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UWorld > February UWorld > Flashcards

February UWorld Flashcards

1
Q

Presence of this serological marker increases the risk of vertical transmission of Hep B

A

HBeAg

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2
Q

Most specific marker for diagnosis of acute Hep B infection

A

Anti-HBcAg IgM

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3
Q

First line tx for generalized anxiety disorder

A

SSRIs (fluoxetine, paroxetine, sertraline, citalopram)
[FLashbacks PARalyze SEnior CITizens]
SNRIs (venlafaxine, duloxetine)

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4
Q

Strep pneumoniae vaccine contains what components

A

Adults- Polysaccharide vaccine

Children- Conjugate vaccine

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5
Q

Ethambutol use and side effect

A

TB

Optic neuropathy

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6
Q

Spironolactone location of action in nephron; ion effects

A

Principal cells of collecting tubules;

Causes decreased Na reabsorption, decreased K/H secretion

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7
Q

Intellectual disability in child, history of seizures, abnormal pallor of catecholaminergic brain nuclei, musty odor- Dx?

A

Phenylkentonuria (deficiency of phenylalanine hydroxylase)

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8
Q

Inducers of CYP450

A

Chronic alcohol use, St. John’s wort, phenytoin, phenobarbital, nevirapine, rifampin, griseofulvin, carbamazepine [Chronic alcoholics STeal PHEN-PHEN and NEVer Refuse GReasy CARBs]

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9
Q

Most important prognostic factor of PSGN

A

Age (younger = better prognosis)

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10
Q

Enzymes inhibited by lead

A

Ferrochelatase and d-aminolevulinic acid (ALA) dehydratase

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11
Q

Symptoms of lead poisoning

A

Anemia, ALA accumulation, and elevated zinc protoporphyrin;

Long term: neurotoxicity

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12
Q

Rett syndrome

A

Neurodevelopment disorder mainly in girls. Normal development until 5-18 mo; loss of motor and language skills; stereotypic hand movements; MECP2 mutation

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13
Q

Budding yeast with thick capsule

A

Cryptococcus neoformans

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14
Q

Diagnosis of cryptococcus

A

India ink stain of CSF shows halos due to polysaccharide capsule

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15
Q

Dorsal and ventral pancreatic buds form what structures, respectively

A

Pancreatic tail, body, most of the head, and small accessory pancreatic duct;
Uncinate process, portion of pancreatic head, and proximal portion of the main pancreatic duct

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16
Q

Phenotypic mixing

A

Host cell is coinfected with two viral strains and progeny virions contain unchanged parental genome from one strain and nucleocapsid (or envelope) proteins from the other strain

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17
Q

Chi-square test is used for what

A

To test association between two categorical variables

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18
Q

Anastomosis that connects SMA and IMA

A

Marginal artery

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19
Q

Function and location of enhancer sequences in DNA

A

Increase rate of transcription;

May be located upstream, downstream, or within introns of the gene

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20
Q

Function and location of promote region

A

Site where RNA pol3 bind to DNA- functions to initiate transcription;
Located 25-75 bases upstream from associated gene

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21
Q

Immune response to pulmonary TB infection

A

CD4+ Th1 lymphocytes and macrophages (the latter mediated by IFNg and IL2)

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22
Q

Venous component of internal and external hemorrhoids drain to what veins, respectively

A

Internal: middle rectal vein -> internal iliac vein
And superior rectal vein -> inferior mesenteric vein

External: inferior rectal veins -> internal iliac vein

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23
Q

Inheritance pattern of NF1

A

Single gene AD

NF1 gene on chromosome 17

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24
Q

Presentation of NF1

A 
Variable, can include all or none:
Cafe-au-lait spots
Neurofibromas
Lisch nodules in eyes
Pseudoarthrosis
Other tumors (meningiomas, astrocytomas, gliomas, pheochromocytomas)
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25
Q

Anti-Rh immunoglobulin belongs to which class of Ab?

A

IgG

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26
Q

Intestinal atresia of the midgut is most like due to

A

Vascular occlusion

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27
Q

Intellectual disability, gait/posture abnormality, eczema, and musty body odor are signs of

A

PKU

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28
Q

Omalizumab MOA and clinical use

A

Anti-IgE monoclonal Ab (binds mostly unbound serum IgE and blocks FcERI);
Asthma add-on therapy for sever allergic asthma

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29
Q

Pleiotropy

A

Occurrence of multiple phenotypic manifestations, often in different organ systems, from a single gene

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30
Q

Iliohypogastric nerve- motor and sensory functions

A

Motor: anterolateral abdominal wall muscles
Sensory: innervates skin in suprapubic region (anterior branch); innervates gluteal region (lateral branch)

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31
Q

Northern, Western, Southwestern, Southern blots are used for what

A

mRNA, proteins, DNA-bound proteins, DNA, respectively

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32
Q

Coronary dominance is determined by

A

…the coronary artery supplying the posterior descending artery (PDA)

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33
Q

Which branch supplies blood to the AV node

A

Posterior descending artery

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34
Q

Where does the posterior descending artery originate from

A

Right coronary artery (70% of population); Left circumflex (10%); codominant (20%)

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35
Q

What causes DiGeorge syndrome

A

Maldevelopment of the third and fourth pharyngeal pouch derivatives

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36
Q

What area of the LN is poorly developed in DiGeorge syndrome

A

Paracortex

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37
Q

Marfan syndrome is a defect in what

A

Fibrillin-1 gene

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38
Q

What is fibrillin-1; defect in this causes what dz

A

Major component of microfibrils that form a sheath around elastin fibers; Marfan syndrome

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39
Q

Why does verapamil not affect skeletal muscles

A

Verapamil blocks L-type calcium channels on plasma membrane; skeletal muscles do not depend on extracellular calcium influx to cause calcium release from SR

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40
Q

DOC for PTSD

A

SSRI, or SNRI

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41
Q

Immunologic mechanism behind hyperacute transplant rejection

A

Preformed IgG antibodies against graft in recipient’s circulation

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42
Q

External hemorrhoids are innervated by

A

Inferior rectal nerve, a branch of the pudendal nerve

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43
Q

Fetal hemoglobin is made of what subunits

A

2 alpha and 2 gamma protein subunits

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44
Q

What is bacillary angiomatosis and what causes it

A

Benign red-purple papular skin lesions; caused by Bartonella infection (cat-scratch dz)

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45
Q

Mechanism behind granulomatous diseases (sarcoidosis, TB) causing hypercalcemia

A

They have PTH-independent conversion of calcitriol (active form of Vit D) due to expression of 1-a-hydroxylase activity in activated macrophages

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46
Q

Presentation of hemochromatosis

A

Classic triad of micronodular cirrhosis, diabetes mellitus, and skin pigmentation

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47
Q

Cause of annular pancreas

A

Failure of the ventral pancreatic bud to properly migrate and fuse with the dorsal bud during the 7th and 8th week of development

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48
Q

What is genomic imprinting, and what causes it

A

Phenomena in which an offspring’s genes are expressed in a paren-specific manner;
Cytosine methylation by S-adenosyl-methionine (SAM)

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49
Q

Case-control study

A

Selects individuals with a particular disease (cases), individuals without that disease (controls), and then evaluates previous exposure status

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50
Q

Conn syndrome

A

Primary hyperaldosteronism due to aldosterone producing adenoma

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51
Q

t(15;17) is translocation of what two genes; what condition does it cause

A

Retinoic acid receptor alpha (RARA) on 17 and promyelocytic leukemia (PML) on 17;
Acute Promyelocytic Leukemia (APML)

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52
Q

Heart sound heart with atrial left-to-right shunt

A

Wide and fixed splitting of S2

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53
Q

Stop codons

A

UAA, UGA, UAG

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54
Q

Decreased AFP and increased nuchal translucency on ultrasonography

A

Down syndrome

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55
Q

Meniere disease presentation

A

Triad of tinnitus in affected ear, vertigo, and sensorineural hearing loss

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56
Q

Gonadal abnormalities in Turner Syndrome

A

Streak ovaries, amenorrhea, infertility

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57
Q

Turner syndrome karyotype

A

45 X

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58
Q

Extragonadal manifestations of Turner syndrome

A

Short stature, shield chest, webbed neck, bicuspid aortic valve, coarctation of aorta, horseshoe kidney

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59
Q

Reassortment

A

Mixing of genomic segments in segmented viruses that infect the same host cell (genetic shift of influenza A)

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60
Q

Hormone-sensitive lipase

A

Enzyme found in adipose tissue that catalyzes breakdown of TG into FFA and glycerol; activated by stress hormones (catecholamines, glucagon, ACTH) and inhibited by insulin

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61
Q

MOA of fibrates

A

Activate peroxisome proliferator-activated receptor alpha (PPAR-a), which increases LPL activity

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62
Q

Predicted respiratory compensation for MAc

A

Pco2 = 1.5 [HCO3-] + 8 +/- 2

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63
Q

Cause of staphylcoccal scalded skin syndrome; sxs

A

Production of exotoxin exfoliatin by staph species; widespread epidermal sloughing, even with gentle pressure (Nicholsky’s sign)

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64
Q

Organophosphates- MOA and end organ effects

A

AChE inhibitor;

muscle weakness, paralysis, lethargy, seizures, miosis, bradycardia, increased lacrimation/salivation

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65
Q

Fungus with polysaccharid capsule; stains red on mucicarmine stain and has a clear unstained zone with India ink stain

A

Cryptococcus neoformans

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66
Q

Adenomyosis; sxs

A

Presence of endometrial glandular tissue within the myometrium;
Heavy menstrual bleeding, dysmenorrhea, uniformly enlarged uterus

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67
Q

Role of voltage-gated calcium channels in neurotransmission

A

Fusion and release of NT vesicles into the synaptic cleft

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68
Q

Caseating granulomas consist of immunological cells; what surface markers do these cells display

A

Epithelioid macrophages; CD14

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69
Q

Embryologic defect in hydrocele

A

Patent processus vaginalis

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70
Q

Screening test for Celiac dz

A

Serology test for IgA anti-endomysial and anti-tissue transglutaminase antibodies

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71
Q

Bordatella pertussis characteristics

A

Gram - coccobacillus; Adenylate cyclase and pertussis toxin; tracheal cytotoxin

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72
Q

Type 2 error in a study

A

Concluding that there is no difference between groups when one truly exists

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73
Q

Power of a study

A

1 - B (type 2 error)

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74
Q

Blood supply to the ovary is in what ligament

A

Infundibulopelvic ligament (suspensory ligament of the ovary)

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75
Q

Causes of polyhydramnios

A

Fetal GI obstruction (esophageal, duodenal, or intestinal atresia), anencephaly, high fetal cardiac output (anemia)

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76
Q

Serum B-hCG test can detect pregnancy ___ days after fertilization/implantation;
Urine can detect ___ days after

A

8;

14

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77
Q

Koilocyte is a hallmark sign of infection with what pathogen

A

HPV

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78
Q

Koilocyte characteristics

A

Pyknotic, superficial or immature squamous cells with a dense, irregularly staining cytoplasm and perinuclear halo-like clearing;
raisinoid appearance of nucleus

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79
Q

Mechanism of exchange of genes between 2 nonsegmented, double-stranded DNA genomes

A

Recombination

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80
Q

Uterine leiomyoma; symptoms

A

Monoclonal tumor;
Uterine enlargement causing bulk-related symptoms (constipation if on posterior uterine wall presses on colon, urinary urgency/imcomplete emptying if uterus is displaced upwards); can cause reproductive difficulties if in the uterine cavity

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81
Q

3 main causes of HIV-associated esophagitis; endoscopic findings of each

A

Candida albicans (pseudomembranes), HSV-1 (“punched out” ulcers), CMV (linear ulcerations)

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82
Q

Microscopic findings of HSV-1 and CMV

A

HSV-1: eosinophilic intranuclear inclusions (Cowdry type A) in multinuclear squamous cells
CMV: Intranuclear and cytoplasmic inclusions

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83
Q

Inactivated influenza vaccine has what effect

A

Induces neutralizing antibodies against the hemagglutinin antigen; prevents live virus from entering cells via endocytosis

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84
Q

Live-attenuated viral vaccines induce what immunological response

A

Stimulate MHC class I antigen-processing pathway and can generate cytotoxic CD8+ T lymphocytes that kill infected cells

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85
Q

Most vulnerable structure to injury during hysterectomy

A

Ureter

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86
Q

Monosaccharide with fastest rate of metabolism in the glycolytic pathway

A

Fructose-1-phosphate bc it bypasses phosphofructokinase (a major regulatory step in glycolysis)

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87
Q

Underlying mechanism for Turner syndrome

A

Paternal meiotic non-disjunction

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88
Q

Fever, malaise, maculopapular rash of palms and soles

A

Treponemal infection (syphilis)

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89
Q

Projection

A

Immature defense mechanism involving the misattribution of one’s unacceptable feelings or thoughts to another person who does not actually have them (eg, boy thinks his parents are angry at him while they are going through divorce, when it is actually him that’s angry)

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90
Q

Dizygotic twins: mono- or di- chorionic/amniotic

A

Dichorionic diamniotic

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91
Q

Monozygotic twins: mono- or di- chorionic/amniotic

A 
Early septation (0-4 days): dichorionic diamniotic
Septation at 5-7 days: monochorionic diamniotic
Late sepatation (8-12 days): monochorionic monoamniotic (high fetal fatality rate)
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92
Q

Virchow’s triad

A

Stasis, hypercoagulability, endothelial damage (exposed collage triggers coag cascade)

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93
Q

Ovarian venous drainage

A

R ovarian vein drains into IVC;

L ovarian vein drains into L renal vein

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94
Q

Serological markers seen with HBV vaccination

A

Anti-HBs

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95
Q

Serological markers seen with HBV recovery

A

Anti-HBs and anti-HBc IgG

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96
Q

Down syndrome quadruple screen results (a-fetoprotein, unconjugated estriol, B-hCG, inhibin A)

A

Low maternal serum AFP, low estriol, high B-hCG, high inhibin A

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97
Q

% of data within 1, 2, and 3 standard deviations

A

68%, 95%, 99.7%

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98
Q

ACh release form presynaptic terminal vesicles at the NMJ depends on what substance

A

Ca

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99
Q

Major immune mechanism against giardiasis

A

CD4+ T helper cells, and secretory IgA production (prevents and clears infection by binding to trophozoites and impairing their adherence to the upper small-bowel mucosa)

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100
Q

Thiazide diuretics MOA

A

Inhibit Na/Cl cotransporter in early distal tubule

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101
Q

Familial hypocalciuric hypercalcemia

A

benign AD disorder caused by defective Ca-sensing by parathyroid and renal tubule cells;
prevents PTH from being suppressed in response to an increase in serum Ca

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102
Q

Lab findings that differentiate familiar hypocalciuric hypercalcemia from primary hyperparathyroidism

A

Both will have elevated Ca and PTH levels, but FHH will have low urinary Ca excretion due to impaired renal Ca sensing

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103
Q

MOA of zafirlukast and montelukast

A

Leukotriene D4 antagonists;

Increases airway caliber and reduces mucosal inflammation

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104
Q

Side effects of niacin

A

Flushing, hyperglycemia, hepatotoxicity, and decreased renal excretion of uric acid (increased risk for acute gouty arthritis)

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105
Q

Pts with Down syndrome are at increased risk of what cancer

A

Acute lymphoblastic leukemia and acute myelogenous leukemia

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106
Q

Gram + rod with tumbling motility

A

Listeria monocytogenes

107
Q

Confounding

A

When a perceived association between an exposure and an outcome is actually explained by a confounding variable associated with both the exposure and the outcome (eg, age is a confounding variable when comparing IQ and shoe size; if controlled for age, there is no correlation between the two)

108
Q

HSV-1 characteristics

A

DNA, double-stranded, enveloped

109
Q

Type IV hypersensitivity

A

Delayed T-cell mediated type; sensitized T cells encounter antigen and release cytokines that lead to macrophage activation; ex: contact dermatitis, GvH dz, MS

110
Q

Head “pounding” with involuntary head bobbing

A

Widened pulse pressure

111
Q

Widened pulse pressure with large stroke volume and heart murmur

A

Aortic regurgitation

112
Q

Classic triad of congenital rubella syndrome

A

PDA (or pulmonary arterial hypoplasia), cataracts, and deafness, +/- “blueberry muffin” rash

113
Q

Live attenuated vaccines are for what diseases

A

Smallpox, yellow fever, rotavirus, chickenpox, Sabin polio virus, MMR, Influenza (intranasal)

114
Q

Difference between PKU d/t phenylalanine hydroxylase deficiency vs dihydrobiopterin reductase deficiency is…

A

Phenylalanine hydroxylase def. can be corrected by limiting phenylalanine intake and supplementing tyrosine; BH2 reductase is required to form DOPA (which is required for dopamine), so prolactemia is present too (from lack of negative feedback in pituitary)

115
Q

Nitrates effects

A

Primary venodilators that increase peripheral venous capacitance –> lowers LVEDP; modest effect on arteriolar dilation

116
Q

Gomori trichrome stain of muscle biopsy showing muscle fibers with blotchy red appearance

A

Mitochondrial myopathies

117
Q

Causes of SCID

A

MC- Defective IL-2R gamma chain (x-linked)

Adenosine deaminase deficiency (AR)

118
Q

Sxs of SCID

A

Failure to thrive, chronic diarrhea, thrush, recurrent viral/bacterial/fungal/protozoal infections

119
Q

Findings of SCID

A

Decreased T-cell receptor excision circles (TRECs); absence of thymic shadow, germinal centers, and T cells

120
Q

Side effects of lithium

A

Diabetes insipidus, hypothyroidism, tremor

121
Q

Symptoms of acute intermittent porphyrias

A

5 Ps: Painful abdomen, Port wine-colored urine, Polyneuropathy, Psychological disturbances, Precipitated by drugs, alcohol, starvation

122
Q

Treatment for AIP

A

Glucose and Heme (both inhibit ALA synthase)

123
Q

AIP is caused by deficiency of what enzyme

A

Porphobilinogen deaminase

124
Q

Vincristine/vinblastine MOA; side effects

A

Bind B-tubulin and inhibit its polymerization into microtubules –> M-phase arrest;
SE: neurotoxicity (peripheral neuropathy), constipation

125
Q

Candida albicans morphology

A

Budding yeast with pseudohyphae

126
Q

Signs of increased intracranial pressure in newborn

A

AMS, enlarging head circumference/fontanelle, downward-driven eyes

127
Q

Telomerase function

A

RNA-dependent DNA polymerase that synthesizes telomeric DNA sequences that can replace the lost chromosomal ends of telomeres (cancer cells have increased activity of telomerase to allow continued proliferation)

128
Q

Presentation of Wiskott-Aldrich syndrome

A

Thrombocytopenia, Eczema, Recurrent infections (combined B- and T-lymphocyte deficiency) (WATER)

129
Q

Sickle cell patients are predisposed to infections by…

A

Encapsulated organisms (pneumococcal)

130
Q

Common presentation of sickle cell dz in children

A

Dactylitis (small infarctions in bones of extremities)

131
Q

Mechanism behind warfarin-induced skin necrosis; how to avoid this

A

Transient hypercoagulability state d/t shorter half-life of Protein C;
“heparin bridge”- coadministration of heparin to combat transient hypercoag

132
Q

MOA of enoxaparin

A

LMWH; binds and activates ATIII, increasing its affinity for factor Xa; end effect- prevents factor Xa from activating prothromin –> thrombin

133
Q

Fibrinolytic drugs

A

tPA, alteplase, reteplase, streptokinase, tenecteplase

134
Q

PECAM is responsible for what step in leukocyte extravasation

A

Diapedesis/transmigration: WBC travels between endothelial cells and exits blood vessels

135
Q

Leukocyte adhesion deficiency type 1: what’s the defect and how does it present

A

Defect in LFA-1 integrin (CD18) protein on phagocytes;

Recurrent bacterial skin and mucosal infections W/O pus formation; delayed separation of umbilical cord (>30 days)

136
Q

Follicular lymphoma genetics and effects

A

t(14;18)- translocation of heavy-chain Ig (14) and BCL-2 (18);
Overexpression of bcl-2 (inhibits apoptosis); presents with painless “waxing and waning” LAD

137
Q

Hypocalcemia following RBC/whole blood transfusion is d/t…

A

Citrate anticoagulant in whole blood chelates Ca and Mg, reducing their blood levels

138
Q

Complement binding site on IgG and IgM is located where on Ig molecule?

A

Fc portion, closer to the hinge region

139
Q

Absence of B cells = malformation of which region of LNs?

A

Germinal centers (contains proliferating B cells) and primary lymphoid follicles

140
Q

Red cell index most specific for spherocytosis

A

Elevated mean corpuscular hemoglobin concentration (MCHC); small, round RBCs with less SA and less cyto => increased concentration of Hb within cell

141
Q

Rivaroxaban/apixaban: MOA and uses

A

MOA: directly inhibit factor Xa
Uses: DVT/PE (riva) and stroke prophylaxis in Afib patients

142
Q

Human multi-drug resistance gene (MDR1) codes for what?

A

P-glycoprotein (transmembrane ATP-dependent efflux pump protein): allows tumor cells to reduce chemo drugs in cytosol

143
Q

Folate deficiency inhibits formation of…

A

dTMP

144
Q

MC viral cause of aplastic crisis

A

Parvovirus B19

145
Q

Findings necessary to diagnose TTP

A

Microangiopathic hemolytic anemia and thrombocytopenia

146
Q

Desmopressin MOA in treating hemophilia and von Willebrand dz

A

Increases vWF release from endothelial cells (W-P bodies); increases circulating factor VIII levels

147
Q

Major clinical manifestations of Factor V Leiden

A

DVT (–> PE), cerebral vein thromboses, recurrent pregnancy loss

148
Q

Heparin reversal agent

A

Protamine sulfate

149
Q

Heparin MOA

A

Increases effect of ATIII; lowers the activity of thrombin (factor IIa) and factor Xa

150
Q

Rapid reversal agent against warfarin

A

Fresh frozen plasma (vit K takes days since new coag factors have to be synthesized)

151
Q

Painless, waxing/waning LAD

A

Follicular lymphoma- t(14;18) IgH;bcl-2

152
Q

What feature of a LN biopsy would be most indicative of malignancy?

A

Monoclonal lymphocytic proliferation (polyclonal = benign)

153
Q

Nevirapine and efavirenz: use and MOA

A

Use: antiretroviral drugs for HIV
MOA: Nonnucleoside reverse transcriptase inhibitors (NNRTIs)- inhibit synthesis of viral DNA from the RNA template

154
Q

Monoclonal antibody against HER-2

A

Trastuzumab

155
Q

Peau d’orange and dermal lymphatic invasion

A

Inflammatory breast cancer

156
Q

Why don’t localized intestinal carcinoid tumors produce carcinoid syndrome?

A

Their secretory products (serotonin, bradykinin, PG) are metabolized by liver via first-pass effect. Must metastasize to liver to bypass metabolism and cause carcinoid syndrome (flushing, watery diarrhea, bronchospasm)

157
Q

Glanzmann thrombasthenia

A

Defect in platelet plug formation due to decreased GpIIb/IIIa

158
Q

GpIIb/IIIa inhibitors

A

Abciximab, eptifibitide, tirofiban

159
Q

Treatment for constitutively active tyrosine kinase activity

A

Imatinib

160
Q

Why are patients with sickle cell dz or other hemolytic anemias more prone to develop folic acid deficiency?

A

Bc of increased rate of erythrocyte turnover

161
Q

Pathophys of sideroblastic anemia

A

Decreased heme synthesis due to X-linked defect in d-ALA synthase gene

162
Q

Sideroblastic anemia may be caused by what drug

A

Isoniazid (inhibits pyridoxine phosphokinase, leading to pyridoxine deficiency- pyridoxine is the cofactor for d-ALA synthase)

163
Q

Apoptosis is mediated via what protein

A

Caspase

164
Q

Rasburicase MOA and clinical use

A

MOA: recombinant version of urate oxidase- catalyzes conversion of uric acid to allantoin (5-10x more soluble than uric acid = increased excretion)
Use: Prevents and treats hyperuricemia and the resulting renal manifestations of tumor lysis syndrome

165
Q

Protein that regulates G1 –> S phase transition

A

Retinoblastoma (Rb) protein;
Active Rb is hypophosphorylated and serves as a “brake” to stop the cell from dividing
Inactive Rb is hyperphosphorylated

166
Q

Adverse effect of TMP

A

Megaloblastic anemia, leukopenia, granulocytopenia

“TMP Treats Marrow Poorly)

167
Q

Dermatomyositis

A

Systemic AI dz characterized by proximal muscle weakness; heliotrope rash (erythematous periorbital); Gottron’s papules (raised erythematous plaques over the joints and bony prominences of the hands); muscle biopsy is diagnostic and shows mononuclear perimysial infiltrates and atrophy with CD4+ T cells; may occur as paraneoplastic syndrome

168
Q

What are integrins

A

Membrane proteins that maintain integrity of basolateral membrane by binding to collagen and laminin in basement membrane (also binds fibronectin)

169
Q

Hypersegmented neutrophils are associated with…

A

Vit. B12 or folate deficiency

170
Q

Auer rods are seen in what disorder

A

AML

171
Q

Difference in immunostaining of B cell leukemia and T cell leukemia

A

B cell will stain TdT+, CD10+, CD19+

T cell will stain TdT+, CD2-8+

172
Q

Translocation seen in Burkitt lymphoma

A

t(8;14)– translocation of c-myc (8) and heavy-chain Ig (14)

c-myc functions as a transcription activator

173
Q

How to distinguish CML from leukemoid reaction

A

CML will have decreased leukocyte alkaline phosphatase (LAP); leukemoid reactions have increased LAP

174
Q

Translocation seen in CML

A

t(9;22), BCR-ABL;

Increases tyrosine kinase activity

175
Q

Treatment for CML

A

Imatinib (tyrosine kinase inhibitor)

176
Q

What does an M spike on serum protein electrophoresis indicate?

A

Multiple myeloma

177
Q

PNH pathophysiology; clinical presentation; treatment

A

Impaired synthesis of GPI anchor for CD55+ DAF that protects RBC from complement leads to complement-mediated intravascular hemolysis;
Pres: triad of hemolytic anemia, pancytopenia, and venous thrombosis
Tx: Eculizumab (terminal complement inhibitor)

178
Q

Amyl nitrite is used for ____ poisoning

A

Cyanide (Nitrites are oxidizing substances that induce production of metHb, which binds to cyanide, preventing its binding to mitochondrial cytochrome enzymes)

179
Q

Key growth factors for angiogenesis

A

Vascular endothelial growth factor (VEGF) and fibroblast growth factor (FGF)

180
Q

Things that can induce hemolytic episodes in G6PD deficiency

A

Sulfa drugs (TMP-SMX), antimalarials, infections, fava beans

181
Q

Gene mutation associated with chronic myeloproliferative disorders

A

V617F JAK2 mutation

182
Q

Drugs that can cause aplastic anemia

A

Chloramphenicol, benzenes, carbamazepines, alkylating agents, antimetabolites, sulfonamides

183
Q

Treatment for Human epidermal growth factor receptor 2 positive breast cancer

A

Trastuzumab (tyrosine kinase inhibitor bc HER2 is a TK)

184
Q

6-mercaptopurine is activated by what enzyme? Inactivated by what enzyme

A

Activated by hypoxanthine-guanine phosphoribosyl transferase (HGPRT);
Inactivated by thiopurine methyltransferase (TPMT) and xanthine oxidase (XO);
Must be careful if pt is on allopurinol (XO inhibitor) as it increases toxicity of 6-MP

185
Q

Histological characteristic of eosinophil

A

Bi-lobed nucleus, packed with large eosinophilic (red or pink) granules of uniform size

186
Q

Unilateral pulmonary opacification on xray with same side tracheal deviation is d/t…

A

Obstructive lesion in mainstem bronchus, which causes obstructive atelectasis and complete lung collapse (as air diffuses out of alveoli);
Pleural effusion will cause the same xray finding, but with contralateral tracheal deviation

187
Q

Why do reticulocytes appear blue on Wright-Giemsa stain?

A

Residual ribosomal RNA

188
Q

MOA of varenicline

A

Partial agonist of nAChR in CNS;
Reduces withdrawal by partially activating receptors;
Attenuates the rewarding effects of smoking by blocking attachment of nicotine

189
Q

MOA of raltegravir

A

HIV antiviral- integrase inhibitor (prevents HIV double-stranded DNA from integrating with host DNA, which prevents viral mRNA transcription)

190
Q

Transformation (bacteria) definition; which organisms can undergo transformation

A

Ability to take up naked DNA;

S. pneumo, H. influenza type b, Neisseria (SHiN)

191
Q

Myeloperoxidase

A

Blue-green heme-containing enzyme that gives sputum its color; released by neutrophil granules to form bleach

192
Q

Function of leukotriene B4

A

Neutrophil chemotactic agent

193
Q

Cause of high chloride content in venous RBCs

A

“Chloride shift”- as CO2 enters RBC, CA turns it into H+ and HCO3-, which then diffuse out of the RBC. Cl- ions diffuse into the RBC to maintain electrical neutrality

194
Q

Metalloproteinase

A

Enzyme that degrades ECM and BM;
Normal process of tissue remodeling;
Increased expression in tumor cells (invasion through BM and connective tissue

195
Q

Reid index- how to calculate and what does it indicate

A

Thickness of mucous gland layer/thickness of bronchial wall;

Index > 0.4 indicates chronic bronchitis

196
Q

Chronic granulomatous disease- Cause, presentation,

A

Defect in NADPH oxidase in neutrophil and macrophage phagolysosomes;
Recurrent bacterial and fungal infections by catalase + organisms

197
Q

Catalase + organisms

A

Nocardia, pseudomonas, listeria, aspergillus, candida, E. coli, staphylococci, serratia, B cepacia, H pylori (CATs Need PLACESS to Belch Hairballs)

198
Q

Calcified, supradiaphragmatic and pleural plaques; ferriginous bodies found in alveolar sputum

A

Asbestosis

199
Q

Airway/GI infections, AI dz, atopy, anaphylaxis to transfusion

A

Selective IgA deficiency

200
Q

Interstitial fibrosis presents with increased or decreased radial traction on airway walls

A

Increased

201
Q

Ghon complex

A

Hilar LAD + peripheral granulomatous lesion in middle or lower lung lobe;
Primary TB infection

202
Q

Inhibitors of P450

A

Acute alcohol abuse, ritonavir, amiodarone, cimetidine, ketoconazole, sulfonamides, isoniazid, grapefruit juice, quinidine, macrolides (except azithro)
(AAA RACKS In GQ Magazine

203
Q

Where is surfactant stored/released from?

A

Lamellar bodies of TII pneumocytes

204
Q

Hirschsprung is a/w with disorder

A

Down syndrome

205
Q

Inspissated fecal mass obstructing the ileum is a finding in what disorder

A

CF

206
Q

Major stimulator of central chemoreceptors

A

Increase in PaCO2

207
Q

Major stimulator of peripheral chemoreceptors (carotid and aortic bodies)

A

Primarily hypoxemia (also PaCO2 increase and pH decrease)

208
Q

Peptostreptococcus, fusobacterium, bacteroides, and provatella cause what

A

Aspiration causes lung abscess

209
Q

H. influenzae type b capsule contains…

A

Polyribosylribitol phosphate (PRP)

210
Q

Long bone fracture followed by hypoxemia, petechial rash over chest, and neurologic abnormalities is indicative of…

A

Fat embolism

211
Q

MOA of 5-FU

A

Thymidylate synthase

212
Q

MOA of methotrexate

A

Inhibits dihydrofolate reductase

213
Q

Effect of leucovorin on methotrexate and 5-FU

A

Leucovorin is folinic acid (THF derivative) that “rescues” methotrexate toxicity but worsens 5-FU toxicity

214
Q

Methacoline MOA and clinical use

A

MOA: muscarinic cholinergic agonist
Use: Bronchoprovocation technique for asthma diagnosis; causes bronchoconstriction and increased airway secretions

215
Q

CREST syndrome

A

Localized variant of systemic scleroderma (triad of autoimmunity, noninflammatory vasculopathy, and collagen deposition with fibrosis);
Calcinosis, Raynaud, Esophageal dysmotility, sclerodactyly, telangiectasia

216
Q

Causes of cheyne-stokes breathing

A

Advanced CHF (cycle of hyperventilation causing hypocapnia, which causes periods of apnea, which causes hypercapnia, which causes hyperventilation), neurologic dz (stroke, brain tumor, traumatic brain injury)

217
Q

Hair cell leukemia

A

Mature B-cell tumor; cells have filamentous projections; marrow fibrosis causes dry tap; massive splenomegaly, stains TRAP; tx = cladribine

218
Q

Deficiency of what vitamin predisposes to squamous metaplasia

A

Vit A (vit A and it’s metabolite retinoic acid are required to maintain specialized epithelia, such as mucus-secreting columnar epithelium)

219
Q

Histological findings of mesothelioma

A

Psammoma bodies; long, slender microvilli; abundant tonofilaments

220
Q

Particles lodged within terminal bronchioles are removed by what mechanism

A

Mucociliary clearance;

Particles distal to this are removed by macrophages

221
Q

Legionella: sxs, lab findings, diagnosis

A

Sxs: High fever, pneumonia, diarrhea, HA/confusion
Lab findings: hyponatremia
Diagnosis: urine antigen test

222
Q

Function of TNF-a

A

Mediates septic shock. Activates endothelium. Causes WBC recruitment, vascular leak. Causes cachexia in malignancy.

223
Q

Factor V Leiden: pathophys; complications

A

Production of mutant factor V that is resistant to degradation by activated protein C;
Complications include DVT, cerebral vein thromboses, and recurrent pregnancy loss

224
Q

Sxs of spinal metastasis; MC cancers that met to bone

A

Constant pain, not responsive to position changes, worse at night.
Prostate, breast, kidney, thyroid, lung (PB/KTL- “lead kettle”)

225
Q

Pathogenesis of chronic transplant rejection

A

CD4+ T cells respond to recipient APCs presenting donor peptides, including allogeneic MHC

226
Q

Effect of pCO2 on cerebral blood flow

A

Decrease in pCO2 (hyperventilation) causes vasoconstriction of cerebral vessels, causing a decrease in CBF

227
Q

Celecoxib MOA; benefits over other NSAIDs

A

Reversibly inhibits COX2, which mediates inflammation and pain;
Spares COX1, which helps maintain gastric mucosa; thus does not have corrosive effects of other NSAIDs on GI lining;
Spares platelet function as TXA2 production is dependent on COX1

228
Q

Primary biliary cirrhosis: pathophysiology; clinical features; biopsy findings

A

Pathophys: Chronic AI liver dz characterized by destruction of small to mid-sized intrahepatic ducts with resulting cholestasis;
Clinical fts: fatigue, itching, hepatomegaly
Biopsy findings: patchy lymphocytic inflammation with destruction of intrahepatic ducts; necrosis and micronodular regeneration of periportal tissues

229
Q

Uses for 5-HT3 antagonist

A

N/V caused by GI irritants (infections, CTX, distention)

230
Q

Replication of HBV

A

Partial dsDNA -> + RNA template -> partial dsDNA progeny

231
Q

Anti-HAV IgG indicates what

A

Prior infection and/or prior vaccination; protects against reinfection

232
Q

Presentation of tracheoesophageal fistula with esophageal atresia in neonate

A

Drooling (inability to swallow saliva), choking, coughing, cyanosis with feeds (d/t reflux of foods and aspiration);
Xray will show stomach bubble due to air from trachea entering distal esophagus

233
Q

Lynch syndrome (HNPCC)

A

AD mutation of DNA mismatch repair genes (MSH2 & MLH1) with subsequent microsatellite instability

234
Q

Function of IL-10

A

Attenuates inflammatory response; decreases expression of MHCII and Th1 cytokines (IFN-y and IL-2); inhibits activated macrophages and dendritic cells (TGF-B also attenuates the immune response)

235
Q

Indications for Vitamin D supplementation in infants

A

Exclusively breast fed, low sunlight exposure, dark pigmented skin

236
Q

Indications for iron supplementation in infants

A

Low birth weight/Pre-term

237
Q

Tx for H. pylori

A

Clarithromycin, amoxicillin, PPI

238
Q

Most specific test for acute cholecystitis

A

Nuclear medicine hepatobiliary scan (cholescintigraphy)

239
Q

What stains magenta in a PAS stain? What is a PAS stain useful for?

A

Glycogen and mucopolysaccharides (PASs the Sugar);

Useful for diagnosing Whipple disease (Tropheryma whipplei)

240
Q

Function of pudendal nerve

A

Sensory: external genitalia and skin around anus/perineum
Motor: pelvic floor muscles, external urethral and anal sphincters

241
Q

Damage to pudendal nerve causes what sxs

A

Fecal incontinence, urinary incontinence, sexual dysfunction, perineal pain

242
Q

Drugs used for methicillin-resistant Staph

A

Vancomycin, daptomycin, linezolid

243
Q

Daptomycin: mechanism, clinical use, and adverse effects

A

MOA: lipopeptide used for Gram + organisms; creates transmembrane channels that cause intracellular ion leakage
Use: S. aureus skin infections (esp. MRSA), bacteremia, VRE, endocarditis
SE: myopathy, CPK increase

244
Q

DOC for supraventricular tachycardia

A

Adenosine

245
Q

IL-8

A

Released by macrophages;

Induces neutrophil chemotaxis and phagocytosis

246
Q

Mechanism of glycogen synthesis upgregulation by insulin

A

Insulin binds cell surface receptors which have intrinsic tyrosine kinase activity; IRS-1 is phosphorylated, which activates phosphatidylinositol-3-kinase (PI3K), which then activates protein phosphatase, which dephosphorylates glycogen synthase (activating it)

247
Q

“Blowing” early decrescendo murmur

A

Aortic regurgitation

248
Q

Glioblastoma features

A

Highly malignant primary brain tumor; found in cerebral hemispheres, can cross corpus callosum (“butterfly glioma”); “psudopalisading” pleomorphic tumor cells border central areas of necrosis and hemorrhage (seen grossly); stain astrocytes for GFAP

249
Q

DOC for OCD

A

SSRI

250
Q

Bicuspid aortic valve most likely leads to…

A

aortic stenosis in 50s; abnormally shaped valve can cause hemodynamic stress, accelerating the aging process and causing premature atherosclerosis and calcification of the aortic valve

251
Q

Abusive head trauma in a baby can result in

A

subdural hematoma and retinal hemorrhages

252
Q

Choriocarcinoma: What is it, when/how can it develop, features seen, lab findings, how/where does it spread, tx, prognosis

A

Malignant ovarian neoplasm of the ovary (malignancy of trophoblastic tissue);
Can develop during or after pregnancy in mother or baby;
NO chorionic villi present, increased frequency of bilateral/multiple theca-lutein cysts;
Increased B-hCG;
Hematogenous spread- lungs most common (SOB, hemoptysis);
Very responsive to CTX

253
Q

Mitochondrial dysfunction presentation

A

Myopathy (muscle weakness, myalgia), nervous system dysfunction (neuropathy, seizures), lactic acidosis, ragged red fibers on biopsy

254
Q

Dobutamine: MOA and effects

A

B-adrenergic agonist (primarily at B1 receptors, slight agonist at B2 receptors);
Positive inotropic effect, slight positive chronotropic effect

255
Q

Adverse effects of foscarnet

A

Nephrotoxicity;
electrolyte imbalances (hypo- or hypercalcemia, hypo- or hyperphosphatemia, hypomagnesemia, hypokalemia);
Hypocalcemia and hypomagnesemia can lead to seizures

256
Q

List the opioid analgesics

A

Morphine, fentanyl, codeine, loperamide, methadone, meperidine, dextromethorphan, diphenoxylate, pentazocine

257
Q

Enteric bacteria produce what vitamins

A

Vitamine K and folate

258
Q

Achondroplasia pathophys

A

Point mutation in FGFR3 (fibroblast growth factor receptor 3), causing overexpressiong of FGFR3, which inhibits chondrocyte proliferation and prevents endochondral ossification in the long bones

259
Q

Microscopic findings in ALS

A

Loss of neurons in anterior horn (LMN lesion);
Degeneration and atrophy of lateral corticospinal tracts (UMN lesion);
Loss of neurons in motor nuclei of CN V, IX, X, XII

260
Q

Clinical findings of tabes dorsalis

A

Sensory ataxia (wide-based gait, positive Romberg sign), lancinating pains, neurogenic urinary incontinence, Argyll Robertson pupils

261
Q

Prinzmetal angina: definition, triggers, tx

A

Episodic, transient attacks of coronary vasospasm (at rest and at night), producing temporary transmural myocardial ischemia with ST- elevation;
Triggers include smoking, cocaine, dihyrdoergotamine/triptans
Tx: smoking/drug cessation, vasodilator therapy (nitrates, CCBs)

262
Q

Immunological response responsible for Crohns Dz

A 
Th1 cells (secrete IFN-g, IL-2, and TNF) causing intestinal damage;
non-caseating granulomas
263
Q

Location of AV node

A

Endocardial surface of the RA, near the insertion point of the leaflet of the triscuspid valve, near the opening of the coronary sinus

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