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My notes from test Flashcards

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USMLE® Step 1 flashcards
1
Q

what is the protein?

Damage Secretory vesicles to get down the axon to synaptic terminals

A

Kinesin protein (microtubule associated ATP protein- antrograde movement)

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2
Q

What is the defecitive protein in Glanzmann thrombasthenia?

and what is the common presentation?

A

GPIIbIIIa
remember: M= 3, and have 2a

חסר שלו או שהוא דפוק

mucocutaneous bleeding
No PLT clumping on blood smear

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3
Q

How a platlet plug is formed?

A

stractural change in GPIIb/III3on PLT&raquo_space; binding to fibrinogen&raquo_space; forming PLT Plug

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4
Q

Which medication inhibit PLT aggragation?

A

Aspirin (COX1,2, TXA2)
Clopidogrel (P2Y12)

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5
Q

Which medication inhibit glycoprotein (GP) IIb/IIIa

A

Abciximab

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6
Q

Which substance oppose the function of Thromboxane A2, and what it would lead to

A

Prostacyclin (prostaglandin I2)
Inhibit PLT aggregation + Vasodilation

Shyntesis in endothelial vascular cells

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7
Q

Which phase in the Cardiac myocytes CBB work ? and what they cause?

A

**CCB (Verapamil, dilitiazem **
Class IV antiarrythmic

Slow sinus rate, prolong condction AV node, Depress myocardial contractility

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8
Q

Which phase in the Cardiac myocytes Class III Anti-aryttmhic work ? and what they cause?

Amiodarone, Sotalol, Dofetilide

A

Late repolarization- stage 3 block pottasium Channels from outward current

prolongation of re-polarization, AP duration, and QT interval

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9
Q

Which medication maintance Sinus rythem in Proxismal Afib

3

A

Type III AA-
Amiodarone, sotalol, dofetilide

Can cause Hyperkalemia

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10
Q

Which drugs are class 1 anti arrhythmic

A

Salty cab- inhibit Na in non pacemaker cells
1c- can’t use post MI
1a- The queen Di after using cocaine
1b- Best post MI

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11
Q

Whats the likely diagnosis?

Pancytopenia (or at least 1 type of cytopenia) + dysplastic erythrocytes +pervious Chemo Tx.

A

Myelodysplastic syndrome

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12
Q

Whats the likely diagnosis?
Blood smear with Hypolobulated and hypograndular neutrophils + Oval macrocytes

and what likely to be seen on BM biopsy

A

MDS
(myelodisplatic syndrome)
Likely on BM: Dysplastic Erythroid and myeloid progenitor cells

Oval macrocyts- dysplastic erytrocytes» most common in MDS

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13
Q

Which moleculs produce by the POMC

3

A
  • beta- endrophins
  • ACTH
  • MSH
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14
Q

pharma

What is the mechanism of action of Metformin

2 arms

A

Activated AMP protein Kinase
Inhibit- mitocondrial G6D

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15
Q

Metformin
What are the metabolid effect on:
* Glucose and liver
* Glucose absorpation
* Glucose uptake / utilization
* Fatty acid

A
  • Inhibit Hepatic Gluconeogenesis
  • Deacrese interstitial Glucose absorpation
  • increase peripheral Glucose uptake / utilization
  • inhibit lipogenesis- Reduce circulating lipid levels

Unchange insulin levels (risk hypoglycemia) , weight loss

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16
Q

Which DM medication has a risk for both Hypoglycemin events + gain weight ?

A

Sulfanylurea (Glyburide, Glimepridine)
Stimulate beta cells to secrete insulin

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17
Q

Where is Wernicke area location and where is Broca

For each one what is the symptoms

A

E- Wernicke&raquo_space; What? dont understand. are not aware to their situation
B- Broca&raquo_space; Bla bla bla, understand but can’t talk (somtimes write also proparly) frustrated

B- Inf.frontal gyrus
E- Caudal sup. temporal lobe

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18
Q

What tumors are associated with VHL syndrome

3

A
  • RCC
  • Hemangiobalstima (Cerebellar &ratinal)
  • Pheochromocytoma

3 letters = chromosome 3

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19
Q

Whice protein is mutated in Hemochromatosis? what it cause

A

HFE protein
Cause Hepatocytes and Enterocyte to decect falsly low iron levels&raquo_space; increase accumulation in the body:
DMT1 (divalent metal transporter) by Enterocytes
Decreasing Hepcidin synthsis = more Iron absorbes to the blood

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20
Q

Hemochromatosis have a high risk for whice comlication?

A

Liver chirrosis + HCC

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21
Q

What is the primary virulence factor of M.tuberculosis

A

Cord Factor

protect bacteria from being digest by macrophages

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22
Q

What is the mnemonic for Reactive Artheritis

Reiters syndrome

A
  • Cant see- Conjuctuvitis
  • Cant pee- Urethritis
  • Can’t climb a tree- Arthritis
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23
Q

Which 4 disease are HLA-B27 positive

“mnemoninc PAIR”

A
  • Psoriatic Arthritis
  • Ankylosing spondylitis
  • IBD
  • Reactive arthritis
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24
Q

Whice pathogens can exceed reactive arthritis

5

A
  • Chlamydia
  • Campylobacter
  • Salmonella
  • Shigella
  • Yersinia

Sterile arthritis due to deposition of immunce complex

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25
Q

What type of medication Abatacept is?
And what is the effect on T-cells

A

CTLA4-Ig
bind CD80/86 in more affinity then T cells = prevent co-stimulation of T cells = T cells Anergy = reduce inf.

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26
Q

What the mnemonic For D-george Syndrome?

Catch 22

A

chromosome 22.
C-Cardiac abnormalitiy (Tetralogy OF, truncus arteriosis)
A- Abnormal Face
T-Thymia aplasia (T-cell def.)
C-Cleft palate
H- Hypocalcemia/ HypoPTH

22- 22q11 micro-deletion

defect development od pharyngeal pouch

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27
Q

How we diagnose Congenital Hypothyroidism

and why clinical menstifation does not present in birth

A
  1. Dx- elevated TSH + low T4
  2. not present in birth- transplacental trasnfer of maternal T4
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28
Q

What the cause of Diabetes insipidus

A

Impaired ADH (anti-diuretic hormone)
Central- problem in production
Nephrogenic- prolem in kideny

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29
Q

how is DI clinicly present?
how to destinguish from central to nephrogenic?

A

presentation- large volume of very dilute urine < 300 mOsml/L

distinguish:
Exogenous ADH:
if increase urine osmolality = central
if little increase to none = nephrogenic

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30
Q

Which injury can cause persistant central DI and which transient?

anatomicaly

A

Persistant- Hypothalamic injury where Magnocellular neurons produce ADH
Transient- anywhere below the indfuldibiulm (including post. pituitray)

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31
Q

Which muscles are innervated by Abducens nerve (VI)

A

Lateral rectus

dipolipia, eye deviate medialy

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32
Q

Which muscles are innervated by Trochlear nerve (CN IV)

A

Sup. oblique

eye deviated upward, Vertial& torsional diplopia

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33
Q

Which Hepatitis antigen reflect immunization and not contamination

A

HBsAb

alone

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34
Q

Where are fluids build up in communication hydrocele?

and in what age group is common

A

Tunica vaginalis

in the setting of patent processus vaginalis- painless

common in newborne

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35
Q

How to calculate drug conentration with a given Drug dose, Half life, and vol of distibution

A

Drug concentation = Drug dose / Vd
after that- by having the Hald life we reduce 50% every half life

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36
Q

which part of the spine is involve in Reumatoid arthritis

A

Cervical spine

instability and cord compression

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37
Q

Hox Genes

What are they coded for?

A

Transcription factors&raquo_space; bind to regulatory regions on DNA

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38
Q

Lack in which molecule will lead to inhibition of glycolysis?

in pt with Lactate dhydrogenase def.

A

NAD+

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39
Q

Whats the diagnosis?

2 yr old boy&raquo_space; urine turn black overnight

A

Alkaptonuria- AR

Homogentinsic acid dioxygenase def in tyrosine metabolism

HOO is has DARK PEE
OHH for - Ochronosis

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40
Q

in Alkaptonuria which sunstance is accumulate and leat to what reaction

A

Homogentisate accumulate&raquo_space; oxidise if allow to sit = black- blue colour = ochronosis

also black pigmentation on the face and ochronotic arthropathy

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41
Q

whats the diagnosis?

26yr old women, dry flaky skin since chilhood, worse in winter and improve in warm weather in spring

and what cause this situation

A

Ichthyosis vulgaris
Filaggrin gene
Defective kertinocyte desquamation

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42
Q

Which family is para-infulenze pathogen?
which URI it can cause

A

CROUP (Barking cough)

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43
Q

Which virus is resposible for aplastic crisis in sick cell anemia and hydrops fatalis?

A

Parvovirus

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44
Q

Which complication can occur after Subarachnoid hemmorage?

A

Atrial vasospasm- delyed cerebral ischemia = new focal deficit

can treat with CCB- Nimodipine

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45
Q

what is epinephrine effect on adrnregic receptors?
a1,b1,b2

A

beta1- increase HR + contractility, SBP
beta 2- lower DBP (low dose)
a1- increase DBP (high dose)

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46
Q

What is the function of Neprulysin inhibitor (Sacubitril) in the setting of CHF?

A

Enhance of activity of ANP and BNP
Diuresis + Vasodilation

inhibit metalloproteases

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47
Q

What the effect of ANP and BNP on the
1. kidneys
2. Adrenal gland
3. Blood vessels

A
  1. kidneys- elevate GFR, Diuresis, renin inhibition
  2. Adrenal gland- inhibit aldosterone
  3. Blood vessels- vasodilation + permeability
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48
Q

Defect in which biochimical way lead to magaloblestosis?

A

DNA synthsis , need Folate and B12

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49
Q

Which medication increase E3 ubiquitin ligase in MM

A

Lenalidomide

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50
Q

Out of the 4 clinical disfectants:
1. which are sporicidal
2. which cause disruption of cell membrane
3. which cuase halogenation of proteins & nucleic acids

  • Alcohols (isopropanol, etahnol)
  • Cholohexidine
  • Hydrogen peroxide
  • Iodine
A
  1. which are sporicidal- Hydrogen peroxice, Iodine
  2. which cause disruption of cell membrane- Alcohols + Chlorhexidine
  3. which cuase halogenation of proteins & nucleic acids- iodine
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51
Q

Which are the 4 common pathogens to cause Diarrhea in HIV

A
  1. CMV
  2. Cryptosporidium
  3. Microsporidium
  4. Mycobacterium avieum
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52
Q

What is the perpose of protease inhibitor in HIV

A

block viral proteas from cleaving gag-pol polyproteins&raquo_space; immature virions that are noninfectious

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53
Q

What are the 3 main causes of Heat related illness in elderely?

A
  1. tonic contraction of peripherial vasculate
  2. Reduce sweat glands density
  3. loss of rete pegs and dermal capilleris = less effective epidermal area for heat transfer
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54
Q

Which medication exacerbate hypoglycemia and mask hypoglycemic symptoms mediated by epinephrine and NE?

A

Non-selective Beta blockers

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55
Q

Which medication can be use to treat Hyperprolactenemia?

A

Dopamine agonist (Cabergoline, Bromocriptine)

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56
Q

**Spinal stenosis
**
whats make the pain worse and what relieve the pain?

A

Make it worse- walking upright + standing

relieve pain- leaning on a stroller / shopping cart

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57
Q

What is the most common cause if Spinal Stenosis

A

Degenerative arthritis (pt >60)

Disc herniation, ligamentum flavun hyperthrophy, oeteophy formation affecting facet joints

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58
Q

What the difference between physican burnout to fatigue?

A

burnout- emontional exhustuim
Fatiuge- just being tired

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59
Q

What is the mechanism used by Gonoccoc to avoid host defense?

A

Antigenic variation
their pili (hair like protein polymerase projection) - go antigenic variation. means evert time he express only 1 type of pili genes, and through recombination they produe new types of pili

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60
Q

Whats the most common cause of vertigo

A

Benign paroxysmal positional vertigo
**most often due to Canalithiasis = presence of crystalline debris in semicircular canals **

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61
Q

Whats the diagnosis?
filling dizinnes, with brief sever spinning sansation when lookin up at objects, having Dix Hallpike meunver positive

A

BPPV
Beingh paroxysmal positional vertigo

Dix-hallpike menuver- vertigo and nystagmus when pt quickly lies back supine + head rotated 45 degrees

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62
Q

Which trisomy is the most common resuly of nondisjuction due to advance maternal age?

A

Trisomy 18- Edwards

Clenched hands, overlapping fingers
Rocker bottem feats
VSD
Microganthia (small mandible)

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63
Q

Patau syndrome-
chromosome
anomality?
physical anomality

A

13
polydactyly
midline facial defect- clef plip/plate.
GI - omphalocele, umbilical hernia

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64
Q

What will be the consquence of incomplete roation of the midgut?

complete = 90 counter clockwise + 180 counterclockwise = 270 total

A

midgut malrotation
Ladd band compress the extrinsic duodenal = interstiral obsturction

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65
Q

What each letter showing

A

A- Endoplasmatic reticulum
B- nucelouls
C- nucleus
D- mitochondria
E- Exocrine granules

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66
Q

Which vitamin deficiancy will vegan patient have?

A

Calcium
Vitamin D
Cobalamin (B12)

possible: iron , zinc

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67
Q

defiecncy in which vitamin cause pallegra?

A

Niacin (B3)
or trypthophan

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68
Q

which bacterial associated with urethritis are aspetic on gram stain

and how we diagnosed?

3

A

non gonococcal urethritis
Chlamydia trachomatis
Mycoplasma genitalium
Trichomonas Vaginalis

will ceack by PCR

only N. gonorrhoeae will stan gram positive intracellular dipolococci

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69
Q

What the treatment for Gonococcal urethritis?

A

N. gonorrhoeae

Ceftriaxone

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70
Q

Whats the treatment for non-gonococcal urethritis

A

קלמידיה טרוכומאטיס, מיקופלזמה גניטליום, טריכומונאס וגינלאס

אזיתרומיצין / דוקסיציקלין

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71
Q

What are the comlication of HELLP syndrome?

A

H- hemolysis, E-elevated liver enzymes L- low P- PLT

severe pre-eclampsia comlication

risk for seizures , DIC, renal insufficiency

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72
Q

Which ligament contain the ovarian artery, vein and lymphatics, nerve

A

Suspensory ligament of the ovary Infundibulopelic ligament

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73
Q

Which Toxicity IV acyclovir can cause and how we treat?

A

Nephrotoxocity- crystalization, crystalluria and renal tubuer demege.

Tx: Adequate hydration

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74
Q

Which Ulcerative STD are painful?

2

A
  • Chancroid- H.ducreyi (You do cry with ducreyi)
  • HSV
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75
Q

which ulcerative STD’s are not painful?

A
  1. Granuloma inguinale (Donovanosis)- Klebsiella granulomatis
  2. Shypilis- T.pallidum
  3. Lymphogranuloma venerum- Chlamydia Trachomatis
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76
Q

from which location a neonatal intraventricular hemmorhage usually originate?

A

Germinal metrix
in infant before 32 wks gasteation or < 1500 gram

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77
Q

what is the major virulance factor of GBS

A

polysaccharide capsule with sialic acid &raquo_space; reduce effectivness of defense due to molecular mimicry

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78
Q

a lesion in the Intercostal brahial nerve dring axillary disscection can cause _______________

A

Sensory dysfucntion- burning, aching, diminish sensation

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79
Q

a lesion in theLong thoacic nerve dring axillary disscection can cause _______________

A

Serratus ant. - Sacpular winging, Weak arm abduction above horizontal level

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80
Q

a lesion in the Thoracodorsal nerve dring axillary disscection can cause _______________

A

L.dorsi
loss powerful adduction of arm + medially rotation

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81
Q

What is the most common cause of primary hypothyroidisim

A

Thyorid dysgenesis

Treatment- Levothyroxine

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82
Q

What are Hemosiderin

A

Iron-storage complex (ferritin michelles)
brown or yellow brown pigments

liver -in kupffer cells

Mainly in Pt with Chronic hemolytic anemia (b-talasemmia) needed blood transfution = iron overload

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83
Q

Which medication will be given in Hypertensive emergency?

and what the effect on HR, SVR, vessels?

A

Labetalol
non selective a1,b1,b2 inhibitor

Deacrease HR
Decrease SVR
Peripherial Vasodilation
SV not change

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84
Q

Which enzyme is decrease in CML

A

Leukocyte (neutrophil) alkaline phosphatase

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85
Q

How CML confirmed

A

Philadelphia chromosome
Tranlocation 9&raquo_space;22&raquo_space; BCR-ABL1

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86
Q

How to diagnose Naegleria fowleri

A

Motile trophozoites on CSF wet mount

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87
Q

Which are the amniotic fluid markers of maturity?

3

A

Phosphatydylcholine (lechitin) + phosphotydylglecerol- increase
Sphingomeylin- stay low

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88
Q

What is the defect in Xeroderma pigmentosum

A

**Neucleotide excision repair
**
UV specific endonuclease

Thyamine dimers

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89
Q

What are the symptoms of Cholinergic stimulation

SLUDGE BAM

A

SLUDGE BAM:

S-salviation
L-lacrimination
U- urination
D- defecation
G-GI distress
E- emesis

B-Bradycardia
A-Abdominal cramps
M-miosis

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90
Q

Anion Gap Metabolic acidosis DDx

MUDPILES

A

MUDPILES:
Methanol
Uremia
DKA
Phenpormin, paraldhyde
Iron
Lactic acidosis
Ethylene glycol
Salicylates

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91
Q

Which medication can be given to reactivate AchE after organophosphate poisning

A

Pralidoxime

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92
Q

What prevent class Xa anticoagulents

A

Prothrombin &raquo_space; thrombin (IIa)

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93
Q

Alendronate
Which family medication is it?

A

Bi-phosphonate
disrupt osteoclasts

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94
Q

Which medication decrease para-thyroid hormone realse due to secondary hyper-para in pt on dialysis

A

Calcicalect = calcimimetic - decrease PTH release

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95
Q

Which luekotrient stimulate neutrophils migration

A

Leukotriant B4

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96
Q

Which triad define PNH?

in what gene the mutation and what it ceause

A
  1. hemolytic anemia
  2. Hypercoagulability
  3. pancytopenia

PIGA GENE- def. in CD55 + CD59 comlement inhibitor protien

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97
Q

Anemia.
when we will see hypersygmented neutrophils?

A

Folic acid Def.
Clue- Alcohol use

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98
Q

Koplik spots and maculopapular rash that strat on the face and spread down is a common finding in ______________

A

Measles virus (Rubeola)

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99
Q

Which artery can be damage by femoral neck fracture

and which complication in can cause

A

Medial circumflex Femoral artery

Neck N close to M = medial

Femoral neck and head necrosis

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100
Q

H.pylori is asocciated with which type of lymphoma?

A

Gastric MALT lymphoma

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101
Q

Which artery can send emboli ceausing TIA

A

Internal carotid artery

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102
Q

Why due mallory weiss syndrome occur

A

Increase intraluminal gastric pressure due to retching, bomiting or other abdominal straining

treas in esopagogastric- suqmicolumnar junciton

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103
Q

Which RNA polymerase function exclusively in the necleolus? and what he transcribe?

A

RNA polymerase I

45S pre-rRNA gene &raquo_space; encode for rRNA 18S, 5.8S. 28S rRNA

all the 8

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104
Q

Canagliflozin is a medication of the family ____________ which cause glucose ________ in the ____________(PCT/DC/LPH) and ________ diuresis

A

Canagliflozin is a medication of the family SGLT-2 which cause glucose reabsorption in the (PCT/DC/LPH) and osmotic diuresis

CGLZ- like SGLT2

Na- glucose channels

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105
Q

Which pathogen causes meningoencephalitis in pt with AIDS <100 CD4, that stain in INDA ink

A

Cryptococcus neoformans
budding- yeast with polysaccharide capsule

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106
Q

What is the cause for non pitting edema? in which congenital symotms this is common?

A

Lymphatic outflow obstruction

Turner syndrome

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107
Q

What is the purpose of phase I trail?

A

Test new treatment on humens- small and healty population - adverse effect + Max tolerance dose

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108
Q

What is the purpose of phase II trail?

A

Treatment effecay- subject with the disease.

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109
Q

What is the purpose of phase III trail?

A

asses the safety and effectiveness of new treatment compared to std.

involve 2 groups of affected subjects

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110
Q

what is the purpose of phase IV trail

A

adverse affect over time after approval and is on the marker.

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111
Q

What is the mechanism of action of Celecoxib?

A

Selective COX 2 inhibitor&raquo_space; decrease inflammation

Cox b = b its 2. cox2

not ingibiton Cox 1 = prevent Gatromocusal injury

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112
Q

How do HBV immunizaiton prevent infection ?

against which part HBV we are immunizied

A

Recombinant HBsAg&raquo_space; HBsAb&raquo_space; binding to the envelope of circulating viral particles and inhibitnig viral entry

Vaccinated HBV = only anti-HBs (Ab) positive

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113
Q

What the HBV viral load level and which serology marker is positive in chronic infection

A

DNA viral load < 2000
+
HBsAg +
Anti-HBc - IgG+

active / carrier

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114
Q

how to indentified HBV acute infeciton serology

A

anti-HbC IgG or IgM

IgM + HBsAg = acute
IgG + HBsAg = chronic

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115
Q

Which serology is positive in the window period
of HBV infection

A

HBeAg +
anti-HBc IgM

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116
Q

HBV
how to differenate Vaccinated vs recover?

A

HBcAb

HBsAb + HBcAb = recover

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117
Q

How we treat unvaccinated pt to HBV after exposure?

A

HBV vaccine + IVIG

for vaccinated = nothing. just follow up

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118
Q

Whats the treatment for chronic HBV

which medication are C/I in pregnancy? and MDD

A

Entecavir + Tenofovir or peygylated INF-alpha

Entecavir + tenofovie - CI in pregnent womens

INF- alpha- CI for MDD

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119
Q

How to differente between HCV active / recover?

serology

A

active- HCV RNA + anti-HCV Ab

Recover- Anti HCV ab , no positive RNA

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120
Q

Which mefication will be given to HCV infection and what sould we check first

A

Sofobavir + Simeprevir

check HBV before treatment

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121
Q

What is the purpose of Case- control studies

A

Compare risk factor exposure between cases and protocol (disease vs non disease)

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122
Q

What is the puprose of prospective cohort

A

Compare disease indicene based on having / not having risk factor

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123
Q

What is crossover study?

A

Randomly subjects having a sequence of 2 or more treatment . the pt themslefs are their own controls.

washout phase- prevent prior treatment influence

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124
Q

What is the presentation of Median nerve injury

A

Ape hand

Motor: weaken thumb flexation and oppositions
Sensory: 3 digit numbness on the palm side

cross between flexod digitorum superficials + profundus

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125
Q

What is Meckels Diverticulum

A

anatomic connection between ileum and umbilics = incomplete obliteration of vitelline duct

true devirticulum= consist all 3 layers of interstitial wall (mucose , Sub + muscularis)

can present with hematochezia + abdominal pain

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126
Q

For each verices which portal circulation is open

Esophageal varices
Antrorecal varices
Capud medusae

A
  • Esophageal varices- Left gastric vein
  • Antrorecal varices- Sup. rectal vein
  • Capud medusae- Paraumbilical veins
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127
Q

How to calculate Helf life?

which parameters?

A

Vd + 0.7 /CL

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128
Q

how to claculate loading dose?

A

Vd * Css

Css= steady state plasma concentraion

affected by body weight + compistion

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129
Q

How to calculate maintance dose?

A

Css XCL X dosing interval

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130
Q

In which diseases we will see nasal polyps?

3

A
  • Granulamatosis with polyangitis (Wegener)
  • CF
  • Asthema
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131
Q

In wihch disease we will see lend dislocation?

A
  1. DM
  2. Marfan&raquo_space; upward
  3. Homocysteine (marfan + pigur)&raquo_space; downeard
  4. Alport (type IV collagen)

הומואים מסתכלים למטה

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132
Q

Why HCV can survive and not resolve in the body

clue- a reason why theres not effective cacination

A

Genetic variation

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133
Q

what is the most common Cardiac neoplasm

A

Myxoma- most common LA

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134
Q

Which mdecation is used to treat hyperthyroidism?

A

Thiomide drugs (methimazole + propylthiouricul

inhibit thyroid peroxidase&raquo_space; no iodine organofication + couplint to iodtyrosinses

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135
Q

Which mutation seen in marfan syndrome?

A

FBN1&raquo_space; fibrillin1

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136
Q

Chromosomal deposition of Klineflter synd

A

47 XXY

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137
Q

Which anatomy development fail in Cleft lip

A

Fail to fusion of maxillary prominance and intermaxiilary segment

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138
Q

Which protien is a marker for Epithelial cell carcinomas

A

Cytokeratin

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139
Q

HER 2 rceptor is a family member of:

A

EGFR receptors
intrinsic TK activity

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140
Q

What is isotype switching

A

in espone to antigen&raquo_space; swtiching of AB b cell produce

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141
Q

Which AA is converted during Acidosis

A

Glutamine &raquo_space; glutamte to generate amnioum and HCO3-

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142
Q

What is the treatment for expose to rabies?

A

prophylactic vaccine- rabies immuniglobulin and vaccine

vaccine- verious rabdovirus strains grown in tissue cell culture and inactivate

after onset of symptoms not effective

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143
Q

CF mutation location,. type of receptos

A

F508 (AR)
ATP gated chloride channel

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144
Q

What are the 2 main function of vWF?

A
  1. PLT adhesion- PLT glycoprotein with expose collagen
  2. Carrier protein for factor VIII
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145
Q

Which anatomical place is frquently associated with Pelvic fracture

A

Bulbomembranous junction
underneath the prostate

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146
Q

What is the immune mechanism of sarcoidosis?

A

APC secrete IL12&raquo_space; Th1&raquo_space;IL-2 + INF-gamma&raquo_space;Th1 prolifarion (IL-2) + activate macrophages (INF-y)&raquo_space; granuloma formation

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147
Q

What is the mehcanism of action of ARBS

A

Angiotensin II receptor blocker
(type I)

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148
Q

Communication hydrocheplaus is a common complication of _—————-_______ thet reasult in ___________

A

Sub arachnoid bleeding

Reault in- impair absorbation of CSF by the arachnoid

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149
Q

Which defeciency can Valporate form

A

Folate&raquo_space; Neural tue defects

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150
Q

Which cells in the skin have Tennis racquet shape (Birbeck granules) and interact with T lymphocytes

צורה של מחבט טניס

A

Langerhans cells

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151
Q

Which Amino acid and where its accumulate in Hyperammonion state?

A

amonium&raquo_space; glutamine in astrocytes

less glutamine avalibale to turn to glutamate = impain exitatory neurotrasnmittion

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152
Q

Who am I?
What is the Stain?

A

Cryptococcus neoformans (yeast), AIDS high risk

India in staining

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153
Q

What are the stages of Base excision repair?

A
  1. glycosylase- cleave alter base
  2. Endonucleas- cleave 5’ end
  3. Lyase cleave the 3’ sugar
  4. DNA polymerase- Fills the gap
  5. Ligase- Seals the nick
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154
Q

Familiel Retinoblastoma
Which tumors are most common?

A

Osteosarcomas

“2 hit hypothsis”

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155
Q

Which proteins are mostly affected in HCM

A

AD

Cardiac myosin binding protein C

Cardiac Beta-myosin heavy chain

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156
Q

Which situation is characterized by acute and painless monocular vision loss + Cherry red macula + pale retina

A

Central retinal artery occlusion

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157
Q

What is the virulence factor of thypodial Slamonella?

A

Vi capsular antigen- Inhibtir neutrophil pagocytosis and recruitment=
intracellular replication without a problem

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158
Q

What is a common Adverse affect of nondihydroprydine CCB (Dilitiazem, verapamil) compare to dhidroproydine (amliodipine)

A

nondihydroprydine
AV block
constipation
bradycardia
dihydroprydine
Lightheadness
flushing
peripheral edema

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159
Q

silicosis increase risk for TB due to

A

Imparied macrophage function

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160
Q

Which muscle is innervated by the Thoracodorsal nerve?

A

Lattisumus dorsi

Extension, Adduction , internal rotaion of humerus

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161
Q

what are the major risk in Theophylline intoxication ?

A

Seizures
Tacchyarrhytmia (no prolong QT)

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162
Q

How to calculate NNH (number needed to harm)

A

1/ ARI

ARI= risk of Adverse effect in treatment - risk AE in control

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163
Q

How to defferiante Staph from Strep

A

Staph are catalase positive

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164
Q

What are common adverse affect of Biphosphonate?

and which other 2 (boney) situation are related to this medication

A

Medication induce esophagitis

other 2 :

Osteonecrosis of Jaw
A-typical femoral fractureres

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165
Q

Which bacteria have IgA proteses and what its function?

A

N.gonorhoeae
N.meningitidis
Strep.pneumo
Hemophilus

Function- Cleavage of hinge region&raquo_space; facilitate bacterial adherence to mucose

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166
Q

MG pt are senstive and resistance to which types of medication?

A

sensetive- Nondepolarizing agents (vecuronum, rocuronium)
Resistance- depolarizing agents (Succunylcholine)

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167
Q

Which medication is given to castreation-resistant prostate cancer

A

Abriaterone (17-a-hydroxylase inhibitor)

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168
Q

Why some type of Influenze virus cannot infect humens?

A

encoded for Hemagglutinin (surface glycoprotein) that cannot bind humen cells (e.g silialyc acid)

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169
Q

How does Megaloblastic changes (def. in folate or B12) will affect neutrophuls?

for exp. alcohol use disorder

A

Hypersegmented

also macrocytic RBC- prone to hymolysis

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170
Q

Presentation of Acoustic nuromas (like Schwannoma)

2 feature

A

Unilateral Sensorinural loss + tinnitus

CN VIII

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171
Q

Which congenital disease present with Bi-lateral acoustic nuromas?

A

NF-2

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172
Q

Which Glycogen storage disese couse poor exrcise tolerance which improve by consuming simple sugars

A

McArdle Disease (type V)
def. in myophosporylase (first step of breaking glycogen)

present only in the muscle

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173
Q

Which disease is characterzied by unilateral eczematous rash in the nipple and areola?

and what biopsy will show

A

Paget disease

biopsy will show - malignant adenocarcinoma

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174
Q

What the pathophysiology of direct and indirect inguinal hernia

A

direct- (older men) weakness of transversalis fascia

indirect- (male infant) patent processus vaginalis

both above inguinal ligament

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175
Q

Loud S1 can present with

A

Mitral stenosis

leaf stiffness- mild disease

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176
Q

Why in PE theres increase in deade space?

A

less oxygen that being inhalted is participating in gas exchange to tue emboli obstruction

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177
Q

Which 2 enzymes incativate 6-mercptopurine (azathiopurine)

A

Xhanthine oxdidase
Thiopurine methyltransferase (TPMT)

transplant rejection, automuumune, leukemia

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178
Q

Gallstone iliues

why it causes
whats a common finding

A
  1. cause by a lrage gallstones erode into the interstital lumen

common finding- pneumobilia- air in the biliary tract

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179
Q

Which proteins accumulate in FTD

A

Abnormal phosphorylated Tau proteins (also in Alz demetia)
+
Abnormal TDP-43 prtien inclusion (also found in ALS)

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180
Q

Vessel landmark for inguinal hernia

A

Inf. epigastric vessel

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181
Q

Where the inf. epigastric vein will be in:
Direct hernia
Indiruct hernia

A

direct- medial
Indirect- Laterl

MD in IL
(md in israrl)

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182
Q

The disease Cystinuria.
What is the cause
which protiens will be effected and what will be the consequence

COAL menminic

A

Cystinuria- AR, defective transportion of Cys, Arg, Ornithine, lysine COAL across interstial and renal tubul epithlium

Only reccurent nephrolithiasis

Cystiene Hexogonal cristals in urinalysis

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183
Q

Which urinary stones are they?

What will be the PH

A

Manesium -ammonium phosphate
(struvite / triple phosphate)
PH > 7

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184
Q

which medication can lower cysteine level (cystenuria)

A

Pencilmine- cyst cathelator

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185
Q

Which 2 etilogies are related to polyhydramnions

A

Impair swallowing- GI obstruction and anenchaply&raquo_space; increase urination

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186
Q

What is the pathophysiology of Wilson disease

A

defective copper transport protein (ATP7B)&raquo_space; impaired bliary xcretion of copper&raquo_space; accumulation in Heptocytes&raquo_space; deposition in External tissues

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187
Q

Which kind of diseases are seen in the present of
Blotchy red muscle fibers in gomori trhicome stain

A

Mitochondrial myopathies

MERRF (myoclonic epilepsy with ragged red fibers

other mitcohondrial diaseae: Leber optic, MELAS = mitochondiral encepalopathy with stroke like epsodes and lactic acidosis.

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188
Q

Which CD surface is found on macrophage epithloid cell surface

A

CD14

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189
Q

What is the cretiria of MDD

SIGECAPS

A

S- skepp disturbance
I- interest
G- guilt/ worthless
E- energy (loss)
C- concentration diff.
A- anhedonia
P- psyomotor agition
S-suicid (tought / plan)

more then 2 weeks

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190
Q

Which toxidrome can cause Cyclosporine + consuming Grapefruit jucie

A

Calcineurin inhibitor nephrotoxicity

Inhibiton of CYP3A in the gut by grapefruit&raquo_space; elevated levels of Cyclosporine&raquo_space; nephrotoxicity

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191
Q

In which nuecleus is located Seratonin relasinh hormones

A

Raphe neuclei

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192
Q

Which factors Hib need for growth?

A

X factor- hematin
V factor - NAD+

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193
Q

In which type of agar Hib can grow toghther with Staph.aeurs and why?

A

Sheep agar:

Staph aureus secrete V factor (NAD+) and X factor (hematin) needed for Hib growth

sheep agar is not rich in V and X factor + have incativate V factor

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194
Q

What is the Tx for essintial tremor

A

non specific b-adrenergic antagonist : propanolol

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195
Q

What are the reasons for seeing Burr cells ?

4

A
  • Uremia
  • Pyruvate kinase def.
  • Microangiopatic hymolytic uremia
  • mechanical demege
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196
Q

Why Budesonide had less sys adverse affect then otherglucocorticoids?

A

High first pass metabolism = active in the GI and less in the systemic circulaiton. (reduce degradation by the liver) good for IBD

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197
Q

Which syndrome is the most associated with WILM tumors?

A

WAGR syndrome
W- Wilms tumors
A- aniridia (abscence of iris)
G-gentourinary anomalis
R- range of development delay

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198
Q

Which type of medications are inhibiting NF-kB?

A

Glucocorticoids

inhibit transcription factors in the nucelus

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199
Q

Which shunt can be seen before closing of the Ductus arteriosus

A

Left to right (also in patent ductus arteriosus)

in the embroyonal life: right to left

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200
Q

Which Congenital heart diasease are Left to Right shunt

CVAP

A

the Acyanotic

rull of thumb:
Acyanotic = L to R
Cyanotic = R to L

**Acyanotic **
CVAP:
common AV canal
VSD
ASD
Patent ductus arteriosus

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201
Q

Which congenital Heart diase are L to R shunt

5 T’s

A

cyanotic HD
1. TGA
2. TOF
3. Truncus arteriosus
4. Tricuspid valve abnormality
5. Total animalous pulmonary venous connection

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202
Q

whats the main different between PKU and BH deficiency

A

PKU - only effect the phenylalanine hydroxylase (from Phe&raquo_space; Tyr)

BH4- def. in Dhdropteriding reductase = PKU + affect on melanin . catcholamine (via low L-dopa) and also Seratonin

All the pathways need BH4.

treatment is restricted diet + BH4 supplements

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203
Q

What is the MOA of Listeria monocytogenes

A

Listeriolysin O enzyme&raquo_space; create pores in phagosomes&raquo_space; bacteria escape lysosomal destruction

Actin based transcellular spread (without returinig to the ECM)

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204
Q

What is the most common cause of bloody nipple discharge without mass / skin changes

A

Intraductal papilloma= myoepithliel lining fibrovascular core

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205
Q

Which uterine exposure is chracterized by this symptoms:

Facial dysmorphism- short palpebral fissure, this upper lip. smooth philtrum
Growth-retardation
Neurological abnormalities
Behavioral difficulties

A

Fetal alchol syndrome

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206
Q

What is the hormonal balance in Klinefleter syndrome XXY47

A

low testosterone
high LH & FSH
high Estradiol

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207
Q

What are the 5 main causes of Avascular necrosis

and which site is the common

A

**Thrombotic / Embolic occlusion
Glucocorticoids
**

also:
Vascular inflammation
Exessive alcohol use
Traumatic fracture

Femoral head

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208
Q

What is the cause of preec,ampsia?

A

increase anti-angiogenic factor relase

decrease in VEFG

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209
Q

What happens to Tau in AZD disease

A

Tau is hyerphosphorylated&raquo_space; disconnect from microtubule&raquo_space; instability and breakdown of microtubules&raquo_space; intracellular neurofibrillary tangles

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210
Q

Which pathogen is a common one in dorms and where people live toghter thet cause -Pharyngoconjuctival fever with acute onset fever, cough, congestion, pharyngitis and conjuctivitis

A

Adenovirus

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211
Q

Whatare cholesteatomas and where they are form

A

Squemous cell debris&raquo_space; form pearly mass behind tympanic membrane &raquo_space; can cause conductive hearing loss

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212
Q

Which enzyme of galactose metabolism present with isolated presence of cataracts?

A

Galactokinase deficency

Cataracts: due to galacticol accumulation

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213
Q

Which enzyme in galactose metabolism present with hepatic and renal dysfunction, FTT, vomiting and latreghy

A

GALT- galactose 1 phosphate uridyl transferase

due to acculmulation of Galactose 1 phosphate = toxic metabolite

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214
Q

How to calculate Absolute risk reduction?

A

ARR= Event rate in control - ER in treatment

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215
Q

How to calculate the Event rate?

A

ER = num of event in the treatment group / total num of subject in the treatment arm

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216
Q

what is the MOA of PCSK9

Evolocumab, alirocumab

A

decrease LDL receptor degradation&raquo_space; greater uptake by the liver

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217
Q

What is the pathophysologic of Chronic granulomatous disease (CGD)

and how is being diagnose

A

Defective in NADPH oxidase

diagnosis: Dihydrodamine testing- measure PMN respiratoy bursh.

if theres no increase in flurosence green > pt have CGD

Phagocyte metabolism disorder

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218
Q

What is the treatment for Hepatic enecephalopathy

A

Lactulose- increase conversion of ammonia to ammonium

Rifaximin- Decrease intraluminal (intestinal) amonia production

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219
Q

Which medication can help to relieve alkalemia in altitude sickness

A

Acetazolamide (cabonic anhydrase inhibitor) = more loss of HCO3-

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220
Q

Which embryonological pouches are maldevelop in Di-gorege syndrome?

A

3+4 paryngeal / brachial pouches

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221
Q

What is the pathogenesis of Gillian barre syndrome

A

Molecular mimicry&raquo_space; T ceels agains shwann cells&raquo_space; segmental demyalination + endonneurial inflammatory inflitrate

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222
Q

What id the def. in Duchenne?

A

Frame shift mutation of Dystrophin gene

X linked = affect boys

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223
Q

Werding Hofman Syndrome

which gene is dagmage , what is the consequence

A

SMA type 1

Gene- mutaton at SMN1
childhood
degenartion of ant. horn = symmetric progressive weakness

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224
Q

Which type of insulin is given as a treatment of DKA

A

Regular insulin
work within mintues.

also the treatment for when realsing home after DKA- just subcutanoeus and not IV (peaks in 2-4 hours)

225
Q

What blood gas paramter should be change in order to low ICP

A

lowering PaCO2&raquo_space; vasoconstirction&raquo_space; reduction in cerebral blood volume&raquo_space; decrease ICP

226
Q

What is the traid of Wiskott Aldrich syndrome

A
  1. Eczema
  2. Easy bleeding (thrombocytopenia)
  3. Reccurent infections (pyogenic- Hib, N.meningitis, Strep.pneumo)

Combined B and T deficiency

WAITER:
Wiskoot
Aldrich
I-imunnodeficieny
T-thrombocytopenia
E-eczema
R- reccurent infections

WAS gene mutation

227
Q

Chediak higasi syndrome

gene and presentation

A

LYST gene = LYSosomal Trafficking defect (fusion defect)
CHEDIAK menmonic
C-CNS/ neurological defect
HE- hemorrhage
Di- decrease immunity
A- albinism (silver grey hair, oculocutneous )
K- coarse granules (peripheral Blood Smear)

228
Q

What is the treatment options for Lyme disease

A

Doxycycline , Ceftriaxone

229
Q

Which pathway is activated in Chronic hyperglycemia that leads to cataract

A

polyol pathway

Glucose&raquo_space; sorbitol via aldose reductase

High sorbitol levels&raquo_space; accumulate in different tissues&raquo_space; influx of water and osmotic cellular injury&raquo_space; cataract

along with: neuropathy, retinopathy, nephropathy

230
Q

Which diasease are positive for Anti-Jo1 (Anti-tRNA synthetase)

A

Poly and dermatomyositis

231
Q

what is the MOA of Shiga toxin produce by EHEC and S.dysenteriae

A

AB cytotoxin&raquo_space; attack 60S ribosomal unit&raquo_space; inhibit protein synthesis&raquo_space; intestinal mucosal Cell death

if there hematognous spread&raquo_space; HUS

232
Q

Which condition cause Fever, prurituc rash, pain, joints with PMN

7-10 daysafter reciving a foreign protein

A

Serum sickness HSR III

233
Q

What is the pathophys of serm sickness

A

foreign proteins&raquo_space; present on APC MHC II&raquo_space; CD4 bind and activate&raquo_space; stimulate B cells to form high affinity IgG&raquo_space;IgG bind and generating immune complex

High quantities of Immune complexes&raquo_space; activate classical complement&raquo_space; high C5a,C3a
C3a , C5a Anaphyltoxins:
Increase vascular permeability, chemotaxis, mast cell granulation

234
Q

Which Gene in Bacteria encoded for Penicillin binding protein 2a (PBP)

A

MecA gene

235
Q

Where does Rota virus work (damage site)

A

Doudonum and proximal jejunum

invase villous epithelium&raquo_space; villus blunting , prolifration of secretory crypt cells, loss of brush border enzymes

Watery diarreah without fecal luekocytes

236
Q

What will be shown in Polyarthritis nodusa in histology?

A

segmental , trans mural arterial inflammation with fibrinoid necrosis.

often associated with HBV and HCV

237
Q

What is the first line treatment of Trigiminal neuralgia and what is the MOA?

A

Carbamazepine by inhibition of nueronal high frequency firing by blocking Na channels

can cause BM suppression&raquo_space; CBC should moniter periodically

238
Q

Which disease can GAS cause

A

phyringitis
Scarlet fever
Impetigo
Necrotizing fascitis

239
Q

Waht is scarlet fever triad

A

streaverry tounge
rash except the face (sandpaper like)
pharyngitis

can present also with “slapped cheeks”

240
Q

Which brachial plexus root is most suspectabl for injury in Cervical spondylosis

A

C7 root

241
Q

What is the MOA of monoclonal Ab against cancer cell surface?

A

Fc portion identified by NK cells via CD16&raquo_space; Ab-dependent cellular cytotoxicity&raquo_space; realse granzyms and perforin

242
Q

What is the pathogenesis of Occult or close NTD?

A

Failure of Vertebral arch fusion (low liying conus medullaris, thickened filum termineale)

243
Q

What is the pattern of inheritance of HLA match?

And what are the chances for 2 brotehs to have the exact match?

A

one HLA heplotype from dad and one from mom

the chance of 2 brothers from same perent to have excat match is 25%

244
Q

What is a Lead time bias?

A

Diagnosis of a condition earlier then conventional studies.

increase in survival time depite no improvment in mortality rate

245
Q

Leiomyomas VS adenomyosis

uterus size and shape
menustral bleeding

A

Leiomyomas:
Uterus non tender + irregulary shape.

Adenomyosis (endometirum glands in uterie myometrium):
Uniformly enlarge uterus

both can cause regular heavy menses

246
Q

In Adrenal crisis which medicaiton should be given first

A

Glucocorticoids

(also fluid resuscitation)

247
Q

Which pathogen must survive the acidic stomach before reaching the intestine

A

Vibrio cholera

248
Q

PT undere use of PPI are in greater risk for Gatroentritis by ——–

A

V. cholrea

249
Q

What is the meaning of S3 sound and when it heard?

A

over 40 yrs:
Eccentric hyperthropy of LV
Diastole-in passive ventricular filling
**Best- **
cardiac apex when pt is in lateral postion

*also in High CO states: pregnency and thyrotoxicisis
*also MR,AR,Dilated Cardiomyopathy

250
Q

What is the meaning of S4 sound and when it heard?

A

Late diastole (atricl systole)
due to bloods strikes a stiff LV

Concentric Hyperthropy
Prolong HTN, severe AS

251
Q

What are the light criteria for Exudative pleural effusion

A

pleural protein / serum protein > 0.5
or
pleural LDH / serum LDH > 0.6
or
Pleural LDH greather 2/3 upper limit of normal serum LDH

252
Q

Which nerve responsible for pleuritic chest pain in LL pneumonia?

A

Phernic nerve (c3-C5)

253
Q

Which mutations aoccur in the adenoma to carcinoma sequence (colon)

A
  1. from normal to small polyp- APC tumor suppresor gene
  2. increase size (uncontrolled cell prolifration)- KRAS
  3. Malignant transformation- TP53
254
Q

What is Sevelamer

A

Nonabsorbale anion exhange resin&raquo_space; bind intestinal Phosphate to reduce absorbtion

In CKD due to Hyperphosphatemia

Secondary hyper-para due to CKD

255
Q

Which IL is elevated in Ankylosing spondylitis (HLA-b27)

A

IL-17&raquo_space; stimulate production of TNF-a and prtostaglnding:

Bony erosin + abnormal bone growth

Bamboo spine

256
Q

What are the triad of Niacin def. (pellagra)

A
  1. Dermatitis
  2. Diarrhea
  3. Dementia
257
Q

Niacin is a essintial component of the coenzymes —— and ——-

also, he can obtained trough dietary taking or synthezied endogenously from ————–

A

NAD , NADP

Tryptophan

Niacin is a essintial component of the coenzymes NAD and NADP

also, he can obtained trough dietary taking or synthezied endogenously fromTryptophan

258
Q

What makes murmurs louder of softer

A

Inspiration = Right sided louder
RINspiration
Expiration&raquo_space; Left sided louder
LEXpiration

259
Q

Murmurs louder of softer?

Increase preload will cause murmurs to be ——– except ———- (2 situations)

A

Increase preload will cause murmurs to beLouder except HOCM, MVP (2 situations)

יותר דם מחזיר את המסתם המיטרלי ואת הספטום למקום- לכן הפוך

261
Q

Murmurs louder of softer?

Decrease preload will cause murmurs to be ——– except ———- (2 situations)

A

Increase preload will cause murmurs to beSofter except HOCM, MVP (2 situations)

Valsalva- מוריד את הSVR, ולכן פחות דם חוזר ללב

262
Q

What will be the affect on the Afterload in this 2 manuvers:

  1. Hand grip
  2. Amyl nitrite (medication)
A
  1. Hand grip - Increase Afterload
  2. Amylnitrite- Decrease afterload
263
Q

Increase Afterlode will cause ——- murmurs to be ——– except ———- (2 situations)

A

Increase Afterlode will cause louder regurgitation murmurs except MVP, HOCM (softer)

264
Q

Systolic Cresendo-decresendo murmue is due to

What is the clinical presentation

A

Aortic stenosis
SAD triad
Syncope
Angina
Dyspnea (extorcitnal)
1. old patient- old and sad
2. calcificed valve

265
Q

Holosystolic murmue is due to

What is the clinical presentation

A

Mitral regurgitation
Rheu-mitral = Hx of Rheumatic fever

Radiate to axilla

266
Q

Which murmur present with opening snap

A

MS

Hx rheumatic fever

Operating System is MicroSoft = OS is MS

267
Q

Which murmur present with mid -systolic click

and which poulaiton we should think about it

A

Mitral valve prolapse

to win MVP , your team has to CLICK

think about young women with psychiatric Hx

268
Q

Which murmer have is a mid systolic with wide spletting fixed of S2

A

Atrial septal defect

269
Q

Which murmur is holosystolic at left sternal border

A

VSD

270
Q

Which substance inhibit the MAT (monoamine transporter?

3

A
  • Cocaine
  • SNRI
  • TCA
271
Q

Which drug can lead to mucosal atrophy&raquo_space; nasal septal perforation

A

Cocaine

272
Q

What is the MOA of BZD

A

Increasing frequency of Clhoride channel opening in the presence of GABA

GABA A receptors

273
Q

What is the sydndrome?

Normal development until 6-18months&raquo_space; loss of motor and language sklls&raquo_space; stereotype hand movment and Decelartion of head growth

A

MECP2 gene

Rett Syndrome

274
Q

Which artery can be octruct in Anorexia and why?

A

Extreme weight loss&raquo_space; deplet mesenteric fat&raquo_space; Compression of 3rd part doudonam by SMA

Sup mesentaric artery syndrome = small bowl obstruction

275
Q

Young pt with HF sign + Viral prodrome.

in what to suspect?

A

Dilated cardiomyopathy after Viral myocarditis

276
Q

What is the diagnosis?

ipsilateral horner syndrome + upper limb pain paresthesia in a smoker

A

Pancost tumor

277
Q

What is the demege to the temporal artery in GCA

A

Intmial thicking , granulomatous inflammation of media, giant cell formation , elasticlamina fragmentaiton

278
Q

Which diseases are associated with Saccular (berry) aneurysms?

A

ADPKD
Ehlers -Danlos
HTN

in circle of willis

279
Q

Which type of cell jucntions play a critical role in labor contraction

A

GAP junctions (from connecxi43)

upregulate by estrogens

280
Q

Which pritens are bulding the tight junctions

A

Claudins , occludin

281
Q

Which proteins built the Desmosomes and Adherenes jucntion and Hemidesmosomes

A

Hemi- integrins
Adherent junction + Desmosomes= Cadherins (Desmogleins + desmoplakin)

282
Q

Which enzyme Vitamin K helps and how to process called

A

Gamma glutamul carboxylase

in posttransitional carboxylation

help to coagulaiton factorsbind Ca in the blood&raquo_space; effifect coagulaiton

283
Q

all the following effect are realated to a curtain group of anesthetics:

incdrase cerebral clood flow&raquo_space; can ceause ICP

Myocardial depression, hypotension, respiratory depression, decrease renal function

A

Volatile (halothane, isoflurane, desflurane, sevoflurane)

284
Q

Which glands neutralized the gastric acid secretion

A

Brunner - Alkaline mucous

285
Q

What is the effect of Hemochromatosis on Joints?

A

Arthritis ( mainly 2-3 MCP joints)
Chondrocalcinosis

286
Q

Which prophylacxis antibiotic is indiceted for HIV with CD <200
under 100
under 50

A

Trimethropin - Sulfamethaxazole

P.neumocystic jirovecci

under < 100:
TMP-SMX (also) for toxoplasma

<50
Azitromycin- Mycobacrterium avium complex

287
Q

Which CN move trough the Sup.orbital fissure

A

III, IV, VI < V1
opthalmic vein , sympathetic fibers

288
Q

In which skull foramen is each CN V branch is coming out
V1
V2
V3

A

V3- sup.orbital fissure
V2- foramin rotundum
V3- foramen ovale

289
Q

The middle meaningeal artery and vein is going trough which foramen?

A

Foramen spinosum

290
Q

CN IX, X, XI and the jugular vein are going trough the ———– foramen

A

Jugular foramen

291
Q

Actinic keratosis can form transformation into ——-

A

SSC

292
Q

What we will give in Heparin overdose and Warfarin overdose

A

Heparin overdose- Protamine (bind heparin = inactivated complex)

Warfarin- vitamin K + FFP

293
Q

Statin inhibit ________

A

HMG- CoA reductase

294
Q

Myotonic Dystrophy
what is the gene, and what is the change in the gene

A

DMPK gene&raquo_space; Expension of CTG trincleotide repeats

AD

295
Q

What is the Negetive predicted value (NPP)
and what is the PPV

A

NPP- probability not having the disease when the test result is negetive
(TN- total number of negetive test)

PPV- probability of having the disease when the test is positive

They are vary with the prestest probaility of the disease

High risk = low NPV, low risk = High NPV

296
Q

What are the histologi sign of Celiac disease

A

Crypt hyperplasia, Villous atrophy, Intraepithelial lympocyte infiltration

297
Q

Thoracic outlet syndrome
What is the mechanism

and what is the presentation

A

Compression on the brachial plexus as it pass trough the scalene triangle (ant. + middle scelene + first rib)

upper extrimity numbness + tingling and weakness (ulner distribuitaion) + worsen with repatitive overhead arm movments

298
Q

Which is a risk factor for Thoracic outlet syndrome

A

Extra cervical rib

299
Q

Sideroblastic anemia

cuase?

A

Imparied heme production within RBC

300
Q

Which type of anemia Isonizied can cuase (mycobacteria treatment)
which enzyme it inhibit?

A

Sideroblastic anemia

iron granuls in mitochondria around the nucleus.

inhibit pyridoxine phosphokinse&raquo_space; convert pyrodixne (b6) into its active form

pyrodixime is cofactor of lambda-aminoevulinic acid (ALA) synthase = rate limiting step in heme shytesis

microcytic anemia

301
Q

Which eletrolyte is increase in absorption in CF

A

Na

302
Q

What is coronary artery L/R dominance mean?

A

R dominance (80% of Pt)- PDA is coming out of RCA
L dominance (20%)- PDA is coming out of LCA (circumflex- branch of LCA)

303
Q

What does it mean coronary dominance?

A

From which main coronary artery the decending posterior artery (PDA) is branching from ( RCA vs LCA)

304
Q

Whats the diagnosis?

Swimming pool exposure + pruritic papulopustular rash in public places or hotels swimming pool or hot tubs

A

P. aeruginosa - self limitied infection

305
Q

What is the main difference between dilirum and alcholoic hallucinations?

A

in aclcoholic hallucinations the orientation is intact

306
Q

When Delirium tremens happens?

A

after 48 hrs from onset of withdrwal

307
Q

Which toxidrome cause yawing?

A

opiods
OOOOOO’s - כמו פיהוק

308
Q

Toxidrome??
Violence/ aggression/ psychosis, analgesia

(super humen strengh)

A

Phencyclidine (PCP)

308
Q

What te different between BZD to barbituates on the influence on Chloride ion channels

A

BZD- increase frequency of Cl chennel opening
Barbiturates- Increase duration of Cl channel opening

Ben wants it happen more often (frequency)
but Barb wants it to last longer (duration)

309
Q

Phencyclidine
what is the MOA?

which association should be berry in mind?

A

NMDA receptor antagonist

association: Rotary (“torsional”) nystagmus =ניסטגמוס סיבובית (בצורה דיאגונלית)
Phen-cyclidine = cycle like rotary nystagmus

310
Q

What is the MOA of MDMA (Ecsrasy)

A

Blocking Seratonin and dopamin receptor to uptake the neurotransmitors.

311
Q

What are associationg with MDMA (Ecstasy)?

A

They are like super- SSRI
therefore:
Seratonin syndrome
SIADH - Hyponathremia, thirst&raquo_space; seziures
Bruxism - also in metaenphatamine
Hallucination persisting perception disorder- re-expirence active effect of MDMA without taking MDMA

312
Q

Which association should think of Marijuana ?

A
  • Paranoia
  • Psychosis
  • Cannabinoid hyperemesis syndrome- in response to heat symptoms are make it better = take a hot shower
313
Q

On which monoamines Cocaine and Meathamphetamine works
and wat are the MOA of each one

A
  1. Cocaine- Block reuptake of monoamine (5HT, NE, DA)
  2. Metaamphtamine- Enhance realse of monoamines (all the 3)
314
Q

Which drugs are GABA modulators?

A

Barbs + BZD

315
Q

What is the MOA of LSD and what is a common buzz word for inhanlet LSD

A

5HT2a agonist (increase 5HT activity)
common buzz word- Rush between upper lip and nose

316
Q

Which proteins are needed to in order to process antigens by MHC I

A

TAP
Transporter associated with antigen processing

317
Q

What is the pathogen?

Fever, chills, cough, shortness of breath. lobar pneumonia, immune response with Th1 cells, INF-gamma and IL-2

A

Legionella pneumonia

inteacellular organism- cell-mediated immune response

318
Q

Which medication treat both Abscnce sezuris and both tonic clonic

A

Valporic acis

319
Q

Which Anti epileptic are good to treat of focal sezuries

A

Phynytoin
Carbamazepine
Gabapentine

320
Q

Which Anti epileptic are use to treat Generlized sezuris?

A

valporic acid
Levetiracetam

321
Q

What is precision

A

reliability- ability to test to reproduce indentical or similar reasults in reapted mesurment

322
Q

What is accuracy? (Validity

A

ability of a test to measure what its suppose to measure.
need to be equivalent to results to the Gold standart test

323
Q

What is the acute effect of corticosteriods on WBC

A

neutrophilia - due to demargination from previosly attech to vessels wall

all the rest decrease: Lymphocye, monocyte, eosinophils, basophils

less neutrophil are recruit to fghit infections

324
Q

What are the adverse effectof COX1 inhibitor (Aspirin, NSADIS)

A

Gastric ulceration (reduce mocosal protection)
Increse bleeding (lowPLT aggregation)

325
Q

Which drug is celecoxib

A

COX-2 inhibitor (selective)

lower risk to peptic ulcers + bleeding

326
Q

Whatis the inital treatment of Status epilepticus?

A

Lorazepam and phenytoin

327
Q

Whiich Anti-sezurie medication block Na channels?

A

Pheyntoin + Carbamazepine (*also valporic acid)

328
Q

wihch pathogens can cuase acute exacerbation of COPD

A

Rhinovirus, Influenzea RSV

Hemophilus, Moraxella catarrhalis, Strep pneumo

329
Q

Whuch pathogen resposible for Athlet’s foot?

and what is the treatment?

A

Tinea pedis
Clotrimazole (azole end + Terbinafine)

Dermatophytes

330
Q

Which medication n is given to Cutaneous Larva migrans

A

Albendazole

331
Q

Whats the main difference between Chi-square to t-test?

A

Chi-square- Qualitative (categorical)
t-test- quantitive

332
Q

What is the job of IL-10 realse by macrophage and regulatory T-cells

A

Anti-inflammatory

333
Q

Which area in the bone is most affected in osteomylaitis?

A

Metaphysis of ling bones

due to higly vascular region with slow flowing sinusoids

334
Q

Which Receptors Lactotroph cells express?

A

TRH receptors &raquo_space; increase TRH production can lead to hyperprolactinemia

335
Q

Which nucelus is damage in PCA and what it would lead to

A

Thalamus
Contra-lateral Hemisensory loss

336
Q

Which hormone responsible for the decelop of internal male genitalia and which for the external male genitalia

A

internal - Testosterone = Wolffian duct prolifration
External = DHT

337
Q

Which hormone allow for the mullerian duct prolifate and wolldian duct regresion

A

Absence of AMH (SRY gene on Y chromosome)
Absence of testosterone = wolffian duct regression = female external genitalia

338
Q

Which hear sound is associated with volume overload?

A

S3
(dilated cardiomyopathy, MR or AR, HFrEF)

339
Q

What is a synovial fluid WBC for Septic arthritis?

A

> 100K WBC

340
Q

What ios preventable adverse event

A

injury / delyaed diagnosis die to failure to follow evidence based best practice guidline

for example: not diagnosting hypothroidism in a perspon with depression and fatiuge

341
Q

What is the MOA of PPI

A

Block H/K Atpase pump

342
Q

Omeprazole and Lansoprazole are a medication from the family of________

A

PPI

343
Q

What is the adverse affect of hCG secreting tumore on testis?

A

Suppresses testosterone production in leydig cells&raquo_space; increasing aromatase activity = testosterone to estradiol&raquo_space; more astrogens = gnycomastia

344
Q

Which GI complication is common in Scleroderma

A

SIBO
Small interstinal bacterial over growth

Alter intestinal motility due to smooth muscle fibrosis and atrophy

345
Q

In Enfective endocarditis. what is the effect of the kidney?

A

Glomerulonephritis due to circulating immune complex (HSR III) = AKI + hematuria with RBC casts

346
Q

Coarctation of the aorta present with ——- which is a risk factor for ————–

A

Secondary HTN&raquo_space; Cerebral aneurysm

347
Q

Pt present with pruritus and signs of Vit A deficency should be evaluated to

A

Primary biliary cholangitis

348
Q

What is the psthophysiology of Subclavian steal syndrome

A

Severe stenosis of proximal subclavian&raquo_space; reverse blood flow from CL vertebral to ipsilateral Vertebral artery&raquo_space; Vertebrobasilar insufficency (dizzy, vertigo, drop attacks).

349
Q

What is the treatment for migranes and what is the MOA of the medication

A

Triptan (sumatriptan)
5- HT agonist &raquo_space; inhibiton of vasoactive peptide ralise (Calcitoni gene related peptide and substance C

Stimulate trigeminovascular seratonin receptors

for acute migrane

350
Q

What is the reason for Cystic hygroma (foe example- post. neck mass)

A

Obstruciton of lymphatic system&raquo_space; suspect Turner

351
Q

Synthetic EPO can incrase risk for

A
  1. HTN
  2. thromboembolic events
352
Q

Which part of the immune system Candida antigen test is assessing

A

Cell mediate immune response

353
Q

Which phase Call VI anti-arrytmic block

A

Phase 4, CCB for L-type = Slowing phase 4 depolarization

354
Q

What is the MOA of tetanospasmin (exotoxin)

A

Prevent release of inhibitory neurotransmitters = Glycine and GABA&raquo_space; increase activition of motor nreves&raquo_space; spasms, hyperreflexia

355
Q

Why Toxo is treated with Sulfadiazine and pyrimethamine?

A

Synergistic reduction of DNA synthesis (prevent formation of THF- a necessary co-factor for purine synthesis)

356
Q

Whats the diagnosis?
Pt with sudden onset confusion , Memory loss, anterograde amnesia&raquo_space; resolving in 2 hours?

which area in the brain does bot function properly?

A

Transient global amnesia
self limited , up to 24 hrs

hippocampus dysfunction- responsible for creating new memmories

357
Q

Which pathogen can cause pneumonay after aspiration?

Tx

A

Actinomycosis

have sulfur granules- look purple

Penicillin G

358
Q

Which medication reduce Uterine contractility + cause hypokalemia?

A

Beta-2 agonist
in uterine - as tocolytics
in other cells- B2 agonist activation&raquo_space; stimulate Na/K atpase pumps, K interalization =hypokalemia

359
Q

Which diureticswork in A and B

A

A- Carbonic anhydraze (Acetazolamide)
B- Osmotic diuretics (Mannitol)

360
Q

Which diuretics work on D

A

Loop diuretics - furosamide

361
Q

Which diuretics workon E

A

DCT- Thiazide (Hydrocholothiazide)

362
Q

Which diuretics work on F

A

Pottasium sparing diuretics
* Aldosterone antagonist
* Na chennel blokers (amiloride)

363
Q

How the endometrium in pregnency (also ectioc present)

A

Progesterone promote Decidualization&raquo_space; Dilated coiled endometrial glands, Edematous stroma

364
Q

What is the 68-95-99.7 rule

A

Std:
1 Std- 68% of population (each side 34)
2 Std- 95% of population (each side 16)
3std- 99.7 of population

365
Q

Which medication help smoking cessation by reducing wthdrway symptoms and less reward affect of nicotine

A

Vareniciline= partial agonist of nicotine Ach receptor in CNS

פחות מגרים את הרצפטור לניקוטין

366
Q

Which glycolysis enzyme is activating by insulin

A

PFK2 (result in activation pof PFK-1) conversion of F-6P&raquo_space; F-1-6 BP

367
Q

Which enzyme catalyze the rate limitng step of glycolysis

A

PFK-1

368
Q

Whice and where Epinaphrine is made?

which hormones upregulate and downregulate it?

A

In the adrenal meddula by PNMT (phenylethanolamine -N - Methyltransferase)

Upregulate by Cortisol- elevate the expression of the enzyme

Any case of low Cortisol (like Pituatry resection , low ACTH)= less Ep by the adrenal medulla (from NE)

369
Q

Chronic use of which medication can cuse Osteoporosis

A

Prednisone (steroid use)

370
Q

Calcification of the bladder increase the risk of————-

A

Adenocarcinoma of the bladder

371
Q

What is Procelain bladder?

A

Menastification of chronic cholecystitis&raquo_space; which cause thick gallbladder wall with calcifications

372
Q

How to calculate odd ratio?

A

a/c / b/d = OR

373
Q

Whats the treatment for scabias?

A

Topical permethrin&raquo_space; block NT by imparing Voltage gated Na channels

374
Q

Who am I and what is the treatment

A

Sarcoptes Scabiei (Scabies)

Tx: Topical Permethrin

375
Q

Whats the treatment for Impetigo?

A

Topical Mupirocin

376
Q

Which syndrome is with high FSH, LH , low testosterone and azoospermia, with high serum inhibin

A

Klifenlter syndrome 47XXY

377
Q

Which IL are produce by Th1 and TH17 in the mechanism of RA

A

TNF-alpha&raquo_space; proliferation of inflammatory cells
IL-1&raquo_space; synthesis of matrix metalloproteinases, which enhance T-cell immune repsone

378
Q

What is the common reason of Empyema?

A

bacterial translocation for the alveoli (progression of complex para-pneumonic effusion)

379
Q

What is the role if IL-12,
and when theres a def. what sould we give?

A

Secrete by macrophages when presenting an antigen on MHC II&raquo_space; differentiation of T0 to T1&raquo_space; produce IL-2, INF-y, lymphotoxin beta

if thetes def in IL-12&raquo_space; inability to mount a strong cell mediategranulomatous response&raquo_space; need to give INF-y (which will activate macrophages + CD8

380
Q

Which kind of infections pt with IL-12 def. are suspectel to

A

Myobacterina infections

12 letters in mycobacteria

381
Q

What is Restless leg syndrome:

when it worse and when it ease
what the proposed explantion in this syndrome

whats the Tx

A

uncomfortable sensation in the legs + urge to move them

sym. worst- with inactivity and nighttime
improve- movement

Explanation: CNS iron def. + abnormalities in Dopaminergic transmitting (dopamine antagonist = worst it)

Tx: alpha-2-delta Ca channel ligands = Gabapentin + Pregabalin

dopmine agonist - second line

382
Q

Which DiBacteria is transfer by Cat scracth or bite?

A

Batonella Henselae

383
Q

What is the mechanism of Radiation -induce injury?

A

inflammatoy response&raquo_space;
acute manifistation (3-12 wks) - exudiatve alveolitis&raquo_space; Hylaine membrane formation (alveolar)

delay phase (6-12 months)&raquo_space; Pulmonary fibrosis

384
Q

Postpartum Hemmorahge can be manage by clippin which vein?

A

Internal iliac artery

385
Q

What is the Deficiecny in Chronic Granulamatous Disease

A

NADPH oxidase deficiency

386
Q

Which Fungal is brance in 90 dagree?

A

Rhizopus, Mucor, Absidia species
causes Mucormycosis

387
Q

Which infection cause achalesia due to the distruction of Meissner and auerbach plexus?

A

Chagas diases- Trypanosoma cruzi

388
Q

What is Haldane effect?

A

Binding of O2 which cause to
1. unloading of CO2 from Hb
2. Protons arerealsed

389
Q

Which channels have problem in Long QT syndrome?

A

Voltage gated K channels

390
Q

What happens when PD-1 connect to PD-L1

A

active T cells becoming Exhausted T-cells

391
Q

What is the MOA of n. Meningitis?

(the Pilli)

A

Attach to nasopharyngeal epithalial cells

392
Q

Which substance are given in Oral rehydration solution and what the job of each one

A

Glucose- trivial calories + enhance Na abosbation ( Na-glucose transporter - SGLT-1)
NA- he goes and water goes after him
K- replace diarrheal K loss
Citrate- metbolized in liver to HCO3-&raquo_space; elevate buffering capacity to helo correct acidosis

393
Q

What is the most importent factor in determing the prognosis of urothelial carcinoma?

A

Depth of invasion

394
Q

What is the difference between dery and wet beri beri

A

Dry- symmetric peripherial neuropathy (motor &sensory)
Wet- cardiomyopathy and HF

395
Q

Thiamine is co-factor for which 3 enzymes:

A

Pyruvate dhydrogenase
a-ketoglutarate (same co-factors as pyruvate)
Transketolase

*remember TP (beacuse a-keto is same as pyruvae DH). and TPP is the cofactor f thiamine (thiamine pyrophosphate)

396
Q

If gastric bypass is mentioned what should i suspect?

A

Vitamins Def.
Thiamine, ADEK, B12, folic acid

397
Q

Which protein is resposible of antrograde movment alont the nueron exon

A

Kinesin- K arry out = antrograde
Dyanin- Retrograde movment (Dine in = retrogarde)

also the protein which allow HSV travel from sensory ganglia (dyanin and kinesin)

398
Q

What is the diff. between congenital deformation and malformation

A

deformation- change in shape and postion of a structure that decelop normally (club foot)

malformation- defect in organogenesis (Aka spina bidis, hloproenchepaaly)

399
Q

What is a congenital association

A

multiple anomaly without knowing why they occur togethrer

remember VACTERL:
Vertebral defects, anal atresia, Cardiac defects, Trachoesophageal fitula, Renal anomalis, Limb abnormaliy

400
Q

Which part of GI tract is with high association to the Sup. mesenteric artery and vein

A

3rd part of duodunum - tumor in that area can press on the SMA

401
Q

Which co-factor is neede in the hydroxylation of Lysine and proline in collagen synthesis

A

Vitamin C

in RER (rough endoplasmatic reticulum)

402
Q

Which gene is damage in PAH (pulmonary heraditary hypertension)

A

BMPR2 (AD)

smooth muscle cell prolifration

403
Q

Which benign condition in early infancy can cuse a painless bloody-streaked stool

A

Food protein induce allergic proctocolitis
(non IgE mediated)

404
Q

Lukocyte adhesion cascade:

Which 2 molecules help PMN to adhede to blood vessel

A
  1. Integrin
  2. Sialylated glycoprotein
405
Q

Which molecules participate in the Rolling of PMN?

A

On endothelial cells:
P-selectin
E -selectin
on PMN- Sialyated glycoprotein attachment

406
Q

In leukocyte adhesion cascade , what couse the activation of PMN?

A

Chemokines release + binding of selectins = conformation change to a high-affinity state of Integrins )on PMN)

407
Q

Which protein is responsible of adhesion and chemotaxis of neutrophils

A

CD18

408
Q

Which connections allow the tight adesion of PMN to endothel?

A

ICAM-1 on endothel

CD18 beta 2 integrins (Mac-1, LFA-1) on PMN

409
Q

Which protein allow thw trasnmifration of PMN from the blood to the tissue?

A

PECAM-1

410
Q

Whuch medication can be give to Idiopathic pulmonary fibrosis?

A

TGF-beta inhibitor aka Pirfenidone =Pulmonary Fibrosis DONE

411
Q

Which molecule is provitamin D3 which change on UV light ?

A

7- Dehydrocholestraol

412
Q

What it the function of the Central Chemoreceptors vs Carotid Chemoreceptors?

(what each one is sensing and what happend?)

A

Carotid and arotic bodies&raquo_space; sensing PaO2&raquo_space; in high oxygen state&raquo_space; reduce stimulation&raquo_space; decrease RR

Central chemoreceptors?
Sense CO2 &raquo_space; high CO2&raquo_space; decrease PH&raquo_space; hyperventilation
not confuse with blood PH- which can’t go trough the BBB, only the H ions in the CSF is senses

413
Q

What is the mehanism of demege in Diffuse axonal injury?

A

tearing the white matter tracts during rapid accelraiton and / deceleration injury.

multiple lesions in white matter tracts,
axonal swelling in gery white matter junctions

414
Q

What s the underline mechanism of Neonatal respiratory distress syndrome?

A

indaquate surfactant production&raquo_space; more tension and less compliance&raquo_space; diffuse collapse (atelectasis) —- CXR as ground glass opacites and air bronchogram

415
Q

What will be change in Aging and the kidney?

A

Reduce renal mass and functional glomeruli&raquo_space; reduce GFR and Cr clearance

Reduce renal blood flow

Reduce hormonal responsivness

416
Q

What is the treatment forcryptoccocal meaningtitis?

A

Fluconazole

417
Q

Which hormone we want to low in PCOS ti induce fartility?

A

Estrogen levels

by:
Letrozole- aromatase inhibitor
Chlomiphene citrate- bind astorgen receptors in the brain

418
Q

When I hear Peau dorange i think?

A

Inflammatory breast cancer

yes its itchy
yes its firm
yes its with edema
yes its obstuct the lymphatic drainage

419
Q

What it the porpuse of Rasburicase (TLS)

A

Convert uric acid to more soluble metabolite

(recombenent verision of Urate oxidase)

420
Q

What happens to the Chest wall and the lung compliance in aging and how it effect RV, FVC and TLC

A

Chest wall- decrese compliance
Lung - increase complience (due to loss of elastic recoil)

RV- increase (air trapp)
FVC- decrease
TLV- unchange

420
Q

Which drugs are anti-urmiec agents?

A

Rasburicase&raquo_space; urate oxidase version of the animal enzyme

Allopurinol (competitive inhibitor) &laquo_space;unhibit Xanthine oxidase (purine catabolism) = less xhantine and uric acid

Febuxostat (non selective xhantine oxidase inhibitor)- same as allopurinol, less adverse affect or interactions

421
Q

Where do Bile acid absorb?
which disease damage this sight and can cause wasting of bile&raquo_space; gallstones

A

Terminal ilium

Chron’s love terminal ilieum&raquo_space; waste of bile acid&raquo_space; suprasaturation of cholesterol in the bile&raquo_space; gallstone formation

422
Q

Which medication is given to RA when MTX failed to treat disease?

A

Etanercept (TNF-alpha inbhibitor)

fusion protein- connect the false receptor to FC component of humen IgG1

act as decoy (false) receptor that bind TNF-a like a sponge and prevent the TNF-a to bind his functional receptos

423
Q

What is the suffix of biological agents as follow?

Receptor molecule suffix
kinase inhibitor suffix

A

Receptor- Cetp
Kinase- nib

424
Q

Which treatment can cause body fat distribution

A

Highly active Anti-retroviral therapy

425
Q

What are the 2 most common cause of HIV with multiple ring enhancing lesion

A
  1. Toxo
  2. Primary central neurvos system lymphoma&raquo_space; B cell origin corrleation with EBV
426
Q

what is the flame looking part and what the reasons?

A

Fibrinoid necrosis who bleed into nerve fiber layers&raquo_space; dots and flame shape hemmorage

in HTN

427
Q

What is the result of a defficancy of INF-y signalin? and when its often happens?

A

Disseminated mycobacterial disease

often after BCG vaccine (for TB)

428
Q

Methylmalonic acidosis

Inheretance?
pathway?
Dx

A

AR

Organic acidemia in newborns
def of methmalonyl-CoA mutase

Dx: Elected propionic acid, hypoglycemia and metabolic acidosis (ketone) hyperammonemia

429
Q

Which organs are prone to demege due to systemic hypotension

A
  1. Hippocampus&raquo_space; remember hipothens = hipocampus

watershad zones:

  1. Splenic flexure
  2. Rectosigmoid junction
  3. borders of the area supplied by the ACA, MCA PCA
430
Q

What is the MOA of MAO inhibitors?

A

inhibit MAO - mitocondrial enzyme that break down NT (dopamine, NE, sratonin)

431
Q

Why MOA-inhibitor can cuase HTN crisis?

A

beacuse Tyramine is sympatomimetic that is broken down by MOA in the intestne.
and when its inhibited&raquo_space; thyamine escape central ciruclation &raquo_space; HTN crisis (when consuming thamyne rich food)

432
Q

What is the pathophyiologyof Hirschpaung?

A

NC cells fail to migrate to the bowl wall.
no Submucosal (Meissner) and Myenteric (Aurbach) plexus = unable to relxax

submocusal abscene og ganglionic cells – seen in the narrowed segments of the bowl

433
Q

Which antiemetics are useful for Chemotherapy emesis?

A

Dopamine receptor antagonist
5-HT receptor antagonist
second line:
Neurokinin 1 receptor antagonist

434
Q

What is the treatment for Malignant hyperthermia and how do we treat it + what is the MOA

A

Genetic mutation in RYR1 receptor &raquo_space; inalation anesthatics & succunylchole&raquo_space;Malignant HT&raquo_space; Tx with Dentrolene = ihibit Ca realse from the abnormal RyR1 (from sarcoplasmic reticulum)

435
Q

Which anti-coagulant is good for most pregnant women?

What about pregnant women > 37 weeks?

A

Heparin&raquo_space; LMWH = Enoxaparin

in term change to unfractionated heparin > short half-life

436
Q

What is the effect of Estrogen on the thyroid

A

Increase TBG level&raquo_space; Increase total thyroid hormone levels with normal levels of free Thyroid hormones

437
Q

Which AA cannot be broken in MSUD (maple syrup urinary disease)

A

Valine, isoleucine , lucine

438
Q

Which co-factors are needed by pyruvate dehydrogenase?

which other 2 enzymes need the same co-factors

A
  1. Thiamine (b1)
  2. Lipoate
  3. Coenzyme A
  4. FAD
  5. NAD

alpha-ketoglutarate dehydrogenase
Brahcned chain alpha keto acid Dhydrogenase complex (BCKDC)- syrum maple disease

439
Q

Avoid fibrates (like Gemfibrozil) when there’s an underlying —————- disease

A

Avoid fibrates (like Gemfibrozil) when there an underline Gallbladder disease

440
Q

most important interlukin In spetic shock

A

TNF-alpha

441
Q

What is the treatmet for cerebral vasospasm after SHA

A

CCB- increase cerebral vasodilation and decrease calcium depndent excitotoxicty

442
Q

Which pathway will be activated by Insulin?

and what will be the result of this activaion

A

RTK&raquo_space; PI3K pathway &raquo_space; activating protein phosphatase &raquo_space; dephosphorylate glycogen synthase&raquo_space; active glycogen synthase

443
Q

What is the patophysiology of Chronic Lung tansplant rejection

A

Sub-mucosal infflamtion granulation and scarring & bronchiolitis obliterans

444
Q

What will happen to GFR and Fractional Filtreation when the res a Urethral obstuction

A

GFR will decrease
FF will decrease (GFR: RPF) due to arteriole consticrtion beacuse of GFR decrease

445
Q

What is the influence of Preeclampsia on
Placental vascular resistance
uteroplacental perfusion
Umbilican vein oxygen delivery

A

Placental vascular resistance- Increase
uteroplacental perfusion- decrease
Umbilican vein oxygen delivery- decrease

446
Q

Which medication can cause Hypsensitive reaction with association to HLA- B*57:01 allele

A

NRTI- Abacavir

HSR-4

447
Q

What is a permissiveness affect of medicaions

A

Permissive drug has no effect on physiologic process itself but when combine with another drug it exert its maximal effect on the process.

448
Q

What is the pathogenesis of Reye syndrome

A

Acute liver failure + rapidly progressive enephalopathy.

Damage to mitochondria&raquo_space; impair fatty acid beta oxidation within hepatocytes

449
Q

Which organ in the body is derive of the mesoderm but its bloody supply is from the foregut origin

A

Spleen

supply by the celiac trunk

450
Q

Which abdominal blood vessel originate fromt he:
Forgut
Midgut
Hindgut

A

Forgut- Celiac artery
Midgut- SMA
Hindgut- IMA

451
Q

How do we detect C. defficelle infection?

A

PCR for bacterial toxin gene

452
Q

which family of medication can cause transient bluish discoloration to vision

A

PDE-5 (Sildenafil, Tadalafil)

453
Q

What is the presentation of right sided colon cancer?

A

occult bleeding
Iron def. anemia

grow to the lumen

454
Q

What is 2 distinct features between NMS to seratonin syndrome

A

NMS- Diffuse rigidity + hypoflexia

Seratonin syndrome- clonus, hyperreflexia

455
Q

Which ligament is involve in overian torsion?

A

Infundibulopelvic ligaments

456
Q

What is Mullerian degeneration?

A

Process of Axonal degeneration and breakdown of myelin sheath distal to the site of injury.

In CNS- there’s myelin debris and not axonal degneration

457
Q

Whats the different in MPA between LMWH and Unfrcational heparin?

A

LMWH- only inhibit factor Xa by binding and activating AT III

Unfr. Heparin- bind to AT III and inhibit both factor Xa and both Thrombin

458
Q

In anapylaxis which specific anzyme is relased from MAST cells garnules?

A

Tryptase - support clinical Dx of anapylaxis after pt is tabilized

459
Q

What is the Dx. what will see in biopsy?

A

Urtecaria (IgE mediated degranulation of mast cells)

Edema of superficial dermis

460
Q

what is Sudan III stain?

A

Stain for testing malabsorption of fat

461
Q

Classic Galactosemia caused by a def in ———–. symptoms including vomiting after breasfeeding, jaundice and——- sepsis.

A

Classic Galactosemia caused by a def in GALT (Glactose-1-phosphate uridyl transferase). symptoms including vomiting after breasfeeding, jaundice and e.coli (Gram neg. rod ) sepsis.

462
Q

Lagionella can cause bardy/tachycardia with fiver, also, it can cause watery/ bloody diarrhea. and can be diagnose by ——————————

A

Lagionella can cause bardycardia with fiver, also, it can cause watery diarrhea. and can be diagnose by urine antigen test and culture on BCYE

463
Q

Which activating mutation is with correlation with gout?

A

PRPP synthetase (De novo purine synthesis) - activating mutation

464
Q

In gout ,, which WBC is involve?

A

Neurtrophils ,

thats why using NSAIDS is a first line.

if C/I&raquo_space; colchicine is uaseful- inhibit PMN chemotaxis and phagocytosis

465
Q

Which Pathogen has a Corkscrew shape on Silver stain?

A

Trponoma pallidum (syphilis)

466
Q

Garlic odor on breath? (tocixdrome) and whats the Tx?

A

Arsenic poisinig

Tx:
Dimercarpol
DMSA

467
Q

How metformin is cleared?

A

By the kidney.

if not&raquo_space; can lead to Lactic acidosis

468
Q

In which disease we test for Ab to Cardiolipin- Cholesterol- Lectihin antigen

A

syphilis (RPR, VDRL- nontreponemal)

not specific

469
Q

Which Drugs interact with Chelation cations and what does ites effect?

A

drugs:
Tetracyclines, Fluroqionolone, levothyroxine

Iron, Ca, Ma, Aluminum

Effect: compkex in GI tract&raquo_space; decrease absorbation of the medicine

470
Q

What is Immune privilege?

A

Areas in the body that conceled from the immune system by physical barriers

like:
eye, Testes

471
Q

Maple syrup urine disease

which enzymr id def.
inheritence?
Enzyme function?

A

Def. in BCKDC (branched chain alpha keto dehydrogenase complex (thiamine dep.)

AR

function: breakdown of branched AA- Leucine, Isoleucine, Valine (for the TCA cycle)

472
Q

Sweet smell urine + irritabilty, porr eating in infant?

A

Maple syrup.
BCKDC def.
(isoluecine, leucine, Valine- VIL)

473
Q

Classic Galactosemia is an —— inheritence

A

AR

474
Q

What we see here?

A

A-vascular necrosis of femoral head

475
Q

22 year old with with neck mass + multiple soft papules on lips and tounges + arm span exceed his height with long fingers

whats the Dx?

A

MEN2B (RET)

PMM
Pheochromocytoma- episodic Headcaes
Medullart thyroid cancer- Calcitonen
Marfan hebitus / mucosal neuromas

476
Q

What is Calcineurin?

A

protien phosphatase essential to activation of IL-2 (induce transcription of it)» promote grow and differenation of T cells.

477
Q

Which medications inhibit Calcinineurin?

A

Cyclosporine + Tacrolimus

478
Q

What is The lepromin skin test?

A

injecting inactivated Mycobacterium leprae under the skin, is a diagnostic tool that helps classify the type of leprosy in a person already diagnosed with the disease;

a positive result» where a nodule forms, tuberculoid leprosy;
a negative result&raquo_space; where no nodule forms, is associated with lepromatous leprosy
, a more severe form of the disease characterized by a weaker immune response, more widespread lesions, and a higher bacterial load

479
Q

Which deposits are found in Psuedogout (CPPD)

A

Calcium pyrophosphate- rhmboid shape (כמו אונקיות זהב)

480
Q

Which Pathogen is a/w progressive multifocal leukoencephalopathy (PML)

A

JC virus- due to attack on the oligodandrocyte

481
Q

What is the pathology seen in Reye syndrome

A
  • Mitochondiral toxin&raquo_space; impair FA oxidation
  • Hepatic dysfunction&raquo_space; ammonia accumulation
  • Astrocyte swelling&raquo_space; due to the amonia high levels
482
Q

Firm violacenous nodule in setting of chronic lymphadema?

A

agiosarcoma

mainly 10 yrs after breast cancer treatment

483
Q

In which enzyme reaction of the TSA cycle GTP is generate

A

Succinul -COA&raquo_space; Succinate

484
Q

Which reactions in the TCA generate NADH

A

Malate to Oxaloacetate

Isocitrate to alpha-ketoglutarate

alpha-keto glutarate to succinyl-coA

485
Q

Tx for Anticholinergic?

A

Alisa Tea party ( Hot as a hare, dry as a bonem red as a beet, blind as a bat, mad is a hatter
full as a flask, fast as a fiddle

Physostigmine

486
Q

Macrophage with hemosidrein is indicated of?

A

Hemmorahge

487
Q

Which signal transduction is mediated trough EPO

A

JAK/ STAT&raquo_space; promot erytrocyte precursor survival and differentiation

488
Q

What ios the surgical treatment for persistent AFib

A

Ablation of the AV node (located on the endocardial surface of of right atrium near the insertion of the septal leaflet and the orficie of coronary sinus

489
Q

which medication can be used to treat visceral nausa

A

5-HT3 receptor antagonist (ondansetron) reduce neause and vomiting caused by GI upset

490
Q

What are hemartomas?

A

Bening lung neoplasms microscopically characterized by nodules of disorgioanzed mature Connective tissue (Cartilage , fat) + entrapped respiratory epithalium.

491
Q

In case of carrying to much weight - Which structre is resposible for giving up in order to not cause the body damage?

A

Golgi tendon

492
Q

What are the 4T’s of ant. mediastinum mass?

A

Thymoma
Teratoma (and other Germ cell tumors)
Terrible lymphoma
Thyroid neoplasm

493
Q

regards to levels of b-HCG and alpha-Feto proteins.

What would be the levels in seminomas and non-seminomas tumors?

A

Seminoma- eleveted beta-hcg, AFP almost always normal

Non-seminomas- Eleveted AFP + b-HCG

493
Q

Which tumors are non seminomas?

A

Yolk sac tumors, Chrocarcinoma, Embryonal carcinoma

494
Q

What is Eisenmenger syndrome?

A

Left to right shunt&raquo_space;Stiffining and narrowing of blood vessels in lungs&raquo_space; PAH&raquo_space; Right to Left shant&raquo_space; cyanosis , clubbing, polycythemia

495
Q

Wide fixed splitting of S2

A

ASD

496
Q

Which enzyme is expressed by macropahges in Granulamatous diseases?
TB, Sarcoidosis)

A

alpha-1- hydroxylase&raquo_space; more active Vitamin D&raquo_space; hypercalcemia

497
Q

Low maternal serum of alpha-feto protein?

A

Aneuploidies&raquo_space; Trisomy 18 & 21

498
Q

High maternal serum of alpha-feto protein

A
  1. open NTD
  2. Ventral wall defect (omphalocele, gastroschisis)
  3. multipe gestation
499
Q

How to values in Down syndrome will change in the Quadraple screen test

A

low APF
Low unconjucated estriol

High b-HCG
High inhibin A

500
Q

Which is the most common indicator of obesity realted disease in Lung test?

A

Reduction in ERV (Expiratory reserve volume)

also FRC = ERV + RV

501
Q

What is the purpose of Southwestern bloth?

A

dsDNA probes to indentify DNA binding protiens (aka. transcription factors)

502
Q

Which Fungi are di-morphic

A

Histaplasma capsultum, Blastomyces, Coccidiodes, Sporotherix, paracocciodes

503
Q

What is the Clinical menifistetion of Vitamin E def.

A

Hemplytic Anemia
Neurological Deficit (Ataxia, Loss of vibatory sensation, hyporeflexia)

504
Q

Erythematous rush in sun exposure regions + Anemia +Reticulocytosis

A

Warm Agglutinin disease (IgG)&raquo_space; AIHA&raquo_space; Extravascular hemolysis ( Secndary to SLE)

505
Q

Which Vitamin Def. will cause Epithalial squemous metaplasia?

A

Vitamin A - responsible for differeation to specilized epithlium (like mucus secrting and ect..)

to a kertinizing epithlium

506
Q

What are the sequence of mutations in colon cancer?

A
  1. APC inactivation + beta-catenin accumulation = hyperproliferative epithelium
  2. KRAS activation = Adenoma (increase in size)
  3. P53 inactivation = Carcinoma
507
Q

How to calculate False negetive?

A

1- sensetivity X number of pt with the disease

508
Q

Which subtype is the most abundant in RCC?

A

Clear cell carcinoma

509
Q

Which plance int he nephron is not permable to water

A

Thick + Thin ascendin loop (regardless of vasopressin levels)

510
Q

Absence of HLA-DR cells indicicate defective expression of —— which can lead to —————

A

MHC-II

can lead to impair activaiton of T & B cells&raquo_space; resulting in form of SCID

511
Q

Which medication treat COPD by blocking Ach at muscarinic receptors
(inhibit parasymphatetic)

A

Ipratropium- anticholinergic ( der. of atropine)

512
Q

What the impact of Unilateral Rental artery stenosis on the unaffected kidney?

A

eleveted systemic pressure&raquo_space; increase NA excretion

513
Q

What is Heteroplasmy?

A

Variability in presentation altough having the same mutation

in mitochondrial disease- inherit from mother only, severity depends on the amount of normal and mutent mitochondria in the daugther cell.

514
Q

Why Brown pigmented stones formes/?

A

Secondary to bacterial (E.coli) or Helminthic inf. of the biliary tract.

realse of beta-glucoronidase by injured hepatocytes and bacteria.

515
Q

What is the cause of formation of black stones?

A

Chronic hemolysis (Sickle cells, spherocytosis), increase enterohepatic cycling of bilirubin

516
Q

Which co-factor is needed for Transamination reactions? (for exemple between AA to alpha-keto-acid)

A

B6- pyrodoxal phosphate (active B6)

in AST, ALT

517
Q

Which kind of PH changes occur when giving excess normal saline infusion

A

Metabolic acidosis with no AG.

518
Q

What is the enzyme def. in Cyclic neutropenia?

A

Neutrophil elastase

519
Q

What is Biliary sludge?

A

mixture of particulate solids that have precipitated from bile. Such sediment consists of cholesterol crystals, calcium bilirubinate pigment, and other calcium salts

Can cause transient bile duct obstruction&raquo_space; promote cholesterol gallstone formation

cuase by hipomobility of the gallbladder

520
Q

What is the pathopysiology of Dudenal atresia?

A

Recanalzation failur = double bubble sign

521
Q

What is the pathophysiology of Jeujenal / ilial atresia?

A

Vascular occlusion. true for all midgut- Jejunum, ileum, proximal colon (SMA occlusion)

522
Q

In glaucoma what is the target of Timolol in treating?

A

Diminish secretion of aqueous humor by the ciliary epithlium

523
Q

Which Clinical feature is very carecteristic for PCP (phencyclidine)

A

Nystagmus (can be vary) and memory loss= distinguish symptoms

PCP = like the P is a sunglasses= nystagmus
also:

ataxia, amnesia
they are very violent

524
Q

Huntington disease is cherectarzie by —— reaptes and affect the ——- nucleus

A

CAG repeats
Atrophy of Caudate nucleus

525
Q

Age realted macular degeneration leading to loss of portion of central visual field called:

A

Central scotoma

526
Q

Whats the diagnosis?

A

AMD = Age related macular degeneration

527
Q

What is the Tx for colesterol gallstones in pt who refuse surgery?

A

Hydrophilic bile acids ( ursodeoxycholic acid) = promote gallstone dissulution

by reducing cholesterol secretion and increase biliary bile acid concentration

528
Q

How to calculate Number needed to harm?

A

NNH= 1/ Absolute Risk increase

ARI = Adverse event rate in study - AER in control

Adverse event rate= adverse event (exp. death) / sum of people treated

529
Q

Which place is the principal site of NE synthesis in the brain?

A

Locus coeruleus - posterior rostal pons near the lateral floor of the 4th ventricle

530
Q

Who do prolactin can ceuase hypogonadism?

A

suprresion of the GnRH produciton from the hypothalamus

531
Q

Which 2 mediators (vasoconstrictors) have an prominent role in the development of LVH

A
  1. Angiotensin II
  2. Endothelin
532
Q

What is the most common inherited disorder of bilirubin metabolism?

A

Gilbert syndrome

low activity of Hepatic UDP glucoronsyltrsaferase = less conjugated bilirubin

533
Q

Pt with self resolving scleral icterus + isolated indirect hyperbilirubinemia
at periods of stress. Dx?

A

Gilbert syndrome

534
Q

Which type of Hormone is produce by Seratoli cells?

A

Anti mullerian hormone in fetus

ABP = androgen binding protein that bind testesoron to keep viable sperms

Inhibin secreted by seratoli cells to provide a negative feedback to FSH

535
Q

What will be the effect of Seratoli cells dysfunction on FSH, inhibin and fertility

A
  • impaired fertility
  • increase FSH levels
  • Decrease inhibin
536
Q

DDx for blusih neoplasm uderneath the nail bed?

A
  1. glomus tumor (glomangioma)- modify smooth muscle cells = thermoregulaiton
  2. Subungual melanoma
537
Q

What is pleiotropy?

A

Multiple phenotypic manifestations reasults from a single genetic mutation

538
Q

What is Gentic linkage?

A

tendancy of alleles located nearby to be inherent together

539
Q

Which WBC are the promary mediators in COPD

A

PMN, CD8, Macrophages

Emphysema
+
Hypersecretion (Chronic bronchitis)

540
Q

What is the Function of R protin secreted from salivery glands

A

to bond B12 in the stomachand realsed it in the duodenum (by pancreatic proteases) so IF can contet it

541
Q

What is The genetic material in Compleye mole vs partial mole

A

Complete- 46XX/ 46XY ( ovum fertilized by 2 sperm w/o maternal chromosomes)

Partial- normal ovum (with maternal chromosomes) fertilized by 2 sperms- 69XXX, 69 XXY 69XYY

542
Q

In which type of molar pregnancy fetus part would be presence?

A

Parital mole

543
Q

Which Brain structure will suffet the most from Chronic Thiamine Def. and by decrease in which enzyme activity?

A

Mamillary body
decrease activity of tansketolase

544
Q

Which IL envolve in

A

IL-4 + IL-13

545
Q

Which IL involve in patohgeenesis of sepsis?

A

TNF-a + IL-1

546
Q

Which IL involve in psoriasis?

A

IL-17 + IL-23

547
Q

Which iL are involve in Granuloma formation?

A

IL-12 + INF-gamma

548
Q

Which feture will present in Peripheral blood smear on lead posining?

A

Basophilic stippling

(remeber TAILS for microcystic anemia = Talahsima, anemia of chronic, Iron def, Lead posining, Sideroblastic anemia

549
Q

In which type of cancer this will be sown?

A

SCLC

550
Q

Prolong use of NSAIDS can lead to (nephrytic / nephrotic syndrome) which can further increase the risk of ———– necrosis

A

Chronic interstitial nephritis, ischemic papillary necrosis

551
Q

Which condition is characteristic with short limbs , frontal bossig , midface hypoplasia with normal torsi length

A

Achondroplasia = גמדות
Autosomal dominant condition

mutation at FGFR3- responsible of limiting endochondroal ossification. in Achondroplasia become consistenly activated = inhibition of chondrocyte prolifration

552
Q

Hypocalcemia after Blood transfusion can be caused by

A

High levels of citrate in transfusion&raquo_space; chalte calcium in blood

553
Q

What is the Tx for Alcohol withdrwal with psycohomotor agiation in order to prevent the progression into seziures and delerium?

A

BZD (Lorazepam, Diazepam, Chrdiazepoxide)- long acting

554
Q

Spinal muscle atrophy SMA

Gene?
What the impaired molecular function?

A

SMN1 (Survival motor neuron) gene
Impaired assembly if snRNP&raquo_space; Defective Splicesome function&raquo_space; no introns are being remove from Pre-mRNA&raquo_space; degenration of Ant. horn cells in spinal cord

555
Q

Syndrome of bilateral sensorineural hearing loss + congenital long QT syndrome

A

Jervell and lange nielsen syndrome (AR)

Mutations in Voltage gated K channels

556
Q
A

USMLE HY notes (34 decks)

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