Mixto

Question 1

Menière disease features

Answer 1

-due to increased vol of endolymph in inner ear
-recurrent vertigo
-ear fullness/pain
Unilateral hearing loss/ tinnitus

Question 2

Labyrinthitis presentation

Answer 2

Acute hearing loss (if not present, vestibular neuritis)
Nausea
Vomiting

Question 3

Actin binds to which part of the sarcomere?

Answer 3

Z line

Question 4

Myosin binds to which part of the sarcomere?

Answer 4

M line

Question 5

What does CREST stand for in Sclerosis?

Answer 5

Calcinosis
Raynaud’s phenomenon
Esophageal dysmotility
Sclerodactyly
Telangiectasias.

Question 6

What markers are useful in Sclerosis?

Answer 6

-Anti-centromere (CREST sd)
-Anti-DNA topoisometase l (Scl-70) (diffuse scleroderma)

Question 7

Anti- histone (+) think of

Answer 7

Drug-induced lupus:
Procainamide, hydralazine, isoniazid, and D-penicillamine

Question 8

Anti-SSA and SSB (+), think of

Answer 8

Sjögren (Ro and La are the same)

Question 9

Hypersensitivity type lV

Answer 9

Occurs upon exposure to an antigen
-T cell and macrophages mediated
Ex: tuberculin, candida tests

Question 10

Hypersensitivity type lll

Answer 10

Inmune complex mediated (ag-ab deposits in tissue)
Neutros recruited
Ex: Lupus, RA, PSG

Question 11

Cystic fibrosis physiopathology

Answer 11

-Mut of CFTR transmemb prot that unables ATP attachment to Cl channels -> less Cl secretion -> Na reabs-> water reabs-> thick mucus production
-impaired post-translational processing

Question 12

Cardiac hemochromatosis features

Answer 12

Excess of intestinal iron absorption
Hepatomegaly, non-tender
Darkly tanned looking skin
Sinus node dysfunction
Brown granular deposits in cells

Question 13

CT scan showing ring-enhancing lesion, think of

Answer 13

Brain abscess

Question 14

Anaphylactic rx elevates

Answer 14

Tryptase and histamine release (due to mast cell and basophil degranulation)

Question 15

Hypersensitivity type l

Answer 15

Allergic rx
IgE ab bind to mast cells and basophils (receptor aggregation)

Question 16

BCL-2 inhibitors increases the activation of

Answer 16

Caspases

Question 17

Effect of progesterone withdrawal on endometrium

Answer 17

Uterine contractions
Constriction of spiral arteries
Apoptosis of cells in the stratum funcrionalis

Question 18

Constrictive pericarditis signs

Answer 18

Increased JVP
Pulsus paradoxus
Kussmaul sign
Pericardial knock (before S3)

Question 19

Ao regurgitation signs

Answer 19

-decrescendo murmur
-Rapid rise-rapid fall pulsation: “bumping” pulses: musset sign (head bobbing/pounding), pistol-shot femoral pulse, etc
-palpitations

Question 20

Thoracocentesis must be performed on which anatomical location

Answer 20

-upper border of ribs to avoid hurting intercostal vessels

Question 21

Untreated hypothyroidism in NB cause

Answer 21

Neurological deficits
Neurocognitive disfx

Question 22

Propranolol in hyperthyroidism is used to

Answer 22

-decrease adrenergic effects
-block peripheral conversion of T4 into T3

Question 23

Tto of patent ductus arteriosus

Answer 23

-inhibition of cliclooxigenase (NSAIDs) -> inhibition of PGE2 synthesis

Question 24

Temporal arteritis/ giant cell vasculitis signs

Answer 24

Headache
Craneofacial pain
Sudden vision loss (feared complication)
Polymyalgia rheumatica ( neck, torso, shoulder pelvic girdle pain), morning stiffness

Question 25

Horseshoe kidney is usually asymptomatic but can cause

Answer 25

Urinary infections and nephroliths

Question 26

Spherocytosis features

Answer 26

RBC without central parlor (spherocytes) Increase mean corpuscular Hb concentration MCHC

Question 27

Malignant hyperthermia features

Answer 27

Post anesthetics Excessive Ca+2 accumulation Muscle contraction Hyperthermia

Question 28

Mitochondrial myopathy

Answer 28

Maternal inheritance Muscle weakness Neuropathy, seizures Red, ragged cells on biopsy

Question 29

Hepatic conversion of pyruvate into glucose requires activation of pyruvate carboxylase via

Answer 29

Acetyl-CoA

Question 30

Why are lysene and leucine useful in pyruvate dehydrogenase deficiency?

Answer 30

They are exclusively ketogenic which helps decrease pyruvate production from glucose

Question 31

McArdle disease features

Answer 31

Myophosphorylase deficiency Poor excercise tolerance Improves by consuming simple sugars

Question 32

What’s the name for different codons producing the same amino acid ?

Answer 32

Wobble

Question 33

Most abundant aa in collagen

Answer 33

Glycine

Question 34

Which enzyme in DNA replication is made from RNA

Answer 34

Primase

Question 35

Dichenne musc dystrophy is the result of

Answer 35

Deletion causing frameshift mut or nonsense mut

Question 36

Aldolase B deficiency

Answer 36

Fructose-1,6-biph accumulation Impaired gluconeogenesis Severe hypoglycemia Avoid fructose and sucrose

Question 37

Li-Fraumeni sd affects a tumor suppressor gene on chromosome

Answer 37

17

Question 38

Which biochemical processes take place in the cytoplasm

Answer 38

Glycolysis, fatty acids synthesis, pentose phosphate pathway

Question 39

Which biochemical processes take place in the mitocondria?

Answer 39

Beta-oxidation of fatty acids, gluconeogenesis, creps cycle

Question 40

Statins inhibit

Answer 40

HMG-CoA reductase

Question 41

Which substances inhibit complex IV of the oxidative phosphorylation process?

Answer 41

CO cyanide

Question 42

Retonone (insecticide) inhibits oxidative phosphorylation by binding to

Answer 42

Complex l

Question 43

Antimycin A and Oligomycin A inhibit oxidative phosphorylation by binding to

Answer 43

Complex III and V respectively

Question 44

Most of the sts produced by heavy OH drinking are due to excess of

Answer 44

NADH

Question 45

Northern blot transcription migration distance is due to

Answer 45

Alternative RNA Splicing

Question 46

Homocystenirua is caused by

Answer 46

Cystathionine synthase -> cysteine cannot be produced so it becomes essential-> homocysteine accumulates (methionine cycle)

Question 47

Genetic anticipation refers to

Answer 47

when a disease is more heavily expressed in a newer generation than the previous

Question 48

Cystic fibrosis is produced due to a ____ mutation

Answer 48

Frameshift

Question 49

Months old baby is recently introduced to solids (fruit) and presents with vomit and hypotension. Think of

Answer 49

Aldolase B def

Question 50

Why does OH inhibit gluconeogenesis?

Answer 50

Not enough NAD req for gluconeogenesis due to excessive NADH

Question 51

Transketolase participates in___ and deps on___

Answer 51

Pentose phosphate pathway Thiamine (B1)

Question 52

Phenylketonuria signs

Answer 52

Musty body odor Eczema Altered gait Intellectual probs

Question 53

Protein expression increased with normal mRNA concentration is likely a prob in

Answer 53

Ubiquinatination

Question 54

Cataracts in children, think of

Answer 54

Classic Galactosemia

Question 55

Pyruvate pathways

Answer 55

TCA cycle Gluconeogenesis Lactate formation Alanine formation

Question 56

High ATP levels ____ fructose-1,6 biphosphatase 1 and ____ phosphofuctokinase-1

Answer 56

Activate (gluconeo) Deactivate (TCA)

Question 57

High AMP levels _____ fructose-1,6 biphosphatase 1 and ____ phosphofuctokinase-1

Answer 57

Deactivate (gluconeo) Activate (TCA)

Question 58

High Frutose 2,6 biphosphate favors____ and low levels favor

Answer 58

Glycolysis Gluconeo

Question 59

Which cells are insulin independent?

Answer 59

Neurons Beta-pancreatic cells Hepatocytes Enterocytes

Question 60

Somatic sts disorder features and Tto

Answer 60

Multiple unexplained medical sts + excessive health care use Schedule regular visits

Question 61

Ant horn and Lat Corticoespinal tract injury have in common

Answer 61

Ipsilat motor sts Ant horn (lower motor neuron) LCT (upper)

Question 62

What type of collagen appears on myocardium after MI (on scars)

Answer 62

Type l

Question 63

Which tissues have collagen type I

Answer 63

Skin, bone, ligaments, tendons, cornea, blood vessels and scar tissue

Question 64

Osteogenesis imperfecta affects collagen type

Answer 64

I

Question 65

Alpert sd affects basement mb, specifically collagen type

Answer 65

IV

Question 66

Major copper excretion occurs via

Answer 66

Biliary excretion

Question 67

Adjustment disorder has to last

Answer 67

Min 3 months Max 6 months

Question 68

Most important RF of Hepatitis B transmission

Answer 68

Injection drug use

Question 69

Recovery from acute Hepatitis B infection will have

Answer 69

Anti-HBc IgG and anti-HBs antibodies

Question 70

Chronic hepatitis B marker

Answer 70

HBsAg for more than 6 months

Question 71

What’s a leading cause of early neonatal sepsis in women with not adequate prenatal care?

Answer 71

Group B streptococcus (S. agalactiae) *key: narrow zone of clear hemolysis

Question 72

COPs are the first line for treating hirsutism due to their effects

Answer 72

Decreasing androgen production

Question 73

What arteries are located on the lesser stomach curvature?

Answer 73

Right and left gastric

Question 74

What arteries are located on the greater stomach curvature?

Answer 74

Gastroepiploic (right and left)

Question 75

Pituitary (ant vs post) derived from which embryologic derivates?

Answer 75

Ant: surface ectoderm (Rathke pouch) Post: Neural tube

Question 76

EBV/mono is associated to which malignancy ?

Answer 76

Burkitt lymphoma Nasopharyngeal carcinoma

Question 77

Scarlet fever is associated to ___ and main complication is

Answer 77

Pharyngitis RA

Question 78

Placenta previa refers to

Answer 78

Placenta covers internal cervical os

Question 79

Placenta percreta refers to

Answer 79

Placental invasion of adjacent structures *bladder has greatest risk

Question 80

Besides SV/HR, what other formula can be used?

Answer 80

Rate of O2 consumption/ arteriovenous O2 content difference

Question 81

Major adverse effects of clozapine

Answer 81

Neutropenia and agranulocytosis

Question 82

Main cause of primary nocturnal enuresis

Answer 82

Brain maturation delay *can’t have been previous continence and have to be 5 or more years old

Question 83

Cryptococcus neoformans features

Answer 83

Budding Yeast with thick capsules

Question 84

Tto for native vs prosthetic valse replacement

Answer 84

Native: naficilin or oxacilin Prosthetic: vancomycin

Question 85

Gynecological Laparoscopic procedures can harm which nerves

Answer 85

-iliohypogastric (loss of sensation on lat gluteal skin) -ilioinguinal (loss of sensation on Mons pubis and medial thigh)

Question 86

Acute retroviral sd refers to what and what are its markers?

Answer 86

-early viral infection before serologic response -HIV p24 antigen (+) and anti-HIV antibodies (-)

Question 87

Focal seizure + awareness + auditory/olfatory hallucinations , think of

Answer 87

Temporal lobe epilepsy

Question 88

Childhood febrile seizures are commonly associated to

Answer 88

Hippocampal sclerosis

Question 89

hCG is most similar to

Answer 89

1.LH 1.FSH 3.TSH

Question 90

Normal response to local alveolar hypoxia

Answer 90

Hypoxic pulmonary vasoconstriction (to limit blood flow to nonventilated alveoli)

Question 91

Increased hemoglobin A2, think of

Answer 91

Beta thalassemia minor

Question 92

What’s hemochromatosis?

Answer 92

Excessive intestinal iron absorption and deposition in various tissues (pancreas, heart, liver, joints)

Question 93

Hemochromatosis causes

Answer 93

Hyperpigmentation Arthritis Liver damage DM, hypopituitarism Cardiomyopathy

Question 94

Expected findings of Giarda lambia under the mic

Answer 94

1. ellipsoidal cysts with smooth, well-defined walls and 2+ nuclei or 2. pear-shaped, flagellated trophozoites.

Question 95

Giardia lambía features

Answer 95

-most common enteric parasite in the US and Canada. -Chronic diarrhea, malabsorption, and flatulence. -Hikers and campers drink contaminated water

Question 96

MTZ can be used to treat which microorganisms?

Answer 96

Giardia lamblia HP E. Ameba Trichomonas

Question 97

Dextromethophan is a first-line cough suppressant bc ___ however it can cause ___ if OD or used with serotoninergic drugs

Answer 97

-similar to codeine but without opioid effects -Serotonin sd

Question 98

How does aging affect the resp system ?

Answer 98

-low PaO2 (+ dead space) -microatelectasis -> shunting -V/Q mismatch-> high A-a gradient -PaCO2 does not really change (pathological if it does) High lung compliance but total is low

Question 99

Down sd is associated with what type of hernia?

Answer 99

Umbilical (due to incomplete closure of umbilical ring)

Question 100

S4 suena como S3 suena como

Answer 100

-una parranda -una cojera

Question 101

S3 and S4 are associated to

Answer 101

S3: eccentric hypertrophy in HF with reduced ejection fraction). S4: normal if >70 but if <70, pathologic LV wall stiffening,

Question 102

Organophosphate (pesticides) poisoning management

Answer 102

1. Decontamination 2. Atropine (reverses muscarinic effects via competitive inh) 3.Pralidoxime (reverses nicotinic and mucarinic sts)

Question 103

Inhibition of the intrinsic coag pathway prolongs ___ whereas inhibition of the extrinsic

Answer 103

aPTT PT

Question 104

Which zona in the adrenal cortex produces mineralocorticoids?

Answer 104

Glomerulosa

Question 105

Hereditary angiogram features

Answer 105

Children or teens Deficiency is dysfunction of C1 inh-> + bradykinin (edema without itching) and - C4 levels

Question 106

Malignant hyperthermia is due to

Answer 106

Abnormal Ryanodine receptors (RYR1) that increase Ca+2 influx

Question 107

Rebound rhinorrhea is associated with the use of

Answer 107

Decongestants for 3 or more days *stop decongestant

Question 108

What’s the irrigation for the inferior LV wall?

Answer 108

Right dominance (85%) : Right coronary artery -> post descending artery Left dom: circumflex artery -> post descending artery

Question 109

A right coronary artery occlusion only causing RV infarction can be explained by

Answer 109

Left dominance

Question 110

SIBO risk factors

Answer 110

(-) Gastric acid, pancreaticobiliary secretions (PPI) (-) Intestinal motility (DM, sclerosis) lleocecal valve resection Low Mucosal Immune response (igA)

Question 111

Hungtington triad

Answer 111

Mov disorder Behavior abnormalities Dementia

Question 112

Subacute thyroiditis markers

Answer 112

Elevated T4, suppressed TSH (hyperthyroid phase) • Elevated serum thyroglobulin • Elevated erythrocyte sedimentation rate • Low radioiodine uptake

Question 113

Black gallstones occur due to

Answer 113

High efflux of bilirrubin into bile

Question 114

white pupillary reflex (leukocoria) in children <5 years old, think of

Answer 114

Retinoblastoma (most common occular childhood tumor)

Question 115

Retinoblastoma is associated to

Answer 115

Sarcomas

Question 116

Clinical trial phases

Answer 116

Preclinical: not in humans I: pharmacokinetic, metab, dynamics ; adverse effects and max dosis. On a small and healthy group Il: efficacy checking, affected subjects lll: safety and effectiveness compared to placebo IV: effect over time after being out in the market

Question 117

Baby born from mother with untreated HPV will likely develop __ due to ___

Answer 117

Weak cry, hoarseness and stridor Infection of true vocal cords (has stritified squamous epithelium)

Question 118

Excertional heat stroke is associated to

Answer 118

DIC (high fibrinolysis, thrombin and plasmin production )

Question 119

Young man with hypertension, episodic headache, anxiety, and diaphoresis; and an adrenal mass on CT scan has

Answer 119

Pheochromocytoma

Question 120

Lung abscess usually forms due to

Answer 120

the aspiration of oropharyngeal bacteria

Question 121

RF for aspiration sd

Answer 121

• Periods of altered consciousness • Impaired swallowing (eg, nasogastric tube, dysphagia) • Periodontal disease (gingivitis)

Question 122

The last structure to disappear in the respiratory epithelium is

Answer 122

Cilliated cells (until prox respiratory bronchioles

Question 123

large hepatocytes filled with finely granular, homogeneous, pale pink cytoplasm (ground glass hepatocytes). Think of

Answer 123

Hepatitis b

Question 124

High Fructose 2.6-biphosphate ->high glycolysis and inh gluconeo->

Answer 124

less alanine to glucose

Question 125

Insulin ___ fructose 2,6-biphosphate

Answer 125

Increases

Question 126

patient developed localized erythema and vesicles 2 days after reexposure to a chemical on patch testing, think of

Answer 126

allergic contact dermatitis

Question 127

Allergic contact dermatitis is a hypersensitivity type__, where there’s

Answer 127

IV Migration of hapten(allergen)-activated Langerhans cells (dendritic cell) to regional lymph nodes

Question 128

Impaired fibrillin synthesis, think of

Answer 128

Marfan sd

Question 129

Impaired elastin degradation

Answer 129

Alpha-1 antitrypsin deficiency

Question 130

The sciatic nerve is particularly susceptible to injury in patients with

Answer 130

femoral head dislocation, hip fracture, and/or arthroplasty

Question 131

Polyarteritis modosa features

Answer 131

-weeks or months of constitutional sts and signs of organ ischemia -biopsy: segmental, transmural inflammation with fibrinoid necrosis disruption of elastic laminae. -rel to HBV

Question 132

Horner syndrome classically presents with

Answer 132

hemifacial ptosis miosis anhydrosis enophthalmos.

Question 133

Bell palsy (CN Vll) presents with

Answer 133

-asymmetry of face when smiling -effacement of nasolabial fold -lips are drawn toward op side. -Loss of taste from 2/3 ant tongue -less tear production

Question 134

Young woman with isolated thrombocytopenia and no other platelet abnormalities, think of

Answer 134

immune thrombocytopenic purpura

Question 135

Red flags of drug-seeking behavior

Answer 135

-requesting a specific medication -running out of medication -claiming pain out of proportion to the physical examination -Reporting lost or stolen medication -obtaining multiple opioid prescriptions from different providers

Question 136

What’s the initial approach for suspected drug-seeking behavior?

Answer 136

Clarify medication/prescription history

Question 137

internal hemorrhoids drain into

Answer 137

superior rectal vein -> inferior mesenteric vein.

Question 138

External hemorrhoids drain via

Answer 138

the inferior rectal vein -> internal pudendal vein -> internal iliac veins

Question 139

Most carcinomas spread via

Answer 139

Lymphatics

Question 140

The following CA spread hematogenously

Answer 140

Sarcomas Renal cell carcinoma Hepatocell carcinoma

Question 141

These Ca spread perineurally

Answer 141

Pancreatic ductal adenocarcinoma Prostate Ca

Question 142

Most Ca spread via

Answer 142

Direct invasion

Question 143

Formation of ketone bodies depends firstly on enzyme

Answer 143

Hormone-sensitive lipase

Question 144

Cocaine-induced chest pain is treated with

Answer 144

Nitro (reduced preload) + BZD (reduces SNS response)

Question 145

Young pt with MI signs, think of

Answer 145

Coronary artery vasoconstriction due to cocaine

Question 146

Which technique is used for detecting large deletions or transloc of chromosomal segments?

Answer 146

Fluorescence in situ hybridization (FISH)

Question 147

Key features of Coccidioides

Answer 147

Spherules full of sndospores Endemic of southwest US (Arizona, New mex)

Question 148

Turner sd is associated to which heart prob?

Answer 148

Bicuspid ao valve

Question 149

Small linear splinter hermorrhages under nail (microemboli) suggest

Answer 149

Infectious endocarditis

Question 150

Pte <40 yo with inflam back pain + tenderness at tendon insertion + forward flex reduced. Think of

Answer 150

Ankylosing spondylitis

Question 151

Ankylosing spondylitis increased markers

Answer 151

HLA-B27 IL-17 TNF-alpha Prostaglandins

Question 152

Transposition of great arteries in NB causes reversed function of ventricules and arteries, in order to live, they need a

Answer 152

sx that widens foremen ovale or maintains ductus arteriosus to provide some oxygenated blood to the body

Question 153

What anatomical landmark is used in a appendectomy?

Answer 153

Teniae coli

Question 154

Ring-enhancing focal brain lesions on HIV patients. Consider ___ or ___

Answer 154

Toxoplasmosis PCNSL (B cell lymphoma) by EBV

Question 155

Class IA and III antiarrhythmics are associated to

Answer 155

acquired QT prolongation

Question 156

Solatol and Ibutilide are class lll antiarrythmics that associate to

Answer 156

Torsades de pointes

Question 157

Hemolytic disease of the NW features

Answer 157

Jaundice Hepatomegaly HypoHb Direct Coombs (+) Little to none prenatal care

Question 158

Contralat complete sensory loss after signs of stroke, structure probably affected

Answer 158

Contralat Thalamus

Question 159

Lacunar infarctions are believed to be primarily caused by

Answer 159

Lipohyalinosis and microatheromas

Question 160

Elderly woman with rash around eye and nose + eye pain +decreased vision. Think of

Answer 160

Herpes zoster ophthalmicus

Question 161

Anemia + High reticylocyte count suugests

Answer 161

Bleeding or hemolysis (intravascular or from splenic erythrocytes destruction)

Question 162

Anemia + very low reticylocyte count (not normal response) suggests

Answer 162

Problema producing RBCib bone marrow. If only Hb low, think of pure red cell aplasia

Question 163

Transient ischemic attack is characterized by

Answer 163

Focal neurological deficits (seems to be a stroke) but resolved without intervention *due to transient brain ischemia

Question 164

Transient ischemic attack management

Answer 164

Antiplatelets (aspirin+clopi) Statin (HMG-CoA redactase inh) Lifestyle modifications

Question 165

Dog bite associated bacteria

Answer 165

Pasteurella multocida and Pasteurella canis Capnocytophaga canimorsus

Question 166

Cat bite associated bacteria

Answer 166

Pasteurella multocida Bartonella henselae

Question 167

Valproate is used as

Answer 167

Anticonvulsant and mood stabilizer

Question 168

Anencephaly is caused by failure of ____ closure

Answer 168

Ant/rostral neuropore

Question 169

What’s the best method for a pt with Turner sd to achieve pregnancy?

Answer 169

In vitro fermentation

Question 170

Sporotricosis (rose disease) biopsy shows

Answer 170

Grandulomas and neutrophilic microabscesses

Question 171

Pt with agitated delirium, sympathetic hyperactivity due to antiAcH toxidrome, give

Answer 171

Physostigmine

Question 172

Pt with sedation/ slurred speech but normal vitals due to BZD OD, give

Answer 172

Flumazenil

Question 173

Sedation with resp suppression + miosis due to opioid OD, give

Answer 173

Naloxone

Question 174

Pt with altered mental status + mydriasis + sympathetic hyperactivity (serotonin sd) due to to SSRI/SNRIs OD, give

Answer 174

Cyproheptadine

Question 175

Lung CA can cause epidural metastasis manifesting as___ and affecting__ nerve

Answer 175

Cauda equina sd Sciatic and pelvic splanchnic

Question 176

Pt unresponsive post partum with profuse bleeding and shock signs, think of

Answer 176

Amniotic fluid embolus sd

Question 177

Amniotic fluid embolus sd hemodynamic effects

Answer 177

High PVR High CVP -> high RVP Low PCWP

Question 178

25% pts with active TB show little to no resp to tuberculin skin test due to

Answer 178

Inadequate lymphocyte resp (T cell anergy)

Question 179

Chronic granulomatous disease featured

Answer 179

Catalase (+) organisms recurrent infections Normal igb levels, no leukopenia *Impaired neutrophilic resp burst

Question 180

MEN2B features

Answer 180

Medullary thyroid Ca signs (mass + high calcitonin Mucosal neuromas Marfanoid habitus Pheochromocytoma

Question 181

Pt with recent partum labor presents with fecal incontinence and loss of anal wink reflex. Nerve injured is

Answer 181

Pudendal

Question 182

22q11 deletion sd features

Answer 182

Recurrent sinopulm infect Craneofacial abnormalities Congenital heart disease Thymic hypoplasia

Question 183

Where in the lymph node are T cells ?

Answer 183

Paracortex

Question 184

Young woman with signs of internuclear ophthalmology, think of

Answer 184

Multiple sclerosis

Question 185

Osmotic diuretics act on

Answer 185

Descending limb of henle loop and PT

Question 186

Carbonic abhydrase inh (acetazolamide) used for angle closure glaucoma acts on

Answer 186

PT

Question 187

Neonatal abstinance sd manifests as

Answer 187

NB with irritability, high-pitched cry, sleeping and feeding probs, autonomic disfx, tachypnea, diarrhea and vomiting

Question 188

Anti-Smith ab relates to Smith prot, which is ____. This participates in

Answer 188

snRNA RNA splicing removing introns via spliceosomes (which have snRNPs )

Question 189

Peripheral artery disease management

Answer 189

Excersise + cilostazol

Question 190

Acute management of variceal hemorrhage reqs

Answer 190

Somatostatin

Question 191

Small gap near the tip of a long arm of the X chromosome , think of

Answer 191

fragile x sd

Question 192

Fragile x sd features

Answer 192

Intelectual disability Prominent forehead, chin Long ears, long and narrow face Macroorchidism

Question 193

Elevated alpha fetoprotein is suggestive of ___ and represents failure of ____

Answer 193

Open neural tube defect -> hindbrain herniation Primary neurulation

Question 194

Primary neurulation process

Answer 194

Neural plate -> neural folds -> neural tube

Question 195

Mediators of sepsis/syst inflam

Answer 195

TNF-a, Il-1, Il-6

Question 196

Why are cholesterol gallstone produced ?

Answer 196

Not enough bile salts

Question 197

Why are brown/pigmented gallstones produced?

Answer 197

Infection-> injured hepatocytes-> release beta glucuronidase-> Excess unconjugated bilirubin

Question 198

Normal Anion gap value and formula

Answer 198

10-14 Na - (HCO3+ Cl)

Question 199

Antipsychotics can produce acute dystonic Rx due to

Answer 199

Strong D2 inh in the nigrostriadal pathway -> excess AcH -> extrapiramidal sts

Question 200

Proliferative phase of HBV express HBsAg and HBcAg + MHC on hepatocyte surface, this causes ___

Answer 200

CD8+ to attack hepatocytes but it’s not a direct citotoxic effect

Question 201

HIV-2 features

Answer 201

West Africa Low viral load 10-25 years to AIDS

Question 202

Prot C is___. Its deficiency causes

Answer 202

Anticoag prot Procoag state (DVT)

Question 203

Factor Vlll deficiency causes

Answer 203

Hemophilia A

Question 204

vWF fx

Answer 204

Binds Gplb (platelets glycoprot) to collagen Protects factor Vlll carrier

Question 205

Venous blanching + induration + pallor on site of norepi (extravasation), give

Answer 205

Phentolamine (op vasodilating effect)

Question 206

During passive expiration, resp system compliance (chest wall vs lungs) reaches eq. That is at an intrapleural P of

Answer 206

-5 cm H2O

Question 207

Sensitivity vs specificity

Answer 207

Positive truly have the disease (low rate of false neg) Negative truly don’t have the disease (low rate of false positives)

Question 208

Multiple sclerosis tremor is

Answer 208

Cerebellar Action tremor Ataxia rel

Question 209

Mass in neck + ear effusion, suspect tumor in

Answer 209

Nasopharynx

Question 210

Von Hippel-Lindau disease produces

Answer 210

-Cerebellar & retinal hemangioblastomas -Pheochromocytoma -Renal cell carcinoma (clear cell subtype)

Question 211

Pt with episodes of irresistible need of sleep during day and inappropriate places, treat with

Answer 211

Modafinil (for Narcolepsy)

Question 212

Alveolar ventilation is

Answer 212

Tidal vol - dead space vol

Question 213

Cocaine withdrawal sts

Answer 213

Low mood, fatigue, hypersomnia, hyperphagia, and vivid dreams

Question 214

Cannabis withdrawal sts

Answer 214

irritability, anxiety, depressed mood, and vivid dreams, insomnia and decreased appetite

Question 215

Opiate withdrawal sts

Answer 215

abdominal cramps, nausea, vomiting, yawning, muscle aches, piloerection, lacrimation, and dilated pupils.

Question 216

OH withdrawal sts

Answer 216

agitation, tremors, tachycardia, and hypertension

Question 217

Pulm artery catheter/Swan-ganz reflects

Answer 217

left atrial and left ventricular end-diastolic pressures.

Question 218

Pulm artery catheter/Swan-ganz go through

Answer 218

right atrium, right ventricle, and pulmonary artery

Question 219

To reduce risk or treat estrogen tumors in post-meno women, give

Answer 219

Aromatase inhibitors (anastrozole, letrozole, exemestane)

Question 220

Digital clobbing, think of

Answer 220

cardiopulmonary hypoxic disease Pulm neoplasia Chronic cardiopulmonary infection

Question 221

Myotonic dystrophy type 1 features

Answer 221

CTG repeats Attacks non-dividing cells: skeletal muscle, brain, myocardium

Question 222

Sudden cardiac death due to MI usually causes

Answer 222

Malignant ventricular arrhythmia (ventricular fib)

Question 223

Active infection of Strongyloides stercolaris is dg via

Answer 223

Rhabfitiform larvae in stool (noninfective) *filariform larva in soil (infective)

Question 224

To which antibody does Graves’ disease associate ?

Answer 224

Thyrotropin receptor

Question 225

To which antibody does Hashimoto’s disease associate ?

Answer 225

Thyroid peroxidase *thyroglobulin is more common in hypothyroidism

Question 226

Physiological response to anaphylaxis

Answer 226

Antigent-igE contact-> igE ab receptor aggregation -> mast cell and basophil degranulation -> histamine and tryptase release.

Question 227

Meckel diverticulum’s features

Answer 227

Persistent vitelline duct Often by age two Painless rectal bleeding

Question 228

Sudden upward jerking (hanging from tree or kid pulled by the arm) may result in Klumpke palsy/ hand clumsiness because

Answer 228

It can injured of the inf trunk of brachial plexus -> median and ulnar N -> intrinsic hand musc

Question 229

History of nasal wound or prolongs tampon + hypotension, rapid onset fever and diffuse erythematous rash, think of

Answer 229

Staphylococcal toxic shock sd (pyrogenic endotoxin superantigen)

Question 230

Hartnup disease features

Answer 230

Deficiency of niacin due to mut of aa transporter (ex triptophan precursor of niacin) Early childhood sts Pellagran-like skin eruptions Cerebellar ataxia aa in urine

Question 231

Predominant Hb before 8 weeks gestation?

Answer 231

Zeta or epsilon globins

Question 232

Predominant Hb before 14 weeks gestation til first months of life ?

Answer 232

HbF (2 alpha, 2 gamma)

Question 233

Chronic (>6mo) lung transplant rejection is marked by

Answer 233

submucosal lymphocytic inflammation in the walls of the small airways.

Question 234

Acyclovir nephrotoxicity can be prevented wit

Answer 234

Adequate hydration

Question 235

Twisting your ankle inward (lat ankle sprain) hurts ___

Answer 235

(Ant) talofibular ligament

Question 236

Dg criteria for schizophrenia

Answer 236

continuous signs of disturbance for at least 6 months an at least 1 month of ≥2 of active or passive sts

Question 237

EPO fx

Answer 237

In resp to hypoxia, it increases progenitor RBC differentiation and reduces apoptosis

Question 238

Medicare covers

Answer 238

65 yo and older who have paid taxes, have residence and citizenship in US Young ppl with disabilities, ESRD and ALS

Question 239

Medicare covers

Answer 239

65 yo and older who have paid taxes, have residence and citizenship in US Young ppl with disabilities, ESRD and ALS

Question 240

Medicaid covers

Answer 240

Homeless Undocumented immigrants Pregnant women Low-income families

Question 241

Cleft lip is a result of failure in the fusion of

Answer 241

Maxillary prominence and intermaxillary segment

Question 242

What test is useful to check if there’s sickle cell trait

Answer 242

Hb electrophoresis

Question 243

Oligodendrocyte depletion, focal demyelination, T2 lesions on MRI, oligoclonal bands on CSF are typical of

Answer 243

Multiple sclerosis

Question 244

Mass blocking ileocecal valve + air in biliary tree (pneumobilia), think of

Answer 244

Gallstone ileus

Question 245

What type of genes are RET, TP53 and RB?

Answer 245

RET: protooncogene TP53, RB: tumor suppressors

Question 246

HPV oncoproteins (E6 and E7) affect

Answer 246

Tumor suppressors E6-P53 E7-RB *rel to head, neck, anal and penile Ca

Question 247

Postpartum depression features

Answer 247

Up to a year Depression sts Guilt

Question 248

Postpartum blues features

Answer 248

Resolves within 14 days Mild depression Tearfulness Irritability

Question 249

Postpartum psychosis features

Answer 249

Delusions, hallucinations, bizarre behavior

Question 250

Old pt with Bradycardia + dropped p waves on EKG, think of

Answer 250

Sick sinus sd

Question 251

Pt with depression and ongoing cellulitis is given atb then presents with seizures, what atb did he receive?

Answer 251

Linezolid

Question 252

HSV-1 features

Answer 252

Gingivostomatitis DNA virus Ds Enveloped

Question 253

Randomization refers to

Answer 253

assignment of 2 groups with similar characteristics to prevent selection bias

Question 254

Acute hemolytic transfusion reaction is caused by

Answer 254

Pt’s abs against blood product ABO-group antigen (ABO incompatibility)

Question 255

Delayed hemolytic transfusion reaction occurs when

Answer 255

A pt was previously exposed (days to weeks before) to a foreign, **minor RBC antigen**

Question 256

Dense lung opacity with air-fluid level in an alcoholic or drug user are consistent with

Answer 256

Lung abscess (due to aspiration during loss of consciousness)

Question 257

Vaccine component of meningococcal meningitis

Answer 257

Capsular polysaccharide

Question 258

Young adult with skin-colored, well-circumscribed plaque painless or without itching, think of

Answer 258

Verruca vulgaris by HPV

Question 259

Histopathologic findings of HPV verruca

Answer 259

Epidermal hyperplasia Hyperkeratosis Cytoplasmic vacuolization

Question 260

Multiple drug Tto is req for TB due to

Answer 260

Altered structure of bacterial ribosomal prots resistance pattern

Question 261

Carcinoid sd dg

Answer 261

High 5-HIAA urinary excretion

Question 262

Trauma to side of the face s and probable temporal bone fracture will affect which nerves ?

Answer 262

Facial and vestibulocochlear nerve

Question 263

BRCA1/2 are responsible for

Answer 263

DNA repair

Question 264

What can reverse MTX toxicity?

Answer 264

Folinic acid

Question 265

Which antifungal drugs bind/inh incorporation of ergosterol into cell mb?

Answer 265

Amphotericin B Nystatin

Question 266

Which antifungal drugs inh ergosterol synthesis?

Answer 266

Azoles

Question 267

The only immune cell that doesn’t go down with aging is

Answer 267

CD8+

Question 268

Mycophenolate is the ideal drug for

Answer 268

helping prevent organ transplant rejection

Question 269

Exercises of pelvic floor for helping with urinary Incontinence are aimed for which muscles?

Answer 269

Levator ani muscle complex

Question 270

Why is profilactic penicillin important in S.pyogenes pharyngitis?

Answer 270

Prevention of acute rheumatic fever and rel cardiovascular disease

Question 271

What type of edema does increased fluid extravasation and decreased oncotic pressure cause?

Answer 271

Pitting edema

Question 272

Child with milky plasma + low lipase activity+ hypertriglyceridemia+ acute pancreatitis + Lipemia retinalis. Suspect

Answer 272

Fam chylomicronemia sd

Question 273

Toxic shock sd toxin from SA features

Answer 273

Rel to tampons and nasal packing Macrophages and T cells response

Question 274

Detrusor musc contraction promotes

Answer 274

Urination (+ decrease int urinary sphincter tone )

Question 275

Fatigue + depressed mood within 3 months of identifyable stressor

Answer 275

Adjustment disorder

Question 276

Chronic depressed mood for more than 2 years

Answer 276

Persistent depressive disorder (disthymia)

Question 277

Spironolactone causes gynecomastia bc

Answer 277

It blocks androgen receptor and decreases testosterone synthesis

Question 278

TAP prot are needed in the immune system bc ___. TAP Mutations lead to

Answer 278

They present antigents to MHC l which then activate T cells Ulcers and recurrent resp infections

Question 279

Nitrates effects and adverse effects

Answer 279

Venodilation-> more blood remains in veins-> less EVDV -> less wall stress -> less O2 demand -> less pain Headaches, hypotension, flushing

Question 280

Greatest severity determinant in Tetralogy of Fallot

Answer 280

Degree of right ventricular outflow tract obstruction

Question 281

Levothiroxyne absorption is decreased when taken with

Answer 281

Iron Calcium Antiacids

Question 282

Night blindness + thickened skin are suggestive of

Answer 282

Vit A def

Question 283

Causes of vit A, D, E, K def

Answer 283

Pancreatic insufficiency Cholestasis/biliary obst Short bowel sd

Question 284

Hemophilia inheritance probability is

Answer 284

1/2 (being carrier) x 1/2 (passing affected chromosome) x 1/2 (having a boy) = 1/8

Question 285

Which mood stabilizers are used for Manic features, manic + depressive, depressive

Answer 285

Valproate, carbamazepine Lithium Lamotrigine

Question 286

Giant cytoplasmic granules inside neutrophils are pathognomonic of

Answer 286

Chédiak-Higashi sd (lysosomal trafficking impaired)

Question 287

Tay-Sachs disease features

Answer 287

By age 6, developmental regression Beta-hexosaminidase A deficiency High GM2 ganglioside Cherry red spot on macula

Question 288

Persistence of HBsAg for more than 6mo indicates

Answer 288

Chronic HBV infection

Question 289

Anti-HBs in HBV represents

Answer 289

Long term immunity

Question 290

Which organisms exacerbate COPD

Answer 290

Viral: rhinovirus, influenza, RSV Bacterial: Haemophilus influenzae, Moraxella catarrhalis, Streptococcus pneumoniae

Question 291

The number needed to harm is

Answer 291

1/ ARI (prob of adverse effect in Tto group - prob of adverse in placebo group)

Question 292

Resistance to Vanco is due to

Answer 292

replacement of the terminal D-alanine-D-alanine with D-alanine-D-lactate

Question 293

Direct inguinal hernia features

Answer 293

Older men Weakness of transversalis fascia Medial to inf epigastric vessels Hasselbach’s triangle

Question 294

Indirect inguinal hernia features

Answer 294

Lat to inf epigastric vessels In males: failure of processus vaginalis to obliterate In females: failure of int inguinal ring to close

Question 295

MAC (dep on C3, C5-9) is most important defense against

Answer 295

Encapsulated organisms *MAC def displays low CH50 and AH50

Question 296

Ras prot is activated when bound to

Answer 296

GTP

Question 297

Mastocytosis is associated with KIT mut which causes

Answer 297

Excessive Histamine release -> gastric hypersecretion

Question 298

From which vessel originate the hepatic arteries

Answer 298

Celiac trunk

Question 299

Desmopressin lowers the clearance of

Answer 299

Urea

Question 300

Pt with history of trauma presents with painful, firm, mobile mass on musc area, think of

Answer 300

Myositis ossificans

Question 301

Mucosal bleeding and easy bruising that resp to desmopressin, think of

Answer 301

Von Willebrand disease

Question 302

Paget disease profile

Answer 302

Old man Multifocal bone pain (skull, vertebrae and extremities) High alk phophatase, normal Ca, PTH and phosphorus Thickening of cortical and trabecular bone Possible spinal stenosis and nerve compression

Question 303

A monocular upper left visual field defect is likely due to a lesion in

Answer 303

The lower right retina

Question 304

What’s the most important measure to reduce risk of transmission in MRSA ?

Answer 304

Hand hygiene

Question 305

Young pt with platypnea, pulmonary vasc disease signs and recurrent epistaxis

Answer 305

Hereditary hemorrhagic telangectasias (Telangenctasias might not be mentioned)

Question 306

infant with erythematous and pruritic patches on her cheeks, think of

Answer 306

has atopic dermatitis (eczema) *high IgE, risk of other atopic diseases

Question 307

Muddy brown granular casts in urine, think of

Answer 307

Acute tubular necrosis

Question 308

Child with erythematous papules and pustules that later erupt, forming a honey/amber colored crusting, think of

Answer 308

Impetigo by SAu or SPiog

Question 309

Beta blockers lower blood pressure via 2 mechanisms:

Answer 309

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

Question 310

Pemphigus vulgaris’ buzz words

Answer 310

Flaccid bullae -> easy eruption-> erosions Desmosomes problem

Question 311

Bullous pemphigoid’s buzz words

Answer 311

Solid bullae Old people Hemidesmosome problem

Question 312

“Transforming unacceptable feeling or impulses into the opposite” refers to

Answer 312

Rx formation

Question 313

Retinal cherry-red macular spot with white surrounding ring + hepatosplenomegaly + neuro degeneration, think of

Answer 313

Sphingomyelinase def

Question 314

Thrush and Leukoplakia white-plaque like lesions on the tongue but only ____ can be scraped off

Answer 314

Thrush (C. albicans)

Question 315

Congenital primary hypothyroidism, think of

Answer 315

Thyroid dysgenesis or TSH resistance

Question 316

Which class lll antiarrhythmic has the least risk of producing Torsades de pointes

Answer 316

Amiodarone

Question 317

“Sustained, involuntary, musc contractions that for body into abnormal and painful posture” refers to

Answer 317

Dystonia

Question 318

For knowing the probability of not having a disease, use

Answer 318

Neg predictive value

Question 319

Which cells and receptors participate in a tuberculin skin test Rx?

Answer 319

CD28-T cells CD80- dedritic cells

Question 320

Unilateral hearing loss, dg to consider

Answer 320

Perforation of tympanic mb Vestibula schwannomas (acoustic neuroma)

Question 321

Noise-induced hearing loss affects

Answer 321

Stereocilliated hair cells of organ of Corti

Question 322

ARR = (Risk control - Risk treatment)

Answer 322

Absolute risk reduction

Question 323

Most common reactivation sd in AIDs pt is from

Answer 323

CMV (herpesvirus family)

Question 324

-navir antiretrovirals mec

Answer 324

Inh of HIV proteases -> not functional viral prots -> noninfectious virions

Question 325

Elderly pt with lightheadedness and feeling of impending fainting when tightening tie, think of ___. EKG finding __

Answer 325

Carotid sinus hypersensitivity Sinus pause

Question 326

Tumor multidrug resistance mec

Answer 326

Increased expression of P-glycoprot-> ATP-dep efflux pump -> chemo agents expelled out of cell

Question 327

Recovery complication after Acute tubular necrosis

Answer 327

Electrolyte wasting

Question 328

Rectus femoris and sartorus hace in common ____ but differ in that

Answer 328

Hip flexion R.F extends the knee and S flexes it

Question 329

Pt with chronic pancreatitis, UTH and tortuous veins in gastric fundus. Think of

Answer 329

Splenic vein thrombosis (due to pancreatic inflammation)

Question 330

Old male pt with back pain, suspect ___ bc it usually metastasizes to__

Answer 330

Prostatic CA Bone (forms new bone via irreg glands)

Question 331

Between 3 weeks and 2 years, a wound heals via

Answer 331

Matrix metalloproteinases which change type lll collagen for type l

Question 332

Schizoid vs schizotypal

Answer 332

• Schizoid: prefers to be a loner, detached, unemotional • Schizotypal: unusual thoughts, perceptions & behavior

Question 333

Most common enteric parasite infection in US and Canada has

Answer 333

Giardia lambia

Question 334

Light microscopy changes at days 1 to 3 after a MI

Answer 334

Coag necrosis Prominent neutrophilic infiltrate (clusters of purple dots areas)

Question 335

Light microscopy changes at days 10 to 14 after a MI

Answer 335

*Collagen depo and granulation tissue (white circles Fibroblast prolif *Neovasc (red dots)

Question 336

Young pt with large mediastinal mass, MPO (-), TdT (+), think of

Answer 336

T-lymphoblastic leukemia if CD2-CD8 (+) B-Lymphoblastic leukemia if CD10-CD79a (+)

Question 337

Most potent chemotactic eicosanoid that causes rapid neutro locomotion is

Answer 337

Leukotriene B4

Question 338

Which pathway can generate NADPH when cells are unable to do it directly form glucose ?

Answer 338

The pentose phosphate pathway (HMP shunt) via transketolase and transaldolase enzymes

Question 339

A patent ductus arteriosus is a left-to-right shunt that allows continuous flow of oxygenated blood from ___ to___

Answer 339

Ao to Pulm artery (which leads to a higher PaO2 there)

Question 340

Which drug can work as MTX toxicity rescue

Answer 340

Leucovorin (NS-formyl-tetrahydrofolate)

Question 341

Exceptions to pt confidentiality

Answer 341

Suspected abuse Knife or gunshot wounds Diseases that most be reported Threat to harm self or others

Question 342

Pt with shortened vigina, rudimentary uterus, amenorrhea, rest of sexual features are normal, think of

Answer 342

Müllerian agenesis

Question 343

Organism that usually causes pneumonia in OH use disorder

Answer 343

Klebsiella

Question 344

Peniciline inh transpeptidases that target

Answer 344

D-alanine-D-alanine

Question 345

In lymph nodes Cortez, B cells form___ where they undergo ____

Answer 345

Germinal centers Isotype switching (other ig apart from IgM)

Question 346

Beta Hb mut in Familial erythrocytosis produces poor binding of 2-3 BPG, which causes HbA to ___. This is similar to___.

Answer 346

Bind more O2. HbF

Question 347

Ureters are ant to ___ in the pelvic cavity

Answer 347

Int iliac artery

Question 348

Which organism causes epiglottitis in children?

Answer 348

H.influenzae type b

Question 349

Pt with harsh, holosystolic murmur along the lower left sternal border, think of ____, which is a _____ shunt

Answer 349

Ventricular septal defect Left to right

Question 350

Pt with Sickle cell disease taking Hydroxyurea presents with pancytopenia and macrocytosis, cause?

Answer 350

Medication-induced inhibition of a nucleic acid synthesis enzyme leading to DNA impaired synthesis

Question 351

P- value is

Answer 351

probability of obtaining a sample value at least as large as the one observed when the population value claimed in H0 is assumed to be true.

Question 352

rapid-onset muscle pain, fever, hemorrhagic bullae with dusky surrounding skin, and tissue edema/crepitus. Thinks of

Answer 352

Spontaneous gas gangrene by Clostridium septicum

Question 353

Spontaneous gas gangrene by Clostridium septicum is associated with

Answer 353

Colonic malignancy

Question 354

Gigantism is caused by hypersecretion of ___ mediated by ____

Answer 354

GH Hepatic IGF-1

Question 355

Pt requiring rapid blood transfusion but flow rate is not helping, you should

Answer 355

Double the diameter of the intravenous catheter

Question 356

Pt with recurrent infections during childhood and absence of fluorescence in neutrophils during dihydrorhodamine flow cytometry, think of

Answer 356

Chronic granulomatous disease

Question 357

Cause of recurrent infections in pt with cystic fibrosis

Answer 357

Development of bacterial macrocolonies

Question 358

HBsAg HBeAg found in blood smear signifies

Answer 358

HBsAg: first marker of HBV infection, surface antigen, implies active infection acute or chronic HBeAg: highly infectious if high, sts appear

Question 359

Anti-HBc (antibody) in blood test implies

Answer 359

Positive in window period (helps when ab and ag may not be detectable )

Question 360

Anti-HBe and Anti-HBs mean

Answer 360

Anti-HBe Anti-HBs: person has recovered, seen in vaccinated people

Question 361

Most common cause of complement deficiency is ___. Marked by___

Answer 361

Auto antibodies (IgG-ag complex formation) Low C4, C3, CH50 Normal Factor B

Question 362

Most common cause of bacterial vaginosis. Key finding is__

Answer 362

Anaerobic gram-variable Gardnerella vaginalis Clue cells

Question 363

Unilateral renal stenosis effects on non-stenotic kidney

Answer 363

small crowded glomeruli

Question 364

Formula for calculating number needed to treat to prevent neg event in 1 person (NNT)

Answer 364

NNT: 1/ARR ARR: control rate - tto rate Control rate: n ppl with neg event/total in control Tto rate: n ppl with neg event/total in tto

Question 365

Why is beta-thalassemia a problem for prot translation initiation ?

Answer 365

It affects the Kozak consensus seq which identifies AUG codon

Question 366

Insult to kinesin would

Answer 366

impair anterograde transport resulting in a deficiency of synaptic vesicles at the nerve terminal.

Question 367

Gastric band must go through ___ to encircle the stomach

Answer 367

Lesser omentum

Question 368

Testosterone replacement therapy adverse effects

Answer 368

Increased Prostate volume Reduced erythrocytosis (must monitor)

Question 369

Which organisms usually cause CF exacerbations

Answer 369

S. Aureus, H. Influenzae, P. Aeruginosa, Burkholderia capacia

Question 370

From which aa does the eNOS make NO to cause vasodilation?

Answer 370

Arginine

Question 371

What formula is used to know if an individual with a positive test truly has the disease ?

Answer 371

Positive predictive value (PPV) PPV: TP/ (TP+FP) ** Do not confuse with sensibility

Question 372

Cerebral palsy causes

Answer 372

Loss of descending inh control -> severe spasticity

Question 373

Ankylosing spondylitis elevates production of

Answer 373

IL-17 TNF-a Prostaglandins

Question 374

Propionic acidemia is caused by ___ ___ must be avoided

Answer 374

Deficiency of propionyl-CoA carboxylase. Valine, isoleucine, methionine, and threonine (create more propionic acid)

Question 375

Pt with chronic constipation and visible bulge protruding from vagina, Musc likely damaged?

Answer 375

Levator ani musc complex

Question 376

Glycosylated HIV polyprot gp160 create gp120 and gp41 whose function is

Answer 376

Mediate viral attachment and viral fusion to host cell

Question 377

Caspofungin blocks

Answer 377

Glucan synthesis needed for polysaccharide component of the fungal cell wall

Question 378

ECO showing microbubles in left heart after peripheral vein injection, think of

Answer 378

Right-to-left intracardiac shunt (PFO or ASD)

Question 379

Resting mb potential is formed with

Answer 379

High K and some Na conductance

Question 380

Myocardial granuloma or Aschoff body are pathognomonic of

Answer 380

Acute rheumatic fever carditis

Question 381

Shortened telomeres trigger

Answer 381

Permanent growth arrest

Question 382

PCA strokes affect and cause

Answer 382

Occipital lobe -> Homonymous hemianopia (visual neglect), contralat to lesion: macula is spared. Thalamus -> contralat hemisensory loss of the face, trunk, and limbs

Question 383

If a pt is in denial about terminal illness but doesn’t interfere with medical care, pte

Answer 383

Should not be confronted. Doctor must be supportive of pt’s hopeful perspective

Question 384

immunofluorescence microscopy shows granular deposits of IgG, IgM, and C3 on the GBM, think of

Answer 384

PSGN

Question 385

NB wit Hb irritability, poor feeding and high pitch cry. Mom with poor prenatal care, think of

Answer 385

Heroin exposure during pregnancy

Question 386

NB with growth def, smooth philtrum, palpebral fissures, thin upper lip and intellectual disability, think of

Answer 386

OH exposure during pregnancy

Question 387

NB with jitteriness, excessive sucking, and a hyperactive Moro reflex, think of

Answer 387

Exposure to cocaine during pregnancy

Question 388

Congenital Rubella sts

Answer 388

NB with cardiac defects, hearing loss and cataracts

Question 389

Extended expectrum beta-lactamase bacteria (E.coli) inactivate penicilins and cephalosporins via

Answer 389

enzymes encoded in plasmids

Question 390

Subclavian steal sd is recognized for

Answer 390

vertebral artery with retrograde (caudal) flow instead of normal antegrade

Question 391

Pt with schizophrenia and poor response to 2 or more antipsychotics, treat with ____. Must monitor____.

Answer 391

Clozapine Absolute neutrophil count (risk of agranulocytosis)

Question 392

systolic ejection murmur that disappears during an episode of cyanosis is a characteristic of

Answer 392

Tetralogy of Fallot

Question 393

systolic ejection murmur that disappears during an episode of cyanosis is a characteristic of

Answer 393

Tetralogy of Fallot

Question 394

Drugs associated with SIADH

Answer 394

carbamazepine, cyclophosphamide, and selective serotonin reuptake inh

Question 395

Medullary thyroid cancer features

Answer 395

Palpable neck nodule High calcitonin Spindle-shaped cells RET mut

Question 396

DM1 during early stages is characterized by

Answer 396

Islet leukocytic infiltration (insulitis). This is mainly due to destruction of beta cells through cell-mediated immunity.

Question 397

Pt with recent head trauma, high serum Osm, ICF and ECF contraction, think of

Answer 397

Diabetes insipidus

Question 398

Pulm Sarcoidosis features

Answer 398

-Dyspnea + cough +hilar adenopathy -Pulm infiltrates: noncaseating granulomas, tightly clustered epitheloid macrophages. -Immune resp: Th1, IL-2, interferon-y

Question 399

Oculocutaneous albinism is a mut of

Answer 399

Tyrosinase

Question 400

HIV fusions with host cell mb binding gp120 to CD4 and then

Answer 400

Chemokine receptor CCR5 -> gp41 -> viral fusion

Question 401

pt with DM1 has postprandial nausea, vomiting of undigested food, bloating, and early satiety, think of ___.

Answer 401

Gastroparesis

Question 402

B-hCG role is

Answer 402

Maintain the corpus luteum Continue progesterone production

Question 403

Risk of infection in systemic chemotherapy is higher due to

Answer 403

Mucositis -> damage to digestive tract epithelial cells -> endogenous bacteria enter bloodstream Neutropenia

Question 404

Drugs used to reverse anticholinergic toxicity

Answer 404

Tertiary amines: physostigmine, galantamine, donepezil, rivastigmine.

Question 405

Neurologic sts on upper extremity in the setting of an extra rib, think of

Answer 405

Thoracic outlet sd -> compression of brachial plexus

Question 406

Neurologic sts on upper extremity in the setting of an extra rib, think of

Answer 406

Thoracic outlet sd -> compression of brachial plexus

Question 407

To treat atrial flutter, conduction block must be made through

Answer 407

Cavotricuspid isthmus (IVC-tricuspid valve)

Question 408

Failure of post neuropore closure results in

Answer 408

Myelomeningocele (open spinal dysraphism)

Question 409

Genetic shift and reassortment in viruses is responsible for epidemics thanks to their ____

Answer 409

Segmented genomes

Question 410

Vesicoureteral reflux (retrograde flow urine) commonly occurs due to

Answer 410

Congenitallly shortened intravesical ureter

Question 411

Key difference between acute stress disorder and PTSD

Answer 411

ASD lasts <1mo PTSD lasts >1mo

Question 412

Key Differences between Hirschsprung disease and intestinal atresia

Answer 412

HD: delayed passage meconium, obst sts. Small intestine unaffected (colon yes). Cellular migration failure. IA: Small intestine affected (blind-ending, certain areas absent). Vasc occlusion prob.

Question 413

MTX is a folate antagonist that causes ___ and ___ to accumulate intracel

Answer 413

Folic acid DFH polyglumate

Question 414

Most common benign liver tumor is___ and it’s recognized by___

Answer 414

Cavernous hemangioma Cavernous, blood filled vasc spaces

Question 415

Pt with acute dystonic Rx (eg torticollis) and history of recently diagnosed schizophrenia, probable cause

Answer 415

antipsychotic property of D2 antagonism in the nigrostriatal pathway. (Eg. haloperidol, fluphenazine)

Question 416

False negative formula

Answer 416

FN= (1-sensitivity %) x (n of ppl with disease)

Question 417

Isoproterenol is a ___ and ___ agonist

Answer 417

B1 and B2

Question 418

Meckel diverticulum features

Answer 418

Failure of vitelline duct obliteration Painless lower gastrointestinal bleeding and anemia Dg with Tc-pertechnate scan Usually by age 2

Question 419

Allergic bronchopulmonary aspergillosis key features

Answer 419

Asthma exacerbation with proximal beonchiectasis

Question 420

Organelle in charge of VLCFAs oxidation

Answer 420

Peroxisomes

Question 421

BRCA1 and 2 muts produce

Answer 421

Defective DNA break repair

Question 422

Block of C3-C7 will not only affect the brachial plexus but also cause

Answer 422

Phrenic nerve block -> ipsilat diaphragmatic paralysis

Question 423

Allergic rhinitis immune response order

Answer 423

1. Sensitization -> T cell induction/activarion, B cell maturation and IgE production 2. Repeat exposure-> IgE cross-link on mast cells -> IgE receptor aggregation

Question 424

outpouching from the ileum with a fibrous band connected to the umbilicus, think of

Answer 424

Meckel diverticulum

Question 425

When do implantation, gastro latino, neurulation and neural crest cell migration occur?

Answer 425

Week 1 Week 3 Week 4 End of week 5

Question 426

Blotchy red muscle fibers on Gomori trichrome stain are characteristic of

Answer 426

Mitochondrial myopathies

Question 427

Causes of neonatal hyperbilirubinemia

Answer 427

-physiologic RBC lysis -decreased UDP glucuronosyltransferase -increase enterohepatic circulation with increased beta-glucuronidase activity

Question 428

Which position helps relieve tetralogy of fallot and why?

Answer 428

Squatting -> increases SVR:PVR -> increases art [o2] -> relieves TET spell

Question 429

Pts with medullary thyroid Ca should be screened for ___ prior to sx

Answer 429

Pheochromocytoma in adrenal medulla (considering MEN2)

Question 430

Positive/negative sts favor prognosis in schizophrenia

Answer 430

Positive

Question 431

most important limiting factor for left ventricular myocardial blood supply

Answer 431

Duration of diastole

Question 432

Key feature of cardiac tamponade

Answer 432

Pulsus paradoxus: drop in pulse amplitude (SBP) during inspiration

Question 433

Hyperacute transplant rejection hietologic findings

Answer 433

Mottling Cyanosis Arterial fibrinoid necrosis Thrombotic occlusion

Question 434

Acute transplant rejection hietologic findings

Answer 434

Lymphocytic interstitial infiltrate C4d deposition Neutro infiltrate Necrotizing vasculitis

Question 435

Chronic transplant rejection hietologic findings

Answer 435

Vasc wall thickening Interstitial fibrosis Atrophy

Question 436

Main cause of SCD in young adults

Answer 436

HCM

Question 437

HCM form of inheritance

Answer 437

Autosomal dom

Question 438

Which Ca blocker do not affect cardiac musc (contractility, conduction)

Answer 438

Dihydropyridines *will only cause vasodilation

Question 439

Transposition of great arteries (pulm art behind Ao) is due to embryonic failure of

Answer 439

Spiraling of aopulm septum

Question 440

How to treat beta blockers OD and mec

Answer 440

Glucagon -> Gprot-> cAMP increase -> Ca release-> HR, contractility and CO improvement

Question 441

Peripheral neuropathy + HF (beriberi), think of

Answer 441

Thiamine (B1) def

Question 442

Hemosiderin-laden macrophages (brown cells) are seen in the context of

Answer 442

Chronic passive lung congestion *decrease LVS fx

Question 443

Phenylephrine mec and use

Answer 443

a-1-agonist that increases peripheral vascular resistance but without direct effect on heart. VR increases and baroreceptors activate PSNS lowering HR Septic shock

Question 444

NB with cyanosis and narrow mediastinum, think of

Answer 444

Transposition of great arteries (parallel and systemic circuits)

Question 445

Cryptogenic stroke features

Answer 445

Evaluated with ecocardio bubble study: microbubblea seen in left heart Associated to PFO and ASD (septal probs)

Question 446

What hemodinamic mec helps with forward flow in MR?

Answer 446

Decrease SVR

Question 447

Vasospatic angina features

Answer 447

<50 yo without RF for CAD Self-limited Chest pain after 10-15min Due to Endothelial dysfunction Smoking is main RF

Question 448

Ascites as a result of RHF will have what portal capillaries parameters?

Answer 448

High hydrostatic P Normal oncotic P Normal capillary perm

Question 449

Which factor stimulates fibrosis?

Answer 449

TGF-b

Question 450

In the context of hipovolemia which lab findings are likely to increase

Answer 450

Hto Alb serum Uric acid serum

Question 451

How does on recognize tRNA?

Answer 451

RNA 90 nucleotides long with high chemically modified bases and cloverleaf-like structure. CCA is 3’ end molecule

Question 452

Proximal redial N injury will cause

Answer 452

Wrist drop (can’t extend wrist) and absent tricipital reflex

Question 453

What drugs can cause aplastic anemia

Answer 453

Carbamazepine, valproic acid Chemo Immunosuppressants Sulfonamides

Question 454

Detrusor musc contraction causes ___ and its relaxation __

Answer 454

Urination Urine retention

Question 455

Midline neck mass that moves upward when swallowing or protruding the tongue, think of

Answer 455

Thryroglosal duct cyst (incomplete obliteration)

Question 456

Acute facial flushing following accidental vitamin ingestion is highly suggestive of

Answer 456

Niacin (B3) toxicity. (Nicotinamide adenine precursor)

Question 457

Best dg test for trichomonas

Answer 457

Wet mount saline microscopy

Question 458

Lung vol changes in preterm NB with RDS

Answer 458

Low compliance Low functional residual cap and total lung cap High airway resistance (inflammation and edema from pneumocyte injury)

Question 459

Genital ulcers diseases: Single painless Multiple painful vesicles Deep purulent and painful Painless, no lymphad, serpiginous

Answer 459

Syphilis HSV Chancroid (H. ducreyi) Granuloma inguinale (donovanosis)

Question 460

HSV tto

Answer 460

Valacyclovir indefinitely

Question 461

Mania or major depressive sts + hallucinations/ delusions, think of

Answer 461

Schizoaffective disorder

Question 462

Hospice care is provided to

Answer 462

Terminally ill pts with <6 mo prognosis Tto is no longer beneficial/desired Irreversible decline

Question 463

Only opioid drug that is a partial opioid agonist but has very high affinity, Can end up acting as an antagonist and produce withdrawal sts

Answer 463

Buprenorphine

Question 464

Pt who ate fava beans or took dapsone recently, presents with anemia, suspect___ and expect___ in blood work

Answer 464

G6PD def High reticulocyte count, high lactate dehydrogenase, low haptoglobin, Heinz bodies (denature Hb)

Question 465

Most common trigger in AFib

Answer 465

Pulm veins

Question 466

Most common trigger in AFib

Answer 466

Pulm veins

Question 467

What does positively skewed distribution mean?

Answer 467

Mean is greater than mean and mode

Question 468

Gout producing conditions

Answer 468

Lympho/ Myeloproliferative Tumor lysis CKD Diuretics

Question 469

HVB carrier presents with rapidly progressive anorexia, nausea, abdo pain, jaundice, tender hepatomegaly, think of

Answer 469

HDV superinfection

Question 470

Why does HDV need HBV to infect?

Answer 470

HDAg must be coated by external coat HBsAg

Question 471

Unilateral bloody breast discharge, think of ____. Microscopy expected___

Answer 471

Intraductal papilloma Epithelial cells lining fibrovasc cores

Question 472

What organisms are cephalosporin resistant?

Answer 472

MRSA Listeria Enterococcus Mycoplasma Chlamydia

Question 473

Baby with Failure to thrive + developmental delay + orotic acid crystals, think of __. Supplement with

Answer 473

Hereditary orotic aciduria. Uridine

Question 474

Wilson’s disease causes

Answer 474

Hepatic, neurological (slurred speech, altered gait) and psychiatric symptoms

Question 475

ToF produces 4 defects, these are

Answer 475

• RVOT obstruction • Ventricular septal defect • Overriding aorta • Concentric RVH

Question 476

Hepatic Angiosarcoma is rare but it’s almost always associated to

Answer 476

Old man >60 Vynil chloride exposure

Question 477

Hepatic Angiosarcoma is rare but it’s almost always associated to

Answer 477

Old man >60 Vynil chloride exposure

Question 478

Graft-vs-host disease usually occur after__. Cells involved are__

Answer 478

Bone marrow transplant or lymphocyte-rich organs (liver) transplant Graft T cells against Host MHC Ag

Question 479

Absent Achilles reflex, nerve root affected is

Answer 479

S1

Question 480

Absent Patellar reflex, nerve root affected is

Answer 480

L2-L4

Question 481

HOX genes are in charge of coding prots that

Answer 481

Bind regulatory regions on DNA of target genes that participate in segmental org of the embryo

Question 482

NB with cleft-palate, polydactylia, umbilical hernia , focal lesion on scalp, microophthalmia, think of

Answer 482

Patau sd (trisomy 13)

Question 483

The metanephric blastema and diverticulum give rise to

Answer 483

-Glomeruli (all its parts), Bowman space. -Major and minor calyces, collecting system, pelvis and ureters

Question 484

Sickle cell trait (heterozygous) pte are different to homozygous sickle cell disease pte bc

Answer 484

HbA remains higher than HbS throughout life making the pt usually asymptomatic and normal RBC, Hb and reticulocyte count

Question 485

Staph exotoxins produce a toxic shock sd due to

Answer 485

binding of toxins to large amounts of T-cells which release massive amounts of cytokines

Question 486

Only cytokine with anti-inflammatory properties

Answer 486

IL-10 (protective in Crohn’s disease)

Question 487

Narcolepsy key features

Answer 487

Cataplexy (loss of musc tone with strong emotions) Low hypcretin-1 in CSF Sleep paralysis and hallucinations

Question 488

Which organism can produce a mono-like sd with a negative aglutination test (no heterophile Ab-horse erythrocyte aglutination)

Answer 488

Cytomegalovirus (immunocompetent) HHV-6, toxoplasmosis

Question 489

Which insurance option is preferable for paying low monthly premiums (payments) and copayments)

Answer 489

Health maintenance org *con: no access to out-of-network providers

Question 490

Pros and cons of “Preferred provider org” insurance

Answer 490

Pros: very flexible chioces for both in or out network providers Cons: very high premiums and deductibles

Question 491

Pros and cons of “Point of service” insurance plan

Answer 491

Pro: access to out of network providers Cons: higher premiums than HMO and high prices if pt indeed goes to out-of-network providers

Question 492

Coccidioides features

Answer 492

Southwestern US (Arizona, New Mexico,California, Texas) Transmision by endospore inhalation Acute pneumonia or flu-like sts + erythema nodosum Meningitis

Question 493

Niemann Pick disease buzz words

Answer 493

Ashkenazi Jews Lysosomal storage disorder Sphingomyelinase def->phospholipid accumulation-> hepatomegaly, splenomegaly, neuro sts, retinal opacification

Question 494

Isolated mitral stenosis vs combined mitral and Ao valve disease

Answer 494

MS: Backward blood transmission-> pulm HT MS/Ao: increased LVDP

Question 495

Neuropathologic findings in frontotemp dementia ?

Answer 495

Tau prot inclusions

Question 496

Neuropathologic findings in Lewy bodies dementia ?

Answer 496

Alpha synuclein

Question 497

Integrase inh antivirals inhibit viral replication via

Answer 497

Preventing synthesis of mRNA

Question 498

Mycobacterium T main virulence factor

Answer 498

Serpentin cord formation (prevents macrophage-med destruction and makes granulomas)

Question 499

Supplement breast-feeded babies with

Answer 499

Vit D Vit K Iron (from 4mo until solid food introduction)

Question 500

Lower cutoff in a quantitative dg means

Answer 500

More ppl with disease will test positive (high sensitivity, low specificity )

Question 501

Small engagement ring inside RBC, think of

Answer 501

Plasmodium falciparum trophozoites

Question 502

Best tto for malaria

Answer 502

Artemisinin

Question 503

Specific marker for Primary biliary cholangitis

Answer 503

Antimitochondrial

Question 504

Specific marker for autoimmune hepatitis

Answer 504

Anti smooth musc

Question 505

Immuno def pt with necrotic ulcer and surrounding erythema, think of __ caused by__

Answer 505

Ecthyma gandrenosum by P. aeruginosa

Question 506

When the inheritance expected freq < actually inherited freq, it is called

Answer 506

Linkage disequilibrium

Question 507

Sulfonylureas mec

Answer 507

Stimulate endogenous pancreatic insulin secretions (elevate c-peptide level) indep of blood glucose levels

Question 508

Pt with outpouching from lieum with a fibrous band connected to umbilicus, hematochezia and intestinal obst signs, suspect

Answer 508

Meckel diverticulum

Question 509

Chronic lung transplant rejection is marked by submucosal lymphocytic inflammation in the

Answer 509

Walls of the small airways leading to bronchiolitis obliterans.

Question 510

In order to be recognized, stop codons (UAA, UAG, UGA) must

Answer 510

Reléase factor 1

Question 511

In order to release catecholamines, which NT is needed to activate chromaffin cells in the adrenal medulla?

Answer 511

ACh

Question 512

Extrapulm features of cystic fibrosis ?

Answer 512

Pancreatic insufficiency Azoospermia Failure to thrive

Question 513

Most common liver neoplasm in children

Answer 513

Hepatoblastoma

Question 514

4 top metastasis places

Answer 514

Lymph nodes Liver Lungs Bone

Question 515

Why can fibrates produce gallstones ?

Answer 515

fibrates inhibit cholesterol 7a-hydroxylase which reduces bile acid production

Question 516

Cholesterol synthesis deps on

Answer 516

Thiolase and HMG-CoA

Question 517

Teenage girl with amenorrhea, normal secundary sexual features and cyclic abdominal pain, think of

Answer 517

Imperforate hymen -> blood obst -> hematocolpos (bulge in vagina, palpable ant to rectum)

Question 518

Immunocompromised with Spherical yeast with thick capsule seen on India ink staining, think of

Answer 518

Cryptococcus

Question 519

Esophagitis in immunocompromised features of Candida a, HSV, CMV

Answer 519

Ca: grey/white patches HSV: small, punched-out (distinct) ulcers and intranuclear eosinophilic inclusions CMV: large, linear ulcers

Question 520

dihydrobiopteridine reductase deficiency affects

Answer 520

Catecholamine, tyrosine and serotonine production Phenylalanine accumulation

Question 521

N. gonorrheae reinfection main cause is

Answer 521

Antigenic variation

Question 522

Cyclosporine and tacrolimus are the most common immunosuppressants used in transplantation. They act inhibiting

Answer 522

Calcineurin -> no NFAT actv-> no IL-2 -> no T cell stimulation

Question 523

Which protein defect is associated with metastasis?

Answer 523

E-cadherin

Question 524

Which papillary musc is more likely to become ischemic after a MI? Why

Answer 524

Postmedial Deps on a single artery (posterior descending artery, a branch of the right coronary artery or left circumflex artery)

Question 525

Consequence of excessive oxygen supplementation

Answer 525

Blood flow is redirected from well ventilated alveoli-> No CO2 exchange -> increasing dead space -> ventilation-perfusion -> *Oxygen-induced hypercapnia*

Question 526

Blunt abdo trauma commonly involves

Answer 526

Liver and spleen Less commonly kidneys

Question 527

Assessment of pt’s decision making capability. Before discharge pt must be able to:

Answer 527

Communicate choice Understand info Appreciate consequences Rationale (explain his decision)

Question 528

Infective endocarditis pathogenesis (steps)

Answer 528

Disruption normal endocardial surface at areas or max blood flow Fibrin deposition/nidus Microorg colonization of nidus *staphylo can affect normal or previously damaged cells

Question 529

Major depressive disorder sts are in SIGECAPS which mean

Answer 529

Lack of Sleep, interest, energy, concentration Guilt Appetite disturbances Psychomotor retardation/agitation Suicide ideation

Question 530

Both Takayasu and temporal arteritis are large-vessel vasculitis. Key differences

Answer 530

Takayasu: Female, <40, Ao branches, constitutional sd, claudication, pulse discrepancies (weak pulses), bruits, myalgias, arthralgias Temporal: ppl >50, carotid branches, visual probs, headache, jaw claudication

Question 531

Histopathology of Takayasu arteritis

Answer 531

Granulomatous inflam of arterial media Transmural fibrous thickening

Question 532

Which org cause head and neck squamous cell carcinoma

Answer 532

EBV: Nasopharyngeal. Has neck mass + nasal obstr + unilat ear effusion HPV (16 and 18): Oropharyngeal. Young. Persistent throat pain + tonsil lesion

Question 533

Vasooclosive pain in sickle cell disease is due to

Answer 533

HbS allows hydrophobic interaction among hemoglobin molecules

Question 534

a p value <0.05 is ___ and >0.05__

Answer 534

Statistically significant Non-statistically significant

Question 535

I’m cystic fibrosis mutations of CFTR causes

Answer 535

Abnormal prot folding

Question 536

Urethral folds evolution in males and females

Answer 536

Males: ventral aspect of penis (failure creates hypospadias) Females: labia minora

Question 537

Epispadias vs hypospadia

Answer 537

Epi: faulty positioning of the genital tubercle Hypo: faulty closure of urethral folds

Question 538

Cryptorchidism

Answer 538

Descend failure of testis into scrotum

Question 539

Multiple myeloma tto aims to ___ or ___

Answer 539

inhibit proteasome activity (bortezomib) or increase ubiquitination (lenalidomide)

Question 540

Girl with hypotension and posterior loss of consciousness after vaccination, think of

Answer 540

Vasovagal syncope, induced cardioinhibitory and vasodepressor response.

Question 541

Before operations, the following should be done

Answer 541

marking the operative site, independent verification of the patient, procedure, and site by 2 health care workers (a nurse and physician)

Question 542

Which molecule has an important role in granuloma formation?

Answer 542

Interferon-gamma

Question 543

Oppositional defiant disorder vs normal teen behavior

Answer 543

In ODD oppositional behavior is excessive in freq and duration (6mo or more)

Question 544

Increase Pol gene mutations mean

Answer 544

Inconsistent use of antiretroviral therapy.

Question 545

Symmetric pitting edema with frothy urine and history of NSAIDs use, think of

Answer 545

Nephrotic sd, membranous nephropathy

Question 546

Competitive vs noncompetitive antagonists curve

Answer 546

C: E50 increases (curve moves to the right) N: Emax decreases (curve is lower but doesn’t move)

Question 547

Ao root dilation (ao aneurysm rel) is one of the most common causes of

Answer 547

Chronic Ao regurgitation

Question 548

Blood-testis barrier is composed of

Answer 548

Sertoli cells joined by tight junctions

Question 549

Antisperm bobies Can be the result of damage to the

Answer 549

Blood testis barrier (due to trauma or ischemia)

Question 550

E. Coli virulence factor for UTI

Answer 550

P-fimbriae

Question 551

E. Coli virulence factor for neonatal meningitis

Answer 551

Capsular polysaccharide

Question 552

Virulence factor that plays major role in septic shock

Answer 552

Lipid A

Question 553

Lack of thiamine B1 produces

Answer 553

Neuro sts (beriberi, wernicke-korsakoff)

Question 554

Lack of thiamine B1 produces

Answer 554

Neuro sts (beriberi, wernicke-korsakoff)

Question 555

Lack of Riboflavin B2, produces

Answer 555

Cheilosis, stomatitis, glossitis, normocytic anemia

Question 556

Lack of Niacin B3, produces

Answer 556

Pellagra (3 d’s)

Question 557

Lack of biotin B7, produces

Answer 557

Dermatitis, conjunctivitis, alopecia, neuro changes

Question 558

Lack of Ascórbico acid Vit C, produces

Answer 558

Scurvy (gingivitis, petechiae, musc pain, hemorrhage due to impaired wound healing, corkscrew hairs)

Question 559

What is transformation in bacteria?

Answer 559

Direct uptake of extracell DNA from a dying neighbor bacteria that allows them to gain virulence

Question 560

Which bacteria can undergo transformation?

Answer 560

Haemophilus, Streptococcus, Bacillus, and Neisseria species.

Question 561

Impaired ornithine transport affects hepatic urea cycle which causes ammonia to accumulate. Restriction of ___is the main Tto

Answer 561

Protein

Question 562

Widely, fixed and split S2 + systolic ejection murmur at left upper sternal border, think of

Answer 562

Atrial septal defect

Question 563

Pt with headache, diplopia, unable to move eye in any direction, fever , loss of upper facial sensation and corneal reflex. Think of

Answer 563

Cavernous sinus trombosis (usually by stapth) *not brainstem infection cause there are no crossed signs, vertigo, ataxia

Question 564

Vasovagal syncope pathophysiology

Answer 564

Increased PSNS tone

Question 565

Transudative pleural effusion features

Answer 565

Low prot <0.5 Low LDH <0.5 Normal glucose Common in HF, cirrhosis, nephrotic sd

Question 566

Dog bite bacteria

Answer 566

Pasteurella multocida Pasteurella canis Capnocytophaga canimorsus

Question 567

Cat bite bacteria

Answer 567

Pasteurella multocida Bartonella henselae

Question 568

Human bite bacteria

Answer 568

Eikenella corrodens Group A Streptococcus

Question 569

Which structure is commonly injured in thoracic and neck procedures?

Answer 569

Thoracic duct

Question 570

Lung Mass + constitutional sd+ progre prox weakness (from legs to arms) + diminished reflexes, think of

Answer 570

Paraneoplastic Lamber-Eaton myasthenic sd

Question 571

Lamber-Eaton myasthenic sd is produced by

Answer 571

antibodies against presynaptic voltage-gated calcium channels -> no Ca+2 influx -> less ACh released -> no musc contraction

Question 572

Which myopathy is mostly associated to paraneoplastic sd

Answer 572

Dermatomyositos *specially rel to adenocarcinoma

Question 573

Which org reqs salt for growth, is oxidase (+), gram-neg and comma shaped

Answer 573

V. Cholerae

Question 574

What enzyme makes the sputum green in bacterial infection?

Answer 574

Myeloperoxidase

Question 575

Cross-species influenza infections deps on

Answer 575

Hemagglutinin, surface glycoprotein

Question 576

Mitral regurgitation BP curve, describe

Answer 576

Left atrium curve peaks near mitral valve closing

Question 577

Mitral stenosis BP curve, describe

Answer 577

LA curve makes “wave pattern” and moves upwards as a whole

Question 578

Ao regurgitation BP curve, describe

Answer 578

Ao curve decreases prominently at valve opening and closing. Still peaks with LV curve tho.

Question 579

Anticholinergic toxicity sts

Answer 579

Hot as a hare Dry as bone Red as beet Blind as a bat Mad as a hatter Full as a flask Fast as a fiddle l

Question 580

Ao stenosis BP curve, describe

Answer 580

Ao curve does not peak with LV curve

Question 581

Drug given to counteract antiACh toxicity

Answer 581

Physostigmine (cholinestease inh -> more ACh available)

Question 582

CD40 fx

Answer 582

On activated CD4 T cell surface, key for signaling APCs( B cells make germinal center and switch class; Macrophages and dendritic make cytokines, MHCII and increase phagocytosis)

Question 583

Colitis rel colorectal Ca vs sporadic colorectal carcinoma

Answer 583

Colitis rel Ca: <55 yo, nonpolypoid, prox>distal, multifocal, multiple mucinous, early p53 but late APC mutation Sporadic: the opposite

Question 584

Esophageal squamous cell carcinoma pt profile

Answer 584

Male, >50yo, smoking and OH use history and dysphagia

Question 585

Which ribs are associated to the spleen and kidneys

Answer 585

Spleen: 9-10*-11 (post sup portion of left abdominal cavity) Kidneys: 11-12*

Question 586

While total serum AlkP levels may be unspecific, high serum levels indicate

Answer 586

High osteoblastic activity (promotes bone mineralization)

Question 587

Cholecystokinin fx

Answer 587

Increase secretion pancreatic enzymes and HCO3

Question 588

Pt with watery diarrhea, hypoK, achorhydria, what enzyme is prob def?

Answer 588

Vasoactive intestinal peptide (think of VIPoma)

Question 589

Alanine transamination steps

Answer 589

1. Amino group-> a-keroglutare-> Glutamate is formed 2. Glutamate-> glutamate dehydrogenase-> ammonia 3. Ammonia-> urea cycle-> urea

Question 590

Neurologic disease rel to cystic degeneration of the putamen

Answer 590

Wilson’s disease

Question 591

Structure affected by Hungtinto’s disease

Answer 591

Caudate nucleus

Question 592

What’s used to prolong the duration of action of local anesthetics?

Answer 592

Epinephrine (vasoconstriction-> less blood flow -> more of the drug remains in place)

Question 593

Niemann-Pick vs Tay-sachs disease

Answer 593

Common: Ashkenazi jews, cherry red macula, recessive Pick: Sphingomyelonase def, areflexia, hepatosplienomegaly Tay: B-hexosaminidase A def, huperreflex, normal abdo exam

Question 594

Corneal reflex nerves

Answer 594

CN V1 with CN VII

Question 595

Cough reflex nerves

Answer 595

CN X

Question 596

Gag and carotid sinus reflexes nerves

Answer 596

CN IX and X

Question 597

Jaw jerk reflex

Answer 597

CN V3

Question 598

Granulosa cell tumor of ovary features

Answer 598

Unilat adnexal yellow mass in post-meno woman (>45yo) Estrogen producer -> Post-meno bleeding Cuboidal granulosa cells with eosinophilic material

Question 599

Yolk sac ovarian tumor buzzwords

Answer 599

Schiller-duval bodies that resemble glomeruli Young women a-fetoprotein

Question 600

Polysaccaride (capsule) vaccine vs Polysaccaride-prot conjugated vaccine

Answer 600

1. Only B cell resp, for kids >2yo 2.B and T cell resp, kids <2yo (need extra help due to immature humoral immunity)

Question 601

Amanita mushroom toxicity mec

Answer 601

mRNA synthesis inh

Question 602

14 yo girl with external female genitals but int male ones, dg

Answer 602

5-a-reductase def

Question 603

Immunocompromised with nucal regidity, CSF will most likely reveal___ typical of___

Answer 603

Lancet-shaped gram-positive cocci Strepto pneumoniae

Question 604

Bulimia Nervosa tto

Answer 604

CBT Nutri rehab Fluoxetine (SSRI)

Question 605

Anorexia nervosa tto

Answer 605

CBT Nutri rehab Olazapine

Question 606

Classic histopathological findings of Alzheimer’s

Answer 606

amyloid plaques and neurofibrillary tangles. Neuritic (senile) plaques in medial temporal lobes

Question 607

Corkscrew hairs are seen in scurvy due to impaired ___ in ___

Answer 607

Collagen synthesis in RER (Vit c needed for hydroxylation of proline and lysine)

Question 608

Hyper- igE sd features

Answer 608

-Auto dom -Jak-stat defective -> less Th17-> reduced neutros -Chronic eczema, recurrent non-inflam abscesses and sinopulm infections -only igE is elevated, rest Igs ok

Question 609

Subfalcine herniation features

Answer 609

Beneath falx recerebri Contralat leg weakness

Question 610

Uncal herniation features

Answer 610

Under tentorium cerebelli Ipsilat dilated and fixed pupil Hemiparesis

Question 611

Miltinone is a selective PDE-3 inh that causes

Answer 611

Ca reputable and increases intracel influx -> positive inotropy and vasodilator

Question 612

Which artery is anatomically related to the splenic artery?

Answer 612

Short gastric

Question 613

In Klinefelter sd gynecomastia is produced due to

Answer 613

Lack of inh of LH/TSH due to defective Leydig cells and and low inhibin levels -> low testo

Question 614

Months old baby girl with developmental regression and stereotypic hand movements, dg

Answer 614

Rett sd

Question 615

Drooping of shoulder, no abduction pass 100 degrees, lat scapula displaced, musc hurt is

Answer 615

Trapezius *Deltoid is pass 30 degrees

Question 616

Improved ventilation in prone positioning occurs due to

Answer 616

Less compression from heart and other organs-> alveoli opened, ventilation is more evenly distributed *Better V-P matching

Question 617

Pt with history of caries or recent dental extraction, Indurated mass, no pain, think of ___. Main feature is

Answer 617

Actinomyces Filamentous, branching, gram-positive bacilli

Question 618

Fat embolism main RF

Answer 618

Long-bone fx

Question 619

Pt with poor night vision, visual field loss, and funduscopic changes (pigment accumulation, optic disc pallor, retinal vessel attenuation) consistent with

Answer 619

retinitis pigmentosa, a genetic disease characterized by progressive dystrophy