DIT Warm-up Questions

Question 1

What embryonic structure (derived from the hypoblast) serves as a secondary energy source?

Answer 1

Endodermal Yolk Sac

Question 2

What embryonic structure serves as a reservoir of nonspecialized (undifferentiated) stem cells

Answer 2

Endodermal Yolk Sac

Question 3

What are the 3 germ layers that derive from the epiblast

Answer 3

Endoderm, Mesoderm, and Ectoderm

Question 4

1. What is the embryologic origin of the tissue just proximal to the pectinate line? 2. What is the origin of the tissue just distal to the anal canal?

Answer 4

1. Endoderm 2. Surface exctoderm

Question 5

What effect might the following teratogens have on the developing fetus? 1. ACE inhibitors 2. Aminoglycosides 3. Diethylstilbestrol 4. Tetracyclines 5. Valproic Acid

Answer 5

1. Renal abnormalities 2. Ototoxicity 3. Clear cell carcinoma of the vagina 4. discoloration of the teeth 5. neural tube defects

Question 6

Which vitamin should not be supplemented in large amounts during pregnancy?

Answer 6

Vitamin A because it can cause cleft palate and cardiac defects

Question 7

Which amino acids are found in nuclear localization signals

Answer 7

Lysine, Arginine, and Proline

Question 8

What is the most common cause of mental retardation in infants?

Answer 8

Fetal Alcohol syndrome

Question 9

How do Rb and p53 regulate the cell cycle?

Answer 9

They prevent the cell from progressing from G1 to S phase

Question 10

During What weeks of fetal development does organogenesis take place?

Answer 10

Weeks 3-8

Question 11

What molecules provide the structural framework for DNA and the nuclear envelope?

Answer 11

Nuclear Lamins

Question 12

What is deficient in I-cell disease?

Answer 12

The phototransferase enzyme is absent and so it doesnt put Mannose-6-Phosphate on proteins that are supposed to go to the lysosome

Question 13

What drug inhibits the cellular sodium-potassium ATPase?

Answer 13

Digoxin

Question 14

What drugs interfere with microtubule functioning

Answer 14

1. Vincristine and Vinblastine 2. Paclitaxel 3. Colchicine 4. Griseofulvin 5. Mebendazole and Thiobendazole

Question 15

Which cell types are constantly regenerating themselves due to an absences of the G0 phase and a short G1 phase?

Answer 15

Labile cells - found in skin, hair follicles, and bone marrow

Question 16

What are the characteristic features of a cell undergoing apoptosis?

Answer 16

1.Nuclear and cellular shrinkage 2. Pyknosis (basophilia) 3. Karyorrhexis (fading of the nucleus) 4. Karyolysis (fading of the nucleus) 5. Apoptotic bodies 6. Membrane blebbing

Question 17

What are some of the substances that can trigger apoptosis?

Answer 17

1. Deprivation of cell signals (growth factors) 2. Cell stress 3. DNA repair process fails -> p53 triggers apoptosis 4. Cytokines (TNF) 5. Cytotoxic T-cells insert Granzyme B

Question 18

What neural crest derivatives are found in each of the following adult structures? 1. Peripheral Nervous System 2. Ear 3. Eye 4. Adrenal Gland 5. Mouth 6. Heart 7. Digestive Tract 8. Thyroid 9. Skin

Answer 18

1. Peripheral Nervous System - Dorsal root ganglia, cranial nerves, schwann cells, ANS 2. Ear - Bones of the inner ear 3. Eye - Structures of the anterior chamber 4. Adrenal Gland - Chromaffin cells 5. Mouth - Teeth 6. Heart - Aorticopulmonary septum 7. Digestive Tract - Enteric nervous system, celiac ganglion, enterochromaffin cells 8. Thyroid - Parafollicular cells 9. Skin - Melanocytes

Question 19

What protein is involved in transporting an endocytosed vesicle from the plasma membrane to the endosome?

Answer 19

Clathrin

Question 20

Which metals are known to facilitate the generation of oxygen free radicals

Answer 20

Iron and Copper

Question 21

Which tumor suppressor proteins prevent the progression of the cell into S phase?

Answer 21

Rb and p53

Question 22

What is the underlying in Chedak-Higashi Syndrome?

Answer 22

Defect in microtubule polymerization causing defects in lysosome and phagosome formation

Question 23

How does having a high cholesterol content in the plasma membrane affect the function of the plasma membrane?

Answer 23

Decreases fluidity, increases melting temperature

Question 24

What area of the colon is the most susceptible to ischemic damage?

Answer 24

Watershed area of the splenic flexure

Question 25

What adult cell types arise from neural crest cells?

Answer 25

1. ANS 2. Celiac Ganglia 3. Dorsal root ganglia 4. Schwann cells 5. Pia 6. Arachnoid 7. Odontoblasts (dentin of teeth) 8. Melanocytes 9. Thyroid & Laryngeal cartilage 10. Aorticopulmonary septum

Question 26

Which amino acids are modified in the golgi apparatus?

Answer 26

Serine, threonine, and Asparagine

Question 27

Failure of what process results in I-cell disease?

Answer 27

Adding mannose-6-phosphate to lysosome enzymes

Question 28

What organelle becomes hypertrophied in hepatocytes with chronic phenobarbital use?

Answer 28

Smooth endoplasmic reticulum

Question 29

What enzyme mitigates the aging effects of cellular division by maintaining chromosomal length?

Answer 29

Telomerase

Question 30

What is currently known as the most effective way of prolonging life span?

Answer 30

Calorie restriction

Question 31

Which neurotransmitters have altered levels in anxiety disorder?

Answer 31

1. GABA is decreased 2. Serotonin is decreased 3. Norepinephrine is increased

Question 32

What arachidonic acid product has actions that opposed that of prostacyclin?

Answer 32

Thromboxane A2 (increases platelet aggregation, increases vascular tone, increases bronchial tone)

Question 33

What organelle and cytochrome are particularly important in intrinsic apoptosis?

Answer 33

Mitochondria releases cytochrome c

Question 34

What effect might aminoglycosides have on a developing fetus?

Answer 34

Ototoxicity

Question 35

What molecule targets proteins in the endoplasmic reticulum for lysosomes?

Answer 35

Mannose-6-phosphate

Question 36

Which amino acids are found in nuclear localization signals?

Answer 36

Lysine, Arginine, and Proline

Question 37

What brain structure is responsible for extraocular movements during REM sleep?

Answer 37

Paramedian Pontine Reticular Formation (PPRF)

Question 38

Name the 7 most testable teratogens

Answer 38

1. Tetracycline 2. Valproic Acid 3. Phenytoin 4. ACE inhibitors 5. Warfarin 6. Excessive vitamin A 7. Lithium

Question 39

Which areas of the hypothalamus regulate the autonomic nervous system?

Answer 39

Anterior (parasympathetic) and posterior (sympathetic) nuclei

Question 40

Which cranial nerve is responsible for each of the following actions? 1. Eyelid opening 2. Taste from anterior 2/3 of tongue 3. Head turning 4. Tongue movement 5. Muscles of mastication 6. Balance 7. Monitoring carotid body and sinus chemo- and baroreceptors

Answer 40

1. Eyelid opening: CN III 2. Taste from anterior 2/3 of tongue: CN VII 3. Head turning: CN XI 4. Tongue movement: CN XII 5. Muscles of mastication: CN V 6. Balance: CN VIII 7. Monitoring carotid body and sinus chemo- and baroreceptors: CN IX

Question 41

A woman involved in a n accident cannot turn her head to the left and has a right shoulder drop. What structure is damaged?

Answer 41

Damage to the right-sided sternocleidomastoid is responsible for the inability to turn her head. The right spinal accessory nerve innervates these actions

Question 42

During what sleep stage would a man have variable BP, penile tumescence, and variable EEG

Answer 42

REM

Question 43

1. Which collagen is typically deficient in Ehlers-Danlos syndrome? 2. In Osteogenesis Imperfecta?

Answer 43

1. Type I or Type III 2. Type I

Question 44

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

Answer 44

Rb and p53

Question 45

What cranial nerves innervate the tongue in the following ways? 1. Taste in the anterior 2/3 2. Taste in the posterior 1/3 3. Motor 4. Sensation in the anterior 2/3 5. Sensation in the posterior 1/3

Answer 45

1. Taste in the anterior 2/3: CN VII 2. Taste in the posterior 1/3: CN IX 3. Motor: CN XII 4. Sensation in the anterior 2/3: CN V3 5. Sensation in the posterior 1/3: CN IX

Question 46

What are the symptoms of excess parasympathetic activity?

Answer 46

“DUMBBELSS” 1. Diarrhea 2. Urination 3. Miosis 4. Bradycardia 5. Bronchospasm 6. Excitation of skeletal muscle 7. Lacrimation 8. Salivation 9. Sweating

Question 47

Atropine is not effective in reversal of organophosphate poisoning. What drug would best help this patient?

Answer 47

Pralidoxime

Question 48

What are the components of the blood-brain barrier?

Answer 48

1. Capillary endothelial cells w/ tight junctions 2. Basement membrane 3. Astrocyte foot processes

Question 49

Which agents are often used in the treatment of urge incontinence?

Answer 49

1. Oxybutinin 2. Tolterodine 3. Trospium 4. Darifenacin 5. Solifenacin

Question 50

What group of genes is responsible for skeletal development?

Answer 50

Hox genes

Question 51

Which cell types are derived from neural crest?

Answer 51

1. Autonomic nervous system 2. Schwann cells 3. Parafollicular cells 4. Chromaffin cells 5. Celiac ganglia 6. Dorsal root ganglia 7. Odontoblasts 8. Cranial nerves 9. Pia & Arachnoid Mater 10. Bones of the skull 11. Thyroid & Laryngeal Cartilage 12. Aorticopulmonary septum

Question 52

Which cytokine is particularly important in maintaining granulomas?

Answer 52

TNF-alpha

Question 53

What is the function of the lysosome?

Answer 53

Break down cellular waste & debris

Question 54

Outline the pathway by which stimulation of a Gq receptor activates Protein Kinase C

Answer 54

Activation of Gq -> Activation of Phospholipase C -> Conversion of lipids to PIP2 -> PIP2 breaks down into IP3 and DAG -> DAG activates Protein Kinase C

Question 55

A gardener presents with shortness of breath, salivation, miosis, and diarrhea. What caused this? what is the mechanism of action?

Answer 55

This was caused by organophosphate poisoning (inhibition of acetylcholinesterase) -> Causing excess acetylcholine -> causing cholinergic stimulation of muscarinic receptors

Question 56

What enzyme catalyzes the conversion of tyrosine to dopa?

Answer 56

Tyrosine Hydroxylase

Question 57

A 30 year-old schizophrenic man now has urinary retention due to his neuroleptic. What do you treat it with?

Answer 57

Urinary retention is caused by anticholinergic effects of many neuroleptics. Treat with cholinergic agonists like bethanechol

Question 58

What is the precursor molecule of ACTH synthesis?

Answer 58

Pro-opiomelanocortin (POMC)

Question 59

What is required for a molecule to enter into the nucleus through a nuclear pore?

Answer 59

A nuclear localization signal: A 4-8 AA sequence rich in Lysine, Proline, and Arginine

Question 60

What are the various clinical applications of atropine?

Answer 60

1. Decrease airway secretions 2. pupillary dilation & cycloplegia 3. Decrease gut motility 4. Decrease stomach acid secretion 5. Decrease urgency/bladder spasms

Question 61

What are the symptoms of inhibiting parasympathetic activity?

Answer 61

1. Hot as a Hare (Increased temperature)
2. Red as a beet (Peripheral vasodilation)
3. Dry as a bone (Decreased secretions)
4. Blind as a bat (Mydriasis & cycloplegia)
5. Mad as a hatter (Agitation/delirium)
6. Bloated as a toad (Constipation/urinary retention)

Question 62

Outline the pathway for the generation of norepinephrine from tyrosine

Answer 62

1. Phenylalanine -> Tyrosine (catalyzed by phenylalanine hydroxylase)
2. Tyrosine -> Dopa (catalyzed by tyrosine hydroxylase)
3. Dopa -> Dopamine (catalyzed by Dopa carboxylase with cofactor B6)
4. Dopamine -> Norepinephrine (Catalyzed by Dopamine beta-hydroxylase with cofactor vitamin C)
5. Norepinephrine -> Epinephrine (Catalyzed by Phenylethanolamine-N-Methyltransferase)

Question 63

What hormones arise from the anterior pituitary?

Answer 63

1. ACTH
2. FSH
3. LH
4. GH
5. TSH
6. Prolactin
7. MSH (Melanotropin)

Question 64

What hormone has the following actions?

1. Stimulates milk secretion during lactation
2. Stimulates metabolic activity
3. Increases blood glucose level and decreases protein synthesis
4. Stimulates ovulation in females and testosterone synthesis in males

Answer 64

1. Stimulates milk secretion during lactation: Oxytocin
2. Stimulates metabolic activity: Thyroid hormone
3. Increases blood glucose level and decreases protein synthesis: Cortisol
4. Stimulates ovulation in females and testosterone synthesis in males: LH

Question 65

What enzymes are used in the catabolism of norepinephrine?

Answer 65

1. Monoamine Oxidase (MAO)
2. Catechol-O-Methyltransferase (COMT)

Question 66

A 50-year-old woman complains of double vision, amenorrhea, and headaches. What is the most likely diagnosis?

Answer 66

Prolactinoma

Question 67

1. What are the symptoms of organophosphate poisoning?
2. What are the symptoms of atropine overdose?

Answer 67

1. Diarrhea, urination, miosis, bronchospasm, bradycardia, excitation of skeletal muscle, lacrimation, salivation, sweating
2. Hot as a hare, red as a beet, blind as a bat, mad as a hatter, dry as a bone, bloated as a toad

Question 68

What are the 3 different G proteins and what are their downstream effects? Which receptors use these G proteins?

Answer 68

1. Gq: H1, alpha1, V1, M1, M3 - Phospholipase C -> Protein Kinase C
2. Gs: B1, B2, D1, V2, - Increase adenylyl cyclase -> Increase Protein Kinase A
3. Gi: M2, alpha2, D2 - Decrease adenylyl cyclase -> Decrease Protein Kinase A

Question 69

What regulates prolactin secretion from the pituitary?

Answer 69

1. Dopamine and Prolactin inhibit prolactin secretion
2. TRH increases prolactin secretion

Question 70

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

Answer 70

GABA and it is decreased in anxiety and Huntington Disease

Question 71

What are the classic presenting symptoms of syringomyelia?

Answer 71

Bilateral loss of pain and temperature sensation in the upper extremities. On rare occaisons, hand muscle weakness can occur

Question 72

What drug inhibits the cellular sodium-potassium ATPase?

Answer 72

Digoxin

Question 73

What category does the following drug belong to?

Norepinephrine

Answer 73

Sympathomimetic (a1, a2, b1 agonist)

Question 74

What category does the following drug belong to?

Metoprolol

Answer 74

beta-blocker (B1 selective)

Question 75

What category does the following drug belong to?

Timolol

Answer 75

Beta-blocker (B2=B1)

Question 76

What category does the following drug belong to?

Scopolamine

Answer 76

Cholinergic agonist

Question 77

What category does the following drug belong to?

Phenoxybenzamine

Answer 77

Alpha-adrenergic antagonist

Question 78

What category does the following drug belong to?

Bethanechol

Answer 78

Direct cholinergic agonist

Question 79

What category does the following drug belong to?

Isoproterenol

Answer 79

Sympathomimetic (B1=B2)

Question 80

What category does the following drug belong to?

Donepezil

Answer 80

Indirect cholinergic agonist (anticholinesterase)

Question 81

What category does the following drug belong to?

Prazosin

Answer 81

Alpha-adrenergic antagonist

Question 82

What category does the following drug belong to?

Atropine

Answer 82

Cholinergic antagonist

Question 83

What category does the following drug belong to?

Propranolol

Answer 83

Beta-blocker (B2=B1)

Question 84

What category does the following drug belong to?

Labetalol

Answer 84

Beta-blocker (B2=B1) & alpha-blocker

Question 85

What category does the following drug belong to?

Hexamethonium

Answer 85

Nicotinic antagonist

Question 86

What category does the following drug belong to?

Atenolol

Answer 86

Beta-blocker (B1 selective)

Question 87

What category does the following drug belong to?

Terbutaline

Answer 87

Sympathomimetic (B2 agonist)

Question 88

What category does the following drug belong to?

Dopamine

Answer 88

Sympathomimetic (D1 = D1 > B1 > a1 agonist)

Question 89

What category does the following drug belong to?

Pilocarpine

Answer 89

Direct cholinergic agonist

Question 90

What category does the following drug belong to?

Carbachol

Answer 90

Direct cholinergic agonist

Question 91

What category does the following drug belong to?

Edrophonium

Answer 91

Indirect cholinergic agonist (anticholinesterase)

Question 92

What category does the following drug belong to?

Phenylephrine

Answer 92

Sympathomimetic (a1>a2 agonist)

Question 93

What category does the following drug belong to?

Glycopyrrolate

Answer 93

Cholinergic antagonist

Question 94

What category does the following drug belong to?

Phentolamine

Answer 94

Alpha-adrenergic antagonist (alpha-blocker)

Question 95

What category does the following drug belong to?

Neostigmine

Answer 95

Indirect cholinergic agonist (anticholinesterase)

Question 96

What category does the following drug belong to?

Benztropine

Answer 96

Cholinergic antagonist

Question 97

What category does the following drug belong to?

Terazosin

Answer 97

Alpha-adrenergic antagonist (alpha-blocker)

Question 98

What category does the following drug belong to?

Pralidoxime

Answer 98

Cholinesterase regenerator

Question 99

What category does the following drug belong to?

Echothiopate

Answer 99

Indirect cholinergic agonist (anticholinesterase)

Question 100

What category does the following drug belong to?

Ipratropium

Answer 100

Cholinergic antagonist

Question 101

What category does the following drug belong to?

Epinephrine

Answer 101

Sympathomimetic (a1, a2, B1, B2 agonist)

Question 102

What category does the following drug belong to?

Esmolol

Answer 102

Beta-blocker (B1 selective)

Question 103

What category does the following drug belong to?

Oxybutynin

Answer 103

Cholinergic antagonist

Question 104

What category does the following drug belong to?

Doxazosin

Answer 104

Alpha-adrenergic antagonist (alpha-blocker)

Question 105

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

Answer 105

1. Lateral nucleus is inhibited by leptin
2. Ventromedial nucleus is stimulated by leptin

Question 106

Which cranial nerve relays the following types of information?

1. Hypoxia measured by the carotid body
2. Motor information for swallowing
3. Blood pressure from the aortic arch
4. Salivation from the sublingual glands
5. Salivation from the parotid gland
6. Blood pressure from the carotid

Answer 106

1. Hypoxia measured by the carotid body: CN IX
2. Motor information for swallowing: CN IX & X
3. Blood pressure from the aortic arch: CN X
4. Salivation from the sublingual glands: CN VII
5. Salivation from the parotid gland: CN IX
6. Blood pressure from the carotid: CN IX

Question 107

What primary hormone is increased or decreased in the following diseases?

1. Cushing Syndrome
2. Conn Syndrome
3. Addison Disease

Answer 107

1. Cushing Syndrome: Increased Cortisol
2. Conn Syndrome: Increased Aldosterone
3. Addison Disease: Decreased Aldosterone & Decreased Cortisol

Question 108

What is the drug of choice for anapylactic shock? Cardiogenic shock? Septic shock?

Answer 108

1. anapylactic shock: Epinephrine
2. Cardiogenic shock: Dobutamine
3. Septic shock: Norepinephrine

Question 109

What cancers are associated with RET gene mutation?

Answer 109

1. MEN 2a
2. MEN 2b
3. Medullary & Papillary Thyroid carcinoma

Question 110

In the dark, both pupils are dilated, but in the light, the control pupil is miotic while the pupil given drug X remains mydriatic. What is drug X?

Answer 110

1. Sympathetic agonist - Epinephrine
2. Cholinergic antagonist - Atropine

Question 111

What are some of the clinical uses for Somatostatin?

Answer 111

1. Treat pituitary excess - Acromegaly, Tumors secreting TSH or ACTH
2. Treat GI endocrine excess - Carcinoid syndrome, Zollinger-Ellison syndrome, VIPoma, Glucagonoma, Insulinoma
3. Treat Diarrhea
4. Reduce splanchnic blood circulation - cirrhosis w/ bleeding esophageal varices, bleeding peptic ulcers

Question 112

What is the name given to a thyroid hormone-secreting teratoma?

Answer 112

Struma Ovarii

Question 113

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

1. Extremely tender thyroid gland
2. Palpation of single thyroid nodule
3. Palpation of multiple thyroid nodules
4. Recent study using IV contrast dye (iodine)
5. Eye changes (proptosis, edema, injection)

Answer 113

1. Extremely tender thyroid gland: Subacute (De Quervain) Thyroiditis
2. Palpation of single thyroid nodule: Toxic thyroid adenoma
3. Palpation of multiple thyroid nodules: Toxic multinodular goiter
4. Recent study using IV contrast dye (iodine): Jod-Basedow Phenomenon
5. Eye changes (proptosis, edema, injection): Graves disease

Question 114

What are the differences between Oligodendroglia and Schwann cells?

Answer 114

Oligodendroglia: Located in CNS and can myelinate many axons

Schwann Cells: Located in PNS and can myelinate only one axon

Question 115

Describe the sensory innervation of the tongue

Answer 115

Anterior 2/3:

1. Sensation: V3
2. Taste: VII

Posterior 1/3:

1. Sensation: IX
2. Taste: IX (X senses tast at the most posterior part of the tongue)

Question 116

A 48 year-old woman has been suffering with progressive lethargy and extreme sensitivity to cold temperatures. What is the most likely diagnosis?

Answer 116

Hypothyrodism most commonly caused by Hashimoto’s Thyroiditis

Question 117

What is the most common salivary gland tumor?

Answer 117

Pleomorphic Adenoma

Question 118

What are the different sinuses that can become infected and cause sinusitis?

Answer 118

1. Frontal sinus
2. Maxillary sinus
3. Ethmoid sinus
4. Sphenoidal sinus

Question 119

What are the various clinical uses for the following sympathomimetics?

1. Dopamine
2. Clonidine
3. Amphetamine
4. Terbutaline
5. Epinephrine

Answer 119

1. Dopamine: Treat shock
2. Clonidine: Treat hypertension (especially in hypertensive emergencies), treat renal disease
3. Amphetamine: Treat ADHD, cause weight loss, treat daytime sleepiness, treat narcolepsy, treat major depressive disorder
4. Terbutaline: Treat asthma, treat tocolysis (it decreases uterine contractility)
5. Epinephrine: Treat anaphylactic shock

Question 120

Where can you find nicotinic acetylcholine receptors in the body?

Answer 120

1. Neuromuscular junction
2. Autonomic ganglion

Question 121

What structures are derived from the branchial pouches?

Answer 121

1. 1st pouch: Mastoid air cells, middle ear cavity, eustachian tubes
2. 2nd pouch: Lining of the palatine tonsil
3. 3rd pouch: Thymus, inferior parathyroids
4. 4th pouch: Superior parathyroids

Question 122

What are the common side effects of Beta-blockers?

Answer 122

1. Bronchospasm
2. Bradycardia
3. Depression of myocardial contractility (may trigger CHF)
4. Increase blood glucose
5. Mask sympathetic symptoms of hypoglycemia

Question 123

What is the medication of choice for the treatment of atrial fibrillation due to hyperthyroidism?

Answer 123

1. Beta-blocker (propranolol)
2. Nondihydropyridine calcium channel blocker (Diltiazem)
3. Treat hyperthyroidism (Methimazole, radioactive iodine etc.)

Question 124

What is the precursor molecule of ACTH synthesis?

Answer 124

Pro-opiomelanocortin (POMC)

Question 125

What gene complex gives rise to a protein that initiates VDJ recombination in B and T cell develpment?

Answer 125

Recombination activating gene complexes (RAG) -> RAG-1 & RAG-2

Question 126

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

Answer 126

Type 1: Bone, tendon, dentin, skin, fascia, cornea

Type 2: Cartilage, vitreous body

Type 3: Blood vessels, granulation tissue, uterus, fetal tissue

Type 4: Basement membrane

Question 127

What medication inhibits the cellular sodium potassium ATPase? What is its clinical application?

Answer 127

Digoxin (Cardiac glycoside): Mostly used in CHF but can be used to control atrial fibrillation

Question 128

What are the mRNA stop codons?

Answer 128

1. UGA: “U Go Away”
2. UAA: “U Are Away”
3. UAG: “U Are Gone”

Question 129

What substance inhibits RNA polymerase II in eukaryotes causing liver damage?

Answer 129

Alpha-amanitin: Found in Amanita Phalloides (Death Cap mushrooms)

Question 130

Which amino acids are modified by the golgi apparatus?

Answer 130

1. Serine
2. Threonine
3. Asparagine

Question 131

What medications are known for having anticholinergic side effects?

Answer 131

1. Typical neuroleptics - Thioridazine & Chlorpromazine
2. 1st generation antihistamines - Diphenhydramine & Hydroxazine
3. Tricyclic Antidepressants - Amytriptyline
4. Amantadine

Question 133

Describe the usefulness of the dexamethasone test

Answer 133

It differentiates between pituitary ACTH production and ectopic ACTH production

1. Normal individuals: Low dose Dexamethasone = Cortisol suppression
2. Ectopic ACTH-producing tumor or Cortisol-producing Adrenal tumor: Low & high Dexamethasone = Cortisol remains high
3. ACTH-producing Pituitary tumor: High dose Dexamethasone = Cortisol suppression

Question 134

What enzyme of the adrenal steroid synthesis pathway is inhibited by ketoconazole?

Answer 134

Desmolase

Question 135

What names are given to monocytes in other tissues of the body?

1. Blood, alveoli, intestines
2. Connective tissue
3. Liver
4. Kidney
5. Brain
6. Bone

Answer 135

1. Blood, alveoli, intestines: Macrophages
2. Connective tissue: Histiocytes
3. Liver: Kupffer cells
4. Kidney: Mesangial cells
5. Brain: Microglia
6. Bone: Osteoclasts

Question 136

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

Answer 136

Cyclins and Cyclin Dependent Kinases (CDKs)

Question 137

What structural motifs allow for proteins to bind to DNA?

Answer 137

1. Leucine zipper
2. Helix-turn-helix
3. Helix-loop-helix
4. Zinc finger

Question 138

What hematological changes would you expect to see in a patient without a functional spleen?

Answer 138

1. Howell Jolly Bodies within RBCs
2. Target cells
3. Thrombocytosis

Question 139

What are the different RNA polymerases in eukaryotes?

Answer 139

RNA polymerase I: Transcribes rRNA

RNA polymerase II: Transcribes mRNA

RNA polymerase III: Transcribes tRNA

Question 140

In what disorder is there an abnormal breakdown of elastin?

Answer 140

Alpha 1-Antitrypsin deficiency - Leads to emphysema in a young patient

Question 141

1. What enzyme is responsible for tRNA charging?
2. What enzyme catalyzes peptide bond formation?

Answer 141

1. Aminoacyl-tRNA synthetase
2. Peptidyltransferase

Question 142

Which cytokines are secreted by the two different types of helper T cells?

Answer 142

1. Th1: IL-2, IFN-gamma
2. Th2: IL-4, IL-5, IL-10, IL-13

Question 143

What substances are utilized by natural killer cells to induce apoptosis in other cells?

Answer 143

Perforin and Granzymes

Question 144

Which type of collagen is abnormal in Alport Syndrome?

Answer 144

Type IV

Question 145

Which type of collagen is abnormal in Ehlers-Danlos Syndrome

Answer 145

Type III most commonly

Question 146

What are the mRNA stop codons?

Answer 146

UGA, UAA, UAG

Question 147

1. What agents stimulate the release of NE from the presynaptic bouton?
2. What agents potentiate the action of NE by inhibiting its reuptake into the presynaptic cel from the synaptic cleft?

Answer 147

1. Amphetamine, Ephedrine, Tyramine
2. Cocaine, Tricyclic antidepressants

Question 148

What immunopathology matches each of the following statements?

1. Antimitochondrial antibodies
2. Antiplatelet antibodies
3. Newborn with chronic diarrhea, failure to thrive and chronic Candida
4. Child with eczema, course facial features, and cold abscesses
5. Child with partial albinism, peripheral neruopathy, and recurrent infections

Answer 148

1. Antimitochondrial antibodies: Primary biliary cirrhosis
2. Antiplatelet antibodies: Idiopathic thrombocytopenic purpura (ITP)
3. Newborn with chronic diarrhea, failure to thrive and chronic Candida: Severe combined immunodeficiency (SCID)
4. Child with eczema, course facial features, and cold abscesses: Hyperimmunoglobulin E syndrome
5. Child with partial albinism, peripheral neruopathy, and recurrent infections: Chediak-Higashi Disease

Question 149

1. Which hormones use steroid receptors?
2. Which hormones use tyrosine kinase receptors?

Answer 149

1. Estrogen, progesterone, testosterone, aldosterone, vitamin D, T3 & T4, Glucocorticoids
2. Insulin, insulin-like growth factor (IGF-1), Fibroblast growth factor (FGF), platelet derived growth factor, prolactin, growth hormone

Question 150

What are the clinical features of osteogenesis imperfecta?

Answer 150

1. Brittle bones with multiple fractures
2. Hearing loss
3. Blue sclera
4. Dental problems

Question 151

What drugs are composed of antibodies against TNF?

Answer 151

Infliximab and Adalimumab

Etanercept inhibits TNF but is a decoy receptor, not and antibody

Question 152

How is hnRNA processed before it leaves the nucleus?

Answer 152

1. 5’ cap
2. 3’ poly-A tail
3. Removal of introns (splicing)

Question 153

1. Which HIV medications cause pancreatitis?
2. Which cause rash?
3. Which cause peripheral neuropathy?
4. Which cause lactic acidosis?

Answer 153

1. Ritonavir and NRTIs (especially Didanosine)
2. NNRTIs and Abacavir (hypersensitivity)
3. Didanosine
4. NNRTIs (except Abacavir)

Question 154

What is the mechanism of type IV hypersensitivity?

Answer 154

Sensitized T-lymphocytes come across antigen and release lymphokines. This is T-cell mediated delayed type hypersensitivity

Question 155

What birth defects can result from each of the following teratogenic agents?

1. ACE inhibitors
2. Folate antagonists
3. Tetracyclines
4. Lithium

Answer 155

1. ACE inhibitors: Renal damage
2. Folate antagonists: Neural tube defects
3. Tetracyclines: Discolored teeth
4. Lithium: Ebstein anomaly (a congenital heart defect in which the septal leaflet of the tricuspid valve is displaced towards the apex of the right ventricle of the heart)

Question 156

To what immune cell do each of the following cell surface proteins belong?

1. CD4
2. CD14
3. CD16
4. CD19
5. CD3
6. CD8

Answer 156

1. CD4: Helper T cells
2. CD14: Macrophages
3. CD16: Macrophages & NK cells
4. CD19: B cells
5. CD3: All T cells except NK cells
6. CD8: Cytotoxic T cells

Question 157

What are the clinical uses for the following antimuscarinic drugs?

1. Ipratropium
2. Atropine, homatropine, tropicamide
3. Benztropine
4. Scopolamine

Answer 157

1. Ipratropium: Asthma & COPD
2. Atropine, homatropine, tropicamide: Induce mydriasis
3. Benztropine: Parkinsons Disease
4. Scopolamine: Motion sickness

Question 158

Distinguish the following types of organ transplant rejection

1. Hyperacute
2. Acute
3. Chronic

Answer 158

1. Hyperacute: Preformed anti-donor antibodies. Occurs within minutes
2. Acute: Cell-mediated immunity. Occurs within weeks
3. Chronic: Antibody-mediated vascular damage. Occurs in months/years

Question 159

What is the classic clinical presentation of a thyroglossal duct cyst?

Answer 159

1. Asymptomatic midline neck mass
2. Moves with swallowing
3. < age 30
4. Can become infected so removal is indicated

Question 160

What conditions are associated with an elevated ESR (erythrocyte sedimentation rate)?

Answer 160

Nonspecific for infection, inflammation, and neoplasm but especially occurs in the following:

1. Osteomyelitis
2. Polymyalgia rheumatica
3. Temporal arteritis
4. Rheumatoid diseases

Question 161

What is the clinical use for tiotropium?

Answer 161

COPD

Question 162

How does the drug dose response curve change with the addition of a competitive antagonist compared to a noncompetitive antagonist?

Answer 162

Competitive antagonist shifts the curve to the right, increasing the Km (decreasing potency) without changing the Vmax (efficacy)

Noncompetitive antagonist shifts the curve down, decreasing the Vmax (efficacy) without affecting the Km (potency)

Question 163

Which autoimmune disorder matches each of the following descriptions?

1. Anti-TSH receptor antibodies
2. Antimitochondrial antibodies
3. Anticentromere antibodies
4. Antihistone antibodies
5. Anti-smooth muscle antibodies

Answer 163

1. Anti-TSH receptor antibodies: Graves Disease
2. Antimitochondrial antibodies: Primary biliary cirrhosis
3. Anticentromere antibodies: CREST scleroderma
4. Antihistone antibodies: Drug-induced lupus
5. Anti-smooth muscle antibodies: Autoimmune hepatitis

Question 164

Which receptors use a Gs protein?

Answer 164

D1, B1, B2, V2, H2

Question 165

Which immunosuppressant fits each of the following descriptions?

1. Derivative of 6-mercaptopurine
2. Causes phocomelia
3. Nephrotoxic in 75% of patients
4. Side effect: acne, osteoporosis, HTN, hyperglycemia, immunosuppression->infection
5. Inhibits secretion of IL-2 and other cytokines
6. Alkylating agent that requires bioactivation in liver
7. Inhibits dihydrofolate reductase

Answer 165

1. Derivative of 6-mercaptopurine: Azathioprine
2. Causes phocomelia (malformation of the limbs): Thalidomide
3. Nephrotoxic in 75% of patients: Cyclosporine
4. Side effect: acne, osteoporosis, HTN, hyperglycemia, immunosuppression->infection: Glucocorticoids
5. Inhibits secretion of IL-2 and other cytokines: Tacrolimus & Cyclosporine
6. Alkylating agent that requires bioactivation in liver: Cyclophosphamide
7. Inhibits dihydrofolate reductase: Methotrexate

Question 166

Which alpha adrenergic antagonists are used in the treatment of pheochromocytoma?

Answer 166

Phenoxybenzamine or Phentolamine

Question 167

How is hnRNA processed before it leaves the nucleus?

Answer 167

1. 5’ cap
2. 3’ poly A tail
3. Removal of introns

Question 168

What is the competitive antagonist in cases of benzodiazepine overdose?

Answer 168

Flumazenil

Question 169

What are the two nervous tissue bundles that run through the GI tract, and where are they located?

Answer 169

Auerbach plexus (Myenteric plexus): Outer layer of the muscularis externa

Meissner’s plexus: Submucosa

Question 170

A child has an immune disorder in which there are repeated Staph abscesses. It is found that the neutrophils fail to respond to chemotactic stimuli. What is the most likely diagnosis?

Answer 170

Job (Hyper IgE) syndrome: No response to IFN-gamma stimuli

Question 171

What are the tumor markers for pancreatic cancer?

Answer 171

CEA: Less specific as it is elevated w/ gastric and colon cancer

CA 19-9: More specific

Question 172

1. Where would you expect to find B cells and T cells in the spleen?
2. In the lymph nodes?

Answer 172

Spleen

1. B cells: White matter follicles
2. T cells: Periarterial lymphatic sheath (PALS)

Lymph node

1. B cells: Cortex follicles
2. T cells: Paracortex

Question 173

What drug categories have each of the following endings?

1. -ane
2. -azine
3. -tidine
4. -tropin
5. -chol
6. -bendazole
7. -azepam
8. -conazole
9. -triptyline
10. -zosin
11. -stigmine
12. -dipine

Answer 173

1. -ane: Inhaled anesthetics
2. -azine: Phenothiazine neuroleptics
3. -tidine: H2 blockers
4. -tropin: Pituitary hormones
5. -chol: Cholinergic agonists
6. -bendazole: Antihelminthic
7. -azepam: Benzodiazepines
8. -conazole: Azole antifungals
9. -triptyline: Tricyclic antidepressants
10. -zosin: Alpha 1 blockers
11. -stigmine: Acetylcholinesterase inhibitors
12. -dipine: Dihydropyridine Ca channel blockers

Question 174

What effect will a noncompetitive antagonist have on Vmax and Km?

Answer 174

It will decrease Vmax (efficacy) without affecting the KM (potency)

Question 175

What is the name given to a thyroid hormone-producing teratoma?

Answer 175

Struma Ovarii

Question 176

A 45 year-old woman complains of malar rash and arthritis. The presence of which antibodies are specific for SLE?

Answer 176

Anti-dsDNA & Anti-Smith antibodies

Question 177

To which lymph nodes does cancer in each of the following areas most commonly metastasize?

1. Stomach
2. Duodenum, jejunum
3. Sigmoid colon
4. Rectum
5. Testes
6. Scrotum

Answer 177

1. Stomach: Celiac nodes
2. Duodenum, jejunum: Superior mesenteric nodes
3. Sigmoid colon: Colic nodes
4. Rectum: Iliac lymph nodes -> Inferior mesenteric lymph nodes
5. Testes: Para-aortic nodes
6. Scrotum: Superficial inguinal nodes

Question 178

1. What is the cause of achalasia?
2. How is achalasia diagnosed?

Answer 178

1. Loss of the myenteric (Auerbach) plexus -> Lower esophageal sphincter is unable to relax
2. Diagnosed with a barium swallow (shows bird beak sign) or manometry (measures pressure in the esophagus)

Question 179

Name 5 drugs that inhibit acetylcholinesterase. What is the clinical application for each?

Answer 179

1. Neostigmine: Treatment for Myasthenia Gravis, Ileus, and urine retention
2. Pyridostigmine: Treatment for Myasthenia Gravis (Longer half life than edrophonium and neostigmine)
3. Physostigmine: Treatment for Glaucoma
4. Echothiophate: Treatment for Glaucoma
5. Edrophonium: Diagnosing Myasthenia Gravis

Question 180

A mother brings in her 2 year-ol child who has had multiple viral and fungal infections and is found to by hypocalcemic. Which of the 3 types of germ cells (ecto-, endo-, and mesoderm) gives rise to the missing structure?

Answer 180

This is DiGeorge Syndrome which results in aplasia of the thymus. This is caused by a failure of the endodermal pouches to develop

Question 181

1. What is the characteristic DNA sequence of the promoter region?
2. What does a mutation in the sequence cause?

Answer 181

1. Minus 25 TATA box (Hogness box) and Minus 75 CAAT box
2. Decreases the amount of gene transcribed

Question 182

1. Which type of collagen is used in “slippery” tissues?
2. Which is used in “bloody” tissues?

Answer 182

1. Slippery = Type II = Cartilage & vitreous body
2. Bloody = Type III = Blood vessels, granulation tissue, skin, uterus, fetal tissue

Question 183

What are the five 2s of a Meckel diverticulum?

Answer 183

• 2 feet from ileocecal valve
• 2 inches in size
• presents < age 2
• Affects 2% of the population
• 2 types of ectopic tissue (Gastric and pancreatic epithelium)

Question 184

What effect will stimulating the following receptors have on heart rate?

1. Beta 1:
2. Beta 2:
3. Muscarinic 2:

Answer 184

1. Beta 1: Increase
2. Beta 2: Increase (vasodilation causes reflex tachycardia)
3. Muscarinic 2: Decrease

Question 185

What is the treatment for Zollinger-Ellison Syndrome?

Answer 185

Proton pump inhibitors

Sporadic gastrinoma - surgical resection

Metastatic gastrinoma - Somatostatin analogs, interferon, chemotherapy, radiotherapy

Question 186

What are the arterial branches off of the common hepatic artery?

Answer 186

1. Gastroduodenal artery: Gives rise to the right gastro-omental (gastroepiploic) artery and anterior superior pancreaticoduodenal artery
2. Right Gastric artery
3. Proper Hepatic artery

Question 187

What cell type secretes the histamine that stimulates the histamine receptor on parietal cells thereby increasing gastric acid production?

Answer 187

Enterochromaffin-like cells (ECL cells)

Question 188

An infant presents to the ER with vomiting. What presenting features would lead you to suspect congenital pyloric stenosis?

Answer 188

1. Non-biliary projectile vomiting
2. Palpable olive-like bulge on abdominal exam
3. Metabolic alkalosis (hypokalemic, hypochloremic)
4. Age 2-6 weeks old
5. Males > Female (often 1st born male)
6. Dehydration

Question 189

What are the different RNA polymerases in eukaryotes?

Answer 189

1. Rna Polymerase I: Makes rRNA
2. Rna Polymerase II: Makes mRNA
3. Rna Polymerase III: Makes tRNA

Question 190

In which order of elimination (zero or first) would you see a linear decrease in the plasma concentration of a substance when plotted against time?

Answer 190

Zero order

Question 191

What is the equation for Gibbs free energy?

Answer 191

^G = ^H - t^S

Question 192

What are the features of Plummer-Vinson Syndrome?

Answer 192

1. Glossitis
2. Iron deficiency anemia
3. Dysphagia due to esophageal web

Question 193

Explain why methanol is such a toxic substance.

Answer 193

Methanol is metabolized to formaldehyde which causes metabolic acidosis and retinal damage/blindness

Question 194

A woman commonly develops intense muscle cramps and darkening of her urine after exercise. What is her diagnosis?

Answer 194

Type V Glycogen Storage Disorder (McArdles Disease)

Question 195

What substances are well known for causing hemolytic anemia in patients with G6PD deficiency?

Answer 195

1. Fava beans
2. Sulfa drugs
3. Primaquine
4. Isoniazid
5. High-dose aspirin
6. Ibuprofen
7. Nitrofurantoin
8. Dapsone
9. Naphthalene

Question 196

What are the 4 important pharmacokinetic equations?

Answer 196

1. Vd = Amount of IV substance given / concentration in serum
2. Clearance = (0.7 x Vd) / t1/2
3. Loading dose = Concentration at steady state x Vd
4. Maintainance dose = Concentration at steady state x Clearance

Question 197

What is seen histologically in patients with celiac sprue?

Answer 197

1. Blunted (shortened) Villi
2. Hyperplastic (deepened) Crypts
3. Lymphocytes in the lamina propria

Question 198

1. What co-factors are required for the function of pyruvate dehydrogenase?
2. What other enzyme requires the same co-factors?

Answer 198

1. “Tender Loving Care For No-one”

• Thiamine Pyrophosphate
• Lipoic Acid
• CoA (Vitamin B5 or Pantothenic acid)
• FAD (Vitamin B2 or Riboflavin)
• NAD (Vitamin B3 or Niacin)

2. Alpha-Ketoglutarate Dehydrogenase

Question 199

What medications are used to shrink prolactinomas?

Answer 199

Bromocriptine or Cabergoline

Question 200

What are the functions of interleukins 1-5?

Answer 200

“HOT T-BONE stEAk”

IL-1: Pyrogen that causes fever and mediates acute inflammation

IL-2: T-cell stimulation

IL-3: Bone marrow stimulation

IL-4: Stimulates IgE

IL-5: Stimulates IgA and Eosinophils

Question 201

What immunodeficiency matches each of the following statements?

1. Neutrophils fail to respond to chemotactic stimuli
2. Adenosine deaminase deficiency
3. Failure of endodermal development
4. Defective Tyrosine Kinas gene
5. Associated with high levels of IgE

Answer 201

1. Neutrophils fail to respond to chemotactic stimuli: Job Syndrome (Hyper IgE syndrome) or Leukocyte Adhesion Deficiency Syndrome
2. Adenosine deaminase deficiency: Severe Combined Immunodeficiency (SCID)
3. Failure of endodermal development: DiGeorge Syndrome
4. Defective Tyrosine Kinas gene: Bruton Agammaglobulinemia
5. Associated with high levels of IgE: Job (Hyper IgE) Syndrome - also associated with high levels of eosinophils

Question 202

How does hexokinase differ from glucokinase?

Answer 202

Hexokinase

1. Not induced by insulin
2. Low Km
3. Low Vmax
4. Located throughout the body

Glucokinase

1. Induced by insulin
2. High Km
3. High Vmax
4. Located throughout the body

Question 203

What is the mechanism of action of each of the followin drug categories?

1. Protease inhibitors
2. Nucleoside Reverse Transcriptase Inhibitors
3. Non-Nucleotide Reverse Transcriptase Inhibitors
4. Fusion Inhibitors

Answer 203

1. Protease inhibitors: Inhibit viral assembly, blocks the protease enzyme from cleaving viral proteins into their component structures
2. Nucleoside Reverse Transcriptase Inhibitors: Nucleoside analogs that competitively inhibit reverse transcriptase, preventing downstream incorporation of viral genome into the host DNA
3. Non-Nucleotide Reverse Transcriptase Inhibitors: Noncompetitive, irreversible inhibition or reverse transcriptase, preventing downstream incorporation of viral genome into the host DNA
4. Fusion Inhibitors: Bind viral protein gp41 and inhibit viral fusion with CD4 cells

Question 204

After loss of his job, a 35 year-old man has diarrhea and hematochezia (Fresh blood in stool). Intestinal biopsy shows transmural inflammation. What is the diagnosis?

Answer 204

Crohns Disease

Question 205

What effect will a competitive antagonist have on efficacy and potency?

Answer 205

1. It will raise the Km (decrease the potency)
2. It will not affect the Vmax (no change in efficacy)

Question 206

What effect does stress have on adipocytes?

Answer 206

1. Stress -> increased sympathetic tone -> activation of hormone-sensitive Triglyceride lipase in fat cells -> rapid breakdown of TGs and mobilization of fatty acids
2. Stress -> Anterior pituitary release of ACTH -> Adrenal cortex secretes more glucocorticoids -> Stimulates lipase

Question 207

1. What is the result of a glycolitic enzyme deficiency?
2. What is the result of a deficiency in pyruvate dehydrogenase?

Answer 207

1. RBC hemolysis
2. Neurological defects

Question 208

Which substances serve as chemotactic agents for leukocytes?

Answer 208

1. C5a
2. Leukotriene B4
3. IL-8
4. Kallikrein

Question 209

1. What enzyme is inhibited by PPIs?
2. Name two different PPIs?

Answer 209

1. Hydrogen/potassium ATPase
2. Omeprazole, Lansoprazole, Pantoprazole, Esomeprazole

Question 210

What cocktail of medications is commonly taken by patients suffering from severe cirrhosis?

Answer 210

Lactulose: Treats encephalopathy by reducing ammonia

Vitamin K: To maximize clotting potential

Diuretics: To reduce ascites/edema

Beta-blockers: To prevent bleeding from esophageal varices

Question 211

1. What is the cause of chronic granulomatous disease?
2. What are the consequences of chronic granulomatous disease?

Answer 211

1. Lack NADPH oxidase activity

• Phagocytes can engulf bacteria but cannot generate free radicals
• Impotent phagocytes

2. Susceptibility to opportunistic infections

• S. Aureus
• Samonella
• Klebsiella
• Aspergillus

Question 212

1. Which immunoglobulin isotype is associated with eosinophilia?
2. Which cytokine is associated with differentiation of eosinophils?

Answer 212

1. IgE
2. IL-5

Question 213

What are the 3 most common types of thyroid cancer?

Answer 213

1. Papillary Carcinoma
2. Follicular Carcinoma
3. Medullary Carcinoma

Question 214

What are the side effects of orlistat?

Answer 214

1. Steatorrhea
2. GI discomfort
3. Reduced absorption of fat-soluble vitamins

Question 215

What are the arterial branches off of the celiac trunk?

Answer 215

1. Left gastric
2. Splenic
3. Common hepatic
   
   • Gastroduodenal
     
     • Anterior Superior Pancreaticoduodenal
     • Right Gastro-omental (Right Gastroepiploic)
   • Right Gastric
   • Proper Hepatic

Question 216

A 2 year-old girl has increase in abdominal girth, failure to thrive, and skin/hair depigmentation. What is her diagnosis?

Answer 216

Kwashiorkor (skin/hair depigmentation is a major clue)

Question 217

What enzyme is deficient in each of the following diseases?

1. Fructose intolerance
2. Essential fructoseuria
3. Classic galactosemia

Answer 217

1. Fructose intolerance: Aldolase B
2. Essential fructoseuria: Fructosuria
3. Classic galactosemia: Galactose-1-phosphate uridyl/transferase

Question 218

What structures run through the cavernous sinus?

Answer 218

CN III, IV, V₁, V₂, VI

Question 219

Which three enzymes are required to convert phenylalanine to DOPA?

Answer 219

1. Phenylalanine Hydroxylase
2. Tyrosine Hydroxylase
3. Dihydropterin Reductase

Question 220

What are the byproducts of MAO and COMT enzymatic activity on dopamine, norepinephrine, and epinephrine?

Answer 220

1. Dopamine: Homovanyllic Acid (HVA)
2. Norepinephrine: Vanillyl Mandelic Acid (VMA)
3. Epinephrine: Metanephrine

Question 221

What substrate and cofactor is required for the generation of GABA?

Answer 221

Glutamate + B6

Question 222

What effect does changing Km and Vmax have on potency and efficacy?

Answer 222

Km is inversely proportional to potency

Vmax is directly proportional to efficacy

Question 223

What are the 4 main pharmacokinetic equations?

Answer 223

1. Vd = (Amount given in IV form)/(Serum concentration)
2. CL = (0.7 x Vd)/(t1/2)
3. LD = Css x Vd
4. MD = Css x CL

Question 224

1. What enzyme is deficient in PKU?
2. What are the symptoms?

Answer 224

1. Phenylalanine Hydroxylase
2. Symptoms
   
   • Musty body odor
   • Growth retardation
   • Mental retardation
   • Seizures
   • Eczema
   • Fair skin

Question 225

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

1. Glycolysis
2. Gluconeogenesis
3. TCA cycle
4. Glycogen synthesis
5. Glycogenolysis

Answer 225

1. Glycolysis: Phophofructokinase
2. Gluconeogenesis: Fructose-1,6-Bisphosphatase
3. TCA cycle: Isocitrate Dehydrogenase
4. Glycogen synthesis: Glycogen Synthase
5. Glycogenolysis: Glycogen Phosphorylase

Question 226

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

1. Lactic acidosis is a rare but worrisome side effect
2. Most common side effect is hypoglycemia
3. MOA: Closes K+ channel on -> cells -> depolarization -> Ca2+ influx -> insulin release
4. MOA: Inhibits Alpha-Glucosidase at intestinal brush border
5. MOA: Agonist at PPAR-gamma receptors

Answer 226

1. Lactic acidosis is a rare but worrisome side effect: Biguanide (Metformin)
2. Most common side effect is hypoglycemia: Sulfonylureas (Glipizide, Glyburide, Glimepiride)
3. MOA: Closes K+ channel on -> cells -> depolarization -> Ca2+ influx -> insulin release: Sulfonylureas (Glipizide, Glyburide, Glimepiride)
4. MOA: Inhibits Alpha-Glucosidase at intestinal brush border: Alpha-glucosidase Inhibitors (Acarbose & Miglitol)
5. MOA: Agonist at PPAR-gamma receptors: Thiazolidinediones (Rosiglitazone & Pioglitazone)

Question 227

What three mineral compounds can be used to treat esophageal reflux?

Answer 227

Antacids

1. Aluminum Hydroxide
2. Magnesium Hydroxide
3. Calcium Carbonate

Question 228

What are the vitamin K dependent clotting factors?

Answer 228

Factors II, VII, IX, X and Protein C & S

Question 229

What are some examples of substances eliminated at a constant rate (Zero-order elimination)?

Answer 229

1. Phenytoin
2. Ethanol
3. Aspirin

Question 230

What enzymes are used to metabolize alcohol?

Answer 230

1. Alcohol dehydrogenase
2. Acetaldehyde dehydrogenase

Question 231

What disorders are associated with the following antibodies?

1. Anti-endomysial
2. Anti-Thyroglobulin
3. Anti-Smooth Muscle

Answer 231

1. Anti-endomysial: Celiac Disease
2. Anti-Thyroglobulin: Hashimotos Thyroiditis
3. Anti-Smooth Muscle: Autoimmune hepatitis

Question 232

An 18 year-old woman has moderate generalized abdominal pain, normal WBC, and no fever. She has paresthesias in her lower extremities. What is her diagnosis?

Answer 232

Acute intermittent porphyria

Question 233

What is the mechanism and time-frame of chronic transplant rejection?

Answer 233

1. Antibody and T cell mediated vascular damage
2. Months to years after transplant

Question 234

1. What is the general byproduct of Phase I metabolism?
2. What is the general byproduct of Phase II metabolism?
3. What reactions take place in Phas I metabolism?
4. What reactions take place in Phase II metabolism?

Answer 234

1. Slightly polar/water soluble metabolite
2. Very polar, inactive metabolite
3. Hydrolysis, Oxidation, and Reduction
4. Glucuronidation, Sulfation, and Acetylation

Question 235

Which tissues are allowed to uptake glucose even in the absence of insulin because they use a GLUT-1 receptor?

Answer 235

Brain & RBCs

Question 236

Arrange the follwoin molecules from most exergonic with loss of phosphate to least exergonic with loss of phosphate: Adenosine monophosphate, adenosine triphosphate, phosphoenolpyruvate

Answer 236

PEP>ATP>AMP

Question 237

What are the differences between carbamoyl phophate synthetase (CPS) I and CPS II?

1. Location
2. Pathway
3. Nitrogen Source

Answer 237

1. Location: CPS I is in the mitochondria, CPS II is in the cytosol
2. Pathway: CPS I is in the urea pathway, CPS II is in the pyrimidine synthesis pathway
3. Nitrogen Source: CPS I gets nitrogen from ammonia, CPS II gets nitrogen from Glutamine

Question 238

A 45 year-old male alcoholic gets blistering lesions in sun-exposed areas especially the dorsum of the hands. He also has hypertrichosis of the face. What is the diagnosis?

Answer 238

Porphyria Cutanea Tarda

Question 239

What is the rate-limiting enzyme of heme synthesis?

Answer 239

Aminolevulinic Acid Synthase which catalyzes The following reaction:

Glycine + Succinyl CoA -> Delta-Aminolevulinic Acid

Question 240

What enzymes involved in hemoglobin synthesis are inhibited by lead toxicity?

Answer 240

1. Ferrochelatase
2. ALA Dehydratase

Question 241

In addition to colon cancer, what is one of the most common causes of GI bleeding in the elderly?

Answer 241

Angiodysplasia

Question 242

What is the most likely scenario that a person would receive toxic exposure to arsenic?

Answer 242

Living in Arsenic-rich regions and ingesting arsenic in ground water (occurs over many years of exposure)

Question 243

What are the 3 different mechanisms cells employ to break down proteins?

Answer 243

1. Ubiquitin protein ligase
2. Lysosome
3. Calcium-dependent enzymes

Question 244

Which medication used in the treatment of HIV is known for causing bone marrow suppression?

Answer 244

Zidovudine (AZT)

Question 245

What is the treatment for lead poisoning?

Answer 245

EDTA or Succimer in an adult or child (Dimercaprol can be used in a child in severe toxicity)

Question 246

What enzyme catalyzes peptide bond formation during protein synthesis?

Answer 246

Peptidyl Transferase

Question 247

What conditions are associated with target cells?

Answer 247

“HALT”

1. HbC
2. Asplenia
3. Liver disease
4. Thalassemia

Question 248

What name is given to anemia resulting from mechanical destruction of erythrocytes due to aortic stenosis or prosthetic heart valves>

Answer 248

Macroangiopathic anemia

Question 249

What neoplasms are associated with AIDS?

Answer 249

1. Kaposi Sarcoma
2. Non-Hodgkin Lymphoma
3. Invasive Squamous Cell cancer
4. CNS lymphoma

Question 250

What is the most common inherited bleeding disorder?

Answer 250

Von Willebrand Disease

Question 251

What cancer is associated with Hashimoto Thyroiditis?

Answer 251

Marginal cell lymphoma

• Outside the lymph nodes
• Chronically inflamed tissues

Question 252

How does the mechanism of type II hypersensitivity differ from the mechanism of type III hypersensitivity?

Answer 252

1. Type II: Antibodies bind to self antigens on the surface of cells. Damage is carried out by complement and macrophages
2. Type III: Antibodies bind to soluble antigens found in circulation and interstitium and form Ab-Ag complexes that get deposited in tissues

Question 253

1. What are some of the risk factors for Esophageal Adenocarcinoma?
2. Esophageal Squamous Carcinoma?

Answer 253

1. GERD, Barret’s espohagus, smoking, obesity, nitrosamines
2. Smoking, alcohol, nitrosamines, pre-existing esophageal pathology (Achalasia, esophageal web, strictures)

Question 254

1. What enzyme is deficient in Lesch-Nyhan Syndrome?
2. What is the treatment?

Answer 254

1. Hypoxanthine Guanine Phosphoribosyltransferase (HGPRT)
2. Allopurinol

Question 255

What are the symptoms of Zinc deficiency?

Answer 255

1. Delayed wound healing
2. Decreased body/facial hair
3. Hypogonadism
4. Anosmia
5. Dysgeusia (dysfunction of the sense of taste)

Question 256

In what disease would you see each of the following antibodies?

1. Anti-mitochondrial
2. Anti-TSH receptor
3. Anti-centromere
4. Anti-Basement membrane
5. Anti-neutrophil

Answer 256

1. Anti-mitochondrial: Primary biliary cirrhosis
2. Anti-TSH receptor: Graves disease
3. Anti-centromere: CREST Scleroderma
4. Anti-Basement membrane: Goodpastures syndrome
5. Anti-neutrophil:
   
   • c-ANCA: Wegener Granulomatosis
   • p-ANCA: Microscopic polyangiitis & Churg-Strauss Syndrome
   • MPO-ANCA: Pauci-immune crescentic glomerulonephritis

Question 257

1. What is the most common salivary gland tumor?
2. What is the second most common salivary gland tumor?
3. What is the most common location for a salivary gland tumor?

Answer 257

1. Pleomorphic Adenoma
2. Mucoepidermoid Carcinoma
3. Parotid Gland

Question 258

What cytokine(s) matches each of the following statements?

1. Promotes B cell growth and differentiation
2. Produced by Th1 cells
3. Produced by Th2 cells
4. Secreted by helper T cells and activates macrophages

Answer 258

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

Question 259

What cytokine(s) matches each of the following statements?

1. Pyrogens secreted by monocytes and macrophages
2. Enhances synthesis of IgE and IgG
3. Enhances synthesis of IgA
4. Released by virally infected cells

Answer 259

1. Pyrogens secreted by monocytes and macrophages: IL-1, IL-6, & TNF-alpha
2. Enhances synthesis of IgE and IgG: IL-4
3. Enhances synthesis of IgA: IL-5
4. Released by virally infected cells: IFN-alpha & IFN-beta

Question 260

Which vitamin deficiency results in gum bleeding, bruising, anemia, and poor wound healing?

Answer 260

Vitamin C deficiency (Scurvy)

Question 261

What clinical presentation would lead you to suspect lead toxicity?

Answer 261

1. Lead lines
2. Anemia
3. Abdominal pain
4. Diarrhea & Nausea
5. Encephalopathy
6. Wrist drop or foot drop

Question 262

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

1. Asthma
2. Tuberculosis skin test
3. Allergies, anaphylaxis, and hay fever
4. ABO-blood type incompatibility
5. Poison ivy
6. Eczema
7. Goodpasture syndrome

Answer 262

1. Asthma: Type I
2. Tuberculosis skin test: Type IV
3. Allergies, anaphylaxis, and hay fever: Type I
4. ABO-blood type incompatibility: Type II
5. Poison ivy: Type IV
6. Eczema: Type I
7. Goodpasture syndrome: Type II

Question 263

An alcoholic develops a rash, diarrhea, and altered mental status. What is the vitamin deficiency?

Answer 263

Vitamin B3 deficiency (These symptoms are characteristic of Pellagra: Dermatitis/rash, diarrhea, and dementia/altered mental status)

Question 264

Which class of antibiotics inhibits prokaryotic DNA topoisomerase?

Answer 264

Fluoroquinolones

Question 265

What diseases might be found immediately proximal to the pectinate line vs. immediately distal to the pectinate line?

Answer 265

1. Internal vs external hemorrhoids
2. Adenocarcinoma vs squamous carcinoma

Question 266

1. How many ATP are generated during aerobic metabolism?
2. During anaerobic metabolism?

Answer 266

1. 32 (Malate shuttle) or 30 (G-3-P shuttle) ATP
2. 2 ATP

Question 267

What enzyme is inhibited by the drug fomepizole?

Answer 267

Alcohol dehydrogenase

Question 268

What is the difference between kwashiorkor and marasmus?

Answer 268

Kwashiorkor

1. Protein malnutrition
2. Skin lesions, edema, liver malnutrition
3. Small child with swollen belly

Marasmus

1. Energy malnutrition
2. Complete nutrient deficiency
3. Tissue muscle wasting
4. Loss of subcutaneous fat

Question 269

What vitamins should vegetarians supplement in their diet?

Answer 269

B12

Question 270

What patient groups must avoid fluoroquinolones?

Answer 270

Children and pregnant women (Concern for cartilage damage)

Question 271

Which coagulation factors are dependent on vitamin K synthesis?

Answer 271

II, VII, IX, X

Protein C & S are also dependent on vitamin K but these are anticoagulation factors

Question 272

What are some of the effects of bradykinin on the body?

Answer 272

Increased vascular permeability

Vasodilation

Increased pain

Question 273

What enzyme converts glucose to sorbitol?

Answer 273

Aldose reductase

Glucose -{Aldose Reductase}> Sorbitol -{Sorbitol Dehydrogenase}> Fructose

Question 274

Which protozoa are responsible for each of the following diseases?

1. Chagas disease
2. Protozoal vaginitis
3. Malaria
4. Birth defects
5. Bloody diarrhea
6. Foul-smelling diarrhea, flatulence, bloating

Answer 274

1. Chagas disease: Trypanasoma cruzi
2. Protozoal vaginitis: Trichomonas vaginalis
3. Malaria: Plasmodium
4. Birth defects: Toxoplasma gondii
5. Bloody diarrhea: Entamoeba Histolytica
6. Foul-smelling diarrhea, flatulence, bloating: Giardia lamblia

Question 275

After bone marrow transplantation, a patient suffers from dermatitis, enteritis, and hepatitis. What disease process is occurring?

Answer 275

Graft-vs-host disease

Question 276

Which regions of the brain are included in the limbic system?

Answer 276

1. Septal nucleus (plays a role in reward and reinforcement along with the nucleus accumbens)
2. Mamillary bodies (involved with the processing of recognition memory)
3. Fornix: (carries signals from the hippocampus to the hypothalamus)
4. Hippocampus: (plays important roles in the consolidation of information from short-term memory to long-term memory and spatial navigation)
5. Cingulate Gyrus: (highly influential in linking behavioral outcomes to motivation)

Question 277

A 20-year-old man contracts influenza, then presents with an idiopathic hyperbilirubinemia. What is the most likely cause?

Answer 277

Gilbert Syndrome: The most common hereditary cause of increased bilirubin and is found in up to 5% of the population. A major characteristic is jaundice, supposedly caused by elevated levels of unconjugated bilirubin in the bloodstream. The cause of this hyperbilirubinemia is the reduced activity of the enzyme glucuronyltransferase, which conjugates bilirubin and a few other lipophilic molecules

Question 278

What is the equation for half-life?

Answer 278

t1/2 = (0.7 x Vd)/CL

Question 279

What are some medications that are known for having a low therapeutic index?

Answer 279

1. Lithium
2. Digoxin
3. Warfarin
4. Phenobarbital

Question 280

Which hypothalamic nuclei fit each of the following descriptions?

1. Considered the “master clock” for most of our circadian rythms
2. Regulates the parasympathetic NS
3. Regulates the sympathetic NS
4. Produces antidiuretic hormone (ADH) to regulate water balance
5. Mediates oxytocin production
6. Regulates the release of gonadotropic hormones (i.e. LH & FSH)

Answer 280

1. Considered the “master clock” for most of our circadian rythms: Suprachiasmatic Nucleus
2. Regulates the parasympathetic NS: Anterior Nucleus & Preoptic Nucleus
3. Regulates the sympathetic NS: Posterior Nucleus & Lateral Nucleus
4. Produces antidiuretic hormone (ADH) to regulate water balance: Supraoptic Nucleus
5. Mediates oxytocin production: Paraventricular Nucleus
6. Regulates the release of gonadotropic hormones (i.e. LH & FSH): Preoptic Nucleus

Question 281

What organisms are transmitted by each of the following vectors?

1. Freshwater snails
2. Ixodes Tick
3. Reduviid bug
4. Anopheles mosquito
5. Sandfly
6. Tsetse fly

Answer 281

1. Freshwater snails: Schistosoma
2. Ixodes Tick: Babesia (Also Borrelia Burgdorferi)
3. Reduviid bug: Trypanasoma Cruzi
4. Anopheles mosquito: Plasmodium
5. Sandfly: Leishmania donovani
6. Tsetse fly: Trypanasoma brucei

Question 282

What drugs should not be given to sulfa allergic patients?

Answer 282

1. Loop diuretics
2. Thiazide diuretics
3. Acetazolamide
4. Celecoxib
5. Probenecid
6. Sulfonamides

Question 283

Which cranial nerve is responsible for each of the following actions?

1. Eyelid opeing
2. Taste from the anterior 2/3s of the tongue
3. Head turning
4. Tongue movement
5. Muscles of mastication
6. Balance
7. Monitoring the carotid body and sinus chemo/baro-receptors

Answer 283

1. Eyelid opeing: CN III
2. Taste from the anterior 2/3s of the tongue: CN VII
3. Head turning: CN XI
4. Tongue movement: CN XII
5. Muscles of mastication: CN V
6. Balance: CN VIII
7. Monitoring the carotid body and sinus chemo/baro-receptors: CN IX

Question 284

What CD surface marker fits each of the following statements?

1. Displayed only by helper T cells
2. Displayed only by cytotoxic T cells (and Suppressor T cells)
3. Found on all T cells (except NK cells)
4. Used to ID B cells
5. Found on all NK cells and binds the constant region of IgG
6. Inhibits complement C9 binding
7. Endotoxin receptor found on macrophages

Answer 284

1. Displayed only by helper T cells: CD4
2. Displayed only by cytotoxic T cells (and Suppressor T cells): CD8
3. Found on all T cells (except NK cells): CD3 (Also CD2)
4. Used to ID B cells: CD19, CD20, CD21
5. Found on all NK cells and binds the constant region of IgG: CD16
6. Inhibits complement C9 binding: CD55, CD59
7. Endotoxin receptor found on macrophages: CD14

Question 285

1. What surface molecule on platelets binds fibrinogen?
2. What surface molecule binds Von Willebrand factor?

Answer 285

1. Gp IIb/IIIa
2. Gp Ib

Question 286

What are the symptoms of inhibiting parasympathetic activity?

Answer 286

1. Host as a hare: Increased temperature
2. Red as a beet: Peripheral vasodilation
3. Dry as a bone: Decreased secretions/salivation
4. Mad as a hatter: Agitation & Delirium
5. Blind as a bat: Mydriasis/cycloplegia
6. Bloated as a toad: Constipation and urinary retention

Question 287

Which cancers are associated with each of the following tumor markers?

1. PSA
2. AFP
3. CA 125
4. Elevated alk phos
5. CEA
6. Beta-hCG
7. S100

Answer 287

1. PSA: Prostate
2. AFP: Hepatocellular carcinoma and Yolk sac tumors
3. CA 125: Ovarian cancer
4. Elevated alk phos: Metastasis to bone
5. CEA: Pancreas, colorectal, stomach, and breast cancer
6. Beta-hCG: Choriocarcinoma & Hydatidiform mole
7. S100: Astrocytoma

Question 288

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

1. Giardia, Entamoeba, Trichomonas
2. Plasmodium vivax or ovale
3. Most flukes and tapeworms
4. Hookworm, pinworm, roundworm

Answer 288

1. Giardia, Entamoeba, Trichomonas: Metronidazole
2. Plasmodium vivax or ovale: Chloroquine + Primaquine
3. Most flukes and tapeworms: Praziquantel
4. Hookworm, pinworm, roundworm: Benzoamidazoles (Mebendazole) or Pyrantel Pamoate

Question 289

What G protein classes do each of the following receptors stimulate?

1. a1
2. a2
3. B1
4. B2
5. M1
6. M2
7. M3
8. D2

Answer 289

1. a1: Gq
2. a2: Gi
3. B1: Gs
4. B2: Gs
5. M1: Gq
6. M2: Gi
7. M3: Gq
8. D2: Gi

Question 290

Which anticancer drug fits each of the following descriptions?

1. Treatment for choriocarcinoma
2. Treament for AML
3. Treatment for CML
4. Prevents breast cancer
5. Treatment for testicular cancer

Answer 290

1. Treatment for choriocarcinoma: Methotrexate, Vincristine, Vinblastine
2. Treament for AML: Cytarabine
3. Treatment for CML: Imatinib
4. Prevents breast cancer: Tamoxifen
5. Treatment for testicular cancer: Bleomycin, Etoposide, Cisplatin, Ifosfamide

Question 291

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

Answer 291

1. Glutamine PrPP Aminotransferase
2. Carbamoyl Phosphate Synthetase 2

Question 292

What clinical presentation might lead you to suspect a patient may have lymphoma?

Answer 292

1. Painless lymphadenopathy
2. B symptoms - Fever, weight loss, night sweats

Question 293

1. How many ATP are yielded from aerobic metabolism?
2. How many are yielded from anaerobic metabolism?

Answer 293

1. 32 ATP (Malate shuttle) or 30 ATP (G-3-P Shuttle)
2. 2 ATP

Question 294

An 80-year-old woman comes to your clinic because her family is concerned about yellowing skin. Exam reveals yellowing of the skin including palms and soles but no scleral icterus. What question could you ask the patient that would most likely identify the cause of the yellowing?

Answer 294

Do you eat a lot of carrots?

This is carotenemia: Excess beta-carotene in the body due to eating too many carrots

Question 295

Which hormones share a common alpha subunit?

Answer 295

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

Question 296

What is the difference between a case-control study, a cohort study, and a clinical trial? Which studies use odds ratios, and which use relative risk?

Answer 296

1. Case control: Retrospective observational study starting with a disease and looking for exposure - Uses OR
2. Cohort: Retro- or prospective observational study starting with an exposure and looking for disease - Uses RR
3. Clinical trial: Prospective interventional study

Question 297

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

1. ACTH -> Cushing Syndrome
2. PTH-related peptide -> Hypercalcemia
3. Erythropoietin -> Polycythemia
4. ADH -> SIADH

Answer 297

1. ACTH -> Cushing Syndrome: Small cell lung cancer
2. PTH-related peptide -> Hypercalcemia: Squamous cell lung cancer, Renal cell lung cancer, Breast cancer
3. Erythropoietin -> Polycythemia: Renal cell carcinoma, Hepatocellular carcinoma, hemangioblastoma, pheochromocytoma
4. ADH -> SIADH: Small cell lung cancer

Question 298

In a randomized, placebo-controlled study of a new blood pressure medication, members of the study group received their supply of pills at a monthly clinic visit at which the blood pressure was checked, and at which the clinic nurses were available to answer questions and to instruct the patients on the importance of controlling blood pressure through diet, exercise, and weight loss. Members of the control group received their supply of placebo pills in the mail each month. After 6 months, the study group’s mean systolic blood pressure had decreased 11 points from baseline, compared to a 2-point decrease in the control group. What type of bias may have contributed to the difference in outcomes between the two groups?

Answer 298

Procedure bias

Question 299

What is Reynold’s pentad for cholangitis?

Answer 299

Charcot’s triad

1. Jaundice
2. RUQ pain
3. Fever

+ Hypotension and Altered mental status

Question 300

What are some of the inducers of cytochrome P450?

Answer 300

“Kenytoin Rides Shotgun in Barbie’s Girl Car”

1. Phenytoin
2. Rifampin
3. St. Johns Wort
4. Barbituates
5. Griseofulvin
6. Carbamazepine

Question 301

1. In a normal Gaussian curve, what percentage of the sample population falls within 1 standard deviation?
2. 2 Standard deviations?
3. 3 Standard deviations?

Answer 301

1. 68%
2. 95%
3. 99.7%

Question 302

What is the equation for determining the confidence interval?

Answer 302

CI = Mean +/- Z(SEM)

SEM = Standard deviation/ sqrt(n)

Question 303

In a study of diabetic patients on drug Meca-leca-liver, the average patient HgbA1C after 3 months is 8.0 and the standard deviation is 0.5. Knowing that the sample size is 10,000, calculate the 99% confidence interval.

Answer 303

SEM = SD/sqrt(n) = .5/100 = .005

CI = MEan +/- Z(SEM) -> CI₉₉ = 8 +/- 2.5(.005) = 8 +/- .0125

Question 304

1. What are the clinical manifestations of Addison disease?
2. What is the cause of Addison disease?

Answer 304

1. Hypotension, Skin hyperpigmentation, weakness, malaise, anorexia, weightloss
2. Autoimmune disease causing adrenal atrophy -> decreased aldosterone and cortisol

Question 305

A heart failure patient is newly diagnosed with cancer and is being evaluated for chemotherapy. Which chemotherapeutic agent should be avoided in this patient?

Answer 305

Doxorubicin & Daunorubicin

Question 306

Assuming a normal Gaussian distribution for the results of a particular test, an average value of 35, and SD of 4, what percentage of people will be in the interval between 31 and 43?

Answer 306

68%/2 + 95%/2 = 81.5%

Question 307

1. What are the common side effects of beta-blockers?
2. Which patient population should use caution when taking beta-blockers?

Answer 307

1. Exacerbation of asthma, hyperglycemia (mask Sx of hypoglycemia), bradycardia, AV block, CHF
2. Asthmatics, Diabetics, uncontrolled CHF

Question 308

1. A small study of USMLE test takers for a particular school revealed scores of 225, 225, 225, 229, 230, 240, and 250 with the average score being 232. What is the mean, median, and mode for these values?
2. Would this create a positively-skewed curve or a negatively-skewed curve?

Answer 308

1. Mean = 232, Median = 229, Mode = 225
2. Positive skew

Question 309

A patient of yours develops hypercalcemia from the most common primary tumor arising within bones of adults. What lab findings would you suspect in theis patient?

Answer 309

Multiple Myeloma

1. Monoclonal antibody spike on UPEP and SPEP
2. Bence Jones proteins in urine
3. Hypercalcemia
4. Rouleaux formation
5. Elevated BUN and Creatinine
6. Lytic bone lesions on skeletal X-rays

Question 310

What patient populations are particularly susceptible to mucomycosis?

Answer 310

1. Leukemia
2. Diabetic Ketoacidosis

Question 311

Chromosomal analysis of a leukemia patient reveals the presence of the Philadelphia chromosome t(9;22). What is the treatment?

Answer 311

This is CML and it is treated with Imatinib

Question 312

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

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

Answer 312

1. Ovarian cancer: CA-125
2. Hepatocellular cancer (Hep B and C patients): Alpha-fetoprotein (AFP)
3. Pancreatic cancer: CA 19-9 (also CEA but less specific)
4. Melanoma: S100
5. Colon cancer: CEA
6. Astrocytoma: S100

Question 313

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

1. Most common type of thyroid cancer (70-75%)
2. Second most common type of thyroid cancer (10%)
3. Activation of receptor tyrosine kinases
4. Hashimoto thyroiditis is a risk factor
5. Cancer arising from parafollicular (C) cells

Answer 313

1. Most common type of thyroid cancer (70-75%): Papillary carcinoma
2. Second most common type of thyroid cancer (10%): Follicular carcinoma
3. Activation of receptor tyrosine kinases: Papillary & Medullary carcinoma
4. Hashimoto thyroiditis is a risk factor: Lymphoma
5. Cancer arising from parafollicular (C) cells: Medullary carcinoma

Question 314

Metastasis to the brain, liver, and bone commonly come from which locations?

Answer 314

Brain: “Lots of Bad Stuff Kills Glia”

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

Liver: “Cancer Sometimes Penetrates Benign Liver”

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

Bone: “Permanently Relocated Tumors Totally Like Long Bones”

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

Question 315

What changes in sleep patterns and sexual anatomy are seen in the elderly?

Answer 315

Sleep

1. Decreased REM
2. Decreased slow wave sleep
3. Increased sleep latency
4. Increased nighttime wakening

Sexual anatomy

1. Men: Increased refractory period, slower erection, slower ejaculation
2. Women: Vaginal atrophy (shortening, thinning, and dryness)

Question 317

To which lymph nodes do each of the following regions drain?

1. Rectum
2. External anus
3. Testes
4. Scrotum

Answer 317

1. Rectum: Internal iliac nodes
2. External anus: Superficial inguinal nodes
3. Testes: Para-aortic nodes (via the superficial & deep plexuses)
4. Scrotum: Superficial inguinal nodes

Question 318

Which ketone body is metabolized by muscle and brain tissue?

Answer 318

Beta-Hydroxybutyrate

Question 319

Which anticancer drug fits each of the following descriptions?

1. Fragments DNA, toxicity -> Pulmonary fibrosis
2. Blocks purine synthesis, metabolized by xanthine oxidase
3. Folic acid analog that inhibits dihydrofolate reductase
4. Prevents tubulin disassembly
5. DNA alkylating agents used in brain cancer
6. SERMs - block estrogen binding to ER (+) cells

Answer 319

1. Fragments DNA, toxicity -> Pulmonary fibrosis: Bleomycin
2. Blocks purine synthesis, metabolized by xanthine oxidase: 6-Mercaptopurine
3. Folic acid analog that inhibits dihydrofolate reductase: Methotrexate
4. Prevents tubulin disassembly: Paclitaxel, taxols
5. DNA alkylating agents used in brain cancer: Nitrosoureas
6. SERMs - block estrogen binding to ER (+) cells: Tamoxifen, Raloxifene

Question 321

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

Answer 321

Th1: IL-2, IFN-gamma

Th2: IL-4, IL-5, IL-10

Question 322

At what age can children stop using a booster seat?

Answer 322

After they reach 4’9” (usually around age 8-12)

Question 323

Which protozoal organism matches each of the following statements?

1. Diarrhea in campers and hikers
2. Itchy vaginitis
3. Sandfly vector
4. Ixodes tick is the vector
5. Anopheles mosquito is the vector

Answer 323

1. Diarrhea in campers and hikers: Giardia
2. Itchy vaginitis: Trichomonas
3. Sandfly vector: Leishmania
4. Ixodes tick is the vector: Babesia & Borrelia Burgdorferi
5. Anopheles mosquito is the vector: Plasmodium

Question 324

Which protozoal organism matches each of the following statements?

1. Sodium stibogluconate is the treatment
2. Suramin or melarsoprol is the treatment
3. Maltese cross seen in RBCs
4. Treat with metronidazole
5. Severe diarrhea in AIDS patients

Answer 324

1. Sodium stibogluconate is the treatment: Leishmania
2. Suramin or melarsoprol is the treatment: Trypanasoma
3. Maltese cross seen in RBCs: Babesia
4. Treat with metronidazole: Giardia, Entamoeba, Trichmonas
5. Severe diarrhea in AIDS patients: Cryptosporidium

Question 325

What are the Kubler-Ross grief stages?

Answer 325

“Death Always Brings Great Acceptance”

1. Denial
2. Anger
3. Bargaining
4. Grief
5. Acceptance

Question 326

What is the life-span of an RBC (Which is the maximum time to expect foreign RBCs to be in a patient after a blood transfusion)?

Answer 326

120 days

Question 327

What drugs and endogenous hormones regulate the secretion of gastric acid?

Answer 327

Pomotion of gastric acid excretion

1. Histamine
2. Acetylcholine
3. Gastrin

Inhibition of gastric acid excretion

1. Prostaglandins
2. somatostatin
3. secretin
4. GIP

Drugs that regulate secretion

1. Proton pump inhibitors
2. H₂ blockers
3. Antimuscarinics

Question 328

1. What is the characteristic sequence of the promoter region?
2. What does a mutation in the sequence cause?

Answer 328

1. -25 TATA box (Hogness box) and the -75 CAAT box
2. Mutations will cause less transcription of genes

Question 329

What are the pathological characteristics of the arteries in pulmonary hypertension?

Answer 329

1. Medial hypertrophy
2. Fibrosis of the intima
3. Atherosclerosis

Question 330

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

1. Urea cycle
2. Hexose monophosphate shunt
3. Fatty acid synthesis
4. Beta-oxidation of fatty acids
5. Ketone body synthesis
6. Cholesterol synthesis
7. Bile acid synthesis
8. Heme synthesis

Answer 330

1. Urea cycle: Carbamoyl phosphate synthetase 1 (CPS-I)
2. Hexose monophosphate shunt: Glucose-6-phosphate dehydrogenase
3. Fatty acid synthesis: Acetyl CoA carboxylase
4. Beta-oxidation of fatty acids: Carnitine acyltransferase
5. Ketone body synthesis: HMG-CoA Synthase
6. Cholesterol synthesis: HMG-CoA Reductase
7. Bile acid synthesis: 7-alpha Hydroxylase
8. Heme synthesis: Aminolevulinate synthase

Question 331

In what disorder is there an abnormal breakdown of elastin?

Answer 331

Alpha-1 Antitrypsin deficiency

Question 332

What is the name of the genetic syndrome that fits each of the following descriptions?

1. Alcoholics with B1 deficiency and neurologic defects
2. Abnormal type I collagen synthesis
3. Heinz bodies
4. Must/mousy odor, albinism, mental retardation, and eczema
5. Hyperextensible skin, loose joints, bleeding tendency
6. Hypoglycemia, jaundice, cirrhosis
7. Bloating, cramps, osmotic diarrhea
8. Dark brown urine, organs, and connective tissue; benign disease
9. Multiple fractures and blue sclera

Answer 332

1. Alcoholics with B1 deficiency and neurologic defects: Pyruvate dehydrogenase deficiency
2. Abnormal type I collagen synthesis: Osteogenesis imperfecta
3. Heinz bodies: G6PD deficiency
4. Must/mousy odor, albinism, mental retardation, and eczema: Phenylketonuria (PKU)
5. Hyperextensible skin, loose joints, bleeding tendency: Ehlers-Danlos Syndrome
6. Hypoglycemia, jaundice, cirrhosis: Fructose intolerance
7. Bloating, cramps, osmotic diarrhea: Lactose intolerance
8. Dark brown urine, organs, and connective tissue; benign disease: Alkaptonuria (benign disease)
9. Multiple fractures and blue sclera: Osteogenesis imperfecta

Question 333

What questions are asked during the 4 clinical phases of drug development?

1. Phase I
2. Phase II
3. Phase III
4. Phase IV

Answer 333

1. Phase I: Is it safe?
2. Phase II: Does it work?
3. Phase III: Does it work better than placebo and gold standard?
4. Phase IV: Post-market surveillance

Question 334

Which immunosuppressant matches each of the following statements?

1. Precursor of 6-Mercaptopurine
2. May prevent nephrotoxicity with mannitol diuresis
3. Antibody that binds CD3 on T cells
4. Antibody that binds IL-2 receptor on activated T cells
5. Inhibits inosine monophosphate dehydrogenase
6. Inhibits calcineurin -> Loss of IL-2 production -> Blockage of T cell differentiation and activation
7. Metabolized by Xanthine oxidase, therefore allopurinol increases its toxicity

Answer 334

1. Precursor of 6-Mercaptopurine: Azothioprine
2. May prevent nephrotoxicity with mannitol diuresis: Cyclosporine
3. Antibody that binds CD3 on T cells: Muromonab
4. Antibody that binds IL-2 receptor on activated T cells: Daclizumab
5. Inhibits inosine monophosphate dehydrogenase: Mycophenolate Mofetil
6. Inhibits calcineurin -> Loss of IL-2 production -> Blockage of T cell differentiation and activation: Cyclosporine
7. Metabolized by Xanthine oxidase, therefore allopurinol increases its toxicity: Azothioprine

Question 335

What is the treatment for homocystinuria?

Answer 335

1. Increase B6
2. Increase B12
3. Add folate
4. Increase Cysteine
5. Decrease Methionine

Question 336

What are the treatments of choice for each of the following protozoa?

1. Trichomonas vaginalis
2. Trypanosoma Cruzi
3. Plasmodium vivax
4. Leishmania donovani
5. Entamoeba Histolytica
6. Toxoplasma gondii

Answer 336

1. Trichomonas vaginalis: Metronidazole
2. Trypanosoma Cruzi: Nifurtimox
3. Plasmodium vivax: Chloroquine + Primaquine
4. Leishmania donovani: Sodium Stibogluconate (Cutaneous), Amphotericin B (Visceral)
5. Entamoeba Histolytica: Metronidazole
6. Toxoplasma gondii: Sulfadiazine + Pyrimethamine

Question 337

What can be seen in erythrocytes in patients that do not have a functional spleen?

Answer 337

Howell-Jolly Bodies

Question 338

A HIV (+) patient with a CD4 count of 75 presents with signs of meningitis. Examination of the CSF reveals a heavily encapsulated organism. What organism is responsible for the meningitis?

Answer 338

Cryptococcus Neoformans

Question 339

What is the difference between direct bilirubin and indirect bilirubin?

Answer 339

1. Direct bilirubin is conjugated with glucuronic acid
2. Indirect bilirubin is unconjugated

Question 340

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

Answer 340

1. GP120 inhibited by Maraviroc (via its binding of CCR5)
2. GP41 inhibited by Enfuvirtide

Question 341

A patient has a genetic disease in which the treatment includes protein restriction to prevent mental retardation, ketoacidosis, and death. What is the diagnosis?

Answer 341

Maple syrup urine disease

Question 342

What pathology fits each of the following high-yield statments?

1. Opacities seen on x-ray on both sides of the carina
2. Dermatitis, diarrhea, and dementia, possibly death
3. Greenish rings around the periphery of the iris
4. Elastic skin, joint hypermobility
5. Enlarged, hard, left supraclavicular lymph node

Answer 342

1. Opacities seen on x-ray on both sides of the carina: Sarcoidosis
2. Dermatitis, diarrhea, and dementia, possibly death: Pellagra (B3 deficiency)
3. Greenish rings around the periphery of the iris: Kayser-Fleischer rings seen in Wilson’s disease
4. Elastic skin, joint hypermobility: Ehlers-Danlos syndrome
5. Enlarged, hard, left supraclavicular lymph node: Virchow’s node (indicates underlying gastric carcinoma)

Question 343

What substance is important for relaxing the lower esophageal sphincter?

Answer 343

Nitric Oxide

Question 344

1. What is the triad of Kartagener Syndrome?
2. What is the underlying defect?

Answer 344

1. Bronchiectasis, Recurrent Sinusitis, Infertility, Also associated with Situs Inversus
2. Dynein arm defect causing primary ciliary dyskinesia

Question 345

What pathology fits each of the following high-yield phrases?

1. Gout + mental retardation + lip-biting
2. Lack of GpIIb/IIIa -> defect in platelets -> prolonged bleeding
3. Anti-histone antibodies
4. Psammoma bodies
5. Lytic bone lesions on X-ray

Answer 345

1. Gout + mental retardation + lip-biting: Lesch Nyhan Syndrome
2. Lack of GpIIb/IIIa -> defect in platelets -> prolonged bleeding: Glanzmanns thrombasthenia
3. Anti-histone antibodies: Drug-induced lupus
4. Psammoma bodies: Papillary adenocarcinoma of the thyroid, serous cystadenocarcinoma of the ovary, meningioma, mesothelioma
5. Lytic bone lesions on X-ray: Multiple Myeloma

Question 346

A 50 year-old obese man with hypertension comes to your clinic to receive care for his chronic fatigue. A CBC is performed and an elevated H&H is discovered. What is the most likely cause of elevated hemoglobin level?

Answer 346

Sleep apnea-induced erythrocytosis

Question 347

What are the acute phase cytokines?

Answer 347

IL-1, IL-6, and TNF-alpha

Question 348

How does the brain utilize ketone bodies?

Answer 348

It metabolizes them to 2 Acetyl CoA molecules

Question 349

A patient presents complaining of pain in the right upper quadrant that he can point to with one finger: The area is tender to light touch, and pain is worsened when the patient is asked to raise his arms above his head. What is most likely this patient’s problem?

Answer 349

Rectus abdominus tear

(visceral pain would not be this pinpoint)

Question 350

What drug categories have the following endings?

1. -ane
2. -azine
3. -barbital
4. -cillin
5. -ipramine

Answer 350

1. -ane: Inhaled anesthetics
2. -azine: Phenothiazines
3. -barbital: Barbituates
4. -cillin: Penicillins
5. -ipramine: TCAs

Question 351

What drug categories have the following endings?

1. -olol
2. -oxin
3. -pril
4. -tidine
5. -tropin

Answer 351

1. -olol: Beta-blockers
2. -oxin: Cardiac glycosides
3. -pril: ACE inhibitors
4. -tidine: H2 blockers
5. -tropin: Pituitary hormones

Question 352

What drug categories have the following endings?

1. -dronate
2. -chol
3. -mustine
4. -statin
5. -bendazole

Answer 352

1. -dronate: Bisphosphonates
2. -chol: Cholinergic agonists
3. -mustine: Nitrosoureas
4. -statin: HMG-CoA Reductase inhibitors
5. -bendazole: Antihelminthics

Question 353

1. What 2 main molecules is iron bound to in human cells?
2. To what main 2 molecules is iron bound in blood?

Answer 353

1. Myoglobin & Ferritin
2. Hemoglobin & Transferrin

Question 354

A CT scan of the chest reveals bilateral hilar lymphadenopathy. What is the diagnosis?

Answer 354

Sarcoidosis

Question 355

What is the name of the genetic syndrome that fits each of the following descriptions?

1. Absence of HGPRTase
2. Deficiency of aldolase B
3. Deficiency of cystathionine synthase
4. Galactose-1-P uridyl transferase deficiency
5. Deficiency of tyrosinase

Answer 355

1. Absence of HGPRTase: Lesch-Nyhan Syndrome
2. Deficiency of aldolase B: Fructose intolerance
3. Deficiency of cystathionine synthase: Homocystinuria
4. Galactose-1-P uridyl transferase deficiency: Galactosemia
5. Deficiency of tyrosinase: Albinism

Question 356

What is the name of the genetic syndrome that fits each of the following descriptions?

1. Decreased NADPH due to lack of HMP enzyme
2. Inherited defect in tubular amino acid transporter
3. Deficiency in homogetisic acid oxidase
4. Blocked degradation of branched chain amino acids

Answer 356

1. Decreased NADPH due to lack of HMP enzyme: G6PD deficiency
2. Inherited defect in tubular amino acid transporter: Cystinuria
3. Deficiency in homogetisic acid oxidase: Alkaptonuria
4. Blocked degradation of branched chain amino acids: Maple Syrup Urine Disease

Question 357

What effect will a noncompetitive antagonist have on Vmax and Km?

Answer 357

Decrease Vmax without affecting Km

Question 358

A woman that is breast-feeding develops redness and swelling of her right breast over a period of 24 hours. Examination reveals a warm, fluctuant mass. What is the diagnosis?

Answer 358

Mastitis likely caused by Staph Aureus

Question 359

A young child has recurrent lung infections and granulomatous lesions. What is the defect in neutrophils?

Answer 359

This is Chronic Granulomatous Disease caused by a deficiency of NADPH Oxidase

Question 360

What might you see histologically in a patient with alcoholic hepatitis?

Answer 360

1. Mallory bodies: Intra-cytoplasmic eosinophilic inclusions
2. Necrosis and swelling of the hepatocytes

Question 361

What drugs and endogenous hormones regulate the secretion of gastric acid?

Answer 361

Promote Gastric acid

1. Histamine
2. Gastrin
3. Ach (not a hormone)

Inhibit Gastric acid

1. Somatostatin
2. Secretin
3. GIP
4. Prostaglandins

Drugs

1. H2 blockers
2. Proton pump inhibitors
3. Antimuscarinics

Question 362

What exotoxin matches each of the following characteristics?

1. Inhibits ACh release -> Flaccid paralysis
2. Stimulates adenylate cyclase -> Cl- and water into gut -> diarrhea
3. Causes scarlet fever
4. Inactivates EF-2 -> Pseudomembranous pharyngitis
5. Blocks the release of the inhibitory neurotransmitter glycine

Answer 362

1. Inhibits ACh release -> Flaccid paralysis: Botulin toxin
2. Stimulates adenylate cyclase -> Cl- and water into gut -> diarrhea: Cholera toxin and heat-labile ETEC toxin
3. Causes scarlet fever: Erythrogenic and pyogenic toxins of strep pyogenes
4. Inactivates EF-2 -> Pseudomembranous pharyngitis: Diptheria toxin
5. Blocks the release of the inhibitory neurotransmitter glycine: Tetanospasmin (Tetanus toxin)

Question 363

What is the mechanism of action of N-acetycysteine when given as an antidote for acetaminophen overdose?

Answer 363

It regenerates Glutathione

Question 364

What is the most common urea cycle disorder?

Answer 364

Ornithine transcarbamylase deficiency

Question 365

When looking at a slide of RBCs you notice RBCs that look spiny, like a medieval mace. What is likely to be deficient in this patient?

Answer 365

These are acanthocytes (burr cells)

They occur in abetalipoproteinemia, caused by a deficiency in apo B-100 and apo B-48

Question 366

Which hormones stimulate pancreatic secretion?

Answer 366

1. CCK
2. Secretin
3. Ach

Question 367

What bacterial structure has each of the following functions?

1. Mediates adherence of bacteria to the surface of a cell
2. Protects against phagocytosis
3. Space between the inner and outer cellular membranes in Gram (-) bacteria
4. Forms attachment between two bacteria during transfer of DNA material (AKA conjugation)
5. Genetic material within bacteria that contains genes for antibiotic resistance

Answer 367

1. Mediates adherence of bacteria to the surface of a cell: Fimbria or pili
2. Protects against phagocytosis: Capsule
3. Space between the inner and outer cellular membranes in Gram (-) bacteria: Periplasm
4. Forms attachment between two bacteria during transfer of DNA material (AKA conjugation): Sex (F) Pilus
5. Genetic material within bacteria that contains genes for antibiotic resistance: Plasmid

Question 368

How does fetal hemoglobin differ from adult hemoglobin?

Answer 368

Fetal

1. Alpha₂-Gamma₂
2. Lower affinity for 2,3-DPG
3. Higher affinity for O₂

Adult

1. Alpha₂-Beta₂
2. Higher affinity for 2,3-BPG
3. Lower affinity for O₂

Question 369

What might you see in an erythrocyte of a patient with lead poisoning?

Answer 369

Basophilic Stippling

Question 370

What would be some of the clinical signs in a patient that would lead you to suspect lead poisoning?

Answer 370

1. Lead lines on gums
2. Anemia (Pallor, fatigue, exercise intolerance)
3. Wrist/foot drop
4. Encephalopathy
5. Colicky abdominal pain, diarrhea, nausea

Question 371

Which anticancer drug fits the following description?

1. Prevents tubulin assembly
2. Inhibits thymidylate synthase -> decreased nucleotide synthesis
3. SERM - blocks estrogen binding to ER(+) cells
4. Mechanism similar to antivirals acyclovir and foscarnet
5. Mechanism similar to fluoroquinolones

Answer 371

1. Prevents tubulin assembly: Vincristine/Vinblastine
2. Inhibits thymidylate synthase -> decreased nucleotide synthesis: 5-FU
3. SERM - blocks estrogen binding to ER(+) cells: Tamoxifen/Raloxifene
4. Mechanism similar to antivirals acyclovir and foscarnet: Cytarabine
5. Mechanism similar to fluoroquinolones: Etoposide

Question 372

Which anticancer drug fits the following description?

1. Mechanism similar to trimethoprim
2. Monoclonal antibody against HER-2 (erb-B2)
3. Free radical-induced DNA strand breakage
4. Inhibitor of PRPP synthestase
5. Reversible with leucovorin

Answer 372

1. Mechanism similar to trimethoprim: Methotrexate
2. Monoclonal antibody against HER-2 (erb-B2): Traztuzumab
3. Free radical-induced DNA strand breakage: Bleomycin, Doxyrubicin/Daunorubicin
4. Inhibitor of PRPP synthestase: 6-Mercaptopurine
5. Reversible with leucovorin: Methotrexate

Question 373

Which bacteria are known for forming spores?

Answer 373

1. Clostridium (perfringens, tetani, botulinum, difficile)
2. Bacillus (cereus, anthracis)
3. Coxiella burnetii

Question 374

What genetic syndrome fits each of the follwoing descriptions?

1. Rx: No nutrasweet, increased dietary tyrosine
2. Rx: Decreased dietary methionine, increased cystein + B6
3. Rx: Acetazolamide to alkalinize urine
4. Rx: Decreased fructose and sucrose intake
5. Rx: Increased intake of ketogenic nutrients (fats)
6. Rx: Exclude galactose and lactose from diet

Answer 374

1. Rx: No nutrasweet, increased dietary tyrosine: Phenylketonuria
2. Rx: Decreased dietary methionine, increased cystein + B6: Homocysteinuria
3. Rx: Acetazolamide to alkalinize urine: Cystinuria
4. Rx: Decreased fructose and sucrose intake: Fructose intolerance
5. Rx: Increased intake of ketogenic nutrients (fats): Pyruvate dehydrogenase deficiency
6. Rx: Exclude galactose and lactose from diet: Galactosemia

Question 375

What is the potential consequence of silicosis of the lungs?

Answer 375

Increased susceptibility to TB infection

Question 376

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

1. Lactic acidosis is a rare but worrisome side effect
2. Most common side effect is hypoglycemia
3. Primarily effects postprandial hyperglycemia
4. MOA: Closes K+ channel on beta cells which leads to depolarization, Ca2+ influx and then insulin release
5. MOA: Inhibits Alpha-glucosidase at the intestinal brush border
6. MOA: agonist at PPAR-gamma receptors which leads to improved target cell response to insulin

Answer 376

1. Lactic acidosis is a rare but worrisome side effect: Metformin
2. Most common side effect is hypoglycemia: Sulfonylureas
3. Primarily effects postprandial hyperglycemia: Alpha-glucosidase inhibitors
4. MOA: Closes K+ channel on beta cells which leads to depolarization, Ca2+ influx and then insulin release: Sulfonylureas
5. MOA: Inhibits Alpha-glucosidase at the intestinal brush border: Alpha-glucosidase inhibitors
6. MOA: agonist at PPAR-gamma receptors which leads to improved target cell response to insulin: Thiazolidinediones

Question 377

A 75-year-old patient that has a 60 pack-year history comes to your office complaining of difficulty standing up from his bed when he wakes up in the morning, and difficulty raising his arms in the morning to wash his hair. What do you immediately suspect is going on with this patient?

Answer 377

Lambert-Eaton Syndrome secondary to small cell lung cancer

Question 378

A 6-month-old child is given honey for symptomatic treatment of a cold and becomes flaccid. What gram (+) rod is implicated? What is the mechanism of action?

Answer 378

1. Clostridium Botulinum
2. Botulin toxin inhibits ACh release

Question 379

The mother of a patient recently hospitalized for Haemophilus meningitis calls the clinic because she notices blood in her urine. What is the likely cause of her symptoms?

Answer 379

Its not blood, it is red secretions: She was taking Rifampin as prophylaxis for meningitis

Question 380

What drug category has each of the following ending?

1. -azepam
2. -azole
3. -caine
4. -cycline
5. -navir

Answer 380

1. -azepam:** Benzodiazepines**
2. -azole: Antifungals
3. -caine:** Local anesthetics**
4. -cycline: Tetracycline antibiotics
5. -navir: Protease inhibitors

Question 381

What drug category has each of the following ending?

1. -operidol
2. -phylline
3. -terol
4. -triptyline
5. -zosin

Answer 381

1. -operidol: Neuroleptics
2. -phylline: Methylxanthines
3. -terol: Beta-2 agonists
4. -triptyline: TCAs
5. -zosin: Alpha-1 blockers

Question 382

What drug category has each of the following ending?

1. -sartan
2. -stigmine
3. -curium/-curonium
4. -glitazone
5. -dipine

Answer 382

1. -sartan: ARBs
2. -stigmine: Cholinesterase inhibitors
3. -curium/-curonium: Non-depolarizing neuromuscular blockers
4. -glitazone: TZDs
5. -dipine: Dihydropyridine Ca channel blockers

Question 383

What are the potential side-effects of prednisone use?

Answer 383

1. Cushingoid features
2. Osteoporosis
3. Immunosuppression
4. Acne
5. Cataracts
6. Peptic ulcers
7. Hypertension
8. Hyperglycemia
9. Insomnia
10. Psychosis

Question 384

Where does erythropoiesis take place in the fetus? Which bones in adults synthesize RBCs?

Answer 384

Fetus

“Young Livers Synthesize Blood”

1. Yolk sac
2. Liver
3. Spleen
4. Bone

Adult

1. Ribs
2. Pelvis
3. Sternum
4. Femur
5. Tibia
6. Vertebrae
7. Cranial bones

Question 385

What adult structures are derived from the 3rd, 4th, and 6th aortic arches?

Answer 385

3rd

1. Common carotid artery
2. Proximal part of internal carotid artery

4th

1. Left: Aortic arch
2. Right: Proximal part of right subclavian artery

6th

1. Proximal part of pulmonary arteries
2. Ductus arteriosis

Question 386

What cell wall inhibitor matches each of the following statements?

1. Next step in treatment of otitis media if resistant to amoxicillin
2. Prophylaxis against bacterial endocarditis
3. Increases the nephrotoxicity of aminoglycosides
4. Sufficient for the treatment of syphylis
5. Single dose treatment for gonorrhea

Answer 386

1. Next step in treatment of otitis media if resistant to amoxicillin: [Amoxicillin + Clavulanic acid] or Cefdinir
2. Prophylaxis against bacterial endocarditis: Penicillin V, aminopenicillin, or 1st gen cephalosporin
3. Increases the nephrotoxicity of aminoglycosides: Cephalosporins
4. Sufficient for the treatment of syphylis: Penicillin G
5. Single dose treatment for gonorrhea: Ceftriaxone

Question 387

What germ layer gives rise to each of the following adult structures?

1. Retina
2. Salivary glands
3. Pancreas
4. Muscles of the abdominal wall
5. Thymus
6. Spleen

Answer 387

1. Retina: Neuroectoderm
2. Salivary glands: Surface Ectoderm
3. Pancreas: Endoderm
4. Muscles of the abdominal wall: Mesoderm
5. Thymus: Endoderm
6. Spleen: Mesoderm

Question 388

What germ layer gives rise to each of the following adult structures?

1. Aorticopulmonary septum
2. Anterior pituitary
3. Posterior pituitary
4. Bones of the skull
5. Cranial nerves

Answer 388

1. Aorticopulmonary septum: Neural Crest
2. Anterior pituitary: Surface Ectoderm
3. Posterior pituitary: Neuroectoderm
4. Bones of the skull: Neural Crest
5. Cranial nerves: Neural Crest

Question 389

What are the clinical uses for 1st, 2nd, 3rd, and 4th generation cephalosporins?

Answer 389

1st

1. “PEcK”
2. Proteus
3. E. Coli
4. Klebsiella
5. Gram (+) cocci

2nd

1. “HENPEcKS”
2. H. infuenzae
3. Enterobacter
4. Neisseria
5. Proteus
6. E. Coli
7. Klebsiella
8. Serratia
9. Gram (+) cocci

3rd

1. Serious Gram (-) infections
2. Pseudomonas
3. Neisseria gonorrhea

4th

1. This is the “big gun”
2. Gram (+)
3. Gram (-)
4. Pseudomonase

Question 390

What are the classic symptoms of carcinoid syndrome?

Answer 390

“BFDR”

1. Bronchospasm
2. Flushing
3. Diarrhea
4. Right sided heart murmur

Question 391

What irreversible enzymes are involved in gluconeogenesis?

Answer 391

1. Pyruvate Carboxylase
2. PEP Carboxykinase
3. Fructose-1,6-Bisphosphatase
4. Glucose-6-Phosphatase

Question 392

What cranial nerves innervate the tongue in the following ways?

1. Taste in the anterior 2/3
2. Taste in the posterior 1/3 (Main innervation)
3. Motor
4. Sensation in the anterior 2/3
5. Sensation in the posterior 1/3

Answer 392

1. Taste in the anterior 2/3: VII
2. Taste in the posterior 1/3 (Main innervation): IX
3. Motor: XII
4. Sensation in the anterior 2/3: V₃
5. Sensation in the posterior 1/3: IX

Question 393

1. Which tumors arise centrally in the lung and are linked to smoking?
2. Which tumors arise peripherally in the lung and are less linked to smoking (if at all)?

Answer 393

1. Squamous & Small Cell lung cancers
2. Adenocarcinoma & Large cell lung cancer

Question 394

What is the most common type of TE fistula?

Answer 394

Type C: Distal esophageal fistula, proximal esophageal blind pouch

Question 395

What are the major regulatory enzymes of the citric acid cycle?

Answer 395

1. Citrate Synthase (First Step)
2. Isocitrate Dehydrogenase (Rate-limiting Step)
3. Alpha-Ketoglutarate Dehydrogenase (Highly regulated step - Regulated by “Tender Loving Care For Noone”)

Question 396

What infections are caused by Chlamydia and Chlamydophila species?

What is the treatment for most of these infections?

Answer 396

Chlamydia trachomatis

• Types A, B, and C: Trachoma eye infection (Africa)
• Types D-K: STP, PID, urethritis, and neonatal conjunctivitis
• Type L1, L2, and L3: Lymphogranuloma venereum

Chlamydia pneumoniae: Interstitial (walking, atypical) pneumonia

Chlamydophila psittaci: Pneumonia with exposure to birds

Treated with Macrolides or Tetracycline

Question 397

Which Rickettsial species has properties unique from the other Rickettsial organisms?

Answer 397

Coxiella burnetii

1. Negative Weil-Felix (an agglutination test for the diagnosis of rickettsial infections)
2. No vector
3. Aerosol transmission
4. Endospore
5. No rash
6. Interstitial pneumonia

Question 398

What is the classic presentation of congenital pyloric stenosis?

Answer 398

1. Palpable epigastric olive mass
2. Poor feeding
3. Projectile vomiting
4. Hypochloremic metabolic alkalosis
5. Hypokalemia
6. 2 weeks of age

Question 399

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

Answer 399

G6PD generates NADPH which is used to reduce glutathione. Reduced glutathione is required by RBCs as an antioxidant. Without it, they lyse

Question 400

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

Answer 400

Fatty acids

Question 401

When placing a femoral venous catheter; while palpatingthe pulsatile femoral artery, where is the femoral catheter placed in relation to the artery?

Answer 401

1-2 cm medial to the artery

“lateral to medial to reach the NAVeL”

Nerve -> Artery -> Vein -> empty space -> Lymphatics

Question 402

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

1. Fatty acid degradation
2. Fatty acid synthesis
3. Glycolysis
4. TCA cycle
5. Electron Transport Chain (Oxidative phosphorylation)

Answer 402

1. Fatty acid degradation: Mitochondria
2. Fatty acid synthesis: Cytoplasm
3. Glycolysis: Cytoplasm
4. TCA cycle: Mitochondria
5. Electron Transport Chain (Oxidative phosphorylation): Mitochondria

Question 403

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

1. Gluconeogenesis
2. Protein Synthesis (RER)
3. Urea Cycle
4. Steroid synthesis (SER)
5. Heme synthesis

Answer 403

1. Gluconeogenesis: Cytoplasm and Mitochondria
2. Protein Synthesis (RER): Cytoplasm
3. Urea Cycle: Cytoplasm and Mitochondria
4. Steroid synthesis (SER): Cytoplasm
5. Heme synthesis: Cytoplasm and Mitochondria

Question 404

What protozoa/helminths match each of the following statements?

1. Contracted by eating undercooked fish and causes an inflammation of the biliary tract
2. Most common protozoal infection in the US
3. Cause of Chagas disease
4. Most common helminthic infection in the US
5. Snail host, “swimmers itch”
6. Diarrhea in campers and hikers
7. Transmitted in raw meat or infected cat feces

Answer 404

1. Contracted by eating undercooked fish and causes an inflammation of the biliary tract: Clonorchis sinensis
2. Most common protozoal infection in the US: Toxoplasma gondii
3. Cause of Chagas disease: Trypanazoma cruzi
4. Most common helminthic infection in the US: Enterobius vermicularis
5. Snail host, “swimmers itch”: Schistosoma mansoni
6. Diarrhea in campers and hikers: Giardia lamblia
7. Transmitted in raw meat or infected cat feces: Toxoplasma gondii

Question 405

What effect does stress have on adipocytes?

Answer 405

1. Stress causes sympathetic activation: Epinephrine and Norepinephrine are released from adrenal medulla
2. This activates hormone-sensitive TG lipase in fat cells causing the rapid breakdown of fats and mobilization of fatty acids used by muscles as energy
3. There is also some release of ACTH from the anterior pituitary and subsequent cortisol release from adrenal cortex

Question 406

What are the 4 obligate aerobic bacteria?

Answer 406

“Nagging Pests Must Breath”

1. Nocardia
2. Pseudomonas
3. Mycobacterium tuberculosis
4. Bacillus species

Question 407

Why do the kidneys retain fluid in heart failure patients?

Answer 407

Decreased renal perfusion -> recognized by the juxtoglomerular apparatus -> activation of the renin-angiotensin system -> Angiotensin II signals adrenal cortex to secrete aldosterone -> Aldosterone increases Na and H20 retention

Question 408

Which hereditary hyperbilirubinemia matches each of the following statements?

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

Answer 408

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

Question 409

What is a disulfuram-like reaction? What drugs cause a disulfuram-like reaction?

Answer 409

1. Inhibition of acetaldehyde dehydrogenase -> Nausea, flushing, sweating, headache, and hypotension when consuming alcohol
2. Drugs:

• Disulfuram
• Metronidazole
• Cephalosporins (cefotetan, cefamandole, cefoperazone)
• 1st generation sulfonylureas (Tolbutamide)

Question 410

At what age should patients begin receiving screening colonoscopies?

Answer 410

1. Normal people: Age 50
2. Family History: Age 40 or 10 years prior to youngest 1st degree family member’s age at diagnosis
3. Lynch Syndrome: 20-25 years old or 10 years prior to youngest 1st degree family member’s age at diagnosis
4. Familial Adenomatous Polyposis: Every 12 months starting at age 10-12

Question 411

A patient develops ARDS from an occupational inhalation of nitrogen dioxide. What histologic change is seen in a patient recovering from ARDS?

Answer 411

Inflammation -> Damage to endothelial cells and type I pneumocytes -> Proliferation of type II pneumocytes

Question 412

What lab value is used to monitor the following medications: Heparin, warfarin, and enoxaparin?

Answer 412

1. Heparin: PTT
2. Warfarin: PT/INR
3. Enoxaparin: factor Xa activity but not usually monitored

Question 413

With what type of congenital heart defect would increasing afterload be beneficial?

Answer 413

Any right to left shunt

1. Tetralogy of Fallot
2. Transposition of the great vessels
3. Truncus arteriosus
4. Eisenmenger Syndrome (VSD, ASD, PDA)

Question 414

What drugs are known for inhibiting cytochrome P450?

Answer 414

“CRACK AMIGOS”

1. Cimetidine
2. Ritonavir (Protease inhibitors)
3. Amiodarone
4. Ciprfloxacin
5. Ketoconazole
6. Acute alcohol use
7. Macrolides
8. Isoniazid
9. Grapefruit juice
10. Omeprazole
11. Sulfonamides

Question 415

What is the target HgbA1C for every diabetic patient

Answer 415

<7

Question 416

What are the 5 hereditary thrombosis syndromes?

Answer 416

1. Factor V leiden
2. Prothrombin 20210 mutation
3. Protein C deficiency
4. Protein S deficiency
5. Antithrombin deficiency

Question 417

Which Mycobacterium species fits each of the following descriptions?

1. Causes leprosy
2. Causes pulmonary TB-like symptoms in COPD patients
3. Causes cervical lymphadenitis in children
4. Causes a disseminated disease in AIDS patients
5. Hand infection in aquarium

Answer 417

1. Causes leprosy: M. Leprae
2. Causes pulmonary TB-like symptoms in COPD patients: M. Kansasi
3. Causes cervical lymphadenitis in children: M. Scrofulaceum
4. Causes a disseminated disease in AIDS patients: M. Avium-Intracellularae or M. Avium-complex
5. Hand infection in aquarium: M. Marinum

Question 418

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

Answer 418

Primary biliary cirrhosis

1. Autoimmune disorder
2. Associated with CREST scleroderma
3. Positive AMA
4. Middle aged females

Primary sclerosis cholangitis

1. Unknown etiology
2. Positive pANCA (60%)
3. Males over 40
4. Associated with ulcerative colitis and cholangiocarcinoma
5. ERCP - alternating beading and stricturing

Question 419

How does increasing the diameter of a vessel by two times affect the resistance of that vessel?

Answer 419

Decreases the resistance by 2^4 = 16

Question 420

What substances are known teratogens?

Answer 420

1. Valproic acid
2. Lithium
3. Thalidomide
4. Phenytoin
5. Vitamin A
6. Tetracyline
7. Warfarin
8. Alcohol
9. ACE inhibitors
10. Aminoglycosides
11. Smoking
12. Cocaine
13. Diethylstilbestrol

Question 421

A tall, thin male teenager has abrupt onset dyspnea and left-sided chest pain. Percussion on the affected side reveals hyperresonance, and breath sounds are diminished. What is the diagnosis?

Answer 421

Spontaneous pneumothorax

Question 422

An 80 year-old man presents with a systolic crescendo-decrescendo murmur. What is the most likely cause?

Answer 422

Aortic stenosis

Question 423

What are the differences between hexokinase and glukokinase?

Answer 423

Hexokinase

1. Located everywhere
2. Low Km
3. Low Vmax
4. Not induced by insulin

Glucokinase

1. Located in the liver and Beta cells of the pancreas
2. High Km
3. High Vmax
4. Induced by insulin

Question 424

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

Answer 424

HMG-CoA Reductase Inhibitors (Statins)

Question 425

What are the primary mechanisms of action of the different classes of antiarrhythmics?

Answer 425

“No Bad Boy Keeps Clean”

1. Class I: Na Channel Blockers
2. Class II: Beta-Blockers
3. Class III: K Channel Blockers
4. Class IV: Ca Channel Blockers

Question 426

Name 8 different indirect cholinergic agonsists and state the use for each

Answer 426

1. Neostigmine: Used for neurogenic ileus, as a neuromuscular junction blockade reversal agent, and to treat Myasthenia Gravis
2. Pyridostigmine: Treats Myasthenia Gravis
3. Edrophonium: Diagnoses Myasthenia Gravis
4. Physostigmine: Treats Atropine overdose
5. Echothiophate: Treats Glaucoma
6. Donepezil: Treats Alzheimers disease
7. Galantamine: Treats Alzheimers disease
8. Rivastigmine: Treats Alzheimers disease

Question 428

Describe how the murmur of mitral regurgitation is different from the murmur of aortic regurgitation

Answer 428

Mitral regurgitation

1. Holosystolic murmur
2. Best heard at the apex
3. Heard best in the left lateral decubitus position
4. Sound is enhanced by squating and expiration

Aortic regurgitation

1. Early diastolic murmur (During isovolumetric contraction)
2. Heard at the right 2nd intercostal region

Question 429

1. Which 2 bacteria are well known for being obligate intracellular bacteria?
2. Why cant these bacteria replicated extracellularly?

Answer 429

1. Rickettsia and Chlamydia
2. They cant make their own ATP

Legionella is also usually intracellular

Question 430

What marker of inflammation produced by the liver and within atherosclerotic plaques is a strong predictor of MI risk?

Answer 430

C-reactive protein (CRP)

Question 431

Which calcium channel blocker can be used to treat both hypertension and tachyarrhythmia?

Answer 431

Nondihydropyridine (Verapamil & Diltiazem)

Question 432

What are the systolic heart murmurs?

Answer 432

1. Tricuspid and mitral valve regurgitation
2. Aortic stenosis
3. PDA
4. VSD
5. Mitral prolapse

Question 433

What problem is most closely associated with the following statement?

1. 50-year-old female presents with pruritis without jaundice, lab reveals (+) AMA
2. A patient with GI bleeding has buccal pigmentation
3. 60-year-old woman with rheumatoid arthritis and no alcohol history presents with fatigue and right abdominal pain. Lab studies reveal high levels of ANA and ASMA, elevated serum IgG levels, and no viral serologic markers
4. Liver biopsy on a 23-year-old female with elevated levels of LKM-1 antibodies, no alcohol history, and no viral serologic markers reveals infiltration of the portal and periportal area with lymphocytes
5. Fatal disease of unconjugated bilirubin resulting from a complete lack of UDPGT activity

Answer 433

1. 50-year-old female presents with pruritis without jaundice, lab reveals (+) AMA: Primary Biliary Cirrhosis
2. A patient with GI bleeding has buccal pigmentation: Peutz-Jeghers Syndrome
3. 60-year-old woman with rheumatoid arthritis and no alcohol history presents with fatigue and right abdominal pain. Lab studies reveal high levels of ANA and ASMA, elevated serum IgG levels, and no viral serologic markers: Autoimmune hepatitis
4. Liver biopsy on a 23-year-old female with elevated levels of LKM-1 antibodies, no alcohol history, and no viral serologic markers reveals infiltration of the portal and periportal area with lymphocytes: Autoimmune hepatitis
5. Fatal disease of unconjugated bilirubin resulting from a complete lack of UDPGT activity: Crigler-Najjar I

Question 434

What problem is most closely associated with the following statement?

1. Nonfatal disease of unconjugated bilirubin resulting from low levels of UDPGT activity
2. Elevated levels of serum ferritin and increased transferrin saturation
3. Alpha-fetoprotein levels >1000 pg/mL
4. Elevated serum copper, decreased serum ceruloplasmin, and elevated 24-hr urinary copper
5. Liver disease + Lung emphysema
6. ERCP reveals alternating strictures and dilation

Answer 434

1. Nonfatal disease of unconjugated bilirubin resulting from low levels of UDPGT activity: Crigler-Najjar II & Gilbert Disease
2. Elevated levels of serum ferritin and increased transferrin saturation: Hemochromatosis
3. Alpha-fetoprotein levels >1000 pg/mL: Hepatocellular carcinoma
4. Elevated serum copper, decreased serum ceruloplasmin, and elevated 24-hr urinary copper: Wilsons Disease
5. Liver disease + Lung emphysema: Alpha-1 Antitrypsin deficiency
6. ERCP reveals alternating strictures and dilation: Primary sclerosing cholangitis

Question 435

What amino acid is a precursor to each of the following molecules?

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

Answer 435

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

Question 436

1. What is the basic equation for cardiac output?
2. What is the Fick principle?

Answer 436

CO = SV x HR

CO = Rate of O2 consumption/(Arterial O2 content - Venous O2 content)

Question 437

What is the mechanism of action of lactulose?

Answer 437

1. It is digested by bacteria in the colon
2. It’s digestion creates an acidic environment
3. NH₃ -> NH₄⁺
4. NH₄⁺ is excreted in the stool

Question 438

What does a relative risk less than 1 indicate?

Answer 438

Disease is less likely to occur in exposed group

Question 439

A screening test under investigation uses a lab marker SCSQ to identify early small cell and squamous cell lung cancer. In a population of 100 smokers over age 60, 20 test positive. Of the 20 that tested positive, 5 actually had either of the two lung cancers. Of those that did not test positive, it was determined that 5 had either of the two cancers. What is the sensitivity, specificity, PPV and NPV?

Answer 439

1. Sensitivity = 5/10 = 50%
2. Specificity = 75/90 = 83%
3. PPV = 5/20 = 25%
4. NPV = 75/80 = 94%

Question 440

What are normal BP’s in the right and left ventricles?

Answer 440

1. Right ventrical: 25/5
2. Left ventrical: 130/10

Question 441

While on an ACE inhibitor for hypertension a patient develops a cough. What is a good replacement drug, and why doesn’t it have the same side effects?

Answer 441

1. ARB because they do not inhibit Angiotensin Converting Enzyme (ACE)
2. ACE inhibitors produce cough by inhibiting ACE and thus preventing it from breaking down bradykinin

Question 442

When should a woman begin to receive regular mammograms?

Answer 442

Every other year beginning at age 40

Question 443

During a high school football game, a young athlete collapses and dies immeditately. What type of cardiac disease did he have?

Answer 443

Hypertrophic Cardiomyopathy

Question 444

What are the characteristic features of alkaptonuria?

Answer 444

1. Deficiency of homogentisic acid oxidase
2. Dark organs and connective tissue
3. Dark urine when out for an extended period of time
4. Benign disease

Question 445

What organisms are known for causing endocarditis?

Answer 445

Most common organisms

1. Staph aureus (30-35%)
2. Viridans strep
3. Enterococci
4. Staph epidermidis
5. Strep bovis (Colon cancer)

Culture-negative organisms (rare): “HACEK”

1. Haemophilus
2. Actinobacillus
3. Cardiobacterium
4. Eikenella
5. Kingella

Question 446

In a study of 100 people, your study results show an average of 500 with a standard deviation of 50. Calculate the 95% confidence Interval.

Answer 446

SEM = SD/ Sqrt(n) = 50/Sqrt(100) = 5

CI = Mean +/- Z(SEM) = 500 +/- 2(5) = 490 to 510

Question 447

In a population of 100 workers that worked to clean an oil spill on a beach, 10 develop leukemia. In a population of 1,000 hotel beach umbrella monitors on a clean beach, 50, develop leukemia. What is the attributable risk?

Answer 447

10/100 - 50/1000 = 0.05

Question 448

Which antihypertensive drug fits each of the following side effects?

1. First dose orthostatic hypotension
2. Hypertrichosis
3. Cyanide toxicity

Answer 448

1. First dose orthostatic hypotension: Alpha-1 blockers
2. Hypertrichosis: Minoxidil
3. Cyanide toxicity: Sodium Nitroprusside

Question 449

Which antihypertensive drug fits each of the following side effects?

1. Dry mouth, sedation, severe rebound HTN
2. Bradycardia, impotence, asthma exacerbation
3. Reflex tachycardia

Answer 449

1. Dry mouth, sedation, severe rebound HTN: Alpha-2 agonists (clonidine)
2. Bradycardia, impotence, asthma exacerbation: Beta-blockers
3. Reflex tachycardia: Nitrates, Hydralazine, Minoxidil, Dihydropyridine calcium channel blockers

Question 450

Which antihypertensive drug fits each of the following side effects?

1. Metabolic alkalosis
2. Elevated anti-histone antibodies
3. Hypercalcemia

Answer 450

1. Metabolic alkalosis: Loop diuretics
2. Elevated anti-histone antibodies: Hydralazine
3. Hypercalcemia: Thiazides

Question 451

An abdominal aortic aneurysm is most likely a consequence of what process?

Answer 451

Smoking is the #1 risk factory for AAA

Also Atherosclerosis as the aorta is the most common location for this process to occur

Question 452

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

1. Chromosome 22q11 deletions
2. Down Syndrome
3. Congenital Rubella
4. Turner Syndrome
5. Marfan Syndrome

Answer 452

1. Chromosome 22q11 deletions: Truncus arteriosus, tetralogy of fallot
2. Down Syndrome: Cushion defect, ASD, VSD, AV septal defect
3. Congenital Rubella: PDS, pulmonary artery stenosis, septal defects
4. Turner Syndrome: Coarctation of the aorta
5. Marfan Syndrome: Aortic insufficiency

Question 453

In which section of the brainstem is each of the cranial nerve nuclei located?

Answer 453

Midbrain: CN III, CN IV

Pons: CN I, CN VI, CN VII, CN VIII

Medulla: CN IX, CN X, CN XI, CN XII

Question 454

What information is communicated at the:

1. Nucleus solitarius?
2. Nucleus ambiguous?
3. Dorsal motor nucleus?

Answer 454

1. Nucleus solitarius: Sensory information - Taste, baroreceptors, gut distention
2. Nucleus ambiguous: Motor information - Pharynx, larynx, upper esophagus
3. Dorsal motor nucleus: Autonomic information - Heart, lungs, upper GI tract

Question 455

Which type of vasculitis fits each of the following descriptions?

1. Necrotizing granulomas of lung and necrotizing glomerulonephritis
2. Necrotizing immune complex inflammation of visceral/renal vessels
3. Young asian women
4. Young asthmatics

Answer 455

1. Necrotizing granulomas of lung and necrotizing glomerulonephritis: Wegeners
2. Necrotizing immune complex inflammation of visceral/renal vessels: Polyarteritis nodosa
3. Young asian women: Takayasu’s
4. Young asthmatics: Churg-Strauss

Question 456

Which type of vasculitis fits each of the following descriptions?

1. Infants and young children, involved coronary arteries
2. Most common vasculitis
3. Associated with hepatitis B infection

Answer 456

1. Infants and young children, involved coronary arteries: Kawasaki’s
2. Most common vasculitis: Temporal (Giant cell) arteritis
3. Associated with hepatitis B infection: Poylarteritis nodosa

Question 457

What portion of the brain is supplied by the:

1. Anterior cerebral artery?
2. Middle cerebral artery?

Answer 457

1. Medial
2. Lateral

Question 458

How does the presentation of a dominant parietal lobe lesion differ from the presentation of a non-dominant parietal lobe lesion?

Answer 458

Dominant side lesion

1. Called Gerstmann syndrom
2. Acaculia
3. Dysarthria
4. Finger agnosia
5. Left/right disorientation

Non-dominant side lesion

1. Hemispatial neglect

Question 459

On auscultation of a patient, you hear a pnasystolic murmur at the apex with radiation to the axilla. What is the most likely cause of this murmur?

Answer 459

Mitral regurgitation

Question 460

Your study shows that high LDL does not increase one’s risk of CAD. What type of error is this?

Answer 460

Type II error

Question 461

1. What medication inhibits alcohol dehydrogenase?
2. What medication inhibits acetaldehyde dehydrogenase?

Answer 461

1. Fomepizole
2. Disulfuram

Question 462

What are the treatments for overdose of heparin and warfarin?

Answer 462

1. Protamine sulfate
2. Vitamin K or fresh frozen plasma

Question 463

What are five hereditary thrombosis syndromes?

Answer 463

1. Factor V leiden
2. Protein C deficiency
3. Protein S deficiency
4. Prothrombin 20210 mutation
5. Antithrombin deficiency

Question 464

Which cancer drugs are known for bein cardiotoxic?

Answer 464

Doxorubicin & Daunorubicin

Question 465

What is the rate-limiting step in heme synthesis?

Answer 465

Aminolevulinic Acid Synthase

Converts glycine + succinyl CoA -(B6)> Aminolevulinic Acid

Question 466

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

Answer 466

1. Beta4
2. Alpha Thalassemia
3. Gamma4
4. Hydrops Fetalis

Question 467

What excitatory neurotransmitter is involved in pain>

Answer 467

Substance P

Question 468

What defect is associated with the following type of murmur?

1. Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd right interspace close to the sternum
2. Rumbling late diastolic murmur with an opening snap
3. Pansystolic (AKA holosystolic or uniform) murmur best heard at the 4th-6th left intercostal spaces, adjacent to the sternum
4. Continuous machine-like murmur (in systole and diastole)

Answer 468

1. Crescendo-decrescendo systolic murmur best heard in the 2nd-3rd right interspace close to the sternum: Aortic stenosis
2. Rumbling late diastolic murmur with an opening snap: Mitral stenosis
3. Pansystolic (AKA holosystolic or uniform) murmur best heard at the 4th-6th left intercostal spaces, adjacent to the sternum: Tricuspid regurgitation or VSD
4. Continuous machine-like murmur (in systole and diastole): PDA

Question 469

What organisms are known for causing endocarditis?

Answer 469

1. Staph aureus
2. Viridans strep
3. Enterococci
4. Staph epidermidis
5. Strep bovis

“HACEK”

1. Haemophilus
2. Actinobacillus
3. Cardiobacterium
4. Eikenella
5. Kingella

Question 470

What four drug regimen is used to treat TB?

Answer 470

1. Isoniazid
2. Rifampin
3. Pyrazinamide
4. Ethambutol

Question 471

What is pulsus paradoxus, and what are the causes?

Answer 471

Systolic BP drops by > 10mmHg with inspiration

Caused by hyperinflated lungs

1. Asthma
2. COPD
3. Croup
4. Cardiac Tamponade

Question 472

With what hematologic disease would you expect to see each of the following?

1. (+) Ham’s test
2. Heinz bodies
3. Basophilic stippling

Answer 472

1. (+) Ham’s test: Paroxysmal Nocturnal Hemoglobinuria
2. Heinz bodies: G6PD deficiency
3. Basophilic stippling: Lead poisoning mostly (“TAIL” - Thalassemia, Anemia of chronic Dx, Iron deficiency, Lead poisoning)

Question 473

With what hematologic disease would you expect to see each of the following?

1. (+) Osmotic fragility test
2. (+) DEB test
3. D-Dimer

Answer 473

1. (+) Osmotic fragility test: Hereditary Spherocytosis
2. (+) DEB test: Fanconi’s Anemia
3. D-Dimer: DIC, DVT/PE, ITP, TTP

Question 474

With what hematologic disease would you expect to see each of the following?

1. Coomb (+)
2. Coomb (-)
3. (+) Ristocetin test

Answer 474

1. Coomb (+): Autoimmune hemolytic anemia
2. Coomb (-): Non-autoimmune hemolytic anemia
3. (+) Ristocetin test: Von Willebrand Disease

Question 475

Outline the flow of fetal circulation

Answer 475

Umbilical vein -> Ductus venosus -> IVC -> Right atrium -> Most blood passes through foramen ovale to enter the left ventricle, the rest enters the right ventricle -> blood in the right ventricle enters the pulmonary artery -> some blood will go to the lungs but most will enter the aorta via the ductus arteriosus -> Blood in the aorta will travel to the body -> some will enter the IVC directly but most will enter the umbilical artery to become oxygenated -> oxygenated blood returns to the fetus via the umbilical vein

Question 476

What drug categories do the following medications fall under?

1. Losartan
2. Vecuronium
3. Ticarcillin
4. Desipramine

Answer 476

1. Losartan: Angiotensin receptor blocker (ARB)
2. Vecuronium: A neuromuscular junction blockade
3. Ticarcillin: Penicillin antibiotic
4. Desipramine: Tricyclic antidepressant

Question 477

What drug categories do the following medications fall under?

1. Enalapril
2. Lorazepam
3. Rosiglitazone

Answer 477

1. Enalapril: ACE inhibitor
2. Lorazepam: Benzodiazepine
3. Rosiglitazone: Thiazolidinedione

Question 478

Which branchial arches develop into the following structures?

1. Common carotid artery
2. Aortic arch
3. Right subclavian
4. Pulmonary arteries

Answer 478

1. Common carotid artery: III
2. Aortic arch: IV (left)
3. Right subclavian: IV (right)
4. Pulmonary arteries: VI

Question 479

What is the classic clinical presentation of a thyroglossal duct cyst?

Answer 479

Midline mass that moves when swallowing

Question 480

Which exotoxin/bacteria works via each of the following mechanisms?

1. Inactivates EF-2
2. Activates Gs
3. Disables Gi
4. Bacterial adenylate cyclase (no G protein involved)
5. Blocks GABA and glycine

Answer 480

1. Inactivates EF-2: Corynebacterium diphtheria
2. Activates Gs: Cholera toxin (Vibrio cholera)
3. Disables Gi: Pertussin toxin
4. Bacterial adenylate cyclase (no G protein involved): Bacillus anthracis
5. Blocks GABA and glycine: Tetanospasmin (Clostridium tetani)

Question 481

Which immune deficiency matches each of the following descriptions?

1. Anaphylaxis on exposure to blood products with IgA
2. Course facial features, abscesses, eczema
3. Thrombocytopenia, purpura, infections, eczema
4. Delayed separation of the umbilicus
5. Neurodefects, partial albinism, recurrent infections

Answer 481

1. Anaphylaxis on exposure to blood products with IgA: Selective Ig deficiency - B cell disorder
2. Course facial features, abscesses, eczema: Hyper-IgE (Job) syndrome - T cell disorder
3. Thrombocytopenia, purpura, infections, eczema: Wiskott-Aldrich syndrome - B and T cell disorder
4. Delayed separation of the umbilicus: Leukocyte adhesion deficiency Type I - Phagocyte dysfunction disorder
5. Neurodefects, partial albinism, recurrent infections: Chediak-Higashi syndrome - Phagocyte dysfunction disorder

Question 482

Describe how the murmur of mitral regurgitation is different than the murmur of aortic regurgitation.

Answer 482

Mitral regurgitation

1. Systolic
2. Blowing
3. High pitched
4. Heard best at apex

Aortic regurgitation

1. Diastolic
2. Blowing
3. High pitched
4. Heard best at left sternal border

Question 483

What is the mechanism of action of the bisphosphonates?

Answer 483

Inhibits osteoclasts

Question 484

In osteomalacia and Rickets, how will the following lab values compare to normal values:

1. Serum Ca
2. Serum phos
3. Serum alk phos
4. Serum PTH
5. Urine Ca
6. Urine phos

Answer 484

1. Serum Ca: Decreased
2. Serum phos: Decreased
3. Serum alk phos: Increased
4. Serum PTH: Increased
5. Urine Ca: Decreased
6. Urine phos: Increased

Question 485

Which hormones work via tyrosine kinase second messengers?

Answer 485

1. Growth hormone
2. Platelet-derived growth factor
3. Fibroblast growth factor
4. Insulin-like growth factor
5. Insulin
6. Prolactin

Question 486

What signs and symptoms would lead you to suspect acute rheumatic fever?

Answer 486

“JONES”

1. Joints
2. Pancarditis
3. Nodules
4. Erythema marginatum
5. Syndenham chorea

Less specific

1. Fever
2. Elevated ESR
3. Prolonged PR interval

Question 487

When does implantation of the ovum take place?

Answer 487

6 days after fertilization

Question 488

What nerve is damaged when a patient presents with each of the following upper extremity symptoms?

1. Claw hand
2. Wrist drop
3. Scapular winging

Answer 488

1. Claw hand:
2. Wrist drop
3. Scapular winging

Question 489

What nerve is damaged when a patient presents with each of the following upper extremity symptoms?

1. Unable to wipe bottom
2. Loss of forearm pronation
3. Weak external rotation of arm

Answer 489

1. Unable to wipe bottom: Thoracodorsal
2. Loss of forearm pronation: Median
3. Weak external rotation of arm: Suprascapular

Question 490

What nerve is damaged when a patient presents with each of the following upper extremity symptoms?

1. Loss of elbow flexion and forearm supination
2. Loss of wrist extension
3. Unable to raise arm above horizontal

Answer 490

1. Loss of elbow flexion and forearm supination: Musculocutaneous
2. Loss of wrist extension: Radial
3. Unable to raise arm above horizontal: Long thoracic and Spinal Accessory

Question 491

1. What portion of the brachial plexus is injured in Erb-Duchenne palsy?
2. What are the symptoms?

Answer 491

1. Superior portion (C5 and C6 roots)
2. Loss of
   
   • Abductors: Adduction of the arm
   • Lateral rotators: Medial rotation of the arm
   • Biceps: Pronation of the arm

Question 492

1. What is the clinical appearance of internuclear opthalmoplegia?
2. With what disorder is it commonly associated?

Answer 492

1. With lateral gaze
   
   • Adducting eye is paralyzed
   • Abducting eye has nystagmus
2. Multiple sclerosis

Internuclear opthalmoplegia is a lesion of the Medial Longitudinal Fasciculus (MLF)

Question 493

Which lipid-lowering agent matches each of the following descriptions?

1. SE - facial flushing
2. SE - elevated LFTs, myositis
3. SE - GI discomfort, bad taste

Answer 493

1. SE - facial flushing: Niacin
2. SE - elevated LFTs, myositis: Fibrates
3. SE - GI discomfort, bad taste: Bile acid binding resins

Question 494

Which lipid-lowering agent matches each of the following descriptions?

1. Best effect on HDL
2. Best effect on triglycerides/VLDL
3. Best effect on LDL/Cholesterol
4. Binds C. diff toxin

Answer 494

1. Best effect on HDL: Niacin
2. Best effect on triglycerides/VLDL: Fibrates
3. Best effect on LDL/Cholesterol: Statins
4. Binds C. diff toxin: Cholestyramine

Question 495

A 75 year-old man presents with acute knee pain and swelling. An X-ray reveals absence of erosion of the joint space, but these are calcium deposits in the menisci. What is the diagnosis, and what would you find on aspiration of the joint?

Answer 495

1. This is Pseudogout
2. Aspiration of the joint would reveal calcium pyrophosphate crystals

Question 496

What are the common locations for tophi in gout patients?

Answer 496

1. External ear (most common)
2. Olecranon bursa
3. Achilles tendon

Question 497

What is the mechanism and time-frame of acute transplant rejection?

Answer 497

Cytotoxic T cells react to foreign MHC

Question 498

A young woman is found to have short stature and shortened 4th and 5th metacarpals. What endocrine disorder is most likely responsible for these manifestations?

Answer 498

Albright’s Hereditary Osteodystrophy

(Type 1A Pseudohypoparathryroidism)

Question 499

What is the rate-limiting enzyme of beta-oxidation of fatty acids?

Answer 499

Carnitine acytransferase I

Question 500

What drugs are known for causing drug-induced lupus?

Question 501

What are the manifestations of CREST scleroderma?

Answer 501

1. Calcinosis
2. Raynaud phenomenon
3. Esophageal dysmotility
4. Sclerodactyly
5. Telangiectasia

Question 502

A patient presents with photosensitivity, arthritis, renal disease and recurrent oral ulcers is taking primaquine and NSAIDs. What type of check-up should she be receiving twice a year?

Answer 502

1. This patienthas lupus
2. Most feared complication of lupus is renal disease
3. Needs renal evaluation 1 to 2 times a year

Question 503

What is the cause of Duchenne muscular dystrophy?

Answer 503

Deletion of dystrophin gene

Question 504

What are some of the characteristics of polymyositis that distinguish it from polymyalgia rheumatica?

Answer 504

Polymyositis

1. Muscle weakness
2. Increased CK
3. Increased Aldolase
4. Positive ANA
5. Anti-Jo-1 antibody

Polymyalgia rheumatica

1. Joint pain but no muscle pain or weakness
2. CK and aldolase are normal

Question 505

What drug category is often used in the treatment of myasthenia gravis?

Answer 505

Acetylcholinesterase inhibitors

Question 506

What sensory receptor communitcates the following types of information?

1. Pricking pain (fast, myelinated)
2. Burning or dull pain and itch (Slow, unmyelinated)
3. Vibration and pressure
4. Dynamic/changing light, discriminatory touch

Answer 506

1. Pricking pain (fast, myelinated): A-delta fibers
2. Burning or dull pain and itch (Slow, unmyelinated): C polymodal fibers
3. Vibration and pressure: Pacinian Corpuscle
4. Dynamic/changing light, discriminatory touch: Meissner Corpuscle

Question 507

What sensory receptor communitcates the following types of information?

1. Static/unchanging light touch
2. Proprioception information - muscle length monitoring
3. Proprioception information - muscle tension monitoring

Answer 507

1. Static/unchanging light touch: Merkel Receptor
2. Proprioception information - muscle length monitoring: Muscle spindle
3. Proprioception information - muscle tension monitoring: Golgi tendon

Question 508

What is the landmark for a pudendal nerve block?

Answer 508

Ischial spine

Question 509

What CSF changes are present in Guillain-Barre syndrome?

Answer 509

Increased protein with normal cell count (Albuminocytologic Disassociation)

Question 510

What are the classic manifestations of Guillain-Barre syndrome?

Answer 510

1. Symmetric ascending paralysis/weakness beginning in lower extremities
2. Facial paralysis in 50% of cases
3. Autonomic dysfunction
4. Preceded by infection

Question 511

What are the symptoms of normal pressure hydrocephalus?

Answer 511

1. Wacky = Dementia
2. Wet = Urinary incontinence
3. Wobbly = Ataxia

Question 512

In what genetic disorder would you find acanthocytosis of RBCs and excess lipids in enterocytes?

Answer 512

Abetalipoproteinemia

Question 513

What disorder is associated with the following mutations?

1. FGF receptor 3
2. FMRI gene

Answer 513

1. FGF receptor 3: Achondroplasia
2. FMRI gene: Fragile X syndrome

Question 514

What problem/abnormality is associated with the following buzzwords?

1. Boot-shaped heart
2. Continuous machine-like murmur
3. Tendon Xanthomas
4. Cafe-au-lait spots
5. Tuft of hair on lower back

Answer 514

1. Boot-shaped heart: Right ventriculary hypertrophy or Tetralogy of Fallot
2. Continuous machine-like murmur: PDA
3. Tendon Xanthomas: Familial hypercholesterolemia
4. Cafe-au-lait spots: Neurofibromatosis type I or McCune-Albright syndrome
5. Tuft of hair on lower back: Spina bifida occulta

Question 515

What sturctures are at risk for injury with an anterior shoulder dislocation?

Answer 515

1. Posterior circumflex artery
2. Axillary nerve

Also Supraspinatus tendon, anterior glenohumoral ligament, glenoid labrum, and posterolateral humeral head

Question 516

What are the layers of the epidermia?

Answer 516

“Californians Like Girls in String Bikinis”

1. Stratum Corneum
2. Stratum Lucidum
3. Stratum Granulosum
4. Stratum Spinosum
5. Stratum Basalis

Outside to Inside

Question 517

Your patient has facial angiofibromas, Ash-leaf spots on skin depigmentation, history of seizures, and mental retardation. What condition does this patient have? What neoplasms is this patient at risk of developing?

Answer 517

The patient has Tuberous sclerosis and is at risk for developing

1. Cardiac rhabdomyoma
2. Astrocytoma
3. Angiomyolipoma

Question 518

What artery is damaged (via hemorrhagic stroke or ischemic stroke) with each of the following presentations?

1. Aneurysm causes the eye to look down and out
2. Aneurysm may cause bilateral loss of lateral visual fields
3. Broca or Wernicke aphasia
4. Unilateral lower extremity sensory and/or motor loss
5. Unilateral facial and arm sensory and/or motor loss

Answer 518

1. Aneurysm causes the eye to look down and out: Posterior communicating artery
2. Aneurysm may cause bilateral loss of lateral visual fields: Anterior communicating artery
3. Broca or Wernicke aphasia: Middle cerebral artery
4. Unilateral lower extremity sensory and/or motor loss: Anterior cerebral artery
5. Unilateral facial and arm sensory and/or motor loss: Middle cerebral artery

Question 519

What are the side effects of amiodarone?

Answer 519

“PFTs, LFTs, and TFTs”

1. Pulmonary fibrosis
2. Hapatotoxicity
3. Thyroid dysfunction

Also corneal deposits, photosensitivity, neurologic effects, constipation, cardiovascular effects

Question 520

A 43 year-old man presents with symptoms of dizziness and tinnitus. CT shows enlarged internal acoustic meatus. What is the diagnosis?

Answer 520

Acoustic Schwannoma

Question 521

What are the different mechanisms by which heart contractility can be increased?

Answer 521

1. Catecholamines (Anxiety, exercise, stress, or catecholamine infusion)
2. Increased intracellular Ca
3. Increased extracellular Na
4. Digoxin (increases intracellular Ca and increases extracellular Na)

Question 522

What medication is used to treat the following parasitic infection?

1. Trichomonas or Gardnerella
2. Plasmodium vivax or ovale
3. Pediculosis capitis or pubis

Answer 522

1. Trichomonas or Gardnerella: Metronidazole
2. Plasmodium vivax or ovale: Chloroquine + primaquine
3. Pediculosis capitis or pubis: This is a Lice infection, Tx is Permethrin or Pyrethrin (Second line is Malathion)

Question 523

What categories of antihypertensives are considered first-line in hypertensive patients with diabetes?

Answer 523

ACE inhibitors or ARBs (Decrease diabetic nephropathy and decrease progression of proteinuria)

Question 524

What are the Kubler-Ross stages of grief?

Answer 524

1. Denial
2. Anger
3. Bargaining
4. Grieving (depression)
5. Acceptance

Question 525

What physiologic changes are sensed by peripheral chemoreceptors? By central chemoreceptors?

Answer 525

Peripheral

1. Decreased PO2
2. Decreased pH
3. Increased PCO2

Central

1. Change in PCO2
2. Change in pH

Question 526

1. Which oncogene is associated with colon cancer?
2. Which is associated with small cell lung cancer?

Answer 526

1. Ras
2. L-Myc

Question 527

What are some of the clinical effects of zinc deficiency?

Answer 527

1. Delayed wound healing
2. Decreased adult hair (body/facial hair)
3. Hypogonadism
4. Problems with smell and taste
5. Predisposition to cirrhosis from alcohol

Question 528

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

1. Microcytic anemia + swallowing difficulty + glossitis
2. Microcytic anemia + >3.5% HbA2
3. Megaloblastic anemia not correctable by B12 or folate

Answer 528

1. Microcytic anemia + swallowing difficulty + glossitis: Iron deficiency anemia (Plummer-Vinson syndrome)
2. Microcytic anemia + >3.5% HbA2: Beta-thalassemia minor
3. Megaloblastic anemia not correctable by B12 or folate: Orotic aciduria

Question 529

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

1. Megaloblastic anemia along with peripheral neuropathy
2. Microcytic anemia + basophilic stippling
3. Microcytic anemia reversible with B6

Answer 529

1. Megaloblastic anemia along with peripheral neuropathy: B12 deficiency
2. Microcytic anemia + basophilic stippling: Lead poisoning
3. Microcytic anemia reversible with B6: Sideroblastic anemia

Question 530

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

1. HIV positive patient with macrocytic anemia
2. Normocytic anemia + red urine in the morning
3. Normocytic anemia and elevated creatinine

Answer 530

1. HIV positive patient with macrocytic anemia: Zidovudine
2. Normocytic anemia + red urine in the morning: Paroxysmal Nocturnal Hemoglobinuria
3. Normocytic anemia and elevated creatinine: Chronic kidney disease (Decreased EPO)

Question 531

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

1. Rb
2. DPC
3. p53

Answer 531

1. Rb: Retinoblastoma and Osteosarcoma
2. DPC: Pancreatic cancer
3. p53: Most tumors

Question 532

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

1. APC
2. WT1
3. BRCA1 and BRCA2

Answer 532

1. APC: Familial Adenomatous Polyposis Coli and colorectal cancer
2. WT1: Wilms Tumor
3. BRCA1 and BRCA2: Breast and ovarian cancer

Question 533

What findings are associated with hereditary spherocytosis?

Answer 533

1. Anemia
2. Jaundice
3. Pigmented gallstones
4. Splenomegaly
5. Positive osmotic fragility test
6. Negative coombs test

Question 534

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

Answer 534

1. Warm = IgG
2. Cold = IgM

Question 535

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

Answer 535

1. Sensitivity = True positives / All diseased = A/(A+C)
2. Specificity = True negatives / All healthy = D/(D+B)
3. PPV = True positives / All positives = A/(A+B)
4. NPV = True negatives / All negatives = D/(D+C)

Question 536

What eye abnormality is seen in a patient with MS and internuclear ophthalmoplegia?

Answer 536

On lateral gaze

1. Abducting eye has nystagmus
2. Adducting eye is unable to adduct

Convergence is normal

Question 537

A man in his 40s begins to develop early dementia and uncontrollable movements of his upper extremities. In what portion of the brain do you expect to see atrophy?

Answer 537

This is Huntingtons disease characterized by atrophy of the Caudate and Putamen

Question 538

A patient with a cortical lesion and left arm paralysis is unaware of his neurologic deficiency. Where is the lesion?

Answer 538

This is hemispatial neglect, due to a lesion of his non-dominant (Usually right) parietal lobe

Question 539

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

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

Answer 539

1. ACTH -> Cushing Syndrome: Small cell lung cancer
2. Erythropoietin -> Polycythemia: Renal cell carcinoma, Hepatocellular carcinoma, Hemangioblastoma, Pheochromocytoma
3. ADH -> SIADH: Small cell lung cancer, any intracranial lesion

Question 540

What are the endogenous agonists to the different opioid receptors?

Answer 540

1. Mu receptor: Morphine
2. Delta receptor: Enkephalin
3. Kappa receptor: Dynorphin

Question 541

Which medication fits each of the following descriptions?

1. Opioid cough cuppressant commonly used with the expectorant guaifenesin
2. Opioid used in the treatment of diarrhea
3. Opioid receptor antagonist
4. Non-addictive weak opioid agonist
5. Partial opioid agonist that causes less respiratory depression

Answer 541

1. Opioid cough cuppressant commonly used with the expectorant guaifenesin: Dextromethorphan
2. Opioid used in the treatment of diarrhea: Loperamide & Diphenoxylate
3. Opioid receptor antagonist: Naloxone/Naltrexone
4. Non-addictive weak opioid agonist: Tramadol
5. Partial opioid agonist that causes less respiratory depression: Butorphanol

Question 542

A patient comes to your office and before you notice any other symptoms, you see that the patient’s uvula deviates to the right when she says “ah.” What neurological areas might be damaged in order for this abnormality to be seen?

Answer 542

1. Left side: CN X damage, Nucleus Ambiguous damage
2. Right side: Corticobulbar tract, soft palate portion of right motor cortex

Question 543

Which fungus fits each of the following statments?

1. Causes San Joaquin Valley fever
2. Found in rural Latin America
3. Associated with plant thorns and cutaneous injury

Answer 543

1. Causes San Joaquin Valley fever: Coccidioides
2. Found in rural Latin America: Paracoccidioides
3. Associated with plant thorns and cutaneous injury: Sporothrix

Question 544

Which fungus fits each of the following statments?

1. Found in states east of the Mississippi River
2. Found in bird and bat droppings
3. Mold form contains barrel-shaped arthroconidia

Answer 544

1. Found in states east of the Mississippi River: Blastomyces
2. Found in bird and bat droppings: Histoplasma
3. Mold form contains barrel-shaped arthroconidia: Coccidioides

Question 545

A patient comes to the clinic complaining of anterior shoulder pain that radiates into the forearm. On examination, you notice swelling of the biceps muscle. What is the most likely diagnosis?

Answer 545

Bicep tendon rupture

Question 546

An ER trauma patient is found to have multiple masses scattered throughout the body and brain as seen on a trauma protocol CT scan of the head, neck, chest, abdomen, and pelvis. Assuming that this represents multiple metastatic lesions, what do you suspect as the primary source of the cancer given that metastases are found in the brain parenchyma?

Answer 546

These tumors metastasize to the brain: “Lots of Bad Stuff Kills Glia”

1. Lung
2. Breast
3. Skin (melanoma)
4. Kidney (renal cell carcinoma)
5. GI

Of these, lung and breast cancers are most common and would be suspected

Question 547

What agents are used in the treatment of Parkinson disease?

Answer 547

“BALSA”

1. Bromocriptine, Pramipexole, Ropinirole (Dopamine agonists)
2. Amantidine
3. Levodopa, Carbidopa
4. Selegiline, Entacapone, Tolcapone (MAO-B inhibitor and COMT inhibitors respectively)
5. Antimuscarinics (Benztropine: Treats symptoms not disease)

Question 548

What should you immediately think about in a patient with “bilateral Bell palsy”?

Answer 548

Lyme disease or Guillain-Barre syndrome

Question 549

What is Dressler syndrome?

Answer 549

1. Pericarditis that occurs 2-4 weeks after MI
2. Chest pain
3. Fever
4. Increased ESR

Question 550

What are the Risk factors for osteoporosis?

Answer 550

1. Old age
2. Smoking
3. Steroid use (Glucocorticoids)
4. Chronic heparin use
5. White or Asian race
6. Being thin
7. Not exercising
8. Decreased Ca & Vit D intakes
9. Decreased Testosterone/Estrogen

Question 551

Which primary brain tumor fits the following description?

1. Polycythemia
2. Neruofibromatosis II
3. Hyperprolactinemia -> Galactorrhea, amenorrhea, anovulation
4. Psammoma bodies

Answer 551

1. Polycythemia: Hemangioblastoma
2. Neruofibromatosis II: Schwannoma
3. Hyperprolactinemia -> Galactorrhea, amenorrhea, anovulation: Pituitary adenoma
4. Psammoma bodies: Meningioma

Question 552

Which primary brain tumor fits the following description?

1. Perivascular pseudorosettes
2. Bitemporal hemianopia
3. Worst prognosis of any primary brain tumor

Answer 552

1. Perivascular pseudorosettes: Ependymoma
2. Bitemporal hemianopia: Pituitary adenoma or craniopharyngioma
3. Worst prognosis of any primary brain tumor: Glioblastoma multiforme

Question 553

A 25 year-old woman presents with sudden uniocular vision loss and slightly slurred speech. She has a history of weakness and paresthesia that have resolved. What is the most likely diagnosis?

Answer 553

Optic neuritis due to Multiple Sclerosis

Question 554

What is the classic triad of symptoms in Multiple Sclerosis?

Answer 554

Charcot’s Triad

1. Scanning speech
2. Intention tremor
3. Nystagmus

Also Bowel/bladder incontinence, intranuclear opthalmoplegia, and optic neuritis

Question 555

Which neoplasm is associated with each of the following statements?

1. Nitrosamines
2. Asbestos
3. Naphthalene
4. Arsenic

Answer 555

1. Nitrosamines: Esophageal, stomach, and colon cancers
2. Asbestos: Mesothelioma & Bronchogenic carcinoma
3. Naphthalene: Transitional cell bladder cancer
4. Arsenic: Squamous cell skin cancer, angiosarcoma of the liver

Question 556

Which neoplasm is associated with each of the following statements?

1. EBV
2. HPV
3. Schistosoma haematobium

Answer 556

1. EBV: Burkitt lymphoma, nasopharyngeal carcinoma
2. HPV: (Types 16 & 18) Genital and anal cancer
3. Schistosoma haematobium: Squamous cell cancer of the bladder

Question 557

What is the cause of ITP?

Answer 557

Antibodies to gp IIb/IIIa

Question 558

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

1. Streptokinase
2. Aspirin
3. Clopidogrel
4. Abciximab

Answer 558

1. Streptokinase: Converts plasminogen to plasmin which cleaves fibrin
2. Aspirin: Irreversibly inhibits COX 1 & 2 by covalent acetylation
3. Clopidogrel: Blocks ADP receptors
4. Abciximab: Binds to gb IIb/IIIa

Question 559

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

1. Tirofiban
2. Ticlopidine
3. Enozaparin
4. Eptifibatide

Answer 559

1. Tirofiban: Binds to gp IIb/IIIa
2. Ticlopidine: Blocks ADP receptors
3. Enozaparin: Catalyzes antithrombin III formation and activation
4. Eptifibatide: Binds to gp IIb/IIIa

Question 560

A patient falls off a motorcycle and lands on his right shoulder. On physical exam you notice his shoulder has an abnormal configuration. X-rays indicate an anterior dislocation of his shoulder. What artery and nerve are most at risk of being damaged?

Answer 560

1. Posterior circumflex artery
2. Axillary nerve

Question 561

Which neruodegenerative disease matches each of the following statements?

1. Senile plaques, neurofibrillary tangles
2. Presents at birth as “floppy baby”
3. Lewy bodies

Answer 561

1. Senile plaques, neurofibrillary tangles: Alzheimers disease
2. Presents at birth as “floppy baby”: Werdnig-Hoffman disease
3. Lewy bodies: Parkinsons disease, Diffuse lewy body dementia, or Lewy body type Alzheimers disease

Question 562

Which neruodegenerative disease matches each of the following statements?

1. Dementia often associated with frequent falls and/or syncope
2. Atrophy of caudate nucleus -> chorea
3. Depigmentation of substantia nigra

Answer 562

1. Dementia often associated with frequent falls and/or syncope: Lewy body dementia
2. Atrophy of caudate nucleus -> chorea: Huntington disease
3. Depigmentation of substantia nigra: Parkinsons disease

Question 563

Which neruodegenerative disease matches each of the following statements?

1. Both upper and lower motor neuron signs (spasticity and weakness)
2. Dementia + visual hallucinations
3. Dementia + personality changes and/or aphasia

Answer 563

1. Both upper and lower motor neuron signs (spasticity and weakness): ALS
2. Dementia + visual hallucinations: Lewy body dementia
3. Dementia + personality changes and/or aphasia: Pick disease

Question 564

A 4 year-old girl complains of pain in her genitalia. On exam, a discharge is noticed and a smear of the discharge shows N. gonorrhoeae. How was she infected?

Answer 564

Sexual abuse

Question 565

What clinical presentation might lead you to suspect a patient may have lymphoma?

Answer 565

1. Painless lymphadenopathy
2. B symptoms (Fever, weight loss, night sweats)

Question 566

What forms of leukemia match each of the following statments?

1. Most common leukemia in children
2. Most common leukemia in adults in the US
3. Characteristic Auer rods
4. Greater than 20% blasts in marrow
5. Leukemia with more mature cells and less than 5% blasts

Answer 566

1. Most common leukemia in children: ALL
2. Most common leukemia in adults in the US: CLL
3. Characteristic Auer rods: AML
4. Greater than 20% blasts in marrow: Acute leukemias (ALL or AML)
5. Leukemia with more mature cells and less than 5% blasts: Chronic leukemias (CLL or CML)

Question 567

What forms of leukemia match each of the following statments?

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

Answer 567

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

Question 568

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

Answer 568

Metaplasia: Columnar -> Squamous

Question 569

A 55 year-old man who is a smoker and heavy drinker presents with a new cough and flu-like symptoms. Gram stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis?

Answer 569

Legionnaire’s disease (Legionella pneumophila)

Question 570

What is the classic presentation of a patient with temporal arteritis?

What lab finding helps diagnose temporal arteritis?

Answer 570

Presentation

1. Unilateral headache
2. Jaw claudication
3. Blindness or impaired vision

Labs

1. Elevated ESR
2. Temporal artery biopsy to confirm diagnosis

Question 571

A 30 year-old woman presents with a low grade fever, a rash across her nose that gets worse when she is out in the sun, and widespread edema. What blood test would you order to confirm your clinical suspicion?

Answer 571

ANA as a screening test for suspected Lupus

Question 572

What are the signs of Vitamin A deficiency?

Answer 572

1. Night blindness
2. Xerophthalmia -> corneal ulceration and blindness
3. Wrinkling/clouding of the cornea
4. Dry, silver-grey plaques on the bulbar conjunctiva

Question 573

What are the major signs of vitamin C deficiency (Scurvy)?

Answer 573

1. Fragile blood vessels (Easy bruising)
2. Loose teeth
3. Sore/spongy gums
4. Anemia
5. Swollen joints (bleeding into joint spaces)
6. Impaired wound healing

Question 574

What is the equation for determining the confidence interval?

Answer 574

CI = Mean +/- Z(SEM)

Question 575

What is the function of the protein that is absent in Duchenne muscular dystrophy?

Answer 575

Dystrophin -> Connects muscle fibers to one another

Question 576

A patient returns from a trip to New Mexico and now has pneumonitis. What is the fungal cause of the patient’s lung disease?

Answer 576

Coccidiodes immitis

Question 577

Which ECG leads will show evidence of ischemia in an inferior wall MI?

Answer 577

II, III, & AV_f

Question 578

What pathology fits each of the following phrases?

1. Antiplatelet antibodies
2. Bamboo spine on X-ray
3. Webbed neck, short stature
4. Painful, raised lesions on palms + fever

Answer 578

1. Antiplatelet antibodies: ITP
2. Bamboo spine on X-ray: Ankylosing Spondylitis
3. Webbed neck, short stature: Turner syndrome
4. Painful, raised lesions on palms + fever: Infective endocarditis

Question 579

What pathology fits each of the following phrases?

1. Dry eyes, dry mouth, arthritis
2. Posterior cervical adenopathy
3. Low serum ceruloplasmin

Answer 579

1. Dry eyes, dry mouth, arthritis: Sjogren syndrome
2. Posterior cervical adenopathy: Infective mononucleosis, bratonella henslae, otitis media
3. Low serum ceruloplasmin: Wilsons disease

Question 580

1. What type of antipsychotic is often the first line of treatment for psychosis?
2. Which antipsychotic should be reserved for severe, refractory cases because of agranulocytosis?

Answer 580

1. Atypical antipsychotics (Risperidone)
2. Clozapine

Question 581

Which skin disorder matches each of the following statements?

1. Pruritic, purple, polygonal papules
2. Pruritic vesicles associated with celiac disease
3. Tickened scar especially around the face/chest
4. Parakeratotic scaling

Answer 581

1. Pruritic, purple, polygonal papules: Lichen planus
2. Pruritic vesicles associated with celiac disease: Dermatitis Herpetiformis
3. Tickened scar especially around the face/chest: Keloid
4. Parakeratotic scaling: Psoriasis

Question 582

Which skin disorder matches each of the following statements?

1. Keratin-filled cysts
2. Skin rash and proximal muscle weakness
3. Honey crusting lesions common about the nose and lips
4. Hyperkeratosis and koilocytosis

Answer 582

1. Keratin-filled cysts: Seborrheic keratosis
2. Skin rash and proximal muscle weakness: Dermatomyositis
3. Honey crusting lesions common about the nose and lips: Impetigo
4. Hyperkeratosis and koilocytosis: Verrucae of HPV

Question 583

A 28 year-old woman is involved in a motor vehicle accident . She initially feels fine, but minutes later she loses consciousness. CT scan reveals an intracranial hemorrhage that does not cross suture lines. Which bone and vessel were injured in the crash?

Answer 583

1. Temporal bone
2. Middle meningeal artery

This is an epidural hematoma

Question 584

A patient presents with rose gardner’s scenario (thorn prick with ulcers along lymphatic drainage). What is the infectious bug?

Answer 584

Sporothrix Schenkii

Question 585

What bone disorder results from excess PTH?

Answer 585

Osteitis fibrosa cystica (Von Recklinghausen disease)

Question 586

A patient with a recent kidney transplant on cyclospornine for immunosuppression requires an antifungal agent for candidiasis. What antifungal agent would result in cyclosporine toxicity?

Answer 586

Ketoconazole (Inhibits P450)

Question 587

What is the most common cause of each of the following?

1. Hypoparathyroidism
2. Metastatic disease to brain
3. Lysosomal storage disease
4. Myocarditis

Answer 587

1. Hypoparathyroidism: Accidental surgical resection of parathyroid during thyroidectomy
2. Metastatic disease to brain: “Lots of Bad Stuff Kills Glia” - Lung, Breast, Skin (Melanoma), Kidney (renal cell carcinoma), GI tumors
3. Lysosomal storage disease: Gaucher Disease
4. Myocarditis: Coxackievirus

Question 588

For what type of information is the Ventral Posterior Lateral Nucleus a relay station?

Answer 588

Somatosensory information from the body

Question 589

For what type of information is the Lateral Geniculate Nucleus a relay station?

Answer 589

Visual retina to the occipital lobe

Question 590

For what type of information is the Ventral Posterior Medial Nucleus a relay station?

Answer 590

Somatosensory from the face

Question 591

For what type of information is the Ventral Anterior Nucleus a relay station?

Answer 591

Motor basal ganglia to the cortex

Question 592

What nerve is damaged when a patient presents with each of the following upper extremity symptoms?

1. Scapular winging
2. Loss of forearm pronation
3. Cannot abduct or adduct fingers
4. Weak external rotation of arm
5. Unable to abduct arm beyond 10 degrees

Answer 592

1. Scapular winging: Long thoracic nerve
2. Loss of forearm pronation: Median nerve
3. Cannot abduct or adduct fingers: Ulnar nerve
4. Weak external rotation of arm: Suprascapular (infraspinatus muscle), and a little bit from the Axillary nerve
5. Unable to abduct arm beyond 10 degrees: Axillary nerve (Suprascapular nerve innervates the supraspinatus muscle that is responsible for the first 10 degrees of abduction

Question 593

What are the common causes of hypocalcemia?

Answer 593

1. Parathyroidectomy
2. Vitamin D deficiency
3. Chronic renal disease
4. Autoimmune destruction of parathyroids
5. DiGeorge Syndrome
6. Pseudohypoparathyroidism (Kidneys unresponsive to PTH)
7. Acute pancreatitis

Question 594

A patient taking lisinopril complains of new onset, constant coughing. To what medication class should this patient be switched?

Answer 594

Angiotensin Receptor Blocker (ARB)

Question 595

What pathology is associated with each of the following high-yield phrases?

1. “Worst headache of my life”
2. Waxy casts in urine
3. Neuropathy + AV nodal block

Answer 595

1. “Worst headache of my life”: Subarachnoid hemorrhage (usually due to a ruptured berry aneurysm)
2. Waxy casts in urine: End stage renal failure (due to stasis of urine flow)
3. Neuropathy + AV nodal block: Lyme disease (Stage 2)

Question 596

What pathology is associated with each of the following high-yield phrases?

1. Port-wine stain in the opthalmic division of the trigeminal nerve
2. Urethritis, conjunctivitis, arthritis
3. Painless jaundice

Answer 596

1. Port-wine stain in the opthalmic division of the trigeminal nerve: Sturge-Weber Syndrome
2. Urethritis, conjunctivitis, arthritis: Reiter syndrome (associated with HLA-B27)
3. Painless jaundice: Pancreatic cancer of the head of the pancreas

Question 597

To what drug category does each of the following drugs belong?

1. Azothioprine
2. Probenecid
3. Primaquine
4. Cefpozil

Answer 597

1. Azothioprine: Immunosuppressant (Antimetabolite precursor of 6-Mercaptopurine)
2. Probenecid: Inhibitor of uric acid reabsorption
3. Primaquine: Antimalarial (used for P. vivax & ovale)
4. Cefpozil: 2nd generation Cephalosporin

Question 598

To what drug category does each of the following drugs belong?

1. Lamivudine
2. Tobramycin
3. Losartan
4. Indinavir

Answer 598

1. Lamivudine: Nucleoside Reverse transcriptase inhibitor (NRTI)
2. Tobramycin: Aminoglycoside
3. Losartan: Angiotensin Receptor Blocker (ARB)
4. Indinavir: Protease Inhibitor

Question 599

To what drug category does each of the following drugs belong?

1. 6-Mercaptopurine
2. Celecoxib
3. Carmustine
4. Doxycycline

Answer 599

1. 6-Mercaptopurine: Anticancer (Blocks de novo purine synthesis)
2. Celecoxib: COX-2 inhibitor
3. Carmustine: Nitrosourea (Alkylating agent)
4. Doxycycline: Tetracycline

Question 600

To what drug category does each of the following drugs belong?

1. Timolol
2. Methotrexate
3. Cimetidine
4. Mefloquine

Answer 600

1. Timolol: Beta-blocker (Non-selective like propranolol, nadolol and pindolol)
2. Methotrexate: Anticancer (Inhibitor of Dihydrofolate reductase)
3. Cimetidine: H2 blocker
4. Mefloquine: Antimalarial

Question 601

In a patient with an elevated alkaline phosphatase, an elevation in which serum lab markers would direct you to a diagnosis of liver disease?

Answer 601

1. AST
2. ALT
3. GGT

Question 602

What effect does asipocyte-generated leptin have on the hypothalamus?

Answer 602

1. It inhibits the lateral nucleus
2. It activates the ventromedial nucleus
3. The combination of these effects is to induce satiety

Question 603

How many half-lives does it take for a drug infused at a constant rate to reach 94% of steady state? What variables determine the half-life of a drug?

Answer 603

4 half lives

50 + 25 + 12.5 + 6.25 = 94%

Question 604

What neoplasms are associated with each of the following conditions?

1. Hashimoto thyroiditis
2. Down syndrome
3. Plummer-Vinson syndrome

Answer 604

1. Hashimoto thyroiditis: Lymphomas
2. Down syndrome: ALL & AML
3. Plummer-Vinson syndrome: Squamous cell carcinoma of esophagus

Question 605

What neoplasms are associated with each of the following conditions?

1. Tuberous sclerosis
2. Ataxia-Telangiectasia
3. Paget disease of bone

Answer 605

1. Tuberous sclerosis: Primarily Cardiac rhabdomyoma, Astrocytoma, Angiomyolipoma
2. Ataxia-Telangiectasia: Leukemias & Lymphomas
3. Paget disease of bone: Osteosarcoma & Fibrosarcoma

Question 606

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

Answer 606

OR = (A/B)/(C/D)

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

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

NNT = 1/ARR

Question 607

Which vitamin matches each of the following statments?

1. Can be used to treat acne and psoriasis
2. Involved in the hydroxylation of prolyl residues
3. Requires intrinsic factor for absorption

Answer 607

1. Can be used to treat acne and psoriasis: Vitamin A (Retinoic acid)
2. Involved in the hydroxylation of prolyl residues: Vitamin C (Ascorbic acid)
3. Requires intrinsic factor for absorption: Vitamin B12 (Cobalamin)

Question 608

Which vitamin matches each of the following statments?

1. Deficiency may result from kidney disease
2. Given prophylactically to newborns
3. Can be used to elevate HDL and lower LDL

Answer 608

1. Deficiency may result from kidney disease: Vitamin D
2. Given prophylactically to newborns: Vitamin K (to prevent hemorrhagic disease)
3. Can be used to elevate HDL and lower LDL: Vitamin B3 (Niacin)

Question 609

Which vitamin matches each of the following statments?

1. Deficiency can be caused by isoniazid use
2. Cobalt is found within this vitamin
3. Critical for DNA synthesis

Answer 609

1. Deficiency can be caused by isoniazid use: Vitamin B6 (Pyridoxine)
2. Cobalt is found within this vitamin: Vitamin B12 (Cobalamin)
3. Critical for DNA synthesis: Vitamin B9 (Folic acid) and Vitamin B12 (Cobalamin)

Question 610

Which portion of the eye is opacified in a cataract?

Answer 610

Lens

Question 611

Which diuretic is used in the treatment of pseudomotor cerebri?

Answer 611

Acetazolamide

Also used in glaucoma and altitude sickness

Question 612

What enzymes do obligate anaerobes lack?

Answer 612

1. Catalase
2. Superoxide dismutase

Question 613

What 5 classes of medications are used to treat glaucoma?

Answer 613

1. Acetazolamide or Mannitol
2. Cholinomimetics
3. Alpha-blockers
4. Beta-blockers
5. Prostaglandins

Question 614

Which antibiotic fits each of the following descriptions?

1. SE: Teeth discoloration
2. SE: Tendonitis
3. SE: Red man syndrome

Answer 614

1. SE: Teeth discoloration: Tetracycline
2. SE: Tendonitis: Fluoroquinolones
3. SE: Red man syndrome: Vancomycin

Question 615

Which antibiotic fits each of the following descriptions?

1. SE: Gray baby syndrome
2. SE: Cartilage damage in children
3. SE: Nephrotoxicity (especially with cephalosporins), ototoxicity (especially with loop diuretics)

Answer 615

1. SE: Gray baby syndrome: Chloramphenicol
2. SE: Cartilage damage in children: Fluoroquinolones
3. SE: Nephrotoxicity (especially with cephalosporins), ototoxicity (especially with loop diuretics): Aminoglycosides

Question 616

Which antibiotic fits each of the following descriptions?

1. SE: Pseudomembranous colitis
2. Drug of choice for gonorrhea
3. Drug class for Lyme disease or Rocky Mountain spotted fever

Answer 616

1. SE: Pseudomembranous colitis: Clindamycin and Ampicillin (any antibiotic can cause this but these ones mainly)
2. Drug of choice for gonorrhea: Ceftriaxone
3. Drug class for Lyme disease or Rocky Mountain spotted fever: Tetracyclines (Doxycycline)

Question 617

Which antibiotic fits each of the following descriptions?

1. Used to treat Giardia lamblia
2. Can be used to treat MRSA as well as C. Diff colitis
3. Treatment for G (-) rods in patients with renal insufficiency

Answer 617

1. Used to treat Giardia lamblia: Metronidazole
2. Can be used to treat MRSA as well as C. Diff colitis: Vancomycin
3. Treatment for G (-) rods in patients with renal insufficiency: Aztreonam

Question 618

Which antibiotic fits each of the following descriptions?

1. Big Gun (effective vs G(+) cooci, G(-) rods, and anaerobes)
2. Prophylaxis in AIDS patients against P. jirovecii pneumonia
3. Used as solo prophylaxis against TB

Answer 618

1. Big Gun (effective vs G(+) cooci, G(-) rods, and anaerobes): Meropenem or Imipenem/Cilastatin
2. Prophylaxis in AIDS patients against P. jirovecii pneumonia: TMP-SMX (could also use Dapsone or Pentamidine)
3. Used as solo prophylaxis against TB: Isoniazid

Question 619

Describe what changes you would see in serum calcium, serum phosphate, alkaline phosphatase, and PTH in Primary hyperparathyroidism

Question 620

Describe what changes you would see in serum calcium, serum phosphate, alkaline phosphatase, and PTH in Paget Disease of the bone

Answer 620

1. Serum Ca: No change
2. Serum Phosphate: No change
3. Alk Phos: Increased
4. PTH: No change

Question 621

Describe what changes you would see in serum calcium, serum phosphate, alkaline phosphatase, and PTH in Vitamin D toxicity

Answer 621

1. Serum Ca: Increased
2. Serum Phosphate: Increased
3. Alk Phos: No change
4. PTH: Decreased

Question 622

Which antifungal fits each of the following statements?

1. Inhibits ergosterol synthesis
2. SE: Arrhythmias and nephrotoxicity
3. Deposits in keratin-containing tissues
4. Inhibits hormone synthesis and sytochrome P450
5. SE: Liver dysfunction

Answer 622

1. Inhibits ergosterol synthesis: Terbinafine & Azoles
2. SE: Arrhythmias and nephrotoxicity: Amphotericin B
3. Deposits in keratin-containing tissues: Griseofulvin
4. Inhibits hormone synthesis and sytochrome P450: Azoles
5. SE: Liver dysfunction: Azoles & Griseofulvin

Question 623

What is the number needed to harm?

Answer 623

Number needed to harm = 1/[Absolute risk]

Absolute risk = A/(A+B) - C/(C+D)

Question 624

An adult patient with a history of hypertension presents with a sudden sharp, tearing pain raditating to the back. What would you expect to see on CXR?

Answer 624

Widening of the Mediastinum (This is an aortic dissection)

Question 625

1. What is the classic presentation of syringomyelia?
2. What malformation is associated with syringomyelia?

Answer 625

1. Classic presentation
   
   • Bilateral loss of pain and temperature sensation (usually in the upper extremity because it typically occurs around C8-T1 where the spinothalamic tracts cross)
   • Also can cause weakness and atrophy of hand muscles
2. Associated with Arnold-Chiari malformation

Question 626

A 30 year-old woman has “cauliflower” skin lesions. Tissue biopsy shows broad-based budding yeasts. What is the likely organism?

Answer 626

Blastomyces

Question 627

What reflexes might you check for in a newborn exam to assess an infant for healthy neurological function?

Answer 627

1. Babinski reflex
2. Moro reflex (a response to a sudden loss of support, when the infant feels as if it is falling)
3. Palmar reflex
4. Rooting reflex
5. Sucking reflex

Question 628

Which antibiotics are safe during pregnancy?

Answer 628

1. Penicillins
2. Aminopenicillins (Piperacillin)
3. Cephalosporins
4. Erythromycin & Azithromycin
5. Metronidazole (After 1st trimester)
6. Nitrofurantoin (Used for UTIs)

Question 629

What nerve is most at risk of injury with each of the following types of injury?

1. Fracture of the shaft of the humerus
2. Fracture of the surgical neck of the humerus
3. Supracondylar humerus fracture

Answer 629

1. Fracture of the shaft of the humerus: Radial nerve
2. Fracture of the surgical neck of the humerus: Axillary nerve
3. Supracondylar humerus fracture: Median nerve

Question 630

What nerve is most at risk of injury with each of the following types of injury?

1. Fracture of the medial epicondyle
2. Anterior shoulder dislocation
3. Injury to the carpal tunnel

Answer 630

1. Fracture of the medial epicondyle: Ulnar nerve
2. Anterior shoulder dislocation: Axillary nerve
3. Injury to the carpal tunnel: Median nerve

Question 631

What makes Lewy body dementia unique?

Answer 631

1. Visual hallucinations
2. Repeated falls
3. Syncopal episodes

Question 632

1. A high school athlete falls on his arm during practice. In the ER, a radiograph shows a midshaft break of the humerus. Which nerve and which artery have the highest risk of being damaged?
2. What muscular actions are affected?

Answer 632

1. Radial nerve and Deep brachial artery
2. Wrist extension will be affected resulting in wrist drop, and there will be loss of the brachioradialis reflex

Question 633

A woman presents with headache, visual disturbance, and amenorrhea. What is the diagnosis?

Answer 633

Pituitary adenoma

Question 634

1. What elbow injury is common in tennis players?
2. What elbow injury is common in golfers?

Answer 634

1. Lateral epicondylitis
2. Medial epicondylitis

Question 635

What pathology fits each of the following High-yield statements?

1. Signet-ring cells
2. Nutmeg liver
3. Maternal elevations of AFP

Answer 635

1. Signet-ring cells: Gastric adenocarcinoma
2. Nutmeg liver: Hepatic congestion (Possibly due to Budd-Chiari syndrome)
3. Maternal elevations of AFP: Anencephaly, spina bifida, omphalocele, Gastroschisis

Question 636

What pathology fits each of the following High-yield statements?

1. RBC casts in urine
2. Currant-jelly sputum
3. Dog or cat bite

Answer 636

1. RBC casts in urine: Acute glomerulonephritis
2. Currant-jelly sputum: Klebsiella pneumoniae
3. Dog or cat bite: Pasteurella multocida

Question 637

Which glomerular disease would you suspect most in a patient with each of the following findings?

1. IF: Granular pattern of immune complex deposition; LM: diffuse capillary thickening
2. IF: Granular pattern of immune complex deposition; LM: Hypercellular glomeruli

Answer 637

1. IF: Granular pattern of immune complex deposition; LM: diffuse capillary thickening: Membranous Glomerulonephritis
2. IF: Granular pattern of immune complex deposition; LM: Hypercellular glomeruli: Acute post-streptococcal Glomerulonephritis

Question 638

Which glomerular disease would you suspect most in a patient with each of the following findings?

1. IF: Linear pattern of immune complex deposition
2. IF: Deposition of IgG, IgM, IgA, and C3 in the mesangium

Answer 638

1. IF: Linear pattern of immune complex deposition: Goodpastures disease
2. IF: Deposition of IgG, IgM, IgA, and C3 in the mesangium: IgA Nephropathy

Question 639

Which glomerular disease would you suspect most in a patient with each of the following findings?

1. EM: Subendothelial humps and tram-track appearance
2. Nephritis, deafness, cataracts

Answer 639

1. EM: Subendothelial humps and tram-track appearance: Membranoproliferative Glomerulonephritis
2. Nephritis, deafness, cataracts: Alport syndrome

Question 640

Which glomerular disease would you suspect most in a patient with each of the following findings?

1. LM: Crescent formation in the glomeruli
2. LM: Segmental sclerosis and hyalinosis

Answer 640

1. LM: Crescent formation in the glomeruli: Rapidly progressive glomerulonephritis
2. LM: Segmental sclerosis and hyalinosis: Focal segmental glomerulosclerosis

Question 641

Which glomerular disease would you suspect most in a patient with each of the following findings?

1. Purpura on back of arms and legs, abdominal pain, IgA nephropathy
2. EM: Spiking of the GBM due to electron dense subepithelial deposits

Answer 641

1. Purpura on back of arms and legs, abdominal pain, IgA nephropathy: Henoch-Schonlein purpura
2. EM: Spiking of the GBM due to electron dense subepithelial deposits: Membranous Glomerulonephritis

Question 642

For which organisms can Tetracyclines be used?

Answer 642

“VACUUM THe BathRoom”

1. Vibrio cholera
2. Acne
3. Chlamydia
4. Ureaplasma Urealyticum
5. Mycoplasma pneumoniae
6. Tularemia
7. H. pylori
8. Borrelia burgdorferi
9. Rickettsiae rickettsii

Question 643

For which organisms can Macrolides be used?

Answer 643

“PUS”

1. Pneumonia
   
   • Legionella pneumoniae
   • Mycoplasma pneumoniae
   • Chlamydia pneumoniae
2. URIs
   
   • Group B strep
3. STDs
   
   • Gonorrhea
   • Chlamydia

Question 644

For which organisms can 2nd Gen cephalosporins be used?

Answer 644

“HENPEcKS”

1. H. influenzae
2. Enterobacter
3. Neisseria
4. Proteus
5. E. Coli
6. Klebsiella
7. Serratia

And Gram (+) bacteria

Question 645

UTI caused by Proteus vulgaris. What type of renal stone is the patient at risk for?

Answer 645

Ammonium magnesium phosphate stones -> Staghorn calculis

Question 646

How do acidosis and alkalosis affect extracellular K+ concentrations?

Answer 646

1. Acidosis: Increase K⁺
2. Alkalosis: Decrease K⁺

Question 647

What is the difference between the following disorders?

1. Schizotypal
2. Schizophrenia
3. Schizoaffective
4. Schizoid
5. Schizophreniform

Answer 647

1. Schizotypal:** Cluster A personality disorder characterized by interpersonal awkwardness, odd appearance and magical thinking**
2. Schizophrenia: Delusions, hallucinations, and negative symptomsfor > 6 months
3. Schizoaffective: Schizophrenia with a mood disorder
4. Schizoid: Cluster A personality disorder characterized by voluntary social withdrawal
5. Schizophreniform: Symptoms of Schizoprenia for > 1 month but < 6 months

Question 648

Name the encapsulated bacteria and the test that can be used to detect them?

Answer 648

“Even Some Pretty Nasty Killers Have Shiny Bodies”

1. E. Coli
2. Strep. pneumo
3. Pseudomonas
4. Neisseria Meningitidis
5. Klebsiella
6. H. influenzae
7. Salmonella
8. Group B strep

Question 649

1. What causes a stepple sign on X-ray?
2. What causes a thumb sign on X-ray?

Answer 649

1. Croup (parainfluenza virus)
2. Epiglottitis (H. influenza type B)

Question 650

What pathology matches each of the following statements?

1. Signet ring cells in the ovary
2. Signet rings in RBCs
3. Smudge cell
4. Spike and dome appearance of glomerulus on EM

Answer 650

1. Signet ring cells in the ovary: Krukenberg tumor (Gastric carcinoma metastasized to the ovary)
2. Signet rings in RBCs: Malaria
3. Smudge cell: CLL
4. Spike and dome appearance of glomerulus on EM: Membranous glomerulonephritis

Question 651

What pathology matches each of the following statements?

1. Tram track appearance of glomerulus on light microscopy
2. Strawberry tongue
3. Most common location of tophi

Answer 651

1. Tram track appearance of glomerulus on light microscopy: Membranoproliferative glomerulonephritis
2. Strawberry tongue: Scarlet fever of Kawasaki disease
3. Most common location of tophi: External ear

Question 652

A patient cannot adduct her left eye on lateral gaze but convergence is normal. What structure is damaged?

Answer 652

Internuclear Opthalmoplegia due to damage to the left Medial longitudinal fasciculus (MLF)

Question 653

A 20 year-old dancer reports decreased plantar flexion and decreased sensation over the back of her thigh, calf, and lateral half of her foot. What nerve is involved?

Answer 653

Tibial nerve

Question 654

What is Dressler syndrome?

Answer 654

1. Pericarditis
2. Occurs 2-4 weeks after a MI
3. Fever, Chest pain, and Elevated ESR

Question 655

What personality disorder fits each of the following statements?

1. Excessive need to be taken care of, submissive and clinging behavior
2. Low self-confidence, fears of separation and losing support
3. Grandiosity, feels he is entitled to things, lack of empathy
4. Suicide attempts (-> 15% mortality), unstable mood and behavior

Answer 655

1. Excessive need to be taken care of, submissive and clinging behavior: Dependent
2. Low self-confidence, fears of separation and losing support: Dependent
3. Grandiosity, feels he is entitled to things, lack of empathy: Narcissistic
4. Suicide attempts (-> 15% mortality), unstable mood and behavior: Borderline

Question 656

What personality disorder fits each of the following statements?

1. Sense of emptiness and loneliness, impulsiveness
2. Odd appearance, thoughts, and behavior; no psychosis; social awkwardness
3. Controlling, perfectionistic, orderly, stubborn, indecisive
4. Criminality, unable to conform to social norms, disregard for other’s rights

Answer 656

1. Sense of emptiness and loneliness, impulsiveness: Borderline
2. Odd appearance, thoughts, and behavior; no psychosis; social awkwardness: Schizotypal
3. Controlling, perfectionistic, orderly, stubborn, indecisive: Obsessive Compulsive
4. Criminality, unable to conform to social norms, disregard for other’s rights: Antisocial

Question 657

What pathology matches each of the following?

1. Antiepithelial cell antibodies
2. Anti-basement membrane antibodies
3. Cough, conjunctivits, coryza, fever
4. Councilman bodies

Answer 657

1. Antiepithelial cell antibodies: Pemphigus Vulgaris
2. Anti-basement membrane antibodies: Goodpastures
3. Cough, conjunctivits, coryza, fever: Measles
4. Councilman bodies: Viral hepatitis

Question 658

What pathology matches each of the following statments?

1. Green/yellow pigment just within the corneoscleral margin
2. Anticentromere antibodies
3. Dementia + eosinophilic inclusions in neurons
4. Anti-dsDNA antibodies (ANA antibodies)

Answer 658

1. Green/yellow pigment just within the corneoscleral margin: Wilsons disease
2. Anticentromere antibodies: CREST syndrome
3. Dementia + eosinophilic inclusions in neurons: Lewy body dementia
4. Anti-dsDNA antibodies (ANA antibodies): Lupus with renal disease

Question 659

What are the different causes of post-op fever?

Answer 659

1. Wind: Bronchiectasis
2. Water: UTI
3. Wound: Wound infection
4. Walking: DVT
5. Wonder drugs: Drug reaction
6. Wein (vein): Thrombophlebitis

Question 660

What is the most common:

1. Cause of DIC
2. Heart murmur
3. Coronary artery involved in thrombosis
4. Cause of death in lupus patients
5. Congenital heart anomaly

Answer 660

1. Cause of DIC: Sepsis, trauma, OB complications, pancreatitis, malignancy, transfusion
2. Heart murmur: Mitral valve prolapse
3. Coronary artery involved in thrombosis: LAD
4. Cause of death in lupus patients: Renal failure (Lupus Nephropathy)
5. Congenital heart anomaly: VSD

Question 661

1. What are the positive symptoms of schizophrenia?
2. What are the negative symptoms of schizophrenia?

Answer 661

1. Delusions, hallucinations, strange behavior, loose associations
2. Flat affect, poor hygiene/grooming, social withdrawal, thought blocking, poor motivation, poverty of speech (alogia)

Question 662

What is the WAGR complex?

Answer 662

1. Wilms tumor
2. Anaridia
3. Genitourinary malformation
4. Retardation (mental and motor)

Question 663

What changes in a basic metabolic panel might you expect in a young patient treated for status asthmaticus?

Answer 663

Patient likely taking a Beta-agonist -> Causing a shift of Potassium into cells -> Hypokalemia

Question 664

1. A 21-year-old man presents with 5 days of fever, chills and enlarged, painful knee. What organisms is most likely responsible for his symptoms?
2. What is the treatment?

Answer 664

1. N. gonorrhoeae
2. Ceftriaxone

Question 665

1. A patient presents with hypertension, hypokalemia, metabolic alkalosis, and low plasma renin. What is the diagnosis?
2. How do you treat it?

Answer 665

1. Primary hyperaldosteronism (Conn syndrome)
2. Aldosterone antagonists like Spironolactone

Question 666

What pathology is associated with each of the following key phrases?

1. Bilateral hilar lymphadenopathy
2. Cherry-red spot on the macula
3. Slapped cheek rash on child
4. Organism associated with dog or cat bite

Answer 666

1. Bilateral hilar lymphadenopathy: Sarcoidosis
2. Cherry-red spot on the macula: Tay-Sachs disease, Niemann-Pick disease, Central retinal artery occlusion
3. Slapped cheek rash on child: Fifth disease (Parvovirus B19)
4. Organism associated with dog or cat bite: Pasteurella multocida

Question 667

What pathology is associated with each of the following key phrases?

1. Facial muscle spasm upon tapping the cheek
2. Cough, conjunctivitis, coryza
3. Nephritis, hearing loss, cataracts

Answer 667

1. Facial muscle spasm upon tapping the cheek: Chvostek’s sign
2. Cough, conjunctivitis, coryza: Measles
3. Nephritis, hearing loss, cataracts: Alport syndrome

Question 668

1. When performing a lumbar puncture for anesthesia administration, where is the anesthesia dosed?
2. Where is CSF found?

Answer 668

1. Epidural space
2. Subarachnoid space

Question 669

What is the female homologue to each of the following male structures?

1. Scrotum
2. Prostate gland
3. Glans penis

Answer 669

1. Scrotum: Labia majora
2. Prostate gland: Urethral & paraurethral glands of Skene
3. Glans penis: Gland clitoris

Question 670

What is the female homologue to each of the following male structures?

1. Corpus spongiosum
2. Bulbourethral glands
3. Ventral shaft of the penis

Answer 670

1. Corpus spongiosum: Vestibular bulb
2. Bulbourethral glands: Vestibular glands (Bartholin glands)
3. Ventral shaft of the penis: Labia minora

Question 671

Outline the pathway of converting phenylalanine to epinephrine.

Answer 671

Phenylalanine -(Phenylalanine Hydroxylase +THB)-> Tyrosine -(Tyrosine Hydroxylase + THB)-> L-Dopa -(Dopa Decarboxylase + B6)->Dopamine -(Vitamin C)-> Norepinephrine -(SAM)-> Epinephrine

Question 672

Where does each of the following spinal tracts decussate/cross over?

1. Dorsal columns
2. Lateral corticospinal tract
3. Spinothalamic tract

Answer 672

1. Dorsal columns: Medulla
2. Lateral corticospinal tract: Medullary pyramids
3. Spinothalamic tract: Anterior white commissure (3 segments above region of innervation)

Question 673

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

Answer 673

The cell bodies of the anterior horn

Question 674

What diseases specifically damage the cell bodies of the anterior horn?

Answer 674

1. Polio
2. West Nile virus
3. ALS

Question 675

After taking a course of amoxicillin, an adult patient develops toxic megacolon and diarrhea. What is the mechanism of diarrhea?

Answer 675

C. Diff Colitis

Question 676

What pathology matches each of the following statements?

1. Lens-shaped lesion on head CT
2. No milk production in the postpartum period
3. Pigmented hamartomas in the iris

Answer 676

1. Lens-shaped lesion on head CT: Epidural hematoma
2. No milk production in the postpartum period: Sheehan syndrome
3. Pigmented hamartomas in the iris: Neurofibromatosis

Question 677

What pathology matches each of the following statements?

1. Howell-Jolly bodies
2. Cancer associated with asbestos
3. Owl’s eye inclusions

Answer 677

1. Howell-Jolly bodies: Asplenia
2. Cancer associated with asbestos: Mesothelioma and Bronchogenic carcinoma
3. Owl’s eye inclusions: CMV

Question 678

What pathology matches each of the following statements?

1. Owl’s eye nucleus
2. Owl’s eye protozoan
3. 50 year-old man with new, unexplained skin yellowing and no other symptoms

Answer 678

1. Owl’s eye nucleus: Hodgkin’s lymphoma
2. Owl’s eye protozoan: Giradia lamblia
3. 50 year-old man with new, unexplained skin yellowing and no other symptoms: Pancreatic cancer (Painless jaundice)

Question 679

In which causes of vaginal discharge/vaginitis will the pH be high?

In which will the pH be low?

Answer 679

High pH

1. Bacterial vaginosis
2. Trichomonas

Low pH

1. Candidiasis
2. Physiologic discharge (normal)

Question 680

What structures arise from the paramesonephric ducts?

Answer 680

Paramesonephric (Mullerian) ducts develop into:

1. Fallopian tubes
2. Uterus
3. Upper 1/3 of the vagina

Question 681

A 15 year-old girl of normal height and weight for her age has enlarged parotid glands but no other complaints. The mother confides that she found laxatives in the daughter’s closet. What is the diagnosis?

Answer 681

Her (parotid gland) symptoms suggest a history of purging. Purging and other weightloss efforts in a patient of normal weight suggests Bulemia nervosa. If the patient was underweight it might be more indicative of Anorexia nervosa

Question 682

What is the classic presentation of roseola? What virus causes this?

Answer 682

Roseola (Sixth disease) is caused by HHV-6 and is characterized by:

1. High fever for a few days
2. Diffuse maculopapular rash

Question 683

A football player who was kicked in the leg suffers from a damaged lateral meniscus. What else is likely to have been damaged?

Answer 683

MCL and ACL (Unlucky triad)

Question 684

What organism is associated with each of the following statements?

1. Cat scratch
2. Cat bite
3. Cat feces
4. Puppy feces
5. Animal urine

Answer 684

1. Cat scratch: Bartonella
2. Cat bite: Pasteurella
3. Cat feces: Toxoplasma
4. Puppy feces: Yersinia enterocolitica
5. Animal urine: Leptospira, Hantavirus (Rodent urine)

Question 685

To what class of medication does each of the following drugs belong?

1. Primaquine
2. Saquinavir
3. Betaxolol
4. Prazosin
5. Thiopental

Answer 685

1. Primaquine: Antimalarial
2. Saquinavir: Protease inhibitor
3. Betaxolol: Beta-blocker (B1 selective when first letter is in the first half of alphabet)
4. Prazosin: Alpha-blocker
5. Thiopental: Barbiturate

Question 686

To what class of medication does each of the following drugs belong?

1. Tranylcypromine
2. Sertraline
3. Temazepam
4. Desipramine
5. Captopril

Answer 686

1. Tranylcypromine: MAOI
2. Sertraline: SSRI
3. Temazepam: Benzodiazepine
4. Desipramine: TCA
5. Captopril: ACE-inhibitor

Question 687

To what class of medication does each of the following drugs belong?

1. Busulfan
2. Moxifloxacin
3. Zanamivir
4. Miconazole

Answer 687

1. Busulfan: Anticancer (DNA alkylating agent)
2. Moxifloxacin: Fluoroquinolones
3. Zanamivir: NRTI
4. Miconazole: Antifungal

Question 688

Which defense mechanism fits each of the following descriptions?

1. Involuntary withholding of a feeling from conscience awareness
2. A veteran that can describe horrific war details without any emotion
3. A child abuser was himself abused as a child

Answer 688

1. Involuntary withholding of a feeling from conscience awareness: Repression
2. A veteran that can describe horrific war details without any emotion: Isolation
3. A child abuser was himself abused as a child: Identification

Question 689

Which defense mechanism fits each of the following descriptions?

1. Underlies all other defense mechanisms
2. May lead to multiple personalities
3. Adult whining, bedwetting, crying

Answer 689

1. Underlies all other defense mechanisms: Repression
2. May lead to multiple personalities: Dissociation
3. Adult whining, bedwetting, crying: Regression

Question 690

What pathology fits each of the following high-yield phrases?

1. Thyroid cells with optically clear nuclei
2. Anemia with hypersegmented neutrophils
3. Branching rods on oral infection
4. Eczema + recurrent infections + thrombocytopenia
5. Hemosiderinuria + thrombosis

Answer 690

1. Thyroid cells with optically clear nuclei: Papillary thyroid carcinoma
2. Anemia with hypersegmented neutrophils: B12 or fotal deficiency
3. Branching rods on oral infection: Actinomyces israelii
4. Eczema + recurrent infections + thrombocytopenia: Wiskott-Aldrich syndrome (mutations in a gene on the short arm of the X chromosome, which was termed Wiskott-Aldrich syndrome protein - WASp)
5. Hemosiderinuria + thrombosis: Paroxysmal Nocturnal Hemoglobinuria

Question 691

Which primary bone tumor fits each of the following descriptions?

1. Most common malignant primary bone tumor of children
2. Most common benign bone tumor
3. 11;22 translocation

Answer 691

1. Most common malignant primary bone tumor of children: Osteosarcoma
2. Most common benign bone tumor: Osteochondroma
3. 11;22 translocation: Ewing Sarcoma

Question 692

Which primary bone tumor fits each of the following descriptions?

1. Soap-bubble appearance on X-ray
2. Onion-skin appearance of bone
3. Codman’s triangle on X-ray

Answer 692

1. Soap-bubble appearance on X-ray: Giant cell tumor
2. Onion-skin appearance of bone: Ewing sarcoma
3. Codman’s triangle on X-ray: Osteosarcoma

Question 693

A 25 year-old pregnant woman in her 3rd trimester has a normal BP when standing and sitting, When supine, her BP drops to 90/50. What is the diagnosis?

Answer 693

Compression of the IVC

Question 694

What are the common causes of restrictive cardiomyopathy?

Answer 694

1. Sarcoid
2. Amyloid
3. Hemochromatosis
4. Loeffler disease (eosinophilia and eosinophilic penetration of the cardiac myocytes leads to a fibrotic thickening of portions of the heart)
5. Endocardial fiber elastosis (thickening of the endocardium due to an increase in the amount of supporting connective tissue and elastic fibers)
6. Post-radiation fibrosis

Question 695

What are the Cs of Huntington disease?

Answer 695

1. Caudate atrophy
2. Chorea
3. CAG repeats on Chromosome 4
4. “Cuarenta” (40 years of age)
5. Cognitive decline

Question 696

What is Potter syndrome?

Answer 696

1. Bilateral renal agenesis from a malformation of the ureteric bud
2. Oligohydramnios
3. Limb & facial deformities
4. Pulmonary hypoplasia

Question 697

When a young monkey is separated from its mother, it becomes withdrawn, socially isolated, and grooms poorly. It is thought that this behavior is the monkey equivalent of what human problem?

Answer 697

Anaclitic depression

Question 698

A weight lifter undergoes emergency surgery for a life threatening condition. Examination of a section of his small bowel reveals focal hemorrhages. What is the process responsible for this?

Answer 698

1. Inguinal hernia
2. Herniated bowel becomes incarcerated

Question 699

What pathology matches each of the following statements?

1. Focal myocardial inflammation with multinucleate giant cells
2. Eosinophilic cytoplasmic globules in liver near nucleus
3. Desquamated epithelial casts in sputum

Answer 699

1. Focal myocardial inflammation with multinucleate giant cells: Aschoff bodies (Rheumatic fever)
2. Eosinophilic cytoplasmic globules in liver near nucleus: Mallory bodies (Alcoholic liver disease)
3. Desquamated epithelial casts in sputum: Curschmann spirals (Bronchial Asthma)

Question 700

What pathology matches each of the following statements?

1. “Onion-skin” Periosteal reaction
2. Pseudopalisading tumor cell arrangement
3. Elevated serum uric acid

Answer 700

1. “Onion-skin” Periosteal reaction: Ewing Sarcoma of bone
2. Pseudopalisading tumor cell arrangement: Glioblastoma (Most common primary brain tumor in adults)
3. Elevated serum uric acid: Gout, Lesch-Nyhan syndrome, Myeloproliferative disorders, Diuretics (loops, thiazides)

Question 701

What are the most common causes of meningitis in the following age ranges?

1. Newborn-6m
2. Children (6m-6y)
3. 6y-60y
4. 60+y

Answer 701

Newborn-6m

1. Group B strep
2. E. Coli
3. Listeria

Children (6m-6y)

1. Strep Pneumo
2. N. Meningitidis
3. H. influenzae
4. Enterovirus

6y-60y

1. Strep pneumo
2. N. Meningitidis
3. Enteroviruses
4. HSV

60+y

1. Strep pneumo
2. Gram (-) rods
3. Listeria

Question 702

What structures form Hesselbach’s triangle?

Answer 702

1. Superior border: Inferior epigastric artery
2. Medial border: Rectus abdominus
3. Lateral border: Inguinal ligament

Question 703

What high-yield pathology fits each of the following statements?

1. Large “Bull’s eye” rash
2. Strawberry tongue
3. Resting tremor; Rigidity
4. Rash on palms and soles

Answer 703

1. Large “Bull’s eye” rash: Lyme disease
2. Strawberry tongue: Scarlet fever, Kawasaki disease, Toxic shock syndrome
3. Resting tremor; Rigidity: Parkinsons disease
4. Rash on palms and soles: Hand, foot, and mouth disease (Coxsackie A virus), Rocky Mountain Spotted Fever, Secondary Syphillis

Question 704

What are the toxic side effects of tricyclic antidepressant use?

Answer 704

1. Convulsions
2. Coma
3. Cardiotoxicity
4. Hyperpyrexia
5. Respiratory depression

Question 705

In which glomerular disease would you expect to see the following changes?

1. Anti-GBM antibodies (Immunofluorescence)
2. Kimmelstiel-Wilson Lesions (Light Microscope)
3. “Spike and dome” appearance (Electron microscope)
4. “Tram-Track” Appearance of subendothelial humps (Electron microscope)
5. Subepithelial humps (Electron microscope)

Answer 705

1. Anti-GBM antibodies (Immunofluorescence): Goodpastures disease
2. Kimmelstiel-Wilson Lesions (Light Microscope): Diabetes nephropathy
3. “Spike and dome” appearance (Electron microscope): Membranous glomerulonephritis
4. “Tram-Track” Appearance of subendothelial humps (Electron microscope): Membranoproliferative glomerulonephritis
5. Subepithelial humps (Electron microscope): Acute Post-Streptococcal glomerulonephritis

Question 706

Which lysosomal storage disease matches each of the following statements?

1. Accumulation of GM2 ganglioside
2. Associated with renal failure
3. Accumulation of dermatan sulfate
4. Defiency in hexosaminidase

Answer 706

1. Accumulation of GM2 ganglioside: Tay-Sachs disease
2. Associated with renal failure: Fabry disease
3. Accumulation of dermatan sulfate: Hunters syndrome, Hurler disease, Scheie syndrome
4. Defiency in hexosaminidase: Tay-Sachs disease

Question 707

Which antiviral(s) matches each of the following statements?

1. Inhibits CMV DNA polymerase
2. Used in treatment for chronic hepatitis C
3. Blocks viral penetration and uncoating
4. Treates both influenza A and B
5. Second-line for CMV retinitis

Answer 707

1. Inhibits CMV DNA polymerase: Ganciclovir, Foscarnet
2. Used in treatment for chronic hepatitis C: Ribavirin (with IFN-alpha)
3. Blocks viral penetration and uncoating: Amantidine and Rimantidine
4. Treates both influenza A and B: Oseltamivir and Zanamivir
5. Second-line for CMV retinitis: Foscarnet

Question 708

What is the function of MacConkey’s agar?

Answer 708

1. Grow Gram (-) bacteria but not Gram (+) bacteria
2. Distinguishes lactose fermenters (appear pink) from non-lactose fermenters (appear white)

Question 709

Which antibiotic matches each of the following descriptions?

1. Inhibits 50S peptidyltransferase
2. Binds 50S, blocking translocation
3. Binds 30S, preventing attachment of tRNA

Answer 709

1. Inhibits 50S peptidyltransferase: Streptogramins, Chloramphenicol
2. Binds 50S, blocking translocation: Linezolid, Macrolides
3. Binds 30S, preventing attachment of tRNA: Tetracyclines

Question 710

Which antibiotic matches each of the following descriptions?

1. Inhibits prokaryotic RNA polymerase
2. Inhibits prokaryotic topoisomerase
3. Inhibits prokaryotic dihydrofolate reductase

Answer 710

1. Inhibits prokaryotic RNA polymerase: Rifampin
2. Inhibits prokaryotic topoisomerase: Fluoroquinolones
3. Inhibits prokaryotic dihydrofolate reductase: Trimethoprim

Question 711

A pregnant patient comes to the clinic complaining of new dark pigmentation on her face. What is the most likely diagnosis?

Answer 711

Melasma

Question 712

A 40 year-old man with a history of MArfan syndrome and hypertension presents with a severe headache. A head CT is normal at presentation and examination of the CSF reveals numerous red blood cells. What is the cause of the man’s headache?

Answer 712

Ruptured berry aneurysm (Subarachnoid hemorrhage)

Question 713

1. What is the clinical use of Clomiphene?
2. How does this drug work?

Answer 713

1. Used to treat infertility
2. Partial agonist to estrogen receptors in the hypothalamus -> induces FSH secretion -> Stimulates follicles

Question 714

Classify the following antibiotics

1. Minocycline
2. Gentamycin
3. Erythromycin
4. Tobramycin
5. Azithromycin

Answer 714

1. Minocycline: Tetracycline
2. Gentamycin: Aminoglycoside
3. Erythromycin: Macrolide
4. Tobramycin: Aminoglycoside
5. Azithromycin: Macrolide

Question 715

Classify the following antibiotics

1. Doxycycline
2. Amikacin
3. Neomycin
4. Clarithromycin
5. Clindamycin

Answer 715

1. Doxycycline: Tetracycline
2. Amikacin: Amikacin
3. Neomycin: Aminoglycoside
4. Clarithromycin: Macrolide
5. Clindamycin: Protein synthesis inhibitor (Lincosamide)

Question 716

What pathology fits each of the following descriptions?

1. Smudge cell
2. Port-wine stain in opthalmic division of trigeminal nerve
3. S3 heart sound
4. Adrenal hemorrhage associated with meningococcemia

Answer 716

1. Smudge cell: CLL
2. Port-wine stain in opthalmic division of trigeminal nerve: Sturge-Weber syndrome
3. S3 heart sound: Dilated cardiomyopathy, Post MI, Associated with LV failure, Associated with mitral regurgitation, Associated with left to right shunt
4. Adrenal hemorrhage associated with meningococcemia: Waterhouse-Friderichsen syndrome

Question 717

What pathology fits each of the following descriptions?

1. Ferruginous bodies
2. Subepithelial humps on EM
3. Spike and dome on EM
4. Myocyte disarray

Answer 717

1. Ferruginous bodies: Asbestos
2. Subepithelial humps on EM: Acute Poststreptococcal Glomerulonephritis
3. Spike and dome on EM: Membranous glomerulonephritis
4. Myocyte disarray: Hypertrophic cardiomyopathy

Question 718

What pathology fits each of the following descriptions?

1. Currant jelly stool
2. Sacrolitis
3. Adverse reaction from mixing succinylcholine with inhaled anesthetics

Answer 718

1. Currant jelly stool: Intussusception
2. Sacrolitis: Ankylosing Spondylitis
3. Adverse reaction from mixing succinylcholine with inhaled anesthetics: Malignant hyperthermia

Question 719

What is the antidote for each of the following toxins?

1. Copper, gold, arsenic
2. Arsenic, mercury, gold
3. t-PA, streptokinase
4. Digitalis

Answer 719

1. Copper, gold, arsenic: Penicillamine
2. Arsenic, mercury, gold: Dimercaperol, Succimer
3. t-PA, streptokinase: Aminocaproic acid
4. Digitalis: Stop digoxin, Lidocaine, normalize K and Mg, atropine, Anti-digoxin antibody fragments

Question 720

What drugs have the following side effects?

1. Agranulocytosis
2. Osteoporosis
3. Pulmonary fibrosis

Answer 720

1. Agranulocytosis: Colzapine, carbamazepine, colchicine, PTU, methimazole
2. Osteoporosis: Glucocorticoids, heparin (longterm use)
3. Pulmonary fibrosis: Busulfan, Bleomycin, Amiodarone

Question 721

What drugs have the following side effects?

1. Gynecomastia
2. Photosensitivity
3. Drug-induced lupus

Answer 721

1. Gynecomastia: “Some Drugs Create Awesome Knockers” - Spironolactone, Digoxin, Cimetidine, Alcohol, Ketoconazole
2. Photosensitivity: “SAT for a Photo” - Sulfonamides, Amiodarone, Tetracyclines
3. Drug-induced lupus: “SHIPP” - Sulfonamides, Hydralazine, Isoniazid, Phenytoin, Procainamide

Question 722

What pathology fits each of the following high-yield phrases?

1. Hypertension + hypokalemia + metabolic alkalosis
2. Fever + night sweats + weight loss
3. Adrenal hemorrhage due to meningococcemia
4. Blue Sclera

Answer 722

1. Hypertension + hypokalemia + metabolic alkalosis: Hyperaldosteronism (Conn syndrome)
2. Fever + night sweats + weight loss: Lymphoma, TB (B symptoms)
3. Adrenal hemorrhage due to meningococcemia: Waterhouse-Friderichsen syndrome
4. Blue Sclera: Osteogenesis Imperfecta

Question 723

What pathology fits each of the following high-yield phrases?

1. Hyperphagia, hypersexuality, hyperorality, hyperdocility
2. Nystagmus, intention, tremor, scanning speech
3. Lower extremity purpura, arthralgias, renal disease

Answer 723

1. Hyperphagia, hypersexuality, hyperorality, hyperdocility: Kluver-Bucy syndrome (Bilateral amygdala lesion)
2. Nystagmus, intention, tremor, scanning speech: Charcot triad of Multiple Sclerosis
3. Lower extremity purpura, arthralgias, renal disease: Henoch-Schonlein purpura