P2W1 Flashcards
which neurons are unmyelinated
C fibers, slow pain, heat and olfaction for efferent. for afferent only the postganglionic autonomic neurons
what do you not use in x4 viruses? what are navirs and gravirs
maraviroc. protease and integrase inhibitors
difference between projection and transference and counter transference
projection is im mad at you so i think youre mad at me, and transference is my other friend made me mad so you are making me mad. counter transference is provider to patient
short palpebral fissures, bifid uvula, cleft palate, absent thymic shadow, chovstek sign, trosseau sign, dx and what is the embryological abnormality?
diGeorge, missing 3rd pharyngeal pouch
before alanine is made into glucose where does nitrate group need to transfered to?
alpha ketoglutarate
what viruses replicate in cytoplasm and nucleus and exceptions for both?
RNA and DNA; orthomyxovirus/retrovirus and poxvirus are exceptions
IgE blocker for asthmatic, moa?
reduces inflammation caused by histamines and leukotrienes
patient with GCA what is the inflammatory marker,and rx?
IL-6, tocililuzumab
full term baby, clitoromegaly, elevated androgens, 46XX, normal uterus. maternal virilization. what is dx?
not CAH. because maternal virilization in aromatase deficiency
boy XY with ambigious genitalia found that sertoli is not working, what are the internal and external organs look like? sertoli cell functinos (3)?
male and female for internal, male for external. sertoli cells make AMH (anti-mullerian hormone), androgen binding protein that concentrates testosterone, and inhibin to reduce FSH production
lung cancer with hyponatremia, what cellular marker is positive?
chromogranin, synpatophysin, NCAM neural cell adhesion molecule. vimentin is mesenchymal
in DNA replication, what removes the RNA primers to put down DNA?
DNA pol 1
stab wound in the back, which muscle internally rotates the humerus
lat dorsi
pectum excavatum and visual difficulties, dx and complication of this?
marfans, aortic dissection/murmurs
sequence of mRNA given, beta thalassemia- point mutation. what is the process that is disrupted?
kozak sequence, initiation of translation. GCCGCCRCC
how do SGA (second generation antipsychotics work)
block D2 receptors less strongly as well as 5HT-2A
most common lysosomal storage disease, what enzyme
gaucher, beta- glucocerebrosidase
headahces palpitations, flushing, BP crazy high, and fast heart beat, CT shows mass on the right dx?
catecholamine secreting tumor, urinary VMA and metanephrines
what drug causes increase in renal blood flow at low doses, and at high doses increases heart rate and lowers renal flow?
dopamine
34 yo man with hemotptysis shows bornchial mass with biopsy, polygonal eosinophilic cells positive for synaptophysin and chromogranin, dx?
carcinoid syndrome, two sources- GI (active) and bronchial (inactive)
dilation of aortic arch and hoarseness, what is dx and which muscle damaged?
LEFT recurrent laryngeal nerve, and innervates everything except cricothyroid
FOOSH complications (2)
lunate fracture- median nerve compression. scaphoid- avascular necrosis and anatomical snuffbox
MG rx and rx for SE of rx
cholinesterase inhibitor, then selective muscarinic antagonist glycopyrrolate
NNT equals
1/ARR
what nerve is vulnerable during thyroidectomy and what muscle?
superior laryngeal- cricothyroid. every other muscle in this region is recurrent laryngeal
small circular DNA in eukaryotic cells coding for rRNA, tRNA, proteins, where is this found?
mtDNA
para para, thymus is derived from which one together with what?
3rd pharyngeal pouch with inferior parathyroid
spherules that contain endospores, dx?
coccidioides
how does bone mets occur and through what path in the pelvis
hematogenous, vertebral venous plexus
mass in the tongue, biopsy, pink material inside surrounded by cells, what embryonic process failed?
migration- thyroid
cox 2 inhibitor side effect?
prevents Prostacyclin PGI2, which is a vasodilator, causing thrombotic events
dyspnea in obese male with hypercarbia with normal A-a gradient, dx and mechanism?
obesity hypoventilation syndrome (OHS)
99tm pertechnate positive in RLQ, with GI blleding in 4 yo, dx?
meckels
difference between NMS and serotonin syndrome
onset is slower for NMS, and has lead pipe rigidity with hyporeflexia, while SS has hyperreflexia and clonus
aortic dissection. biggest risk factor? smoking or HTN
HTN
diuretics effect common and unique,
CA inhibitor-metabolic acidosis. loop diuretic- no hyponatremia but volume depletion, hypocalcemia (unique). thiazide- hypercalcemia. All diuretics increase aldosterone, so K and H are low, except potassium sparing (also is metabolic acidosis
structure of MHC class II molecules and what is degraded during antigen processing
alpha beta chain and invariant chain which is degraded
how is elisa done?
antigen, then serum then anti human antibody with peroxidase attached, then susbtrate
sepsis due to GI blood loss, what is elevated in smooth muscle of bv of the patient? what is the only receptor that uses this…
IP3 because , alpha 1 receptors, vasoconstricting via Gq
Rb familial leads to what cancers
retinoblastoma and osteosarcoma
lacking nissl bodies in neurons, eosinophilic. nuclear shrunk, what is mechanism?
irreversible ischemic injury. nissl body is ER
DKA, nasal eschar, facial pain, headache, dx? and how to dx?
mucosal biopsy, its mucormycosis caused by mucor or rhizopus
guy in a bar fight last week gets nasal packing, which later reveals purulent discharge and erythema. then also has septic shock with a diffuse erythematous rash, dx and mechanism?
TSS by Staph aureus- nasal packing/tampons lead to TSS, via a superantigen which doesn’t need MHC class 2 processing (usually done by phagolysosome) but directly activates T cells. TLR activation is done by LPS, endotoxin
man with altered mental status, renal failure and oxalate stones and tubular degeneration with ballooning, dx?
ethylene glycol poisoning
sawtooth appearance in skin rash, hyperkeratosis, eosinophilic colloid bodies, dx
lichen planus
infertile guy, normal testosterone and LH, but testosterone concetrations low in seminiferous tubules and epididymus. dx?
sertoli cells not producing enough ABP, which keeps the testosterone in the lumen
gel electrophoresis shows after induction, 85 kDa is initally big then goes away and 35 and 45 kDa show up. what is happening?
proprotein is formed then cleaved into protein
what causes differentiation of cells and de-differentiation?
transcription factors
barefoot, transient skin rash,thin walled eggs in stool, what is complication? and dx
hookworm (necator, ancylostoma) , IDA
denervated eye, what drug causes constriction?
pilocarpine because it works not via acetylcholinesterase like physostigmine but as a cholinomimetic
median radial ulnar what muscles does it go between
pronator teres heads/FDP and FDS; deep and superficial extensor muscles; FDP and flexor carpi ulnaris
what happens in the lymph node germinal centers?
isotype switiching of B cells. the VDJ shit happens in the bone marrow
what form of virus is infectious by itself?
SS positive RNA, can replicate on its own. picornavirus
describe tract from eye (temporal ) to occipital lobe
ipsilateral optic nerve, lateral optic chiasm, optic tract, lateral geniculate nucleus, optic radiation, primary visual cortex
push against wall, winged scapula, what muscle and nerve?
serratus anterior, long thoracic nerve
how do azoles work, how about ampho B and side effect?
ergosterol synthesis vs ergosterol binding and pore formation. SE of azole is P450 inhibition
tyrosing kinase receptor binds ligand, what happens after?
dimerization, phosphorylation
pompe disease carrier wants kid, sperm donor doesn’t have but may be a carrier, incidence is 1/40000, what is likelihood of kid being affected?
p2 plus 2pq plus q2, so q2 equals 1/40000
systolic heart failure, milirinone mechanism?
PDE3 inhibitor, increases CAMP, increases myocardial contractility and causes vasodilation
TMP-SMX increases the INR of warfarin. why?
hepatic enzyme inhibition. CYP450 inhibition by TMP leads to less metabolism of warfarin leading to higher INR
chromosome translocations (3 lymphoma 3 leukemia). which one does bcl 2 and which one does c-myc and which one does cyclinD
(8,14)-burkitts, (11,14)-mantle cell, (14,18)-follicular. (12,21)ALL, (15,17) AML, (9,22)- CML. c-myc is burkitt, bcl2 is follicular, cyclin is mantle
what physiologic function leads to positive anti-histone antibodies?
acetylation of liver (phase 2 liver reaction)- drugs that cause drug induced lupus are metabolized by liver this way
3 ways that virus get new genetic material and explain
transduction- virus, transformation- pick up off the street, conjugation- sexy time
mechanism of TMP-SMX, similar drugs
sequential blockade; blocks DHF then THF synthesis from PABA. methotrexate (humans) and pyrimethamine (protzoans) works the same way
needle shaped, azure, cytoplasmic inclusions on sphere with blasts, dx and chromsomal translocation?
auer rods, acute promyelocytic leukemia, t(15,17)
alcohol cessation drugs (3)
acamprosate (NMDA), naltrexone (mu opioid), aldehyde dehdrogenase inhibitor (second line)
hypertensive emregency with AKI, what drug improves renal perfusion and natriuresis?
fenoldopam (dopamine-1 receptor agonist) causing vasodilation
how does leuprolide affect testosterone and DHT
both go up and come down in CONCERT. leuprolide does not affect 5-alpha reductase
macrocytic anemia, in woman with autoimmune thyroid disease, what is dx and mechanism. WHAT secretion is elevated?
pernicious anemia, chronic atrophic gastritis, causing mucosal destruction, which means no acid, which means increased gastrin
parasite ova detected after a person has an episode of wheezing, cough and dyspnea, dx and why respi sxs? what type of hypersensitvity?
ascaris, due to transpulmonary migration, IgE! (eosinophilic)
fluid filled capsule in the internal capsule after a pure motor stroke, due to what?
HTNive arteriolar sclerosis
intraerythrocytic organisms (3)
MBB- malaria (anopheles mosquito), babesiosis and bartonella
posterior aspect of shoulder trauma, cannot externally rotate arm, what muscle is damaged?
infraspinatus
young woman with headache, bilateral papilledema, visual disturbances, dx? what is mechanism of papilledema
IIH, optic nerve compression due to increased INTRACRANIAL not intraocular pressure
62 yo with constipation, low back pain, weight loss, perianal anesthesia, what is dx and nerves?
cauda equina syndrome, greater splanchnic nerves
person using cocaine just had MI, hypokalemia. why?
beta stimulation, produces insulin, as well as speeds up the Na/K ATP pump, pushing K inside.
what makes drug more inclined toward hepatic metabolism and not renal?
high lipophilicity and high volume of distribution
neutropenic fever, most likely cuprits?
patient’s own endogenous flora
sarcoidosis and hypercalcemia, what is the link?
activated macrophages express 1-alpha hydroxylase which makes 1,25- dihydrovitamin D
genetic frequency of 2 HLA-DR genes together is greater than expected, what is this called?
linkage disequilibrium
HPV likes to infect where else in the body and why
true vocal chords because predilection for stratifed squamous
dying cells apoptosing but still making protein, mechanism?
internal ribosome entry- 5’ UTR has a region that allows for mRNA translation in the beginning, even without the eIF (eukaryotic initiation factors)
TST for tuberculosis and for candida injection test and wheal/flare test uses what cell types response primarily
T cell, delayed hypersensitivty (typeIV)
dysphagia, food sticking, barium studies show birds beak, dx and mecahnism
achalasia, because myenteric plexus knocked out, specifically the inhibitory ganglion cells
woman with MVA presents with HA and neck pain, fracture in C2 foramina. then has nystagmus, ipsilateral cerebellar signs, loss pain/temperature in ipsilateral face and contralateral body, bulbar weakness, ipsilateral horners, where is the lesion?
vertebral artery dissection leading to PICA occlusion leading to lateral medullary wallenburg syndrome
molluscum contagiosum, biopsy?
eosinophilic intracytoplasmic inclusions
triple positive breast cancer treated with monoclonal antibody, what is it and what signaling mechanism?
Herceptin, tyrosine kinase
neonatal tetanus how to prevent and treat
prevent-maternal vaccination, treat- antibiotics and immunoglobulins
invasive breast cancer, what causes skin retraction
suspensory ligament fibrosis and shortening
metabolic acidosis in baby, with branched-chain alpha keto acids in blood and urine, dx and cofactor used in the enzyme?
maple syrup urine disease, thiamine for alpha-ketoacid dehydrogenase
muscarinic agnoist leads to what? in sm muscle
NO prodcution and vasodilation
difference bwetween complete and partial mole
complete is 46XX - absent ovum and sperm meet. absent fetal tissue, mostly hydropic villi, can progress to chorioCA. partial is XXX or XXY 69, two sperm fertilize one egg, present fetal tissue
rett syndrome inheritance
x linked dominant, in girls, guys die in utero
patient has urge to move legs at night, with IDA, what is dx and rx?
restless leg syndrome, dopamine agonist like pramipexole
9 mo girl with fever, then rash on the trunk with no fever. dx?
roseola HHV-6. rubella and measles have rash from face to trunk and spread. fever and rash come together
why does HbF have greater affinity for O2?
histidine replaced by serine, binds less tightly to 2,3BPG
patient has hemoptysis but no B sxs. past history of TB and has a cavity in a lung, now somehting is growing in that cavity, dx?
aspergilloma
over the decades more incidences of s aureus bacteremia, cause?
increased use of intravascular catheters
patient is hypoglycemic. but no symptoms of tremor, tachycardia etc, but hungry. what drug is causing this?
propranalol (blocking the neurogenic/autonomic symtpoms of hypoglycemia due to epinephrine/norE release. but not the ones mediated by Ach (hunger)). on top of that, blocking epinephrine induced gluconeogenesis/glucagon secretion
halflife equation
0.7*Vd/clearance
intermittent abdo pain, dark urine, neurological manifestation, no skin rash, dx? if skin rash, dx?
Acute intermittent porphyria- deficiency of PBG deaminase. If photosensitivity, caused by porphyrinogens. could be porphyria cutaneous tarda or also could be ferrochelatase
reentrant pathway, accessory conduction pathway, what is changes on ECG?
delta wave, short PR interval, widened QRS (WPW- ventricular preexcitement)
what cytokine is only made by lymphocytes?
IL-2. lymphocytes favorite cytokine. IFN alpha fights against virus
cavernous hemangioma increased risk of?
seizures and intracerebral hemorrhage
kid with fever and facial rash, now parent with arthritis, dx?
parvovirus b19
rod shaped kinetoplasts and chronic pinkish papule
leishmaniasis- from parasitic sand fly with protozoa
pseudomonas has an antibiotic-modifying enzyme, what antibiotic is it resistant to?
gentamycin (protein synthesis inhibitor)
distal hardening of finger bones, brief morning stiffness, activity related, acetaminophen doesn’t help.dx?
OA, RA is spongy swelling
what vessels have the lowest o2 content?
coronary sinus (heart has the greatest capillary network, leading to high oxygen demand)
guy with substance abuse problems, comes in and has hypersonolence, hyperphagia dysphoria and vivid dreams. which withrdrawal sxs is this?
cocaine
2 examples of true and false diverticula
true- meckels and appendix false- zenkers and diverticulosis in the colon
urine that turns black, what amino acid pathway is deficient
tyrosine to fumarate, dx: alkaptonuria due to build up of homogentisic acid
young woman with loud s2, parasternal heave, clear lungs, family history of mother dying at 40, dx?
pulmonary arterial hypertension (BMPR2)
bilateral sensorineural hearing loss and long QT, what is defect?
potassium channel- Jervell and Lange-Nielsen syndrome
hamartoma in lung? what is defintion?
abnormal mixture of cells in a normal location, chondroma in lung is common hamartoma
radiation accident, a lot of radioactive iodine release, what do you give?
potassium iodide to block uptake of radioactive iodine, protect the thyroid
psoriasis in young man, treatment?
Vit D analog (prevent hyperkeratinization) and corticosteroids,
struvite stone why did they form? mechanism
urease producing organisms made urine more alkaline because urease makes ammonia
man with transplanted kidney who gets allopurinol rx for gout, what drug that he is taking now will be affected and how?
azathioprine, 6-MP. This gets converted via XO to inactive metabolite but since XO is inhibited, it will boost the effects of this. effect is that 6-MP is like a fake purine that gets added to PRPP and HGPRT thinks it’s a purine
what lipid drug causes hypertriglyceridemia?
bile acid sequestrants, cholestyramine, col drugs. work in colon to prevent enterohepatic circulation. liver uses cholesterol to make more bile acids, but then SE makes more triglycerides
person w HIV develops hematological malignancy and then develops candida in the blood, fungemia. what defense mechanism breach led to this?
neutropenia. localized candida is T lymphocytes. so HIV predisoposes to candidiasis locally but systemic has to do with neutropenia
kids have FGFR when parents dont. what is genetic mechanism called?
germline mosaicism
3 enzymes used as antioxidants
superoxide dismutase, catalase, glutathione oxidase. NADPH oxidase is used to make O2-
heart failure, what diuretic improves mortality
spironolactone because it blocks aldosterone remodeling of heart
maxillary sinusitis how did it enter
middle nasal meatus
how does estrogen protect against osteoporosis?
makes OPG (binds RANK to prevent RANK-L from binding) and decreases RANK production. RANK and RANK-L interaction leads to osteoclast maturation
postauricular LAD, rash that spreads from face to trunk and extremities, what virus?
togavirus, dx: rubeola
HEME synthesis- TB rx, lead poisoning
SA-PHUC-PH. ALA synthase needs B6. ALA dehydratase is inhibted in lead poisoning (and ferrochelatase). PBG deaminase for AIP, uroporphyrinogen deaminase in Porphyria cutanea tarda
serotonin syndrome, rx?
octreotide
gential lesions, vesicles, now has targetoid rash over the arm and mouth, dx? and a/w?
erythema multiforme- HSV and mycopalasma, and can lead to SJS and TEN
wife has a kid with SCA, new husband, what to do to check for risk?
husband hb electrophoresis. it is autosomal recessive
dizziness, retrograde flow through left vertebral artery, dx?
subclavian steal. atherosclerosis /obstruction in subclavian proximal to the left vertebral, causing steal from R vertebral.
how does combined OCP and progestin- local and progestin systemic work?
local is to stop sperm from invading, systemic-including the COCP and systemic progestin (IUD) is to downregulate FSH/LH.
HLA B*57:01 , HIV patient, don’t give which drug
abacavir
why do you get green color in sputum in pneumonia?
myeloperoxidase is a blue green heme based enzyme that makes hypochlorous acid,
older asian woman, smoker and rinker and fam history of breast ca in mother, eats food that she makes, renal mass shows cuboidal cells with clear cytoplasm. what is the risk factor associated with this condition
smoking. RCC
young guy with both arms jerking in a seizure, rx?
broad spectrum- valproic or levitiracetam - because involves both hemispheres
silicosis has tuberculosis why?
macrophages phagolysosome formation is disrupted
22 yo guy with recurrent purulent papules on the back. why
rx doesn’t clear Staph aureus from nares (i though it was CGD but maybe cause no infections from young
10 yo boy comes with fever, hypotensino, tachycardia, then develops new murmur, biopsy of heart shows these weird multi nucleated like cells in the myocardium, dx?
aschoff bodies and anitschkow cells due to rheumatic fever
otitis leading to temporal lobe abscess, how did it gain entry?
mastoid air cells. ethmoid and maxillary is frontal lobe abscess
32 yo woman with lump in throat, dysphagia of saliva, examination and investigation there’s nothing. dx?
globus sensation. feels psy
focal neurological deficits and CT shows hemorrhage near the basal ganglia/thalamus area, dx?
charcot bouchard aneurysms of lenticulostriate arteries causing intraparenchymal hemorrhage in deep brain structures
propofol effect fast on fast off, what is the mechanism?
highly lipophilic, leads to rapid redistribution of the drug
after pregnancy, PVB, significantly increased B-HCG, hemoptysis, dx and what do you see on endometrial biopsy
chorioCA, proliferation of cytotrophoblasts (cyto- makes cells) and synctitiotrophoblast (synct- synthesizes hormones) with no villi
kid scratching between toes, exhibit shows branching hyphae, rx?
clotrimazoleor miconazole, the antifungal cream! not permethrin- would show ova and feces on the scrape
pulmonary embolism, O2, CO2, pH levels
low low high, CO2 due to hyperventilation
homonymous hemianopia with macula sparing where is the defect?
PCA. macula sparing because MCA and PCA dual supply at the occipital pole
social anxiety disorder rx?
SSRI, not beta blocker only if performance driven
isoniazid causes what and how?
B6 deficiency due to increased excretion of B6. B6 makes GABA so neuropathy is common in isoniazid
misoprostol and mifepristone moa
PGE analog and progesterone antagonist
painless goiter, hypothyroidism, radiation exposure, diffuse lymphocytic infiltrate with epithelial cells that have prominent nucleoli and abundant eosinophilic cytoplasm, dx?
hashimotos and hurthle cells
excessive eating, small hands and feet, temper tantrums in 3 yo boy, FISH cannot detect anything. dx and problem?
prader-willi, loss of paternal chromosome 15 all comes from mom
mitral stenosis, when do you hear the snap
right after mitral valve opens
prostate on MRI
right below pubic symphsis, and above anal canal and levator ani
what is FGF 23
released in high phosphate states, to decrease 1-alpha hydroxylase, drops calcium reabsorption
53 yo frequent headache and dizziness, high BP, facial plethora, splenomegaly, erythrocytosis, thrombocytosis, leukocytosis, dx and mutation?
poly vera, JAK/STAT WHICH IS A CYTOPLASMIC tyrosine kinase. bcr abl is too
how do you treat CAH, 21 deficiency?
exogenous corticosteroids, replaces cortisol and stops ACTH excess production
AIP (porphyria) what enzyme is deficient and what is management?
PBG deaminase. Give Hemin, which blocks ALA synthase. AAPHUC. order of substrate
osteoporostic lady just had a fracture, what would the parathyroid hormone and calcium level be
normal
haploid organism, outer and inner membrane but no nuclear membrane, and resistance to SOME penicilins. is it ecoli or chlamydia
ecoli, because chlamydia has a weird cell wall
reye’s syndrome histo findings? sxs?
microvascular steatosis without inflammation, hepatomegaly vomiting and encephalopathy
fastest and slowest cardiac conductino
purkinje (interventricular septum), atria, ventricles, av node
what skin condition does celiac disease cause and why?
dermatitis herpetiformis because of tissue transglutaminase in the dermis
baby with illness then won’t weight bear, where in bone is affected?
metaphysis, hematogenous osteomyelitis, slow blood flow in this area is good for infection progressing to necrosis
middle aged guy with SOBOE, nodular densities, calcified hilar lymphnodes, biorefringent particles surrounded by dense collagen fibers, dx?
silicosis
macroorchidism and joint laxity and learning difficulty in teenage boy, dx?
fragile x
HLA associations
audiA3, O behave, PAIR, celion dion, hay multiple wolves pasture, 4 walls in a room, five-itis
most common cause of viral meningits and viral family
enterovirus- picornaviridiae
gowers sign only, getting worse. what is the inheritance. what is possibility that fetus son will get the disease?
1/2 x linked recessive. because it’s a boy. half the boys will get it, half the girls will be carrier
how does adding enzyme affect the lineweaver burke plot?
y int is 1/vmax, x int is 1/km. adding enzyme increases vmax, but km (affinity) stays the same
suspect cholecystitis, but initial imaging inconclusive, what following diagnostic test results with clinch dx?
not presence of echogenic structures, but the absence of gall bladder on radionuclide biliary scan
serum glucose, sodium, and potassium levels in DKA
high low high/normal
HCMC anemia with glossal pain, dry mouth etc
IDA
recurrent stone formation in 16 year old, testing shows hexagonal crystals in the urine, dx?
cystinuria, because of defective dibasic amino acid transport
vesicular rash on gums hardpalate and lips, what kind of virus? DNA/RNA/SINGLE/DOUBLE/NAKED/ENVELOPED
HSV-1. herpangina/HFMD is cosackie (RNA). HSV1 is DNA double strand, enveloped. parvo is single strand naked DNA
patient with RTA, stabilized, then 2 days later has hypoxemia and tachypnea. ARDS pathophysiology?
endothelial damage leads to activated macrophages releasing cytokines and inflammatory mediated by neutrophils which damage and make membrane permeable
gastrectomy, glossitis and macrocytic anemia. which portion of spinal cord damaged?
subacute combined degeneration- posterior column and lateral column (ataxia and spastic paresis)
case control study, risk difference or odds ratio
odds ratio because you can pick the number of cases and controls
cirrhosis, trichrome stains blue, what is the cell responsible for this
stellate cell of ito. usally stores vit A but when activated by injury it transforms into myofibroblasts that secrete collagen which stains blue on masson trichrome stain. Kupfer cells are the phagocytic macrophages
TB meningitis leads to what type of hydrocephalus and how. other conditions that can cause this?
non-communicating because no CSF obstruction, destruction of arachnoid granulations lead to widespread dilation of ventricles. SAH and intraventricular hemorrahge can
difference between somatic symptom, illness anxiety, conversion and factitious
somatic symptom got somatic symptom, illness anxiety no symptoms, conversion is neuro symptom, factitious is acting
what drug given for HTN without affecting HR, patient has bradycardia
nifedipine (CCB)- dihydropyridine. verapamil and diltiazem affect heart
patient with gout, given drug that binds to enzyme that is induced by IL-1, and inhibits inflammation, what is the drug? how does predinosone work?
celecoxib. COX-2. prednisone express anti-inflammatory peptides by affecting DNA
waxy eosinophilic casts, gamma gap, dx?
MM
PTSD for less than 1 month is called?
ASD
absent cerebellar vermis and dilated fourth ventricle dx?
dandy-walker
preproinsulin, has N-terminal hydrophobic residues that are missing. where does it get stuck?
cytosol. the N-terminal stuff takes it to the ER
guy with COPD gets IM injection of a vaccine, which he gets yearly. how does vaccine prevent infection?
prevents viral entry by making antibodies against the hemagglutinin antigen, preventing entry. THIS is MOA for inactivated viruses, given IM, because they cannot infect cells, leading to humoral response. For live attenuated viruses given via intranasal, you generate cell-mediated response to attack infected cells
man with obstructive urinary symptoms, smooth enlarged prostate, PSA normal, has hematuria (RBC) and cystoscopy shows increased trabeculations in the bladder wall, dx? and cause of hematuria?
BPH,friable vessels in the prostate. bladder CA you would see mucosa changes and have more storage sxs not obstructive
thiazide diuretics side effect?
decreased glucose uptake and increased insulin resistance, and raising cholesterol
19 yo woman in MVA, PMH of celiac, 3 episodes of pneumonia now has anaphylaxis after ABO transfusion, dx?
IgA deficiency, IgE can form against IgA, ABO would be antibody mediated and c1 inhibitor ONLY causes angioedema
what drug reverses bronchial airway muscle contraction?
atropine and anticholinergics. edrophonium is a ACh-ase inhibitor and so is physostimine
pupillary reflex blown and doll’s reflex blown, where in the brain is affected?
midbrain and pons respectively
asbestosis exposure leads to what 2 cancers and which more common?
bronchogenic CA and mesothelioma, former
moa of acyclovir
complete inhibtion of DNA replication. drug is a guanosine analog?
pancytopenia without hepatosplenomegaly with recent respi infection
aplastic anemia
additive permissive synergistic
additive and synergistic must have 2 drugs with similar effect. permissive is cortisol and glucagon/catecholamines
phosphotidyl is protective or not protective of cholesterol stones?
protective
chest tube insertion, cannot lift arm above head, muscle?
serratius anteror
73 yo woman with low grade fever and leukocytosis and abdo tenderness with mass palpated in LLQ. diagnosis?
diverticulitis! can have mass. hernia should be in the groin
explain heteroplasmy with an example
mitochondrial diseases, coexistence of distinct mTDNA genomes in an individual cell, explains the variability of expression in affected offspring of mother
woman with type 1 DM, now has weight loss, ACTH test doesn’t do anything, hyperpigmentation, what are Na, K, Cl, and HCO3 levels and dx
low high high low- primary hypoaldosteronism (autoimmune)
pancreatitis, AST2x>ALT, no stones, what will clinch dx?
macrocytic anemia due to folate def. alcohol related. can have hypocalcemia, hyperglycemia, leukocytosis, hyponatremia but all non-specific consequences of pancreatitis
bugs crawling on skin
NOT LSD. spend more than 20 seconds reading the question carefully
fever, joint pain urticarial rash, liver enzymes highly elevated, hepatomegaly, jaundice, dx?
HEP B, Hep C has no rash
asthma, eosinophilia, sinusitis, granulomatous, dx?
p-anca churg-strauss polyangitis
BRAF mutation, brain mets, where is source?
melanoma, BRAF V600E is common mutation
patient with depressino taking SSRI is treated for cellulitis couple days ago, now comes in with diaphoresis, tremulus, clonus, hyperreflexia, dx? what drug?
SS kicked off by linezolid which also has MAO-i activity
19 wks pregnant, US fetus shows bilaterally enlarged kidneys with diffuse small cysts, low AFI. what complication will boy have at birth? dx/
respi distress because of potter sequence due to oligohydramnios, ARPKD. can have HTN but later. aneurysm in ADPKD
confusion, ataxia, opthalmoplegia, where in brain is affected?
mammilary body, above the midbrain
pancreatitis because of hypertriglyceridemia, drug?
fenofibrate
woman with lupus nephritis treated with prenisone and goes berserk, what is wrong and what WBC is high on CBC?
corticosteroid induced psychosis- RF is hypoalbuminemia. and neutrophil is high due to margination- the bats come off
callous is thickening where
stratum corneum
baby boy who is regressing in developmental assessment, anemia, from a poor part of town, what is dx and enzymes inhibited?
lead poisoning, 5-ALA and ferrocheletase
saggy eyes, skin changes in old people due to what?
collagen fibril production
Vancomycin moa
d-ala-d-ala binding. some bacteria mutate to d-ala-d-lactate
how is CFTR gated?
two ATP, cyclic AMP is for olfactory and photoreceptor neurons
tetatnus where does it travel in the body
puncture wound–>motor neurons –> spinal interneurons (inhibitory)
what gene causes resistance to penicillin
mecA
high A-a gradient is due to? and Co2 in these situatinos? is it perfusionor diffusion limited in these situations?
diffusion barrier. Co2 is normal. normally o2 and co2 are both perfusion limited, but o2 is more easily affected by diffusion than co2 is
sarcoidosis, which WBC predominate
CD4 T cells IFN-gamma and tnf-alpha to activate macrophages
guanosine analog that is antiviral, EBV and CMV are less susceptible than VZV or HSV. why?
b/c of viral thimidine kinase that activates acyclovir (which is the drug in this question) more present in VZV and HSV
two opsonins and 4 chemotaxis
c3a and IgG, LTB4, bacterial products, C5a, IL-8
2 complications from a condition that is positive osmotic fragility test
pigment gallstones and aplastic crisis after B19 infection
30 s 50 s which antibiotics
amnioglycosides and tetracyclins, macrolides and chloramphenicol
what is skeletal muscle preload and afterload
stretch of muscle before contraction and pressure against which muscle must contract
fluoroquinolone resistance how? commonly
MDR efflux pumps
RA, which paart of spine is involved?
cervical
huntingtons affects which part of brain and what do you see on MRI
caudate atrophy, enlarged frontal horns of lateral ventricle
neutral amino acids in the urine, dermatitis in sun exposed area, irritable behavior, ataxia in boy. what is rx?
niacin. dx is hartnup disease, leads to niacin deficiency because lack of neutral aa transporter
uterus didelphys and limb deformities, recurrent miscarriages where is mutation
HOXA1
zinc fingers found on hormone receptor. what hormone does it bind?
fat soluble hormones because zinc fingers bind to DNA directly. thyroid hormone is lipid soluble
absence of melanocytes in epidermis, melanasome agreggations in cytoplasm, poor melanin formation dxx?
vitiligo, cafe-au-lait, albinism
intestinal atresia is due to what and what characteristic surgical finding do you see?
vascular occlusion, apple peel/christmas tree- distal ileum winding around an ileocolic vessel
zoster biopsy
multinucleated cells and intranuclear inclusions in keratinocytes
left dominant circulation patient with AMI, block is right before branch to AV node, what is this artery?
left circumflex. most patients are right dominant, which means AV node is supplied by right. SA is also by right
suprapubic cystostomy, what layer does it penetrate?
anterior abdominal aponeurosis, not through the peritoneum because bladder is extraperitoneal
what immune thing protects against giardia? IgA or eos
IgA. rmb XLA and IgA def got problem with chronic giardia
sarcomere where does actin bind to structural filaments? at the z line. what is actin and myosin called?
I band and A band
positively or negatively skewed data, what is relatinoship between mean and median
positive- mean is greater than median, vv
copper reduction test and glucose oxidase test is used for? asymptomatic patient with positive copper reduction and negative glucose oxidase
reducing sugar in the urine and urine dipstick uses glucose oxidase thing. aldolase B is the symptomatic one, essential fructosuria- fructokinase deficiency
z drug mechanism?
GABAa, selective so no anxiolytic effects
HIV and now CMV patient, what to give that doesn’t require intracellular activation?
usually gancyclovir which needs activation so can give foscarnet
what causes honey colored crust
impetigo, staph aureus and GAS
causes of SAH and ICH
saccular anueyrsm (marfans, ADPKD) and trauma for SAH. cb aneurysm due to HTN and CAA for ICH.
cell starts replicating more after a signal. is it GDP binding to RAS or Rb being phosphorylated
Rb phosphorylation by Cyclin D and CDK4 leads to letting go of E2F by Rb
internuclear opthalmoplegia and optic neuritis, comes and goes, moa?
decreased saltatory conductino- MS
26 yo woman with genrealized weakness, mylagia, and unintentional weight loss. history of hypothyroidism on levothyroxine. NCNC anemia, Orthostatic hypotension, glucose is low, dx and what is urine and serum Na and K?
primary adrenal insufficiency- no aldosterone so high urine sodium and low urine K, high serum k and low serum Na because lack of cortisol stimulates ADH production: hyponatremia
how is glycogenolysis regulated in muscle and liver
muscle- ca levels, liver-epinephrine and glucagon levels raise cAMP, to activate enzyme that does glycogenolysis
baby born at term, has flattened face and club feet. and no breath sounds. what is the dx? and associated finding?
potter’s sequence, renal agenesis is the causes. rocker bottom feet….
posionous mushroom ingestion toxin? and synthesis of what does it impair?
amatoxin; rRNA. toxin binds to RNA pol II
guy with hodkins disease if found to have bacteria that is gram positive, cold resistant, motile, and narrow beta hemolysis. how is this bacteria cleared?
listeria. T-cell mediated because intracellular. Hodgkin’s is like immunosuppresion so cell mediated is weak, hence listeria infection
fish bone near the piriform recess, nerve is damgaed, what sensation/reflex is lost?
cough, due to internal laryngeal nerve
boy who keeps grunting sniffing, throat clearing, frequent eye blinking, shoulder shurggin. dx?
tourettes
metabolic alkalosis patient is desating. what test is next?
urine chloride. this is next branching point in metabolic alkalosis. either it is low (in vomiting, and in diuretic use), which means volume depletion and saline responsive. however if cl high, it means excess aldosterone, saline unresponsive. (high aldosterone–> HTN–> pressure naturesis–> high urine Cl
doxorubicin sideeffects? restrictive and ho cardiomyopathy-common causes
dilated cardiomyopathy is SE for doxo. common cause of restrictive is infiltartive (hemochromatosis, amyloidosi, sarcoidosis.) dilated- ABCCD, alcohol, beri beri, chagas/cocaine, doxorubicin
metyrapone stimulation test, the 17 hydroxycorticoid rises and falls. what is this
metyrapone used in suspected cortisol/HPA abnormality. it blocks 11-b-hydroxylase, leading to low cortisol–>decreased negative –>feedback, increased ACTH (normally)
MOA of rifampicin and isoniazid and vancomycin?
rifampicin (RNA polymerase inhibitor) isoniazid (inhibition of mycolic acid synthesis), vanco is d-ala-d-ala glycoprotein binder
strept pneumo given radiolabled ceftriaxone, then protein electrophoresis, five distinct bands on radioautography
penicllin/ceftriaxone binds penicillin binding proteins such as transpeptidases
rat poison ingestion, what is rx?
fresh frozen plasma- rat poison contains coumarin, which acts like warfarin- need 2,7,9,10 replacement quick.
palliative patient on morphine, what drug precipitates opioid withdrawal sxs
buprenorphine- partial agonist, high affinty for mu agonist, kicks off real opioid
13 yo girl that comes and shows lack of secondary sexual characteristics and blind vagina, and has hypokalemia and low Test and e2 levels, karyotype is XY. dx?
17a-hydroxylase deficiency
disorderly, diffusely hypercellular connective tissue with cellular atypia and leaf like projections in breast stroma, dx?
phylloides
at what day do you detect serum and urine b-hCG?
6-7 days implant, synctitiotrophoblast makes bhcg then 8 days detect in serum, 14 days in urine
altitude sickness caused by and what happens to arterial pH, Hydrogen ion secretion and HCO3 reabsorption?
hypoxia. respiratory alkalosis. renal tries to compensate by decreasing H secretion and decreasing HCO3 reabsorption.
southewestern blotting technique, which substance is identified?
c-Jun (like c-myc) it binds directly to DNA it is a proto-oncogene
man with high frequency hearing loss related to work. which type of hearing loss and what is damaged?
sensorineurla, organ of corti cells
which viral gp act on attachment and fusion? example of drug?
gp120 for attach, gp41 for fusion. CCR5/CXCR4 inhibitors / enfuviritide
fatigue in 45 yo male, SOB, constipation, decreased concentration peripheral neuropathy, MCHC anemia, what do you see on peripheral smear?
basophilic stipling (lead poisoning)
treatment for RA is initiatied, develops stomatitis and hepatotoxicity, what is the drug?
methotrexate
middle aged guy presents with melena, segmental transumural inflammation and fibrinoid necrosis of medium sized vessels with internal elastic lamina involvement, dx? what predisposes to this?
polyarteritis nodosa, viral hepatits B
younger guy with testicular pain, posterior/superior part of testes hurts, but cremasteric intact. urinalysis shows leukocytes but no organism, dx? and what caused it?
epididymitis, chlamydia/gonorrhea in younger guys, ecoli infection due to BPH-obstruction in older guys
which antifungal prevents cell wall?
e-kinda-cant-do’s (echinocandins) casofungin etc
what regulates hyperplasia of G-F-R layers in adrenal cortex
g is angiotensin, f and r is ACTH (but ACTH has transient effect of G too, so increase aldosterone synthesis)
3 drugs used in MRSA when to use and moa of each and side effects
vancomycin, daptomycin, linezolid. vanco is d-ala-d-ala glycopeptide formation, dapto is cell membrane disruption of potential, linezolid is 23 subunit of ribosomes. linezolid can cause serotonin syndrome, vanco causes red man syndrome/nephroteox, dapto can cause myopathy
upper middle lower rectum where does lymph drain
upper is sUPerior mesenteric. middle is superior mesenteric and internal iliac. lower is superficial inguinal
NF-1 the neurofibromas are what and derived from? why headaches in NF?
schwann cells from neural crest, can have CNS tumors (optic gliomas, pilocytic astrocytomas)
woman with CIN, what is the greatest risk factor for developing this? how about douching?
unprotected sexual intercourse. HPV is an STI…. douching leads to bacterial vaginosis, normal flora
train of four stimulation for anesthetics, which one is equal but diminished at first then becomes a fade pattern
succinylcholine- depolarizing NMJ blocker
what is tryptophan a precursor for? arginine? orotic acid?
melatonin, niacin, serotonin. arginine is precursor for urea, creatine, NO. orotic acid is pyrimidines
repated jumping causes avulsion fractures in the?
tibial tubercle
fever, tachycardia, hypertension and muscle rigidity after a major surgery. what is dx and rx and moa of rx?
malignant hyperthermia, commonly seen after inhaled anesthetic. rx is dantrolene which blocks ryanodine receptors prevents further Ca release
alcohol and breast cancer link is found to be non-significant, but its found that the a lot of the alochol users died (and were deemed lost to follow up.) what is the bias in this study?
attrition bias which is a form of selection bias (which was the answer).
what is lead time bias
lead time bias is when a screening tool detects the disease earlier and leads to a falsely prolonged survival time
anterior compartment of the leg has acute compartment syndrome, what nerve is affected?
deep peroneal
alcohol base disinfectant, which part of virus does it affect?
lipid bilayer. non-enveloped viruses are immune to this disinfectant
cardiac biopsy shows prussian blue staining/lymphocytic infiltrate and multiple protozoa/numerous stellate cells in ground substance background/acellular pink material. 4 dx?
hemochromatosis, chagas disease, myxoma, senile amyloidosis
nephrotic syndrome and left varicocele link? dx?
antithrombin 3 is lost, leading to hypercoagulable state
61 yo with thyroid nodule, asymptomatic, FNA shows cells with large overlapping nuclei containing sparse, finely dispersed chromatin and inclusion bodies and grooves. dx?
papillary carcinoma of thyroid
3 types of hypothyroidsm
riedels (woody hard fibrosis), hashimotos (germinal centers, lymphocytic infiltrate, hurthle cells- oxyphilic cells with granular cytoplasm), deQuervains (painful with multinucleated giant cells with mixed cellular infiltrate)
angioedema causes? (4)
IgE dependent mast cell activation, IgE independent- opioids, vancomycin, contrast for radio (a/w pruritis), ACEi which increases bradykinin which increases vessel permeability, c1 inhibitor deficiency
edwards or pataus or both? meckels/micrognathia/omphalocele/ rockerbottom feet/polydactyly/ cutis aplasia/heart-renal defects
e/e/p/b/p/p/b
severe PPH in woman, what vessels should you ligate?
internal iliac because it supplies the uterine artery. uterus has collateral blood supply from the ovarian vessels in the IP ligament
temporal lobe hemorrhage, leads to herniation. what sign would you see?
pupils dilated because uncal herniation leads to 3rd nerve palsy as it exits from midbrain. abducens nerve palsy is seen in intracranail pressure/central hernation
turners syndrome, give growth hormone, what second messenger system do you use?
JAK/STAT
guy with dilated ventricles, walls are not thick, no scarring. has fatigue and exertional dyspnea and dies from aortic anueuyrsm. dx and cause of aneuyrsm?
eccentric hypertrophy, aortic regurgitation. pressure overload leads to concentric hypertrophy (mitral stenosis). volume overload is eccentric
two viruses infect one cell and then the offspiring gets a mutatino. offspring of the offspring reverts back to having no mutatino, what is this phenomenon called?
phenotypic mixing
CF woman, has squamous metaplasia of the pancreatic ducts, deficiency in which vitamin?
Vitamin A- repsonsible for the orderly differentiation of specialized epithelia
lung disease in competetnt, disseminated in immunocompromised, thick walled endospores in spherules, some empty some bursting, dx?
coccidioides immitis
THBSO, post surgery develops flank pain and from loin to groin, ballotoable mass in flank. dx?
ureteral injury during surgery, causing hydronephrosis
hodkin’s lymphoma guy, started on rx, later has lung problem- diffusion problem. dx and what is the drug? and mechanism?
pulmonary fibrosis and bleomycin, free radical generation by binding iron and oxygen, DNA double strand breaks results
confusion and urinaryretention in older guy who has insomnia, what drug?
TCA-amitryptilin, has anticholinergic effects
volume of distribution equation and concept
higher it is, the more it is lipophilic etc. drug dose divided by drug concentration
what parts of brain is most susceptible to ischemia? (3)
hippocampus, purkinje cells of cerebellum and pyramidal cells of neocortex
medullary carcinoma histology?
nests/sheets of polygonal cells in an amyloid background staining for congo red
spindle shaped cells in a background of bone and osteoid, dx?
osteosarcoma
neonate with abnormal facies, tetralogy of fallot and dx confirmed by FISH. what is dx and mechanism?
di george syndrome, pharyngeal pouch abnormality and chromosome microdeletion (22q11.2)
what ratio is important in surfactant
lecithin (phosphotidylcholine) : sphingomyelinase should be greater than 2. lecithin production increases after 30
hepatic encephalopathy mechanism?
excess ammonia absorbed by astrocyte, made into glutamine, but glutamine excess causes swelling and dysfunction in releasing glutamine to be converted into glutamate in the neurons. so block of excitatory transmission
fever and maculopapular rash over body , arthralgia, malase, and LAD everywehere. test is done and found that patients serum added to cardiolipin, cholesterol, lecithin leads to clumping. what to do next?
treponemal tests because the VDRL test (described inquestion) can be positive for a lot of ther things
antibody against Fc- portion of IgG is what?
rheumatoid factor
