PHASE2 Flashcards
weakness in MG patient, after edrophonium test, dx?
cholinergic crisis, stop AChE for awhile
most common cause of diarrhea outbreak in developed countries
norovirus
drug administered rectally has higher concentration in blood then oral administration. what is the reason?
NOT increased absorption. oral actually has better absorption because small intestine has such a large surface area for absorption. the reason is the porto-caval thing, caval bypasses the first pass mechanism
which bb to use in COPD patient after MI?
cardioselective- A-BEAM- atenolol, bisoprolol, metoprolol, etc
4000000 population, 2000 have fatal disease, 7000 new cases of disease, what is the incidence?
respect the question
flank pain and nausea and distended bladder in 74 yo who takes naproxen occasionally. dx?
urethral obstruction secondary to BPH,anticholinergics, DM
menotropin, clomiphene, HCG, fertility medicine. moa?
FSH surge, increase FSH and LH, LH surge
!!!!!!!!!!!!!!!!!!!!!!!!!!!! ICF and ECF stuff !!!!!!!!!!!!!!!!!!!!!!!!!!!!!! guy after accident has loss in ICF and loss in ECF and increase in osmolarity. what causes this?
DI. after TBI
guy in RTA, unconscious, CT is clear. but dies. Autopsy shows widespread axonal swelling esp at grey white junction. has amyloid and alpha-synuclein depositions also, dx?
diffuse axonal injury due to shearing force
testicular mass, AFP and HCG is elevated in a guy 18 yo, dx?
non-seminomatous germ cell tumor
11 yo girl with blurry vision, normal height/weight, came from oversease, urine has reducing sugars, bilateral lens opacity. dx?
galactokinase deficiency. galactosemia has two versions GALK def or GALT def, latter being more serious. reducing sugars is glucose, fructose and galactose, not just fructose
recent hip surgery, now has loss of ankle reflex, loss of sensation in in lateral calf and dorsum of foot, weakness in knee flexion, dx?
sciatic nerve injury- near hip joint and femur
acute pancreatitis, CT shows large cyst what is this and what epithelium is it lined by
pancreatic pseudocyst, granulation tissue and fibrosis
glutamate to alpha ketoglutarate after transamination to oxalacetate, which becoming aspartate, what is the cofactor?
B6 takes care of decarboxylation and transamination
baseball player with upper extremity tingling, numbness, weakness with repeititve overhead movements, dx?
thoracic outlet syndrome due to anterior, middle scalene muscles with 1st cervical rib affecting the brachial plexus
narcolepsy, what chemical is missing in the brain
hypocretin-1 (orexin A) produced in the lateral hypothalmaus
erythema multiforme pathophysio?
CD8 damage against epithelial cells
influenza patient, what interferon is released and what does it do?
type 1 interferon, alpha and beta, increases MHC class I expression and makes enzymes RNase L nd protein kinase R that disrupts viral protein synthesis
SSPE vs PML
measles- fatal vs JC virus- attacks the oligodendrocytes.
treatment for PAH?
bosentan, an endothelin receptor antagonist
posteromedial papillary muscle rupture after myocardial infarction, which artery and why
PDA, only one artery that supplies this muscle. LAD and circumflex supply the anterolateral papillary muscle
11 mo old boy, dancing eyes dancing feet, lot of VMA in the urine, midline fixed abdominal mass, dx and histopathology?
neuroblastoma, n-myc/homer-wright rosettes
hiking in the applaachian, fever, rash on soles and palms, dx? and rx?
RMSF, doxycycline
neck, torso, shoulder, pelvic pain with fever and weightloss now has headache with blindness, dx?
polymyalgia rheumatica leading to GCA
1 week after sore throat rx with penicillin, has violaceous non-blanchable purpura on legs, dx and biopsy?
leukocytoclastic vasculitis, fibrinoid necrosis
what acts as positve regulator for gluconeogensis? from pyruvate to glucose?
acetyl coA
family history of prolonged bleeding, epistaxis continues. bleeding time, PTT are prolonged, Pt normal. dx?
vWD. bleeding time is for platelet function test
young woman who has sudden onset dyspnea and left sided chest pain. nearly passed out. tachycardia, hypoxemia and respiratory alkalosis. what is seen on echo? and dx?
PE leading to enlarged RV cavity. no time to enlarge wall thickness because sudden onset
brown granular casts, which part of nephron is prone to ischemia
proximal tubules and ascending loop of henle because in the medulla and most metabolically active
ergotamine and topiramate for migraines, what are its uses?
abortive and preventinve
54 yo man with fatigue and weakness, pallor, splenomegaly. has dry tap and pancytopenia. dx?
hairy cell leukemia- TRAP. trapped in reticuloendothelial, trapped in BM and spleen, TRAP so no aspiration. rx with ADA
postmenopausal woman, ovrian mass, cuboidal cells growing in sheets with cells that form a glandular appearance? what is this and dx? and what does it produce?
call-exner body- granulosa cell tumor that makes estrogen
TB drugs mechanism
rifampin is the RNA polymerase inhibitor, isoniazid is the mycolic acid synthesis blocker, pyrimidiazine? dunno, ethambutol is the cell wall synthesis
42 yo woman with AIDS, CD4 less than 78, multiple ring-enhancing lesions. ddx? and dx? how do you get it (the question was this)
toxoplasmosis and CNS lymphoma. Toxo in multiple?.. ingestion of contaminated particles…
heart failure, given neprilysin inhibitor and ATII inhibitor together why?
neprilysin metabolizes BNP and ANP and also angiotensin II. so inhibiting that leads to increasing BNP/ANP and sodium excretion, and also increasing ATII, which is bad so ARB given tgt with it.
what does EBV and parvovirus B19 bind?
CD21 and erythrocyte P antigen respectively
new trial of selective arterial vasodilators, what is common SE and mechanism why?
sodium and water retention due to reflex tachycardia and symptathetic stimulation causing RAAS activation
CFTR baby who starts vomiting and AMS. sunken fontanelles and dry mucuous membranes. what is the metabolic abnormality causing this? and mechanism
hyponatremia because defective Cl and Na and water absorption from sweat. so hot day can trigger this
CML patient, RT-PCR is done, what does this detect?
mRNA transcript containing BCR-ABL exons
mice undergo pituitary resection, decreased production of epinephrine is due to which enzyme?
phenylethanolamine-N-methyltransferase. in order from tyrosine to DOPA to dopamine to nor-E to epinephrine. tyrosine hydroxylase, DOPA decarboxylase, dopamine beta-hydroxylase, PNMT (which is upregulated by cortisol)
internal capsule stroke, what happens there 6 months later?
not calcification but wallerian degeneration, leading to persistent myelin debris
TNF-alpha opposeds insulin effects how? biochemistry wise?
serine phosphorylation (this is how glucagon and nor-E works)
35 yo concert pianist woman has Acute limb ischemia, embolectomy reveals gelatinous mass, where is this from and dx?
cardiac myxoma from LA
measuring the bioavailability of isoniazid after 4 hrs of administration, drug has bimodal distribution: a lot of ppl have little and a lot of ppl have a lot of the drug. what is responsbile for this?
acetylation. isoniazid is activated by acetylation, and there is slow and fast acetylators in the population
eyelid mass biopsy shows lipid laden macrophages, dx and what condition?
xanthelesma, PBC
osteolytic vs osteoblastic lesions of bone? mets from where?
osteolytic-MM, non-hodgkins, non-small cell, RCC, melanoma osteoblastic- prostate, small cell, hodgkins
base repair! sequence of enzymes?
glycosylase, endonuclease, lyase, polymerase, ligase
how do you treat bacterial vaginosis
clindamycin
DVT in woman who is pregnant, rx?
heparin- enoxaparin
trigeminal neuralgia rx and SE and moa
carbamazepine and bone marrow suppression, sodium channel inactivation
person with primary aldosteronism, what is sodium, potassium and bicarb levels in the serum
normal sodium, low potassium, high bicarb. normal sodium because of aldosterone escape (ANP/BNP and pressure natriuresis leads to normal sodium not hypernatremia) bicarb is high because you know right you better know
MI patient, gets reperfusion arrythmia then back to normal. what rx was given?
alteplase. given when you cannot do PCI. heparin is only an anticoagulant
how does corneybacterium diphtheriae get its toxin powers from? how about strep pneumo? b.cereus and c.tetani?
transduction. transformation. environmental stimulants
two drugs used in opioid abuse treatment?
methadone and buprenorphine. latter is partial agonist
petic ulcer disease patient who comes with gout, what medication that was given in this patient causes nausea vomiting and diarrhea
colchicine- MT inhibitor
21 yo man with 1d history of flank pain and hematuria, sister with sickle cell, no CVA tenderness not much findings on PE. dx?
renal papillary necrosis
difference between bullemia and binge eating disorder
compensatory stuff
guy with hepatomegaly and ascities gets vitamin K but PT does not improve, why?
liver makes the clotting factors, so bad liver, no clotting factors, vit K doesn’t do jack
a lot of thymidine residues on latex beads. what is attracted to this?
mature mRNA b/c of poly A tails, not telomere. they have TTAGGG
efficacy vs potency
max effect vs how much drug you need to reach ED50
brain infarction 4 months later, what is the cells than line the walls of the lesion? walk through the process
astrocytes (glial scar). fibroblasts are in the core, but walled off by astrocytes.
so first its red neurons, then neutrophils for 3 days, then macrophages, then gliosis from 1-2 weeks and vascular proliferation. then astrocytes form glial scar
bilateral renal artery stenosis patient starts on ACEi, what is GFR, RPF and FF?
low low low. the RPF decreases because no angiotensin II means less vasoconstrction, which means cannot get through the stenosis due to lowered hydrostatic pressure
in sympathetic, parasympathetic, how does NT work, preganglion/postganglion
parasympatehtic is all nicotinic cholinergic (pre) then muscarinic cholinergic (post). sympathetic is cholinergic nicotinic (pre) and mostly adrenergic alpha/beta receptors except for 1. sweat glands (cholinergic muscarinic) and 2. adrenal medulla (it makes its own epi and NorE
GnRH therapy initiated for prostate CA. what drug is given? flutamide. MOA?
blocks androgen receptor interaction. ketoconazole stops production of androgen
sarcoidosis patient had hypercalcemia, started on rx, then stopped glucotherapy therapy 6 months later. now presents with headache, fatigue, bitemporal hemianopsia, MRI shows soft tissue mass on hypothalamus and stalk, what hormone is likely to be increased in this patient?
sarcoidosis relapse on hypothalamus. this dirupts the dopaminergic pathways, leading to prolactin increase
hemoglobin that has lower Km than normal, what complication from this?
erythrocytosis because hypoxia
long standing smoker, chronic breathlessness gets suddenly worse, decreased breath sounds on right and CXR shows right opacification of entire lung field and tracheal deviation to the right. dx?
bronchial obstruction leading to atalectasis. can be due to mass
uncle with CRAB, urine dipstick negative, but 24 hr is positive. what do you see on urine protein electrophoresis?
lambda light chain
malignant HTN , kidney biopsy shows what
fibrinoid necrosis then hyperplastic arteriolosclerosis
burnt sugar smell in diaper, rx?
thiamine supplementation, and also branched chain amino acid dietary restriction
35 yo man with fatigue and dyspnea, has ascities and pedal edema, dies. autopsy shows fibrous deposits on right side of heart valves and pulmonary valve stenosis, dx?
carcinoid heart disease- serotonin secretion in excess makes fibroblasts to proliferate
S2 to opening snap time interval is a marker of?
severity of mitral stenosis. if shorter its worse
HIV patient with ascites and anorexia, CT shows mass around the small intestine, medium sized round tumor cells with ki67 high %. what is dx and what virus led to this?
burkitt’s lymphoma (B-cell proliferation), EBV
floppy baby, large anterior fontanelle poor feeding, macroglossia and umbilical hernia, dx?
hypothyroidism
gancyclovir ressitant CMV, drug given, causing hypocalcemia, dx?
foscarnet
baby head tilted to side, left sided mass, dx?
congential torticolis because of uteral malposition of the head
blue-black deposits in eye and ears, joint pain in 38 yo. dx?
HGA deficiency- Alkaptonuria (black urine)
monozygotic/dizygotic twins, what is most common?
MCDA, DCDA. the later you divide the more connected you are. after 13 days you are conjoined
3 most common viral meningitis
enterovirus, arbovirus, HSV-2 (HSV -1 is encephalitis)
migraine abortive treatment and mechanism?
abortive- sumatriptan, prophylaxis- Bb, venlafaxine, valproate/topiramate. sumatriptan works by blocking release of vasoactive substances from the trigeminal afferent neurons (which are irritated in migraines)
SLE woman with friction rub and diffuse ST elevation, dx?
fibrinous pericarditis
24 yo woman with bloody diarrhea and pain, colonoscopy shows inflammation and dysplasia and thickend bowel wall, colectomy of region looks like FAP, dx?
crohn’s- cobblestone and bowel thickening are more specific to crohn’s
neurophysin gene point mutation leads to what
diabetes inspidus. neurophysin is a carrier molecule for oxytocin and vasopressin. TIP: guess what the answer choices are asking for (i.e. infertility- GnRH, short stature- GH)
in high risk mother, baby with tremors, irritability, dairrhea, tachypnea, poor feeding, dx? and rx?
neonatal abstinence syndrome. give methoadone
what enzymes in krebs cycle need NAD
isocitrate dehydrogenase, a-ketoglutarate dehydrogenase, malate dehydrogenase
45 yo woman with history of sore throat now has oropharyngeal cancer, what infectious agent predisposed her to this cancer?
HPV-16
baby IEM soon after weaning or right after breastfeeding, what are the 2 dx? and cataract formation is ?
weaning- aldolase B def. breastfeeding- galctosemia. catract is galactokinase def
boy eats unknown pills that belong to mom who has anxiety, depression and chronic back pain, vitals stable, somnolent. dx and rx?
benzo poisoning- give flumazenil.
propofol administration, where does it go to first then last
highly perfused tissues then skletal muscle, bone, fat etc
65 yo man with dyspnea and cough, hx of HTN and CKD, heavy smoker, lungs there are macrophages with golden-brown cytoplasmic granules that turn dark blue with prussian blue staining, dx and why
heart failure cells, due to left ventricular dysfunction, leading to back up of blood, increased hydrostatic pressure in pulmonary capillaries leading to extravasation of RBC and breakdown leading to macrophages eating that up
difference between nitrates and nitroprusside
latter is balanced vasodilation -meaning it dilates both veins and arteries
FOOSH, radial pulse is normal. supracondylar fracture of the humerus in antero lateral displacement, what nerve is damaged?
radial nerve. median nerve is anteromedial displacement
pharmacotherapy for bullemia?
SSRI- fluoxetine
elderly patient with strep pneumo, how to prevent this?
vaccination with bacterial POLYSACCHARIDE, not the inactivated microbial agent- children can get the toxoid one but adults need to get just the polysaccharide one
middle aged guy with joint pain, weight loss, greasy stool, PAS filled macrophages, dx and rx?
tropheryma whippelii, antibiotic treatment
CFTR mutations, 28 bases shorter, what is mutation
frameshift. not all CFTR mutation is F508del
severe septic shock patient, now has bleeding on nasogastric aspiration, what is this due to?
cushing ulcer, ischemia and intracranial injury can lead to increased acid production and decreased mucosa production leading to ulcer
fever, chills, abdo pain and diarrhea for 2 weeks, past hx of salmonella enteriditis, now has faint macular rash on trunk, blood culture shows gram neg rods, what is dx and how can it stick around for so long?
salmonella typhi, it replicates inside macrophages, secretes Vi, which prevent its destruction and can spread to reticuloendothelial systems
90 nucleotide structure with weird base s like dihydriuridine etc, secondary sequence by folding on each other, what does it end with?
CCA, this is tRNA. CCA is where the AA binds
thyroidectomy, what is near the ITA and STA (inferior & superior thyroid artery) and could get damgaed, bonus: what happens in each and where is the source of the arteries?
RLN and superior laryngeal nerve. hoarseness and cricothyroid musc, respectively. STA from external carotid, inferior from thyrocervical trunk
42 yo woman with jaw pain, recurrent dental infections facial edema over the left mandible, tapping of molar elicits pain, dx?
sjrogrens
painless ulcer on penis, and LAD in inguinal region, RPR negative. dx?
syphyllis- RPR may be falsely negative
myoglobinuria, muscle cramps, which GSD?
Type V mcardle, glycogen phosphorylase
child with meningitis, mom wants to leave against advice, what do you do?
court injunction….
esophagitis- 1: multinucleated giant cells, punched out ulcer. 2: large linear ulcerations intranuclear and cytoplasmic inclusions. 3: grey white pseudomembranes
- HSV-acyclovir. 2. CMV- ganciclovir. 3. candida- fluconazole
guy doing sports in the water, gets foot laceration, and necrotizing fasciitis. gram stain shows gram negative curved rods. what group of patients is particularly susceptible to nec fas? what is organism?
vibrio vulnificus; iron overload (causes uncontrolled bacterial growth) and liver disease
person in DKA. what enzyme is working to make gluconeogenesis happen right now? from fatty acids to glucose?
glycerol kinase
G6PD reaction makes ribulose-5-phosphate, what is created as a byproduct as what is it used for (2)
NADPH, fattyacid synthesis and glutathione replenishment
postmenopausal woman with hot flashes gets estrogen and progesterone combination treatment. how does this affect thyroid hormone?
estrogen increases TBG, which increases total T4 but still euthyroid. increased TBG binds to free T4 and T3–> decreased feedback inhibition –> increased TSH synthesis –> T4 produced to euthyroid levels
NNH how to do calculation
percentage (Decimal) of people who died - percentage of people who died on intervention, then you get a decimal. reciprocal of that is NNH
woman with constipation and bloating and hypokalemia and low Cl and metabolic alkalosis. amylase is elevated and dental erosion, dx?
bullimia
patient with 3 highs starts a drug and gets rhabdomyolysis and muscle pain and renal failure, dx?
P450 inhibitors leads to high concentration of statins and causes myopathy/rhabdo
ATN after HIV patient starts therapy. bactrim or tenofovir
tenofovir- proximal tubules are fast replicating so this NRTI affects it
aldolase B deficiency, what should be removed from diet
fructose and sucrose. hereditary fructose intolerance is dx
blood hormone A rises, bicarb concentration rises. where is hormone A produced
duodenal S cells make secretin
schizoaffective vs schizophrenia
former needs major depressive or bipolar episode and 2 weeks psychosis independent from mood disorder
how does enoxaparin work
its LMWH. it binds to ATIII and prevents factor Xa from turning prothrombin into thrombin
constipation weight gain in biopolar patient due to what?
lithium induced hypothyroidism
man in emergency, can tell wife or not?
can but just basics
tetanus infection but no neurological sxs in a fully immunized child. why?
vaccine against the toxoid- circulating antibodies
aminoglycosides affect which part of bacteria?
rRNA, which leads to misreading of mRNA transcript
patient with multiple skin lesions gets test to see severity of disease, inject mycobacterium leprae that is heat killed. makes a wheal. what is found in this guys skin lesions?
IFN gamma and IL-2. The test showed that this patient has mycobacterium the tuberculoid version (less virulent). the jail cell Th2 is the lepromatous version, which would not have the wheal/lump because it activates IL4 IL5 and IL10
hydrocephalus chorioretinitis, jaundice, hepatomegaly, intracellular crescent shaped organisms in neonate, dx? and how to avoid
toxoplasmosis. don’t eat undercooked meat and avoid cat feces
klinefelters with infertility, what is LH, FSH, T2, sperm?
high high low absent. testes are small because damaged, so hypergonadotropic hypogonadism
decelration of hand growth, wringing of hands, loss of speech and motor skills dx?
rett syndrome
desending aortic dissection, high BP in right arm, where is the dissecting flap located?
Left subclavian
phospholipase C second messenger system, walk thorugh how it works
Gq protein, GTP is made, which makes phospholipase C, which cleaves PIP2 to make DAG and IP3, IP3 is the key that releases Ca from ER, activating Protein kinase C, which is the effector!
guy with sudden onset mitral regurg with hypotension, and crackles in lungs. what is EF, preload and afterload of the LV right now?
high, high, low. decreased afterload because it has a low resistance tract to the LA. since acute the EF increases
sudden cardiac death after myocardial infarction, what is the cause?
ventricular fibrillation
quad screen in 35 yo mother who drank wine in pregnancy, AFP and unconjugated estriol is low. dx?
trisomy 21. AFP high is myelomeningocele etc. TIP: figure out why or how the test writer is asking the question.. would you ask this way? get in to their mind
status epilepticus, what do you give? and how do they work (2)
IV lorazepam and IV phenytoin (to prevent recurrence). phenytoin disrupts sodium currents by preventing them from recovering
research study that wants to see correlatino between high or normal groups of fibrongen levels with statin use. what statistical test should be used?
chi square- uses categorical variables
pericarditis 3 days after MI, dx?
peri-infarction pericarditis, due to necrosis of muscle
24 yo woman from senegal has positive HIV serology but no viral load. dx?
HIV-2
HSV-2 infection. how to stop recurrence?
daily ganciclovir. condoms don’t do jack (for recurrence)
c1 inhibitor deficiency angioedema is due to what?
bradykinin buildup, blocks kallikrein induced coversion of kininogen to bradykinin
patient with colon polyp has hypokalemia and hypoproteinemia, what is dx?
villous adenoma
neonatal meningits does not improve with cefotaxime and vancomycin. need to add what for what?
ampicillin for listeria
woman treated with a drug before, now has asian glow after drinking a little bit. what drug did she take for what?
metronidazole for trichomonas
breast cancer survivor after lymph node dissection. has lymphedema, now has violaceous nodules on arm, dx?
angiosarcoma- stewart-Treves syndrome
oxaloacetate to phosphoenol pyruvate requires what?
GTP
medicare vs medicaid coverage
former is people over 65 and disable younger people. latter is marginalized people in society
patient traveled to africa, now has malaria, rx?
atovaquone and proguanisil, chloroquine has been outsmarted in africa
prostatectomy nerve to watch out for? and what does it affect?
prostatic plexus- erectile dysfunction
attributable risk equation
RR-1/RR times 100
photosensitivity, rash on forearms, vesicles and erosions,what enzymes in heme synthesis?
after PBG deaminase, so uroporphyrinogen synthase and uroporphyrinogen decarboxylate. the deficiency in the latter causes porphyria cutanea tarda. PBG deaminase causes AIP, which presents with abdo pain and neuropsychiatric sxs
guy with endocarditis has shock and hypotension. gets wedge shaped infarcts bilaterally and symmetrically, dx?
global cerebral hypoperfusion. if it was emboli then it would be scattered instead it’s in the watershed region
26 yo woman with joint pain, erythema nodosum, respi symptoms and biopsy shows giant cells and large epitheliod cells, dx and rx?
sarcoidosis and prednisone
postmenopausal woman has hypokinetic heart in segments of the left ventricle, a month later normal. echo is normal. dx?
takotsubo, octopus trap… due to catecholamine surge
6 yo boy with easy bruising and abdo distension, has hepatosplenomegaly and pancytopenia, bone marrow smear shows some weird coccidio looking cells, dx?
gauchers has gaucher cells. absence of beta glucocerebrosidase
gastric ulcer bleeding which artery?
left and right gastric- lesser curvature of the stomach
what medications lead to osteoprosis and fracture risk?
omeprazole, PPI because calcium needs acidic environment. also, P450 inducers like phenytoin, phenobarbital, carbemazepine - they break down vit D
how does trop/actin/myosin work?
Ca released from SR, binds to troponin, which pulls off tropomyosin, which reveals myosin binding sites on the actin that it was sitting on top of. then myosin binds to actin and pulls, requires ATP to release (rigor mortis when ATP is not around)
hepatic abscess in the right lobe, no travel history. what is most likely mode of infection?
hematogenous spreading of Staph aureus
missionary goes without water and food for 24 hrs. where in the nephron is most water being absorbed?
proximal tubules
adaptive immune response against influenza virus is due to antibody against what?
hemaglutinin
clavicle fracture, the distal part moves downwards because of what muscle?
deltoid
pvc pipe cellular marker and CA
hepatic angiosarcoma CD31 (PECAM1)
T1D with hypoglycemic episodes, in college student with exams coming up. what most likely precipitates this?
intense exercise
painless ulcer in a sailor’s penis, later develops painful lymphadenopathy in the genital area, cytoplasmic inclusions. dx?
chlamydia- lymphogranuloma venereum L1-L3
46 yo woman has GI illness, then has scattered petichial rash, facial puffiness, bilateral pedal edema, anemia, thrombocytopneia, and schistocytes and proteinuria/hematuria. PT/PTT normal. dx and moa?
HUS, endothelial damage in glomerulus/arterioles leading to pathological activation of platelets, the thrombi cause hemolysis
exposure to chemical fumes, the pt is dyspneic, palpitations and dizziness. reddish discoloration of skin, given amyl nitrite. how does this work?
nitrites convert Fe2 to Fe3, which makes it bind tightly to cyanide, which prevents cyanide toxicity from it binding to cytochromeC
antidoes for overdose: benzos, anticholinergic, opioid, SSRI?
flumazenil, physostigmine, naloxone, cyproheptadine
first change you see in RA
synovial neovascularization
red urine that turns dark, abdo pain, confusion, dextrose helps this. dx?
AIP
when starting metformin, should you check creatinine kinase levels or lactic acid levels?
creatinine because poor renal function can lead to lactic acidosis.
parvovirus, where does it replicate?
RBC
30 yo man with brain tumor, biphasic pattern of cellularity, and S-100 positive, dx?
schwanoma. S-100 is for neural crest - so also positive in melanoma
central diabetes inspidus patient given desmopressin. clearance of what is decreased? for what reason?
V2 receptor stimulation leads to urea reabsorption in the collecting ducts so you can maximally concentrate urine
etanercept in RA moa?
receptor decoy protein
muslce pain everywhere, point tenderness and psychiatric symptoms, dx?
fibromyalgia
warfarin is below therapeutic INR due to another drug, what is this drug?
PRP-CAB: p450 inducers and inhibitors- phenytoin, rifamipin, phenobarbital/cimetidine, amiodarone, bactrim
meningitis. when to use dexamethasone
only in pneumococcal because it is gram positive. techoic acid causes inflammation.
patient after IM injection on the butt gets trendelenburg. where was the IM injected?
superior medial, hits the superior gluteal nerve, affecting gluteus medius
3 month history of weight loss fatigue, pain, LOA, dx?
autoimmune adrenalitis - bilateral adrenal atrophy
alpha-galactosidase deficiency, what complication?
renal failure/angiokeratomas fabry disease
sleep related hallucinations and atonic episodes, dx?
narcolepsy
38 yo man dies suddenly after complaining of chest pain and dyspnea the week before. biopsy shows myofibrillary necrosis and mononucleocytic infiltrate. dx?
acute myocarditis
deer hunter bit by tick , blood microscopy shows mulberry shaped intracytoplasmic inclusions in monocytes. also with leukopenia, thrombocytopneia and elevated liver enzymes, dx?
erlichiosis - ehrlichia chaffeensis
HIV patient with diarrhea, bloody, colonoscopy shows multiple hemorrhagic polypoidal lesinos, biopsy shows spindle cells and neovascularization, dx>
kaposi’s sarcoma
cyclosporin and tacrolimus mechanism
calcineurin NFAT inhibitor–> IL2 decreases
UTI, gram positive cocci with no hemolysis. organism?
enterococcus- gamma hemolytic
anti-Scl70 (DNA topoisomerase) , anti-centromere is for what?
systemic sclerosis, CREST syndrome respectively
ataxia, loss of position and vibration sense, areflexia, weakness in lower limbs, dx?
freiderich’s ataxia- trinucleotide repeat
HepB virus unique point
DNA virus, but uses reverse transcriptase to make DNA virus again from RNA transcript
ethylene glycol poisoning. antidote and mechanism
fomepizole inhibits alcohol dehydrogenase, preventing conversion to aldehydes which is toxic metabolite!
3 changes that lead to spinal stenosis in older people
ligamentum flavum thickening, osteophytes, disc prolapse
how do NRTIs work?
does not have a 3’ OH group so phosphodiester bond cannot form
34 y/o patient with progressive fatigue and dyspnea, enlarged coronary sinus on echo, dx?
pulmonary hypertension. increased RA pressure leads to enlarged coronary sinus
protein C level in DIC
decreased because of actvitaion ma
person has fixed pupils and rigid extension of upper extermities, where is lesion?
pons
patient on lithium for many years starts anti-HTN, and gets tremors and ataxia. which HTN drug was started?
thiazide diuretic. Li is absorbed the same way as Na
thickening of trabeculum and cortical bone. bone pain, erythema, warmth, bowing of legs, dx? and lab findings?
paget’s disease of bone, normal calcium and phosphorus, just elevated ALP
no viral thimidine kinase around but zoster infection, rx?
foscarnet or cidofovir
flushed face, dry mouth, QRS and QT prolongation. rx?
sodium bicarbonate
which malaria type has hypnozoites? chloroquine, mefloquine, primaquine moa? why must you take these medicines for longer after return?
ovale and vivax. falciparium don’t have. causes build up of heme, toxic to parasites. primaquine added to prevent liver hypnozoites causing relapses. takes a while to eliminate everything (falciparum takes 8-30 days to mature and rupture) plus dormant stuff
TB drugs side effects
rifampin- rash, red-orange urine, cytopenia. isoniazid- neurotox/hepatotox. pyrazinamide- (purine) hepatotox/hyperuricemia. ethambutol- (eye) scotoma/opitc neuropathy
multiple painful genital ulcers on a erythematous base and tender lymphadenopathy, dyspareunia and dysuria risky sex, how to dx?
viral PCR for herpes. may not have ulcers
anti retroviral meds and hyperglycemia, what is the link?
PI (protease inhibitors) SE is hyperglycemia. and lipodystrophy and inhibition of CYP450
etoposide, irinotecan, topotecan inhibits what
topo II, and topo I respectively
neonatal meningitis, organism is macconkey positive, gram neg rod. what is the main virulence factor?
capsule. K1 antigen
nonvirulent bacteria, then virulent bacteria that is lysed, then lysed virulent bacteria plus nonvirulent bacteria. only the last group kills mice, what is mechanism?
transformation. picking up DNA from the street
how does piperacillin work and why is tazobactam given together with it?
similar to builiding block d-ala-d-ala so that transpeptidase picks it up and uses it, but has beta lactam ring that disrupts synthesis. but beta-lactamase enzyme can destroy that. then tazobactam comes as says gotcha i destroy the beta-lactamase
explain weber and rinne
bone conduction better in conductive hearing loss
obese guy being given aminoglycoside. but uses a body weight lower than the actual weight during drug dosing. why?
because aminoglycosides are highly charged, remains in the extracellular space, which does not really enlarge in obese individuals. if drug had high volume of distribution and goes into fatty tissues, then maybe must increase dose
hepatitis virus in pregnant women in India, that leads to fulminant hepatitis. dx? and what kind of virus?
hepatitis E, ss positive, RNA, unenveloped virus
guy with little wart like stuff papules on lips and tongue, had thyroidecomy, dx?
MEN 2B
midline vs mediolateral episiotomy what does it cut through
perineal body vs transverse perineal muscle
why does verapamil work in cardiac but not skeletal muscle?
L-type calcium channel leads to activation of RyR channels where as in skeletal muscle, it doesn’t need the l type calcium channel to activate RyR, can do it on it’s own
painless, solid scrotal mass in 18 yo guy, dx?
cancer until rpoven otherwise
kidney transplant in the past, presents with chest pain pleuritic and cough, low grade fever. mucimarcine stain
cryptococcus
dry eyes, dry mouth in a guy with depression history. CMAP originally decreased, but increases after repeated stimulation. what is dx?
botulinism toxin because it affects both muscarinic and nicotinic. decreased ACh release from vesicles, but gets better after multiple depolarizations because of increased Ca, leading to utilization of whatever ACh is left
aspirin ingestion toxicity. after 12 hours. what is the ABG show?
mixed respi alkalosis and metabolic acidosis. so pH is normal. CO2 compensation for HAGMA is not as good as you expect. first 12 hours is just respiratory alkalosis because aspirin directly stimulates breathing center
lung abscess in alcoholic, rx principles and rx?
both anaerobic and aerobic, so give clindamycin
necrotic, large, midline shift mass that causes seizures, dx?
GBM
mecahnism of cancer cell resistance to chemotherapy, a glycoprotein on the surface. what is this?
ATP dependent transporter- P-glycoprotein
guy gets PCI through femoral approach. then later has blue toe, livedo reticularis and AKI. dx?
emboli that broke off from PCI, causing these sx
ST elevation MI in AvL and I, where is occlusion
left circumlex
hypoketotic hypoglycemia after fasting, what are the 2 ddx?
fatty acyl ( acyl-CoA) dehydrogenase or Carnitine deficiency
painless otrorrhea and hearing loss, pearly mass and the tympanic membrane is disrupted, dx?
cholesteatoma, a squamous cell remnant that can make enzymes that lyse the membrane. caused by chronic negative pressure in the middle ear? ( has not cholesterol in it, despite name)
epinephrine given after drug A. what happens to diastolic BP and heart rate if drug A is phentolamine, phenylephrine, propranalol, atropine, isopreterenol
answer was propranalol
why does lactic acidosis happen in metformin?
inhibit gluconeogenesis, so more substrate for pyruvate to turn into lactate
vertical diplopia, dx?
isolated IV
midshaft fracture of humerus, supracondylar fracture, surgical neck of humerus, what is damaged in each
radial nerve and deep brachial artery/median nerve and brachial artery/axillary nerve and artery
difference between tamoxifen and raloxifene
anti-estrogen effects on endometrium
hemophilia A, what is enhancers job and where is it found
enhancers can be downstream, upstream in the introns, in facilitates bending of DNA and increases the rate of transcription by bringing TF and polymerases together
diabetes in young person, fasting hyperglycemia and gestational diabetes suspected to be hereditary. what is the enzyme that is defective?
glucokinase, works as a glucose sensor in the pancreatic beta cells. it has lower affinity to glucose, so acts as sensor for releasing insulin
soccer injury sutures placed, comes back with painful nodule around injury area, biopsy shows granulomatous inflammation, dx?
foreign body leading to granuloma formation
decerebrate vs decorticate
extensors (below red nucleus), flexors (above red nucleus)
pygmalion effect, lead-time bias, and berkson bias
higher expectations for high IQ students, screening test that “prolongs” survival, choosing study subjects from hospital
cough with thick yellow sputum, night sweats, fatigue. pulmonary lesion on imaging. transthoracic needle leads to growth of fusobacterium and peptostreptococcus. what led to this?
seizure disorder, aspiration. those bacteria are anaerobic oral flora
phenylephrine blocker after IP3, what activity is decreased?
PLC/IP3/DAG/PKC, so PKC
67 yo with fatigue, itchiness and weakness, renal arterioles are narrowed, homogenous glassy substance positive for PAS, dx?
diabetic hyaline arteriolosclerosis, malignant HTN is hyperplastic onion skinning
4 yo boy with recurrent infections, partial albinism, nystagmus, and large granules in neutrophils and monocytes, dx?
chediak-higashi syndrome
asbestosis 3 occupations?
drywalling, insulation, shipbuilding
RA patient gonna start etanercept. what check to do?
TNF-a inhibitor, TST
45 yo woman with long history of pruitis and fatiguewho has pale stools and xanthelesma, dx? granulomatous destruction of bile ducts
PBC
rash on elbows, hyperkeratosis, parakeratosis, acanthosis, elongated rete ridges, dilated capillaries, neutrophilic foci dx? what are all these words…
psoriasis. hyper-thickening of keratin layer, para- nucleated cells in corneum, rete ridges- the saw tooth things, acanthosis- thickening of epidermis
muscle biopsy shows a lot of myoglobin, and mitochondria but poor in glycogen. which muscle?
type 1 fibers (slow twitch)- postural muscle like paraspinal
NNT equation, how to calculate ARR
control rate minus drug rate. convert into decimal. then reciprocal of that
hypovolemic shock, what does normal saline infusion do to this patient?
increases end diastolic sarcomere length. does not increase TPR, because that means arterioles constrict even more than they alr. constricted in shock b/c of sympathetic stimulation
hypovolemic shock due to diarrhea and vomiting. BP 90/60, HR 120. What is FF, GFR, RPF compared to patient’s baseline which is normal?
GFR and RPF are low because of renal vasoconstriction due to hypovolemia. RAAS causes angiotensin II to rise, which preferentially constricts efferent arteriole to increase GFR. GFR is still lower than normal, but less lower than RPF. FF is GFR/RPF. so FF increase. GREAT QUESTION
atherosclerotic plaque has fibrous cap, what makes this cap? go over patho please
vascular smooth muscle cells. endothelial injury and hyperlipidemia leads to LDL build up and monocyte/macrophage extravasation into the layer between intima and media. foam cells die, macrophages produce growth factors and stuff. cause sm muscle proliferation. sm muscle cells make the cap on top
medullary carcinoma of thyroid and RET gene, where should you look for the other tumor?
adrenal medulla
otoscope speculum in otitis media, patient faints, what nerve is affected?
vagus nerve supplies posterior aspect of auditory canl
after traumatic brain injury, person personality is changed, is rude and insensitive which part is damaged?
orbitofrontal cortex. prefrontal is calculation
power of a study is?
1-B (1-FN- falsely thinking there is no association when there actually is)
pancytopenia, dry tap, tear drop cells, splenomegaly, dx and patho?
myelofibrosis, new kid in town “atypical megakaryocytes” makes TGF-B that repels everyone by making fibrosis. hematopoietic cells move out to spleen and etc
honey colored bullae, dx? and patho
bullous impetigo, exfoliative toxin A against desmoglein
holoprosencephaly is a defect of what in embryological process?
developmental field defect
mechanism of heparin induced thrombocytopenia
generation of IgG antibodies to heparin and platelet factor 4, this lead to widespread platelet activation
aplastic pancytopenia in 7 yo with easy bruising and frequent epistaxis. dx?
idiopathic most of the times. FANCONI has absent thumbs and short stature
IEM , metabolic acidosis with hypoglycemia nad ketosis, defective conversion of proprionyl coa to MMA. which amino acid cannot be used for energy?
the essential 4: valine, isoleucine, threonine, methionine. as well as odd chain fatty acids and cholesterol. lysine and leucine are ketogenic AA.
hypermethylation is the genetic basis for what phenomenon?
imprinting- parent-specific inheritance of genes, BY silencing the other parents gene via methylation
Not epistasis- which is another gene affecting the genes phenotype
pregnant lady with previous LSCS, without previous antenatal care for this pregnancy comes and delivers uddenly, PPH that continues even after uterotonic medicines and massage. placenta alr removed manually, dx?
placenta accreta- abnormal decidualization due to prev surgery
gingival hyperplasia from a guy with seizures and mental health problems, what is the culprit drug?
phenytoin. ginigival hyperplasia through increasing PDGF. also get alveolar bone
bipolar plus epilepsy, what drugs are good for this? (3)
valproate, carbamazepine, lamotrigine (Also mood stabilizers)
ventriculomegaly but no sulcal enlargement on CT, wet weird wobbly, why urinary incontinence
normal pressure hydrocephalus. cortical inhibition lack
sclerotic lesions in smokinng uncle with bone pain and bony mets, ddx?
SPH-sekolah pelita harapan- small cell, prostate, hodgkins are osteoblastic- sclerotic. the rest are osteolytic
when does drug given at continuous infusion reach steady state at 95%?
4 - 5 halflives
heparin moa
binds to ATIII which makes it more avidly bind to factor X, not thrombin
hip fracture in auntie, what artery disruption leads to osteonecrosis?
medial circumflex
persistence of primary spongiosa in the medullary canal, bone, dx
osteopetrosis
after reperfusion why does creatine kinase elevate?
membrane damage, NOT glutathione peroxidase which reduces radical damage
why are reticulocytes blue?
rRNA
bleeding when trauma skin rash dx, on extensor surface
psoriasis
hypocalcemia after a lot of transfusions. dx?
calcium chelation due to citrate
ugly mass on breast, positive for HMB-45 and S-100, dx?
melanoma
huntington’s disease, what is mechanism
increased trinucleotide repeat leads to abnormal accumulation of huntingtin protein, which leads to GABA neuron atrophy
how does struvite stones form?
urease produceing organism break down urea to ammonia and causes urine pH to rise, which means magnesium ammonium phosphate stones precipitate
where is EPO produced, and where is ischemic injury most possible in kidney?
peritubular fibroblasts, and proximal tubule (b/c of high metabolic burden) respectively
appendicitis, removed, reveals sheets and islands of uniform round cells, dx?
carcinoid- neuroendocrine cells
zenker’s diverticulum, mechanism?
cricopharyngeal motor dysfunction
teenage girl with ataxia, kyphoscoliosis and LL weakness and joint/vibration sense absent. inherited disease. what is dx and a/w?
friederich’s ataxia, hypertrophic cardiomyopathy and diabetes
thick LV wall, transverse thickening of cardiomycotyes with hyperchromatic nuclei and interstitial fibrosis dx?
hypertension
UV light exposure, gets bad sunburn. what is happening? biochem
pyrimidine dimers and then endonuclease nicks the damaged region and then repair happens
4 weeks after phenytoin, has rash over body, generalized LAD, hepatosplenomeglay, facial swelling, what else is present? and dx?
eosinophils, DRESS
deep brain stimulation happens where?
subthalamic nuclei or globus pallidus interna
lymphocytic meningitis in a 7 yo boy, dead birds around most likely organism?
west nile virus- cryptooccall is for immunocompromised
verapamil, as antiarhythmic, how does it work?
it slows the depolarization phase (the piano keys sliding) at cardiac pacemakers cells
CCK test in fat forty female,contraction is slow and incomplete. what is present in the gb?
cholesterol stones WAS NOT ONE OF THE OPTIONS. biliary sludge is the answer
heparin vs unfractionated heparin vs fondaparinoux, vs enoxaparin
unfractionated heparin can bind to both thrombin and factor X, LMWH such as fonda and enoxa only binds factor X
multiple groups with varied smoking exposure, comparing FEV1 levels of all 4 of the groups, what statistical test to use?
ANOVA- analysis of variance
older guy has SOBOE, autopsy of heart shows dilated left ventricle, what caused his symptoms?
poor force of contraction due to dilated cardiomyopathy. volume overload. pressure overload on the other hand is due to hypertension, impaired filling and decreased compliance
telangiectasias evreywhere and nose bleed, dx
osler-weber-rendu: hereditary hemorrhagic telangiectasia
organophosphate poisoning farmer. what symptom(s) is not reversed by atropine?
muscle weakness. atropine only reverses the muscarinic affects. pralidoxime is need to reverse the nicotinic affects. pralidoxime does both muscarinic and nicotinic, but only works peripherally
b-frag abx?
pip-tazo
Gi Gs Gq
Adenyl cyclase, cAMP, pkA. (all As). For Gq, PLC/IP3/DAG/PKC
guy with bone pain and hearing loss, tibia deformatino, biopsy shows bone cells with more than 100 nuclei, dx and why is chemical mediator?
paget’s disease of bone, NFKB
ureter in the pelvis is anterior to which structure? bonus: ureter course
internal iliac artery. follows psoas muscle down, goes posterior to the gonadal vessels, then posterior to internal iliac, then anterior to the uterine artery (Water under bridge)
vertigo that is recurrent, meniere’s or vestibular neurtiis
meniere’s
panic attack patient, prescribed with short acting anxiolytic and muscle relaxant how does it work?
benzos work by binding to GABAa channels, increasing the frequency of Cl- channel opening. barbiturates increase the duration of the channel
factor V leiden leads to what complication
DVT
when is membrane most permeable to K in the action potential?
during repolarization in the middle of it, not the beginning
travel to SEA, pulse-temperature disassociation, maculopapular rash on trunk, abdo pain, hepatosplenomegaly, leukopenia. dx?
typhoid fever- fecal oral transmission
what prlonges QT interval?
macrolides, fluoroquinolones, azoles, antipsychotics, antiemetics
TB cells have no catalase peroxidase. what drug is this resistant to?
isoniazid
RTA, CVS collapse, widened mediastinum, death. where is the injury on the aorta?
aortic isthmus after L subclavian
42 yo woman with painless LAD, waxing and waning, dx?
follicular lymphoma
multiple myeloma uncle, what risk of complication?
amyloidosis
systemic sclerosis, and the PFT is normal, dx?
pulmonary arterial hypertension, not IPF, it can happen in SS, but PFT would be decreased. (less than 80% of predicted)
ASD, VSD, and single AV valve, what is dx?
Downs
more HbA2 in a guy, dx and why does this lead to false HbA1c levels?
beta thal minor, prone to hemolysis and RBC turnover
older guy with long standing HTN with randomly swinging arms, which part of brain is damaged
subthalamic nucleus
sexual contact, deep painful ulcerswith ragged borders a/w grey exudate and inguinal LAD
h. ducreyi- chanchroid
pseudomonas in burn victim, rx?
cefepime and ceftazadime
what leads to kernicterus, direct or indirect bilirubinemia
indirect because direct can be peed out
50 year smoking history patient presenting with dizziness, dysrathria and bilateral limb ataxia, autopsy shows degeneration of purkinje cells in cerebellum, what is the dx?
autoimmune/paraneoplastic destruction of these cells with anti-Yo, anti-P/Q, anti-Hu antibodies, common in SCLC and breast ovarian and uterine cancer
hydatid cyst (echinococcus granulosus) rupturing during surgery leads to
anaphylaxis
phenelzine being switched to sertraline , why must wait 2 weeks?
MAO must regenerate, or else can lead to SS
person has disseminated histoplasmosis, ampho B given, next has premature ventricular beats and palpitations. dx?
renal nephrotocixity leading to hypokalemia. can lead to anemia as well (EPO def)
somatostatin producing antral cells are destroyed. where are ulcers gonna form, duodenum or stomach? what is patho of each?
duodenal, caused by increased acid secretion by stomach. gastric ulcers is because of cytotoxic compounds that Hpylori makes as well as direct invasion and then inflammatory response–> this happens more in the gastric body. can lead to GALT and adenoCA
premature activation of trypsin, mutation that prevents the inhibiting of premature trypsin, what complication od you have from this?
pancreatitis
frequent knee trauma, which bursa is affected?
prepatellar- housemaid’s knee
why give magnesium with aluminum hydroxide
because mg causes diarrhea and Al causes constipation
how to calculate RBF given PAH and urine flow rate and hematocrit
RBF equals RPF/1-hematocrit. RPF is PAH clearance: urine PAH x urine flow rate/serum PAH
acne caused by weight loss or sports?
sports, obesity is related with acne
young man from guatemala gets seizure. he owns a cat. but is immunocompetent. MRI shows brain cyst. what is dx and how did he get it?
neurocystercicosis. through ingesting eggs in feces. if he had undercooked pork with the cysts, he would have tapeworm infection. but the eggs become larvae and become cysts
ataxia, telangiectasia on sun exposedareas, recurrent sinopulmonary infections, dx and what gene is defective?
ataxia-telangiectasia, - ATM gene which helps with double strand DNA break repair
theophylline poisoning complications?
tachyarrhythmia and seizures. it’s like caffeine..
