June 1st Exam

Question 1

Drugs that block Folate :

= NTDs

Answer 1

1. Methotrexate (RA and cancer)
2. Sulfasalazine (RA , IBD)
3. Trimeterene ( HCTZ diuretic, edema and HTN)
4. Trimethoprim (Cystitis , pneumocystis) + Sulfanethoxalate

= inhibit dihydrofolate reductase (1st tri, limit precursors for DNA synthesis of cell growth)

5. Valproic Acid, Carbamazepine, Phenytoin (Bipolar and Seizure disorders)

Question 2

Retinoids and Vit A and preg

Answer 2

How genes blocking

= brachial arch problems ( CNS, Thymic, Craniofacial defects)

Question 3

ACE inh and preg

Answer 3

In 2nd + 3rd tri

= Renal Dysplasia (pulm hypoplasia, limb contractions, growth restriction, cord compression)

Question 4

Sacral agenesis in preg occurs in who

Answer 4

DM pts

Question 5

Pregnancy and :

1. Syphilis
2. CMV
3. Rubella
4. Hepes

Answer 5

1. Syphilis = bone lesions and defects, Hutchinson teeth, periostitis, osteochondritis, RASH (palms /soles) , rhinorrhea
2. CMV = hearing probs, microcephaly, periventricular calcifications
3. Rubella = hearing probs , cataracts, PDA
4. Hepes= vesicular, ulcer rash (intrapartum meningitis)

Question 6

TB drugs : side effect

1. Rifampin
2. Isoniazid
3. Pyrazinamide
4. Ethambutol

Answer 6

1. Rifampin = rash, red/orange body fluids, Cytopenia, GI probs
2. Isoniazid = X VIT B6, hepatotoxic
3. Pyrazinamide = hyperuricemia, hepatotoxic
4. Ethambutol = optic neuropathy

Question 7

TB drugs : MOA

1. Rifampin
2. Isoniazid
3. Ethambutol

Answer 7

1. Rifampin = inhibit bacterial DNA- dependent RNA Polymerase
2. Isoniazid = Inhibit Mycolic Acid synthesis
3. Ethambutol = Inhibit Arabinosyl transferase

Question 8

1. Iliohypogastic nerve innervates
2. Ilioingunal nerve
3. Genitofemoral N

Answer 8

1. Iliohypogastic nerve : suprapubic + gluteal sensation (anterolateral abd wall muscles) ,can get injured in appendectomy and cause suprapubic burning
2. Ilioingunal nerve : upper + medial thigh + external genitalia
3. Genitofemoral N : Upper anterior thigh + motor genitalia

Question 9

P bodies are what

Answer 9

In cytoplasm bind to mRNA and prevent them from being translated ( decapping, miRNA silencing, exonucleases, mRNA storage and release when ready)

Question 10

AAUAAA means

Answer 10

Cleave the mRNA there and add the polyA tail after it (3’end)

Question 11

5’ end mRNA capping is done by what

Answer 11

Guanine 7-methyltransferase adding the methyl group to guanine cap

Question 12

Drugs for Primary Adrenal insufficiency

Answer 12

1. Hydrocortisone : increase cortisol ( increasing vasoconstriction)
2. Fludrocortisone : increase MINERALCORTIcoIds ( aldosterone) = increase BV volume and vasoconstriction

Question 13

Aldosterone acts on what cells

Answer 13

Principal cells CT kidney

Question 14

Desmopressin

Answer 14

1. ADH given in DI

2 increase F8 and vWF

Question 15

What other things happen in Graves’ disease that is specific to this disease and no other type of hyperthyroidism

Answer 15

DX with TRAb (Thyrotropin ABs)

1. Pretibial myxedema (thickening and induration of skin over shins)
2. Opthalmopathy ( retro-orbital tissues causing proptosis)

= TSH stimulation can happen in other parts of the body leading to glycosaminoglycan accumulation in these areas

Question 16

Cholestyramine MOA

Answer 16

Increase hepatic cholesterol and bile acid synthesis (MOA = increase excretion of cholesterol + bile acids)

Question 17

Ileum absorbs what

Answer 17

IF + bile acid

Question 18

What causes hyperglycemia in stress situations

Answer 18

Hepatic glycogenolysis + gluconeogenesis (from secretary cortisol, catecholamines, glucagon, and inflammatory cytokines)
+ increase GLUT1 in CNS (increase brain glucose uptake)

Question 19

GH uses what pathway and 3 others that use this pathway

Answer 19

JAK STAT ( causing IGF-1 making ) 
( cytokines, EPO, G-CSF)

Question 20

1. What uses adenylyl cyclase Gprotein , cAMP, PKA

2. What uses Gprotein, phospholipase C, DAG + IP3, PKC

Answer 20

1. PTH, ACTH, TSH, ADH (V2)

2. GnRH, TRH, Angiotensin 2, ADH (V1)

Question 21

V1 vs V2 ADH

Answer 21

V1 = vasopressin vasoconstriction 
V2 = kidney water absorption

Question 22

Dilated cardiomyopathy causes problems in what

Answer 22

Contraction dysfunction

Question 23

Sertoli cells are activated by and secrete

Answer 23

FSH —> Sertoli cells —-> Inhibin B (seminiferous tubules)

Question 24

LH does what in males

Answer 24

Activate Leydig cells —» testosterone

Question 25

Multiple Myeloma causes what blood thing and cytokine

Answer 25

1. IL6 = bone mineralization 2. Rouleaux formation (from elevated circulating proteins (monoclonal paraproteins = Igs) ( also seen in Waldenström macroglubulinemia) 3. Renal Insuffieciency = Ig light chain cast nephropathy ( M-spike)

Question 26

Cold Agglutinin does what to blood and what infection causes this

Answer 26

Clumps it into clumps ( cross reactive IgMs) | = Mycoplsma Pneumonia

Question 27

Hypersegmented N seen in

Answer 27

VIT B12 def

Question 28

E. COli have what properties

Answer 28

1. Gram - bacilli, MacConkey agar, Eosin-methylene blue agar (green metallic color) 2. Beta hemolysis on blood agar

Question 29

E.Coli virulence factor backed on disease : 1. Bacterimia / sepsis 2. Neonatal meningitis 3. bloody D 4. Watery D 5. UTI

Answer 29

1. Bacterimia / sepsis : Lipopolysaccharides Lipid A (Macrophages) + Lipid O 2. Neonatal meningitis : K1 capsular polysaccharide (prevent complement and phago) 3. bloody D : shiga toxin (inactivates 60S = cell death) 4. Watery D : heat stable (cGMP) + heat labile (cAMP) enterotoxin 5. UTI : P-fimbriae (adhesion in bladder)

Question 30

PPAR-gamma MOA | PPAR-alpha MOA

Answer 30

1. Decrease insulin resistance (Thiazolidinediones : nuclear receptors : -glitz) = increase GLUT4 (insulin glucose uptake) , Adioponectin (FFA oxidation in fat cells) -> fat mass increase 2. Lower TAGs, (Fibrates : Fenofibrate, Gemfibrozil)

Question 31

Most common site of thrombus formation in heart

Answer 31

LA appendage (usually from Atrial fib)

Question 32

Hookworm causes what in blood

Answer 32

Anemia chronic IDA + eosinophilia

Question 33

Schistoomiasis 3 things that can happen

Answer 33

1. Hematuria, dysuria, bladder cancer, hydronephrosis, pylo 2. GI ulcers = IDA 3. Periportal fibrosis + portal HTN in portal veins (esophageal Varices, hepatomegally,)

Question 34

Trauma to superior orbital fissure

Answer 34

CN3,4,6, + CN5 injured | CN V1= corneal reflex (pons)

Question 35

Mastoid process hematoma causes

Answer 35

Battle sign, periorbital bruising, clear otorrhea = BASIAllAR SKULL FRACTURE

Question 36

Fracture to temporal bone or Zygomatic orbit fracture causes

Answer 36

CN 7 damage

Question 37

CN from midbrain, pons , medulla

Answer 37

MIDBRAIN : 3-4 (x memory, vision ,hearing) PONS : 5-8 (diplopia, dizzy, X balance, X swallowing, numbness, nystagmus ) MEDULLA : 9-12

Question 38

Atrial Fib not responding to BB due to

Answer 38

Artiea structural remodeling ( stretching and dilation ) = happens with age

Question 39

Phenytoin + carbamazepine MOA | What transports NT to axon) (CA role

Answer 39

Block NA voltage gates = disrupts AP in neurons (Kinesin) (CA= fusion and release of NTs)

Question 40

``` HIV and : 1. Cryptococcus neoformans 2. Isospora belli 3 .HSV 4. CMV 5. Candida ```

Answer 40

1. Meningitis 2. Profuse D 3. Punched out ulcers in esophagus _ COWDRY type A (multi nuclear squamous cells) 4. Linear esophageal ulcers (cytoplasmic inclusions) 5. Pseudomembranes in esophagus, psuedohyphae

Question 41

CCB in AV/SN node and cardiomyocytes

Answer 41

1. Slows spontaneous depolarizations (phase 0) = treat PSV tachy 2. Decrease excitation and contraction coupling

Question 42

Burkitt Lymphoma | (Chr, histo, gene, sx and mutation cause) associated with what

Answer 42

Chr14/CHR8 translocation heavy Ig chain , starry sky (macrophages) , MYC overexpression = transcription activator* 1. Kids with mandibular or maxillary mass 2. Associated with EBV

Question 43

1. Follicular Lymphoma 2. MAntel cell lymphoma 3. CML

Answer 43

1. Follicular Lymphoma : Chr 18/Chr 14 translocation = BCL2 overexpression 2. MAntel cell lymphoma : CHR 11/14 translocation = cyclin D1 overproduction = G1–>S 3. CML : BCR/ABL = CHR9/22 translocation = Tyrosine Kinase increased —I apoptosis

Question 44

Chlamydia 1. Urine and gram culture 2. TX

Answer 44

1. None , need nucleic acid amplification (due to no pepridoglycan in cell wall) 2. Azithromycin + Doxycycline

Question 45

Gonorrhea 1. Urine and gram culture 2. TX

Answer 45

1. Gram stain only gram - diplococci THAYER MARTIN AGAR (+ purulent urethral fluid) 2. Ceftriaxone

Question 46

E. Coli + Klebsiella Pneumonia | 1. Urine and gram culture

Answer 46

1. Both

Question 47

NKC activated by and markers

Answer 47

CD16, CD56 IL12, INF-gamma (Kill cells with low MHC 1 expression)

Question 48

Thorecentesis below what can injury abd structures

Answer 48

below rib 9 Around rib 10 = injure right hepatic lobe 1. Midclavicular 6th rib 2. Midaxillary 8th 3. Paravertebral 10th rib * SHOULD BE DONE*

Question 49

Inheritance : 1. Rett syndrome (neurodegenerative hand movement in F, males die inutero) 2. HD 3. Hemophilia B 4. Galactosemia classic (jaundice, Hepatomegaly, V, X Galactose-1phosphate uridyl transferase)

Answer 49

1. X link 2. AD 3/ X -link 4. AR

Question 50

REason you give Chloroquine + Primaquine

Answer 50

``` Chloroquine = in infected RBCs (trophozoites) Primaquine = dormant in liver (hypnozoites) (Vivax + Ovale strains) ``` MALARIA ( Giemsa stain, paroxysms fever