"High Yield or U-World Only" Step 1 Cards Flashcards

Question

Describe the Chvostek sign and the Trousseasu sign associated with DiGeorge Syndrome

Answer 1

The hypocalcemia assc. with DGS leads to increased neuromuscular excitability. _Chvostek sign_- tapping on the facial nerve elicits **twitching of the nose and lips** _Trousseau sign_- inflation of the BP cuff leads to carpal spasm

Answer 2

They dec. AV nodal conduction, leading to an increased AV nodal refractory period

Answer 3

1. Sudden unilateral chest pain 2. Hyperresonance 3. Absent breath sounds 4. Often seen in tall, thin males around age 20 Can be the spontaneous result of the rupture of an **apical subpleural bleb**

Answer 4

THey interact with MHC II on APCs (macrophages) and w/ T-cell receptor to widely _activate T cells_. (this leads to IL2 release from T cells, and TNF / IL1 release from macrophages, ultimately causing shock symptoms)

Answer 5

Decreases GFR (because AT-II can no longer constrict the efferent arteriole)

Answer 6

Loss of focal contractility occurs within _60secs_!

Answer 7

1. Segmental, transmural, necrotizing nflammation of medium to small sized arteries in _any_ organ 2. **Lungs are spared** 3. Can be cutaneous manifestations, including livedo reticularis and palpable purpura 4. Inflammation can result in ischemia, infarcation, or hemorrhage and _bead-like aneurysm formation_

Answer 8

They can present with groin discomfort or manifest with a bulge on the upper thigh. Incarceration and strangulation are common complications of femoral hernias.

Answer 9

_Cardiac Muscle_: surface membrane depolarization → opening of voltage-sensing DHPR channel → Ca2+ dependent activatin of RyR2 channel **(calcium induced calcium release)** _Skeletal Muscle_: surface membrane depolarization → conformational change in voltage-sensing DHPR channel → allosteric activaton of RyR channel **(mechanical coupling)**

Answer 10

It is when superficial venous thromboses may appear in one site, resolve, and occur in another site. This often indicates _visceral cancer._

Answer 11

_Proximal_: renal artery _Distal_: superior vesical artery

Answer 12

**Tophi** (uric acid crystals in the soft tissues/joints), or **renal failure** due to uric acid deposition in tubules

Answer 13

Increase trabecular outflow of aqueous humor

Answer 14

_Carbidopa_- a DOPA decarboxylase inhibitor _Entacapone_- a COMT inhibitor These both increase levadopa bioavailability to the brain

Answer 15

They are comprised mostly of _Schwann cells_, which are embryologically derived from the _neural crest_

Answer 16

**Hot T-Bone** st**EAK** IL-1: fever (_hot_) IL-2: stimulates _T_ cells IL-3: stimulates _bone_ marrow IL-4: stimulates Ig**_E_** production IL-5: stimulates Ig**_A_** production IL-6: stimulates a**_K_**ute-phase protein production

Answer 17

1. Dec. LDL and TG; Inc. HDL 2. _MOA_: Upregulate LPL, resulting in inc. oxidation of fatty acids; also, inhibit **cholesterol 7a-hydroxylase**, which catalyzes rate-limiting step of bile acid synthesis 3. Reduced bile acid production results in dec. cholesterol solubility, favoring **cholesterol stone formation**

Answer 18

1C \> 1A \> 1B (least use dependent)

Answer 19

B-1 receptors (which is why B-blockers can help dec. blood pressure)

Answer 20

1. Short-acting balanced **venous and arterial vasodilator** 2. Decreases both preload and afterload, thus maintaining stroke volume 3. Indicated for hypertensive HF

Answer 21

It can cause joint destruction with **verterbal malalignment (subluxation)**, particularly at C1. Extension of neck (particularly during ET placement), can worsen the subluxation, leading to _acute compression of the spinal cord and/or vertebral arteries_

Answer 22

1. Focal pain + swelling at the tibial tuberosity 2. Repetitive quadriceps contractions in adolescent (quads are attached to the tibial tuberositt, via the patella)

Answer 23

* Typically presents w/ cardiac arrhythmias and nonspecific GI, neuro and visual (color change) sx * Elevated K+ is another sign of digoxin toxicity (due to inhibition of Na-K-ATPase)

Answer 24

1. **Tetrahydrobiopterin** 2. Accumulation of phenylalanine in body fluids and the CNS. Homozygous infants are normal at birth but gradually develop **severe intellectual disabilities and seizures**. May also have **hypopigmentation** of skin, hair, eyes, and catecholaminergic brain nuclei

Answer 25

1. MIld, nonprogressive hyperglycemia that often worsens with pregnancy-induced insulin resistance 2. Often a result of _mutation of the **glucokinase gene**_. Glucokinase = glucose sensor. Mutation leads to dec. beta cell metabolism of glucose, less ATP formation, and dec. insulin secretion 3. Could lead to fetal growth retardation and sever hyperglycemia at birth

Answer 26

1. **Metronidazole** (Initial mild/moderate C. Diff tx) 2. **Vancomycin** (Severe or recurrent C. Diff) 3. **Fidaxomicin** (recurrent C. Diff and inc. risk of recurrence)

Answer 27

1. Usually in **infants** born before 32 weeks gestation or with a low birth weight 2. IVH in premies usually originates in **germinal matrix**, where neurons and glial cells migrate out during brain development 3. Clinically silent or present with altered level of conciousness, hypotonia, and decreased movement. **Symptoms of catstrophic bleeding are the same as those of increased ICP**.

Answer 28

hypothalamus

Answer 29

**Disruption of sensory and motor function of the contralateral leg and foot**, while sparing the contralateral arm/face

Answer 30

Most often presents with **painless melena** (gastric tissue can cause ulceration leading to lower GI bleed). The diverticulum may also become inflamed and simulate presentation of acute appendicitis.

Answer 31

1. Genetic disorder resulting in abnormal development of the first and second pharyngeal arches 2. _Result_: (1) Craniofacial abnormalities which often compromise airway and feeding; (2) absent or abnormal ossicles leading to profound conductive hearing loss

Answer 32

They carry out the **nonoxidative reactions of the HMP shunt** (Pentose Phosphate Pathway) _All cells_ can synthesize ribose from fructose-6-phosphate using the nonoxidative rxns.

Answer 33

Myopathy + Lactic Acidosis due to failure of oxidative phosphorylation. Muscle biopsy often show **"ragged red fibers"**

Answer 34

a2y2 (alpha 2, gamma 2)

Answer 35

This antibiotic can lead to both dose-dependent (reversible) **cytopenias** and dose-independent (irreversible) **aplastic anemia**.

Answer 36

Both are CD4+ Helper T-cells **_Th1_** 1. Secretes IFN-y 2. Activates macrophages and cytotoxic T cells 3. Activated by INF-y and IL-12 4. Inhibited by IL-4 and IL-10 (from Th2) **_Th2_** 1. Secretes IL-4, 5, 10, and 13 2. Recruits eosinophils for parasite defense and promotes IgE production by B cells 3. Activated by IL-4 4. Inhibited by IFN-y (from Th1 cells)

Answer 37

\> or equal to 75%

Answer 38

- Choriocarcinoma - Germ cell tumors

Answer 39

They secrete very high levels of hCG, which can bind the **TSH receptor** (leading to _paraneoplastic hyperthyroidism_)

Answer 40

1. Autosomal-recessive 2. Result of a defect in DNA-repair genes, making the genes _hypersensitive to ionizing radiation_ 3. Presents as child w/ (1) **cerebellar ataxia,** (2) oculocutanoeous telangiectasias, (3) repeated sinopulmonary infxn, (4) inc. incidence of malignancy

Answer 41

The activity of T cell-mediated immunity via recruitment of _macrophages, and CD4+ and CD8+ T lymphocytes_

Answer 42

**Hydrophilic bile acids** (eg ursodeoxycholic acid). These decrease biliary cholesterol secretion and increase biliary bile acid concentration, improving cholesterol solubulity.

Answer 43

Phenylethanolamine-N-methyltransferase (**PNMT**) It is upregulated by cortisol

Answer 44

Pancreatic

Answer 45

1. CN III is most commonly involved 2. Caused predominantly by _central ischemia_ 3. **_Sx_**: ptosis, "down and out" gaze, normal light/accomodation reflexes

Answer 46

1. First-line tx for **major deppression disorder** 2. Does _not_ cause sexual dysfunction (unlike the SSRIs) 3. Can lead to _seizures_ so contraindicated in any patient with **seizure disorders** or prior dx of _bulimia/anorexia_

Answer 47

* Carbonic Anhydrase activity w/in erythrocytes forms bicarb from CO2/water * Many of the bicarb ions diffuse from the RBC to the plasma * To maintain electroneutrality, chloride ions diffuse into the RBC

Answer 48

**Macrophages** (control w/ Tissue Inhibitos of Metalloproteinases- _TIMPs_) and **Neutrophils** (control w/ serum _a1 antitrypsin_)

Answer 49

Pyrophosphate

Answer 50

1. Sudden onset palpitations 2. Tx w/ adenosine 3. _SE_: (1) Flushing, (2) chest burning (from bronchospasm), (3) hypotension, (4) AV block

Answer 51

H1 = allergies H2 = acid (GERD, ZE, etc.) Both are histamine receptors

Answer 52

Tx with high dose corticosteroids (to prevent blindness), and _then_ get a biopsy

Answer 53

1. **Congestion** (first 24 hours): Vascular dilation; exudate contains bacteria 2. **Red hepatization** (days 2-3): erythrocytes, PMNs and fibrin in exudate 3. **Gray hepatization** (days 4-6): RBCs disintegrate. Exudate contains PMNs and fibrin 4. **Resolution**: Enzymatic digestion of exudate

Answer 54

1. Microangiopathic hemolytic anemia 2. Thrombocytopenia 3. Renal insufficiency Result of **0157:H7** E.coli, usually in undercooked ground beef

Answer 55

Over-expression of MHC-I on the sarcolemma leads CD8+ infiltration, and subsequent myocyte damage

Answer 56

**Protein phosphatase**, via the PI3K pathway

Answer 57

1. Important cofactor for the Phenylalanine hydroxylase and Tyrosine hydroxylase 2. **Dihydropteridine reductase** is responsible for converting BH2 to BH4 3. Deficiency would lead to inc. phenylalanine (can be corrected by diet) and def in tyrosine conversion to its downstream products such as dopamine, NE, Epi, and serotonin (leading to neuro deterioration)

Answer 58

1. Acid a-glucosidase 2. Acid a-glucosidase is responsible for breakdown of glycogen w/in lysosomes. Its absence leads to glycogen accumulation w/in liver and muscle lysosomes 3. _Presentation:_ **Pompe** trashes the **Pump** (heart, liver, and muscle) -- cardiomegally, hypertrophic cardiomyopathy, excercise intolerance, hypotonia, etc.

Answer 59

**Adenosine and dipyridamole** They can lead to _coronary steal_ because they vasodilate everything in the heart. The vessels going to ischemic areas are already maximumly dilated so they only lose out on blood.

Answer 60

1. Higher pressure peaks (more blood in LV) 2. Loss of dichrotic notch 3. Steeper fall in aortic pressure

Answer 61

Vascular Smooth Muscle Cells (VSMCs)

Answer 62

Injury with the MCL (test ability to passively abduct knee)

Answer 63

Cerebellopontine angle

Answer 64

_Transudate_- plasma only. Due to hemodynamic changes _Exudate_- plasma + ions. Due to structural damage

Answer 65

**When one hormone allows another to exert its maximal effect** (ex. cortisol allows NE to work even better although cortisol has no direct vascular effect itself)

Answer 66

1. 10-15 um: Trapped in the upper respiratory tract 2. 2.5 - 10um: mucociliary transport 3. \<2.5um: phagocytized

Answer 67

1. Gram positive rod (**beading/branching**); acid-fast; Aerobic 2. Endemic in soil; get disease from spore inhalation/ trauma inoculation; **immunocomprimised/elderly** 3. Pneumonia (similar to TB); CNS (abscess); Cutaneous involvement 4. _Tx_: Bactrim and surgical drainage of abscess

Answer 68

It is a small saclike structure that is particularly susceptible to thrombus formation

Answer 69

1. Constipation 2. Sx of Intestinal Obstruction (Left sided colon CA tends to infiltrate the intestinal wall and encircle the lumen)

Answer 70

1. Homocystinuria is most commonly caused by a defect in _cystathionine sythase_ 2. The result is an inability to form cysteine from homocysteine. Cysteine then becomes essential and buildup of homocysteine leads to elevated methionine 3. May present as _premature thromboembolic events_ (atherosclerosis, acute coronary syndrome, etc.), because homocysteine is **prothrombotic**

Answer 71

**Sensitivity** = true-positive rate (the probability that a test detects disease when a disease is present) **Specificity**= true-negative rate (Probability that a test indicates no disease when disease is absent)

Answer 72

Increase uveoscleral outflow of aqueous humor ## Footnote **PREFERED TX FOR OPEN ANGLE GLAUCOMA**

Answer 73

_MOA_: Irreversibly blocks the P2Y component of ADP receptors on the platelet surface and prevents platelet aggregation _Indication_: Just as effective as aspirin for prevention of CV events and should be used if patient has aspirin allergy.

Answer 74

Vd x .7/CL

Answer 75

1. **Indications**: (1) anxiolytic, (2) sedative-hypnotic, (3) anticonvulsant, (4) muscle relaxant 2. **SE**: Sedation 3. **Contraindications**: Don't give to patients on other CNS depressants (ex. chlorpheniramine)

Answer 76

1. _Irreversible a1 and a2 antagonist_ that effectively reduces the arterial vasoconstriction induced by NE. 2. **Pheochromocytoma** 3. Because it is irreversible, even very high concentrations of NE (like those seen in pheochromocytoma) cannot overcome its effects

Answer 77

**Symmetrical** proximal _muscle weakness_

Answer 78

CO2 is a potent cerebral vasodilator and therefore a drop in CO2 (due to hyperventilation and subsequent hypocapnia for example), causes a linear decrease in cerebral perfusion.

Answer 79

1. Used in the tx of hyperlipidemia. Effective in raising HDL cholesterol levels, and lowering LDLs and TGs 2. SEs include cutaneous flushing, warmth and itching 3. SEs are mediated by release of prostaglandins and can therefore be prevented by aspirin.

Answer 80

1. Medium-vessel vasculitis 2. **CRASH** and **burn** * **_C_**onjuctival injection, **_R_**ash, **_A_**denopathy, **_S_**trawberry tongue, **_H_**and/foot changes (edema and erythema) and _fever_ 3. Risk of **coronary artery aneurysm** 4. Tx w/ *IV and aspirin*

Answer 81

1. **Bone marrow fibrosis,** severe fatigue, _splenomegaly_ (often causing early satiety/abdominal discomfort), hepatomegaly, and anemia 2. Mutation: JAK2 (of the JAK-STAT signaling pathway-- tyrosine kinase)

Answer 82

1. When a thrombus from the venous system crosses into arterial circulation (as oppose to the pulmonary) via an abnormal connection between the right and left cardiac chambers 2. May see **fixed splitting of S2** if a shunt is present

Answer 83

Autosomal recessive

Answer 84

NPV represents the probability of not having a disease given a negative test result. NPV = true negatives/total negative tests

Answer 85

They are both **stored** in islet cell secretory granules unti they are secreted in equimolar amounts

Answer 86

1. Failure of the _endocardial cushions_ of the atrioventricular canal to fuse completely during embryonic development can lead to a lower interatrial septum defect 2. **Malformation of mitral valve** leading to mitral regurg is often present 3. Wide, fixed splitting of the second heart sound (S2) 4. Pulmonary HTN 5. _Down syndrome_

Answer 87

NAD+ is needed to convert G3P to 1,3-BPG NADH then transfers electrons to pyruvate to form lactate and regenerate NAD+

Answer 88

Anterior humerous dislocation (most common type of shoulder dislocation)

Answer 89

1. **Lactic acid** (via lactate dehydrogenase in anaerobic conditions) 2. **Acetyl-CoA** (via pyruvate dehydrogenase in aerobic conditions) 3. **Oxaloacetate** (via pyruvate carboxylase)

Answer 90

1. An infection caused by nontuberculous mycobacteria M avium and M intracellulare. 2. Risk factor: CD4 count 3. Presents w/ nonspecific symptoms- fever, weight loss, and diarrhea in HIV patient 4. Differs from TB due to _hepatosplenomegally_, _anemia_, and _elevated alk phosp/ LDH_

Answer 91

Decreased temps help stabilize the bonds between O2 and hemoglobin

Answer 92

Vd x Cpss (steady state plasma concentration)/ [bioavailability fraction]

Answer 93

**F508 mutation**. This causes impaired _postranslational processing_ (improper folding and glycosylation) of the CFTR. As a result, the abnomormal protein is targeted for degradation.

Answer 94

**Helper T to...** Th1 (via IL-12) Th2 (via IL-4) Th17 (via TGF-B and IL-6)

Answer 95

1. _Dorsal_: majority of the pancreatic tissue (body, tail, and most of the head) 2. _Ventral_: precursor of the uncinate process, inferior/posterior portion of the head, and the major pancreatic duct

Answer 96

They reduce the rate of spontaneous depolarization of cardiac pacemaker cells by prolonging phase 4

Answer 97

1. Lymphocytix inflammation + epithelial destruction in **small airways**. Exudate and granulation tissue later found ultimately leading to fibrosis. Leads to obstructive lung disease **bronchiolitis obliterans**. 2. Dyspnea + dry cough 3. _Dx_: Spirometry shows airflow limitation w/ a drop in FEV1 and FEV1/FVC

Answer 98

1. Benign congenital tumor of unencapsulated aggregates of closely packed, thin-walled capillaries 2. Initial growth followed by regression (excellent prognosis)

Answer 99

1. Comes from the jejunal brush border 2. Activates trypsin from trypsinogen (needed for peptide breakdown and activation of other pancreatic enzymes) 3. Deficiency impairs protein and fat absorption

Answer 100

**Pericardial dz**, asthma and COPD Beta-adrenergic agonisists are useful for the asthma/COPD etiologies

Answer 101

Within the first _60 secs (1 minute)_ after the onset of total ischemia.

Answer 102

_acute_: NSAIDs (1st line), glucocorticoids, or colchicine (GI issues due to inhibition of microtubule formation) _chronic_: Xanthine oxidase inhibitors

Answer 103

The inhibitors _Glycine_ and _GABA_

Answer 104

Prevent w/ hydration + use of hypouricemic agents such as allopurinol or rasburicase

Answer 105

1. _Pathology_: As an increasing volume of air accumulates w/in the pleural space, the lungs and mediastinum shift to the opposite side and this pressure drops systemic venous return to the heart, leading to decreased cardiac output 2. _Presentation_: Tachycardia, hypotension, tachypnea, hypoxemia 3. _Dx_: Hx, mediastinal shift on CXR, absent breath sounds and hyperresonance to percussion on affected side 4. _Tx_: Emergency needle thoracostomy or chest tube

Answer 106

1. Debranching enzyme 2. It is a milder version of Von Gierke (type I)

Answer 107

1. (1) Cafe-au-lait spots, (2) Neurofibromas (short, sessile or pedunculated lesions), (3) Lisch nodules (pigmentated hamartomas of the iris), (4) pseudoarthritis 2. Autosomal-dominate inheritance 3. Schwann cells are the main component

Answer 108

It leads to increased parasympathetic tone causing temporary inhibition of the SA node and the prolongation of AV node refractory period

Answer 109

**Fusion** of the sacroiliac and apophyseal joints of the spine are most commonly affected _Complications_: 1. Respiratory: limited chest wall expansion leading to hypoventilation 2. CV: \*\*\***most common!!!**-- aortitis, leading to dilation of the aortic ring and aortic insufficiency 3. Uveitis (blurred vision, photophobia, conjunctival erythema, etc.)

Answer 110

1. Purified single-stranded positive-sense RNA can be infectious 2. Single-stranded negative sense or double stranded RNA cannot be infectious For a purified RNA molecule to induce viral protein synthesis in a host cell, it must be able to act **DIRECTLY AS mRNA USING HOST INTRACELLULAR MACHINERY** for translation.

Answer 111

_First few decades of life_: MR _Middle-aged_: MS (most common cause of MS) _Elders_: Mixed mitral disease (S and R)

Answer 112

1. Rolling: Selectin 2. Adhesion/crawling: ICAM-1 and integrins 3. Transmigration: PECAM-1 and integrins

Answer 113

Fibrates (like Gemfibrozil). They impair the hepatic clearance of Statins leading to excessive blood levels.

Answer 114

* A mutation in Bruton tyrosine kinase gene causes _failure of BM pre-B cells to mature_. * These patients have: 1. low B-cells in peripheral blood (CD19+, CD20+, CD21+) 2. pan-hypogammaglobulinemia (low Ig's) 3. Increased risk of infection w/ encapsulated bugs and certain viruses and parasites

Answer 115

1. **_A_**sthma and CF 2. Recurrent infiltrates and **_B_**ronchiectasis 3. Eosinophilia; **_P_**ositive skin test and Ig for **_A_**spergillus; Elevated IgE

Answer 116

1. _Presentation_: Reddish skin discoloration, tachypnea, HA. Lab studies indicate severe lactic acidosis and dec. venous-arterial PO2 gradient

Answer 117

**CRAB** (hyperCalcemia, Renal involvement, Anemia, Bone lytic lesions/Back Pain) + Primary amyloidosis, Rouleaux formation, and numerous plasma cells w/in bone marrow sample

Answer 118

A _benign_ autosomal dominant disorder casued by a defective calcium-sensing receptor (G-protein coupled), which is suppose to regulate PTH secretion. Defect raises the Ca2+ threshold

Answer 119

Aortic isthmus

Answer 120

Granuloma formation as a manifestation of cell-mediated immunity driven by _products_ of _Th1 type CD4 helper T-cells_, particularly _IL-2 and IFN-y_, which stimulate Th1 type **cell proliferation** and **macrophage activation**, respectively.

Answer 121

**OSATO** 1. **O**culomotor nerve 2. **S**uperior Ophthalamic vein 3. **A**bducens nerve 4. **T**rochlear nerve 5. **O**pthalmic nerve (CN V1) branches

Answer 122

1. Presents with hypotension, elevated JV pressure, _clear lungs_ 2. Most often occurs in the setting of **acute inferior wall MI** 3. CVP= inc.; Wedge pressure = dec.; CO = dec.

Answer 123

Pericarditis

Answer 124

**Low**: exogenous insulin injection **High**: insulin secretagogue or insulin-secreting tumor

Answer 125

Fetal lung maturity Phospholipids (such as lecithin aka phosphatidylcholine) are a majory component of pulmonary surfactant

Answer 126

BAB resins (ex. cholestyramine) Inc. stimulation of HMg-CoA Reductase, which will need to be compensated by giving a Statin. Synergistic effects with the statin further reduce plasma LDL level.

Answer 127

_G6PD_ deficiency is a defect in the HMP shunt (aka the Pentose Phosphate Pathway), which leads to impairment of glutathione reduction due to failure to produce NADPH **Glutathione reductase deficiency** causes a similar clinical picture

Answer 128

**MHC Class I**: Heavy chain and B2-microglobulin **MHC Class II**: Alpha and beta polypeptide chains

Answer 129

_Ventricular Septal Defects_ 1. Small VSDs have a loud, "blowing", holosystolic **murmur** at the mid/lower left sternal border (louder with handgrip). Murmur is usually inaudible _until_ 4-10 days when pulmonary vascular resistance declines enabling left-to-right shunt. 2. Right ventriclular blood has increased O2 content 3. Most are clinically insignficant and close spontaneously

Answer 130

Erosive esophagitis and the formation of an ulcer Dx via upper endoscopy

Answer 131

1. Congenital **long-QT syndrome**; thought to result from mutations in a K+ channel protein 2. Syncopal episodes; sudden cardiac death (*torsades de pointes*); 3. _Autosomal recessive condition_ 4. Similar to Romano-Ward syndrome

Answer 132

1. *Amlodipine and Nifedipine* 2. Effective for monotherapy or in combination with other agents for Tx of HTN 3. **_Peripheral Edema_** and _Dizziness/ Lightheadedness_

Answer 133

Migratory superficial thrombophlebitis assc. with visceral CA

Answer 134

Failure of the dorsal and ventral pancreatic buds to fuse

Answer 135

Decreased lung volumes Increased lung elastic recoil The increased recoil leads to _radial traction_ (outward pulling) of airways, leading to increased corrected expiratory flow rates.

Answer 136

snRNA is synthesized by RNA pol II and complexes w/ specific proteins to form small nuclear ribonucleoproteins (snRNPs). **These snRNPs are essential components fo the spliceosome and remove introns from to form mature mRNA.** Autoantibodies directed against snRNPs are called anti-Smith antibodies, and are assc. with SLE.

Answer 137

Mediated by the interaction of allergen w/ preexisting IgE bound to basophils and mast cells. Cross-linking occurs allowing for degranulation and immediate allergy signs.

Answer 138

Anterior **talofibular ligament**

Answer 139

Retinal damage

Answer 140

Systemic and Pulmonary HTN, and right heart failure

Answer 141

Saddle anesthesia and loss of the anocutaneous reflex, assc. with damage to the S2 through S4 nerve roots

Answer 142

1. _Myxomatous_ (weakening of connective tissue) changes with pooling of proteoglycans in the _media layer of large arteries_ 2. **Aortic dissections/ Aneurysms** 3. Younger patients with _Marfan Syndrome_

Answer 143

1. **Mycoplasma pneumoniae** 2. CXR looks much worse than the clinical appearance of the patient indicates 3. Cholesterol medium 4. Nagging unproductive cough, low-grade fever, and malaise

Answer 144

1. SIDS 2. Low birth weight 3. Dental caries 4. Middle ear disease 5. Asthma 6. LRTI 7. Decreased GFR

Answer 145

1. Chronic inflammatory condition assc. wtih HLA-B27 serotype 2. Low back pain + stiffness in a young man. **Fusion** of axial joints (hence bamboo spine)

Answer 146

1. Arises from alveolar epithelium at the periphery of lung 2. _Microscopy_ shows well-differentiated, dysplastic **columnar cells** w/ or w/o mucin 3. Similar to other lung cancers (SOB, cough, hemoptysis) 4. Discrete mass or pneumonia-like consolidation on imaging

Answer 147

1. Mitral valve prolapse/ mechanical valves 2. Rheumatic fever

Answer 148

1. **MOA**: melatonin agonist 2. Initial insomnia treatment that demonstrates _high safety and efficacy_ in **older adults** 3. Very few SEs and no dosage adjustment needed

Answer 149

1. CHF 2. Neurologic disease

Answer 150

They suppress pituitary LH secretion and subsequently decrease ovarian androgen production

Answer 151

1. NTDs occur due to failure of fusion of the neural tube during the 4th week of development. This leaves an opening between the neurotube and the amniotic cavity. 2. Can present with encephalocele (herniation), anencephaly (no brain), or the spina bifadas 3. Leakage of alpha-fetpoprotein and AchE occurs, allowing for prenatal diagnosis

Answer 152

_Pathogenesis_: If familial form, result of inactivation of the pro-apoptotic BMPR2 gene. Results in increased **endothelial and smooth muscle cell proliferation and vascular remodeling** _Presentation_: Dyspnea, excercise intolerance in women 20-40 _Treatment_: Lung transplant and **bosentan** (endothelin-receptor antagonist) in the meantime

Answer 153

Cpss (steady-state plasma concentration) x CL/[bioavailability fraction]

Answer 154

Both of them can bid to AT3 to increase its activity against factor Xa. _Only unfractionated heparin_ is able to bind to **both AT3 and thrombin**, thereby allowing antithrombin to inactivate thrombin.

Answer 155

1. _Indications_: Tx of hypercholesterolemia 2. Inhibit **HMG-CoA reductase**, thus blocking hepatic cholesterol synthesis. This forces the liver to _increase surface expression of LDL receptors_, thus pulling LDL from circulation 3. _SE_: Myopathy, rhabdomyolysis, and hepatoxicity 4. Drugs that interfere w/ statin metabolization, particuarly via cytochrome p450 enzymes (ex. fibrates)

Answer 156

1. An inherited **inability to synthesize apoB**, which is critical for chylomicrons and VLDL 2. As a result, _lipids absorbed by the small intestine cannot be transported into the blood_ and accumulate in the intestinal epithelium. 3. Enterocytes w/ clear/ foamy cytoplasm

Answer 157

_LV EDP_ is increased due to the increased return _Systemic vascular resistance_ decreases due to large levels of vasodilation in muscles

Answer 158

1. Non-selective Beta-_agonist_ 2. Increases myocardial contractility and decreases systemic vascular resistance

Answer 159

Nonselective B-adrenergicc **_agonist_** (leads to inc. vasodilation, inc. cardiac rate, and inc. contractility)

Answer 160

1. Occult bleeding 2. Sx of iron deficient anemia

Answer 161

1. **Sx**: Weakenss that is worse at the end of the day/ with exertion; extraocular muscles are affected first (ptosis/diplopia) 2. **Assc. with** risk of _thymoma_ 3. **Path**: antibodies against Ach receptors 4. Improvement/ resolution w/ tensilon test 5. Decremental response to nerve stim. test

Answer 162

A measure of how far along an axon an electrical impulse can propagate This is _increased_ by **myelination**

Answer 163

1. **Ergot compounds**- Bromocriptine 2. **Nonergot compounds**- Pramipexole, ropinirole

Answer 164

1. A mold found in soils of **Mississippi and the Ohio River Valley** 2. It is transmitted by the respiratory route when bird/rat droppings containing fungal spores are inhaled 3. _Pathology_: In the lungs, the fungus is ingested by macrophages and a granuloma forms, similar to TB 4. _Presentation_: Asymptomatic if immunocompetent. May develop acute pulmonary disease, or develop chronic pulmonary histoplasmosis (**looks like TB**). May see lymphadenopathy and hepatosplenomegally 5. _Dx._: **small oval bodies w/in macrophages** 6.

Answer 165

It is an antimuscarinic agent Only reverses vagally-mediated bronchoconstriction

Answer 166

1. Increased pressure in the left gonadal vein resulting in valve leaflet failure and varices of the testicular pampiniform plexus 2. Presents with flank/abdominal pain and gross or microscopic hematuria

Answer 167

1. Cholestyramine 2. Binds bile acids, forcing the liver to inc. uptake of LDL in order to create more bile.

Answer 168

Airway pressure = 0 Alveolar pressure = 0 Intrapleural pressure = Negative, with a value of -5cm H2O (prevents pneumothorax)

Answer 169

1. ...Bacterial pneumonia 2. Elderly 3. S. Pneumo, S. Aureus, H. Flu

Answer 170

1. _Path_: defect in *a-keto dehydrogenase*, leading to inability to degrade branched chain amino acids (**leucine, isoleucine, valine**) beyond deaminated a-keto acid state 2. _Sx_: Dystonia; poor feeding; maple syrup scent urine in first few days of life 3. _Tx_: *Dietary restriction* of branched-chain AA's

Answer 171

1. Defective intestinal and renal tubular absorption of _dietary tryptophan._ This can result in **Niacin** deficiency, as Niacin is synthesized from tryptophan 2. Sx: Often asymptomatic but may result in photosensitvity or pellegra-like skin rashes 3. Tx w/ nicotinic acid/ nicotinamide and a high-protein diet

Answer 172

1. Staph aureus is #1. Pseudomonas is #2 2. IV drug users 3. These patients can develop multiple septic emboli in lungs. Resulting pulmonary infarcts will be hemorrhagic due to dual blood supply.

Answer 173

1. Beta cell hyperplasia due to increased trans-placental glucose delivery to the fetus (leads to **TRANSIENT** hypoglycemia at birth) 2. Fetal macrosomia (large size at birth!)

Answer 174

In the first several years after menarche (immature H-P-Ovarian axis), and in menopause.

Answer 175

1. _Endemic_ to southeastern US (east of mississippi river) 2. _Characteristics_: Dimorphic fungus which is a large yeast (in the human body) with a single, **broad-based bud**. 3. Infxn follows inhalation and may present as a _lung infection_ (with GRANULOMA) or cause _flu-like illness/pneumonia_ in the *immunocompetent*. Can present as systemic disease in *immunocomprimised patients.*

Answer 176

Ex: Hydralazine and minoxidil There can be reflex sympathetic stimulation (leading to **inc. HR**, contractility, and CO) and also stimulation of the RAA system leading to **sodium and fluid retention/edema**

Answer 177

_Afferent_: **G****lossopharyngeal nerve** _Efferent_: **Vagus nerve**

Answer 178

**VOIR**: 1. VSD 2. Overiding aorta 3. Infundibular pulmonary stenosis 4. RVH _Presentation_: Cyanosis; Improvement w/ squatting (increases SVR)

Answer 179

Genitourinary instrumentation or catheterization

Answer 180

1. Result of **sudden upward jerking** of the arm at the shoulder 2. May causes paralysis of all **intrinsic hand muscles (Klumpke's palsy)** w/ sparing to the extensors, leading to **total claw hand deformity**. Can also see sensory loss and weakness.

Answer 181

The **_4th_** power

Answer 182

1. Acute-onset dyspnea, calf-swelling (indicative of DVT), obesity, Hx of prolonged immobility 2. Hypoxemia and respiratory alkalosis 3. CT pulm angiography is image testing of choice

Answer 183

1. **Acceptor stem** (mediates corrct tRNA recognition) 2. **3' CCA tail** (used as recognition sequence by proteins) 3. **D loop** (facilitates correct tRNA recognition) 4. **Anticodon loop** (used by the ribosome complex to select the right tRNA) 5. **T loop** (facilitates binding of tRNA to ribosomes)

Answer 184

1. _Extracellular domain_- responsible for ligand binding 2. _Intracellular domain_- coupled with heterotrimeric G proteins 3. _Transmembrane domain_- composed of **nonpolar, hydrophobic amino acids** (alanine, valine, leucine, etc.), arranged in an **alpha-helical fashion**. Serve to **anchor** the proteinto the **phospholipid bilayer.** May also play role in cellular signaling and transport.

Answer 185

**Spinal Muscular Atrophy** (delayed motor development + flaccid paralysis) SMN1 gene

Answer 186

Thin: Z-line Thick: M-line

Answer 187

The submucosa of the narrowed area

Answer 188

1. They supply the medial portions of the 2 hemispheres (frontal and parietal) 2. Occlusion can cause contralateral motor and sensory deficits of the lower extremities, behavorial changes, and urinary incontinence

Answer 189

_**T**ender **L**oving **C**are **F**or **N**ancy_ **T**hiamine pyrophosphate **L**ipoate **C**oenzyme A **F**AD **N**AD

Answer 190

Unlike tamoxifen, raloxifene has does not have agonist activity in the uterus (which inc. risk of endometrial hyperplasia/CA)

Answer 191

The **aortic _isthmus_** (located just past the aortic arch)

Answer 192

1. LSD 2. **Sphingomyelinase** 3. AR (common in Ashkenazi Jew population) 4. Sphingomyelin accumulation, leading to _hepatosplenomegally_ , "Cherry-red" spot on macula, and _progressive neurodegeneration_

Answer 193

1. Found in adipose tissue 2. Functions to **drive the breakdown of stored triglycerides** into free fatty acids and glycerol. During times of starvation, this enzyme _provides substrates for hepatic gluconeogenesis and ketone body formation_

Answer 194

1. Skeletal muscle glycogen phosphorylase 2. Muscles can't breakdown glycogen in muscle (McArdle = Muscle) 3. Present with painful muscle cramps, myoglobinuria w/ strenuous excercise, and arhytmia from electrolye abnormalities.

Answer 195

1. Form of primary ciliary dyskinesia, that is autosomal recessive in nature 2. _Presentation_ * Recurrent respiratory infections (e.g., sinusitis, bronchiectasis) * Situs inversus (reverse organ positioning) * Infertility

Answer 196

It begins a phosphorylation cascare that results in the activation of **mitogen-activated protein kinase**, which enters the nucleus to influence gene transcription.

Answer 197

1. Bradykinin induced cough and angioedema if there is accumulation 2. First dose hypotension due to volume depletion

Answer 198

1. Facultative intracellular gram-negative bacillus 2. _Symptoms_- high fever, elevated transaminases, cough, confusion, and diarrhea, 3. _Dx_- Hyponatremia and sputum gram stain showing many neutrophils but few to no organisms 4. Passed from contaminated water 5. Respiratory fluroquinolones or newer macrolides

Answer 199

A measure of how far along an axon an electrical impulse can propagate. Myelination increases this constant.

Answer 200

1. **Progression from normal mucosa to a small polyp**: mutation of the _APC tumor suppressor gene_ 2. **Inc. in the size of the polyps**: mutation of the _K-ras protoncogene_ 3. **Malignant transformation**: requires mutation of *both* _p53_ and _DCC_ (Deleted in Colorectal Carcinoma)

Answer 201

An inactive form of T3, that is generated almost entirely from peripheral conversion of T4

Answer 202

1. Rare form of marrow failure that is characterized by severe hypoplasia of marrow erythroid elements in the setting of normal granulopoiesis and thrombopoiesis 2. Assc. with **Thymoma**, lymphocytic leukemias and Parvovirus B19

Answer 203

1. Can occur in individuals with fat malabsorption 2. Assc. w/ inc. susceptibility of the **neuronal** and **erythrocyte** membranes to oxidative stress 3. _Clinical manifestations_: ataxia, impaired proprioception and vibratory sensation, and hemolytic anemia

Answer 204

Accumulation of uremic toxins impair platelet aggregation and adhesion (no effect on platelet count, PT or aPTT)

Answer 205

The **cervical spine**

Answer 206

Prevents posterior displacement of the tibia relative to the femur. Tested via the posterior draw test.

Answer 207

1. _Microscopic_: Progresive fibrosis an lead to cystically-dilated bronchioles that later coalesce to from "honeycomb" appearance 2. Presents with **gradual-onset dyspnea**, first w/ exertion and then eventually even at rest 3. Physical exam can show _end-inspiratory crackles_ and _PFTs show restriction_ (decreased FEV1 and FVC w/ normal ratio)

Answer 208

Presence of anticardiolipin antibody (which is tested for in Treponema pallidum, but is also present in this dz)

Answer 209

Beta-myosin heavy chain | (A cardiac sarcomere protein)

Answer 210

There is signficant risk for a **_retroperitoneal hemorrhage_** if you do it above the inguinal

Answer 211

1. Common in elderly, _postoperative patients_ who are **intubated or dehydrated** 2. *S. Aureus* 3. Elevated serum amylase (in the presence of normal serum lipase/ no evidence of pancreatitis)

Answer 212

Neutrophils

Answer 213

**Erythrocytes** 2, 3- BPG dec. hemoglobin affinity for O2. When 2,3-BPG needs to be synthesized, the RBC bypasses the step which converts 1,3 BPG to 3-phosphoglycerate, instead **forming 2,3 BPG in a process which does _not_ create ATP.**

Answer 214

_Trapezius_- drooping of shoulder, impaired abduction **above horizontal,** winging of the scapula _Deltoid_- impaired abduction at angles below the horizontal plane

Answer 215

_MOA_: 5-alpha-reductase inhibitor that suppresses conversion of testosterone to DHT _Ind_: BPH, Androgenetic alopecia

Answer 216

The intensity is proportional to the magnitude of the LV to aorta pressure gradient during systole, (i.e. whenever aortic pressure is at its strongest)

Answer 217

1. It is derived from amino acids (Val, Ile, Met, and Thr), as well as odd-numbered fatty acids and cholesterol side chains 2. **Propionyl CoA carboxylase** is the enzyme responsible 3. Deficient enzyme leads to development of proprionic acidemia

Answer 218

1. Regeneration of the alveolar lining 2. Surfactant production

Answer 219

1. _Epidemiology_: Increased incidence of syphilis in MSM/ HIV-infected patients 2. _Pathology_: Treponema pallidum spirochetes directly damage the dorsal sensory roots 3. _Clinical findings_: sensory ataxia, lancinating pains, neurogenic urinary incontinence, Argyll Robertson pupils

Answer 220

The left ventricle (All other chambers lie medial to the midclavicular line)

Answer 221

Among other symptoms, Pancoast tumors can lead to Horner's syndrome due to involvement of the cervical sympathetic ganglia.

Answer 222

Longterm PPI use may be associated with increased osteoporosis risk, most likely do to a decreased absorption of Ca2+ (acidic environment is needed)

Answer 223

A **t-test** is used to compare the difference between the means of (2) groups. **ANOVA** compares bbetween the means of 2 or more groups.

Answer 224

1. Oxidation of iodide 2. Iodination of thyroglobuin 3. Coupling rxn between 2 iodized-tyrosine residues

Answer 225

**Coronary sinus** Myocardial oxygen extraction is very high and has a high demand

Answer 226

1. Contralateral hemiplegia of the face/ upper limb 2. Relative preservation of the lower limb 3. Aphasia (if occlusion is in dominant hemisphere -- usually left)

Answer 227

An autosomal dominant disorder, leading to increased number of trinucleotide repeats on the myotonia-protein kinase gene

Answer 228

Decreased lung volume, bringing the heart closer to the chest wall.

Answer 229

1. _MOA_: selective peripheral D1 receptor agonist 2. _Indication_: given IV ti lower BP in HTN crisis, especially in patients with **renal insufficiency** 3. _Effects_: (1)Arteriolar dilation, (2) increased renal perfusion, and (3) promotion of diuresis/ natriuresis

Answer 230

1. Path: Compression of SVC (often by an intrathoracic carcinoma-- eg. mediastinal mass) leading to impaired venous return 2. Presentation: Dyspnea, facial swelling, and dilated collateral veins in upper trunk

Answer 231

Trypsinogen (to trypsin)

Answer 232

**Boy appear phenotypically femaile at birth, but girls develop normally.** (Result of dec. androgen, estrogen, and cortisol synthesis) Patients present with hypogonadism, HTN, and hypokalemia

Answer 233

**Cardiac and smooth muscle** cells depend on extracellular _calcium influx_ into cells via L-type calcium channels. **Skeletal muscle** cells do not, because they have a _direct mechanical coupling_ of the L-type channel and the RyR.

Answer 234

_Medial_: **Inguinal** lympadenopathy _Lateral_: **popliteal** and **inguinal** lymphadenopathy

Answer 235

1. Candida albicans 2. Albuterol inhaler 3. HIV

Answer 236

1. Serves as the endpoint of venous drainage from the coronary blood supply, _draining directly into the right atrium_ 2. Will be dilated by any factor that dilates the right atrium (most commonly **pulmonary HTN**), because it freely communicates with the RA.

Answer 237

Transmural aortic wall inflammation

Answer 238

* Primarily **venodilators** (but also vaso) that increase **peripheralvenous capacitance** * Reduce cardiac preload and afterload and LVEDP and volume, reducing work of heart * Modest effect on arteriolar dilation _Side Effects_: HA, cutaneous flushing, hypotension

Answer 239

1. Mold that froms septate hyphae that branch at 45-degree angles 2. Spores are inhaled and particularly impact those in immunocompromised states 3. Wide spectrum of diseases: * **Invasive pulmonary aspergillosis** (for the immunosuppressed/ neutropenic) * **Aspergillus colonization** in preexisting lung cavities * **Allergic bronchopulmonary aspergillosis** (lung hypersensitivity reaction) for patients w/ asthma

Answer 240

Mitochondrial diseases The mitochondria accumulate under sarcolemma

Answer 241

1. **Lower abdominal aorta** 2. Coronary arteries

Answer 242

1. _Presentation_: progressive fatigue + dypsnea 2. _Pulses_: "water-hammer" pulses (bounding femoral and carotids) and head-bobbing with each heartbeat (de Musset sign) 3. _Murmur_: * Decrescendo murmur after A2 * High-pitched, blowing quality * Best heard at left sternal border, at 3rd/4th intercostal space, with the patient _sitting up and leaning forward_ 4. The pulse pressure is widened

Answer 243

During sepsis, cytokines circulate in response to infection, activate pulmonary epithelium and provoke an inflammatory response mediated by **neutrophils**. This leads to _capillary damage_ and the leakage of protein/fluid into the alveolar space.

Answer 244

Circadian rhythm regulation and pineal gland function

Answer 245

Blocking of the Brachiocephalic vein Shows one sided face-swelling, arm swelling and engorgement of subcutaneous veins .

Answer 246

**Gastric (most common),** pancreatic, colonic, endometrial, small bowell, etc. This is an example of _ectopy_

Answer 247

They block K+ efflux from cardiac myocytes and prolong phase 3 of the myocyte AP

Answer 248

Type I Glycogen Storage Dz 1. Glucose 6- phosphatase 2. Severe fasting hypoglycemia (can't convert G6P to glucose); hepatomegaly 3. Tx: frequent oral glcose/cornstarch; avoidance of fructose and galactose

Answer 249

Blanching of vein into which NE is being infused due to NE leakage causing major a1 receptor activation and subsequent constriction. Use _phentolamine_ (alpha-receptor blocker)

Answer 250

1. Immunosuppression (except with neutrophilia!!) 2. Corticosteroid-induced psychosis

Answer 251

1. _Activates_ peroxisome proliferator-activated receptor alpha **(PPAR-a)**. 2. This leads to _decreased hepatic VLDL_ production and increased _Lipoprotein lipase_ activity, thus **lowering triglyceride levels** 3. Fish oil supplements w/ O3FA dec. VLDL and ApoB production

Answer 252

Suspect _Primary Central Nervous System Lymphom__a_ It is typically composed of B-lymphocytes, and is associated with EBV.

Answer 253

1. Bind glycoprotein hormones (eg TSH, LH, FSH) 2. **3 major domains**: Extacellular domain, transmembrane domain, intracellular domain

Answer 254

1. Doxorubicin, daunorubicin, epirubicin and idarubicin 2. Their most severe side effect is a cumalitive dose-related _dilated cardiomyopathy_ due to free-radical formation 3. Presents w/ right and left ventricular CHF 4. Prevented via **dexrazoxane**- iron-chelating drug which reduces free radical formation

Answer 255

1. Caused by a **defect in B cell maturation**, resulting in the absence of mature B cells with severe defiency of all Ig types. T cells remain fxnal and intact! 2. No B cells = _no_ germinal center formation 3. Recurrent infxn in setting of intact T Lymphocyte function

Answer 256

1. _Pathology_: Due to low levels o stimulatory neurotransmitter **orexin** (hypocretin) which is involved in maintaining wakefulness and suppressing REM sleep 2. Episodes of refreshing sleep during the daytime + at least one REM sleep-related phenomena (cataplexy, hypogogic/hyponopompic halluciantions, and sleep paralysis) 3. Psychostimulants: **Modafinil**

Answer 257

_Presentation_: Acute, painless, monocular vision loss _Pathogenesis_: Thromboembolic complications of athersclerosis in the **internal carotid**. _Path_: Internal carotid --\> Ophthalmic artery --\> retinal artery

Answer 258

Viral pericarditis w/ signficant pericardial fluid accumulation (following a respiratory infection)

Answer 259

1. _Path_:Immune mediated, widespread noncaseating granulomas 2. _Pres_: Black women w/ possible erythema nodusum, arthralgia, elevated ACE levels, etc. 3. _Dx_: Bilateral hilar adenopathy on CXR 4. _Tx_: Steroids

Answer 260

A state of _chronic myocardial ischemia_ in which myocardial metabolism and function is **reversibly** reduced in order to match a reduction in coronary blood flow, thus _preventing myocardial necrosis_

Answer 261

Intracellular iron

Answer 262

1. _IA_: **Dispyramide, Procainamide, Quinidine**- *slows AP conduction velocity; prolongs APD* 2. _1B_: **Lidocaine, Mexiletine, Phenytoin**- *Shortens APD* (no effect on AP conduction velocity) 3. _1C_: **Flecainide, Propafenone**- *Slows AP conduction velocity; minimal effect on APD* "Double Quarter Pounder; Light Mayo and Pickles; Fries Please"

Answer 263

1. Mycoplasma pneumoniae 2. EBV infection 3. Hematologic malignancy

Answer 264

RANK-L is the receptor for activated NFK-B

Answer 265

Smoking cessation

Answer 266

AA substitution at the C terminal end of the B chain

Answer 267

1. May produce **A**CTH 2. SI**A**DH 3. **A**ntibodies against presynaptic Ca2+ channels (Lambert-Eaton) 4. **A**mplification of *myc* oncogenes

Answer 268

a1, B1, and B2

Answer 269

It lies along the posterior wall of the duodenal bulb. It is likely to be eroded by posterior duodenal ulcers, leading to potential life-threatening hemorrhage.

Answer 270

These yellowish macules/papules are found on the medial eyelids. They are accumulations of macrophages + cholesterol/ TG and are assc. with hyperlipidemia/ dyslipidemia

Answer 271

1. Indolent B-cell neoplasm 2. MIddle-aged men w/ **bone marrow /fibrosis** (leading to dry tap) + massive **splenomegaly** (due to red pulp infilitration) + cytoplasmic projections on lymphocytes

Answer 272

1. Endemic in developing countries 2. ***Corynebacterium diphtheriae*** colonize repiratory tract and secrete _diphtheria toxin_ (inhibits protein synthesis via **ribosylation** of EF-2) 3. (1) Pseudomembrane; (2) cervical adenopathy (3)sore throat (4) fever 4. (1) Suffocation due to edema/pseudomembrane aspiration; (2) Heart failure/ (3) neuro toxicity from the toxin

Answer 273

Mutation in the ***PIGA*** gene. This leads to absence of the GPI anchor that normally protects the RBC from _complement_, and associated deficiency of CD55/CD59 complement inhibitor proteins.

Answer 274

_Inactivated_: Generate a humoral response, inducing neutralizing antibodies which **keep virus from entering the cell membrane** _Live-attenuated_: Generate a strong cell-mediated response, _in addition_ to a humoral response

Answer 275

ANP and BNP are similar to NO. They activate _guanyl cyclase_ which increases the levels of _cGMP_. cGMP leads to relaxation of vascular smooth muscle and vasodilation, via myosin light-chain dephosphorylation _Sildenafil_ is a phosphodiesterase inhibitor and therefore decreases degradation of cGMP, ultimately causing the same result.

Answer 276

1. Innervates the major forearm flexors and the coracobrachialis 2. Provides sensory innervation to the lateral forearm

Answer 277

1. High Output cardiac failure 2. Osteosarcoma

Answer 278

1. Inhibit Na+/Cl- co-transporter in the DCT, thereby decreasing reabsorption of NaCl 2. Lower BP by decreasing intravascular volume, reduce CO, and lower systemic vascular resistance 3. Dec. insulin secretion and glucose uptake, and increase LDL cholesterol and TG levels

Answer 279

Pharynx --\> blood --\> choroid plexus --\> meninges

Answer 280

1. X-linked recessive 2. Defect in hypoxanthine-guanine phosphoribosyltransferase (**HGPRT**) 3. Results in failure of the purine salvage pathway leading to inc. _degradation of hypoxanthine and guanine to uric acid._ De novo purine synthesis must inc. to compensate via inc. **PRPP amidotransferase**

Answer 281

1. Autosomal recessive disorder 2. B-hexosaminidase A deficiency 3. GM2 ganglioside accumulation 4. _Presentation_: progressive neurodegeneration and cherry-red macular spot, **NO HEPATOSPLENOMEGALY**!!! (unlike Niemann-Pick dz)

Answer 282

Ethanol metabolism reduces NAD+ to NADH and **increases the NADH/NAD+ ratio.** This inhibits all other pathways requiring NAD+, including reactions required for _gluconeogenesis_.

Answer 283

Frontal, parietal, temporal, and sphenoid bones **Middle meningeal artery** (branch of the maxillary artery)

Answer 284

Cumulative dose-related dilated cardiomyopathy, due to formation of free radicals in the myocardium

Answer 285

1. **Lacunar stroke** can cause damage 2. Damage may result in **contralateral hemiballism**, characterized by wild, involuntary, large-amplitude, flinging movements of proximal limbs on one side of the body

Answer 286

**Acute Respiratory Distress Syndrome** 1. Characterized by diffuse injury to the pulmonary microvascular endothelium and alveolar epithelium, resulting in increased pulmonary capillary permability and a leaky alveolocapillary membrane 2. Presents as progressive hypoxemia refractory to O2 therapy and diffuse interstitial edema w/o cardiogenic cause. 3. Hyaline membranes on histo 4. **Pancreatitis**

Answer 287

1. Penicillans 2. Cephalosporins 3. Vancomycin

Answer 288

1. High HBV replication 2. mildly elevated liver enzymes 3. very high (90%) risk of chronic infection

Answer 289

P/C: 4 C F: 9 C

Answer 290

1. Mu-opiod receptor 2. First line tx for moderate to severe alcohol use disorder (blocks the rewarding and reinforcing effects)

Answer 291

ACE-I's raise the level of Bradykinin causing non-productive cough. ARBs do not. The two drugs are very similar otherwise

Answer 292

Sustained muscle contraction (can't release doorknob) + weakness/atrophy (often also see cataracts, frontal balding and gonadal atrophy)

Answer 293

(Spironolactone and Eplerenone) They prevent aldosterone from binding to its receptor in the distal renal tubules, leading to increased sodium excretion. Indications: CHF and reduced left ventricular EF Contraindications: Hyperkalemia and renal failure

Answer 294

Paradoxical rise in JVP during inspiration, because volume-restricted right ventricle is unable to accomadte the inspiratory increase in venous return. Associated with **constrictive pericarditis**

Answer 295

1. Eggshell calcification at the hilar nodes 2. _Birefringent_ silica particles surround by fibrous tissue on histology Silicosis impairs the **_macrophages_**, by disrupting them with internalized silica particles

Answer 296

1. _Digestion_: in the **duodenum** via pancreatic enzymes 2. _Absorbed_: in the **jejunum** in the form of water-soluble micelles

Answer 297

1. **Venodilation** (as well as general vasodilation) 2. **Decreased preload** (i.e. decreased LV EDV and EDP) All told, this results in decreased left ventricular systolic wall stress and myocardial oxygen demand

Answer 298

**Subacute combined degeneration!!!** _demyelination_ of dorsal columns, lateral CST, and spinocerebellar tracts, leading to: ataxic gait, paresthesia, and impaired position/vibration sense

Answer 299

It is a transcription factor and thus is capable of _binding DNA_.

Answer 300

Aka delayed (T-cell mediated) type Sensitized T cells encounter antigen and then release cytokines (leading to macrophage activation) **No antibodies involved** _4 T's_: T cells Transplant rejections TB skin tests Touching (contact dermatitis)

Answer 301

* CF can lead to pancreatic insufficency, fat malabsorption, and an ADEK deficiency. * Vitamin A maintains orderly differentiation of specialized epithelia. * Avitaminosis A can cause squamous metaplasia of such epithelia to keratinizing epithelium

Answer 302

- Hepatocellular carcinoma - Germ cell tumors

Answer 303

**Neurological** symptoms that are incompatible with a neurological disease. Often stressed associated.

Answer 304

The functional residual capacity (the trough of the tidal volume)

Answer 305

1. _Cause_: Damage to frontal lobe 2. _Presentation_: Issues with executive fxn (complex tasks, motivation, organization, etc.) and personality 3. **Left sided**: apathy/depression | **Right sided**: disinhibtion 4. Dx: info from fam/friends, neuropsych testing and structural brain imaging

Answer 306

They may cause a repurfusion arrhythmia on arterial reopening. These arrhytmias are usually benign.

Answer 307

1. AV shunt _increases_ the **preload** and _decreases_ the **afterload** by routing blood directly from the arterial system to the venous system 2. Physical exam may reveal pulsatile mass w/ thrill on palpation. Ausculation reveals a constant bruit over the site.

Answer 308

It would cause bronchoconstriction and increased bronchial mucus secretion via Ach binding to M3 receptors. This ultimately increases the work of breathing.

Answer 309

Of these, _only Duodenal ulcers_ are not associated with an inc. risk of CA

Answer 310

The _nucleolus_ (All ribosomal RNA except 5S RNA is transcribed here)

Answer 311

1. Limited **scleroderma** 2. Increased proliferation and accumulation of monoclonal T-cells in affected tissues. Leads to increased TGF-B release and thus increased production of collagen and ECM 3. Calcinosis, Raynaud's, Esophageal dysmotility, Sclerodactyly, Telangiectasia

Answer 312

When mitral stenosis causes left atrial dilatation sufficient to impinge on the left laryngeal nerve

Answer 313

1. **Sx**: _Liver_ injury (sometimes asymptomatic), _psych_ sx's (impulsive and moody), _Basal ganglia_ injury (leading to parkinsonism) 2. **Dx**: Kayser-Fleischer rings; labs show increased transaminases (liver injury) and low **serum ceruloplasmin**

Answer 314

1. **Mycolic Acid** (like mycobacterium and some Nocardia species) 2. Aniline dye is applied to a smear and then is decolorized w/ acid alcohol

Answer 315

1. Decreasing the effect of adrenergic impulses on target organs 2. Decreasing the rate of peripheral T4 to T3 conversion

Answer 316

It causes free radical injury, after being oxidized by the P450 system. The result is CCl3 which causes lipid degradation and formation of H2O2

Answer 317

A measurement of the partial pressure of oxygen dissolved in the **_plasma only_**! (not in the RBCs)

Answer 318

1. X-linked recessive 2. _Presentation_: **self-mutilation, hyperuricemia**, dystonia, and choreoathetosis in the _first few years of life_ 3. _Pathology_: HGPRT deficiency (used in purine salvage pathway). Leads to degradation of hypoxanthine bases into uric acid. 4. Increased demand for de novo purine synthesis leads to **i****ncreased _PRPP_** activity

Answer 319

1. Hepcidin is an **acute phase reactant** synthesized by the liver that acts as the **central regulator of iron homeostasis.** It _prevents release of iron_ bound by **ferritin** 2. High iron levels/ inflammatory conditions increase hepcidin synthesis. Hypoxia and increased EPO lower hepcidin levels

Answer 320

1. **Sx**: "Worst headache of my life" + fever/nuchal rigidity 2. **Path**: Saccular (berry) aneurysms are most common cause. Associated with Ehlers-Danlos syndrome, ADPKD, and AV malformations 3. **Dx**: Non-contrast CT showing hyperdensity in cisterns/sulci; LP showing gross blood or xanthochromia (yellow discoloration of the CSF)

Answer 321

Sjrogren's syndrome (and other autoimmune disorders)

Answer 322

**RA**: 0 and 8 mmHg **RV**: 4 and 25 mmHg **PA**: 9 and 25 mmHg **LA**: 2 and 12 mmHg **LV**: 9 and 130 mmHg **Aorta**: systolic BP

Answer 323

**_Myeloperoxidase (MPO)_** from neutrophil azurophilic granules. MPO is a heme-containing pigmented molecule.

Answer 324

Villous adenomas

Answer 325

Stratified squamous

Answer 326

**_Prostacyclin_**: vasodilates, *inhibiting platelet aggregation* and increasing vascular permeability **_Thromboxane A2_**: prostaglandin which enhances platelet aggregation and causes vasoconstriction

Answer 327

1. **Fibrous dysplasia** (multiple osteolytic-appearing lesions of the hip/ pelvis) 2. **Cafe-au-lait spots** 3. **Endocrine abnormalities** (precocious puberty, hyperthyroidism, etc.)

Answer 328

The mixture of two types of genetic material, known as heteroplasmy. In other words, during mitosis there is a random distribution of mitochondria, some containing lots of damaged mitochondria, others containing very few.

Answer 329

Thymus and **inferior** parathyroid glands

Answer 330

_Internal_: drain into the middle and **superior rectal veins**, which communicate with the internal iliac and **inferior mesenteric veins** _External_: drain via the **inferior rectal vein** into the internal pudendal vein, which communicates with the internal iliac veins

Answer 331

Aorta lying anterior to the pulmonary artery

Answer 332

In the hypothalamus. It is then _transported_, to the posterior pituitary for storage and later release into the circulation. Only hypothalamic damage will be enough to cause central Diabetes insipidus

Answer 333

1. Destruction of **parietal cells** (chronic atrophic gastritis). 2. They secrete HCL and IF, and are found primarily in the **superficial region of the gastric glands**

Answer 334

Frameshift

Answer 335

When parasites enter the body they are coated by IgG and IgE which bind to the Fc receptor on the eosinophil, prompting it to degranulate. (**Antibody-dependent cell-mediated cytotoxicity**) Eos also contribute to _late stage_ hypersensitivity

Answer 336

\>400?: **strep pneumo** pneumo jiroveci (PCP)

Answer 337

Increases hematocrit

Answer 338

1. The most common congenital anomaly of the small intestine 2. It forms due to incomplete obliteration of the omphalomesenteric duct that connects the midgut lumen and yolk sac cavity

Answer 339

Staph aureus

Answer 340

They can both be induced by disseminated cancers, usually due to some hypercoagulable state.

Answer 341

Inferior to the inguinal ligament, lateral to the pubic tubercle, and medial to the femoral vein

Answer 342

1. Anterior and Septal 2. Left lateral 3. Inferior and Right

Answer 343

They are interstitial myocardial granulomas, found in myocarditis due to acute rheumatic fever The macrophages are aka as caterpillar cells

Answer 344

Phosph. of serine and threonine residues of insulin receptor and insulin receptor substrate by serine kinase, leads to insulin resistance

Answer 345

1. Episodic, transient attacks of **coronary vasospasm** 2. Usually occurs at rest and during late night/early morning 3. Temporary transumral MI w/ ST elevation on EKG 4. Tx with vasodilators and CCBs 5. **_Ergonovine_** can provoke vasospasm and can *aid in diagnosis*

Answer 346

1. Crescendo-decrescendo murmur **right sternal border** 2. Typically asymptomatic. If advanced can present w/ exertion and inlcude syncope, dizzyness, angina or even HF 3. **Main causes**: abnormal valve w/ calcification (e.g. bicuspid aortic); calcified normal valve; or rhemuatic heart disease

Answer 347

1. (1) upper body hypertension; (2) diminished lower extremity pulses; (3) enlarged intercostal artery _collaterals_ 2. **Notching of ribs** as a result of the enlarged, tortuous intercostal arteries

Answer 348

1. _Pathogenesis_: A *genetic* defect in the **NADPH oxidase complex** decreases the formation of reactive oxygen species which have a direct _microbicidal_ activity and also _activate granule proteases_. 2. _Presentation_: Child with recurrent bacterial and fungal infections

Answer 349

1. Mold in the cold, endospore in the heat 2. Southwest US, northern Mexico, regions of Central and South America 3. Transmitted via spore inhalation which form endospores that rupture and disseminate 4. _Presentation_: * acute pneumonia (most common) * chronic pneumonia * pulmonary nodules and cavities * extrapulmonary nonmeningeal disease * meningitis

Answer 350

1. Usually involve the sigmoid colon 2. The result of increased intraluminal pressure (**pulsion**) created during strained bowel movements

Answer 351

They are mast cell stabilizing agents which inhibit mast cell degranulation independent of stimuli. They are a second-line treatment for _allergic rhinitis_ and _bronchial asthma_. Glucocorticoids are the first line prophylactic and are a superior drug.

Answer 352

1. Deficiency in carnitine impairs fatty acid transport from the cytoplasm into mitochondria, **preventing B-oxidation of fatty acids into acetyl CoA** 2. Sx: _Cardiac_ and _skeletal myocyte_ injury (lack of ATP from Citric acid cycle) and impaired ketone body production by the liver during fasting periods

Answer 353

1. Disruption of normal endocardial surface (usually in areas of maximum turbulence) 2. Focal adherence of **fibrin and platelets**, forming _sterile fibrin-platelet nidus_ 3. Colonization by microorganisms (*strep* to damaged areas; *staph* to damaged or normal areas) 4. Formation of macroscopic vegetations made of debris

Answer 354

1. HTN is most important risk factor 2. Tunica intima is the layer which tears away 3. Marfan's which leads to _cystic medial degeneration_

Answer 355

Glycine (occupies every thrid AA position)

Answer 356

1. Hereditary hemorrhagic **_telangiectasia_** 2. Autosomal dominat 3. Presence of telangiectasias in the skin and mucous membraes of the lips, oropharynx, respiratory tract, GI tract and urinary tract 4. Rupture of these vessels may cause epistaxis (**_nosebleeds_**), GI bleed, or hematuria

Answer 357

Low hepcidin levels increase intestinal iron absorptin and stimulate iron release by macrophages

Answer 358

1. **Sx:** weakness improves during the day and with excercise. Weakness of proximal muscles 2. **Assc**. with pre-existing malignancy 3. **Path**: antibodies against pre-synaptic calcium channels 4. No improvement from tensilon test 5. Incremental response from nerve stim. test

Answer 359

Via **domestic animals** or from contaminated food

Answer 360

1. Develops during chemo for CAs with rapid cell turnover, high tumor burden, or high chemo sensitivity 2. Characterized by a **leak of intracellular ions** (such as hyperphosphatemia, hypocalcemia, hyperkalemia, and hyperuricemia)

Answer 361

Strep Pneumo

Answer 362

1. The result of either serotonin overdose or co-prescription with an MAOI or triptan 2. (1) neuromuscular excitation, (2) autonomic stimulation, (3) altered mental status 3. _Antidote_- **Cyproheptadine** ( a first generation histamine antagonist) 4. **Tryptophan** is the precursor to serotonin

Answer 363

1. _Low dose_: stimulate D1 receptors in the renal and mesenteric vasculature 2. _Medium dose_: stimulate B-1 receptors, increasing cardiac contractility 3. _High dose_: stimulate a-1 receptors, producing generalized vasoconstriction

Answer 364

1. Ex. **Chlorpheniramine, diphenhydramine** 2. Also have antimuscarinic, anti-alpha adrenergic, and anti-serotonergic properties 3. Anticholinergic effects on occular ciliary muscles impair accomdation and cause **blurring of vision for close obects**

Answer 365

1. _Acute_: N/V, vertigo, blurred vision 2. _Chronic_: alopecia, dry skin, hyperlipidemia, hepatotoxicity/ hepatosplenomegaly, and visual difficulties 3. _Teratogenic_: Microcephaly, cardiac anomalies, fetal death

Answer 366

B-Blockers decrease AV nodal conduction, leading to an increased AV nodal refractory period

Answer 367

1. Lung dzs (oft associated with hypoxia) 2. Heart dzs (especially cynotic congenitals dzs and bacterial endocarditis) 3. IBD 4. Hyperthyroidism 5. Malabsorption

Answer 368

Regular cardiac cell: 0 = Na+ rush Pacemaker: 0 = Ca2+ rush

Answer 369

_Vascular_: 1. Systemic emboli 2. Mycotic aneurysm 3. Janewy lesions (**nontender**- palms/soles) _Immunologic_: 1. Osler nodes (**Painful**- toes/fingertips) 2. Roth spots

Answer 370

1. Croup 2. Brassy, barking cough; Dyspnea; Recent history of upper respiratory infection (URI) 3. **Parainfluenza virus** is the most common cause

Answer 371

_Substance P_ An intitial burning/stinging sensation, but chronic exposure leads to **reduced pain transmission**

Answer 372

Anti-IgE antibody Add-on therapy for patients with severe allergic asthma

Answer 373

1. Late-onset food poisoning (consisting of transient watery diarrhea) 2. Clostridial myonecrosis (gas gangrene)

Answer 374

It crosses horizontally acros the abdominal aorta and the IVC at the level of L3. The Superior mesenteric vessels lie anterior to the duodenum at this location.

Answer 375

1. Alveolar hypotension (**normal A-a gradient**) 2. V/Q mismatch 3. Diffusion impairment 4. Right-to-left shunting

Answer 376

They are Methylxanthines They cause bronchial dilatation by decreasing phosphodiesterase enzyme activity, thereby increasing intracellular camp.

Answer 377

**_P**_ark _**At**_ _**Vent**_ure _**Av_**enue *Fastest*- Purkinje system, Atrial system, Ventricular system, AV node- *slowest*

Answer 378

1. Autosomal recessive mutation of the ATP7B gene 2. _Path:_ Mutation leads to a decrease in copper incorporation into ceruloplasmin and reduced biliary copper excretion leading to copper accumulation in liver, brain, and eye

Answer 379

_Hyperacute_: Occurs in minutess. Preformed antibodies lead to graft blood vessel spasm and diffuse intravascular coagulation (white graft rejection) _Acute_: 1-2 weeks. Due to recipients rection to the HLA of the graft. Causes **vascular damage and bronchial infiltration**. Perihilar and lower lobeopacities on CXR. _Chronic_: months to years after transplant. Inflmmation of the small bronchioles (lungs) or vessels (kidneys) leading to narrowing and obstruction

Answer 380

Cardiac tissue and renal juxtaglomerular cells

Answer 381

1. Shigella 2. Entamoeba histolytica 3. Giardia lamblia 4. Campylobacter jejuni

Answer 382

1. _Obstruction_ in the **_ileum_** due to passage of a large gallstone through a cholecystenteric fistula in the small bowel 2. SBO 3. _Dx_: Ab XR may reveal gas within the gallbladder and biliary tree

Answer 383

_Transformation_: **Direct uptake** of naked DNA form the environment _Conjugation_: One way transfer of chromosomal or plasmid DNA between bacteria via direct physical contact (one of them must have F factor which codes for a _sex pilus_). _Transduction_: Transfer via **bacteriophage**

Answer 384

1. Neurologic symptoms 2. Renal failure 3. Fever 4. Thrombocytopenia 5. Microangiopathic hemolytic anemia

Answer 385

1. _Hypertrophic_: Autosomal dominant mutations in cardiac sarcomere proteins (usually **beta-myosin heavy chain**) 2. _Dilated_: Autosomal dominant mutations of myocyte cytoskeleton (**dystrophin**) or **mitochondrial enzymes**

Answer 386

1. Unilateral HAs, with pulsating/throbbing quality, associated with photophobia, phonophobia, and nausea 2. **Abortive**: Triptans (serotonin agonists) 3. **Prophylactic**: Beta-blockers, antidepressantts, and anti-convulsants

Answer 387

You must provide a nitrate-free interval every day in patients w/ long acting nitrates.

Answer 388

1. Severe resp. distress + diffuse neurological impairment + upperbody petechial rash, following long bone injury 2. Fat emboli turns block from stain w/ **osmium tetroxide**

Answer 389

3rd and 4th branchial pouches

Answer 390

1. CN V; Maxillary artery 2. CN VII; Stapedial artery (regresses) 3. CN IX; Common carotid and prox. internal carotid 4. CN X (superior laryngeal); True aortic arch and Subcalvian arteries 5. Obliterated 6. CN X (recurrent branch); Pulmonary arteries and Ductus arteriosus

Answer 391

The presence of a left-sided **_S3 gallop_**. This indicates high regurgitant volume and left ventricular volume overload

Answer 392

_Indication_: Used to tx severe acne w/ significant scarring _Contraindication_: Pregnancy, due to high risk of teratogenicity

Answer 393

Scattered, focal granulomatous inflammation centered on the media with : 1. intimal thickening 2. elastic lamina fragmentation 3. giant cell formation (not granulomatous) Same histo as **Takayasu arteritis**

Answer 394

It often occurs after a food handler inoculates food **(usually a _mayonnaise_ containing product),** w/ *S.aureus* that is allowed to incubate at room temp, producing heat-stable _exotoxin_ that causes rapid-onset N/V and abdominal cramping

Answer 395

1-a hydroxylase expression in activated macrophages, leads to **PTH independent Vit D activation** and subsequent inc. intestinal absorption of Ca2+

Answer 396

1. Elderly/ young children are most at risk 2. Both affect the _outer polysaccharide covering_: * **Pneumococcal polysacharide vaccine** * **Pneumococcal conjugate vaccine**

Answer 397

**GI**: 5-HT3 receptor antagonists **Migraine**: Dopamine antagonists

Answer 398

1. Toxic shock syndrome 2. Staphylococcal scalded syndrome 3. Gastroenteritis

Answer 399

Protein A is a virulence factor found in the peptidoglycan wall of Staph Aureus that **_binds the Fc portion of IgG_**, leading to impaired complement activation, opsonization, and phagocytosis.

Answer 400

1. Group of rare hereditary disorders charcterized by defective collagen synthesis 2. The result of procollagen peptidase deficiency, which results in _impaired cleavage of terminal propeptides_ in the extracellular space 3. Patients present with joint laxity, hyperextensible skin, and tissue fragility, due to collagen which does not crosslink

Answer 401

**ACE-inhibitors**: inhibit chronic angiotensin II-mediated remodeling that occurs in association w/ MI and CHF **Thiazides**: useful as an initial treatment for essential HTN w/o CHF or diabetes

Answer 402

Astrocytic processes (glial scar)

Answer 403

1. _Pathology_: Failure of B-cells to switch from IgM to IgA production. Very common 2. _Presentation_: Usually asymptomatic but can have recurrent sinopulmonary and GI tract infections 3. _Risk_: Many of these patients form IgG antibodies directed against IgA so risk anaphylaxis during transfusion

Answer 404

(In contrast to the RER,) the smooth ER contains **enzymes for steroid and phospholipid biosynthesis**. _ALL_ steroid-producing cells (adrenals, gonads, liver, etc.) contain a well-developed smooth ER.

Answer 405

* Rare malignant neoplasm of mesothelial cells. * Primary risk factor is consistent _Asbestos_ exposure * Symptoms include: dyspnea and chest pain * _Dx_ tests will show: 1. Hemorrhagic pleural effusion 2. Pleural thickening on radiographic study 3. Long slender microvilli and abundunt tonofilaments on histo.

Answer 406

_Dystrophic_: Occurs normally, w/ age, in **damaged** or **necrotic** tissues in the setting of **normal calcium levels**. _Metastatic_: Occurs in normal tissue in the setting of **hypercalcemia**

Answer 407

1. Encapsulated 2. Lactose fermenting (grows pink on MacConkey agar) 3. It causes pneumonia in subjects with impaired host defenses, especially alcoholics 4. Characterized by tissue necrosis, early abscess formation and currant jelly sputum

Answer 408

1. Isoniazid (TB drug) inhibits pyridoxine phosphokinase, leading to a **vitamin B6 deficiency** (pyridoxine). 2. The active form of pyridoxine is a cofactor for **delta-aminolevulinate synthase**, an enzyme which catalyzes the rate-limiting step of _heme synthesis_. 3. Inhibition leads to **sideroblastic anemia**.

Answer 409

_Heparin_: protamine sulfate _Warfarin_: Vitamin K and Fresh Frozen Plasma (FFP)

Answer 410

1. Oxidative injury to the respiratory bronchioles by _smoking_ 2. Macrophage activation 3. Inflammatory recruitment of neutrophils 4. Release of _proteases_ by _neutrophils_ and _macrophages_

Answer 411

Genitourinary instrumentation or catherization (enterococcus is a component of normal colonic and GU flora)

Answer 412

**Verapamil; Dilitiazem** 1. *Slows sinus node discharge rate; slows AV nodal conduction and prolongs refractoriness* 2. Can lead to severe bradycardia and hypotension (especially in combo with a beta-blocker)

Answer 413

1. **H**: Everywhere but liver and pancreatic B cells; **G**: Liver and pancreatic B cells 2. **H**: High affinity, low capicity; **G**: low affinity, high capacity 3. **H**: Not induced by insulin; **G**: induced by insulin 4. **H**: Not assc. with MODY; **G**: Assc. w/ MODY

Answer 414

1. Primers that are complementary to the regions of DNA flanking the segment of interest 2. Thermostable DNA polymerase 3. Deoxynucleotide triphosphates 4. A source DNA template strand

Answer 415

This complex characterizes the initial stages of _M. tuberculosis_ infection. It consists of a lower **lobe lung lesion** (Ghon focus) and **ipsilateral hilar adenopathy**. Reactivation of TB occurs most often in immunosuppressed patients and is characterized by apical cavitary lesions and hemoptysis.

Answer 416

**Early-onset pericarditis** develops in 10-20% of patients. It represents an inflammatory reaction to adjacent cardiac muscle necrosis.

Answer 417

An injury to a patient due to failure to follow evidence-based best practice guidlines. (Not to be confused with *malpractice,* which is a legal determination)

Answer 418

1. Lymphoid hyperplasia 2. Recurrent sinopulmonary infections

Answer 419

1. Carotid sinus hypersensitivity (triggered by pressure from the shirt) 2. The afferent limb of the carotid sinus reflex is a branch of the **glossopharyngeal nerve**

Answer 420

Mutation in the GNAS gene which leads to constitutive activation of the G protein/cAMP/ adenylate cyclase signaling cascade

Answer 421

Digoxin directly blocks the Na/K+ pump in myocardial cells, leading to increased intracellular Na. This slows functioning of Na+/Ca+ exchanger, thereby keeping Ca+ trapped in the the myocardial cell as well, increasing contractility.

Answer 422

1. Increased CAG trinucleotide repeats in the gene that codes for the huntingtin protein, leading to gain-of-fxn mutation. 2. Transcriptinal repression (silencing), via histone _**de**acetylation,_ is thought to be one of the main mechanisms in which this mutation causes disease

Answer 423

Parvovirus B19

Answer 424

1. Comes from pufferfish 2. Binds to voltage-gated sodium channels in nerve and cardiac tissue, preventing sodium influx and depolarization -- leads to paralysis

Answer 425

1. An exaggerated drop (\>10mmHg) in systolic BP during inspiration 2. Detected when taking the BP, by listening to the difference between when korotkoff sounds are first heard during expiration and the pressure at which they are heard throughout all phases of respiration 3. Inspiration inc. venous return and normally this expands RV into pericardium but if this expansion can't happen, the interventricular septum pushes into the LV, dropping LV EDV and subsquently the stroke volume 4. Pericardial disease, acute cardiac tamponade, asthma, COPD

Answer 426

GI (colorectal)

Answer 427

1. Caused by reduced numbers of inhibitory ganglion cells in the esophageal wall 2. Manometry shows dec. amplitude of peristalsis in the mid esophagus, w/ increased tone and incomplete relaxation at the LES

Answer 428

Coccidioides immitis

Answer 429

1. Glucose enters the beta cell through GLUT-2 2. Glucose is metabolized by glucokinase to glucose-6-phosphate 3. Glucose 6-phosphate is further metabolized by glycolysis and the Krebs cycle to produce ATP 4. High ATP to ADP ratio causes closure of ATP-sensitive K+ channels 5. Subsequently, depolarization of beta cells results in opening of voltage-dependent Ca2+ channels 6. High intracellular Ca2+ leads to insulin release

Answer 430

ALL and AML

Answer 431

1. Polymorphic v.tach that occurs in the setting of a congenital or acquired _prolonged QT interval_ 2. **Medications** such as certain (1) _antiarrhythmics_ (sotalol, quinidine); (2) _antipsychotics_ (haloperidol); (3) _antibiotics_ (macrolides, fluoroquinolones)

Answer 432

Transient ipsilateral diaphragmatic paralysis due to involvement of the phrenic nerve roots as they pass through the interscalene sheath.

Answer 433

Hydrocortisone or dexamethasone

Answer 434

Coarse erythrocyte basophilic stippling and microcytic hypochromic anemia

Answer 435

The excess risk in the exposed population that can be attributed to the risk factor. ARP_exposed = 100 x [(RR-1)/RR], where RR = relative risk

Answer 436

Blockade of the serotonin transporter

Answer 437

1. Vascular connection between the main pulmonary artery and the aorta still remains after birth 2. Patent due to prostaglandin E2 production by the placenta 3. Clinical features vary by size: _Small_: continuous machine-like murmur w/ no other symptoms. _Large_: progressive pulmonary HTN, reversal of shunt (now right-to-left), ultimately leading to **HF** and **cyanosis** (Eisenmenger syndrome), particularly in lower extemities. 4. Childhood 5. Tx: **Indomethacin** (prostaglandin E@ inhibitors)

Answer 438

**Glulisine, Aspart, Lispro** They have rapid onset and offset of action, mimicking physiologic postprandial insulin secretion

Answer 439

1. Blocked degradation of **_branched_** amino acids-- **_I_**soleucine, **_L_**eucine, and **_V_**aline (**I L**ove **V**ermont) due to decreased a-ketoacid dehydrogenase 2. Sx: severe CNS defect, intellectual disabiity, and death 3. Urine smells like maple syrup/ burnt sugar 4. Tx: restriction from branched amino acids in diet, and **thiamine supplementation**

Answer 440

Beriberi and Werknicke-Korsakoff syndrome 1. **Wernicke-Korsakoff**- Confusion + occulomotor abnormalities + memory deficita + ataxia (**COMA**) 2. **Dry beriberi**- characterized by symmetrical peripheral neuropathy 3. **Wet beriberi**- includes the addition of high-output CHF

Answer 441

Lyosomal enzyme release from neutrophils

Answer 442

Anterior (right on top of them)

Answer 443

1. Aspergillus develops in old lung cavities (from TB, emphysema, sarcoidosis, etc) and it forms a **fungus ball** w/o tissue invasion 2. Appears on CXR as radioopaque structure which shifts when Pt changes postion 3. Can cause hemoptysis (otherwise asymptomatic)

Answer 444

1. Beta-endorphins (endogenous opioid peptide) 2. ACTH 3. MSH

Answer 445

Blocks T-type Ca2+ channels in thalamic neurons (used to treat absence seizures)

Answer 446

A _microtubule-associated_, ATP-powered motor protein that **facilitates the anterograde** transport of neurotranmsitter-containing *secretory vesicles* down axons to synaptic terminals.

Answer 447

1. Growth factor ligand binds to a **receptor tyrosine kinase** on the cell membrane, causing _autophosphorylation_ 2. Proteins interact with Ras, promoting **GDP removal and GTP binding!**

Answer 448

1. Reducing myocardial contractility and HR 2. Decreasing renin release by the kidney

Answer 449

**Amiodarone, Dronedarone, Dofetilide, Sotalol** (also class II) *Prolongs APD by blocking K+ channels* (no effect on AP conduction velocity)

Answer 450

Leads to 1. Increased indirect bilirubin 2. Increased lactate dehydrogenase 3. Decreased **haptoglobin** (binds free hemoglobin and is then removed by the spleen)

Answer 451

1. Heavy smokers, males 2. **Path**- Segmental thromboding vasculitis 3. **Presentation**- Intermittent claudication which can lead to gangrene, autoamputation, and superficial nodular phlebitis. Also associated w/ Raynauds 4. **Tx**: smoking cessation

Answer 452

It is synthesized from arginine by NO synthase

Answer 453

1. _Fxn_: urea cycle enzyme that produces urea and ornithine from arginine 2. _Sx_: (1) Progressive spastic diplegia, (2) growth delay, (3) abnormal movements 3. _Tx_: Arginine-free, low protein diet

Answer 454

Val, Ile, Met, and Thr

Answer 455

All of these organisms _lack peptidoglycan cell walls_ and are therefore **resistant to agents that attack this wall**, uch as penicllins, cephalosporins, carbapenems, and vanco. Must treat with _anti-ribosomal agents_ (tetracycline and macrolides)

Answer 456

A dec. in Ach level due to the **deficiency of choline acetyltransferase**, needed to synthesize Ach. Most notable in the _basal nucleus of Meynert_ or the _hippocampus_

Answer 457

Due to the persistence of **myelin debris**, secretion of neuronal inhibitory factors, and development of dense glial scarring.

Answer 458

AUC (Oral)/ AUC (IV) This assumes they've been administered at equal doses

Answer 459

Yellow-brown, granular product of lipid peroxidation and considered to be a sign of "wear and tear"/aging.

Answer 460

SJS (30% of body surface)

Answer 461

Blood flow is directly proportional to vessel radius raised to the fourth power.

Answer 462

This biopsy is associated with cytomegalovirus (CMV). This is particuarly common among patients who have recently had _lung transplants_ or are generally immunocompromised. It is an enveloped double-stranded DNA virus

Answer 463

1. _Defected_: Lipoprotein lipase; ApoC-II 2. _Elevated_: Chylomicrons 3. _Manifestations_: **Acute pancreatitis**; lipemia retinalis (milky lipids in retinal vasculature); eruptive skin xanthomas; hepatosplenomegaly

Answer 464

HTN and benign prostatic hyperplasia (relaxes the bladder) **ANP/BNP** has the same effects

Answer 465

_Triptans_ They are **serotonin 5-HT1B/5-HT1D agonists**, and thus inhibit the release of vasoactive peptides, promoting vasoconstriction, and blocking pain pathways in the brainstem.

Answer 466

An alternative means for calculating cardiac output. CO = O2 consumption/ AV O2 difference

Answer 467

They function to destroy virally-infected B-lymphocytes

Answer 468

**DMARDs** (Dz-modifying antirheumatic drugs) such as methotrexate and sulfasalazine are the most key tx. DMARDs take weeks to kick in so short-term tx with anti-inflammatory tx is often used in the meantime.

Answer 469

It has both beta-adrenergic blocking properties and class 3 antiarrhtmic (K+ channel blocking) properties. It prolongs the PR interval and the QT interval.

Answer 470

1. _Central_: Increased PaCO2 2. _Peripheral_ (carotid and aortic bodies): PaO2 -- stimulated by hypoxemia 3. _Pulm Stretch:_ Regulates duration of inspiration based on degree of lung distension

Answer 471

_Langhans Giant Cells._ Formed from macrophages which are activated in response to pulmonary TB.

Answer 472

1. New onset of lupus symptoms 2. Anti-nuclear antibodies (ANA) and anti-histone antibodies 3. Anti-dsDNA **_ALMOST NEVER SEEN_** 4. _HIP_: **_H_**ydralazine, **_I_**soniazid, **_P_**rocainamide

Answer 473

1. Found ina variety of posionous mushrooms 2. Potent inhibitors of RNA pol, thus halting mRNA synthesis

Answer 474

_Sensation_ to the **suprapubic** and **gluteal** regions _Motor function_ to the **anterolateral abdominal wall muscles**

Answer 475

1. Pigmented gallstones 2. Aplastic crises from parvovirus B19 infection

Answer 476

**Fetal squamous cells**

Answer 477

Deficient cortisol and aldosterone synthesis + adrenal androgen overproduction _Males_: normal genitalia + vomiting, hypoTN, hyponatremia, hyperkalemia _Females_: ambiguous genitalia (+ sx above)

Answer 478

1. Common, slow-growing (benign), intracranial tumors 2. Typically adults 3. Arise in regions of dural reflection (falx cerenri, tentorium cerebelli, etc.) 4. Patients are often asymptomatic but may present w/ HA, seizure or focal neurologic deficits depending on size/ location of tumor

Answer 479

Collagen, due to repetitive AA sequences within each alpha chain

Answer 480

1. _Non-Selective_- Propanolol, timolol, and nadolol 2. _Selective_- metoprolol, atenolol, acebutolol and esmolol 3. Selective only target B1, so if you have patients w/ COPD/asthma, you want to only use these.

Answer 481

Beta-blockers

Answer 482

Smoking tobacco and drinking alcohol

Answer 483

The _ventral pancreatic bud_ abnormally encircles the 2nd part of the duodenum, forming ring of pancreatic tissue. May cause **duodenal narrowing.**

Answer 484

1. **Sx**: _LMN_- muscle weakness, atrophy, fasiculations; _UMN_- spasticity, hypereflexia, pathologic reflexes 2. **Gross**: (1)Thin anterior roots; (2) mild atrophy of precentral gyrus 3. **Histo/micro**: loss of anterior horn neurons, lateral CSTs, motor nuclei neurons, and denervation atrophy of muscles 4. **Genetics**: mutation of gene for superoxide dismutatse (SOD1) may be implicated 5. **Tx**: _Riluzole_ (decreases glutamate release)

Answer 485

1. Metabolizes very long chain fatty acids or fatty acids with branch points at odd-numbered carbons since they cannot undergo mitochondrial beta-oxidation 2. Can lead to neurologic defects from _improper CNS myelination_

Answer 486

**SITS** **_S_**upraspinatus- abducts arm initially (before deltoid takes over) **_I_**nfraspinatus (laterally rotates arm) **_T_**eres minor (adducts and laterally rotates arm) **_S_**ubscapularis (medially rotates and adducts arm)

Answer 487

1. Cerebellar ataxia + telangiectasias + inc. risk of sinopulmonary infections 2. Defect in the gene that encodes for the ATM gene, which plays a role in DNA break repair

Answer 488

1. Budding yeasts w/ thick capsules 2. Passed via pigeons/soil and affect only **immunocompromised** 3. _Meningoencephalitis_ is the most common disesase caused 4. India Ink/ Mucarmine

Answer 489

1. Left ventricular outflow obstruction; sudden death in stressful situation 2. Extreme myofiber disarray w/ interstitial fibrosis 3. Mutations in genes encoding cardiac sarcomere proteins 4. Harsh crescendo-decrescendo systolic ejection-type murmur best heard along left sternal border and apex 5. * Mechanisms dec. preload or afterload _increase obstruction_ -- such as sudden standing or nitro. * Mechanisms inc. preload or afterload _decrease obstruction_ -- such as squatting, sustained hand grip, or passive leg raise

Answer 490

It is a Type II hypersensitivity, in which there are antibodies to the glomerulus basement membrane and alveolar basement membrae

Answer 491

1. (1) Pleural thickening + (2) calcified lesins of the posterolateral midlung zones/diaphragm + (3) occasional pleural effusions 2. **Bronchogenic carcinoma** (most common and can occur w/o asbestos) and **malignant mesothelioma** (rare but more specific to heavy asbestos exposure)

Answer 492

Antibodies to citrullinated peptides/ proteins (anti-CCP)

Answer 493

1. B2 (inhibits uterus) 2. a2 (dilates pupils)

Answer 494

Painful swelling of the hands and feet It is a common presentation of sickle cell in young children.

Answer 495

1. Innervation to the skin of the posterior arm, forearm, and dorsal lateral hand 2. Motor innervation to all of the extensors of the upper limb (below the shoulder) Damage leads to _wrist drop_

Answer 496

QRS = Phase 0 QT = Phase 3

Answer 497

**Interferon-gamma** | (needed to activate macrophages)

Answer 498

**Estrogen** (leading to gynecomastia + spider angiomas + hair loss + testiclar atrophy)

Answer 499

Mamillary bodies

Answer 500

**Polyribosyl-ribitol-phosphate** (PRP)

Answer 501

It's the number of patients that need to be treated with a medicatin to avoid a negative outcome. It is 1 divided by the percent difference in outcome between the control and the experiment

Answer 502

1. Loss of **gag reflex** 2. Loss of **general sensation** of the upper pharynx, posterior tongue, tonsils and middle ear cavity 3. Loss of **taste** on posterior third of tongue

Answer 503

Fibromyalgia

Answer 504

Carcinoma in the apex of the lung. These usually arise in the superior sulcus (groove fromed by the subcalvian vessels) _Common presentation_: 1. Pt. w/ extensive smoking history 2. **Shoulder pain-** _most common symptom_ 3. Horner syndrome 4. Pain in distribution of C8-T2 roots (spinal cord compression)

Answer 505

Hydrogen bonds

Answer 506

1. Self-mutilation 2. Hyperuricemia

Answer 507

Eosinophils and Charcot-Leyden crystals (crystalloid bodies containing eosinophil membrane proteins).

Answer 508

1. Requires both **X factor** (hematin) and **V factor** (NAD+) to grow 2. Pathogenicity depends on the presence of a _capsule_ 3. Type B strain = most invasive and virulent 4. _Type B causes_- severe epiglottitis, meningitis, and bacteremia; _Non-type B_ causes noninvasive sinusitis, bronchitis, otitis media and conjunctivitis

Answer 509

**_Colonic malignancy_** with colonoscopy

Answer 510

They are **_lipophilic_** and thus readily diffuse across membranes. First accumulate in tissues with _high blood flow_ (like brain, hence rapid onset), then dubsequently redistributed to organs receiving less blood flow, like fat or muscles (hence short duration)

Answer 511

**Organic solvents** (ex. _Ether_) [Non-enveloped viruses are generally resistant to the action of ether]

Answer 512

Aspirin impairs prostaglandin synthesis by irreversibly inhibiting COX. Inhibition of COX-1 in platelets prevents synthesis of thromboxane A2, a potent stimulator of platelet aggregation and vasoconstriction.

Answer 513

It has intrinsic GTPase activity , that allows it to hydrolyze the attached GTP

Answer 514

1. Occurs in up to 25% of patients with SLE 2. Can cause small cardiac valvular vegetations on either side of a valve, resulting in fibrotic valve thickening and deformity 3. May cause acute coronary syndrom in young patients with **normal coronary arteries**

Answer 515

It blocks the GP IIb/IIIa receptor, which normally promots platelet binding to fibrinogen

Answer 516

1. Antiphospholipid antibodies (either primary or due to **_SLE_**) 2. Venous or arterial thromboembolism (in the presence of **paradoxical inc. PTT)** + recurrent pregnancy loss

Answer 517

1. Seizure tx 2. Blockage of _voltage-gated sodium channels_ in neuronal membranes 3. Can cause **bone marrow suppression**

Answer 518

Differential clubbing and cyanosis w/o blood pressure or pulse discrepancy

Answer 519

1. aka _Temporal_ arteritis 2. **Jaw Claudication**, HA, facial pain, and vision loss 3. Temporal artery biopsy demonstrates granulomatous inflammation of the media

Answer 520

Continuous GnRH agonist

Answer 521

(GP) IIb/IIIa, needed for platelet aggregation

Answer 522

1. Leukotriene B4 2. 5-HETE (leukotriene precursor) 3. C5a (complement component) 4. IL-8

Answer 523

Staph aureus

Answer 524

**Presence of an audible S3** (indicating a large volume of regurgitant flow re-entering the ventricle during mid-diastole)

Answer 525

Scattered cells within a mucopolysaccharide stroma, with abnormal blood vessels and hemorrhaging

Answer 526

1. Cardiac atria: **atrial natriuretic peptide** 2. Thyroid gland: **calcitonin** 3. Pancreatic islets: **islet amyloid protein** 4. Cerebrum/cerebral blood vessels: **B-amyloid protein** 5. Pituitary gland: **prolactin** 6. Multi-organ amyloid deposition? **Immune globulin light chains**

Answer 527

A family of small G-proteins involved in **signal transduction** in the Ras-MAPK pathway

Answer 528

This can only be done via immunophenotyping **B-ALL**: TdT+, _CD10+_ and _CD19+_ **T-ALL**: TdT+, CD1a+, and + for T-cell markers (CD2 , 3, 4, 5, 7, and 8)

Answer 529

1. _Pathogenesis_: Inactivating mutation affecting **NADPH oxidase.** Impaired respiratory burst inhibits phagocytic _intracellular killing_ 2. _Clinical Manifestation_: **Recurrent infections** in child w/ catalase (+) bacteria/fungi (commonly in lungs, skin, LNs and liver). Diffuse **granuloma formation**

Answer 530

1. **Garlic odor breath** + diarrhea + N/V 2. Insecticides 3. Cure = Dimercaprol

Answer 531

Cardiac arrhythmias/ arrest

Answer 532

_Oligodendrocytes_- CNS myelin (oligarchy means central power) _Schwann_- Peripheral Myelin

Answer 533

1. Composed of Ca2+ salts of unconjugated bilirubin 2. Soft, dark brown or black 3. Typically arise secondary to **bacterial** or **helminthic infection** of the biliary tract. **_Beta-glucuronidase_**, released by injured hepatocytes and bacteria, hydrolyzes bilirubin glucorinides to unconjugated bilirubin 4. The liver fluke *Clonorchis sinensis* (high prevalence in East Asian countries), is a common cause

Answer 534

By impairing insulin-dependent glucose uptake and increasing hepatic gluconeogenesis

Answer 535

**Anaerobic bacteria** normally found in the oral cavity are the most common cause. Risk factors include anything that increases _aspiration risk_ (seizure, alcholism, drug abuse, stroke, dementia, etc.) Ex: **Actinomycosis** Tx: Penicillin or Clindamycin (if hypersensitive to Penicillin)

Answer 536

**Referred shoulder pain** due to irritation of the phrenic nerve sensory fibers around the diaphragm as the **result of some abdominal process** (ruptured spleen, peritonitis, hemoperitoneum)

Answer 537

1. The interval between A2 and the opening snap (OS). **Shorter interval = more severe stenosis**

Answer 538

1. Pineal gland mass 2. (1) **Obstructive hydrocephalus** due to aqueductal stenosis - Sx: papilledema, HA, vomiting (2) **Dorsal midbrain (Parinaud) syndrome** due to direct compression of the pretectal region of the midbrain- Sx: paralysis of upward gaze, ptosis, pupillary abnormalities 3. Dx via _MRI_

Answer 539

_Accuracy_: the degree to which the aerage measurment value matches that of the gold standard _Reliability_: reproducibility of a result

Answer 540

A state of reduced CO2 in the blood. Always implies alveolar hyperventilation.

Answer 541

Small bowel obstruction due to abnormally dehydrated **meconium** in a patient w/ _cystic fibrosis_

Answer 542

Erythematous cutaneous marks in a fern-leaf pattern. They are pathognomonic of **_lightning strikes_**

Answer 543

1. Chronic liver dz characterized by autoimmune destruction of the intrahepatic bile ducts and cholestasis (elevated alk phos) 2. Most common in middle aged women 3. _Sx_: Severe pruritis (especially at night)

Answer 544

* On _EKG_, it is characterized by: **absent P waves, irregularly irregular R-R intervals,** and **narrow QRS** * Ventricular response is based on transmission of the abnormal impulses through the AV node. _The AV node refractory period regulates the number of impulses._

Answer 545

1. 1st line treatment for moderate to severe alcohol use disorder 2. Blocks the mu-opiod receptor 3. **Effect**: blocks the "rewarding and reinforcing" effects of alcohol, thus reducing cravings

Answer 546

MHC Class II so that they can present antigen to CD4 cells

Answer 547

1. Short-acting hypnotic used for **short-term insomnia** 2. Same MOA as benzos but a much lower risk of tolerance and dependence

Answer 548

1. Autosomal-recessive disorder 2. Deficiency of **homogentisic acid dioxygenase** (an enzyme involved in tyrosine metabolism) 3. _Presentation_: (1) diffuse blue-black deposits in connective tissues, (2) adults have slerae and ear cartilage hyperpigmentation, (3) osteoarthropathy of spine and large joints

Answer 549

1. Incomplete closure of the umbilical ring 2. **D**at **B**ig **H**ernia --\> assc. w/ **_D_**own Syndrome, **_B_**eckwith-Wiedmann syndrome, **_H_**ypothyroidism

Answer 550

1. Gives rise to true hyphae when incubated at 37 degrees C 2. Normally found in the **GI tract** (including the oral cavity) and thus is a common contaminant of sputum cultures

Answer 551

The proportion of indivudals with positive test results who actually have the dz PPV = TP/ (TP + FP)

Answer 552

1. B-agonist (predominant activity on B1 receptors) 2. Management of refractory HF w/ severe LV systolic dysfunction/ cardiogenic shock 3. (1) Positive **inotropic** effect (2) weakly positive **chronotropic** effect (3) mild **vasodilation** 4. Some increased O2 consumption due to increased chronotropy

Answer 553

Decrease **secretion** of aqueous humor via the _ciliary epithelium_

Answer 554

The release of _Platelet-derived growth factor (PDGF)_ by locally adherrent platelets, endothelial cells, and macrophages.

Answer 555

1. Hilar adenopathy 2. Pulmonary infiltrates 3. Non-caseating granuloma 4. AA Woman

Answer 556

1. Intracranial HTN 2. skin changes 3. Hepatosplenomegaly

Answer 557

1. Macrophages eat m. tuberculosis 2. **Macrophages** present to T cells and also secrete **IL-12** 3. T-cells differentiate to **Th1** 4. Th1 produces **IFN-y** which activates macrophages 5. Activated macrophages produce **TNF-a**, increasing recruitment, allowing for walling off of infection

Answer 558

Generations 2-5 (then drops off due to high cross-sectional area)

Answer 559

Persistent DD is \> 2y, while MDD is greater than 2 weeks (usually 6-12mo) Also Pers. DD tends to be milder

Answer 560

The **cricothyroid membrane**

Answer 561

Lack of HCl in gastric secretions

Answer 562

Vesicoureteral reflux

Answer 563

The **infundibulopelvic ligament** (IP). It suspends the ovaries and has blood vessels/nerves for the ovary running through it.

Answer 564

Stretching of the periventricular pyramidal tracts

Answer 565

1. Acute inflammation of GB in **_absence_** of *gallstones* 2. Occurs in critically ill patients (and thus has very poor prognosis)

Answer 566

Bacteroides (gram-negative, anaerobic rods) produce **_B-lactamase_**, an enzyme that breaks down penicillins. Tazo inhibits the B-lactamase, so that piperacillin can do its job.

Answer 567

Damage at or below the midbrain tegmentum, pons (below the red nucleus)

Answer 568

Damage w/in the cerebral hemispheres (above the red nucleus)

Answer 569

**Human placental lactogen (hPL)** It decreases maternal fatty acid stores and increases maternal serum glucose, but also increases insulin resistance

Answer 570

1. Courses between the humeral and ulnar heads of the pronator teres muscle 2. Runs between the flexor digitorum superficialis and the flexor digitorum profundus muscles (like meat in a sandwich) 3. Crosses wrist w/n carpal tunnel

Answer 571

Serum TSH | (even more sensitive than T3/T4)

Answer 572

IL-6 (cell mediated immunity is the primary mechanism underlying this dz)

Answer 573

Ornithine is a crucial part of the **_urea cycle_**, needed to breakdown protein. Defects can lead to neurological damage, due to ammonia accumulation.

Answer 574

1. Penicillins 2. Cephalosporins 3. Vancomycin

Answer 575

The **hexokinase pathway** can be used, if the _fructokinase pathway_ is broken (as it is in the case of essential frucosuria)

Answer 576

_First_: a constant proportion of the drug is metabolized per unit time (based on serum levels) _Zero_: a constant amount of drug is metabolized per unit time (independent of serum levels)

Answer 577

1. Pseudopalisading 2. Central areas of necrosis + hemorrhage (hence, multiforme)

Answer 578

1. Collection of squamous cell debris that forms a pearly mass behind the tympanic membrane 2. Congenital or acquired following infxn, trauma or middle ear surgery 3. Can cause hearing loss

Answer 579

1. **Prophase** of _meiosis I_ (prior to ovulation) 2. **Metaphase** of _meiosis II_ (prior to fertilization)

Answer 580

Cardiac and Renal JGA cells

Answer 581

secretory **_IgA production_**

Answer 582

1. **RSV** 2. Low-grade fever, cough, tachypnea, inc. work of breathing 3. Wheezing + crackles

Answer 583

An anaerobic gram-variable rod

Answer 584

Budding yeast

Answer 585

The external branch of the superior laryngal nerve

Answer 586

1. Inguinal crease = optimal site 2. Skin and muscles of the anterior thigh (e.g. quads), femur, and knee

Answer 587

Because it is both filtered and secreted in the proximal collecting tube (PCT), resulting in nearly 100% excretion of PAH by the kidneys.

Answer 588

Dilated cardiomyopathy caused by viral myocarditis

Answer 589

All normal

Answer 590

Hyperventilate. This will blow off CO2, leading to a vasoconstriction.

Answer 591

Blistering cutaneous photosensitivity

Answer 592

Bicuspid aortic valve + coarctation of the aorta

Answer 593

1. **Autonomic instability** (hyperthermia, HTN, tachycardia) 2. **AMS** 3. **Neuromuscular hyperactivity**

Answer 594

It has MAOI activity, so combined with an SSRI, it can precipitate serotonin syndrome

Answer 595

They _increase Ca2+ reabsorption from the nephron_, so are effective for calcium based nephroliths

Answer 596

Anesthetics with _high tissue solubility_ are characterized by **large** AV concentration gradients and **slower** onsets of action.

Answer 597

(1) sterile fibrin-platelet nidus + (2) bacterial colonization

Answer 598

Calcification

Answer 599

SCA and PCA

Answer 600

Mild w/drawal (tremors, diaphoresis, etc.) --\> seizures --\> alcoholic hallucinosis --\> delirium tremens

Answer 601

**Heme --\> Biliverdin** (via heme oxygenase) **Biliverdin --\> unconjugated bilirubin** (via biliverdin reductase)

Answer 602

1. Alveolar hypoventilation 2. Inspiration of air at high altitude

Answer 603

**The left and right gastric arteries.** They run along the lesser curvature of the stomach, where the great majority of ulcers occur.

Answer 604

Decreased _leptin_, leads to decreased _GnRH_ secretion via the **_hypothalamus_**

Answer 605

Intravascular devices (indwelling catheters)

Answer 606

W/in the **_tunica vaginalis_**

Answer 607

(PYR)-positive

Answer 608

Low Molecular Weight Heparins

Answer 609

The presence of alpha fetoprotein and AchE in the amniotic fluid (or even serum for AFP)

Answer 610

Tamoxifen is a prodrug and relies on CYP2d to become activated, as _endoxifen_

Answer 611

The paracortex region

Answer 612

Aorta and SMA

Answer 613

Connexins assemble into **gap junctions** which are needed to facilitate communication and coordination between cells preparing for labor contractions. They increase in response to rising estrogen levels.

Answer 614

3'CCA tail (loaded by aminoacyl tRNA synthetase)

Answer 615

_Testes_: para-aortic LNs _Scrotum_: superficial inguinal LNs

Answer 616

The _long thoracic nerve_. The results in weakness of the **serratus anterior muscle.** (leading to winged scapula and impaired abduction of the shoulder beyond the horizonal)

Answer 617

Chronic interstitial nephritis + papillary necrosis

Answer 618

They are involved in posttranslational processing and stabilization w/in neurosecretory vesicles during transport to the posterior pituitary.

Answer 619

1. Reduction of glutathione (i.e. prevention of oxidative damage) 2. Biosynthesis of cholesterol, fatty acids, and steroids

Answer 620

Atropine only reverses _muscarinic_ _sx_ of the poisoning. It has no effect on the **nicotinic receptors**, which cause the muscle paralysis (need pralidoxime→**PAM**)

Answer 621

Overuse causes negative feedback, resulting in dec. NE synthesis and release from nerve endings, diminishing their effect

Answer 622

The GI tract (including the oral cavity)

Answer 623

Binds to mu receptors, resulting in G-protein activation of potassium conductance. This hyperpolarizes the postsynaptic neurons, blocking pain transmission

Answer 624

Deficiency in galactose-1-phosphate uridyl transferase (GALT)

Answer 625

**Microglial nodules** (activated macrophages/giant cells around center of necrosis)

Answer 626

1. Compression of lower trunk of brachial plexus in the scalene triangle (bordered by anterior/ medial scalene and first rib) 2. **Sx**: uper extremity numbness, tingling, and weakness 3. Having an extra rib

Answer 627

D-penicillamine (copper chelating agent)

Answer 628

1. Fallopian tubes 2. Uterus 3. Cervix 4. Upper vagina

Answer 629

Increase its synthesis of a bunch of other proteins (including VLDL, LDL, and HDL). This often leads to lipiduria.

Answer 630

They work in the _cytoplasm_. Play an important role in mRNA translation regulation and mRNA degradation

Answer 631

CMV (agglutination to horse erythrocytes = **_monospot test_**)

Answer 632

Doxycycline or azithromycin

Answer 633

_Fenoldopam_ (dopamine-1 receptor agonist) 1. Arteriolar dilation 2. Inc. renal perfusion 3. Promotes diuresis and natriuresis

Answer 634

1. Rxn to antipsychotic drugs **FEVER** (**F**ever, **E**ncephalopathy, **V**itals unstable, **E**nzyme inc., **R**igidity of muscles) Tx w/ _Dantrolene_

Answer 635

**Central pontine myelinolysis** (osmotic demyelination of the axons in the central pons). Can cause quadriplegia.

Answer 636

Dual identifiers (usually a nurse and physician)

Answer 637

Nonsterile gloves + gown

Answer 638

It can have a _humoral_ and _cellular_ component * **Humoral**- necrotizing vasculitis with a neutrophilic infiltrate * **Cellular**- lymphocytic interstitial infiltrate and endotheliitis

Answer 639

It means that the one mRNA codes for several proteins

Answer 640

An X-linked trinucleotide repeat disorder (**CGG**)_n which affects _methylation_ and expression of the _FMR1 gene_

Answer 641

1. A fib can lead to acute ischemic colitis 2. Ischemia forces bowel to use anaerobic respiration 3. Anion gap acidosis occurs 4. Kidneys generate **ammonia** and bicarb (via conversion of _glutamide to glutamine_), so **bicarb** can be used to buffer blood 5. **Ammonia is urinated out** (hence acidic urine!!!)

Answer 642

**_Free_** = produce proteins for the cytosol **_Attached_** = produce proteins for cell membrane/ secretion

Answer 643

Mineralocorticoids (eg, spironolactone, eplerenone, etc.)

Answer 644

The _inferior epigastric artery_

Answer 645

The backflow of blood causes damage to the endothelium, which causes impaired NO function and endothelin release.

Answer 646

Hep C is typically _asymptomatic_! There may be skin manifestations in chronic Hep C.

Answer 647

Attachment to the **Posterior descending/interventricular artery** **(PDA)**

Answer 648

The AV node (via the AV nodal artery)

Answer 649

Gap junctions

Answer 650

Severe vasospasm Tx w/ nimodipine to prevent

Answer 651

1. dark urine + jaundice + clay colored stools in first months of life 2. Dx: conjugated hyperbilirubinemia and take biopsy 3. Biopsy reveals duct prolifeation, portal tract edema, and fibrosis

Answer 652

**Ivabradine** Selective inhibition of funny sodium channels (I_f)

Answer 653

1. nephrotoxicity 2. ototoxicity

Answer 654

**a2**: inhibits insulin secretion **B2**: promotes insulin secretion a2 predominates when both are activated

Answer 655

Dopamine agonists

Answer 656

Epithelial-derived tissues

Answer 657

1. **Mood reactivity** (ex. feeling better n response to positive events) 2. **Leaden paralysis** (heavy arms/legs) 3. **Rejection sensitivity** 4. **Increased sleep/appetite** _Tx_: MAOIs

Answer 658

The **liver**, due to increased hepatic gluconeogenesis and glycogenesis (contributes to the hyperglycemia seen).

Answer 659

Inhibition of ovulation by dec. FSH and LH synthesis

Answer 660

von Willebrand dz (should show decreased aggregation of platelets)

Answer 661

Allergic contact dermatitis (type IV hypersensitivity)

Answer 662

_Radial nerve_ during its passage through the supinator canal

Answer 663

Diphtheria antitoxin (passive immunization)

Answer 664

**LARGE _VEINS_**!!! (It's a venodilator, which allows it to decrease preload)

Answer 665

MRI of the spine

Answer 666

Drugs w/ high _lipophilicity_

Answer 667

Cerebral aqueduct

Answer 668

Lateral foramina of Luschka and Median foramen of Magendie

Answer 669

1. Drug rxn with eosinophilia and systemic symptoms 2. **2-8 weeks after exposure to high risk drugs** (ex. anticonvulsants, allopurinol, sulfonamides, and antibiotics)

Answer 670

1. **F**ever 2. **E**osinophilia 3. **D**iffuse rash 4. **I**nternal organ Dysfunction 5. **F**acial edema You will be **FED IF** you get **_DRESS_**ed

Answer 671

Citrate and fluids

Answer 672

Can cause _overflow incontinence_ due to inability to sense a full bladder and due to incomplete bladder emptying.

Answer 673

_Thiazides_: Hyponatremia and hypercalcemia _Loop diuretics_: Hypocalcemia

Answer 674

1. **Intestinal obstruction** (due to compression by the adhesive bands) 2. **Midgut volvulus** (intestinal ischemia due to twisiting around the blood vessels)

Answer 675

First-pass metabolism by the liver

Answer 676

Reduces intestinal absorption of **_cholesterol_** at the brush border (this leads to inc. LDL expression pulling more cholesterol out of the circulation)

Answer 677

_Catalase-postive bugs_ which destroy their own hydrogen peroxide **Specifically**: 1. S. aureus 2. Burkholderia cepacia 3. Serratia marcescens 4. Nocardia 5. Aspergillus

Answer 678

Secretion of _Parathyroid hormone-**related** protein_ (PTHrP). It closely resembles parathyroid hormone and causes increased bone resorption and decreased renal excretion of calcium.

Answer 679

1. Leads to occurence of colonic adenocarcinomas at a young age ( 2. Mutations in DNA mismatch repair is responsible 3. **MSH** = key gene

Answer 680

The septum touches the mitral valve leaflets, and blocks the aortic valve

Answer 681

Perchlorate and pertechnetate ions

Answer 682

Common peroneal nerve

Answer 683

The **RER**, where it is a cofactor for hydroxylation of proline and lysine.

Answer 684

Cardiac arrhythmias and refractory hypotension. Due to Inhibition of fast sodium channels in cardiac myocytes.

Answer 685

Proto-oncogene

Answer 686

1. abnormal mitoses 2. giant, multinucleated tumor cells

Answer 687

Unbalanced _Robertsonian Translocations_ [46, XX, t(14;21)] or Mosaicism (some cells have extra copy of chromosome 21)

Answer 688

During hyperglycemia, excess plasma glucose is converted to sorbitol by _aldose reductase_. Sorbitol accumulates w/in some cells and attracts water, leading to osmotic cellular injury.

Answer 689

Diagnosis: DHR **flow cytometry** (prefered); **Nitroblue** tetrazolium (NBT) testing

Answer 690

Induce posttranscriptional gene silencing by base-pairing w/ complementary sequences w/in target mRNA molecules

Answer 691

Irritation of the parietal peritoneum

Answer 692

Autosomal recessive

Answer 693

Herpes simplex virus

Answer 694

1. Persistent vitelline duct 2. Meckel diverticulum 3. Vitelline sinus 4. Vitelline duct cyst

Answer 695

1. Hematuria 2. Flank pain 3. Palpable mass

Answer 696

1. Swelling of tongue, lips, eyelids, or sometimes larynx 2. Caused by bradykinin accumulation from ACE-I's

Answer 697

ARR= (event rate in the control group) - (event rate in the tx group)

Answer 698

Transverse carpal ligament

Answer 699

Direct _renin inhibitor_ (Blocks conversion of angiotensinogen to angiotensin I)

Answer 700

Approximate measure of GFR (secreted 10%)

Answer 701

**GFR** (freely filtered and neither reabsorbed or secreted) (can also estimate extracellular volume)

Answer 702

Loss of cortisol and aldosterone, increased androgens (most common casued of CAH)

Answer 703

Loss of cortisol and aldosterone, increased androgen **and** increased aldosterone precursor, **_11DOC_** (binds strongly to mineralocorticoid receptor, *simulating* increased aldosterone)

Answer 704

Loss of Cortisol and androgens. Increased aldosterone.

Answer 705

Neuroblastoma

Answer 706

1. Rare autosomal recessive disorder of de novo pyrimidine synthesis 2. Defect in _uridine 5'-monophosphate (UMP) synthase_

Answer 707

Children with 1. Physical/mental retardation 2. Megaloblastic anemia 3. Large amounts of urinary orotic acid Tx w/ **uridine**

Answer 708

**Langerhans cells** (derived from myeloid cell line and possess racquet-shaped intracytoplasmic granules called _Birbeck granules_)

Answer 709

**Metastatic** (The cytokines of local carcinoid tumors _confined to the intestine_, are metabolized by the liver before reaching systemic circulation)

Answer 710

Via the vertebral venous plexus

Answer 711

Greater = Greater curvature of stomach Lesser = lesser curvature of stomach (to liver/duodenum)

Answer 712

_Deficient_: vitamins B12, A, D, E, and iron _Increased_: folic acid and vitamin K

Answer 713

**Fimbrae** (allows it to stick to uroepithelial cells)

Answer 714

1. **Prenatal screening** (35-37 weeks) 2. **_INTRAPARTUM_ antibiotics**

Answer 715

1. Tx of **acute gouty arthritis** in patients who can't take NSAIDs 2. **Blocks tubulin polymerization**, thus inhibiting leukocyte migration/phagocytosis 3. N/Dia

Answer 716

1. Ataxia 2. Nystagmus 3. Gingival hyperplasia

Answer 717

1. Most common in **children** 2. The **_metaphysis_** of **long bones** (slower blood flow)

Answer 718

**Glucagon** (causes inc. of intracellular cAMP)

Answer 719

Carbon monoxide (CO) -bound hemoglobin

Answer 720

Adult onset

Answer 721

**Secretin**, produced in the S cells of the duodenum

Answer 722

**Increases** Lecithin is a component of surfactant (greatly inc. during third trimester), while sphingomyelin is a general amniotic fluid component which should remain constant.

Answer 723

Type II HSN rxn, w/ subsequent complement activation

Answer 724

No adrenergic postganglionic neurons

Answer 725

Conduction hearing loss

Answer 726

_Inferior rectal_ nerve (branch of the **pudendal**)

Answer 727

It is a stain for **fat** and it is the most sensitive strategy for malabsorptive disorders

Answer 728

It is an **180 nucleotide**, highly conserved **gene**, which codes for _transcription factors_

Answer 729

Organisms with _mycolic acid_ present in their cell walls

Answer 730

1. Ovarian 2. Lung 3. Colorectal 4. non-Hodgkin

Answer 731

_Sciatica-like_ sx as a result of **compression** of the sciatic nerve, due to muscle injury or hypertrophy of the **piriformis muscle**

Answer 732

**Sebaceous** (a _holocrine_ gland)

Answer 733

**V. Fib** (due to electrical instability in the ischemic myocardium)

Answer 734

Steroids (ex. dexamethasone)

Answer 735

Subjects are randomly allocated to a sequence of 2 or more tx given consecutively

Answer 736

Inhibin B, which feedsback to inhibit FSH secretion

Answer 737

Defects in ApoE2 and ApoE4. Leads to dec. clearance of chylomicrons and VLDL remnants

Answer 738

The cytosol

Answer 739

Through the length of the respiratory bronchioles

Answer 740

Instances where multiple phenotypic manifestations result from a single genetic mutation

Answer 741

Erectile dysfunction (it innervates the corpus cavernosa of the penis)

Answer 742

Neural crest cells

Answer 743

aka _VPN_ (vanco, polymyxin, and nystatin + trimethoprim) Kills everything except *_Neisseria_*

Answer 744

Enteroviruses (polio/ coxsackie)

Answer 745

1. Leukotriene (and its precursor) 2. C5a 3. IL-8

Answer 746

Homocystinuria (responds dramatically to vit B6-- pyridoxine)

Answer 747

Presence of a central vascular catheter + receipt of parenteral nutrition

Answer 748

_Proximal_: inferior mesenteric and internal iliac LNs _Distal_: inguinal nodes

Answer 749

Autoimmune hemolytic anemia (it looks like human erythrocytes)

Answer 750

The presence of viral HBsAg and HBcAg on the cell surface stimulates the host's cytotoxic CD8+ cells to destroy infected hepatocytes.

Answer 751

When it gets beyond the "Transport Maximum of Glucose", which is around 200 mg/dL. Prior to this value, it is completely reabsorbed.

Answer 752

Unpredictable fluctuations in motor function

Answer 753

Granulated (Dohle bodies)

Answer 754

Primary Hyperaldosteronism | (tx w/ eplerenone or spironolactone)

Answer 755

1. Trimethoprim 2. Methotrexate 3. Pyrimethamine

Answer 756

Openings in the external abdominal oblique

Answer 757

Physiologic openings in the transversalis fascia

Answer 758

Monoclonal antibody directed against the CD20 antigen

Answer 759

Bipolar maintenance drug

Answer 760

Caused by admin of inhalation anesthetics/ succinylcholine to genetically susceptible individuals. Tx w/ **Dantrolene** (Ryr receptor blocker)

Answer 761

Respiratory papillomatosis, w/ infection of larynx (true vocal cords)

Answer 762

Secondary tumors, especially **_osteosarcomas_**

Answer 763

PCP (angeldust)

Answer 764

In schizoaffective disorder, there _are_ signficant mood symptoms (ie mania or depression) in conjunction with the hallucinations.

Answer 765

(Sensitivity) \* (number of patients actually with the dz)

Answer 766

Blocks the action of bacterial DNA-dependent RNA polymerase

Answer 767

(1-sensitivity) \* number of patients actually with the dz

Answer 768

Intraductal papilloma (typically presents _w/o_ breast mass or skin changes)

Answer 769

**CDK4**, after exposure to proliferation signals

Answer 770

FMN and FAD (electron acceptor for _succinate dehydrogenase_)

Answer 771

**_Hypercalcemia_** Activated macrophages produce excess 1,25 dihydroxyvitamin D

Answer 772

1. APP (chromosome 21) 2. Presenilin 1 3. Presenilin 2

Answer 773

Apoliporotein E4

Answer 774

The inferior wall of the left ventricle. Fed by the **_PDA_**, which usually derives from the right heart

Answer 775

Severe **_pancarditis_** | (inflammation of the entire heart)

Answer 776

Because there is no normal enteral stimulation, there is dec. CCK release and subsequent billiary stasis.

Answer 777

Gingivostomatitis

Answer 778

Behavioral therapy

Answer 779

1. Gastroenteritis 2. Septicemia 3. Meningoencephalitis

Answer 780

It can decrease renal excretion of **uric acid**, precipitating _acute gouty arthritis_

Answer 781

NH₃ and HPO₄^2- | (are urinated out as NH4 and H2PO4)

Answer 782

D-alanine-D-alanine (penicillin looks like it, vanco directly binds to it)

Answer 783

1. Fecal/urinary incontinence 2. Perineal pain 3. Sexual Dysfunction Often occurs as a stretch injury during labor

Answer 784

1. Psoriatic arthritis 2. Nail pitting 3. Uveitis

Answer 785

Large hepatocytes folled with finely granular, homogenous, pale pink cytoplasm (eosinophilic inclusions), often described as **ground glass**. This is from the accumulation of _Hep B surface antigen_ w/in affected hepatocytes.

Answer 786

The result of _abnormal_ migration of **neural crest cells** during embryogenesis. These cells are ganglion precursors, and always involve the **rectum** because they migrate caudally

Answer 787

**_Thymidine_** supplementation

Answer 788

Older patients, with cognitive or fxnal impairments

Answer 789

**_Tryptase_** (it is a preformed inflammatory mediator released by the mast cell)

Answer 790

The medullary segment

Answer 791

1. **Western**: id's proteins 2. **Northern**: id's RNA 3. **Southern**: id's DNA

Answer 792

Inhibits synaptic _reuptake_ of NE, DA, and Ser

Answer 793

Elevated FSH and LH (no feedback), and decreased testosterone due to Leydig damage Azoospermia (no sperm)

Answer 794

The _minimal alveolar concentration_. This is the ED₅₀ and is inversly proportional to the MAC (the lower the MAC, the higher the potency)

Answer 795

They are modifed SM cells of the _afferent glomerular arteries_. They secrete renin in response to the Macular Densa. Chronic hypoperfusion will cause hypertrophy and hyperplasia.

Answer 796

The _hep B surface antigen_ of the hep B virus **_must coat the hep D antigen_** of the hep D virus, before it can infect hepatocytes and multiply.

Answer 797

Damage to the _sterociliiated hair cells_ of the **O****rgan of Corti**

Answer 798

Mast cell proliferation

Answer 799

1. Abnormal proliferation of mast cells and inc. histamine release 2. Histamine causes _hypersecretion_ of gastric acid by _parietal cells_ of the stomach, as well as a variety of other symptoms (hypotension, flushing, pruritus, etc.)

Answer 800

1. Procainamide 2. Hydralazine

Answer 801

1. Agonist at the **GABA-B receptor** 2. Effective monotherapy for _spasticity_ secondary to both _brain and spinal cord dz_, including MS

Answer 802

Activating mutations of the **_RET proto-oncogene_**

Answer 803

Anaplastic thyroid CA

Answer 804

Follicular thyroid CA (and some follicular adenomas)

Answer 805

Smooth muscle hypertrohy of the pyloric muscularis mucosae _Presentation_ 1. projectile nonbilious vomit 2. olive-sized mass in distal stomach

Answer 806

1. Thiazides 2. ACE inhibitors 3. NSAIDs

Answer 807

**Agranulocytosis** Sudden onset of fever and sore throat (discontinue drug and take white count)

Answer 808

Low doses of corticosteroids to suppress excessive ACTH secretion

Answer 809

Slightly dec. HbA with inc. HbA₂ and HbF

Answer 810

*N. gonorrhea* (gram-negative intracellular diplococcus)

Answer 811

1. Factor X (hematin) 2. Factor V (NAD+) ## Footnote *S. aureus*

Answer 812

Histoplasma capsulatum (in the form of oval bodies w/in a macrophage)

Answer 813

Common peroneal

Answer 814

**_COX-1_**: House keeping fxns such as platelet aggregation, gastric mucosal protection, etc. (consitutively expressed) **_COX-2_**: *Inducible* enzyme only expressed by **inflammatory tissues**

Answer 815

Selective COX-2 inhibitor

Answer 816

**Type I (slow twitch, aerobic, lots of mitochondria)** [this differs from type II, fast twitch, which is anaerobic, and is for rapid forceful pulses of movement]

Answer 817

**Directly correlated** Leptin is produced by adipocytes in proportion to the quantity of fat stored. Increased leptin leads to _decreased_ appetite and increased satiety

Answer 818

**Cyproheptadine** (an antihistamine)

Answer 819

_Anterior_: Surface ectoderm _Posterior_: Neural tube (Both are derivations of the ectoderm)

Answer 820

1. **_CT/MRI_**: pleural thickening 2. **_Histo_**: long, slender microvilli and abundant tonofilaments

Answer 821

UV-light (due to an endonuclease deficiency)

Answer 822

It bypasses PFK-1, the major rate-limiting enzyme of glycolysis

Answer 823

1. Sacral agenesis causing lower extremity paralysis and urinary incontinence in a newborn 2. Poorly controlled maternal diabetes

Answer 824

1. _Sensory_: Perineum 2. _Motor_: Urethral and anal sphincters

Answer 825

_Inactivated_: humoral response (antibodies against hemagglutin, thus preventing **viral entry into the cell**) _Live-attenuated_: cell-mediated + humoral

Answer 826

_Infraorbital nerve_ Damage can result in paresthesia of the upper cheek, upper lip, and uper gingiva.

Answer 827

Hyperbolic (not sigmoid)

Answer 828

The **superior vena cava**, and other constituents of the systemic venous circulation

Answer 829

They increase cerebral blood flow, which can sometimes lead to increased ICP.

Answer 830

1. Hemolytic anemia 2. Pancytopenia 3. Thrombosis at atypical sites

Answer 831

Given _with_ penicillin family antibiotics, so that they can work against beta-lactamase inhibitor secreting bacteria. **Ex**: Clavulanic acid, sulbactam, and tazobactam

Answer 832

Hemophilia (dec. factor 8 or 9) Give thrombin

Answer 833

Transmural inflammation

Answer 834

1. Sudden, involuntary contraction of a major muscle group 2. Recent initiation of a first gen. _antipsychotic medication_, leading to **_D2 antagonism_** in he nigrostriatal pathway

Answer 835

**Incomplete fusion of atrial septum primum and secundum** Can lead to paradoxical embolization of venous clots into the systemic arterial circulation

Answer 836

Fall onto an outstretched hand Large risk of **_avascular necrosis_** due to their weak blood supply

Answer 837

1. Thickened bronchial walls 2. Leukocyte infilitrate 3. Mucus gland enlargement 4. Squamous metaplasia

Answer 838

_Cavernous hemangioma_ Cavernous, blood-filled vascular spaces of variable size lined by single epithelial layer. DON'T BIOPSY! (likely to bleed)

Answer 839

Mannose-residue

Answer 840

HLA B27 (a specific human leulocyte antigen _class **II**_ serotype) *Emphasis on class _TWO_!!*

Answer 841

Allergic rhinitis and asthma

Answer 842

Epithelial ovarian CA

Answer 843

Unilateral pulmonary opacification and deviation of the mediastinum _toward_ the opacificed lung

Answer 844

Left gastric vein

Answer 845

1. Mucosa 2. Muscularis mucosa (erosion doesn't go past this point) 3. Submucosa 4. Muscularis propria 5. Serosa

Answer 846

1. Anti-smith (snRNPs) 2. Anti-DS-DNA 3. Anti-nuclear

Answer 847

Inhibition of the heme synthesis pathway, leading to a microcytic, hypochromic anemia

Answer 848

**Adenomyosis** The presence of endometrial glandular tissue within the myometrium (presents w/ menorrhagia and dysmenorrhea)

Answer 849

Elevated serum FSH (due to loss of feedback)

Answer 850

They can cause contraction of smooth muscle in the sphincter of Oddi

Answer 851

In the duodenum and the proximal jejunum

Answer 852

Increased intraluminal gastric pressure due to retching/vomiting/other abdominal strain

Answer 853

Sertoli-Leydig

Answer 854

1. Aut. recessive 2. Genetic lack of UGT enzyme, leads to inability to conjugate bilirubin via glucuronidation (infants often die early)

Answer 855

**APL** (M3 AML variant)

Answer 856

1. Deficiency of methylmalonyl-CoA mutase 2. **Sx**: lethargy + vomiting + tachypnea

Answer 857

1. _Labs_: hyperammonemia, ketotic hypoglycemia, metabolic acidosis 2. _Dx_: elevated urine methylmalonic acid and proprionic acid

Answer 858

Inadequalte canalization of the _Utereropelvic Jxn_

Answer 859

Type III HSNT (IC deposition)

Answer 860

**COLA** Cysteine, Ornithine, Lysine, Arginine (leads to nephrolithiasis)

Answer 861

1. _-cept_: receptor molecule 2. _-nib_: kinase inhibitor

Answer 862

Liver cirrhosis + hepatocellular carcinoma

Answer 863

_Valine_ for _glutamic acid_

Answer 864

1. Eczema 2. Thrombocytopenia 3. B-cell/T-cell deficiency

Answer 865

* Inappropriate activation of the complement cascade (due to increased C2 and C4 cleavage) * Also leads to inc. Bradykinin because C1INH blocks its formation

Answer 866

Inhibits release of many other hormones/enzymes (Secretin, CCK, glucagon, insulin, and **g****astrin**)

Answer 867

Both are a-antagonists _Phentolamine_: reversible, competitive (effects can be overcome by dose) _Phenoxybenzamine_: irreversible (effects cannot be overcome by dose)

Answer 868

1. _Biopsy_: rosenthal fibers (eosinophilic, corkscrew fibers) 2. _Gross_: cystic + solid CHILDREN ONLY!

Answer 869

1. Decrease/discontinue drug 2. Give **anticholinergic**

Answer 870

1. Direct binding of cyanide (via hydroxocobalamin) 2. Use of detoxifying sulfur donors (via sodium thiosulfate) 3. Induction of methemoglobinemia (via sodium nitrate) **DUI**

Answer 871

1. Originates from modified smooth muscle cells that control thermoregulatory functions 2. Very tender, small, red-blue lesion under the nail bed

Answer 872

Collagen _fibril_ production

Answer 873

Atropine May increase introcular pressure, precipitating closed-angle glaucoma

Answer 874

Can cause _disulfiram-like_ effects, such as **abdominal cramps, nausea, HA** due to acetaldehyde accumulation

Answer 875

Gluconeogenesis (increases activity of pyruvate carboxylase)

Answer 876

Adenocarcinoma of the gallbladder

Answer 877

Can lead to chronic pulmonary hypertension due to left-to-right intracardiac shunting

Answer 878

Synthesized from _Tryptophan_ Requires vitamins B2 and B6 as cofactors (B6/B2 = B3)

Answer 879

1. Bile salts 2. Phosphatidylcholine

Answer 880

_FSH_: Sertoli to release **Inhibin** (feedsback) _LH_: Leydig to release **Testosterone** (feedsback)

Answer 881

_Conjugate:_ Good for infants; more robust immune response via B and T cell activation _Polysaccaride_: Good for adults; more serotypes covered (23 vs 13)

Answer 882

The _annular ligament_ is torn and displaced

Answer 883

The **medial femoral circumflex** and its branches

Answer 884

Extrinsic restrictive pulmonary function tests are seen **(everything decreases except RV which remains normal)** Less capacity + air gets out faster

Answer 885

1. Vascular malformations mostly in the brain parenchyma 2. Inc. risk of intracerebral hemorrhage and seizure

Answer 886

1. Cholinesterase inhibitor 2. Atropine poisoning (ex. via jimson weed)

Answer 887

1. Autosomal-**dominant** 2. Mutation to NF1 (Ch. 17) 3. Cafe-au-lait spots + multiple neurofibromas + Lisch nodules

Answer 888

**Within the cytoplasm** It then translocates to the nucleus after binding its substrate.

Answer 889

vWF deficiency leads to impaired platelet function (prolonged bleeding time) and coagulation pathway abnormalities because it is a **carrier for _factor VIII_** (prolonged PTT)

Answer 890

**(1-Beta)** A study's ability to detect a difference when one exists

Answer 891

Transpeptidases are an example of a **"penicillin-binding protein",** which penicillins/cephalosporins bind to

Answer 892

Radial nerve + deep brachial artery

Answer 893

1. Hyperpigmentation (bronze diabetes) 2. DM 3. Pigment cirrhosis leading to hepatomegally

Answer 894

1. Painless waxing and waning lymphadenopathy 2. t(14;18) w/ bcl-2 overexpression

Answer 895

Max effect achievable

Answer 896

It is synthesized by _succinyl-CoA synthetase_ during conversion of **succinyl-CoA → succinate**

Answer 897

Constipation

Answer 898

**Hypospadia** | (opening along ventral shaft of penis)

Answer 899

Dec. appetite and insomnia

Answer 900

Acyl-CoA dehydrogenase (catalyzes the first step)

Answer 901

**Clomiphene** (estrogen receptor modulator which decreases negative feedback inhibition on the hypothalamus, thus inc. GnRH)

Answer 902

Prophylactic _azithromycin_ to prevent **Mycobacterium Avium Complex** (MAC)

Answer 903

Rapid stimulation

Answer 904

Superior oblique

Answer 905

HBeAg (a marker of viral replication and increased infectivity)

Answer 906

NF-kB is a _proinflammatory transcription factor_ that increases **cytokine production**

Answer 907

Injury to the _contralateral_ superior gluteal nerve (superomedial quandrant)

Answer 908

Bicarb comes from the submucosal glands of the duodenum (**Brunner glands**) and from the _pancreatic duct secretions_

Answer 909

Simple cuboidal

Answer 910

1. Fallopian 2. Uterus 3. Endocervix

Answer 911

1. Ectocervix 2. Vagina

Answer 912

**Protein M** (Inhibits phagocytosis and complement activation)

Answer 913

Inhibits protein synthesis by inactivating the 30S (small) ribosomal subunit

Answer 914

An accumulation of edema fluid in the intercellular spaces of the epidermis

Answer 915

1. Peripheral vasculature 2. Bronchi 3. **Uterus**

Answer 916

1. LV failure 2. Ruptured aortic aneurysm 3. intracranial hemorrhage (**HTN** **associated complications**)

Answer 917

rRNA | (forms ribosome components)

Answer 918

mRNA, snRNA, microRNA (gene silencing)

Answer 919

1. tRNA 2. 5s rRNA

Answer 920

Ineffective (though useful for prevention of Acute RF)

Answer 921

X-linked recessive

Answer 922

Leads to activation of **_protein kinase C_**, via *direct* **DAG** activation or *indirect* **IP3** induced, Ca2+ (Phospholipase C breaks PIP2 into DAG and IP3)

Answer 923

Silicosis impairs **_macrophage function_** (disrupted by internalized silica particles)

Answer 924

K1 capsular polysaccharide

Answer 925

UAA UAG UGA

Answer 926

ANA and Anti-Jo-1 (Histidyl-tRNA synthetase)

Answer 927

Exophtalmos

Answer 928

OR = ad/bc

Answer 929

Removal of the defective base via _glycosylase_ (the empty spot on the sugar backbone is then cleaved and removed by endonuclease + lyase)

Answer 930

In the lungs, binding of oxygen drives hemoglobin to release H+ (protons) and CO2

Answer 931

1. _Supine_: posterior segment of upper lobes (and superior segment of lower lobes) 2. _Upright_: Base RIGHT SIDE FOR BOTH

Answer 932

_Open_: Prostaglandin E2 (E, k**EE**ps it open) _Closes_: Indomethacin

Answer 933

Anaphylactic shock

Answer 934

1. Autosomal dominant 2. Mutated TP53 3. Family Hx of many CA types (sarcoma, leukemia, breast, adrenal)

Answer 935

Failure of the **urachus** (allantois remnant), _to obliterate_ at birth

Answer 936

1. A folic acid analog that competitively inhibits dihydrofolate reductase (normally converts folic acid to THF). 2. Serves as a chemotherapeutic and anti-psoriasis agent

Answer 937

Contracture (along with myofibroblasts)

Answer 938

**CEREBRAL AMYLOID ANGIOPATHY** (Commonly in the occipital and parietal lobes)

Answer 939

Parkinson dz and Lewy body dementia

Answer 940

1. GI obstruction 2. Anencephaly

Answer 941

Intracellular (ex. steroids, thyroid hormone, fat-soluble)

Answer 942

Recognize _stop codons_ and terminate protein synthesis

Answer 943

Intentional falsification or inducement of sx w/ goal to assume sick role

Answer 944

1. Decoy receptor for TNF-a 2. Tx for extreme RA First must eval for TB

Answer 945

Blocks 11-B-hydroxylase (steroid pathway)

Answer 946

By budding through the plasma membrane of the host cell. (except for herpesviruses)

Answer 947

Vasospasm (prevent with CCB)

Answer 948

Invasive squamous cell carcinoma

Answer 949

Leukocyte Adhesion Deficiency | (They can't cross into tissues)

Answer 950

1. **_S_**eizures 2. **_L_**ight pigmentation 3. **_I_**ntellectual disability 4. "**_M_**usty" odor

Answer 951

Results from the inability to convert **phenylalanine** to **tyrosine** (via the phenylalanine hydroxylase system). Tyrosine becomes an essential AA

Answer 952

1. _Sx_: (1) **Necrolytic migratory erythema** - bronze-colored, central indurated area w/ peripheral blistering/scaling around face, perineum, and extremities (2) **DM** 2. _Dx_: Elevated glucagon levels

Answer 953

Congenital contraction of unilateral SCM, usually due to malposition in utero, or birth trauma.

Answer 954

Intranuclear inclusions in keratinocytes + multinucleated giant cells

Answer 955

High-dose glucocorticoids (ex. prednisone)

Answer 956

*Coccidioides immites*

Answer 957

Dengue + Chikungunya

Answer 958

**Facial** | (leading to ipsillateral facial droop)

Answer 959

Transplacental (in utero)

Answer 960

Point at the nasal septum where the **anterior ethmoidal, sphenopalatine,** and **superior labbial arteries** all meet. (most common location for epistaxis)

Answer 961

**Oxalate** (bowel damage leads to dec. Ca2+ absorption, and thus inc. free Oxlatate excretion in the urine)

Answer 962

Dec. **Free fatty acid oxidation** secondary to excess NADH production by _alcohol dehydrogenase_ and _aldehyde dehydrogenase_

Answer 963

a1-blockers

Answer 964

Lower border of the ribs (subcostal)

Answer 965

**Mitochondrial vacuolization** (loss of ability to further generate ATP)

Answer 966

Ratio of thickness of the mucous gland layer in the bronchial wall, compared to everything in the wall above the level of the cartilage (measures bronchitis progression)

Answer 967

**Methylation** of the aminoglycosidee-binding portion of the 30S ribosome

Answer 968

When the maxillary prominence fails to fuse with the intermaxillary segment

Answer 969

When the palatine shelves fail to fuse w/ one another or w/ the primary palate

Answer 970

Flulike symptoms (And labs show anemia + thrombocytopenia)

Answer 971

Blood smear shows **Intraerythrocytic** _pleimorphic ring forms_ (maltese cross)

Answer 972

Antifungal which inhibits synthesis of the plysaccharide _glucan_, an essential component of the fungal cell wall.

Answer 973

1. At least (2) of the following (5): **delusions**, **hallucinations**, **disorganized speech**, grossly disorganized behavior, and negative sx (at least _one_ of the bolded must be present) 2. \>6 months w/ \>1 month of active sx's

Answer 974

It **binds/inhibits the action of pili** as well as other cell surface antigens that normally mediate _mucosal adherence and subsequent penetration_ by bacteria

Answer 975

IV thiamine supplementation prior to IV dextrose (or else risk precipitating Wernicke encephalopathy)

Answer 976

_Recombination_: **Crossover** between 2 chromosomes from different viruses _Reassortment_: Exchange of entire genome **segments** (segmented viruses only)

Answer 977

Loss of structural proteins in the lens leads to _presbyopia_ (far-sightedness), but also tends to **slightly correct pre-existing myopia**

Answer 978

1. Painful abdomen 2. Port wine-colored urine 3. Polyneuropathy 4. Psych disturbances 5. Precipitated by drugs (CYP450), alcohol, starvation

Answer 979

Glucose + heme (Inhibits ALA synthase, halting build-up of PBG and ALA)

Answer 980

1. **Vascular occlusion** in utero leads to ischemia of segments of bowel, and subsequent narrowing/obliteration 2. Bilious emesis 3. Absence of large portions of the gut, potential winding of gut remnants winding around vascular stalk

Answer 981

Glycoprotein

Answer 982

Increases circulating factor VIII and endothelial secretion of vWF

Answer 983

1. Spastic diplegia 2. Growth delay 3. Abnormal movements

Answer 984

Posterior urethra

Answer 985

Immunosuppressant (binds to FKBP in cytoplasm, inhibiting mTOR thus blocking IL-2)

Answer 986

An **_intracellular nuclear receptor_** that acts as a transcriptiona regulator of many genes involved in glucose and lipid metabolism

Answer 987

1. Fibronectin 2. Collagen 3. Laminin

Answer 988

**Lysosomal enzyme** release from _neutrophils_ and _macrophages_

Answer 989

Erythrocytes | (lack mitchondria)

Answer 990

1. _Diminished relaxation_ of **cricopharyngeal muscles** during swallowing, leading to increased intraluminal pressure in the oropharynx (forming outpouching) 2. Dysphagia + halitosis (food stuck) + regurg + recurrent aspiration

Answer 991

It excarcebates and masks the NE/epi mediated sx of hypoglycemia

Answer 992

Occlusion of hepatic vein

Answer 993

It is either corrected by the aminoacyl-tRNA synthetase proofreader, or that incorrect AA is incorporated into the growing chain.

Answer 994

MDD psych sx which are **only present during the episode of MDD**

Answer 995

It can destroy the myenteric plexi in the esophagus, intestines, and ureters (leading to achalasia, megacolon, and megaureter)

Answer 996

They _constrict it_!! This pushes urine out.

Answer 997

Estrogen inc. the level of _thyroxine-binding globulin_ which leads to a corrective, transient increase in **TSH and T4**

Answer 998

HYPER**_PLASIA_** of the Zona fasiculata and reticularis

Answer 999

Decreases levels of folic acid, thus _increasing risk of NTDs_

Answer 1000

The more soluble a gas, the _slower_ its onset of action (less soluble gases saturate the brain quicker)

Answer 1001

1. _Splenic_ flexure 2. Rectosigmoid colon

Answer 1002

* Acute gastric mucosal defects that develop in response to severe physiological stress * _Sx_: multiple, small gastric erosions/**_ulcers_**, which may **perforate or bleed**

Answer 1003

1. Cerebellar ataxia + dorsal column issues + scoliosis/foot abnormalities + hypertrophic cardiomyopathy 2. AR disorder caused by mutation of the **FXN gene**

Answer 1004

**_Hep A_** (also shows **ballooning degeneration** and _mononuclear_ infiltrates)

Answer 1005

Formed from **granulation tissue** and **fibrosis** (true cysts are lined by epithelium)

Answer 1006

None | (does not cause cell death at all)

Answer 1007

_Effect modification_: When the effect of the main exposure on the outcome is modified by the presence of another variable _Confounding_: It looks similar to effect modification but appropriate stratification reveals there is actually no true difference that exists

Answer 1008

Monocyte-macrophage cell lineage

Answer 1009

_Left_: drains into the **left renal vein** _Right_: drains directly into the **IVC**

Answer 1010

Patient is in the process of planning to make a change in the near future, and mapping out how to do that

Answer 1011

**LOT** **_L_**orazepam **_O_**xazepam **_T_**emazepam

Answer 1012

Xanthine oxidase catalyzes one of the main mechanisms for **azathioprine** metabolism (Any drug blocking XO will thus inc. the level of **Aza**)

Answer 1013

Ultrasound or otherwise nuclear medicine hepatobiliary scanning

Answer 1014

Psoas muscle

Answer 1015

Bone marrow suppression + liver function abnormalities

Answer 1016

1. Caused by repetitive activity, leading to inflammation of the upper costal cartilage at the costochondral or costosternal jxn 2. Pain is **reproducable w/ palpation** and _worsened w/ movement or changes in position_

Answer 1017

It belongs to the HLA-B27 assc., seronagtive spondyloarthropathies (thus there is risk for _sacroiliitis_)

Answer 1018

Virtually every organ (just need mitochondria). But principally in the **BM** (erythrocyte precursor cells) and **hepatocytes**

Answer 1019

The loss of anticoagulant factors in the urine (especially antithrombin III)

Answer 1020

1. Loss of **ADAMTS13** (aka vWF cleaving protease), which is normally responsible for breaking vWF into smaller multimers 2. Inc. large vWF multimers leads to inc. platelet adhesion and subsequent aggregation/thrombosis

Answer 1021

1. Hemolytic anemia (schistocytes, inc. LDH, dec. haptoglobin) 2. Give plasmapherisis + steroids

Answer 1022

**5a-reductase deficiency** (converts testosterone to dihydrotestosterone, which mediates development of the external genitalia in the male fetus)

Answer 1023

First dose hypotension

Answer 1024

Lifelong Hx of mucosal bleeding (gingival, epistaxis, and/or menorrhagia) Platelet levels are normal but they don't fxn well

Answer 1025

For sickle cell patients w/ frequent pain crises **Increases fetal hemoglobin** (mechanism unknown)

Answer 1026

1. Sickle cell 2. Hinder the efflux of potassium and water from the cell, **thus preventing dehydration** of erythrocytes and subsequent polymerization of Hb S

Answer 1027

Ribs 9, 10, and 11

Answer 1028

_Left_: Ribs 11 and 12 _Right_: 12

Answer 1029

Shiga toxin (*E. Coli* O157:H7 or *Shigella* ) induces capillary endotheial damage, resulting in platelet activation and formation of **microthrombi**

Answer 1030

**_H_**emolytic anemia (w/ schistocytes) **_A_**cute kidney injury **_A_**ntecedent diarrheal illness **_T_**hrombocytopenia (HUS- **HAAT**)

Answer 1031

Abrupt onset of lupus sx w/ positive anti-histone antibodies

Answer 1032

Patients w/ expression of slow hepatic acetylators

Answer 1033

Congenital disorder that results from the underdevelopment of the posterior fossa. Causes parts of the cerebellum and medulla to herniate through the foramen magnum.

Answer 1034

Relatively benign and presents in adulthood w/ occipital HA and cerebellar dysfxn (type of Chiari malformation)

Answer 1035

Severe form. Affects neonates and often assc. w/ myelomeningocele and hydrocephalus (Type of Chiari malformation)

Answer 1036

Slow onset and no risk of dependence

Answer 1037

Regularly schedule medical visits w/ focus on fxnal improvement. Avoid unecessary dx testing.

Answer 1038

_Activate_: HGPRT _Deactivate_ Xanthine Oxidase

Answer 1039

MIxed, cellular infilitration w/ occasional multinucleated giant cells

Answer 1040

Painful thyroid enlargement and transient hyperthyroid sx, following a _viral illness_

Answer 1041

46, XX (haploid sperm enters empty egg and duplicates. At least one X required for survival-- hence no 46, YY)

Answer 1042

_Delusional disorder_: \> or = 1 delusion in **absence** of other psychotic sx _Paranoid_: general suspiciousness or distrust of *everyone*, w/o odd fixed belief

Answer 1043

1. Can have sclerosis of renal, **pulm**, CV, and GI systems (due to small vessel deposits) 2. Antibodies: (anti-centromere)

Answer 1044

Prion protein (**PrP**) is normally _a-helical_ in neurons. If converted to _B-pleated sheets_, it becomes resistant to proteases and accumulates in the brain matter creating vacuoles (spongiform encephalopathy) ex. Creutzfeldt-Jakob and Bovine Spongiform

Answer 1045

Sx are often **_episodic_** in nature, coming and going with fluctuations in catecholamine synthesis

Answer 1046

1. _Longitudinal tears_ in the mucosa, usually due to passage of hard stool in patients w/ _chronic constipation_ 2. Usually at the **posterior midline** (low blood flow)

Answer 1047

1. Only major nerve that exits the pelvis via **obturator foramen** 2. Injury via compression 3. _Sx_: weakness in thigh **adduction** + sensory loss over distal medial thigh

Answer 1048

The _gonadal arteries_ originate from the AA

Answer 1049

1. Fever, uterine tenderness, and foul-smelling discharge after a pregnancy 2. *S. aureus* or *E.coli*

Answer 1050

Erythema multiforme

Answer 1051

**Peripheral Edema** + Dizziness/lightheadedness

Answer 1052

1. Bats 2. Killed vaccine

Answer 1053

Agitation + spasms progressing to coma

Answer 1054

Dec. **GABA** in the brain

Answer 1055

1. It is critical for fibroblast migration, proliferation, and connective tissue synthesis 2. Increase is responsible for **hypertrophic/keloid scarring** (as well as _fibrosis_ of the lung, liver and kidney in chronic inflammation)

Answer 1056

In childhood w/ recurrent episodes of acute pancreatitis

Answer 1057

G:C → T:A transversion in codon 249 of the p53 gene (Greatly increases risk for **HEPATOCELLULAR CARCINOMA**)

Answer 1058

An amino group from an AA, is transfered to an a-keto acid, which in turn becomes an AA Catalyzed by vitamin B6 (**pyridoxal phosphate**)

Answer 1059

A **ketogenic diet** (high fat, low carbs) This near-absence of glucose in the diet decreases the amount of pyruvate enerated, thereby decreasing lactate levels

Answer 1060

Lysine and Leucine

Answer 1061

**Stimulant medications!** (inc. NE and Epi to prefrontal cortex)

Answer 1062

1. Atrophy/ thinning of dermis 2. Tightening of skin

Answer 1063

**Axonal reaction** (sets the stage for regeneration) * Swelling * Nuclei displaced to periphery * Nissl substance becomes fine, granular, and dispersed

Answer 1064

Females age 10-30

Answer 1065

* Biphasic cellularity * S-100 positivity (neural crest derived protein)

Answer 1066

**The portal triad** (hepatic artery, portal vein, common bile duct)

Answer 1067

The bladder is _extraperitoneal_

Answer 1068

1. Patient w/ _diabetic ketoacidosis_, presenting w/ facial pain, HA, and **black necrotic eschar** 2. Biopsy needed for dx

Answer 1069

They are oropharyngeal contents (**NOT STOMACH!**)

Answer 1070

t(8;14) (c-Myc to Ig heavy chain)

Answer 1071

Transcription activator

Answer 1072

_Heinz bodies_ (Hb precipitation), which can be "bitten" from the cell forming **bite cells**

Answer 1073

These _zinc-containing enzymes_ (**Metalloproteinases)** degrade ECM, making plaques more unstable

Answer 1074

Immature defense mechanism that involves replacing unacceptable feelings and impulses w/ their extreme opposite.

Answer 1075

1. Benign tumor composed of blood vessels, SM, and fat 2. Assc. w/ **tuberous sclerosis**

Answer 1076

1. Hamartomas in the brain 2. Facial angiofibroma 3. Leaf-shaped patches of skin w/o pigment 4. Seizures/ Cognitive disability

Answer 1077

It crosses the **BBB** and is taken up by **astrocytes**, inc. _glutamine production_. This ultimately leads to inc. intracellular osmolarity, swelling, and impaired glutamine release for conversion to **glutamate**

Answer 1078

Cidofavir and Foscarnet

Answer 1079

1. Peristent pattern of unstable relationships 2. Mood lability (possible suicidal ideation) 3. Impulsivity

Answer 1080

Exaggerated inhibition of **_chondrocyte_** proliferation in the growth plates of long bones, due to _FGFR3_ mutation.

Answer 1081

Ipsilateral

Answer 1082

Falsely concludes there is a stastical difference

Answer 1083

Falsely concludes that there is NO statistical difference

Answer 1084

Selection bias that can be created by selecting hospitalized patients as the control group

Answer 1085

Burkitt lymphoma

Answer 1086

Pelvis/ abdomen (HIV+ or generally immunocomprimsed adults)

Answer 1087

Absence of the **CD40 ligand**, resulting in defective immunoglobulin class switching

Answer 1088

The right and left common iliac veins

Answer 1089

The internal laryngeal nerve, which mediates the afferent limb of the _cough reflex_

Answer 1090

Defective hepatic excretion of **bilirubin glucuronides** across the canaicular membrane, resulting in direct _hyperbilirubinemia_ and _jaundice_

Answer 1091

_Gross_: liver appears black due to impaired excretion of epinephrine metabolites _Histo_: Epi metabolites apprear as dense pigments w/in lysosomes

Answer 1092

The **pyrrolidonyl arylamidase test (PYR)**

Answer 1093

1. _MOA_: Increases cGMP, leading to vasodilation (A \> V) and afterload reduction 2. _Indication_: severe HTN

Answer 1094

A complete _atrioventricular septal defect_

Answer 1095

Adenylate cyclase second messenger system (G_s, cAMP, PKA)

Answer 1096

TSH, glucagon, and PTH receptors

Answer 1097

1. When an individual inherits 2 coies of a chromosome from one parent and none from the other 2. Ex. Prader-WIlli syndrome or Angelman syndrome

Answer 1098

Paternal **meiotic nondisjuntion**

Answer 1099

_95%_: z-score = 1.96 _99%_: z-score= 2.58

Answer 1100

Cholestasis

Answer 1101

**Modafinil** (or other psychostimulants)

Answer 1102

1. Loss of speech and motor skills 2. deceleration of head growth 3. stereotypic hand movements (Usually in girls, following period of normal development) **Rett syndrome** = **REGRESS syndrome**

Answer 1103

*MECP2* gene

Answer 1104

_Histo_: clusters of small, ovoid cells w/ scant cytoplasm and high mitotic count _Immunohisto_: stains positive for neuroendocrine markers, especially **chromagranin**

Answer 1105

**Fixed splitting of S2** (because right side of heart now ALWAYS gets more blood, not just during respiration)

Answer 1106

Metabolic _acidosis_

Answer 1107

It is an IgA-mediated type III HSN Rxn (which is why it often follows an URT infxn)

Answer 1108

It catalyzes conversion of 7-dehydrocholesterol to _cholecalciferol_ (vitamin D3)

Answer 1109

Positive allosteric modulation of GABA_A

Answer 1110

Chorioretinitis

Answer 1111

Leads to a **hemolytic anemia** due to loss of ATP and subsequent loss of cation transport. Spleen must dispose of these parts, leading to red pulp hyperplasia.

Answer 1112

Neuraminidase inhibitor

Answer 1113

Being a heavy smoker

Answer 1114

Segmenting (and medium sized vessels)

Answer 1115

1. **Intestinal**- solid mass that projects into stomach (glandular cuboidal/columnar cells) 2. **Diffuse**- linitis plastica. Infiltrates stomach wall + displays _signet-ring cells_

Answer 1116

*Bacteroides fragilis* and *E. coli*

Answer 1117

Bone marrow suppression

Answer 1118

**p-ANCA/c-ANCA** (will not show up on light micro or IF, unlike IC's or antiglomerular BM antibodies)

Answer 1119

1. Injured via **shoulder trauma** 2. _Presentation_: sensory loss over lateral shoulder + **deltoid** weakness

Answer 1120

Release of sarcoplasmic **_calcium_** following neuromuscular stimulation, causes activation of _phosphorylase kinase_, stimulating glycogen phosphorylase to inc. glycogenolysis

Answer 1121

Prevent degradation of ANP (Neprilysin normally breaks down natriuretic peptides)

Answer 1122

Peripheral neuropathy

Answer 1123

When a payor (often an employer) pays a **fixed, predetermined fee** (to an insurance company, or physician group), to provide all services required by a patient (often employees) (payment structure of HMOs)

Answer 1124

Topoisomerase II

Answer 1125

The removal of RNA primers and replacement w/ DNA

Answer 1126

Malignant infiltration of the **_suspensory ligaments_**, leading to fibrosis, shortening, and thus skin traction.

Answer 1127

Can cause highly lethal _fulminant hepatitis_. Elevated AST and PT

Answer 1128

**Axillary LN dissection which leads to chronic lymphedema.** (angiosarcoma is a misnomer, as it is technically a *lymphangiosarcoma*)

Answer 1129

**Intramuscular** glucagon | (IV dextrose in-hospital)

Answer 1130

Bile concentration (since gallbladder absorbs water), leading to formation of **BILE SLUDGE**

Answer 1131

The degree of _obstruction_ of the **right ventricular outflow tract**

Answer 1132

Depolarizes the bacterial cell membrane

Answer 1133

The anterior comportment of the leg, which contains: 1. Deep peroneal nerve 2. Anterior tibial artery/veins

Answer 1134

1. Suprasellar (rathke's pouch) 2. Calcified Cysts 3. Cholesterol rich fluid w/in cysts 4. Children

Answer 1135

4-5 half-lives

Answer 1136

t (14;18) BCL-2

Answer 1137

Sexual dysfunction

Answer 1138

_Osteblastic_: sclerotic _Osteolytic_: lucent (assc. w/ osteoclasts)

Answer 1139

Extensive _cross-linking_ between elastin monomers, which is facilitated by **lysyl oxidase** (related to lysine)

Answer 1140

1. It is also known as **lateral epicondylitis** (the lateral epicondyle is injured) 2. Attach point for _extensor carpi radialis brevis_ and extensor digitorum (both involved in wrist extension)

Answer 1141

**CRAB** eating a **Roll** of **M** & **M**'s hyper**C**alcemia **R**enal involvement **A**nemia **B**one lytic lesions **Roul**eaux formation **M**onoclonal **M** spike

Answer 1142

_Glu_ has a _negative_ charge and **val** is **neutral**. Changing out the charge for neutral leads to _hydrophobic interactions_ between deoxygentated Hb, causing the sickling shape

Answer 1143

neurosyphilis

Answer 1144

1. Cerebellum 2. Primitive, blue cells (homer-wright rosettes) 3. Children

Answer 1145

Loss of nephrons and secondary HTN (due to all the inflammation)

Answer 1146

Bacterial fermentation of lactose **lowers stool pH**

Answer 1147

1. Type III HSN rxn to non human proteins, resulting in IC deposition 2. Fever, pruritis, skin rash, arthralgia, dec. complement levels

Answer 1148

IBC patients develo early p53 and late APC mutations

Answer 1149

Microvesicular steatosis of hepatocytes (no inflammation or edema)

Answer 1150

Gaucher | (Most common LSD)

Answer 1151

The straight _proximal tubule_ and _thick ascending Loop of Henle_ (higher oxygen demands due to active transport of ions)

Answer 1152

_Indirect_: lateral _Direct_: medial

Answer 1153

**Maternal vaccine** (passive immunity via transplacental IgG)

Answer 1154

small and shallow + large, painful LNs

Answer 1155

single, well-circumbscribed

Answer 1156

**Candida albicans** | (germ tube formation at 37 degrees C)

Answer 1157

Psoriasis med that is a **vitamin D** analog, which binds to the vit D receptor and _inhibits keratinocyte proliferation_

Answer 1158

Any that decrease preload and/or **_systemic vascular resistance_** (you want both to be relatively high)

Answer 1159

Both are in kids 1. Pilo is more common and imaging shows both solid and cystic components 2. Medullo is always solid

Answer 1160

Helps control the balance between gluconeogenesis and glycolysis

Answer 1161

1. Damage/issue with the _mandibular division_ of the **trigeminal nerve** 2. Pain/sx within the middle ear issues and muscles of mastication

Answer 1162

Loss of inhibition of detrusor contraction in the bladder

Answer 1163

Formation of abnormal pyrimidine-pyrimidine covalent bonds (**pyrimidine dimers**) Corrected via nucleotide excision repair

Answer 1164

1. Autosomal dominant dz caused by nucleotide mismatch repair 2. Mutation in MSH2 and MLH1

Answer 1165

Essential for _IL-2_ activation Blocked by the immunosuppressants **cyclosporine** and **tacrolimus**

Answer 1166

Hypoxemia + respiratory alkalosis

Answer 1167

Tyrosine kinase receptor

Answer 1168

Schizotypal

Answer 1169

PAS (+) granules of unsecreted, polymerized AAT in the hepatocytes

Answer 1170

_Local_: T cells _Systemic_: Neutrophils

Answer 1171

Many pro-carcinogens rely on **CYP450 monoxygenase** metabolization to become activated (and thus dangerous)

Answer 1172

1. Antibiotic which alters GI flora to decrease intestinal production and absorption of ammonia 2. **Hepatic Encephalopathy** (too much ammonia due to liver damage)

Answer 1173

Carbamazepine

Answer 1174

**High TGs and low HDL** | (no LDL involvement)

Answer 1175

**_Cytoplasmic_** tyrosine kinase receptor

Answer 1176

_Missence mutation_ leading to **glutamate → lysine**, change

Answer 1177

Vagus branch (auricular branch)

Answer 1178

1. **_h_**ip flexors (**iliopsoas**) 2. **_e_**xternal abdominal oblliques 3. **_r_**ectus abdominus (I got up for **HER**)

Answer 1179

Autosomal dominant

Answer 1180

The **epithelial cells** of the _proximal renal tubules_

Answer 1181

1. Inherited mutation causing factor Va resistance to inactivation by **Protein C** 2. Thrombosis in young person (usually pulmonary)

Answer 1182

Adherence to nasopharynx epithelium

Answer 1183

Pyramidal cells of the neocortex or **Hippocampus (#1!!!)** and _Purkinje cells_ of the cerebellum

Answer 1184

Autosomal recessive

Answer 1185

IgG autoantibodies against **desmosomal proteins** (eg, desmoglein-- connects epithelial cells to epithelial cells)

Answer 1186

IgG antibodies against hemidesmosomes (connect epithelium to BM)

Answer 1187

Most have normal/high _serum_ levels of potassium, despite a total body (i.e. intracellular) deficit. d**K**a = dec. **K+** (you must replace potassium as you manage these patients)

Answer 1188

The presence of genetically "fast" and "slow" acetylators, as INH is metabolized by acetylation. (slow acetylators = inc. risk of AE)

Answer 1189

**Supraspinatus** (Due to impingement between the acromion and the head of the humerus)

Answer 1190

1. Retro-orbital pain 2. Break-bone fever (hemorrhagic) 3. Rash 4. Thrombocytopenia

Answer 1191

_Primary_: often asymptomatic _Secondary_: often much worse (**different serotype**)

Answer 1192

Inactivates 60S ribosomal subunit

Answer 1193

**Bence-Jones proteins** (large eosinophilic casts in tubular lumen)

Answer 1194

It lacks reverse transcriptase

Answer 1195

1. VEGF 2. **Fibroblast growth factor**

Answer 1196

Needed to elicit Th2 response

Answer 1197

It can tx manic episodes assc. w/ bi-polar dz

Answer 1198

Anything htat **decreases the amount of repair** at the ovarian surface which ust take place as a result of lifetime ovulatory frequency (ex. oral contraceptives, multiparity, breastfeeding)

Answer 1199

Secretin (in addition to secreting biochem), _normally_ serves to **decrease gastrin** secretion from G cells. In _ZE_, it paradoxically causes an **increase in gastrin**

Answer 1200

1. Produced by most human cells in response to viral infections 2. Halts viral protein synthesis and promotes apoptosis of infected cels

Answer 1201

1. Chronic pancreatitis can push a clot into the **splenic vein** 2. It would show varices belonging to only the veins of the gastric fundus

Answer 1202

Sodium bicarb

Answer 1203

Cholera toxin

Answer 1204

Pyruvate dehydrogenase and a-ketoglutarate dehydrogenase

Answer 1205

Microfold (M) cells of the Peyer patches

Answer 1206

Neutralizes ROS, preventing cell injury

Answer 1207

Focal "mounding" of muscle (lump formation) following percussion. Assc. w/ **hypothyroid myopathy**

Answer 1208

Give the **lepromin skin test** (similar to a PPD) (+) in patients with tuberculoid leprosy (strong Th1 cell-mediated response to *mycobacterium leprae*) (-) in patients w/ lepromatous leprosy (they have a weak Th1 response and a strong Th2 response to *m. leprae)*

Answer 1209

Orexin (**hypocretin**)

Answer 1210

Inhibits serotonin receptors and is used to treat N/V following chemo

Answer 1211

Severe stenosis of proximal subclavian artery, leading to reversal in blood flow from the contralateral vetebral artery to the ipsilateral vertebral artery

Answer 1212

Small vessel occlusion/lipohyalinosis in the deep brain vessels, usually due to DM or HTN

Answer 1213

Histoplasma capsulatum

Answer 1214

*N. gonorrhoeae*

Answer 1215

**PEROXIDASE!!! (MPO+)**

Answer 1216

**Birefringent** _silica particles_ surrounded by fibrous tissue

Answer 1217

Painless, gross hematuria in an older male (Usually do to smoking or occupation)

Answer 1218

Anti GBM antibodies and anti-alveolar antibodies (Present w/ hemotysis and renal failure)

Answer 1219

Hereditary fructose intolerance

Answer 1220

1. Phosphodiesterase-3 inhibitor 2. Increases cAMP concentration leading to inc. **cardiac contractility** and **vasodilation**

Answer 1221

Chloroquine only kills malaria in the blood stream, but has no effect on the latent hepatic infxns assc. w/ *P vivax* and *P ovale. Primaquine* can eradicate these hypnozoites, preventing relapse.

Answer 1222

SAD PUCKER **S**uprarenal glands **A**orta/IVC **D**uodenum (except 1st part) **P**ancreas (head/body) **U**reters and bladder **C**olon (ascending and descending) **K**idneys **E**sophagus **R**ectum

Answer 1223

The **non-dominant** side

Answer 1224

Hyponatremia (they lose sodium via sweat because it is normally reabsorbed with Cl-)

Answer 1225

_Low_: non-neurological (sedation, anticholinergic, orthostatic hypotension) _High_: extrapyramidal

Answer 1226

_anti-phagocytosis_: polysacharide capsule _toxicity_: outer membrane lipooligosaccharide (LOS), [analogous to LPS of enteric rods]

Answer 1227

Commonly begins w/ the STT, but later stages will also compromise the DCT and/or the CST

Answer 1228

**Membranous nephropathy** | (PLA2R is found in the podocytes)

Answer 1229

Bile acids are normalaly reabsorbed in the terminal ileum, which is often inflamed in Crohn dz. Dec. bile acids = inc. cholesterol precipitation and stone formation.

Answer 1230

Persistence of myelin debris, secretion of neuroinhibitory factors, and development of dense glial scars.

Answer 1231

1. Fever, back pain, inguinal mass, difficulty walking 2. (+) psoas sign-- pain when hip is extended

Answer 1232

1. Subdural hemorrhage 2. Retinal hemorrhage

Answer 1233

Wet, Wobbly, Wacky (urinary incontinence, ataxia, cognitive dysfunction)

Answer 1234

Septic arthritis

Answer 1235

If a patient has _\>1000 mg/dL of TGs_, the [FFA] exceeds the binding capacity of albumin and leads to **direct tissue injury**

Answer 1236

1. **Pyruvate carboxylase**: pyruvate → oxaloacetate 2. **Acetyl-CoA carboxylase**: acetyl-CoA → malonyl-CoA 3. **Propionyl-CoA carboxylase**: propionyl-CoA → methylmalonyl-CoA (Blocked by _Avidin_ found in **egg whites**)

Answer 1237

1. Pronounced atrophy of frontal and temporal lobes 2. **Pick bodies** (cytoplasmic inclusions of microtubule-associated protein tau)-- silver staining

Answer 1238

NF2 | (NF**_2_** = **_bi_**lateral acoustic neuroma)

Answer 1239

Optic neuropathy

Answer 1240

1. Impaired abduction above the horizontal 2. Shoulder drooping

Answer 1241

1. Sudden, painless, monocular blindness 2. "Cherry-red macula" (has its own blood supply) and pale retina

Answer 1242

**Aldosterone escape**: Inc. sodium → inc. GFR → filtration → dec. sodium retention (this prevents volume overload)

Answer 1243

Caudate/Putamen | (indirect path of the motor circuit)

Answer 1244

Ornithine transcarbamylase deficiency (hyperammonemia and elevated urinary orotic acid)

Answer 1245

Originates at the **medial** side of the foot, courses anterior to the medial malleolus and then travels up the medial leg/thigh

Answer 1246

1. Assc. w/ carcinogens such as **arsenic, thorotrast,** and **polyvinyl chloride** 2. Express CD31 (PECAM)

Answer 1247

Advanced malignancy or inflammatory dz/sepsis

Answer 1248

**Plaque like deposits of fibrous tissue** on the right heart endocardium, which may progress to pulmonic stenosis and/or restrictive cardiomyopathy

Answer 1249

To absorb CSF, to remove it from the subarachnoid space. (A malfunction here could cause communicating [normal pressure] hydrocephalus)

Answer 1250

**Persistent lymphedema** (due to chronic dilatation of lymphatic channels)

Answer 1251

To anesthetize the _brachial plexus_ for shoulder/upper arm procedure. (Must be careful because the phrenic is almost always affected)

Answer 1252

**Paraneoplastic Cerebellar Degeneration** (an autoimmune attack of the cerebellum for CA patients)

Answer 1253

Idiopathic paresis of the facial nerve

Answer 1254

It is global cerebral ischemia, due to profound cerebral hypoperfusion. (Shows **triangular watershed infarcts** at locations between the zones of perfusion of the major cerebral arteries)

Answer 1255

Propranolol

Answer 1256

Neurons | (and thus tumors of neuronal origin)

Answer 1257

a**_D_**duction

Answer 1258

Partial opiod agonist w/ low activity but high affinity to mu-receptor-- thus it can precipitate w/drawal

Answer 1259

**Polymyalgia Rheumatica!!**

Answer 1260

**Hypertrophic cardiomyopathy**

Answer 1261

1. **Varenicline** (partial agonist of **_nic_**otinic Ach receptors 2. Bupropion

Answer 1262

This preinvasive lesion is characterized by _growth along intact alveolar septa_, w/o vascular or stromal invasion. Can spread aerogenously and be invasive!

Answer 1263

Deficits in CN's III, IV, V and VI, following an infection

Answer 1264

**Hepatic excretion** in the _bile_

Answer 1265

Breakdown glycerol (from TGs) to eventually create energy/glucose

Answer 1266

1. Vasodilates 2. Inhibits platelet aggreggation 3. Increases vascular permeability (All the opposite of thromboxane A2)

Answer 1267

**Anti-diarrheal** Binds mu-opiod receptor to slow motility of the gut

Answer 1268

_Plasma cells_ in MM are producing lots of protein so they are particlular susceptible to proteosomes. The result is **apoptosis**.

Answer 1269

By decreasing vitamin B6 levels. It is **_NOT_** DIRECTLY TOXIC ITSELF!

Answer 1270

1. Anti-apoptosis 2. Pro-cell proliferation 3. Pro-angiogenesis (All play a role in CA)

Answer 1271

y-glutamyl transpeptidase

Answer 1272

Primary biliary cirrhosis

Answer 1273

The release of tissue factor (thromboplastin) from an injured placenta, into maternal circulation

Answer 1274

Jervell and Lange-Nielsen Syndrome

Answer 1275

The prepyloric area of the gastric antrum (just before the pyloric sphincter)

Answer 1276

_Type 1_: (fundus/body) **A**utoantibodies to **_parietal_** cells → pernicious anemia + achloridia _Type 2_: (antrum) H. pylori **B**acteria → inc. CA risk (MALT or adenocarcinoma) "A" comes before "B"

Answer 1277

**Ulcerative colitis** Abdominal pain/distension, bloody diarrhea, signs of shock. **Abdominal XR** (colonoscopy and barium contrast study are contraindicated due to perforation risk)

Answer 1278

1. _**N**egative_ via binding of the repressor protein to the **O**perator locus 2. _**P**ositively_ via binding by cAMP-CAP binding upstream from the **p**romoter region N-O = NO **_p_**ositive = **_p_**romoter

Answer 1279

Atherosclerosis involving the mesenteric arteries, which leads to bowel hypoperfusion during meals and subsequent pain.

Answer 1280

Atrophy and **fibrous replacement** of the muscularis in the lower esophagus. Leads to the LES becoming atonic and dilated (can result in GERD)

Answer 1281

1. Bacterial invasion + ischemic necrosis of the bowel wall 2. Asc. w/ premature newborns and enteral feeding (tube to stomach)

Answer 1282

Abdominal XR showing air in the bowel wall

Answer 1283

Extramedullary hematopoiesis (oft assc. w/ severe chronic hemolytic anemia, such as B-thalassemia)

Answer 1284

**Citrate** It chelates Ca2+ and Mg, and thus may reduce their plasma levels

Answer 1285

The toxic component of _LPS_ (Causes macrophage activation leading to sx of septic shock)

Answer 1286

Whether or not a viral envelope glycoprotein w/ a high binding affinity for a host cell surface **_glycoprotein_** is present

Answer 1287

**Proliferate continously** | (ie immortalization)

Answer 1288

**Heterophile Antibody Test**

Answer 1289

**MOTILE!!**

Answer 1290

T-ALL has **t****hymic mass**

Answer 1291

1. Seizures 2. Tachyarrhythmias

Answer 1292

Ascertaining the patient's _volume status_ and _urine Cl-_

Answer 1293

**Endometrial hyperplasia/carcinoma** (anovulation leads to progesterone-estrogen misbalance)

Answer 1294

Close the ATP-dependent _K+ channel_ in the pancreatic beta cell membrane, inducing depolarization and thus stimulating insulin release

Answer 1295

_Chemo_: dopamine receptor antagonists, serotonin antagonists, Neurokinin 1 (nK1) receptor antagonists _GI_: antimuscarinics, antihistamines

Answer 1296

Constitutive activation of the epidermal growth factor (EGFR) pathway, promoting increased cell proliferation and growth.

Answer 1297

**Fever, rash, and acute renal failure** following administration of certain drugs (ex. penicillin derivatives). Also see pus (often eosinophils) in the urine

Answer 1298

_Dry_: basic gradual vision loss in one or both eyes _Wet_: Inc. VEGF, in response to Dry AMD

Answer 1299

Fundoscopy showing grayish-green subretinal discoloration w/ adjacent fluid/hemorrhage

Answer 1300

Dysplasia is _reversible_

Answer 1301

Osteoblastic activity

Answer 1302

_Osteoclastic_ activity (**urinary hydroxyproline** is the most reliable)

Answer 1303

_PCP_ is an NMDA receptor **antagonist**

Answer 1304

Residual ribosomal RNA

Answer 1305

_light_: enlarged, hypercellular glomeruli _IF_: "lumpy-bumpy" granular deposits of **IgG** and **C3** _EM_: electron dense deposits on the epithelial side of the BM (camel hump)

Answer 1306

They bring AP into the interior of the muscle fibers

Answer 1307

Endothelial disruption, necrosis and subsequent hemorrhage

Answer 1308

Neurotoxicity

Answer 1309

They increase, due to a decreased filtered load

Answer 1310

Occult blood

Answer 1311

**WARFARIN** (so tx w/ FFP)

Answer 1312

Antifungal which inhibits squalene epoxidase

Answer 1313

N-f-THF (folinic acid, leucovorin) supplementation

Answer 1314

_Benign_ autosomal recessive disorder which causes some dietary fructose load to be secreted in the urine unchanged (due to defective fructokinase metabolism)

Answer 1315

(+) copper reduction test (-) urine dipstick

Answer 1316

Hypokalemia (can cause arrhythmia)

Answer 1317

Gottron papules (pictured) and heliotrope rash (rash on eyelids)

Answer 1318

_Recurrent_, self-limited, **painless hematuria** w/in 5 days after a _URI_

Answer 1319

**LAME** Listeria, MRSA, Enterococci, Atypicals

Answer 1320

When the placenta adheres to the myometrium as opposed to the endometrium (can cause severe postpartum hemmorhage)