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[3] Step 1 USMLE > Factionless > Flashcards

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1
Q

Why is Succinylcholine contraindicated in pts with burns, myopathies, crush injuries or denervating Dz

A

Can cause SIGNIFICANT K+ RELEASE –> VFIB in pts at high risk for Hyperkalemia

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2
Q

What is Priapism and which antiPsychotic is associated with it

A

Painful Long-Lasting Erections; Trazodone (TraZaBone)

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3
Q

What is Rxn Formation in Psychiatry

A

Reacting to an unacceptable situation by Forming a completely opposite response

covering fears of faling exam by being overly confident

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4
Q

Cocaine intoxication stimulates _____ [Miosis vs. Mydriasis]

A

Cocaine intoxication stimulates Mydriasis

Pupils Wide Open on Coke!

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5
Q

Pts who’ve had a major depressive episode in the past have to be screened for what before giving Antidepressants

A

Mania (rule out Bipolar DO)

Antidepressants are contraindicated in Bipolar pts since they precipitate mania

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6
Q

[ADHD medication] SE (2)

A
  1. DECREASED appetite
  2. Insomnia

These Drugs INC NorEpi & Dopamine in PreFrontal Cortex

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7
Q

What’s the most effective tx for Specific phobia?

A

CBT (Systematic Exposure)

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8
Q

Drug used for Tx-Resistant Schizophrenia

A

Clozapine

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9
Q

Tx for [Somatic Symptom DO]

A

Regularly scheduled Med visits (Goal: Improve functionality)

DO = preocupation with unexplained (but proven to be benign) medical sx

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10
Q

MOD for Death from TriCyclic Antidepressant OD

A

Blocks Fast Na+ in cardiomyocytes –> Prolonged QT/Arrhythmia

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11
Q

Is the EDV in Diastolic HF Elevated, Normal, or DEC?

A

NORMAL

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12
Q

Which Vitamins are intestinal bacteria known for producing? (2)

A

Vitamin K and [Folate B9]

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13
Q

Describe the histology for [lactase deficiency] pts and how you diagnose it?

A

Normal; STOOL pH less than 7

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14
Q

Tx for Hepatic Encephalopathy and their MOA (2)

A
  1. Lactulose (converts NH3 –> NH4+ in colon - but DOES CAUSE DIARRHEA)
  2. Rifaximin abx (⬇︎NH3 producing colonic bacteria)
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15
Q

Which parts of the GI tract are affected in Hirschsprung Dz? (2)

A
  1. RECTUM - always
  2. Sigmoid Colon sometimes
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16
Q

What is linkage disequilibrium

A

When a pair of alleles are inherited together in the same [gamete haplotype] more than would be expected by random chance

Can occur even if genes are on different chromosomes

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17
Q

What GI structure is used to identify the appendix during an appendectomy?

A

Teniae Coli

Teniae Coli travel outside colon and converge at root of appendix vermiform

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18
Q

Where would you find [Branched Tubular Submucosal glands] with alkaline secretions in the GI tract

A

[Brunner Submucosal glands] are found from the Pylorus all the way through [Duodenum 1st segment]

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19
Q

What’s the major immune mechanism against Giardia (2)

A

[CD4 Helper T] & IgA

Eosinophils can’t help against Giardia

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20
Q

Lymph drainage of [Rectum proximal to dentate] drains into the _____ lymph nodes (2)

A

*Inferior Mesenteric

*[Internal iLiac]

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21
Q

Lymph drainage of [Rectum Distal to dentate] drains into the _____ lymph nodes

A

Superficial Inguinal

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22
Q

Failure of the [Vitelline Omphalomesenteric Duct] to obliterate leads to what 2 things?

A
  1. Meckel Diverticula
  2. Enterocyst
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23
Q

Estrogen ____[INC/DEC] the level of TBG in the blood. How does this affect [Free thyroid hormone]? Explain

A

Estrogen INC TBG in blood –> INC binding sites available to carry thyroid hormone –> INC [TOTAL T4 (bound + free)] and [Total T3].

Free thyroid hormone levels are NOT affected

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24
Q

Identify sections of the Adrenal Gland

A

1 = Glomerulosa

2= Fasciculata

3= Reticularis

4 = Medulla chromaffin (stimulated by ACh)

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25
Q

How does Anorexia cause Amenorrhea?

A

Anorexia –> DEC GnRH from hypOthalamus

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26
Q

Which drug is used to control, [Graves Dz Ophthalmopathy] specifically and how does this help

A

Prednisone; DEC inflammation

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27
Q

Which layer of the stomach is Parietal cells found?

A

B; Upper Glandular Layer

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28
Q

Where, in the GI tract, is iron absorbed? (2)

A

Duodenum & Proximal Jejunum

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29
Q

What are the levels of Cholesterol, Phosphatidylcholine and Bile in pts with Gallstones?

A

INC Cholesterol

DEC Bile (since it’s saturated w/Cholesterol instead)

DEC Phosphatidylcholine

Bile & Phosphatidylcholine are protective against Gallstones

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30
Q

SCID MOD

A

auto recessive deficiency of Adenosine Deaminase (needed to eliminate excess adenosine inside cells)

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31
Q

What happens when SCID affects WBC

A

Adenosine accumulates in Lymphocytes –> Death –> Deficiency –> Multile Pathogen infections

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32
Q

NF-kB is most involved in what process

A

INFLAMMATION; allows Cytokine production

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33
Q

[Tracheoesophageal fistula w/esophageal atresia] results from what?

A

Failure of [PleuroPeritoneal membrane] to form completely

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34
Q

Describe the location of Femoral Hernias (3)

A

Inferior to Inguinal ligament

Lateral to Pubic Tubercle

Medial to Femoral Vein

Keep in mind: Incarceration/Stragulation is common

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35
Q

The Celiac trunk is the ___ main branch of the abd aorta. It provides oxygenated blood to which organs (6)

A

1st main branch of abd aorta = SPALDS

  1. Spleen
  2. Pancreas
  3. Abd Esophagus
  4. Liver (via Hepatic a. daughter branch)
  5. Duodenum
  6. Stomach
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36
Q

Out of the Retroperitoneal Organs, which is most commonly associated with Retroperitoneal Bleeding?

A

PANCREAS (body)

SAD PUCKER

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37
Q

Which Colon CA is the most common GI malignancy?

A

Colon ADC

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38
Q

Compare clinical manifestations between [R Colon ADC] and [L Colon ADC]

A

[R Colon ADC] = Bleeds / Iron deficiency anemia

vs.

[L Colon ADC] = Obstruction sx (altered bowel habits / NV)

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39
Q

Weakening of the ____ in ___ triangle causes Direct Inguinal hernia. They protrude only through the ______

A

Weakening of the Transversalis Fascia in Hesselbach’s triangle causes [Direct Inguinal Hernia]. They protrude only thorugh the EXTERNAL inguinal ring

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40
Q

How can we diagnose Tropheryma Whippelii with stains?

A

Cell Wall Glycoprotein in T.Whippelii stains magenta with PAS

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41
Q

Sucralfate MOA

A

Binds to [Mucosal Ulcer Base] and physically protects it against gastric acid –> Speeds up healing

Does NOT inhibit acid secretion

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42
Q

Which lab markers are the best indicators for Poor pgn in Cirrhosis pts? (3)

A
  1. Albumin
  2. Bilirubin
  3. ProThrombin Time

These Reflect Liver function in Cirrhotic pts

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43
Q

Function of Betalipoproteins

A

Component of [Chylomicrons and VLDL] that enables LDL small intestinal absorption

Abetalipoproteinemia = inhertied dz –> enterocytes accumulated with clear foamy cytoplasm from INC LDL

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44
Q

What are the most occuring CA amongst Women from greatest to least

A

Breast > Lung > colon

Breast = Most occuring

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45
Q

Why does [Hemolytic Dz of Newborn(Erythroblastosis Fetalis) ] occur more in [O- Mothers] and less in [A- or B- Mothers]?

A

[A- or B- Mothers] have mostly [anti-Rh IgM antibodies]–IgM does NOT cross placenta

  • [TYPE O -MOTHERS] HAVE MOSTLY* [anti-Rh IgG antibodies] –IgG crosses placenta! –> HDNEF
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46
Q

Sickle cell anemia is ___(mode of inheritance) and should be diagnosed with what?

A

auto recessive; [HgB electrophoresis] determines carrier status

[GlutaMATE –> Valine @ 6th position]

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47
Q

[Wiskoff Aldrich Syndrome] Clinical Manifestation

A

“My Recessive-X WAS Bleeding, [always sick] and had Eczema!

  1. Bleeding (thrombocytopenia)
  2. always sick (recurrent infection)
  3. Eczema

X-linked recessive

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48
Q

[Ataxia Telangiectasia] MOD and clinical presentation

A

ATM gene defect –> Faulty DNA repair –> ROE

Recurrent Infection

Oculocutaneous telangiectasia

Early cerebellar ataxia

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49
Q

Where does complement bind on the Immunoglobulin

A

Heavy chain near the hinge point

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50
Q

Mode of Inheritance for [Hemophilia A vs. B]

A

Both are X-linked Recessive

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51
Q

What part of the Thymus/lymph node is underdeveloped in DiGeorge Syndrome? How does this affect function?

A

Paracortex; prevents 1° lymphoid follicles & germinal centers form forming in cortex

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52
Q

Identify which Knee this is (L vs. R) and the letters

A

RIGHT Knee

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53
Q

What should be monitored in pts with Ankylosing Spondylitis? Why?

A

Chest Wall Expansion; involvement of thoracic & costovertebral spine can limit chest wall expansion –> hypOventilation

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54
Q

After Clavicle Fracture, which muscle causes SUPERIOR displacement of the midshaft and which causes INFERIOR (2)

A

SUPERIOR = Sternocleidomastoid

inferior = PEC Major & arm weight

CLAVICLE = MOST FRACTURED BONE (especially in kids)

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55
Q

What type of Hypersensitivity is Myasthenia Gravis?

A

Type 2 (Ab-mediated)

Same as GoodPasture

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56
Q

Preferred Diagnostic tool for Vertebral Osteomyelitis

A

MRI

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57
Q

What 3 markers reflect Osteoclast activity

A
  1. Urine DeOxyPyridinoline (most specific)
  2. Urine HydroxyProline
  3. [Tartrate Resistant Acid Phosphatase]
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58
Q

MOD for [Giant Cell temporal Arteritis]

A

IL6 drives cell-mediated immunity against LARGE blood vessels

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59
Q

[Mccune Albright] Clinical Presentation (3)

A
  1. Unilateral Cafe Au Lait
  2. Endocrine Problems
  3. Polyostotic Fibrous Dysplasia

Lethal if onset b4 fertile but survivable in mosaicism pts

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60
Q

How are Contractures formed and what do they ultimately result in

A

comes from too much [matrix metalloproteinase activity + myofibroblast accumulation]. Contractures –> Wound deformitites

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61
Q

How does Anabolic Steroid misuse cause Acne?

A

Androgens stimulate follicular epidermal hyperproliferation and INC sebum –> Acne (inflammatory nodular eruptions)

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62
Q

Clinical Presentation for [Caudal Regression Syndrome] (2). What’s the major RF

A
  1. [LumboSacral AGENESIS NTD] –> [Flaccid LE + Urinary incontinence]
  2. Heart defects

Maternal DM = RF

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63
Q

Allopurinol (a ___ inhibitor) INC the concentration of what 2 drugs as a result?

A

Allopurinol = Xanthine Oxidase inhibitor –> INC

Azathioprine

6-MP

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64
Q

Sarcomere is defined as the distance between _____. [Actin Thin filaments] are bound & structurally supported by the _____

A

Sarcomere = Distance between Two Z Lines

[Actin Thin filaments] are bound & structurally supported by the [Z Lines] in the [I band]

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65
Q

Sarcomere is defined as the distance between _____. [Myosin THICK filaments] are bound & structurally supported by the _____

A

Sarcomere = Distance between Two Z Lines

[Myosin THICK filaments] are bound & structurally supported by the [M Lines] in the [A band]

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66
Q

In Lateral Epicondylitis, which tendon is often swollen and what function does it have?

A

[Extensor Carpi Radialis brevis]; Extends Wrist

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67
Q

What’s significant about Black women and Bone mass

A

Black women have Higher bone density and DEC risk of fractures

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68
Q

Lymph drainage of medial foot drains into the _____ lymph nodes. What part of the reproductive system also drains here?

A

Superficial Inguinal ; SCROTUM

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69
Q

Lymph drainage of Lateral foot drains into the _____ lymph nodes (2)

A

Superficial Inguinal AND Popliteal

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70
Q

Clinical Presentation for [Serum Sickness Type 3 Hypersensitivity] (5)

A

“Drugs can make ur Serum CAUFF”

  1. [C3 & C4 DEC]
  2. Arthralgia
  3. Urticaria
  4. Fibrinoid Vasculitits Necrosis
  5. Fever
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71
Q

What is [Serum Sickness Type 3 Hypersensitivity] mostly caused by?

A

Drugs acting as Haptens

(such as Infliximab :-) )

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72
Q

The Thymus and [inferior parathyroid] comes from the ___ pharyngeal pouch

A

3rd

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73
Q

Which pharyngeal arch does the [SUP parathyroid] come from?

A

4th

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74
Q

Which DO is characterized as [Endomysial CD8 inflammation + patchy necrosis] and what’s the MOD

A

Polymyositis; Ab against [Histidyl tRNA synthetase]

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75
Q

What ions contribute to the resting potential of a cell

A

[HIGH K+ conductance] AND [some Na+ conductance]

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76
Q

Tibial n. supplies sensory innervation to what part of the foot?

A

Plantar Foot

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77
Q

Falls onto an outstretched hand may dislocate the ____ bone, fracture the ____ bone –>which INC risk of developing _____. Fracture of the ____bone is in between which 2 tendons?

A

disLocate Lunate; [fracture Scaphoid–> Avascular Necrosis] found between extensor longus and brevis (snuff box)

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78
Q

Which drug DEC risk of both Breast CA and Bone Fractures in Women

A

Raloxifene SERM

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79
Q

Histology description for Osteoclast and list what 2 factors activate differentiation

A

multinucleated; [M-CSF and RANKL -both from OsteoBLast]

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80
Q

How does Omeprazole affect Skeleton system

A

long term use of PPI –> Osteoporosis

These CoAg Canners Obliterate SpongyBoneTrabeculae

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81
Q

Identify the finding

A

Clubbing (associated with prolonged hypoxia-typically from Lung Dz)

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82
Q

Difference between [Muscle Spindle system] and [Golgi Tendon system]

A

[Muscle Spindle system] = monitors muscle length

vs.

[Golgi Tendon system] monitors muscle force (associated with relaxation)

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83
Q

Defect in [PECAM1] –> No Neutrophil ____

A

Transmigration

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84
Q

Hematogenous Osteomyelitis is most common in ____ and usually affects the ____ of bone

A

Children; Metaphysis

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85
Q

Buttock injections to what quadrant(s) risk Sciatic n. injury

A

Superomedial, Inferomedial, InferoLateral

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86
Q

Butt injections to what quadrant(s) risk SUP Gluteal n. injury –> ___ Gait

A

Superomedial

Will cause Trendelenburg gait

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87
Q

COX __ is an inducible enzyme (by IL1) usually undetectable except during inflammation

A

COX2

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88
Q

Which musculoskeletal condition is associated with having an extra cervical rib?

A

Thoracic Outlet Syndrome –> UE paresthesias & weakness

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89
Q

Function of [Human Placental Lactogen] (2)

A

“HPL gives Mom Higher Plasma [Lipids & Glucose] for the baby”

[DEC Mom’s Fatty acid stores] and INC Mom’s Blood Glucose] for the baby

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90
Q

What would an US of the uterus in an ectopic pregnancy show?

A

Decidualized endometrium - Dilated, coiled endometrial glands & [vascularized edematous stroma] from progesterone preparation but no implant

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91
Q

Pelvic fractures are associated with injury to what Male GU structure?

A

[Posterior Urethra: Membranous segment]

  • Cather placement is cx in Urethral injury*
  • Prostatic segment is protected by Prostate*
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92
Q

Saddle injuries are associated with injury to what Male GU structure?

A

Anterior Urethra

Catheter placement is cx in Urethral injury

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93
Q

Between Epispadia and hypOspadia, which is associated with faulty positioning of the genital tubercle?

A

Epispadia

You PEE in ur Eye with Epispadia

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94
Q

Difference between [Androgen insensitivity Syndrome] and [Mullerian aplasia]

A

AIS have [NO Fallopian tube and Uterus (even rudimentary)] and [NO sexual hair] (2)

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95
Q

Saline Microscopy is AKA _____

A

WET MOUNT

think Trichomonas vaginalis

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96
Q

What is Cervical Cytology typically used for?

A

This is a PAP Smear ; HPV

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97
Q

Both [Indirect inguinal hernia] and [Communicating Hydroceles] are caused by what?

A

Incomplete obliteration of Processus Vaginalis –> connection between scrotum & Abd cavity

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98
Q

Most dangerous SE of Tamoxifen SERM

A

Although [E2 blocker @ Breast], it’s [E2 agnoist @ Endometrium] –> [Endometrioid Endometrial ADC]

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99
Q

What does pregnancy analytes show for [Down Syndrome] (4)

A
  1. INC inhibin A
  2. INC beta-HCG
  3. DEC AFP
  4. DEC Estriol
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100
Q

Bilateral ligation of which vessel resolves Postpartum Hemorrhage

A

Internal iLiac

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101
Q

Describe Septic Abortion and what causes it (2)

A

Seeding of Uterine cavity from instruments after having abortion –> Foul discharge + fever + abd pain

Staph Aureus & E.Coli cause it!

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102
Q

[Gestational Placental Choriocarcinoma] is usually preceded by _____ and causes ____ with ____. What happens if this metastasizes?

A

some form of pregnancy; [VERY HIGH bHCG + Vaginal Bleeding] ; Hematogeous spread –> Lungs–> Hemoptysis

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103
Q

Tx for PCOS (4)

A

Use a SOCK to treat PCOS

  1. Spironolactone -2ND LINE AND SHOULDN’T BE USED IN FERTILE PTS
  2. OCP - 1ST LINE
  3. Clomiphene
  4. Ketoconazole
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104
Q

Ovarian CA is usually diagnosed in _____. What are the CA marker? (2)

A

Postmenopausal women; [Epithelial = CA-125] but [Stromal/Granulosa = Estrogen]

Granulosa will have Call-Exner rosette & appear yellow from theca lipid

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105
Q

Which drug reduces the volume of the prostate in pts with BPH

A

Finasteride (5a-reductase inhibitors)

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106
Q

What’s the most common cause of [Blood Nipple Discharge] in women and describe its Histology

A

Intraductal Papilloma; [Papillary cells w/fibrovascular core] –> Unilateral bloody/serous discharge

1.5-2 risk of CA

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107
Q

What is a Cystic Hygroma and what pts have it?

A

Posterior neck mass made of cystic spaces separated by connective tissue; Turner Syndrome

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108
Q

Ovarian Torsion MOD

A

[SIPL - Suspensory InfundibuloPelvic Ligament] twist due to large adnexal mass –>arterial Occlusion—>Ovarian ischemia

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109
Q

[Kegel Pelvic floor strengthening] targets what muscle for [Stress Urinary Incontinence] tx

A

Levator Ani

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110
Q

Congenital Torticollis MOD

A

Malpositioning of Head in Utero vs. During birth –> constant contraction of SCM–>Lateral Neck swelling

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111
Q

Adenomyosis clinical presentation (3)

A
  1. Uniformly enlarged Uterus w/normal endometrial
  2. Menorrhagia
  3. Dysmenorrhea

MOD= endometrial glands within myometrium

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112
Q

Which thyroid tx contains Iodide and thus acts by competitively blocking

A

Perchlorate & PerTechnetate

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113
Q

Pt taking Hyperthyroid medication with [sudden fever & sore throat] should receive what test and why?

A

WBC w/ diff; Anti-Thyroid meds can –> Agranulocytosis

PTU also causes Liver Failure

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114
Q

What is the recommended regimen for Diabetics on Insulin

A

1 Long Acting (Glaaaaaaarrgine vs. Detmir)

+

1 short acting pre-meal (glulisine vs. aspart vs. lispro)

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115
Q

Between Glycogenolysis and Gluconeogenesis, which does EtOH inhibit in liver?

A

Gluconeogenesis

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116
Q

Which Lipid lowering drug actually INC HDL and TAG if used alone?

A

BABR (Bile Acid binding resin)

[Cholestyramine & Cole]

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117
Q

Type 2 DM pts mostly die from what?

A

MI

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118
Q

What are the 4 most common causes of Myopathy (elevated CK)

A

Statins Probably hurt Muscles

  1. Statins
  2. Polymyositis vs. Dermatomyositis (autoimmune)
  3. Muscular Dystrophy
  4. hypOthyroidism
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119
Q

Histology for Osteopetrosis (2)

A

Primary spongiosa in medullary cavity with no mature trabeculae + accumulated woven bone

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120
Q

Even though Prolactin INC during pregnancy, why is lactation actually inhibited?

A

Actual Lactogenesis (not Prolactin secretion) is inhibted by HIGH levels of E2 or Progesterone

Dopamine also bock Prolactin

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121
Q

Genetic causes for Down Syndrome (3)

A
  1. Meiotic Nondisjunction (most common)
  2. Mosaicism for a trisomy 21 cell line
  3. Robertsonian Translocation (14 –>21)
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122
Q

Why are pregnant pts (Fertile) at higher risk for Gallstones?

A

[E2 –> Cholesterol Hypersecretion] & [Progesterone–> Gallbladder hypOmotility]

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123
Q

Polyhydraminos (INC amniotic fluid) is caused by what? (2)

A
  1. Impaired fetal swallowing (Anencephaly, GI obstruction/atresia)
  2. Excessive amniotic production (high cardiac output, twin transfusion syndrome)

Renal Agenesis –> Oligohydraminos (not enough amniotic)

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124
Q

Define Pyknosis

A

Nuclear Shrinkage

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125
Q

Describe the process of EtOH breakdown to Acetic Acid and explain how Metronidazole disrupts this

A

Metronidazole has Disulfiram-like activity –> Acetaaldehyde accumulation –> Flushing/NV/Cramps after drinking

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126
Q

Testicular Torsion MOD

A

Twisting of Testes around spermatic cord which cuts off [testicular vein outflow] but still preserves [gonadal a. inflow (from Abd aorta)] –>Engorgement –>Hemorrhagic infarct

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127
Q

How does Testicular Torsion present? (2)

A
  1. High - riding Testis
  2. Absent Cremasteric reflex
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128
Q

What is Vaginal Adenosis and what demographic is it seen

A

Persistence of upper 2/3 [Glandular columnar]–> [Clear cell ADC]; DES daughters

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129
Q

[Prader Willi]

MOD (2)

&

Clinical Presentation (3)

A

[Paternal gene deletion] vs. [Maternally imprinted (silenced) gene disomy (receiving both genes from Mom)]

  1. [Short & Obese]
  2. hypOtonia
  3. Retarded
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130
Q

Which structures should be ligated during an oophorectomy and why?

A

[SIPL - Suspensory InfundibuloPelvic ligament] contains [ovarian NAVL(Nerve/Artery/Vein/Lymphatics)] ; prevents bleeding

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131
Q

What is Ebstein anomaly (3)? What medication is associated with it?

A

[Tricuspid displacement toward apex] + [DEC RV volume] + [atrialization of RV]

Lithium during pregnancy

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132
Q

Although the prostate drains into the ___ lymph nodes, how does osteoblastic metastasis to skeletal system occur?

A

[Prostate drains –>Internal iLiac Lymph nodes]

BUT

Bone metastasis from Pelvis spread via [Vertebral venous Plexus] (Prostatic venous plexus)

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133
Q

Where is the [Prostatic plexus] located and what does it innervate

A

[Inside Fascia surrounding Prostate]; innervates [Corpus Cavernosa –> Penile Erection]

Can be damaged during prostatectomy

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134
Q

Cystic Fibrosis and Kartagener (SIBS) present VERY similarly! What is the differentiating sign?

A

Cystic Fibrosis has [Bilateral Absence of Vas Deferens]! (This –> Infertility)

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135
Q

MiFepristone MOA

A

F this baby, smh

Progesterone R Blocker

Used for [1st trimester Abortion]

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136
Q

Misoprostol MOA

A

Prostaglandin E1 agonist; given with MiFepristone

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137
Q

[Sertoli Leydig ovarian tumors] come from ____ and secrete _____. Describe the Histo

A

[Sex Cord Stroma]; Testosterone; Round Sertoli surrounded by fibrous stroma w/ Reinke crystals]

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138
Q

What is Rheumatoid factor

A

IgM Ab that targets [host IgG Fc region]

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139
Q

What all conditions are associated with [HLA B27 Seronegative spondyloarthropathies] (4)? Which class of MHC do they belong to?

A

PAIR

Psoriatic Arthritis

Ankylosing Spondylitis

Inflammatory bowel Dz arthritis

[Reiters Reactive arthritis]

[MHC Class 1 = HLA A, B and C] (all else = MHC Class 2)

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140
Q

Latissimus Dorsi

A: Innervation

B: function (3)

C: Attachment (3)

A

A: Thoracodorsal n.

B: [Humerus: Extension / ADDuction / medial rotation]

C: iLiac crest –> [Spinous process of T7-12] and inserts at bicipital humerus groove

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141
Q

Describe the “Empty-Can” test and which muscle it test for?

A

[ABduction of arm] + [30°flexion of arm forward] + [thumbs pointed toward floor] –> Pain = [Supraspinatus Rotator cuff injury]

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142
Q

What are T-Tubules and what is their job?

A

[Invaginations of the Sarcolemma] that extend into each fiber; Coordinates contraction of myofibrils by transmiting depolarization to BOTH Sarcoplasmic Reticulum between 2 muscle fibers

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143
Q

What is Calcitriol

A

Vitamin D (1-25 Dihydroxycholecalciferol)

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144
Q

Where is Calcitonin produced and how does it DEC serum Ca+

A

[Thyroid parafollicular C-cells]; inhibits Osteoclast

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145
Q

Effect of T3 on bone

A

Activates Osteoclast (INC bone turnover) –> INC Ca+ and Phosphate

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146
Q

What biochemical change is exhibited in Myasthenia gravis on the motor end plate?

A

REDUCED MOTOR END PLATE POTENTIAL (from inability of ACh to stimulate opening of Na+ influx)

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147
Q

Which muscles allow you to sit up from supine position (3)

A
  1. [iLiopsoas Hip Flexors (iLiacus/Psoas Major & minor)]
  2. Rectus Abdominis
  3. External Oblique
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148
Q

Clinical Presentation for [DILE - Drug Induced Lupus Erythematosus] (3). Which drugs cause this (3)?

A

[Sudden FAP - Fever/Arthralgia/Pleuritis]; (Drugs linked to Liver Acetylation –>Procainamide/Hydralazine/INH)

SLOW ACETYLATORS = INC RISK!

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149
Q

Describe the [Psoas Sign] and what it indicates

A

Pain when Hip is extended; Psoas m. damage/abscess

Psoas and iLiopsoas m. are the major hip flexors

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150
Q

Which arteries are associated with the following nerves?

A: Long Thoracic

B: Axillary

C: Radial

D: Median

E: Tibial: Popliteal fossa

F: Tibial: posterior to medial malleolus

A

A: Long Thoracic = Lateral Thoracic artery

B: Axillary = POST Circumflex a.

C: Radial = DEEP Brachial a.

D: Median = Brachial a.

E: Tibial: Popliteal fossa = Popliteal a.

F: Tibial: posterior to medial malleolus = POST Tibial a.

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151
Q

Involuntary deviation of the Head to the R with neck muscle pain is an example of ___

A

DYSTONIA = abnormal (painful) movements or postures from sustained contraction

[Spasmodic Torticollis Cervical Dystonia] = most common

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152
Q

Hiccups and [Hypnic jerks seen when falling asleep] are an example of what?

A

Myoclonus = Sudden brief shock-like muscle contraction

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153
Q

A: List the n. roots associated with Obturator n.

B: Associated Injury (2)

C: Sensory deficit

D: Motor Deficit

A

Obturator nerve

A: L2-4

B: Pelvic Surgery vs. ANT Hip Dislocation

C: medial thigh loss

D: No Thigh ADDuction

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154
Q

A: List the n. roots associated with Femoral n.

B: Associated Injury (2)

C: Sensory deficit

A

Femoral nerve

A: L3-4

B: [Pelvic path involving iLiopsoas m.] vs. [Retroperitoneal path]

C: [(AnteroMedial Thigh) & (Medial leg)]

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155
Q

List the n. roots associated with Common Peroneal n.

A

L4-S2

foot is dropPED (Peroneal Everts & Dorsiflexes)

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156
Q

List the n. roots associated with Tibial n.

A

L4-S3

can’t walk on TIPtoes (Tibial Inverts & Plantarflexes)

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157
Q

A: List the n. roots associated with [SUP Gluteal n.]

B: Associated Injury (2)

C: Sensory deficit

D: Motor Deficit (2)

A

[SUP Gluteal nerve]

A: L4-S1

B: [Superomedial Butt injection] vs. POST Hip dislocation

C: none :-)

D: [Trendelenburg gait] & [No Thigh ABduction]

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158
Q

A: List the n. roots associated with [inferior Gluteal n.]

B: Associated Injury (2)

C: Sensory deficit

D: Motor Deficit (2)

A

[inferior Gluteal nerve]

A: L5-S2

B: Butt injection vs. POST Hip dislocation

C: none :-)

D: [No Thigh Extension]

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159
Q

What are the 3 drugs used for Acute Gout attack and which are first line?

A

GNC

Glucocorticoid/NSAIDs/Colchicine

Use NSAID 1st > Colchicine > Glucocorticoid

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160
Q

What is Dystrophin and in what dz is the gene for it deleted?

A

Protein allowing connection between [Extracell Conennective tissue] and [intramuscle cell contraction apparatus]; Duchenne Muscular Dystrophy (Gower sign)

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161
Q

Injury to the Femoral Neck can –> [Femoral head osteonecrosis] by damaging which artery

A

[Medial Femoral Circumflex] = perfuses Femoral Head & Neck

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162
Q

[Lateral Twisted Ankle sprain] is due to _________ and involves the ______ ligament

A

[Plantar flexed foot that’s forcefully inverted]; [ANT TaloFibular ligament]

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163
Q

Which drug is used for [rapid sequence intubation] and how does it affect the body longterm?

A

[Succinylcholine = fast acting depolarizing neuromuscular blocker]–> Phase 1 Neuromuscular blockade; Prolonged admin –> Phase 2 Neuromuscular blockade

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164
Q

Which cytokine plays the biggest role in IBD? What is its role and how does it do this? (3)

A

IL10; ANTI-inflammation;

  1. Inhibits TH1 cytokine release
  2. [DEC MHC Class 2 expression]
  3. [deactivates macrophages/dendritic cells]
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165
Q

Function of Enteropeptidase and where is it secreted?

A

Converts [inactive trypsinogen] –> [ACTIVE TRYPSIN]; Secreted from Jejunum

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166
Q

Which nerve enables visceral umbilicus pain during appendicitis?

What causes pain to shift from umbilicus to McBurney point? (2)

A

[T10 Afferent Pain fibers]; Irritation of Parietal peritoneum & Abd Wall shifts pain to McBurney

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167
Q

Which diagnostic is best to screen for malabsorption DO?

A

Sudan 3 Stain (test stool for fat)

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168
Q

Which 2 vitamins can Breast milk not provide for newborns?

A

Vitamin D and K

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169
Q

Annular Pancreas MOD

A

abnormal migration of [Pancreatic ventral bud] –> encircles the [descending 2ndpart duodenum] during 8th week gestation

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170
Q

Pancreas Divisum MOD

A

vusion incompletion of Ventral & Dorsal pancreatic buds –> Asx w/ no obstruction

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171
Q

Pancreatitis can cause blood clots in the ____ which affects the stomach how?

A

Pancreatitis can cause blood clots in the splenic vein –> INC pressure in [short gastric fundal veins] –> [short gastric fundal varices]

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172
Q

Identify

A
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173
Q

Which cytokines do TH1 produce to cause injury in Crohn’s IBD (3)

A

IF-gamma / IL2 / TNFa

Infliximab targets TNFa

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174
Q

Imaging characteristics of Cholecystitis (4)

A
  1. US Gallbladder wall thickening
  2. US Pericholecystic fluid
  3. Positive Sonographic Murphy sign
  4. Failed gallbaldder visualization on radionuclide scan
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175
Q

Describe the Histo (2) and Identify the GI lesion

A

Villous Adenoma

[Long glands + Villi projections from the surface]

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176
Q

Describe the Histo (2) and Identify the GI lesion

A

[Disorganized glands] + [smooth m. & tissue]

Hamartomatous polyps

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177
Q

What is Courvoisier sign and what is it associated with?

A

[Palpable BUT NONTENDER Gallbladder] = Pancreatic CA

  • will be accompanied w/obstructive jaundice + CA sx*
  • smoking = biggest risk factor for Pancreatic CA*
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178
Q

Identify

A
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179
Q

Describe [SUP Mesenteric Artery] Syndrome

A

Occurs when [Transverse Duodenum] becomes trapped between the SMA and aorta due to [DEC in the aortomesenteric angle] –> intestinal obstruction

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180
Q

What compounds are Absorbed EXCLUSIVELY in Duodenum only (4)

A

MIC + [Vitamin A]

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181
Q

What compounds are Absorbed EXCLUSIVELY in Jejunum only (6)

A

TEAM Water + [Vitamin DEK]

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182
Q

Dietary Lipids are Digested in the _____ but absorbed in the _____. How does reabsorption occur?

A

Lipids = Digested in Duodenum; Absorbed in Jejunum

Bile from Duodenum forms water-soluble micelles around [fatty acids] which are passively absorbed into the [Jejunum brush border enterocyte].

[Fatty acids] are then reconstructed and combined with apoprotein –> Chylomicron –> intestinal lymphatics

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183
Q

What compounds are Absorbed EXCLUSIVELY in iLeum only (3)

A
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184
Q

[Lynch HNPCC Hereditary CA] MOD

Which genes are implicated (3)

A

DNA mismatch repair –> microsatellite instability –> CRC

[MSH2 & 6 / MLH1 / PMS2]

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185
Q

Name the key differentiating factors for CRC from Ulcerative Colitis (vs. Lynch/Sporadic) (3)

A

CRC from UC are like MEN!

  1. Comes from [NON-Polyp dysplastic lesions]
  2. Multifocal
  3. [EARLY p53 but LATE APC] –> Higher Histological grade
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186
Q

Identify the Dz and describe its MOD

List 2 classic findings

A

Intussuception; Telescoping of proximal bowel into distal usually at iLeocecal junction; [Currant jelly stool + Bulls Eye US]

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187
Q

Anal fissures are ___ tears that come from ______. Where do they occur?

A

longitudinal; hard stools; [Distal to Dentate in the Posterior midline]

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188
Q

Identify

A
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189
Q

What do the Dorsal and Ventral Pancreatic buds each form?

A

Ventral = [Major pancreatic Duct of Wirsung], Uncinate, [posterior Head]

Dorsal = Everything Else

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190
Q

Which neonatal GI condition are Down syndrome pts most susceptible to? MOD? Name 2 other GI conditions

A

Umbilical Hernia;

Linea Alba defect –>incomplete umbilical ring closure –> [Reducible protrusion COVERED BY SKIN] that resolves spontaneously

Omphalocele = herniation within a thin membranous sac

Also susceptible to Duodenal Atresia, Hirschprung

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191
Q

Identify the key finding. What is this pt at risk of developing?

A

[Porcelain Gallbladder from Chronic Cholecystitis] –>Gallbladder ADC

Dystrophic intramural Ca+ deposition + chronic inflammation

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192
Q

Where is the Ligament of Treitz

A
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193
Q

lithium toxicity (LMNOP) can be precipitated by what? (4)

A
  1. Thiazides
  2. ACE inhibitors
  3. NSAIDs
  4. Volume Depletion
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194
Q

Which drugs cause Agranulocytosis? (6)

A

Gangs CCCrush Myeloblast & Promyelocytes

Ganciclovir

Clozapine

Carbamazepine

Colchicine

Methimazole(also Teratogenic–>Cutis Aplasia)

PTU

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195
Q

Which 4 conditions is Buproprion contraindicated in?

A
  1. SEIZURES hx
  2. Anorexia
  3. Bulimia
  4. Panic DO
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196
Q

Out of the anti-convulsants (Carbamazepine, Valproate & Lamotrigine), which is used for Seizure Px

A

Valproate

These are also used for Bipolar tx

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197
Q

Why is Antidepressant monotherapy contraindicated in Bipolar or person who may have Bipolar

A

Antidepressant monotherapy can INDUCE MANIA in Bipolar vs. [Unrecognized Bipolar DO]

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198
Q

Difference between Avoidant DO and SchizoiD DO

A

Avoidant DO = avoidance only due to fears of rejection or criticism (pts don’t want or like this)

vs.

SchizoiD DO = avoidance that these pts are perfectly content with

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199
Q

How do you differentiate [Bulimia Nervosa] from [Sjogren syndrome] (3)

A

Bulimia Nervosa will have

  1. Abnormal Electrolytes
  2. INCREASED Amylase and Lipase (Parotid swelling)
  3. [Russell Dorsal Hand Calluses]
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200
Q

Common characteristics of Cocaine Withdrawal (3)

A
  • SEVERE ACUTE DEPRESSION (CRASH)
  • Hyperphagia
  • Hypersomnia w/vivid dreams
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201
Q

Phencyclidine (AKA ___) is a __(MOA)___ and main toxication sign is _____

A

PCP (Hallucinogen = [NMDA Glutamate Blocker])! ; [Vertical Nystagmus]

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202
Q

LSD main toxication sign is _____

A

Visual Hallucinations

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203
Q

Heroin main toxication sign is _____ (2)

A
  1. Miosis
  2. Respiratory Depression
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204
Q

What are the signs of Cocaine intoxication? - 3

A
  1. MyDriasis (Pupils Wide Open on coke!)
  2. Chest Pain
  3. Seizures
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205
Q

What is the primary SE of [SSRI AND SNRI] and which drug is an appropriate alternative

A

Sexual dysfunction; replace with Buproprion

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206
Q

Describe [Atypical Depression] (3)

Which drug is best for this type of Depression?

A
  1. Mood Reactivity (positive events brightens mood)
  2. Leaden Paralysis (extremities feel “heavy”)
  3. Rejection Sensitivity (super sensitive to criticism)

MAO inhibitors = tx resistant and atypical depression

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207
Q

Damage to what lobe of the brain results in [Apathy and organization impairment]?

R handed person

A

LEFT Frontal

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208
Q

Damage to what lobe of the brain results in Disinhibition?

R handed person

A

RIGHT Frontal

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209
Q

Difference between Tourette and [Chronic Tic DO]

A

Tourette = [Motor AND Vocal Tics both] for GOE 1 year

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210
Q

Which Benzodiazepines have short half life but can’t be used in Liver failure pts? Wh

A

Alprazolam & Clonazepam = intermediate] and [Triazolam & = short half life]

CAN NOT USE IN LIVER FAILURE PTS (they undergo hepatic metabolism) - LOT is preferred in liver failure pts [Lorazepam/Oxazepam/Temazepam]

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211
Q

Difference Between [Bulimia Nervosa] and Anorexia

A

pts with [Bulimia Nervosa] will NOT show signs of malnutrition because they still maintain body weight at or above minimal

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212
Q

Which function is dysfunctional in Xeroderma Pigmentosum and which enzyme is implicated

A

[Nucleotide Exicision Repair]; Endonuclease

These pts have hyperpigmentation in sun exposed areas and INC risk for Skin SQC

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213
Q

Explain how sun exposure causes skin DNA changes and how it’s repaired

A

UVB forms Pyrimidine dimers

Endonuclease nicks the damaged strand on both sides of the Pyrimidine dimer –> Excises it–>

Replacement by DNA polymerase

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214
Q

Acanthosis Nigricans is mostly associated with ____ but can also be tied to _____

A

mostly Insulin Resistance!; Gastric ADC

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215
Q

Terbinafine MOA

A

[Squalene Epoxidase] inhibitor

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216
Q

Accessory Nipples MOD

A

Failed regression of mammary ridge during utero –> Asx but sometimes tender (espeically during menses) mass in Teens

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217
Q

Which cells are responsible for the Type __ TB Skin Test reponse

A

Type 4; [CD4, CD8, macrophages]

CD4 & macrophages also keep TB in check with granuloma formation

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218
Q

Typically, Type 1 Hypersensitivity involves IgE-mediated mast cell stimulation

Which compounds do NOT need IgE to stimulate [Type 1 Hypersensitivity mast cell degranulation]? (3)

A
  1. Morphine (Opioids)
  2. Radiocontrast
  3. Vancomycin
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219
Q

Name the common causes of Erythema Multiforme (7)

A

“Only CHAMPPS can hit the Target!”

Cancer

HSV

Autoimmune

Mycoplasma Pneumoniae

PCN

Phenytoin

Sulfa abx

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220
Q

What is [Osgood Schlatter Dz]

A

Repetitive Quadricep contractions –> overuse injury of [2° ossification apophysis] of Tibial Tuberosity

Presents as pain at the Tibial Tubercle

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221
Q

The Piriformis muscle passes through the ____ foramen and functions to do what?

A

[Greater Sciatic Foramen] –>can compress Sciatic n. if injured; External Hip rotation

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222
Q

In psychiatry, what is splitting? Which demographic is commonly seen in

A

Splitting people into either all good, or all bad; Borderline PD

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223
Q

For Bipolar Mania dx, you need at least [__ sx +/- ___] that last for ___ duration. What are the sx? (7)

A

[3 sx +/- major depression]; 1 week duration;

BIPOLAR

Buying excessively (INC in pleasurable activity)

Inflated self-esteem

Psychomotor agitation (pacing)

wide awOke - won’t sleep

Lots of Language (talking a lot)

ADD-like distractability

Racing thoughts & Ideas

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224
Q

Cocaine MOA and toxicity signs (4)

A

[Presynaptic Reuptake inhibitor] of DNS [Dopamine/NorEpi/Serotonin]

  1. myDriasis responsive to light
  2. Tachycardia
  3. Agitation
  4. Vasoconstriction –> Myocardial ischemia (cp)
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225
Q

In Psychiatry, what is Displacement

A

Displacing feelings meant (but never given to) one person toward a “safer” person

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226
Q

In Psychiatry, what is Transference

A

Transfering unconscious emotions associated with a person in the past –> person in present

Pts abused as kids have difficult time seeking care in the future since they associate it with poor caretaking

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227
Q

In Insomnia tx, what is Stimulus Control

A

Eliminating stimulating bedroom activities and only getting in bed when sleepy

pt should leave bedroom if unable to fall asleep within 20 min

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228
Q

Buspirone MOA, indication and primary cons (2)

A

Buspirone = [5HT1a agonist]; GAD; [slow onset] and [lacks muscle relaxant/anticonvulsant properties]

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229
Q

In Psychiatry, what is Projection

A

Projecting your unaccetable feelings of something onto someone else (as if they have the feelings) so u don’t have to acknowledge ur own feelings

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230
Q

What is unique regarding frequency of Pheochromocytoma presentation

A

Sx may be Paroxysmal or Constant

Sx can resolve on their own sometimes

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231
Q

Ovarian vein thrombosis can extend to which vessels (L Ovarian vein vs. R Ovarian Vein)

A

[L Ovarian Vein] –> [L Renal Vein]

[R Ovarin Vein] –> IVC

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232
Q

List the peak times for

A: Glulisine/Aspart/Lispro

B: Regular insulin

C: NPH

D: Detemir

E: GLargine

A
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233
Q

Cinacalcet MOA

A

[Mimics Ca+] and allosterically sensitizes [Parathyroid CaSR] –> DEC PTH

Used for 1° or 2° HyperParathyroidism

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234
Q

Describe the Histo for [Hashimoto Autoimmune hypOthyroid] (3)

A
  1. [Hurthle Oncocytes] = pink cytoplasm from numerous mitochondria
  2. [Mononuclear parenchymal infiltration] +
  3. [Germinal centers]
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235
Q

[Primary Biliary Cirrhosis] MOD and marker

What other DO has similar findings?

A

Autoimmune Lymphocytic & Granulomatous destruction of intraHepatic AND interlobular Bile ducts

Marker = AntiMitochondrial Ab

This is all similar to [Graft vs. Host Dz]

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236
Q

What are the HLA associations for Type 1 DM (2)

A

HLA [DQ] and [DR3 & 4]

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237
Q

[INC ACTH + Hyperpigmentation] should make you suspicious for what dz

A

[Addison’s 1° Adrenal Insufficiency]

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238
Q

What’s the most serious complication of untreated Prolactinoma in women

A

Bone loss

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239
Q

The following histo from an Ovary likely indicates what dx?

A

Mature Teratoma

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240
Q

Describe how a female may end up with an indented uterus fundus

A

Incomplete lateral fusion of paramesonephric ducts –> Bicornuate uterus (indented uterus fundus)

Paramesonephreic ducts –> Fallopian/Uterus/Cervix/Upper Vagina

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241
Q

How does elevated Free Fatty acid contribute to Insulin resistance (2)

A

impairs [insulin-dependent] glucose uptake by Liver and INC liver gluconeogenesis

Sedentary Lifestyle & Obesity can also do this

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242
Q

Describe the Histo; Identify Dz

sample come from Breast Mass

A

[Fibrous myxoid stroma] that encircles [Glandular spaces]; Fibroadenoma

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243
Q

Describe the Histo; Identify Dz

sample come from Breast Mass

A

Cell proliferation surrounded by well preserved [Ductal basement membrane]; DCIS (Ductal Carcinoma In Situ)

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244
Q

Identify Dz and its MOD

sample come from Breast Mass

A

malignancy spreading from superficial DCIS –> nipple skin w/out crossing basement membrane –> Nipple Crust; [Paget Dz of Nipple]

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245
Q

What is an Imperforate Hymen and how does it present?

A

Incomplete degeneration of central fibrous tissue band connecting vaginal walls –>

Teen with 1°Amenorrhea, normal secondary sex characterisitcs but cyclical pelvic pain due to menstrual blood accumulation (hematocolpos)

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246
Q

During pregnancy, a mother who experiences [Maternal Virlization] probably has a fetus & placenta with what defective enzyme? Explain

A

Aromatase! (not 21aH) - the fetus and placenta will both have Aromatase deficeincy

In 21aH, placenta aromatase is still functional –> NO Maternal virilization during pregnancy

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247
Q

A: [Age related Macular Degeneration] MOD

B: Tx (2)

A

Retinal neovascularization from INC VEGF –> [Grayish subretinal membrane +/- hemorrhage]

B: [VEGF inhibitors(RaniBizumab)] & Smoking cessation

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248
Q

A: Glaucoma MOD

B: Tx approaches (3) and how specifically does B-blockers work?

A

INC intraocular pressure from [INC production vs. DEC outflow of Aqueous humor]

B:B-Blockers –> DEC Ciliary Epithelium Aqueous humor secretion!

Topical Prostaglandins = latanoprost (open angle glaucoma)

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249
Q

The testicles drain lymph into the ____ lymph nodes. Where do Glans Penis drain?

A

ParaAortic; Glans Penis–> [Deep inguinal nodes]

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250
Q

Identify Dz and its MOD

A

[CLOSED angle Glaucoma]; INC intraocular pressure from DEC aqueous humor drainage

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251
Q

Describe how Granulomas are formed

A

[CD4+ T] secrete IF-gamma –> activates macropages –> macrophages secrete TNFa –> further matures them and forms granuloma (walled off defense)

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252
Q

Common complications of Psoriasis (3)

A
  1. Psoriatic Arthritis (PAIR) -[Dactylitis Sausage fingers/Pencil in Cup]
  2. Nail pitting
  3. Uveitis
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253
Q

___ is the most common ocular childhood tumor. How does it present and what CA does it predispose them to?

A

Retinoblastoma (2 hit hypothesis); [Leukocoria White pupillary reflex] and may –> OsteoSarcoma

  • Unilateral = sporadic*
  • Bilateral = familial (worst pgn)*
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254
Q

Dz

A

[Retinal pale whitening] + [Cherry Red Macula] = [Central Retinal Artery Occlusion] –> Painless monocular blindness

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255
Q

Common characteristics of Down Syndrome pts - 7

A

the SHEEPPS of genetics

  1. Skin excessive at nape of the neck = nuchal skin
  2. HypOtonia w/ ⬇︎ Startle Moro reflex
  3. Epicanthal folds
  4. Ears that are small
  5. Protruding tongue w/flat face
  6. Palpebral fissures are upslanted
  7. Single palmar crease
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256
Q

In [Graft versus Host Dz] the transplant __ cells attack the Recipient. What are the manifestations? (4)

Which transplants are associated with GVHD? (2)

A

[Donor Tcells] proliferate in immunoCOMPRO recipient;

  1. Maculopapular Rash
  2. Jaundice
  3. Diarrhea
  4. Hepatosplenomegaly

Bone Marrow & Liver

Has similar Histo to Primary Biliary Cirrhosis

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257
Q

How can Testicular CA or [Gestational Trophoblastic Dz] cause Hyperthyroidism

A

Both of these secrete a lot of HCG, which is structurally similar to TSH –> INC T3/T4

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258
Q

Functions of TNFa (4)

A

WECS

WBC recruitment

Endothelium activation –> vascular leakage

CA Cachexia

Septic shock

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259
Q

Significant SE of Nitroprusside and reversal tx (3)

A

Cyanide toxicity –> seizures, bright red venous blood & lactic acidosis;

Antidote =

  1. Hydroxocobalamin (directly binds)
  2. Sodium Nitrite (induces methemoglobinemia)
  3. Sodium ThioSulfate (Sulfur donor)
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260
Q

Which layers of the Throat are passed when doing a Cricothyrotomy? (3)

A

[Superficial Cervical fascia], [Pretracheal fascia] & [Cricothyroid membrane]

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261
Q

Prolonged exposure to loud noises prediposes to damage of what part of the ear

A

[Organ of Corti: stereociliated hair cells]

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262
Q

Classic triad for ASA toxicity ; What acid-base state will these pts be in? (2)

A

ASA –> [Mixed Respiratory alkalosis + AG metabolic acidosis] (Normal pH/Low PCO2/Low HCO3)

[Air is Fast (Tachypnea)]

[Sound ringing (Tinnitus)]

[Air is Hot (Fever]

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263
Q

[Meniere TVS] Dz Sx Triad and MOD

A

[Meniere TVS]

INC endolymph volume in vestibular apparatus –> RECURRENT

Tinnitus

Vertigo

[Sensorineural hearing loss]

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264
Q

What is a Cholesteatoma?

A

Squamous cell debris that form pearly masses behind tympanic membrane of middle ear

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265
Q

Which arteries anastomose at the [Kisselbach plexus] of the ANT nasal septum (3)

A

ANT Ethmoidal

Sphenopalatine

SUP labial

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266
Q

Sensation to the ear canal is NOT innervated by Vestibulocochlear n. What does innervate it? (2)

A

Vagus –> POST External Auditory canal

[CN5: B3] –> the rest

267
Q

Which nerve is dangerously close to the inferior thyroid artery

A

[RIGHT Recurrent Laryngeal n.]–> [Raspy Vocal Cord Paralysis(same as L)]

268
Q

Cleft LIP mechanism of formation.

Cleft palate mechanism of formation?

When does this occur

A

Cleft lip = [maxillary &
medial nasal processes (formation of 1° palate)] fail to fuse

Cleft palate— [the two lateral palatine shelves] vs. [lateral palatine shelf with median palatine shelf (or nasal septum) (formation of 2°
palate)] fail to fuse

5th-6th Week Embryo

269
Q

MOA of Succinylcholine

A

ACh receptor agonist tht actually produces sustained depolarization and prevents
muscle contraction.

270
Q

Describe Succinylcholine Phase 1 and its OD antidote

A

ƒ Phase I (prolonged depolarization)—no antidote. Block potentiated by cholinesterase inhibitors.

271
Q

Describe Succinylcholine Phase 2 and its OD antidote

A

ƒ Phase 2 (repolarization finally starts but ACh R are still blocked since even tho they’re available, they’re desensitized)

antidote is cholinesterase inhibitors

272
Q

How might a newborn suffering from Vitamin K deficiency present? (3)

A

Impaired clotting factor carboxylation

  1. Intracranial hemorrhage
  2. Bulging ANT Fontanelle
  3. [Eyes driven downward & unable to track up]
273
Q

Clinical Presentation of Fanconi Anemia (3)

A
  1. Short stature
  2. Absent Thumbs
  3. INC CA Risk [Myelodysplastic syndrome and AML]
274
Q

What is Fanconi Anemia

A

[Loss of DNA crosslink repair] –> Inherited Aplastic Anemia

275
Q

Describe Pancytopenia (3)

A

Pan cytopenia : TAN

Thrombocytopenia (petechiae, hemorrhage)

Anemia (fatigue, pallor)

Neutropenia (opportunistic infection)

276
Q

What’s the most important Pgn factor for [Bladder Urothelilal Transitional cell carcinoma]

A

Tumor Penetration into Bladder Wall

277
Q

Chemotherapeutic (and toxic) effect of MTX can be overcome with what drug? Why does this help?

A

[Leucovorin THFolinic acid]; This is a reduced form of Folic Acid BUT doesn’t require DHF reductase like Folic Acid

278
Q

MTX Indications (7)

A
  1. Brain Tumor - HIGH IV DOSES
  2. Meningitis (carcinomatous vs. lymphomatous)
  3. Leukemia
  4. Lymphoma
  5. Psoriasis
  6. RA
  7. Ectopic Pregnancy
279
Q

[Tumor Lysis Syndrome] MOA and Clinical Presentation (4)

A

Develops during Chemo in CA with rapid turnover

HYPERKUP + [low Ca+]

  1. HYPERKalemia
  2. HYPERUricemia (tx: Rasburicase vs. Allopurinol)
  3. HYPERPhosphatemia
  4. hypOcalcemia
280
Q

The MDR1 gene codes for the _____, which is a _____

A

MDR1 gene codes for [P-GlycoProtein Efflux Pump], which is an transmembrane ATP-dependent protein that effluxes hydrophobic protein out of the cell –> ChemoResistance

281
Q

Hydroxyurea Indication (3)

A
  • Sickle Cell Anemia (INC HbB Fetal synthesis)
  • Rapidly DECREASES High [WBC Blast count] in pts with AML and [Chronic Granulocytic Leukemia w/blast crisis]

Inhibits [Ribonucleotide Reductase] –> inhibits [DNA thymine] synthesis

282
Q

Multiple Myeloma [Tx and its MOA]

A

Crazy Ass BUMP

[Bortezomib Proteasome inhibitor] = Boronic acid-protein that inhibts breakdown of [Excess Proteins like (Monoclonal IgG)]–>intracell accumulation –> Plasma cell apoptosis

Also tx for Mantle Cell Lymphoma

283
Q

Etoposide MOA

A

E2oposide: Topoisomerase 2 inhibitor –> Double stranded DNA breaks

284
Q

Etoposide Indication (3)

A
  1. Testicular CA
  2. Lymphoma
  3. SOLC
285
Q

Etoposide SE

A

Leukomogenic (Leukemia Promoter)

286
Q

Function of Ristocetin

A

Activates [GP1B/2A Platelet R] –>INC availability for vWF adherence

287
Q

Elderly who’ve received intubation or dehydrated are at risk for [Acute Staph Aureus ____] Dx? (2)

A

Acute Staph Auerus Parotitis; [Amylase & imaging]

288
Q

Difference between Reassortment & Recombination

A

Reassortment (ex. influenza) = reassortment of [viral genome segments] within a host cell infected with 2 viruses

vs.

Recombination = gene exchange via crossing over of 2 double-stranded DNA molecules

289
Q

How does LOE (LPS OuterMembrane Endotoxin) from [Gram negative bacteria] facilitate Gram negative sepsis

A

[LOE = LPS OuterMembrane Endotoxin]

LOE is passively released from Gram neg bacteria. LIPID A is the toxic component of LOE and activates macrophages –> IL1 and TNFa –> Sepsis

290
Q

Is Angioedema Hereditary or Acquired? What enzyme deficiency INC the risk of Angioedema and why?

A

BOTH!; [Low C1 esterase inhibitor] activity –>INC bradykinin from the start –> INC risk of acquired Angioedema

ACEk2 inhibitors are contraindicated in these pts!

291
Q

Describe the Monospot EBV test

A

Heterophile Ab that react with [Horse or Sheep RBC = EBV +]

292
Q

[C1 esterase inhibitor deficiency] MOD (2) and presentation

A
293
Q

What is the major virulence factor for [Group A Strep Pyogenes] and what does it do? (3)

A

M Protein

  1. Inhibits Phagocytosis
  2. Inhibits Complement
  3. Mediates Bacterial Adherence
294
Q

Anaphylaxis (IgE) involves widespread mast & ___ degranulation. What is a specific marker for mast cell activation?

A

mast & basophil degranulation; Tryptase

Histamine & Heparin are also released

295
Q

What is one of the more severe complications of [Reiters Reactive Arthritis]

A

SacroiLiitis

Also: RRA can also cause skin rash on palms & soles!

296
Q

Formula for Drug Concentration

A

[Drug Dose (mg) / VD]

VD = Volume of Distribution (L)

297
Q

Presbyopia and skin wrinkles are [Age related changes] (along with Macular degeneration)

Describe Presbyopia & how it’s related to skin wrinkles

A

[Denaturated Lens Hardening] –> DEC Lens elasticity–>inability to thicken

(In skin: DEC collagen & elastin –> wrinkles)

298
Q

The following was obtained from a Liver biopsy. What’s the Dx, MOD

A

[Alpha 1 Antitrypsin deficiency];

No [Alpha 1 antitrypsin] –> INC [(macrophage tryptase)/(neutrophil elastase)] –> [Panacinar emphysema from alveolar wall destruction]

AND

Liver Cirrhosis from accumulation of malfolded [Alpha1AntiTrypsin] (seen in PAS+ image)

299
Q

Name MOD and key findings for [Patau Trisomy __] (6)

A

[Patau Trisomy 13]; Prechordal mesoderm fusion –> midline defects

  1. aPlasia cutis
  2. holoProscencephaly (incomplete separation of prosencephalon forebrain - cerebral hemispheres)
  3. [Cleft Palate/Cleft Lip]
  4. Polydactyly
  5. [omPhalocele umbilical hernia]
  6. Rocker bottom feet
300
Q

Describe [Acute Compartment Syndrome] and describe which vessels are impacted by

A: ANT Compartment (2)

B: Lateral (1)

C: Deep Posterior (3)

A

INC pressure within fascial compartments –> DEC perfusion

301
Q

Explain the purpose of adding Primaquine to a Chloroquine regimen

A

Targets the [Plasmodium Vivax & Ovale] [intrahepatic hypnoZoite stage] –> DEC Relapses from these species

302
Q

Difference in MOA between BetaLactams and Vancomycin

A

BetaLactams = bind to PBP (SUCH AS TRANSPEPTIDASE)–> DEC peptidoglycan cell wall cross-link

vs.

Vancomycin = BINDS DIRECTLY TO [Terminal D-alanine glycoproteins of cell wall itself] prevents [PBP Transpeptidases] from ever binding

Both bind irreversibly

303
Q

Difference in MOA between [Echinocandin (i.e. Caspofungin)] and Azole antifungals

A

Azoles inhibit fungal [Ergosterol membrane synthesis]

vs.

[Echinocandin (Caspofungin) inhibits fungal [WALL synthesis]

304
Q

N. meningitidits, gonorrhea, Strep Pneumo and H.Flu all have IgA Protease. What is its function?

A

Cleaves IgA at hinge region –> INC ability to bind to mucosal surfaces

305
Q

Tx for [Gardnerella Bacterial Vaginosis] (2)

A

Metronidazole

Clindamycin

306
Q

What’s unique about the Herpes virus membrane envelope?

A

Although most enveloped viruses get their [lipid bilayer envelope from host plasma membrane], Herpes family get theirs from host NUCLEAR membrane

Image showing HSV Tzanck Smear

307
Q

Describe how Acyclovir is activated (3)

A

[Herpesfamily Thymidine Kinase] MUST first monophosphorylate Acyclovir –> intermediate –(host cell enzymes)–> [Active Triphosphate form]

Acyclovir = Guanosine analog

308
Q

Organisms that are Indole positive means what

A

Can convert Tryptophan –> Indole

(Ex. E.Coli & Pasteurella)

309
Q

[Cavernous Sinus Thrombosis] MOD and Presentation (3)

A

Infection of medial face sinuses or teeth spread thru facial venous –> cavernous sinus

  • [CN3 / 4 / CN5B1 and B2 / 6] ipsilateral involvement
  • Proptosis
  • HA
310
Q

[Facial CN7] exits the ____ foramen and courses through the ____ gland. Tumors of this gland cause what n. manifestation?

A

Stylomastoid; Parotid; [Ipsilateral Facial Droop]

311
Q

What are the 2 immune defenses for Candida Albican infection

A

Local = T Cells (Reason HIV pts have local candida infections)

vs.

Systemic = neutrophils

312
Q

Describe a Gumma and its Demographic

A

Cutaneous [Painless indurated granulomatous white-gray rubbery lesions]; [TERTIARY syphillis]

313
Q

Name the cases in which [INH Monotherapy] can and can not be given

A

NEVER for ACTIVE TB

but [INH Monotherapy] can be given to pts with [Positive PPD but NEGATIVE CXR (Latent TB)

314
Q

What is the main source of immunity against Influenza

A

Humoral Ab against Hemagglutinin prevents reinfection

315
Q

Name the 2 common organisms that cause [Osteomyelitis in Sickle cell pts]

A

Salmonella & Staph Aureus

Sickle Cell = [GlutaMATE –> Valine @ 6th position]

316
Q

What constitutes as a low Volume of Distribution and what drug characteristics cause this? (4)

A

low Vd = 3-5 L;

  • Too much protein binding
  • Too Hydrophilic
  • Too Heavy (high molecular wt.)
  • Too much charge
317
Q

Describe the process of antigen presentation (starting with Ubiquitin ligases) (3)

A

Ubiquitin ligase recognize protein substrate and tags it –> [tagged complex is degraded by proteosome & coupled with MHC1 in ER]–>presented to CD8

This process is impaired in Parkinson’s & Alzheimer’s

318
Q

Function of Northern, Southern, Western and Southwestern Blots

A

“No Man Steals Drugs With Pride”

Northern = mRNA detection: “Is gene being expressed?”

Southern = DNA detection

Western blots = Protein detection

Southwestern = [DNA-bound Protein] detection

All separated by size & charge on electrophoresis

319
Q

Nucleosomes are made of ______. How does [H1 Histone] associate with Nucleosomes?

A

Nucleosomes = DNA wrapped around core of 8 histone proteins (2 each of H2A/H2B/H3/H4).

[H1 histone] is outside nucleosome core & compacts nucleosomes by linking DNA between adjacent nucleosomes

320
Q

During continuous infusion, 1st order kinetic drugs reach steady state in how many half lives?

A

[1st order kinetic drugs] reach steady state in 4 half lives

321
Q

Telomerase Function and [Locations (2)]

A

[Reverse Transcriptase Ribonucleoprotein] that adds TTAGGG to [3’ telomere region of chromosomes] –> lengthens Stem cell telomeres; Bone marrow & [Epidermis Stratum Basale]

322
Q

Which molecules recognize stop codons and terminate protein synthesis

A

Releasing Factors

(these release the polypeptide chain from ribosome & disolve ribosome-mRNA complex)

323
Q

What do Homeobox genes encode for

A

Transcription factors important in segmental organization of embryo along cranio-caudal axis

324
Q

[Ragged Red Fibers on muscle biopsy] indicates what type of DO

A

Mitochondrial DO! (passed by Moms)

325
Q

How are thyroid DO associated with depression

A

hypOthyroidism —> Depression

326
Q

What type of receptors contain Zinc-finger domains

A

INTRAcellular receptors (steroid/thyroid/fat-solbule vitamins)

327
Q

When is [Anti-Rh (D) IgG] given to Rh- Moms

A

1st: 28 weeks gestation

2nd time: Immediately postpartum

328
Q

Describe [JAK-STAT] and list which ligands use it (6)

A

[Cytoplasmic (Not Receptor) Tyrosine Kinase]. STAT enters nucleus –> tx

PIGGLET

Prolactin

Immunomodulators (cytokines/IL)

GCSF

GH

Erythropoietin

Thrombopoietin

329
Q

What 2nd messenger is used by [GPCR/cAMP pathway] and name the main hormones that use this (12)

A

PKA;

FLAT ChAMP Calls Girls Gluttunous

  1. FSH
  2. LH
  3. ACTH
  4. TSH
  5. CRH
  6. hCG
  7. ADH
  8. MSH
  9. PTH
  10. Calcitonin
  11. GHRH
  12. Glucagon
330
Q

Pts with a hx of _____ are at risk for inaccurate pregnancy dating. Maternal serum quadruple screen is for identifying ____

A

Irregular menses; Congential Defects

331
Q

Glucose is typically transported into cells via _____ from high to low concentrations. GLUT transporters prefer what isomer of glucose?

A

[Facilitated carrier mediated Diffusion]; D-Glucose

332
Q

Lab findings for Absent Seizures (2)

A
  1. [3 Hz Spike EEG]
  2. Slow wave EEG
333
Q

Gold standard for TIA px and what’s the MOA

A

ASA; COX inhibitor –> DEC [Thromboxane A2] –> DEC Platelet aggregation and vasoconstriction

334
Q

Why is there actually an overall DECREASE in Mean Arterial pressure during exercise

A

Skeletal m. arterial Dilation from local [Adenosine/K+/Co2/lactate] —> [DECREASE overall systemic vascular resistance]

335
Q

Characteristics for Carcinoid Syndrome (9)

A
336
Q

How do ACEk2 inhibitors affect Bradykinin?

A

[ACEk2 inhbiitors] –> INCREASE Bradykinin

Kininase2 degrades Bradykinin

337
Q

Difference between SchizoAffective and Schizophrenia

A

ShizoAffective = [Psychosis occurs WITHOUT mood DO] but [Mood DO can only occur with Psychosis]

Schizophrenia has NO significant mood sx

338
Q

Pathognomonic presentation for [Large PDA –> Eisenmenger] (3)

A

[Clubbing hemipresent] + [Cyanosis hemipresent] + [NO BP or pulse discrepancy]

hemipresent = present in LE but not UE = differential

339
Q

Hydralazine MOA and [SE (5)]

A

INC cGMP –> selective arteriole vasoDilation

Reflex Tachycardia + HALF

HA

Angina

Lupus syndrome

Fluid/Na+ retention

340
Q

Cyanide poisoning MOD

A

Cyanide inhibits Fe3+ in the [mitochondrial cytochome c oxidase] –> DEC O2 cell consumption –> No change in Arterial O2 parameters but INC venous O2 content –> DEC AV O2 gradient

341
Q

Which artery perfuses the inferior heart

A

PDA

342
Q

Tx for Carcinoid Syndrome Sx

A

Octreotide

343
Q

How does Opioid analgesics affect the Biliary system

A

Opioids can contract [Sphincter of Oddi smooth m.] –> INC pressure in common bile duct & gallbladder!

344
Q

Explain how cells adere to Extracell Matrix starting with [ECM Collagen]

A
345
Q

5a-reductase deficiency is ___(mode of inheritance)___ and presents with what? (3)

A

auto recessive;

  1. Feminized External genitalia (will masculinize @ puberty)
  2. small phallus
  3. hypOspadia
346
Q

Adenosine [Indications (2)] and [major SE (3)]

A

Antiarrhythmic used for [PSVT and Chemical stress test] due to rapid 10 second half life

SE:

[Bronchospasm chest burn]

Flushing

High Grade BLOCK

347
Q

Describe the Urease test used for H.Pylori Dx

A

[Pt Gastric mucosa] is added to [solution with pH indicator & urea].

If H.Pylori present, [bacterial urease] converts [Urea –> CO2 + NH3] –> INC pH –> COLOR CHANGe

348
Q

[VPL thalamus] receives input from ____(2).

[VPM thalamus] receives input from _____

Damage to these result in ____(ipsilateral/contralateral) sensory loss

A

[Dorsal column & Spinothalamic] –> VPL

TrigeMinal —> VPM

Damage –> CONTRALATERAL sensory loss ( pure sensory stroke - Lacunar syndrome)

349
Q

[MAC Mycobacterium Avium Complex] occurs in HIV+ pts with CD4 less than ___ and requires ____ px. List key characteristics (4)

A

50; Azithromycin

  1. Hepatosplenomegaly
  2. INC [ALP and lactate dehydrogenase]
  3. Can grow at HIGH temperatures (i.e. 41 C )
  4. [Fever/Wt loss / Diarrhea]

MAC is Acid Fast

350
Q

Define Venous Capacitance

A

the AMOUNT of blood that can be held in the Veins

351
Q

Ca+ sensing receptors are what type of receptors?

A

GPCR

352
Q

Dynein is a microtubular motor protein used in ___ transport. Explain this directionality?

A

RETROgrade transport;

TOWARDS THE NUCLEUS! = Retrograde

353
Q

Which Five Catalase + organisms are pts with [Chronic Granulomatous Dz] at risk for? (9)

A

“These cats [Need Big PLACESS] to kill”

  1. Nocardia
  2. Burkholderia
  3. Pseudomonas
  4. Listeria
  5. Aspergillus
  6. Candida
  7. E.Coli
  8. Serratia
  9. Staph
354
Q

What causes bruises to turn green several days after injury

A

Heme oxygenase converts heme –> BiliVerdin (green color) — (BiliVerdin Reductase) —> UnConjugated Bilirubin –> Out into Blood

355
Q

Terbutaline MOA and indication

A

B2 agonist that relaxes uterus and DEC contraction freq. during labor

356
Q

What are the common areas of infection for HPV (3)

A

Cervix , Anus, [True Vocal Cords]

HPV likes Stratified Squamous epithelium

357
Q

Why is Desmopressin used to treat [Von Willebrand Dz]

A

Desmopression stimulates endothelial release of vWF

358
Q

Why do pts with Chronic hemolytic anemia (such as Sickle cell pts) develop folic acid deficiency?

A

Rapid INC RBC turnover –> depletes folic acid –> Macrocytic changes

359
Q

Anesthetic [Blood Gas partition coefficient] is AKA ____

A

Anesthetic Solubility

Image: Drug A has HIGHER Solubility (reason it takes longer)

360
Q

Name the factors that INC(2) and DEC(2) TPR on the [Cardiac & Vasulcar function Curve]

A

[Sympathetics / Vasopressors = INC TPR

vs.

Exercise /AV Shunt = DEC TPR

REMEMBER THAT MEAN SYSTEMIC PRESSURE DOESN’T CHANGE

361
Q

Anaphylaxis would change what parameter of the [caridac output curve]

A

DEC Venous Return curve only

362
Q

Name the factors that INC and DEC(3) Venous Return on the [Cardiac & Venous Return Curve]

A

[Fluid infusion = INC TPR]

vs.

[Spine anesthesia / Acute hemorrhage / Anaphylaxis] = DEC TPR

REMEMBER THAT MEAN SYSTEMIC PRESSURE DOESN’T CHANGE

363
Q

[Drug-induced parkinsonism] is an EPS component caused by ____ blockers. ; What’s the antidote for it?-4

A

D2 blockers;

  1. Benztropine
  2. Trihexyphenidyl
  3. Propranolol
  4. Lorazepam
364
Q

Why would damage to the POST Pit only produce TRANSIENT DI

A

ADH & Oxytocin are MADE in the hypothalamic nuclei and just secreted from POST Pit. Axonal regeneration would rebuild POST Pit

Only hypothalamic (paraventricular & supraoptic) n. damage –> permanent DI

365
Q

Tx for [Maple Syrup Urine Dz] (2)

A
  1. Lifelong restriction of “I Love Vermont” = Isoleucine/Leucine/Valine
  2. Thiamine B1 (a-ketoacid dehydrogenase needs Thiamine B1)
366
Q

How do macrophages play a role in atherosclerotic plaque stability?

A

inflammatory intraplaque macrophages secrete Metalloproteinases –> Degrade [ECM collagen] –> Plaque rupture

367
Q

Which growth factors promote CA angiogenesis (4)

A
  1. VEGF
  2. [Fibroblast GF]
  3. [IL1 and IL-gamma –> INC VEGF]
368
Q

Function of [2,3 BPG]

A

DECREASES Hgb O2 affinity (for unloading) by stabilizing the [Taut DeOxyHgB]

369
Q

What is the major Cause of Death in Acute Rheumatic Fever

A

PANcarditis

Mitral Stenosis develops later down the line

370
Q

What component of N.meningiditis actually causes the toxic effects

A

LOE

[LipoOligoSaccharide OuterMembrane Endotoxin]

371
Q

Cirrhosis MOD for Asterixis neuro changes

A

Liver can’t metabolize nitrogenous waste and cant convert to Urea –>

  1. NH3 crosses Blood Brain Barrier –> [Astrocyte Glutamine & GABA Accumulation] –> Disrupts neurotransmission
  2. DEC BUN (since there’s no Urea conversion)
372
Q

How does the sympathetic NS respond to HF

A

INC Afterload from vasoconstriction –> cardiac remodeling :-(

Renin pathway will also be activated

373
Q

How does BNP respond to HF (2)

A

it helps!

BNP vasoDilates, stimulates diuresis –> DEC BP

374
Q

Describe Streak Ovaries and what demographic they’re seen

A

Ovaries made of connective tissue with no follicles; Turner Syndrome

375
Q

What is the difference between [Superior Vena Cava] and [Brachiocephalic vein] syndrome

A

Both have [Facial Edema] & [SubQ Vein engorgement]

BUT [SUPERIOR VENA CAVA] SYNDROME WILL BE BILATERAL

376
Q

Homocystinuria MOD, Clinical presentation (3) and tx

A

[Cystathionine synthase] deficiency –> Thromboembolism

  1. Marfanoid habitus (elongated limbs, arachnodactyly, scoliosis)
  2. Ectopia Lentis
  3. Retarded

tx = [Pyridoxine B6]

377
Q

What type of pulmonary manifestations are seen in pts with [Diffuse or CREST Scleroderma]

A

[Pulmonary arteriole intimal thickening] –>Pulm HTN –> Cor Pulmonale

small arterioles & capillaries are affected first in this DO

378
Q

Explain why [R Testicular Varicoceles] typically indicate ____ or ____ dx

A

[Renal Vein Thrombosis with spread to IVC] vs. Renal CA; [R Testicular vein] dumps directly into IVC. If IVC is occluded –> R Varicocele

  • L Testicular Vein dumps into L renal vein*
  • Renal Vein Thrombosis is a known complication of nephrOtic syndrome!*
379
Q

SE for ACEk2 inhibitors (4)

A
  1. DEC GFR
  2. Hyperkalemia
  3. Cough
  4. Angioedema (rare)
380
Q

How is [PRPP amidotransferase] related to Lesch Nyhan syndrome

A

Absence of HGPRT to ReConvert [hypOxanthine–> inosine monophosphate] and [Guanine –> Guanosine monophosphate] means INC degradation of these 2..-> INC de novo purine synthesis involving [PRPP synthetase & amidotransferase]

381
Q

What does this lymph node biopsy indicate?

A

Follicular Lyphoma (t18 <—->14 BCL2)

[Anti-Apoptosis BCL2] overexpression

382
Q

Where does isotype switching occur

A

[2°Follicle Germinal Center]

isotype switching = IgM –> IgG

383
Q

Where does [VDJ/VJ Recombination] occur (2)

A

Bone marrow during B-cell maturation and then affinity maturation occurs in [2° follicle germinal centers]

384
Q

Where does Negative selection/Tolerance occur?

A

Fetal Thymus: Medulla

Positive occurs in [Fetal Thymus: Cortex]

385
Q

How does Acidemia affect the kidneys?

A

Tubular cells convert Glutamine –> GlutamATE –> [NH3(excreted) + HCO3(ReAbsorbed)]. This helps acidemia

386
Q

Describe Delirum (4) and its tx

A

Acute confusion w/ agitation & possible psychosis

Tx = Haloperidol

387
Q

Describe how Glucose stimulates Insulin release in Beta cells

A
388
Q

Ammonia is made in the ___ from ____ and ____. How does GI Bleeds affect this?

A

Ammonia is made in the GI tract from [Glutamine Catabolism] and [Bacterial Protein Catabolism]. GI Bleeds allow more HgB to reach GI Tract –> INC Ammonia Absorption into blood –> Asterixis

389
Q

How are Monosacchardies processed in the GI tract and role does the [D-xylose test] play in this?

A

Monosacchardies are absorbed directly w/ no need for amylases.

D-xylose = Differentiates between pancreatic insufficiency & physical malabsorption problem

390
Q

Identify the Dz and describe the histo

A

Candida

Budding yeast w/[pseudohyphae germ tubes] (Germ Tube test @ 37 °C)

MOST COMMON OPPORTUNISTIC FUNGI

391
Q

Amniocentesis showing [INC AChE & AFP] indicates ____

A

Neural Tube Defects

(Failure of Neural tube to fuse during 4th week gestation)

392
Q

Identify and Note which part is involved in MVC

A

Rapid Deceleration while restrained/seatbelted (occurs in MVC) causes Aortic Isthmus to tear —> Aortic Rupture

393
Q

[Cromolyn and Nedocromil] MOA

A

[Mast Cell Stabilizing agents] –> Inhibit Mast cell degranulation indepedent of stimuli.

BLOCKS D in image

394
Q

Chronic Granulomatous Dz MOD and Dx (2)

A

[NADHPH oxidase (normally reduces O2 –> Superoxide ROS)] is deficient –> [Cat +infection]

Dx:

  1. [Nitroblue Tetrazolium] = absent dark blue precipitate

or

  1. [DHR flow cytometry] = absent green fluorescence
395
Q

What are the main factors that INCREASE HgB Affinity for O2 (4)

A

“LAF & [DEC H2]O”

  1. DEC H+ and High Altitude
  2. DEC 2,3 BPG (2,3BPG increases at high altitude–>DEC affinity)
  3. cOld temp (DEC temp)

Leftward shift/Affinity INC/Fetal HgB

396
Q

What would [Chronic high-altitude adaptation] do to HgB O2 affinity

A

“LAF & [DEC H2]O​”

[Chronic high altitude adaptation] –> INC 2,3BPG –> DECREASES O2 HgB Affinity

Severe Anemia ALSO DEC O2 HgB Affinity

397
Q

[Pericardial fluid accumulation with late diastolic collapse of the R atrium] describes ____ and occurs why?

A

Cardiac Tamponade; when ventricles relax they displace pericardial fluid –> collapses R atrium during diastole

398
Q

Clinical findings for [Middle Cerebral Artery] occlusion

A

CTL [Face (no forehead)] & UE paralysis

+ [aphasia(if dominant hemisphere)] or [spatial Neglect (if Non-dominant hemisphere)]

399
Q

Clinical findings for [Anterior Cerebral Artery] occlusion (unilateral vs. bilateral)

A

CTL LE paralysis

or

[Behavioral/Primitive Reflex/Urinary incontinence - if bilateral]

400
Q

Severe Chronic Hemolytic Anemia (i.e. B-thalassemia) —> ______ hematopoiesis in the __ and ___. Seeing ____ precursors in these organs is a good sign.

Why does this happen?

A

Extramedullary Hematopoiesis in Liver & Spleen. [Clumps of Erythryoid Precursors in Liver & Spleen] is a good sign

EPO stimulates marrow cells to invade extramedullary organs if bone marrow isn’t sufficient –> Hepatosplenomegaly

401
Q

2 most common bacterial isolates in intraabdominal infection

A

(B.Fragilis) & (E.Coli)

402
Q

We all know Statins cause Muscle toxicity. What is another big SE?

A

LIVER toxicity

403
Q

[Diffuse Esophageal Spasm] MOD

A

Loss of [MAP (Myenteric Auerbach Plexus) Inhbition] –> Periodic, simultaneous and Non-peristaltic LARGE contractions

404
Q

Hepatitis E

A: Enveloped? Double vs. Single strand?

B: Transmission

C: Virulence

A

A: Naked single-RNA

B: Fecal Oral

C: Fulminant Hepatits in Pregnant Women

405
Q
A
406
Q

Etiology for Gallstones made of Calcium (2)

Which enzyme plays the biggest role & how?

A

[Liver fluke Clonorchis Sinensis] vs. bacteria infect biliary tract –> [CUPS (Ca+: UnConjugated bilirubin Pigment Stones]

[Beta Glucuronidase from injured hepatocytes] & Bacteria both hydrolyze bilirubin glucuronide –> INC UnConjugated bilirubin –> [CUPS (Ca+: Unconjugated bilirubin Pigment Stones]

407
Q

What is Secondary Lactase deficiency

A

[Celiac inflammation] vs. [Infection] damage [small intestinal microvilli brush border] that carries lactase –> Lactose intolerance

1° Lactase deficiency occurs with age

408
Q

Genetic Cause of Neurofibromatosis Type 1

A

[chromo 17 mutation]–> [NeurofibroMin loss]. NeurofibroMin tumor suppresses (RAS GTPase activating protein

409
Q

Characteristics of Neurofibromatosis Type 1 (6)

A

CLAP ON type 1!”

  1. Neurofibroma PLEXIFORM
  2. Acoustic Schwannoma-Unilateral (HA/Tinnitus/Vertigo)
  3. [Optic n. Glioma]
  4. Lisch nodules
  5. [Cafe Au Lait Spots]
  6. Pheochromocytoma
410
Q

Neurofibromatosis Type 2 Genetic Cause

A

[chromo 22 tumor suppresor gene mutation–> (Merlin cytoskeletal protein)]

411
Q

In [Neurofibromatosis Type 1], Fleshy cutaneous neurofibromas are made of ______ which embryologically come from _____. These pts may also have hyperpigmented spots known as ____

A

In NF1, Fleshy cutaneous neurofibromas are made of Schwann cells, which are embryologically from Neural Crest. May also have [Cafe Au Lait Spots (image)]

Image: Cutaneous Neurofibromas & Cafe Au Lait Spots

412
Q

Dz

A

Constrictive Pericarditis (Pericardial Calcification)

413
Q

A: Explain how Wallerian Degeneration works in the PNS.

B: Why doesn’t this work in the CNS?

C: What role do Astrocytes play

A

A: After axon damage, Schwann degrade myelin distal to injury and recruit macrophages to clear myelin debris –> allows axon regeneration

B: IN CNS: macrophages are recuirted slowly due to BBB AND Oligodendrocytes undergo apoptosis –> inhibits axon growth & allows persistent myelin debris to accumulate

C: Astrocytes proliferate weeks-months post injury and form glial scar –> also blocks axon regeneration

414
Q

Why are ESRD Renal Failure pts at risk for bleeding? What type of coagulopathy will they have? Labs?

A

UREMIA in ESRD –> Qualitative Platelet dysfunction –> PRIMARY Hemostasis DO –> [ONLY INC BLEEDING TIME] (all other labs are normal)

415
Q

Arsenic Poisoning Presentation(3), MOD and Tx

A
  1. Garlic breath!
  2. Prolonged QT
  3. Watery Diarrhea

Arsenic inhibits pyruvate dehydrogenase –> DEC Cellular respiration

Tx = Dimercaprol

416
Q

BLack Gallstone etiology (2)

A
  1. HemoLysis Chronically–> INC UnConjugated bilirubin –> Ca+ bilirubinate precipitation–> BLACK [CUPS: Ca+ UnConjugated bilirubin Pigment Stones]

vs.

  1. Can also come from iLeal Dz that –> INC recycling of Bilirubin
417
Q

Clinical signs for HyperCalcemia (3)

A

” Probably Mucho Ca+! “

  1. Muscle Weakness
  2. Constipation
  3. PolyUria –> Polydipsia
418
Q

Which n. is associated with Piriform Recess damage and what is it responsible for?

A

Internal Laryngeal n.(CN10) = Cough Reflex

419
Q

Describe the life cycle of Hepatitis B starting with entry

A
420
Q

OLDER Pt with severe braydcardia is treated with Atropine but develops Severe Eye Pain. What happened?

A

Exacerbation of Closed angle Glaucoma!

ATROPINE IS CX IN GLAUCOMA PTS

421
Q

Dz

A

[RSO-Reed Sternberg OwlEye] cells in Hodgkin Lymphoma

422
Q

Describe [Bronchioalveolar ADC in situ]

A

Lung ADC subtype = [dysplastic columnar cells] which line alveolar septa and secrete mucus without invasion

423
Q

Identify & Describe composition(2)

A

Benign Hamartoma (coin lesion on CXR!); [Disorganized Hyaline Cartilage + Fat]

424
Q

A: Clinical Manifestations of DiGeorge Syndrome (5)

B: Genetic Cause

C: Embryologic cause

A

“CATCh 22 & Pa3”

Cardiac (Tetralogy of Fallot + Aortic Arch abnormalitites)

Abnormal face (Bifid Uvula/low set ears)

Thymus Aplasia (Thymic shadow in image) –> Virus/Fungal infection

Cleft Palate

[hypOcalcemia from PTH deficiency] may–> Carpopedal Spasms

22q.11.2 deletion

Pharyngeal arch - 3rd/4th both fail to develop

425
Q

Describe the DDx for [Polycythemia Erythrocytosis]

A
426
Q

IF-___ is important for mycobacterial infections. Explain how it helps to kill them

A

IF-GAMMA

427
Q

Describe how Iron is Absorbed and stored

A
428
Q

Which drug is used in Acute MI management but can also precipitate SOB in pts with COPD/asthma

A

[General B-blockers]

429
Q

RA management centers around ____, which take ____ to onset. Name them (5)

A

DMARDS take weeks to onset

  1. MTX
  2. Hydroxychloroquine
  3. Sulfasalazine
  4. Minocycline
  5. TNFa inhibitors
430
Q

In which cell does low O2 stimulate Glucose –> pyruvate but maybe no ATP, and why?

A

RBC; 2-3BPG INC when O2 is low but the ATP generating step is bypassed in order to make 2,3BPG

431
Q

Isolated Systolic HTN (Sys>140 & Diastolic<90)

A

Age-Related Stiffness of aorta & arteries

432
Q

Anatomically, During Thorancentesis how would you access:

A: [Lungs & Visceral Pleura] (3)

B: Which visceral structures are you attempting to Avoid by using these positions?? (2)

A

image

B:

  1. Abdominal Structures
  2. [Subcostal Neurovascular bundle]
    * Paravertebral = [POST Scapular]*
433
Q

Describe [Acidophilic Councilman bodies] and when you’d see them

A

Hepatocytes that have shrunk, undergone nc.fragmentation and become eosinophilic. ; Indicates Apoptosis

434
Q

Kidney Embryo: What does the [Metanephric mesoderm blastema] give rise to? [Ureteric Bud]?

A

[Metanephric Mesoderm blastema] –> Internal Kidney structures

vs.

[Ureteric bud] –> Collecting system (CD, Calyces, Pelvis, Ureters)

435
Q

Which joints are involved in RA (5)

A
  1. MCP & PIP
  2. Wrist
  3. Elbows
  4. Knees
  5. Cervical spine subluxation vs. cord compression
436
Q

Sciatica MOD and Clinical Manifestation (3)

A

“Having Sciatica is like breaking LAWS”

  • [Lower Back pain w/radiation down POST thigh –> lateral foot]
  • Ankle jerk reflex ABSENT - (S1-S2 involvement)
  • Weak Hip Extension-(S1-S2 involvement)
  • [S1 n. posterolateral compression between L4-S3]
437
Q

Which artery perfuses the Broca and Wernicke area?

A

MCA

438
Q

A completely opacified hemithorax with tracheal deviation toward the opacification suggest _____. Explain

A

Mainstem Bronchus obstruction; Obstruction allows air distal to it to remain there and once pulm blood absorbs all of it, everything squishes together (opacification) and trachea moves toward the vacuum

439
Q

Steps for converting Tyrosine –> Epinephrine (4)

A
440
Q

Liver Dz Portacaval Venous Anastomses used during:

Esophageal Varices

A

[L Gastric] with [Esophageal]

441
Q

Liver Dz Portacaval Venous Anastomses used during:

Rectal Hemorrhoids

A

[SUP Rectal] with [Mid & inf. rectal]

442
Q

Liver Dz Portacaval Venous Anastomses used during:

Caput Medusae

A

Paraumbilical with [Superficial & inf. epigastric]

443
Q

[T or F] DIC (elevated D-Dimer and low Fibrinogen) is associated with HUS-HAT

A

FALSE

only Unconjugated bilirubin & LDH will be INC

444
Q

Lung Biopsy

A

[Sulfur Granules - Actinomyces Israelii]

445
Q

Cystic Fibrosis MOD

A
446
Q

Describe [Ladd’s Fibrous Bands]. What’s their MOD

A

Bands connecting RLQ to Retroperitoneum –> bilious emesis from duodenal compression;

Incomplete counterclockwise rotation –>midgut malrotation around SMA –> Volvulus and/or [Ladd’s Fibrous Bands]

447
Q
A
448
Q

What is the most common cause of DIC in Pregnant Women

A

Injured Placenta can release [Tissue factor Thromboplastin] in mom –> DEC platelet count from hyperactivation –> DIC

449
Q

Which Fungus

A

Candida (oval yeast w/narrow base budding)

450
Q

Which Fungus

A

Histoplasma Capsulatum

451
Q

A pt taking Clindamycin (abx) who suddenly develops Intractable Watery Diarrhea + Leukocytosis probably has what? MOD?

A

C.Diff; Toxin A (and B) both disrupt actin cytoskeletal structure & intracell signal in GI tract

Contact Precautions = Germs N’ Hospitals! = [Gown/NonSterileGloves/HandWashing]

452
Q

Which DO is associated with [KIT Receptor Tyrosine Kinase] mutation? Describe its presentation

A

Mastocytosis; Mast cell proliferation –> Excess Histamine release –> [INC gastric acid] & [pruritus post hot shower]

453
Q

What are the 2 watershed areas of the colon

A

[Splenic Flexure] and [Rectosigmoid Junction]

454
Q

Which mucous membranes are affected by OWR - Osler Weber Rendu syndrome

What’s the worst complication?

A

Telangiectasias on…

  1. Mucocutaneous (Lips, Skin)
  2. GI
  3. Respiratory
  4. Urinary

May rupture –> Bleeds

455
Q

Clinical Presentation for [Type 1 Hypersensitivity IgE Mast cell response] (3)

A

PUB

Pruritus

Urticaria

Bronchospasm

456
Q

Desrcribe the intracellular change AND clinical effect for each receptor

a1, a2, B1, B2

A
457
Q

[Ehlers Danlos] MOD

A

Heritable Abnormal Collagen formation from [Procollagen Peptidase deficiency (impaired cleavage of N-terminal propeptides)] –>abnormal collagen

458
Q

[MarFan Syndrome MOD].

Where is this protein found normally (3)

A

[Fibrillin1 defect (an extracellular scaffold for elastin)]

  1. Lens
  2. Periosteum
  3. Aortic Media –> Aortic Root Dilation –> Dissection
459
Q

DDx breakdown for Gram negative bacteria

A
460
Q

SE for HCTZ and Chlorthalidone (6)

A
  • HyperGLUC (Glucose/Lipids/Uric/Ca+)
  • [hypOkalemic metabolic alkalosis] (Aldosterone mediated)
  • hypOnatremia
461
Q

Describe the following

A

[Multinucleated Giant Cell] with epithelioid macrophages

This makes up a Granuloma

462
Q

Sciatica MOD and Clinical Manifestation (3)

A

“Having Sciatica is like breaking LAWS”

  • [Lower Back pain w/radiation down POST thigh –> lateral foot]
  • Ankle jerk reflex ABSENT - (S1-S2 involvement)
  • Weak Hip Extension-(S1-S2 involvement)
  • [S1 n. posterolateral compression between L4-S3]
463
Q

What are Contact Precautions (3)?

When should you use them(4)?

A

Germs N Hospitals!

Gown / NonSterileGloves / HandWashing

  1. MRSA
  2. C.Diff
  3. VRE
  4. Scabies
464
Q

[Alcohol Hepatic Steatosis] MOD

A

[EtOH dehydrogenase] & [Acetealdehyde dehydrogenase] produces EXCESS NADH –> [DEC Free Fatty Acid oxidation] –> Fatty acummulation

465
Q

Fill in the Blanks; Which is associated with [E.Coli Sepsis]

A

GALT deficiency –> E.Coli Sepsis

466
Q

Hepatic biopsy showing [Spotty Necrosis + Ballooning Degeneration] indicates _____

A

Acute Viral Hepatitis

467
Q

What type of Hypersensitivity is [Seronegative Spondyloarthropathy PAIR HLA-B27]

A

Type 3 (Immune Complex deposition)

468
Q

What causes AAA (3)

A
  1. Transmural Aortic wall Inflammation
  2. Abnormal collage remodeling
  3. DEC Smooth m. & Elastin

All together –> Wall weakening

469
Q

Renal failure Azotemia with [Large Eosinophilic Cast] in an elderly with fatigue likely indicates _____

A

[Bence Jones Proteinuria] in Multiple Myeloma

470
Q

Why do VSD sometimes present after a neonate has already been discharged?

A

Neonatal VSD (most common congenital heart defect) presents AFTER [pulm vascular resistance] has DEC

471
Q
A
472
Q

Why do pts with Sepsis have [INC Anion Gap] (2)

A

Tissue hypOperfusion DEC Oxidative phosphorylation –> Forces Pyruvate to shunt into Lactate instead

+

Hepatic hypOperfusion –> Lactic Acid accumulation since Liver normally clears lactate

473
Q

What are the most common aspiration sites when Supine (2)

A

Dense air space opacities

474
Q

What are the most common aspiration sites when Upright

A

Dense air space opacities

475
Q

Pts with hypersensitivity to [intradermal tobacco injections] probably have ____. Describe Histo

A

[Buerger’s Thromboangiitis Obliterans]; Thrombosing Segmental Vasculitis extending into contiguous veins & nerves

476
Q

Neonate with Olive sized mass on deep palpation to RUQ indicates ____

A

Pyloric Stenosis from muscularis mucosae hypertrophy

477
Q

CA Activating mutation of ____ can –> constant EGFR pathway stimulation —> Resistance to Anti-EGFR drugs

A

KRAS

478
Q

[Creutzfeldt Jakob Dz] MOD

A

PrP (prion protein), normally in neurons as [a-helical structure] converts–> [INFECTIOUS Beta pleated sheets] –> Protease resistance –>

Vacuoles in [Gray Matter Neurons & Neutrophils] develop –> Cyst = [Spongiform Gray Matter]

479
Q

What is Transthyretin

A

(Heriditary vs. Senile) [Primary AL Amyloidosis] deposition

480
Q

[Familial hypOcalciuric Hypercalcemia]

A

Defective Parathyroid CaSR (Ca+ Sensing Receptors) –> INC PTH

481
Q

[Thiamine B1] deficiency causes ____ and BeriBeri.

Describe BeriBeri (2)

What biochem rxn is [Thiamine B1] needed for?

A

[Wernicke Korsakoff Syndrome] and [BeriBeri]

BeriBeri (Wet vs. Dry vs. BOTH) is associated with…

  1. Heart involvement = WET
  2. Symmetrical Peripheral Neuropathy = DRY

[Thiamine B1] = Decarboxylation of a-ketoacids (carb metabolism)

482
Q

What biochem rxn is [RiboFlavin B2] needed for(2)? What sx are present with deficiency(3)?

A

No RiboFlavin–>Problems with Flavor

FMN & FAD; [Glossitis/ Angular Stomatitis / Normocytic Anemia]

483
Q

What biochem rxn is [Niacin B3] used in

A

Hydrogen acceptor (NAD / NADH)

484
Q

Which DNA Polymerase has exonuclease activity and what is the exonuclease function (2)

A

[DNA Pol 3] = [3 —> 5 exonuclease activity] + [5–>3 Polymerase]

&

[DNA Pol 1]= [3 <<—>> 5 exonuclease acvitiy] + [5 —>3 Polymerase]

Exonuclease removes RNA primer and repairs DNA sequences

485
Q

A: List the n. roots associated with Femoral n.

B: Associated Injury (2)

C: Motor Deficit (3)

A

Femoral nerve

A: L2-4

B: [Pelvic path involving iLiopsoas m.] vs. [Retroperitoneal path]

C:

1) [No Thigh Flexion]
2) [No Leg extension]
3) [Patellar Reflex loss]

486
Q

In Pudendal n. blocks during labor, anesthesia is injected ____ medial to the _____ through the _____ —> ____ anesthesia

A

Anesthesia is injected intravaginally medial to Ischial Spine through the Sarcospinous Ligament = perineum anesthesia

487
Q

Classic Presentation for [Renal Cell Carcinoma] (4)

A

RCC looks like HAWF!

[Hematuria PAINLESS (most common)] / [Abd Yellow Mass] / [Wt loss] / [Flank Pain]

L RCC in image

488
Q

Fibrates MOA (2)

What other drug has similar MOA

A

Activates PPARa –> [INC LPL(TAG clearance)] AND [DEC Hepatic VLDL synthesis]

[Omega 3 Fish Oil] ALSO [DEC Hepatic VLDL synthesis] + [DEC apo B]

489
Q

Glucagonoma Manifestation (4)

A

[Dermatitis (necrolytic migratory erythema)]

Depression

DVT

DM

comes from pancreatic alpha cells

490
Q

Which CA cause [OsteoBlastic Sclerotic] Bone Metastasis (3)?Aggressive or indolent?

A

indolent

491
Q

Which CA cause [Mixed] Bone Metastasis (2)?

A
492
Q

Which CA cause [OsteoLytic Lucent] Bone Metastasis (5)?Aggressive or indolent?

A

AGGRESSIVE

493
Q

Multiple Myeloma Presentation (10)

A

Crazy Ass BUMP

CR2AB - [HyperCalcemia/(Renal damage from Bence Jones prOteinuria) & (Rouleaux RBC stacking)/Anemia/(Bone Dark lytic lesions from IL6)]

AL amyloidosis

Back pain

Urine IgG

[Mott cell histo-full of Russel bodies - image]

[Protein M serum spike from monoclonal IgG]

494
Q

Glioblastoma Histological Findings (5)

A

CREEPY

  • Cystic Change
  • Reddish brown hemorrhage
  • Endothelial Cell Hyperplasia on Histo
  • Pseudopalisading Necrosis on Histo - image
  • Yellow necrosis
495
Q
A
496
Q

In [Wolff Parkinson White] an accessory AV conduction path can –> ______. What is the sx triad

A

PSVT

497
Q

Recall the [PAm: PI3K AKT mTOR] pathway starting with Growth factor receptor binding

A
498
Q

Describe [Hairy Cell Leukemia] (6)

A

“Hairy Men Make Dicks Penis Totally Freakin hard!”

  1. Mid Aged Men
  2. Massive Splenomegaly
  3. [Dry Tap from fibrosis 2° to (B-lymphocyte) infiltration & cytokines]
  4. [Pentostatin / 2CDA / Cladribine tx]
  5. TRAP dx - replaced with… Flow cytometry
  6. hypOcellular bone marrow (pancytopenia)
499
Q

What is Chlordiazepoxide

A

ChlorDIAZEpoxide (like DIAZEpam)

Benzo (GABA - A allosteric modulator)

500
Q

POMC is a polypeptide precursor cleaved into what 3 substances?

A
  1. ACTH
  2. MSH
  3. B-Endorphin
501
Q

Explain difference between tumor Stage vs. Grade? Which is more important for Pgn?

A

Stage = Spread/expansion of Tumor = MOST IMPORTANT PGN FACTOR!

vs.

Grade = differentiation (anaplastic vs. well-differentiated)

502
Q

Why are Nitrates contraindicated in HOCM pts (2)

A

HOCM pts have LV outflow obstruction so if you DEC venous return or DEC total peripheral resistance you will worsen amount of blood getting through

503
Q
A
504
Q

[Thin curvilinear areas of lucency that parallel bowel lumen] indicates ______, often seen in _______. Causes(2)?

A

Pneumatosis Intestinalis(air in bowel wall); Necrotizing Enterocolitis

Caused by Prematurity vs. [Enteral feeding initiation]

505
Q

Starting with [Day 0 Fertilization], describe the process of Implantation (9 steps)

A
506
Q
A
507
Q

In which parts of the TCA cycle do you get ___(x)___ and how many ATP do they give

A: NADH

B: GTP

C: FADH2

A

Can I Keep Selling Sex For Money, Officer?

A: NADH = 2.5 ATP each = (I-Keep) (Keep-Selling) (Money-Officer)

B: GTP = 1 ATP = (Selling - Sex) - used in Gluconeogenesis by PEP Carboxykinase to convert Oxaloacetate–>PEP

C: FADH2 = 1.5 ATP each = (Sex - For)

508
Q

[Maturity onset Diabetes of the Young] MOD

A

Glucokinase mutation in the beta cells

509
Q

Which nerve is classically affected by [L Atrial Enlargement] and how does it manifest

A

[LEFT Recurrent Laryngeal n.]–> [Raspy Vocal Cord Paralysis(same as R)]

510
Q

Which 2 bedside maneuvers INC Intensity of the HOCM mumur?

A

“Val [Stood Up] to Hulk HOCM, the MVP, which INC anxiety”

Valsalva

[Standing Up]

(both DEC Preload AND Afterload)

511
Q

Genetic cause for [Fragile X]

A

[CGG repeat] –>[FMR1 gene Methylation] on [X Chromo long arm] –>small gap near tip of [X Chromo long arm]

512
Q

Huntington’s Dz MOD

A

[AUTO DOM [Chromo 4 CAG repeats]] —> Degeneration of (Caudate nc. inside the ((I)ndirect Striatum) –> [DEC GABA]

“Hunting 4 food is way too aggressive & dancey”

513
Q

Huntington’s Dz Clinical Presentation (2)

A

“Hunting 4​ food is way too aggressive & dancey”

1st: Aggressive Dementia w/ strange behavior
2nd: Dance-like Chorea mvmnts

514
Q

Anatomically, what is the diff. between ulcers from [H.Pylori] and [Zollinger Ellison]?

A

[H.Pylori] = Antrum & Proximal Duodenum

vs.

Zollinger Ellison = DISTAL Duodenum

515
Q

Vomiting is a reflex regulated by which receptors? (5)

A

5 Days of Having Nauseating Moomoo :-(

  1. 5HT3 (ondansentron tx) ****
  2. D2
  3. H1 Histamine
  4. [NK1 Neurokinin 1] ***
  5. M1 muscarinic
516
Q

[Bruton X-linked aGammaglobulinemia] MOD.

What pathogens are these pts most susceptible to (2)?

A

[Bruton tyrosine kinase gene mutation] –> failure of [CD19 & 20 B cells] to mature –> NO B CELLS OR ANTIBODIES

  • Giardia Lamblia
  • [Encapsulated Pyogenic bacteria - sinopulmonary]
517
Q

In a pt with an elevated ALP, how can you determine whether or not it’s bone origin and why?

A

Check GGT; GGT is found in Liver(just like ALP).. BUT NOT BONE, so if GGT also elevated –> indicates Liver pathology

518
Q

How long does it take kidneys to INC HCO3 during respiratory acidosis? How is Heroin related to this?

A

Kidneys need 24 hours to activate [HCO3 compensation] during respiratory pH changes; Heroin –> cardiorespiratory depression –>might present as [Respiratory Acidosis w/normal HCO3] if <24 hours

519
Q

Describe the process of Ca+ movement within the Sarcolemma starting with T-tubule

A
520
Q

GI biopsy shows image. Identify cells and explain its association with appendicitis

A

Neuroendocrine cells(islands of uniform eosinophilic cells w/round nuclei) are in CARCINOID TUMORS

Appendiceal carcinoids may cause Appendcitis

521
Q

CD15 is a marker for ____ and _____

A

Granulocytes & [Hodgkin RSO cells]

522
Q
A
523
Q

Label; Which rxn is associated with [Thiamine B1 deficiency]

A

RBC Transketolase requires [Thiamine B1]

524
Q

Which step in the TCA cycle is [Thiamine B1] dependent and thus most affected by EtOH intoxication

A

Can I Keep Selling Sex For Money, Officer?

[Keep - Selling] (a-Ketogluarate –>SuccinylCoA)

525
Q

Amatoxins are in ____ and inhibit _____. This stops ____ synthesis

A

[Death Cap mushrooms]; RNA Pol2 –> no mRNA synthesis

526
Q

How is [Apolipoprotein E] related to Alzheimers

A

Apo E –> impaired synthesis and clearance of AB-amyloid —> INC risk for LATE onset Alzheimers

527
Q

What are the n. roots for Bicep/Brachioradialis Reflex? What motor functions are involved(2)?

A
528
Q

What are the n. roots for Tricep Reflex? What motor functions are involved(2)?

A
529
Q

What are the n. roots for Finber ABduction?

A
530
Q

Which part of the EKG is affected by [Phase 0 Fast Na+ influx]

A

QRS (will be widened)

531
Q

An anti-arrhtymic that extends [Phase 3 K+ efflux] will change what on EKG

A

T Wave

532
Q

Name the Psoriasis drugs that are Topical Vitamin D analogs and why they help (3)

A

Calcipotriene / Calcitriol / Tacalcitol

These bind to intranuclear Vitamin D R –> Inhibits Keritinocyte proliferation & differentiation

533
Q

A: Common manifestations of Sarcoidosis (10)

B: Which demographic is most commonly affected

A

CD4 TH1 mediated

A: LAR CUBED

[Liver with scattered noncaseating granulomas around portal triad] + [Lymphadenopathy-Bilateral Hilar]

ACE elevation & [Asteroid vs. Schumann bodies]

Restrictive cardiomyopathy (RAMILIES)

Calcemia INC (hyperCalcemia)

Uveitis

Bell’s Palsy (Facial CN7)

Erythema Nodosum (SubQ Fat lesions)

Diffuse Intersitial Fibrosis (INC FEV1/FVC ratio)

B: AA Females

534
Q

This Liver Biopsy indicates _____

Describe the MOD and it contraindications

A

Cavernous Hemangioma; MOST COMMON BENIGN LIVER TUMOR, made of cavernous blood filled vascular spaces

NO BIOPSY SINCE BIOPSY –> FATAL HEMORRHAGE

In Brain –> Intracerebral Hemorrhage + Seizures

535
Q

List main functions of each hypOthalmic nuclei:

A: VentroMedial

B: ANT

C: POST

D: Lateral

A

A: VentroMedial = Satiety-Satisfied (full)

B: ANT = Lets Heat Go

C: [POST = Keeps you Pyogenic/warm]

D: [Lateral = Lots of food eating (INC Hunger)]

536
Q

List main functions of each hypOthalmic nuclei:

A: Arcuate (3)

B: PVN (4)

C: SON (Supraoptic) (2)

D: SCN (Suprachiasmatic)

E: POA

A

A: Arcuate = GHRH & Dopamine(inhibits Prolactin) & GnRH

B: PVN = [AVP accessory], CRH, TRH, [AVP Main]

C: SON = [AVP Main] & Oxytocin

D: SCN = Circadian Rhythm

E: POA = [GnRH Main]

537
Q
A
538
Q
A
539
Q

Describe the Difference between Gastric Ulcer and Erosion

Where are Gastric pits and glands in relation to this?

A

Ulcers make a deep U all the way into Muscularis Propria

vs.

erosions are mucosa only (Pits are invaginations of mucosa that articulate glands in the laminal propria of mucosa)

540
Q

[Carpal Tunnel Syndrome] MOD

A

BILATERAL Median n. Compression from the [Flexor Retinacular Transverse carpal ligament] –> Peripheral mononeuropathy

[Flexor Retinacular Transverse Carpal ligament] can be surgically incised for relief

541
Q

Purpose of the Smooth ER (2)

Where is it mostly found (3)

A

Steroid Synthesis & Drug Detox

Liver / Adrenal Cortex / Gonads

542
Q

Mesothelioma Histology (3)

A

Cells with

[long slender microvilli]

[abundant tonofilaments]

[Pleural thickening]

543
Q

Name the 3 mutations sites associated with EARLY Alzheimer

A
  1. Trisomy 21
  2. [Chromo 14 Presenilin 1]
  3. [Chromo 1 Presenilin 2]
544
Q

Name the MAOIs (4)

A

MAO Takes Pride In Shanghai

Tranylcypromine

Phenelzine

Isocarboxazid

Selegiline (MAOB inhibitor)

545
Q

Why does Iron supplementation –> Enlarged RBC with blue cytoplasm

A

INC bone marrow erythropoiesis initially –> accelerated release of [immature reticulocytes] which have blue cytoplasm from residual ribosomal RNA

546
Q

What should make you suspect spinal metastasis? (4)

A
  1. [Back Pain WORST AT NIGHT - not relieved with rest]
  2. Older pt
  3. Systemic Sx
  4. [Hx of Infection or IV Drug use]

lead kettle (PB KTL) - Prostate/Breast/Kidney/Thyroid/Lung = most common

547
Q

BRCA1 is responsible for _____ and most involved in what 2 CA?

A

DNA repair; Breast & Ovarian

548
Q

A: Name the COX 1 inhibitors (2)

B: What do they inhibit

C: Function of what they inhibit (3)

A

C: SAR [Stomach protection/Aggregating Platelets/Renal Perfusion INC]

549
Q

A: Name the COX 2 inhibitors (3)

B: What do they inhibit

C: Function of what they inhibit (5)

A

C: VIPR [VasoDilation/Inflammation-Pain/Renal Perfusion INC]

550
Q
A
551
Q

Describe the process by which Eosinophils attack parasites

A

[IgE dependent cell mediated cytotoxicity]

552
Q

Intestinal Atresia MOD

A

SMA obstruction during utero –> [BlindEnd Proximal Jejunum], ABSENT BOWEL, and [terminal iLeum spiraled around iLeocolic vessel]

553
Q

Most serious SE of Loop Diuretics (i.e.furosemide)

A

Ototoxicity

(especially in renal dz/rapid IV admin/other ototox agents/high doses)

554
Q

What is [Brown Adipose tissue]

A

[Brown Adipocytes (1 cell with many fat vacuoles & many mitochondria)] = produces heat via [uncoupling oxidative phosphorylation] with thermogenin - in newborns/hibernating mammals

White Adipoctyes only have 1 intracytoplasmic fat droplet

555
Q

Liver Angiosarcoma is associated with exposure to __(3)___. What’s the tumor marker?

A

[Vinyl Chloride / Arsenic / Thorotrast]

CD31

556
Q

Milrinone MOA

A

PhosphodiesterAse inhibitor –> INC cAMP –> [INC contracility AND Arteriole Dilation] in HF pts

557
Q

[Nesiritide BNP] MOA (3)

A

BNP analog that INC cGMP –>

  1. Natriuresis
  2. Arteriole Dilation (DEC Afterload)
  3. Venous Dilation (DEC preload)
558
Q

Oligohydraminos –> ______. Describe this Sequence and Name the 3 most common causes of Oligohydraminos

A

Oligohydraminos –> POTTER Sequence

Pulm hypOplasia

Oligohydraminos(cause)

[Twisted Face & Extremities]

Twisted Skin

Ears set low

Renal Failure

559
Q

What is the main MOA for pregnancy prevention in OCP

A

Progestins negatively feeds back on ANT Pit –> DEC FSH & LH

560
Q

[Radial Head Subluxation Nursemaid’s Elbow] MOD and Demographic

A

[Sudden Traction/Hand pull] on [outstretched and pronated arm] –> Annular Ligament tear & subsequent displacement

Little kids

561
Q

[Nucleotide Excision Repair] involves a damaged base

vs.

[Base Excision repair] which involves an Altered(deaminated/alkylated/oxidated)

Describe [Base Excision Repair]

A
562
Q

Identify

A
563
Q

Identify

A

Remember:

  • [R middle Lung lobe] is adjacent to [R Atrium]
  • R side of Heart of CXR is [R Atrium]
564
Q

Glycolysis, Fatty Acid Synthesis and Pentose phosphate all occur in what part of the cell?

A

Cytosol

565
Q

B-oxidation, TCA and Pyruvate Decarboxylation all occur in what part of the cell?

A

Mitochondria

566
Q

[Toxic Shock Syndrome] MOD

A

[Staph TSS exotoxin] activates BOTH T-cells (leading to IL2 release) and APC MHC2

567
Q

Pts with [Nausea from Acute Migraines] should have which nausea receptor blocked?

A

5 Days of Having Nauseating Moomoo :-(

D2 (central nausea)

568
Q

Pts with [Nausea from GI irritation (gastroenteritis/chemo/anesthesia)] should have which nausea receptor blocked?

A

5 Days of Having Nauseating Moomoo :-(

5HT3

569
Q

Pts with [Nausea from Vestibular/Motion Sickness] should have which nausea receptor blocked?

A

5 Days of Having Nauseating Moomoo :-(

H1 vs. M1

570
Q

Difference between [Rheumatic Fever] and [Infective Endocarditis]

A

RF = [Fibrosis & Fusion of valves(mitral>aortic) and endocardium - Type 2 Hypersensitivity]

vs.

[Infective Endocarditis] = Vegetations on valve cusps –> destruction

571
Q

HER2 is a ____ receptor

A

Tyrosine Kinase

572
Q

[Allergic Atopic Asthma] is the most common and is treated with what 2 agents for acute relief?

A
  1. Leukotriene blockers ( -lukast )
  2. M3 blockers ( Ipratropium )
573
Q

The Red dot represents ____ which indicates what for lung volume? What is the intrapleural pressure at this point?

A

FRC; resting state where airway pressure = zero;

[At FRC, intrapleural pressure = -5]

574
Q

Vitamins A and D are both involved in epithelial regulation. What’s the difference?

Deficiency of which is liked to [Keratinizing squamous metaplasia]?

A

Vitamin A regulates [SPECIALIZED Columnar epithelia] and deficieny –> [Keratinizing Squamous metaplasia] of…

  1. Conjuntiva
  2. Respiratory tract
  3. Urinary Tract
  4. Pancreatic ducts
575
Q

Explain the uniqueness of second infection with Dengue fever

A

Dengue has 4 serotypes

1st time infected w/1 serotype = asx vs. self-limited

2nd time infected w/diff. serotype = SEVERE pancytopenia + Elevated Liver Enzymes

576
Q

Familial Chylomicronemia Syndrome

Sx (5)

A

HHALX

  1. Acute Pancreatitis - recurrent
  2. HyperTriGlyceridemia (especially Chylomicrons)–>creamy supernatant
  3. [Lipdemia Retinalis]= milky retinal vasculature
  4. [SKIN Xanthomas- eruptive= yellow erythematous papules on extensor surfaces]
  5. HepatoSplenomegaly

Familial HyperCholesterolemia would produce [Tendon Xanthomas and Xanthelasmas]

577
Q

How are [PD1 and CTLA4 receptors] associated with CA

A
578
Q

Somatomedin C is AKA ____

A

IGF1

579
Q

Identify and describe the histology

A

[Contact Dermatitis Type 4 Hypersensitivity]; [Spongiosis (edema in the intercellular spaes of epidermis)

CD = Weeping, Erythematous, papulovesicular

580
Q

Describe [Lipid PerOxidation]

A

Lipid degradation and H2O2 formation 2° to Free Radical damage –> [Fatty change and necrosis] ; Carbon Tetrachloride

581
Q

Name the Vitamins and Enzymes inhibited by Excess EtOH (2)

A
  1. [Thiamine B1]
  2. [Folate B9]
582
Q

In [Acute Calculous Cholecystitis], describe how Gallstone obstruction INITIATES the dz (3)

A

[Cystic Duct Obstruction] –>

  1. INC hydrolysis of lecithins into LysoLecithins–>
  2. DEC mucus layer –>allows Bile salt to irritate wall and cause Inflammation –>
  3. invasion by [KE3 - Kleb/E.Coli / Enterococcus / Enterobacter]—> Necrotic Gall bladder
583
Q

Macrophage cell Marker

A

CD14

584
Q
A
585
Q
A
586
Q

Describe [RNA Polymerase 1] (3)

A
587
Q

Describe [RNA Polymerase 2] (3)

A
588
Q

Describe [RNA Polymerase 3]

A
589
Q

Name the mainstay Drugs for Staph Aureus (8)

A

i Love Crazy Crazy Deranged Boys N’ TV

  1. Linezolid
  2. Clindamycin
  3. [CefTaroline 5° generation]
  4. Daptomycin
  5. [Bactrim - Skin Infection]
  6. [Nafcillin - MSSA only]
  7. Tigecylcine
  8. Vancomycin
590
Q

What is the [Colon Adenoma –> Carcinoma] Sequence (6)

A

AMCK - (DCC) - 53

591
Q

Describe Chiari Malformation Type 2

A

Type 2 is TOO BAD:

Congenital Underdevelopment of [POST fossa] –> Cerebellum & Medulla herniation thru Foramen Magnum

Type 2 = SEVERE NEONATAL ONSET –> [MEDULLA COMPRESSION–>apnea] + [NON-COMMUNICATING HYDROCEPHALUS] + [LUMBAR MYELOMENINGOCELE]

592
Q

Describe Friedreich Ataxia (8)

A

FriEdreich is Fratastic! He’s your fav., twisted frat iHouse brother, always studdering and falling, but has a sweet, big heart

FriEdreich = [Vitamin E Deficiency] mimics it

Fratastic has 9 letters = [Chromo 9 Auto Recessive]

twisted = Kyphoscoliosis @ childhood

frat = [frataxin (iron binding protein) defect]

iHouse = [(iron binding protein) defect]

studdering = Dysarthria

falling = [Falls + Gait Ataxia + (Pes Cavus High Foot Arch)]

sweet = DM

big heart = Hypertrophic Cardiomyopathy

Involves Degeneration of [Dorsal, Lateral CST & Spinocerebellar]

593
Q

Describe T-cell differentiation for TH1 and TH2

A
594
Q

List the Arterial and Venous(3) supply for [ABOVE Pectinate Anus]

A

Arterial: [IMA: Sup Rectal]

Venous: [SUP Rectal] –> [inf. mesenteric] –> Portal

595
Q

List the Arterial, Venous(5) and Nerve supply for [BELOW Pectinate Anus]

A

Arterial: [Internal Pudendal: inf rectal]

Venous: [inf rectal] –> [Internal Pudendal] –> [Internal iLiac] –> [Common iLiac] –> IVC

Nerve = [Pudendal: inf rectal]

596
Q

MOD for [HFE mutation 1° Hemochromatosis]

A

HFE mutation –> Liver & Enterocytes falsely detecting low iron –> [1 and 2] –> [Liver Cirrhosis & HCC] AND BRONZED SKIN

  1. Liver DEC Hepcidin release —> [INC Ferroportin on Enterocytes basolaterally]–>INC iron absorption
  2. Enterocytes [INC Apical DMT1] –> ALSO INC iron absorption
597
Q

Why does Diastolic HF –> Pulm HTN

A
598
Q

[ST Elevations] or [Q waves] in these leads indicate INFARCT in which areas?

A: [V1 - V2]

B: [V3 - V4]

C: [V5 - V6]

D: [Lead 1 / aVL]

E: [Lead 2 / 3 / avF]

A

A: [(V1 - V2) = Anteroseptal - LAD]

B: [(V3 - V4) = Anteroapical - distal LAD]

C: [(V5 - V6) = AnteroLateral - LAD vs. LCX]

D: [Lead 1 / aVL] = [Lateral - LCX]

E: [Lead 2 / 3 / avF] = [InFerior - RCA] = R Vt

599
Q
A
600
Q

What is the [Cord Factor] in mycobacteria (3)

A

INC mycobacteria Virulence by enabling growth as [Serpentine Cords] –>

  1. inhibits neutrophils
  2. destroys MITOchondria
  3. releases TNFa
601
Q

Classic Presentation for [Acute Viral Hepatitis (4)] and accompanying histo

A
  1. RUQ TTP
  2. Dark Urine
  3. Fever
  4. [Serum Sickness “like”(CAUFF) - Hep B]

Histo = Spotty Necrosis + Ballooning Degeneration

602
Q

___(3)___ activate Guanylyl cyclase –> what? What other drug has a similar end-goal?

A

Sildenafil has similar end-goal

603
Q

What [mini mental state exam] do you use to test for:

  1. Orientation
  2. Comprehension
  3. Concentration
  4. Short term memory
  5. Long Term memory
  6. Language
  7. Visual-Spatial
  8. Executive Function
A
604
Q

What are the 2 biggest RF for Esophageal Squamous carcinoma?

A

Alcohol and Cigarettes

Fat / Barretts / GERD = Esophageal ADC

605
Q

List and Describe the 5 causes of CRC

A
606
Q

Describe the [pH / HCO3 / O2 / CO2] during PE < 24 hours

A

INC pH

Normal HCO3

low EE

607
Q

Histology for [Acute Neuronal Injury] (AKA ___ _____) (4)

A

[Acute Neuronal Injury (AKA RED NEURON)]

  • Cell Body Shrinks
  • Nuclei Pyknosis
  • Loss of Nissl substance
  • Eosinophilic Cytoplasm

THIS IS IRREVERSIBLE INJURY that eventually –> Neuronal Degeneration!

608
Q

Histology for [Chromatolysis Axonal Rxn (Loss of Axon)] (4)

A

[Chromatolysis Axonal Rxn (Loss of Axon)]

  • Cell Body ENLARGES
  • Nucleolus ENLARGES
  • Eccentric nucleus
  • Dispersion of Nissl substance
609
Q

What are the Neuroendocrine markers (3)

A
  1. Chromogranin
  2. Neuron-specific enolase
  3. Synaptophysin
610
Q

In [Renal Cell Carcinoma], what accumulation makes the cytoplasm clear? (2)

A

RCC looks like HAWF!

intracell Glycogen & Lipids

L RCC in image

611
Q

What are the 7 P’s of [Congenital hypOthyroidism Cretinism]

A
  1. Poor Brain
  2. Protruding Fontanelle
  3. Puffy Face
  4. Protuberant Tongue
  5. Pot Belly
  6. Protruding Umbilicus
  7. [Can’t Plank = hypOtonia]

Usually Asx

612
Q

[Eczema Atopic Dermatitis] MOD and its associations (2)

A

Type 1 Hypersensitivity –> skin inflammation triggered by environmental AND food antigens

associated with [allergic rhinitis] and asthma

613
Q

Dz AND Describe the composition

A

[Signet Ring Gastric ADC]; NON-gland cells that ironically contain abundant Mucin & undergo [Stomach wall infiltration] –> [Leathery Linitis plastica]

614
Q

[Burkitt Lymphoma - EBV] is associated with ___ translocation and overexpression of ____. Describe the Histo (3)

A

[8 14]; c-MYC overexpression (EBV INC B- cell proliferation–>INC translocation risk)

Histo = [Diffuse mid-sized lymphocytes with basophilic cytoplasm and high [Ki-67 fraction-proliferation index]

615
Q
A
616
Q
A
617
Q

Which organisms cause [Liver Abscess via Biliary Tract ascension (4)]? Which cause [Liver Abscess via Hematogenous Seeding]?

A

[Biliary Tract ascension] = [KE3 - Kleb/E.Coli / Enterococcus /][Entamoeba: Colon–>Portal Vein]

Hematogenous = Staph A

618
Q

What are the 2 best diagnositc labs for determining cause of [Metabolic ALKalosis]

A

[Urine Cl] and Volume Status

619
Q

7 common causes of Dilated Cardiomyopathy

A

“the PIG PAID for Dilated Cardiomyopathy”

  1. Post Myocarditis from [Coxsackie B Enterovirus]
  2. Alcoholic Cardiomyopathy from long term EtOH usage (direct toxicity vs. nutritional deficiency)
  3. [Doxorubicin and Daunarubicin Chemotherapy]= dose-dependent
  4. Peripartum - (late in pregnancy vs. 5 mo. post partum)
  5. Genetic= affects cytoskeleton
  6. Iron Overload: [Hereditary Hemochromatosis] or [Multiple Blood Transfusion Hemosiderosis] = Iron accumulates and interferes with metal-dependent enzyme system in myocytes
  7. Idiopathic
    * MOST COMMON CARDIOMYOPATHY*
620
Q

List the common causes of Restrictive Cardiomyopathy (8)

A

RAMILIES

  1. Radiation Fibrosis
  2. Amyloidosis (heterogenous misfolded proteins)
  3. Sarcoidosis= [Noncaseating granuloma formation] in multiple organs 2º to [CD4 Helper T] attack on unidentified antigen
  4. Metastatic Tumor
  5. Inborn metabolism errors
  6. Endomyocardial fibrosis= Common in [African/Tropic children]
  7. [Loeffler Endomyocardial fibrosis] = (Has [Peripheral blood eosinophilia and infiltrate])
  8. Iron overload
621
Q

[Fish oil Omega 3 FA] MOA (3)

A
  1. [DEC TAG by DEC VLDL and apoB]
  2. INC Gallbladder motility
  3. INC Bile Acid synthesis –> DEC Cholesterol saturation
622
Q

Ribavirin MOA (4)

A

RIBA = RIMA

  1. RNA polymerase inhbitor
  2. IMPDH inhibitor –> GTP depletion
  3. Methylation of RNA
  4. Activates Immune system
623
Q

Histo Description for VZV (2)

A

Multinucleated Giant Cells w/ Keratinocyte Intranuclear inclusions

624
Q

Dermatitis Herpetiformis Histo

A

SubEpidermal blister with neutrophils in dermal papilla

625
Q

Alzheimer’s Dz etx (3)

A

Alzheimers MOD = CHA

**Cleavage, Hemorrhage, ACh **

  1. Cleavage of [transmembrane amyloid precursor glycoprotein] –> Beta-amyloid which accumulates–> [Neuritic Senile plaques] in temporal lobe early on.
  2. Hemorrhages Spontaneously occur in Occipital/Parietal lobes (image) from Beta-amyloid starting to deposit in cerebral vessels
  3. ACh ⬇︎ in the [Basal nc. of Meynert] & Hippocampus 2/2 B-amyloid accumulation causing defective [Choline Acetyltransferase] in those areas –> Alzheimer Sx
626
Q

How do we acquire Schistosomiasis

A

Freshwater SNAILS infected with larvae

627
Q

Why do Myocardial cells swell during transient ischemia (2)

A

Na+ accumulation (DEC Na/K ATP pump)

and

Ca+ accumulation (DEC [Sarcoplasmic Reticulum Ca+ ATPase])

628
Q

What vessels are found within the [HepatoDuodenal Ligament] and how is this associated with RUQ Bleeding?

A

Portal Triad; If Pringle maneuver does NOT stop RUQ Bleeding, then source of bleeding = IVC vs. Hepatic veins

629
Q

ESR is a non-specific marker for ____. What specifically causes INC ESR

A

Inflammation; [IL1 / 6 / TNFa] –> [Hepatic AKute phase proteins]–> INC Fibrinogen –> INC ESR

630
Q

Diveritculosis MOD

A

INC [Pulsion Pressure] from strained BM–> [Mucosa & SubMucosa] herniation thru weak Muscularis = FALSE Diverticula

This is similar to Zenker

631
Q

How are Blood transfusion related to hypOcalcemia?

A

[Giving GOE 6 L whole blood] can–> [INC SERUM CITRATE(typically added to stored blood)]–> Chelates Ca+ and Mg+ –> hypOcalcemia –> Paresthesia

632
Q

Which 5 Drugs groups cause Osteoporosis?

A

These CoAg Canners Obliterate SpongyBoneTrabeculae

Thyroid meds

anti-Coagulants

anti-Convulsants(Phenytoin)

****Omeprazole****

Steroids - exogenous

633
Q

Patellar fractures inhibit ____ (Flexion / Extension) of the Knee against gravity

A

EXTENSION

634
Q

_____ is the most common cause of both kid and Adult Acute Gastroenteritis. Transmission (2)?

A

Campylobacter Jejuni;

  1. [Food: Contamined Poultry vs. Unpasteurized milk]
  2. [Domestic Animals: Dog / Cow / Chicken / Sheep]
635
Q

Formula for Bioavailability

A
636
Q

A: Dystrophic calcifcation is the Hallmark of _____ (3)

B: What is Plasma Ca+ in this DO?

A

A: [Dystrophic calcification] is the HALLMARK OF

  • CELL INJURY
  • CELL DEATH and
  • Necrosis

B: Plasma Ca+ will be normal

This occurs naturally from aging

637
Q

Main SE for Nitrates (3)

A
  1. HA
  2. Flushing
  3. hypOtension
638
Q

Name the 2 opiate antidiarrheals

A

Loperamide & DiPhenOxylate

639
Q

[Pure RBC Aplasia MOD] and dz’s its associated with (3)

A

Failure of marrow to produce only [RBC precursor elements];

Parvo B19

Lymphocytic Leukemia

Thymoma

640
Q

The Trapezius muscle is innervated by the _____, found in the _______. Manifestation of injury to this? (3)

A

Spinal Accessory; POST Triangle

  1. Impaired ABduction past 90°
  2. Shoulder Droop
  3. Winged Scapula (also caused by Serratus ANT)
641
Q

Clinical Manifestations for [Bells Palsy] (4)

A

​Bells Palsy = Facial CN7 paralysis

Loss of F –> Unilateral Paralysis

Loss of A –> Hyperacusis

Loss of C–> DEC Eye lacrimation (tearing)

Loss of E –> Loss of ANT 2/3 Tongue Taste

FACE

  1. Facial Muscles
  2. Afferents(Somatic) from [Ear Pinna (Pain/Temp)] & [External Auditory Canal (stapedius m.)]
  3. Cry: Parasympathetics to [Lacrimal/Salivary/Sublingual/Submandibular/]
  4. Eat: Taste from ANT 2/3 Tongue
642
Q

Describe [Intestinal Angina]

A

Postprandial epigastric pain from [Chronic Mesenteric ischemia 2° to Atherosclerosis]

643
Q

A: Histology for [PNET - Primitive NeuroEctodermal Tumors] (MeDulloblastoma)

B: Pgn

A

A: Sheets of [small, primitive blue cells] + [abundant mitotic figures]

B: POOR! (PNET tumors are undifferentiated and aggressive)

644
Q

A: Histology for [Pilocytic Astrocytoma] (3)

B: Pgn

A

A:

Pilocytic Astrocytes (spindle cells with hair-like glial processes)

+

Rosenthal Fibers

+

[Cerebellar Vermis Cyst]

B: (Better than MeDulloblastoma since it is well-differentiated)

645
Q
A
646
Q

Identify

A

LAD

647
Q

[Leukocyte Adhesion Deficiency Type 1] MOD

A

Absence of [CD18 integrin] –> [No WBC Chemotaxis: Tight Binding w/ICAM1] but with persistent leukocytosis –> Mucocutaneous infections & [delayed umbilical cord separation]

648
Q

What endothelial cell defect –> No Neutrophil Rolling

A

[L vs. (E / P)] Selectin defect

These can be upregulated by Cytokines and [SiaLyl selectin] is on the neutrophils

649
Q

What target organ does the M3 Receptor work in (6)

A

“[M1s need Brain], [M2s need Heart], [M3s BEGs for Private Lounges”

“M3’s BEGS for Private Lounges”

Bladder(contraction) / Eyes / GI / Skin / [Peripheral Vasculature] / Lungs

650
Q

A: Describe Histology (3)

B: Dz

C: What’s the primary leukocyte in the skin

A

A: image

-Solar Elastosis=Grayish-bluish color of the Dermis from sun damage

B: [Actinic Keratosis-PreMalignant]

C: Lymphocyte

651
Q

A: Describe Histology (3)

B: Dz

A

A: image

B: Basal Cell Carcinoma

652
Q

Identify

A

Malaria

653
Q

Common causes of DIC (7)

A

STOP Making New Thrombi

Sepsis (gram-negative)

  • *T**rauma
  • *O**bstetric path
  • *P**ancreatitis-Acute
  • *M**alignancy
  • *N**ephrOtic syndrome
  • *T**ransfusion
654
Q

What Pharyngeal functions are [Vagus CN10] responsible for? (4)

A
  1. Uvula (moves away from lesion in CN10 damage)
  2. Epiglottic Taste
  3. Swallowing
  4. Soft palate elevation
655
Q

Which direction does the jaw point in [Trigeminal CN5] damage?

A

jaw points TOWARD lesion (since force from opposite pterygoid will be weak)

656
Q

Loop Diuretics SE (6)

A

OH DANG

Ototoxicity

hypOkalemia

Dehydration

Allergy

Nephritis (intersitial)

Gout

657
Q

What is the First sign of puberty in Males vs. Females

A

Males = Pubic Hair

Females = Breast Buds

658
Q

Sensitivity

Formula(2) & meaning

A
659
Q

SPecificity

Formula(2) & meaning

A
660
Q

Recall the [2 x 2 Test vs. Disease] diagram

A
661
Q

How many ATP are yielded in Aerobic vs. AnAerobic metabolism?

A

Aerobic = 32

AnAerobic = [2 + Lactate]

662
Q

Define [p-value] and its relation to Null hypothesis

A

[p-value] = Chance that study results happened randomly

[p-value] < 0.05 means you can Reject Null hypothesis since it means there’s lil chance the results happened randomly

663
Q

Difference between [Type 1 alpha] and [Type 2 Beta] error

A

[Type 1 alpha] = u sAw a difference that doesn’t exist (accepted Alternative hypothesis when you shouldn’t have)

vs.

[Type 2 Beta] = Blind to the Truth (accepted Null hypothesis when in actuality there was an effect)

[3] Step 1 USMLE (8 decks)

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