Q Banks: Week of 03/27/17 Flashcards
A question describes a young girl with aplastic anemia. How could you decide whether the etiology is idiopathic or related to a previous Parvovirus infection?
Parvovirus infection only causes aplastic anemia in those with underlying hematologic issues such as sickle cell (remember the USSR sickle on the plane bombing the bone in the Sketchy scene!). Thus, if the girl has no known hematologic problems, then the cause is likely idiopathic.
Genetic absence of ____________ leads to inability to digest proteins or fats.
enteropeptidase
This enzyme cleaves trypsin and initiates the enzymatic cascade. Thus, without it none of the pancreatic enzymes would be activated.
Hydatid cysts present with what kind of capsule?
“Eggshell” calcifications (like the egg award in the Sketchy scene)
The locus ceruleus secretes _____________ to maintain alertness.
norepinephrine
The red nucleus is a go-between for the _________________.
cerebellum and cortex; it helps to coordinate movement
The nucleus of Meynert is involved in which disease?
Alzheimer’s
Just think that your MEmorY will be iNERT if you don’t have acetylcholine from your MEYNERT nucleus.
Which nuclei do SSRIs target?
The nuclei of Raphe in the brainstem
Remember that RAPHaEl was the most depressed TNMT, so of course you’d want a drug to target the nucleus of Raphe.
In a CT at the level of the heart, what structure is immediately posterior to the SVC?
The arch of the azygos vein
If a male has an exceptionally full bladder, you may see the bladder on a CT in which location?
Anterior to the prostate!
Why do PPIs cause osteoporosis?
Calcium absorption requires an acid environment in the stomach
Why do antiepileptics cause fractures?
Phenytoin and carbamazepine upregulate CYP450 which degrades vitamin D.
Where are pudendal nerve blocks supposed to be injected?
Medial to the sacrospinous ligament (near the sacral ganglia)
In those with CF, more ___________ is absorbed by the respiratory epithelium.
sodium
Without being able to secrete chloride, the transmembrane potential is much more negative. Thus, sodium in the mucus is pulled in. This makes the mucus even thicker.
When does multicystic dysplastic kidney present?
At birth
List three types of non-neoplastic polyps.
- Hyperplastic
- Lymphoid (bulges caused by underlying lymph proliferation)
- Hamartomatous
Important: hyperplastic polyps DO NOT carry risk of malignant transformation!
Measles and rubella have similar presentations. How can you distinguish the two?
•Rubella:
- The rash does not coalesce. It remains as a lacy network.
- Auricular lymphadenopathy particularly common.
- Rash spreads fast
•Measles:
- Rash often coalesces to become solid (red dress in Sketchy scene).
- The C’s: conjunctivitis, coryza, cough, Koplik’s spots.
True or false: the MYC genes are tumor suppressors.
False. They are oncogenes. Remember how Burkitt lymphoma presents with amplification of MYC.
NK cells express CD16 and CD____.
56
Penicillin is structurally similar to what bacterial component?
D-ala-D-ala
This is tricky: Vancomycin binds directly to D-ala-D-ala and prevents elongation. Penicillin binds to the transpeptidase protein in the spot that would bind D-ala-D-ala and crosslink the strands.
What is uterine atony?
The most common cause of postpartum hemorrhage, uterine atony is the failure of the uterus to contract after labor. Most often it can be treated with uterine massage or agents that stimulate uterine contraction.
How is chylomicronemia different from dysbetalipoproteinemia?
- Chylomicronemia presents with elevated chylomicrons only. It results from defects in lipoprotein lipase or C-II.
- Dysbetalipoproteinemia presents with elevated chylomicrons and VLDL. It results from defective apoE.
Why, again, does C1 esterase deficiency cause edema?
Kallikrein converts kininogen to bradykinin. C1 esterase normally degrades kallikrein. Without C1 esterase, excess levels of kininogen build up.
SSPE can present with what neurologic signs?
Ataxia and myoclonus
The ototoxicity of furosemide can present as tinnitus or _____________.
hearing loss
Long-term use of NSAIDs can cause what renal complication?
NSAIDs accumulate in the renal medulla if taken chronically. They uncouple oxidative phosphorylation and cause lipid peroxidization. This leads to chronic interstitial nephritis with subsequent nephropathy and shrinking of the kidneys.
What urinalysis signs will be seen in chronic interstitial nephritis?
Nephropathy with no cells
What most often causes torticollis?
Malposition of the head in utero
Torticollis will present with a firm mass in the neck that doesn’t move with swallowing. The infant may also have plagiocephaly.
What clinical symptom might suggest that a child has T-cell ALL as opposed to B-cell ALL?
Dysphagia
In a young child, the thymus is high enough that it can impinge on the trachea and esophagus.
Describe Kussmaul sign.
Kussmaul sign is a symptom of constrictive pericarditis.
Normally, the JVP should decrease with inspiration because of increased right-ventricular filling. In constrictive pericarditis, the right ventricle cannot expand and thus JVP either doesn’t decrease or can even increase.
Patients with high levels of microsomal monooxygenase are at higher risk of _____________.
cancer from toxins
Many toxins require activation by hepatic phase I metabolism. Thus, those with high levels of microsomal monooxygenase (a CYP enzyme) will produce more toxins from polyaromatic hydrocarbons.
Describe eclampsia andpreeclampsia.
•Preeclampsia:
- new-onset hypertension after 20 weeks’ gestation
- proteinuria
•Eclampsia:
- preeclampsia
- seizures
What are risk factors for preeclampsia?
- Obesity
- Chronic hypertension
- Personal history of preeclampsia
True or false: fibrinous pericarditis five days after an MI is an autoimmune disorder.
False.
There are two kinds of fibrinous pericarditis:
- Within one week of an MI, the pericardium can react to the transmural necrosis of the myocardium and secrete fibrin. This is a normal immune response to necrotic tissue.
- One week to a few months after an MI, immune cells can react to necrotic myocardium and cause pericardial effusion and diffuse inflammation of the pericardium
Note: one clinical symptom that suggests the first situation is localized pain. For example, pain in the neck with inspiration suggests inferior MI fibrinous pericarditis.
Expanding abscesses within bone can cause __________ disruption.
periosteal
Sorbitol is converted to ____________.
fructose by sorbitol dehydrogenase
Which enzyme makes sorbitol?
Aldose reductase
This is another method by which hyperglycemia damages tissues. Saturation of glucose leads to overactivity of aldose reductase. Aldose reductase uses NADPH and thus makes the cell more vulnerable to oxidative injury.
Which type of hydatidiform mole is more hyperplastic?
Complete mole
They are COMPLETELY hyperplastic.
Mycobacteria that do not have _____________ are not virulent.
cord factor (which makes them appear serpiginous)
Cord factor is also called trehalose.
How soon do myocytes stop contracting after an MI?
Within 60 seconds
Note: irreversible cell injury occurs within about 30 minutes.
Regardless of hydration status, the ______________ part of the nephron absorbs the most water.
PCT
What pH disturbance can cause uric acid kidney stones?
Contraction alkalosis
In this disturbance, the kidneys excrete more H+. As such, the collecting duct becomes acidic. This promotes the protonation of uric acid which removes the charge and makes stones more likely to form.
What is the proper course of action in a situation where a parent wants to take their child home when not receiving care could be fatal for the child?
Obtain a court order to hospitalize the child against the parent’s will.
Lactobacilli are Gram-_______________.
positive
Which alpha-hemolytic is bile-insoluble?
S. viridans (the boots mean insoluble in the Sketchy scene)
This conversely means the S. pneumoniae is bile-soluble.
A woman with sickle cell trait presents with abrupt hematuria. What likely caused this?
Renal papillary necrosis
People with sickle cell disease or trait can have infarction of the distal two-thirds of the renal pyramids. This produces hematuria in the absence of flank pain.
It’s possible to have an ASD that is _____________.
asymptomatic for years
List the cytokines and cell types involved in the development of granulomas.
- Th1: secretes IL-2 to activate more Th1 cells and IFN-gamma to activate macrophages
- Macrophages: forms granuloma
In a pressure-volume loop, arteriovenous fistulas will present with _______________.
increased end-diastolic volume with subsequent increase in stroke volume; also, systolic opening pressure may be less due to the loss of arteriolar resistance
Which two vasculitis disorders can have GI involvement?
Polyarteritis nodosa and Henoch-Scholein purpura
“Poopyarteritis nodosa and Henoch-Shitlein purpura”
True or false: ANCA will be positive in those with polyarteritis nodosa.
False.
Which kind of lymphoma has a waxing/waning presentation?
Follicular (again, like the Fases of the moon)
Think of the Renaissance-fighting pirates on a ship that’s under a waning moon.
Histologic examination of follicular lymphoma will present with what signs?
Splitting/cleavage of the nuclei
Most anal fissures present on the _______________ side of the rectum.
posterior
Anal fissures typically happen in the context of constipation. With repetitive straining, the rectal arteries have less perfusion. The posterior rectum is a watershed area and is more likely to weaken from poor perfusion.
Anti-snRNA antibodies, which are highly specific to lupus, are also called ________________.
anti-Smith antibodies
Describe lichen planus.
The five P’s:
- polygonal
- pruritic
- purple
- planar
- plaques
Associated with hepatitis C and often seen on the wrist.
True or false: seborrheic keratoses are always yellow.
False. They can be yellow, but they can also be brown or tan.
Key features are well-demarcated border, stuck-on appearance, and often velvety look.
What is the Leser-Trelat sign?
Sudden appearance of seborrheic keratoses can portend underlying cancer.
Not describing the actual moves, what increases the sound of HOCM murmurs?
Decreased preload (think about it: Valsalva, standing, NO)
The sustained hand grip maneuver does what?
Increases afterload
Describe Wallerian degeneration.
Severing the axon leads to cell swelling, nucleus being pushed to the periphery, and Nissl degeneration.
Explain the mechanism of ivabradine.
Ivabradine is an I(funny) channel inhibitor that leads to the selective slowing of the heart rate. It only affects the phase 4 outward current and not contractility.
(Think IVabradINe = I(vunny) INhibitor)
Describe the appearance of atypical lymphocytes.
Large lymphocytes with pale cytoplasm and a basophilic rim
List two side effects associated with raloxifene.
- DVT
* Hot flashes
These features are all common in fragile X syndrome: •Macroorchidism •Long face •Prominent ears •Prominent mandible •Neuropsychiatric disturbance •\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Hyperlaxity of the finger and thumb joints
Describe these possible outcomes of GERD:
•Ulceration
•Stricture
- Ulceration: sudden onset odynophagia; dysphagia to solids
* Stricture: dysphagia to solids; less painful
How can vertical transmission of HIV be prevented?
- Standard HAART for pregnant women –regardless of CD4 count
- Zidovudine for neonates
True or false: opiates can cause hypertension.
False. They cause hypotension (and bradycardia)>
Describe the stomach cancer that presents with signet rings.
- Diffuse-type adenocarcinoma (as opposed to the intestinal type)
- Typically does not form glands
- Often spread out into the stomach wall and make the “leather-bottle stomach” sign (medically called linitis plastica)
- Do not project into the lumen (adenocarcinoma does this)
- IS NOT GIST
- When it invades the ovaries, diffuse adenocarcinoma is called Krukenberg tumor
Final point: intestinal adenocarcinoma often ulcerates and causes bleeding, whereas diffuse-type does not.
Rugal thickening is a characteristic of which gastric malady?
Zollinger-Ellison syndrome
Remember that ACTH-secreting adenomas cause hyper-_____________ of the adrenal cortex.
plasia
The JAK mutation that leads to polycythemia vera causes what cellular process?
Increased sensitivity to bone-marrow-stimulating factors
Spongiosa filling the medulla is characteristic of which disease?
Osteopetrosis
In healthy individuals, the spongy bone that protrudes into the medulla will be resorbed and that space will be filled in by bone marrow. In those with osteopetrosis, the new bone cannot be resorbed.
Describe the utility of the cosyntropin and metyrapone tests.
If you have a patient that presents with suspected adrenal insufficiency, you can do these tests to decide where in the pathway the defect lies.
coSYNtropin is SYNthetic ACTH. Thus, it will stimulate cortisol production. If someone’s cortisol does not rise in response to cosyntropin, then you know their adrenal glands aren’t working.
Metyrapone inhibits the last step in cortisol synthesis. Thus, if you give this then their ACTH levels should rise (provided their hypothalamus and pituitary are working). If their 11-deoxycortisol rises after being given metyrapone, then you know they are able to make ACTH. (meTYRapone TYRranizes cortisol.)
What’s the difference between myoclonus and dystonia?
Dystonia is sustained while myoclonus is brief.
ANOVA is basically the ____________ test for more than two groups.
T test
The _____________ test is essentially the chi square test for very small populations (like, less than 10 participants).
Fischer exact test
It is also used to compare categorical data.
What does the power of a study (1 –ß) mean in words?
It is the probability that the study will show a difference/association when there really is one.
_______________ results from a defect in a protein that repairs crosslinked DNA.
Fanconi anemia
Phenylephrine ____________ pulse pressure.
decreases
The increased peripheral resistance leads to reflexive decrease in stroke volume which lowers pulse pressure.
Describe pyruvate dehydrogenase deficiency.
PDH deficiency is an autosomal recessive disease. Because pyruvate cannot be converted to acetyl-CoA, all of the pyruvate generated from glycolysis leads to lactic acid metabolism. As such, these individuals need to have extreme glucose restriction with ketogenic diets. This prevents excess gluconeogenesis and subsequent acidosis.
They thus need to be given diets rich in leucine and lysine which are the only two amino acids which are strictly ketogenic.
Which are the ketogenic and gluconeogenic/ketogenic amino acids?
Those that are both can be remembered as PITTT: •Phenylalanine •Isoleucine •Tryptophan • Tyrosine • Threonine
Those that are strictly ketogenic are LL (“they’re LoneLy):
•Leucine
•Lysine
Describe the sensory areas supplied by the iliohypogastric and ilioinguinal nerves.
- Iliohypogastric: suprapubic area and lower abdomen (can be severed in appendectomy)
- Ilioinguinal: external genitalia and medial thigh
What mechanism accounts for the increased risk of gallstones in pregnancy?
- Estrogen increases the production of cholesterol.
* Progesterone slows the motility of the gallbladder.
Severe retroorbital pain is a common finding in which zoonotic bacterial infection?
Coxiella
All of the following can cause schistocytosis: •Hemolytic uremic syndrome •Thrombotic thrombocytopenic purpura •DIC •\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
Mechanical trauma from prosthetic devices (particularly artificial valves)
The superior mesenteric artery passes over which two anatomical structures that are bounded posteriorly by the abdominal aorta?
- Left renal vein
- Transverse portion of the duodenum
Note: Rapid weight loss can decrease the mesenteric fat and cause pinching of the transverse duodenum.
Overexpression of ___________ is associated with aggressive breast cancer.
HER2
Note: Overexpression of estrogen and progesterone are associated with improved outcomes.
Children exposed to secondhand smoke are at increased risk for the following: ________________.
- Asthma
- URIs
- Poor growth
- SIDS
- OM
What respiratory pathologies are associated with each of the following exposures? •Asbestos •Beryllium •Silica •Organic dust •Coal dust
- Asbestos: pleural plaques, mesothelioma, and bronchogenic carcinoma; look for ferruginous bodies on Prussian blue staining
- Beryllium: granulomatous lung disease
- Silica: upper lung nodules with hilar calcifications; look for birefringent particles on examination (think of a bunch of blue and yellow sand beaches)
- Organic dust: hypersensitivity pneumonitis with granulomas
- Coal dust: lower lobe infiltrations with coal-laden macrophages
Alpha toxin (found in C. perfringens) is also called _____________.
lecithinase or phospholipase C
Pasteurella multocida is said to have a __________ odor.
“mousy”
This comes from being indole-positive.
Anti-Jo-1 antibodies (found in both polymyositis and dermatomyositis) attack which molecule?
Histidyl-tRNA synthetase
Don’t forget that IL-2 also stimulates __________ cells.
NK, B, and monocyte
The mechanism behind Curling ulcers is the same as that in _______________.
trauma and hypovolemic states (decreased perfusion)
In addition to vascular proliferation, Kaposi’s sarcoma will also show _____________ on histologic examination.
spindle cells
Keep in mind that this is a sarcoma –a proliferation of mesenchymal cells.
What will CMV colitis look like on a colonoscopy?
Multiple ulcerations and erosions
This is distinct from ulcerative colitis because UC is contiguous.
Other than cardiac anomalies, long QT syndrome often presents with symptoms in what other system?
Hearing!
The potassium channels needed in the heart are also seen in the endolymph. Lange-Nielsen presents with defects in both these ares (heart and ear).
Describe the pathogenesis of main bronchus obstruction.
If one of the bronchi is completely obstructed, such as from a central lung tumor, then no air is getting to the lung. Over time, the air that was trapped in the alveoli will get replaced with blood as the lungs collapse into total atelectasis.
The absence of radiolucent air will show up on x-ray as a total whiteout of the lungs. Furthermore, the atelectasis can pull the trachea toward the affected side (also visible on x-ray).
Think of this diagnosis if you see an x-ray that shows remarkable opacity in a person WITHOUT A FEVER!
How can you differentiate massive unilateral pleural effusion from bronchus occlusion in an x-ray that shows complete opacity of one lung?
Bronchus occlusion will lead to tracheal deviation TOWARD the affected lung because of atelectasis, whereas massive pleural effusion would lead to tracheal deviation AWAY from the affected lung.
Neuroendocrine tumors often express _____________ adhesion molecule.
neural cell (because neural crest cells are the helper cells of the neurons)
They can also express chromogranin, synaptophysin, and enolase.
What hematologic disorder can cause falsely low A1cs in a diabetic?
Beta-thalassemia trait
To correct for this, A2c is often used (alpha-delta hemoglobin).
The ____________ test makes fat particles black.
osmium tetraoxide
Describe the three phases of acute tubular necrosis.
- Initial phase: often silent as the main injury predominates (such as blood loss, etc.)
- Maintenance phase (1 day to 1 week): oliguria with consequent hyperkalemia, hyperphosphatemia, metabolic acidosis, decreased sodium and calcium
- Recovery phase (1 to 2 weeks): rapid diuresis –from the pent up need to excrete fluids –leads to hypokalemia
All of the drugs that make uric acid more soluble end in ______________.
-icase (pegloticase, rasburicase)
The external carotid artery splits into the _______________.
maxillary artery and the superficial temporal artery
The middle meningeal artery branches off of the ______________ artery.
maxillary (a branch of the external carotid)
What is the mechanism of alcoholic steatosis?
Increased NADH leads to decreased fatty acid oxidation.
Arthralgias, hepatomegaly, and thrombocytopenia after a trip to Mexico suggests ______________.
Dengue fever
Another classic sign is retro-orbital pain.
________________ dramatically increases the rate of symptom progression in those with alpha-1 antitrypsin deficiency.
Smoking
What is unique about the vertebral venous plexus?
It is a valveless system that allows for a buffering zone for increased intracranial pressure.
What genetic disease presents with bone pain and pancytopenia?
Gaucher
Aortic rupture and dissection most commonly occur at what point in the upper aorta (you’ve missed this question twice, so remember!)?
Near the left subclavian
This site is where the ligamentum arteriosum attaches. Rapid translational movement can produce shearing forces that tear the aorta here (such as in a car accident).
What drug causes nasal hypoplasia in fetuses?
Warfarin
How should physicians respond to patients saying that they take herbal supplements found on the internet?
Educate them that supplements may have risks and are unregulated.
What is the main function of the IgA-cleaving enzyme that many bacteria secrete?
It helps them colonize mucosal surfaces! Think about it: IgA is normally found on mucous membranes and prevents bacteria from binding because the IgA binds to pili. If all the IgA is destroyed, then the bacteria can colonize.
Which parts of the tubule will be injured in acute ischemic necrosis of the kidney?
This answer has two parts:
- The renal medulla is less perfused than the cortex, so all structures that are deeper in the kidney will be more affected.
- The parts of the kidney that are most metabolically active will be the most affected, so the PCT and thick ascending limb will be the most damaged. (Less metabolically active parts –like the descending limb and the collecting duct –will be spared.)
Which murmur is heard best when the patient is sitting up and breathing out?
Aortic regurgitation
Describe how a pressure tracing will show in aortic regurgitation.
The aortic pressure line will drop much more than would in a normal person.
Which nerve are you massaging in a carotid neck rub?
The glossopharyngeal
Massaging this can lead to g-LOSS-OF blood pressure.
What is the psychological concept of identification?
Modeling one’s behavior after a figure perceived to be powerful
How does senile amyloidosis appear in the heart?
As varying areas of light pink mingled in with the normal darker pink of myocytes
Which disappears first in erythrocytes, ribosomes or the nucles?
The nucleus
Erythrocytes in the blood may be blue on Wright-Giemsa staining due to the presence of ribosomes.
HBV and HCV can lead to similar histologic presentations. What’s a key feature of HBV, though?
Ground-glass, eosinophilic opacities in the cytoplasm
This represents the HBsAg accumulation in the cytoplasm. It is not found in HCV infection.
S. bovis is associated with ____________.
colon cancer
BOvis BOwels.
____________ presents with high inhibin and b-hCG.
Trisomy 21
Also, low AFP and estradiol.
____________ bonds determine secondary protein structure.
Hydrogen
Where is the least oxygenated blood in the body found?
In the coronary sinus
The myocardium has the highest oxygen extraction of any organ. Thus, the coronary sinus has the lowest levels of oxygen. This is why vasodilation is needed to deliver more oxygen to the heart.
What virulence factor accounts for the increased risk of Salmonella osteomyelitis in sickle cell patients?
The capsule
Salmonella’s capsule is antiphagocytic (just like how the birds couldn’t eat the salmon because it was covered with the glass case). This is how Salmonella can survive encounters with macrophages and then invade them.
True or false: multinucleated giant cells have high phagocytic ability.
False. They are not great at phagocytosing bacteria and it’s thought that these cells allow Mycobacteria to survive.
The muscle innervated by the thoracodorsal nerve does what to the arm?
Internal rotation, extension, and adduction
This is the latissimus dorsi.
What process leads to calcification of the aortic valve in healthy, aging adults?
Dystrophic calcification
What signs are suggestive of right coronary infarctions?
- Bradycardia (due to ischemic damage to the SA node)
* ST elevation in II, III, and aVF
In questions that ask “what should the physician say?”, look for __________________.
the most open-ended, least judgemental statement
Small cell carcinoma of the lung can lead to two paraneoplastic conditions: __________________.
- SIADH
* ACTH-dependent Cushing’s
The nerve that innervates the trapezius also innervates the ________________.
sternoclediomastoid
Yawning and lacrimation are signs of _______________ withdrawal.
opiate
What normally prevents NF-kB from initiating transcription?
IkB (Inhibitor of kappa-B)
Normally, IkB binds NFkB and inhibits it from moving to the nucleus. Inflammatory signals or growth signals stimulate IkB kinase to phosphorylate IkB. Phosphorylation causes it to be ubiquitinated and degraded, thus freeing NF-kB to transcribe genes.
True or false: injecting botox into a muscle will cause it to become permanently paralyzed.
False. Peripheral axons can regrow, so botox injections are temporary.
Which bacterium have intracellular polyphosphate granules?
C. diphtheriae
Glioblastoma presents with central necrosis and _____________.
hemorrhage
Explain DRESS syndrome.
Drug-induced eosinophilia with systemic symptoms (DRESS) is a known adverse effect of the following drugs: vancomycin, phenytoin, carbamazepine, allopurinol, and sulfonamides. It presents with diffuse rash, eosinophilia, and a wide range of systemic symptoms such as hepatitis, renal failure, and cough.
What treatment is recommended for those with asthma-induced candidiasis?
Nystatin swishes
True or false: bands indicate AML.
False. Blasts indicate AML.
In a person with elevated bands and neutrophil count over 50,000, fever and leukemoid reaction are likely the cause.
Osteogenesis imperfecta is caused by defective _________________ formation.
bone matrix
Describe Buerger disease.
Buerger disease is a vasculitis that results from a hypersensitivity to tobacco. It primarily affects the distal extremity arteries and can lead to ulcers of the fingers and toes. Uniquely, the inflammation can invade nerves and become quite painful.
It is also called thromboangiitis obliterans.
Myxomas are known to produce what two proteins?
- VEGF (leading to vascularization)
* IL-6 (leading to constitutional symptoms)
Pituitary hemorrhage is referred to as _______________.
apoplexy
What is the only organ that undergoes hypertrophy in response to glucocrticoid therapy?
Liver (glycogenolysis and gluconeogenesis)
A young child presents with non-salt-wasting CAH. How can you treat him?
Give low doses of glucocorticoids
In those with CAH, the low cortisol levels stimulate ACTH. The ACTH then stimulates all three layers of the adrenal cortex, but since the only layer that works is the reticularis, then children undergo precocious virilization. As such, giving low-dose corticosteroids inhibits the release of ACTH and lessens the levels of testosterone.
What does the serositis present as in lupus?
Pleuritis, pericarditis, or peritonitis –any kind of inflammation of serosal tissue
True or false: contact precautions are needed for MRSA infections.
True. They’re not, however, needed for MSSA infections.
Which extremities are adjacent to the cingulate gyrus?
Lower (legs affected by ACA infarctions)
Those with hereditary spherocytosis are at increased risk of _______________.
pigment gallstones
Which epithelium does RCC arise from?
PCT
The best way to think of this is to remember the other disorders that VHL deletions cause:
•Pheochromocytoma
•Cerebellar hemangioblastomas
• Thick blood (from RCC EPO production)
Get it?
Describe granulosa cell tumors.
- They produce estrogen and so can cause endometrial hyperplasia.
- They make Call-Exner bodies –gland-like structures with pink material inside. (“Don’t forget to CALL your GRANdma.”)
- They are often unilateral.
- The cells are cuboidal.
True or false: the Kegel exercise strengthens the external urethral sphincter.
FALSE!
Kegel’s strengthen the levator ani muscle. The levator ani helps stabilize the sphincter in response to increased abdominal pressure.
Trace the four main events in TB infection.
1) Mycobacteria infect macrophages and proliferate.
2) Infected macrophages travel to the lymph nodes and stimulate Th1 response.
3) Th1 secretes interferon and causes macrophages to become multinucleated and form granulomas.
4) Granulomas caseate and infect more macrophages.
H. ducreyi ulcers –called chancroids–often present __________________________.
with gray exudate and swollen, tender lymph nodes
True or false: brain infarctions present with non-ezymatic fat necrosis.
FALSE!
Non-enzymatic fat necrosis is a characteristic of traumatic fat necrosis. Brain necrosis is liquefactive necrosis.
Write the formula for the description “X divided by Y.”
X/Y
Chalky areas of necrosis from pancreatitis can spread to the ______________.
mesentery
Describe the pulmonary changes that occur with age.
Overall, age causes a COPD-like state but without increases in TLC.
- Residual volume increases because the lungs have decreased elastic recoil (like how your skin loses its compliance). This decreases ERV and VC, just like in COPD.
- The reason TLC doesn’t expand is because the chest wall –the ribs and cartilage –become stiffer and don’t exert as much outward force on the lungs as they would in a younger person with COPD.
Like cancer, sarcoidosis can present with _______________.
nocturnal fevers and weight loss
True or false: PSGN occurs exclusively in those younger than 20.
False.
It is more common in kids, but it can happen at any age.
Notably, adults have a much poorer outcome and more than half don’t fully recover.
Hormone-sensitive lipase is activated by _____________________.
stress hormones: glucagon, epinephrine, and ACTH
Specifically, when these hormones bind to Gs they activate PKA which then phosphorylates and activates HSL.
Lichen planus presents with what on histologic examination?
Lymphocytic infiltrate
It’s easy mix up the phenotypes of the disorders caused by these enzyme defects, so list the features.
•Tyrosinase
• Phenylalanine hydroxylase
• Dopamine hydroxylase
•Tyrosinase:
- Can’t make melanin
- Only symptom/sign is albinism
•Dopamine hydroxylase:
- Can’t make norepinephrine from dopamine
- Rare syndrome of dysautonomia (from lack of norepinephrine)
• Phenylalanine hydroxylase:
- PKU
- Musty odor, hypotonia, retardation
- Paleness in the substantia nigra and locus ceruleous from lack of dopamine
What tests assess orientation, concentration, and short-term memory?
- Orientation: AO x 4
- Concentration: serial tasks (counting backward or reciting the months of the year backward)
- Short-term memory: 3 unrelated words after five minutes
Excess __________________ will be found in the astrocytes of those with hepatic encephalopathy.
glutamine
Which has a lower infectious particle load, Shigella or Clostridium perfringens?
Shigella –it is one of the most infectious GI bugs
This is kind of a funny question, but of all the torsades-causing drugs, which one has the lowest likelihood of causing torsades?
Amiodarone
A person presents having a panic attack. What are the next two steps in helping them?
- Immediate: benzodiazepine (if they are acutely panicking)
* Long-term: SSRI and CBT
Patients with trigeminal nerve dysfunction will have loss of sensation and what two other symptoms?
- Motor: loss of muscles of mastication
* Otologic: jaw clicking or noise complaint while eating (tensor tympani)
The type of nodule found in syphilis primarily depends on _________________________.
the stage
For instance, primary syphilis has chancres, secondary has condyloma lata, and tertiary has gummas. This is particularly important in differentiating chancres from gummas because gummas can ulcerate and are also painless.
Gallstone risk increases with ____________________ phosphatidylcholine.
decreased
Phosphatidylcholine is an amphipathic molecule that helps dissolve cholesterol.
