Practice 1

Question 1

Characterize the changes observed with analgesic abuse induced nephropathy:

Answer 1

marked thickening of the vasa recta capillaries and intermittent tubular necrosis. Eventually, papillary necrosis, FSGN, interstitial infiltration, and fibrosis can occur.

Question 2

Is Pagets assoc with osteosarcoma or osteoblastoma?

Answer 2

osteosarcoma

Question 3

What effect can prolonged use of high dose glucocorticoids have on bone?

Answer 3

avascular necrosis. pathognomonic crescent sign indicates subchondral collapse.

Question 4

Esophageal webs are seen with what metabolic/nutritional deficiency?

Answer 4

Plummer Vinson syndrome (iron deficiency, esophageal webbing)

Question 5

___ is the feeling of a “lump in the throat” without accompanying physical, endoscopic, or radiologic findings of esophageal obstruction.

Answer 5

Globus sensation.

Question 6

Why do you get increased gouty attacks when you use thiazide diuretics?

Answer 6

Normally uric acid crystals have an ApoE or ApoB coating, but if uric acid levels fluctuate, bare uric acid crystals are exposed to circulating IgG&raquo_space; IgG binding to uric acid crystal&raquo_space; neutrophil phagocytosis and release of IL-1&raquo_space; neutrophil and Mac infiltration and inflammatory changes.

Question 7

What vitamin is indicated as first line therapy for nausea and vomiting in pregnancy?

Answer 7

B6

Question 8

What’s the MOA of oseltamivir (Tamiflu) in treating influenza a and b?

Answer 8

Oseltamivir (Tamiflu) is a sialic acid analogue that inhibits neuraminidase of influenza A and B.

Forces the newly made virion particles to remain adherent to the host cell surface (forms viral aggregates unable to infect new cells)

Question 9

What’s the MOA of ribacirin in treating HepC?

Answer 9

Ribavirin inhibits RNA pol and RNA fragment initiation and elongtation&raquo_space; viral protein synth inhibition

Question 10

Most follicular B cell lymphomas are assoc with a ___ translocation that leads to overexpression of what protein?

Answer 10

t(14;18)&raquo_space; BCL2 overexpression.

Question 11

What’s the Warburg effect?

Answer 11

Malignant cells can undergo high rates of glycolysis to produce the macromolecules needed for rapid cellular growth.

Question 12

How does ACh cause bronchoconstriction?

Answer 12

Stimulates muscarinic M3 R on bronchial SM, activating G1q phospholipase C - IP3 pathway&raquo_space; increase in intracellular Ca2+ and muscle contraction.

Question 13

How does atropine promote bronchodilation?

Answer 13

Atropine is a competitive muscarinic antagonist that opposes the effects of ACh&raquo_space; decreased muscle contraction.

Question 14

MOA of edrophonium:

Answer 14

acetylcholinesterase inhibitor (used to Dx Myasthenia Gravis in Tensilon test)

Question 15

Clinical manifestations of anticholinergic syndrome:

Answer 15

fever, dry skin and mucous membranes, flushing, mydriasis, cycloplegia, altered mental status:

“Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter”

Question 16

Translocation in APL (acute promyelocytic leukemia)

Answer 16

t(15;17)

• Chr 17 - RARA
  Chr 15 - PML gene

Question 17

Rx for APL:

Answer 17

ATRA

• Should be started early to prevent early mortality from associated hemorrhage (APL causes pancytopenia and DIC)

Question 18

Translocation in follicular lymphoma:

Answer 18

t(14;18) -&raquo_space; BCL2 activation

Question 19

How would an infection of molluscum contagiosum appear on histology?

Answer 19

Epidermal hyperplasia with molluscum bodies (large eosinophilic cytoplasmic inclusions made of virus particles)

Question 20

Neurovascular elements at risk for damage in knee dislocation include:

Answer 20

popliteal artery, tibial nerve, common peroneal nerve

Question 21

Why is popliteal artery commonly damaged in knee dislocation?

Answer 21

Popliteal artery is tightly proximal and distal to the popliteal fossa by the adductor magnus and soleus muscles respectively, making it susceptible to tearing via traction forces.

Question 22

What’s the most important risk factor of post-partum endometritis?

Answer 22

C section delivery because this introduces microbial organisms and foreign bodies into the incised uterus. Signs and symptoms can include: fever, leukocytosis, uterine tenderness, and foul smelling vaginal discharge.

Question 23

___ is a mature defense mechanism in which a person channels unacceptable thoughts or impulses into a socially acceptable behavior:

Answer 23

sublimation

Question 24

Why is receptor dimerization necessary for RTK activation?

Answer 24

After the ligand binds to the extracellular part of the RTK, the tyrosine kinase receptor dimerizes and each subunit phosphorylates the other, causing a conformational change in the intracellular domains of the tyrosine kinase R dimer&raquo_space; exposure of each subunit’s catalytic domain, and phosphorylation of the tyrosine residues on target proteins.

Question 25

Does sildenafil act in the corpus cavernosum or the corpus spongiosum?

Answer 25

Sildenafil = selective PDE-5 inhibitor&raquo_space; ^ cGMP&raquo_space; SM relaxation in venous sinuses of corpus cavernosum.

Question 26

Craniopharyngiomas typically grow in what area of the brain?

Answer 26

They are suprasellar tumors arising from remnants of Rathke’s pouch. Can cause bitemporal hemaniopia due to compression of optic chiasm

Question 27

Winging of the scapula is due to damage to what muscle>

Answer 27

serratus anterior innervated by long thoracic nerve.

Question 28

The pancreas secretes bicarb for digestion. How does pancreatic exocrine secretion flow rate change Cl- and HCO3- levels?

Answer 28

Flow rate ^ with secretin ^. During low flow, the exocrine pancreas has low bicarb and high Cl-. During high flow, the exocrine pancreas has high bicarb, and low Cl-

This is all due to the effect of the Cl/HCO3 exchanger

Question 29

Where are Brunner glands found and what’s their function?

Answer 29

Brunner glands are in the duodenum and release bicarb rich alkaline mucus to neutralize stomach acid.

Question 30

How does flow rate alter salivary gland secretion?

Answer 30

Salivary gland acinar cells normally secrete isotonic solution similar in composition to plasma. Low flow rate increases ductal epithelial contact with secretions&raquo_space; saliva with lower [ ] Na and Cl but higher K+

Question 31

Timeline for acute stress disorder:

Answer 31

WLast > 3 days and < 1 month

Question 32

False positive rate calculation:

Answer 32

FPR = (1-specificity)

• This is characteristic of the test, and does not change with disease prevalence.

Question 33

Formula for NNT:

Answer 33

NNT = 1/ARR

Question 34

What’s the MCC of viral encephalitis?

Answer 34

HSV-1

Question 35

What part of the brain is commonly affected by viral encephalitis?

Answer 35

Temporal lobe (via HSV-1)&raquo_space; olfactory hallucinations, anosmia, temporal lobe seizure, personality changes, bizarre/psychotic changes, delirium, aphasia/hemiparesis.

Question 36

Acute intermittent porphyria is caused by deficiency of what enzyme?

Answer 36

porphobilinogen deaminase. Characterized by intermittent episodes of abdominal pain with neurological manifestation, following exposure to offending medication. Urine from patients will appear dark when exposed to sunlight.