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Boards Review > Goljan High Yield > Flashcards

Goljan High Yield Flashcards

1
Q

Roles of cortisol (4)

A
  1. Permissive action over glucagon and epinephrine
  2. Gluconeogenesis from aa
  3. Proteinolysis
  4. Lipolysis
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2
Q

Roles of glucagon (5)

A 
Liver glucogenolysis
Lvier gluconeogenesis
Ureagenesis
Ketogenesis
Lipolysis
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3
Q

Roles of epinephrine (4)

A
  1. Liver glycogenolysis and gluconeogensis (from alanine release from skeletal muscle)
  2. Skeletal Muscle glycogenolysis and gluconeogenesis.
  3. Decrease glucose uptake
  4. Adipose tissue lipolysis and gluconeogenesis (from glycerol)
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4
Q

Roles of growth hormone (3)

A

Adipose tissue lipolysis
Stimulates Protein synthesis via IGF-1
Decreases glucose tissue uptake

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5
Q

Response to hypoglycemia is largely driven by ____ (2)

A

Epinephrine and glucagon

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6
Q

Early sx of hypoglycemia

A

sweating, tremors, palpitations, hunger, nervousness => due to NE & Epi release

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7
Q

Late sx of hypoglycemia

A

behavioral changes, confusion, visual disturbances, stupor, seizures; and if prolonged hypoglemia, irreversile neuro deficits and death.

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8
Q

Why don’t you give beta blockers in hypoglycemia?

A
  1. Exacerbate hypoglycemia. Recall that Beta2 receptors increase liver gluconeogenes, glycogenolysis, lypolysis and skeletal muscle glycogenolysis. If this is blocked, the result is hypoglycemia.
  2. Mask adrenergic symptoms. Because of inhibition of Epi & NE compensatory response.
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9
Q

Cocaine acts by ___

A

Decreased uptake of Serotonin/Dopa/Nor (triple reuptake inhibitor)

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10
Q

UVB light produces what DNA mutations?

A

Thymidine dimers

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11
Q

Cytochrome oxidase is inhibited by ___ (2)

A

CO and cyanide

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12
Q

Muscle atrophy in a cast is caused by ___

A

Polyubiquitination of proteins

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13
Q

MC vitamin deficiency in alcoholics

A

Folic acid (B9)

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14
Q

In the case of ambiguous genitalia, one must always confirm ___

A

Genetic sex

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15
Q

MC mineral deficiency in alcoholics

A

Magnesium

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16
Q

Caisson’s disease (decompression sickness)

A

Due to large volumes of N2 dissolved in blood; PN2 decreases due to bubble formation and movement into tissues

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17
Q

Vitamin E toxicity

A

Decreases Vitamin K dependent factors

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18
Q

Pyridoxine (B6) used in ___

A

Transamination rxns involving AST/ALT

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19
Q

ANP acts in opposition to ___

A

Angiontensin II (–| ADH/aldo release, –| Na reabsorption, –| renin release, vasodilation)

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20
Q

Vitamin deficiency in baby of vegan woman

A

B12 (anemia)

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21
Q

EBV attaches to ____ on B cells

A

CD21

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22
Q

Hypogonadism, MR, and unilateral gynecomastia

A

Klinefelter syndrome (XXY)

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23
Q

Hypogonadism, anosmia, and color blindness

A

Kallmann syndrome (absent GnRH)

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24
Q

Hypogonadism, MR, and retinitis pigmentosum

A

Laurence-Moon-Biedl syndrome (cilia defect)

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25
Q

Male with hypogonadism, MR, short stature, and webbed neck

A

Noonan syndrome (similar to Turner’s, RAS/MAPK defects)

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26
Q

Male pseudohermaphrodite with cryptorchidism

A

Testicular feminization (absent androgen receptors)

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27
Q

Microdeletion syndrome with hypogonadism, MR, short stature, obesity

A

Prader Willi (Chr.15 deletion, paternal origin)

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28
Q

Neurofibromatosis patient with severe diastolic HTN

A

Pheochromocytoma

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29
Q

Automobile workers present with headache, N&V, muscle weakness, and abdominal cramps

A

Lead poisoning from battery incineration

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30
Q

Newborn female with hand/foot edema and webbed neck

A

Turner’s (45XO)

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31
Q

What has led to decreased incidence of SIDS?

A

Baby lies supine! (otherwise they don’t move their head in response to hypercapnia and die)

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32
Q

Mature breast milk v. cow milk

A

Cow milk: more Vit K, B12, casein protein

Breast milk: more ascorbic acid, better-absorbed iron, whey protein

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33
Q

Vitamin absent in colostrum

A

Vitamin D

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34
Q

Infant fed on goat milk at risk of. . . ?

A

B9, B6, iron deficiency –> anemia

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35
Q

Type of UV light responsible for majority of corneal burns and cancer?

A

UVB (‘B is bad’)

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36
Q

Retinal hemorrhage in young child

A

Abuse (shaken baby syndrome)

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37
Q

Fire ant bites

A

Multiple wheals that later develop into vesicles and pustules

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38
Q

Black widow bite (latrotoxin)

A

Painful bite –> crampy pain in thighs/abdomen (excessive Ach release)

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39
Q

Southwest scorpion bite

A

Painful sting –> itching, paresthesias, N&V, HTN

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40
Q

Brown recluse spider bite

A

Painless bite (red papule) –> hemorrhagic blister surrounded by purpura

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41
Q

Chigger bites

A

Extremely pruritic discrete bright red papules on legs/waist

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42
Q

Child who ingests bottle of aspirin

A

AG metabolic acidosis (do NOT develop mixed metabolic acidosis/resp alkalosis)

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43
Q

Rx for aspirin OD

A

Gastric lavage with activated charcoal; alkalinize urine

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44
Q

____ more likely to infect fetus after first trimester

A

Syphilis

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45
Q

THC metabolites in urine

A

Marijuana

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46
Q

Causes of liver angiosarcoma

A

Vinyl chloride, Ar, thorotrast

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47
Q

Urine 17-ketosteroids increased in ___

A

21-hydroxylase, 11-hydroxylase deficiency

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48
Q

Urine 17-hydroxycorticoids increased in ___

A

11-hydroxylase deficiency

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49
Q

Ambiguous male genitalia in CAH

A

17-hydroxylase deficiency

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50
Q

Ambiguous female genitalia in CAH

A

21-hydroxylase, 11-hydroxylase deficiency

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51
Q

Normal aging - CV

A

Loss of aortic elasticity

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52
Q

Normal aging - Derm

A 
Osteoarthritis
Loss of skin elasticity
Increased collagen cross bridging
Senile purpura (vessel instability)
Decreased skin turgor
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53
Q

Normal aging - Pulm

A

Senile emphysema

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54
Q

Normal aging - Special Senses

A

Cataracts
Presbycusis, otosclerosis
Reduced taste/small
Arcus senilis

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55
Q

Normal aging - Immuno

A

Increased autoantibodies
Decreased cellular immunity
CD4 > CD8

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56
Q

Normal aging - Repro

A

Breast/vulvovaginal/testicular atrophy
BPH
Decreased E/T
Increased FSH/LH

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57
Q

Normal aging - Renal

A

Decreased GFR/Cr clearance

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58
Q

Normal aging - Endocrine

A

Increased insulin resistance

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59
Q

Organs injured by acetaminophen toxicity

A

Kidney (renal medulla), liver

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60
Q

Mechanism of corticosteroid immunosuppression

A

Block phospholipase A2 –| PG, LT production
Block leukocyte adhesion
Neutrophilia (marginating pool knocked into circulation)
Decrease lymphocytes/eos

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61
Q

Ectopic ACTH (Cushing syndrome)

A

Small cell lung carcinoma, medullary thyroid carcinoma

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62
Q

SIADH (dilutional hyponatremia)

A

Small cell lung carcinoma

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63
Q

Ectopic calcitonin (hypocalcemia)

A

Medullary thyroid carcinoma

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64
Q

Ectopic EPO (polycythemia, normal PaO2)

A

Renal adenocarcinoma, Wilm’s tumor, HCC, VHL disease, leiomyomas

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65
Q

Insulin-like peptide (hypoglycemia)

A

HCC, retroperitoneal tumors

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66
Q

PTH-like peptide (hypercalcemia with low PTH)

A

Squamous lung carcinoma, renal adenocarcinoma, breast cancer, ovarian cancer

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67
Q

Ectopic serotonin (flushing, diarrhea, R heart valvular lesions)

A

Carcinoid syndrome with liver mets, small cell lung carcinoma, medullary thyroid carcinoma

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68
Q

Tumor marker: AFP

A

HCC; germ cell tumors,: yolk sac or endodermal sinus tumors of testes/ovary

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69
Q

Tumor marker: AAT

A

HCC, yolk sac/endodermal sinus tumors

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70
Q

Tumor marker: beta-hCG

A

Trophoblastic tumors in GCTs; hyatidiform moles; choriocarcinoma

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71
Q

Tumor marker: beta2-microglobulin

A

Multiple myeloma

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72
Q

Tumor marker: bombesin

A

Small cell lung carcinoma, neuroblastoma

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73
Q

Tumor marker: CA-15

A

Breast cancer

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74
Q

Tumor marker: CA-19-9

A

Pancreatic cancer

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75
Q

Tumor marker: CA-125

A

Epithelial ovarian cancer

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76
Q

Tumor marker: CEA

A

Colorectal, pancreatic, breast, small cell lung cancer

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77
Q

Tumor marker: LDH

A

Hodgkin’s disease, non-specific

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78
Q

Tumor marker: NSE (enolase)

A

Small cell carcinoma of lung, neuroblastoma

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79
Q

Tumor marker: PSA

A

BPH/prostate adenocarcinoma

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80
Q

Tumor: HTLV-1

A

Adult T cell leukemia/lymphoma

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81
Q

Tumor: HTLV-2

A

Hairy cell leukemia

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82
Q

Tumor: HIV

A

CNS malignant lymphoma

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83
Q

Tumor: HCV/HBV

A

HCC

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84
Q

Tumor: EBV

A

Burkitt’s lymphoma, nasopharyngeal carcinoma, polyclonal malignant lymphoma

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85
Q

Tumor: HPV

A

Squamous cell carcinoma of vagina, cervix, vulva, anus, penis

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86
Q

Tumor: HHV-8

A

Kaposi’s sarcoma

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87
Q

EM of zebra bodies in lysosomes

A

Niemann Pick DIsease (look like lamellar bodies in T2 pneumocytes)

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88
Q

Enamel injury in young woman

A

Bulimia (metabolic alkalosis from vomiting, Boehaave’s syndrome)

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89
Q

Anorexia nervosa

A

Secondary amenorrhea, osteoporosis, ventricular arrhythmia

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90
Q

Kwashiorkor

A

Decreased protein intake, adequate caloric intake

Fatty liver –> decreased apolipoproteins
Pitting edema
Flaky paint dermatitis

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91
Q

Marasmus

A

Decreased caloric intake –> loss of all muscle mass

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92
Q

Vitamin A deficiency

A

Squamous metaplasia in eyes, bronchus; nyctalopia

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93
Q

Vitamin A toxicity

A

Increased ICP, hypercalcemia

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94
Q

Primary hypothyroidism

A

Beta-carotenemia from decreased conversion of beta-carotenes into retinoic acid from intestine (b/c thyroxine is a co-factor)

Yellow patient (but not sclerae!)

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95
Q

Vitamin E deficiency

A

Cerebellar dysfunction, hemolytic anemia

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96
Q

Vitamin C deficiency (“tea and toast diet”)

A

Bleeding gums, glossitis, perifollicular hemorrhages

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97
Q

Thiamine deficiency

A

Blocks pyruvate DHGN, transketolase, ketoglutarate DHGN

Wernicke’s (confusion, nystagmus, ataxia) and Korsakoff (antegrade and retrograde memory loss)

Mamillary bodies shrunken, periventricular area decreases

High-output heart failure, peripheral neuropathy

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98
Q

Niacin/B3 deficiency (corn diet, carcinoid syndrome, Hartnup’s disease, tryptophan deficiency)

A

NAD/NADH; NADP/NADPH missing

Diarrhea, dermatitis, dementia

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99
Q

Riboflavin (B2) deficiency

A

FMN/FAD reactions, synthesis of glutathione

Magenta tongue, cornea neovascularization, angular stomatitis

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100
Q

Pyridoxine (B6) deficiency (INH, goat milk diet)

A

Transaminase, heme synthesis

Sideroblastic anemia with ringed sideroblasts, neuropathy

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101
Q

Pantothenic (B5) acid

A

Important in fatty acid synthase complex

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102
Q

Biotin deficiency (avidin in raw eggs)

A

Alopecia

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103
Q

Chromium deficiency

A

Glucose intolerance, peripheral neuropathy

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104
Q

Copper rxns

A

Lysyl oxidase (cross-links in collagen), cyt-c oxidase, SOD, ferroxidase, tyrosinase

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105
Q

Copper deficiency

A

Microcytic hypochromic anemia (loss of transferrin:iron binding), skeletal abnormalities, depigmentation, dissecting AA, Mencke’s kinky hair syndrome

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106
Q

Copper toxicity

A

Wilson’s disease - AR, Chr. 13, ATP7B

Liver damage, Kayser-Fleischer ring, lenticular nuclei damage (ataxia, tremor), psychosis

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107
Q

Selenium rxns

A

Glutathione peroxidase (prevents peroxides from wreaking havoc in cytosol, while Vit E protects membranes)

Stimulates immune system

Co-factor in peripheral T4–>T3 conversion

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108
Q

Zinc rxns

A

Co-factor in SOD, carbonic anhydrase, alkaline phosphatase, collagenases, RNA/DNA polymerases, thymidine kinase, EtOH DHGN

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109
Q

Zinc deficiency (diabetics, alcoholics, cirrhosis, arcodermatitis enteropathica)

A

Growth retardation, hypogonadism/infertility, decreased taste, rash around eyes/mouth, poor wound healing, impaired immunity

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110
Q

Vit C functions

A

Dietary iron (ferric–>ferrous), hydroxylation of proline/lysine for collagen, prevents nitrosamination, reduces MetHb back to Hb

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111
Q

Cyanosis not relieved by oxygen in patient coming home from camping trip

A

Methemoglobinemia (water has nitrites), give methylene blue

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112
Q

Fetal EtOH syndrome

A

Low nasal bridge, epicanthal folds, minor ear abnormalities, short palpebral fissures, smooth philtrum, thin upper lip, micrognathia

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113
Q

HbF shifts oxygen dissociation curve ___

A

Left

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114
Q

Raising upper limit of normal in a test

A

Increased specificity and PPV; decreased sensitivity and NPV

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115
Q

Adrenal atrophy in patient on corticosteroids

A

FR, not glomerulosa (aldosterone)

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116
Q

Normal karyotype with Down’s syndrome

A

Acrocentric (Robertsonian) translocation of chr. 21/14

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117
Q

Sepsis in elderly man with BPH

A

E. coli (septic shock –> release of anaphylatoxins/NO from damaged cells –> dementia exacerbated)

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118
Q

Barbiturates increase ___ to precipitate porphyric attacks

A

ALA synthase

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119
Q

Normal changes in pregnancy

A

Increased: plasma volume, GFR/CCr, Alk Phos, T4/cortisol (increased binding proteins)

Decreased: Hb, BUN, Cr, uric acid

Respiratory alkalosis from progesterone effect

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120
Q

Children v. adults blood studies

A

Increased AlkPhos (osteoblasts from bone growth) and phosphate, slight Hb decrease

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121
Q

Analytes increased with hemolyzed blood sample

A

K+, LDH

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122
Q

Lipid most affected by fasting

A

TG (chylomicrons)

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123
Q

First sign of tissue hypoxia

A

Na/K ATPase inactivity –> swelling

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124
Q

Chemical mediators of inflammation

A

Histamine, C3a/b, C5a, LTB4, LTC-D-E4, bradykinin, PGs

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125
Q

Factors decreasing adhesion molecule synthesis

A

Catecholamines, corticosteroids, lithium

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126
Q

Suppurative inflammation is the same thing as ___

A

Abscess

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127
Q

Serous inflammation is the same thing as ___

A

Blister

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128
Q

BRCA2 is found on ___

A

Chromosome 13

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129
Q

Cri-du-chat is often associated with this CV defect

A

VSD

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130
Q

Marfan’s syndrome is ____ inheritance

A

Autosomal dominant

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131
Q

Homocystinuria v. Marfan’s

A

MR, vessel thrombosis

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132
Q

MCC of death in Marfan’s

A

Aortic dissection

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133
Q

AD // Neurofibromas, pheochromocytoma, cafe au lait spots, Lisch nodules (iris hamartomas)

A

Neurofibromatosis 1 (Chr. 17)

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134
Q

AD // cerebellar hemangioblastomas, pheochromocytomas, bilateral renal adenocarcinoma

A

Von Hippel Lindau disease

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135
Q

Low grade

A

Well differentiated, can tell origin

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136
Q

High grade

A

Poorly differentiated/anaplastic, can’t tell tissue of origin

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137
Q

Choristoma

A

Normal tissue in wrong place (i.e. pancreatic tissue in stomach wall)

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138
Q

AG

A

Na - [Cl + HCO3] = 12 +/- 4mEq/L

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139
Q

Why does AG rise in some forms of metabolic acidosis?

A

Adding an acid and its anion replaces bicarbonate used to buffer hydrogen ions

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140
Q

Examples of metabolic acidosis causes

A

Lactate, acetoacetate, beta-hydroxybutyrate, phosphate/sulfate in renal failure, salicylate, formate (methanol poisoning), oxalate (ethylene glycol poisoning), acetate (paraldehyde)

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141
Q

Normal AG metabolic acidosis

A

Lose bicarbonate, which is replaced by equal # of Cl ions

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142
Q

Examples of normal AG metabolic acidosis

A

HARDUPS -

Hyperalimentation, acetazolamide, RTA, diarrhea, ureteroenteric fistula, pancreaticoduodenal fistula, spironolactone

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143
Q

Type 1 RTA

A

Distal: cannot secrete H+ ions or reabsorb K+ (alpha intercalated cells), cannot regenerate bicarbonate

Urine pH > 5.5, hypokalemia

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144
Q

Type 2 RTA

A

Proximal; bicarbonate lost in urine until serum bicarb is 15mEq/L

Urine pH < 5.5, hypokalemia

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145
Q

Type 4 RTA

A

Aldosterone deficiency or resistance, decreased in ammonium excretion

Urine pH > 5.5, hyperkalemia

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146
Q

Tumor association: aniline dyes, benzidine, cyclophosphamide, phenacetin

A

Transitional cell carcinoma of urothelium

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147
Q

Tumor association: vinylchloride, thorotrast

A

Liver angiosarcoma

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148
Q

Tumor association: asbestos

A

Bronchogenic carcinoma&raquo_space; mesothelioma

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149
Q

Tumor association: OCPS

A

Liver adenomas, HCC

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150
Q

Tumor association: aflatoxins (esp. with HBV)

A

HCC

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151
Q

Tumor association: cadmium

A

Prostate/lung cancer

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152
Q

Tumor association: polycyclic hydrocarbons (EtOH co-carcinogen)

A

Small cell lung carcinoma, squamous carcinoma of URT, squamous cervical carcinoma, transitional carcinoma of bladder, pancreatic adeno

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153
Q

Tumor association: chromium, nickel, uranium

A

Lung cancer

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154
Q

Tumor association: woodworking

A

Nasal cavity cancer

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155
Q

Tumor association: chewing tobacco

A

Verrucous oral carcinoma

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156
Q

Tumor association: alkylating agents, benzene

A

ALL, malignant lymphoma

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157
Q

Tumor association: DES

A

Clear cell adenocarcinoma of vagina/cervix

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158
Q

Tumor association: nitrosamines

A

Esophageal, gastric cancer

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159
Q

Tumor association: soot

A

Squamous carcinoma of skin/scrotum

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160
Q

Tumors with vessel invasion (4)

A

Renal carcinoma, HCC, choriocarcinoma, follicular thyroid cancer

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161
Q

0 ESR

A

Polycythemia, HbSS disease

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162
Q

Rx for SIADH

A

Demeclocycline, restrict water not salt

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163
Q

5 features of primary hyperaldosteronism (Conn syndrome)

A
  1. No pitting edema (aldosterone escape, block of proximal reabsorption of Na), 2. Severe hypokalemia (muscle weakness, U waves)
  2. Metabolic alkalosis (tetany from low ionized Ca)
  3. Nl to increased serum Na
  4. Low renin HTN
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164
Q

MC primary cancer in LN

A

NHL

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165
Q

MC metastatic cancer in LN

A

Breast

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166
Q

MC primary cancer in lung

A

Adenocarcinoma

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167
Q

MC metastatic cancer in lung

A

Breast

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168
Q

MC primary cancer in bone

A

Multiple myeloma

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169
Q

MC metastatic cancer in bone

A

Breast, prostate

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170
Q

MC primary cancer in liver

A

HCC

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171
Q

MC metastasis in liver

A

Colon

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172
Q

MC primary cancer in adrenals

A

Adenocarcinoma

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173
Q

MC metastatic cancer in adrenals

A

Lung

174
Q

MC primary cancer in brain

A

GBM

175
Q

MC metastatic cancer in brain

A

Lung

176
Q

Necrosis of globus pallidus, SaO2 decreased, PaO2 normal, left shifted ODC, inhibition of cyt-oxidase

A

CO poisoning

177
Q

Increased PaCO2, decreased PaO2/SaO2

A

Respiratory acidosis

178
Q

Normal PaO2/SaO2, decreased Hb

A

Anemia

179
Q

Normal O2 content

A

1.34[Hb] x SaO2 + PaO2

180
Q

Disorders with nl O2 content

A

Cyanide poisoning, ischemia, uncoupled ox-phos

181
Q

Dystrophic calcification

A

Atherosclerotic plaques, enzymatic fat necrotic, periventricular calcification in CMV

182
Q

Metastatic calcification (in setting of increased serum Ca/P)

A

Nephrocalcinosis (hyperPTH), BG calcification (hypoPTH)

183
Q

MC site of bone mets

A

Vertebrae due to Batson vertebral plexus from IVC

184
Q

HTN in left gastric/azygous veins

A

Esophageal varices

185
Q

Cryptococcus neoformans spreads via ___ route

A

Hematogenous

186
Q

3Hz spike and wave activity on EEG

A

Absence seizures

187
Q

Absent myenteric (Auerbach’s) ganglia

A

Achalasia

188
Q

Absent myenteric and submucosal (Meissner’s) ganglia

A

Hirschsprung disease

189
Q

Hoarseness in aortic aneurysm

A

Stretching of L recurrent laryngeal n.

190
Q

Mitochondria are lost in ___ of sperm after fertilization

A

Tail

191
Q

MCC of rabies in USA

A

Skunk bites

192
Q

Treatment of CMV retinitis if ganciclovir fails

A

Foscarnet (renal toxicity, hypocalcemia/hypomagnesemia)

193
Q

Anti-estrogen receptor, may cause endometrial cancer

A

Tamoxifen

194
Q

False-positive RPR in SLE patient due to ____

A

Anti-cardiolipin antibodies

195
Q

Anti-SCL-70

A

Systemic scleroderma

196
Q

Features of SLE

A

SOAP BRAIN MD

S=serositis (pleurisy, pericarditis)
O=oral ulcers
A=arthritis
P=photosensitivity, pulmonary fibrosis
B=blood cells (hemolytic anemia, thrombocytopenia, leukopenia) 
R=renal, Raynauds
A=ANA
I=immunologic (anti-Sm, anti-dsDNA, anti-Ro/La)
N=neuropsych
M=malar rash
D=discoid rash
197
Q

Metyrapone testing

A

Blocks 11-hydroxylase –> increased ACTH, 11-deoxycortisol in urine in normal HPA axis

198
Q

Osteophytes in DIP joints

A

Heberden’s nodes

199
Q

Flask shaped ulcers in cecum

A

Amebiasis

200
Q

MC post-MI complication (3-7 days)

A

Ventricular wall rupture

201
Q

MC post-MI complication (4-6 weeks)

A

Dressler’s syndrome (autoimmune pericarditis)

202
Q

Hemoptysis and renal failure (RPGN) with linear immunofluorescence

A

Goodpasture’s syndrome

203
Q

MCC of sepsis in AIDs patient

A

Disseminated MAI

204
Q

MCC of infection post-transfusion

A

CMV (hides in donor lymphocytes)

205
Q

Alternative causes of rusty sputum

A

CHF, mitral stenosis, Goodpasture’s

206
Q

Cyanosis in ToF patient depends on ___

A

Degree of intravalvular pulmonary stenosis

207
Q

Baby with icterus and edema

A

Congenital CMV infection

208
Q

Black granules in hepatocyte EM photo

A

Glycogen (disappears with 6 hours of fasting)

209
Q

MCC of abdominal abscess

A

Bacteroides fragilis

210
Q

MR, astrocyte hamartomas (“candlestick drippings on ventricles), adenoma sebaceum, angiomyolipoma of kidneys, heart rhabdomyoma

A

TSC (AD)

211
Q

Increased ALA synthase and decreased porphobilinogen deaminase; severe colicky abdominal pain, neuropsych syndromes

A

AIP - dALA buildup

212
Q

Decreased activity of uroporphyrinogen decarboxylase, wine-red urine, photosensitivity, hypertrichosis

A

Porphyria cutanea tarda

213
Q

Yellow needles in parallel polarized light

A

Monosodium urate

214
Q

Black spot, associated with Pseudomonas and UC

A

Ecthyma (pyoderma) gangrenosum

215
Q

Fever in malaria occurs when ____

A

RBCs rupture

216
Q

Young man with low back pain

A

Sacroilitis; look for HLA-B27, uveitis, aortitis, bamboo spine, UC

217
Q

Sickle cell mutation

A

Valine for glutamic acid on 6th position of beta globin

218
Q

Osteosarcoma occurs in the ___

A

Metaphysis

219
Q

Osteomyelitis occurs in ___

A

Metaphysis

220
Q

UC primarily targets ___

A

Rectum and colon

221
Q

Gross features of UC

A

Friable, red mucosa that bleeds easily when touched, no skip areas, “pseudopolyps”

222
Q

Microscopic features of UC

A

Mucosal inflammation with crypt abscesses

223
Q

Complications of UC

A

Toxic megacolon, sclerosing cholangitis, pyoderma gangrenosum, adenocarcinoma, HLA B27

224
Q

Clinical picture of UC

A

L-sided abdominal cramping with bloody diarrhea, rectal urgency, tenesmus

225
Q

Radiograph of UC

A

“Lead pipe” appearance of haustra

226
Q

Murmur of MVP moves closer to S1 with ___

A

Anxiety (shorter diastole)

227
Q

Murmur of MVP moves closer to S2 with ___

A

Lying down (more venous return)

228
Q

Cave explorer in Arizona with resp infection

A

Coccidiodomycosis

229
Q

Begin treatment for DKA with ___

A

Volume replacement

230
Q

Turner’s syndrome has what type of coarctation?

A

Preductal

231
Q

Lung findings in ARDS

A

Atelectasis (massive intrapulmonary shunting due to lack of surfactant); hyaline membranes composed of protein

232
Q

S. aureus food poisoning

A

1-6 hours after eating (preformed toxin); self-limited

233
Q

MCC of iron deficiency in young child

A

Meckel’s diverticulum

234
Q

Deficiency associated with ileal resection

A

B12, bile salts (DEAK)

235
Q

Deficiency associated with jejeunal resection

A

Folate (B9), most water/sodium

236
Q

Deficiency associated with duodenum resection

A

Iron

237
Q

Unequal pulses in upper extremity

A

Dissecting aortic aneurysm

238
Q

Diabetic lower leg with pigmented lesions

A

Necrobiosis lipoidica diabeticorum

239
Q

MCC of esophagitis in AIDS

A

Herpes

240
Q

URI in child followed by epistaxis and petechia

A

ITP (IgG against platelets, T2HS)

241
Q

Bridge painter in NYC with resp infection

A

Histo (starling dung) or cryptococcus (pigeons) –> amphotericin

242
Q

Rat poison ingestion

A

Contains warfarin; treat with Vit K, FFP

243
Q

ABO incompatibility

A

Spherocytes in cord blood, + direct Coombs on cord blood RBCs, mild hemolysis (jaundice in 1st 24 hours)

244
Q

Child with rash and skin infiltrate with CD1 cells

A

Histiocytosis X (most likely: Letterer Siwe dz)

245
Q

Elderly man with low back pain – what do you do?

A

Check the rectal exam, alk phos for prostate metastases

246
Q

MC benign brain tumor

A

Meningioma

247
Q

MCC of pediatric HTN

A

Kidneys (Wilm’s, renal dysplasia), adrenals (neuroblastoma)

248
Q

Hamman’s sign

A

Crunching chest due to subcutaneous emphysema (trauma)

249
Q

Athlete with jaundice and elevated serum transaminases, Alk Phos

A

Anabolic steroids (cholestatic jaundice)

250
Q

Port wine nevus on face in trigeminal distribution with ipsilateral AV malformation in brain

A

Sturge Weber dz

251
Q

Polyarteritis nodosa

A

Vasculitis with urticaria, fever, arthralgia, nephrotic syndrome, hepatitis (Hep B)

252
Q

Flat hyperpigmented lesion on forehead/cheeks of woman

A

OCP/pregancy (melasma)

253
Q

Axillary freckling in patient with HTN

A

Neurofibromatosis

254
Q

Blurry vision, dry mucus membranes, ptosis, facial weakness, dilated pupils

A

C. botulinum food poisoning (like atropine)

255
Q

Patient with dysphagia and fetid odor to breath

A

Zenker’s diverticulum

256
Q

Young man with low back pain and limited chest movement

A

Ankylosing spondylitis (vertebral kyphosis)

257
Q

Oxidizing UCB into harmless water soluble dipyrroles

A

UV light in physiologic jaundice of newborn

258
Q 
Total Serum T4: up
Resin T3 uptake: up
Free T4 index: up
TSH: suppressed
I-131: up
A

Graves’ disease

259
Q 
Total Serum T4: up
Resin T3 uptake: up
Free T4 index: up
TSH: suppressed
I-131: down
A

Factitious thyroiditis

260
Q 
Total Serum T4: up
Resin T3 uptake: up
Free T4 index: up
TSH: suppressed
I-131: up
A

Thyroiditis (acute, subacute)

261
Q 
Total Serum T4: down
Resin T3 uptake: down
Free T4 index: down
TSH: increased
I-131: down
A

Primary hypothyroidism (Hashimoto’s)

262
Q 
Total Serum T4: down
Resin T3 uptake: down
Free T4 index: down
TSH: down
I-131: down
A

Secondary hypothyroidism

263
Q 
Total Serum T4: up
Resin T3 uptake: down
Free T4 index: normal
TSH: normal 
I-131: normal
A

Increased TBG (pregnancy)

264
Q 
Total Serum T4: down
Resin T3 uptake: up
Free T4 index: normal
TSH: normal 
I-131: normal
A

Decreased TBG (androgens)

265
Q

Flu-like syndrome, hyponatremia/hyperkalemia (interstitial nephritis), silver stain

A

Legionella

266
Q

MCC of myocarditis, pericarditis, aseptic meningitis

A

Coxsackievirus

267
Q

High AFP

A

Open neural tube defects, HCC, yolk sac tumors

268
Q

Drugs that increase surfactant

A

Glucocorticoids, thyroxine

269
Q

ECG changes in hypercalcemia

A

Short QT

270
Q

ECG changes in hypokalemia

A

U waves

271
Q

ECG changes in hypercalcemia

A

Long QT

272
Q

ECG changes in hyperkalemia

A

Peaked T waves

273
Q

Polycythemia differential

A

Relative polycythemia (volume depletion), polycythemia vera (Epo suppressed), epo-secreting tumors, hypoxic stimulus (low SaO2)

274
Q

Leukemias by age:

A

60: CLL

275
Q

MC ALL

A

CALL-A + pre-B cell ALL

276
Q

AD, spectrin deficiency, increased osmotic fragility

A

Congenital spherocytosis

277
Q

Peroxide damaged Hb in RBCs in G6PD deficiency

A

Heinz bodies

278
Q

Howell Jolly body

A

Asplenia

279
Q

Antibody screen of serum

A

Indirect Coombs test

280
Q

Pb deposits in ___ of bone

A

Epiphyses

281
Q

Generalized lymphadenopathy in elderly man, malignant B cells, hypogammaglobulinemia, massive splenomegaly

A

CLL

282
Q

AST>ALT, increase in GGT

A

EtOH consumption

283
Q

HLA loci associated with T1 diabetes

A

HLA-DQ, HLADR3/4

284
Q

Deviation of uvula to opposite side in exudative tonsilitis

A

Peritonsillar abscess

285
Q

MCC of nephrotic syndrome in children, loss of negative charge

A

Minimal change disease

286
Q

MCC of nephrotic syndrome in adults, subepithelial deposits (“spikes”), HBV association

A

Membranous GN

287
Q

MC renal disease in AIDS, renal transplant, IVDU

A

FSGS

288
Q

Wire looping in glomerulus

A

SLE

289
Q

T1 membranoproliferative GN

A

HCV, tram-tracking, subendothelial deposits

290
Q

T2 membranoproliferative GN

A

C3 nephrotic factor (autoantibody against C3), dense deposits in GBM

291
Q

Foamy macrophages in lamina propria

A

Whipple’s disease

292
Q

Childhood version of ALS

A

Werdnig-Hoffmann (floppy baby)

293
Q

MC space-occupying lesion in AIDS

A

Toxoplasmosis

294
Q

Prolonged PR interval

A

First degree block

295
Q

Weight lifter with weakness in hand, numbness, absent pulse

A

Thoracic outlet syndrome (anterior scalene compresses subclavian a., brachial plexus)

296
Q

MCC of AAA

A

Atherosclerosis

297
Q

Sx of ruptured AAA

A

Left flank pain, hypotension, pulsatile mass

298
Q

Wilm’s tumor associations

A

Aniridia, HTN

299
Q

CXR with right middle lobe pneumonia obscuring heart margin

A

Bronchogenic carcinoma or aspiration while supine on R side

300
Q

Sterile pyuria (WBCs) and negative culture

A

Renal TB or chlamydia

301
Q

Antimicrosomal antibodies

A

Graves disease and Hashimoto’s thyroiditis

302
Q

Neonatal pneumonia, afebrile, staccato cough, eosinophilia, wheezing

A

Chlamydia infection in birth canal

303
Q

Platelet dysfunction and hemorrhagic pericarditis

A

Uremia from renal failure

304
Q

Consequences of essential HTN

A

Charcot-bouchard aneurysms (putamen bleeds), concentric LVH, hyaline arteriolosclerosis, nephrosclerosis

305
Q

Hyperextension of PIP, flexion of DIP joint

A

Swan neck deformity in RA

306
Q

Flexion of PIP and extension of DIP

A

Boutonniere’s deformity

307
Q

Atlantoaxial joint subluxation

A

Associated with RA, risk for vertebrobasilar insufficiency

308
Q

Coal worker’s pneumoconiosis or silicosis + RA lung disease

A

Caplan’s syndrome

309
Q

RA associations

A

ACD, reactive amyloidosis, Sjogren’s syndrome, Felty’s syndrome (autoimmune neutropenia + splenomegaly), carpal tunnel syndrome, uveitis, Baker’s cyst, pulmonary disease, fibrinous pericarditis

310
Q

autoimmune neutropenia + splenomegaly in RA

A

Felty’s syndrome

311
Q

Psoriasis signs

A

Hyperkeratosis, regular rete ridge hyperplasia, munros microabscesses, superficial dermis next to epithelial surface (Auspitz sign), erythematous salmon-plaques with silvery scales, nail pitting, psoriatic arthritis (HLA-B27+), elbows + scalp

312
Q

Fatty casts with maltese crosses

A

Nephrotic syndrome

313
Q

Associations with pheochromocytoma

A

VHL, NF1, MENII

314
Q

High output heart failure

A

Hyperthyroidism, B1 deficiency, too much isotonic saline, AV fistula, endotoxic shock, Paget’s

315
Q

Chest pain on exertion with ST depression, relieved by nitroglycerin

A

Stable angina (~75% occlusion)

316
Q

Chest pain at rest, “infarct waiting to happen”

A

Unstable angina (Thrombosis of occlusion)

317
Q

Chest pain from vasoconstriction, ST elevation on stress EKG

A

Prinzmetal angina

318
Q

___ = massive intrapulmonary shunting

A

ARDS

319
Q

MC site of diverticulosis, polyps, cancer in GI

A

Sigmoid colon

320
Q

Hepatotoxicity of INH

A

Metabolite - acetylhydrazine, 10-20% of cases

321
Q

Drugs causing acute hepatitis

A

INH, salicylates, halothane, methyldopa, phenytoin, ketoconazole

322
Q

Hepatotoxicity of halothane

A

1 week post-op, fevers then jaundice, p450 metabolites

323
Q

Drugs causing chronic hepatitis

A

Methyldopa (+ Coombs test), acetaminophen, aspirin, INH, nitrofurantoin, halothane

324
Q

Zonal necrosis (I)

A

Yellow phosphorus, ferrous sulfate

325
Q

Zonal necrosis (III)

A

Carbon tetrachloride, acetaminophen

326
Q

Drugs causing intrahepatic cholestasis

A

Non-inflam: OCPs, steroids

Inflamm: erythromycin, amoxicillin-clavulanic acid, chlorpromazine, thiazides

327
Q

Drugs causing liver fatty change

A

Single droplet: EtOH, corticosteroids, amiodarone

Microvesicular: tetracycline, valproic acid

328
Q

Drugs causing liver fibrosis

A

MTX, too much Vit A

329
Q

Drugs causing granulomatous hepatitis

A

Allopurinol, hydralazine, sulfonamides, phenylbutazone

330
Q

MCC of ischemic ATN

A

Prerenal azotemia

331
Q

MCC of nephrotoxic ATN

A

Aminoglycosides and contrast

332
Q

Causes of renal papillary necrosis

A

Acetaminophen+ASA, DM, sickle cell, acute pyelonephritis

333
Q

Epidydimitis

A

35: Ecoli, Pseudamonas

334
Q

IUD infection

A

Actinomycosis with sulfur granules

335
Q

Endometritis

A

Plasma cells present; group B strep

336
Q

Goodies in the rectal pouch of Douglas

A

Induration 50: ovarian mets
Unclotted blood: ruptured ectopic
Pus: PID

337
Q

B-HCG function

A

LH analog that maintains CL for 8-10wks of pregnancy, then placenta takes over

338
Q

Painless vaginal bleeding in pregnancy

A

Placenta previa (implantation over cervical os)

339
Q

Painful vaginal bleeding in pregnancy

A

Abruptio placenta (retroplacental hemorrhage, maternal HTN or cocaine use)

340
Q

Urine estriol source

A

Fetal adrenal, placenta, maternal liver

341
Q

Implantation on day 21

A

3 days in tube, 2 days in uterus

342
Q

Duffy antigens

A

Surface receptor for P vivax, uncommon in blacks

343
Q

I antigens

A

Cold agglutinins in M. pneumoniae (IgM), infectious mono (IgM)

344
Q

O blood group

A

Universal blood donor; universal plasma recipient

345
Q

AB blood group

A

Universal blood recipient; universal plasma donor

346
Q

Risk of HIV + post-needle stick

A

1:300

347
Q

Cryoprecipitate contains. . .

A

Factor VIII, fibrinogen, factor XIII, fibronectin

348
Q

Rh HDN

A

Second prgenancy: anti-D IgG cross placenta –> attach to fetal RBCs –> extravascular hemolysis by fetal spleen –> unconjugated bilirubinemia, anemia –> mama liver takes care of UCB but still have risk of HF/hydrops fetalis

At delivery, baby needs exchange transfusion for UCB and anemia correction

349
Q

Febrile transfusion rxn

A

Patient has anti-HLA antibodies against donor leukocytes, release of pyrogens (T2 HS)

350
Q

Allergic transfusion rxn

A

Patient has H1S against donor antigens

351
Q

Hemolytic transfusion rxn (ABO mismatch)

A

IGM: Complement activation –> intravascular hemolysis (T2 HS)

IGG: extravascular hemolysis, jaundice, Hb drop, + Coombs (T2 HS)

352
Q

Polyarteritis nodosa

A

HBsAg, T3 HS vasculitis of muscular arteries, different ages of lesions, renal infarcts, p-ANCA, pulm sparing

353
Q

Legg-Perthe

A

Femoral head, child <10, aseptic necrosis

354
Q

Definitive test for Zollinger-Ellison

A

Secretin challenge: paradoxical increase in gastrin

355
Q

Characteristic rash of glucagonoma

A

Necrolytic migratory erythema + DM

356
Q

Signs of VIPoma

A

Normal gap metabolic acidosis, hypokalemia, achlohydria

357
Q

Gap junction test

A

Dye passes from one cell to the next

358
Q

Tibial n. function

A

Plantarflexion, inversion, sensory to sole of foot

359
Q

Aortic/pulmonic valves

A

Lined by endothelium with abundant fbiroelastic tissue + dense collagenous core; avascular

360
Q

Mitral/tricuspid valves

A

Loose connective tissue core (increased in prolapse)

361
Q

Winged scapula

A

Long thoracic nerve (serratus anterior paralysis)

362
Q

Patient with nosebleed and rhinorrhea

A

Fracture of cribiform plate in ethmoid sinus

363
Q

MLF demyelination

A

INO

364
Q

Meiosis I arrest for oocytes

A

Prophase

365
Q

Meiosis II arrest for oocytes

A

Metaphase

366
Q

What runs along the radial a.?

A

Median nerve

367
Q

Artery affected in femoral neck fracture

A

Medial femoral circumflex a.

368
Q

Collagen X location

A

Epiphyses of bone

369
Q

Wallerian degeneration

A

Schwann cell proliferation –> tube for guiding axon from proximal surviving fraction

370
Q

Nerve injured in midshaft humerus fracture

A

Radial n.

371
Q

Bilateral lateral rectus palsy

A

Increased ICP

372
Q

Parinaud syndrome

A

Paralysis of upward gaze in infant (hydrocephalus 2/2 stenosis of aqueduct of Sylvius)

373
Q

Weakness of quads/absent knee jerk

A

Herniated L3-L4 disk

374
Q

Pain in hip/lat quads, numbness of AL leg and webbed space between great toe, weakness of dorsiflexion, nl knee/ankle jerk reflex

A

Herniated L4-L5 disk (compresses L5)

375
Q

Numbness along PL leg, plantar foot, absent ankle jerk

A

Herniated L5-S1 disk

376
Q

What level does herniated disc affect, and why?

A

Protruded disc usually compresses next lower nerve as that nerve crosses level of disc in its path to its foramen (higher nerve escapes!)

377
Q

C8-T1 nerve palsy

A

Klumpke’s

378
Q

C5-C6 nerve palsy

A

Erb-Duchenne

379
Q

Paralysis of CNIII after head injury

A

Uncal herniation (ptosis, mydriasis)

380
Q

Wrist bone with highest incidence of avascular necrosis

A

Scaphoid bone

381
Q

Injury to median nerve and brachial artery –> forearm muscle damage

A

Volkmann’s ischemic syndrome

382
Q

A band in skeletal muscle has ___

A

Myosin ATPase

383
Q

Site of obstruction in asthma, CF, chronic bronchitis

A

Terminal bronchioles

384
Q

Weakened palate/gag reflex, trapezius/SCM weakness, loss of posterior taste sensation

A

Schwannoma in jugular foramen (X, XI, IX)

385
Q

CNIII lesion with UMN signs and midline, midbrain lesion

A

Weber syndrome

386
Q

C2 transection of fasiculus gracillis

A

Affects LE only

387
Q

Loss of P/T and CL UMN signs

A

Mid pons lesion

388
Q

Why cyclosporine in identical twin transplant?

A

Some difference in MHC sites from crossover during meiosis ?

389
Q

Lymphocyte common marker

A

CD45

390
Q

Rodents, ARDS, hemorrhage, renal failure

A

Hantavirus

391
Q

Protein A

A

Attaches to Fc-R in macrophages and blocks opsonization

392
Q

Pneumonitis and ova in stools

A

Ascaris or hookworms

393
Q

Pneumonitis and rhabditiform larvae in stools

A

Strongyloides

394
Q

Cells that attack protozoans

A

CD4 T cells

395
Q

“Breakbone fever”, hemorrhagic, Aedes mosquito

A

Dengue

396
Q

Live vaccines

A

MMR, varicella, OPV, BCG, smallpox, yellow fever

397
Q

Spring/summer colds

A

Adenovirus

398
Q

Winter/fall colds

A

Rhinovirus

399
Q

Pruritic skin lesion in Gulf War veteran

A

Cutaneous leishmaniasis from sandfly bite

400
Q

Verrucoid lesion in LE from S. America patient

A

South American blastomycosis, yeast with ship’s wheel appearance

401
Q

ELISA test for HIV

A

anti-gp120 antibodies

402
Q

Biochemical processes in both mitochondria/cytosol

A

HUG - heme synthesis, urea cycle, gluconeogenesis

403
Q

Glucokinase

A

High Vm, high Km, only in liver

404
Q

Hexokinase

A

Low Vm, low Km, all cells, inhibited by G6P

405
Q

Ketoacidosis

A

Increased beta-oxidation of fatty acids and production of acetyl CoA –> ketone bodies synthesized by liver

406
Q

Rx for schistosomiasis

A

Praziquantel

407
Q

Rx for benzo OD

A

Flumazenil

408
Q

Rx for malignant hyperthermia

A

Dantrolene (reduced Ca++ release from SR)

409
Q

Rx for acetominophen OD

A

N-acetylcysteine (Replaces GSH)

410
Q

Mech of loop diuretic

A

Blocks NKCC in TA; in renal medulla

411
Q

Rx for cyanide poisoning

A

Amyl nitrite and thiosulfate

412
Q

Xanthine oxidase rxns

A

Hypoxanthine –> xanthine, xanthine –> uric acid

413
Q

Endocarditis prophylaxis

A

Amoxicillin

414
Q

Blue-grey skin

A

Chlorpromazine and arsenic

415
Q

Toxic epidermal necrolysis

A

Barbituates, sulfonamides, phenytoins, NSAIDs

416
Q

Maculopapular rash

A

Amoxicillin, TMP/SMX, ampicillin/penicillin

417
Q

Elderly woman on thiazides may develop ___

A

Gout

418
Q

Antipsychotic producing visual sx

A

Thioridazine

419
Q

Substitute for ASA in stroke prevention

A

Ticlopidine

420
Q

Finasteride

A

Blocks 5-a-reductase (T–>DHT)

421
Q

Ketoconazole

A

Inhibits T synthesis

422
Q

Leuprolide

A

GnRH analog

423
Q

Rx for arsenic poisoning

A

Dimercaprol

424
Q

Chloroquine fails to cure malaria (vivax/ovale)

A

Can’t hit hypnozoites in liver (use primaquine)

425
Q

Methanol tox

A

Optic n. degeneration and blindness due to formic acid, rx ethanol

426
Q

Major site of water reabsorption in GI tract

A

Jejeunum > ileum > colon

427
Q

Most effective nephron site for acid excretion

A

PT

428
Q

Nephron site for greatest generation of free water

A

TAL in medulla

429
Q

S1 heart sound correlates with ___ wave in JVP

A

C wave

430
Q

Carotid massage

A

Decreased HR / increased vasodilation –> inhibits tonic discharge of vasoconstrictor nerves and excites vagal innervation of heart

Boards Review (9 decks)

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