High Yield Facts Flashcards
Chest xray of pt who is Alcoholic with fever, chills, and obvious signs of pleural issue within the lung cavity. What microbe is suspected?
Klebsiella pneumonia
HIV Markers correlate with:
p24
gp120
gp41
P34= Old HIV infection
GP120/GP41 help bind and fuse the virus inside the cell
Tx for C.trachomatis
MOA of Tx
Azithromycin
or
Doxycycline
African American taking Primaquine and has dark urine. What blood disorder ?
G6PD Deficiency
Sudden death, thick myocardium, and decreased diastolic function
Hypertrophic Cardiomyopathy (HCM)
History of anemia, scleral icterus, hepatoslenomegaly, Hb=9 and Hct=33%, unconjugated bilirubin with peripheral smear of LARGE ROUND ERYTHROCYTES w/o Central Pallor?
Hereditary Spherocytosis
History of gastritis, anemia, and atrophic glossitis. Low B12. What results due to pernicious anemia?
Loss of Intrinsic Factor
Patient has rhonchi that indicates aspiration of food. Vomits all meals since birth in a 3 day old child
Tracheoesophageal fistula
What change in sleep electrical activities is seen in depressed patients?
Decreased delta sleep waves
Most specific testing for HIV
Western blot (PROTEIN)
Mechanism of Cyanide poisoning
Cyanide binds to iron of cytochrome oxidase
Tx for friends and close contacts of a patient with N.meningitis
MOA of Tx
Rifampin
MOA:
Serum Iron 500
Ferritin 10
TIBC 500 (elevated)
Low Hb
Anemia of Iron Deficiency
Rheumatoid Arthritis feature
Synovitis
Osteoarthritis Features
Heberden nodes
Osteophytes
Bone eburnation
Subchondral Bone formation
3yr old Immigrant w/ sever cough described as short coughs with copious mucous followed by a peculiar grunt. What is the illness?
Bordetella Pertussis aka Whooping Cough
Anaphylaxis Drug allergy occurs via
Good Pasture pathophysiology and HSR?
Rheumatoid arthritis HSR?
Type 1 HSR = IgE Crosslinking
Good Pasture = Type II HSR
Rheumatoid arthritis = Type III HSR = immune complex
Alcoholic patient with liver disease and hyperlipidemia.
What drug is contraindicated and why?
What is an alternative drug that can be given?
ATORVASTATIN aka Lipitor
Inhibits HMG-Coa Reductase and damages liver and muscle cells.
Alternative: Gemfibrozil
Fever, yellow sputum w/ blood and large cavity lesion in upper right lobe of lung
Granulomatous lesion with acid fast bacilli (TB). Cavitation description always refers to TB
Young AA female with SOB, diffuse lymphadenopathy, subcutaneous nodules, fine dry crackles on lung auscultation. Hilar Lymphadenopathy
Disease?
What will be elevated in disease process?
Sarcoidosis
ACE and Alpha1Hydroxylase enzyme levels will be elevated
Bloody diarrhea, continuous inflammation from rectum. Inflammation involves mucosa w/o involving entire thickness
Disease?
Ulcerative Colitis involves the mucosa and submucosa inflammation
Succinylcholine will have a prolonged effect due to what enzyme deficiency?
Deficiency of Pseudocholinesterase
Median nerve w/ carpal tunnel will cause pain in which part of the hand?
Radial half of the palm
ST segment elevations in Leads V3-V4 are due to what?
LAD occlusion. Most common location for MI
Iron is maintained in a reduced state by what?
NADPH
What cells lack mitochondria?
Red Blood Cells
Anti-dsDNA Antibody is related to what disease?
SLE
Anti-centromere antibody is related to what disease?
CREST Syndrome
Relative refractory period of cardiac potential in Purkinje fibers is what phase?
Phase 3 which is efflux of K+
Primary Biliary Cirrhosis is associated with what autoimmune antibody?
Anti-mitochondrial antibodies
Systemic emboli cause what?
Paradoxical embolism
Hb curve LEFT shift occurs from what?
Carbon monoxide (HbCO)
Decreased 2,3 BPG
Cold
Where is the Posterior Descending artery (PDA) located?
Distal to the Left subclavian a.
Hallucinations right before waking up is known as?
Hallucinations upon falling asleep is known as?
Hypnopompic
Hypnagogic
What cell type is dependent exclusively on glucose for fuel?
RBC
Hepatic dysfunction patients should be on what restriction diet?
HTN patients should be on what diet?
LOW PROTEIN for patients with liver issues
HTN patients should Restrict Salt (Na+)
What is the MOA for Fondaparinux?
Inhibits the formation of Factor Xa
Why does it take time for Warfarin’s to be effective?
Clotting factor degradation rates take time
Renal failure that is reversible is called?
What is a significant finding for it?
Acute Tubular Necrosis (ATN)
Muddy brown casts in the urine (Acute renal failure)
Thrombocytic thrombocytopenic purpura (TTP)
Features?
Peripheral blood smear?
What should not be given to these patients?
Fever, neurological deficits, purpura, hemolysis, anemia
Schistocytes
They SHOULD NOT BE GIVEN PLATELETS since they could thrombose again.
Infant with cataracts, deafness, pulmonic stenosis, microcephaly, blue lesions on the body. What is the causal agent?
Rubella Virus
Triad: Microcephaly, Cataracts, Deafness
Pregnant women with tingling in hands. What structure contributes to the tingling?
Flexor Retinaculum
Young child w/ fatigue, exercise intolerance after play, cyanosis, and systolic ejection fraction murmur at LSB
What is the disease?
What would a catheter in the RV show?
Tetralogy of Fallot: VSD, Pulmonary stenosis, RV hypertrophy, and Cyanosis
Increased BP
Person exposed to second hand smoke for life, Xray with peripheral opacity. What disease?
Bronchoalveolar Adenocarcinoma..always occurs peripherally in lung
40yr old male, vague abdominal pain, weight loss, diarrhea.
What is the disease?
What is seen upon closer exam?
Crohn’s Disease
Will show sarcoid like “NONCASEATING TRANSMURAL EPITHELIOID GRANULOMAS” in the intestinal wall
Acetaminophen toxicity results in what?
Centrilobular necrosis of the liver
Most specific test for diagnosis of SLE
Anti-ds DNA antibodies
Rheumatic valve disease patient will have what kind of murmur?
Describe the murmur
Mitral Stenosis: snapping early diastolic click and mid diastolic rumble. Also described as a low pitched diastolic rumble preceded by opening snap
SNAP= Stenosis
Scar tissue in the brain is created by what?
Astrocytes
What are the macrophages of the CNS system?
Microglia
What muscle helps to initiate ABduction of the shoulder?
What innervates it?
Supraspinatus innervated by…
25 yo woman experiences transient cerebral ischemia. She’s found to have upper limb BP asymmetry. What is the disease?
Takayasu Disease: large vasculitis in young women that commonly affects the aorta aka “Pulseless disease”
25 yo woman with nontender erythematous rash over her nose, cheeks, and polyarthritis. What will lab tests show?
Anti-Smith or Anti-ds DNA antibodies for SLE
Hepatic conjugation involves?
Glucoronide formation
Potency of gas depends on?
Oil/Gas partition coefficient and membrane solubility
Phase 1 of acute inflammation–Vasodilation and increased blood flow are caused by?
Bradykinin
Most common place for obstruction hydrocephalous after traumatic injury is?
Cerebral Aqueduct of Sylvius
Narrowed mainstem bronchus by 50% will lead to what change in airway resistance?
Greater than 100%
Conductance is proportional to the diameter to the fourth power, narrowing of lumen by 50% would increase airway resistance 16 fold
Child with calcified mass in the suprasella region and peripheral blindness
Disease?
Craniopharyngioma (supratentorial mass)
What common causes Nasopharyngeal Carcinoma?
Ebstein Barr virus (EBV)
Common drug addiction
Oxycodone
Tick bite 10 days ago, fever, headache, peripheral rash that spreads to involve the trunk and face. Petechiae present from BP cuff.
Disease?
Cause?
Rickettsia rickettsii caused by tick
AA female around 35yo with fever, weight loss, arthralgia, Lymphadenopahy and hypergammaglobulinemia, hyperuricemia and restrictive pattern of lung disease.
Disease?
Chest Xray will reveal what?
Sarcoidosis. Will show hilar adenopathy on xray
Small population in a study, the significance of the results will be most limited what what?
Type II Error
Adequate sample size protects against this error, which is beta or false negative, the incorrect acceptance of the null hypothesis.
Type I Error would be thinking the results are true when they are false.
Elderly hospitalized with nosocomial pneumonia (upper lobar) with organism that has “mucoid agar growth”
Klebsiella pneumonia
Absolute risk = 1/100,000 but health car workers contract it 50x the rate of general population. What is the number of healthcare workers who require immunization to prevent one additional case?
2000
Since healthcare workers have 50x risk then their rate of infection is 50/100,000 = 1/2,000. The NNT is the inverse of the absolute risk ratio (1/2000)
19yr old woman with multiple erythematous lesions with silvery scales, pitting lesions in the nails. Lab test with HLA-B27.
Disease?
Psoriatic arthritis
Enzyme in Kreb cycle found in the inner mitochondrial membrane?
Succinate Dehydrogenase
60yo alchoholic in early stages of recovery. What agent will block cravings?
Naltrexone
What is the rescue drug to help with opioid overdose?
Naloxone
Pt with hypertrophic cardiomyopathy and primary AV block should be treated by?
What’s the drug MOA?
Verapamil (Non-DHP)
MOA:
Slow acetylators are at increased risk for drug induced lupus by what drug?
What’s the drug MOA?
Procainamide
MOA:
Psychiatric patient recently put on medication and develops increased urinary output. What are they taking?
Lithum sulfate…blocks the effects of ADH and likes to cause Nephrogenic DI
What are the features of Nodular Hyaline Glomerulosclerosis?
Diabetes affect the kidney and leads to Mesangial deposits and KM granules
Young boy with history of joint pains. Tea colored urine. Weakness in arms and legs without obvious deformity. Cartilaginous pigmentation of pinnae. Degenerative arthritic changes in long bones?
Diagnosis?
Deficiency?
Alkaptonuria due to deficiency homogentisic oxidase
Will lead to accumulation of homogentisic acid in joints, dark/black urine and pigmented cartilage.
40yr old man with new onset dyspnea, tachypnea, headache, confusion. Has cherry red color of skin and mucous membranes. Toxin is lethal via effects on Hb and by?
Carbon Monoxide poisoning leads to Inhibition of the activity of cytochrome oxidase
70 yr old man with pancreatic cancer, new onset dizziness, cold extremities, chest pain. Blowing systolic murmur heard best at the apex. Echo shows SMALL FIBRIN DEPOSITS randomly on the MITRAL AND AORTIC VALVES.
Disease?
Nonbacterial Thrombotic Endocarditis
Deep knife wound to the leg. Site of entry is purplish and very tender. Evidence of gas production by surrounding tissue. What microbe is responsible?
Clostridium Perfringens causes skin necrosis with black debris and gas
Fever, Night sweat, weight loss, cervical lymphadenopathy. Lymph node has large reticulum cell multinucleated, bi- and tri-lobed masses.
Disease?
Hodgkin’s Disease with REED STERNBERG cells (large cells with bi- or trilobed nuclei) present
Most important excretory product of protein/nitrogen metabolism is?
Urea
Child below 5th percentile for height/weight but in 95th for head circumference. Teeth are carious and xray show bone demineralization.
Disease?
SEs of therapy for this condition include?
Rickets
Treatment may cause Hypercalcemia
What is the cellular marker for Reed Sternberg cells
CD30+
Pt has seizure in ER. BITTER ALMOND BREATH Trismus and must be mechanically ventilated and expires. MOA of toxic effect of the cellular hypoxia produced by the formation of the inactive complex of cyanide and XX?
Complex IV (Cytochrome oxidase) = Cyanide
Massive splenomegaly, Low Hb, Low Hct, Elevated WBC count, and low leukocyte alkaline phosphatase
Chronic Myelogenous Leukemia (CML)
The low leukocyte alkaline phosphatase and the WBC>100k are giveaways
What drug improves efficiency of the heart, typically given to patients with previous history of heart failure?
IV DIGOXIN
CHF can shift the starling curve left via a positive iotrope
55yo, not married, lives alone, and forms no normal social relationship. Has magical thoughts. Alone and strange thoughts
SCHITZOTYPICAL
Combination of impaired social interaction and odd thinking, behavior, and speech.
Inability to name object with vision alone without aid of touch
Visual Agnosia
Oxidative phosphorylation happens where?
Inner Mitochondrial membrane
Necrosis of renal papillae in women with proteinuria
Diabetes Mellitus commonly associated with renal papillary necrosis
Pts that take Phenothiazine are at risk for developing what?
Masked facies and altered gait. Extrapyramidal SEs similar to parkinsons since dopaminergic.
Ebstein’s anomaly associated with maternal-fetal exposure to lithium carbonate, the anomaly includes?
Ventricular displacement of the Tricuspid valve
Hexose monophosphate shunt is regulated by?
Ratio of NADPH/NADH ratio
Contaminated water disease causes pulmonary HTN w/ Cor pulmonale heart disease. A variant form of the ivader is commonly seen in Egypt where it is linked to causing SCC of the bladder.
Disease?
Schistoscomiasis due to Schistosoma haematobium that leads to SCC of the bladder
Fast knee reflex is mediated by what tract?
Vestibulospinal
What is the electrolyte content of the bronchial mucus in a CF patient?
Low Chloride
High Elastase
Sweat had elevated chloride
MAO inhibitors + Patient having wine/cheese can lead to bad rxn. What drugs would be an issue?
Tranylcypromine sulfate (Phenelzine, Isocarboxazid)
Diet of mainly corn, pruritic skin rash, diarrhea, red tongue, altered mental status
Deficiency of Vit B3 (NIACIN) = Pellagra
50yo with deterioration of cognitive function via a prion
Subacute Spongiform Ecephalopathy
Melanin pigmentation of oral mucosa, lips, hands, scrotum, and complaints of hematochezia. What would you expect to find upon colonoscopy?
Disease?
Peutz Jegher Syndrome
Will see HAMARTOMAS on colonoscopy.
Irregular spasmodic movements of face and arms and loss of recent memories and impaired judgment
Changes in Caudate nucleus due to DECREASED GABA
4yr old with Lymphoblasts on peripheral blood sample
Translocation?
Acute Lymphocytic (Lymphoblastic) Leukemia
t(12;21)
32 yr old women during second trimester have heat intolerance, nervous, tremor, increased resting HR, proptosis. What would be found on histological section?
Diffuse Thyroid Hyperplasia with follicular hypercellularity and colloidal shrinkage aka GRAVES DISEASE (common in pregnancy)
Fatigue, weakness, balance difficulties, with positive Romberg sign and Macrocytic anemia.
What’s the vitamin deficiency?
What test would identity the deficiency?
Vitamin B12
Schilling’s Test: measures Vit B12 absorption w/ and w/o IF
How can you identify manic type of patients?
Mood disturbance, Hyperactivity, GRANDIOSITY, decreased need for sleep, RACING THOUGHTS, PRESSURED SPEECH, and involvement in dangerous activities.
Berylliosis mimics sarcoidosis in xrays. What industry do workers commonly obtain this disorder?
METAL PLANTs providing beryllium products to the AEROSPACE PROGRAM
Leads to restrictive lung disease
Irritable Bowel Syndrome associated with what?
Associated with PRETIBIAL ERYTHEMA NODOSUM and pyoderma gangrenosum lesion over ankle and uveitis
4yr old with Lymphopenia, failure to thrive, recurrent infections with normal and opportunistic agents. Hyperuricemia
Deficiency of Adenosine Deaminase
Eaton Lambert Syndrome of impaired ACh release is associated with men who have?
Oat Cell Carcinoma of the lung aka small cell
Crystal violet by gram positive is due to?
Peptidoglycan layer
What is the primary lipid storage product in adipose?
Triacylglycerol
Rheumatic disease in 40yo with myalgias, weight loss, fatigue, what else will the patient most likely have?
POLYARTERITIS NODOSA is common in patients with rheumatoid arthritis
Prader Willi occurs how?
Differential methylation of genetic material dependent on parental source of inheritance
“Doctor, you are beginning to sound just like my mother” What is this an example of?
Transference
Chronic Alcoholic with WIDE BASED GAIT due to permanent damage to what structure?
Cerebellar Vermis
What characterizes Francisella Tularensis?
Gram negative zoonotic bacilus
Female with mosaicism variant of Down Syndrome
46XX, 47XX +21
What cell produces of beta-hCG?
Syncytiotrophoblast
“Reduce sentence each time inmate is cooperative” is an example of what?
Negative Reinforcement. Rewarding by removing a negative
Most common cause of Subarachnoid hemorrhage with the worst headache of their life?
What is it associated with?
Defect in ANTERIOR COMMUNICATING ARTERY (Berry Aneurysm)
Is associated with adult kidney disease
Sensory stimulus to contract and respond by relaxation when tension is too high as a way to protect the muscle
Golgi Tendon organ
Child with distended abdomen with mother w/ decreased amniotic fluid (Oligohydramnios), what is the most likely cause
Urethral valve obstruction
Livestock farmer with goats and cattle, 1 year long fever. What would you expect upon biopsy of the patient’s bone marrow?
Cause of the illness?
Granuloma from infection with BRUCELLA species with an undulant fever that can last years
Hyperthyroidism. What would be used to control arrhythmias?
Propanolol
Multiple myeloma monoclonal antibody
IgG spike
What is Bombesin?
Secretagogue on pancreatic acinar cells
Amphotericin B MOA to fight Candida infection?
Disruption of ergosterol containing membranes
What drug inhibits 5-lipooxygenase?
Zileuton
What drug can cause Asthma?
Aspirin
8yr old with ALL develops bilateral interstitial pulmonary infiltrates, diagnostic lung biopsy is performed and shows spherical structures within the alveoli of the lung impregnated with silver stain.
Cysts from Pneumocystis Carinii. (Any lung biopsy that reveals things with silver stain is automatically pneumo carinii)
Adrenal cortex cells that synthesize mineralcorticoids have an abundance of what structure?
SMOOTH ER which is the site of synthesis of steroids like mineralcorticoids, glucocorticoids, andrograns, estrogens
Transection of C7 will lead to…?
Bradycardia due to cutting off the sympathetic plexus
Nausea and vomiting symptoms are mediated by what region of the brain?
Area Postrema
Bee sting allergy rxn is mediated by?
IgE antibodies
Pet bird gave women severe mitral regurgitation..what microbe is responsible?
Chlamydia psittaci..causes both atypical pneumonia and endocarditis
HIV patient with bilateral large white areas with perivascular exudates and hemorrhages. What is the patient CD4 count?
<200, around 50/mm cubed
Kawarshiokor is caused by?
Protein deficiency. Worse prognosis than Marasmus (which is total calorie deficiency)
Colchicine MOA
Blockage of polymerization of microtubules
60yr with Type II DM treated with Chlorpropamide. Serum Na 118 and specific gravity of 1.012. What is the cause?
Syndrome of Inappropriate ADH (SIADH)
Chlorpropamide is a classic inducer as well as carbamazepine, cyclophosphamide.
Bipolar disorder with Lithium producing 5x normal urine…SE?
Nephrogenic Diabetes
Major side effect of Zidovudine for a man with HIV
Neutropenia
Chronic stable angina pectoralis
Isosorbide dinitrate (Long acting nitrate)
Post pregnancy, less hair, postural hypotension, loss of female secondary sex characteristics
Panhypopituitarism aka SHEEHAN’S SYNDROME Due to ischemic hemorrhage necrosis
Hypotension, hyperkalemia, and hyponatremia, fatigue, skin pigmentations (high levels of POMC)
Adrenal Insufficiency (Addison’s low cortisol and aldosterone)
Head trauma can lead to polyuria, polydipsia, hypernatremia…characterized as what?
Diabetes insipidus (decreased production of ADH)
Thick brown lesions in axilla of large obese patient..what is the underlying disease?
Diabetes Mellitus…brown lesions are Acanthosis nigricans
Can also be a sign that should suspect of GI malignancy
Claw hand deformity..injury to what nerve?
Ulnar nerve
Child who violates other children’s rights aka fights and argue with teacher
Conduct Disorder
Drug that blocks the catalytic action of RNA polymerase
Actinomycin D..intercalates b/t base pairs of DNA to stabilize the helix
Skin blisters and blisters in oral mucosa that easily peel off. What autoantibody would be present?
Disease?
Anti-Desmoglein antibodies present in Pemphigus vulgaris
What is most common Testicular cancer that presents as painless mass?
Seminoma: germ cell tumor with gonadal differentiation
Glossitis, corneal vascularizaiton, cheilosis, and seborrheic dermatitis in 33 yr old man
Vit B2 (Riboflavin) deficiency
15yo F with bleeding from left breast. No traume or skin chagnes. Most like explanation?
Intraductal papilloma. Bloody nipple discharge should lead to intraductal thoughts
Common site of Aspiration
Right Middle lobe bronchus
Patients with Celiac disease are at increased risk for what GI cancer?
Intestinal Lymphoma
Painful genital ulcer that leads to enlarged inguinal lymph node. No multiple sexual partners.
Microbe?
Chancroid caused by Haemophilus ducreyi
Upper Left limb drains into
Thoracic duct
Child 2-3 weeks after pharyngitis now has random jerking hand movements
Name?
Cause?
Chorea symptom due to Acute Rheumatic fever as a result of Strep Pyogenes infection
21yo comes to health office from episodic lumbar, abdominal pain. Splenomegaly, hemoglobinuria, and free hemoglobin in plasma. An acid hemolysis test is positive.
Paroxysmal nocturnal hemoglobinuria with markers CD55 or CD59
Peripheral smear shows RBCs filled with fine, round, pink, uniform, reddish granules with some ringed structures with an eccentric nucleus
Disease?
Malaria
Hand, arm, shoulder pain on right side with numbness in fingers. Patient complains of having trouble blow drying hair, arm readily fatigued, supraclavicular bruit when arm is abducted
Disease?
Thoracic Outlet Syndrome
Elevated Ca, Osteitis fibrosa cystica, in a AA female in her 40s. Most common etiology is?
HyperPTH
24yo male with neck pain, tenderness, worsened with swallowing and head turning. Pain radiates to jaw.
Disease?
Mumps
Patient with ridiculous appetite. Lesion is located where?
Lesion in the VENTROMEDIAL of Hypothalamus
Chest XRay with diffuse, finely nodular pattern at base of lungs. Evidence of pulmonary HTN. There is reduced vital capacity. What drug could have caused this?
Amiodarone which leads to Pulmonary fibrosis
Site of blood is identified as an outpouching from antimesenteric side of terminal ileum that represents the persistence of what embryonic structure?
Vitelline Duct (or yolk sac) Meckel's Diverticulum
18yo who routinely breaks the law and has no plan for the future. No remorse for harm to others
Antisocial personality
Chorea, low pitched diastolic murmur preceded by early diastolic sound that increases with inspiration.
TRICUSPID STENOSIS..typically an opening snap then a diastolic rumble over the triscupid valve
Murmur INCREASES WITH INSPIRATIOn means right heart problem.
7yo child with fever, anorexia, then tachycardia and cardiomegaly. What organism caused this?
Group B Coxsackie Virus
Most common cause of viral etiology myocarditis in children
Organophosphate in pesticide that causes symptoms
Parathion
Post surgery need tetracycline to then be able to absorb Vit B12
Blind Loop Syndrome
Fever, vomit, watery diarrhea. Cruise ship. Stool with no bacteria
Norwalk virus
What structure is located posterior to the thymus?
Left brachiocephalic vein
Urease positive. Hydrogen sulfide positive. Indole negative. Motile and associated with putrefactive odor is most likely?
Proteus Mirabilis
What structure is directly posterior to the sella?
Basilar artery
What glands are most susceptible to CF?
Exocrine glands
50yo homeless man with AIDS complains of back pain…lost weight and has fever/chills. Has tenderness over T7 and T8 as well as inguinal mass. What is the most likely explanation of symptoms?
Tuberculous Osteomyelitis aka Pott’s Disease
Tear drop shaped RBCs. Bone marrow shows a dry tap
Idiopathic Myelofibrosis
Removal of anterior pituitary tumor. What structure needs to be ligated?
Superior hypophyseal arteries
G6PDH deficiency results in dark urine and RBCs that have precipitates of what?
Hemoglobin= Heinz Bodies
What is the most treatable viral encephalitis?
What’s the tx?
Herpes Simplex
Tx with Acyclovir
Situs Inversus is a result of what mutation?
Name of syndrome?
Abnormality of Dynein arms results in Kartagener Syndrome that results in defective cilia arms and leads to
Reversed organs–situs inversus
Infertility
Nonfunctional mucociliary elevator
Child with enlarged and discolored tonsils, corneal opacities, recurrent polyneuropathy. Low HDL but no history of premature CAD. Most likely explanation is?
Familial lipoprotein deficiency aka Tengier’s Disease
Orange tonsils are pathognomonic
Bullous infective impetigo is caused by what organism?
In what location?
Staph aureus
Most commonly at the Nares
Esophageal varices occur between the L. Gastric vein and what structure?
Azygous vein
Long standing alcoholic. Bleeding is caused by dissolution of vessel walls by what pancreatic enzyme?
Elastase
AIDS with chronic diarrhea. (Cysts?) surrounded by a halo containing spindle shaped sporozoites
Organism?
Cryptosporidium
Oocytes surrounded by protective covering of granulosa cells that persists to fertilization known as…
Corona radiata
OCD patient..Tx?
SSRI (example: Fluoxetine)
Intense pruritus after hot shower or bath. Visual changes, ruddy complexion, engorged retinal veins. Diagnostic test would be?
Red blood cell mass due to Polycythemia vera
Itchy with shower almost always identifier for Polycythemia vera
Causes: EPO is low (primary)
Secondary: Elevated EPO and increased sensitivity of BM to growth factors
Monoclonal spike (IgG), protein in urine, H. influenza infection, and Lytic lesions
Multiple Myeloma
Will have decreased immunity to encapsulated organisms
Failure of intestinal loops/GI tract to return to abdomen during fetal development?
Omphalocele…failure of intestinal loops to return to abdominal cavity from the umbilical cord during the 10th fetal week
Beaded structure that wraps 200 bps of DNA on histones
Nucleosomes
PTH given to patient with low Ca but normal PTH levels and no response is illicited after dose
Pseudohypoparathyroidism
Dreaded complication of acute pancreatitis
Abscess
Cannot develop a tolerance to morphine’s SE of?
Constipation
Antidote to Heparin effects
Protamine/ Protamine sulfate
One major complication with lung transplant is Intense Perivascular mononuclear infiltrate that fills the small airways with inflammatory fibrous exudate known as?
Bronchiolitis Fibrosa Obliterans
Amyloid deposition in pancreatic islet cells
Type II DM
South American person with megaesophagus…
Disease?
Cause?
Chagas disease caused by Trypanosoma cruzi
Basal ganglia hematoma leads to ipsilateral dilated pupil
What kind of herniation?
Transtentorial herniation
After GI instrumentation then develop new heart murmur from what organism?
E. Coli from the gut
Difficult to swallow, enlarged esophagus that does not peristalse and obstruction of the LES. Newest treatment for this disorder is the injection of?
Clostridium Botulinum which will relax the LES sphincter
81yo with pericolic mass in pelvis. LLQ abdominal pain, muscle spasm, guarding, rebound tenderness
Acute colonic diverticulitis
usually seen in elderly who have appendicitis symptoms on left side
What drug will help reduce Parkinson med SEs?
Carbidopa
Chemo drug most likely to cause cardiotoxicity?
Doxorubicin
Large kidneys via angiotensin II induced mesangial hyperplasia are seen in?
Diabetic Nephropathy
Apoptosis is increased during chronic inflammation from what drug?
TNF-alpha..also leads to loss of appetite and subsequent catabolism and weight loss
Distal muscles weaker than proximal..disease?
Inclusion Body Myositis
Pernicious anemia is characterized by achlorhydria with shrinkage of the parietal cell mass. Patient are now susceptible to infrection from
Salmonella typhimurium. Loss of HCl is known as the concept of “loss of gastric barrier”
Acromegaly is treated with?
Octreotide
TCAs main side effect?
Orthostatic Hypotension and anticholinergic SEs
Optimum intake level of dietary calcium to promote peak bone mass once women reach young adulthood
1000 mg
What medication induces involuntary muscle movements of arms, legs, tongue and lips?
Haloperidol
What condition is Ipratropium used to treat and what is its classification?
Used to treat ASTHMA and is classified as an anticholinergic
Farmer with high levels of eosinophils and epigastric pain is caused by what microbe?
Ascaris Lumbricoides
Clindamycin MOA
Inhibition of tRNA translocation
Acute gout treatment
Chronic gout treatment
NSAIDs such as Indomethacin
Allopurinol
Patients on Sildenafil aka Viagra should be concerned with interactions with what other drug type?
Nitrates
Elderly with cerebral brain tumor..most likely?
Glioblastoma multiforme
Bifid carotid impulses with harsh systolic murmur that increases with standing or valsalva strain (decreased preload) and gets worse when decrease VR
Hypertrophic Cardiomyopathy (HCM)…young athlete sudden death.
Aortic stenosis intensity of murmur increases when you squat
Osteoarthritis remedy that increases creatinine levels
Ibuprofen–reversible decline in kidney clearance
Serum Triglycerides >1000. Is at high risk for pancreatitis. Txt with triglyceride lowering agent such as?
Gemfibrozil
Tx for Chagas disease is Nifurtimox….MOA?
Producing oxygen radicals
Infant born with systemic HTN, abnormalities of salt homeostasis, and androgenization. Sibling would have benefited from maternal dexamethasone during pregnancy. Disease?
Adrenogenital syndrome…most common form os 21 hydroxylase deficiency
Short small round head, large furrowed tongue, brachydactylyl with an incurved fifth finger
Trisomy 21
Hyperamylasemia does not necessarily equate to pancreatic disease. It can also be seen in…?
Mumps
Patient receiving therapy for rheumatoid arthritis is given medication that instantly makes her feel woozy and develop a pounding headache. She is noted to be hypotensive. What drug was she given?
Gold Sodium Thiomalate..causes acute development of hypotension, the nitritoid rxn.
40yo with flank pain and gross hematuria. US is found to have numerous renal cysts. Renal function shows mild azotemia. Most likely explanation?
Polycystic Kidney Disease
Autosomal dominant type associated with Berry Aneurysm, hepatic cysts, and mitral valve prolapse
Auto accident to one side of skull. Appears fine at first, then hours later has ipsilateral impaired pupillary reflex, hemiparesis, and decerebrate posturing. What happened?
Epidural hematoma caused by tear of meningeal artery.
Patient presents with an upward gaze palsy and pupils accommodate to near objects but do not react to light. Issue with what structure?
Pineal gland problem
4yo recently returned from Africa presents with fever, anemia. He then goes into coma and dies. Most likely organism?
Plasmodium falciparum
New born with meningomyelocele most likely have?
Malformation of the brainstem and cerebellum
Tonsillar herniation = arnold chiari malformations
Most common cause of cancer death with men and women?
Lung cancer
Lack of response to iron supplementation indicates?
Malabsorption problem
Mechanism for the proximal tubular avidity for Na?
Basolateral Na/K ATPase pump
Jamaican child with diarrhea alternating with constipation, weakness, hematochezia, anemia, rectal prolapse. Stool shows barrel shaped eggs with brown outer shell, transparent inner shell, plug like translucent polar prominences.
What microbe?
Treatment?
Trichuriasis…Trichuris trichiura (whip worm) presents with alternating constipated and diarrhea, anemia, and rectal prolapse. Barrel shaped eggs on wet prep
Treatment: Mebendazole
Dominant x linked disease that presents with nephritis and deafness?
Alports Syndrome defect in Type IV collagen
45yo woman with Scleroderma noted to a decreased DLCO (pulmonary diffusion capacity of Carbon monoxide) and decreased TLC. Disease?
Pulmonary Fibrosis which has diffuse interstitial fibrosis
Congestive heart failure complains of severe dyspnea and leg swelling. Serum K is 3.2 (LOW) Condition is related to?
Aldosterone levels…chronic CHF results in secondary hyperaldosteronism that further exacerbates CHF symptoms
Premature labor with edematous and anemic baby that dies two days later. What other findings would be present?
Extramedullary Hematopoiesis
Kernicterus in infant brain from hyperbilirubinemia from overwhelming hemolysis seen in erythrobalstosis fetalis.
Expect to find Unconjugated Bilirubinemia that will lead to Urobilinogen formation.
Marker for Chronic carrier of Hepatitis B
HBeAg (Hep Be antigen)
Carpal Tunnel Syndrome. Pain is mediated by what nerve?
Median nerve
Women feels empty when bf threatens to leave her. She drinks and does cocaine daily and has outburst of rage. What personality disorder?
Borderline Personality Disorder
Anticodon for GUG
CAC
Collagen is composed entirely of what type of structure?
Triple helix–formed INSIDE the RER
Mediterranean woman is given Sulfamethoxazole to treat a bladder infection. Adverse rxns would be seen in a patient with what enzyme deficiency?
Glucose 6 Phosphate Dehydrogenase deficiency (G6PDH) Expect to find HEINZ BODIES of Hb
Patient has Pheochromocytoma. What would be found in urine and what is it a metabolite of?
Expect to find METANEPHRINE which is a metabolite of Epinephrine
Increased levels of homocysteine, normal lipid levels,. What aa is most likely reduced in patient?
Methionine. Due to VitB12 deficiency and increased levels of homocysteine and decreased levels of methionine can lead to Atherosclerosis
Vit C deficiency leads to defect in collagen synthesis that involves what aa?
Hydroxylproline
Right hip flexed and resists active extension of the hip to due inflammation of what structure?
Psoas major
6yo boy with intraabdominal mass in midline above pubic symphysis. A cystic mass is found attached to the umbilicus and the apex of the bladder. Diagnosis?
Urachal cyst
Alcoholic cirrhosis–what dilated veins leads to vomit blood?
Left Gastric vein
Suprahyoid stab wound; now tongue deviates to the right when protrudes. What nerve is injured?
Right Hypoglossal
Hypoglossal will deviate toward injured side
Patient has Adenocarcinoma of the left breast. What is the name of the lymph node that this breast cancer would drain to?
Ipsilateral axilla
Urine leaking from the umbilicus due to an abnormality of what structure?
Urachus
Patient has their IMA blocked. Where is the additional source of blood to the descending colon?
Middle Colic Artery
Left knee can be displaced anteriorly. What structure is injured?
Anterior cruciate ligament
70yo at ER 1 week with increasing severe left sided abdominal pain and passing gas in urine. Fever. Cuase of condition?
Diverticulitis
Tenderness in region distally between extensor pollicis longus and extensor pollicis brevis after falling on palm. A fracture to what carpal bone is most likely?
Scaphoid
7yo harsh continuous murmur at left sternum between first two ribs. Arterial blood oxygen is higher in the right hand than in the left hand. What’s wrong?
Patent Ductus Arteriosus (PDA)
6yo with Split S2 and Grade 2/6 pansystolic murmur heard maximally at the left sternal border. Higher oxygen levels in the right ventricle. Most likely from?
Ventricular Septal defect
Left ovarian vein thrombosis most likely to extend into what vein?
Left Renal vein
Voluntary control of urination due to what structure?
External urethral sphincter
Estrogen causes the endometrium to undergo?
Hyperplasia
What synthesizes myelin in the CNS?
Oligodendrocytes
What synthesizes myelin in the PNS?
Schwann cells
Urticaria is a result of what?
Mast cells releasing histamine
Zollinger Ellison syndrome patient undergoes gastrectomy. What type of cells will patient now lack in his stomach?
What supplement will they have to take?
Will lack PARIETAL CELLS and supplement with Vit B12
Hepatocytes secrete proteins into blood vessels via?
Exocytosis
Cell with greatest mitochondrial contest is located in what organ?
Heart (cardiac muscle cells)
Mechanism by which E6 causes cervical cancer?
What role does E7 play?
E6 prevents apoptosis via p52.
E7 interferes with Rb
What cell type creates mucous?
Goblet cells
What leads to the elevated plasma CK-MB after heart attacks?
Cell membrane damage causes CKMB to leak out of cell and into the circulation
What is the function of Kinesin?
Helps gather presynaptic NT vesicles (anterograde)
Diabetes poorly controlled, necrotic lesion with black eschar on right ear. Microscope show non septate hyphae with branches at right angles. Microbe?
Rhizopus oryzae
What vaccine would you give a 21 yr old college student w/ meningitis
Meningococcal conjugate vaccine
Strep virulence interferes with phagocyte’s ability to do what?
Ingestion
Pt treated with chloroquine and then later develops RBCs with rings inside them. What species of plasmodium caused this infection?
Plasmodium vivax
Person travels to Cali and has red, tender nodule on shins with ankle tenderness/pain and xray shows left pleural effusions. Which microbe is responsible?
Coccidiodes immitis…causes Coccidiodmycosis.
Urease positive organism with swarming motility on nonselective agar?
Proteus mirabilis
Which part of the complement causes the vascular permeability and chemo attractant?
C5a aka IL-8
Staph aureus is resistant to penicillin via…
B-lacatamase production
3yo vomits after paroxysm of coughing…cause?
Bordetella pertussis aka Whooping cough
Person went hiking in NE USA and develops fever 1 week later. Also has rash with partial central clearing
Cause?
Borrelia burgdorferi
Loss of pain and temperature on right face and contralateral body, paralysis of soft palate, larynx, pharynx, ataxia from thrombosis of?
Right Posterior inferior cerebral artery aka R. PICA
Severe headache, bulging optic disc, retinal veins are engorged. What is suspected?
Increased intracranial pressure
What structure is the source of CSF fluid that then flows into the ventricles?
Choroid plexus
Personality changes, difficulty walking, clumpsy, slurred speech. Slit lamp shows brownish ring around cornea.
Disease?
What would be found in plasma?
Wilson’s Disease
Will see Kayser Fleischer rings
In plasma, will have DECREASED CERULOPLASMIN
Down syndrome patient that lives to 40. What would be expected in brain?
Neuronal plaques and tangles susceptible to Alzheimers.
Leading cause to loss of sensation to feet?
Type II DM
Prolonged palmar flexion of the wrist induces tingling due to compressing
Median nerve and overtime can lead to Carpal Tunnel syndrome
Increased osmotic fragility. What would be found on peripheral smear?
Spherocytes
22yo woman with history of nervousness, light headed, dizziness that resolves after eats a meal. Serum glucose is 25. She is given IV saline and glucose and gains consciousness.
What is the cause?
Insulinoma
Carpenter with absent breath sounds, dullness to percussion over right lung base, thickened pleura with pleural effusions with spindle cells
Disease?
Mesothelioma Expect to find FERRUGINOUS BODIES that look like dumbbells
Does Necrosis require protein synthesis and is it energy dependent?
Necrosis: cellular swelling. Death of many cells. Lysosomal breakdown, inflammation, calcification, cessation of protein synthesis ENERGY NOT REQUIRED
Is there inflammation or calcification in Apoptosis?
Apoptosis: Cellular shrinkage, chromatin condensation and fragmentation, death of single cells, lysosomes intact
NO INFLAMMATION, NO CALCIFICATION
Requires protein synthesis and is energy dependent
Name a proapoptotic marker
BCL-2 comes into cytoplasm and triggers apoptosis
What would be seen histologically Day 1 after an MI?
Wavy cells; Day 7 would see granulation and day >24 Scar
Mycosis Fungiodes tend to lead to what disease?
Cutaneous T cell Lymphoma
Celiac patient should avoid what from their diet? What is the HLA type that predisposes to celiac disease?
Should avoid GLUTEN. HLA DQ2
Ethanol is metabolized by?
Aldehyde dehydrogenase
What would be been on a histo slide of a liver due to Acetaminophen toxicity?
Centrilobular Necrosis due to damage from NAPQI metabolite
HSV Skin lesions has Tzanck cells. What are they composed of?
Multinucleated keratinocytes
What virus causes Molluscum contagiosum?
Pox Virus
What is the histologic form of contact dermatitis?
Spongiotic Dermatitis
Skin lesion with small round blue cells
Merkel Cell Carcinoma
Painless mass on right neck (lateral neck)–what type of cyst do you expect?
Brachial cleft cyst
41yo FM patient eats mainly fatty foods, complains of colicky pain. RUQ pain radiates to her back. What is going on?
Cholecystitis
Minimal Change Disease shows that under light microscope?
Podocyte Foot Effacement
5yo with left large renal mass. Disease?
Wilms Tumor. Tend to have good prognosis >90% survive.
Where are most insulinomas located?
What substance will be elevated?
TAIL of the PANCREAS. Should expect to have elevated C peptides.
Beta blockers can sometimes mask what condition?
Hypoglycemia
Exogenous use of insulin would have increased or decreased levels of C peptide?
Decreased aka low levels of C Peptide
What diseases can Pheochromocytoma develop in?
NF-1, MEN IIa, MENIIb, and VHL
What are the most common risks for breast cancer?
Nulliparity, Hormone replacement therapy, Obesity, BRCA1, Early Menarche
Does ductal carcinoma ever metastasize?
NEVER
Dysgerminomas are similar to what testicular cancer?
Seminoma
What are Heberdon nodes in patients with Osteoarthritis?
Osteophytes
What is the name of the CNS macrophage?
Microglia cells
16yo male with Tibia showing lifting of the periosteum and SUNBURST APPEARANCE on xray
Osteosarcoma
Patient with Thalassemia..what would be elevated?
HbA2
Celiac disease is common in people with what type of immune disease?
IgA Deficiency
Patient has elevated levels of IgM and no other immunoglobulin types in their blood. Disease?
Hyper IgM Disorder
Patient with Dermatitis/eczema and Thrombocytopenia, and susceptible to recurrent infections. Disorder?
Wiskott-Aldrich Syndrome. Xlinked disease. Cannot make antibodies to organisms with capsules…common to have bloody diarrhea
Complete moles tend to lead to what type of female cancer?
Choriocarcinoma
FM has increased levels of Beta bCG and AFP. What type of tumor is suspected?
Mixed Germ Cell Tumor
26yo w/ 1cm nodule in testicle and histology reveals fried egg appearance with numerous small lymphocytes. What cancer is suspected?
Seminoma
Rheumatic fever can escalate and lead to death via…?
Myocarditis
Patient with Syphilitic heart condition due to living a life w/ unprotected sex. What would expect to find on the patient’s aorta?
Aortic Regurgitation as a result of LINEAR CALCIFICATION ALONG THE ASCENDING AORTA
Patient shows signs of CREST SYNDROME such as Raynaud’s phenomenon and esophageal dysmotility due to fibrosis. What auto antibody would be found?
Anti-Centromere antibodies
Graft vs Host Disease. Damage is mediated by what immune cell type?
CD8+
33yo FM patient diagnosed with TTP. What would be found on peripheral blood smear?
Schistocytes and Helmet cells
Most common Cavitary lesion on the lung is due to ..?
Secondary TB
12yo w/ hematuria a few days after a viral infection and continues to have a sore throat. What kidney disorder do you suspect?
IgA Nephropathy
22yo woman with one day history of fever, right flank pain, bacteria in urine with numerous WBCs and WBC casts. CBC shows leukocytosis…Disease?
Pyelonephritis
Procainamide induced Lupus stems from what genetic polymorphism in drug metabolism?
Slow acetylator phenotype
2yo boy with protrusion of small intestines before ileocecal valve most likely from?
Meckel Diverticulum
Take what vitamin to reduce the risk of child with Anencephaly?
Folate aka Folic Acid
Long term bond
Short term bond
Covalent bond
Ionic bond
Carbamazepine for tonic clonic seizure doe what to CYP liver enzymes (inhibitor or inducer)
INDUCER Increases metabolism by the liver
PLC cascade, the release of Ca is mediated by what secondary messenger?
Inositol 1,4,5, Triphosphate aka IP3
Epinephrine production is from what cells?
Chromaffin cells
Acid in duodenum triggers the release of what substance?
Secretin
Decreased radius of lung alveoli of newborn leads to respiratory distress. What does this do to compliance?
Decreases compliance
