Q Banks: Week of 01/30/17

Question 1

Scar tissue is which kind of collagen?

Answer 1

Type I

Question 2

Granulation tissue is the same type of collagen as _____________.

Answer 2

reticular collagen and lung gollagen (type III)

Question 3

Clefts are on the __________ side of the primitive pharynx and pouches are on the __________.

Answer 3

outer; inner

Question 4

True or false: the palatine tonsils arise from the first pharyngeal pouch.

Answer 4

False. The first pharyngeal pouch develops into the inner ear. The tonsils develop from the second pharyngeal pouch (TWOnsils).

Question 5

Explain Shine-Dalgarno and Kozak sequences.

Answer 5

The rRNA recognizes AUG as the start sequence. However, because there can be multiple AUGs in a transcript, rRNA searches upstream for the GCCGCC Kozak sequence in eukaryotes and Shine-Dalgarno sequence in prokaryotes.

(Prokaryotes are older, so they’re like the original star that Shines.)

Question 6

What bone is adjacent to the pisiform?

Answer 6

The triquetrum

Question 7

Lunate dislocation can disrupt the __________ nerve.

Answer 7

median (MediaN = MooN = Lunate)

Question 8

In addition to water, ADH also increase the resorption of _________.

Answer 8

urea, which helps build the medullary concentration gradient needed to concentrate urine

Question 9

What is pulsus paradoxus?

Answer 9

When a person has cardiac tamponade, inspiration leads to greater filling of the pericardium. This presses down on the ventricle and decreases systolic blood pressure by 10 mmHg or more.

Question 10

When cardiac output decreases in heart failure, what three systems get overactivated?

Answer 10

Sympathetic nervous system: increases HR and contractility
•This damages the heart by increasing afterload and stimulating deleterious remodeling.

RAAS: increases vasoconstriction and fluid retention
•Can lead to edema and pulmonary congestion

ADH system: increases fluid retention

Question 11

What factors are needed for branched chain alpha ketoacid dehydrogenase?

Answer 11

Thiamine
Lipoate
Coenzyme a
FAD 
NAD 

(“Tender Loving Care For Nancy”)

Question 12

Other than tear-drop cells (dacrocytosis) and anemia, how does primary myelofibrosis present?

Answer 12

With hepatosplenomegaly from extramedullary hematopoiesis and early satiety

Question 13

Which disorders are caused by JAK stat mutations?

Answer 13

Polycythemia vera
Essential thrombasthenia
Primary myelofibrosis

Question 14

Low estrogen causes a decreased ratio of _______________ in the bone.

Answer 14

osteoprogerin:RANK-L

Question 15

The side effects of nitrates include _______________.

Answer 15

headaches, flushing, and hypotension

Question 16

Nitrates should be avoided in patients with ________________.

Answer 16

hypertrophic obstructive cardiomyopathy

Question 17

The function of glucokinase might be _____________ in a patient with insulin resistant diabetes.

Answer 17

decreased

Glucokinase is the enzyme that traps glucose in pancreatic beta cells. Thus, deficient levels of this could lead to decreased insulin secretion.

Question 18

____________ blocks neurokinin 1 receptors in the area postrema.

Answer 18

Aprepitant

Question 19

The two drugs that decrease aqueous humor inflow are ________________.

Answer 19

beta-2 antagonists and alpha-2 agonists; both work on the ciliary epithelium

Question 20

How do muscarinic agonists treat closed-angle glaucoma?

Answer 20

They stimulate the pupillary sphincter to contract which loosens up the trabecular network on the periphery of the iris and promotes outflow. Also, they cause the ciliary muscle –which connects to the lens –to contract which flattens the lens and allows more room for the aqueous humor to escape.

Question 21

________________ following the rupture of a berry aneurysm can produce focal neurologic deficits.

Answer 21

Vasospasm

Substances released into the parenchyma are believed to be the causative agent. This can be prevented with calcium channel blockers.

Question 22

What nerve is sometimes injured in thyroidectomies?

Answer 22

The recurrent laryngeal nerve

Question 23

By what mechanism do CCA and CCG lead to the same amino acid?

Answer 23

Wobble

Question 24

Describe the differences between acute and chronic heart failure lung pathology.

Answer 24

Acutely, lung specimens of a patient with heart failure will display transudate (plasma in the alveoli). Chronically, hemosiderin-laden macrophages will arise.

Question 25

Why does normal-pressure hydrocephalus lead to incontinence?

Answer 25

Stretched cortical fibers leads to impaired inhibition.

Question 26

Describe the anatomy of the femoral triangle.

Answer 26

NAVy VAN! From lateral to medial, the order is nerve, artery, and vein. Thus, the best place to access the femoral vein is just medial to the femoral artery.

Question 27

The suffix "-cept" is reserved for molecules that ______________.

Answer 27

are soluble reCEPTors (e.g., etanercept)

Question 28

Where is VSD heard best?

Answer 28

The 3rd and 4th left intercostal spaces

Question 29

How does inspiration affect circulation?

Answer 29

Inspiration increases the blood flow to the right heart and actually decreases the blood flow to the left heart; the decrease is owing to the decrease in pressure of the pulmonary vessels. Example: inspiration increases right heart sounds like tricuspid regurgitation and decreases or doesn't affect left heart sounds.

Question 30

What is the difference between simple and complex partial seizures?

Answer 30

In simple partial seizures, the patient does not lose consciousness or have a postictal state, whereas in complex partial seizures the patient does. ("When it's Simple you can Say you've had a seizure. When it's COmplex you're COnked out.")

Question 31

What's the difference between a tonic-clonic and myoclonic seizure?

Answer 31

Myoclonic seizures do not involve loss of consciousness.

Question 32

The most common mutation that causes cystic fibrosis leads to __________________.

Answer 32

misfolding and improper post-translational modification of the protein with subsequent proteolysis

Question 33

Describe all that can happen in Patau syndrome.

Answer 33

``` Think of the P's with Patau: • Polydactyly • Palate defects • holoProsencephaly • Protrusion of the gut (omPhalocoele) • rocker bottom feet ("you'll need a Podiatrist") • renal problems ("can't Pee") • Punched-out lesions on the pate (cutis aPlasia) ```

Question 34

What does nicotine use during pregnancy cause?

Answer 34

Low birth weight

Question 35

What embryologic defect causes the phenotype seen in Patau syndrome?

Answer 35

Defective fusion of the prechordal mesoderm

Question 36

What is the formula for absolute risk reduction?

Answer 36

ARR = (incidence of event in control group) – (incidence of event in test group)

Question 37

Describe the overall process of ketone metabolism.

Answer 37

Fatty acids are converted to acetoacetate and beta-hydroxybutyrate in the mitochondria of hepatocytes. Those products circulate to peripheral tissues. In the mitochondria of peripheral tissues, acetoacetate and beta-hydroxybutyrate are converted to acetyl CoA.

Question 38

Which artery supplies the AV node?

Answer 38

The posterior descending artery Note: most people are right-dominant, meaning the PDA arises from the right coronary. In left-dominant people, however, the PDA arises from the left circumflex artery.

Question 39

Those with PKU usually have high levels of what serum marker?

Answer 39

Prolactin Phenylalanine hydroxylase is needed to make tyrosine. Dopamine is synthesized from tyrosine. Without dopamine the tonic inhibition in the tuberoinfundibular pathway becomes activated and prolactin levels rise.

Question 40

Remember that ___________ secretase leads to amyloid accumulation in Alzheimer's.

Answer 40

beta

Question 41

What is key for a diagnosis of body dysmorphic disorder?

Answer 41

Engagement in deleterious, repetitive behaviors related to preoccupation with perceived body imperfections

Question 42

What is one of the best ways to ensure adherence with discharge instructions?

Answer 42

Provide a checklist for patients

Question 43

When the clavicle breaks, the medial portion is usually elevated by the ________________ and the lateral portion is brought down by the ______________.

Answer 43

SCM; pectoralis major

Question 44

What can cause restrictive cardiomyopathy?

Answer 44

Hemochromatosis Amyloidosis Sarcoidosis Radiation therapy

Question 45

What does ristocetin do?

Answer 45

It activates GpIb receptors and makes them available for binding to vWF.

Question 46

How does silicosis activate TB?

Answer 46

It's thought that silicosis causes macrophage dysfunction – specifically by inhibiting phagolysosome fusion – which causes bacteria to spill out.

Question 47

Which values are increased in COPD?

Answer 47

TLC FRC (= RV + ERV) RV

Question 48

Typically, those with COPD have ___________ lung elastic recoil.

Answer 48

decreased (due to increased compliance)

Question 49

Cholestyramine can cause high levels of ___________.

Answer 49

triglycerides (think of the lobster chasing the pitchfork-wielding men into the hot air balloon)

Question 50

What's the best way to distinguish between confounding and effect modification?

Answer 50

Effect modification can be subject to stratification analysis, meaning you can isolate the variable and still have a valid project. Confounding occurs when a variable cannot be teased out. For instance, you might look at shoe size and IQ in elementary school students. Age would obviously be a confounding factor, but it could not be isolated.

Question 51

The channel that thiazides inhibit pumps ____________.

Answer 51

sodium and chloride (calcium is brought in through another channel via the gradient that is produced)

Question 52

Diphenoxylate is often combined with __________.

Answer 52

atropine; this is done because diphenoxylate can cause euphoria if taken in high doses. Adding atropine, however, will make it toxic

Question 53

What two signs suggest a specific cause of hyperthyroidism?

Answer 53

Pretibial myxedema and exophthalmos Hyperthyroidism might be caused by a hot nodule or exogenous intake. Graves disease, however, will present with pretibial myxedema because that is a direct result of antibodies directed again the TSH receptor.

Question 54

_____________ are invaginations of the extracellular space into the outer membrane of myocytes.

Answer 54

T-tubules

Question 55

T-tubules ensure that _______________.

Answer 55

myofibrils receive the depolarization signal at the same time

Question 56

In addition to forming a diverticulum, the omphalomesenteric duct can also form a ____________.

Answer 56

cyst

Question 57

True or false: single-strand binding proteins only interact with the lagging strand.

Answer 57

False. SSBs interact with both strands as soon as DNA helicase unzips the DNA.

Question 58

Describe the functions and position of H1.

Answer 58

It is the only histone protein outside the core nucleosome. H1 binds the linker regions of DNA (the part that wraps around and overlaps with the preceding segment.

Question 59

How can antibody-mediated blood transfusion reactions be differentiated from IgE-mediated reactions?

Answer 59

IgE-mediated reactions present with anaphylaxis while IgG mediated reactions present with hemoglobinuria and fever.

Question 60

By what mechanism does Huntington's disease lead to neuronal death?

Answer 60

It is a gain-of-function mutation that leads to histone deacetylation. This silences the transcription of many genes needed for neuron survival. (Think of Woody Guthrie unable to Hunt because he lost his acetylation gun.)

Question 61

What is a scotoma?

Answer 61

A visual defect with normal vision around the edges

Question 62

Which antiviral can cause hypocalcemia?

Answer 62

Foscarnet (because it chelates calcium)

Question 63

Why are FICNBs not administered directly into the femoral ring?

Answer 63

The femoral nerve is lateral to the femoral sheath in the inguinal crease, so it is best accessed lateral to the femoral ring.

Question 64

How should a physician who morally opposes abortion respond to a patient who seeks an abortion?

Answer 64

Doctors are not required to perform procedures that are against their moral codes, so physicians in this case should refer patients to doctors who will provide abortions without imposing moral guidelines on the patient.

Question 65

What two things inhibit ALA synthase?

Answer 65

Heme and glucose

Question 66

In an H&E stain of the adrenal gland, the ____________ layer will appear as the most basophilic.

Answer 66

adrenal medulla

Question 67

In an infusion of norepinephrine, the area around the catheter can become cold and hard due to extravasation. How can this be treated?

Answer 67

Alpha-agonists like phentolamine

Question 68

Somatostatin binds to a ___________ receptor.

Answer 68

Gi

Question 69

What does glycosylase do?

Answer 69

In base-excision repair, glycosylase removes the errant nucleoside. Endonuclease and then lyase follow glycosylase by removing the sugar-phosphate backbone from the chain. Polymerase can then fill in the correct base and ligase complete BER.

Question 70

Which of the lipid drugs can cause gallstones?

Answer 70

Fibrates (stones behind jellyfish) and bile-acid sequestrants (gull flying gold down to rock pile)

Question 71

Give the correct order of airway resistance among the trachea, bronchi, bronchioles, and terminal bronchioles.

Answer 71

Bronchi Trachea Bronchioles Terminal bronchioles The bronchi have the most resistance because that is where airway comes together and is most turbulent.

Question 72

Amatoxins from mushrooms and ricin from castor beans both inhibit protein synthesis. How does each do so?

Answer 72

Ricin inhibits the 60S subunit and prevents translation Amatoxin inhibits RNA polymerase II. (aMatoxin inhibits mRNA. Ricin inhibits rRNA.)

Question 73

Differentiate erosions and ulcers.

Answer 73

*  Erosions: more superficial; less bleeding; extends through the mucosa and into the muscularis mucosa *  Ulcers: deeper; more bleeding; extends into the submucosa (where the arteries are) ("Ulcers are Under the SUBmucosa like SUBmarines are Under the sea.")

Question 74

Describe the pathogenesis of tachyphylaxis.

Answer 74

Tachyphylaxis is the process by which excessive use of nasal decongestants leads to relative vasodilation. This occurs because nerve terminals down-regulate norepinephrine in response to excess alpha-adrenergic agonist release. With decreased levels of norepinephrine in the nasal mucosa, the blood vessels dilate. Note: this can also happen with nitroglycerine for angina.

Question 75

What is linkage disequilibrium?

Answer 75

Normally, separate alleles should be inherited at random. In some cases, however, alleles are more likely to stick together in gametogenesis; this process is called linkage disequilibrium. Example: x is found in 10% of the gametes and y is found in 10% of the gametes but xy is found in 6% of the gametes (when you'd expect only 1%).

Question 76

What is heteroplasmy?

Answer 76

Finding different genes in the nucleus and the mitochondria

Question 77

Describe the areas that the left gastric, right gastric, and the gastroepiploic arteries feed.

Answer 77

The left and right gastric arteries supply the lesser curvature and the gastroepiploic arteries (from the splenic artery and the gastroduodenal artery) supply the greater curvature.

Question 78

Most ulcers arise in the area where the ___________ (superiorly) meets the ______________ (inferiorly).

Answer 78

gastric acid producing epithelium; gastrin-producing epithelium (of the antrum)

Question 79

What is the most sensitive test for malabsorption?

Answer 79

Fats are typically the first nutrient affected in malabsorption, so a Sudan fat stain is the most sensitive test – even more so than intestinal biopsy.

Question 80

What's the difference between DNA polymerase I and III?

Answer 80

*  III just goes 5' to 3' (for leading strand replication) | * I can go 5' to 3' and also has 5' to 3' exonuclease activity to remove the pr1mer (get it?)

Question 81

True or false: primase removes primers.

Answer 81

False. It synthesizes primers.

Question 82

In general, you cannot share patient information with friends or family without permission from the patient. What is an exception to this rule?

Answer 82

If the patient is incapacitated (e.g., in surgery, unconscious) and the other individual is wondering if the patient is alive. Example: a woman tells you she is Bob's wife. Bob has been in a bad accident and is in surgery. You can inform her that Bob is alive but that she'll have to verify that she is his wife before you can share specifics.

Question 83

The right renal artery passes _____________ to the IVC.

Answer 83

posterior

Question 84

The primary defect in tetralogy of Fallot is _____________.

Answer 84

anterior/superior deviation of the infundibular septum | "anterior displacement of the inFUNdibular septum makes your pulmonary artery as narrow as a FUNnel."

Question 85

Say you've got an adolescent who has signs of long-term cyanosis. In the clinical history, how might you be able to distinguish between TOF and VSD?

Answer 85

TOF will present with cyanotic episodes that started at birth, while VSD will usually be asymptomatic until the left-to-right shunt becomes a right-to-left shunt.

Question 86

Which are typically deeper into the gastric mucosa, the parietal cells or the chief cells?

Answer 86

Chief cells | "The Parietal cells are suPerficial. The CHief cells are as deep as the CHallenger."

Question 87

What does glucagon do that helps correct beta-blocker overdose?

Answer 87

It raises intracellular calcium.

Question 88

Remember that filtration fraction (FF) is a dependent variable, so if you decrease renal blood flow (with, say, angiotensin II) then ______________.

Answer 88

FF will increase (as will GFR)

Question 89

Which anticoagulant is indicated in the treatment of TIA?

Answer 89

COX inhibitors

Question 90

Looking at a graph of pressures of the heart and great vessels, what is the classic sign of aortic stenosis?

Answer 90

A large pressure gradient between the left ventricle and the aorta Normally, the pressure should be very close between the LV and the aorta.

Question 91

What kind of anemia might present with constipation?

Answer 91

Lead poisoning

Question 92

True or false: the anemia found in liver disease is most often microcytic.

Answer 92

False. It is usually normocytic.

Question 93

What clinical sign distinguishes PDA from the other congenital cardiac defects that may cause cyanosis?

Answer 93

PDAs are distal to the left subclavian artery, so highly oxygenated blood is delivered to the upper extremities. As such, Eisenmenger's syndrome from a PDA will usually have worse clubbing on the lower extremities.

Question 94

Which of the sulfonylureas is shortest acting?

Answer 94

Glipizide (it's the ZIg-zagging baby swan that moves so fast!)

Question 95

Aortic regurgitation can lead to _______-centric hypertrophy.

Answer 95

ec (expanding diameter – get it? – DCM)