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

Question 1

IV Benzodiazepines

1. Main one
2. Indication
3. MOA

Answer 1

1. Lorazepam
2. Intitial drug of choice for status epilepticus
3. They work by enhancing the effect of GABA at GABA -A receptor, leading to increased chloride influx and suppression of AP firing

Question 2

What is Vernet syndrome?

Answer 2

It is when you have lesions of the jugular foramen, thus leading to CN Ix, X, and XI dysfunction

Question 3

What are lamellar bodies?

Answer 3

They are organelles which contain parallel stacks of membrane lamellae and are a component of type II pneumocytes. They function to store and release pulmonary surfactant.

Question 4

Normal Vitamin E function

Answer 4

Protection of fatty acids against oxidation

Question 5

What is responsible for swelling in myocardial cells during ischemia?

Answer 5

Ion pump failure due to ATP loss, leading to increased intracellular Na+ and Ca2+

Question 6

Between (Na+, K+, Cl-, and Ca2+):

Which are mostly located intracellularly? Extracellularly?

Answer 6

Intracellular: K+

Extracellular: Na+, Cl-, Ca2+

Question 7

What path does fetal blood take from the placenta to the heart?

Answer 7

Umbilical vein - liver - ductus venosus - IVC - heart

Question 8

What type of Bacteria are capable of surviving boiling?

Answer 8

Spore forming

Question 9

What are Hamartomas? How do they present? What are they composed of?

Answer 9

The most common benign lung tumor

Present as asymptomatic peripherally located “coin lesion” in patients 50-60 y/o

Composed of disorganized cartilage, fibrous and adipose tissue

Question 10

What is responsible for the clinical variability of mitochondrial diseases?

Answer 10

HETEROPLASMY

The mixture of (2) types of genetic material

Question 11

Lidocaine

1. What class drug?
2. MOA?
3. Effect?

Answer 11

1. IB antiarrhythmic
2. Binds (mostly) to inactivated sodium channels and rapidly dissociates
3. Effective in suppressing v.tach induced by rapidly depolarizing and ischemic myocardium.

Question 12

Primase

How is it related to uracil showing up in partially replicated DNA strands?

Answer 12

A DNA-dependent RNA polymerase that incorporates short RNA primers into replicating DNA

Because it is composed of RNA, this primer could have uracil in it

Question 13

Lung mass + hyponatremia, is suggestive of what?

Answer 13

SIADH (secondary to Small cell lung carcinoma)

Question 14

Pertussis (Whooping cough)

1. Who gets it?
2. Describe the (3) phases
3. What causes it?

Answer 14

1. Was mostly in kids prior to vaccinations. Now usually adolescents/adults w/o a booster
2. (phases)
   
   • Catarrhal stage- similar to many routine URI’s
   • Paroxysmal stage- severe coughing spells w/ classic whoop (post-tussive emesis)
   • Convalescent stage- during which cough improves
3. Caused by gram-negative Bordetella pertussis.

Question 15

Thiazide diuretics

1. Indication
2. MOA
3. Effect on serum Ca2+

Answer 15

1. Primary HTN
2. Inhibit the Na+/Cl- cotransporter in the distal tubule, leading to inc. excretion of Na+ and H2O (as well as K+ and H+ ions)
3. Increases distal tubular Ca2+ reabsorption, causing both hypercalcemia and hypocalciruria

Question 16

What effect does left ventricular HF have on lung compliance?

Answer 16

Leads to fluid accumulation in the lung interstium resulting in decreased lung compliance.

Question 17

What artery is responsible for supplying the occipital lobe?

Answer 17

Posterior Cerebral Artery

Question 18

Linkage disequilibrium

Answer 18

When a pair of alleles are inherited together in the same gamete (haplotype) more or less often than would be expected given random chance

Question 19

Which components of the skin drain to the superficial inguinal lymph nodes?

Answer 19

All skin from the umbilicus down, including the anus (below the pectinate line), excluding the testes, glans penis, and posterior calf

Question 20

Name the muscles/areas that the musculocutaneous nerve innervates/provides sensory innervation to (3)

Answer 20

1. Movement to Major forearm flexors
2. Movement Corcobrachialis
3. Sensory to lateral forearm

Question 21

Theophylline

1. Indication
2. MOA
3. Metabolization
4. AE

Answer 21

1. Used as an alternate therapy for asthma and COPD
2. Adenosine receptor antagonist and phosphodiesterase inhibitor that causes bronchodilation by increasing cAMP levels and has mild anti-inflammatory effects
3. Metabolized predominantly by hepatic cytochrome oxidase
4. AE: Theophylline toxicity

Question 22

After invading the nasopharnyx, how does N. meningitidis gain access to the brain?

Answer 22

Bloodstream followed by choroid plexus

Question 23

Between positive/ negative predicative values, and sensitivity/ specificty, which are dependent on disease prevalence in the tested population?

Answer 23

Positive/ negative predictive values

Question 24

Name the Glycogen Storage Diseases

Answer 24

Very Poor Carbohydrate Metabolism

1. Von Gierke Disease
2. Pompe Disease
3. Cori Disease
4. McArdle Disease

Question 25

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

Answer 25

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

Question 26

Beta Blocker MOA

Answer 26

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

Question 27

What is the common clinical presentation for a pneumothorax?

What is often the cause of spontaneous pneumothorax?

Answer 27

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

Question 28

Describe the specific effect of the superantigens assc. with TSS

Answer 28

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)

Question 29

Effect of ACE-I on GFR

Answer 29

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

Question 30

Following focal ischemia in an MI, how long until there is a loss of cardiomyocyte contractility?

Answer 30

Loss of focal contractility occurs within 60secs!

Question 31

Polyarteritis nodosa

1. Pathology
2. What organ is normally spared?
3. Presentation
4. Potential consequences

Answer 31

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

Question 32

Presentation/ potential complications of femoral hernias

Answer 32

They can present with groin discomfort or manifest with a bulge on the upper thigh.

Incarceration and strangulation are common complications of femoral hernias.

Question 33

Describe the essential differences in excitation-contraction coupling in cardiac vs skeletal muscle

Answer 33

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)

Question 34

What is Trousseau sign? What does it indicate?

Answer 34

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

Question 35

The proximal ureter receives its blood supply from what artery? The distal ureter?

Answer 35

Proximal: renal artery

Distal: superior vesical artery

Question 36

Consequences of chronic gout

Answer 36

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

Question 37

Role of muscarinic agonists, in glaucoma tx

Answer 37

Increase trabecular outflow of aqueous humor

Question 38

What drugs are/can be given with L-DOPA to reduce their peripheral metabolism?

Answer 38

Carbidopa- a DOPA decarboxylase inhibitor

Entacapone- a COMT inhibitor

These both increase levadopa bioavailability to the brain

Question 39

What are the cutaneous neurofibromas assc. with NF1, derived from? What is its embryological derivation?

Answer 39

They are comprised mostly of Schwann cells, which are embryologically derived from the neural crest

Question 40

Describe the main roles for IL-1 through IL-6 when secreted by macrophages

Answer 40

Hot T-Bone stEAK

IL-1: fever (hot)

IL-2: stimulates T cells

IL-3: stimulates bone marrow

IL-4: stimulates IgE production

IL-5: stimulates IgA production

IL-6: stimulates aKute-phase protein production

Question 41

Fibrate medications

1. Function
2. MOA
3. AE

Answer 41

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

Question 42

Order the class one subcategories based on sodium-channel-binding strength (as measured by use dependence)

Answer 42

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

Question 43

What receptors on the juxtaglomerular cells are responsible for stimulating renin release? What drugs take advantage of this fact, to decrease BP?

Answer 43

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

Question 44

Nitroprusside

1. MOA
2. Effect
3. Indication

Answer 44

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

Question 45

How can severe chronic rheumatoid arthritis lead to spinal cord injury?

Answer 45

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

Question 46

Osgood-Schlatter Dz

1. Presentation
2. Etiology

Answer 46

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

Question 47

Describe the Sx of Digoxin Toxicity

(what ion is often elevated?)

Answer 47

• 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)

Question 48

1. What is the cofactor of phenylalanine hydroxylase?
2. What would be the presentation for a deficiency in either of these enzymes?

Answer 48

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

Question 49

Maturity-onset Diabetes of the Young

1. Presentation
2. What is the main pathogenesis? Describe in detail
3. Potential Consequences

Answer 49

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

Question 50

What are the (3) tx for C.diff and in what situation would you use each?

Answer 50

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)

Question 51

Intraventricular Hemorrhage

1. Most frequent occurance is in what population?
2. Pathology?
3. Presentation?

Answer 51

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.

Question 52

In Kallmann syndrome, there is an absence of GnRH secretory neurons in the _____________

Answer 52

hypothalamus

Question 53

What is the affect of occluson of the anterior cerebral artery?

Answer 53

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

Question 54

Presentation of Meckel diverticulum

Answer 54

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.

Question 55

Treacher-Collins syndrome

1. Path?
2. What is the effect?

Answer 55

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

Question 56

What is the role of transketolase and transaldolase? What cells can use them and for what purpose?

Answer 56

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.

Question 57

Path of mitochondrial myopathy

What does muscle biopsy show?

Answer 57

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

Question 58

What is the composition of fetal hemoglobin?

Answer 58

a2y2 (alpha 2, gamma 2)

Question 59

Chloramphenicol AE

Answer 59

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

Question 60

Th1 vs Th2

What do they secrete? What do they recruit/activate? How are they activated? How are they inhibited?

Answer 60

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)

Question 61

What percentage of vessel must be blocked to qualify as stable angina?

Answer 61

> or equal to 75%

Question 62

What tumor type(s) is the following tumor marker assc. with?:

HCG

Answer 62

• Choriocarcinoma
• Germ cell tumors

Question 63

How can malignant, nonseminomatous germ cell testicular tumors cause hyperthyroidism?

Answer 63

They secrete very high levels of hCG, which can bind the TSH receptor (leading to paraneoplastic hyperthyroidism)

Question 64

Ataxia-telangiectasia

1. Inheritance
2. Path
3. Sx/Presentation (4)

Answer 64

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

Question 65

What does the candidal antigen test assess?

Answer 65

The activity of T cell-mediated immunity via recruitment of macrophages, and CD4+ and CD8+ T lymphocytes

Question 66

What is the best non-surgical tx for cholesterol gallstones?

Answer 66

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

Question 67

What enzyme is responsible for the conversion of NE to Epi? What upregulates this enzyme?

Answer 67

Phenylethanolamine-N-methyltransferase (PNMT)

It is upregulated by cortisol

Question 68

What tumor type(s) is the following tumor marker assc. with?:

CA 19-9

Answer 68

Pancreatic

Question 69

Diabetic Mononeuropathy

1. Usually involves which CN?
2. Pathology
3. Sx (3)

Answer 69

1. CN III is most commonly involved
2. Caused predominantly by central ischemia
3. Sx: ptosis, “down and out” gaze, normal light/accomodation reflexes

Question 70

Buproprion

1. Indication?
2. What key side-effect does it NOT have?
3. Contraindications/ Adverse Effects?

Answer 70

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

Question 71

Describe the Chloride Shift

Answer 71

• 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

Question 72

Which cells found in the lungs, contain elastase? How do they keep it controlled?

Answer 72

Macrophages (control w/ Tissue Inhibitos of Metalloproteinases- TIMPs)

and

Neutrophils (control w/ serum a1 antitrypsin)

Question 73

Bisphonates have a chemical structure similar to _____________

Answer 73

Pyrophosphate

Question 74

Paroxysmal Supraventricular Tachycardia

1. Presentation
2. Tx
3. Potential SEs of tx (4)

Answer 74

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

Question 75

What is the indication for drugs which act on H1 receptors vs H2 receptors

Answer 75

H1 = allergies

H2 = acid (GERD, ZE, etc.)

Both are histamine receptors

Question 76

Tx of Giant cell (temporal) arteritis

Answer 76

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

Question 77

What are the (4) stages associated with Lobar Pneumonia? Describe the exudate.

Answer 77

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

Question 78

What is the presentation for Hemolytic Uremic Syndrome? (3) What is the etiology?

Answer 78

1. Microangiopathic hemolytic anemia
2. Thrombocytopenia
3. Renal insufficiency

Result of 0157:H7 E.coli, usually in undercooked ground beef

Question 79

Describe the pathogenesis of Polymyositus

Answer 79

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

Question 80

What molecule does insulin promote activation of, in order to increase glycogen synthesis?

Answer 80

Protein phosphatase, via the PI3K pathway

Question 81

The KRAS gene is a member of what gene subfamily?

Answer 81

Ras

Question 82

1. Tetrahydrobiopterin (BH4), serves as cofactor for which enzymes?
2. What enzyme is responsible for forming BH4?
3. What effect would a deficiency in BH4 have?

Answer 82

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)

Question 83

Describe Pompe Disease

1. Deficient enzyme?
2. Pathology
3. Presentation

Answer 83

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.

Question 84

What (2) drugs are selective vasodilators of coronary vessels? How can they affect the heart negatively during ischemic events?

Answer 84

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.

Question 85

Describe the hemodynamic profile of aortic regurg (3 key differences from normal)

Answer 85

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

Question 86

What are the only cells within atherosclerotic plaque which are capable of synthesizing collagen isoforms and ECM?

Answer 86

Vascular Smooth Muscle Cells (VSMCs)

Question 87

The valgus stress test indicates injury where?

Answer 87

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

Question 88

What is the most common location for acoustic schwannomas?

Answer 88

Cerebellopontine angle

Question 89

Transudate vs exudate

Answer 89

Transudate- plasma only. Due to hemodynamic changes

Exudate- plasma + ions. Due to structural damage

Question 90

Permissiveness

Answer 90

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)

Question 91

What is the clearence mechanism for inhaled particles which are…

1. 10-15 um?
2. 2.5-10 um?
3. less than 2um?

Answer 91

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

Question 92

Nocardiosis (Nocarda asteroides infection)

1. Key micro characteristics
2. Epidemiology (where is it, how does it get to people and who does it affect?)
3. Clinical features (3)
4. Tx

Answer 92

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

Question 93

What is an appendage, in the context of the heart?

Answer 93

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

Question 94

Presentation of Left-sided Colon CA

Answer 94

1. Constipation
2. Sx of Intestinal Obstruction

(Left sided colon CA tends to infiltrate the intestinal wall and encircle the lumen)

Question 95

1. Most common cause of homocystinuria
2. What is the result of this defect?
3. How might this present clinically?

Answer 95

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

Question 96

Sensitivity vs Specificity

Answer 96

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)

Question 97

Role of prostaglandin agonists in glaucoma

Answer 97

Increase uveoscleral outflow of aqueous humor

PREFERED TX FOR OPEN ANGLE GLAUCOMA

Question 98

Name the microscopic and macroscopic changes associated with Ischemic Brain Injury, during the following times after injury:

• 12-24 hours
• 24-72 hours
• 3-7 days
• 1-2 weeks
• >2 weeks

Answer 98

Question 99

Clopidogrel

1. MOA
2. Indication

Answer 99

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.

Question 100

Formula for half life

Answer 100

Vd x .7/CL

Question 101

Diazepam

1. Indications (4)
2. SEs (1 most common)
3. Contraindications

Answer 101

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)

Question 102

Phenoxybenzamine

1. MOA
2. Indication
3. Effect

Answer 102

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

Question 103

Polymyositus

Presentation

Answer 103

Symmetrical proximal muscle weakness

Question 104

What is the relationship between CO2 and cerebral perfusion?

Answer 104

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.

Question 105

Niacin (nicotinic acid)

1. Indication
2. Adverse Effects
3. What is the mechanism for the adverse effects and how can they be prevented?

Answer 105

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.

Question 106

Kawasaki Disease

1. What type of disease is this?
2. Presentation
3. Potential consequence
4. Tx

Answer 106

1. Medium-vessel vasculitis
2. CRASH and burn
   
   • Conjuctival injection, Rash, Adenopathy, Strawberry tongue, Hand/foot changes (edema and erythema) and fever
3. Risk of coronary artery aneurysm
4. Tx w/ IV and aspirin

Question 107

Primary Myelofibrosis

1. Presentation
2. Mutation

Answer 107

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)

Question 108

Paradoxical Embolism

1. Pathology
2. Dx

Answer 108

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

Question 109

Inheritance of CF

Answer 109

Autosomal recessive

Question 110

What is the negative predictive value and how do we calculate it?

Answer 110

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

Question 111

Following cleavage of pro-insulin, what is the fate of insulin and C-peptide?

Answer 111

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

Question 112

ASD

1. What is the usual pathology?
2. What other cardiac condition is often also present?
3. Dx
4. Potential consequence
5. What genetic disease is also associated?

Answer 112

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

Question 113

What is the role of NAD+ in glycolysis? How is NAD+ regenerated after reduction to NADH?

Answer 113

NAD+ is needed to convert G3P to 1,3-BPG

NADH then transfers electrons to pyruvate to form lactate and regenerate NAD+

Question 114

Flattening of deltoid muscle + acromial prominence, suggests what type of injury?

Answer 114

Anterior humerous dislocation (most common type of shoulder dislocation)

Question 115

What are the (3) options for Pyruvate metabolism and how do they occur?

Answer 115

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

Question 116

Mycobacterium Avium Complex

1. What is it?
2. Risk factors?
3. Normal presentation?
4. How do you differentiate MAC from disseminated TB?

Answer 116

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

Question 117

How does hypothermia lead to a left shift of the O2-dissociation curve?

Answer 117

Decreased temps help stabilize the bonds between O2 and hemoglobin

Question 118

Formula for Loading dose

Answer 118

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

Question 119

What is the most common CFTR mutation associated w/ CF?

Answer 119

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

Question 120

What key interleukin/cytokines are responsible for converting a helper T-cell into a Th1 cell? Th2 cell? Th17 cell?

Answer 120

Helper T to…

Th1 (via IL-12)

Th2 (via IL-4)

Th17 (via TGF-B and IL-6)

Question 121

Embryologically, the dorsal pancreatic bud forms what?

The ventral pancreatic bud?

Answer 121

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

Question 122

What effect do Ach and adenosine have on cardiac pacemaker cells?

Answer 122

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

Question 123

Chronic lung transplant rejection

1. Pathology/ histopathology
2. Presentation
3. Dx

Answer 123

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

Question 124

Cutaneous, strawberry-type capillary hemangiomas

1. Pathology
2. Prognosis

Answer 124

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

Question 125

Enteropeptidase

1. What secretes it?
2. What does it do?
3. What does its deficiency lead to?

Answer 125

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

Question 126

What are the main causes of pulsus paradoxus. Name one option for tx

Answer 126

Pericardial dz, asthma and COPD

Beta-adrenergic agonisists are useful for the asthma/COPD etiologies

Question 127

In an MI, when does loss of cardiomyocyte contractility occur?

Answer 127

Within the first 60 secs (1 minute) after the onset of total ischemia.

Question 128

Tx of acute gout vs chronic gout

Answer 128

acute: NSAIDs (1st line), glucocorticoids, or colchicine (GI issues due to inhibition of microtubule formation)

chronic: Xanthine oxidase inhibitors

Question 129

Clostridium tetani blocks the release of what?

Answer 129

The inhibitors Glycine and GABA

Question 130

Prevention of Tumor Lysis Syndrome

Answer 130

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

Question 131

Tension Pneumothorax

1. Pathology?
2. Clinical presentation?
3. Dx?
4. Tx?

Answer 131

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

Question 132

Describe Cori Dz

1. Deficient enzyme
2. Which other GSD is it similar to?

Answer 132

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

Question 133

Neurofibromatosis Type 1 (NF-1)

1. Sx (4)
2. Inheritance
3. What type of cells are the main compent of cutaneous neurofibromas?

Answer 133

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

Question 134

How is carotid sinus massage useful for termination of paroxysmal SVT?

Answer 134

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

Question 135

What specifc joints are most commonly fused in Ankylosing Spondylitis?

What are potential complications of AS? (3 systems)

Answer 135

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.)

Question 136

What type of RNA can be infective, what type cannot, and why?

Answer 136

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.

Question 137

How does the effect of Rheumatic Heart Disease on the mitral valve vary as the patient’s age changes?

Answer 137

First few decades of life: MR

Middle-aged: MS (most common cause of MS)

Elders: Mixed mitral disease (S and R)

Question 138

(Leukocyte Accumulation:) What receptors are involved in:

1. Rolling?
2. Tight Adhesion/Crawling?
3. Transmigration?

Answer 138

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

Question 139

When given with a Statin, what drug is most likely to lead to myopathy or even rhabdomyolosis? Why?

Answer 139

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

Question 140

X-linked agammaglobulinemia

Pathogenesis?

Diagnostics?

Presentation?

Answer 140

• 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

Question 141

Allergic bronchopulmonary aspergillosis (ABPA)

1. History commonly associated (2)?
2. Chest imaging?
3. Dx?

Answer 141

1. Asthma and CF
2. Recurrent infiltrates and Bronchiectasis
3. Eosinophilia; Positive skin test and Ig for Aspergillus; Elevated IgE

Question 142

Key presentation for cyanide poisoning

Answer 142

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

Question 143

What are the key associations with Multiple Myeloma? (7)

Answer 143

CRAB (hyperCalcemia, Renal involvement, Anemia, Bone lytic lesions/Back Pain)

+

Primary amyloidosis, Rouleaux formation, and numerous plasma cells w/in bone marrow sample

Question 144

Familial Hypocalciuric Hypercalcemia (FHH)

What is it?

Describe the associated receptor?

Answer 144

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

Question 145

Most common site of injury during a traumatic aortic rupture

Answer 145

Aortic isthmus

Question 146

Describe the pathogenesis of Sarcoidosis

Answer 146

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.

Question 147

Name the (4) nerves/ vessels which enter the orbit via the superior orbital fissure

Answer 147

OSATO

1. Oculomotor nerve
2. Superior Ophthalamic vein
3. Abducens nerve
4. Trochlear nerve
5. Opthalmic nerve (CN V1) branches

Question 148

Right Ventricular MI

1. Presentation
2. Pathology
3. What does the hemodynamic assessment reveal? (CVP? Wedge pressure? CO?)

Answer 148

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.

Question 149

What is the most common CV manifestation associated with SLE?

Answer 149

Pericarditis

Question 150

Hypoglycemia with an elevated insulin and low C-peptide level, suggests what?

High C-peptide level?

Answer 150

Low: exogenous insulin injection

High: insulin secretagogue or insulin-secreting tumor

Question 151

When amniocentesis is performed to check phospholipids, what are we really checking for?

Answer 151

Fetal lung maturity

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

Question 152

Structural cardiac changes due to aging are generally not prominent before the age of…

Answer 152

65y/o

Question 153

Describe the relationship between Bile acid-binding resins and Statins

Answer 153

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.

Question 154

What is the effect of G6PD deficiency?

What other enzyme deficiency might paint a similar picture?

Answer 154

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

Question 155

What are the structural differences between MHC Class I and Class II?

Answer 155

MHC Class I: Heavy chain and B2-microglobulin

MHC Class II: Alpha and beta polypeptide chains

Question 156

What is the most common congenital heart lesion?

1. Dx/ Presentation?
2. Effect on blood oxygenation
3. Prognosis?

Answer 156

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

Question 157

New-onset odynophagia in the setting of chronic GERD usually indicates what?

Dx?

Answer 157

Erosive esophagitis and the formation of an ulcer

Dx via upper endoscopy

Question 158

Jervell and Lange-Nielsen Syndrome

1. Pathology
2. Clinical presentation
3. Mode of inheritance
4. What other disease is this similar to?

Answer 158

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

Question 159

Dihydropyridine CCBs (Anti-hypertensives)

1. Main examples
2. Indications
3. SEs

Answer 159

1. Amlodipine and Nifedipine
2. Effective for monotherapy or in combination with other agents for Tx of HTN
3. Peripheral Edema and Dizziness/ Lightheadedness

Question 160

Trousseau syndrome

Answer 160

Migratory superficial thrombophlebitis assc. with visceral CA

Question 161

What is pancreas divisum?

Answer 161

Failure of the dorsal and ventral pancreatic buds to fuse

Question 162

Interstitial lung disease has what effect on lung volumes? Lung elastic recoil?

How does this affect expiratory flow rates?

Answer 162

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.

Question 163

What is the role of Small nuclear RNA (snRNA)?

What is the name of autoantibodies which work against the function of snRNA and what dz are they associated with?

Answer 163

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.

Question 164

Type I Hypersensitivity

Explain the mechanism. What mediates these reactions?

Answer 164

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.

Question 165

Which ligament is most commonly involved in a lateral ankle sprain?

Answer 165

Anterior talofibular ligament

Question 166

Main potential AE of neonatal oxygen therapy?

Answer 166

Retinal damage

Question 167

Name the potential sequelae of Obstructive Sleep Apnea (3)

Answer 167

Systemic and Pulmonary HTN, and right heart failure

Question 168

What type of gating does the CFTR channel have?

Answer 168

ATP-gated

Question 169

Cauda Equina Syndrome

Presentation?

Specific areas damaged?

Answer 169

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

Question 170

Cystic Medial Degeneration

1. Characteristics
2. What does it predispose you for?
3. Who is it common in?

Answer 170

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

Question 171

Walking pneumonia

1. What bug causes it?
2. Dx?
3. What type of medium is required for this bug to grow?
4. Sx?

Answer 171

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

Question 172

Risks of secondhand smoke exposure (7)

Answer 172

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

Question 173

Ankylosing Spondylitis

1. What is it?
2. Presentation

Answer 173

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)

Question 174

Adenocarcinoma In-situ (of the lung)

1. Pathology
2. Microscopy
3. Presentation
4. Imaging

Answer 174

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

Question 175

What is the most common condition predisposing a patient to infective endocarditis in…

1. Adults in wealthier nations?
2. Poorer nations/ children?

Answer 175

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

Question 176

Ramelteon

1. MOA
2. Indications
3. SEs

Answer 176

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

Question 177

In what conditions do we see Cheyne-Stokes breathing? (2)

Answer 177

1. CHF
2. Neurologic disease

Question 178

How do OC treat hirsutism?

Answer 178

They suppress pituitary LH secretion and subsequently decrease ovarian androgen production

Question 179

Neural Tube Defects

1. Pathophysiology
2. Presentation
3. Dx

Answer 179

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

Question 180

Idiopathic Pulmonary Artery Hypertension

Pathogenesis/pathophys?

Presentation?

Treatment?

Answer 180

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

Question 181

Formula for Maintenance dose

Answer 181

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

Question 182

What is the main difference in effect between unfractioned heparin and LMWH?

Answer 182

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.

Question 183

PPO vs HMO vs POS (Point of Service)

1. Compare the monthly premiums
2. Compare copayments and deductibles
3. Is a PCP referral required for specialist visits?
4. Size of network
5. May go outside network?

Answer 183

Question 184

Statins

1. Indication
2. MOA
3. Side effects
4. What sort of things can help lead to adverse effects from Statins

Answer 184

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)

Question 185

Abetalipoproteinemia

1. What is it?
2. Consequence?
3. Describe the histo

Answer 185

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

Question 186

What is the effect of excercise on LV EDP?

On systemic vascular resistance?

Answer 186

LV EDP is increased due to the increased return

Systemic vascular resistance decreases due to large levels of vasodilation in muscles

Question 187

Isoproterenol

1. MOA
2. Effect

Answer 187

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

Question 188

Isoproterenol

(MOA)

Answer 188

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

Question 189

What are the (3) main dopaminergic systems? What are their functions? What diseases are they associated with?

Answer 189

Question 190

Presentation of Right-Sided Colon CA

Answer 190

1. Occult bleeding
2. Sx of iron deficient anemia

Question 191

Myasthenia Gravis

1. Sx
2. Disease associated with
3. Pathogenesis
4. Tensilin test result
5. Nerve stimulation studies

Answer 191

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

Question 192

Length constant

Answer 192

A measure of how far along an axon an electrical impulse can propagate

This is increased by myelination

Question 193

Name the (2) classes of dopamine agonists (and examples).

What dz are they most often used for?

Answer 193

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

Question 194

Histoplasma Capsulatum

1. What is it/where is it found?
2. How is it transmitted?
3. Pathology?
4. Presentation?
5. Dx?

Answer 194

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.

Question 195

What type of drug is ipratropium and what type of bronchoconstriction is affected by it?

Answer 195

It is an antimuscarinic agent

Only reverses vagally-mediated bronchoconstriction

Question 196

Varicocele

1. Pathophysiology?
2. Presentation?

Answer 196

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

Question 197

Bile acid-binding resins

1. Give one major example
2. MOA

Answer 197

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

Question 198

At the FRC, the airway pressure is? alveolar pressure is? Intrapleural pressure is?

Answer 198

Airway pressure = 0

Alveolar pressure = 0

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

Question 199

1. A subset of patients stricken by influenze got on to develop secondary…
2. What types of patients are these?
3. What are the most common causes for this secondary disease state?

Answer 199

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

Question 200

Maple Syrup Urine Disease (MSUD)

1. Pathology
2. Presentation
3. Treatment
   4.

Answer 200

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

Question 201

Hartnup Dz

1. Path
2. Sx
3. Possible Consequences
4. Tx

Answer 201

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

Question 202

Tricuspid Valve Endocarditis

1. Most common bug associated?
2. Usual patient population?
3. Potential complications?

Answer 202

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.

Question 203

What are the key effects of uncontrolled gestational diabetes on the fetus?

Answer 203

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!)

Question 204

When is anovulation most common?

Answer 204

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

Question 205

Blastomyces dermatitidis

1. Endemic to where?
2. Characterisitics?
3. Presentation?

Answer 205

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.

Question 206

What is the main side effect which limits the long-term efficacy of arteriolar vasodilators. Give (2) main examples of these drugs

Answer 206

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

Question 207

What are the afferent and efferent limbs leading to/away the carotid bodies?

Answer 207

Afferent: Glossopharyngeal nerve

Efferent: Vagus nerve

Question 208

Tetralogy of Fallot Pathophysiology and clinical presentation

Answer 208

VOIR:

1. VSD
2. Overiding aorta
3. Infundibular pulmonary stenosis
4. RVH

Presentation: Cyanosis; Improvement w/ squatting (increases SVR)

Question 209

What types of procedures are associated with enterococcus endocarditis?

Answer 209

Genitourinary instrumentation or catheterization

Question 210

Injury to the lower trunk of the brachial plexus

1. What mechanism of injury which causes this?
2. Consequence of this injury?

Answer 210

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.

Question 211

Blood flow is directly proportional to the vessel radius raised to what power?

Answer 211

The 4th power

Question 212

Pulmonary Embolism

1. Presentation
2. Lab data (blood gases?acidosis or alkalosis?
3. Other diagnostic tests

Answer 212

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

Question 213

Name the (5) regions of the secondary structure of tRNA

Answer 213

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)

Question 214

Describe the functions of each of the (3) domains of G protein-coupled receptors.

Describe composition of the transmembrane domain in detail.

Answer 214

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.

Question 215

What dz is associated with incorrect assembly of snRNPs? What is the specific mutation associated?

Answer 215

Spinal Muscular Atrophy (delayed motor development + flaccid paralysis)

SMN1 gene

Question 216

Thin (actin) filaments of the I band are bound to structural proteins, where? Thick (myosin) filaments?

Answer 216

Thin: Z-line

Thick: M-line

Question 217

What is the most superficial layer in which you can appreciate an absence of ganglion cells in Hirschsprung dz?

Answer 217

The submucosa of the narrowed area

Question 218

The anterior cerebral arteries supply which portions of the brain? (2)

What is the affect that occlusion can have?

Answer 218

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

Question 219

Name the a-ketoglutarate dehydrogenase co-enzymes which may be defective in Maple Syrup Urine Dz (MSUD)

Answer 219

Tender Loving Care For Nancy

Thiamine pyrophosphate

Lipoate

Coenzyme A

FAD

NAD

Question 220

Why is raloxifene usually a better choice than tamoxifen for tx of osteoporosis in women?

Answer 220

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

Question 221

What is the most common location on the aorta for a traumatic aortic rupture (blunt aortic injury)?

Answer 221

The aortic isthmus (located just past the aortic arch)

Question 222

Niemann-Pick Dz

1. What type of dz is this?
2. Deficient enzyme
3. Inheritance
4. Presentation

Answer 222

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

Question 223

Hormone Sensitive Lipase (HSL)

1. Where is it found?
2. What is its function?

Answer 223

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

Question 224

McArdle dz

1. Deficient enzyme
2. Path
3. Presentation

Answer 224

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.

Question 225

Kartagener Syndrome

1. Pathology
2. Presentation (3)

Answer 225

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

Question 226

Describe the work that activated Ras does.

Answer 226

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

Question 227

SE profile for ACE-Inhibitors (2)

Answer 227

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

Question 228

Legionella pneumophila

1. Description of bug
2. Symptoms
3. Dx info
4. Pathogenesis
5. Tx

Answer 228

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

Question 229

Length constant

(How is it affected by myelination?)

Answer 229

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

Question 230

Name the genes involved in each of the (3) steps of the “adenoma-to-carcinoma sequence”

Answer 230

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)

Question 231

What is rT3 and what is it created from?

Answer 231

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

Question 232

Pure Red Cell Aplasia

1. What is it?
2. What dz’s is it associated with?

Answer 232

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

Question 233

Vitamin E deficiency

1. Who does it occur in?
2. What is defiency in this vitamin associated with?
3. Clinical manifestations

Answer 233

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

Question 234

Why might patients with signficant renal dysfunction demonstrate prolonged bleeding time?

Answer 234

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

Question 235

Other than the small joints of the hand, what other joints/bones are often affected by RA?

Answer 235

The cervical spine

Question 236

Function of the Posterior Cruciate Ligament

How is its integrity tested?

Answer 236

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

Question 237

Pulmonary Fibrosis

1. Microscopic view
2. Clinical presentation
3. Dx
4. What disease can help cause it?

Answer 237

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)

Question 238

Why do patients with Antiphospholipid antibody syndrome often get false positive syphillus exams?

Answer 238

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

Question 239

Almost 100% of cases of Hypertrophic Cardiomyopathy result from mutations in genes encoding what?

Answer 239

Beta-myosin heavy chain

(A cardiac sarcomere protein)

Question 240

Why do you normally do cardiac catherization via the femoral artery, below the inguinal ligament and not above?

Answer 240

There is signficant risk for a retroperitoneal hemorrhage if you do it above the inguinal

Question 241

Acute bacterial parotitis

1. Occurs most commonly in who?
2. Bacteria most commonly involved?
3. Dx

Answer 241

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)

Question 242

Elastase from what cells, are inhibited by alpha-1 antitripsin?

Answer 242

Neutrophils

Question 243

Which cell types, when metabolizing a single glucose molecule, will always ueild pyruvate but sometimes generate NO net ATP?

(Explain this mechanism)

Answer 243

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.

Question 244

Sx of trapezius weakness vs deltoid weakness

Answer 244

Trapezius- drooping of shoulder, impaired abduction above horizontal, winging of the scapula

Deltoid- impaired abduction at angles below the horizontal plane

Question 245

Finasteride MOA and indication

Answer 245

MOA: 5-alpha-reductase inhibitor that suppresses conversion of testosterone to DHT

Ind: BPH, Androgenetic alopecia

Question 246

When is an aortic stenosis murmur at its loudest?

Answer 246

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)

Question 247

1. Propionyl CoA is derived from what?
2. What enzyme is responsible for its conversion to methylmalonyl CoA?
3. What would deficiency of this enzyme lead to?

Answer 247

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

Question 248

What are the (2) key functions of type II pneumocytes?

Answer 248

1. Regeneration of the alveolar lining
2. Surfactant production

Question 249

Tabes Dorsalis

1. Epidemiology?
2. Pathogenesis?
3. Clinical findings?

Answer 249

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

Question 250

Which ventricle forms the apex of the heart?

Answer 250

The left ventricle

(All other chambers lie medial to the midclavicular line)

Question 251

Pancoast tumors and Horner’s syndrome

Answer 251

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

Question 252

How do PPIs affect osteoporosis?

Answer 252

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

Question 253

T-test versus analysis of variance (ANOVA)

Answer 253

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.

Question 254

What rxns does Thyroid peroxidase catalyze? (3)

Answer 254

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

Question 255

Which blood vessel carries blood with the lowest content of oxygen in the body and why?

Answer 255

Coronary sinus

Myocardial oxygen extraction is very high and has a high demand

Question 256

What are the effects of occlusion of the MCA?

Answer 256

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)

Question 257

What is the cause of Myotonic Dystrophy?

Answer 257

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

Question 258

Why does listening to heart sounds at end expiration make them more audible?

Answer 258

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

Question 259

Fenoldopam

1. MOA
2. Indication
3. Effects (3)

Answer 259

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

Question 260

Superior Vena Cava Syndrome

1. Pathogenesis?
2. Presentation?

Answer 260

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

Question 261

Inapparopriate activation of what enzyme, leads to pancreatitis?

Answer 261

Trypsinogen (to trypsin)

Question 262

17a-hydroxylase def.

Presentation?

Answer 262

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

Question 263

Why is it that calcium channel blockers affect smooth and cardiac muscle, but not skeletal?

Answer 263

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.

Question 264

Lesions on the medial foot cause, what type of lymphadenopathy?

On the lateral foot?

Answer 264

Medial: Inguinal lympadenopathy

Lateral: popliteal and inguinal lymphadenopathy

Question 265

Causes of oral thrush (3 main)

Answer 265

1. Candida albicans
2. Albuterol inhaler
3. HIV

Question 266

Coronary Sinus

1. What does it serve as?
2. Under what condition might it be dilated?

Answer 266

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.

Question 267

What is usually the most key component of the pathogenesis of AAAs?

Answer 267

Transmural aortic wall inflammation

Question 268

What are the effects of nitrate? (3 general categories of effects)

Side Effects?

Answer 268

• 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

Question 269

Aspergillus fumigatus

1. Describe its structure
2. How do people get it?
3. Describe associated disease processes

Answer 269

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

Question 270

“Red ragged” muscle fibers on Gomori trichome are seen in what kinds of disease…?

Answer 270

Mitochondrial diseases

The mitochondria accumulate under sarcolemma

Question 271

Of all major vascular beds, which (2) are most susceptible to athersclerosis?

Answer 271

1. Lower abdominal aorta
2. Coronary arteries

Question 272

Aortic Regurgitation

1. Presentation
2. Describe how the pulses may feel
3. Describe the murmur and the best way to hear it
4. What is the state of the pulse pressure?

Answer 272

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

Question 273

How does sepsis lead to ARDS? Describe step by step.

Answer 273

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.

Question 274

What is the marker for hematopoietic stem cells?

Answer 274

CD34+

Question 275

Function of the suprachiasmatic nucleus (of the hypothalamus)

Answer 275

Circadian rhythm regulation and pineal gland function

Question 276

Blockage of what vein causes symptoms similar to those in SVC syndrome, except only on one side of the body? What are those symptoms?

Answer 276

Blocking of the Brachiocephalic vein

Shows one sided face-swelling, arm swelling and engorgement of subcutaneous veins .

Question 277

What types of tissues are comonly found in a Meckel diverticulum? Which is most common?

The presence of these tissues is an example of what?

Answer 277

Gastric (most common), pancreatic, colonic, endometrial, small bowell, etc.

This is an example of ectopy

Question 278

MOA of class 3 antiarrhytmic agents

Answer 278

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

Question 279

Describe Von Gierke Dz

1. Deficient enzyme
2. Presentation
3. Tx

Answer 279

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

Question 280

What is NE extravasation and what is the treatment?

Answer 280

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)

Question 281

Major SEs of Corticosteroids

Answer 281

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

Question 282

Fibrates

1. MOA
2. Effect
3. Compare this to fish oil

Answer 282

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

Question 283

If a patient with HIV has rin-enhancing lesions, and treated for toxoplasmosis is negative, what dz should you suspect?

What cell typically compose this dz?

Answer 283

Suspect Primary Central Nervous System Lymphom__a

It is typically composed of B-lymphocytes, and is associated with EBV.

Question 284

G protein-couple receptors

1. What do they bind?
2. What are the domains which make them up? (3)

Answer 284

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

Question 285

1. Name the anthracycline chemotherapeutic agents.
2. What is their most severe side effect
3. How does it present?
4. How is this SE prevented?

Answer 285

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

Question 286

X-linked (Bruton) agammaglobulinemia

1. Caused by what?
2. Effect on germinal center formation
3. Presentation?

Answer 286

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

Question 287

Narcolepsy

1. Pathology
2. Presentation
3. Tx

Answer 287

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

Question 288

Retinal Artery Occlusion

Presentation?

Pathogenesis?

What is the path most likely taken to occlude the artery?

Answer 288

Presentation: Acute, painless, monocular vision loss

Pathogenesis: Thromboembolic complications of athersclerosis in the internal carotid.

Path: Internal carotid –> Ophthalmic artery –> retinal artery

Question 289

Other than trauma, what is one major cause for cardiac tamponade?

Answer 289

Viral pericarditis w/ signficant pericardial fluid accumulation

(following a respiratory infection)

Question 290

Sarcoidosis

Pathophys?

Presentation?

Dx?

Treatment?

Answer 290

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

Question 291

Myocardial hibernation

Answer 291

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

Question 292

What does Prussian blue stain detect?

Answer 292

Intracellular iron

Question 293

Antiarrhythmic drugs

Drugs + Predominant actions

Class IA, IB, IC

Answer 293

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”

Question 294

What illnesses can result in cold agglutinins (3)

Answer 294

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

Question 295

What role does NFK-B play in osteoclast differentiation?

Answer 295

RANK-L is the receptor for activated NFK-B

Question 296

What is the most effective preventative intervention in almost all patients?

Answer 296

Smoking cessation

Question 297

Describe the structure of the mealtime insulin analogs

Answer 297

AA substitution at the C terminal end of the B chain

Question 298

Name the A’s of small cell (oat cell) carcinoma

Answer 298

1. May produce ACTH
2. SIADH
3. Antibodies against presynaptic Ca2+ channels (Lambert-Eaton)
4. Amplification of myc oncogenes

Question 299

What receptors is epinephrine capable of affecting?

Answer 299

a1, B1, and B2

Question 300

Where does the gastroduodenal artery sit? How can it be affected by ulceration?

Answer 300

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.

Question 301

Xanthomas are found where? What are they associated with?

Answer 301

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

Question 302

Hairy Cell Leukemia

1. What type of neoplasm?
2. Presentation?

Answer 302

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

Question 303

Diphteria

1. Epidemiology
2. Micro/pathology
3. Clinical Sx (4)
4. Complications (3)

Answer 303

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

Question 304

Paroxysmal nocurnal hemoglobinuria is result of an acquired mutation in what gene? What inhibitor proteins is absent and/or deficient as a result?

Answer 304

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.

Question 305

What is the difference in the response generated by inactivated vs live-attenuated viral vaccines?

Answer 305

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

Question 306

What is the MOA for ANP and BNP? How is this similar to sildenafil?

Answer 306

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.

Question 307

Role of the musculocutaneous nerve (2)

Answer 307

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

Question 308

Complications of Paget dz (2)

Answer 308

1. High Output cardiac failure
2. Osteosarcoma

Question 309

Thiazide diuretics

1. MOA
2. Effects
3. AEs

Answer 309

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

Question 310

What is the (4) step route that N. meningitidis uses to cause meningitis?

Answer 310

Pharynx –> blood –> choroid plexus –> meninges

Question 311

Lesch-Nyhan Syndrome

1. Inheritance
2. Specific defect
3. What are the results of this defect?

Answer 311

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

Question 312

Tay-Sachs Dz

1. Inheritance
2. Enzyme that is deficient
3. What accumulates?
4. Presentation

Answer 312

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)

Question 313

How does eithanol block gluconeogenesis?

Answer 313

Ethanol metabolism reduces NAD+ to NADH and increases the NADH/NAD+ ratio.

This inhibits all other pathways requiring NAD+, including reactions required for gluconeogenesis.

Question 314

What bones meet at the pterion? What vessel lies underneath it?

Answer 314

Frontal, parietal, temporal, and sphenoid bones

Middle meningeal artery (branch of the maxillary artery)

Question 315

Most severe AE of the anthracyclines (rubicins)

Answer 315

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

Question 316

Subthalamic nucleus

1. What pathology can cause damage to this structure?
2. What is the consequence of this damage?

Answer 316

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

Question 317

What is ARDS?

1. Pathology?
2. Presentation?
3. Histo?
4. What main diseases/issues can lead to ARDS?

Answer 317

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

Question 318

What (3) types of drugs disrupt the peptidoglycan cell wall of gram-positive/ gram-negative organisms?

Answer 318

1. Penicillans
2. Cephalosporins
3. Vancomycin

Question 319

For neonates infected with Hep B, what is their…

1. level of HBV replication?
2. level of liver enzymes?
3. risk of chronic infection?

Answer 319

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

Question 320

Metabolism of 1g of protein or carbohydrate, produces ______ Calories of energy.

Metabolism of 1g of fat produces _____ Calories of energy.

Answer 320

P/C: 4 C

F: 9 C

Question 321

Naltrexone

1. MOA
2. Indication

Answer 321

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

Question 322

Main Side Effect difference between ACE-I’s and ARBs

Answer 322

ACE-I’s raise the level of Bradykinin causing non-productive cough.

ARBs do not.

The two drugs are very similar otherwise

Question 323

Myotonic dystrophy presentation (5)

Answer 323

Sustained muscle contraction (can’t release doorknob) + weakness/atrophy

(often also see cataracts, frontal balding and gonadal atrophy)

Question 324

What is moa of mineralocorticoid receptor antagonists? What diseases are they good for and who should they not be used for?

Give (2) examples

Answer 324

(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

Question 325

Kussmaul sign

Answer 325

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

Question 326

Name the key characteristics of which distinguish Slicosis from other forms of pneumoconiosis (2)

How can silicosis impair immune function?

Answer 326

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

Question 327

Where are dietary lipids digested? Where are they absorbed?

Answer 327

1. Digestion: in the duodenum via pancreatic enzymes
2. Absorbed: in the jejunum in the form of water-soluble micelles

Question 328

What are the (2) main effects of nitrates?

Answer 328

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

Question 329

What is the neurological effect of vitamin B12 deficiency?

Answer 329

Subacute combined degeneration!!!

demyelination of dorsal columns, lateral CST, and spinocerebellar tracts, leading to: ataxic gait, paresthesia, and impaired position/vibration sense

Question 330

Why is N-myc capable of being detected by DNA probes?

Answer 330

It is a transcription factor and thus is capable of binding DNA.

Question 331

Describe Type IV Hypersensitivity

How are antibodies involved?

What are the (4) T’s of this hypersensitivity?

Answer 331

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)

Question 332

What is the relationship between Cystic Fibrosis, ADEK, and squamous metaplasia?

Answer 332

• 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

Question 333

What tumor type(s) is the following tumor marker assc. with?:

Alpha fetoprotein

Answer 333

• Hepatocellular carcinoma
• Germ cell tumors

Question 334

Conversion disorder

Answer 334

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

Question 335

At what point in the respiratory cycle is the total pulmonary vascular resistance at its lowest?

Answer 335

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

Question 336

Frontal Lobe Syndromes

1. Cause
2. Clinical manifestation
3. Left sided vs Right sided
4. Dx

Answer 336

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

Question 337

What effect might fibrinolytics have on heart rhythm?

Answer 337

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

Question 338

AV Shunts

1. What affect do they have on preload/afterload?
2. What might the physical exam reveal?

Answer 338

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.

Question 339

Stimulation of the vagus nerve would have what effect on the lungs?

Answer 339

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

Question 340

Ulcers in which of these locations are NOT associated with an increased risk of carcinoma in that location?

• Duodenum
• Esophagus
• Stomach
• Colon/Rectum

Answer 340

Of these, only Duodenal ulcers are not associated with an inc. risk of CA

Question 341

What organelle serves as the primary site of ribosome synthesis and assembl?

Answer 341

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

Question 342

CREST Syndrome

1. What is this disease a subset of?
2. Pathology?
3. What are the sx?

Answer 342

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

Question 343

Ortner syndrome

Answer 343

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

Question 344

Wilson Dz

1. Sx (3)
2. Dx

Answer 344

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

Question 345

1. Acid-fast stans ID organisms that have ______ ______ (2) in their cell walls.
2. How do acid fast stains specifically work?

Answer 345

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

Question 346

What are the two ways in which Beta-blokers ameliorate the sx of thyrotoxicosis?

Answer 346

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

Question 347

What type of injury does Carbon tetrachloride (CCL4) cause, and how?

Answer 347

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

Question 348

PaO2

Answer 348

A measurement of the partial pressure of oxygen dissolved in the plasma only! (not in the RBCs)

Question 349

Lesch-Nyhan Syndrome

1. Inheritance?
2. Presentation?
3. Pathology?
4. The [] of what enzyme increases as a result?

Answer 349

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 increased PRPP activity

Question 350

Hepcidin

1. What is it/ what does it do?
2. When is it released?

Answer 350

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

Question 351

Subarachnoid Hemorrhage (SAH)

1. Presentation
2. Pathology and associated diseases (3)
3. Dx

Answer 351

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)

Question 352

What is the main dz Primary Biliary Cirrhosis (PBC) is associated with?

Answer 352

Sjrogren’s syndrome (and other autoimmune disorders)

Question 353

What are the normal adult pressures in the cardiac chambers, the pulmonary artery and the aorta (minimum and maximum)

Answer 353

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

Question 354

What is responsible for the green discolortion of pus or sputum during bacterial infections?

Answer 354

Myeloperoxidase (MPO) from neutrophil azurophilic granules. MPO is a heme-containing pigmented molecule.

Question 355

What type of polyps are most likely to undergo malignant transformation?

Answer 355

Villous adenomas

Question 356

What type of epithelium makes up the true vocal cords?

Answer 356

Stratified squamous

Question 357

Prostacyclin vs Thromboxane A2

Compare their effects

Answer 357

Prostacyclin: vasodilates, inhibiting platelet aggregation and increasing vascular permeability

Thromboxane A2: prostaglandin which enhances platelet aggregation and causes vasoconstriction

Question 358

McCune-Albright Syndrome

Name the triad of clinical features

Answer 358

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

Question 359

What is responsible for the clinical variability of mitochondrial dz?

Answer 359

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.

Question 360

What key structures form from the third pharyngeal pouch?

Answer 360

Thymus and inferior parathyroid glands

Question 361

The venous component of internal hemorrhoids drain where?

External hemorrhoids?

Answer 361

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

Question 362

Describe the echocardiogram assc. with Transposition of the Great Arteries (TGA)

Answer 362

Aorta lying anterior to the pulmonary artery

Question 363

Where is ADH synthesized? Is this the same location, or a different location from where it is stored?

Answer 363

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

Question 364

1. Pernicious anemia (Vit B12 def.) is caused by autoimmune destruction of what cells?
2. What do these cells secrete and where are they located?

Answer 364

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

Question 365

Deletions or additions of a number of base pairs which are not a multiple of three, indicate that a ___________ mutation has occured.

Answer 365

Frameshift

Question 366

What prompt eosinophils to release their cytoplasmic granules to kill a parasite?

Answer 366

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

Question 367

If a pneumonia patient has a CD4+ count greater than 400cells/uL, what bug do you expect to be the cause?

Answer 367

>400?: strep pneumo

pneumo jiroveci (PCP)

Question 368

What effect does expgenous steroid abuse have on hematocrit?

Answer 368

Increases hematocrit

Question 369

Meckel diverticulum

1. What is it/ How common is it?
2. What causes it?

Answer 369

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

Question 370

For an otherwise health child, what is the most common cause of osteomyelitis?

Answer 370

Staph aureus

Question 371

How is the pathogenesis of Non-bacterial thrombotic endocarditis (NBTE) related to that of Trousseau’s?

Answer 371

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

Question 372

Location of femoral hernias

Answer 372

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

Question 373

Coordinate each artery with the leads associated with them

1. LAD
2. LCX
3. RCA

Answer 373

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

Question 374

Aschoff bodies

What are they and with what dz process are they found?

What is another name for the cellular component?

Answer 374

They are interstitial myocardial granulomas, found in myocarditis due to acute rheumatic fever

The macrophages are aka as caterpillar cells

Question 375

Phosphorylation of what residues (and via what?), leads to insulin resistance?

Answer 375

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

Question 376

Prinzmetal’s (variant) Angina

1. Pathology?
2. When does it occur?
3. Dx?
4. Tx?
5. What drug can make it worse?

Answer 376

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

Question 377

Aortic stenosis

1. Common murmur
2. Sx
3. Main causes

Answer 377

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

Question 378

Adult type Aortic Coarctation

1. Key triad
2. View on imaging

Answer 378

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

Question 379

What drug group is responsible for most of the overdoses in the country?

Answer 379

Opioids

Question 380

Chronic Granulomatous Disease

1. Pathogenesis?
2. Presentation?

Answer 380

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

Question 381

Coccidioides immitis

1. Describe the (2) forms
2. Where is it endemic to?
3. How is it transmitted?
4. How does it present (5)

Answer 381

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

Question 382

Colonic Diverticula

1. Involve what part of the colon?
2. What process leads to their development?

Answer 382

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

Question 383

What is the MOA and Indication for both Cromolyn and Nedocromil? How effective are they compared to drugs with a similar indication?

Answer 383

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.

Question 384

Primary Carnitine Deficiency

1. What is the effect at the level of the cell?
2. Presentation

Answer 384

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

Question 385

Describe the process of Infective Endocarditis (4)

Answer 385

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

Question 386

Aortic Dissection

1. Most important risk factor
2. What specific layer tears?
3. What genetic issue predisposes for aortic dissection?

Answer 386

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

Question 387

What is the most abundant AA in collagen?

Answer 387

Glycine (occupies every thrid AA position)

Question 388

Osler-Weber-Rendu Syndrome

1. What is the other name?
2. Genetics
3. Clinical Presentation
4. Possible consequences

Answer 388

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

Question 389

What is the effect of low hepcidin levels?

Answer 389

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

Question 390

Lambort-Eaton syndrome

1. Sx
2. Disease associated with
3. Pathogenesis
4. Tensilin test result
5. Nerve stimulation studies

Answer 390

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

Question 391

How is Campylobacter infection spread?

Answer 391

Via domestic animals or from contaminated food

Question 392

Tumor lysis syndrome

1. When can it develop?
2. What characterizes it?

Answer 392

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)

Question 393

What is the most common cause of bacterial meningitis in adults of all ages?

Answer 393

Strep Pneumo

Question 394

Serotonin syndrome

1. How do we get this syndrome?
2. Sx (3)
3. What is the antidote?
4. What is the precursor to serotonin?

Answer 394

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

Question 395

Dopamine: What is the effect of…

1. Low doses?
2. Medium doses?
3. Very high doses?

Answer 395

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

Question 396

First generation anti-histamines

1. Name them
2. In addition to blocking histamine receptors, what other affects?
3. How can the eye be affected?

Answer 396

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

Question 397

Vitamin A toxicity

1. Acute affects (3)
2. Chronic affects (5)
3. Teratogenic affects (3)

Answer 397

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

Question 398

MOA of B-Blockers

Answer 398

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

Question 399

What are the (5) general dz types associated with clubbing?

Answer 399

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

Question 400

Main phase “0” difference between regular cardiac cell and a pacemaker cell

Answer 400

Regular cardiac cell: 0 = Na+ rush

Pacemaker: 0 = Ca2+ rush

Question 401

Vascular and Immunologic Manifestations of Infective Endocarditis

(3) Vascular
(2) Immunological

Answer 401

Vascular:

1. Systemic emboli
2. Mycotic aneurysm
3. Janewy lesions (nontender- palms/soles)

Immunologic:

1. Osler nodes (Painful- toes/fingertips)
2. Roth spots

Question 402

Viral Laryngotracheitis

1. Also known as?
2. Presentation?
3. Most common virus responsible?

Answer 402

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

Question 403

Elevated prolactin levels (from a prolactinoma), directly suppress what?

Answer 403

GnRH

Question 404

Capsaicin causes depletion of what neurotransmitter? What does this lead to?

Answer 404

Substance P

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

Question 405

Omalizumab MOA/ indication

Answer 405

Anti-IgE antibody

Add-on therapy for patients with severe allergic asthma

Question 406

What are the (2) major effects of Clostridium perfingens?

Answer 406

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

Question 407

Which blood vessels does the third part of the duodenum interact with?

Answer 407

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.

Question 408

What are the (4) major causes of hypoxemia? Which has a normal A-a gradient?

Answer 408

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

Question 409

What kind of drug are theophylline and aminophylline? What is their MOA?

Answer 409

They are Methylxanthines

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

Question 410

Compare cardiac tissue conduction velocity between the:

AV node, purkinje system, ventricular muscle, and atrial system

Answer 410

_P_ark _At_ _Vent_ure _Av_enue

Fastest- Purkinje system, Atrial system, Ventricular system, AV node- slowest

Question 411

Wilson Disease

1. Inheritance
2. Path

Answer 411

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

Question 412

Hyperacute rejection vs acute rejection vs chronic rejection

(particularly in the lung)

Time-frame? What part of the lung is affected?

Answer 412

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

Question 413

Which cell types have B1 receptors?

Answer 413

Cardiac tissue and renal juxtaglomerular cells

Question 414

Name the main organisms that can cause diarrhea with only a small inoculum (4)

Answer 414

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

Question 415

Gallstone ileus

1. What is it?
2. Presentation
3. Dx

Answer 415

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

Question 416

Mechanisms of bacterial transfer: Transformation vs Conjugation vs Transduction

Answer 416

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

Question 417

Name the pentad for Thrombotic thrombocytopenic purpura

Answer 417

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

Question 418

What is the most common genetic cause for:

Hypertrophic cardiomyopathy?

Dilated cardiomyopathy?

Answer 418

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

Question 419

Migraine

1. Sx
2. Abortive therapy (1)
3. Prophylactic therapy (3)

Answer 419

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

Question 420

How is tolerance to nitrates avoided?

Answer 420

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

Question 421

Fat Embolism

1. Presentation?
2. Staining?

Answer 421

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

Question 422

The 22q11.2 microdeletion associated with DiGeorge, causes what embryological component(s) not to develop?

Answer 422

3rd and 4th branchial pouches

Question 423

What cranial nerves and what aortic arch derivatives are associated with each pharyngeal/aortic arch (1-6)

Answer 423

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

Question 424

In patients with mitral regurg, what is the most reliable ausculatory finding to assess severity

Answer 424

The presence of a left-sided S3 gallop. This indicates high regurgitant volume and left ventricular volume overload

Question 425

Isotretinoin

Indication and Contraindication

Answer 425

Indication: Used to tx severe acne w/ significant scarring

Contraindication: Pregnancy, due to high risk of teratogenicity

Question 426

Describe the biopsy specimen associated giant cell arteritis. What other dz is this identical to?

Answer 426

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

Question 427

Describe the process of staphylococcal food poisoning

Answer 427

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

Question 428

Describe the mechanism with which Sarcoidosis can lead to hypercalcemia

Answer 428

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

Question 429

1. Who should be vaccinated against Strep Pneumo?
2. What are the (2) main vaccines?

Answer 429

1. Elderly/ young children are most at risk
2. Both affect the outer polysaccharide covering:
   
   • Pneumococcal polysacharide vaccine
   • Pneumococcal conjugate vaccine

Question 430

What type of drug is useful for nausea assc. with GI insults?

For nausea assc. with migraine?

Answer 430

GI: 5-HT3 receptor antagonists

Migraine: Dopamine antagonists

Question 431

What disease are caused by “exotoxin” release by S. aureus?

Answer 431

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

Question 432

What is the role of protein A in staph aureus?

Answer 432

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.

Question 433

Ehlers-Danlos syndrome

1. What is it?
2. Usual cause?
3. Presentation

Answer 433

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

Question 434

What is the indication for an ace-inhibitor? For a thiazide?

Answer 434

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

Question 435

What cell type composes the wall of the cyst in the years after a stroke?

Answer 435

Astrocytic processes (glial scar)

Question 436

Selective IgA Deficiency

1. Pathology
2. Presentation
3. What are these patients at risk for?

Answer 436

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

Question 437

What does the smooth ER contain? What type of cells contain lots of smooth ER?

Answer 437

(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.

Question 438

Mesothelioma

What is it?

Risk factor(s)?

Presentation?

Dx factors? (3)

Answer 438

• 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.

Question 439

Dystrophic vs Metastatic calcification

What conditions do they each occur in?

Answer 439

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

Question 440

Klebsiella

Encapsulated or not?

Lactose-fermenting or not?

Usual presentation/ patients affected/characteristics?

Answer 440

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

Question 441

How can Isoniazid lead to sideroblastic anemia? Describe the process in detail (3 main steps)

Answer 441

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.

Question 442

What drugs do you give to reverse heparin effects? Warfarin effects?

Answer 442

Heparin: protamine sulfate

Warfarin: Vitamin K and Fresh Frozen Plasma (FFP)

Question 443

Describe the pathogenesis of centriacinar emphysema

Answer 443

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

Question 444

What sort of procedure is associated with enterococcal endocarditis

Answer 444

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

Question 445

Antiarrhythmic drugs

1. Drugs + Predominant actions
2. Potential SEs

Class IV

Answer 445

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)

Question 446

Hexokinase vs Glucokinase

1. Location
2. Affinity vs Capacity?
3. Induced by insulin?
4. Mutation assc. with Maturity-onset diabetes of the young?

Answer 446

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

Question 447

What components are needed to do PCR? (4)

Answer 447

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

Question 448

Ghon Complex and TB reactivation (who is it in and what characterizes it?)

Answer 448

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.

Question 449

What sometimes occurs between days 2-4 following a transmural MI? Why?

Answer 449

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

Question 450

Define Preventable Adverse Effect

Answer 450

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)

Question 451

What is the usual clinical presentation for Hyper-IgM syndrome? (2)

Answer 451

1. Lymphoid hyperplasia
2. Recurrent sinopulmonary infections

Question 452

Patient presents due to lightheadedness/ passing out while buttoning a tight shirt collar.

1. Most likely dz process
2. What nerve is most assc. with this dz process?

Answer 452

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

Question 453

McCune-Albright Syndrome

Pathogenesis

Answer 453

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

Question 454

Digoxin MOA

Answer 454

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.

Question 455

Huntington disease

1. Describe the genetic/cellular level cause of this disease.
2. How are histones involved?

Answer 455

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 deacetylation, is thought to be one of the main mechanisms in which this mutation causes disease

Question 456

What is the most common viral cause for aplastic crisis for sickle cell patients?

Answer 456

Parvovirus B19

Question 457

Tetrodotoxin

1. Where does it come from?
2. What effect does it have?

Answer 457

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

Question 458

Pulsus Paradoxus

1. What is it?
2. How is it detected?
3. Why does it happen?
4. What disease processes is it associated with? (4)

Answer 458

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

Question 459

What tumor type(s) is the following tumor marker assc. with?:

Carcinoembryonic antigen

Answer 459

GI (colorectal)

Question 460

Achalasia

1. Cause
2. What is seen on esophageal manometry?

Answer 460

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

Question 461

What pathology does this histological image indicate?

Answer 461

Coccidioides immitis

Question 462

List the (6) steps for Ggucose-induced insulin release from beta cells

Answer 462

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

Question 463

Patients with Down Syndrome are at an increased risk for what CA types?

Answer 463

ALL and AML

Question 464

Torsades de Pointes

1. Pathology
2. What are the most common precipitants? (3 categories + examples)

Answer 464

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)

Question 465

When providing a nerve block of the brachial plexus between scalene muscles, what must you be weary of?

Answer 465

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

Question 466

What is the site of lowest osmolarity in the nephron?

Answer 466

DCT

Question 467

Tx of Acute Adrenal insufficiency

Answer 467

Hydrocortisone or dexamethasone

Question 468

What tumor type(s) is the following tumor marker assc. with?:

PSA

Answer 468

Prostate

Question 469

Describe the peripheral blood smear associated with lead poisoning

Answer 469

Coarse erythrocyte basophilic stippling and microcytic hypochromic anemia

Question 470

Attributable Risk Percent (definition + calculation)

Answer 470

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

Question 471

MOA of SSRIs

Answer 471

Blockade of the serotonin transporter

Question 472

Patent Ductus Arteriosus (PDA)

1. Pathology
2. Why is it patent
3. Clinical manifestations
4. Typical age at presentation
5. Tx.

Answer 472

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)

Question 473

Name the mealtime insulin analogs

Describe their onset/ offset

Answer 473

Glulisine, Aspart, Lispro

They have rapid onset and offset of action, mimicking physiologic postprandial insulin secretion

Question 474

Maple Syrup Urine Disease

1. Pathogenesis
2. Sx
3. Dx
4. Tx
   5.

Answer 474

1. Blocked degradation of branched amino acids– Isoleucine, Leucine, and Valine (I Love Vermont) 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

Question 475

Describe the key presentations associated with thiamine deficiency?

Answer 475

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

Question 476

Tissue damage and resultant abscess formation is primarily caused by…

Answer 476

Lyosomal enzyme release from neutrophils

Question 477

Where do the ureters sit in respect to the common, external, and internal iliac?

Answer 477

Anterior (right on top of them)

Question 478

Describe Aspergillus fumigatus colonization

1. What is it?
2. How does it look on imaging?
3. Sx

Answer 478

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)

Question 479

POMC, a polypeptide precursor, goes through enzymatic cleavage and modification to produce what (3) proteins?

Answer 479

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

Question 480

Ethosuximide MOA

Answer 480

Blocks T-type Ca2+ channels in thalamic neurons

(used to treat absence seizures)

Question 481

What is Kinesin and what does it do?

Answer 481

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

Question 482

Describe the activation of Ras proteins (2 steps)

Answer 482

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!

Question 483

What are the (2) mechanisms by which beta-blockers lower blood pressure?

Answer 483

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

Question 484

Antiarrhythmic drugs

Drugs + Predominant actions

Class III

Answer 484

Amiodarone, Dronedarone, Dofetilide, Sotalol (also class II)

Prolongs APD by blocking K+ channels (no effect on AP conduction velocity)

Question 485

What effect does sickling (in SCD) have on labs?

Answer 485

Leads to

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

Question 486

Buerger’s disease (thromboangiitis oblierans)

1. Main population demographics
2. Pathophysiology
3. Presentation
4. Tx

Answer 486

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

Question 487

How is nitric oxide synthesized?

Answer 487

It is synthesized from arginine by NO synthase

Question 488

Ariginase

1. Fxn
2. Sx of Arginase deficiency
3. Tx of Arginase deficiency

Answer 488

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

Question 489

Propionyl CoA is derived from which amino acids? (4)

Answer 489

Val, Ile, Met, and Thr

Question 490

What types of drugs are not effective against organisms of the mycoplasma species? What type are? Why?

Answer 490

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)

Question 491

Describe themost important biochemical abnormality in Alzheimer dz

Where is this decline most notable?

Answer 491

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

Question 492

Why doesn’t Wallerian degeneration occur in the CNS?

Answer 492

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

Question 493

What is the best determinate of oral bioavailability of a drug?

Answer 493

AUC (Oral)/ AUC (IV)

This assumes they’ve been administered at equal doses

Question 494

Lipofuscin

Answer 494

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

Question 495

Key AE associated with lamotrigine

Answer 495

SJS (30% of body surface)

Question 496

Relationship between blood flow and radius

Answer 496

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

Question 497

What virus is the pictured biopsy associated with?

What is the normal type of patient who has this virus?

Describe the virus?

Answer 497

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

Question 498

Familial chylomicronemia syndrome

1. Which protein is defected? (2)
2. Which lipoprotein is elevated?
3. Major manifestations?

Answer 498

1. Defected: Lipoprotein lipase; ApoC-II
2. Elevated: Chylomicrons
3. Manifestations: Acute pancreatitis; lipemia retinalis (milky lipids in retinal vasculature); eruptive skin xanthomas; hepatosplenomegaly

Question 499

a-1 blockers are useful for the treatment of … (2 conditions)

What natural secretion has these same effects?

Answer 499

HTN and benign prostatic hyperplasia (relaxes the bladder)

ANP/BNP has the same effects

Question 500

What drug is used as abortive therapy during an acute migraine?

What is its MOA?

Answer 500

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.

Question 501

Fick Principle

Answer 501

An alternative means for calculating cardiac output.

CO = O2 consumption/ AV O2 difference

Question 502

What is the role of atypical T-cells in assc. with EBV?

Answer 502

They function to destroy virally-infected B-lymphocytes

Question 503

What is the foundation of management for RA? Why are anti-inflammatory drugs often used?

Answer 503

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.

Question 504

MOA of Sotalol

Answer 504

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

Question 505

1. What do Central Chemoreceptors sense?
2. What do Peripheral Chemoreceptors sense?
3. What do Pulmonary Stretch Receptors sense?

Answer 505

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

Question 506

You see a large cell with multiple nuclei in the shape of a horshoe. What is it called and what disease process is it associated with?

Answer 506

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

Question 507

Drug-induced Lupus Erythematosus

1. Presentation
2. Dx
3. What is almost never seen?
4. Drugs normally implicated

Answer 507

1. New onset of lupus symptoms
2. Anti-nuclear antibodies (ANA) and anti-histone antibodies
3. Anti-dsDNA ALMOST NEVER SEEN
4. HIP: Hydralazine, Isoniazid, Procainamide

Question 508

Amatoxins

1. Where are they found?
2. What is there MOA?

Answer 508

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

Question 509

What (3) parts of the body does the iliohypogastric nerve innervate?

Answer 509

Sensation to the suprapubic and gluteal regions

Motor function to the anterolateral abdominal wall muscles

Question 510

Potential complications from hereditary spherocytosis (2)

Answer 510

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

Question 511

What type of cells are seen in the pulmonary vasculature in cases of an Amniotic fluid embolism?

Answer 511

Fetal squamous cells

Question 512

Path and Presentation of patients with 21-hydroxylase deficiency

Answer 512

Deficient cortisol and aldosterone synthesis + adrenal androgen overproduction

Males: normal genitalia + vomiting, hypoTN, hyponatremia, hyperkalemia

Females: ambiguous genitalia (+ sx above)

Question 513

Meningiomas

1. Pathophysiology?
2. Who is usually affected?
3. Where do these tumors occur?
4. Presentation?

Answer 513

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

Question 514

What molecules take on a trple helical conformation?

Answer 514

Collagen, due to repetitive AA sequences within each alpha chain

Question 515

1. Name the non-selective beta-blockers
2. Name the selective beta-blockers
3. Why would you choose selective over non-selective?

Answer 515

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.

Question 516

What are the type II Anti-arrhythmics?

Answer 516

Beta-blockers

Question 517

The (2) most signficant risk factors for development of esophageal SCC in the US

Answer 517

Smoking tobacco and drinking alcohol

Question 518

What is Annular Pancreas? What might it cause?

Answer 518

The ventral pancreatic bud abnormally encircles the 2nd part of the duodenum, forming ring of pancreatic tissue. May cause duodenal narrowing.

Question 519

Amyotrophic Lateral Sclerosis

1. Sx
2. Gross anatomy
3. Histo/ microscopic
4. Genetics
5. Tx

Answer 519

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)

Question 520

1. Peroxisomes are responsible for metabolizing what?
2. What does Peroxisomal disease commonly lead to?

Answer 520

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

Question 521

Name the muscles of the rotator cuff and what each one does

Answer 521

SITS

Supraspinatus- abducts arm initially (before deltoid takes over)

Infraspinatus (laterally rotates arm)

Teres minor (adducts and laterally rotates arm)

Subscapularis (medially rotates and adducts arm)

Question 522

Ataxia Telangiectasia

1. Classic triad
2. Specific defect

Answer 522

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

Question 523

Cryptococcus neoformans

1. How do they look?
2. Who do they affect/ how is it passed?
3. Most common disease processes caused
4. Dx

Answer 523

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

Question 524

Hypertrophic Cardiomyopathy

1. Key potential clinical consequences (2)?
2. Histo
3. Pathology
4. Dx of this consequence?
5. What actions make those sx better or worse?

Answer 524

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

Question 525

Describe the pathology of Good Pasture Syndrome

Answer 525

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

Question 526

Asbestos exposure

1. Potential clinical manifestations? (3)
2. What two cancer types can Asbestos lead to? Which is most common?

Answer 526

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)

Question 527

What antibodies have a high specificity for Rhematoid arthritis?

Answer 527

Antibodies to citrullinated peptides/ proteins (anti-CCP)

Question 528

1. Inhibition of uterine contractons is a result of stimulation of which adrenergic receptor?
2. Pupillary dilation is the result of stimulation of which adrenergic receptor?

Answer 528

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

Question 529

Dactylitis

(What is it and what is it a common presentation of?)

Answer 529

Painful swelling of the hands and feet

It is a common presentation of sickle cell in young children.

Question 530

What does the radial nerve do? Damage to it may result in what?

Answer 530

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

Question 531

What phase of the AP corresponds with the QRS of the EKG?

QT?

Answer 531

QRS = Phase 0

QT = Phase 3

Question 532

Inherited defects involving what signaling pathway, result in disseminated mycobacterial dz in infancy/ early childhood?

Answer 532

Interferon-gamma

(needed to activate macrophages)

Question 533

What hormone is often increased in liver cirrhosis? What can this lead to?

Answer 533

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

Question 534

Which neural structure is most affected by the thiamine deficiency associated with Wernicke encephalopathy?

Answer 534

Mamillary bodies

Question 535

What specific component of the H. Flu capsule is the vaccine set against?

Answer 535

Polyribosyl-ribitol-phosphate (PRP)

Question 536

What is the “Number Needed to Treat”, and how is it calculated?

Answer 536

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

Question 537

What are the main effects of a glossopharyngeal nerve lesion?

Answer 537

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

Question 538

Diffuse muscle pain + fatigue +neuropsych disturbances, w/ negative labs = what dz?

Answer 538

Fibromyalgia

Question 539

What is a pancoast tumor? Where is the most likely location for a pancoast tumor to occur? What is the most common presentation?

Answer 539

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)

Question 540

What is the stabilizing force for the secondary structure of proteins?

Answer 540

Hydrogen bonds

Question 541

Lesch-Nyhan syndrome

Key presentation components (2)

Answer 541

1. Self-mutilation
2. Hyperuricemia

Question 542

What are the classic sputum findings for Extrinsic Allergic Asthma

Answer 542

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

Question 543

H. flu

1. What does it require in order to grow?
2. What does its pathogenicity depend on?
3. Which strain is most invasive?
4. How does it present in unvaccinated individuals?

Answer 543

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

Question 544

Streptococcus gallolyticus (formely S. Bovis) can cause endocarditis and bactermia. When this bug is cultured in the blood, workup for what, is absolutely essential?

Answer 544

Colonic malignancy with colonoscopy

Question 545

Explain the rapid onset and short duration of action for drugs similar to propofol

Answer 545

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)

Question 546

What substances are capable of inactivating enveloped viruses?

Answer 546

Organic solvents (ex. Ether)

[Non-enveloped viruses are generally resistant to the action of ether]

Question 547

Aspirin

MOA

Answer 547

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.

Question 548

Under normal cricumstances, how does Ras protein become inactivated?

Answer 548

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

Question 549

Verrucous endocarditis

1. Who does it occur in?
2. What is it?
3. Potential consequence?

Answer 549

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

Question 550

Abciximab MOA

Answer 550

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

Question 551

Antiphospholipid Antibody Syndrome

1. Type/ cause of antibodies
2. Sx (2)

Answer 551

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

Question 552

Carbamazepine

1. Indication
2. MOA
3. Adverse Effects

Answer 552

1. Seizure tx
2. Blockage of voltage-gated sodium channels in neuronal membranes
3. Can cause bone marrow suppression

Question 553

What is the pathognomnic presentation for a large patent ductus arteriosus complicated by Eisenmenger syndrome?

Answer 553

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

Question 554

Giant Cell Arteritis

1. Also known as?
2. Main Sxs (4)
3. What does the artery look like on biopsy?

Answer 554

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

Question 555

Leuprolide MOA

Answer 555

Continuous GnRH agonist

Question 556

What is the specific deficiency in patients with Glanzmann thrombasthenia?

Answer 556

(GP) IIb/IIIa, needed for platelet aggregation

Question 557

Name the (4) key neutrophil chemotactic agents during inflammation

Answer 557

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

Question 558

Which bug is associated with right-sided endocarditis in IV drug users?

Answer 558

Staph aureus

Question 559

What is the best ausculatory indicator of the severity of a patient’s mitral regurgitation?

Answer 559

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

Question 560

Describe the histo of myxomas

Answer 560

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

Question 561

Name the precursor protein/peptide responsible for localized amyloidosis for each of the following organs:

1. Cardiac atria
2. Thyroid gland
3. Pancreatic islets
4. Cerebrum/cerebral blood vessels
5. Pituitary gland
6. Multi-organ amyloid deposition?

Answer 561

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

Question 562

What do RAS genes code for?

Answer 562

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

Question 563

Distinguish Precursor B-ALL from precursor T-ALL

Answer 563

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)

Question 564

Chronic Granulomatous Disease

1. Pathogenesis?
2. Clinical Manifestations?

Answer 564

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

Question 565

Acute Arsenic Posioning

1. Presentation
2. Source
3. Antidote

Answer 565

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

Question 566

What is the most common cause of death in patients who have been struck by lightning?

Answer 566

Cardiac arrhythmias/ arrest

Question 567

Oligodendrocytes Vs Schwann Cells

Answer 567

Oligodendrocytes- CNS myelin (oligarchy means central power)

Schwann- Peripheral Myelin

Question 568

Pigment gallstones

1. Composition
2. Appearence
3. Cause (including key enzyme)
4. What organism is often associated

Answer 568

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

Question 569

How do chronically elevated FFA levels contribute to insulin resistance?

Answer 569

By impairing insulin-dependent glucose uptake and increasing hepatic gluconeogenesis

Question 570

What is the most frequent cause of lung abscess and what type of conditions increase their risk.

Name (1) key example of this cause.

Tx (2)?

Answer 570

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)

Question 571

What is the primary site for complement production?

Answer 571

The liver

Question 572

Kehr sign

Answer 572

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)

Question 573

Mitral Stenosis

1. What is the best/most reliable asuculatory indicator of the severity?

Answer 573

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

Question 574

Germinoma

1. What type of mass is it?
2. Classical manifestations (2) and the Sx associated with each (3)
3. Dx

Answer 574

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

Question 575

Define accuracy vs reliability

Answer 575

Accuracy: the degree to which the aerage measurment value matches that of the gold standard

Reliability: reproducibility of a result

Question 576

What is hypocapnia and what does it imply for a patient?

Answer 576

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

Question 577

Meconium Ileus

What is it and what disease is it associated w/?

Answer 577

Small bowel obstruction due to abnormally dehydrated meconium in a patient w/ cystic fibrosis

Question 578

What are “Lichtenberg figures” and what are they associated with?

Answer 578

Erythematous cutaneous marks in a fern-leaf pattern.

They are pathognomonic of lightning strikes

Question 579

Primary Biliary Cirrhosis/ Cholangitis

1. What characterizes this dz?
2. Who is it common in ?
3. Presentation?

Answer 579

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)

Question 580

How does A-fib look on an EKG? In this condition, what ultimately regulates the number of atrial pulses which reach the ventricle?

Answer 580

• 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.

Question 581

Naltrexone

1. Indication
2. MOA
3. Effect

Answer 581

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

Question 582

What type of MHC do APCs express?

Answer 582

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

Question 583

Zolpidem

1. Indication
2. SImilar to what drug? How does it differ?

Answer 583

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

Question 584

Alkaptonuria

1. Inheritance
2. Enzyme that is deficient
3. Presentation (3)

Answer 584

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

Question 585

1. What is the cause of umbilical hernias?
2. What conditions are they associated with?

Answer 585

1. Incomplete closure of the umbilical ring
2. Dat Big Hernia –> assc. w/ Down Syndrome, Beckwith-Wiedmann syndrome, Hypothyroidism

Question 586

What tumor type(s) is the following tumor marker assc. with?:

CA 125

Answer 586

Ovarian

Question 587

Candida Albicans

1. What does it give rise to when heated?
2. Where is it found normally in humans?

Answer 587

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

Question 588

Positive Predictive Value

Answer 588

The proportion of indivudals with positive test results who actually have the dz

PPV = TP/ (TP + FP)

Question 589

Dobutamine

1. MOA
2. Indication
3. Effect (3)
4. AE

Answer 589

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

Question 590

Role of B-blockers and a2 agonists in tx of glaucoma

Answer 590

Decrease secretion of aqueous humor via the ciliary epithelium

Question 591

In the pathogenesis of atherotic plaques, What is responsible for promoting migration of smooth muscle cells from the media into the intima, and subsequent proliferation?

Answer 591

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

Question 592

Describe the common presentation for sarcoidosis

Answer 592

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

Question 593

What are the (3) main sx of vitamin A overuse?

Answer 593

1. Intracranial HTN
2. skin changes
3. Hepatosplenomegaly

Question 594

Describe the process of granuloma formation for TB

Answer 594

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

Question 595

Resistance in the airway is maximal between which bronchial generations?

Answer 595

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

Question 596

Main difference between MDD and Persistent depressive disorder (dysthymia)

Answer 596

Persistent DD is > 2y, while MDD is greater than 2 weeks (usually 6-12mo)

Also Pers. DD tends to be milder

Question 597

After cutting through fascia, what else is cut during a cricothyrotomy?

Answer 597

The cricothyroid membrane

Question 598

Achlorydia

Answer 598

Lack of HCl in gastric secretions

Question 599

_______________ is almost always needed in order to develop acute pyelonephritis (as opposed to regular UTI)

Answer 599

Vesicoureteral reflux

Question 600

What key structure is assc. with ovarian torsion (other than the ovary)?

Answer 600

The infundibulopelvic ligament (IP).

It suspends the ovaries and has blood vessels/nerves for the ovary running through it.

Question 601

How can untreated hydrocephalus in an infant lead to UMN issues?

Answer 601

Stretching of the periventricular pyramidal tracts

Question 602

Acute acalculous cholecystitis

1. What is it?
2. Who does it occur in?

Answer 602

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

Question 603

Why is Piperacillin-tazobactam such an effective tx for Bacteroides?

Answer 603

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.

Question 604

What type of brain damage leads to decerebrate (extensor) posturing?

Answer 604

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

Question 605

What type of brain damage leads to decorticate (flexor) posturing?

Answer 605

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

Question 606

What hormone is ultimately responsible for causing gestational diabetes?

Answer 606

Human placental lactogen (hPL)

It decreases maternal fatty acid stores and increases maternal serum glucose, but also increases insulin resistance

Question 607

Describe the path the median nerve takes prior to the carpal tunnel

Answer 607

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

Question 608

What is the most sensitive screening test for dx od primary hypothyroidism?

Answer 608

Serum TSH

(even more sensitive than T3/T4)

Question 609

The production of what cytokine is a very important driver of Giant Cell Arteritis?

Answer 609

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

Question 610

Why should protein be restricted in an ornithine transport deficiency?

Answer 610

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

Question 611

Which antibiotic groups disrupt the peptidoglycan cell wall of bacteria? (3)

Answer 611

1. Penicillins
2. Cephalosporins
3. Vancomycin

Question 612

What compensatory pathway can help convert fructose to a useable form, in cases of essential fructosuria?

Answer 612

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

Question 613

First-order kinetics vs zero-order kinetics

Answer 613

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)

Question 614

(2) key histo findings in Glioblastoma Multiforme

Answer 614

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

Question 615

Cholesteatoma

1. What is it?
2. Etiology
3. Presentation

Answer 615

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

Question 616

What are the (2) normal arrest points for oocytes?

Answer 616

1. Prophase of meiosis I (prior to ovulation)
2. Metaphase of meiosis II (prior to fertilization)

Question 617

What tissue types have B1 receptors?

Answer 617

Cardiac and Renal JGA cells

Question 618

What is the major immune mechanism against Giardia?

Answer 618

secretory IgA production

Question 619

Viral bronchiolitis

1. Cause
2. Presentation (4)
3. Dx

Answer 619

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

Question 620

What type of bacteria is Gardenella vaginalis?

Answer 620

An anaerobic gram-variable rod

Question 621

Describe the morphology of cryptococcus neoformans

Answer 621

Budding yeast

Question 622

What nerve innervates the cricothyroid muscle?

Answer 622

The external branch of the superior laryngal nerve

Question 623

What is the optimal site for a femoral nerve block and what becomes anesthetized?

Answer 623

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

Question 624

Why can PAH be used to estimate Effective Renal Plasma Flow (eRPF)?

Answer 624

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

Question 625

Progressive onset of heart failure in the setting of recent viral infection should raise suspicion for what?

Answer 625

Dilated cardiomyopathy caused by viral myocarditis

Question 626

What are the values for serum Ca2+, phosphorous, and PTH in primary osteoporosis? (low, normal, high– for each)

Answer 626

All normal

Question 627

What is the most efficient way to decrease cerebral blood flow/ ICP in a patient?

Answer 627

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

Question 628

Presentation of Porphyria cutanea tarda

Answer 628

Blistering cutaneous photosensitivity

Question 629

Cardiac defect assc. with Turner’s syndrome

Answer 629

Bicuspid aortic valve + coarctation of the aorta

Question 630

What is the triad of sx assc. with Serotonin Syndrome?

Answer 630

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

Question 631

How is Linezolid able to cause Serotonin syndrome?

Answer 631

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

Question 632

Why are thiazides effective for some patients with nephrolithiasis?

Answer 632

They increase Ca2+ reabsorption from the nephron, so are effective for calcium based nephroliths

Question 633

What does arteriovenous concentration gradient tell us about the tissue solubility and onset of action of an anesthetic?

Answer 633

Anesthetics with high tissue solubility are characterized by large AV concentration gradients and slower onsets of action.

Question 634

Ultimately, what are vegetations assc. with infective endocarditis, composed of?

Answer 634

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

Question 635

Craniopharyngiomas commonly show what?

Answer 635

Calcification

Question 636

CN III courses between which 2 vessels?

Answer 636

SCA and PCA

Question 637

Put Alcohol w/drawal symptoms in order (4)

Answer 637

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

Question 638

Describe the breakdown of heme to unconjugated bilirubin

Answer 638

Heme –> Biliverdin (via heme oxygenase)

Biliverdin –> unconjugated bilirubin (via biliverdin reductase)

Question 639

A patient has hypoxemia, in the setting of a normal A-a gradient. What (2) differentials should you consider?

Answer 639

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

Question 640

Which vessels are most likely to be penetrated by gastric ulcers? Why?

Answer 640

The left and right gastric arteries.

They run along the lesser curvature of the stomach, where the great majority of ulcers occur.

Question 641

Why do individuals who’ve experienced excessive weight loss or who excercise strenously, often miss menstruation?

Answer 641

Decreased leptin, leads to decreased GnRH secretion via the hypothalamus

Question 642

What is most responsible for the increase in nosocomial bloodstream infections?

Answer 642

Intravascular devices (indwelling catheters)

Question 643

Where does fluid accumulate in cases of communicating hydrocele?

Answer 643

W/in the tunica vaginalis

Question 644

Is S pyogenes PYR-positive or PYR-negative?

Answer 644

(PYR)-positive

Question 645

In a pregnant woman, which drugs are the best tx choice for for DVTs?

Answer 645

Low Molecular Weight Heparins

Question 646

What substances allow for a prenatal dx of NTDs?

Answer 646

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

Question 647

For what reason does Tamoxifen rely on CYP2D?

Answer 647

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

Question 648

What region of the LN is populated primarily by T lymphocytes (as well as dendritic cells)?

Answer 648

The paracortex region

Question 649

The transverse portion of the duodenum (the bottom part of the C), runs between which (2) vessels?

Answer 649

Aorta and SMA

Question 650

Why is their a major increase in the density of connexins in the uterus just before delivery?

Answer 650

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.

Question 651

What component of the tRNA serves as the AA binding site?

Answer 651

3’CCA tail (loaded by aminoacyl tRNA synthetase)

Question 652

Where does lymph from the testes drain?

The scrotum?

Answer 652

Testes: para-aortic LNs

Scrotum: superficial inguinal LNs

Question 653

Dissection of what nerve leads to “winged scapula”, and why?

Answer 653

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)

Question 654

What types of renal injury can be caused by NSAIDs? (2)

Answer 654

Chronic interstitial nephritis + papillary necrosis

Question 655

What role do neurophysins play for oxytocin and vasopressin?

Answer 655

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

Question 656

What are the (2) main roles that NADPH plays?

Answer 656

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

Question 657

Why are patients who’ve experienced organophosphate poisoning still at risk for muscle paralysis, even after being given atropine?

Answer 657

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

Question 658

Why must you be careful not to overuse a-adrenergic agonists as decongestants?

Answer 658

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

Question 659

Candida albicans is a normal inhabitant of what?

Answer 659

The GI tract (including the oral cavity)

Question 660

Morphine MOA

Answer 660

Binds to mu receptors, resulting in G-protein activation of potassium conductance.

This hyperpolarizes the postsynaptic neurons, blocking pain transmission

Question 661

Most common cause of galactosemia

Answer 661

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

Question 662

Describe the characteristic histopathological findings assc. with HIV-associated dementia

Answer 662

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

Question 663

Thoracic outlet syndrome

1. Pathlogy
2. Presentation
3. What is it associated with?

Answer 663

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

Question 664

Gout or pseudogout: associated with myeloproliferative disorders

Answer 664

Gout

Question 665

Tx of Wilson Dz

Answer 665

D-penicillamine (copper chelating agent)

Question 666

In females, the paramesonephric ducts fuse to form, what? (4 things)

Answer 666

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

Question 667

What does the liver do in attempts to compensate for protein loss in nephrotic syndromes?

Answer 667

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

Question 668

P bodies play an important role in protein synthesis. Where do they operate/ what is their general role?

Answer 668

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

Question 669

If a patient presents with mono, but has a negative agglutination to horse erythrocytes, what is the likely dx?

Answer 669

CMV (agglutination to horse erythrocytes = monospot test)

Question 670

Tx for Chlamydia trachomatis

Answer 670

Doxycycline or azithromycin

Question 671

IV tx to lower BP in hypertensive emergency.

What is its effect (3)

Answer 671

Fenoldopam

(dopamine-1 receptor agonist)

1. Arteriolar dilation
2. Inc. renal perfusion
3. Promotes diuresis and natriuresis

Question 672

Neuroleptic Malignant Syndrome

1. Etiology
2. Sx
3. Tx

Answer 672

1. Rxn to antipsychotic drugs

FEVER (Fever, Encephalopathy, Vitals unstable, Enzyme inc., Rigidity of muscles)

Tx w/ Dantrolene

Question 673

Rapid correction of chronic hyponatremia, may lead to what?

Answer 673

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

Question 674

How do you reduce the risk of “wrong-site surgery”?

Answer 674

Dual identifiers (usually a nurse and physician)

Question 675

What is the appropriate attire for C-dif?

Answer 675

Nonsterile gloves + gown

Question 676

Describe the morphology of acute transplant rejection

Answer 676

It can have a humoral and cellular component

• Humoral- necrotizing vasculitis with a neutrophilic infiltrate
• Cellular- lymphocytic interstitial infiltrate and endotheliitis

Question 677

What does it mean when we say that the lac operon is polycistronic?

Answer 677

It means that the one mRNA codes for several proteins

Question 678

What is the specific defect associated with Fragile X syndrome?

Answer 678

An X-linked trinucleotide repeat disorder (CGG)_n which affects methylation and expression of the FMR1 gene

Question 679

Explain how A fib, with subsequent abdominal pain, can lead to acidic urine.

Answer 679

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!!!)

Question 680

What is the difference in fxn between free and attached ribosomes?

Answer 680

Free = produce proteins for the cytosol

Attached = produce proteins for cell membrane/ secretion

Question 681

Which diuretics are best for improving survival in patients with CHF and decreased EF?

Answer 681

Mineralocorticoids (eg, spironolactone, eplerenone, etc.)

Question 682

If the rectus abdominis muscle is incised laterally, what vessel is at greatest risk of injury?

Answer 682

The inferior epigastric artery

Question 683

How can left-sided heart dz, lead to pulmonary vasoconstriction?

Answer 683

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

Question 684

Sx associated with hep C

Answer 684

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

Question 685

What determines which side of the coronary circulation is dominant?

Answer 685

Attachment to the Posterior descending/interventricular artery (PDA)

Question 686

The PDA (posterior descending/interventricular artery) supplies blood to what key structure?

Answer 686

The AV node (via the AV nodal artery)

Question 687

Osteocytes send signals and nutrients/waste to one another via what structure?

Answer 687

Gap junctions

Question 688

What is the major cause of morbidity and mortality in patients recovering from SAH? How do you prevent this?

Answer 688

Severe vasospasm

Tx w/ nimodipine to prevent

Question 689

Biliary Atresia

1. Presentation
2. Dx
3. What is seen on Biopsy?

Answer 689

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

Question 690

Name the only medication which selectively decreases HR but has no effect on myocardial contractility or relaxation.

What is its MOA?

Answer 690

Ivabradine

Selective inhibition of funny sodium channels (I_f)

Question 691

Name the toxicities associated with aminoglycosides (2)

Answer 691

1. nephrotoxicity
2. ototoxicity

Question 692

a2 receptor effect on insulin secretion?

B2 receptor effect?

Which predominates

Answer 692

a2: inhibits insulin secretion

B2: promotes insulin secretion

a2 predominates when both are activated

Question 693

Tx of Restless Leg Syndrome

Answer 693

Dopamine agonists

Question 694

Cytokeratin is a commonly-used immunohistochemical marker for what?

Answer 694

Epithelial-derived tissues

Question 695

What symptoms characterize Atypical Depression?

Tx?

Answer 695

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

Question 696

What is one of the rare tissues to have an anabolic increase in protein synthesis in response to longterm glucocorticoid tx?

Answer 696

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

Question 697

What is the main MOA of all hormone containing Oral Contraceptives?

Answer 697

Inhibition of ovulation by dec. FSH and LH synthesis

Question 698

Ristocetin aggregation test is used to test for what?

Answer 698

von Willebrand dz

(should show decreased aggregation of platelets)

Question 699

A rxn to Poison Ivy, is a form of what?

Answer 699

Allergic contact dermatitis (type IV hypersensitivity)

Question 700

A patient has weakness during finger and thumb extension (w/o wrist drop or sensory deficits).

Most likely site of injury?

Answer 700

Radial nerve during its passage through the supinator canal

Question 701

Most important tx for Diptheria?

Answer 701

Diphtheria antitoxin (passive immunization)

Question 702

Nitroglycerin acts primarily on which vessels?

Answer 702

LARGE VEINS!!!

(It’s a venodilator, which allows it to decrease preload)

Question 703

Best mechanism for Dx of vertebral osteomyelitis

Answer 703

MRI of the spine

Question 704

What type of drugs are preferentially metabolized and eliminated by the liver?

Answer 704

Drugs w/ high lipophilicity

Question 705

What connects the 3rd ventricle to the 4th ventricle?

Answer 705

Cerebral aqueduct

Question 706

What drains the 4th ventricle?

Answer 706

Lateral foramina of Luschka and Median foramen of Magendie

Question 707

DRESS Syndrome

1. What does it stand for?
2. When does it occur?

Answer 707

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

Question 708

DRESS Syndrome presentation

Answer 708

1. Fever
2. Eosinophilia
3. Diffuse rash
4. Internal organ Dysfunction
5. Facial edema

You will be FED IF you get DRESSed

Question 709

Increased intake of what substances, helps to prevent renal calculi formation?

Answer 709

Citrate and fluids

Question 710

Effect of DM on urinary continence

Answer 710

Can cause overflow incontinence due to inability to sense a full bladder and due to incomplete bladder emptying.

Question 711

SE: Hyponatremia, Hypercalcemia, Hypocalcemia

Thiazides are more likely to cause which of these?

Loop Diuretics are more likely to cause which of these?

Answer 711

Thiazides: Hyponatremia and hypercalcemia

Loop diuretics: Hypocalcemia

Question 712

Presentation of Intestinal Malrotation

Answer 712

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

Question 713

What aspect of oral administration of a drug is responsible for its decreased bioavailability?

Answer 713

First-pass metabolism by the liver

Question 714

Ezetimibe action

Answer 714

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

Question 715

Name the organisms most often involved in Chronic Granulomatous Dz (5)

Answer 715

Catalase-postive bugs which destroy their own hydrogen peroxide

Specifically:

1. S. aureus
2. Burkholderia cepacia
3. Serratia marcescens
4. Nocardia
5. Aspergillus

Question 716

Which checkpoint does Rb regulate?

Answer 716

G1 → S

Question 717

What causes Humoral Hypercalcemia of Malignancy?

Answer 717

Secretion of Parathyroid hormone-related protein (PTHrP).

It closely resembles parathyroid hormone and causes increased bone resorption and decreased renal excretion of calcium.

Question 718

Lynch Syndrome (HNPCC)

1. What does it lead to?
2. What is responsible?
3. What is the key gene affliated?

Answer 718

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

Question 719

What is responsible for the outflow block associated with hypertrophic cardiomyopathy?

Answer 719

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

Question 720

Other than iodide, what other ions are absorbed into the thyroid gland via the sodium-iodide symporter?

Answer 720

Perchlorate and pertechnetate ions

Question 721

Injury of what nerve, leads to foot drop and weak eversion/ toe extension?

Answer 721

Common peroneal nerve

Question 722

In what part of the cell does Vitamin C function?

Answer 722

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

Question 723

What is the most common COD in patients with TCA overdose, and why?

Answer 723

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

Question 724

KRAS

Proto- oncogene or tumor suppressor?

Answer 724

Proto-oncogene

Question 725

What is used for prevention of hemorrhagic cystitis, during tx with systemic chemo (w/ cyclophosphamide or ifosfamide)?

Answer 725

Mesna

Question 726

In addition to looking completely different from their tissue of origin, what other characteristics might anaplastic cells possess?

Answer 726

1. abnormal mitoses
2. giant, multinucleated tumor cells

Question 727

In addition to trisomy 21, what else can lead to Down syndrome?

Answer 727

Unbalanced Robertsonian Translocations [46, XX, t(14;21)]

or

Mosaicism (some cells have extra copy of chromosome 21)

Question 728

What is the specific mechanism implicated in the pathophysiology of cataracts and peripheral neuropathy in DM?

Answer 728

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.

Question 729

Dx of Chronic Granulomatous Dz

Answer 729

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

Question 730

What is the role of short non-coding RNA sequences (microRNA and small interfering RNA)?

Answer 730

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

Question 731

What causes appendicitis pain to eventually localize?

Answer 731

Irritation of the parietal peritoneum

Question 732

What is the inheritance for classical galactosemia?

Answer 732

Autosomal recessive

Question 733

What bug/virus causes encephalitis that can lead to hemorrhagic necrosis of the inferior and medial temporal lobes?

Answer 733

Herpes simplex virus

Question 734

What happens if obliteration of the omphalomesenteric (vitelline) duct fails?

Answer 734

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

Question 735

Classic triad of sx for RCC?

Answer 735

1. Hematuria
2. Flank pain
3. Palpable mass

Question 736

Sx of angioedema (and what drug can cause it?)

Answer 736

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

Question 737

Equation for absolute risk reduction

Answer 737

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

Question 738

What structure is cut in tx of carpal tunnel syndrome?

Answer 738

Transverse carpal ligament

Question 739

Aliskiren MOA

Answer 739

Direct renin inhibitor

(Blocks conversion of angiotensinogen to angiotensin I)

Question 740

What can creatinine be used to measure?

Answer 740

Approximate measure of GFR (secreted 10%)

Question 741

What can inulin be used to measure?

Answer 741

GFR (freely filtered and neither reabsorbed or secreted)

(can also estimate extracellular volume)

Question 742

What would be the result of, loss of CYP21A2 (21-hydroxylase) on:

Cortisol

Aldosterone

Androgens

Answer 742

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

Question 743

What would be the result of, loss of CYP11B1 or B2 (11-hydroxylase) on:

Cortisol

Aldosterone

Androgens

Answer 743

Loss of cortisol and aldosterone, increased androgen and increased aldosterone precursor, 11DOC (binds strongly to mineralocorticoid receptor, simulating increased aldosterone)

Question 744

What would be the result of, loss of CYP17 (17-hydroxylase) on:

Cortisol

Aldosterone

Androgens

Answer 744

Loss of Cortisol and androgens. Increased aldosterone.

Question 745

Non-rhytmic conjugate eye movements + myoclonus (opsoclonus-myoclonus syndrome) is assc. with what dx?

Answer 745

Neuroblastoma

Question 746

Orotic aciduria

1. What is it?
2. What causes it?

Answer 746

1. Rare autosomal recessive disorder of de novo pyrimidine synthesis
2. Defect in uridine 5’-monophosphate (UMP) synthase

Question 747

Presentation of individuals with Orotic aciduria

Tx?

Answer 747

Children with

1. Physical/mental retardation
2. Megaloblastic anemia
3. Large amounts of urinary orotic acid

Tx w/ uridine

Question 748

What are the dendritic cells of the skin called? Describe them? (cell line? structure?)

Answer 748

Langerhans cells

(derived from myeloid cell line and possess racquet-shaped intracytoplasmic granules called Birbeck granules)

Question 749

Which Carcinoid tumor types are capable of causing carcinoid syndrome?

Answer 749

Metastatic

(The cytokines of local carcinoid tumors confined to the intestine, are metabolized by the liver before reaching systemic circulation)

Question 750

How do cancers of the pelvis spread to the lumboscral spine?

Answer 750

Via the vertebral venous plexus

Question 751

Attachement point for greater and lesser omentum

Answer 751

Greater = Greater curvature of stomach

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

Question 752

In cases of Small Intestinal Bacterial Overgrowth (SIBO), what vitamins/minerals…

… become deficient? (5)

…increase in production? (2)

Answer 752

Deficient: vitamins B12, A, D, E, and iron

Increased: folic acid and vitamin K

Question 753

What is the most important virulence factor for E. Coli?

Answer 753

Fimbrae (allows it to stick to uroepithelial cells)

Question 754

Prophalictic procedures for Group B Strep (S. agalactia)

Answer 754

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

Question 755

Colchicine

1. Indication
2. MOA
3. SE

Answer 755

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

Question 756

Main AE of Phenytoin (3)

Answer 756

1. Ataxia
2. Nystagmus
3. Gingival hyperplasia

Question 757

Hematogenous osteomyelitis

1. Most common in who?
2. What part of the bone is affected?

Answer 757

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

Question 758

Drug of choice for B-blocker overdose

Answer 758

Glucagon (causes inc. of intracellular cAMP)

Question 759

What is carboxyhemoglobin?

Answer 759

Carbon monoxide (CO) -bound hemoglobin

Question 760

What’s the worst long-term prognostic factor for PSGN?

Answer 760

Adult onset

Question 761

What hormone stimulates release of Bi-carb rich secretions from the exocrine pancreas?

Answer 761

Secretin, produced in the S cells of the duodenum

Question 762

What happens to the ratio of Lecithin to sphingomyelin during the third trimester?

Answer 762

Increases

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

Question 763

What is the cause of Acute hemolytic transfusion Rxn?

Answer 763

Type II HSN rxn, w/ subsequent complement activation

Question 764

What differentiates eccrine and adrenal medulla neural input, from the rest of the sympathetic responding glands/organs?

Answer 764

No adrenergic postganglionic neurons

Question 765

If bone conduction is greater than air conduction, what type of hearing loss is it?

Answer 765

Conduction hearing loss

Question 766

Innervation of external hemorrhoids

Answer 766

Inferior rectal nerve (branch of the pudendal)

Question 767

What volume counts as low Vd?

Answer 767

3-5L

Question 768

What protein is most involved in the transport process, leading to HSV-1 recurrence?

Answer 768

Kinesin

Question 769

What is the Sudan III stain, and what is it the best test for?

Answer 769

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

Question 770

What is a homeobox and what do they code for?

Answer 770

It is an 180 nucleotide, highly conserved gene, which codes for transcription factors

Question 771

What does acid-fast stain specifically identify?

Answer 771

Organisms with mycolic acid present in their cell walls

Question 772

What (4) CAs are associated with dermatomyositis?

Answer 772

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

Question 773

Piriformis Syndrome

Answer 773

Sciatica-like sx as a result of compression of the sciatic nerve, due to muscle injury or hypertrophy of the piriformis muscle

Question 774

What type of gland is assc. with inflammatory acne?

Answer 774

Sebaceous (a holocrine gland)

Question 775

Most frequent mechanism of sudden death in the first 48h after acute MI?

Answer 775

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

Question 776

What is given to women at risk of premature delivery, to prevent NRDS?

Answer 776

Steroids (ex. dexamethasone)

Question 777

What occurs in a crossover study?

Answer 777

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

Question 778

What do sertoli cells produce and what does it do?

Answer 778

Inhibin B, which feedsback to inhibit FSH secretion

Question 779

What causes Familial dysbetalipoproteinemia? What does it lead to?

Answer 779

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

Question 780

The enzymes responsible for glycolysis, fatty acid synthesis, and the PPP, all reside where?

Answer 780

The cytosol

Question 781

How far down into the airway do cilia persist?

Answer 781

Through the length of the respiratory bronchioles

Question 782

Pleiotropy definition

Answer 782

Instances where multiple phenotypic manifestations result from a single genetic mutation

Question 783

Which histone type is outside of the histone core?

Answer 783

H1

Question 784

What can injury of the prostatic plexus (often during a prostatectomy) lead to?

Answer 784

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

Question 785

What cells do melanocytes derive from?

Answer 785

Neural crest cells

Question 786

What is the “Thayer-Martin” selective medium, and what is it used for?

Answer 786

aka VPN (vanco, polymyxin, and nystatin + trimethoprim)

Kills everything except Neisseria

Question 787

Most common cause of aseptic meningitis

Answer 787

Enteroviruses (polio/ coxsackie)

Question 788

What are the (3) main chemotactic agents for neutrophils?

Answer 788

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

Question 789

Most common cause of cystathionine synthase deficiency? How do you tx this issue?

Answer 789

Homocystinuria (responds dramatically to vit B6– pyridoxine)

Question 790

HBsAg and HBeAg

Which is the marker for high infectivity?

Answer 790

HBeAg

Question 791

Drug of Choice for Tx of resistant schizophrenia?

Answer 791

Clozapine

Question 792

RF for C__andidemia

Answer 792

Presence of a central vascular catheter + receipt of parenteral nutrition

Question 793

Lymphatic drainage of the rectum proximal to the anal dentate line? Distal?

Answer 793

Proximal: inferior mesenteric and internal iliac LNs

Distal: inguinal nodes

Question 794

Describe the anemia assc. with Mycoplasma pneumoniae

Answer 794

Autoimmune hemolytic anemia (it looks like human erythrocytes)

Question 795

What is the mechanism of liver injury for Hep B Pts?

Answer 795

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

Question 796

When is glucose excreted?

Answer 796

When it gets beyond the “Transport Maximum of Glucose”, which is around 200 mg/dL.

Prior to this value, it is completely reabsorbed.

Question 797

What complicates the long term tx medicating of Parkinson’s patients?

Answer 797

Unpredictable fluctuations in motor function

Question 798

How do neutrophils often look in Leukemoid rxn?

Answer 798

Granulated (Dohle bodies)

Question 799

Conn’s Syndrome?

Tx?

Answer 799

Primary Hyperaldosteronism

(tx w/ eplerenone or spironolactone)

Question 800

What (3) drugs work via inhibition of dihydrofolate?

Answer 800

1. Trimethoprim
2. Methotrexate
3. Pyrimethamine

Question 801

What makes up the superficial ring?

Answer 801

Openings in the external abdominal oblique

Question 802

What makes up the deep inguinal ring?

Answer 802

Physiologic openings in the transversalis fascia

Question 803

Rituximab MOA

Answer 803

Monoclonal antibody directed against the CD20 antigen

Question 804

Valproate indication

Answer 804

Bipolar maintenance drug

Question 805

What causes malignant hyperthermia? Tx?

Answer 805

Caused by admin of inhalation anesthetics/ succinylcholine to genetically susceptible individuals.

Tx w/ Dantrolene (Ryr receptor blocker)

Question 806

What effect can HPV have on newborns?

Answer 806

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

Question 807

Patients w/ familial retinoblastoma have increased risk for what type of tumor?

Answer 807

Secondary tumors, especially osteosarcomas

Question 808

What is phencyclidine?

Answer 808

PCP (angeldust)

Question 809

How does schizophrenia differ from schizoaffective disorder?

Answer 809

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

Question 810

Equation for true positives

Answer 810

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

Question 811

Rifampin MOA

Answer 811

Blocks the action of bacterial DNA-dependent RNA polymerase

Question 812

False negatives

Answer 812

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

Question 813

Most common cause of bloody nipple discharge?

Answer 813

Intraductal papilloma (typically presents w/o breast mass or skin changes)

Question 814

What is responsible for the phosphorylation of Rb?

Answer 814

CDK4, after exposure to proliferation signals

Question 815

Riboflavin is a precursor of what coenzymes? What are they used for?

Answer 815

FMN and FAD

(electron acceptor for succinate dehydrogenase)

Question 816

What effect does sarcoidosis have on calcium levels? How?

Answer 816

Hypercalcemia

Activated macrophages produce excess 1,25 dihydroxyvitamin D

Question 817

Name the gene mutations assc. w/ early onset Alzheimer

Answer 817

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

Question 818

Name the gene mutations assc. with late-onset Alzheimer dz

Answer 818

Apoliporotein E4

Question 819

Best drugs for alcholol w/drawal

Answer 819

Benzos

Question 820

What forms the inferior surface of the heart? What vessel supplies it?

Answer 820

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

Question 821

Primary cause of morbidity in acute rheumatic fever?

Answer 821

Severe pancarditis

(inflammation of the entire heart)

Question 822

How can total parenteral nutrtion lead to gallstones?

Answer 822

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

Question 823

Presentation of primary HSV-1 infection in children

Answer 823

Gingivostomatitis

Question 824

Systematic desensitization is an example of what type of therapy?

Answer 824

Behavioral therapy

Question 825

Listeriosis Sx (3)

Answer 825

1. Gastroenteritis
2. Septicemia
3. Meningoencephalitis

Question 826

Key AE of Niacin

Answer 826

It can decrease renal excretion of uric acid, precipitating acute gouty arthritis

Question 827

What are the (2) most important buffers in settings of diabetic ketoacidosis?

Answer 827

NH₃ and HPO₄^2-

(are urinated out as NH4 and H2PO4)

Question 828

Penicillin is structurally similar to what part of the pepidoglycan?

Answer 828

D-alanine-D-alanine

(penicillin looks like it, vanco directly binds to it)

Question 829

Effects of a Pudendal Nerve Injury

When does it usually occur?

Answer 829

1. Fecal/urinary incontinence
2. Perineal pain
3. Sexual Dysfunction

Often occurs as a stretch injury during labor

Question 830

Name the common complications of Psoriasis (3)

Answer 830

1. Psoriatic arthritis
2. Nail pitting
3. Uveitis

Question 831

What does Hep B look like on liver Biopsy?

Answer 831

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.

Question 832

Pathogenesis of Hirschsprung dz

What organ is always involved?

Answer 832

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

Question 833

Folate deficiency can lead to erythroid precursor cell apoptosis. What can be given to help allieviate this?

Answer 833

Thymidine supplementation

Question 834

Who should you avoid giving first gen. antihistamines to, and why?

Answer 834

Older patients, with cognitive or fxnal impairments

Question 835

Other than histamine, what is the best marker for mast cell activation?

Answer 835

Tryptase

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

Question 836

On what part of the collecting duct, does ADH work?

Answer 836

The medullary segment

Question 837

Differentiate between the following:

1. Western Blot
2. Northern Blot
3. Southern Blot

Answer 837

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

Question 838

Cocaine MOA

Answer 838

Inhibits synaptic reuptake of NE, DA, and Ser

Question 839

What is the prefered longterm tx for panic disorder?

Answer 839

SSRIs

Question 840

Describe the hormone status of patients w/ Klinefelter

Sperm count?

Answer 840

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

Azoospermia (no sperm)

Question 841

What parameter correlates with the potency of an inhaled anesthetic?

Answer 841

The minimal alveolar concentration.

This is the ED₅₀ and is inversly proportional to the MAC (the lower the MAC, the higher the potency)

Question 842

Where are the juxtaglomerular cells located? What is the effect of chronic renal hypoperfusion on them?

Answer 842

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.

Question 843

How does Hep B facilitate the infectivity of Hep D

Answer 843

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.

Question 844

How does prolonged exposure to loud noises cause hearing loss?

Answer 844

Damage to the sterociliiated hair cells of the Organ of Corti

Question 845

What are mutations in the KIT receptor tyrosine kinase, often assc. with?

Answer 845

Mast cell proliferation

Question 846

Systemic mastocytosis

1. Path
2. Presentation

Answer 846

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.)

Question 847

Which (2) drugs have the highest risk of causing drug-induced lupus erythematosus (DILE)?

Answer 847

1. Procainamide
2. Hydralazine

Question 848

Baclofen

1. MOA
2. Indication

Answer 848

1. Agonist at the GABA-B receptor
2. Effective monotherapy for spasticity secondary to both brain and spinal cord dz, including MS

Question 849

What mutation is assc. with medullary thyroid CA?

Answer 849

Activating mutations of the RET proto-oncogene

Question 850

Inactivating mutations of p53 are fairly common in what typeof thyroid CA?

Answer 850

Anaplastic thyroid CA

Question 851

RAS mutations are common in what type of thyroid CA?

Answer 851

Follicular thyroid CA (and some follicular adenomas)

Question 852

What is Congenital Pyloric Stenosis?

How does it present?

Answer 852

Smooth muscle hypertrohy of the pyloric muscularis mucosae

Presentation

1. projectile nonbilious vomit
2. olive-sized mass in distal stomach

Question 853

Interaction with what drugs can lead to chronic lithium toxicity?

Answer 853

1. Thiazides
2. ACE inhibitors
3. NSAIDs

Question 854

Potential serious complication of antithyroid drugs

What is the presentation and how should you respond?

Answer 854

Agranulocytosis

Sudden onset of fever and sore throat

(discontinue drug and take white count)

Question 855

Tx of CAH

Answer 855

Low doses of corticosteroids to suppress excessive ACTH secretion

Question 856

What does hemoglobin electrophoresis show for B-Thalassemia minor?

Answer 856

Slightly dec. HbA with inc. HbA₂ and HbF

Question 857

Identify this microorganism

Answer 857

N. gonorrhea

(gram-negative intracellular diplococcus)

Question 858

What factors does H. flu require to grow, and what other microorganism can provide them?

Answer 858

1. Factor X (hematin)
2. Factor V (NAD+)

S. aureus

Question 859

What organism?

Answer 859

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

Question 860

Pt presents w/ foot drop + inability to evert

Name the damaged nerve

Answer 860

Common peroneal

Question 861

COX-1 vs COX-2

Answer 861

COX-1: House keeping fxns such as platelet aggregation, gastric mucosal protection, etc. (consitutively expressed)

COX-2: Inducible enzyme only expressed by inflammatory tissues

Question 862

Celecoxib MOA

Answer 862

Selective COX-2 inhibitor

Question 863

What type of muscle fibers compose postural skeletal muscles? (Type I or Type II)

Answer 863

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]

Question 864

Describe the relationship between BMI and Leptin

Answer 864

Directly correlated

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

Question 865

Tryptophan is a precursor for what chemical?

Answer 865

Serotonin

Question 866

What is the antidote for serotonin syndrome?

Answer 866

Cyproheptadine (an antihistamine)

Question 867

Compare the embryological derivations of the anterior and posterior pituitary

Answer 867

Anterior: Surface ectoderm

Posterior: Neural tube

(Both are derivations of the ectoderm)

Question 868

Mesothelioma

1. Main finding on radiographic studies
2. Histopathology

Answer 868

1. CT/MRI: pleural thickening
2. Histo: long, slender microvilli and abundant tonofilaments

Question 869

Kids with Xeroderma pigmentosum are very sensitive to, what?

Answer 869

UV-light (due to an endonuclease deficiency)

Question 870

Why is dietary fructose rapidly metabolized?

Answer 870

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

Question 871

Caudal regression syndrome

1. What is it?
2. What condition is it commonly associated with?

Answer 871

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

Question 872

Pudenal nerve block

Blocks sensory to what area?

Motor to what area?

Answer 872

1. Sensory: Perineum
2. Motor: Urethral and anal sphincters

Question 873

MOA of inactivated viral vaccines

MOA of live-attenuated viral vaccines

Answer 873

Inactivated: humoral response (antibodies against hemagglutin, thus preventing viral entry into the cell)

Live-attenuated: cell-mediated + humoral

Question 874

What nerve runs along the orbital floor? What would be the result of damage to this nerve?

Answer 874

Infraorbital nerve

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

Question 875

What does the oxygen-dissociation curve of myoglobin look like?

Answer 875

Hyperbolic (not sigmoid)

Question 876

The common cardinal veins of the developing embryo ultimately give rise to what?

Answer 876

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

Question 877

What effect do almost all volatile (inhaled) anesthetics have on cerebral blood flow? What potential risk does this hold?

Answer 877

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

Question 878

What is the classic triad assc. with Parocysmal nocturnal hemoglobinuria?

Answer 878

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

Question 879

What is the role of beta-lactamase inhibitors? Give (3) examples.

Answer 879

Given with penicillin family antibiotics, so that they can work against beta-lactamase inhibitor secreting bacteria.

Ex: Clavulanic acid, sulbactam, and tazobactam

Question 880

Bleeding after a tooth extraction is suggestive of what? What do you give to stop the acute bleeding?

Answer 880

Hemophilia (dec. factor 8 or 9)

Give thrombin

Question 881

What accounts for the fistulas and strictures associated with Crohn’s Dz?

Answer 881

Transmural inflammation

Question 882

Acute Dystonic Reaction

1. What is it?
2. What causes it?

Answer 882

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

Question 883

What is Patent Foramen Ovale? What can it lead to?

Answer 883

Incomplete fusion of atrial septum primum and secundum

Can lead to paradoxical embolization of venous clots into the systemic arterial circulation

Question 884

Scaphoid fractures most frequently result from what? What is the largest risk associated with them?

Answer 884

Fall onto an outstretched hand

Large risk of avascular necrosis due to their weak blood supply

Question 885

How does chronic bronchitis appear on biopsy? (4)

Answer 885

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

Question 886

What is the most common benign liver tumor? (include description)

Should you biopsy?

Answer 886

Cavernous hemangioma

Cavernous, blood-filled vascular spaces of variable size lined by single epithelial layer.

DON’T BIOPSY! (likely to bleed)

Question 887

What type of residue is attached to lysosome-bound proteins?

Answer 887

Mannose-residue

Question 888

What specific serotype is Ankylosing Spondylitis associated with?

Answer 888

HLA B27 (a specific human leulocyte antigen class II serotype)

Emphasis on class TWO!!

Question 889

What other atopic dzs is eczema associated with? (2)

Answer 889

Allergic rhinitis and asthma

Question 890

Ca-125 serves as a marker for what CA type(s)

Answer 890

Epithelial ovarian CA

Question 891

Characteristic CXR for bronchial obstructive lesion

Answer 891

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

Question 892

What vessel of the portal circulation is associated with esophgeal varices?

Answer 892

Left gastric vein

Question 893

Give the layers of the stomach, in order.

Which layer does an erosion not go beyond?

Answer 893

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

Question 894

Name the autoantibodies assc. w/ SLE

Answer 894

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

Question 895

How does Lead cause anemia?

Answer 895

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

Question 896

What is one of the main pathological causes for a uniformly enlarged uterus?

Presentation?

Answer 896

Adenomyosis

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

Question 897

What test is used to confirm dx of menopause?

Answer 897

Elevated serum FSH (due to loss of feedback)

Question 898

How can opiods lead to increased pressures in the commmon bile duct/ gallbladder?

Answer 898

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

Question 899

Where does iron absorption primarily occur?

Answer 899

In the duodenum and the proximal jejunum

Question 900

Etiology for Mallory-Weiss Tears

Answer 900

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

Question 901

Which ovarian tumor secrtes testosterone?

Answer 901

Sertoli-Leydig

Question 902

Crigler-Najjar syndrome

1. Inheritance
2. Path

Answer 902

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

Question 903

t(15;17)

What CA?

Answer 903

APL (M3 AML variant)

Question 904

Methylmalonic acidemia

1. Etiology
2. Presentation

Answer 904

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

Question 905

Methylnalonic Acidemia

1. Labs
2. Dx

Answer 905

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

Question 906

Most common cause of unilateral fetal hydronephrosis

Answer 906

Inadequalte canalization of the Utereropelvic Jxn

Question 907

What mediates the glomerulonephritis assc. with PSGN?

Answer 907

Type III HSNT (IC deposition)

Question 908

In Cystinuria, there a defective transporter causes build up of what AAs in the intestinal lumen/kidneys?

Answer 908

COLA

Cysteine, Ornithine, Lysine, Arginine

(leads to nephrolithiasis)

Question 909

What does the following suffix indicate about a medication?

1. -cept
2. -nib

Answer 909

1. -cept: receptor molecule
2. -nib: kinase inhibitor

Question 910

Patients with hemochromatosis are at incrased risk for what?

Answer 910

Liver cirrhosis + hepatocellular carcinoma

Question 911

What is the substitution associated with Sickle Cell?

Answer 911

Valine for glutamic acid

Question 912

What is the triad associated with Wiskott-Aldrich syndrome?

Answer 912

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

Question 913

C1 inhibitor deficiency (C1INH)

What happens?

Answer 913

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

Question 914

Somatostatin Function

Answer 914

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

Question 915

Phentolamine vs Phenoxybenzamine

Answer 915

Both are a-antagonists

Phentolamine: reversible, competitive (effects can be overcome by dose)

Phenoxybenzamine: irreversible (effects cannot be overcome by dose)

Question 916

Pilocytic Astrocytoma

1. View on biopsy
2. View on gross

Answer 916

1. Biopsy: rosenthal fibers (eosinophilic, corkscrew fibers)
2. Gross: cystic + solid

CHILDREN ONLY!

Question 917

Tx of Drug-induced Parkisonism

Answer 917

1. Decrease/discontinue drug
2. Give anticholinergic

Question 918

3 tx for cyanide toxicity

Answer 918

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

DUI

Question 919

Glomangioma

1. Etiology
2. Presentation

Answer 919

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

Question 920

A decrease in what component of collagen is responsible for wrinkling?

Answer 920

Collagen fibril production

Question 921

Common tx for bradycardia?

Associated side effect?

Answer 921

Atropine

May increase introcular pressure, precipitating closed-angle glaucoma

Question 922

Why must alcohol be avoided when on metronidazole?

Answer 922

Can cause disulfiram-like effects, such as abdominal cramps, nausea, HA due to acetaldehyde accumulation

Question 923

Acetyl-CoA serves as an allosteric activator of what?

Answer 923

Gluconeogenesis (increases activity of pyruvate carboxylase)

Question 924

Porcelain gallbladder is associated with an increased risk of what?

Answer 924

Adenocarcinoma of the gallbladder

Question 925

What effect might an ASD have on pulmonary circulation?

Answer 925

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

Question 926

What is Niacin (vit B3) synthesized from? What other cofactors are needed?

Answer 926

Synthesized from Tryptophan

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

Question 927

High levels of what, serve to increase cholesterol solubility and decrease the risk of gallstones? (2)

Answer 927

1. Bile salts
2. Phosphatidylcholine

Question 928

What does FSH stimulate in males?

What does LH stimulate in males?

Answer 928

FSH: Sertoli to release Inhibin (feedsback)

LH: Leydig to release Testosterone (feedsback)

Question 929

Key differences between the pneumococcal conjugate and pneumococcal polysaccharide vaccines

Answer 929

Conjugate: Good for infants; more robust immune response via B and T cell activation

Polysaccaride: Good for adults; more serotypes covered (23 vs 13)

Question 930

A child falls while holding someone’s hand. On presentation, refuses to move elbow.

What is the injury?

Answer 930

The annular ligament is torn and displaced

Question 931

What arteries supply the head and neck of the femur?

Answer 931

The medial femoral circumflex and its branches

Question 932

Describe the alteration in resting respiratory function in obesity

Answer 932

Extrinsic restrictive pulmonary function tests are seen

(everything decreases except RV which remains normal)

Less capacity + air gets out faster

Question 933

What are cavernous hemangiomas (neuronal)?

What increased risk is associated with them?

Answer 933

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

Question 934

Physostigmine

1. MOA
2. Indication

Answer 934

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

Question 935

Neurofibromatosis Type 1

1. Inheritance
2. Mutation
3. Presentation (3)

Answer 935

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

Question 936

Where is the cortisol receptor located?

Answer 936

Within the cytoplasm

It then translocates to the nucleus after binding its substrate.

Question 937

How does vWF lead to increased PTT and bleeding time?

Answer 937

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

Question 938

Define Statistical Power

Answer 938

(1-Beta)

A study’s ability to detect a difference when one exists

Question 939

What is the relationship between transpeptidases and peniclllins/cephalosporins

Answer 939

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

Question 940

What artery/nerve run along the midshact of the humerus?

Answer 940

Radial nerve + deep brachial artery

Question 941

Name the triad associated with Hemochromatosis

Answer 941

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

Question 942

Follicular Lymphoma

1. Presentation
2. Associated translocation

Answer 942

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

Question 943

Efficacy

Answer 943

Max effect achievable

Question 944

During what portion of the TCA is GTP synthesized?

Answer 944

It is synthesized by succinyl-CoA synthetase during conversion of succinyl-CoA → succinate

Question 945

Key GI manifestation of lead poisoning

Answer 945

Constipation

Question 946

What is the result of non-fusion of the urethral folds in a male?

Answer 946

Hypospadia

(opening along ventral shaft of penis)

Question 947

Most common adverse effects of ADHD meds

Answer 947

Dec. appetite and insomnia

Question 948

What enzyme is most commonly deficient in impaired B-oxidation of fatty acids?

Answer 948

Acyl-CoA dehydrogenase (catalyzes the first step)

Question 949

Best tx for patients w/ PCOS who wish to become pregnant

Explain the MOA

Answer 949

Clomiphene

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

Question 950

Patients w/ CD4 counts

Answer 950

Prophylactic azithromycin to prevent Mycobacterium Avium Complex (MAC)

Question 951

What tx can be used to partially overcome food poisoning with C. botulinum?

Answer 951

Rapid stimulation

Question 952

Individual presents with vertical and torsional diplopia and an eye that is deviated upward.

What muscle is the issue?

Answer 952

Superior oblique

Question 953

The presence of which serologic marker is most likely to increase the risk of vertical Hep B transmission?

Answer 953

HBeAg (a marker of viral replication and increased infectivity)

Question 954

What process is directly stimulated by the NF-kB pathway?

Answer 954

NF-kB is a proinflammatory transcription factor that increases cytokine production

Question 955

What is the etiology for trendelenburg gait (hip drop)?

Answer 955

Injury to the contralateral superior gluteal nerve (superomedial quandrant)

Question 956

Where does bicarb to neutralize gastric acid come from?

Answer 956

Bicarb comes from the submucosal glands of the duodenum (Brunner glands) and from the pancreatic duct secretions

Question 957

What cell type composes the ovaries?

Answer 957

Simple cuboidal

Question 958

What female repro organs have simple columnar epithelium?

Answer 958

1. Fallopian
2. Uterus
3. Endocervix

Question 959

What female repro components have stratified squamous non-keratinized epithelium?

Answer 959

1. Ectocervix
2. Vagina

Question 960

What is the major virulence factor for S. pyogenes? What does it do?

Answer 960

Protein M

(Inhibits phagocytosis and complement activation)

Question 961

Streptomycin MOA

Answer 961

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

Question 962

Define spongiosus

Answer 962

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

Question 963

What (3) organs/systems does stimulation of B2 receptors, relax?

Answer 963

1. Peripheral vasculature
2. Bronchi
3. Uterus

Question 964

Common COD for patients w/ adult-type coarctation of the aorta (3)

Answer 964

1. LV failure
2. Ruptured aortic aneurysm
3. intracranial hemorrhage

(HTN associated complications)

Question 965

RNA produced by RNA Pol I

Answer 965

rRNA

(forms ribosome components)

Question 966

RNA produced by RNA Pol II

Answer 966

mRNA, snRNA, microRNA (gene silencing)

Question 967

RNA produced by RNA Pol III

Answer 967

1. tRNA
2. 5s rRNA

Question 968

Result of early antibiotics on preventing PSGN

Answer 968

Ineffective

(though useful for prevention of Acute RF)

Question 969

Inheritance of G6P dehydrogenase deficiency

Answer 969

X-linked recessive

Question 970

Other than IL-1, and IL-6, what other cytokine is critical in inducing a systemic inflammatory response?

Answer 970

TNF-a

Question 971

What is the effect of Phospholipase C activation?

Answer 971

Leads to activation of protein kinase C, via direct DAG activation or indirect IP3 induced, Ca2+

(Phospholipase C breaks PIP2 into DAG and IP3)

Question 972

Why does silicosis lead to an increased risk of TB?

Answer 972

Silicosis impairs macrophage function (disrupted by internalized silica particles)

Question 973

Name the key E.coli virulence factor assc. w/ neonatal menigitis

Answer 973

K1 capsular polysaccharide

Question 974

Name the stop codons

Answer 974

UAA

UAG

UGA

Question 975

In polymyositis, what autoantibodies are common? (2)

Answer 975

ANA

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

Question 976

Name the only sx of grave’s dz which is not improved via B-Blockers

Answer 976

Exophtalmos

Question 977

Equation for Odds Ratio

Answer 977

OR = ad/bc

Question 978

What is the first step of base excision repair?

Answer 978

Removal of the defective base via glycosylase

(the empty spot on the sugar backbone is then cleaved and removed by endonuclease + lyase)

Question 979

Explain the Haldane Effect

Answer 979

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

Question 980

1. Where in the lungs do supine patients tend to aspirate?
2. Upright patients?

Answer 980

1. Supine: posterior segment of upper lobes (and superior segment of lower lobes)
2. Upright: Base

RIGHT SIDE FOR BOTH

Question 981

What keeps a PDA open? What closes it?

Answer 981

Open: Prostaglandin E2 (E, kEEps it open)

Closes: Indomethacin

Question 982

In cases of Echinococcus granulosus, what can be the result of spilling of cyst contents during surgery?

Answer 982

Anaphylactic shock

Question 983

Li-Fraumeni Syndrome

1. Inheritance
2. Mutation
3. Family Hx

Answer 983

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

Question 984

What phenomenon facilitates dischare of urine from the umbilicus?

Answer 984

Failure of the urachus (allantois remnant), to obliterate at birth

Question 985

Methotrexate

1. What is it?
2. Indications

Answer 985

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

Question 986

Role of metalloproteinases during wound healing

Answer 986

Contracture (along with myofibroblasts)

Question 987

What is the most common cause of spontaneous lobar hemorrhage in the elderly?

What are the most common sites of this hemorrhage?

Answer 987

CEREBRAL AMYLOID ANGIOPATHY

(Commonly in the occipital and parietal lobes)

Question 988

What dz’s are Lewy bodies assc. w/?

Answer 988

Parkinson dz and Lewy body dementia

Question 989

What conditions lead to polyhydramnios (excessive amniotic fluid)?

Answer 989

1. GI obstruction
2. Anencephaly

Question 990

What kind of receptors contain zinc-finger binding domains?

Answer 990

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

Question 991

What is the role of releasing factors?

Answer 991

Recognize stop codons and terminate protein synthesis

Question 992

What nerve handles plantar foot sensory?

Answer 992

Tibial

Question 993

Factitious Disorder

Answer 993

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

Question 994

Etanercept

1. What is it?
2. Indication
3. What must you do first?

Answer 994

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

Question 995

Metyrapone MOA

Answer 995

Blocks 11-B-hydroxylase (steroid pathway)

Question 996

How do most enveloped nucleocapsid viruses acquire their lipid bilayer envelope?

(exception?)

Answer 996

By budding through the plasma membrane of the host cell.

(except for herpesviruses)

Question 997

What commonly occurs following an SAH? How can it be prevented?

Answer 997

Vasospasm (prevent with CCB)

Question 998

Patients w/ Actinic keratoses are at inc. risk for what?

Answer 998

Invasive squamous cell carcinoma

Question 999

Lab tests show no CD18 on leukocyte surfaces.

Dx?

Answer 999

Leukocyte Adhesion Deficiency

(They can’t cross into tissues)

Question 1000

Classic presentation for Phenylketonuria

Answer 1000

1. Seizures
2. Light pigmentation
3. Intellectual disability
4. “Musty” odor

Question 1001

Phenylketonuria

Pathology

What becomes an essential AA as a result?

Answer 1001

Results from the inability to convert phenylalanine to tyrosine (via the phenylalanine hydroxylase system).

Tyrosine becomes an essential AA

Question 1002

Glucagonoma

1. Presentation
2. Dx

Answer 1002

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

Question 1003

TOC for OCD

Answer 1003

SSRIs

Question 1004

Congenital torticollis

Answer 1004

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

Question 1005

How does VZV look on light microscopy?

Answer 1005

Intranuclear inclusions in keratinocytes + multinucleated giant cells

Question 1006

Tx of Graves’ ophthalmopathy

Answer 1006

High-dose glucocorticoids (ex. prednisone)

Question 1007

What mold has spherules packed with endosphores?

Answer 1007

Coccidioides immites

Question 1008

What viruses does the Aedes aegypti mosquito carry?

Answer 1008

Dengue + Chikungunya

Question 1009

A mass in the parotid gland, risks compressing what nerve?

Answer 1009

Facial

(leading to ipsillateral facial droop)

Question 1010

Transmission of congenital toxoplasmosis

Answer 1010

Transplacental (in utero)

Question 1011

Kiesselbach Plexus

Answer 1011

Point at the nasal septum where the anterior ethmoidal, sphenopalatine, and superior labbial arteries all meet.

(most common location for epistaxis)

Question 1012

What type of kidney stones are assc. w/ Crohn dz?

Answer 1012

Oxalate

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

Question 1013

Key pathogenesis for Alcohol-induced Hepatic Steatosis

Answer 1013

Dec. Free fatty acid oxidation secondary to excess NADH production by alcohol dehydrogenase and aldehyde dehydrogenase

Question 1014

What drug is useful for tx of both BPH and HTN?

Answer 1014

a1-blockers

Question 1015

Where do the intercostal nerves/vessels lie?

Answer 1015

Lower border of the ribs (subcostal)

Question 1016

What structural change indicates irreversible myocardial cell injury?

Answer 1016

Mitochondrial vacuolization

(loss of ability to further generate ATP)

Question 1017

Reid index

Answer 1017

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)

Question 1018

Mechanism of resistance against aminoglycosides

Answer 1018

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

Question 1019

When does cleft lip occur?

Answer 1019

When the maxillary prominence fails to fuse with the intermaxillary segment

Question 1020

When does cleft palate occur?

Answer 1020

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

Question 1021

Clinical manifestations of Babesiosis

Answer 1021

Flulike symptoms

(And labs show anemia + thrombocytopenia)

Question 1022

Dx of Babesiosis

Answer 1022

Blood smear shows Intraerythrocytic pleimorphic ring forms (maltese cross)

Question 1023

Echinocandin MOA

Answer 1023

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

Question 1024

Schizophrenia

1. What is sx are required for dx
2. Duration?

Answer 1024

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

Question 1025

What is the role of IgA on mucosal surfaces?

Answer 1025

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

Question 1026

What order of IV medications should be given to alcoholics/malnourished patients? Why?

Answer 1026

IV thiamine supplementation prior to IV dextrose

(or else risk precipitating Wernicke encephalopathy)

Question 1027

Genetic Recombination vs Reassortment

Answer 1027

Recombination: Crossover between 2 chromosomes from different viruses

Reassortment: Exchange of entire genome segments (segmented viruses only)

Question 1028

How is vision affected by age?

Answer 1028

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

Question 1029

What are the (5) P’s of Acute Intermittent Porpyria?

Answer 1029

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

Question 1030

Tx for Acute Intermittent Porphyria

Answer 1030

Glucose + heme

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

Question 1031

Jujenual/Ileal Atresia

1. Path
2. Sx
3. Gross

Answer 1031

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

Question 1032

What does PAS staining, stain for?

Answer 1032

Glycoprotein

Question 1033

What role does desmopressin play in clotting?

Answer 1033

Increases circulating factor VIII and endothelial secretion of vWF

Question 1034

Arginase Deficiency

Presentation

Answer 1034

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

Question 1035

Injury to what portion of the male genitalia is assc. with pelvic fractures?

Answer 1035

Posterior urethra

Question 1036

Sirolimus MOA

Answer 1036

Immunosuppressant

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

Question 1037

What is PPAR-gamma?

Answer 1037

An intracellular nuclear receptor that acts as a transcriptiona regulator of many genes involved in glucose and lipid metabolism

Question 1038

Adhesion of cells to the ECM involves integrin-mediated binding to what?

Answer 1038

1. Fibronectin
2. Collagen
3. Laminin

Question 1039

Tissue damage and resultant abscess formation is primarily caused by…

Answer 1039

Lysosomal enzyme release from neutrophils and macrophages

Question 1040

What tissue type is unable to use ketones and why?

Answer 1040

Erythrocytes

(lack mitchondria)

Question 1041

Zenker (false) diverticulum

1. How does it form?
2. Presentation?

Answer 1041

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

Question 1042

Why must you be cautious when using B-blockers for patients w/ DM?

Answer 1042

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

Question 1043

Budd-Chiari Syndrome

Path

Answer 1043

Occlusion of hepatic vein

Question 1044

What happens if a tRNA is mischarged w/ an incorrect AA?

Answer 1044

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

Question 1045

First line tx for general anxiety disorder

Answer 1045

SSRIs

Question 1046

What defines Major Depressive Disorder w/ Psych Features?

Answer 1046

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

Question 1047

How does Trypanosoma cruzi cause its effects?

Answer 1047

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

Question 1048

What effect do muscarinic agents have on the detrusor muscle?

Answer 1048

They constrict it!! This pushes urine out.

Question 1049

What effect does estrogen have on the H-P-Thyroid axis?

Answer 1049

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

Question 1050

What effect does prolonged ACTH stimulation have on the adrenal glands?

Answer 1050

HYPERPLASIA of the Zona fasiculata and reticularis

Question 1051

Describe the teratogenicity assc. w/ valproate

Answer 1051

Decreases levels of folic acid, thus increasing risk of NTDs

Question 1052

Describe the relationship between the solubility of gas, and the onset of action

Answer 1052

The more soluble a gas, the slower its onset of action

(less soluble gases saturate the brain quicker)

Question 1053

Name the (2) watershed ares of the colon, which are most susceptible to ischemic damage in hypotensive states

Answer 1053

1. Splenic flexure
2. Rectosigmoid colon

Question 1054

Stress-related Mucosal Dz

1. What is it?
2. Sx?

Answer 1054

• Acute gastric mucosal defects that develop in response to severe physiological stress
• Sx: multiple, small gastric erosions/ulcers, which may perforate or bleed

Question 1055

Friedreich ataxia

1. Sx
2. Path

Answer 1055

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

Question 1056

What dz is described as spotty necrosis on histo? What else does the histo show?

Answer 1056

Hep A

(also shows ballooning degeneration and mononuclear infiltrates)

Question 1057

What makes up the walls of Pancreatic Pseudocysts? How is this different from true cysts?

Answer 1057

Formed from granulation tissue and fibrosis

(true cysts are lined by epithelium)

Question 1058

Long term effect of Vibrio cholerae on cells of the colon

Answer 1058

None

(does not cause cell death at all)

Question 1059

Effect modification vs Confounding

Answer 1059

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

Question 1060

CD14 is the surface marker for what?

Answer 1060

Monocyte-macrophage cell lineage

Question 1061

Where does the left ovarian vein drain?

The right ovarian vein?

Answer 1061

Left: drains into the left renal vein

Right: drains directly into the IVC

Question 1062

Digoxin Clearence

Answer 1062

Renal

Question 1063

Describe the “preparation” stage in the stages of change model

Answer 1063

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

Question 1064

Which Benzos are preferred for patients w/ impaired hepatic metabolism?

Answer 1064

LOT

Lorazepam

Oxazepam

Temazepam

Question 1065

Relationship between Azathioprine and Xanthine oxidase

Answer 1065

Xanthine oxidase catalyzes one of the main mechanisms for azathioprine metabolism

(Any drug blocking XO will thus inc. the level of Aza)

Question 1066

How do you dx acute cholecystitis?

Answer 1066

Ultrasound or otherwise nuclear medicine hepatobiliary scanning

Question 1067

Identify #8

Answer 1067

Psoas muscle

Question 1068

Methotrexate AE

Answer 1068

Bone marrow suppression + liver function abnormalities

Question 1069

What mediates paraneoplastic cachexia

Answer 1069

TNF-a

Question 1070

Costosternal Syndrome (Costochondritis)

1. What causes it?
2. Sx

Answer 1070

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

Question 1071

What group does “reactive arthritis” from chlamydia, belong to? What does this mean?

Answer 1071

It belongs to the HLA-B27 assc., seronagtive spondyloarthropathies

(thus there is risk for sacroiliitis)

Question 1072

What organs synthesize heme?

Answer 1072

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

Question 1073

What is responsible for the hypercoagulative state of nephrotic syndrome?

Answer 1073

The loss of anticoagulant factors in the urine

(especially antithrombin III)

Question 1074

Thombotic Thrombocytopenic Purpura

1. What is missing?
2. What happens as a result?

Answer 1074

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

Question 1075

TTP

1. Presentation
2. Tx

Answer 1075

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

Question 1076

Stimulation of what adrenergic receptor causes increased IP3 release?

Answer 1076

a-1

Question 1077

Male born w/ feminized external genitalia (small phallus and hypospadia) that masculinizes at puberty.

Dx?

Answer 1077

5a-reductase deficiency

(converts testosterone to dihydrotestosterone, which mediates development of the external genitalia in the male fetus)

Question 1078

What must we be careful of early in tx w/ an ACE-Inhibitor?

Answer 1078

First dose hypotension

Question 1079

Presentation of patients w/ von Willebrand dz

Answer 1079

Lifelong Hx of mucosal bleeding (gingival, epistaxis, and/or menorrhagia)

Platelet levels are normal but they don’t fxn well

Question 1080

Hydroxyurea

MOA + Indication

Answer 1080

For sickle cell patients w/ frequent pain crises

Increases fetal hemoglobin (mechanism unknown)

Question 1081

Gardos channel blocker

1. Indication
2. MOA

Answer 1081

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

Question 1082

Which ribs overlie the spleen?

Answer 1082

Ribs 9, 10, and 11

Question 1083

Which ribs overlie the left kidney? Right kidney?

Answer 1083

Left: Ribs 11 and 12

Right: 12

Question 1084

Hemolytic uremic syndrome

Etiology/pathology

Answer 1084

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

Question 1085

Hemolytic Uremic Syndrome

Clinical features

Answer 1085

Hemolytic anemia (w/ schistocytes)

Acute kidney injury

Antecedent diarrheal illness

Thrombocytopenia

(HUS- HAAT)

Question 1086

What gene is abnormal w/ inherited Pulmonary Arterial HTN?

Answer 1086

BMPR2

Question 1087

What charaterizes Drug-induced lupus erythematosus?

Answer 1087

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

Question 1088

What type of individuals are genetically predisposed for Drug-induced lupus srythematosus (DILE)?

Answer 1088

Patients w/ expression of slow hepatic acetylators

Question 1089

In general, what is a Chiari malformation?

Answer 1089

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

Question 1090

Describe Chiari type I

(prognosis and sx)

Answer 1090

Relatively benign and presents in adulthood w/ occipital HA and cerebellar dysfxn

(type of Chiari malformation)

Question 1091

Describe Chiari type II

(prognosis and sx)

Answer 1091

Severe form. Affects neonates and often assc. w/ myelomeningocele and hydrocephalus

(Type of Chiari malformation)

Question 1092

Describe the onset of action and risk of dependence for Buspirone

Answer 1092

Slow onset and no risk of dependence

Question 1093

Tx of somatic symptom disorder

Answer 1093

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

Question 1094

What is the dx?

Frontal bossing

Delayed fontanel closure

Femoral/tibial bowing

Answer 1094

Rickets

Question 1095

What is required to activate 6-MP?

To deactivate it?

Answer 1095

Activate: HGPRT

Deactivate Xanthine Oxidase

Question 1096

Describe the biopsy findings of Subacute granulomatous (de Quervain) thyroiditis

Answer 1096

MIxed, cellular infilitration w/ occasional multinucleated giant cells

Question 1097

Describe the clinical features of Subacute granulomatous thyroiditis

Answer 1097

Painful thyroid enlargement and transient hyperthyroid sx, following a viral illness

Question 1098

Typical genotype of a complete mole and why

Answer 1098

46, XX

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

Question 1099

What is responsible for destruction of cells w/ decreased or absent MhC class I proteins on their surface?

Answer 1099

NK cells

Question 1100

What is Delusional disorder?

How does this differ from paranoid personality disorder?

Answer 1100

Delusional disorder: > or = 1 delusion in absence of other psychotic sx

Paranoid: general suspiciousness or distrust of everyone, w/o odd fixed belief

Question 1101

1. Potential consequences of CREST syndrome
2. Assc. antibodies

Answer 1101

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

Question 1102

Describe the pathogenesis of prion dz

Give the (2) major examples

Answer 1102

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

Question 1103

How (time-frame) does pheochromocytoma present?

Answer 1103

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

Question 1104

Anal fissures

1. What are they/ what causes them?
2. Most common location (be specific)?

Answer 1104

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)

Question 1105

Obturator nerve

1. What path does it follow?
2. How is it injured?
3. How does injury present?

Answer 1105

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

Question 1106

Where do the arteries going to the testicles/ovaries originate from?

Answer 1106

The gonadal arteries originate from the AA

Question 1107

Septic abortion

1. Presentation
2. Common pathogens assc.

Answer 1107

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

Question 1108

What is the targetoid skin disorder assc. w/ HSV?

Answer 1108

Erythema multiforme

Question 1109

Key AE of dihydropiridine CCBs (2)

Answer 1109

Peripheral Edema + Dizziness/lightheadedness

Question 1110

Rabies

1. Main source in the US
2. Prevention

Answer 1110

1. Bats
2. Killed vaccine

Question 1111

Rabies

Presentation

Answer 1111

Agitation + spasms progressing to coma

Question 1112

What is the most characteritic biochemical change in Huntington dz?

Answer 1112

Dec. GABA in the brain

Question 1113

1. What role does TGF-B play in the healing process?
2. What happens in the body if there is too much TGF-B

Answer 1113

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)

Question 1114

How do patients w/ familial chylomicroenmia syndrome frequently present?

Answer 1114

In childhood w/ recurrent episodes of acute pancreatitis

Question 1115

High levels of dietary aflatoxin exposure (produced by aspergillus) leads to what? What does this increase risk for?

Answer 1115

G:C → T:A transversion in codon 249 of the p53 gene

(Greatly increases risk for HEPATOCELLULAR CARCINOMA)

Question 1116

What is AA transamination and what serves as the cofactor for it?

Answer 1116

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)

Question 1117

What kind of diet must you place a patient on who has Pyruvate Dehydrogenase Comlex Deficiency and why?

Answer 1117

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

Question 1118

Name the (2) exclusively ketogenic AA’s (can’t be metabolized to pyruvate)

Answer 1118

Lysine and Leucine

Question 1119

First line tx of ADHD

Answer 1119

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

Question 1120

Local cutaneous AE of chronic topical corticosteroid administration (2 major ones)

Answer 1120

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

Question 1121

When a nerve is severed, what happens to the segment of axon still connectd to the cell body?

Answer 1121

Axonal reaction (sets the stage for regeneration)

• Swelling
• Nuclei displaced to periphery
• Nissl substance becomes fine, granular, and dispersed

Question 1122

Who do Ovarian teratomas most comonly occur in?

Answer 1122

Females age 10-30

Question 1123

Describe the histology of Schwannomas (2 key components)

Answer 1123

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

Question 1124

What runs through the hepatoduodenal ligament?

Answer 1124

The portal triad

(hepatic artery, portal vein, common bile duct)

Question 1125

Where in the peritoneum does the bladder sit?

Answer 1125

The bladder is extraperitoneal

Question 1126

Mucormycosis

1. Presentation
2. Dx

Answer 1126

1. Patient w/ diabetic ketoacidosis, presenting w/ facial pain, HA, and black necrotic eschar
2. Biopsy needed for dx

Question 1127

Where do the aspiration contents come from that cause lung abscesses?

Answer 1127

They are oropharyngeal contents (NOT STOMACH!)

Question 1128

Key translocation for Burkitt lymphoma

Answer 1128

t(8;14)

(c-Myc to Ig heavy chain)

Question 1129

c-Myc fxn

Answer 1129

Transcription activator

Question 1130

Tx for oral/esophageal candidiasis

Answer 1130

Nystatin

Question 1131

How do RBCs look in G6PD deficiency?

Answer 1131

Heinz bodies (Hb precipitation), which can be “bitten” from the cell forming bite cells

Question 1132

What role do metalloproteinases of inflammatory macrophages, play in plaque stability?

Answer 1132

These zinc-containing enzymes (Metalloproteinases) degrade ECM, making plaques more unstable

Question 1133

Reaction Formation

Answer 1133

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

Question 1134

Renal Angiomyolipoma

1. What is it composed of?
2. What dz is it associated with?

Answer 1134

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

Question 1135

Tuberous sclerosis

Presentation

Answer 1135

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

Question 1136

How does excess ammonia disrupt excitatory neurotransmission in the brain?

Answer 1136

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

Question 1137

What drugs for herpes virus do not require viral phosphorylation?

Answer 1137

Cidofavir and Foscarnet

Question 1138

What characterizes Borderline Personality Disorder?

Answer 1138

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

Question 1139

Achondroplasia

Path (including key mutation)

Answer 1139

Exaggerated inhibition of chondrocyte proliferation in the growth plates of long bones, due to FGFR3 mutation.

Question 1140

What side of the body does each cerebellar hemisphere coincide with?

Answer 1140

Ipsilateral

Question 1141

Type I (alpha) error

Answer 1141

Falsely concludes there is a stastical difference

Question 1142

Type II (Beta) error

Answer 1142

Falsely concludes that there is NO statistical difference

Question 1143

Berkson’s bias

Answer 1143

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

Question 1144

A high mitotic index (Ki-67 fraction) approaching 100% is typical for what CA type?

Answer 1144

Burkitt lymphoma

Question 1145

Where does Burkitt lymphoma happen in adults and what adults are most likely to have it?

Answer 1145

Pelvis/ abdomen

(HIV+ or generally immunocomprimsed adults)

Question 1146

Most common cause of Hyper-IgM syndrome

Answer 1146

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

Question 1147

Which vessels come together to form the IVC

Answer 1147

The right and left common iliac veins

Question 1148

Foreign bodies lodged in the piriform recess, put what nerve/reflex at risk?

Answer 1148

The internal laryngeal nerve, which mediates the afferent limb of the cough reflex

Question 1149

Dubin-Johnson Syndrome

Path

Answer 1149

Defective hepatic excretion of bilirubin glucuronides across the canaicular membrane, resulting in direct hyperbilirubinemia and jaundice

Question 1150

Dubin-Johnson Syndrome

Gross and Histo

Answer 1150

Gross: liver appears black due to impaired excretion of epinephrine metabolites

Histo: Epi metabolites apprear as dense pigments w/in lysosomes

Question 1151

What is the most specific test for S. pyogenes?

Answer 1151

The pyrrolidonyl arylamidase test (PYR)

Question 1152

Hydralazine

1. MOA
2. Indication

Answer 1152

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

Question 1153

What is the most common congenital heart defect associated w/ Down Syndrome

Answer 1153

A complete atrioventricular septal defect

Question 1155

What messenger system does Glucgaon use to exert its effects?

Answer 1155

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

Question 1156

What hormone receptors use PKA?

Answer 1156

TSH, glucagon, and PTH receptors

Question 1157

Uniparental disomy

1. What is it?
2. Give (2) examples

Answer 1157

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

Question 1158

What is the most common cause of Turner syndrome?

Answer 1158

Paternal meiotic nondisjuntion

Question 1159

What z-score represents 95% of the statistical distribution? 99%?

Answer 1159

95%: z-score = 1.96

99%: z-score= 2.58

Question 1160

What does a liver biopsy w/ green-brown plugs and pigment accumulation, signify?

Answer 1160

Cholestasis

Question 1161

First line tx for narcolepsy

Answer 1161

Modafinil (or other psychostimulants)

Question 1162

Rett Syndrome

Presentation

Answer 1162

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

Question 1163

Most common mutation assc. w/ Rett Syndrome

Answer 1163

MECP2 gene

Question 1164

Describe the histo and immunohisto for Small Cell Lung Carcinoma

Answer 1164

Histo: clusters of small, ovoid cells w/ scant cytoplasm and high mitotic count

Immunohisto: stains positive for neuroendocrine markers, especially chromagranin

Question 1165

Describe the murmur assc. w/ ASD

Answer 1165

Fixed splitting of S2

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

Question 1166

Metabolic effect of vomiting

Answer 1166

Metabolic acidosis

Question 1167

What is this dx?

Necrotizing vasculitis of upper/lower resp tract (causing ulcers, sinusitis, hemoptysis) + renal issues

Answer 1167

Wegener’s

Question 1168

HSP

Path

Answer 1168

It is an IgA-mediated type III HSN Rxn

(which is why it often follows an URT infxn)

Question 1169

What is the role of sunlight exposure in vitamin D activation?

Answer 1169

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

Question 1170

Benzos

MOA

Answer 1170

Positive allosteric modulation of GABA_A

Question 1171

Common eye-related injury w/ congenital CMV

Answer 1171

Chorioretinitis

Question 1172

What effect does pyruvate kinase deficiency have on RBCs and the spleen?

Answer 1172

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.

Question 1173

Oseltamivir

MOA

Answer 1173

Neuraminidase inhibitor

Question 1174

What causes hypersensitivity to intradermally injected tobacco extract?

Answer 1174

Being a heavy smoker

Question 1175

What type of vaculitis is Buerger dz?

Answer 1175

Segmenting (and medium sized vessels)

Question 1176

Decribe the (2) morphological variants of gastric adenocarcinoma

Answer 1176

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

Question 1177

Most prominent organisms associated w/ intraabdominal infxns

Answer 1177

Bacteroides fragilis and E. coli

Question 1178

Major SE of ganciclovir, especially in combination w/ bactrim or zidovudine

Answer 1178

Bone marrow suppression

Question 1179

What sort of antibodies can be expected in Pauci-immune RPGN?

Answer 1179

p-ANCA/c-ANCA

(will not show up on light micro or IF, unlike IC’s or antiglomerular BM antibodies)

Question 1180

Axillary Nerve

1. How is it injured?
2. How does injury present?

Answer 1180

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

Question 1181

How does synchronization of glycogen degradation w/ skeletal muscle contraction occur?

Answer 1181

Release of sarcoplasmic calcium following neuromuscular stimulation, causes activation of phosphorylase kinase, stimulating glycogen phosphorylase to inc. glycogenolysis

Question 1182

Neprilysin inhibitors (MOA)

Answer 1182

Prevent degradation of ANP

(Neprilysin normally breaks down natriuretic peptides)

Question 1183

In addition to the eosinophilia and respiratory issues, what is a major sx assc. w/ Churg-Strauss?

Answer 1183

Peripheral neuropathy

Question 1184

Capitate

Answer 1184

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)

Question 1185

DNA gyrase is aka…?

Answer 1185

Topoisomerase II

Question 1186

Fxn of DNA polymerase I

Answer 1186

The removal of RNA primers and replacement w/ DNA

Question 1187

What is responsible for “dimpling” that can occur in breast CA?

Answer 1187

Malignant infiltration of the suspensory ligaments, leading to fibrosis, shortening, and thus skin traction.

Question 1188

Affect of inhaled anesthetics on the liver? What lab values are affected?

Answer 1188

Can cause highly lethal fulminant hepatitis. Elevated AST and PT

Question 1189

What predisposes individuals for angiosarcoma?

Answer 1189

Axillary LN dissection which leads to chronic lymphedema.

(angiosarcoma is a misnomer, as it is technically a lymphangiosarcoma)

Question 1190

Best tx for severe hypoglycemia in a nonmedical setting

Answer 1190

Intramuscular glucagon

(IV dextrose in-hospital)

Question 1191

Effect of gallbladder hypomotility

Answer 1191

Bile concentration (since gallbladder absorbs water), leading to formation of BILE SLUDGE

Question 1192

What is the major determinant of cyanosis severity in tetralogy of fallot?

Answer 1192

The degree of obstruction of the right ventricular outflow tract

Question 1193

Daptomycin MOA

Answer 1193

Depolarizes the bacterial cell membrane

Question 1194

What is the most common site for acute compartment syndrome? What is housed in this site? (2)

Answer 1194

The anterior comportment of the leg, which contains:

1. Deep peroneal nerve
2. Anterior tibial artery/veins

Question 1195

Idenitifying characteristics of a craniopharyngioma (4)

Answer 1195

1. Suprasellar (rathke’s pouch)
2. Calcified Cysts
3. Cholesterol rich fluid w/in cysts
4. Children

Question 1196

During continous infusion, how long does it take to reach steady state?

Answer 1196

4-5 half-lives

Question 1197

What is the translocation assc. w/ follicular lymphoma? What does it lead to?

Answer 1197

t (14;18)

BCL-2

Question 1198

Most likely AE of SSRIs?

Answer 1198

Sexual dysfunction

Question 1199

Other name for “mole”

Answer 1199

Nevus

Question 1200

Osteoblastic lesions are also known as…?

Osteolytic?

Answer 1200

Osteblastic: sclerotic

Osteolytic: lucent (assc. w/ osteoclasts)

Question 1201

Elastin

What gives it its rubber-like properties?

Answer 1201

Extensive cross-linking between elastin monomers, which is facilitated by lysyl oxidase (related to lysine)

Question 1202

Tennis Elbow

1. What is injured?
2. What attaches to this injured point?

Answer 1202

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)

Question 1203

At what point does coagulative necrosis begin after an acute MI?

Answer 1203

4 hours

Question 1204

Multiple Myeloma

Sx/ presentation

Answer 1204

CRAB eating a Roll of M & M’s

hyperCalcemia

Renal involvement

Anemia

Bone lytic lesions

Rouleaux formation

Monoclonal

M spike

Question 1205

How does the glu → val change in HbS lead to sickling?

Answer 1205

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

Question 1206

(+) VDRL of the spinal fluid indicates, what?

Answer 1206

neurosyphilis

Question 1207

Medullablastoma

1. Location
2. Cell types
3. Who?

Answer 1207

1. Cerebellum
2. Primitive, blue cells (homer-wright rosettes)
3. Children

Question 1208

If uncorrected, what can vesicoureteral reflux lead to?

Answer 1208

Loss of nephrons and secondary HTN (due to all the inflammation)

Question 1209

What does EBV bind on the B-cell to gain entry?

Answer 1209

CD21

Question 1210

Effect of lactose intolerance on stool pH

Answer 1210

Bacterial fermentation of lactose lowers stool pH

Question 1211

Serum sickness

1. What is it?
2. What causes it?

Answer 1211

1. Type III HSN rxn to non human proteins, resulting in IC deposition
2. Fever, pruritis, skin rash, arthralgia, dec. complement levels

Question 1212

For patients w/ IBD, how are mutations leading to colorectal cancer different from the ones which lead to sporodic CRC?

Answer 1212

IBC patients develo early p53 and late APC mutations

Question 1213

Characteristic histo assc. w/ Reye syndrome

Answer 1213

Microvesicular steatosis of hepatocytes

(no inflammation or edema)

Question 1214

What dz is this associated with?

Answer 1214

Gaucher

(Most common LSD)

Question 1216

What portions of the nephron are most suceptible to ATN and why?

Answer 1216

The straight proximal tubule and thick ascending Loop of Henle

(higher oxygen demands due to active transport of ions)

Question 1217

Where are indirect and direct hernias located (relative to the inferior epigastric)?

Answer 1217

Indirect: lateral

Direct: medial

Question 1218

Prevention of neonatal tetanus

Answer 1218

Maternal vaccine

(passive immunity via transplacental IgG)

Question 1219

Describe the ulcers assc. w/ chlamydia

Answer 1219

small and shallow + large, painful LNs

Question 1220

Describe the ulcers assc. w/ syphillus

Answer 1220

single, well-circumbscribed

Question 1221

What is this?

Answer 1221

Candida albicans

(germ tube formation at 37 degrees C)

Question 1222

Calcipotriene

MOA and indication

Answer 1222

Psoriasis med that is a vitamin D analog, which binds to the vit D receptor and inhibits keratinocyte proliferation

Question 1224

What medications should be avoided for individuals with hypertrophic cardiomyopathy?

Answer 1224

Any that decrease preload and/or systemic vascular resistance

(you want both to be relatively high)

Question 1225

Where does the majority of water reabsorption occur (regardless of hydration status)?

Answer 1225

PCT

Question 1226

Differentiate pilocytic astrocytoma and medullablastoma

Answer 1226

Both are in kids

1. Pilo is more common and imaging shows both solid and cystic components
2. Medullo is always solid

Question 1227

What is the job of fructose 2,6 bisphosphonate?

Answer 1227

Helps control the balance between gluconeogenesis and glycolysis

Question 1228

Temporomandibular Disorder

1. What is wrong?
2. Presentation

Answer 1228

1. Damage/issue with the mandibular division of the trigeminal nerve
2. Pain/sx within the middle ear issues and muscles of mastication

Question 1229

Why do patients w/ MS develop urinary incontinence?

Answer 1229

Loss of inhibition of detrusor contraction in the bladder

Question 1230

What is the main way in which UV rays cause DNA damage?

(How is it corrected?)

Answer 1230

Formation of abnormal pyrimidine-pyrimidine covalent bonds (pyrimidine dimers)

Corrected via nucleotide excision repair

Question 1231

Lynch Syndrome

1. What is it?
2. What genes are mutated?

Answer 1231

1. Autosomal dominant dz caused by nucleotide mismatch repair
2. Mutation in MSH2 and MLH1

Question 1232

Calcineurin

Essential for what?

What (2) drugs block it?

Answer 1232

Essential for IL-2 activation

Blocked by the immunosuppressants cyclosporine and tacrolimus

Question 1233

Effect of high altitude exposure on blood gases

Answer 1233

Hypoxemia + respiratory alkalosis

Question 1234

What is HER2?

Answer 1234

Tyrosine kinase receptor

Question 1235

Most important environmental risk factor for pancreatic CA

Answer 1235

Smoking

Question 1236

Name this psych disorder:

Eccentric, odd beliefs/magical thinking, interpersonal awkwardness/anxiety (despite familiarity)

Answer 1236

Schizotypal

Question 1237

How might alpha-1 antitrypsin deficiency appear on histo?

Answer 1237

PAS (+) granules of unsecreted, polymerized AAT in the hepatocytes

Question 1238

What is responsible for local defense against Candida?

Systemic defense?

Answer 1238

Local: T cells

Systemic: Neutrophils

Question 1239

What role can CYP450 play in carcinogenesis?

Answer 1239

Many pro-carcinogens rely on CYP450 monoxygenase metabolization to become activated (and thus dangerous)

Question 1240

Rifaximin

1. MOA
2. Indication

Answer 1240

1. Antibiotic which alters GI flora to decrease intestinal production and absorption of ammonia
2. Hepatic Encephalopathy (too much ammonia due to liver damage)

Question 1241

TOC for trigeminal neuralgia

Answer 1241

Carbamazepine

Question 1242

What values characterize the dyslipidemia seen in insulin resistance?

Answer 1242

High TGs and low HDL

(no LDL involvement)

Question 1243

What kind of receptor is JAK2?

Answer 1243

Cytoplasmic tyrosine kinase receptor

Question 1244

Path of HbC dz

Answer 1244

Missence mutation leading to glutamate → lysine, change

Question 1245

What nerve provides sensation to the external auditory canal?

Answer 1245

Vagus branch (auricular branch)

Question 1246

Name the (3) muscles/ muscle groups involved in sitting up

Answer 1246

1. hip flexors (iliopsoas)
2. external abdominal oblliques
3. rectus abdominus

(I got up for HER)

Question 1247

Achondraplasia inheritance

Answer 1247

Autosomal dominant

Question 1248

Where do most RCCs originate from?

Answer 1248

The epithelial cells of the proximal renal tubules

Question 1249

Factor V Leiden

1. What is it?
2. Consequences?

Answer 1249

1. Inherited mutation causing factor Va resistance to inactivation by Protein C
2. Thrombosis in young person (usually pulmonary)

Question 1250

Role of N. meningitidis pili (fimbriae)

Answer 1250

Adherence to nasopharynx epithelium

Question 1251

What parts of the brain are most susceptible to “global ischemia”?

Answer 1251

Pyramidal cells of the neocortex or Hippocampus (#1!!!) and Purkinje cells of the cerebellum

Question 1253

PKU inheritance

Answer 1253

Autosomal recessive

Question 1254

What is responsible for the presentation assc. w/ Pemphigus Vulgaris?

Answer 1254

IgG autoantibodies against desmosomal proteins (eg, desmoglein– connects epithelial cells to epithelial cells)

Question 1255

What is responsible for the presentation assc. w/ bullous pemphigoid?

Answer 1255

IgG antibodies against hemidesmosomes (connect epithelium to BM)

Question 1256

Describe the potassium levels in patients w/ DKA

Answer 1256

Most have normal/high serum levels of potassium, despite a total body (i.e. intracellular) deficit.

dKa = dec. K+

(you must replace potassium as you manage these patients)

Question 1257

What accounts for the bimodal distribution of isoniazid metabolism speed in the population?

Answer 1257

The presence of genetically “fast” and “slow” acetylators, as INH is metabolized by acetylation.

(slow acetylators = inc. risk of AE)

Question 1258

What are metalloproteinases composed of?

Answer 1258

Zinc

Question 1259

Which SITS muscle is most vulnerable in a rotator cuff injury and why?

Answer 1259

Supraspinatus

(Due to impingement between the acromion and the head of the humerus)

Question 1260

BRAF V600E mutation is associated w/ dz?

Answer 1260

Melanoma

Question 1261

Dengue Fever

Presentation

Answer 1261

1. Retro-orbital pain
2. Break-bone fever (hemorrhagic)
3. Rash
4. Thrombocytopenia

Question 1262

Primary vs secondary infxn of Dengue

Answer 1262

Primary: often asymptomatic

Secondary: often much worse (different serotype)

Question 1263

Shiga-like toxin MOA

Answer 1263

Inactivates 60S ribosomal subunit

Question 1264

What is often seen in renal tubular lumen for patients with multiple myeloma?

Answer 1264

Bence-Jones proteins (large eosinophilic casts in tubular lumen)

Question 1266

Why does Hep C not integrate into the host genome?

Answer 1266

It lacks reverse transcriptase

Question 1267

What are the (2) key growth factors that promote angiogenesis in neoplastic and granulation tissues?

Answer 1267

1. VEGF
2. Fibroblast growth factor

Question 1268

Why is the H-flu vaccine conjugated to a tetanus toxoid or n. menigitidis membrane protein?

Answer 1268

Needed to elicit Th2 response

Question 1269

In addition to its anti-seizure effects, what other use does valproate have?

Answer 1269

It can tx manic episodes assc. w/ bi-polar dz

Question 1270

What is the common mechanism for the protective factors against ovarian CA?

Answer 1270

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)

Question 1271

How does the effect of exogenous secretin differ between normal gastric G cells and ZE gastrinomas?

Answer 1271

Secretin (in addition to secreting biochem), normally serves to decrease gastrin secretion from G cells.

In ZE, it paradoxically causes an increase in gastrin

Question 1272

Interferons a and B

1. What produces them?
2. What is their role?

Answer 1272

1. Produced by most human cells in response to viral infections
2. Halts viral protein synthesis and promotes apoptosis of infected cels

Question 1273

Splenic Vein Thrombosis

1. How might it occur?
2. How might it present in imaging?

Answer 1273

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

Question 1274

What do you give to treat TCA overdose?

Answer 1274

Sodium bicarb

Question 1275

The toxin for traveler’s diarrhea is similar to what other toxin?

Answer 1275

Cholera toxin

Question 1276

What enzymes require thiamine as a cofactor? (2)

Answer 1276

Pyruvate dehydrogenase and a-ketoglutarate dehydrogenase

Question 1277

What route does shigella use for invasion?

Answer 1277

Microfold (M) cells of the Peyer patches

Question 1278

Superoxide dismutase

Function

Answer 1278

Neutralizes ROS, preventing cell injury

Question 1279

What is myoedema and what is it associated with?

Answer 1279

Focal “mounding” of muscle (lump formation) following percussion.

Assc. w/ hypothyroid myopathy

Question 1280

How do you distinguish between tuberculoid leprosy and lepromatous leprosy?

Answer 1280

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)

Question 1281

What compound tends to be low in patients w/ narcolepsy?

Answer 1281

Orexin (hypocretin)

Question 1282

Ondansetron

MOA/indication

Answer 1282

Inhibits serotonin receptors and is used to treat N/V following chemo

Question 1283

Subclavian Steal Syndrome

Answer 1283

Severe stenosis of proximal subclavian artery, leading to reversal in blood flow from the contralateral vetebral artery to the ipsilateral vertebral artery

Question 1285

Damage to what structure leads to a pure sensory stroke?

Answer 1285

Thalamus

Question 1286

Main cause for Lacunar infarcts

Answer 1286

Small vessel occlusion/lipohyalinosis in the deep brain vessels, usually due to DM or HTN

Question 1287

Which fungi?

Mississippi and Ohio River Basins

Answer 1287

Histoplasma capsulatum

Question 1288

Common cause of acute bacterial arthritis in sexually active young adults.

Answer 1288

N. gonorrhoeae

Question 1289

Auer rods are chrystalized, what?

Answer 1289

PEROXIDASE!!! (MPO+)

Question 1290

How do the particles look in silicosis

Answer 1290

Birefringent silica particles surrounded by fibrous tissue

Question 1291

Transitional Cell Carcinoma (of the bladder)

Presentation

Answer 1291

Painless, gross hematuria in an older male

(Usually do to smoking or occupation)

Question 1292

Goodpasture syndrome

Pathology? Presentation?

Answer 1292

Anti GBM antibodies and anti-alveolar antibodies

(Present w/ hemotysis and renal failure)

Question 1293

What does Aldolase B deficiency cause?

Answer 1293

Hereditary fructose intolerance

Question 1294

Milirinone/inamrinone

1. Drug type
2. Drug effect

Answer 1294

1. Phosphodiesterase-3 inhibitor
2. Increases cAMP concentration leading to inc. cardiac contractility and vasodilation

Question 1295

Why is Primaquine added to the tx regimen w/ Chloroquine?

Answer 1295

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.

Question 1296

In sarcoidosis what enzyme is found to be increased in the serum?

Answer 1296

ACE

Question 1297

Name the Retroperitoneal Abdominal Organs

Answer 1297

SAD PUCKER

Suprarenal glands

Aorta/IVC

Duodenum (except 1st part)

Pancreas (head/body)

Ureters and bladder

Colon (ascending and descending)

Kidneys

Esophagus

Rectum

Question 1298

Damage to what side of the brain can lead to neglect?

Answer 1298

The non-dominant side

Question 1299

What is the status of sodium in the blood for CF patients?

Answer 1299

Hyponatremia (they lose sodium via sweat because it is normally reabsorbed with Cl-)

Question 1300

What’s the main difference in symptoms between low-potency and high-potency anti-psychotics?

Answer 1300

Low: non-neurological (sedation, anticholinergic, orthostatic hypotension)

High: extrapyramidal

Question 1301

What component of n. meningitidis assist it in resisting phagocytosis? What part is responsible for its toxic effects?

Answer 1301

anti-phagocytosis: polysacharide capsule

toxicity: outer membrane lipooligosaccharide (LOS), [analogous to LPS of enteric rods]

Question 1302

What parts of the spinal cord can be affected by syringomyelia?

Answer 1302

Commonly begins w/ the STT, but later stages will also compromise the DCT and/or the CST

Question 1303

Serum antibodies to the phospholipase A2 receptor is indicative of what?

Answer 1303

Membranous nephropathy

(PLA2R is found in the podocytes)

Question 1304

How can Chron’s lead to gallstones?

Answer 1304

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.

Question 1305

Why doesn’t axonal regeneration occur in the CNS?

Answer 1305

Persistence of myelin debris, secretion of neuroinhibitory factors, and development of dense glial scars.

Question 1306

Psoas abscess

1. Presentation
2. Dx

Answer 1306

1. Fever, back pain, inguinal mass, difficulty walking
2. (+) psoas sign– pain when hip is extended

Question 1307

(2) key vascular signs of abusive head trauma

Answer 1307

1. Subdural hemorrhage
2. Retinal hemorrhage

Question 1308

What is the triad associated w/ Normal pressure hydrocephalus?

Answer 1308

Wet, Wobbly, Wacky

(urinary incontinence, ataxia, cognitive dysfunction)

Question 1309

Synovial fluid showing leukocyte count > 100,000 and no crystals

Dx?

Answer 1309

Septic arthritis

Question 1310

How can hypertriglyceridemia lead to acute pancreatitis?

Answer 1310

If a patient has >1000 mg/dL of TGs, the [FFA] exceeds the binding capacity of albumin and leads to direct tissue injury

Question 1311

What (3) enzymes/rxns require Biotin (vit. B7) as a cofactor?

What can often block the fxning of biotin?

Answer 1311

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)

Question 1312

Pick’s Dz

1. Gross presentation
2. Microscopic presentation

Answer 1312

1. Pronounced atrophy of frontal and temporal lobes
2. Pick bodies (cytoplasmic inclusions of microtubule-associated protein tau)– silver staining

Question 1313

Mutation of what gene leads to Bilateral acoustic Neuroma?

Answer 1313

NF2

(NF2 = bilateral acoustic neuroma)

Question 1314

AE of Ethambutol

Answer 1314

Optic neuropathy

Question 1315

Presentation assc. w/ weakness in the trapezius muscle

Answer 1315

1. Impaired abduction above the horizontal
2. Shoulder drooping

Question 1316

Central Retinal Artery Occlusion

1. Presentation
2. Funduscopic exam

Answer 1316

1. Sudden, painless, monocular blindness
2. “Cherry-red macula” (has its own blood supply) and pale retina

Question 1317

Why is hypernatremia not seen in patients w/ hyperaldosteronism?

Answer 1317

Aldosterone escape:

Inc. sodium → inc. GFR → filtration → dec. sodium retention

(this prevents volume overload)

Question 1318

Loss of which neurons is characteristic of Huntington Dz?

Answer 1318

Caudate/Putamen

(indirect path of the motor circuit)

Question 1319

Most common disorder of the urea cycle

Answer 1319

Ornithine transcarbamylase deficiency

(hyperammonemia and elevated urinary orotic acid)

Question 1320

Where does the great saphenous vein originate? Where does it travel up?

Answer 1320

Originates at the medial side of the foot, courses anterior to the medial malleolus and then travels up the medial leg/thigh

Question 1321

Hepatic Angiosarcoma

1. Associated with what?
2. What do the tumor cells express?

Answer 1321

1. Assc. w/ carcinogens such as arsenic, thorotrast, and polyvinyl chloride
2. Express CD31 (PECAM)

Question 1322

What is nonbacterial thrombotic endocarditis most commonly associated with?

Answer 1322

Advanced malignancy or inflammatory dz/sepsis

Question 1323

What effect might carcinoid syndrome have on the heart?

Answer 1323

Plaque like deposits of fibrous tissue on the right heart endocardium, which may progress to pulmonic stenosis and/or restrictive cardiomyopathy

Question 1324

What is the job of arachnoid granulations?

Answer 1324

To absorb CSF, to remove it from the subarachnoid space.

(A malfunction here could cause communicating [normal pressure] hydrocephalus)

Question 1325

What predisposes patients to lymphangiosarcoma?

Answer 1325

Persistent lymphedema (due to chronic dilatation of lymphatic channels)

Question 1327

What is an interscalene nerve block used for?

(what must you be careful of?)

Answer 1327

To anesthetize the brachial plexus for shoulder/upper arm procedure.

(Must be careful because the phrenic is almost always affected)

Question 1328

Anti-Yo, Anti-P/Q, and anti-Hu are the most common antibodies associated with what dz?

Answer 1328

Paraneoplastic Cerebellar Degeneration

(an autoimmune attack of the cerebellum for CA patients)

Question 1329

Bell’s palsy

Answer 1329

Idiopathic paresis of the facial nerve

Question 1330

What is Hypoxic-ischemic Encephalopathy and what would it show on autopsy?

Answer 1330

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)

Question 1331

First line tx of essential tremor

Answer 1331

Propranolol

Question 1332

What cells stain (+) for synaptophysin?

Answer 1332

Neurons

(and thus tumors of neuronal origin)

Question 1333

Is ulnar deviation wrist aBduction or wrist aDduction?

Answer 1333

aDduction

Question 1334

Buprenorphine

MOA and potential effect

Answer 1334

Partial opiod agonist w/ low activity but high affinity to mu-receptor– thus it can precipitate w/drawal

Question 1335

More than 1/2 of patients w/ Temporal Arteritis, have what sx associated?

Answer 1335

Polymyalgia Rheumatica!!

Question 1336

Most common COD in Friedreich Ataxia

Answer 1336

Hypertrophic cardiomyopathy

Question 1337

Phrenic nerve arises from which spinal cord segments?

Answer 1337

C3-C5

Question 1338

Options to assist patients in quiting smoking

Answer 1338

1. Varenicline (partial agonist of nicotinic Ach receptors
2. Bupropion

Question 1339

What characterizes Adenocarcinoma in situ of the lung?

Answer 1339

This preinvasive lesion is characterized by growth along intact alveolar septa, w/o vascular or stromal invasion.

Can spread aerogenously and be invasive!

Question 1340

What do Granulosa Cell Tumors of the Ovary, secrete?

Answer 1340

Estrogen

Question 1341

Cavernous Sinus Thrombosis

Presentation

Answer 1341

Deficits in CN’s III, IV, V and VI, following an infection

Question 1342

Primary mechanism for excess copper removal in the healthy human body?

Answer 1342

Hepatic excretion in the bile

Question 1343

Role of glycerol kinase

Answer 1343

Breakdown glycerol (from TGs) to eventually create energy/glucose

Question 1344

Prostacyclin action

Answer 1344

1. Vasodilates
2. Inhibits platelet aggreggation
3. Increases vascular permeability

(All the opposite of thromboxane A2)

Question 1345

Diphenoxylate

MOA and indication

Answer 1345

Anti-diarrheal

Binds mu-opiod receptor to slow motility of the gut

Question 1346

What role can proteosomes play in tx of multiple myeloma?

Answer 1346

Plasma cells in MM are producing lots of protein so they are particlular susceptible to proteosomes. The result is apoptosis.

Question 1347

How does INH lead to peripheral neuropathy?

Answer 1347

By decreasing vitamin B6 levels.

It is NOT DIRECTLY TOXIC ITSELF!

Question 1348

The PI3K/Akt/mTOR pathway, is an intracellular pathway for what?

Answer 1348

1. Anti-apoptosis
2. Pro-cell proliferation
3. Pro-angiogenesis

(All play a role in CA)

Question 1349

What is the best follow-up test for an elevated alk phosph of unknown etiology?

Answer 1349

y-glutamyl transpeptidase

Question 1350

Anti-mitochondrial antibodies are typically found in what disease?

Answer 1350

Primary biliary cirrhosis

Question 1351

What is the most common trigger for DIC in pregnancy?

Answer 1351

The release of tissue factor (thromboplastin) from an injured placenta, into maternal circulation

Question 1352

Prolonged QT + Neurosensory deafness

What Dz?

Answer 1352

Jervell and Lange-Nielsen Syndrome

Question 1353

Where is H. pyolori found at the greatest concentration?

Answer 1353

The prepyloric area of the gastric antrum (just before the pyloric sphincter)

Question 1354

What are the (2) types of Chronic Gastritis?

Answer 1354

Type 1: (fundus/body) Autoantibodies to parietal cells → pernicious anemia + achloridia

Type 2: (antrum) H. pylori Bacteria → inc. CA risk (MALT or adenocarcinoma)

“A” comes before “B”

Question 1355

Toxic megacolon is mostly associated with which IBD?

Sx + Dx?

Answer 1355

Ulcerative colitis

Abdominal pain/distension, bloody diarrhea, signs of shock.

Abdominal XR (colonoscopy and barium contrast study are contraindicated due to perforation risk)

Question 1356

What are the (2) distinct regulatory mechanisms of the lac operon?

Answer 1356

1. Negative via binding of the repressor protein to the Operator locus
2. Positively via binding by cAMP-CAP binding upstream from the promoter region

N-O = NO

positive = promoter

Question 1357

Chronic Mesenteric Ischemia

Answer 1357

Atherosclerosis involving the mesenteric arteries, which leads to bowel hypoperfusion during meals and subsequent pain.

Question 1358

What causes the esophageal dysmotility associated w/ CREST syndrome?

Answer 1358

Atrophy and fibrous replacement of the muscularis in the lower esophagus. Leads to the LES becoming atonic and dilated (can result in GERD)

Question 1359

CEA levels are useful for the monitoring of what dz?

Answer 1359

Colon CA

Question 1360

Necrotizing enterocolitis

1. Path
2. Pt demographic

Answer 1360

1. Bacterial invasion + ischemic necrosis of the bowel wall
2. Asc. w/ premature newborns and enteral feeding (tube to stomach)

Question 1361

Necrotizing enterocolitis

Dx

Answer 1361

Abdominal XR showing air in the bowel wall

Question 1362

The presence of erythroid precursors in organs such as the liver and spleen is indicative of what?

Answer 1362

Extramedullary hematopoiesis (oft assc. w/ severe chronic hemolytic anemia, such as B-thalassemia)

Question 1363

What compound is added to stored blood and what effect might it have on a patient?

Answer 1363

Citrate

It chelates Ca2+ and Mg, and thus may reduce their plasma levels

Question 1364

Lipid A

Answer 1364

The toxic component of LPS

(Causes macrophage activation leading to sx of septic shock)

Question 1365

Autism spectrum disorder is typically recognized by what age?

Answer 1365

2y

Question 1366

What determines whether or not an enveloped virus can attach to a specific host cell?

Answer 1366

Whether or not a viral envelope glycoprotein w/ a high binding affinity for a host cell surface glycoprotein is present

Question 1367

EBV commonly stimulates B cells to do what?

Answer 1367

Proliferate continously

(ie immortalization)

Question 1368

Monospot test is aka what?

Answer 1368

Heterophile Antibody Test

Question 1369

Pseudomonas

Motile or non-motile?

Answer 1369

MOTILE!!

Question 1370

Key difference between B-ALL and T-ALL

Answer 1370

T-ALL has thymic mass

Question 1371

What are the (2) major causes of concern w/ theophylline intoxication?

Answer 1371

1. Seizures
2. Tachyarrhythmias

Question 1372

What are the (2) most important steps in workup of metabolic alkalosis?

Answer 1372

Ascertaining the patient’s volume status and urine Cl-

Question 1373

Longterm risk w/ PCOS (and why?)

Answer 1373

Endometrial hyperplasia/carcinoma

(anovulation leads to progesterone-estrogen misbalance)

Question 1374

Meglitinides MOA

Answer 1374

Close the ATP-dependent K+ channel in the pancreatic beta cell membrane, inducing depolarization and thus stimulating insulin release

Question 1375

What drugs tx N/V from…

Chemo?

GI issues?

Answer 1375

Chemo: dopamine receptor antagonists, serotonin antagonists, Neurokinin 1 (nK1) receptor antagonists

GI: antimuscarinics, antihistamines

Question 1376

Activating mutations of the KRAS gene lead to what?

Answer 1376

Constitutive activation of the epidermal growth factor (EGFR) pathway, promoting increased cell proliferation and growth.

Question 1377

Drug-Induced Interstitial Nephritis

Presentation

Answer 1377

Fever, rash, and acute renal failure following administration of certain drugs (ex. penicillin derivatives). Also see pus (often eosinophils) in the urine

Question 1378

Wet vs Dry Age-related Macular Degeneration

Answer 1378

Dry: basic gradual vision loss in one or both eyes

Wet: Inc. VEGF, in response to Dry AMD

Question 1379

Dx of Wet Age-related Macular Degeneration

Answer 1379

Fundoscopy showing grayish-green subretinal discoloration w/ adjacent fluid/hemorrhage

Question 1380

Key difference between dysplasia and carcinoma

Answer 1380

Dysplasia is reversible

Question 1381

What does bone-specific alkaline phosphatase reflect?

Answer 1381

Osteoblastic activity

Question 1382

What do TRAP, urinary hydroxyproline, andurinary deoxypyridinoline reflect?

Answer 1382

Osteoclastic activity

(urinary hydroxyproline is the most reliable)

Question 1383

Phencyclidine MOA

Answer 1383

PCP is an NMDA receptor antagonist

Question 1384

Why do reticulocytes stain blue w/ Wright-Giemsa stain?

Answer 1384

Residual ribosomal RNA

Question 1385

How does PSGN look on light microscopy?

On IF?

On EM?

Answer 1385

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)

Question 1386

What is the role of T-tubules?

Answer 1386

They bring AP into the interior of the muscle fibers

Question 1387

Effect of severe htN in the retinal precapillary arterioles

Answer 1387

Endothelial disruption, necrosis and subsequent hemorrhage

Question 1388

Main dose-limiting AE of vincristine?

Answer 1388

Neurotoxicity

Question 1389

What happens to phosphate levels in kidney dz?

Answer 1389

They increase, due to a decreased filtered load

Question 1390

What does a stool guiac test screen for?

Answer 1390

Occult blood

Question 1391

Rat poison has the same toxicities as what drug? How do you tx?

Answer 1391

WARFARIN (so tx w/ FFP)

Question 1392

Terbinafine MOA

Answer 1392

Antifungal which inhibits squalene epoxidase

Question 1393

What can reverse the effects of methotrexate?

Answer 1393

N-f-THF (folinic acid, leucovorin) supplementation

Question 1394

Essential fructosuria

1. What is it?

Answer 1394

Benign autosomal recessive disorder which causes some dietary fructose load to be secreted in the urine unchanged

(due to defective fructokinase metabolism)

Question 1395

Testing for fructose in the urine

Answer 1395

(+) copper reduction test

(-) urine dipstick

Question 1396

What is one of the most serious complications of the recovery phase of ATN?

Answer 1396

Hypokalemia (can cause arrhythmia)

Question 1397

What are the (2) most characteristic signs of dermatomyositus?

Answer 1397

Gottron papules (pictured) and heliotrope rash (rash on eyelids)

Question 1398

Presentation of IgA nephropathy (Berger dz)

Answer 1398

Recurrent, self-limited, painless hematuria w/in 5 days after a URI

Question 1399

List the cephalosporin-resistant organisms

Answer 1399

LAME

Listeria, MRSA, Enterococci, Atypicals

Question 1401

Placenta accreta

Answer 1401

When the placenta adheres to the myometrium as opposed to the endometrium (can cause severe postpartum hemmorhage)