First 50

Question 0

Membranous nephropathy can be caused by? Think metal

Answer 0

Gold

Question 1

What can cause significant serum creatinine rise in a patient started on ACE inhibitors

Answer 1

Increase in creatinine is normal as patient loses efferent constriction to maintain GFR. Caution in patient with bilateral renal stenosis, decompensated heart failure, CKD or volume depletion, as a decrease in RPF also decreases FF, hence acute kidney failure

Question 2

FSGS can be caused by which two substances

Answer 2

Palmidronate and heroin

Question 3

Drug induced glomerula disease caused by..name 5

Answer 3

Aminoglycosides, radiocontrast, crisplatin, ampB, foscarnet

Question 4

Drug induced TUBULAR OBSTRUCTION caused by? Name them

Answer 4

Sulfonamides, MTX, intra acyclovir and triamterene. Precipitate In tubules and cause renal failure

Question 5

Renal interstitial infiltration caused by…name 6.. One main

Answer 5

METHICILLIN
cephalosporins
Acetazolamide
Allopurinol
Sulfonamides
NSAIDs

Question 6

Thyroid development

Answer 6

The phargyngeal membrane epithelium evaginates or out pouches with the thyroid gland itself at the end of that evagination. Remaining evagination forms the thyroglossal duct which extends from the thyroid isthmus superiorly to the dorsal tongue surface,foramen cecum, the thyroid migrates to the lower anterior neck between upper trachea and larynx. Failure of migration leads to formation on the thyroglossal duct..at any point

Question 7

Lingual thyroid, features of hypothyroidism in children

Answer 7

Lingual thyroid forms within the tongue when the thyroid fails to migrate. Can cause airway obstruction. Surgical removal leads to hypothyroidism:- lethargy, feeding problems, hypotonia, macroglossia, large fontanelles, prolonged jaundice, dry skin, umbilical hernia

Question 8

Other embryological conditions relating to failed migration. Name two

Answer 8

1. Kallmans, here the GnRH secreting neurons do not migrate for the olfactory bulb to the hypothalamus
2. Crytorchism, here the testes to not migrate from the intra abdominal location to scrotum

Question 9

On schwanommas, where do these arise

Answer 9

They belong to the PNS, arise from neural crest cells consequently. They stain for S100. Densely cellular is the antoni a pattern and antoni b pattern is myxoid. Oligodendrocytes, CNS version of these cells transition to Schwann between brain and spinal cord, hence cranial vault and spinal canal have inhabit schwanommas. Cranial nerves are covered by Schwann cells! Most common occurs at the cerebella pontine angle, acoustic neuroma, tinnitus, vertigo and sensorineural hearing loss

Question 10

Intraabdominal abcesses due to two common bacteria

Answer 10

Bactericides and Ecoli. Enterococci and strep possible too

Question 11

Risperidone. MOA and side effects

Answer 11

Used for schizophrenia.
Inhibits hypothalamic dopamine, dopamine acts on d2 lactotroph receptors causing decreased synthesis and secretion of prolactin.
Hence, drug causes hyperprolactinemia hence causes breast soreness, amenorrhea and galactorrhea

Question 12

Name two anticholinergic agents used to counter the effects of vagal stimulation on the pulmonary system

Answer 12

Vagal stimulation can lead to increased bronchoconstriction via M3 receptors and increased mucus production leading to increased resistance and work of breathing. Ipratronium and tiotropium counteract these effects

Question 13

Hypoxic vasoconstriction..describe

Answer 13

It occurs in the lungs and allows for diversion of flow from under ventilated lung to more ventilated lung. Blood oxygen content falls with increased vascular resistance

Question 14

DSM V criteria for narcolepsy

Answer 14

Recurrent lapses into sleep or napping several times a day at least 3 times weekly for 3 months plus one of the following
cataplexy
Hypocretin 1 deficiency in CSF
REM latency <= 15 mins

Question 15

Virulence in Mycobacteria

Answer 15

Cord factor a mycoside made of 2 mycolic acid bound to disaccharide trehalose. It prevents neutrophil inhibition and induces TNF release, destroys mitochondria. This allows serpentine pattern growth
Sulfatides inhibit lysosomal fusion to phagosomes hence Mycobacteria remain facultative intracellular within phagocytes

Question 16

Raltegravir

Answer 16

First integrate inhibitor. Prevents virus from using host machinery to synthesize its mRNA

Question 17

LIPOOLIGOSACCHARIDE OR LOS OF MENINGITIS

Answer 17

Associated with toxic effects of meningitis

Question 18

C-difficule, how many toxins? Name them and what they do

Answer 18

Two toxins.

1. Toxin A is an Enterotoxin ANDOs a neutrophil chemoattractant. Hence leads to inflammation, gut water loss and diarrhea and mucosal death
2. Toxin B is a cytotoxin which de polymerizes actin hence cytoskeletal destruction, mucosal necrosis and death

Question 19

Which bacterial toxins and/or drugs are associated with the following:-
Mitochondrial energy production, ribosomal protein synthesis, apical ion transport, cell membrane integrity?

Answer 19

1. Mitochondria- NRTI, cyanide
2. Ribosomal protein- shiga from shigella and shiga like from EHEC and EIEC. Not part of normal gut flora
3. Apical transport- A part Of AB cholera toxin. Activates AC and G protein leading to increased Na and Cl exit. Water follows hence diarrhea
4. Cell membrane integrity- alpha toxin lecithinase from c perfringes. Normally causes gas gangrene. Soil contaminant. Can cause transient watery diarrhea.

Question 20

At what point do other energy sources, than glucose become important. How much energy is gained from those sources.

Answer 20

Starvation periods 16-24 hours, ketone bodies and free fatty acids, products of lipid oxidation. With starvation, lipid triglycerides are broken down into free fatty acids., free fatty acids are then beta oxidized to ketone bodies in mitochondria of liver. For 1 fatty acid, you get 1 of NADH, fadh2, acetyl coA. Acetyl coA is oxidized to Co2 and 3 nadh, 1 Fadh and 1 GTP is released. With overwhelming oxidation, acetyl coA is shunted to make ketone bodies.

Question 24

Glycogen storage enzymes and disease states 1, 2 and 5

Answer 24

Von Gierke is type 1, due to deficient glucose 6 phosphatase enzyme (note g6p is the end product of glycogenolysis and gluconeogenesis in liver). Cannot make glucose. Hence hypoglycemiam lactic acidosis, stunted growth

Question 25

Detection bias
Lead time bias
Allocation bias

Answer 25

Detection is when a risk factor dna lead to more investigation such as smoking
Lead is when a screening test diagnoses a disease earlier without the duration or natural history of the disease changing. It makes it look like a change in survival but there isn’t
Allocation is when there is no random assignment to control and treatment group

Question 26

Three causes of polyuria and polydipsia

Answer 26

Diabetes Mellitus, diabetes insipidus and psychogenic or primary polydipsia

Question 27

Treatment for nephrogenic polydipsia

Answer 27

HCTZ, indomethacin..the later causes an increase in water absorption by decreasing prostaglandin synthesis, remember prostaglandins inhibit ADH

Question 28

Antidotes for hemorrhagic cystitis..what drug causes it | Neutropenia, platinum and alkylating agents, cardiotoxicity

Answer 28

Give Mensa, for cyclophosphamide induced. Neutropenia give filgastrim, a Gcsf analog For PLT/Akyl agents give amisfostine, a free radical scavenger to reduce nephrotoxicity, For cardiotoxicity, give iron chelation agent dexrazoxane, for anthracyclines such as doxorubicin

Question 29

Cardiac action potentials. Pacemaker versus non pacemaker

Answer 29

Phase 4 to 0, 3, 4 for pacemaker. 4 is due to Na, then Ca, then K, the. Na Phase 4,0,1,2,3,4 for non pacemaker cells. 0 is Na, 1 is due to k leaving and 2 is due to Ca entering, 3 due to K

Question 30

Vaginal adenosis? What is it a precursor for?

Answer 30

Replace vaginal squamous with columnar, happens in female kids of women e posed to DES or diethylstilbestrol during pregnancy. Precursor for clear cell adenocarcinoma of the vagina

Question 31

Turners associated with 3 main extra gonadal abnormalities. Name them

Answer 31

Btw these lose normal follicles by age 2 due to lack of paternal X. - physical- short, webbed neck, shield chest with widely spaced nipples - cardiac such as bicuspid AV, dissection and coarctation - lymphadema

Question 32

Treatment for PSVT..NB it is due to re entrant impulse through AV NODE

Answer 32

Sinus massage. Sinus is distal to the bifurcation of the common carotid..increased baroreceptor firing via IX,.PROLONGS AV NODE REFRACTORY PERIOD.Note the refractory period of ventricle is fixed

Question 33

Tx for gono, and chylamydia...cause for urethritis in MSM

Answer 33

Fluoroquinolones and ceftriaxone for gono, One dose of azithromycin or multiple doses for doxycycline for Chylamdia..Ecoli in MSM

Question 34

Rules of 2 for merckels diverticulum

Answer 34

``` 2% of the population 2 feet from the ileocecal valve 2 inches in length 2% asymptomatic Males 2* more likely to be infected ```

Question 35

Duodenal atresia, hirschsprung, umbilical hernia, imperforate anus, omphanocele, mal rotation ...describe

Answer 35

1. Duodenum does not recanalize in early embryo..trisomy 21 associated 2. Neural crest cells don't migrate to intestinal wall 3. Weak abdominal wall at umbilicus. Common, close spontaneously at 2 years kids. Midline, covered by skin unlike omphanoceles which are covered by peritoneal sac, otherwise similar 4. Anorectal structures fail to develop adequately. First days of life, newborn does not pass meconium 5. Done 6. Midgut does not COUNTERCLOCKWISEly rotate as it returns to abdominal cavity in early development. Intestine is abnormally positioned in the cavity and can twist to form a volvulus or loop.

Question 36

When does the omphalomesenteric duct or Vitellinr duct obliterate. Describe what it connects and diseases associated with failed obliteration

Answer 36

By 7th week, connects the lumen of mid gut/intestine to the yolk sac cavity..then umbilicus 1. Persistent Vitelline duct or vitelline fistula; does not close at all.meconium discharge at umbilicus 2. Meckels; most common. Partial closure with patent part attached to ileum 3. Vitelline sinus; partial closure with patent part at the umbilicus 4. Vitelline duct cyst or entero cyst when peripheral portions such as ileum and umbilicus obliterate but central portion stays. Fibrous bands connect the cysts to abdominal wall and ileum These are incidentally discovered, usually asymptomatic..recall rules of 2's for meckels.

Question 37

Collagen types and disease associations

Answer 37

1 (think hardest), bone, tendon, ligament, cornea, (dentin, bv, scar tissue) MOST ABUNDANT..MATURE SCARS Autosomal dominant osteogenesis imperfecta 2 cartilage, vitreous humor, nucleolus pulposus 3 (think other main organs) lung, skin, intestines, marrow, lymphatic and granulation tissue... Ehler- danios associated with 3 and 4 4 basement membrane Alport syndrome associated

Question 38

Myocardial infarction pathology

Answer 38

4 hrs and less, no change visible Within 1 day early to late COAGULATIVE necrosis with edema, hemorrhage, wavy fibers which progress to marginal contraction bands 1-5 days neutrophils!!!! And coag necrosis 5-10 macrophage phagocytosis 10-14 granulation tissue and new vessels 2wks-2 months collagen deposits and scar forms

Question 39

Categories of benzos

Answer 39

Short is triazolam 6hrs Medium is lorazepam 6-24hrs Long is chlordiazepoxide, flurazepam and diazepam 24 hrs

Question 40

First line for GAD and panic disorder..time before effect seen..option and side effect

Answer 40

SSRI LIKE parole tine is first line 4 wks minimum before effect seen Give benzos as bridge therapy..side effect is daytime fatigue and impaired judgement

Question 41

Define conus MEDULLARIS syndrome

Answer 41

Spinal cord ends at L2 in most adults known as conus medullaris. Spinal nerves leave now as peripheral nerves called Cauda equina. In this syndrome, there is a lesion at L2. Leads to flaccid paralysis of the bladder and rectum, impotence, saddle s3-s4 roots anesthesia..can be due to a fracture, disk hernia or tumor

Question 42

Cauda equina syndrome

Answer 42

Rupture of disc that compresses 2 or more of the 18 spinal roots of the equina, can also be due to trauma or lesion. Cauda equina does sensory and motor innervation to lower extremities, pelvic floor and sphincters Symptoms of low back pain radiating to one or both kegs, saddle anesthesia, anocutaneous reflex loss, bowel and bladder dysfunction at s3-s5 roots and loss of ankle jerk reflex with plantar flexion weakness.

Question 43

HPA axis SUPPRESION what causes that

Answer 43

Patients on steroids. Need to increase dose if having surgery or with stress

Question 44

Fabry disease aka angiokeratoma corpora diffusum

Answer 44

Inherited alpha galactosidase A deficiency leading to the globoside ceramide tri hexoside accumulation Burning pain in extremities called acroparesthesia, punctuate dark red non blanching macules or papules called angiokeratoma between umbilicus and knees, progressive renal failure and hypohydrosis or reduced sweat

Question 45

Increased risk of acute leukemia with what diseases or syndromes

Answer 45

Bloom, downs, ataxia-telangiectasia, Patau and fanconi anemia

Question 46

What drug most likely and least likely causes EPS

Answer 46

Risperidone most likely and clozapine least likely. Clozapine associated with agranulocytosis

Question 47

Antipsychotic timeline and symptoms

Answer 47

Rules of 4 Hours to days acute dystonia. Give antihistamine like diphenhydramine and anticholinergics like benztropine or trihexyphenidyl Days to weeks Weeks to months Parkinsonism give anticholinergic benztropine Months to years tardive dyskinesia , involuntary perioral movements..can be irreversible even post stopping drug Akathsia or restlessness happens anytime Worst is NMS where there's autonomic instability, muscle rigidity, delirium and fever

Question 48

Treatment for MAC, potential complication of measles, rabies affecs vs rhinovirus and CMV

Answer 48

1. Azithromycin 2. Subacute sclerosing panencephalitis that is fatal..non m protein antibody 3. Affects NachR, CMV affects integrins and rhinovirus ICAM1

Question 49

What enzyme is responsible for the first step in fatty acid synthesis

Answer 49

Acetyl coA carboxylase

Question 50

Pathway for Neisseria meningitis contamination..in what population is it highest? Pathway for infection spread

Answer 50

Pharynx, blood, choroid plexus and meninges..high in military recruits and college students, respiratory droplets.

Question 51

Pharynx to lymphatics and meninges is the pathway of contamination of which bacteria Middle ear, contiguous tissues and meninges is for?

Answer 51

H.flu, strep pneumoniae

Question 52

Common site for aortic rupture from trauma. Compare to that for aneurysms

Answer 52

Traumatic Aortic rupture occurs mostly at the isthmus distal to where the left subclavian come off the aorta. The site where the brachiocephalic artery comes out is notable for aneurysms due to syphilis, hypertension and vasculitis