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Kaplan Questions Flashcards

1
Q

glomeruloid-like cells and eosinophils in a young childs scrotum or ovary

A

yolk sac tumor

  • schiller duval bodies
  • high alpha-fetoprotein
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2
Q

what is the appropriate meal for pts post gastric bypass

A

eat smaller, frequent meals that are low in simple carbohydrates, and high in protein, fiber, and complex carbs

-these pts usually get something called dumping syndrome due to the osmotic effects of eating lots of simple carbs (fruit juice is likely to cause this)

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3
Q

rheumatoid factor

A

seen in rheumatoid arthritis and these are directed against the Fc portion of IgG

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4
Q

list the second generation antihistamines

A

loratadine, fexofenadine, loratadine, and cetirizine

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5
Q

pathophysiology that leads to duodenal atresia

A

failure of recanalization of part of the embryonic gut

ileal atreasia is due to vascular problem in utero

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6
Q

creatinine kinase MB vs MM vs BB

A

MB –> cardiac muscle specific
MM –> skeletal muscle specific
BB –> brain damage

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7
Q

foramen cecum

A

develops part of the thyroid gland and part of the middle of the tongue

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8
Q

side effects of metformin

A

lactic acidosis (in pts with renal insufficiency), GI upset, B12 deficiency

-it can also cause potential weight loss

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9
Q

child (usually 2 years old) with large, palpable, nontender mass that is in the superior pole of the kidney and does not cross the renal capsule
-unilateral flank mass with possible hematuria

A

Wilms tumor

-embryonic glomerular structures

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10
Q

complications of succinylcholine

A

hypercalcemia, hyperkalemia, and malignant hyperthermia

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11
Q

scl antibodies

smith antigen

A

systemic form of scleroderma

systemic lupus erythematosus

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12
Q

equation for confidence interval

A

CI = mean +/- Z x (SD/squareroot(n))

95% CI = Z = 1.96
99% CI = Z = 2.58

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13
Q

3-hydroxybutarate

A

this is a ketone body

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14
Q

inheritance pattern of marfans

A

autosomal dominant

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15
Q

cyclobenzaprine

A
  • used for muscle spasticity
  • acts within CNS (mainly at brain stem)
  • structurally related to TCAs
  • may cause anticholinergic side effects and sedation
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16
Q

what are the endocardial cushions derived from

A

neural crest

-inadequate migration causes a primum defect (ASD)

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17
Q

alprostadil vs indomethacin

A

alprostadil –> PGE1 analog

indomethacin –> inhibits prostaglandins and closes the shunt

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18
Q

atropine mechanism of action

A

it acts as a muscarinic blocker so it doesnt work at nicotinic sites and therefore doesnt help with muscle paralysis

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19
Q

theophylline mechanism of action

A

inhibits PDE and adenosine receptors

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20
Q

what causes dilation of the coronary vessels

A

when the heart requires more oxygen it uses more ATP and that gets broken down into adenosine and the increased adenosine concentration causes coronary vessel dilation

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21
Q

laboratory studies for diffuse slceroderma vs CREST syndrome

A

diffuse –> anti-Scl-70

CREST –> anti-centromere

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22
Q

what is the falciform ligament derived from

A

part of the liver (ligamentum teres hepatis) and its a derivative of the fetal umbilical vein
-also contains patent paraumbilical vein

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23
Q

good pasture has antibodies to what

A

antibodies to alpha3-chain of type 4 collagen

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24
Q

what does the superior gluteal nerve innervate

A

gluteus medius, gluteus minimus, and tensor fascia latae

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25
Q

how to treat dilated cardiomyopathy vs hypertrophic obstructive cardiomyopathy

A

dilated –> Na+ restriction, ACEi, Beta-blocker, diuretics, digoxin, ICD, heart transplant

hypertrophic cardiomyopathy –> cessation of high-intensity athletics, Beta-blockers, non-dihydropyridine Ca2+ channel blockers, ICD if pt is at high risk

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26
Q

describe kimmelstiel-wilson lesions

A

mesangial periodic acid schiff-positive stain with hyaline masses

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27
Q

white pupillary reflex in a baby

A
  • if the child was given oxygen think inappropriate vascular proliferation
  • retinoblastoma
  • if the child has cataracts too then think rubella
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28
Q

how to histologically tell the difference between small cell lung carcinoma and squamous cell carcinoma of the lung

A

squamous cell has a mass with central necrosis and small cell does not form cavitary lesions with central necrosis

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29
Q

what type of reaction does the body have to contact dermatitis/poison ivy

A

type 4 hypersensitivity –> release of IFN-gamma from activated Th1 cells

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30
Q

CD16 and CD56

A

natural killer cells

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31
Q

pt with catheter has kidney stone… what is it made of?

A

ammonium magnesium phosphate (struvite stone)
staghorn calculi
urease + bugs

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32
Q

newborn with cleft palate, rhinitis, and desquamating rash

A

congenital syphilis

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33
Q

rapid plasma reagin +

A

syphilis

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34
Q

what can you give a pt with the jerish-herxhemier reaction after syphilis treatment has been initiated

A

TNF-alpha inhibitor

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35
Q

what gets affected with Rh incompatibility

A

anemia, high output heart failure, edema, elevated unconjugated bilirubin (which can go to the CNS and cause damage/kernicterus)

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36
Q

what is the defect in xeroderma pigmentosum

A

inability to repair DNA pyrimadine dimers caused by UV exposure
findings: dry skin, extreme light sensitivity, skin cancer

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37
Q

baby who is tachypnic and hyperammonia with increase in orotic acid

A

ornithine transcarbamylase deficiency

  • if the pt had orotic acid but regular ammonia then they would have orotic aciduria
  • note: there will be absent citrulline
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38
Q

when does ovulation occur for a woman no matter how long her cycle is

A

during the last 14 days of her cycle

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39
Q

hemineglect vs hemiplegia

A

hemineglect –> contralateral problems with parietal (or even frontal) cortex

hemiplegia –> contralateral internal capsule

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40
Q

G6PD deficiency inheritance

A

X-linked recessive

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41
Q

why do you give someone lactulose, rifaximin, or neomycin and what are their mechanisms of action

A

All given for hepatic encephalopathy

lactulose –> intestinal content acidification to increase NH4+ generation

rifaximin or neomycin –> decreases NH3 producing gut bacteria

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42
Q

how to treat a pt with acromegaly and what should you expect to see

A

somatostatin analog
-ex: octreotide

large tongue, deep furrows, large hands and feet, coarse facial features, frontal bossing, impaired glucose tolerance (insulin resistance), hypertension

  • increased risk of colorectal polyps and cancer
  • increased IGF-1
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43
Q

large, binucleated cells with prominent nucleoli with an eosinophilic cytoplasm

A

reed-sternberg cells

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44
Q

pt presents with cystic mass on lateral neck that does not move with swallowing

vs

pt preseting with midline neck mass that does move with swallowing

A

persistent cervical sinus leading to pharyngeal cleft cyst (lateral neck, anterior to sternocleidomastoid)

vs

thyroglassal duct cyst

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45
Q

large white worm that can be coughed up

A

ascaris lumbricoides (giant worm)

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46
Q

sirolimus (aka rapamycin)

A

mTOR inhibitor that blocks T-cell activation and B-cell differentiation by preventing IL-2 response

  • used in pts with kidney transplant
  • side effects –> pancytopenia, insulin resistance, hyperlipidemia (NOT NEPHROTOXIC like cyclosporine and tacrolimus)
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47
Q

whatre two causes of subarachnoid hemorrhage and why would you think one vs the other

A
  1. Arteriovenous malformation
    - pt with history of hereditary hemorrhagic telangectasias (recurrent epistaxis as childhood, seizures, melena, and iron deficiency anemia)
  2. Berry aneurysm
    - pt with hypertension, connective tissue disorders, and adult polycystic kidney disease
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48
Q

lymphatic drainage of lateral vs medial side of the leg

A

lymph drainage usually follows venous drainage

  • lateral side and dorsum of the foot goes to popliteal fossa
  • medial side of leg and sole of foot goes to inguinal region
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49
Q

where should an intercostal nerve block be administered

A

just below the rib and lateral to the angle of the rib to be anesthetized
-the nerve is under each rib

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50
Q

pt with UTI and subsequent DIC, what will you see in their kidney

A

diffuse cortical necrosis

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51
Q

type 1 vs type 2 muscle fibers

A

type 1: (ENDURANCE TRAINING) 1 slow red ox, slow twitch, red fibers, increased oxidative phosphorylation (increased myoglobin)

type 2: (STRENGTH TRAINING) fast twitch, white fibers, increased anaerobic metabolism (increased glycogen)

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52
Q

what activates the classical complement pathway

A

antigen-antibody complexes

*unlike the alternative pathway which is activated by the spontaneous hydrolysis of C3 or by antigens directly

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53
Q

where do the splenic artery and vein travel

A

within the splenorenal ligament

  • if the spleen is ruptured and these leak they will leak into the peritoneal cavity
  • this ligament also contains the tail of the pancreas
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54
Q

how to treat CML

A

imatinib –> tyrosine kinase inhibitor

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55
Q

pindolol

A
  • partial beta-1 agonistic properties (intrinsic symphathomimetic activities)
  • contraindicated in pts with angina because it does NOT decrease myocardial O2 demand
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56
Q

what happens to blood flow during muscle contraction

A

decreased blood flow and increased vascular resistance because when the muscle is contracting its literally compressing the arteries and causing them to collapse

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57
Q

clonidine mechanism of action

A

alpha 2 agonist

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58
Q

what does a heave indicate on cardiac exam

A

ventricular hypertrophy

  • left parasternal = right
  • apical heave = left
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59
Q

dermacentor tick

A

rocky mountain spotted fever and franscella tularemia

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60
Q

amphetamine mechanism of action

A

release norepinephrine which stimulates the a1 and beta1 receptors to cause vasoconstriction and increase in heart rate

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61
Q

gamma glutamyl transferase

A

very sensitive indicator of recent alcohol use (elevated even before liver function tests)

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62
Q

pathophysiology of reye syndrome

A

enlarged distorted mitochondria

-major impact is on liver (microvesicular steatosis) and brain (edema)

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63
Q

between LCAD/MCAD and carnitine uptake deficiency what makes you tell the difference

A

both are hypoketotic hypoglycemia

BUT if you see a build up in both muscle and serum then you know the carnitine uptake is working fine and vice versa

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64
Q

when would you see a positive kussmaul sign

A

its an increased JVP on inspiration

  • constrictive pericarditis
  • restrictive cardiomyopathy
  • right atrial or ventricular tumors
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65
Q

what is one of the most common courses of chronic meningitis

A

mycobacterium tuberculosis

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66
Q

which antihypertensive medications can cause lipid abnormalities

A

metoprolol and thiazides

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67
Q

what will you see pathologically in COPD

A

loss of elastic recoil of the lung

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68
Q

4 parts of medicare

A

A –> hospitAl insurance and home hospice care
B –> Basic medical Bills
C –> Combo, delivered by approved private Companies
D –> prescription Drugs

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69
Q

vital capacity

A

total amount in lung EXCEPT residual volume

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70
Q

impaired copper absorption and transport due to defective ATP7A
-results in brittle “kinky” hair, growth retardation, and hypotonia

A

Menkes disease

  • X-linked recessive connective tissue disease
  • leads to decreased activity of lysyl oxidase (copper is a necessary cofactor) –> defective collagen
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71
Q

violent retching then pain onset that worsens with deep breaths and swallowing
-subQ crackles on the left side of the neck

A

Boerhaave syndrome

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72
Q

preferred drugs for OCD

A

SSRI, venlafaxine, and clomipramine

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73
Q

preferred drugs for panic disorder

A

SSRI, venlafaxine, and benzodiazepines

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74
Q

what can induce cytochrome p450 (smooth endoplasmic reticulum of the liver)

A

chronic alcohol use and cigarette smoking

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75
Q

what is increased in diabetic ketoacidosis

A

hyperkalemia

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76
Q

type of reaction a person may get after a tetanus shot

-pt will present with edema, necrosis, and activation of compliment

A 
arthus reaction (type III hypersensitivity)
-usually due to intradermal injection of antigen into a presensitized (circulating IgG) individual leads to immune complex formation in the skin
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77
Q

pt has ataxia, urinary incontinence, and cognitive dysfunction

A

symptoms potentially reversible with CSF/ventricular shunt placement

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78
Q

N-acetylcysteine

A
  • used in acetaminophen overdose

- replenishes glutathione stores

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79
Q

how to treat all tenia mycoses vs tinea unguium treatment

A
  • all others you can use topical azoles

- tinea unguium (nails) you have to use terbinafine and griseofulvin

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80
Q

paralysis of the entire side of the face leads you to think what

A

bells palsy of the IPSILATERAL pons

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81
Q

when you see a pt with fatty poop, especially after part of the small intestine being resected whats the first step you should think about?

A

possible decrease in vitamins A, D, E, and K because they are fat soluble vitamins (esp if you see a decrease in bile too)

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82
Q

serum calcium and phosphate are BOTH decreased… what do you think?

A

vitamin D deficiency

-you will also see an increase in PTH

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83
Q

crampy abdominal pain followed by hematochezia in an old person

A

colonic ischemia

  • reduction in intestinal blood flow causes ischemia
  • usually due to atherosclerosis
  • commonly occurs at watershed areas (splenic flexure and distal colon)
  • thumbprint sign on imaging due to mucosal edema/hemorrhage
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84
Q

what is the initial mechanism of hepatocellular carcinoma

A

inactivation of tumor suppressor genes

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85
Q

what family of hepatitis is more associated with pregnant women

A

Hep E: hepevirus

Note
A: picornavirus 
B: hepadenavirus
C: flavivirus 
D: defective
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86
Q

woman with markedly elevated AST and epigastric pain

A

ischemic heart disease

  • AST is found in kidney, heart, liver, and RBCs
  • if you see an isolated increase in AST then get an EKG right away

*note that ALT is the more specific one for liver involvement

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87
Q

exudative pharyngitis, cervical lymphadenopathy, and diffuse sandpaper-like erythematous rash on trunk and arms

A

streptococcal pharyngitis

-lysogenic conversion of toxin

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88
Q

whats associated with lysogenic conversion

A 
COBEDS
C: Cholera toxin
O: O antigen of salmonella 
B: Botulinum toxin
E: Erythrogenic toxin of streptococcus pyogenes 
D: Diphtheria toxin
S: Shiga toxin
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89
Q

side effects of glucocorticoid therapy

A

hypocalcemia, hypokalemia
fluid retention, hyperglycemia, hypertension

with chronic use: osteoporosis and avascular necrosis

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90
Q

what happens to the majority of high grade dysplasias

A

they stay at the same level of dysplasia (60%)

-only 10% usually turn into an invasive carcinoma

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91
Q

whats a side effect of octreotide therapy

A

it also blocks TSH release so it can cause hypothyroidism

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92
Q

main cause of abdominal aortic aneurysm

A

atherosclerosis (pulsatile abdominal mass)

-ultrasound or CT is diagnostic

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93
Q

helmet cells/schistocytes

A

TTP

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94
Q

CSF analysis with 14-3-3 protein

A

creutzfeldt-jacob disease

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95
Q

5 Rs of medication

A
  1. right drug
  2. right patient
  3. right dose
  4. right route
  5. right time
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96
Q

what are the two stages that egg development gets arrested in

A

prophase I until ovulation

metaphase II until fertilization

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97
Q

whatre the two mechanisms that increase summation to increase the force of a muscle contraction

A

frequency summation and multiple fiber summation

-this increases the load that the muscle can lift

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98
Q

common causes of fetal loss in first and third trimesters

A

first –> chromosomal abnormalities

third –> abruptio placentae and placenta previa

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99
Q

what is the major adverse effect of halothane

A

hepatotoxicity (halothane hepatitis)

  • hepatitis with focal to massive hepatic necrosis
  • usually just hepatotoxic but can present as hepatitis
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100
Q

if the thoracic duct is occluded where will you have edema

A

entire left side and right lower limb
Lymphatic circulation
-Right upper body: right lymphatic duct –> right subclavian vein
-Rest of body: thoracic duct –> left subclavian vein

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101
Q

what causes gastric acid secretion

A

stimulation of parietal cells by histamine, gastrin, and vagal stimulation

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102
Q

how to treat acute prostatitis

A

ampicillin, fluoroquinolones, or TMP/SMX

-with TMP/SMX watch out for low hemoglobin after due to G6PD deficiency (X-linked recessive)

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103
Q

what nerve supplies the posterior half of the external auditory meatus

A

auricular branch of the vagus nerve

-stimulation of the this nerve can cause reflexive symptoms such as fainting (vasovagal syncope), coughing, and gagging

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104
Q

fibroblast vs myofibroblast

A

fibroblast –> connective tissue repair and deposition, produce extracellular matrix proteins such as collagen, proteoglycan, and elastin… also promoted by TGF-beta

myofibroblast –> specialized fibroblast cell with smooth muscle cell function containing contractile proteins, also the primary cell type for wound contracture

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105
Q

treatment of choice for carcinoid treatment (pts with this get tricuspid valve stenosis)

A

octreotide (somatostatin analog)

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106
Q

abscesses

A

produced by catalase positive organisms which destroys hydrogen peroxide (substrate for myeloperoxidase)

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107
Q

which form of leprosy can be grown in lowenstein jensen agar?

A

lepromatous leprosy can be grown in L-J agar

tuberculoid leprosy cannot be grown in L-J agar

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108
Q

how to diagnose hypertrophic pyloric stenosis

A

abdominal ultrasound demonstrating increased pyloric muscle width and length

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109
Q

peripheral blood smear shows red granules in enlarged young erythrocytes (schuffner dots) with history of going to africa or south america

A

malaria

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110
Q

what nerve mediates the urge to defecate

A

pelvic splanchnic nerves which arise from S2 to S4

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111
Q

colic and bloody diarrhea in the first week of life

A 
necrotizing enterocolitis (premature, low birth weight infants)
-transmural necrosis is seen on histology
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112
Q

first line treatment for osteoporosis

A

bisphosphonates

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113
Q

difference between myelomeningocele and encephalocele

A

encephalocele has brain tissue

myelomeningocele has spinal cord tissue

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114
Q

recurrent skin and mucosal bacterial infections, absent pus, impaired wound healing, delayed (>30days) separation of umbilical cord

A

leukocyte adhesion deficiency (type 1)

  • defect in LFA-1 integrin (CD18) protein on phagocytes, impaired migration and chemotaxis
  • increased neutrophils in blood but none at infection sites
  • AR
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115
Q

what type of breast cancer is associated with adherens junctions

A

mutations in E-cadherin are associated with an increased risk of gastric adenocarcinoma and infiltrating lobular carcinoma

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116
Q

pt presents with enlarged gastric rugal folds

-WAVEE –> Weight loss, Anorexia, Vomiting, Epigastric pain, Edema (due to protein loss)

A

Menetrier disease (protein losing enteropathy)

  • mucous cell hyperplasia
  • hyperplasia of gastric mucosa –> hypertrophied rugae (look like brain gyri)
  • causes excess mucus production with resultant protein loss and parietal cell atrophy with decreased acid production
  • precancerous
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117
Q

what is carnitine necessary for

A

transport of long chain fatty acids into the mitochondria

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118
Q

what does protein tyrosine phosphatase 1B

A

opposes insulin signaling by dephosphorylating the phosphotyrosine residues of the insulin receptor, blocking further transmission

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119
Q

scrotal swelling that can be transilluminated

A

hydrocele (scrotal fluid collection)
-in a baby its usually from failure of obliteration of the process vaginalis
or
-incomplete fusion of the process vaginalis if the fluid is slightly above the testis

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120
Q

smudge cells on peripheral blood smear (small mature lymphocytes which are fragile and have ruptured)

A

B-cell chronic lymphocytic leukemia (CD19 and CD20)

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121
Q

nail clubbing, joint pain, fatigue, tenderness of fibula, radius, and ulna (essentially a pt with digital clubbing and arthritis)

A

hypertrophic osteoarthropathy

  • associated with a thoracic malignancy (lung cancer/mesothelioma)
  • get a chest radiograph to rule of bronchogenic carcinoma
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122
Q

if a pt has gerd and is on meds for that what antibiotic should you avoid giving

A

for gerd they would be on antacids and if someone is on antacids you should not prescribe fluoroquinolones because iron and calcium limit the absorption of fluoroquinolones

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123
Q

what population has the highest risk for gastric cancer and why

A

immigrant asian population because the high levels of preservatives traditionally found in their diet

  • food preservatives, nitrosamines, and polycyclic hydrocarbons found in smoked fish, preserved foods, and red meats
  • nitrosamines from red meats are also converted into carcinogens by salivary and gastric reactions
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124
Q

what to think of when you see a pt with a mixed acidosis

A

cardiopulmonary arrest

  • respiratory acidosis due to hypoventilation
  • metabolic acidosis due to poorly oxygenated tissues leading to lactic acid production
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125
Q

pt is unable to look up past the horizontal gaze

A

lesion of the vertical gaze center in dorsal midbrain

-possibly due to a pineal gland tumor due to its proximity to the dorsal midbrain

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126
Q

what induces growth of the definitive kidney

A 
ureteric bud (aka. metanephric duct)
-induces development of the metanephros to give rise to the definitive kidney
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127
Q

failure to develop what will lead to renal agenesis

A

ureteric bud

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128
Q

explain the mechanism of aspirin induced asthma

A

aspirin inhibits COX pathway without affecting lipooxygenase pathway –> increase in leukotrienes (bronchoconstriction) and decrease in prostaglandins (bronchodilation)

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129
Q

mass in distal esophagus that shows glands that invade into the muscular layer and cells with large, hyperchromatic nuclei

A 
esophageal adenocarcinoma (this metaplasia is called barret esophagus)
-usually due to reflux esophagitis
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130
Q

what does a premature ventricular contraction do to the heart

A

shorten diastole so you have decreased LV filling time and decreased LV end diastolic volume

3 possible reasons

  1. structural anomalies create reentry circuit
  2. after-depolarizations that are accentuated by electrolyte abnormalities (ex. hyperkalemia), ischemia, or drugs can be a trigger
  3. normal pacemaker properties of purkinje fibers enhanced by electrolyte abnormalities or sympathetic stimulation

-these can lead you to see a wider QRS as well

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131
Q

which form of chlamydia is extra vs intracellular

A

Elementary body = Extracellular

RetIculate body = Intracellular

132
Q

CD25

A

one of the chains of the IL-2 receptor

-binds IL-2 for use as a cell growth factor

133
Q

CD40 vs CD40L

A

CD40 is on the surface of T cells
CD40L is on the surface of B cells

*these two bind during antigen presentation

134
Q

histology and etiology of fibromuscular dysplasia

A

string of beads appearance on histology and pts usually present with hypertension and due to renovascular stenosis

-polyarteritis nodosa also as string of beads appearance but this usually affects more than just the kidney and its due to deposition of immune complexes with fibrinoid necrosis and aneurysm dilatations and the pt will present with fever and weight loss as well as abdominal pain

135
Q

anti-glutamic acid decarboxylase antibodies

A

type 1 diabetes mellitus

-linked to HLA- D3 and D4

136
Q

what HLA is associated with UC and Crohns

A

HLA-B27

137
Q

pt presents with anorexia, apathy aggressiveness, poor coordination, abdominal pain, and constipation (sometimes diarrhea)

what enzymes are potentially blocked

A

LEAD POISONING
Aminolevulinic acid dehydratase (D-Ala)
Ferrochelatase

-this can lead to microcytic, hypochromic anemia due to impaired heme synthesis

138
Q

what is the most common cause of aortic stenosis in an elderly patient

A

calcification of the aortic valve

  • bicuspid aortic valve can also cause this but its rare and usually seen in pts with turner syndrome
  • vegetations on the aortic valve can also cause this but this is usually seen in infective endocarditis
139
Q

what bug should you think of in a pt with pneumonia who is also either an alcoholic, diabetic, or with COPD

how do you treat this

A

Klebsiella

-treat with third generation cephalosporin (ceftriaxone, cefotaxime, cefpodoxime, and cefazidime)

140
Q

pt with super thick and kinda nodular omentum presents with vague abdominal pain and bloating
-possible breast and colon cancer in the family

A

peritoneal carcinomatosis

  • due to direct spread (transcoelomic) of cancers located in the abdominal cavity
  • ovarian carcinoma is the most common cause (BRCA mutation)
141
Q

where does hepatocellular carcinoma usually spread

A

lungs first via invasion of the hepatic vein system

142
Q

where doe gastrinomas most commonly occur in pts with MEN I

A

pancreas or duodenum

143
Q

most common primary cardiac tumor in adults vs children

A

adults: atrial myxoma
children: rhabdomyoma (associated with tuberous sclerosis)– confirm with desmin

144
Q

most common cause of intellectual disability (mental retardation)

A

fetal alcohol spectrum disorder

145
Q

what is associated with chromosome 15 abnormalities

A

autism spectrum disorder
prader willi syndrome
angelman syndrome

146
Q

what activates zinc finger receptors

A

lipid soluble hormones

147
Q

HER-2

A

member of the epidermal growth factor receptor family and signals through Ras and MAP kinases

148
Q

inheritance pattern of sturge weber

A

TRICK QUESTION

-its sporadic not inherited

149
Q

memory device for MEN 1, 2a, 2b

A 
Pit 
Pan
Para
Pheo
Medullary carcinoma of thyroid 
Mucosal neuroma

*note that MEN2b also presents with a pt with a marfanoid habitus

150
Q

tumors in the ileum and liver arising from submucosal layer composed of uniform round cells arranged in trabeculae

A

carcinoid tumor (neuroendocrine neoplasm usually just in the GI tract) –> if also found on the liver then metastasis has occurred and its called carcinoid syndrome

dx via 24hr 5-HIAA (due to serotonin hypersecretion)

carcinoid heart disease –> right sided endocardial fibrosis with tricuspid valve damage

151
Q

drug for maintenance of cardiac output

A

dobutamine (beta1 stimulation)

152
Q

chemo induced nausea and vomiting and promotes gastric motility

A

metoclopramide

153
Q

tranexamic acid

A

indicated for dental bleeding prophylaxis (acts competitively to inhibit multiple plasminogen binding sites)

154
Q

phytonadione

A

aka. vitamin K

- indicated for treatment of hypoprothrombinemia and warfarin stabilization

155
Q

friedreich ataxia

A
  • AR
  • GAA trinucleotide repeat
  • spinal cord and dorsal root atrophy due to the affect on the large myelinated axons in the peripheral nerves, posterior (dorsal) columns, spinocerebellar tracts, and corticospinal tracts
156
Q

what is seen in the urine in pts with minimal change

A

massive proteinuria
lipiduria
(note that these pts also have edema, hyperlipidemia, and an increased risk of thrombosis)

157
Q

transplant rejection

A

hyperacute (type 2 hypersensitivity and complement)
acute (type 4 hypersensitivity and CD4 and CD8 T cells)
chronic (type 2 and 4 hypersensitivity with T cell activation)

158
Q

at what level of blood glucose do you start to have glucosuria (when are SGLT1 and 2 maxed out on absorption)

A

180-200 (so the levels have to be at least 250)

159
Q

femur tumor with onion skin periosteal reaction in bone
-in younger pt (around 12yo)

(painful growing mass over bone)

A

Ewing sarcoma

  • diaphysis of long bones (especially femur) and pelvic flat bones
  • anaplastic small blue cells neuroectodermal origin (resemble lymphocytes)
  • aggressive with early metastases but responsive to chemotherapy

-differentiate from conditions withs imilar morphology (lymphoma or chronic osteomyelitis) by testing for t(11;22) (fusion protein EWS-FLI1)

160
Q

what inflammatory disorder can increase the likelihood of getting colorectal cancer

A

ulcerative colitis (also crohns but mainly think of UC first)

161
Q

how do our vessels react to anemia

A

anemia leads to hypoxia so arteriolar vessels dilate to allow for more blood flow (unlike the lungs)

162
Q

alveolar ventilation

A

this is the volume of gas that reaches the respiratory blood-gas interface and participates in gas exchange

(tidal volume - dead space) x respiratory rate

163
Q

ventral wall defects

A

failure of…
rostral fold closure (ectopia cordis )
lateral fold closure (omaphalocele, gastroschisis)
caudal fold closure (bladder extrophy)

164
Q

child with history of infection with aspergillus and staph aureus

A

deficiency in NADPH oxidase (chronic granulomatous disease)

-cause they are both catalase positive

165
Q

second vs third intercostal space on the right side

A

second –> ascending aorta

third –> right atrium/SA node

166
Q

what aortic arch parts come from the 4th and 6th derivatives

A

4 –> aortic arch and proximal part of right subclavian artery

6 –> proximal part of pulmonary artery and ductus arteriosus

167
Q

common cause of conjugated hyperbilirubinemia

A

choledocholithiasis

-pt will have dark urine and grayish stool meaning that the conjugated bilirubin never reached the intestine

168
Q

list the JONES criteria and what is this used for

A 
used for pts with Strep Pyogenes
J --> joints
O (heart) --> mitral stenosis/valvular disease
N --> nodules subQ
E --> erythema marginatum
S --> sydenhams chorea
169
Q

what part is always involved in hirschsprungs

A

rectosigmoid colon (aka short segment of the rectum)

170
Q

physiology of edema

A

abnormally increased net filtration pressure

171
Q

how to measure net filtration pressure

A

what goes out of the capillary - what goes into the capillary

172
Q

whats the pathology of fragile X

A

expanded trinucleotide repeat

CGG (Chin Giant Gonads)

173
Q

drug used for hypertension and BPH that can cause orthostatic hypotension on the first dose

A

alpha1 antagonists like prazosin

174
Q

if you see a pt with celiacs disease what do they have an increased risk of getting

A
  • dermatitis herpetiformis
  • intestinal lymphoma
  • esophageal squamous cell carcinoma
  • non-hodgkin lymphoma
175
Q

what is the content of black pigmented gallstones

A

high in unconjugated bilirubin (insoluble) and low in cholesterol

  • usually associated with hemolytic anemia
  • increased enterohepatic cycling of bilirubin

*Note: brown pigmented stones usually come from a biliary tree infection (E-coli, liver fluke) causing a release of microbial beta-glucuronidases (released by injured hepatocytes)

176
Q

bilateral decreased pain and temp in a cape distribution with light touch, vibration, and position sense in tact

  • lower motor neurons affected causing atrophy of hand muscles
  • upper motor neurons affected causing increased deep tendon reflexes
A

syringomyelia (syrinx within the cervical spinal cord)

177
Q

fractional excretion of Na for prerenal, intrarenal, and postrenal

A

prerenal: >1%
intrarenal: >2%
postrenal: >2% (severe)

178
Q

what defect can cause an increased likelihood of colorectal cancer

A

mismatch repair

-occurs predominantly in the S phase of cell cycle

179
Q

what are the second line drugs for DM2 if metformin does not work or cannot be used due to the pt having a high creatinine (some sort of renal failure)

A

sulfonylureas (stimulate pancreatic beta cells)
DPP-4 inhibitors
GLP-1 agonists
Glitazones

180
Q

whats associated with hMLH1 and hMSH2

A

hereditary nonpolyposis colon cancer
-pts with this have loss of function mutations in hMLH1 and hMSH2 = microsatellite instability/dinucleotide instability

Note: pts are also at an increased risk of endometrium, ovary, stomach, and pancreas cancer

181
Q

what nerve does the following: Oppose, Abduct, and Flex (OAF) for both the thenar and hypothenar

A

thenar (median nerve)–> thumb

hypothenar (ulnar nerve) –> pinky

182
Q

what nerve is immediately lateral to the flexor digitorum superficialis tendon

A

median nerve

183
Q

what nerve does extension of the thumb and what muscles are involved

A

radial nerve

extensor pollicis longus and extensor pollicis brevis muscles

184
Q

pt with psoriatic arthritis comes in with eye pain and redness… what do you check?

A

psoriatic arthritis is associated with HLA-B27 which is also associated with reactive arthritis (cant pee/non-gonococcal urethritis, cant see/anterior uveitis conjunctivitis, cant climb a tree/arthritis)

  • cause the pt is coming in with eye pain you would want to check for anterior uveitis (inflammation of middle layer of eye including the iris and ciliary body) via a slit lamp examination
  • anterior uveitis can lead to vision loss
185
Q

C3 deficiency

A

causes defects in opsonization and removal of immune complexes
-pts usually have increased susceptibility to extracellular pathogens that utilize complement for clearance (ex: neisseria meningitis, haemophilus influenzae, and strep pneumo)

186
Q

pt presents with erythematous, itchy, ulcerating lesion of the nipple associated with oozing serousanguinous nipple discharge

  • biopsy shows scattered, large cells with abundant cytoplasm within the epidermis of the nipple
  • cytokeratin+
A

paget disease of bone caused by an underlying breast carcinoma

  • if palpable mass –> invasive ductal carcinoma
  • if no palpable mass –> ductal carcinoma in situ
187
Q

numbness and parasthesias of the leg with difficulty walking

A

tertiary syphilis with tabes dorsalis

-you will also see gummas which are granulomas that are predominant in macrophages

188
Q

neuroblastoma vs wilms tumor

A

neuroblastoma does cross midline and wilms tumor does not

189
Q

if a pt has trouble opening the jaw to resistance what muscle is involved

A

lateral pterygoid

  • acts to pull the mandible forward in the process of jaw opening
  • also protracts the mandible and moves it side to side (like in chewing)
190
Q

what muscles are involved to close the jaw

A

masseter, medial pterygoid, and temporalis

191
Q

what is the only part of the kidney that contains a brush boarder

A

proximal convoluted tubule

192
Q

superior vs inferior colliculi

A

superior –> direct eye movements to stimuli (noise/movements) or objects of interest

inferior –> auditory

your eyes are above your ears

193
Q

vertical gaze palsy, pupillary light-near dissociation (pupils accommodate but do not react), lid retraction, convergence-retraction nystagmus

A

parinaud syndrome

-can result from stroke, hydrocephalus, or pinealoma

194
Q

what damages the mammillary bodies

A

Wernicke Korsakoff syndrome

195
Q

what is one of the most common side effects of the transurethral resection of the prostate (TURP) procedure and why is it done?

A
  • its done for pts who have BPH
  • most pts then suffer from retrograde ejaculation as a result of damage to the internal urethral sphincter
  • this is because it is the smooth muscle at the neck of the bladder (at the junction of the bladder and the urethra)
  • this is sympathetic smooth muscle making the “shoot” part of ejaculation difficult because it does not block retrograde flow the way it should
196
Q

what is a medication used for headache prophylaxis that is contraindicated in pts with COPD and asthma

A

propranolol (or other non selective beta blockers) cause it can make exacerbate COPD and asthma due to the beta-2 effects on the lungs

197
Q

how to tell the difference between a direct or indirect inguinal hernia

A

direct: does not pass through the deep inguinal ring
indirect: does pass through the inguinal ring

to clinically tell the difference b/w direct and indirect have the pt cough while compressing the deep inguinal ring

  • direct: if this compression does not prevent the hernia from descending
  • indirect: if this compression does prevent the hernia from descending
198
Q

inability to elevate the tongue is as a result of which muscles and what nerves are they innervated by

A

palatoglossus (CN 10)

styloglossus (CN 12)

199
Q

what type of cells does the PNS arise from

A

neural crest cells (make up both sympathetic and parasympathetic)

200
Q

what are the two most important hormones in establishing a pregnancy

A

hCG and progesterone

-if progesterone is low then you will be more likely to have recurrent early pregnancy loss

201
Q

very young pt with febrile diarrhea (blood and pus)… can even cause a mini-epidemic

in older pts usually a pseudoappendicitis that presents with right lower quadrant abdominal pain

A

yersinia enterocolitica

202
Q

how is multiple sclerosis inherited

A

trick question

-ITS AUTOIMMUNE

203
Q

x-linked recessive disorder where you cant give certain drugs…

A

G6PD deficiency!!!!

-cant give TMP-SMX

204
Q

Th1 activation of macrophages is what type of hypersensitivity

A

type 4

205
Q

TCA overdose

A

3 Cs

  1. cardiotoxicity –> use sodium bicarb to treat and alkalinize serum
  2. convulsions
  3. coma
206
Q

how to detect rubella

A

IgM can be detected in serum within 1-2 days of developing rash

207
Q

child with developmental delay, low serum calcium, high serum phosphate, high serum PTH, and shortened 4th/5th metacarpals

A

pseudohypoparathyroidism

208
Q

most common form of albinism

A

deficiency of tyrosinase, blocking melanin production from the aromatic amino acid tyrosine (AR)

-other forms could be due to defective tyrosine transporter and failed neural crest migration

209
Q

significance of diarrhea in an alcoholic pt

A

loss of bicarb in the feces

210
Q

what type of antibodies do pts with celiac disease have

A

anti-endomysial antibodies (tissue transglutaminase)

-associated with HLA-DQ2 and DQ8

211
Q

what type of channel is NMDA

A

both voltage and ligand gated

212
Q

moro reflex

A

aka. startle reflex
- extension and abduction of the arms with fingers spread followed by flexion and adduction of the arms
- normal reflex that disappears within 3-6 months

213
Q

when is the only time someone will develop hyperplastic arteriosclerosis

A

due to untreated malignant hypertension

-thickening of arteriolar wall media from hyperplasia of myocytes arranged in concentric layers (onion skinning)

214
Q

most common examples of chronic transplant rejection

A

months to years (lymphocytes –> fibrosis –> destruction)
type 2 and 4 hypersensitivity response

  1. lungs: bronchiolitis obliterans
  2. heart: accelerated atherosclerosis of graft vasculature
  3. kidney: chronic graft nephropathy
  4. liver: vanishing bile duct syndrome
215
Q
  1. anti-myeloperoxidase

vs

  1. anti-proteinase 3 antibodies

NOTE: ANCA =antineutrophil cytoplasmic antibodies

A
  1. aka. p-ANCA
    - seen in eosinophilic granulomatosis with polyangitis/Churg-Straus
    - involves small to medium sized blood vessels mostly in kidney and GI tract
  2. aka. c-ANCA
    - seen in pts with granulomatosis with polyangiitis/Wegers
216
Q

if pt presents with lung and kidney problems what should you suspect

A

good pasture!!!!!

-antibodies to type 4 collagen

217
Q

most common types of bacterial endocarditis

A

acute –> staph aureus

subacute –> strep viridans

218
Q

compare and contrast enfuvirtide to maraviroc

A

they are both fusion inhibitors

  • enfuvirtide blocks gp41
  • maraviroc blocks CCR5 on surface of T cells to inhibit its interaction with gp120
219
Q

gelatin-like mucus that fills the peritoneal cavity

A

psuedomyxoma peritonei

  • produced when benign or malignant mucus producing tumor produces this material and it leaks into the peritoneal cavity
  • usually originate from the ovary and/or appendix
220
Q

two most common tumors of the appendix

A
  1. carcinoid tumor

2. adenocarcinoma (50% found here are of the mucinous type)

221
Q

zones of the liver

A

zone 1 - periportal zone (closest to blood)
zone 2 - intermediate zone
zone 3 - pericentral vein/centrilobular zone (furthest from blood)

222
Q

currant jelly dark red stools in an infant without a fever and the when babies cry with this they usually draw their legs to their chest to ease the pain

A

intussusception

  • usually at ileocecal junction
  • pt will be okay sometimes then not okay and in pain other times (due to the ischemia)
  • sausage shaped mass on palpation
  • ultrasound and CT may show target sign
  • may be associated with IgA vasculitis (HSP) or recent viral infection
223
Q

malrotation of gut

A

anomaly of midgut rotation during fetal development –> improper positioning of bowel (small bowel clumped on the side) with formation of fibrous bands (Ladd bands)
-can lead to volvulus or duodenal obstruction

224
Q

volvulus

A

twisting of portion of the bowel around its mesentery which can lead to obstruction/infarction
-can occur all throughout the GI tract

  • MIDGUT: infants and children
  • SIGMOID: elderly (look for coffee bean sign on x-ray)
225
Q

what produces ACE

A

produced in lungs by pulmonary endothelial cells

226
Q

explain ethanol induced hypoglycemia

A

high cytoplasmic NADH/NAD+ ratio

  • this ratio inhibits gluconeogenesis
  • liver glycogen is exhausted after 30 hours
  • note that the NAD+ levels are low in alcoholics cause both alcohol dehydrogenase and acetaldehyde dehydrogenase require NAD+
227
Q

how do your lipoprotein levels change in nephrotic syndrome

A

hyperlipidemia cause of the massive protein loss

-you will also have hypoalbuminemia and edema

228
Q

proliferation of glands without atypia

-sawtooth glandular epithelium composed of proliferated goblet cells and columnar epithelium

A 
hyperplastic polyp (90% of all colonic polyps are hyperplastic)
-NO malignant potential
229
Q

description of tubular adenoma in the colon

A

pedunculated

230
Q

description of villous adenoma

A

sessile and high malignant potential

231
Q

what is AD polycystic kidney disease associated with

A
  • numerous cysts in cortex and medulla of kidney
  • flank pain, hematuria, hypertension, urinary infection
  • progressive renal failure
  • complications: chronic kidney disease, hypertension, berry aneurysms, mitral valve prolapse, benign hepatic cysts, and diverticulosis

-try to treat with ACEi or ARBs

232
Q

if a pt was just put on a new med for hypertension then their kidney function decreases and you have to take them off the drug… what drug is this?

A

ACEi

233
Q

small, pale-staining, slow-growing, aerobic, gram negative, coccobacili that require cysteine for growth
-assoicated with deer tick and bunnies

A

francisella tularensis

234
Q

at the basic level… what is a granuloma

A

type 4 hypersensitivity response

235
Q

atrophy of mucosa in the body and fundus of the stomach along with lymphocytic infiltrate

A

autoimmune gastritis

  • CD4 T cells directed against ATPase
  • this can then lead to pernicious anemia and a megaloblastic anemia as well
236
Q

what is a normal PaO2 (someone at sea level with no pulmonary problems)

A

about 100mmHg

237
Q

what does arterial O2 depend on

A

hemoglobin levels

238
Q

what is the purpose of running an ELISA

A

to detect the presence of certain antibodies

239
Q

what must the lumbar puncture needle pass through

A

skin –> superficial fascia –> deep fascia –> supraspinous ligament –> interspinous ligament –> interlaminar space –> epidural space –> dura –> arachnoid –> subarachnoid space

240
Q

what is the major ion change to know when pts have rhabdomyolysis

A

they become hyperkalemic

-this stimulates aldosterone release to promote K+ excretion and sodium reabsorption

241
Q

what does DNA gyrase do

A

counteracting excessive supercoiling of DNA during replication or transcription

242
Q

what can be treated with uridine

A

orotic aciduria

243
Q

how to find the stead state concentration of drug thats continuously being infused

A

Css = dosing rate/CL

244
Q

what does Th1 secrete (virus)

A

IFN-gamma

IL-2

245
Q

what does Th2 secrete (parasite)

A

IL-4,5,6

IL-10 and 13

246
Q

what does Th17 secrete (bacteria)

A

IL17,21,22

247
Q

what do Tregs secrete

A

TGF-beta
IL-10
IL-35

248
Q

what drug can you give to reverse the effects of epinephrine (you have to administer the drug first then epinephrine will not be able to increase blood pressure)

A

phentolamine (alpha antagonist)

249
Q

what chromosome is neurofibromatosis 1 vs 2 on

A

1: chromosome 17
2: chromosome 22 (all the 2s)

250
Q

desmin vs vimentin

A

desmin: marker for skeletal muscle/rhabdomyosarcoma
vimentin: marker for soft tissue sarcomas and mesenchyal tumors

251
Q

composition of molecules that produce the M spike in multiple myeloma

A

2 gamma heavy chains

2 kappa light chains

252
Q

how to treat methemoglobin

A

methylene blue and vitamin C

253
Q

watery diarrhea in a pt with AIDs who just went camping

A

cryptosporidium parvum

-intracellular multiplication within the intestinal epithelium

254
Q

what two things can result from strep pyogenes

A
  1. rheumatic fever (JONES) due to M protein
  2. scarlet fever (blanching, sandpaper-like body rash, strawberry tongue, and circumoral pallor in the setting of group A strep pharyngitis) due to erythrogenic/pyrogenic toxin
255
Q

what is one of the most potent activators of macrophages

A

IFN-gamma

256
Q

what are the three branches that come off of the celiac trunk

A
  1. left gastric artery
  2. splenic artery
  3. common hepatic artery
257
Q

what is hyperpnea

A

increased depth and rate of breathing

258
Q

what will you see histologically on a pt with parkinsons vs a pt with rabies

A

parkinsons –> lewy bodies (a-synuclein/intracellular eosinophilic inclusions) in the substantia nigra
rabies –> negri bodies in cerebellum and hippocampus

259
Q

how does the brain react to changes in PCO2 levels

A

increase in CO2 = cerebral vasodilation and a decrease in cerebrovascular resistance –> cerebral blood flow increases

decrease in CO2 = cerebral vasoconstriction and an increase in cerebrovascular resistance –> cerebral blood flow decreases

260
Q

what type of rash do pts with lyme disease get

A

erythema migrans (target rash)

261
Q

what is erythema nodosum

A
  • painful raised inflammatory lesions of subcutaneous fat (panniculitis), usually on anterior shins
  • usually idiopathic but can be associated with: sarcoid, coccidioidomycosis, histoplasmosis, TB, strep infections, leprosy, and IBD
262
Q

what parts of the adrenal gland are controlled by ACTH

A

FR

zona fasciculata and reticularis

263
Q

what are the possible causes of horner syndrome

A

anything that denervates the sympathetic system in the face causing ptosis, miosis, and anhidrosis

  • apical lung tumor
  • aortic dissection
  • carotid dissection
  • PICA stroke (lateral medullary syndrome)
264
Q

excretion rate of a drug that is freely filtered and neither absorbed or secreted

A

excretion rate = GFR x plasma concentration

265
Q

pt in pain with scrotal mass that at one point was reducible but now is not and pt also has an elevated ammonia level

A

inguinal hernia strangulation

  • elevated ammonia is from the bacterial proliferation in the damaged tissue
  • note that you will also see gram negative bacteria due to enteric flora
266
Q

what is another name for a macrophage

A

histiocyte

267
Q

when would you see an aschoff body

A

acute rheumatic myocarditis

268
Q

posterior cord of the brachial plexus

A

axillary and radial nerves come off the posterior cord

269
Q

how to treat diabetic ketoacidosis

A

insulin + IV fluids + potassium supplementation
-make sure to supplement potassium cause when the insulin you gave pulls glucose inside of cells it will also pull K in with it which can cause life threatening hypokalemia

270
Q

what separates in meiosis I vs II

A

I –> homologous chromosomes separate
II –> sister chromatids separate

you can tell which stage nondisjuction occurs by seeing if you have two separate chromosomes from one parent or if you have two from the same of another pt

271
Q

what type of bilirubin can be seen in the urine

A

conjugated bilirubin can be seen in the urine

-unconjugated bilirubin is not water soluble so it cannot be seen in the urine

272
Q

RNA virus with retrovirus activity

pt presents with skin lesions, lymphadenopathy, hepatosplenomegaly, and hypercalcemia

A

human T cell lymphotrophic virus 1 –> enveloped single stranded RNA retrovirus

  • can be transmitted via breast milk or blood exchange
  • resides in T cells but NO LYSIS
  • 20/30 years after infection the pt usually develops T cell lymphoma/leukemia
  • flower shaped nuclei
  • Japan and caribbean and sporadically in the USA
273
Q

young pt with changes in personality/behavior/memory, myoclonic jerks, blindness, spasticity
-note that the child is unvaccinated

A

this is due to measles/rubeola

-this is a problem called subacute sclerosing panencephalitis (SSPE)

274
Q

high-pitched tinky bowel sounds

A

small intestinal obstruction

  • hernia
  • adhesions
  • tumor
  • meckels
  • crohns
  • ascaris infections
  • midgut volvulus
  • intussusception due to tumor
275
Q

pt with very tender prostate gland

A

acute bacterial prostatitis

-most commonly due to e.coli cause its so close to the bladder

276
Q

primary hemolytic anemia… what should be on your differential

A

defects in glycolysis or PPP

277
Q

autosomal recessive glycolytic enzyme deficiency

A

pyruvate kinase deficiency

  • hemolytic anemia
  • increased levels of 2,3-BPG
278
Q

drug that vasodilates and decreases insulin release in response to glucose

A

Diazoxide

  • open kATP channels on vascular smooth muscle causing hyperpolarization and vasodilation
  • opening kATP channels on pancreatic beta cells results in hyperpolarization and decreased calcium entry through voltage-gated calcium channels, resulting in decreased insulin secretion in response to glucose
279
Q

if you have a pt suffering from amenorrhea what should be the first test you run

A

progestin challenge

-the pt probably has anovulation if the progestin challenge triggers menstruation

280
Q

slippage

A

expansion of DNA via trinucleotide repeat expansion

  • this occurs during the S phage
  • slippage of DNA polymerase during replication
281
Q

what cranial nerve does salivation

A

CN 9

282
Q

what drug causes gray baby syndrome

A

chloramphenicol

  • blocks peptidyltransferase at 50S ribosomal subunit
  • bacteriostatic
283
Q

what will you see on chest x-ray of a pt with an aortic dissection

A

widened mediastinum

284
Q

basis of a type 2 hypersensitivity response

A

cytotoxicity

285
Q

if you think a pt has appendicitis but you go in to do the surgery and they dont… what do they likely have

A

yersinia enterocolitica

  • gram negative bacilli that optimally grows at 25-28C
  • contracted via puppy poop or contaminated milk products
286
Q

what are chiari II malformation associated with

A

myelomeningocele (it always present in these pts)

-usually in the lumbosacral region

287
Q

list the bacteria that are natural transformers

A

strep pneumo
haemophilus influ
bacillus
neisseria

288
Q

most common GI emergency in neonates

A 
necrotizing enterocolitis (gangrenous bowel)
-prematurity is a key risk factor
289
Q

what medication sensitizes Ca2+ sensing receptor (CaSR) in parathyroid gland to circulating Ca2+ –> decreasing PTH

A

cinacalcet

290
Q

neurotransmitters of sleep

A

S- serotonin (initiates sleep)
A- acetylcholine (higher in REM/erections in men)
N- norepinephrine (lower in REM)
D- dopamine (arousal and wakefulness)

*note: trigger for REM sleep = ratio of ache/ne

291
Q

pt with ulcerative colitis presenting with p-ANCA

A

primary sclerosing cholangitis
-concentric “onion skin” bile duct fibrosis –> alternating strictures and dilation with “beading” of intra- and extra- hepatic bile ducts of ERCP, magnetic resonance cholangiopancreatography

292
Q

deep fibular/peroneal nerve

A

the space in between the 1st and 2nd toes

293
Q

superficial fibular/peroneal nerve

A

front of leg and dorsum of foot

294
Q

punched out ulcers in the lower esophagus of the pt

A

herpes simplex virus

295
Q

shallow linear ulcerations in the lower esophagus of the pt

A

CMV

296
Q

closing quality gap by improving pt care based on scientific knowledge and avoiding waste in equipment and supplies

A

STEEEP

297
Q

antibodies against glutamic acid decarboxylase

A

diabetes mellitus type 1

298
Q

what type of T cell is involved in intracellular pathogen responses

A

Th1

299
Q

how to test for tertiary syphillus

A

FTA-ABS

fluorescent treponemal antibody absorption test

300
Q
  • memory, insight, judgement, and social behavior deficits

- and pt becomes relaxed/expressionless facies, tremor, dysarthria, and pupillary abnormalities

A

neurosyphilus

-tabes dorsalis also happens here (degeneration of the dorsal columns)

301
Q

persistently high levels of bands? (>5%)

A

bands = immature neutrophils

persistently high levels indicates extracellular bacterium

302
Q

drug efficacy

A

maximum effect a drug can produce regardless of dose

303
Q

mechanism of resistance for aminoglycosides

A

ex: gentamicin, neomycin, amikacin, tobramycin, streptomycin
- bacterial transferase enzymes inactivate the drug by acetylation, phosphorylation, or adenylation (enzymatic inactivation)

304
Q

mycosis fungoides

A
  • skin patches and plaques (cutaneous T-cell lymphoma)
  • atypical CD4+ cells with cerebriform nuclei and intraepidermal neoplastic cell aggregates (pautrier microabscess)

may progress to sezary syndrome (T cell leukemia)

305
Q

gastric inhibitory polypeptide

A

stimulates insulin release

306
Q

histology of a pt with alcoholic hepatitis

A

mallory bodies –> intracytoplasmic eosinophilic inclusions of damaged keratin filaments (cytoskeletal filaments)

-formed when hepatocytes degenerate and just leave a mass of cytoskeletal filaments

307
Q

where is fusobacterium nucleatum found

A

oral cavity

-can be aspirated to cause anaerobic lung abscess

308
Q

what does chronic alcohol use do to your sleep

A

decreases the amount of time spent in REM

  • so in someone who stops drinking they can get REM rebound where they spend a ton of time in REM
  • this can also happen with pts taking barbs, stimulants, tricyclic antidepressants, SSRIs, lithium, and moai
309
Q

first line treatment for ulcerative colitis

A

mesalamine (used in mild acute flares) –> 5-aminosalicylic acid
-olsalazine and sulfasalazine can also be used

310
Q

what gives rise to the spinal cord

A

neural tube which is divided into alar and basal plates

  • alar = dorsal/sensory spinal cord
  • basal = ventral/motor spinal cord
311
Q

lateral vs medial medullary syndrome

A

lateral –> caused by occlusion of the PICA, vertigo, nystagmus, nausea, vomiting, ipsilateral cerebellar signs, dysphagia, dysphonia, loss of pain/temp in ipsilateral face and contralateral body, and horner syndrome

medial –> contralateral spastic hemiparesis, contralateral loss of vibration and position sense, damage to fibers of CN 6

312
Q

lateral vs medial pontine syndrome

A

lateral –> facial droop and hearing loss

medial –> contralateral hemiparesis of body, contra loss of vibration and position sense

313
Q

what does cushing syndrome do to bones

A

osteoporosis

314
Q

what comes off of the aorta at T12

A

celiac artery

315
Q

chronic constipation in an elderly pt.. what part of their colon is more likely to torsion

A
  • “overload” of the sigmoid colon rendering it susceptible to torsion
  • then a volvulus can occur (a complete twisting of the bowel)
  • then that could lead to bowel infarction
316
Q

endochondral ossification vs membranous ossification

A

endochondral –> bone formed from cartilage (woven bone to lamellar bone), axial skeleton, appendicular skeleton, base of skull

membranous –> woven bone formed directly without cartilage, bones of calvarium, facial bones, and clavicle

317
Q

nitrates in the urine

A

gram negative (E.coli, Klebsiella, Proteus)

318
Q

where do corticospinal tract fibers decussate

A

caudal medulla

-this is what helps with reflexes (ex: Babinski reflex)

319
Q

flutamide

A

androgen receptor antagonist

320
Q

what is the most common trisomy that leads to a spontaneous abortion

A

trisomy 16

-second most common is a full triploidy

321
Q

pt has positive anti-cyclic citrullinated peptide antibodies… what HLA is associated with this

A

HLA-DR4

322
Q

what type of bleeding in the brain is associated with polycystic kidney disease in adults

A

pckd is associated with berry aneuyrsms which is associated with subarachnoid hemorrhages

323
Q

when you hear radiation exposure and throat mass what should you immediately think of

A

papillary thyroid carcinoma

-has psammoma bodies

324
Q

pt with heart failure becomes diabetic (type 2)

-what drug is contraindicated in this pt

A

thiazolidinediones

  • sensitizes peripheral tissue to insulin
  • can exacerbate heart failure
325
Q

top causes of brain ring enhancing lesion and abscess

A

staph, strep, bacteroides

326
Q

chronic endometritis

A

infiltration of lymphocytes, plasma cells, and histiocytes into the endometrium
-important predisposing factors in the US include chlamydia, IUDs, and recent pregnancy

327
Q

dinoprostone

A

PGE2 analog (increases uterine tone)

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