Molecules

Question 0

High total cholesterol and LDL: yellow papules under the eyes. What cell type on histology?

Answer 0

Xanthelasma can be a clinical manifestation of lipid metabolism disorders and are commonly located on the eyelids.
On histopathology, lesions are composed of lipid-laden macrophages and may also contain multinucleated giant cells.

Question 1

What amyloid types are associated with:

1. Primary amyloidosis
2. Secondary amyloidosis
3. Long term hemodialysis
4. Alzheimer’s disease

Answer 1

1. AL, ATTR
2. AA
3. ABeta2M
4. ABeta

Question 2

How can we definitively diagnose rabies?

Answer 2

Rabies:

Manifests with extraordinary excitability, headache, difficulty swallowing, convulsions, and coma
Elongated intracytoplasmic neuronal inclusions (Negri bodies) are diagnostic of rabies.
Negri bodies are most common in the hippocampus and cerebellar cortex.

Question 3

What tissues derive from the ectoderm?

Answer 3

Ectoderm gives rise to central nervous system; peripheral nevous system; sensory epithelium of eye, nose, and ear; and the epidermis with skin adnexal structures.

Question 4

What tissues derive from the endoderm?

Answer 4

Endoderm gives rise to structures such as the biliary tree, urinary bladder, vagina, middle ear cavity, and parenchyma of the liver and pancreas, as well as other structures.

Question 5

What tissues derive from the mesoderm?

Answer 5

Mesoderm gives rise to muscle, connective tissue, bone and cartilage, heart, spleen, kidney, and other structures.

Question 6

Chromosomal defects associated with spontaneous abortions?

Answer 6

Approximately half of all spontaneous abortions are of fetuses with major chromosomal defects, most commonly trisomy 16, triploidy (due to fertilization of an egg by two sperm), and 45,X0 (Turner syndrome). Trisomy 16 and triploidy do not produce viable offspring, unlike 45,X0.

Question 7

Bone biopsy shows a mosaic pattern of bone spicules with prominent osteoid seams. For which disorder is the patient at increased risk?

Answer 7

Paget disease (also called osteitis deformans) is the second most common bone disorder following osteoarthritis in elderly patients.
Osteosarcoma is the most feared complication of this disorder, occurring in approximately 1% of affected patients.
Other associations include pathologic fractures, headaches and pains, cranial nerve palsies, hearing loss, and high output cardiac failure.

Question 8

A biopsy specimen shows invasive ductal carcinoma. The connective tissue adjacent to the nests of tumor is very densely collagenous. Which of the following best describes this type of pathologic change in the connective tissue?

Answer 8

This is an example of desmoplasia, which is excessive fibrous tissue formation in the stroma of a tumor. The abundant fibrous tissue growth is, itself, benign. Desmoplasia is usually seen with malignant neoplasms, although there are benign processes such as surgical scars that can also constitute a desmoplastic reaction.

Question 9

What are the essential amino acids?

Answer 9

During severe starvation, essential amino acids, which must be acquired from the diet, become deficient.
Essential amino acids include: phenylalanine, valine, tryptophan, threonine, isoleucine, methionine, histidine, arginine, lysine, and leucine. (mnemonic: PVT TIM HALL)

Question 10

The most important chemotactic factors for neutrophils are… ?

Answer 10

complement factor C5a

interleukin IL-8

Question 11

Fentanyl and midazolam reversal?

Answer 11

Fentanyl is an opioid analgesic used along with benzodiazepines, such as midazolam, during general anesthesia.
Naloxone and flumazenil are antidotes used to counteract the effects of opioids and benzodiazepines, respectively.

Question 12

What two substance abuse problems are similar? What are the symptoms?

Answer 12

Alcohol withdrawal and cocaine intoxication can lead to the same symptoms, which include sympathetic system activation, nausea, vomiting, hallucinations (visual, tactile, or auditory), and, in severe cases, seizures.

Question 13

Vercuronium use and reversal?

Answer 13

Vecuronium is a non-depolarizing skeletal muscle relaxant that competitively blocks the nicotinic acetylcholine (ACh) receptor.
Its effect can be reversed by an acetylcholinesterase inhibitor such as neostigmine because the increased levels of ACh will compete with vecuronium at the receptor.

Question 14

How can we diagnose papillary carcinoma of the thyroid on aspiration biopsy?

Answer 14

Features of papillary carcinoma of the thyroid on aspiration include papillary clusters, “Orphan Annie” nuclei, and psammoma bodies. Psammoma bodies are laminated, concentric, calcific spherules seen most frequently in papillary adenocarcinoma of the thyroid, serous papillary cystadenocarcinoma of the ovary, meningioma, and malignant mesothelioma.

Question 15

What are the clinical signs of lead poisoning?

What are the inhibited enzymes in lead toxicity?

Answer 15

Anorexia, apathy, aggressiveness, poor coordination, abdominal pain, and constipation/diarrhea may all be symptoms of lead intoxication.
Inhibition of aminolevulinate (ALA) dehydratase and ferrochelatase can result in microcytic, hypochromic anemia due to impaired heme synthesis. Inhibition of 5’ nucleotidase produces basophilic stippling in erythrocytes due to retained RNA.

With high serum lead levels, lead lines may appear in the gums (usually seen in adults more than in children) and in bones on x-ray (lead lines that are opaque metaphyseal bands in growing bone). Inhibition of ALA dehydratase and ferrochelatase can result in microcytic, hypochromic anemia due to impaired heme synthesis. Treatment with dimercaprol (which crosses the blood-brain barrier and so is the drug of choice in lead encephalopathy) or chelation therapy with ethylenediaminetetraacetic acid (EDTA) is indicated in cases with high blood lead levels. Chelating agents enhance lead excretion in urine. Lead also inhibits 5’ nucleotidase activity, producing basophilic stippling of erythrocytes due to retained RNA.

Question 16

A patient has mitral stenosis, atrial fibrillation, and chronic pulmonary disease. What is the drug of choice to control his arrhythmia?

Answer 16

Verapamil, a calcium channel blocker.

Atrial fibrillation is characterized by an irregularly irregular ventricular rhythm without discrete P waves and the QRS complex is often narrow, but may be widened if aberrant conduction or bundle branch block is present.
If rapid rate control in the setting of atrial fibrillation is necessary, calcium channel blockers and beta-blockers are superior to digoxin.
If uncontrolled pulmonary disease is present, calcium channel blockers are preferred over both selective and nonselective beta blockers.

Question 17

DiGeorge syndrome is represented by what developmental abnormalities ?

Answer 17

DiGeorge syndrome is caused by abnormal 3rd and 4th pharyngeal pouch development and abnormal neural crest cell migration, related to chromosome 22 abnormalities. The syndrome results in three types of malformations:

(1) Craniofacial, including micrognathia, low-set ears, and cleft palate
(2) Partial or total agenesis of the derivatives of pharyngeal pouches 3 and 4 (no parathyroid hormone or thymic tissue, resulting in hypocalcemia and impaired immune system due to T cell deficiency.
(3) Cardiac anomalies, including a persistent truncus arteriosus because neural crest cells fail to properly form the aorticopulmonary septum

Question 18

Which post-transplant immunosuppressive drug must be reduced in dose upon concurrent administration of allopurinol?

Answer 18

Azathioprine, metabolized by xanthine oxidase, must be reduced in dose upon coadministration of allopurinol.

Azathioprine, a purine antimetabolite and an imidazolyl derivative of 6-mercaptopurine, is converted to additional metabolites that inhibit de novo purine synthesis.
Xanthine oxidase, a primary enzyme involved in the catabolism of azathioprine metabolites, is blocked by allopurinol.
The major side effect of azathioprine is bone marrow suppression, which includes leukopenia, thrombocytopenia (less common), and anemia (relatively uncommon).

Question 19

Some antihypertensive medications, such as _____ and _____, can cause lipid abnormalities.

Answer 19

Some antihypertensive medications, such as metoprolol and thiazides, can cause lipid abnormalities.

Question 20

What are the long term side effects of steroid use?

Answer 20

The major disadvantage of using glucocorticoids for an extended period of time is the severe side-effect profile. For example, long-term use of prednisone is associated with hypocalcemia, fluid retention, hypokalemia, hyperglycemia, and hypernatremia.

Question 21

Describe natural transformation. Which species display this attribute?

Answer 21

Natural transformation is the uptake of naked DNA from the environment by competent cells (i.e., cells that are able to bind and import short pieces of DNA).
The DNA released from dead cells is taken up and incorporated by homologous recombination.
The result is a “modified” bacterium that has acquired new characteristics, such as higher virulence or drug resistance.
Some bacteria that are capable of natural transformation include Haemophilus influenzae, Streptococcus pneumoniae species, and Neisseria species.

Question 22

Which anti hypertensive would be recommended in a woman with diabetic nephropathy and hyperuricemia?

Answer 22

The angiotensin-converting enzyme (ACE) inhibitors, such as captopril, are commonly recommended for the treatment of hypertension in diabetic patients, especially those with renal complications, since these agents have been shown to delay the progression of renal disease. Furthermore, these agents are generally well tolerated.

Question 23

ACE inhibitor cough. Alternative?

Answer 23

To relieve his symptoms, the doctor should substitute captopril with an angiotensin II receptor (AT1) antagonist (ARB), which prevents the effects of angiotensin II, but has a lower incidence of chronic coughing because it does not interfere with bradykinin metabolism. Losartan is an example of an ARB and is associated with the development of hypotension, hyperkalemia, and angioedema.

Angiotensin-converting enzyme (ACE) inhibitors, such as captopril, can cause a dry cough because they block the metabolism of bradykinin.
Losartan, an angiotensin II receptor (AT1) antagonist, has similar therapeutic effects as ACE inhibitors but has a much lower incidence of cough.
Switching from an ACE inhibitor to an angiotensin II receptor antagonist is generally effective in alleviating the chronic cough.

Question 24

How can we treat acne? What is a common drug interaction?

Answer 24

Acne vulgaris originates from the pilosebaceous units in the dermis, which produce sebum (a mixture of waxes and fats).
Acne is believed to be caused by the hormone dihydrotestosterone, which causes the sebaceous glands to increase in size and capacity to produce sebum.
Acne can be treated with tetracycline.
Antacids bind with tetracycline in the intestinal tract, thereby decreasing their absorption.

Question 25

New medication -> INROADS increase on warfarin. What are the suspects?

Answer 25

Ketoconazole is an azole antifungal drug and a potent inhibitor of P450 enzymes. Other antimicrobials that are P450 inhibitors are erythromycin, clarithromycin, ciprofloxacin, and the protease inhibitors used for treating HIV. Additional potent hepatic enzyme inhibitors include amiodarone, diltiazem, isoniazid, and fluoxetine. Conversely, potent hepatic enzyme inducers are carbamazepine, phenytoin, phenobarbital, and rifampin. Although not a prescription medication, it should be noted that St. John’s wort is also a potent hepatic enzyme inducer.

It is important to note that azithromycin is the least likely of all the macrolides, such as erythromycin and clarithromycin, to interact with warfarin.

Question 26

C-ANCA vs P-ANCA ?

Answer 26

c-ANCA : Wegener’s

p-ANCA: Churg Strauss (*asthma)

The correct answer is E. This patient’s most likely condition is Churg-Strauss syndrome, also known as eosinophilic granulomatosis with polyangiitis. This necrotizing vasculitis is clinically associated with asthma and eosinophilia and occurs in three phases. During the prodromal phase, the patient has no overt symptoms of vasculitis but characteristically has atopic disease, allergic rhinitis (as with this patient), or asthma. In the second phase, the eosinophilic phase, there is significant eosinophilia and eosinophilic infiltration of multiple organ systems. Finally, a life-threatening vasculitic phase may occur in which medium and small vessels are affected, resulting in constitutional symptoms such as fever, weight loss, and malaise.

Question 27

Name a virus that undergoes genetic shift like influenza!

Answer 27

Rotavirus!!

Reassortment of the genome of segmented viruses causes pandemics = genetic shift
Viruses with segmented genome: ROBA (Reoviridae (eg, rotavirus), Orthomyxoviridae, Bunyaviridae, Arenaviridae)
Genetic reassortment in influenza A causes pandemics of disease.

Question 28

A CT scan of the abdomen shows large intraabdominal and peritoneal masses. An exploratory laparotomy is performed which shows loculated masses of semi-translucent mucinous material produced by a mucinous cystadenoma. Which of the following is the most likely location of the primary disease process?

Answer 28

This rare but dramatic condition is called pseudomyxoma peritonei, and is produced when a malignant or benign (spread by rupture into the peritoneal cavity rather than true metastasis) mucus-producing tumor (mucinous cystadenoma or mucinous cystadenocarcinoma) produces gel-like mucus that fills the peritoneal cavity. The usual sites of origin of these tumors are the ovary and appendix. The condition, even when benign, is difficult to treat because the mucus-producing cells are spread all over the peritoneal lining and cannot be effectively removed. Home parenteral nutrition may be necessary because the gut (particularly peristalsis) just does not function well in a sea of Jell-O that slowly becomes replaced with fibrous tissue bands.

Question 29

You give a drug to a burn patient during surgery. The patient develops tall tented T-waves, then ventricular fibrillation and dies. What was the drug?

Answer 29

Hyperkalemia is a potentially life-threatening complication of succinylcholine. Succinylcholine is a depolarizing skeletal muscle relaxant. It acts by binding to and stimulating nicotinic acetylcholine receptors (Nm) at skeletal muscle motor end plates. Nm receptors are voltage-gated cation channels that allow Na+ in and K+ out of the cell. (In order to have skeletal muscle contraction, there must be a change in voltage. The constant depolarization produced by succinylcholine initially causes fasciculations, but then leads to muscle relaxation.)

Patients with burns and extensive soft tissue injury are at greater risk for hyperkalemia because the tissue damage leads to a loss of potassium into the circulation. Because succinylcholine causes prolonged muscle depolarization, the muscle can release substantial amounts of K+. Therefore, succinylcholine should be either avoided or used with extreme caution in such patients.

In addition to hyperkalemia, this agent is associated with malignant hyperthermia, prolonged paralysis, respiratory depression, cardiac arrhythmias, rhabdomyolysis, and myoglobinemia.

Question 30

Bilateral hilar lymphadenopathy?

Answer 30

Sarcoidosis is a multisystem granulomatous disease characterized by bilateral hilar adenopathy, noncaseating granulomas, and elevated angiotensin-converting enzyme levels.
Symptoms include constitutional and cutaneous manifestations, as well as central nervous system, cardiac, and musculoskeletal involvement.
Patients may also be asymptomatic at the time of diagnosis.

Question 31

What single symptom is specific for an older patient with congestive heart failure?

Answer 31

A third heart sound (S3) is a low-pitched sound occurring at the termination of rapid filling. In patients over 40 years of age, the appearance of a third heart sound strongly suggests congestive heart failure. It also occurs in patients with atrioventricular valve incompetence, and can be a normal finding in some young athletes.

Question 32

Recurrent upper respiratory infections mad immobile spermatozoa with a normal sweat test?

Answer 32

Kartagener syndrome is a collection of genetic illnesses characterized by immotile cilia due to defects in cytoskeletal structure of the cilia, particularly the dynein “cellular motors” on the microtubular doublets at the periphery of the ciliary axoneme. As a result, defects in mucociliary clearance lead to chronic upper and lower respiratory tract disease, and males demonstrate infertility secondary to immotile spermatozoa (in which the defect affects the sperm flagella motion as well).

Question 33

Asymptomatic with a reducing urinalysis?

Answer 33

Fructokinase deficiency has no clinical manifestations. It generally presents as an accidental finding of a reducing substance in the urine that is not glucose. It is autosomal recessive and no treatment is required. Fructokinase catalyzes the first step of dietary fructose metabolism by converting fructose to fructose-1-phosphate. With a deficiency of the enzyme, fructose levels increase in the blood; but almost all of it is excreted in the urine because there is no renal threshold for fructose.

Question 34

How do we treat a benign resting tremor?

Answer 34

This patient has benign essential tremor, which is a familial, progressive, bilateral, largely symmetric postural tremor of the upper extremities that is not typically associated with other neurologic symptoms. This condition generally increases with increasing age and is more prevalent in patients with a positive family history. Benign essential tremor is characterized by a 6- to 12-Hz tremor primarily affecting the arms. Other body parts can be affected also, including the head (titubation). Propranolol, a nonselective beta-adrenergic receptor antagonist, and primidone, a barbiturate, are effective first-line therapies. Second-line therapies for this condition include gabapentin, topiramate, and alprazolam.

Question 35

A 55-year-old woman comes to the physician because of progressive dark discoloration of her armpits and groin.

Answer 35

Acanthosis nigricans (acanthosis = hyperplasia of the stratum spinosum of the epidermis) is used to describe thickened, hyperpigmented zones of skin, often with a velvet-like texture most commonly involving the flexural areas (groin, axilla, skin folds of the neck, anogenital regions). It is an important cutaneous marker for associated benign and malignant conditions and, accordingly, is divided into two types.

The benign type, which constitutes about 80% of all cases, develops gradually and usually occurs in childhood and during puberty. It is particularly associated with obesity and insulin resistance (metabolic syndrome or type 2 DM). As with seborrheic keratoses, acanthosis nigricans may less commonly result from abnormal production of epidermal growth-promoting factors by a variety of tumors. This may account for many instances of the malignant type, in which lesions arise in middle-aged and older individuals, often in association with an underlying gastrointestinal adenocarcinoma. Because lesions of acanthosis nigricans may precede clinical signs and symptoms of the underlying disorder, knowledge and recognition of this entity may be of great diagnostic importance in early recognition of overt systemic disease.

All forms of acanthosis nigricans have similar histologic features. The epidermis and underlying enlarged dermal papillae undulate sharply to form numerous repeating peaks and valleys. Variable hyperplasia may be seen, along with hyperkeratosis and slight basal cell layer hyperpigmentation.

Question 36

How do we treat neurogenic bladder?

Answer 36

This patient has a neurogenic bladder, which is a bladder that does not empty properly due to a neurologic condition. Bladder function is governed by storage reflexes and voiding reflexes. Both of these mechanisms are coordinated by a center in the pons. Transection of the spinal cord eliminates this descending control of micturition. After a period of time following a spinal cord transection, the parasympathetic voiding reflex becomes hypersensitive and there is detrusor hyperreflexia. Blockade of the muscarinic acetylcholine receptors in the bladder wall is utilized to reduce the effect of parasympathetic hyperactivity in patients with spinal cord transection. Tolterodine is a competitive muscarinic receptor antagonist indicated for the treatment of urinary incontinence, urinary urgency, and urinary frequency.

Question 37

What steps are unique to gluconeogenesis?

Answer 37

The three irreversible steps of glycolysis are catalyzed by hexokinase, phosphofructokinase-1, and pyruvate kinase. In gluconeogenesis, other enzymes are needed to bypass these key steps. Pyruvate cannot be directly converted to phosphoenolpyruvate in gluconeogenesis. Therefore, pyruvate carboxylase (a mitochondrial enzyme) converts pyruvate to oxaloacetate, which can be converted to phosphoenolpyruvate by phosphoenolpyruvate carboxykinase, using two ATP equivalents per molecule of phosphoenolpyruvate. Fructose-1,6-bisphosphatase is the enzyme that splits fructose-1,6-bisphosphate into fructose-6-phosphate and inorganic phosphate. It is also required for gluconeogenesis.

Question 38

Which cell surface marker identifies macrophages?

Answer 38

Macrophages, regardless of their tissue of origin (Kupffer cells, mesangial cells, alveolar macrophages, microglia) are best counted with the endotoxin receptor, otherwise known as CD14.

Question 39

Serum sickness?

Answer 39

Serum sickness is a type III hypersensitivity reaction that is commonly caused by a reaction to certain drugs. It is suggested that the drug acts as a hapten, which binds to plasma proteins. This drug-protein complex is recognized as being foreign to the body and induces the serum sickness. Medications commonly associated with the development of this condition include polyclonal and monoclonal antibodies, antitoxins, streptokinase, vaccines, cephalosporins, ciprofloxacin, griseofulvin, penicillins, tetracyclines, allopurinol, captopril, phenytoin, iodides, and iron dextrans. Common signs and symptoms of serum sickness include fever, cutaneous eruptions, lymphadenopathy, and arthralgias. Erythema multiforme may also appear in severe cases. The reaction is generally delayed for 7 to 10 days after initial exposure, because it takes that long for the generation of specific IgG antibodies. With respect to cefaclor, the incidence of serum sickness is much higher in infants and children than in adults. Due to the severity of the signs and symptoms in this patient, oral prednisone and diphenhydramine should be administered. The prednisone will treat the arthralgias and the skin rash, and the diphenhydramine will alleviate the urticaria.

Question 40

How does N-acetylcysteine treat acetaminophen overdose?

Answer 40

Replenishes glutathione

Question 41

How does autoregulation maintains filtrated fraction (RPF / GFR)? Specifically, what are the effects on the efferent and afferent arterioles?

Answer 41

Afferent constriction

Efferent dilation

Question 42

A child presents with kinky, depigmented, lusterless hair as well as a number of facial, ocular, vascular, and cerebral manifestation.

Answer 42

Menkes disease
Mutations in ATP7A, defect in copper eflux out of mucosa, low activity of lysyl oxidase (which crosslinks collagen fibers)

Question 43

Tamoxifen is a selective estrogen receptor modulator (SERM). What is a side effect of this therapy?

Answer 43

Tamoxifen is a partial estrogen receptor agonist, and increases the risk of endometrial carcinoma as well as uterine sarcoma.

Tamoxifen may also increase the incidence of hypercalcemia.

Question 44

Erythema multiforme (target lesions) has no known specific precipitating cause in 50% of cases.

However, sometimes it is associated with:

Answer 44

Infections (herpes simples, enterovirus, mycoplasma pneumoniae, chlamydia, histoplasmosis)

Drugs (penicillin, sulfonamides, phenytoin, aspirin, corticosteroids, cimetidine, allopurinol, oral contraceptives)

Neoplasia (leukemia, lymphoma, multiple myeloma, internal malignancy

Sarcoidosis

Foods (emulsifiers in margarine)

Question 45

Describe the lymph drainage of the inguinal nodes.

Answer 45

The lymph nodes of the groin are divided into superficial and deep groups. The superficial group is further divided into horizontal and vertical chains. It is worth remembering that tumors from the penis, vagina, and anal canal can drain to the medial side of the horizontal chain of the superficial group of inguinal lymph nodes.

Question 46

Coma, metabolic acidosis, oxalate crystalluria

Answer 46

This man with coma, metabolic acidosis, and oxalate crystalluria most likely has ethylene glycol poisoning. Ethylene glycol is found in commercial antifreeze and is occasionally ingested accidentally (by children), in a suicide attempt, or as an ethanol substitute (by desperate alcoholics with no liquor on hand). In addition to the features illustrated in the question stem, poisoned individuals may appear inebriated and have nausea, vomiting, carpopedal spasm, lumbar pain, renal failure, respiratory distress, and convulsions.

Question 47

An immunosuppressive drug binds mTOR and has minimal nephrotoxic or neurotoxic side effects. What WOULD be a major side effect?

Answer 47

Sirolimus inhibits T-cell activation and proliferation by binding mTOR, a serine-threonine kinase that is instrumental in cell cycle progression. This agent also inhibits antibody production. It is important to note that sirolimus has an immunosuppressant action that is different from other immunosuppressant agents, including tacrolimus and cyclosporine. Remember that one of the primarily differences between sirolimus and both tacrolimus and cyclosporine is that this drug has minimal nephrotoxicity and neurotoxicity, which is the key point needed to correctly answer this question.

The most common reactions associated with the agent include peripheral edema, hypertension, hypercholesteremia, and hypertriglyceridemia. Other common side effects include thrombocytopenia and leukopenia. Additional serious adverse effects associated with sirolimus include atrial fibrillation, heart failure, interstitial pneumonitis, hypervolemia, and palpitations.

Question 48

What are the endocrine outcomes in Turner’s syndrome?

Answer 48

The 45,X karyotype results in Turner syndrome, which is characterized by ovarian dysgenesis and a variety of somatic abnormalities, including micrognathia, a fishlike mouth, a shield chest, low-set ears, ptosis, and a webbed neck. Other findings can include coarctation of the aorta, hypertension, and renal abnormalities. Plasma levels of follicle-stimulating hormone (FSH) are markedly increased due to the lack of feedback inhibition by ovarian secretions. FSH levels are high during infancy and rise again after 9-10 years of age. Luteinizing hormone (LH) levels typically parellel FSH levels, and would be increased rather than decreased at age 14. Combination estrogen and progesterone replacement therapy can induce the development of secondary sex characteristics and menses.

Question 49

Which diseases should I associate with Ashkenazi Jews?

Answer 49

Tay-Sach’s
Gaucher type I
Niemann-Pick type A

Question 50

Which type of light chain do most multiple myeloma Bence-Jones proteins express?

Answer 50

Most multiple myeloma cases express kappa, not lambda, light chains.

Question 51

On which chromosomes are the mutations responsible for / associated with:

Neurofibromatosis type 1
Neurofibromatosis type 2
Retinoblastoma, osteosarcoma
Familial / sporadic colon cancer (APC)
Colon / gastric cancer (DCC); pancreatic cancer (DPC)
Breast, ovarian cancer (BRCA-1)
von Hippel-Lindau (VHL)
Friedreich's ataxia

Answer 51

NF-1  17q
NF-2  22q
Rb  13q
APC  5q
DCC/DPC  18q
BRCA-1  17q
VHL  3p
Friedreich's ataxia  9p

Question 52

How do you treat brittle, discolored toenails?

Answer 52

Patient with brittle, discolored nails: tinea unguium (onychomycosis)
Usually caused by dermatophytes: Epidermophyton and Trichophyton
Treatment is oral imidazoles or griseofulvin when nail bed or hairs are infected.
Terbinafine is the drug of choice for toenail infections, which are harder to penetrate and slower to grow.

Question 53

Which cell types stain pink or blue in the pituitary?

Answer 53

Pituitary acidophils (stain pink with eosin) can secrete growth hormone or prolactin.
Pituitary basophils (stain blue with hematoxylin) can secrete ACTH, FSH, LH, or TSH.