei
2) Dense fibrous tissue extending beyond the thyroid capsule
3) Follicular hyperplasia with tall cells projecting into the follicular lumen
4) Intense lymphoplasmacytic infiltrate with active germinal centers
5) widespread inflammatory infiltrates, giant cellls, and disrupted follicles

A

1) Papillary thyroid cancer
- orphan annie eye

2) Reidel thyroiditis
3) Graves disease
4) Hashimoto
5) Subacute granulomatous (de Quervain) thyroiditis

819
Q

Ureters anterior to

A

Internal iliac artery

820
Q

Drugs with pt fever, joint pains, rash of face and trunk, Positve anti-nuclear ab

A

Drug induced lupus

SHIPP
Sulfonamides
Hydralazine
Isoniazid
Phenytoin
Procainamide
821
Q

Pencillin binding proteins

A

Transpeptidases

822
Q

Smokers have 5x the risk of esopahgeal carcinoma compared to non smokers (relative risk = 5.0, 95% CI 2.9-7.1)

What percentage of SCC of the esophagus in smokers can be attributed to smoking?

A

Attributable risk percentage in exposed (ARP)

ARP exposed= 100 x (risk in exposed - risk in unexposed)/ risk in exposed

ARP= 100 x [(RR-1)/ RR]

ARP= 100 x [(5-1)/5]= 80%

823
Q

Ionizing radiaton tx for cancer does what

A

DNA ds breaks

free radical formation

824
Q

What is released as O2 saturation curve moves up

A

protons

CO2

825
Q

Anal fissures occur where

A

Posterior midline distal to dentate line

826
Q

Multiple ulcers
Mucosal erosions
Large cells iwth basophili cintranuclear and intracytoplasmic inclusions

A

CMV

herpesvirus

827
Q

Patent foramen ovale

A

wide and fixed splitting

no change with respiration

828
Q 
Headache
Fever
Malaise
Cough 
Nodular infiltrates
Clumping once room temp
A

Mycoplasma pneumoniae

Walking pneumoniae
Cross reactive IgM
Activate complement –> erythrocyte lysis

Cold agglutinins

829
Q 
Action potential conduction velocity
Point 1- 0.05
Point 2 - 0.3
Point 3- 1.1
Point 4- 2.2

Points correspond to what location

A

AV node

Ventricular muscle

Atrial muscle

Purkinje system

830
Q

Insulin effect

A

decrease glucagon secretion

increase glycogen synthesis

Increase glucose uptake

831
Q

Cirrhosis
Agitated and confused.
Jerky irregular flexion-extension tremor in hands

What is elevated in astrocytes

A

Hepatic encephalopathy

Increased nitrogen, ammonia

Ammonia + glutamate –> glutamine (non-neuroactive compond)

832
Q

Demyeliantion of pons

A

overly rapid correction of electrolyte abnromalities

833
Q

Neurodegenerative disease presents at birth as “floppy baby”

A

Werdnig Hoffman disease

834
Q

Perfusion is greatest where in the lung
-V/Q ratio

Exercise effect of V/Q

A

Bases
- V/Q <1

Exercise

  • V/Q moves down toward 1
  • Vasodilation in apex
  • perfusion increases
835
Q

V/Q –> zero

V/Q –> infinity

A

V/Q –> zero

  • low ventilation, high perfusion
  • air way obstruction
  • pneumonia, pulmonary edema, lung cancer
  • supplemental O2 ineffective

V/Q –> infinity

  • high ventilation, low perfusion
  • blood flow obstruction
  • supplemental O2 effective
836
Q

Responses to exercise

  • O2
  • Co2
  • ventilation rate
  • V/Q in apex vs base
  • Pulmonary blood flow
  • pH
  • arterial PO2
  • arterial pCO2
  • Venous CO2 content
A

Increase O2 consumption

Increase CO2 production

Increase ventilation rate

V/Q more uniform

Increase pulmonary blood flow due to increase CO

Decrease pH

No change in arterial PO2 and PCO2

Increase venous CO2 content

837
Q

Normal A-a gradient

Causes of elevated A-a gradient

A

10-15 mmHg

High FiO2
Shunting o f blood
Diffusion limitation (pulmonary fibrosis)
V/Q mismatch
Advanced age

Pressure alveolar oxygen to pressure arterial oxygen

838
Q

Name the exotoxin

1) Causes scarlet fever
2) Inactivates EF-2
3) Blocks release of the inhibitory neurotransmitter glycine

A 
1) Erythogenic toxin
Pyogenic toxins (s. pyogenes)
2) Diphtheria toxin
Exotonin A (pseudomonas)

3) Tetanospasmin (c. tetani)

839
Q

Underlying cause of achalasia?

How is it diagnosed?

A

Failure of LES to relax due to loss of myenteric (Auerbach) plexus due to loss of postganglionic inhibitory neurons ( which contain NO and VIP)

Dysphagia solids and liquids

Diagnosis
- Manometry
(Uncoordinated or absent peristalsis)
- Barium swallow
(dilated esophagus with an area of distal stenosis ) (birds beak)
840
Q

Clinical derangements that come about in a patient with acute mountain sickness

A

Headache
Fatigue

Extreme cases

  • Acute cerebral edema due to hypoxia induced vasodilation
  • acute pulmonary edema
841
Q

Partial pressure of oxygen difference at sea level vs 20,000

A

Sea level= 760 mmHg
20,000= 349 mm Hg

Partial pressure of oxygen is 21% of barometric pressure

Partial pressure is higher at sea level

842
Q

Response to high altitude (6)

A

Increase ventilation

  • have to breathe more
  • blow off more CO2

Increased erythropoietin

  • HCT 40% –> 64%
  • Hgb 15 –> 20 g/dL

Increase 2,3 BPG
- unloads oxygen to tissue better

Increase mitochondria

Increase efficiency of O2 utilization

Increase renal excretion of bicarb

843
Q

pH =

Breathing more causes what pH change

A

HCO3/ pCO2

Respiratory alkalosis
Decreases pCO2 –> raises pH

844
Q

Physiologic changes that occur in chronic mountain sickness (6)

A

Increase RBC mass and hematocrit

Increased blood viscosity and decrease tissue blood flow

Elevated pulmonary artery pressure (pulmonary artery constricts in response to hypoxia)

Right sided heart enlargement ( due to increase pulmonary artery pressure)

Peripheral artery pressure falls

Congestive heart failure

845
Q

Positive G-force in which visual black out occurs

Due to

G force in space lift off

A

4-6 G

Insufficient blood return to heart
Insufficient pumping of blood to brain

8-9 G

846
Q

Nitrogen narcosis

A

Nitrogen dissolves into neuronal membrane, which causes reduced neuronal excitability

Diver becomes jovial/ careless

Loss strength and coordination

847
Q

Symptoms of decompression sickness

A

aka “Bends”

Nitrogen bubbles undissolving from blood, make bubbles in blood vessels can occlude

Joint/ muscle pains in arms and legs

Neurologic problems (dizziness, paralysis, syncope)

“The chokes (Bubbles occlude the lung capillaries –> SOB, pulmonary edema, death)

"BENDS"
Breathign problems
Extremity pain
Neurologic changes
Death
848
Q

VIrchow triad for

A

DVT “SHE”

Stasis
- severely ill, paralyzed, long trips, cast

Hypercoagulability
- sickle cell, polycythemia, estrogen excess, cancer, pregnancy, OCPs, smoking

Endothelial damage
- vessel trauma, fracture, froeign body, bacterial infection

849
Q

Homan’s sign

A

Pain with ankle dorsiflexion

DVT

850
Q 
Tall thin young male
Smoker
Uneven chest expansion
Unilateral Chest pain
Hyperresonance
Dimished breath sounds

Due to

A

Primary spontaneous Pneumothorax

Due to rupture of apical subpleural blebs or cysts

851
Q

Location for needle for tension pneumothorax

A

Above 2nd rib

852
Q 
Pleuritic chest pain
SOB
Cough
Tachypnea
Tachycardia
Low grade fever

Elevated D dimer
Normal CXR
Large A-a gradient

ECG?

A

Pulmonary embolism (PE)

ECG S1Q3T3

  • deep S in lead I
  • large Q and inverted T in lead III
853
Q

Elevated D-dimer

A

DVT

PE

854
Q

The C’s of huntington disease

A 
Chorea
Cuarenta (40)
CAG repeats
Chr Cuatro 4
Cognitive decline
Caudate atrophy
855
Q

FEV1/ FVC normal

Obstructive
restrictive

A

80%

<80% obstructive

> 80% restrictive

856
Q

Hexagonal, double pointed, needle like crystals in bronchial secretions

A

Charcot-Leygen crystals
- eosinophilic granules

Asthma

857
Q

Spiral shaped mucus plugs

A

Curschmann spirals

Desquamated epithelium

Asthma
Obstructive lung disease

858
Q

Pulsus paradoxus

A

Abnormal drop of 10 mm/Hg in systolic pressure during inspiration

Decreased intrathoracic pressure –> increased right ventricle blood return

Right ventricle push into left ventricle –> poor cardiac output and drop in systolic pressure

Decreased capacity of LV

Cardiac tamponade
Asthmatics
Severe pulmonary embolism
COPD 
Croup
859
Q

Hyperplasia of both goblet cells and submucosa glands

A

Chronic bronchitis

860
Q

Emphysema increased what

A

Compliance (loss of elastic fibers)

861
Q

Right main stem bronchi same size
Productive cough
Increased sputum production
FEV1/FVC <80%

Causes (4)

A

Bronchiectasis

Allergic bronchopulmonary aspergillosis

Kartagener syndrome
- sinus inversus

Cystic fibrosis (most common)

Primary ciliary dyskinesia

862
Q

Hallmark of obstructive lung disease

A

FEV1/FVC= < 80%

Difficulty getting air out

Increased lung volumes

863
Q

Hallmark of restrictive lung disease

A

FEV1/FVC= >80%

Decreased lung volume
Can not get air in

864
Q

Reid index

A

Thickness/ glands/ thickness of wall

Chronic bronchitis

50% composed of mucus glands elevated reid index= normal

865
Q

What disease is associated with the Ab

1) Anti- mitochondrial
2) Anti- neutrophil cytoplasmic
3) Antiplatelet Ab

A

1) anti-mitochondrial
Primary biliary cholangitis

2) Anti-neutrophil cytoplasmic

cANCA
- granulomatosis w/ polyangiitis

pANCA

  • Eosinophilic granulomatosis with pollyangiitis (churg-strauss)
  • Microscopic polyangiitis
  • Pauci-immune crescentric glomerulonephritis
  • primary sclerosing cholangitis
  • ulcerative collitis

3) Immune thrombocytopenic purpura (ITP)

866
Q

Female homolog?

1) Corpus spongiosum
2) Bulbourethral glands
3) Ventral shaft of penis

A

1) Corpus spongiosum
- Vestibular bulb

2) Bulbourethral glands
- Vestibular (Bartholin) glands

3) Labia minora

867
Q

Most common salivary gland tumor

A

Pleomorphic adenoma

868
Q

ARDS pathway

A

Shock, infection, toxic gas inhalation, aspiration, pancreatitis, heroin OD, sepsis, trauma, uremia, amniotic fluid embolism
–>

Inflammatory cells/ mediators and oxygen free radicals –>

Damage to endothelial or alveolar epithelial (type I) cells –>

Diffuse alveolar damage (DAD)

869
Q

Sarcoidosis mneumonic

tx

A

A GRUELING Disease

ACE enzyme increase
Gammaglobulinemia
Rheumatoid factor
Uveitis
Erythema nodosum
Lmphadnopathy (bilateral, hilar)
Idiopathic
Noncaseating
Granulomas
Vit D increase (hypercalcemia or hypercalcinuria)

Glucocorticoids

870
Q

Honeycomb lung on CT
Patchy interstitial fibrosis

  • mutations
  • risk factors
  • survival
  • also seen
A

Idiopathic pulmonary fibrosis
(cryptogenic fibrosing alveolitis)

Mutations: telomerase, mucin MUC5B

3 year survival

Usual interstitial pneumonia

871
Q

A 68-year-old man has had worsening dyspnea with a
nonproductive cough for the past 9 months. On physical examination,
he is afebrile and normotensive. On auscultation
of the chest, diffuse dry crackles are heard in all lung fields.
A chest radiograph shows irregular opacifications throughout
both lungs. A transbronchial biopsy is obtained and the
microscopic findings with trichrome stain are shown in the
figure. Laboratory studies include negative serologic tests for
ANA, anti–DNA topoisomerase I, ANCA, and anticentromere
antibody. Despite glucocorticoid therapy, his condition does
not improve, and he dies 2 years later. What is the most likely
diagnosis?
A Goodpasture syndrome
B Hypersensitivity pneumonitis
C Idiopathic pulmonary fibrosis
D Sarcoidosis
E Systemic sclerosis

A

C. idiopathic pulmonary fibrosis

872
Q

A 50-year-old man has increasing dyspnea with idiopathic
pulmonary fibrosis, which was diagnosed 18 months
ago. Physical examination shows elevated jugular venous
pressure and pedal edema. Laboratory studies show serum
AST of 221 U/L, ALT of 234 U/L, alkaline phosphatase of 48
U/L, lactate dehydrogenase of 710 U/L, total bilirubin of 1.2
mg/dL, albumin of 3.5 g/dL, and total protein of 5.4 g/dL.
The figure shows the microscopic appearance of a liver biopsy
specimen. Which of the following terms best describes these
findings?
A Apoptosis
B Centrilobular congestion
C Cholestasis
D Hemosiderin deposition
E Macrovesicular steatosis
F Mallory-Denk bodies
G Portal fibrosis

A

B. Centrilobular congestion

873
Q

What is low in restrictive lung disease

A

TLC
FVC

Both FEV1 and FVC decreased

FEV1/FVC = > 80%

874
Q

Innumerable calcified nodules
Eggshell calcification in hilar nodes

  • increased susceptibility to
  • increased risk of
A

Silicosis

Susceptibility to TB
Increased risk of cancer

875
Q

Sandblasting
Mining
Demolition
Cement/concrete

A

Silicosis

876
Q

Shipbuilding
Roofing
Pipe fitting
plumbing

A

Asbestosis

877
Q 
Fibers in lung bases
Dumbbells on stain (prusian blue) 
Pleural plaques
Pleural effusions
interstitial fibrosis
  • seen w/ cells
  • cancer
A

Asbestosis

Macrophages release inflammatory mediators and free radicals

Cancer

  • Bronchogenic carcinoma
  • mesothelioma
878
Q

Tennis racket shaped cytoplasmic organelles

Young adult smoker

A

Pulmonary Langerhans Cell histiocytosis

Focal collections of langerhans often accompanied by eosinophils

Burbbeck granules

Quit smoking

879
Q

Lung disease + glomerulonephritis think

A

Goodpasture syndrome

Granulomatosis with polyangiitis (Wegener’s granulomatosis)

880
Q

Necrotizing granulomas vasculitis most prominent in lungs and upper airways

Focal necrotizing glomerulonephritis

A

Granulomatosis with polyangiitis

881
Q

Bilateral hilar adenopathy

uveitis

A

Sarcoidosis

882
Q

CD surface marker fits each of the following

1) Found on all NK cells and binds the constant region of IgG
2) Inhibits complement C9 binding
3) Endotoxin receptor found on macrophages

A

1) CD16
2) CD55/59
3) CD14

883
Q

Lung cancer

1) in peripheral lung
2) in central lung
3) most common in non smokers
4) hypercalcemia
5) giant cells
6) ACTH, ADH
7) Ab to presynaptic Ca channels leading to?
8) Mutations in Adenocarcinoma
9) Mutations in TP53, Rb

A

1) adenocarcinoma, large cell carcinoma
2) SCC, small cell carcinoma
3) Adenocarcinoma
4) SCC
5) Large cell carcinoma
6) Small cell carcinoma

7) Small cell carcinoma
Lambert Eaton syndrome

8) “MARKER”
MET, ALK, RET, KRAS, EGFR, ROS

9) Small cell carcinoma

884
Q

Lambert Eaton syndrome

A

Muscle weakness that improves iwth use

Ab against Ca channels

Small cell carcinoma

885
Q

Tumor in apex of lung

  • symptoms
A

Pancoast tumor

Hoarseness (compress recurrent laryngeal n.)
Horner syndrome 
- ptosis
- miosis
-anhidrosis
(affect cervical sympathetic plexus)
886
Q

Lung cancer metastasize to

Receive metastases from

A 
To: 
Brain
Bone 
Liver 
Adrenal glands
Receive from:
Breast
Colon
Prostate
Bladder
887
Q

Which lysosomal storage disease
1) Accumulation of dermatan sulfate

2) Deficiency in hexosaminidase

A

1) Hurler dis, hunter syn, scheic syn

2) Tay-sach disease

888
Q

Which infectious agent fits

1) Common cause of pneumonia in immunocompromised patients
2) Most common cause atypical pneumonia
3) Agent for penumonia in alcoholics
4) Can cause an interstitial pneumonia in bird handlers
5) Pneumonia in pts w/ hx of exposure to bats and bat droppings
6) Pneumonia in pt who visited south california, new mexico, or west texas
7) Pneumonia associated iwth currant jelly sputum
8) Q fever
9) Assocaited with pneumonia acquired from air conditioners
10) Most common cause of pneumonia in children 1 year old or younger
11) Pneumonia in neonate
12) Pneumonia in children and young adults (college, militrary, prison inmates)
13) Viral pneumonia
14) Causes wool-sorter’s disease (life-threatening pneumonia)
15) Common pneumonia in ventilator patients and those with CF
16) Pontiac fever

A

1) Pneumocystis jirovecii
2) Mycoplasma pneumoniae
3) Klebsiella pneumoniae
4) Chlamydophila psittaci
5) Histoplasma
6) Coccidioides immitis
7) Klebsiella pneumoniae
8) Coxiella burnetii
9) Legionella pneumophilia
10) RSV
11) Group B strep, E coli
12) Mycoplasma pneumoniae
13) RSV
14) Bacillus anthracis
15) Pseudomonas, MRSA
16) Legionella pneumophila

889
Q

Lung abscess bacteria

Tx

Complication of

A

Anaerobes

Peptostreptococcus
Prevotella
Bacteroids
Fusobacterium
S. aureus
Klebsiella pneumoniae
Gram negative bacteria

First line for anaerobe
- Clindamycin

Aspiration pneumonia

  • alcoholics
  • drug abusers
  • general anesthesia
890
Q

Test for sleep apnea

A

Polysomnography

891
Q

GI problem associated

1) 50 y.o woman, pruritus w.o jaundice, positive AMA
2) GI bleeding, buccal pigmentation
3) 60 y.o female, RA, no alcohol hx, fatigue, and right abdominal pain, elevated ANA adn ASMA, elevated serum IgG lvel, no viral serologic markers
4) 23 y.o woman no alcohol hx; elevated levels of LKM-1 ab, no viral serologic markers, liver biopsy with infiltration of the portal and periportal area with lymphocytes
5) Fatal disease of unconjugated bilirubin resulting from a complete lack of UDPGT activity

A

1) Primary biliary cirrhosis
2) Peutz-jegher syndrome
3) Autoimmune hepatitis
4) Autoimmune hepatitis
5) Crigler- Najjar type I

892
Q

What substances act on smooth muscle myosin light chain kinase?

How does this affect blood pressure

A

Dihydropyridine Ca channel blockers
Epinephrine (acting at beta2 receptor)
Prostaglandin E2

Relaxation of vascular smooth m -> vasodilation –> decrease BP

893
Q

Watery diarrhea
Dyspnea and wheezing
Flushed and red
Mass in right liver lobe and ileum

What is it?
Treatment?

A

Carcinoid syndrome
- secrete serotonin

Hepatic metastasis

Octreotide for symptomatic patients

894
Q 
Developmental delay
Difficulty seeing board
Tall, thin habitus
Elongated limbs
Lens subluxation
Thrombus and infarct

Supplement?

A

Homocystinuria

Error of methionine metabolism

AR deficiency cystathionine beta-synthase that requires pyridoxine (Vit B6) as cofactor

895
Q

A 6-year-old girl is found to be nearsighted during
a vision screening at school, and the school
nurse tells the parents the child should be fi tted
for corrective lenses. Her mother is upset
because her daughter is already much taller
than her classmates, has an awkward gait, and
was recently diagnosed with scoliosis. She is
afraid that the glasses will only add to her
daughter’s problems at school, where her classmates
frequently tease her. When the ophthalmologist
observes that the patient’s right lens is
dislocated, he suspects that her symptoms are
in fact related to an enzyme defi ciency. As a result
of this defi ciency, which of the following
amino acids is essential in this patient’s diet?
(A) Cysteine
(B) Lysine
(C) Methionine
(D) Tryptophan
(E) Tyrosine

A

The correct answer is A. Homocystinuria is an
inborn error of metabolism caused by a defect
in cystathionine synthase, the enzyme that
converts homocysteine to cystathionine. Cystathionine
is later converted to cysteine, so patients
with this enzyme defi ciency are required
to supplement their diets with exogenous
cysteine. In addition to marfanlike features and
subluxation of the lens, these patients are at increased
risk of a variety of cardiovascular derangements,
includin

896
Q

Arteries off splenic artery

A

Short gastric

Left gastroepiploic

897
Q

CXR reveals a round density with an air fluid level in right lung

Copious sputum

  • What is it
  • Key player in formation
A

Lung abscess

Neutrophils that release cytotoxic granules (lysosomes) containing myeloperoxidase

Copious sputum (foul smelling)

898
Q

intermittent claudication (pain comes and goes) due to

Chest pain relieved by rest

Cause?

A

Atherosclerosis

Lipid filled arterial intimal plaques

899
Q

Onion-like concentric thickening of arteriolar walls

Homogenous acellular thickening of the arteriolar wall

A

Hyperplastic arteriosclerosis

Hyaline arteriolosclerosis
- homogenous deposition of hyaline material in the intima and medial of small arteries and arterioles

900
Q 
Man to ER
Found unconscious
Temp
White patches on mucosa
Bilateral crackles in lungs
Bilateral interstitial infiltrates

Silver stain

A

Pneumocystisi pneumonia

atypical fungal infection
Opportunistic infection

901
Q

Silver stain

A

Fungi

  • coccidoides
  • pneumocystis jirovecci

Legionella

Helicobacter pylori

902
Q

Hernia that originates medial to the inferior epigastric vessels

Defect in

A

Direct hernia

MDs dont LIe

  • medial to inferior epigastric = direct
  • lateral = indirect

Weakness of transversalis fascia

903
Q

Cause of indirect hernia

Location

A

Lateral to inferior epigastric vessels

Due to patent processus vaginalis

904
Q

Cause of femoral hernia

Location

A

Emerges inferiro to inguinal ligament

Widening of the femoral ring is defect

905
Q

Epistasis

A

Phenomenon in which the allele of one gene affects the expression of alleles in another gene

906
Q

Imprinting

A

Phenomenon in which an offspring’s genes are expressed in a parent specific manner.

Caused by DNA methylation

907
Q

Person is exercising what value will increase

What will decrease

A

Venous blood mean CO2 content will increase

pH decreases
- Lactic acid produced

Decrease physiologic dead space
- due to decrease in pulmonary vascular resistance

Mean O2 content of venous blood remains the same or decreases

908
Q

S. bovis risk of

A

Streptococcus gallolyticus

Causes subacute bacterial endocarditis

Part of normal flora of colon

Associated with colon cancer

909
Q

Still get Haemophilus influenzae even though had vaccine how?

A

The strain responsible for the patients disease does not produce a capsule

H. influenzae nontypeable

Vaccine only against more invasive type b strain

910
Q

Diuretic that causes hypercalcemia

A

Thiazide diuretic

911
Q

Nerve associated with cremasteric reflex

A

Genitofemoral n.

912
Q

Nerve that passes through spermatic cord through superficial inguinal ring

A

Ilioinguinal nerve.

913
Q

Nerve damaged in appendectomy causes decreased sensation to suprapubic region

A

Iliohypogastric n.

914
Q 
Fever 
Malaise
sore throat
VERY tired
Palatal petechiae
cervical LAD
Splenomegaly

-Assoc with

A

Mono

- EBV

915
Q

EBV associated with

A

Burkitt lymphoma
Nasopharyngeal carcinomas
Mononucleosis

916
Q

Severe HTN emergency >180/120

Manifests as (2)

A

Fibrinoid necrosis

Hyperplastic arteriolosclerosis
- onion skin

917
Q

Glutamate –> alpha ketoglutarate for TCA cycle requires

Oxaloacetate –> aspartate

A

Transamination

Vit B 6 Pyridoxine

918
Q

Biotin is cofactor for

A

Vit B7

carboxylase enzymes
- pyruvate carboxylase
Acetyl-COA carboxylase
Propionyl--CoA carboxylase
3-methylcrotonyl-CoA- carboxylase
919
Q

Vessel with lowest oxygen content

A

Coronary sinus

920
Q

Emysema causes what to lung compliance

Asthma on lung compliance

What shifts the graph right and down? decrease compliance

A

Increase
Shift left and up

No change

Pulmonary fibrosis

921
Q

What hormone increases bicarb secretion?

Cell type?

A

Secretin

- Duodenal S cells

922
Q

Skin lesion on eyelid
ma
Lipid laden macrophages

Assoc with

A

Xanthelasma

Associated iwth primary or secondary hyperlipidemias
- Primary biliary cirrhosis

923
Q

Most common cause of overdose death

A

Opioids

924
Q

Aortric regurgitation
Mediastinal widening
+ fluorescent treponemal ab

Suggest?

  • Due to
  • Begins with
A

Aortic aneurysm

Syphilis
Vasa vasorum endarteritis adn obliteration

925
Q

H. influenzae type b virulence factor

A

Polysaccaride capsule

composed of polyribosylribitol phosphate (PRP)

926
Q

Goes with?

Lecithinase

M protein

Protein A

Trehalose dimycolate

Polyribosylribitol phosphate (PRP)

A

Lecithinase: toxin A, clostridium perfringens
- results in cell lysis and gas gangrene

M protein: strep. pyogenes
-Binds factor H to prevent opsonization and destruction by alternative complement pathway

Protein A: staph aureus
- prevent opsonization by binding Fc region of immunoglobulins

Trehalose dimycolate: cellw all component , mycobacterium tuberculosis
- protects from being killed by macrophages and stimulates granuloma formation

Polyribosylribitol phosphate: Haemophilus influenzae type b
- capsule protects against phagocytosis and complement mediated lysis by binding factor H (prevents complement C3b deposition on host cells

927
Q

Rebound anxiety, tremor, insomnia, palpitations, diaphoresis

Seizure

A

Benzodiazepine withdrawal

Lorazepam

928
Q

Itching after hot showers
Fatigue
Rash worse with rubbing
Flushing

Clusters of mast cells

A

Systemic mastocytosis

Excessive histamine

929
Q

Excessive histamine causes

A

Mastocytosis

Gastric hypersecretion

930
Q

Hyperestrogenic states can cause

A

Gynecomastia
Spider angiomata
- estrogen effect on arteriolar dilation

931
Q

Continous IV infusion with first order kinetics takes __ half lives to reach 95%

A

4-5

932
Q

High urinary excretion of ketones suggests

A

absolute insulin deficiency

Diabetes type I

933
Q

Huntingtons neuroimaging

A

Caudate atrophy with enlargement of the lateral ventricles

Enlargement of frontal horns of the lateral ventricles

934
Q

Seen with?

1) Diffuse ventriculomegaly without sulcal widening
2) Enlargement of frontal horns of the lateral ventricles
3) Hypoplastic vermis with a dilated fourth ventricle
4) Pronouced atrophy of bilateral hippocampi
5) Regional atrophy of frontal and temporal lobes

A

1) Normal pressure hydrocephalus
2) Huntington’s dis
3) Dandy-walker malformation
4) Early onset alzheimer dis
5) Frontotemoral dementia

935
Q

Winging scapula can occur due to what nerve and what event

A

Long thoracic nerve to serratus anterior

Axillary LN dissection

936
Q

Histopathologic evaluation of syphilis lesion

A

Intense plasma cell rich infiltrate with proliferative endarteritis

937
Q

What is this?

1) Acantholysis with superficial dermal lymphocytic infiltrate
2) Dysplastic spndle cells iwht viral genome that form vascular channels
3) Intense plasma cell-rich infiltrate with proliferative endarteritis
4) Panniculitis and sepal inflammation with multinucleated giant cells
5) Papillomatous epidermal hyperplasia with cytoplasmic vacuolization

A

1) Pemphigus vulgaris
2) Kaposi sarcoma
3) Syphilis
4) Erythema nodosum
5) Anogenital warts, HPV-6

938
Q 
Headaches
Dizziness
Facial plethora (reddish)
Splenomegaly
Peptic ulcer disease
Increased erythrocytes
  • Mutation
A

Polycythemia vera
- uncontrolled erythrocyte production

Abnormal transduction of erythropoietin growth signals

Mutation in JAK2

Erythropoietin receptor has no intrinsic kinase activity and must interact with JAK2 a cytoplasmic tyrosine kinase

939
Q

Mutation of

1) Growth stimulating transcription factor
2) Tumor suppressor protein

A

1) c-myc
- burkitt lymphoma

2) p53
- Li-fraumeni syndrome

940
Q

Protein 4.5 g
antinuclear ab
glomerular capillary wall thickening
Irregular spikes protruding from glomerular basement membrane

A

Membranous glomerulopathy

941
Q

HIV process involving glycosylation

A

Only glycosylated HIV polyprotein is gp160
- product of the env gene

gp160 is extensively glycosylated in the rough ER and golgi

cleaved into envelope proteins gp120 and gp41

gp120: mediates viral attachment
gp41: mediates viral fusion

942
Q

HIV pol gene encodes for

A

reverse transcriptase
integrase
protease

RT: ssRNA –> ds DNA

Integrase: integrate into host genome

Protease: cleave HIV polyproteins into individual proteins after trasncription in rough ER

943
Q

Acondroplasia inheritence

A

AD

944
Q 
Anorexia
Nausea
Dark-colored urine
Trip to mexico
Fever
Right upper quadrant pain

liver biopsy?

A

Acute viral hepatitis
HAV

Hepatic swelling

945
Q

Seen with?

1) Fibrinoid necrosis of liver
2) Liquefactive necrosis
3) Hepatocyte swelling
4) Regenerative nodules

A

1) Fibrinoid necrosis= immune vasculitis or malignant hypertension
2) Liquefactive necrosis= severe viral hepatitisor entamoeba histolytica infection
3) Hep A acute infection
4) Regenerative nodules= cirrhosis form chronic hepatitis

946
Q

For viral particle to be coupled to MHC class I it first has to be involved with what

A

Ubiquitin ligase

947
Q

Increase in fructose 2,6 bisphosphate causes a decrease in

A

Inhibits gluconeogenesis

Decrease Alanine –> glucose

948
Q

Thiamine deficiency
Get thiamine infusion
What neurologic finding will persist despite treatment?

A

Memory loss

Korsakoff syndrome

949
Q

Airway resistance from trachea –> medium sized bronchi –> bronchioles –> terminal bronchioles

A

Airway resistance increases from trachea to medium sized bronchi

Decreases after that due to lower respiratory tract are arranged in parallel

950
Q

N gonorrhoeae infection and repeat infections

A

High variability of gonococcal surface antigens (porins, opa proteins and lipooligosaccharide) limits effectiveness of antibody response

Previous infections results in almost no protective immunity against future infections

951
Q

Decrease in PAH level would be due to

A

Carrier transport saturation

952
Q

Vaginal discharge
Grayish white
Fishy smelling

What is seen on microscopy?

A

Epithelial cells covered with gram-variable rods

953
Q

Identify

1) Epithelial cells covered with gram-variable rods
2) Epithelial cells with rare leukocytes
3) Gram-negative intracellular diplococci
4) leukocytes and pear-shaped organisms
5) Pseudohyphae with leukocytes

A

1) Gardnerella
2) normal vaginal discharge
3) Gonorrhea
4) trichomonas vaginitis
5) Candida vaginitis

954
Q

Back pain that is better when leaning on stroller

Thickening of what?

A

Ligamentum flavum

Spinal stenosis

955
Q

Paroxysmal atrial fibrillation can be caused by aberrant electrical foci in the

A

Aberrrant electrical foci in the pulmonary veins

956
Q

Alpha 1 effects

Examples

A

Increase blood pressure

Contraction of internal urethral sphincter

Mydriasis (eye dilation)
- contraction of pupillary dilator muscle

Epinephrine
NE
Phenylephrine
Methoxamine

957
Q

Beta 1 effects

examples

A

Heart
- Increase HR, contractility and conductance

Epinephrine
Dopamine
Dobutamine
Isoproterenol

958
Q

Beta 2 effects

examples

A

Vasodilation
Decrease diastolic BP
Bronchodilation
Relaxation (uterus)

Isoproterenol
Terbutaline
Ritodrine

959
Q

What releases growth factors in formation of atheroma

A

platelets

960
Q 
Rapid onset
Headache
Fever
Altered mental status
Nuchal rigidity 
Pruritic rash

Type of vaccine?

A

Meningococcal meningitis

Capsular polysaccharide Ag

961
Q

Vaccine with inactivated (killed organisms)

A

RIP Always

Rabies
Influenza (injection)
Polio (oral)
Hep A

962
Q

Vaccine with live attenuated organisms

A

“Attention Teachers! Please vaccinate SMALL, Beautiful Young INFants with MMR Regularly!”

Adenovirus
Typhoid
Polio
Varicella 
Small pox
BCG
Yellow fever
Influenza (intranasal)
MMR
Rotavirus
963
Q

Vaccine with virus-like particles

Subunit type

A

Induces only the Ag that stimulate the immune system

Hep B
HPV

964
Q

Hypercalcemia

Lung mass

A

Hypercalcemia of malignancy

Parathyroid hormone-related peptide (PTHrP)

965
Q

Multiple polyps found in colon due to mutation of

A

Familial adenomatous polyposis

APC mutation

966
Q

What mutation

1) Lung adenocarcinoma
2) CML, ALL
3) Follicular lymphoma
4) non-hodgkin lymphoma
5) Neuroblastoma
6) Melanoma
7) MEN 2A and 2B
8) Colorectal cancer assoc w/ FAP
9) Hairy cell leukemia
10) Osteosarcoma
11) Li-Fraumeni
12) Tuberous sclerosis
13) Burkitt lymphoma
14) Colon cancer
15) Diffuse large B cell lymphoma

A

1) ALK
2) BCR-ABL
3) BCL-2
4) BRAF
5) n-myc
6) BRAF, CDKN2A
7) RET
8) APC
9) BRAF
10) Rb
11) TP53
12) TSC1/2
13) c-MYC
14) KRAS
15) BCL-2

967
Q 
Exertional dyspnea
Dry cough
Bilateral hilar adenopathy
Reticular pulmonary infiltrates
ACE and Ca elevated

Predominant cell type?

A

Sarcoidosis

CD4 lymphocytes

968
Q

Painless lymph node enlargement

Translocation?

A

Follicular lymphoma

t(14;18)

969
Q

Most common cause of bilateral fetal hydronephrosis in boys

A

Posterior urethral valves

970
Q

Heart murmur
Best heard when patient sits up and leans forward

Peak intensity?

A

Aortic regurgitation

Just after aortic valve closure

971
Q

What causes the green color of sputum

A

Neutrophil myeloperoxidase

972
Q

Pathologic finding of varicella zoster

A

Multinucleated cells with intranuclear inclusions

973
Q

Identify

1) Acantholysis and intrercellular IgG deposits
2) Eosinophilic cytoplasmic inclusions
3) Microabscesses at the tips of dermal papillae
4) Multinucleated cells with intranuclear inclusions
5) Koilocytosis of the superfical epidermal layers

A

1) Pemphigus vulgaris
2) Molluscum contagiosum (poxvirus)
3) Dermatitis herpetiformis
4) Varicella zoster
5) HPV of skin w/ warts

974
Q

Serotonin syndrome

A 
Mental status changes
Hyperthermia
Sympathetic hyperactivity
Clonus
Hyperreflexia
975
Q

Neuroleptic malignant syndrome

Tx

A 
Mental status changes
Hyperthermia
Sympathetic hyperactivity
Diffuse rigidity (lead pipe)
Hyporeflexia

Dantrolene
Dopaminergic drugs
- Bromocriptine (DA agonist)
- Amantadine (Increase DA release)

976
Q

Meningitis –> bleeding from venous puncture sites

Results in what cells

A

Disseminated intravascular coagulopathy (DIC)

Schistocytes

977
Q

Bite cells

A

Oxidant induced damage

G6PD deficiency

978
Q

Surgery –> Fever, lethary, N/V

Scleral icterus
RUQ tenderness
Elevated AST, ALT and bilirubin

What drug used during surgery

A

Acute hepatitis

Inhaled halogenated –> hepatocellular damage

-flurane

979
Q

High fever
Nasal discharge
Bilateral conjunctival injection
Several small white spots with an erythematous base on buccal mucosa

No vaccines

What else is seen

A

Measles

Maculopapular rash

980
Q

Measles vaccine is

A

Live attenuated

981
Q

Vesicular rash

A

Chicken pox

982
Q 
Myalgia
Fatigue
HA
Chills
Fever

Sick and recovered

Mild jaundice
Hepatosplenomegaly
Elevated indirect bilirubin

Ringed inclusions

A

Malaria

Trophozoites (ringed inclusions) on Giemsa

Dormant hepatic phase

983
Q

Virus that infects by CD21

Virus that infects by glycoprotein gp120

Virus that infects via the blood group P antigen (globoside)

A

1) EBV
2) HIV
3) Parvovrus B19

984
Q

Damage seen due to megaloblastic anemia

A

Vit B12 deficiency

Damage to dorsal column of spinal cord

Axonal degeneration of the peripheral nerves

Loss of poition and vibration sense
Gait problems

985
Q

Pear shaped organism

Watery diarrhea

Small bowel shows?

Immune mechanism?

A

Giardia lamblia
(parasite)

Villus atrophy and crypt hyperplasia

CD4 T cells and secretory IgA production

986
Q

Lesion to cerebellar vermis leads to

A

truncal ataxia

Gait ataxia

987
Q

Pain in both knees
Pain in multiple joints

Blue-black spots on sclerae
Diffuse darkening of the auricular helices

Deficiency?

A

Alkaptouria

AR

Deficiency of homogentisic acid dioxygenase

Accumulated homogentisic acid

988
Q

Decreased ceruloplasmin

A

Wilson disease (copper buildup)

989
Q

Proteinuria
Hematuria
lactate dehdyrogenase elevated

A

Renal infarction

Renal vein thrombosis due to antithrombin III loss

990
Q

HTN is defined as

A

> = 140/90

3 different occasions

991
Q

Tearing chest pain that radiates to the back

See on CXR?
TX?

A

Aortic dissection

Widening of the mediastinum

Large aorta, double circle

Lower BP
- Beta blocker

992
Q

Substances that act on smooth muscle mysoin light chains kinase

How does this affect blood pressure

A

Dihydropyridine Ca channel blockers

Epinephrine (acting at beta 2 receptor)

Prostaglandin E2

Relaxation of vascular smooth m.
Vasodilation
Decrease BP

993
Q

Loss of forearm pronation nerve

A

Median

994
Q

Guillain- Barre syndrome preceded by what infection

A

Symmetric ascending muscle weakness

Campylobacter jejuni

(CMV, HIV, EBV, mycoplasma pneuonae)

995
Q

Where do neurons of the lateral corticospinal tract synapse prior to exiting the spinal cord

A

At the cell body of the anterior horn

996
Q

Endogenous hormones that stimulate gastric acid secretion

Endogenous hormone that inhibit gastric acid secretion

Drugs that regulate secretion

A

Stimulate

  • Histamine
  • Acetyl choline
  • Gastrin

Inhibit

  • Prostaglandins
  • Somatostatin
  • Secretin
  • GIP

Drugs that regulate

  • PPIs
  • H2 blockers
  • Antimuscarinic drugs (atropine)
997
Q

What type of lipoproteins accumulates first in atherosclerosis

What cell adheres next

Steps

A

LDL

Macrophages and foam cells

1) Endothelial dysfunction
2) Accumulation of lipoprotein
3) Monocytes adhesion
4) Migration into intima transformation –> macrophages and foam cells
5) Factor release (platelets, macrophages)
6) Smooth muscle proliferation, deposition extracellular matrix elastin and collagen
7) Lipid accumulation

998
Q

Onion skin appearance of vessels

A

Arteriolosclerosis (Not atherosclerosis)

Hyperplasia of vascular smooth muscle cells

Hyaline thickening of arterioles

999
Q

Most common MI

A

Anterior wall MI

LAD

1000
Q

Inferior wall MI artery

Lateral wall MI artery

A

Inferior: Posterior descending A (RCA most common)

Lateral: circumflex

1001
Q

Chest pain in younger adult
Occurs at rest

  • Due to
  • ECG changes
  • Tx
A 
Prinzmetal angina
(variatn angina)

Coronary artery spasm

ST segment elevation

Dihydropyridine Ca channel blockers (Nifedipine)

1002
Q

Classic presentation of congenital pyloric stenosis (5)

A

2-6 weeks age
Nonbillous projectile vomiting
Palpable “olive” RUQ

Hypochloremic metabolic alkalosis

Hypokalemia

1003
Q

Relays what type of information from thalamus

1) Ventral posterior lateral
2) Lateral geniculate
3) Ventral posterior medial
4) Ventral anterior

A

1) Somatosensory info from body
2) Visual retinal to occipital lobe
3) Somatosensory from face
4) Motor basal ganglia to cortex

1004
Q

Changes seen on EKG after MI

Hours

1-2 days

Weeks

A

Hours

  • ST elevation
  • R wave decreases
  • Q wave appears

1-2 days

  • T wave inverts
  • Q wave deepens

Weeks

  • ST normal
  • T wave normal
  • Q wave persists
1005
Q

Dressler syndrome

A

Post MI pericarditis

Chest pain
Pericardial freiction rub
Persistent fever occuring several weeks after MI

1006
Q

Type of hyperbilirubinemia that responds to phenobarbital

A

Crigler Najjar type II

Gilbert

1007
Q

ECG leads the correspond

1) Left anterior descending
2) Left circumflex
3) Right coronary
4) Right coronary (posterior descending )

A

1) Anterior wall
V1-V4, V5

2) Lateral wall
aVL, V5, V6, lead I

3) Inferior wall
II, III, aVF

4) Posterior wall
- R precordial ECG, V4

1008
Q

MI

Sudden onset mitral regurgitation

New holosystolic murmur

Cardiac tamponade

A

Papillary muscle rupture

Intraventricular septal rupture (VSD)

Ventricular wall rupture
- bleeding into pericardium

1009
Q

Cardiac tamponade

A

Compression of heart by fluid
Decrase Cardiac output

Equilibration of diastolic pressures in all 4 heart chambers

Hypotension
Distended neck veins
Distant heart sounds
Increased HR
Pulsus paradoxus

Electrical alternans

1010
Q

Kartagener syndrome

A

Situs inversus
Bronchiectasis
Recurrent sinusitis

Dynein arm defect

1011
Q

A 2-year-old boy presents to the pediatrician
with fever, facial tenderness, and a green, foulsmelling
nasal discharge. The patient is diagnosed
with sinusitis, and the physician notes
that he has a history of recurrent episodes of sinusitis.
X-ray of the chest is ordered because of the fever; it reveals some dilated bronchi and
shows the heart situated on the right side of his body. A congenital disorder is diagnosed. Which other finding would this patient be
most likely to have?
(A) Defective chloride transport
(B) Elevated blood sugar
(C) Infertility
(D) Reactive airway disease
(E) Tetralogy of Fallot

A

C. infertility

Kartagener’s syndrome

1012
Q

Bronchiectasis

A

Abnromal bronchial dilation caused by chronic infection

Purulent sputum

1013
Q

A 19-year-old man has a history of recurrent mucoid
rhinorrhea with chronic sinusitis and otitis media since childhood.
He has experienced multiple bouts of pneumonia. His
temperature is 37.7° C. On examination of his chest, there is
tactile fremitus, rhonchi, and rales in lower lung fields. Nasal
polyps are noted. A chest radiograph shows bronchial dilation
with bronchial wall thickening, focal atelectasis, and areas of
hyperinflation; his heart shadow appears mainly on the right.
Which of the following abnormalities is he most likely to have?
A α1-Antitrypsin deficiency
B Atopy
C Chloride ion channel dysfunction
D Ciliary dyskinesia
E HIV infection

A

D. Ciliary dyskinesia

1014
Q

Carcinoid syndrome

A

B FDR

Bronchospasm and wheezing
Flushing
Diarrhea
Right sided heart lesions

1015
Q

Painful red nodules on finger and toe pads

Erythematous maculoes on palms and soles

Splinter hemorrhages in fingernails

Fever

Organisms?

Acute vs subacute

A

Endocarditis
- inflammation of valves

S. Aureus
Viridans streptococci
Enterococcus
Coagulase neg staph

Acute

  • s. aureus
  • days
  • normal valves

Subacute

  • Viridans streptococci
  • wks –> months
  • previously damaged valves
1016
Q

Systolic murmer louder with valsalva
- due to

Softer with squatting
- due to

Tx

A

Hypertrophic cardiomyopathy

  • Hypertrophy of interventricular septum
  • outflow tract obstruction

Reduces preload

Increases afterload

Beta blocker
Verapamil

1017
Q

Endocarditis with streptococcus bovis also check

A

Colon cancer

1018
Q

Endocarditis with negative blood cultures

A

HACEK

  • Haemophilus
  • Actinobacillus
  • Cardiobacterium
  • Eikenella
  • Kingella

Coxiella burnetii (Q fever)
Bartonella
Brucella

1019
Q

Endocarditis mneumonic

Treatment

A 
Bacteria FROM JANE
Fever
Roth spots (eye) 
Osler nodes (tender fingertip)
Murmur
Janeway lesions (painless)
Anemia
Nail bed hemorrhage
Emboli

Prophylactic Penicillin
Empiric IV vancomycin (covers staph and strep)

1020
Q

Retinal hemorrhages with pale centers

A

Roth spots

Infective endoarditis

1021
Q

Valve affected in infective endocarditis

Valve affected in IV drug user infective endocarditis

A

Mitral valve

Tricuspid valve

1022
Q

Kussmaul’s sign

A

JVD during inspiration
Right sided heart problem

Decreased capacity of RV

Constrictive pericarditis (»tamponade)

1023
Q

Aschoff bodies

Anitschkow cells

A

Aschoff bodies

  • granuloma with giant cells
  • area of fibrinoid necrosis infiltrated by lymphocytes and giant cells

Anitschkow cells
- activated histocytes with owl eye appearance

1024
Q

EKG change with pericarditis

A

Diffuse ST elevation

1025
Q

Most common primary cardiac tumor in adults

A

Myxomas

Left atrial myxoma

Ball valve obstructs mitral valve –> syncopal episodes

Plop sound

1026
Q

Tuberous sclerosis is associated iwth what three tumors

A

Rhabdomyoma
Astrocytoma
Angiomylipoma

1027
Q

What heart pathology

1) Focal myocardial inflammation with multinucleate giant cells
2) Chest pain and coarse rubbing heart sounds in patient with Cr of 5.0
3) Tree barking of the aorta
4) ST elevation in all ECG leads
5) ECG shows electrical alternans
6) Child with fever, joint pain, cutaneous nodules, four weeks after throat infection

A

1) Aschoff bodies
- Rheumatic heart disease

2) Uremic pericarditis
3) Tertiary syphilis
4) Pericarditis
5) Cardiac tamponade
6) Acute rheumatic fever

1028
Q

Primary biliary cholangitis vs primary sclerosing cholangitis

A

PBC

  • Autoimmune
  • (+) AMA
  • Middle aged female
PSC
- (+) p-ANCA
- Males > 40
- Assoc: UC and cholangiocarcinoma
ERCP: alternating beading stricturing
1029
Q 
Fever
Jaundice
RUQ pain
Hypotension
Altered mental status
A

Reynold’s pentad for cholangitis

1030
Q

Pulseless disease

Poor pulses in extremities
Young asain female

  • Histology
  • Elevated
A

Takayasu arteritis

Granulomatous inflammation of arteries of teh arotic arch

Elevated ESR

1031
Q

Unilateral headache
Jaw claudication
Vision loss

  • Histology
  • Elevated
  • Assoc with
  • Tx
A

Giant cell arteritis
aka temporal arteritis

Inflammation of branches of external carotid artery
- temporal arteries

Vision loss (occlusion of opthalamic artery)

Elevated ESR

Polymyalgia rheumatic
- pain and joint stiffness

High dose steroids for several months

1032
Q 
Child 
Fever 5 days
Conjunctivitis
Rash on trunk
Cervical lymph nodes swollen
Red tongue
Erythema on hands and feet

Potential for?
Tx?

A

Kawasaki disease (Mucocutaneous lymph node syndrome)

Potential for coronary aneurysms

  • rupture
  • thormbosis –> MI

Tx

  • VI immunoglobulin
  • Hig dose aspirin
1033
Q

Only child you give asprin to?

A

Kawaski disease

1034
Q

Gangrene of fingers
Smoker
Male in 40s

A

THromboangititis obliterans
Buerger disease

Small medium peripheral arteries adn veins

Cold sensitivity

Stop smoking

1035
Q

Hep B
Vasculitis
(-) anca

involves
spares
assoc with
Tx

A

Polyarteritis nodosa (PAN)

Involves kidneys, skin, GI, heart

spares lungs

Associated iwth hep B adn C

Corticosteroids

1036
Q

Recent upper respiratory infection
Palpable purpura on butt and legs
Abdominal pain
Protein and blood in urine

  • also have what disease
  • Tx
A

Henoch-Schonlein purpura
(IgA vasculitis)

Renal dease
- IgA nephropathy (berger’s disease)
Nephritis andhematuria

Self limiting

1037
Q 
Patient with asthma
Sinusitis
Multinucleated giant cells and eosinophils
\+ p-ANCA
Increased IgE
A

Eosinophilic granulomatosis with polyangiitis

Churg-Strauss syndrome

1038
Q

A 53-year-old man with a long-standing history of allergic rhinitis and asthma presents with uveitis, mild hearing loss, numbness and tingling in his right hand, and diffuse joint pain for the past 10 days. Physical examination shows
weak to absent left knee patellar reflexes (right knee reflex strong and intact). Laboratory studies
show a markedly elevated eosinophil count. A diagnosis is made, and the patient is treated
with cyclophosphamide. Further laboratory studies show elevated serum levels of the most common autoantibody associated with this condition. What structure is primarily targeted by the autoantibodies that are most likely elevated in this patient’s serum?
(A) Acetylcholine receptors
(B) Neutrophils
(C) Oligodendrocytes
(D) RBCs
(E) TSH receptors

A

B

1039
Q

p-ANCA

  • Ag
  • Ab

c-ANCA

  • Ag
  • Ab
A

p-ANCA

  • Myeloperoxidase (MPO)
  • MPO-ANCA

c-ANCA

  • Proteinase 3 (PR3)
  • PR3-ANCA
1040
Q

Affects both kidneys and lungs

A

Granulomatosis with polyangiitis (GPA)

Goodpasture

1041
Q 
Dyspnea
Hemoptysis
Heamturia
Saddle nose
\+c-ANCA
Necrotizing granulomas

Tx

A

Granulomatosis with polyangiitis (GPA)
Wegners
Focal necrotizing vasculitis

1042
Q

A 46-year-old man comes to the clinic with a cough that is occasionally productive of blood,
diffuse muscle and joint pain in the upper extremities,
and blood in his urine for the past several days. On further questioning, the patient
reveals that he has had chronic sinusitis for the past several years. The patient has a low grade fever and nasal ulcerations. Laboratory
studies show a markedly elevated erythrocyte
sedimentation rate, and staining for antibodies to cytoplasmic antigens of neutrophils is positive.Biopsy of a nasal ulceration reveals vasculitis
and necrotizing granulomas. Which of the following is the most likely diagnosis?
(A) Alport’s syndrome
(B) Giant cell (temporal) arteritis
(C) Goodpasture’s syndrome
(D) Takayasu’s arteritis
(E) Wegener’s granulomatosis

A

E. wegeners

1043
Q

(+) p-ANCA

A

Eosinophilic granulomatosis with polyangiitis

Microscopic polyangiitis

1044
Q

(+) c-ANCA

A

Granulomatosis with polyangiitis (GPA)

1045
Q

Necrotizing vasculitis of lungs kidneys skin
Crescentic GN
Palpable purpura
+ p-ANCA

Doesnt have

A

Microscopic polyangiitis

No naropharyngeal involvement

1046
Q 
Recurrent nose bleeds
Gi bleeding
Hematuria
Telangiectasias
Skin discolorations
Microcytic anemia
  • inheritence
A

Hereditary Hemorrhagic Telangiectasia

aka osler-weber rondu syndrome

AD

Due to vascular malformations in mucosa –> prone to bleeding

1047
Q

Microcytic anemia

A

Iron deficiency
Thalassemias
Lead poisoning

1048
Q

Normocytic Hemolytic anemia

A 
Sickle cell 
HbC disease
Pyruvate kinase deficiency
G6PD deficiency
Paroxysmal nocturnal hemoglobunuria
Hereditary spherocytosis
1049
Q

Megaloblastic macrocytic anemia

A

Folate def
Vit B12 def
orotic aciduria
Fanconi anemia

1050
Q

Can cause perforation of nasal septum

Vasculitis

A

Granulomatosis with polyangiitis (wegener’s granulomatosis)

1051
Q

Anti smooth muscle Ab

Antimitochondrial Ab

A

Autoimmune hepatitis

Primary biliary cholangitis

1052
Q

Chronic granulomatous disease

suspectable to

A

Lack NADPH oxidase activity

Catalase positive
s. aureus
aspergillus

1053
Q 
Port wine stain
Intellectual disability
Hemiplegia 
Calcification of outer boarder of brain 
Also see
A

Sturge-Weber disease
- affects capillaries

Seizures
Early onset glaucoma

Hemiplegia (paralysis one side body)

Leptomeningeal angioma

1054
Q

Red polyp on skin
Can ulcerate and bleed
Assoc w/ trauma and pregnancy

A

Pyogenic granuloma

1055
Q

Red prominent bumps smooth dots

A

Baronella henselae

Bacillary angiomatosis

1056
Q

Large dark brown spots on legs

A

Kaposi sarcoma (KS)

Herpes virus 8

1057
Q

Raynaud phenomenon associ with

A

Blue fingers in cold

SLE
CREST scleroderma
Thromboangiitis obliterans (Buerger dis)
Mixed CT disease

1058
Q

What cell type secretes histamine that stimulates the histamine receptor on parietal cells

A

Enterochromaffin -like cells (ECL cells)

1059
Q

Cohort study gives

A

Relative risk

A/A+B) / (C/ C+D

1060
Q

Cross sectional gives

A

Prevalence

1061
Q

Plummer vinson

A

Dysphagia
(esophageal webs)
Glossitis
Iron deficiency

1062
Q

what changes depending on disease prevalence?

A

PPV increases with increasing prevalence

NPV decreases with increase prevalence

1063
Q

Sensitivity equation (2)

A

A/ A+C

1- false negative rate

1064
Q

What is seen in distal duodenum of patients with celiac sprue

A

Blunting of villi
Hyperplastic crypts
Lymphocytes in lamina propria

1065
Q

Attributable risk (AR) equation

A

AR= incidence disease (exposed) - incidence of disease (unexposed)

AR= (A/ A+B) - (C/C+D)

1066
Q

Odds ratio

A

(A/B)/ (C/D)

1067
Q

Relative risk

A

Probability to getting disease in exposed group compared to unexposed group

(A/A+B) / (C/C+D)

1068
Q

Absolute risk reduction (ARR)

A

(C/C+D) - (A/A+B)

1069
Q

Number needed to harm

A

1/ AR

AR= (A/ A+B) - (C/C+D)

1070
Q

Number needed to treat (NNT)

A

NNT= 1/ ARR

ARR= (C/C+D) - (A/A+B)

1071
Q 
NNT? 
100 acute stroke patients given tPA
40 have complete recovery
400 acute not give tPA
80 have complete recovery
A

60 40
320 80

(320/ 400) - (60/100)= 0.2
NNT= 1 / 0.2= 5

1072
Q

Most common benign salivary gland neoplasm

Most common malignant slaivary gland neoplasma

Most common location for salivary gland neoplasm

A

Pleomorphic adenoma

Mucoepidermoid carcinoma

Parotid gland

1073
Q

Positive skew

A

Tail toward positive direction (to right)

Mean > Median > Mode

1074
Q

Negative Skew

A

Tail on left

Mean < Median < Mode

1075
Q

Small p value

A

indicates that the study values didnt occurred on chance alone

Reject null

Statistically significant

1076
Q

Type I error

A

alpha

Stating there is an effect when there isnt one

Accusing an innocent man

False positive

1077
Q

Type II error

A

beta
Stating there is no effect when there is one

You blindly let the guilty man go free

False negative

1078
Q

Power=

A

Probability that a test will correctly reject the null hypothesis

Increases with increased number of study participants

1-beta

1079
Q

Confidence interval =

A

CI= mean +- Z (SEM)

90% CI; Z= 1.5
95% CI; Z= 2
99% CI; Z= 2.5

SEM= standard dev/ squr root ( sample size)

1080
Q

One standard deviation away from zero percentage

2 standard deviation away

3 standard deviation away

A

68%

95%

99.7%

1081
Q

Male vs female
Diseased vs not diseased

Comparing percentages of members

Test?

A

Chi-squared

1082
Q

Correlation coefficient (r)

A

Measure of relationship of two variables

r= - 0.8 straight negative line
r= - 0.4 spread out up negative line
r=0 no relationship
r= 0.4 spread out positive line
r= 0.8 straight positive line
1083
Q

Blood pressure between men and woemn test

A

T test

1084
Q

What hormones stimulate pancreatic secretion

A

Acetylcholine
CCK
Secretin

1085
Q

IPV vaccine

A

Poliomyelitis

1086
Q

Meningococcal vaccine recommendation

A

11 or 12 yo

Boooster at 16

1087
Q

What diarrheal illnesses should be reported

A

Salmonella

Shigella

1088
Q

E/M

ICD-10

CPT

A

E/M= evaluation and management codes

ICD-10= international classification of diseases
(diagnosis)

CPT= current procedure terminology
(produre done)

1089
Q

Capitation

A

Fixed payment for a period of time or number of patients (ER shift, concierge practice)

1090
Q

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

A

Utilization management department

1091
Q

In patient with elevated alkaline phosphatase, elevation in which other serum lab markers would point toward a diagnosis of liver disease?

A

AST
ALT
GGT

1092
Q

Ethical duty to act in the patients best interest

A

Beneficience

1093
Q

Physicians must strive to treat people fairly

A

Justice

1094
Q

Dont need informed consent from parents or guardians for (7)

A 
Emancipated minors
STDS
Pregnancy
Drug addiction
Child of a minor
Minor serving a sentence of confinement
Emergency situation
1095
Q

Right sided heart failure signs

A

Peripheral signs

Lower extremity edema
Jugular venous distention
Hepatosplenomegaly

1096
Q

What areas of the hypothalamus regulate the autonomic nervous system

A

Anterior hypothalamus: parasympathetic

Posterior: sympathetic

1097
Q

Pneumonia in neonates (Birth to 28 days

Pneumonia in children

Pneumonia in adults

A

Neonates

  • Group B streptococcus
  • E coli
  • Chlamydia trachomatis
  • HSV

Children

  • Viruses (RSV)
  • Streptococcus pneumoniae
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae

Adults

  • Streptococcus pneumoniae
  • H. influenza
  • Mycoplasma pneumoniae
  • Chlamydophila pneumoniae
  • Influenza virus

Elderly

  • Streptococcus pneumoniae
  • H. influenza
  • Influenza virus
  • S. aureus
  • Gram negative rods (klebsiella )
1098
Q

Organism taht causes pneumonia in each of these patients

1) Alcoholic patient
2) Patient with decrased level of consciousness
3) Pt w/ cystic fibrosis
4) Pt w/ HIV and CD4<200
5) Post-influenza
6) Acquired from patio-cooling water mister
7) Travel to southwestern U.S.
8) Exposure to bird/ bat droppings in ohio missiissippi river
9) Patient with pet parrot

A

1) Klebsiella
2) Anaerobes
3) Pseudomonas
4) Pneumocystis jirovecii
5) Staphylococcus aureus
6) Legionella pneumophilia
7) Coccidioides immitis
8) Histoplasma capsulatum
9) chlamydophila psittaci

1099
Q

Meningitis by age

Neonates

Infants/children

Adults

Elderly adults

A

Neonates

  • Group B strep
  • E.coli
  • Listeria monocytogenes

Infants/ children

  • Streptococcus pneumoniae
  • Neisseria meningitides
  • H. influenza type B
  • viruses (enteroviruses)

Adults

  • strep pneumoniae
  • Neisseria meningitidis
  • enteroviruses

Elderly

  • Streptococcus pneumoniae
  • Listeria
  • Gram negative rods (ecoli)
1100
Q

Meningitis gram positive diplococci

A

Streptococcus pneumoniae

1101
Q

Meningitis gram negative coccobacilli

A

H. influenzae

1102
Q

Meningitis gram positive rod

A

LIsteria monocytogenes

1103
Q

Variola virus

A

Pox virus
Small pox

Respiratory droplets
Contaminated objects

Rash around mouth –> spread to face –> trunk extremities

1104
Q

What type of meningitis?

1) Unvaccinated child
2) Outbreak in dorm
3) Meningitis with petechial rash
4) Patient with HIV
5) RBCs in CSF + temporal lobe involvement on MRI

A

1) H. influenza type B
2) N. meningitis
3) N. meningitides
4) Cryptococcus neoformans
5) HSV encephalitis

1105
Q

CSF findings bacterial meningitis

Opening pressure
WBC count
Cell type
Protein
Glucose
Gram stain
A

Increased pressure

Increased WBC

Neutrophils

HIGH protein

Decreased glucose

Gram stain positive

1106
Q

CSF findins TB/ fungal meningitis

Opening pressure
WBC count
Cell type
Protein
Glucose
Gram stain
A

Increased pressure

INcreased WBC

Lymphocytes

Increased protein

Decreased glucose

No stain

1107
Q

CSF findings in viral meningitis

Opening pressure
WBC count
Cell type
Protein
Glucose
Gram stain
A

Normal or increased opening pressure

WBC increased

Lymphocytes

Normal or increased protein

Normal glucose

No stain

1108
Q

Meningitis
Slightly increased protein
Normal glucose
Incrased opening pressure

A

Viral meningitis

1109
Q

1) Newborn with chronic diarrhea, Failure to thrive
Chronic candidiasis

2) Child with eczema, coarse facial features and cold abscesses
3) Child with partial albinism, pepripheral neuropathy, and recurrent infections

A

1) Severe combined immunodeficiency (SCID)
2) Hyper IgE syndrome
3) Chediak- Higashi disease

1110
Q

Frothy yellow green
Fishy odor
pH > 4.5
Pear shaped

Tx

A

Trichomonas vaginalis

Metronidazole

1111
Q

Thick white cottage cheese like
4-4.5 pH

Tx

A

Candida spp

Azoles
Nystatin

1112
Q

Thin gray-white fishy odor
>4.5 pH
Clue cells

Tx

A

Gardnerella vaginalis

Part of normal flora

Metronidazole
Clindamycin

1113
Q

Budding yeast and peudohyphae

A

Candidiasis

1114
Q

Strawberry cervix

A

Trichomoniasis

1115
Q

Perinuclear cytoplasmic clearing

A

Koilocytes

HPV

1116
Q

What can have painful inguinal lymphadenopathy

A

Bubo

Lymphogranuloma venereum

Chlamydia trachomatis

1117
Q

Identify

1) Multiple painful ulcers
2) Painful single ulcer
3) Painless ulcer, raised indurated edges
4) School of fish
5) Granulomatous lesions on skin ( large areas of dying flesh)

A

1) Herpes simplex
2) Haemophilus ducreyi
3) Syphilis
4) Haemophilus ducreyi

5) Tertiary syphilis
- Gummatous syphilis

1118
Q

Adhesion to liver

Violin strings

A

FItz-Hugh Curtis

Extension of PID

1119
Q

WBC cast

A

Formed in tubules of kidney

Pyelonephritis

1120
Q

Gram negative rod
Swarming motility
Urease positive

Forms what

A

Proteus mirabilis

Hydrolyzes urea to ammonia
Urine more alkaline
Struvite stones

Magnesium ammonium phosphate stones

Staghorn calculus

1121
Q

Staghorn calcus

A

Urease producing bacteria

Proteus mirabilis
Kelbsiella

1122
Q

Rash followed by desquamation of hands and feet (sloughing of skin)
Snuffles (blood tinged nasal secretions)
Skeletal abnromalities
Hepatomegaly

A

Early manifestations Congenital syphilis (during first 2 years)

1123
Q 
Frontal bossing
Interstitial keratitis
Hutchinson teeth
Saddle nose
Perforation of hard palate
Sabershins
A

Late mnaifestation of congenital syphilis

1124
Q

Infects transfered through placenta or during birth

A

TORCHeS

Toxopolasmosis
Other (parvovirus B19)
Rubella
CMV
HIV/HSV
Syphilis
1125
Q

Pregnant lady and cat feces or undercooked meat

  • What happens
A

Toxoplasmosis

Chorioretinitis
Hydrocephalus
Intarcranial calcifications

1126
Q

Child

Red rash on cheek spread to chest and shoulder

A

Parvovirus B19

1127
Q

Severe fetal anemia
Ascites
Pleural effusions

A

Hydrops fetalis

Parvovirus B19

1128
Q 
Newborn
Cataracts
Harsh machine like murmur
Deafness
Blueberry muffin rash
A

Rubella

1129
Q

Newborn
Jaundice
Hepatosplenomegaly
Sensorineural hearing loss

A

CMV

1130
Q

Nosocomial infection

1) Catheter assoc UTI
2) Ventilator assoc pneumonia
3) Central lines infxn
4) Surgical wounds/ decubitus ulcers
5) Parenteral nutrition

A

1) E. coli
Gram neg rods
Pseudomonas
Candida

2) Pseudomonas
Staph aureus

3) Staph epidermdiis
4) Staph aureus
5) Candida

1131
Q

Osteomelitis

Gangrene organism

A

Clostridium perfringens

Alpha toxin

1132
Q

Wolff parkinson White syndrome

A

D wave (curving of slope between P and R wave

Ventricular pre-excitation syndrome

Abnormal fast accessory conduction pathway from atria to ventricle (bypass AV)

Ventricles begin to partially depolarize earlier

–> SVT

1133
Q

Infantile cataracts

A

Galactokinase deficiency

Classic galactosemia

Rubella

1134
Q

Vit B12 used for

A

Methionine synthase

1135
Q

Herpes virus

A

dsDNA

1136
Q

Calcium stone due to diuretic

A

Thiazide diuretic

1137
Q

Cataracts and deafness

A

Rubella

1138
Q

Migraine NT

A

Excessive glutamate

1139
Q

Liver abscess

A

E histolytic
Protozoan
Amebic dysentery

1140
Q

Bloody dirarrhea

Eosinophils

A

E. histolytica

1141
Q

Saccular aneurysm

A

aka berry aneurysm

ACA

1142
Q

Empysema

A

Increase compliance

Increases alveolar dead space

1143
Q

Hesselbach triangle?

A

Inguinal ligament
Inf. epigastric
Lateral border rectus abdominis

1144
Q

Carbamoyl phosphate synthetase (1 and 2)

A

CPS-1

  • urea cycle
  • mitochondria
  • source of nitrogen: ammonia

CPS-2

  • pyrimidine synthesis
  • cytosol
  • source of nitrogen: glutamine
1145
Q

Rate limiting step in pyrimidine synthesis

A

Carboamoyl phosphate synthetase 2

1146
Q

Rate limiting step in purine synthesis

Inhibited by

A

Glutamine PRPP amidotransferase

6-mercaptopurine

1147
Q

Sources of carbon in sythesis of purines?

In pyrimidine synthesis?

A

Pyrimidine: aspartate, CO2

Purine= CO2, glycine, tetrahydrofolate

1148
Q

What medication inhibits each

1) Ribonucleotide reductase
2) Dihydrofolate reductase
3) Thymidylate synthase
4) Inosine monophosphate dehydrogenase
5) PRPP amidotransferase`1)

A

1) Hydroxyurea

2) Trimethoprim
Methotrexate

3) 5-fluorouracil
4) Mycophenolate
5) 6-mercaptopurine

1149
Q

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

A

2000 + 1000= 3000

1150
Q

Self-mutilating behavior
intellectual disability
Gout

  • Deficency
  • inheritence
  • tx
A

Lesch-Nyhan syndrome

Deficency HGPRT

X linked

Allopurinol
Febuxostate

1151
Q

Orotic acid in urine + elevated serum ammonia

  • inheritence
  • causes
A

Ornithine transcarbamylace deficiency

X linked recessive

Excess carbamoyl phosphate –> orotic acid

Hyperammonemia
Decreased BUN

No megaloblastic anemia

1152
Q

Orotic acid in urine + normal serum ammonia

  • deficency
  • inheritence
  • feature seen
  • tx
A

Orotic aciduria

Deficiency of UMP synthase

AR

Megaloblastic anemia

Tx: Uridine supplementation

1153
Q

Megaloblastic anemia that does not improve with B12 and folate

A

Orotic aciduria

1154
Q

Histones consist of what amino acids

A

Lysine and arginine

1155
Q

Pyrimidine synthesis requires what four things

A

Aspartate
Co2
Glutamine
ATP

1156
Q

Purine synthesis requires what 5 things

A

Cats PURRR until they GAG and Cough on Fur balls

Purine synthesis
GAG= glycine, aspartate, glutamine
Cough= CO2
Fur balls= folic acid or tetrahydrofolate

1157
Q

SCID due to

A

Adenosine deaminase deficiency

1158
Q

DNA Polymerase I:

DNA polymerase III:

A

I: Breaks down RNA primer fills in gap w/ DNA

III: leading strand 5 –> direction
Lagging stand, short discontinous segments

1159
Q

DNA enzyme that can go in 3–> 5 direction and 5–> 3 direction

A

DNA polymerase I

3–> 5 remove 1 nucleotide at a time

5–> 3 remove 1-10 nucleotides

1160
Q

DNA polymerase alpha

DNA polymerase beta

DNA polymerase delta

DNA polymerase episilon

DNA polymerase gamma

A

Alpha

  • makes own primer
  • replicates first 20 nucleotides

Beta
- DNA repair

Delta
- Build okazaki fragments on lagging strand

Episilon: Elongates teh leading strand

Gamma: Replicates mitochodnrial DNA

1161
Q

Base excision repair (5)

A

Glycosylase
- recognized damaged bases and removes them

Lyase
- cuts 3’ end of back bone

Endonuclease
- cuts the 5- end and removes backbone

DNA polymerase beta
- Fills gaps

Ligase
-seals

1162
Q

Mismatch repair

A

Nick daughter strand upstream and remove a whole bunch of bases

Redo replication and fill gap

1163
Q

DNA repair that repairs both strands

A

Nonhomologous end joining

1164
Q

Hereditary nonpolyposis colorectal cancer DNA defect

-risk of

A

Defect mismatch repair

Increased risk of colon cancer

1165
Q

Xeroderma pigmentosum DNA repair defect

  • inheritence
  • cant do
  • increased risk
A

AR

Defective nucleotide excision repair

Sensitive to sunlight

Cant remove pyrimidine dimers from UV radiation

Increased risk of skin cancer, melanoma, SCC, basal cell

1166
Q

Bloom syndrome

  • DNA defect
  • Sensitive to
  • increased risk
A

Mutation of helicase

  • DNA replication
  • DNA repair

Hypersensitive to sunlight

Increased risk of leukemia and lymphoma

1167
Q

Ataxia-telangiectasia defect

  • syndrome
  • elevated
  • sensitive to
A

Defect repair of dsDNA breaks

IgA deficiency
Cerebellar ataxia
Smooth persuit with eye

Elevated alpha fetoprotein after 8 months

Sensitive to ionizing radiation

1168
Q

BRCA1 and BRCA 2 DNA repair defect

A

dsDNA breaks

1169
Q

What strand of DNA nucelotide opposes this DNA strand?

5’ - ATTGCGTA-3’

A

5’- TACGCAAT- 3’

1170
Q

Which eukaryotic DNA polymerase performs this function

1) Replicates lagging strand
2) Synthesizes RNA primer
3) Repairs DNA
4) Replicates mitochondrial DNA
5) Replicates leading strand DNA

A

1) DNA polymerase delta (first 20 alpha)
2) Alpha
3) Beta
4) Gamma
5) Epsilon (alpha first 20)

1171
Q

What gets compressed in pregnant female to decrease blood pressure when supine

A

Inferior vena cava

1172
Q

DNA promoter regions

A
  • 25 Hogness/ TATA box
  • 75 CCAAT box
  • 10 Pribnow/ TATAAT box
1173
Q

Operator region of transcription

A

Binds repressor or inducer

Located between promoter region and start site

1174
Q

Response elements of trascription

A

Enhancer region and repressor region

Increase or decrease the rate of transcription

Location: close to, far from or within the promotor region

1175
Q

mRNA

tRNA

rRNA

A

mRNA

  • messenger RNA
  • coupled to DNA template
  • transcribed into proteins
  • largest type
  • made in nucleoplasm

tRNA

  • transfer RNA
  • matches to mRNA and brings AA, transfers mRNA to polypeptide chain
  • Smallest type
  • made in nucleoplasm

rRNA

  • Part of ribosome
  • binds AA together
  • Most abundant
  • made in nucleus
1176
Q

Start codon

A

AUG

Methionine

1177
Q

Stop Codons

A

UGA
UAA
UAG

1178
Q

What breaks down lactose into two particles

A

beta-galactosidase

Into glucose and galactose

1179
Q

What do you need for transcription of beta-galactosidase. When is it present

A

CAP (catabolite activating protein)
-Present when glucose absent

Allolactose

  • lactose metabolite binds to lac repressor protein and changes shape
  • Present with abundant lactose
1180
Q

5- cap

  • what is it
  • provided by
A

1- methyl-guanosine cap

Provided by s-adenosyl-methionine (SAM)

1181
Q

specific signal to start polyadenylate tail

A

AAUAAA

1182
Q

Substances that inhibit reuptake of NE

A 
Cocaine
TCAs
SNRIs
- venlafaxine
- duloxetine
Methylphenidate
Bupropion
1183
Q

When enzyme matches amino acids to tRNA

A

Aminoacyl tRNA synthetase

1184
Q

Tendon xanthomas

Cafe au alit spot

Boot shaped heart

A

Familial hypercholesterolemia

NF1, McCune albright syndrome

RVH –> tetralogy of fallot

1185
Q

Triad of tuberous sclerossi

A

Seizures
Intellectual disability
Angiofibromas (reddish borwn bumps on nose/ cheeks)

1186
Q

Autosomal dominant inheritence

Disease?

A

Both male and female
Every generation affected
50% in any generation

Von Hippel Lindau
Von Willebrand Dis
ALS
Retinoblastoma
MEN
Tuberous sclerosis
Hereditary spherocytosis
Huntington's disease
Marfan 
Ehler's danlos syndrome
Neurofibromatosis
Familial adenomatous polyposis
Osler-weder-Rondu
Achondroplasia
Family hypercholesterolmia
ADPKD
1187
Q

X linked dominant disease

A

Fragile X

1188
Q

Autosomal recessive

Type

A

25% offspring
ONly 1 generation

Alpha 1 AT
Beta-thalassemia
PKU
Hemochromatosis
Wilson's dis
Bernard-Soulier
Hartnup syndrome
Glanzman thrombasthenia
Fanconi
Cystic fibrosis
Pompe dis
Sphingoolipidoses
Mucopolysaccharidoses
Sickle cell disease
Cori disease
McArdle
Albinism
Von Gierke
1189
Q

X linked recessive

A

50% sons affected

Hunter
Lesch-Nyhan
Fabry disease
Meinke's disease
Wiskott Aldrich syndrome
G6PDH
Bruton's agammaglobulinemia
Duchenne's muscular dystrophy
Hemophilia A 
Hemophilia B
Diabetes insipidus
1190
Q

Single gene has more than one effect

Mutations oat different loci have same phenotype

A

Pleiotrophy

Locus heterogeneity

1191
Q

Prader-Willi

A

POP

Prader willi
Overeating Obesity
Paternal gene

1192
Q

Angelmann

A 
MAMA
Maternal gene
Angelmann
Mood- happy laughter
Ataxia
1193
Q

Southern blot

Northern Blot

Western blot

Southwestern blot

A

Southern
- DNA sample, DNA probe

Northern
- RNA sample, DNA probe

Western
- Protein sample, Ab probe

Southwestern

  • Transcription factors, DNA binding proteins
  • DNA binding proteins sample, Oligonucltide probe
1194
Q

Direct ELISA test for

A

Antigens

1195
Q

Indirect ELISA test for

A

Antibodies

1196
Q

Hallmark of COPD on pulmonary function testing

A

Decreased FEV1/ FVC

1197
Q

Schizophrenic brain

A

Smaller
Enlarged ventricles
Thin cortex

Increase dopamine in mesolimbic
Decrease dopamine in mesocortical

1198
Q

RNA made from different polymerase

RNA polymerase I

RNA polymerase II

RNA polymerase III

A

I= rRNA

II= mRNA

III= tRNA

1199
Q

Hallmark of restrictive lung disease

A

Decrease in total lung capacity

Normal FEV1/ FVC ratio

1200
Q

Dystonia

A

sustained muscle contraction

1201
Q

Adjustment disorder

A

Identifiable psychosocial stressor

<6 months after stressor gone

1202
Q

Virchow node

A

Left supraclavicular LN

Gastric cancer metastasis

1203
Q

Pattern of behaviors that violate social norms and rights of others

A

Conduct disorder

Theft
Violence
Fire
Cruelty to animals

< 18 conduct
> 18 antisocial personality disorder

1204
Q

Trichotillomania

Tx

A

Hair pulling disorder

Education
Cognitive behavioral

Fluoxetine (SSRI)
Clomipramine (TCA)

1205
Q

Redirection of emotions or impulses to a neutral person or object

A

Displacement

1206
Q

Partially remaining at a more childish level of development

Surgeon throws tantrum in operating room because last case ran late

A

Fixation

1207
Q

Separating feelings from ideas and events

Describing murder with not emotional response

A

Isolation

1208
Q

Replacing a warded-off idea or feeling with an (unconsciously derived) emphasis on its opposite

Lustful thoughts so go to church

A

Reaction formation

1209
Q

Alleviatin negative feelings via unsolicited generosity, which provides gratification

mafia boss makes large donation of charity

A

Altruism

1210
Q

Replacing an unacceptable with with a course of action that is similar to the wish but socially acceptable

Teenagers aggression towards parents because of high expectations is channeled into excelling in sports

A

Sublimations

1211
Q

30 year old says you are the best doctor shes ever had, nurses are the worst. Threatens to change doctors when you wont do a particular lab test

Personality disorder?

A

Borderline personality disorder

Splitting
Fear of abandonment
Self mutilation

1212
Q

Women comes into office wearing all black, and excessive lipstick. Talks to everyone in waiting room. Wearing feather boa

Also?

A

Histrionic personality disorder

Sexually provocative

1213
Q

A patient with IL-12 receptor deficiency is at particualr risk for what type of infection?

A

Mycobacterial

1214
Q

Alcohol has affects on what receptors

A

GABA

1215
Q 
Alcohol in hospital for 2-3 days
Sudden confusion
Nightmares
Agitation
Disorientation
Hallucinations
Fever
HTN
Seizures

Tx

A

Delirium Tremens

Benzo
Alcohol

1216
Q

Wernicke-Korsakoff damages what

A

Medial thalamus and mamillary bodies of posterior hypothalamus

1217
Q

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

1) Smooth parts of the left and right ventricles
2) Smooth part of the right atrium
3) Trabeculated left and right atria
4) Trabeculated parts of the left and right ventricles

A

1) Smooth parts of the left and right ventricles
= Bulbus cordis

2) Smooth part of the right atrium
= Right horn of sinus venosus

3) Trabeculated left and right atria
= primitive atria

4) Trabeculated parts of the left and right ventricles
= primitive ventricle

1218
Q

Mesonephros

  • does what
  • becomes
A

Fetal kidney (1st trimester)

Becomes male genital system

1219
Q

Potter sequence due to

A

Failure of ureteric bud to develop

No collecting system
Nothing to induce metanephros to develop into nephron

Bilateral renal agenesis

1220
Q

Horseshoes kidney gets stuck on

Associated iwth

A

Inferior mesenteric artery

Turners syndrome

1221
Q

What remains in capillaries after filtration

A

Blood cells
Platelets
Large proteins

Exits through efferent arterioles

1222
Q

Juxtaglomerular apparatus composed of

A

Juxtaglomerular cells
- secrete renin

Macula densa

  • specialized sensory cells
  • senses if Na in lumen of distal nephron is too low
1223
Q

Three things that cause JG cells to secrete renin

A

Beta adrenergic stimulation
Low Na in DCT
Low pressure in afferent arteriole

1224
Q

Effect of GFR, RPF, FF

1) Increase serum protein
2) Ureter stone obstruction
3) ACE inhibitors
4) NSAIDS

A

1) Osmotic load keeps fluid in
GFR: Decrease
RPF: No change
FF: Decrease

2) High hydrostatic pressure in Bowman capsule, favors blood staying in capillaries
GFR: decrease
RPF: No change
FF: decrease

3) Dilate efferent
GFR: Decrease
RPF: Increase
FF: Decrease

4) Afferent constriction
GFR: decrease
RPF: decrease
FF: no change

1225
Q

How much of body is water?

Extracellular fluid
Interstitial fluid
Plasma volume
Intracellular fluid

A

60% total

40% Intracellular

20% Extracellular

  • 75% Interstitial fluid
  • 25% Plasma
1226
Q

Renal clearance=

A

UV/P

Urine concentration of substance x urine flow rate / plasma concentration substance

1227
Q

Substance that gives GFR

Normal GFR

A

Inulin
Creatinine

90-135 (think 100)

1228
Q

Substance that gives Renal plasma flow

A

PAH

1229
Q

Filtration fraction=

A

GFR/ RPF

Normally 20%

1230
Q

Prostaglandin effect of GFR, RPF, FF

A

Vasodilators

Dilate afferent arterioles

1231
Q

Angiotensin II on GFR, RPF, FF

A

Constrict efferent arterioles

1232
Q

Filtered load=

Reabsorbed amount=

Secretion=

A

FL= GFR x P (plasma)

Reabsorbed= filtered - excreted

Secretion= excreted - filtered

1233
Q

A 55-year-old woman has had worsening problems
with memory and the ability to carry out tasks of daily living
over the past year. She has had watery diarrhea for the past
3 months. Physical examination shows red, scaling skin in
sun-exposed areas. Deep tendon reflexes are normal, and sensation
is intact. Which of the following diseases is she most
likely to have?
A Beriberi
B Cheilosis
C Hypothyroidism
D Marasmus
E Pellagra

A

Pellagra 3D’s
Hartnup disease

Deficient transporter for neutral amino acids (tryptophan)

Inability to make niacin (Vit B3)

1234
Q

What is HUS

A

Hemolytic uremic syndrome

Associated w/ E.coli 0157:H7

Hemolytic anemia (red blood cells being destroyed)
Thrombocytopenia
Acute kidney injury

1235
Q

What is absorbed in PCT first half

A

All glucose
All amino acids
2/3 fluid
2/3 electrolytes

Reabsorbs primarily

  • Bicarb
  • Na
1236
Q

Na transporter

  • PCT (early)
  • PCT (late)
  • Thick ascending
  • Early distal tubule
A

PCT (early)
- Na/ X (glucose, AA, lactate) into cell

PCT (late)
- Na reabsorption is with chloride

Thick ascending
- Na/K/ 2CL transporter

Early distal tubule
- Na/ Cl-

1237
Q

Relative concentrations of ultrafiltrate along proximal tubule (graph)

A

“Plasma Concentrations Increase Unless Cleared by Kidneys”

PAH
Creatinine
Inulin
Urea
Chloride
Potassium

Sodium
Water

HCO3
Aminoacids
Glucose

1238
Q

What do you need to get an anion from interstitium to lumen

What do you need to get an cation from interstitium to lumen

A

alpha-ketoglutarate

Cation
- Na/K ATPase (2 Na/ 3 K)
- electrochemical gradient
- Cation move down gradient in to cell
Cation/H exchange into lumen
1239
Q

Responsible for water reabsorption

Impermeable to Na

A

Thin descending limb

Water follows osmotic gradient into hypertonic medulla

Concentrates lumen

1240
Q

Thick ascending limb

  • fxn
  • what also gets in
  • what doesnt
  • Result
A

Actively absorbing Na, Cl, and K (passive in PCT)

Ca and Mg sneak inbetween cells

Impermeable to water

Dilutes urines

1241
Q

PTH acts on

A

Ca in early distal convoluted tubule

1242
Q

ADH works on

A

V2 vasopressin receptors on principal cells in collecting tubule

Tells cells to insert aquaporins into lumen surface of cells

Allows water to be resorbed

Lithium

  • Enters through Na channel
  • Blocks aquaporin
1243
Q

Potassium-sparing diuretics (2 types)

A

“SEAT”
Aldosterone antagonists
- Spironolactone
- Eplerenone

Inhibit epithelial Na channel

  • Amiloride
  • Triamterene
1244
Q

What class of drug inhibits Na/2Cl/K symporter in thick ascending limb

A

Loop diuretics

Cause isotonic water excretion

1245
Q

Two cells in collecting duct and function

A

Principal cells

  • reabsorb water and Na
  • secrete K

Intercalated cells

  • Secrete H or HCO3
  • reabsorb K
1246
Q

Two types of intercalated cells

A 
Alpha cells (A cells)
- Secrete H
Beta cells (B cells)
Secrete HCO3
1247
Q

What diuretic directly affects principal cells

A

Potassium sparing diuretics

1248
Q

What effect does aldosterone have on the principal cells and intercalated cells of the collecting duct?

A

Principal= reabsorptionof Na and secretion of K

Intercalated cells: stimulates secretion of H

1249
Q

What bacteria secrete enterotoxins?

A 
Vibrio cholerae
Enterotoxigenic E.coli
Staph aureua
Shigella
Yersinia
Clostridium spp.
1250
Q

Charcot’s neurological triad

A

Associated iwth MS

Scanning speech
Intention tremor
nystagmus

1251
Q

Damage to which part of substantia nigra causes hypokinesia

A

Substantia nigra pars compacta

1252
Q

What shifts potassium out of cells –> hyperkalemia

A 
Low insulin
Beta blockers
Acidosis
Digoxin 
Cell lysis
1253
Q

What shifts potassium into cells –> hypokalemia

A

Insulin
beta agonist
Alkalosis
Cell creation

1254
Q

You have a patient with an EKG with tall peaked T waves

Tx?

A

Hyperkalemia

1st: IV calcium
- to prevent arrhythmias
- wont correct hyperkalemia

To correct hyperkalemia:
Beta agonist (albuterol)
IV bicarb
IV insulin + dextrose

1255
Q

Atrial natriuretic peptide

  • Released from
  • Due to
  • MOA
  • Effect
A

Release by atria of heart due to increased atrial volume and atrial pressure

ANP on kidneys –> constrict efferent arterioles and dilates afferent arterioles

Increase GFR, diuresis

1256
Q

SIADH caused by

A

Too much ADH

Small cell lung cancer
COPD, pneumonia
Head trauma
Stroke
CNS infection
Drugs: cyclophosphamide
1257
Q

Locked in syndrome

A

Central pontine myelinolysis

Correct hyponatremia too quickly

Causes lysis of myelin and pons

1258
Q

Diabetes insipidus

A

Too little ADH
Cant concentrate urine

Central
- Abnormal ADH production by hypothalamus

Nephrogenic

  • Kidneys unresponsive to ADH
  • Lithium, hypercalcemia, mutation
1259
Q

Patient with excessive thirst and polyuria

What to do?

A

1) First think DM
- check urine and serum glucose

2) Check urine and serum osmolality
- Low urine osmolality
- High serum osmolality

3) Water deprivation test
- Healthy: dehydrate –> secrete ADH –> concentrate urine
- DI: urine osm stays low

4) Desmopressin challenge
- ADH analog
- Central: increase osm
- Nephrogenic: no change

1260
Q

Polymyositis vs polymyalgia rheumatica

A

Polymyositis

  • muscle weakness
  • increased CK and aldolase
  • Increased ANA
  • Positive Anti-Jo

Polymyalgia rheumatica

  • Joint pain
  • No muscle pain
  • No weakness
  • Normal Ck and aldolase
1261
Q

MPTP exposure causes depletion of waht

A

Dopamine

1262
Q

pH
pCO2
HCO3

A 
pH= 7.35-7.45
pCO2= 35-45
HCO3= 22-28
1263
Q

Anion gap

A

[Na]- [Cl] - [HCO3]

10-12 normal

1264
Q

Adding acids to blood does what to anion gap

A

Add acid, buffered by bicarb

Lowers bicarb amount
Increases anion gap

–> High anion gap

1265
Q

High anion gap acidosis

A

“MUDPILES”

Methanol
Uremia (renal failure)
Diabetic ketoacidosis
Propylene glycol
Iron tablets/ Isoniazid
Lactic acid (shock or coding)
Ethylene glycol 
Salicylastes (aspirin)
1266
Q

Normal anion gap acidosis

A

DIarrhea
Renal tubular acidosis
Spironolactone
Acetazolamide

1267
Q

Normal anion gap metabolic acidosis

Urine pH > 5.5

A

Renal tubular acidosis Type I

Alpha intercalated cells in collecting tubule unable to secrete H

Hypokalemia

1268
Q

Normal anion gap metabolic acidosis
Urine pH < 5.5
Hyperkalemia

A

Renal tubular acidosis Type 4

Often due to hypoaldosteronism

If low not putting potassium into urine

Hyperkalemia
Prevents PCT from generating NH4

1269
Q

Normal anion gap metabolic acidosis
Urine pH < 5.5
Hypokalemia

A

Renal tubular acidosis Type 2

Proximal tubule defect of HCO3 reabsorption

Hypokalemia
hypophosphatemia

1270
Q

Renal tubular acidosis three types

A

Type 1
- Impaired hydrogen (H) excretion
1 letter

Type 4

  • impaired ammonium (NH4) excretion
  • Type 4= NH4 = aldo

Type 2
- impaired BIcarb reabsorption

1271
Q

pH equation

A

HCO3/ pCO2

1272
Q

Nephritis vs Nephrosis

A

NephrOsis

  • Proteinuria > 3.5 g day
  • Hyperlipidemia
  • Hypoalbuminemia

Nephritis

  • Proteinuria < 3.5g
  • HTN
  • Hematuria
  • Hardly any urine (oliguria)

I= eye= symptom you can see

1273
Q

Poststreptococcal glomerulonephritis

A

PSG= 3 letters

Lump3- Bump3
C3
3 wks poststrep
Type 3 rxn

Subepithelial humps
Coca-cola urine

Decrease C3
Increase anti-streptolysin O
Decrease anti-DNase B

1274
Q

Rapidly progressive glomerulonephritis

A

“Crescentic”

Rapidly crescentic glomerulonephritis

Crescentic shaped

Made up of fibrin and complement and cellular debris

1275
Q

Diffuse proliferative glomerulonephritis

A

Dilupus

Wire loops= wire lupus

SLE

1276
Q

Thin distinct membrane

A

Wire loop
SLE
Anti ds DNA
Lupus

Diffuse proliferative glomerulonephritis

1277
Q

Vision problems
Deafness
Protein in urine
Coughing up blood

A

Cant see Cant pee Cant hear high C

Alport syndrome

Splitting of basement membrane

Defect in Type IV collagen

Al-4
Type IV
4 things
Lung, kidney, ear and eyes

1278
Q

Goodpasture syndrome

A

Goodpasture= 2-pasture

Type II hypersensitivity
2 organs (lung + kidneys)
Ab vs Type IV collagen

1279
Q

Wegeners Gramulomatosis

A

Granulomatosis w/ polyangiitis

We-C-ners
C over stick figure
- nasopharynx
- lungs
- kidney

C-anca

1280
Q 
Palpable purpura on butt and legs
Abdominal pain
Increased IgA
RBC casts
Hematuria
A

IgA Nephropathy

Henoch-Schonlein purpura

1281
Q

What nerve most likely damaged in fibula neck fracture

A

Common peroneal n.

1282
Q

Defining features of nephrotic syndrome

A

Proteinuria > 3.5 g/day
Hypoalbuminemia
Peripheral edemia Hyperlipidemia

1283
Q

Flattening or effacement of podocyte foot process

Child

Post URI

Tx

A

Minimal change disease

Corticosteriods

Minimal

  • kids= minimal age
  • foot= minimal body part
1284
Q

HIV patient

Proteinuria

A

Focal segmentla glomerulosclerosis (FSGS)

1285
Q

Spike and Dome

A

Membranous Glomerulonephropathy

Thickening of basement membrane
Hep B and Hep C

Subepithelial immune deposits

1286
Q

Membranous glomerulonephropathy

A

” suck some dick to become a MEMBER of the club”

Blow job= Dome
Who sucks dick= Hepatitis

1287
Q

Membranoproliferative glomerulonephritis

A

Prolife
“Train Track”

Hep B and C

Subendothelial humps

1288
Q

Focal segmental Glomerulosclerosis (FSG)

A

FSG HIV

Half glomerulus affected

1289
Q

Round acellular nodules

A

Kimmelstiel wilson nodule

Diabetic nephropathy

1290
Q

Congo red stain

Apple green birefringence

A

Amyloidosis

1291
Q

Glomerular histology reveals multiple mesangial nodules. THis lesion is indicative of what disease

A

Diabetic nephropathy

1292
Q

Prerenal azotemia vs intrinsic renal disease

A

Prerenal

  • Urine Na < 20 mEq/L
  • FE(Na) < 1%
  • BUN:CR >20:1

Intrinsic
- urine Na > 40
FE (Na) > 2%
BUN:Cr 10-15:1

1293
Q

Urinary Casts made up of

Secreted by

A

Tamm-Horsfall mucoprotein

Secreted by tubule epithelial cells

1294
Q

Muddy Brown Casts

Drugs that cause

A

Acute tubular necrosis

Most common cause of acute kidney injury

Acute necrosis or death of epithelial cells

Aminoglycosides
Cisplatin

1295
Q

Azotemia

A

Nitrogen in blood

High urea
High creatinine

1296
Q

Fever
Eosinophilia
Azotemia
Maculopapular rash

A

Acute interstitial nephritis (AIN)

1297
Q

Gross hematuria
Flank pain
Azotemia
HTN

A

Renal papillary necrosis

1298
Q

1) Hyaline casts
2) RBC casts
3) WBC casts
4) Epithelial cell casts
5) Granular casts
6) Fatty casts
7) Waxy casts

A

1) Hyaline casts= Normal patient with concentrated urine

2) RBC casts = Glomerular bleeding (glomerulonephritis, vasculitis)
Yellow brown

3) WBC casts= Tubular interstitial disease, acute pyelonephritis, proliferative glomerulonephritis
4) Epithelial cell casts= Acute tubular necrosis, acute interstitial nephritis, glomerulonephritis
5) Granular casts= Acute tubular necrosis, muddy brown
6) Fatty casts= nephrotic syndrome, contain cholesterol (maltese cross)
7) Waxy casts= end stage renal disease

1299
Q

Basic metabolic panel for patient with renal failure

A 
INcreased BUN adn Cr
Increased K
Decrease Calcium
Decrased bicard
(metabolic acidosis)
1300
Q

WBC casts

A

Pyelonephritis

1301
Q

What is associated iwth AD polycystic kidney disease

A

Hepatic cysts
Intracrnail aneurysms
Mitral valve prolapse

1302
Q

ADPKD vs ARPKD

A

ADPKD
- mutation: PKD1 (chr 16) , PKD2 (chr 4)

ARPKD
- mutation PKHD1 (chr 6)
- infancy
oliguria –> potter

1303
Q

Small shrunken kidneys and fiborsis

A

Autosomal dominant tubulointerstitial kidney disease

aka medullary cystic kidney disease

Progressive renal failure

1304
Q

Stone

1) Envelope (square)
2) rectangle (coffin lid)
3) hexagon
4) rhombus or rosette

A

1) Calcium oxalate
2) struvite
3) cystine
4) uric acid

1305
Q

Renal cell carcinoma

  • arises from
  • deletion –>
  • triad
  • secretion
  • pathology
A

PCT in the cortex

Deletion on Chr 3
(Von Hippel Lindau dis)

Flank pain, hematuria
palpable abdominal mass

Polycythemia
- erythrocytosis due to excess erythropoeitin production

Solid tumor wit “clear cells” full of lipids and carbohydrates

1306
Q

Intellectual disability
Absence of iris
renal tumor
Child

Also see

A

Wlims tumor (nephroblastoma)

Also see genitourinary malformations
Cryptorcidism, bicornuate uterus

1307
Q

Painless hematuria

Major risk

A

Transitional cell carcinoma (urinary tract)

Smoking
Aniline dyes
Naphthylamine dyes
Cyclophosphamide

1308
Q

WAGR complex

A

Wilms tumor
Aniridia (no iris)
Genitourinary malformation
Mental retardation

1309
Q

Organism that causes bladder cancer

A

Squamous cell bladder cancer

schistosoma haematobium

Middle east
Urinary blood fluke
Trematode

1310
Q

Developmental milestones

3 m

6 m

9 m

12 mo

A

3 mo 3= before everything else

  • roll
  • hands together
  • laugh and squeal
  • smile

6 mo “Six= S’s”

  • Sit up
  • Switch objects between hands
  • Shmooze
  • Self feed
  • Stranger danger

9 mo “9= P’s (9 in penis)

  • Pull itself (crawl)
  • Pincer grasp
  • Papa
  • play
  • permance (object)

12mo “TWELVE= T’s”

  • Two legs (stand, walk)
  • Track ( object tracking), block in a cup
  • 2 words
  • 2 of use (separation anxiety)
  • drink from cup
1311
Q

Apgar score

A

1 and 5 minutes after delivery
0-10

Appearance
0= cyanotic
1= blue extremities
2= pink

Pulse
0= absent
1= < 100
2= > 100

Grimace
0= no response
2= cries and pulls away from stimulus

Activity
0= limp and floppy baby
2= flexed arms and legs, resist extension

Respiration
0= absent effort
1= slow irregular or labored
2= crying and vigorous breathing

1312
Q

What zoonotic bacterium causes each

1) Cat scratch fever
2) Lyme disease
3) Recurrent fever from variable surface antigens
4) Bloody diarrhea
5) Q fever
6) Tularemia
7) Leptospirosis
8) Cellulitis and osteomyelitis from cat or dog bites

A

1) Cat scratch fever
- Bartonella

2) Lyme disease
- Borrelia burgdorferi

3) Recurrent fever from variable surface antigens
- Borrelia recurrentis

4) Bloody diarrhea
- Campylobacter (puppies, livestock, fecal oral, sexual)

5) Q fever
- Coxiella burnetti (spores from tic feces, cattle placenta)

6) Tularemia
- Francisella tularesis

7) Leptospirosis
- Leptospira spp (animal urine)

8) Cellulitis and osteomyelitis from cat or dog bites
- Pasteurella multocida

1313
Q

First step in glucose utilization

A

Phosphorylate it to trap in muscle

Hexokinase
Glucokinase
- liver and beta cells

1314
Q

Main enzymes in glycolysis pathway

A
  1. Hexokinase/ glucokinase
  2. Phosphofructokinase-1
  3. Pyruvate kinase
1315
Q

Muscle biopsy on patient reveals elevated glycogen levels, elevated fructose-6- phosphate, and decreased pyruvate. What enzyme is deficient?

A

Phosphofructokinase-1 deficiency

1316
Q

Insulin on glycolysis pathway

Glucagon on pathway

A

Doesn’t directly stimulate glycolysis

Stimulates Phosphofructokinase-2 (fed)

–> Forms fructose-2,6 BP

Glycogen formation stimulated by insulin

GLucagon

  • stimulates FBPase-2 (fasting)
  • -> Fructose-6-P
1317
Q

Increase in fructose-2,6 BP leads to

A

Decrease conversion of alanine –> glucose

1318
Q

To get ATP need

Which requires

That is from

What is needed for that

That comes from

Get that from

This occurs where

TCA and oxidative phosphorylation occur where

A

ATP from Oxidative phosphorylation

NADH needed for oxidative phosphorylation is from TCA cycle

Need acetyl-CoA for TCA cycle

Acetyl-CoA from decarboxylation of pyruvate

Pyruvate is from glycolysis of glucose

Glycolysis in cytosol

TCA and oxidative phosphorylation are in mitochondria

1319
Q

Aerobic metabolism two different types of shuttle

A

Malate-aspartate shuttle

  • Heart liver and kidneys
  • 32 ATP

Glycerol-3-phosphate shuttle

  • brain adn skeletal muscles
  • 30 ATP
1320
Q

GLUT Transports

GLUT 1

GLUT 2

GLUT 3

GLUT 4

GLUT5

A

GLUT1

  • RBC
  • Endothelium of BBB
  • mediates basal glucose uptake (low level)
  • Takes up glucose regardless of insulin

GLUT2

  • Found on cells that regulate glucose
  • Hepatocytes, pancreatic beta cells

GUT3

  • Neurons
  • Placenta

GLUT4

  • Skeletal muscle
  • Adipose tissue
  • INSULIN dependent

GLUT5
- Fructose uptake in GI tract

1321
Q

Gluconeogenesis steps

A

Pyruvate –> Oxaloacetate
(pyruvate carboxylase w/ biotin)

(+) acetyl-CoA

Oxaloacetated –>Phosphoenol pyruvate
(PEP carboxykinase )

…

Fructose-1,6-BP –> Fructose6P
(Fructose-1,6-bisphosphatase)
RL

(+) ATP
(-) AMP, Fructose 2,6 BP

Glucose 6 phosphate –> Glucose
(Glucose-6-phosphatase)

1322
Q

Rate limiting enzymes

1) De novo pyrimidine synthesis
2) De novo purine synthesis
3) Glycolysis
4) Gluconeogenesis
5) Glycogen synthesis
6) Glycogenolysis
7) TCA cycle
8) Hexose monophosphate shunt

A

1) carbamoyl phosphate synthetase-2
2) glutamine PRPP amidotransferase
3) Phosphofructokinase -1
4) Fructose-1,6- bisphosphatase
5) Glycogen synthase
6) Glycogen phosphorylase
7) isocitrate dehydrogenase
8) glucose-6-phosphate dehydrogenase

1323
Q

What irreversible enzymes are involved in gluconeogenesis

A

Pyruvate carboxylase w/ biotin
PEP carboxykinase
Fructose-1,6- bisphosphatase
Glucose-6- phosphatase

1324
Q

RL step of gluconeogenesis

A

Fructose-1,6- bisphosphatase

1325
Q

Order molecules based on energy the contain

Pyruvate
Adenosine monphosphate
Glucose
Adenosine
Adenosine triphsphate
A

Glucose > pyruvate > ATP > AMP > adenosine

1326
Q

Flow of aqueous humor

A

Formed in capillary bed of ciliary body

  • -> posterior chamber
  • -> flows between angle formed by lens and iris diaphragm
  • -> anterior chamber

–> reabsorbed in canal of schlemm

1327
Q

Glucose -6- phosphate –> glucose

A

Glucose-6- phosphate

Last step in glycogenolysis and gluconeogenesis

Deficency= Von Gierke

1328
Q

Glycogenolysis

To break alpha-1,4 glycosidic linkage need

To break alpha- 1,6 glycosidic linkage need

A

alpha-1,4= glycogen phosphorylase (RL)

alpha-1,6= alpha 1,6 glucosidase (aka debraching enzyme)

  • two functions
  • take 3 of last 4 glucose and move to end of other branch (transferase)
  • remove last glucose (alpha 1,6 glucosidase)
1329
Q

Epinephrine effect of glycogen regulation

A

Beta adrenergic receptor stimulate adenylyl cyclase –>

Glycogen phosphorylase –>

Glycogenolysis

1330
Q

Glycogen synthase

  • pathway
  • regulated by
A

Glucose 1 phospahte –> glycogen

Glycogen synthesis

(+) insulin

1331
Q

Glycogen phosphorylase

  • pathway
  • regulated by
A

Glycogenolysis

Glycogen –> Glucose -1- phosphate

(+) glucagon
(+) Epinephrine
(+) cAMP

1332
Q

Von Gierke

A

Lack of glucose-6-phosphatase

Accumulation of Glucose-6-phosphate in liver

Hepatomegaly, Hypoglycemia

Hyperlipidemia, Hyperuricemia (fat/protein catabolism)
- cant get free glucose have to get energy from fats and proteins

Von GEEK disease

  • Fat
  • No Muscle (hyperuricemia)
  • Fatty liver
1333
Q

Cori Disease

A

Defect in Debranching enzyme (alpha-1,6- glycosidic linkage)

Same symptoms as Von Gierke
Only different is abnormal glycogen structure

Milder hypoglycemia
Hepatomegaly

No elevation in lactate levels
No elevation in uric acid

Cori disease= coral reef

1334
Q

McArdle disease

A

Deficiency in glycogen phosphorylase

Deficiency in Muscle

McArdle= Muscle

Muscle cramps on exertion
Myoglobinuria
Hypoglycemia on exertion

Osmotic pressure from glycogen draws water into cells
Cell lyses –> myoglobin into serum

Rhabdomyolysis

  • -> Myoglobin in blood to kidney
  • -> Myoglobinuria
  • -> Renal failure
1335
Q

Pompe disease

A

Deficiency of alpha-1,4, glucosidase in LYSOSOMES

Infantile form (severe)

  • severe muscle weakness
  • CARDIOMEGALY and heart failure
  • Only live 1 year

Adult form

  • No cardiac involvement
  • Gradual onset of skeletal muscle weakness
  • Diaphragm weakness
  • Respiratory failure

POMPE volcano= build up in volcano, cardiomegaly, explodes

1336
Q

A 2-year-old child with failure to thrive since infancy
now exhibits a seizure. Physical examination shows hepatomegaly
and ecchymoses of the skin. Laboratory studies show
a blood glucose level of 31 mg/dL. A liver biopsy specimen
shows cells filled with clear vacuoles that stain positive for
glycogen. Which of the following conditions is most likely to
produce these findings?
A Hurler syndrome
B McArdle disease
C Pompe disease
D Tay-Sachs disease
E Von Gierke disease

A

E. Von Gierke

Def glucose-6-phosphatase

1337
Q

A 25-year-old woman stops going to her aerobic exercise
class because of severe muscle cramps that have occurred
during every session for the past 2 months. Four hours after
each session, she notices that her urine is a brown color. On
physical examination, she has normal muscle development
and strength. An inherited defect in which of the following
substances is most likely to explain her findings?
A Dystrophin
B Fibrillin
C Glucose-6-phosphatase
D Lysosomal glucosidase
E Muscle phosphorylase
F Spectrin

A

E. Muscle phosphorylase

McArdle

1338
Q

A 6-month-old male infant has failure to thrive and
abdominal enlargement. His parents are concerned that
he has shown minimal movement since birth. On physical
examination, the infant has marked muscle weakness and
hepatosplenomegaly. A chest radiograph shows marked
cardiomegaly. He dies of congestive heart failure at age 19 months. The microscopic appearance of myocardial fibers at autopsy is shown in the figure. A deficiency of which of the
following enzymes is most likely to be present in this infant?
A Glucocerebrosidase
B Glucose-6-phosphatase
C Hexosaminidase A
D Homogentisic acid oxidase
E Lysosomal glucosidase
F Sphingomyelinase

A

E. Lysosomal glucosidase

Pompe

1339
Q

An 8-month-old boy is brought to the pediatrician by his parents because he has recently lost
the ability to crawl or hold his toys. On examination
the patient is tachypneic and breathing with considerable effort; the liver is palpable
fi ve fi ngerwidths below the right costal margin.
X-ray of the chest reveals cardiomegaly. He has
a diffi cult time sitting upright and cannot squeeze the physician’s fi ngers or the ring of
his pacifi er with any noticeable force. Despite
a number of interventions, the child’s symptoms
continue to worsen until his death 2 weeks later. On autopsy, it is likely that this patient’s
cells will contain an accumulation of which of the following substances?
(A) Glucose
(B) Glycogen
(C) Oxaloacetate
(D) Pyruvate
(E) Urea

A

B. Glycogen

Pompe disease

1340
Q

A 14-year-old high school freshman presents to
her family doctor for a sports physical. She has
not played organized sports in the past but is in
good physical shape. She mentions that she experienced
severe leg cramps after trying out for
the soccer team last week. The night after the
tryouts, she noticed that her urine had a reddish
tinge. She has no other medical complaints.
Her physician orders an ischemic forearm
exercise test, which reveals no increase in
venous lactate. Which of the following enzymes
is most likely defi cient in this patient?
(A) Cystathionine synthase
(B) Glucose-6-phosphatase
(C) α-1,6-Glucosidase
(D) Glycogen phosphorylase
(E) Lysosomal α−1,4-glucosidase

A

D. Glycogen phosphorylase

McArdle’s disease

1341
Q

What glycogen storage disease matches

1) Glycogen phosphorylase deficiency
2) Glucose-6-phosphatase deficiency
3) Lactic acidosis, hyperlipidemia, hyperuricemia (gout)
4) Alpha -1,6- glucosidase deficiency
5) alpha-1,4- glucosidase deficiency
6) Cardiomegaly
7) Diaphragm weakness leading to respiratory failure
8) Increased glycogen in liver, severe fasting hypoglycemia
9) Hepatomegaly, hypoglycemia, hyperlipidemia (normal kidneys, lactate, and uric acid)
10) Painful muscle cramps, myoglobinuria with strenuous exercise
11) Severe hepatosplenomegaly, enlarged kidneys

A

1) McArdle
2) Von Gierke
3) Von Gierke
4) Cori disease
5) Pompe
6) Pompe
7) Pompe
8) Von Gierke
9) Cori
10) McArdle
11) Von Gierke

1342
Q

What is the landmark for a pudendal nerve lbock

A

Palpate for ischial spine

1343
Q

Which enzyme catalyzes the RL step in carbohydrate digestion

A

Oligosaccharide hydrolases (at intestinal brush border)

1344
Q

What vitamin deficiency results from Hartnup disease?

A

Deficiency tryptophan –> Niacin deficiency (vit B3)

Pellagra

1345
Q

Electron transport chain steps

Energy required
steps inhibited by

A

1) NADH reductase
(NADH –> NAD)
(Needs 2.5 ATP)

(-) Amytal
(-) Rotenone
(-) MPP

2) Succinate dehydrogenase w/ Coenzyme Q
(Succinate –> fumarate)
(Needs FADH2, 1.5 ATP)

3) Cytochrome b + c1

(-) antimycin A

4) Cytochrome a +a3
(1/2 O2 +2H –> H2O)

(-) CN
(-) N3 -
(-) CO
(-) H2S

5) ATPase
(ADP + Pi –> ATP)

(-) Oligomycin A

1346
Q

Cofactors for Pyruvate Dehydrogenase

A

Pyruvate –> acetyl-CoA

"TLC For Nobody"
Thiamine pyrophosphate (vit B1) 
Lipoid acid
Coenzyme A (vit B5)
FAD- Vit B2
Nad- Vit B3
1347
Q

Garlic breath
Vomiting
Rice water stool

A

Arsenic exposure

Inhibits lipoic acid

No acetyl-CoA for TCA cycle

1348
Q

Pyruvate dehydrogenase deficiency

A

Cant make acetyl CoA

Back up of pyruvate

  • -> Lactate (Lactic acidosis)
  • -> Alanine (neurologic defects)

X linked
Arsenic exposure
B vitamin deficiency

1349
Q

TCA cycle main points

A

Acetyl-CoA –> citrate
(Citrate synthase)

Isocitrate –> alpha ketoglutarate
(isocitrate dehydrogenase)
(NADH + CO2)
RL

a-ketoglutarate –> succinyl-CoA
(a-ketoglutarate dehydrogenase)
(NADH + Co2)
Highly regulated, needs all cofactors as pyruvate dehydrognase

"TLC For Nobody"
Thiamine pyrophosphate (vit B1) 
Lipoid acid
Coenzyme A (vit B5)
FAD- Vit B2
Nad- Vit B3
1350
Q

Uncoupling agents on Electron transport chain

A

Uncouples the electron transport chain from ATPase, so it increases the permeability of inner mitochondria membrane to hydrogen ions, hydrogen ions can leak back in (wasted as heat)

Thermogenin (brown fat, hybernation)
High dose aspirin
2,4-dinitrophenol (2,4-DNP)

1351
Q

What four end products can be made from pyruvate

A

Oxaloacetate
(Pyruvate carboxylase)

Acetyl-CoA
(pyruvate dehydrogenase)

Lactate
( Lactae dehydrogenase)

Alanine
(Alanine Transaminase)

1352
Q

What four B vitamins are needed to make cofactors for pyruvate dehydrogenase

A

B1 (thiamine)
B2 (riboflavin)
B3 (niacin)
B5 (pantothenic acid)

plus lipoic acid

1353
Q

Which TCA cycle enzyme requires the same cofactors as pyruvate dehydrogenase

A

alpha ketoglutarate dehydrogenase

1354
Q

What cofactor is required by all transaminases

A

Pyridoxal phospahte (derivative of vitamin B6)

1355
Q

Two main nitrogen transporters in blood

A

Alanine

Glutamine

1356
Q

Oxidative burst pathway

A

O2 –> O2 (-) superoxide ion
(NADPH oxidase)

O2 (-) –> H2O2 hydrogen peroxide
(Superoxide dismutase)

H2O2 –> (+ Cl) –> HOCl hypochlorous acid
(Myeloperoxidase)

1357
Q

Steps to neutralize H2O2

A

1) React w/ reduced glutathione (antioxidant)
–> glutathione disulfide + H2O
[Glutathione peroxidase]

2) Glutathione disulfide –> GSH
(Need NADPH)
–> GSH + NADP+
[Glutathione peroxidase]

3) NADP+ –> NADPH
(Need G6P)
–> NADPH + 6PG
[ Glucose-6-phosphate dehydrogenase]

1358
Q

Deficiency in G6PD –>

What substances can cause

A

Decrease in NADPH
Decrease in GSH
Cant neutralize H2O2

"Spleen Purges Nasty Inclusions From Damaged Cells"
Sulfonamides
Primaquine
Nitrofurantoin
Isoniazid
Fava beans
Dapsone
Chloroquine
1359
Q

Hemolytic anemia

Bit cells

A

G6PD deficiency

X linked

1360
Q

Build up of fructose in urine

Asymptomatic

A

Essential fructosuria

Deficency of fructokinase

1361
Q 
Hypoglycemic
Vomiting
Hepatomegaly
Jaundice
Elevated Fructose-1-P
A

Fructose intolerance

Deficiency of aldolase B

1362
Q

Infantile cataracts
galactosuria
galactosemia

A

Galactokinse deficiency

Deficiency of galactokinase

Accumulation of galactitol

1363
Q

A 3-month-old infant presents with failure to thrive, poor feeding, and lethargy. A physical
examination reveals an enlarged liver and jaundice. Laboratory analysis reveals an elevated
blood galactitol level and increased urinary reducing
substance. Which of the following could correctly describe the levels of intermediates of galactose metabolism in this patient?
(A) Decreased galactose
(B) Decreased uridine diphosphoglucose
(C) Elevated glucose-1-phosphate
(D) Increased galactose-1-phosphate
(E) Increased glycogen

A

D. Increased galactose-1-phosphate

1364
Q 
Infantile cataracts
Failure ot thrive
Jaundice
Hepatomegaly
Intellectual disability
A

Classic galactosemia

Deficiency of galactose-1-phosphate uridyltransferase

Excess Galactose-1- phosphate
Excess Galactose
Excess Galactitol

1365
Q

RL step of pentose phosphate pathway

A

Glucose 60 phosphate dehydrgenase G6PD

1366
Q

Pentose phosphate pathway

what is it used for
pathway
what tissues use it

A

aka HMP shunt

Provides a source of NADPH from G6P

G6P –>2 NADPH, Ribulose 5P
[ G6PD]

RBCs
Liver
Adrenal cortex
mammary glands (during lactation)

1367
Q

What disorder is caused by a deficiency of each enzyme

1) Galactokinase
2) Aldolase B
3) Lactase
4) Galactose-1- phosphate uridyltransferase
5) Fructokinase

A

1) Galactokinse deficiency
2) Fructose intolerance
3) Lactose intolerance
4) Galactosemia
5) Essential fructosuria

1368
Q

Ketogenesis RL enzyme

A

HMG-CoA synthase

1369
Q

Child super skinny arms and legs, proturbarant belly

A

Kwashiorkor

Protein malnutrition
- Fatty liver disease (cant make ApoB 100)

Edema
Anemia
Skin lesions
Depigmentation

"Flames"
Fatty Liver 
Anemia
Malnutrition
Edema
Skin lesions
1370
Q

Child stick and bones

A

Marasmus

Total energy malnutritoon (protein, fat, carbohydrates)

Muscle wasting
Subcutaneous fat loss

1371
Q

Lipid transport pathway

A

1) Dietary fat broken down
[ Pancreatic lipase]

2) Fat particles absorbed by enterocytes an dpacked into chylomicrons

3) Chylomicrons released with help of Apo-B-48
- W/O = abetalipoprotinemia

4) Chylomicrons pass cells that draw free fatty acids off
[ Lipoprotein Lipase]

5) End up w/ chylomicron remnant –> Liver
6) Liver synthesizes VLDL from remnant
7) VLDL secreted into circulation with help of Apo-B- 100
8) Free fatty acids pulled off VLDL, VLDL becomes IDL
9a) IDL reabsorbed by liver

9b) IDL hydrolyzed further to become LDL
[ Hepatic lipase]

10) LDL reabsorbed by liver or other cells, absorbed by endocytosis by LDL receptor

1372
Q

Apo Proteins

1) Apo-B-48
2) Apo-B-100
3) ApoE
4) ApoA-I
5) ApoC-II

A

1) Helps release of chylomicrons from enterocytes
- Without you get abetalipoprotinemia

2) Helps VLDL secretion into circulation from liver
3) Mediates extra remnant uptake
4) Activates LCAT, found on HDL
5) Cofactor for lipoprotein lipase

1373
Q

HDL pathway

A

1) HDL produced by liver contains Apo-A-I
2) Has increased protein low TG = Nacent HDL

3) Takes up cholesterol
[Lecithin-cholesterol acyltransferase (LCT)]

4) Now HDL-2
Exchanges cholesterol esters for TG with other lipoproteins
[Cholesterol ester transfer protein (CETP)]

5) HDL full
a. Hydrolyzed by Hepatic lipase
b. Travels back to liver, Scavenger receptor B1 (SRB1) pulls of cholesterol esters

1374
Q

Fatty acid metabolism

  • precursor molecule
  • location
  • RL enzymes
A

Precursor: acetyl-CoA
Laction: cytoplasm of hepatocytes
RL: Acetyl-CoA carboxylase

1375
Q

Fatty acid degradation

  • Location
  • RL
  • Two outcomes
A

Mitochondria

Carnitine acyltransferase 1
(carnitine palmitoyltransferase 1)

Build up of ketones or
Move into TCA cycle

1376
Q

Weakness
Hypotonia
Hypoketotic hypogycemia

A

Deficiency of carnitine acyltransferase 1

Accumulation of LCFA into cytopasm
- cant transfer to mitochondria

1377
Q

Abetalipoproteinemia

  • ineritence
  • deficency
  • mutation
  • lipoproteins
  • signs
  • intestinal biopsy
  • peripheral smear
A

AR

Decrease ApoB-48 and ApoB-100

Mutation MTP gene

Decrease chylomicron adn VLDL synthesis and secretion

Steatorrhea
Ataxia
Night blindness

Enterocytes swollen with TGs

Acanthocytosis of RBC
- Misshaped and spiky

1378
Q

Type I hyperchylomicroenemia

  • inheritence
  • deficiency
  • lipoproteins
  • signs
  • extra
A

AR

Lipoprotein lipase deficiency or defective ApoC-11

Increase chylomicrons, TG and cholesterol

Pancreatitis
Hepatosplenomegaly
Pruritic xanthomas

No risk of atherosclerosis

1379
Q

Type IIa familial hypercholesterolemia

  • inheritence
  • defect
  • lipoproteins
  • signs
A

AD

Absent of LDL receptor

Elevated LDL in blood

Tendinous xanthomas (achilles tendon)
Corneal arcus
Accelerated atherosclerosis
MI in 20s

1380
Q

Type IV hypertriglyceridemia

  • inheritence
  • defect
  • lipoproteins
  • signs
A

AD

Overproduction of VLDL

High level of TG

Pancreatitis

1381
Q

A 30-year-old man is diagnosed with type I familial
dyslipidemia. He has had recent laboratory
studies showing elevated triglycerides and
normal cholesterol levels. Which of the following
explains the pathophysiology of this disease?
(A) Apolipoprotein E defi ciency
(B) LDL cholesterol receptor defi ciency
(C) Lipoprotein lipase defi ciency
(D) VLDL cholesterol clearance defi ciency
(E) VLDL cholesterol overproduction

A

C. Lipoprotein lipase deficiency

Type I dyslipidemia

1382
Q

Which apolipoprotein

1) Activates LCAT
2) Mediates chylomicron secretion
3) Mediates VLDL secretion
4) Cofactor for lipoprotein lipase
5) Mediates uptaek of remnant particles

A

1) ApoA-1
2) ApoB-48
3) ApoB-100
4) ApoC-11
5) ApoE

1383
Q

What is the rate limiting enzyme for each pathway

1) Fatty acid synthesis

B) Beta oxidation of FA

3) ketone body synthesis
4) Cholesterol synthesis

A

1) Acetyl-CoA carboxylase
2) Carnithine acyltransferase I
3) HMG CoA synthase
3) HMG CoA reductase

1384
Q

Essential amino acids

A 
"Private (PVT) TIM HaLL"
Phenylalanine
Valine
Threonine
Tryptophan
Isoleucine
Methionine
Histidine
Leucine
Lysine
1385
Q

Basic charged amino acids

A

Lysine
Argine
Histidine (no charge)

1386
Q

Acidic amino acids

A

Aspartate and glutamate

negatively charged

1387
Q

Phenylalanine breakdown

A

1) Phenylalanine –> Tyrosine
(BH4)
[Phenylalanine hydroxylase ]

(-) def –> PKU

2) Tyrosine –> DOPA
(BH4)
[Tyrosine hydroxylase]

(-) def –> parkinson, albinism

3)DOPA –> Dopamine
(Vit B6)
[Dopa decarboxylase

(-) inhibited by carbadopa to tx parkinsons

4) Dopamine –> NE
(Vit C)
[DOPA beta-hydroxylase]

5) NE –> Epi
(SAM)
(+) cortisol

1388
Q

PKU

A

Deficiency of phenylalanine hydroxylase

Deficiency BH4

Musty odor
Intellectual disability
Light skin
Seizure

1389
Q

An 18-month-old, light-skinned African American child
has a developmental delay characterized by mental retardation and inability to walk. The child’s urine has a distinctly
“mousy” odor. On physical examination, there is no lymphadenopathy
or hepatosplenomegaly. Laboratory studies show
hemoglobin, 14 g/dL; platelet count, 302,700/mm3; WBC
count, 7550/mm3; glucose, 80 mg/dL; total protein, 7.1 g/dL;
albumin, 5 g/dL; and creatinine, 0.5 mg/dL. A mutation involving a gene that encodes which of the following enzymes is
most likely to be present in this child?
A Adenosine deaminase
B α1-Antitrypsin
C Galactose-1-phosphate uridyltransferase
D Glucose-6-phosphatase
E Lysosomal acid maltase
F Phenylalanine hydroxylase
G Sphingomyelinase

A

F. PKU

1390
Q 
A woman gives birth to a full term baby. Upon delivery, the baby is small and has a musty odor. Upon questioning the woman says that she did not smoke or drink alcohol during the pregnancy, and she only drinks diet soda and water. Which of the following amino acids is most likely to be deficient in the newborn?
(A) Alanine
(B) Cysteine
(C) Glutamine
(D) Phenylalanine
(E) Proline
(F) Serine
(G) Tyrosine
A

G. Tyrosine

PKU

1391
Q

Deficency of DOPA beta hydroxylase

A 
Excess dopamine
Deficiency NE and Epi
Nasal congestion
Ptosis
Orthostatic hypotension
1392
Q

Precursor for

1) Arginine
2) Tryptophan
3) Histidine
4) Glutamate
5) Glycine

A

1) Arginine –>
Creatine
Urea
Nitric oxide

2) Tryptophan
Niacin –> NAD/NADP (req B6)
Serotonin –> Melatonin

3) Histidine –>
Histamine (req B6)

4) Glutamate –>
GABA (Req B6)
Glutathione

5) Glycine –>
Porphyrin (Req B6) –> Heme

1393
Q

Deficency of Vit B6 –>

A

Lack of inhibition

–> seizures

1394
Q

RL enzyme of urea cycle

A

Carbamoyl phosphate 1 (CPS-1)

Mitochondria

1395
Q

Urea cycle

A

CPS-1 in mitochondria
RL step

Ornithine transcarbamylase
- carbamoyl phosphate –> citrulline

1396
Q

Ornithine Transcarbamylase deficiency

A

Most common urea cycle disorder

X linked

Cant undergo urea cycle
- build up nitrogen and ammonia

Excess carbamoyl phosphate
–> orotic acid

Orotic acid in blood and urine

Decreased VUN
Hyperammonemia

Child
Slurring speech
Vomiting
Cerebral edema
Blurring vision
Hepatoencephalopathy
1397
Q

A 9-month-old boy is brought to the emergency
department after his mother is unable to rouse
him. His past medical history is signifi cant for
the onset of seizures at the age of 4 months and
for a delay in reaching developmental milestones.
On examination, the patient is found to
have poor muscle tone and an enlarged liver.
Laboratory studies show a blood urea nitrogen
level of 3.2 mg/dL, a creatinine level of 0.4 mg/
dL, and a serum ammonia level of 300 mg/dL.
A plasma amino acid analysis fails to detect citrulline,
while his urinary orotic acid level is increased.
This patient suffers from a defi ciency
of which of the following enzymes?
(A) Argininosuccinate lyase
(B) Carbamoyl phosphate synthetase II
(C) Glutamate dehydrogenase
(D) Ornithine transcarbamoylase

A

D. Ornithine trasncarbamoylase

1398
Q

What does each cell secrete

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

A

1) G cells
- Gastrin

2) I cells
- CCK

3) S cells
- secretin

4) D cells
- Somatostatin

5) Parietal cells
- Gastric acid & intrinsic factor

1399
Q

A 35-year-old man presents to the physician with arthritic pain in both knees along with back pain. He states that the pain has been
present for months. In an effort to obtain relief, he has taken only aspirin, but this has been of
little benefit. The patient is afebrile, and his slightly swollen knee joints are neither hot nor tender to palpation; however, the pain does restrict his motion. The cartilage of his ears appears slightly darker than normal. No tophi are
present. A urine specimen is taken for analysis of uric acid content and turns black in the laboratory
while standing. A defect in which of
the following is the most likely underlying cause of the patient’s condition?
(A) Galactokinase
(B) Homogentisic acid oxidase
(C) α-Ketoacid dehydrogenase
(D) Orotate phosphoribosyltransferase
(E) Phenylalanine hydroxylase

A

B. Homogentisate Oxidase

Alkaptonuria
- Deficiency of homogentisate oxidase

AR

Build up homoentic acid in urine

Darkens CT and urine
Arthralgias

1400
Q

A 6-year-old girl is found to be nearsighted during
a vision screening at school, and the school nurse tells the parents the child should be fitted
for corrective lenses. Her mother is upset because her daughter is already much taller than her classmates, has an awkward gait, and was recently diagnosed with scoliosis. She is afraid that the glasses will only add to her
daughter’s problems at school, where her classmates frequently tease her. When the ophthalmologist observes that the patient’s right lens is dislocated, he suspects that her symptoms are in fact related to an enzyme deficiency. As a result of this deficiency, which of the following amino acids is essential in this patient’s diet?
(A) Cysteine
(B) Lysine
(C) Methionine
(D) Tryptophan

A

A. Cysteine

Homocystinuria

Homocysteine –> cystathionine

  • Deficency of cystathionine synthase
  • decreased affinity of cystathionine synthase for Bit B6

Homocysteine –> Methionine

  • Deficiency of homocysteine methyltransferase
  • Deficiency of Vit B12
1401
Q 
Intellectual disability
Tall stature
Osteoporosis
Kyphosis
Atherosclerosis
Subluxation of lens (down ward)
A

Homocystinuria

1402
Q

The mother of a 16-month-old girl is concerned because she noticed that her daughter
became lethargic and irritable 2 days after an ear infection. The mother recalls periodically
noticing sweet-smelling urine in her child’s diaper but that otherwise her development has
been normal. An inability to metabolize which of the following would explain these symptoms?
(A) Glucosylceramide
(B) Histidine
(C) Phenylalanine
(D) Sphingomyelin
(E) Tyrosine
(F) Valine

A

F. Valine

Maple syrup urine disease

Urine smells like maple syrup (sweet)

Deficiency of branched chain alpha-ketoacid dehydrogenase complex
- build up of branched chain amino acids

“I LoVe Maple Syrup”

  • Isoleucine
  • Leucine
  • Vaine

Intellectual deficiencies
Severe CNS defects
High mortality

1403
Q

39-year-old woman presents to the physician with complaints of itchy skin and diarrhea. On
examination, the patient appears slightly confused and is having trouble remembering what she did earlier in the day. A physical examination shows that the patient has a large, deeply pigmented tongue with thickened papillae. On
further questioning, it is discovered that the patient
has been taking isoniazid for suspected tuberculosis infection. Which of the following
supplements should this patient take?
(A) Ascorbic acid
(B) Biotin
(C) Folic acid
(D) Niacin
(E) Ribofl avin
(F) Thiamine
(G) Vitamin D

A

D. Niacin

Patient has Pellagra

1404
Q

Patient presents to office with itchy skin and diarrhea. She is confused to the day. Examination shows an large deeply pigmented tongue.

Genetic cause

A

Hartnup disease

AR

Defective neutral aminoacid transporter

Tryptophan not absorbed

No Niacin

Pellagra

1405
Q

What goes with there

1) homogentisic acid oxidase deficency
2) Alpha ketoacid dehydrogenase def
3) Tyrosine def
4) Decreased tryptophan
5) Phenylalanine hydroxylase def
6) Cystathionine synthase def
7) B6 def
8) COLA def
9) Tetrahydrobiopterin def
10) Decreased Niacin
11) Sweet smelling urine
12) Musty smell
13) Dark urine
14) Increased skin cancer
15) Lens dislocation
16) Cystine stones

A

1) Alkaptonuria
2) Maple syrup urine
3) Albinism
4) Hartnup
5) PKU
6) Homocystinuria
7) Homocystinuria
8) Cystinuria
9) PKU
10) Hartnup
11) Maple syrup urine
12) pKU
13) Alkaptonuria
14) Albinism
15) Homocystinuria
16) Cystinuria

1406
Q

Ferritin

A

Storage form of iron

Acute phase reactant
- Alot of inflammation release ferritin to bind up iron so bacteria cant use it

1407
Q

Transferrin

A

Transport ferric molecules

Increased in iron deficiency

1408
Q

Zinc

  • use
  • deficency
A

Healing
Imune system
Carbonic anhydrase
- CO2 –> bicarb

Delayed wound healing
Decrase body and facial hair
Hypogonadism
Decreased ability to smell
Decreased taste
Rash around eyes, mouth, nose, anus
Impaired night vision
Infertility
1409
Q

Lead poisoning

A 
Decreased IQ
Hearing problems
Growth impairment
Wrist/ foot drop
Lead lines
Anemia

Basophilic stippling

Tx: Chelating agent
- succimer or EDTA

Pediatric
- dimercaprol + succimer

1410
Q

Basophilic stippling

Ringed sideroblasts

A

Lead poisoning

1411
Q

Mecury poisoning affects

Key feature

A

Kidneys and brain

Acrodynia: peeling of fingertips

1412
Q

Acrodynia

A

Peeling of fingertips

Kawaski disease
Mercury posoning

1413
Q

Fat soluble vitamins

Absrobed in

A

Vit AdEK

ileum

1414
Q

Sarcoidosis and vit D

A

Increases coversion of 25-OH Vit D –> 1,25 (OH2) Vit D

Hypercalcemia

1415
Q

Vit K does post-translational modification of what clotting factors

A

“diSCo started in 1972”

Protein S
Protein C
Clotting factor 10, 9, 7 and 2

1416
Q

Vit E

  • fxn
  • deficency
A

Antioxidant
Prevents free radials on RBCs

Deficiency
- hemolytic anemia
- Spinocerebellar degeneration 
(ataxia)
- peripheral neuropathy
- proximal muscle weakness
1417
Q

Vit C

  • fxn
  • deficiency
A

Hydroxyaltion of prolyl and lysyl residues of collagen

Required for dopamine –> NE
[Dopamine beta hydroxylase]

Antioxidant

Iron absorption in gut

Deficiency

  • cant make collagen
  • scurvy
1418
Q

Differential diagnosis for eosinophilia

A

CANADA-P

Collagen vascular disease
Atopic disease
Neoplasma
Adison disease
Drugs
Acute interstitial nephritis
Parasites
1419
Q

Vit B1

A

Thiamine

Deficiency

  • Wernicke-Korsakoff
  • Beriberi
1420
Q

A 9-month-old infant has failure to thrive following a
premature birth with low birth weight. The infant has chronic
cholestatic hepatobiliary disease. The infant is now at the
40th percentile for height and the 25th percentile for weight creased
vibration and pain sensation, muscle weakness, and
abnormalities of eye movement. Laboratory studies show hemoglobin,
9.2 g/dL; hematocrit, 27.6%; MCV, 86 μm3; platelet
count, 208,000/mm3; WBC count, 6080/mm3; total protein,
6.4 g/dL; albumin, 3.4 g/dL; glucose, 70 mg/dL; and creatinine,
0.3 mg/dL. A deficiency of which of the following vitamins
is most likely to contribute to these findings?
A Vitamin A
B Vitamin B1
C Vitamin B3
D Vitamin B12
E Vitamin C
F Vitamin E
G Vitamin K

A

F. Vitamin E

1421
Q

The symptoms of thiamine defi ciency were
fi rst described over 4,000 years ago. In adults,
these symptoms commonly include polyneuropathy
of the distal extremities, resulting in
paresthesias and motor dysfunction. In addition
to neuropathy, how else can isolated thiamine
defi ciency present in adults?
(A) Chronic infection
(B) Convulsions, hyperirritability, and jaundice
(C) Excessive diarrhea, dermatitis, and dementia
(D) Kidney failure
(E) Peripheral edema and congestive heart
failure

A

(E) Peripheral edema and congestive heart
failure

BeriBeri

1422
Q

Beriberi

Dry vs wet

A

Thiamine deficiency

Dry Beriberi
- peripheral neuropathy
(toe drop, wrist drop, foot drop)
- Muscle weakness
- Hyporeflexia or areflexia

Wet Beriberi

  • Peripheral vasodilation
  • High output heart failure
  • peripheral edema
  • cardiomegaly
1423
Q

Vit B2

A

Riboflavin
FMN and FAD

Cofactors for redox reactions

Deficiency

  • Dermatitis
  • Cheilosis
  • Glossitis
1424
Q

Vit B3

A

Niacin
NAD and NADP
Redox reactions
Derived from Tryptophan

Deficiency
- pellagra

1425
Q

Vit B5

A

Pantothenate
Component of coenzyma A

Fxn in transfer of acyl groups

Deficiency
-dermatitis
Enteritis
-alopecia-adrenal insufficiency

1426
Q

Vit B6

A

pyridoxine

coenzyme for transaminations and deaminations
Conversion of AA precursors

Deficiency
- cheilosis
-glossitis
- convulsions **
(B6 essential for GABA) 
-Peripheral neuropathy
1427
Q

Vit B7

A

Biotin

Apoenzyme for caboxylation rxns

1428
Q

Vit B9

A

Folic acid

Synthesis and repair of DNA
Rapid cell division and growth

Tetrahydrofolate

Deficiency
- Meds (phenytonin, sulfonamides, TMP, MTX)

Neural tube defect
Megaloblastic anemia

Glossitis
Diarrhea
Depression
Confusion

1429
Q

Megaloblastic anemia

A

RBC large
Macrocytic anemia

Hypersegmented neutrophils

Folate and B12

1430
Q

Vit B12

A

Cobalamin

Need Intrinsic factor to be absorbed in duodenum

Cofactor w/ homocysteine methyltransferase –> THF

Deficiency
- Anemia
Ataxia
Paresthesias
Memory loss
Dementia

Vegetarians
Pernicious anemia

1431
Q

A patient presents with convulsions and irritability, what vitamin deficiency

A

Vitamin B6

1432
Q

Which vitamin deficiency

1) Peripheral neuropathy, glossitis
2) Neural tube defects
3) Dermatitis, diarrhea, dementia
4) Megaloblastic anemia
5) Pernicious anemia

A

1) B12, B6
2) Folic acid (B9)
3) B3
4) B12 or folic acid (B9)
5) B12

1433
Q

Tumor markers for pancreatic cancer

A

CA 19-9

CEA (also elevated in gastric and colon cancer)

1434
Q

Uses cAMP and protein kinase A as secondary messengers

A 
FSH
LH
ACTH
TSH
hCG
MSH
GHRH, CRH
PTH, Calcitonin
Glucagon
V2 Vasopressin receptor
1435
Q

Uses IP3 as second messenger

A

GnRH
TRH
Oxytocin
V1 vasopressin receptor

1436
Q

Uses tyrosine kinase receptor as second messenger

A 
Growth hormone
Prolactin
Inulin
insulin-like growth factor
Platelet derived growth factor
Fibroblast growth factor
Cytokines
1437
Q

Uses cGMP as secondary messenger

A

Nitric oxide

Atrial natriuetic peptide

1438
Q

Uses steroid receptors as second messenger

A 
Estrogen, progesterone, testosterone
Glucocorticoids
Aldosterone
Thyroid hormone
Vitamin D
1439
Q

What are the two nervous tissue bundles that run through the GI tract and where re they located

A

Meissner plexus: submucosa

Auerbach’s plexus: between layers of the muscularis propria

1440
Q

What disesases specifically damage tehn aterior horn?

A

Polio
West nile virus
ALS
Werdnig-Hoffman dis (spinal muscular atrophy)

1441
Q

ACTH is synthesized as part of

A

Large precursor called POMC

1442
Q

POMC contains

A

Lipotropin
MSH
beta-endorphin

1443
Q

Somatostatin fxn

A

Reduces splanchnic blood flow
Reduces GI motility adn GB contraction
Inhibits secretion of most GI hormones

1444
Q

Sheehan syndrome

A

Postpartum hemorrhage leading to underperfusion of the pituitary

Pituitary necrosis and hypopituitarism

Agalactorrhea
Amonorrhea after delivery
Hypothyroidism

1445
Q

Pituitary

Anterior lobe forms from
- type of cells

Posterior lobe

  • forms from
  • type of cells
A

Anterior lobe

  • forms from rathke’s pouch
  • ectodermal diverticulum

Posterior lobe
- forms from invagination of the hypothalamus

  • neuroectoderm
1446
Q

What increases ADH

What decreases ADH

A

Increase ADH

  • Nicotine
  • Opiates

Decrease ADH
- Ethanol
Atrial natriuretic factor
- decreased serum osmolarity

1447
Q

What hormones share a common alpha subunit

A

FSH
LH
TSH
hCG

1448
Q

what do type II pneumocytes need to mature

A

Cortisol

1449
Q

Adrenal cortex from

Adrenal medull afrom

A

Cortex= mesoderm

Medulla= ectoderm

1450
Q

Tumor in adrenal medulla of kids

Causes?

A

Adrenal neuroblastoma

Sustained HTN

1451
Q

Deficiency in 21 alpha hydroxylase

A

Masculization
Hypotension

Cant make aldosterone or cortisol

Hypotension
Hyponatremia
HYPERkalemia

High 1-OH progesterone

Cortisol deficiency –> increase ACTH, hyperplasia of adrenal glands

Most common

1452
Q

Deficiency in 11b- hydroxylase

A

Masculization
Hypertension

Build up of 11-deoxycorticosterione
Still have mineralocorticoid properties

Cortisol deficiency –> increase ACTH, hyperplasia of adrenal glands

1453
Q

Deficiency of 17a- hydroxylase

A

HTN
Ambiguous genitalia

Can only make mineralocorticoids
Salt and H20 retention

Hypokalemia

Cortisol deficiency –> increase ACTH, hyperplasia of adrenal glands

1454
Q

3beta-hydroxysteroid dehydrogenase deficiency

A 
Inability to produce
- Glucocorticoids
Mineralocorticoids
Androgens
Estrogens

Excessive sodium

Early death

Ambigous genitalia

1455
Q

Adrenal steroids are made from

A

Cholesterol

1456
Q

Dexamethasone suppression test, high dose works on

A

ACTH-producing pituitary tumor

1457
Q

Cortisol effect on bones and immune system

A

Reduces bone formation –> osteoporosis

Suppress immune system

1458
Q

Waterhouse-Friderichsen syndrome

A

Acute primary adrenal insufficiency due to adrenal hemorrhage

  • Severe meningococcal sepsis
  • DIC

Petechial rash

Coagulopathy

1459
Q

Primary adrenal insufficiency deficient in

Tx

A

Cortisol and aldosterone

Tx: glucocorticoid

1460
Q

Conn syndrome

A

Aldosterone-secreting adrenal tumor

Hyperaldosteronism

HTN
Hypokalemia
Metabolic alkalosis

Decrease in Renin levels

1461
Q 
Hypotension
Hyponatremia
Hyperkalemia
Fatigue
Anorexia
Weight loss
Hyperpigmentation
A

Primary adrenal insufficiency (addison disease)

1462
Q

A 42-year-old woman has had increasing weakness,
nausea, vomiting, watery diarrhea, and a 5-kg weight loss
over the past 7 months. She has generalized muscle weakness,
muscle wasting, and increased skin pigmentation on physical
examination. After an upper respiratory tract infection lasting
1 week, she develops abdominal pain and faintness and lapses
into a coma. Her temperature is 36.9° C, pulse is 83/min, respirations
are 17/min and shallow, and blood pressure is 80/40
mm Hg. Laboratory findings show Na+, 129 mmol/L; K+, 3.5
mmol/L; Cl−, 95 mmol/L; CO2, 23 mmol/L; glucose, 48 mg/
dL; and creatinine, 0.6 mg/dL. Atrophy of which of the following
tissues is most likely to be present?
A Adrenal cortex
B Hypothalamus
C Islets of Langerhans
D Parafollicular C cells in thyroid
E Pineal gland
F Thyroid epithelium

A

A. Adrenal cortex

1463
Q

A 55-year-old man has experienced increasing lethargy
for the past 7 months. Physical examination shows hyperpigmentation of the skin. Vital signs include temperature
of 36.9° C, pulse of 70/min, respirations of 14/min, and
blood pressure of 95/65 mm Hg. Laboratory studies include a
serum cortisol level of 3 μg/mL at 8:00 AM with a serum corticotropin
level of 65 pg/mL. Which of the following diseases
most often occurs in patients with this disorder?
A Type 2 diabetes mellitus
B Classic polyarteritis nodosa
C Hashimoto thyroiditis
D Systemic lupus erythematosus
E Ulcerative colitis

A

C. Hashimoto thyroiditis

Addison disease

1464
Q

A 44-year-old woman has become increasingly listless
and weak and has had chronic diarrhea and a 5-kg weight loss
over the past 7 months. She also notices that her skin seems
darker, although she rarely goes outside because she is too
tired for outdoor activities. On physical examination, she is
afebrile, and her blood pressure is 85/50 mm Hg. A chest radiograph
shows no abnormal findings. Laboratory findings
include serum Na+, 120 mmol/L; K+, 5.1 mmol/L; glucose,
58 mg/dL; urea nitrogen, 18 mg/dL; and creatinine, 0.8 mg/
dL. The serum corticotropin level is 82 pg/mL. Which of the
following is most likely to account for these findings?
A Adenohypophyseal adenoma
B Autoimmune destruction of the adrenals
C Pancreatic neuroendocrine tumor
D Metastatic carcinoma with lung primary
E Neisseria meningitidis infection of the adrenals
F Sarcoidosis of the lung and adrenals

A

B Autoimmune destruction of the adrenals

1465
Q

30 y.o man undergoing an evaluation for hypertension. Has a history of multiple episodes of hypokalemia. Lab shows a potassium of 3.0 despite replacement and metabolic alkalosis. What is the cause of HTN?

A

Primary hyperaldosteronism

1466
Q

Which causes of vaginal discharge/ vaginitis are associated iwth a high vaginal pH?

Wjocj are associated iwth a low vaginal pH?

A

Low vaginal pH
- physiologic dischrage
Candida

High vaginal pH
- gardnerella
Trichomonas

1467
Q

Erythropoietin=secreting tumors

A

Pheochromocytoma
Renal cell carcinoma
Hemangioblastoma (vascular tumor of CNS)
Hepatocellular carcinoma

1468
Q

Neuroblastoma

  • tumor of
  • type of cells
  • see in
  • causes
  • associated with
  • histology
  • tumor marker
A

Home Wright rosettesTumor of the adrenals
Tumor of sympathetic ganglion cells

Most common tumor of adrenal medulla in children

Mild HTN

N-myc oncogene

Homer Wright rosettes

Bombesin tumor marker

1469
Q

Homer Wright rosettes

A

Adrenal neuroblastoma

1470
Q

N-myc oncogene

A

Adrenal neuroblastoma

AM- STEP1 (20 decks)

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