RANDOM BOARD REVIEW

Question 1

CD55, CD59 should make you think of this particular blood d/o. What are the triad that this d/o commonly presents with?

Answer 1

Paroxysmal Nocturnal hemoglobinuria (PNH)

ø CD55/CD59 prevents complement from inactivating -> complement stays activated -> hemolysis

hemolytic anemia

hypercoagulable state (thrombosis on imaging)

decreased blood counts (leukopenia + thrombocytopenia)

Question 2

location of carnitine acyltransferase II

Answer 2

inner-mitochondrial matrix

Question 3

patient w/ thyroid w/ mixed, cellular infiltration w/ multi-nucleated giant cells

Answer 3

sub-acute thyroiditis “de Quervain’s thyroiditis” aka granulomatous thyroiditis - usually due to viral infection of the thyroid; starts off w/ brief thyrotoxic phase followed by transient hypothyroidism.

Painful, tender thyroid

Question 4

cola-colored urine following a URI + renal biopsy of the mesangium showing darkened areas of deposits

cola-colored urine following a skin infection + renal biopsy that shows granular deposits in the mesangium + BM

Answer 4

IgA nephropathy “Berger’s disease” (deposits = IgA)

Post-strep glomerulonephritis (deposits = IgG, IgM, C3)

Question 5

bug that can cause achalasia, megacolon, and megaureter, and enlarged cardiac apex

Answer 5

chaaaaaaagas disease (american trypanosomiasis)

endemic in rural areas of centra/south america

Question 6

how do you think these variables will change in a patient with lactase deficiency:

stool osmotic gap

stool pH

breath H content

Answer 6

• **stool osmotic gap - increase **due to presence of poorly absorbable contents in the colon
• pH - decrease because more lactose is delievered to the colon where it is fermented by bacteria to produce SCFA + excess H+
• breath H content - increase

Question 7

3yo M presents with arm held close to the body w/ elbow extended and forearm pronated; is in minimal distress until attempts are made to move the elbow. No other problems are noted

What happened to get the child in this?

how to reduce this?

Answer 7

radial head subluxation “nursemaid’s elbow”

occurs when there is a sharp pull on the hand while the forearm is pronated and the elbow extended, which causes the annular ligament to slip over the head of the radius and slide into the radiohumeral joint, where it becomes trapped

reduce: fully supinating the arm, followed by full flexion of the elbow

Question 8

how do these factors change with Glanzmann thrombasthenia

Platelet Count

Bleeding time

PT

PTT

ristocetin response

Answer 8

Platelet Count = NC

Bleeding time = increase

PT = NC

PTT = NC

ristocetin = normal

Question 9

common sx of TTP/HUS in adults vs kids

trmt?

Answer 9

pentad: neurologic ∆’s, renal failure, fever, thrombocytopenia, and microantiopathic hemolytic anemia
adults: mostly neurological ∆s
kids: mostly renal ∆s
trmt: plasmapheresis

Question 10

Patient comes in complaining of a sensory deficit (green). What is the nerve injury and accompanying motor deficits? What is usually the cause of injury?

Answer 10

Femoral n. (L2-L4)

∆ thigh flexion, leg extension (ie difficulty w/ stairs, frequent falling due to knees buckeling, diminished patellar reflex)

usually due to mass (hematoma) involving iliopsoas or iliacus muscles, since the femoral n. travels through the psoas major m. and emerges laterally btwn the psoas and iliacus m. and runs down the inguinal ligament into the thigh

Question 11

patient comes in with this has what d/o? how do yout ell?

inheritance pattern of this d/o?

Answer 11

NF-1

• cutaneous neurofibromas - fleshy, dome-shaped, pedunculated
• cafe-au lait spots (hyperpigmention)

AD

Question 12

Medial malleolus

what runs anterior to it? posterior to it?

Answer 12

anterior: saphenous n. + great saphenous v

posterior: posterior tibial a., tibial n., flexor digitorum longus, flexor hallucis longus, tibialis posterior

Question 13

buzzword: polymyalgia rheumatica

Answer 13

Temporal arteritis (increased ESR)

Question 14

∆ btwn sampling and selection bias?

Answer 14

• sampling bias = type of selection bias that occurs due to non-random sampling of a target population
• selection bias (attrition bias) = loss to follow-up; usually a problem in prospective studies because

Question 15

absence seizure

description (post-ictal state)?

first line treatment?

Answer 15

brief episodes of staring, ø post-ictal confusion

ethosuximide

valproate

Question 16

diagnosis?

Answer 16

Malassezia furfur - spaghetti and meatballs appearance on LM

Question 17

tetralogy of fallot

caused by abnormal development of?

what determines the severity of symptoms?

how do these patients usually present?

Answer 17

neural crest cell migration through the primitive truncus arteriosus and bulbus cordis

degree of RV outflow tract obstruction (pulmonic stenosis) - the more severe it is, the more blood will flow from RV -> LV across the VSD and cause cyanosis

infants: cyanosis that worsens w/ feeding, crying, or exercis

older children: squatting to improve pulmonary blood flow

Question 18

how do these factors change with TTP-HUS d/o?

Platelet Count

Bleeding time

PT

PTT

plasma fibrinogen levels

smear

Answer 18

Platelet Count = decrease

Bleeding time = increase

PT = NC

PTT = NC

plasma fibrinogen levels = normal

smear = RBC fragmentation

Question 19

unilocular cystic mass w/ clear fluid in ovaries; cyst wall covered w/ papillary outgrowths

dx?

Answer 19

serous cystadenocarcinoma - thin-walled, lined with fallopian-like epithelium

Question 20

what is the lecithin-sphingomyelin ratio indicative of?

when and why does this ratio increase?

Answer 20

fetal lung maturity

^{note that lecithin is also known as phosphatidylcholine}

>1.9 = indicative of mature fetal lungs, usually at ~32-32wks gestation; Lecithin increases sharply while sphingomyelin is unchanged; increases are due to cortisol

^{<em>(due to ACTH/CRH from fetal pituitary and placenta; CRH secretion from the placenta is also upregulated by cortisol)</em>}

Question 21

ectopic pregnancies are generally treated with…

Answer 21

MTX - folate antagonist that ultimately inhibits trophoblast division

Question 22

muscle rigidity is observed in experimental animal with chemically destroyed dopaminergic neruons of the substantia nigra, but the rigidity fails to improve w/ continuous dopamine infusion. Why?

Answer 22

BBB (tight junctions = zonula occludens), duh

Question 23

“ballooning degeneration” is indicative of

Answer 23

acute viral hepatitis

Question 24

reducing substance in urine that is not glucose

Answer 24

fructose - fructokinase deficiency (AR, benign, asymptomatic condition)

Question 25

HTN Rx to avoid if you're also hypoparathyroid

Answer 25

loop diuretics bc they decrease blood Ca levels.

Question 26

what exits the formaen ovale

Answer 26

v3 - provides sensory + motor innervation to muscles of mastication and the muscles that open the jaw

Question 27

what is a compression lesion that can result in 3rd nerve palsy? what is an ischemic process that can also result in 3rd nerve palsy?

Answer 27

**compression:** aneurysm of R _posterior cerebral artery_ (remember that it courses between this and the _superior cerebellar arteries_ as it leaves the midbrain) **ischemic:** diabetes afftects ipsilateral eye

Question 28

HBV antigen that correlates w/ viral replication

Answer 28

HB**c**Ag, HB**e**Ag

Question 29

of these, which one is resistant to outliers? mean mode standard deviation variance range

Answer 29

mode

Question 30

how do you calculate GFR?

Answer 30

calculated using **creatinine** or **inulin** clearance, or the Starling equation ## Footnote **Clearance = (Urine Conc \* Urine Flow Rate ) / plasma conc.**

Question 31

patient suspected of malaria has enlarged erythrocytes containing punctate granulations + oval bodies. Which malaria subtype?

Answer 31

plasmodium vivax or ovale

Question 32

newborn with scrotal sac w/o palpable testes, enlarged phallus w/o the normal appearance of a penis. Urogenital sinus is present. CT shows 2 normal sized ovaries. Karytotype is 46 + barr body

Answer 32

21 - hydroxylase deficiency -\> ø cortisol, ø aldosterone, but increased androgen production (which control the external genital differentiation) -\> F fetus will be masculinized (ie labial fusion, phallic enlargement, urogenital sinus) karyotype = genetically F (barr body = inactivated X chromosome, which only happens in females) ø SRY = Mullerian develops into uterus, fallopian tubes, ovaries

Question 33

pathogenicity of H influenza

Answer 33

anti-phagocytic capsule Type B is most invasive - made w/ polyribitol phosphate

Question 34

Which one does this graph represent? (choose one) Aortic insufficiency Aortic Stenosis Mitral Stenosis Mitral regurgitation

Answer 34

mitral regurgitation

Question 35

Eaton Lambert Syndrome is a paraneoplastic syndrome of....

Answer 35

small cell carcinoma of the lung forms autoantibodies that react w/ PRE-synaptic Ca channels and hamper the release of ACh

Question 36

nerve that passes the **lateral** epicondyle of the humerus? **medial** epicondyle?

Answer 36

lateral: radial medial: ulnar

Question 37

baby w/ subdural hematoma + bilateral retinal hemorrahages

Answer 37

shaken baby syndrome - results in tearing of bridging veins -\> subdural hematoma

Question 38

if angle btwn SMA and aorta is decreased, what structures are going to be obstructed by the artery?

Answer 38

**transverse** portion of duodenum -\> partial intestinal obstruction

Question 39

oxaloacete reacts with glutamate to form aspartatey. What cofactor is required?

Answer 39

**B6 - pyridoxine** - cofactor for **transamination** + decarboxylation of a.a., gluconeogenesis transamination rxns occur btwn **amino acid and a-ketoacid**: the amino group is transferred from the a.a to the a-ketoacid, which becomes an a.a. key to this question is to know that oxaloacetate (a-ketoacid) reacts w/ glutamate (a.a.) --\> aspartate (resulting a.a.) + a-ketoglutarate (resulting a-ketoacid)

Question 40

dx + complication?

Answer 40

**bicornuate uterus** * congenital malformation taht results in an abnormal Y shaped uterine cavity * complication: recurrent **spontaneous abortions, esp. in the 2nd trimester**, because it results in defective placental implantation

Question 41

patients with allergic bronchopulmonary aspergillosis (ABPA) have very high serum levels of what?

Answer 41

**serum IgE** **eosinophilia** **IgE + IgG antibodies against aspergillus** causes intense airway inflammations + mucus pluggings w/ remission + exacerbations; repeated exacerbations -\> transient **pulmonary infiltrates** + **proximal bronchiectasis**

Question 42

34M, tall/slender w/ disproportionately long arms and legs has flesh colored nodules on lips and tongue. underwent tyroidectomy a few years ago. dx?

Answer 42

MEN2B - marfanoid habitus + mucosal neuromas + thyroidectomy (suggests hx of MTC)

Question 43

17yo girl is troubled by her sexual dreams and tells her friends that she is going to become a nun.

Answer 43

Reaction formation - unconscious adoption of behavior opposite to that which owuld reflect true feelings and intentions

Question 44

How does the etiology of hepatic absesses differ between developed countries vs developing countries?

Answer 44

developed countries - 2˚ to bacterial infection (S. aureus) developing countries - 2˚ to parasitic infection (amebic or echinococcal)

Question 45

demeclocycline

Answer 45

ADH antagonist

Question 46

to make the diagnosis of hirschsprung's disease, where should you sample? mucosa or submucosa or muscular layer dilated or narrow part

Answer 46

submucosa of the narrow part - the disease is due to failure of the neural crest cells to migrate into the bowel and develop into the ganglion cells of the **submucosal (meissner)** and** myenteric (auerbach)** plexus of the bowel wall

Question 47

patient w/ thyroid that extends into the surrounding structures; hard and fixed

Answer 47

reidel's thyroiditis w/ (+) anti-thyroid peroxidase antibody titers; hard and fixed gland can simulate a malignancy

Question 48

infant w/ persistant jaundice, muscle rigidity, lethargy and seizures and kernicterus dx? trmt?

Answer 48

Crigler-Najjar ∆UGT = no bilirubin conjugation = elevated **un**conjugated hyperbilirubinemia patients have **kernicterus** (bilirubin deposition in brain) trmt: phototherapy + plasmapheresis

Question 49

why would you treat Crigler-Najjar - type II patients with phenobarbital?

Answer 49

phenobarbital increases hepatic enzyme synthesis, and may increase UDP-GT in patients with Crigler-Najjar

Question 50

patient w/ enlarged ventricles *_only_* has a problem w/ what type of cells?

Answer 50

arachnoid granulations (resorbs CSF into the venous sinuses)

Question 51

when is pulmonary vascular resistance the LOWEST?

Answer 51

at **FRC**, which occurs at the _end_ of an expiration during normal tidal volume change incr. lung volume -\> incr PVR due to longitudinal stretching of alveolar capillaries decr. lung volume -\> incr PVR due to decreased radial traction from adjacent tissues onto the large extra-alveolar vessels

Question 52

patients w/ non-coronary atherosclerotic disease are most likely to die from what disease? how about diabetes? how about chronic kidney disease

Answer 52

**cardiovascular mortality, stroke, MI**

Question 53

How do you determine RBF? RPF?

Answer 53

**RPF = PAH clearance = (urine PAH \* urine flow rate) / plasma PAH** **RBF = PAH clearance / (1-Hct)**

Question 54

how does N. Meningitidis infection occur

Answer 54

pharyngeal colonization - adheres + penetrates mucosal epithelium into the blood

Question 55

fibrous intimal thickening w/ endocardial plaques limited to the R heart what correlates with disease severity?

Answer 55

carcinoid heart dz associated with carcinoid syndrome degree of endocardial fibrosis is correlated w/ - plasma levels of **serotonin** + urinary **5-OH-indoleacetic acid** (serotonin metabolite)

Question 56

defective ossicles causes what type of hearing loss

Answer 56

condutive

Question 57

cell involved in clearing the infection in a patient with PID

Answer 57

**Th1 cells** - if it's not mentioned, assume gonococci or chlamydia. In the US - chlamydia is the most common bacterial STD; intracellular pathogens -\> elicit **Th1** lymphocyte response

Question 58

how does small cell carcinoma compare to squamous cell carcinoma of the lung compare in terms of the paraneoplastic symptoms?

Answer 58

small cell - ACTH + vasopressin + Lambert Eaton Syndrome squamous cell - PTHrP

Question 59

CMV treatment? CMV treatment in HIV patients?

Answer 59

gangciclovir - guanine nucleoside analog foscarnet - may cause nephrotoxicity, electrolyte ∆s (hypo-Mg, Ca, K)

Question 60

**status epilepticus** treatment to stop the seizures? Rx to prevent recurrence of seizures? if patient continues to seize?

Answer 60

* 1st line treatment: **Benzodiazepines (lorazepam)** - binds GABA_A channels and increases Cl conductance, thereby stabilizing the membrane from further depolarization * Prevention: **Phenytoin** - reduces ability of Na channels to recover from inactivation * continues to seize: **phenobarbital -** same MoA as benzo

Question 61

immunocompetent hosts infected w/ coccidiodes immitis can present with? what about immunocompromised hosts?

Answer 61

immunocompetent: **acute pneumonia** + **erythema nodosum** immunocompromised**: chronic progressive pneumonia, pulmonary nodules, meningitis, erythema nodosum**

Question 62

patient w/ small bowel bx w/ nests of mast cells within mucosa, pruritus, rash, flushing, and abd cramps most likely also has ...

Answer 62

gastric hypersecretion why? mast cells release **histamine** -\> parietal cell production of HCl this person has systemic mastocytosis - where mast cell proliferation occurs in the bone marow and other organs

Question 63

MoA for Rx used to treat acute asthma excerbations

Answer 63

**ß₂ (Gs) agonist** - results in **increased cAMP** in smooth mucle cells -\> bronchial smooth muscle relaxation

Question 64

IL4 function

Answer 64

stimulates growth of B cells and increases # of Th2 cells to site of inflammation (produced by Th2 cells)

Question 65

F w/ small mobile mass taht changes in size with her menstrual cycle should make you think of this breast tumor

Answer 65

**Fibroadenoma** * Small, mobile firm mass, usually in stroma * ∆s with menstrual cycle, pregnancy (due to ∆'s in estrogen) * not a precursor to breast Ca

Question 66

MEN 1 gene mutation? what does it affect?

Answer 66

MEN1 gene mutation **p**ituitary gland, **p**arathyroid gland, **p**ancreas (the 3 "P"s) (presents w/ kidney stones + stomach ulcers)

Question 67

sleeping agent that has less potential for tolerance and addiction compared to other medications

Answer 67

**Zolpidem** - binds to **GABA_A** receptor and enhances the inhibitory action of GABA in the CNS less risk of potential compared to other sleeping agents (ie Benzodiazepines such as Temazepam and estazolam) since it has a shorter half-life than these.

Question 68

eye field looks like this: where is the lesion?

Answer 68

R optic tract or optic radiation E

Question 69

Enteracept MoA

Answer 69

"decoy receptor" - TNFa-receptor molecule linked to the Fc component of IgG1, thereby sequestering TNFa w/ subsequent removal note: get PPD before initiating therapy to determine if there is latent TB

Question 70

what is the Hawthorne effect?

Answer 70

tendency of study population to affect an outcome (ie change their behavior) due to the knowledge of being studied ^{think of hawthorne as a  "hawk" that is watching their prey (study population); obviously if the prey knows thier being watched by their predator, they will modify their behavior to avoid getting caught}

Question 71

26yoM w/ single genital ulcer that is indurated and painless. What should you treat him with? What is the MoA of this Rx?

Answer 71

Patient likely has syphillis (Treponema pallidum); treat w/ Penicillin G MoA: structural analog of D-Ala-D-Ala, thereby inhibiting transpeptidase, which normally cross-links peptidoglycan cell wall formation. Weakened cell wall integrity = osmotic lysis of bacterium

Question 72

pupillary light reflex involves which 2 nerves?

Answer 72

afferent: CN 2 efferent CN 3

Question 73

S. bovis endocarditis is associated with?

Answer 73

GI lesions (Colon cancer)

Question 74

increase HR and CO w/ a normal PaO2 + PaCO2

Answer 74

exercising not to confuse w/ panic attacks, which usually has increase RR --\> respiratory alkalosis

Question 75

why is making an anti-gonococcal vaccine using the pilus component likely to fail?

Answer 75

b/c the pilus is known to undergo **antigenic variation at high frequency**

Question 76

what's going on here?

Answer 76

blood transfusion increased MSFP and decreased resistance to VR (extra blood distends the BV)

Question 77

pt w. signs of CHF on aspirin and hctz should also add what to his regimen hx is signficant for HTN and MI 2 years ago

Answer 77

* ß blockres, esp. **carvedilol** - slows ventricular rate and decreases PVR (afterload) by antagonizing ß1, ß2, and alpha1 receptors * ACEi/ARB - prevents chronic AII-mediated L ventricular hypertrophy and remodeling that occurs in association w/ myocardial failure

Question 78

1yo M w/ severe hypotonia, hepatomeagly, cardiomeagly deficient enzyme?

Answer 78

**Pompe** disease - alpha-1,4-glucosidase

Question 79

evidence of acute graft rejection in a cardiac transplant?

Answer 79

usually occurs within 1-4 weeks following transplant dense infiltrate of T cells (rejection is mediated by **host** **T cells** sensitization** **against **graft MHC**) sx: systolic dysfunction (dyspnea on exertion or paroxysmal nocturnal dyspnea)

Question 80

A patient presents to your office after lunch at one of the better restaurants in town. She is complaining of dizziness, flushing, diarrhea, tachycardia, and a severe headache. This started about 30 minutes after she had a grilled tuna fish steak for lunch. A number of other patrons had the fish as well but did not develop symptoms. The fish tasted fine although a bit peppery for her liking. She has never had an allergic reaction to seafood before. The most likely diagnosis is: A) Staphylococcus food poisoning. B) Bacillus cereus food poisoning. C) Ciguatera poisoning. D) Scombroid poisoning. E) Seafood allergy.

Answer 80

C) **Ciguatera poisoning** Scombroid poisoning occurs when bacteria in a dark-meat fish produce **histidine** which is broken down into **histamine** (ie tuna, mackerel, bluefish, mahimahi, etc.) and the food is improperly handled. Fish may have a **metallic or peppery taste**. When eaten, patient develops a symptom complex suggestive of histamine effects including: **flushing, diarrhea, dizziness, wheezing, tachycardia**, and severe HA. An occasional patient will become hypotensive. The symptoms occur 20-30 minutes after ingestion. Self-limited, generally lasting less than 6 hours, but patient respond well to antihistamines such as diphenhydramine. Patients with ciguatera poisoning present with GI symptoms such as cramping, vomiting, and diarrhea followed by nondermatomal neurologic symptoms such as **perioral numbness**, burning foot pain, ataxia, weakness, and vertigo. The neurologic symptoms can last for up to 1 year. An almost pathognomonic finding for ciguatera poisoning is **hot-cold sensory reversal** on the face.

Question 81

complication of subarachnoid hemorrhage what can the patient be treated with to prevent this?

Answer 81

**arterial vasospasms** (occur due to impaired brain autoregulation) trmt: **Nimodipine** - selective Ca channel blocker

Question 82

11yoM w/ difficulties with balancing and night vision. Mother complains of foul smelling stools and failure to thrive as an infant. PE: poor muscle coordination, ataxia, decreased proprioception, and vibratory sense. Labs: decreased cholesterol and vitamin E. Dx?

Answer 82

**∆ MTP (microsomal transfer protein)** - transfers TG onto apolipoprotien B as part of VLDL synthesis and affects abosrption of dietary fats, cholesterol, and fat-soluble vitamins * inability to generate chyloµ -\> fat accumulation in enterocytes -\> foamy enterocytes * decreased VLDL secretion into blood stream findings: failure to thrive, steatorrhea, acanthocytosis, ataxia, night blindness, clear foamy macrophages

Question 83

bcr-abl

Answer 83

CML t9;22

Question 84

contraindication for thiazolidinediones (TZD) such as rosiglitazone

Answer 84

CHF patients

Question 85

main pancreatic duct is derived from what structure?

Answer 85

ventral pancreatic primordium

Question 86

superior vs inferior parathyroid glands originates from: shares embryological origins with

Answer 86

superior: 4th **pouch** inferior: **3rd pouch; **shares embryological origins thymus

Question 87

patient w/ vitamin C deficiency has gingival bleeding, petechiae, ecchymoses and poor wound healing. Why?

Answer 87

impaired **collagen hydroxylation** of **proline + lysine residues**, which happens in the **RER** this process helps collagen attain its maximum tensile strength

Question 88

discrete subepithelial humps on EM is seen in which renal disease?

Answer 88

post-strep glomerulonephritis (PIGN) - usually occur a few weeks following a skin or pharyngeal infection

Question 89

down syndrome is associated with two leukemias two GI abnormalities cardiac defects

Answer 89

ALL, AML duodenal atresia, Hirschsprung ASD, VSD (endocardial cushion defects)

Question 90

interpret this HBsAg negative anti-HBc positive anti-HBs positive

Answer 90

Immune due to natural infection

Question 91

c-myc

Answer 91

burkitt's lymphoma t8;14

Question 92

hamartoma definition

Answer 92

growth of a tissue type native to the organ of involvement

Question 93

genes involved adenoma to carcinoma sequence (what structures are typically seen w/ each mutation?

Answer 93

_AK53 (with intervening mutations)_ * **APC** - hyperproliferative epithelium -\> **small** (*if you can see the entire polyp on the slide)* adenomatous polyp w/ a fibrovascular stalk w/ tubular glands + villous components * **COX2 ** * ^{​patients taking aspirin have been shown to have a lower incidence of adenomas compared to the general population}** ** * **Kras** -\> unregulated cell proliferation -\> **large** adenomatous polyp * **DCC** * **P53** -\> disordered/carcinoma

Question 94

Pathophysiology of Zenker's diverticulum type of diverticula?

Answer 94

cricopharyngeal muscle dysfunction FALSE diverticulum = contains only mucosa + submucosa layers

Question 95

how do you tell whether a transplant patient is undergoing rejection (acute/chronic) or GVHD?

Answer 95

* **rejection (acute/chronic)** - **host CTLs** activated aganist **donor** MHC -\> rejection of graft * _findings_: acute rejection = vasculitis of graft vessels; chronic rejection = fibrosis of graft stroma + BV * **GVHD** - **graft T cells **activated aganist against host MHC -\> _rejection of host_ * _findings_: any host organ may be a target of GVHD, but the skin, liver, and GI tract are most severely affected -\> desquamating skin rash, bloody diarrhea

Question 96

What does this represent? (choose one) Increase preload Increase afterload Systolic dysfunction Increased ejection Fraction Normal Saline Infusion

Answer 96

Increased afterload

Question 97

Serotonin syndrome (mental status ∆, neuromuscular dysfunction, autonomic instability - rapid/large ∆BP, ∆HR) is treated with....

Answer 97

**Cyproheptadine -** antihistamine w/ anti-serotonergic properties

Question 98

pt w/ a-fib and hx of pulmonary disease. Of these Rx, what would you give to the patient? amiodarone diltiazem esmolol lidocaine procainamide

Answer 98

**diltiazem** - Ca blocker that inhibits Ca influx into the VSM and myocardium; also has AV nodal blocking effects and is used to control rapid a-fib and a-flutter * amiodarone - cases ARDs/pulmonary fibrosis * esmolol - selctive ß1 blocker - generally not use in patients w/ poorly controlled pulmonary disease * lidocaine - used in MI * procainamide - class IA - often used for ventricular arrhythmias

Question 99

maculopapular rash that starts on head and progresses downwards to the extremities cough, coryza, conjunctivitis, and koplik spots

Answer 99

measles (rubeola)

Question 100

Rust colored urine + facial swelling should make you think of... what determines prognosis?

Answer 100

PIGN prognosis determined by** AGE!! ** young children = good; most recover completely w/ conservative Tx adults = not so good; only 50% will resolve completely; rest will develop chronic GN or RPGN

Question 101

what is **tertbutaline** and what is it used for? ADR?

Answer 101

ß mimetic tocolytic drug used to delay labor + delivery by suppressing uterine contractions ADR: increased risk of neonatal intraventricular hemorrhage, hypoglycemia, hypocalcemia, **ileus**

Question 102

During excitation-contraction coupling, Ca released from the sarcoplasmic reticulum binds to ___________ and causes \_\_\_\_\_\_\_\_\_\_\_

Answer 102

troponin C (bound to tropomyosin) causes the tropomyosin to shift, thereby exposing the actin binding sites for myosin and allowing contraction to occur

Question 103

"bilateral wedge-shaped bands of necrosis seen over the cerebral convexity that follow the interhemispheric fissure - just a few cm lateral to it" hx report described in a patient who suffered a massive MI/cardiogenic shock

Answer 103

watershed infarction - necrosis that occurs btwn the zones of perfusion of the MCA, ACA, and PCA

Question 104

why is it that a heavy smoker w/ chronic cough + lower extremity edema + cyanosis + expiratory wheezes faint with supplemental O2?

Answer 104

prolonged hypercapnia = CO2 doesn't stimulate the respiratory drive in central chemoreceptors (medulla) as it normally does therefore hypoxia is the only stimulator of respiratory drive; **rapid** increase in O2 --\> **respiratory stimulus disappears** --\> **decr. respiration -\> confusion + fainting**

Question 105

bipolar patient recently started a HTN Rx and develops involuntary movements, ataxia, and tremor. What HTN Rx was she given?

Answer 105

basically anything that increases PCT reabsorption of Na/H2O Thiazide ACEi NSAIDS (not loop diuretics)

Question 106

in menstruation: proliferative phase begins with\_\_\_\_\_\_\_\_\_ and ends with \_\_\_\_\_\_\_\_\_ secretory phase begins with\_\_\_\_\_\_\_\_\_ and ends with \_\_\_\_\_\_\_\_\_

Answer 106

proliferative phase begins with** _menstruation**_ and ends with _**ovulation_** secretory phase begins with **_ovulation_ **and ends with **_onset of menses_**

Question 107

46xx with BP 150/95, serum K 3.2, elevated plasma androgens, and 17OH progesterone, and decreased aldosterone has a mutation in what enzyme

Answer 107

11ß hydroxylase - note the high P and low K - indicates that some Aldo-like factor is being made (ie DOC)

Question 108

hypophysectomy (removal of pituitary gland) induces a decrease in epinephrine secretion by the adrenal glands. What enzyme is responsible for the observed effect?

Answer 108

in the adrenal medulla, the synthesis of catecholamines begins with conversion of **tyrosine -\> DOPA** via **tyrosine hydroxylase** conversion of NE -\> Epi occurs via **phenylethanolamine-N-methyltransferase (PNMT),** which is under the control of **cortisol** (increases the synthesis of PNMT). Therefore, ø ACTH = ø Epi

Question 109

46 XX neonate w/ male external genitalia should make you think of...

Answer 109

androgen excess during gestation; usually due to CAH (21 hydroxylase or 11 hydroxylase deficiency)

Question 110

why are there 2 peaks in isoniazid metabolism? what other Rx have similar patterns of metabolism?

Answer 110

2 peaks = 2 distinct groups in the population that suggest a polymorphism in drug metabolizing capacity isoniazid is metabolized via acetylation, therefore there are fast acetylators (normals) slow acetylators (leads ot accumulation of Rx in plasma) other Rx that show this pattern: **dapsone, hydralazine, procainamide** **note: slow acetylators have a higher risk of developing drug-induced lupus!!**

Question 111

what 2 disorders specificially cause degeneration of spinocerebellar tracts, dorsal column of the spinal cord, and peripheral nerves

Answer 111

Vitamin E Friedreich ataxia both result in ataxia, dysarthria, and loss of position/vibration sensation

Question 112

how is MCHC affected in patients with hereditary spherocytosis?

Answer 112

elevated MCHC - indicates membrane loss and red cell dehydration *(think of these cells going through the spleen and the macrophages taking a bite of the cytoplasm every time, therefore the Hgb concentration increases with every bite removed)*. dx best confirmed with the osmotic fragility test

Question 113

45yo F w/ long history of pruritis and fatigue who developed pale stool and xanthelasma

Answer 113

**primary biliary cirrhosis - **pruritis is often the first symptoms and may be very severe, esp at night. * hx: destruction of intralobular bile ducts by granulomatous inflammation and infiltrate of macrophages, lymphocytes, plasma cells, eosinophils

Question 114

blastomycosis dermatitidis where is this endemic to?

Answer 114

dimorphic fungus - cause pulmonary symptoms (cough, sputum production, hemoptysis, dyspnea, and pleuritic chest pain) in immuno**COMPETENT** hosts; usually w/ travel **Great Lakes, Mississippi, Ohio River basins** forms **GRANULOMATOUS** inflammation in immunocompromised hosts, it may lead to disseminated mycosis **(fever, lung + skin + bone involvement)** trmt: **itraconazo**le

Question 115

describe all of the MEN and associated organs

Answer 115

**1,2,3 --- 3,2,1** Type I has 3 Ps: Parathyroid, Pancreas, and Pituitary Type II has 2 Ps: Parathyroid, and Pheochromocytoma Type III has 1 P: Pheochromocytoma.

Question 116

difference between hypnagogic vs hypnopompic hallucinations?

Answer 116

hypnagogic = occur when patient is falling asleep hypnopompic = occur when a person is just awakening from sleep; usually with sleep paralysis, cataplexy, and sleep attacks (narcolepsy)

Question 117

metabolic enzyme that is most upregulated when cells switch to anaerobic metabolism

Answer 117

PFK-1 (first committed step of glycolysis) why? glycolysis becomes the sole source of ATP via substrate level phosphorylation + phosphoglycerate kinase + pyruvate kinase

Question 118

anti-arrhythmia agent that causes agranulocytosis, bbone marrow suppression, neutropenia, hypoplastic anemia

Answer 118

procainamide, class IA

Question 119

short stature, hypotonia, obesity, mental retardation

Answer 119

Pradar Willi Syndrome - microdeletion on chr. 15 that is inherited from the father

Question 120

adherent membrane, gram + rod

Answer 120

diphtheria - produces toxins that inactivates eukaryotic elongation factor 2

Question 121

what is metyrapone?

Answer 121

* agent used to test whether there is an interruption in the HPA feedback loop * **inhibits 11ß-hydroxylase**, which is responsible for the conversion of 11ß-deoxycortisol -\> cortisol *(resulting in increased pituitary secretion of ACTH, which causes the adrenal glands to produce even more 11ß-deoxycortisol - measurable in the urine as 17-OH-corticosteroids)* * normal HPA = metyrapone will cause significant increase in 11-deoxycortisol and 17-OH-corticosteroids in urine

Question 122

Patients w/ alcoholic-induced cirrhosis have **gynecomastia**, **palmar erythema**, **spider angiomata**, asterixis, ascites, pedal edema, **testicular atrophy**, hepatic encephalopathy, and splenomeagly. What causes the signs in bold?

Answer 122

Hyperestrinism "hyper-estrogenism" is due to: 1) liver cannot metabolize circulating androstenedione *(which results in increased estradiol levels)* 2) SHBG rises, which results in a higher binding of testosterone, thus decreasing the ratio of free T to E *(ie more estrogen)*

Question 123

64yo M w/ persistent back pain, constipation, easy fatigability, low hemoglobin, and eelvated serum creatinine should make you think of....? What would a biopsy of the affected organ show?

Answer 123

**Multiple myeloma** easy fatigability - due to anemia constipation - due to hypercalcemia bone pain - osteoclast activation by myeloma cells renal failure (zaotemia) Bx: **large eosinophilic casts (bence-jones proteins)**

Question 124

ulnar nerve (C8-T1) is commonly injured at which location?

Answer 124

passes in **"Guyon's Canal"** (btwn hook of hamate and pisiform bone) medial epicondyle of humerous "funny bone"

Question 125

pt with recurrent URI (susceptible to strep. pneumonia and H. influenzae) has a mutation in..

Answer 125

bruton agammaglobulinemia (x-linked recessive)

Question 126

derivative of the common cardinal veins

Answer 126

SVC

Question 127

drug that reduces post-prandial hyperglycemia in diabetics

Answer 127

**acarbose** - inhibits alpha-glucosidase on intestinal brush border to delay glucose absorption) (car going through the intestines) **Aspart, Lispro, Gluisine** - activates insulin receptors in fat, muscles, and liver

Question 128

spherules should make you think of...

Answer 128

**coccidiodes immitis** thick-walled spherules filled w/ endospores common in southwestern states (desert area, mold form is present in soil pulmonary form: **flu-like illness, cough, erythema nodosum** disseminated form can affect **skin, bone, and lungs**

Question 129

name this please

Answer 129

cryptococcus

Question 130

only partially dsDNA circular virus

Answer 130

HepB

Question 131

where embryonic hemoglobin synthesis occurs during 1-7 month

Answer 131

liver (before that will be in the yolk sac) (after that will be in the bone marrow)

Question 132

What do you want to treat AML patients with? What is absolutely contraindicated and why?

Answer 132

AML - acute myelogenous leukemia M3 form - treat with ATRA (all trans-retinoic acid) since it stimulates the differentiation of myeloblasts into mature granulocytes and induces remission DO NOT TREAT WITH CHEMORX - it can induce release of Auer rods and cause DIC

Question 133

how to differentiate between CML + leukemoid reaction

Answer 133

leukocyte alkaline phosphatase **CML = LOW** (granulocytes are dysfunctional) **leukemoid = HIGH **(granulocytes are functional)

Question 134

bromocriptine

Answer 134

dopamine agonist that inhibits prolactin secretion; trmt for prolactinoma

Question 135

macrocondida

Answer 135

histoplasma capsulatum

Question 136

cause of unilateral SVC syndrome (R face + arm swelling and engorgement of subcutaneous veins on the R side of the neck)

Answer 136

obstructed R brachiocephalic vein (drains R internal jugular + R subclavian v. (which drains the R external jugular), usually due to an apical lung tumor, thrombotic occlusion, or prolonged central cathther placement

Question 137

alkaline phosphatase is a marker of?

Answer 137

osteo**B**lasts staining with this enzyme can help identify bone tumors

Question 138

Urinary deoxypyridinoline reflects activity of which cell type?

Answer 138

osteo**C**lasts note that these cells use carbonic anhydrase to produce H+, which are then pumped from the cytoplasm -\> resorptive pit to create the acidic milieu required for bone demineralization

Question 139

common cause of pyelonephritis?

Answer 139

can occur via **hematogenous** or _**ascending **(more common)_ in ascending pyelo - there is vesicoureteral reflux, which brings pathogens present in the bladder up to the ureter. this is common in patients w/ **frequent bladder infections**, which may **weaken the vesicoureteral junction **and facilitate reflux

Question 140

gastric ulcer on the lesser curvature can penetrate into which arteries?

Answer 140

L/R gastric (both form gastro, depending on its location

Question 141

decreased exercise tolerance, muscle pain and cramping during exercise + myoglobinuria blood lactate is very low post exercise muscle bx: excess glycogen

Answer 141

McArdle - ∆ glycogen phosphorylase

Question 142

what two statistical measures depend on disease prevalence in the population?

Answer 142

**NPV** and **PPV** NPV = inversely related (lower prevalence = higher NPV) PPV = directly related (higher PPV = lower NPV) *(sensitivity and specificity of a test do not depend on the prevalence of the disease in the population)*

Question 143

how would SV or compliance change in order to increase PP?

Answer 143

increase in SV decrease in compliance

Question 144

42yo alcoholic has a smear that shows hypersegmented neutrophils. What is he deficient in?

Answer 144

folic acid deficiency (note that B12 deficiency also shows hypersegmented neutrophils, but folic acid deficiency is common in alcoholics)

Question 145

normal function of progesterone? what happens if you withdraw progesterone?

Answer 145

**function**: differentiation of endometrial stromal cells into decidual cells that can accomodate pregnancy **withdrawal**: endometrial cells undego apoptosis -\> bleeding

Question 146

where is the sphenoid sinus located?

Answer 146

anterior to the optic chiasm

Question 147

cause of megaloblastic anemia (low Hg and elevated MCV) in an alcoholic

Answer 147

**folic acid deficiency** -\> defect in DNA synthesis (due to ø purine/pyrimidine production) -\> megaloblastic RBCs

Question 148

a drug is virtually eliminated after how many half-life intervals?

Answer 148

5

Question 149

What should you monitor continuously in cirrhotic patients who are at risk of developing HCC?

Answer 149

AFP

Question 150

normal atrial/ventricular pressures on the R vs L side of the heart

Answer 150

max/ min * R atria = 10, 0 * R ventricle = 25, **4** * Pulmonary artery = 25, **9** * L atria = 12, 2 * LV = 130, **9** * Aorta = 130, **70**

Question 151

virulence factor of bacillus anthracis? what are diagnostic clinical features of this bug? what do you treat bacillus anthracis with?

Answer 151

**D-glutamate capsule** - antiphagocytic mediastinal widening + black eschar + serpentine/medusa head on microscopy **ciprofloxacin**

Question 152

clavulanic acid, sulbactam, and tazobactam can "extend the spectrum" of penicillin-family antibiotics. What does this mean?

Answer 152

allows the the penicillin family of antibiotics to be effective aganist organisms that produce ß-lactamases (ie S. aureus, H. influenza, Bacteriodes, and other GN bacteria)

Question 153

internuclear ophthalmoplegia cause common manifestation in what d/o?

Answer 153

demyelination of MLF -\> impaired adduction of corresponding eye during lateral gaze *(note that bilateral adduction during ocular convergence is spared)* (MLF connects ipsilateral abducens w/ contralateral medial rectus to allow horizontal conjugate gaze movements) MULTIPLE SCLEROSIS (or MLF stroke)

Question 154

hammerhead ribozymes

Answer 154

degradation of mutant SOD1 mRNA

Question 155

**Werdnig-Hoffman Syndrome** what is another d/o that can present the same way?

Answer 155

aka spinal muscular atrophy **congenital degeneration of anterior horn cells** -\> LMN lesion floppy baby w/ marked hypotonia, tongue fasciculations, areflexia, muscle atrophy other d/o: poliomyelitis

Question 156

korotkoff sounds

Answer 156

first become audible during expiration and subsequently becomes audible during all phases of respiration ∆ greater than 10mmHg = think pulsus paradoxicus (acute cardiac tamponade, constrictive pericarditis, severe obstructive lung dz, restrictive cardiomypathy

Question 157

greatest concentration of H. pylori is found where?

Answer 157

pre-pyloric areas of the gastric antrum

Question 158

rhomboid crystals w/ weak positive birefringence under polarized light

Answer 158

**calcium pyrophosphate** (black arrow indicates the direction of the compensator) Crystals parallel to the compensator = **blue** Crystals perpendicular to the compensator = **yellow** (compare to monosodium urate crystals, which are ye**ll**ow when para**ll**el to the light)

Question 159

hamartomatous polyps

Answer 159

Peutz-Jegher's syndrome non-malignant hamartomas in the GI hyperpigmented mouth, lips, hands, and genitalia

Question 160

brain imaging shows a 9mm cavitary lesion in the brain. what type of infarct is this? what is it usually caused by?

Answer 160

lacunar infarcts ( often due to hypertensive arteriosclerosis of small, penetrating arteries.

Question 161

what accounts for the sx (acute abd. pain + neurological sx) observed in acute intermittent porphyria (AIP)? treatment for these sx?

Answer 161

**d-aminolevulinic acid + porphobilinogen** hepatic heme production is used for CYP450; AIP can precipitated by anything that alter levels of CYP450 (ie phenobarbital, griseofulvin, phenytoin, OH, low calorie diet), which result in low heme []'s As a result ALAS is upregulated and there is increased formation of the two substrates above. AIP patients have **∆porphobilinogen deaminase,** which results in an accumulation of these substrates -\> acute abd. pain, port-wine colored urine, neurologic symptoms (anxiety, muscle weakness) trmt: heme (inhibits ALAS, thereby decreasing production of these substrates)

Question 162

identification

Answer 162

modeling of one's behavior after someone who is perceived to be more powerful *(ie parent who was abused as a child becomes an abusive parent)*

Question 163

**buboes vs chancroid vs chancre** bugs that cause them? what do they look/feel like?

Answer 163

buboes = chlamydia trachomatis (swollen, painful inguinal nodes that coalesce, ulcerate, and rupture) chancroid = haemophilus ducreyi (tender red papules) chancre = treponema pallidum (painless lesion)

Question 164

**Meningioma** Location Appearance Prognosis, presentation

Answer 164

Brain surface (extraaxial attached to dura) Spindle cells in whorled pattern w/ psammoma bodies, well circumscribed Adults, Benign; seizures or focal deficits

Question 165

What does this represent? (choose one) Increase preload Increase afterload Systolic dysfunction Increased ejection Fraction Normal Saline Infusion

Answer 165

Systolic Dysfunction

Question 166

Pregnancy and the usage of OCs predispose to gallstone formation. How?

Answer 166

* **Estrogen** - increases cholesterol synthesis by upregulating HMG-CoA activity, which causes bile to become supersaturated with cholesterol * **Progesterone** - reduces bile acid secretion and slowing gall bladder emptying (hypomotile)

Question 167

phenytoin MoA ADR

Answer 167

MoA: inhibits electrical activity in the brain by blocking VG Na channels in neurons, thus increasing the refractory period ADR: * gingival hyperplasia (via increasing PDGF) * megaloblastic anemia (interferes w/ folic acid metabolism) * ataxia and nystagmus (affects cerebellum+vestibular system) * induces CYP450 cytochrome oxidase * fetal hydantoin syndrome * pseudolymphoma (generalized lymphadenopathy)

Question 168

what is the common ground between sildenafil and ANP?

Answer 168

sildenafil - inhibits cGMP phosphodiesterase -\> increase **cGMP** ANP - increases **cGMP **via a second messenger system (NO also has the same MoA as ANP)

Question 169

ADR of TMP-SMX

Answer 169

**TMP = Treats Marrow Poorly** Megaloblastic anemia (folate antagonist), leukopenia, granulocytopenia Steven-Johnson Syndrome, Toxic Epidermal Necrolysis

Question 170

causes of 1˚ hemolytic anemia

Answer 170

defect in glycolysis or hexose monophosphate shunt (PPP) - pyruvate kinase (due to G6PD)

Question 171

urine measurement of this would allow diabetic nephropathy to be detected at its ***earliest*** stage.

Answer 171

albumin - screen for microalbuminuria ^{(30-300mg/day in a 24h collection or 30-300protein/mg of creatinine in a spot collection)}

Question 172

MoA of CRH in the H-P axis

Answer 172

stimulate release of ACTH, MSH, ß endorphin

Question 173

diuretics that cause ototoxicity

Answer 173

furosemide

Question 174

L homonymous hemianopia w/ macular sparing

Answer 174

R primary visual cortex - occipital lobe - usually due to occlusion of **posterior cerebral artery**. macula spared due to collateral flow from MCA

Question 175

fructose intolerance

Answer 175

∆ aldolase --\> hypoglycemia

Question 176

patient on NTG cannot be on these Rx and why?

Answer 176

sildenafil - both cause incr. cGMP --\> extreme vasodilation

Question 177

fever and ulcers on the tongue and oral mucosa + maculopapular and/or vesicular rash on the palms and soles

Answer 177

HFMD - coxsackie type A

Question 178

sandpaper-like erythematous rash (blanches w/ pressure) that begins on the neck, armpits, and groin, and then generalizes fever + sore throat (gray-white tonsillar exudates) + bright red tongue

Answer 178

s. pyogenes (scarlet fever) may result in rheumatic fever + glomerulonephritis later on

Question 179

immediate treatment for patients in adrenal crisis (hypotensive, tachycardia, hypoglycemic, vomiting, abd pain, weight loss, hyperpigmentation)

Answer 179

steroids adrenal glands normally respond to stress by secreting large quantities of glucocorticoids to that is essential to cardivascular and metabolic adaptations during stress

Question 180

gp120 and gp41 function? what can you use to block their functions with?

Answer 180

env proteins of HIV - viral envelope **gp120** = mediates **attachment** via CD5 + CCR5 (or CXCR4); block w/ **maraviroc ** **gp41** = mediates **fusion**; block w/ **enfuvirtide **"FOURSION; enFOURvirtide"

Question 181

6mo F w/ crying, sweating, shaking chills 1 hr after eating apple-sauce and pureed pears Deficient enzyme?

Answer 181

Fructose intolerance - ∆ frustose-1-phosphate aldolase

Question 182

how does TLC, RV, FRC, elastic recoil, FEV1/FVC ratio affected in COPD

Answer 182

**increased TLC, RV, FRC** **decreased elastic recoil, FEV1/FVC**

Question 183

external stimulus applied to cells increases the activity of several enzymes, including DHFR and DNA polymerase. What immediately precedes the observed effect?

Answer 183

Rb protein phosphorylation by cyclin kinases (CDK 4, 6) = thereby inactivating it and allowing G1-\>S transition to occur.

Question 184

42 F complains about episodic spinning sensation associated w/ nausea, ringing on L ear, and always having to use R ear when talking on the phone.

Answer 184

**Meniere's disease** - increased endolymph (due to defective resorption) causes damage to vestibular + chochlear components of inner ear -\> triad of tinniitus, vertigo, and sensorineural hearing loss

Question 185

patient w/ sx of dysphagia and chest pain what would you do if a patient came in complaining of these sx?

Answer 185

## Footnote **diffuse esophogeal spasms** = intermittent dysphagia and occasional chest pain - may mimic angina pectoris and thereoore it is important to get a cardiac workup to r/o a cardiac cause of chest pai

Question 186

6yo living in old house is irritable, constipated, and has anemia. He has high blood levels of delta-aminolevulinic acid, which is maintained secondary to the presence of which cofactor?

Answer 186

b6 - pyridoxal phosphate

Question 187

splinter hemorrhages on subungual areas

Answer 187

janeway lesions - small, nontender, lesions that can appear on the soles of the feet, palms of hthe hands - sign of microembolism likely due to bacterial endocarditis, where vegetations on the cardiac valves are the source of microemboli

Question 188

when is Ig therapy useful for herpes infections?

Answer 188

immunocompromised hosts, neonates whose mother developed a perinatal varicella infection, or prophylaxis in pregnant females exposed to varicella

Question 189

diagnose this patient: recurrent epistaxis, ecchymoses marked thrombocytopenia normal Hgb, leukocyte count, and differential normal fibrinogen levels and PT/INR no hepatosplenomeagly

Answer 189

immune thrombocytopenic purpura - acquired d/o where there is immune destruction of platelets via anti-platelet antibodies.

Question 190

major stimulator of RR in normal folks

Answer 190

PaCO2 is the major stimulator of respiration (input from central + peripheral chemoreceptors + airway mechanoreceptors)

Question 191

Which one corresponds to this graph? Acute GI bleed Pyschogenic polydipsia Diabetes insipidus Hypertonic saline infusion

Answer 191

**Hypertonic saline infusion** - leads to hypertonic volume expansion (both volume + osmolarity of ECF are increased); high osmolarity of ECF causes water to shift from ICF into ECF, further increasing extracellular volume net: decreased ICF, increased ECV

Question 192

virluence factor of e. coli that causes UTIs

Answer 192

p. fimbrae - allows adhesion of e. coli to the uroepithelium

Question 193

patient w/ DIC if you could only order 3, which labs should you order

Answer 193

Platelet count fibrinogen levels FDP

Question 194

ultrastructural change that would most likely indicate irreversible myocardial cell injury?

Answer 194

appearance of vacuolization or amorphous densities in the mitochondria = implies permanent inability to generate ATP via oxidative-phosphorylation (note: mitochondrial swelling may be associated with reversible cellular injury)

Question 195

diagnose

Answer 195

CMV - owl eye inclusions

Question 196

what is calcitriol?

Answer 196

1,25-dihydroxycholecalciferol (ie active form of vitamin D)

Question 197

how will a dose-response curve change if you add a competitive vs non-competitive antagonist to the solution?

Answer 197

competitive = R shift non-competitive - shift down

Question 198

palatine tonsils originates from...

Answer 198

originates from **2nd **pharyngeal **pouch**

Question 199

mild fever + maculopapular rash that spreads from the head inferiorly to the trunk and extremities; resolves in 3-5 d PE: occiptal and posterior cervical lymphadenopathy

Answer 199

rubella

Question 200

high fever for 3-5d with rash appearing once fever subsides macules + papules that begin on trunk and spreads to extremities

Answer 200

roseola infantum (HHV6)

Question 201

riboflavin - used to make what? what reactions is it involved in?

Answer 201

FAD, FMN serve as coenzymes that participate in the TCA cycle as a coenzyme of * **succinate dehydrogenase** (converts succinate into fumarate) * **Complex I (FMN) /Complex II (FAD) of the ETC** diagnose w/ RBC glutathione reductase assay or measuring urinary riboflavin excretion

Question 202

why is it that excess alcohol can inhibit gluconeogenesis?

Answer 202

ethanol is metabolized to acetaldehyde by alcohol DH and then to acetate via aldehyde dehydrogenase, and in the process, converting NAD+ to NADH high NADH favors conversion of * pyruvate -\> lactate * conversion of oxaloacetate -\> malate thereby inhibiting gluconeogenesis

Question 203

tumor cells can become resistant after exposure to various anti-cancer agents. Why?

Answer 203

due to expression of **MDR1** (multi-drug-resistance) gene, which codes for **P-glycoprotein** a transmembrane protein that functions as an **ATP-dependent** efflux pump

Question 204

gene for both breast cancer + ovarian cancer is on this chromsome

Answer 204

17q (17 is when girl's prime age for developing everything!)

Question 205

male physician spends extra tiem with an attractive F patient but insists that it is because her case is more complicated than the others

Answer 205

rationalization - offering of a false but acceptable explanation for behavior

Question 206

equation for TPR

Answer 206

TPR = (MAP - RAP) / CO since RAP = 0 **TPR = MAP/CO** remember this to help you remember TPR: P = QR

Question 207

brocas and wernicke's area are both supplied by this artery

Answer 207

MCA

Question 208

patient with sx of night blindness, dry skin, and generalized pruritis has which of the following * decreased sunlight exposure * stright vegetarian diet * chronic renal failure * prolonged biliary obstruction * chronic hemolytic anemia * RA

Answer 208

prolonged biliary obstruction - her sx are consistent with vitamin A deficiency. Biliary obstruction -\> cholestasis -\> fat soluble vitamin malabsorption

Question 209

how do these factors change with ITP d/o? Platelet Count Bleeding time PT PTT plasma fibrinogen levels smear

Answer 209

Platelet Count = decrease Bleeding time = increase (less platelets) PT = NC PTT = NC plasma fibrinogen levels = normal smear = isolated thrombocytopenia usually occurs in females of childbearing age

Question 210

digoxin - MoA 2 OD can result what side effects? 3 what can you treat it with? 2 what worsens digoxin toxicity? 2 BOTTOM LINE - DIGOXIN IS A COMPLICATED DRUG

Answer 210

**1) inhibits Na/K ATPase** -\> decreased Na efflux -\> decreased Na/Ca exchanger (pumps Na in, Ca out) -\> increased Ca intracellular -\> increased contractility 2) **increase parasympathetic tone** **-\>** increased parasympathetic tone OD: **Hyperkalemia** (weakness), **blurry yellow vision**, life-threatening **arrhythmias** trmt: **anti-digoxin Fab fragments + Mg** Worse OD w/: * **age-related decreases in renal function** (digoxin is renally cleared; renal fxn declines w/ age and is often not associated w/ a concomitant rise in creatinine since muscle mass also declines w/ age) * **hypokalemic **- K and digoxin competes for the same binding site on Na/K ATPase, there is less K to compete w/ digoxin! (compare to hyperkalemia, which reduces digoxin efffect!)

Question 211

**Oligodendroglioma** Location Appearance Prognosis, presentation

Answer 211

WM of frontal lobe Chicken-wire capillary pattern w/ fried egg cells (round nuclei w/ clear cytoplasm); often calcified Adults, Slow growing

Question 212

glyburide, repaglinide, metaglinide MoA

Answer 212

**Sulfonylureas -** ATP-like molecule that **binds to K_ATP channels **on pancreatic ß cells, causing them to **close** -\> depolarization -\> VG Ca channels open -\> Ca influx -\> insulin release via exocytosis

Question 213

radiographic findings of mesotheliomas

Answer 213

diffuse nodular or smooth thickening of the pleura may present w/ hemorrhagic pleural effusions

Question 214

Female LH / FSH stimulates which cells? stimulates production of what?

Answer 214

LH = theca (interna) cells; stimulates conversion of cholesterol -\> T FSH = granuolosa cells ; stimulates conversion of T -\> estrogen (estradiol)

Question 215

prazosin major ADR w/ this?

Answer 215

selective **alpha -1 blocker** that is used in **HTN and BPH** - peripherally acting vasodilator first dose-effect - tendency to cause hypOtension when the first dose is started; prevent by starting off w/ a very small first dose

Question 216

amyl nitrate

Answer 216

use for **cyanide poisoning** induces **formation of methemoglobin (Fe3+) **which cannot carry oxygen, but has a high affinity for cyanide, thereby sequestering cyanide in the blood and keeping it away from mitochondrial enzymes.

Question 217

29yoM w/ scrotal mass (malignant neoplasm) complains of sweating, palpitations, and recent weight loss. Labs show increased T3 and T4. What should this make you think of? What serum markers would be elevated?

Answer 217

**testicular malignancy + hyperthyroidism** should make you think of a hCG-secreting _teratoma_ (non-seminomatous germ cell tumor ofen found in testes and ovaries) or _seminoma_ **hCG is similar to TSH, LH, and FSH,** therefore it can bind to TSH receptor on thyroid gland -\> hyperthyroidism

Question 218

patient on anti-pyschotics develops corneal deposits. Rx?

Answer 218

chlorpromazine

Question 219

anterior dislocation can result in injury to which nerve? outcome?

Answer 219

axillary n. deltoid paralysis, loss of sensation over lateral arm

Question 220

Aspirin should be avoided in all children, with this one exception

Answer 220

**Kawasaki's disease**

Question 221

What is Reyes Syndrome and what is caused by?? histological findings? how does this happen?

Answer 221

**hepatic failure/dsyfunction + acute encephalopathy** (due to hepatic dysfunction) when a parent treats a **viral infection** (VZV, influenza B) with **ASPIRIN ** histological findings: **microvesicular steatosis** (ø necrosis or inflammation) MoA: aspirin metabolism causes decreased ß oxidation of fatty acids

Question 222

organophosphate poisoning reversed with atropine still puts the patient at risk of this what's a better option?

Answer 222

muscle paralysis organophosphate stimulates both N + M cholinergic receptors atropine reverses M cholinergic receptors only, but does _not_ prevent the development of N effects (ie paralysis) better option: Pralidoxime - reverses N + M cholinergic receptors by restoring cholinesterases

Question 223

TdT (+), CD19, CD10

Answer 223

ALL - precursor B cell leukemia

Question 224

how does coronary steal work?

Answer 224

in coronary artery disease, coronary vessel occlusion can be bypassed by the presence / recruitment of collateral vessels that allow blood flow to myocardium distal to an occluded vessel. Drugs such as **adenosine + dipyridamole** are selective vasodilators of **coronary arterioles**. Use of these agents in patients w/ MI can cause vasodilation of these vessels, thus resulting in decreased perfusion within the collateral microvessels that were supplying the ischemic myocardium (ie diverts blood from ischemic areas to non-ischemic areas), leading to hypoperfusion/worsening of existing ischemia

Question 225

15 M w/ periodic sudden onset of arrhythmic jerking movements, usually happen in the AM and are aggravated by stress or sleep deprivation; denies losing consciousness, but he has fallen during these episodes dx? trmt?

Answer 225

myoclonic seizures - generalized seizures trmt: valproate acid

Question 226

what nerve passes from the obturator foramen? what happens there is compression of this nerve?

Answer 226

**obturator n. **- splits into anterior + posterior divisions after exiting the foramen to supply the medial (adductor) compartment of the thigh therefore, nerve impingement or injury can result in impaired adduction of the thigh

Question 227

in systemic mastocytosis, where the small bowel contains nests of mast cells within the mucosa, what is a common occurence?

Answer 227

gastric acid hypersecretion by parietal cells (due to histamine stimulation)

Question 228

STEMI in I, aVL leads

Answer 228

lateral wall - LCX

Question 229

infant w/ white pupils, hearing loss, and continuous machinery mumur over L infraclavicular area. What could've prevented this?

Answer 229

live-attenuated rubella vaccine patient has congenital rubella syndrome classic clinical triad: white pupils (cataracts), deafness, and PDA (heart problems).

Question 230

type of hernia that passes through through superficial inguinal ring, but not through the deep inguinal ring

Answer 230

direct inguinal hernia - passes through the **inguinal triangle** and **medial** to the inferior epigastric arteries

Question 231

what decreases risk of non-hereditary ovarian + endometrial cancers? increases risk?

Answer 231

decreases: OC, multi-parity, breast feeding increases: infertility, nulliparity, miscarriages, use of clomiphene citrate (induce ovulation)

Question 232

entacapone MoA?

Answer 232

COMT inhibitors - prevents levodopa degradation -\> more dopamine enters the brain tolcapone - same thing

Question 233

56yoM has a 20yr hx of alcoholism has increasing confusion + abdominal distension. Massive dilation of what essels will put him at risk of

Answer 233

azygous vein - major accessory pathway for VR in patients with cirrhosis and major outlet for the esophageal venous plexus In cirrhosis, it can become engorged, making esophageal varices more prone to **rupture**

Question 234

Based on the RFLP, at which stage did the non-disjunction occur? Maternal meiosis I Maternal meiosis II Paternal meiosis I Paternal meiosis II

Answer 234

Paternal meisois II upper band = mother lower band = father, but is thicker/darker, which signifies the inheritance of both sister chromatids

Question 235

Type of collagen found when - macrophages are present - scar formation is complete

Answer 235

- macrophages: granulation tissue (type III collagen) - scar formation: type I collagen

Question 236

APC chromosome

Answer 236

5q (5 follows the outline of the GI)

Question 237

Based on the RFLP, at which stage did the non-disjunction occur? Maternal meiosis I Maternal meiosis II Paternal meiosis I Paternal meiosis II

Answer 237

Maternal Meiosis II lower band = father upper band = thick, indicating that both sister chromatids were inherited ^{(producing an equal sized restriction fragment, but twice the normal amount)}

Question 238

linear IgG and C3 deposits are characteristic of which renal disease?

Answer 238

Goodpasture - anti-GBM; often accompanied by pulmonary sx (hemoptysis), as well as GBM disruptions + fibrin deposition on EM later on in the disease

Question 239

when lung injury occurs, local neutrophils and macrophages release what cytokines? what do they do?

Answer 239

TNFa, IL1, Il6 - mediate systemic inflammatory response (ie stimulate hepatic production of acute phase reactants, which can increase ESR)

Question 240

26yoF w/ tremors, weight loss, and discomfort on warm days has a palpable unilateral abdominal mass. No ophthalmopathy, no neck masses. Lab shows Low TSH levels. US shows unilateral ovarian cystic mass. DX?

Answer 240

**Monodermal Teratoma - Struma ovarii**

Question 241

what cells provide major proliferative stimuli for the cellular components of atherosclerotic plaques?

Answer 241

platelets - release * PDGF - promote smooth muscle migration from the media -\> intima * TGF-ß - chemotactic for SMC and induces interstitial collagen production

Question 242

4 things that can affect DCML

Answer 242

B12 deficency Folate deficiency Vitamin E deficiency syphillis

Question 243

virluence factor of e. coli that causes bacteremia leading to septic shock

Answer 243

LPS - toxin A - causes macrophage activation and widespread release of IL1, IL6, and TNFa

Question 244

Avitaminosis A in CF patients can contribute to?

Answer 244

squamous metaplasia of epithelial lining of pancreatic exocrine ducts (which are already injured and predisposed to squamous metaplasia by inspissated mucus why? bc Vit A is impt to maintain orderly differentiation of specalized epithelia

Question 245

sodium (cyanide) nitroprusside test is used in this particular d/o

Answer 245

presence of** cystine** in the urine since the cyanide added to the urine converts **cystIne -\> cystEine**, then nitroprusside binds the cysteine, resulting in a **purple color** **Cystinuria** - defect in the PCT that causes decreased reabsorption of cystine, ornithine, lysine, and arginine - COLA; cysteine is the only one that will precipitate into **hexagonal stones** *do not confuse w/ nitroprusside - anti-HTN Rx*

Question 246

boundaries of inguinal triangle

Answer 246

bound * laterally by inferior epigastric a/v * medially by the lateral border of the rectus abdominis * inferiorly by the inguinal ligament

Question 247

Rx to treat post-op urinary retention

Answer 247

**Bethanechol **- muscarinic agonist that causes contraction of the detrusor muscle ## Footnote *(or an a1 blocking drug)*

Question 248

which organ is supplied by a foregut artery but is NOT a foregut derivative? what other structures does the foregut a. supply?

Answer 248

**spleen** - derived from mesodermal mesentery - supplied by splenic artery (branch of celiac trunk - foregut) also supplies: **pharynx -\> proximal duodenum liver pancreas**

Question 249

22yoM w/ skin lesions on abdomen has fibroblasts that can't metabolize ceramide trihexose. He is at greatest risk of...

Answer 249

cardiovascular + renal failure dz: **Fabry** - ∆ alpha-galactosidase A - peripheral neuropathy of hands/feet, angiokeratoma, cardiovascular + renal failure problems

Question 250

what kind of withdrawal: confusion, sweating, shakiness, tremulous

Answer 250

alcohol

Question 251

endocarditis due to s. viridans

Answer 251

tooth extraction

Question 252

hemisphere dominant for speech and verbal material in the majority of individuals?

Answer 252

L hemisphere

Question 253

coronary sinus dilation

Answer 253

anything that causes R atrium dilation (ie pulmonary HTN)

Question 254

why can corticosteroids cause reactivation of TB and candidiasis?

Answer 254

blocked IL2 production

Question 255

patient with really high ferritin levels and a (+) family hx should make you think of... What other presenting sx do you expect? how do you treat this?

Answer 255

**Hereditary Hemochromatosis** - mutation in HFE gene (affect intestinal absorption of Fe that results in iron deposition in the body) presenting sx: **cirrhosis, DM, skin pigmentation, CHF, testicular atrophy** regular **phlebotomy, diferasirox, deferoxamine**

Question 256

**Low MCV** **high serum Fe** **normal-to-decreased TIBC ** should make you think of...

Answer 256

sideroblastic anemia - abundant iron is available to developing RBCs but it is not used effectievly. Abundant Fe leads to decreased total Fe-binding capacity as the body compensates by downregulating fe-binding capacity

Question 257

23yo w/ confusion has a blood glucose level of 38mg/mL; liver cells have high NADH. Why?

Answer 257

he likely has been consuming large volumes of alcohol lately - the **high NADH in the setting of hypoglycemia** indicates that a fuel other than glucose is being metabolized (ie ethanol) ethanol is metabolized to acetaldehyde by alcohol DH and then to acetate via aldehyde dehydrogenase, and in the process, converting NAD+ to NADH high NADH favors conversion of * pyruvate -\> lactate * conversion of oxaloacetate -\> malate thereby inhibiting gluconeogenesis

Question 258

27yoM w/ dyspnea, chest pain, and severe episodes of post-exertional syncope. ECHO: anterior motion of hte mitral valve during systole, asymmetric LVH, early closing followed by reopening of the aortic valve dx and treatment?

Answer 258

patient has **hypertrophic cardiomyopathy** Best Rx: **ß blockers - **slows HR to improve diastolic filling

Question 259

How are intracellular and extracellular K levels different in a patient with DKA ?

Answer 259

**intracellular = decreased** **extracellular = normal or increased** thus DKA patients have a normal-increased serum K levels despite a total K because of: * increased plasma osmolality leads loss of intracellular free water loss, results in extracellular movement of K secondary -\> increasing intracellular K concentration * lack of insulin also causes extracellular shifting of K as insulin normally promotes cellular uptake of K

Question 260

vaginal bx dx and treatment?

Answer 260

HSV - **ground glass nuclei** + intra-**nuclear inclusiosn (Cowdry type A),** formation of **multinucleated giant cells** trmt: acyclovir

Question 261

12yoM w/ turbid plasma that forms creamy-appearning supernatant on standing

Answer 261

likely due to **lipoprotein lipase deficiency** -\> * increased conc. of serum chyloµ (hyperlipidemia) * pancreatitis (abd. pain) * lipemia retinalis * eruptive skin xanthomas (mainly on extensor surfaces) * hepatosplenomeagly

Question 262

T4 can cannot be converted to T4 and rT3 T3 cannot be converted to T4 and rT3 which statement is true? which one is false?

Answer 262

* T4 can cannot be converted to T4 and rT3 = **FALSE**. T4 **_can_** be converted to both * T3 cannot be converted to T4 and rT3 = **TRUE**

Question 263

Based on the RFLP, at which stage did the non-disjunction occur? Maternal meiosis I Maternal meiosis II Paternal meiosis I Paternal meiosis II

Answer 263

**Maternal Meiosis I** lower band = father upper + middle bands = _mother_; ie both homologous chromosomes were inherited, therefore problem occured during meiosis I

Question 264

perifollicular hemorrhages hair fragmentation purpura + ecchymoses all over splinter hemorrhages gum changes

Answer 264

Vitamin C deficiency - (vitamin C is impt for collagen formation) - leads to weak blood vessels aka Scurvy

Question 265

drug that can be used to treat bipolar AND seizures?

Answer 265

valproic acid - augments inhibitory actions of GABA in CNS

Question 266

what are howell-jolly bodies?

Answer 266

nuclear remnants within RBCs that are normally removed by the spleen; indicates splenetomy or spleen malfunctioning

Question 267

cells that mediate wound contracture

Answer 267

myofibroblasts

Question 268

hyponotic agent that has anxiolytic, muscle relaxant, and anti-convusalnt actions

Answer 268

benzodiazepines - bind gaba-a receptor and increase frequency of Cl channel opening

Question 269

XY male born w/ feminized external genitalia, but male reproductive tracts and testes in the abdominal cavity. Dx? Potential cause?

Answer 269

**5a-reducase deficiency - **patients remain genotypically F until puberty, when increased T results in virilization (penis at 12 syndrome) potential cause - Mother was using or handling Finasteride (blocks 5a-R enzyme) during her pregnancy _{do not confuse with testicular feminization (androgen insentivity), in which an XY male has neither male nor female reproductive parts (has MIF -> mullerian degeneration, but cells are unable to respond T, therefore Wolffian degenerates), but external genitalia defaults to female phenotype (since the cells can't respond to T)}

Question 270

ß endorphin is an endogenous opioid peptide that is derived from?

Answer 270

**POMC** undergoes enzymatic cleavage to produce **ßendorphins, ACTH, and MSH**

Question 271

F w/ thin, gray malodorous discharge. Culprit?

Answer 271

Gardnerella vaginalis

Question 272

Fondaparinux MoA

Answer 272

Synthetic pentasaccharide (“extremely LMWH”) that inhibits **Factor Xa** directly

Question 273

virluence factor of e. coli that causes watery gastroenteritis

Answer 273

heat-stable/heat-labile enterotoxins - promote fluid and electrolyte secretion from intestinal epithelium

Question 274

negative nitroblue tetrazolium test indication of?

Answer 274

measures reactive oxygen intermediates produced by NADPH if negative -\> **chronic granulomatous disease** (defect in NADPH oxidase); recurrent infections by catalase producing organisms inability to kill bacteria and fungi that are catalase (+)

Question 275

first peak in the jugular venous pressure tracing is due to:

Answer 275

atrial contraction

Question 276

pioglitazone MoA What should you check periodically if you prescribe this Rx? ADR? contraindications?

Answer 276

**Thiazolidinediones (TZD)** - binds and activates **PPAR-gamma** (an ***intracellular nuclear receptor*** ) -\> increases production of **adiponectin (cytokine secreted by fat tissue)**, thereby **reducing insulin resistance (increases sensitivity of target tissues to insulin)** **Get LFTS** due to risk of severe hepatotoxicity ADR: **hepatotoxicity\*\*, weight gain, edema\*\*** Contraindications: **patients with CHF**

Question 277

features of atypical depression? how to differentiate from major depression?

Answer 277

\*\*mood reactivity\*\* (improvement in mood in response to something positive) = distinguishing feature from major depression leaden fatigue (arms/legs feel really heavy) rejection sensitivity (overly sensitive to criticism) increased sleep and appetitie

Question 278

how does a winged scapula occur? what are other presenting sx?

Answer 278

damage to **long-thoracic n.** -\> serratus anterior is unable to : * hold the medial border and inferior angle of the scapula against the posterior chest wall * unable to abduct the arm above the horizontal position, since it is required to rotate the glenoid cavity superiorly

Question 279

breast lump bx shows focal calcifications + multi-nucleated giant cells. Diagnosis?

Answer 279

Fat necrosis of the breast (likely due to trauma to the breast) -\> release lipids that induce chronic inflammatory response -\> **multi-nucleated giant cells (key to dx)**

Question 280

common causes of decreased Mg

Answer 280

diarrhea aminoglycosides diuretics alcohol "DADA"

Question 281

STEMI in V1-V4 leads

Answer 281

anterior wall (LAD)

Question 282

what can reverse vagally-mediated bronchoconstriction?

Answer 282

anti-muscarinics (ipratropium), thereby blocking ACh-induced bronchoconstriction and enhancing bronchodilatory effects of ß-2 adrenergic agents

Question 283

how do you calculate clearance?

Answer 283

clearance = (urine concentration \* urine flow rate) / plasma concentration

Question 284

peripheral blood smear looks like this. Dx?

Answer 284

CLL

Question 285

What is the pygmalion effect?

Answer 285

researcher's belief in the efficacy of treatment that can potentially affect the outcome

Question 286

budding yeast should make you think of...

Answer 286

cryptococcus neoformans - round/encapsulated cells w/ naorrw based buds (NOT "spherules" which is more indicative of coccidiodes)

Question 287

part of the aorta that is most susceptible to impact injury

Answer 287

aorta isthms, where the connection btwn the ascending + descending aorta occurs (distal to where the L subclavian a. branches off)

Question 288

primary pulmonary artery hypertension is most likely caused by what

Answer 288

AD mutation in BMP-R2 -\> vascular smooth muscle proliferation in the pulmonary vasculature and elevated pulmonary pressures

Question 289

nname this please

Answer 289

aspergillus

Question 290

recurrent lobar hemorrhages in elderly patient most likely results from...

Answer 290

cerebral amyloid angiopathy - occurs when ß amyloid is deposited into the arterial wall --\> weakens it and predisposes it to rupture NOT related to systemic amyloidsois

Question 291

small, sterile, fibrinous vegetations along the edges of the mitral valve leaflets; no inflammation

Answer 291

**nonbacterial thrombotic endocarditis (NBTE)** ^{aka MARANTIC endocarditis} usually due to * hypercoagulable state (cancer ie adenocarcinoma of the pancreas or lung) * ^{similar to Trousseau syndrome, where tumors release procoagulants that are responsible for migratory thrombophlebitis} * endothelial injury see small, sterile, fibrinous vegetations along the lines of closure of cardiac valve cusps; no inflammation

Question 292

uterine smooth muscle contains what kind of receptors? which set of these drugs will produce these patterns?

Answer 292

**alpha 1 and b2 adrenergic receptors** epinephrine (X) + propranolol (antagonist)

Question 293

24yo AA mother has a child w/ sickle cell anemia decides to remarry. What is the initial best test to offer the family to determine the chances that their next child will be affected.

Answer 293

**PATERNAL** hemoglobin electrophoresis - why? woman already has one child w/ sickle cell anemia, indicating that she is obviously a carrier of the trait, so you want to test the father to see if he's a carrier.

Question 294

breathing difficulty due to pain w/ inspiration _AND_ sharp pain in neck in shoulder due to which nerves

Answer 294

phrenic nerve C3-4-5

Question 295

invasive malignancy in the 3rd part of the duodenum can affect what structures? ureter SMA portal vein CBD gastroduodenal artery

Answer 295

SMA associations 1st part - nothing - its the bulb 2nd part - head of pancreas, ampulla of vater 3rd part - uncinate process of pancreas, SMA

Question 296

how does verapamil, a Ca blocker, accelerate the progression/exacerbation of heart failure in certain patients?

Answer 296

strong negative ionotropic effects  ^{(can exacerbate an already present heart failure (ie post-MI))} ## Footnote **constipation** **gingival hyperplasia **

Question 297

definition of reassortment

Answer 297

change in genetic composition when host cells are co-infected with two **segmented** viruses that exchange whole-genome segments; results in sudden alterations of the surface antngens of the viral progeny that is **transmitted to the next generation**

Question 298

how does blood flow change w/ dynamic (running) vs static (weight lifting) exercises?

Answer 298

**dynamic (running)** = metabolic vasodilation of arterioles due to local vasodilator substances **static (weight lifting)** = muscle contraction compresses blood vessels, which raises vascular resistance and decreases blood flow during the exercise. reactive hyperemia occurs during the recovery period

Question 299

pathophysiology of alcohol-induced hepatic steatosis

Answer 299

alcohol DH + aldehyde DH -\> excess NADH production -\> decreased FFA oxidation -\> TG accumulation in hepatocytes

Question 300

amt of REM sleep in a patient with major depressive d/o

Answer 300

increase

Question 301

odansetron MoA (2)

Answer 301

* 5HT3 receptor antagonist - blocks vagus-mediated nausea and vomiting *(which normally sends info back to the vomit center in medulla)* * blocks serotonin in the chemoreceptor trigger zone

Question 302

immune response in a patient w/ PID

Answer 302

chlamydia trachomatis - obligate intracellular pathogen, therefore **cell-mediated cytotoxicity**, a **Th1**-dominant response) is the primary defense aganist the infection

Question 303

fructosuria

Answer 303

∆ fructokinase --\> asymptomatic

Question 304

patient w/ renal cell carcinoma - lesion most likely originated from what part of the nephron/kidney? histological features? gross features?

Answer 304

epithelium of **PCT ** ## Footnote hx: **clear cell carcinoma** (most common type; due to high lipid content) gross features: **golden yellow mass**

Question 305

urge incontinence what is it and what is caused by? treatment?

Answer 305

caused by uninhibited bladder contractions (detrusor instability) that result in sudden sensations of urgency, with involuntary leakage of urine often before reaching the toilet trmt: **M3 (G_q) antagonists (ie oxybutynin) ** - \> decreased production of IP₃/Ca - \> smooth muscle relaxation - \> decreased involuntary detrusor contractions - \> increased bladder capacity + decreased sense of urgency ADR: anticholinergic effects: dry mouth, blurred vision, tachycardia, drowsiness, constipation

Question 306

sensory innervation above the vocal cords and below the vocal cords are different.

Answer 306

above: superior laryngeal, internal br. below: recurrent laryngeal

Question 307

hapatients who undergo general anesthesia are at great risk of these 2 ADRs

Answer 307

halogenated anesthetics (**HALOTHANE**, enflurane, isoflurane, and sevoflurane) can cause massive **CENTRILOBULAR HEPATIC NECROSIS**, as evidenced by increased AST, ALT, and bilirubin levels *usually presents 2d-4wks after exposure * **malignant hyperthermia -** when anesthetic is given w/ succinylcholine -\> induce fever+severe muscle contractions trmt: dantrolene (muscle relaxant)

Question 308

amyloid deposit only in heart

Answer 308

transthyretin (cardiac amyloidosis)

Question 309

R nasal hemianopia has damage to

Answer 309

R perichiasmal lesion - ie calcification of ICA impinging on uncrossed, lateral retinal fibers

Question 310

definition of phenotypic mixing

Answer 310

**co-infection of a host cell by two viral strains**, resulting in progeny **virions w/ nucleocapsid proteins from one strain and the genome of the other strain**; since there is **no ∆ in the underlying viral genomes**, the next generation of virions **revert to their original, unmixed phenotypes**

Question 311

What should you consider in a patient with stable, compensated cirrhosis who suddenly decompensates without apparent reason?

Answer 311

Hepatocellular carcinoma, esp if serum AFP is elevated

Question 312

atrial myxomas common sx? what does it like to produce?

Answer 312

scattered cells with mucopolysaccharide stroma, abnormal blood vessels, and hemorrhage - results in a pedunculated and gelatinous structure that can lead to valve obstruction tend to occur in the **LA**; causes **mid-diastolic rumbling best heard at apex; positional dyspnea** produces * IL-6 --\> constitutional sx (weight loss, fever) * VEGF --\> angiogenesis

Question 313

MoA of somatostatin in the H-P axis

Answer 313

inhibits GH, TSH

Question 314

a 36yo woman with 5 miscarriages, all which occured in her first trimester. cause of her infertility?

Answer 314

suspect a robertsonian translocation in an apparently healthy woman who has many first-trimester spontaneous abortions

Question 315

patient on anti-pyschotics develops agranulocytosis and seizures. Rx?

Answer 315

clozapine

Question 316

galactose ∆

Answer 316

blood, urine, cataracts (osmotic damage)

Question 317

prevent herpes reactivation with...

Answer 317

**daily** valacyclovir after the **first** episode a short course of acyclovir during the primary herpetic episode just reduces the _duration_ of viral shedding, _time_ for lesional healing, _constitutional sx_ and _pain_

Question 318

virulence factor of ALL bugs that cause increased cAMP

Answer 318

* **b. anthracis** - _edema factor acts as an adenylate cyclase_ -\> increased cAMP -\> edema + phagocyte dysfunction * **bordetella pertussis** - _pertussis toxin disables Gi_ -\> disinhibits adenyl cylase -\> increased cAMP levels -\> edema + phagocyte dysfunction * **ETEC**: Heat-labile toxin _activates adenylate cyclase_ -\> increase cAMP -\> increase Cl/H2O efflux * **Vibrio cholera -** cholera toxin activates Gs -\> increase cAMP -\> increase Cl/H2O efflux **PE**T**A**-**Vib**es likes to cAMP

Question 319

honey

Answer 319

spores from c. botulinum

Question 320

inflammatory exudate causes rapid neutrophil chemotaxis. What signaling molecule the most responsible? Others that may play a role?

Answer 320

LT-**B3 ** **others: 5-HETE (LT precursor), C5a** Note: **LT-C4, D4, and E4** are impt for vasoconstriction, bronchospasm, and increased vascular permeability = role in pathogenesis of bronchial asthma because they cause bronchospasm and increased bronchial mucus scretion

Question 321

what should you treat patients with age-related macular degeneration (AMD) with?

Answer 321

**anti-VEGF** if it's "wet" AMD - meaning that it is due to abnormal blood vessels w/ subretinal fluid/hemorrhage, gray subretinal membrane, or neovascularization

Question 322

antiarrhythmic drug that causes QT prolongation and also have ß-adrenergic blocking abilities (bradycardia)

Answer 322

Sotalol (other class 3 = amidarone, ibutilide, and dofetilide but these do not have ß adrenergic blocking abilities

Question 323

Stretpomycin MoA how does resistance to streptomycin develop?

Answer 323

aminoglycoside that binds to **30S** ribosome and distorts the structure (thereby preventing bacterial protein synthesis) resistance acquired via **ribosomal gene mutations **

Question 324

acute myelogenous leukemia translocation

Answer 324

AML t15;17 ∆ = 2 = hAMLet = 2 syllables

Question 325

What about brown fat causes them to produce heat?

Answer 325

it contains more mitochondria and multiple intracytoplasmic fat vacuoles (compared to white fat, which only has one). These mitochondria have electron transport and phosphorylation that is uncoupled (ie - the protons pumped out by ETC is returned to the matrix via thermogenin (uncoupling protein) and the energy released by e-transport is dissipated as heat; ø ATP is produced

Question 326

bilateral lens subluxation + stroke should make you think of.. what could've prevented this?

Answer 326

homocystinuria treatment w/ pyridoxine (B6)

Question 327

**drug-induced lupus** is usually caused by which Rx? Who is more likely to develop this?

Answer 327

**HIPP = Hydralazine, Isoniazid (INH), procainamide, phenytoin ** these are metabolized via** **hepatic **N-acetylation, **therefore **slow acetylators** are more likely to develop this (indicating that parent Rx are more likely culprits)

Question 328

what is a glomangioma? how does it present?

Answer 328

tumor of the modified smooth muscle cells of a glomus body ^{(glomus body = small encapsulated neurovascular organ found in the dermis of the nail bed, pads of fingers/toes/ears that is connected to a blood supply; functions to shunt bloood away from the skin surface in cold temperatures in order to prevent heat loss and to redirect blood flow to the skin surface in hot environments to facilitate the heat dissipation; ie THERMOREGULATION)} Presentation: small bluish lesion under the nail of the finger that is extremely tender to touch.

Question 329

non-bacterial thrombotic endocarditis associated with disseminated cancer is termed ...

Answer 329

marantic endocarditis

Question 330

patient w/ R sided white pupillary reflex is at risk of developing what two neoplasms

Answer 330

Retinoblastoma sarcomas (esp. osteosarcoma)

Question 331

autism chromosome associations

Answer 331

15 and 11

Question 332

csf culture from neonate w/ fever + poor feeding reveals GNR that forms pink colonies on macconkey agar

Answer 332

e. coli - contains K-1 capsular antigen one of the main causes of meningitis in babies (\*BEL\*)

Question 333

raltegravir

Answer 333

**integrase inhibitor** that disrupts the ability of HIV to integrate its genome into the host cell, thus preventing the host cellular machinery from being used to synthesize HIV mRNA in**tegra**se ra**tegra**vir

Question 334

What are the functions of these molecules? ICAM-1 VCAM-1 CD11/18 integrin LFA-1 VLA-4

Answer 334

Intracellular **adhesion** molecules (IC**A**M) = involved in **tight** binding Endothelial cells = I**CAM-1**, V**CAM-1** leukocytes: **CD11/18 integrin, LFA-1, VLA-4** ^{leukocytes = L'A; blood vessels = CAM}

Question 335

what opposes insulin action?

Answer 335

glucagon

Question 336

long-acting insulins

Answer 336

Glargine - 1x/day "Glarrrrrrrrrrr" = long Detemir - 1x/day NPH - 2x/day

Question 337

common cause of Trisomy 21

Answer 337

non-disjunction at **maternal meiosis I **

Question 338

chemoRx associated w/ leg swelling + orthopnea

Answer 338

doxorubicin prevent w/ Dexrazoxane

Question 339

definition of transformation

Answer 339

uptake of naked DNA from the environment _or_ incorporation of viral DNA into a host cell chromosome; alters genetic composition of the host cell but typically does not cause genomic change in progeny virions

Question 340

patient w/ acute intermittent prorphyria is deficient in what enzyme and has increased serum levels of..

Answer 340

enz: porphobilinogen deaminase increased: ALAD and porphobilinogen

Question 341

3 major causes of valvular aortic stenosis

Answer 341

valve w/ calcifications (ie bicuspid valve) calcified normal valve rheumatic heart disease

Question 342

ELISA/WB tests in a recently acquired HIV

Answer 342

falsely (-)

Question 343

**Ependymoma** Location Appearance Prognosis, presentation

Answer 343

Ventricles, 4th -\> hydrocephalus w/ drop metz to the spinal cord to form spinal ependymomas hx: **ependymal pseudorosettes w/ GFAP processes tapering toward blood vessels ** **kids dz**

Question 344

area implicated in hemiballism

Answer 344

subthalamic nucleus (involuntary flinging movements is contralateral to the lesion)

Question 345

patient with Myasthenia gravis is started on treatments and complains of abdominal cramping, nausea, sweating, and diarrhea. What can be used to control her new sx?

Answer 345

patient was probably given a cholinesterase inhibitor (AChEi), such as pyridostigmine and is now experiencing ADRs of excessive cholinergic stimulation. Trmt: **Scopolamine** - muscarinic cholinergic receptor antagonist will reduce effects of the cholinesterase inhibitor in sites where ACh action is mediated by a muscarinic receptor (ie gut) w/o affecting the action of the cholinesterase inhibitor on skeletal muscles, which use nicotinic cholinergic receptors.

Question 346

viral infections that usually show atypical (reactive) lymphocytes

Answer 346

atypical lymphocytes are non-specific (as are fever + joint pain), but **EBV** and **CMV** usually have the highest counts

Question 347

14yoF w/ development of painful cramps in her legs during exercise. labs show no increase in serum lactate dx and enzyme?

Answer 347

McArdle disease - lack of myophosphorylase (muscle glycogen phosphorylase) leads to abnormal glycogen accumulation in muscles -\> painful cramps + myoglobinuria during strenuous exercise w/o an increase in lactic acid

Question 348

In syringomyelia, where are the affected dermatomes relative to the actual lesion?

Answer 348

1-2 levels **below** the lesion, since first-order axons **ascend slightly** in the zone of Lissauer before synapsing)

Question 349

in a woman who is able to conceieve but not maintain a pregnancy probably has a lab serum finding of..?

Answer 349

low progesterone levels - causes endometrium to atrophy and pregnancy to terminate

Question 350

patient on anti-pyschotics develops weight gain. Rx?

Answer 350

olanzapine

Question 351

sickle cell anemia mutation

Answer 351

glutamic acid -\> valine

Question 352

vincristine affects this part of the cell cycle common ADR of this drug? how does vinblastine ADR's differ (even though they have the same MoA)

Answer 352

M phase - prevents microtubule formation by binding to ß tubulin (therefore ø mitotic spindle) and therefore failure of division occurs ADR: peripheral neuropathy ADR of vinblastine: bone marrow suppression

Question 353

STEMI in II, III aVF leads

Answer 353

inferior wall (RCA) may cause sinus node dysfunction

Question 354

loss of knee jerk is usually due to damage to which nerve?

Answer 354

femoral n. (L2-L4)

Question 355

unlar nerve courses btwn these two structures. injury to this nerve results in:

Answer 355

olecranon + medial epicondyle of humerus injury - motor + sensory innervation to the last 1.5 fingers of the hand

Question 356

what are pappenheimer bodies?

Answer 356

Fe containing, dark blue granules in wright stain RBC in patients with sideroblastic anemia

Question 357

T/F tetanus can be confirmed by performing a serum toxin assay

Answer 357

FALSE!! There is no serum (or antibody) toxin assay available for tetanospasmin Diagnosing tetanus = history & physical

Question 358

defect in NADPH oxidase sequelae

Answer 358

chronic granulomatous disease incr. susceptibility to catalase + organisms

Question 359

how does epinephrine increase glucose?

Answer 359

* increased glycogenolysis and gluconeogenesis * decrease glucose uptake from skeletal muscles * increase alanine release from skeletal m. (subtrate for gluconeogenesis in the liver) * increase breakdown of Tg in the adipose (FFA + glycerol substrate for gluconeogenesis in the liver)

Question 360

type of diuretic that is implicated for treating HTN or CHF in a woman who is also at risk for osteoporosis

Answer 360

HCTZ - increases absorption of Ca in the DCT

Question 361

beading along posterior aspect of the chest + lateral bowing of the legs in a 2yo boy

Answer 361

rickets - vitamin D deficiency - rosary chest + genu varus histologically - there is an **increase in unmineralized osteoid matrix** + **widening between osteoid seams**

Question 362

what factors reduce likelihood of gallstone formation? increase?

Answer 362

* reduce: low cholesterol, high level of bile salts + phosphatidylcholine * increase: opposite of ^

Question 363

brain histology - what does this person have?

Answer 363

Alzheimers

Question 364

pol gene

Answer 364

HIV contains 3 enzymes **- reverse transcrpitase, integrase, and protease**

Question 365

when is phenylzine and tranylcypromine usually prescribed for?

Answer 365

MAOi - atypical depression or treatment-resistant depression

Question 366

IFNg function

Answer 366

recruits leukocytes + activates phagocytosis produced by activated T cells and NK cells; function to promote Th1 differentiation, induce MHCII, and activate macrophages

Question 367

What is the MoA of ANP + BNP? What factor(s) do ANP + BNP counteract?

Answer 367

activates guanylate cyclase, which increases cGMP; subsequently leads to vasodilation, diuresis/naturesis, and decrease in BP endothelin, sympathetic effects, and AII

Question 368

generalized edema, proteinuria, hypoalbuminemia, hyperlipidemia, lipiduria

Answer 368

nephrotic syndrome

Question 369

prolonged exposure to loud noises can cause hearing loss due to damage of this

Answer 369

shearing-forces cause damage (distortion/fracture) to teh **sterociliated hair cells of the organ of corti**

Question 370

What is a common OTC drug that patients with hyperthyroidism MUST avoid?

Answer 370

aspirin and ibuprofen because they displace TH from binding proteins --\> worsens thyrotoxic state (acetaminophen is a-OK)

Question 371

6mo F w/ seizures, diminished responsiveness + progressive blindness. PE shows no abnormalities, but fundoscopic exam shows retinal pallor except in the macular area. D/O & Deficent enzyme?

Answer 371

Tay Sachs - Hexosaminidase A ## Footnote **TSH**

Question 372

in what diseases would you see an elevated AFP?

Answer 372

HCC non-seminomatous testicular germ cell tumor (ie yolk sac tumor)

Question 373

in what patients would you expect to see idiopathic hypertrophic subaortic stenosis? typical sx + PE findings?

Answer 373

young adults - thickening of the interventricular septum at the level of the mitral valve episodes of syncope, dyspnea, angina, dizziness, or CHF PE: systolic ejection murmur + thrill, increased ejection fraction, impaired diastolic function patients are often asymptomatic util they undergo sudden death, usually during strenuous exercise b/c the aortic outlet becomes completely occluded as a result of muscle contraction

Question 374

excess ACh can cause

Answer 374

## Footnote **DUMBBELSS** Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation.

Question 375

phenylephrine paradoxical effects of this?

Answer 375

a1 agonist - vasoconstrictor used in cases of shock or severe hypotension can cause **reflex bradycardia**

Question 376

F w/ bloody nipple discharge should make you think of this particular breast cancer

Answer 376

Intraductal papilloma - Small, usually in lactiferous ducts

Question 377

what is the minimal alveolar concentration? what is this a measure of?

Answer 377

concentration required to prevent movement in 50% of patients when exposed to noxious stimuli meausre of potency: potent anesthetics have low MAC

Question 378

this a.a. is a precursor for serotonin

Answer 378

tryptophan

Question 379

prolonged bleeding time + thrombocytopenia + **giant** platelets

Answer 379

Bernard-Souiler Syndrome

Question 380

Patient w/ Hodgkin lymphoma. What is the expected: MCV Serum Iron TIBC Ferritin

Answer 380

Anemia of chronic disease; common in patients with hodgkin's lymphoma (or chronic infection, inflammation, cancer) MCV = low Serum iron = low TIBC = low Ferritin = normal/high

Question 381

patient on anti-pyschotics develops retinitis pigmentosa Rx?

Answer 381

thioridazine

Question 382

patient on anti-pyschotics develops corneal deposits Rx?

Answer 382

chlorpromazine

Question 383

patient on anti-pyschotics develops extrapyramidal symptoms Rx?

Answer 383

haloperidol

Question 384

patient on anti-pyschotics develops prolonged QT Rx?

Answer 384

ziprasidone

Question 385

patient on anti-pyschotics gains weight Rx?

Answer 385

olanzapine

Question 386

patient on anti-pyschotics develops agranulocytosis + seizures Rx?

Answer 386

clozapine

Question 387

epinephrine binds these receptors

Answer 387

a1, b1, b2

Question 388

patient on anti-pyschotics develops retinitis pigmentosa Rx?

Answer 388

thioridazine

Question 389

glutamate activates what type of receptors? be very specific

Answer 389

NMDA receptor - ligand gated and voltage gated channel

Question 390

Composition of hemoglobin F hemoglobin A

Answer 390

F = a2g2 **(Fag)** A = a2b2

Question 391

what is retinopathy of prematurity?

Answer 391

neonatal RDS-induced retinal neovascularization *(due to temporary hyperoxia as a result of oxygen therapy for RDS),* followed by possible retinal detachment and blindness

Question 392

what is the pathophysiology behind a bicornuate uterus? uterus didelphys? How do these patients usually present?

Answer 392

**bicornuate uterus** = partial failure of paramesonephric duct fusion; patients have a partially septate uterus attached to a single cervix and vagina **uterus didelphys** = complete "" - patients have 2 separate vaginas, cervies, and uterine horns

Question 393

neurons that display cell body rounding, peripheral displacement of the nuclei and dispersion of Nissl substance to the periphery is indicative of:

Answer 393

* **_Wallerian degeneration_ - **severed axon **degenerates distally** and **axonal retraction** proximally to the site of injury * **_axonal reaction_** - cell increases proteins in an attempt to repair the axon; cell body shows signs of cellular edema (described above); usually occurs 12-48hrs post injury

Question 394

congenital QT interval prolongation is generally associated with?

Answer 394

K channel abnormalities neurosensory deafness (because endolymph is normally composed of high K concentrations and defects in these channels will result in abnormal endolymph production)

Question 395

uniform, diffuse thickening of glomerular capillary walls on LM is seen in which renal disease?

Answer 395

membranous glomerulopathy - most common cause of nephrotic syndrome

Question 396

flutamide MoA clinical use

Answer 396

non-steroid anti-androgen that impairs androgen-receptor interaction prostate cancer

Question 397

Physical differences btwn short stature and achondroplasia?

Answer 397

**Short stature (∆ IGF1)** - axial and appendicular skeleton are proportionately small **Achondroplasia (∆FGF-R3 at the epiphyseal plate)** - appendicular skeleton is a lot smaller than the axial skeleton

Question 398

FRC what is it? calculation? where is this on the spirometry graph? what is the intrapleural pressure at FRC?

Answer 398

point where the PVR is the lowest tendencies of the chest wall to expand and the lung to collapse oppose one another equally FRC = **RV + ERV** Spirometry graph - at the **bottom of the V_T trough** intrapleural pressure at this point = **-5 cm H₂O**

Question 399

22 yo presents to the ED complaining of severe HA and vomiting; slips into coma and dies. Autopsy shows atraumatic head w/ ruptured cerebral aneurysm w/ extensive intracranial hemorrhage. Dx?

Answer 399

spontaneous intracranial hemorrhage (SICH) - usually due to AVM, ruptured cerebral aneurysm, or cocaine use. berry aneurysms are prone to rupture when there is an associated coarctation bc of HTN in the branches of the aortic arch proximal to the coarctation

Question 400

Pathophysiology of Hemochromatosis typical labs (Fe, why do women present later? trmt?

Answer 400

**Hemochromatosis** AR, **ø HFE** (*normally regulates transferrin/Fe uptake*) Labs: **elevated Fe, elevated ferritin, \>50% TIBC** (transferrin sat.) Classical Triad: **skin pigmentation, DM (**2˚ to pancreatic islet destruction), **Cirrhosis** Complications: **CHF, testicular atrophy, HCC** Trmt: **phlebotomy, deferasirox, deferoxamine** Women tend to present later due to blood loss during menstruation + pregnancy

Question 401

rapid treatment of hypoglycemia -induced loss of consciousness in a non-medical setting

Answer 401

IM glucagon - corrects hypoglycemia by increasing hepatic glycogenolysis and gluconeogenesis IM injection of hypertonic glucose solutions can damage local tissues and is unpredicatable in systemic absorption

Question 402

toxin responsible for producing bright red tonsils, enlarged anterior cervical LN and skin rash

Answer 402

SCARLET FEVER - complication of strep pyogenes - pyrogenic exotoxin

Question 403

ß glucuronidase

Answer 403

enzyme that deconjugates bilirubin released by damaged hepatocytes and bacteria

Question 404

Violent stretch btwn the head and shoulder can result in this particular injury

Answer 404

**ERb-Duchenne palsy** damage to musculocutaneous n. + suprascapular n. -\> waiter's tip posturing of arm (shoulder adducted, arm pronated, elbow extended)

Question 405

CT findings of constrictve pericarditis

Answer 405

thickening and calcifications of pericardium (bright white outline surrounding heart) sx: slowly

Question 406

sporangium should make you think of...

Answer 406

mold fungi

Question 407

Diagnosis

Answer 407

Tzanck smear multi-nucleated giant cells - **HSV**

Question 408

patient w/ pulmonary mass complains of dyspnea and hiccups. Why?

Answer 408

pulmonary mass likely impinges upon the **phrenic n. C3,4,5** resulting in hiccups + diaphragmatic paralysis w/ dyspnea

Question 409

benzos that have a short half-life. why is this impt?

Answer 409

Triazolam Alprazolam Oxazepam **"TAO"** impt for **reducing daytime drowsiness/"hangover" effect** that can impair judgement and concentration, and cause ataxia (increased risk of falls) on the flip side, this can cause a makes it so that it has a **higher addictive potential**

Question 410

What are Clara Cells and what is their role in the body?

Answer 410

non-ciliated, secretory cells present in the terminal respiratory epithelium; secrete stuff that inhibit neutrophil recruitment and activation

Question 411

MoA of mifepristone vs MoA of misoprostol

Answer 411

**mifepristone (RU486) = progesterone receptor antagonist - results in decidual necrosis + expulsion of products of conception; **used as an abortifacient (up to 49d post-conception) since progesterone is necessary for implantation and maintenance of pregnancy **miso**_prost_**ol = **_prost_**aglandin analog - causes uterine contractions + cervical dilation; also used to prevent NSAID-induced ulcer dz** don't confuse them!!!

Question 412

patient with increased susceptibility to encapsulated, pyogenic bacteria (strep. pneumo, h. influenza, pseudomonas)

Answer 412

Bruton X-linked agammaglobulinemia (absence of C19+)

Question 413

virluence factor of e. coli that causes bloody gastroenteritis

Answer 413

verotoxin (shiga-like toxin) - inactivates 60S component, halting ribosomal protein synthesis and causing cell death

Question 414

5yo w/ fever, abd pain, diarhea mixed w/ small amounts of blood who develops marked pallor and oliguria should make you think of... what test is going to be abnormal?

Answer 414

HUS - EHEC 0157-H7 bleeding time will be abnormal since widespread capillary thrombi consume platelets (also cause schistocyte formation) -\> pallor, weakness, and tachycarida (compensatory response) thrombocytopenia -\> petechiae + purpura labs: decr. hemoglobin, hct, RBC count labs: increased LDH and reticulocytes, bleeding time (due to reduced platelets) labs: normal coagulation studies because there are no clotting factor deficiencies or DIC associated with HUS

Question 415

chromogranin A is a marker of...

Answer 415

neuroendocrine cells

Question 416

amlodipine MoA clinical use ADR

Answer 416

Ca channel blocker - selective for arteriolar smooth muscle ^{(decrease SVR and thereby decrease afterload + cardiac work)} HTN flushing, peripheral edema (bilateral ankle swelling)

Question 417

damage to tibial n. results in..

Answer 417

weak plantarflexion (ie **foot is held in unopposed dorsiflexion**) and weak inversion of ankle (ie **food is held in eversion**), inability to curl toes loss of sensation over _sole_ of foot

Question 418

damage to common peroneal n. results in..

Answer 418

weak dorsiflexion (ie **foot drop**) and weak eversion of ankle (ie **food is held in inversion**) loss of sensation over _dorsum_ of foot

Question 419

primary virulence factor of s. pneumoniae?

Answer 419

polysaccharide capsule IgA protease

Question 420

Segmented viruses

Answer 420

* **B**unyavirus (california encephalitis, sandfly/Rift valley fever, crimean-Congo hemorrhagic fever, Hantavirus * **O**rthomyxovirus (influenza) * **A**renavirus (LCMV, Lassa fever encephalitis) * **R**eovirus (rotavirus) capable of genetic shifts through reassortment

Question 421

cohort study

Answer 421

compares a group with a given exposure or risk factor to a group without. LOOKS TO SEE IF EXPOSURE INCREASES LIKELIHOOD OF DISEASE

Question 422

why would someone with acute pancreatitis (AST156, ALT 44) have a mean corpuscular volume of 108fL?

Answer 422

dude likely has **OH abuse** (his AST/ALT ratio is \>2, which is indicative of alcoholic hepatitis) chronic alcholism -\> vitamin associated deficiencies (B12/Folate) -\> macrocytosis

Question 423

T/F aspirin is an effective anticoagulant for DVTs T/F aspirin is an effective anticoagulant for MIs/ischemic stroke

Answer 423

F T - aspirin is commonly used in patients who have had a TIA to prevent 1˚ or 2˚ coronary artery events and ischemic strokes

Question 424

MoA of TRH in the H-P axis

Answer 424

stimulates TSH + prolactin release

Question 425

23yoF with chronic viral hepB on liver bx. presence of which serological marker is most likely to increase risk of vertical transmission of the virus? what should you do?

Answer 425

HBeAg = marker of viral replication and increased infectivity newborns: passive immunization with HepB Ig, followed with active immunization with recombinant HBV vaccine

Question 426

in SLE, how does thrombosis occur? Libman-Sack's endocarditis?

Answer 426

hypercoagulable anti-phospholipid antibody syndrome IC deposition on the cardiac valves -\> fibrosis

Question 427

patient started on an anti-coagulant comes in 2 weeks later complaining of this. What was this patient given and what is his problem?

Answer 427

warfarin he's probably protein C deficient - which lead him to a relatively hypercoagulable state with thrombotic occlusion of the microvasculature and skin necrosis

Question 428

source of blood in lateral ventricles of a preemie

Answer 428

germinal matrix- highly cellular + vascularized layer of the SVZ BV are thin and lack the glial fibers that normally support the blood vessels, thereby increasing its risk of hemorrhage occurs only in preemies because the germinal matrix becomes less prominent and its cellularity and vascularity decrease, thereby reducing the risk of intraventricular hemorrhage

Question 429

drug for patient with both absence _and_ tonic clonic seizures

Answer 429

valpric acid (ethosuximide does not effective against tonic clonic seizures)

Question 430

nifedipine moA

Answer 430

peripherally acting Ca channel blocker -\> reflex tachycardia

Question 431

histology of type I dm? type II dm?

Answer 431

type I - leukocytic infiltrate of the islet type II - islet amyloid deposition (IAPP)

Question 432

PKU inheritance

Answer 432

AR

Question 433

greast risk of long-term exposure to asbestos

Answer 433

**bronchogenic carcinoma **- 1st leading cause of death in this population **mesothelioma** - 2nd leading of death

Question 434

combination of **low MCV** **normal serum Fe** **normal TIBC** should make you think of..

Answer 434

thalassemia minor _or_ lead poisoning

Question 435

N-myc is a marker of...

Answer 435

neuroblastoma and small carcinoma of the lung

Question 436

patients on clozapine should be monitored for...

Answer 436

**seizures** CBC - can cause **agranulocytosis** (MoA: acts on D4 receptors) but note that it is an atypical antipsychotic that is less likely to cause EPS

Question 437

cytokine that inhibits Th1 cells

Answer 437

IL-10 (produced by TH2 cells

Question 438

which organ has an O2 extraction that exceeds that of any other tissue or organ in the body?

Answer 438

heart - resting myocardium extracts ~75% of the O2 present in the blood, while the myocardium at work extracts up to ~90% of the O2 in the blood

Question 439

prolonged bleeding after tooth extraction and surgeries can be of two things. What can distinguish between them?

Answer 439

can be hemophilia A _or_ vWF d/o Hemophilia A = spontaneous hemoarthroses, prolonged PTT vWF = prolonged PTT _and_ prolonged bleeding time

Question 440

Prolactin in the H-P axis what factors can stimulate its release? inhibit it?

Answer 440

**inhibits GnRH -\> ** decreased LH/FSH/sex hormones, thereby causing impotence in M and amenorrhea in women of reproductive age; aka "hypogonadotropic amenorrhea" it is **inhibited by Dopamine**, and **stimulated by TRH** (in cases of severe hypothyroidism) dopmaine antagonists (bromocriptine) are used to treat prolactinomas anti-psychotics (dopamine antagonists) - galactorrhea

Question 441

Which parts of the inner ear is best suited to detect high frequency sounds? low frequency sounds?

Answer 441

high frequency: **base** of the cochlea, near the oval/round windows low frequency: **apex** of of the cochlea, near the helicotrema "It's **low-**ny at the top (apex)" ^{(can think of the base as having a wider area = big; high,} whereas the apex has a smaller area = small; low)

Question 442

Patients w/ Trisomy 21 are at increased of 3 diseases

Answer 442

childhood: AML-M7, ALL adulthood: Alzheimers

Question 443

how does carotid sinus massage affect PaO₂ and PaCO₂?

Answer 443

causes reflex vagal discharge to the SA node, atrial myocytes, and AV node -\> HR + CO is also decreased but carotid sinus massage would **n​ot** signfiicantly affect the PaO2 or PaCO2

Question 444

in what ways can you think of someone with ß thalassemia major experiencing heart failure?

Answer 444

these patients require a lot of transfusions, resulting in an Fe overload that results in hemosiderosis that can contribute to cardiac failure The heart is damaged by the chronic high CO state needed to compensate for the anemia.

Question 445

paraneoplastic syndromes of renal cell carcinoma (2)

Answer 445

**EPO** -\> polycythemia **PTHrP** -\> hypercalcemia

Question 446

what is the scala media composed of? What does it house?

Answer 446

endolymph; houses the tectorial membrane + organ of corti

Question 447

surgeon w/ shaky hand was trying to ligate the inferior thyroid a. and accidently severed this nerve and its innervation to these structures

Answer 447

recurrent laryngeal n. innervations: all laryngeal m. (except cricothyroid) and sensory innervation below the vocal cords

Question 448

endocarditis with vegetations + negative blood cultures

Answer 448

HACEK organisms (haemophilus, actinobacillus, cardiobacterium, eikenella, kingella)

Question 449

diffuse large b-cell lymphoma translocation

Answer 449

follicular t14;18; 4 = “four”llicular _OR_ diffuse large b-cell lymphoma t14;18 = 4 words

Question 450

L atrium enlargement can result in:

Answer 450

L recurrent laryngeal impingement difficulty swallowing

Question 451

mother dx w/ GBS - what should you do?

Answer 451

give INTRApartum penicillin or ampicillin

Question 452

common cause of oxalate stones in an alcoholic homeless with vomiting and prolonged oliguria.

Answer 452

ethylene glycol increased osmolar gap with AG acidosis

Question 453

**Pilocytic astrocytoma** Location Appearance Prognosis, presentation

Answer 453

**Cerebellum** **Cystic tumor w/ nodule** on the wall; pilocytic astrocytes (GFAP +), eosinophilic **rosenthal** fibers **Kids** Low-grade tumor

Question 454

gluteus maximus functions in

Answer 454

hip extension

Question 455

acute intermittent porphyria can be preciptiated by which epilepsy Rx?

Answer 455

phenobarbital (increases GABA_A action) other ADR: sedation, cardiovascular + respiratory depression

Question 456

cause of pharyngitis and myocarditis

Answer 456

corynebacterium diphtheriae

Question 457

Name these strctures

Answer 457

A = globus pallidus B = putamen C = internal capsule D = caudate nucleus E = amygdala

Question 458

leading cause of chronic bronchitis

Answer 458

smoking

Question 459

kappa and delta opioid receptors excessive stimulation results in

Answer 459

mioiss dysphoria sedation antidepressant effects

Question 460

Rx that activates **PPAR-gamma** is used for...? activation of this receptor does what?

Answer 460

**Thiazolidinediones (TZDs)** - exert their glucose lowering effect by **binding to PPAR-gamma receptor**, thereby activating genes (ie **adiponectin)** involved in glucose + lipid metaolism net: **decreased insulin resistance**

Question 461

what dopaminergic pathway connects hypothalamus and pituitary gland? such that it allows DA to inhibit PRL secretion?

Answer 461

tuberoinfundibular dopaminergic pathway

Question 462

G6PD inheritance

Answer 462

X-Linked Recessive

Question 463

schoolboy acts cruelly to a girl that he actually likes

Answer 463

reaction formation - adoption of a behavior that is opposite to that of one's true feelings

Question 464

name this please

Answer 464

mucormycosis branches at 90˚

Question 465

CA-19-9

Answer 465

pancreas adenocarcinoma - marker for tracking tumor recurrence, but not screening

Question 466

what factors act through GPCRs?

Answer 466

peptide hormones (glucagon, PTH, ACTH, gonadotropins)

Question 467

corneal reflex involves which 2 cranial n.?

Answer 467

afferent: CN V**1** efferent: CN **VII** *(enters the orbit via superoir orbital fissure)*

Question 468

mastectomy can injure what nerve? effects of this?

Answer 468

long thoracic - winged scapula + inability to abduct arm above the horizontal plane

Question 469

viruses with segmented genome

Answer 469

ROBA rotavirus (reovirus) influenza (orthomyxovirus) lymphocytic choriomeningitis california encephalitis (bunyaviridae) virus (arenavirus)

Question 470

how do these viruses enter the cells? CMV EBV HIV Rabies Rhinovirus

Answer 470

CMV: cellular integrins EBV: CR2/CD21 HIV: CD4, CXCR4, CCR5 Rabies: Nicotinic ACh receptor Rhinovirus: ICAM

Question 471

treatment for OCD

Answer 471

TCAs (clomipramine) _or_ SSRIs

Question 472

where are there high expiratory flow rates in restrictive lung diseases?

Answer 472

1) low lung volumes due to increased elastic recoil pressure 2) increased radial traction on the conducting airways by the fibrotic pulmonary interstitium

Question 473

location of the great saphenous vein relative to the small saphenous vein?

Answer 473

**great** = _medial_ aspect of the leg, courses upwards medially and drains into the common femoral vein just inferolateral to the pubic tubercle **small** = _lateral_ aspect of the leg; courses posteriorly to drain into the popliteal vein

Question 474

initial cellular event triggered by Digoxin

Answer 474

decreased Na efflux (via inhibition of Na/K/ATPase) ultimately results in AV nodal blockage

Question 475

how does damage to the inferior parietal lobe of the dominant hemisphere differ than that of the non-dominant hemisphere?

Answer 475

* **dominant** = Gerstmann syndrome - R/L confusion, dysgraphia, dyscalculia, and finger agnosia * **non-dominant** = apraxia (inability to execute learned purposeful movements despite having the desire and physical capacity to perform the movements), contralateral hemi-neglect

Question 476

45yo w/ pelvic pain that is worse before and during menstrual period. US shows non-focal thickening of the myometrium w/ normal ovaries. Pap + bimanual exam is normal. Dx?

Answer 476

Adenomyosis - presence of endometrial glands in the myometrium of the uterus in addition to their normal location in the endometrium. They undergo cyclic changes w/ menstrual cycle in response to the same stimuli as the normal endometrial glands.

Question 477

brain tumors that are prevalent in the adults

Answer 477

Schwannoma acoustic neuroma Glioblastoma multiforme meningioma Oligodendrioma **ADULTS SAG MO'**

Question 478

long crystals that are negatively birefringent under polarized light are of what composition?

Answer 478

**monosodium urate (uric acid salt) **- is what accumulates in the synovial fluid and forms crystals that deposit in the synovium and cartilage

Question 479

F w/ breast pathology that looks like this. What is her diagnosis? what other findings should you expect?

Answer 479

paget's - should see eczematous patches on nipple. cells seen are paget's cells = large cells w/ clear halo confined to the epidermis

Question 480

What is Von Recklinghausen's disease?

Answer 480

**NF-1** - inherited peripheral nervous system tumor

Question 481

2 symptoms of CN 3 palsy

Answer 481

somatic: * down and out gaze (∆ innervation to inferior, superior, medial rectus, inferior oblique) * ptosis (∆ innervation to levator palpebrae) parasympathetic * fixed, dilated pupil, loss of accomodation (∆ iris sphincter, ciliary muscle)

Question 482

mercaptopurine affects this part of the cell cycle common ADR of this drug? how is it mostly cleared?

Answer 482

S. phase - purine analog that inhibit de novo purine synthesis after being converted to active metabolites by HGPRT ADR: cholestasis, hepatitis (ie abd. pain, jaundice) mostly cleared by xanthine oxidase (since they are purine analogs) in the liver

Question 483

how do central chemoreceptors differ than peripheral chemoreceptors in terms of location + what they detect? what happens in COPD patients?

Answer 483

**C**entral: medulla, detect ∆H (**C**O₂; main stimulator of respiratory drive) * note that chronically elevated CO2 levels result in desensitization *(ie CO2 ceases to stimulate the respiratory drive)* and O2 is the only stimulator of respiratory drive. Therefore giving supplemental O2 to COPD patients decrease respiratory drive, since the body thinks that there's enough O2!!) Peripheral = carotid/aortic bodies; detect ∆O2

Question 484

HIV patient who is non-adherent with his meds have a: * colonoscopy = reddish violet flat maculopapular lesions or hemorrhoragic nodules * hx = spindle shaped tumor cells with small vessel

Answer 484

kaposi sarcoma (HHV8)

Question 485

2 causes and effect of congenital torticollis

Answer 485

**birth trauma** (breech delivery) **malposition of the head in utero** (fetal macrosomia or oligohydramnios) effect: SCM injury + fibrosis; head tilts *towards* affected site w/ the chin pointed away from the contracture

Question 486

how to destroy hepA infection? treat w/ acid heat to 60˚C for 1 hr boiling for 1 minute treat w/ diethyl ether drying

Answer 486

**F/O transmission = inactivated w/ water chlorination, bleach, formalin, UVR, boiling for 1 min** methods that do not work: * drying = stable * ø lipid soluble envelop = resitant aganist diethyl ether, chloroform * acid = HepA can withstand the acidic gastric environment (F/O, remember?) * Heating to 60˚C will not inactivate it

Question 487

What is the Berkson's bias?

Answer 487

selection bias created by selecting hospitalized patients as the control group.

Question 488

how do these factors change with Bernard Soulier d/o? Platelet Count Bleeding time PT PTT ristocetin response

Answer 488

Platelet Count = NC to decreased Bleeding time = increased PT = NC PTT = NC ristocetin: abnormal

Question 489

34yoM asthmatic develops wrist drop. CBC shows elevated eosinophils. Dx?

Answer 489

Churg-strauss syndrome - **p**-ANCA (myelo**p**eroxidase) * **Wrist** **drop** - develops secondary to a **radial n**. mononeuropathy, polyneuropathy * adult-onset asthma * **eosinophilia** * hx of **allergy** * migratory/transient pulmonary infiltrates * paranasal sinus abnormalities

Question 490

44yo w/ nuchal rigidity. gram stain would most likely show...

Answer 490

lancet shaped, GP cocci in pairs = STREP pneumo most common cause of bacterial meningitis in adults consider N. meningitidis only in outbreaks where individuals live in close quarters (ie dorms)

Question 491

cardiac findings in digeorge syndrome

Answer 491

tetralogy of fallot, aortic root anomalies

Question 492

warfarin - what factor is most implicated in skin/subcu fat necrosis?

Answer 492

inhibition of **protein C** activity can predispose patients to warfarin-induced skin necrosis. often seen in patients with protein C deficiency

Question 493

reliability vs accuracy in terms of a particular lab test

Answer 493

* **reliability** = reliable test is a reproducible test in that it gives similar results on repeated measurements * **accuracy (validity)** = test ability to measure what it is supposed to measure; must be compared to the gold standard

Question 494

Female that has not yet begun menstruating has a shallow vagina, no palpable uterus, palpable masses in the labia majora. What does she have?

Answer 494

androgen insensitivity (testicular feminization) phenotypically female but genetically XY (SRY -\> MIF -\> regression of mullerian ducts, but cells can't respond to T which results in external female development)

Question 495

what drug is used to control severe Grave's ophthalmopathy? (edema and infiltration of lymphocytes into the extraocular muscles and CT)

Answer 495

glucocorticoids

Question 496

definition of recombination

Answer 496

**exchange of genes between two chromosomes** by crossing over within homologous regions; genetic changes will be **passed down to subsequent generations**

Question 497

"jaundice and exertional dyspnea" should make you think of...

Answer 497

A1AT deficiency

Question 498

eye field looks like this: where is the lesion?

Answer 498

R parietal lobe (dorsal optic radiation) G

Question 499

genetic defect that leads to diminished proliferation of chondrocytes in the growth plate of long bones

Answer 499

achondroplasia - constitutive activation of fibroblast growth receptor inhibits chondrocyte proliferation (∆cell signaling)--\> dwarfism

Question 500

indicator of severity of a mitral reguritation

Answer 500

presence of audible S3 - reflects an increased rate of LV filling due to a large volume of regurgitant flow re-entering the ventricle during mid-diastole

Question 501

liver bx: extensive lymphocytic infiltration + granulomatous destruction of interlobular bile ducts

Answer 501

**primary biliary cirrhosis ** (increase serum-mitochondrial antibodies) pruritis is often the first symptoms and may be very severe, esp at night. hx: destruction of intralobular bile ducts by granulomatous inflammation and infiltrate of macrophages, lymphocytes, plasma cells, eosinophils

Question 502

how is a non-capsule forming strain of s. pneumo able to acquire genes that encode for the capsule and gain virulence?

Answer 502

transformation - acquisition of genetic material following the death/llysis of neighboring bacterial cells other bacterias have the same ability to do so: H. influenza Neisseria gonorrhea and meningitidis

Question 503

vimentin is a marker of...

Answer 503

mesenchymal cells

Question 504

penicillamine is used to treat what d/o?

Answer 504

Wilson's disease - AR d/o characterized by toxic accumulation of Cu within organ tissues (esp of the liver, brain, and eye) Penicillamine is basically a chelator that removes excess copper in tissues

Question 505

first EKG signs of acute transmural MI

Answer 505

peaked T waves (localized hyperkalemia) followed by STEMI followed by Q waves

Question 506

Weightlifter lifts a very heavy bar over his head for a few seconds and suddenly drops it to the ground. What is the physiology behind this?

Answer 506

**Golgi-tendon organs (GTO)** - receptors at the junction of muscle + tendon; innervated by sensory axons (Grp Ib) GTOs are activated when a muscle actively contracts against resistance, results in stimulation of inhibitory interneurons in the spinal cord, which *_inhibit_* contraction of the muscle. -\> results in sudden muscle relaxation (prevents damage to musculoskeletal system, esp when a muscle exerts too much force)

Question 507

Piriform recess in the pharynx contains

Answer 507

where food is directed as the epiglottis folds down on the laryngeal opening contains the **internal laryngeal n. (br. of superior laryngeal n. of CN-X)** that mediates afferent limb of the **cough reflex** - damage to this may result in ø cough reflex

Question 508

how does an indirect/direct inguinal hernia differ in terms of the layers that encase it? what is it caused by? how do they each present?

Answer 508

indirect = Li * covered by all 3 spermatic layers * failure of the **processus vaginalis** to obliterate * hydrocele direct = Md * covered only by the external spermatic fascia * weakness of the abdominal wall/**transversalis fascia** (@ **hesselbach's triangle**) * buldge on the groin that increases w/ during straining

Question 509

last feature to disappear along the bronchial tree serous glands clilia goblet cells mucous glands cartilage

Answer 509

cilia - prevents bronchiolar mucus accumulation and airflow obstruction; persist up to the end of the respiratory bronchioles mucus + serous glands travel within the cartilaginous plates and end at hte smallest bronchi (bronchioles lack these features)

Question 510

why would someone w/ severe aortic stenosis suddenly have heart failure?

Answer 510

a-fib ## Footnote severe AS may already have reduced CO and this may be exacerbated by the sudden loss of normal atrial contraction that contributes significantly to ventricular filling these patients depend on atrial contraction and w/o it, **LV preload can decrease to the point of producing severe hypotension**.

Question 511

17yo man w/ fever, sore throat, and cervical + axiallary lymphadenopathy. Dx?

Answer 511

infectious MONO; picture: Downey cells note - there are multiple causes of pharyngitis, but generalized lymphadenopathy is common w/ infectious mono!! (do not confused with smudge cells (pictured below)

Question 512

pyrophosphate analog that is used to treat osteoporosis

Answer 512

bisphophonates - alen**dronate**, rise**dronate**, iban**dronate** makes hydroxyapatite more insoluble; decrease bone resorption by interfering w/ osteoclasts function \*patients must stay upright for at least 30 minutes to prevent reflux because these agents can cause stomach/esophageal inflammation + erosions\*

Question 513

fatty streaks begin as flat yellow spots on the inner surface of the aorta. When do these normally start appearing?

Answer 513

in children as young as 1 years old and are present in the aortas of all children over 10

Question 514

how does an AVM affect cardiac circulation?

Answer 514

AVM shunts blood directly from Arterioles -\> Venous system (bypassing arterioles) --\> **increase preload** by increasing the rate and vol. of blood flow back to the heart --\> **decrease afterload**/**TPR **since blood is allowed to bypass the arterioles *(long-term response: sympathetic activation + kidneys -\> increase MSFP)*

Question 515

definition of uniparental disomy when do you normally see this?

Answer 515

when a fetus inherits 2 copies of homologous chromosomes from ONE parent and NO copy from the other parent ex: hydatidiform mole

Question 516

c. perfringenstoxins

Answer 516

**alpha toxin - lecithinase** **causes clostridial myonecrosis (gas gangrene)** - a rapidly progressive form of fasciitis that is associated with penetrating injury by **soil contaminated** objects

Question 517

c. diff toxins

Answer 517

**toxin A** - **neutrophil** chemotrractant -\> inflammation -\> mucosal death **toxin B** -\> **actin** depolymerization -\> ∆ cellular integrity, death, and mucosal necrosis both **inactivate Rho - **involved in signal transduction and actin cytoskeletal structure maintenance -\> **disrupts tight junctions**, leading to increased paracellular intestinal fluid secretions as well as cell rounding/retractions

Question 518

which two cell types in the body can't _use_ ketone bodies for energy and why?

Answer 518

**RBC** - lack mitochondria **hepatocytes** - lack thiophorase (succinyl-CoA-acetoacetate CoA transferase). *note: ketones are produced in the liver even though they can't use it!!*

Question 519

what 2 factors cause insulin resistance in overweight individuals??

Answer 519

FFA and serum Tg

Question 520

what is the specific site in the inner ear where sound is transduced into the nervous system?

Answer 520

organ of corti

Question 521

Role of muscle spindles?

Answer 521

aka **intrafusal muscle fibers** (connected in parallel with extrafusal fibers, innervated by grp IA and grp II sensory axons) mediate stretch reflex (myotactic reflex) which is commonly tested via deep tendon reflexes when a muscle is stretched, reflex activation of the a-motor neuron causes contraction to resist the stretch

Question 522

Which one corresponds to this graph? Acute GI bleed Pyschogenic polydipsia Diabetes insipidus Hypertonic saline infusion

Answer 522

Acute GI bleed - isotonic loss of ECF volume (ø osmolarity change, therefore normal ICF and decreased ECV); aka iso-osmotic volume contraction diarrhea would result in a similar looking graph

Question 523

72 M develops hypotension during surgical repair of abdominal aortic aneurysm. What part of the large bowel is most likely to be affected?

Answer 523

Splenic flexture + distal sigmoid colon = both are watershed area that are most susceptible to ischemic damage during hypotension/low perfusion states

Question 524

opsonic antibody

Answer 524

IgG - binds to Fc receptors to enhance speed of phagocytosis

Question 525

saccular aneurysms where do they occur? why do they occur? rupturing of these can result in?

Answer 525

"Berry aneurysms" typically within the circle of willis occur due to hereditary weakness of blood vessels (ADPKD, Marfans, Ehlers-Danlos" subarachnoid hemorrhage (WHOML)

Question 526

nitroprusside moa

Answer 526

venous + arterial vasodilator that decreases BOTH preload and afterload; resulting in maintained SV

Question 527

ddx of mitral valve thickening w/ vegetations

Answer 527

infectious endocarditis rheumatic disease Libman sacks- endocarditis associated wtih SLE non-bacterial endocarditis

Question 528

what does this patient suffer from?

Answer 528

**lead poisoning -** basophilic stippling on a background of hypochromic microcytic anemia. stippling = abnormal aggregation of ribosomes hypochromic microcytic anemia = ALAD inhibition -\> reduced Fe incorporation into heme -\> decreased Hb synthesis

Question 529

pt. w/ grayish pharyngeal exudate + enlarged cervical nodes and partial soft palate paralysis bacteria produces exotoxin - what is the MoA of this toxin?

Answer 529

ribosylates and inactivates elongation factor 2 (EF2)

Question 530

hormone profile of PCOS in terms of GnRH LH FSH estrogen androgens

Answer 530

GnRH = elevated **LH = increased** FSH = low (not enough to recruit dominant follicle) estrogen - may be low (due to low follicular maturation) or elevated increased androgen production

Question 531

21yo M patient w/ progressive impaired balance, difficult speaking; has elevated AST/ALT. Hx is otherwise unremarkable. Diagnosis? Labs?

Answer 531

**Wilson's disease** low ceruloplasmin ( increased Cu excretion Kayser-Fleischer rings (Slit lamp examination)

Question 532

18yo M suddenly collapses and dies. Autospy likely shows...

Answer 532

**hypertrophic cardiomyopathy** (esp of the interventricular septum) (don't confuse w/ "endocardial thickening and non-compliant ventricular walls", which is indicative of restrictive cardiomyopathy; often leads to CHF)

Question 533

agent that blocks inositol triphosphate interaction w/ its intracellular receptor would most likely decrease the activity of..?

Answer 533

protein kinase C remember: PLC -\> IP3 + DAG IP3 -\> Ca release from SR DAG + Ca -\> **PKC** activation

Question 534

Describe process of B12 absorption (from the mouth -\> terminal ileum)

Answer 534

1. salivary glands secrete R protein (haptocorrin), which binds B12 *(protects it from denaturation by gastric acid)* 2. complex reaches the duodenum, where pancreatic proteases cleave the R protein to release B12, which then binds to IF (prevents digestion in the small intestines and also facilitates its absorption in the distal ileum)

Question 535

resected testes show non-encapsulated, yellow, mucinous mass w/ endodermal sinuses. Tumor marker?

Answer 535

AFP - this is a yolk sac tumor. the endodermal sinuses are actually schiller duval bodies

Question 536

what factors signal through nuclear receptors?

Answer 536

**thyroid hormone** **retinoids** **peroxisomal proliferating activated receptors** **fatty acids**

Question 537

virluence factor of e. coli that causes neonatal meningitis

Answer 537

K1 capsular polysaccharide - prevents phagocytosis and complement mediated lysis

Question 538

at low doses, dopamine stimulates which receptors? high doses? even higher doses?

Answer 538

* _low doses_: **D1** receptors in renal vasculature -\> **increase GFR, RBF, Na excretion** * _high doses_: **ß1** receptors in the heart -\> **increase contractility, PP, systolic BP** * _even higher doses_: **a1** receptors in systemic vasculature -\> vasoconstriction (-\> **decreased CO** due to increased afterload) **d**oped **b**ut **a**mped

Question 539

drug that is causes disturbed color perception + its ADR (2) treatment?

Answer 539

digoxin ventricular tachycarrhythmias hyperkalemia trmt: anti-digoxin antibody fragments

Question 540

80yo man w/ creatinine: 2.0 mg/dL BUN: 65 mg/dL FeNa is 4% Diagnosis?

Answer 540

BPH note that his BUN/creatinine ratio is 62/2 = ~32, which is greater than the normal 12-20 for individuals on a normal diet. High ratios w/ elevated creatinine levels are due to POST-RENAL OBSTRUCTION, ie BPH or POST-RENAL AZOTEMIA

Question 541

baby boy at 37wks gestation shows a unilateral testicular mass. Gross Hx shows homogenous, yellow-white in color Hx shows epithelial lined spaces w/ flattened to cuboidal epithelial cells w/ vacuolated cytoplasm containing eosinophilic, hyaline-like globules. Scattered primitive glomeruli is observed. eosinophilic hyaline-like globules will stain for what?

Answer 541

**AFP + **A1AT | (indicates yolk cell differentiation)

Question 542

treatment of extra-pyramidal sx (cogwheel rigidity, resting tremor, masked facies, bradykinesia) caused by first-generation anti-psychotics

Answer 542

anti-muscarinic Rx (**trihexyphenidyl, benztropine**) DO NOT USE LEVODOPA, or BROMOCRIPTINE because it can preciptate or exacerbate psychosis, respectively

Question 543

mother taking her anger out on her son, who in turns, yells at his little sister

Answer 543

displacement

Question 544

why is it that thyrotoxicosis (thyroid storm) results in hyper-adrenergic manifestations (ie racing heart, insomnia, SOB)

Answer 544

TH upregulates ß adrenergic receptor expression (also reason why ß blockers are used to treat thyroid storm!!!)

Question 545

tachyphylaxis - what is it?

Answer 545

**rapidly declining effect of drugs (such as phenylephrine or NTG) after a few days of use** - occurs bc of a decreased production of endogenous NE or NO from the nerve terminals due to (-) feedback mxn, resulting in relative vasodilation and subsequent edema + congestion) patients tend to see rebound rhinorrhea, edema, congestion w/ this stop Rx to allow restoration of normal NE/NO feedback pathways

Question 546

what stain is this? what is it used for?

Answer 546

prussian blue stain - stains iron; used to diagnose hemochromatosis

Question 547

what should one do after D&C of hydatidiform mole??

Answer 547

serial measurements of **ßhCG** levels; if elevated or rising, it may signify the development of an invasive mole or choriocarcinoma

Question 548

patient with CREST is at risk for developing what?

Answer 548

accentuated 2nd heart sound pitting edema hepatomeagly ALL BECAUSE of intimal thickening of pulmonary arterioles (due to increased collagen deposition) --\> leads to narrowed lumens and increased pressure in the pulmonary circuit --\> Pulm HTN --\> R sided CHF

Question 549

chronic myelogenous leukemia

Answer 549

CML t9;22 ∆ = 13 = rotate the 13 90˚ = CaMeL has 2 humps on its back

Question 550

**Glioblastoma multiforme** Location Appearance Prognosis, presentation

Answer 550

Hemispheres (frontal, temporal, or near basal ganglia); can cross midline “butterfly glioma” Pseudopalisading pattern = central areas of necrosis and hemorrhage (ring enhancing lesion); GFAP (+) Adults, Poor prognosis (1 yr survival)

Question 551

ascending muscle weakness after GI or respiratory infection name of dz and common culprit

Answer 551

Guillain-Barre Syndrome Campylobacter jejuni

Question 552

most important hormones to replace in hypopituitarism

Answer 552

corticosteroids and thyroxine

Question 553

MoA of hydroxyurea

Answer 553

increase Hg **F** synthesis such that it confers protection against the polymerization of sickle cells

Question 554

what molecules signal through TK associated receptors?

Answer 554

cytokines (ie IL-2) GH prolactin all act via **JAK/STAT** pathway

Question 555

Bony metz = if **osteoblastic + osteolytic**, you should think of...

Answer 555

breast cancer

Question 556

what does it mean when the arteriovenous concentration gradient of a gas anesthetic is LOW in terms of tissue solubility time to reach blood saturation brain saturation

Answer 556

* low tissue solubility (ie a small amt of anesthetic is taken up from arterial blood, which results in high venous concentration) * time to reach blood saturation = faster * brain saturation = faster because of the factors above

Question 557

How is copper absorbed from the body? Removed?

Answer 557

Ingested Cu is absorbed in the stomach + duodenum and transported to the liver, where it is conjugated w/ a2-globulin to form **ceruloplasmin**, which is then resecreted into plasma Ceruloplasmin + unabsorbed Cu is secreted into bile and excreted into stool, which is the 1˚ route for Cu elimination

Question 558

what should you check in a patient w/ bitemporal visual field deficits w/ a history of hypercalcemia?

Answer 558

pancreas tumor (MEN1) - pituitary, parathyroid, and pancreas

Question 559

How do you differentiate between alkaline phosphatase that originates from the bone vs those that originate from other sources (ie placenta, liver, intestines)

Answer 559

heat denaturation: bone-specific AlkPhos is easily denatured by heat (**b**one=**b**oil)

Question 560

patient w/ thyroid that has branching papillary structures w/ concentric calcifications (psammoma bodies) w/ ground glass nuclei

Answer 560

papillary thyroid cancer

Question 561

cleft lip and palate, polydactyly, omphalocele

Answer 561

Patau - trisomay 13

Question 562

initial reaction to form heme involves which two substrates

Answer 562

glycine + succinyl CoA catalyzed by ALAS to form d-ALA

Question 563

virus that can replicate in the cytoplasm of an enucleated cell

Answer 563

RNA virus (poliovirus, picoRNAviridae)

Question 564

bone changes consistent w/ hyperparathyroidism?

Answer 564

**subperiosteal** **thinning **w/ cystic degeneration of cortical, aka compact, bone (due to PTH-mediated osteoclast activation and resorption

Question 565

amastigote

Answer 565

Leishmania

Question 566

how does TB develop resistance to isoniazid?

Answer 566

* decr. expression of catalase-peroxidase enz (required for isoniazid activation) * modification of the protein target binding site

Question 567

mother also likely experienced increased facial hair growth and some voice deepening during pregnancy should make you think of...

Answer 567

* **aromatase deficiency** - inability to convert androgens to estrogens in the gonads and peripheral tissues; infants should: * have high levels of T/androstenedione, since they're not converted to estradiol or estrone, respectively * F: ambigious or male-type genitaliaa, 1˚ amenorrhea + tall stature (E is impt for epiphyseal closure) * M: tall stature + osteoporosis * This hormonal imbalance can cause virilization in the mothers due to transfer of the excess androgens into the maternal circulation

Question 568

why is HPV 16/18 oncogenic?

Answer 568

produce E6/E7 E6 = binds p53 E7 - binds Rb

Question 569

bilirubin can be conjugated or unconjugated. what happens if there are excessive amounts of these? Bonus: what D/O are these present in?

Answer 569

**conjugated** = water soluble, loosely bound to albumin and excreted in urine when present in excess * problems w/ hepatocellular excretion of bilirubin glucuronides into bile canaliculi: **Dubin-Johnson** (ø), **Rotor** (low) **unconjugated** = water insoluble; tightly bound to albumin and therefore cannot be filtered by the glomerulus and therefore slowly deposits into various tissues, including the brain (-\> seizures, neurologic impairment) * problems with conjugation of bilirubin glucuronidation: **Crigler-Najjar** (ø), **Gilbert (low)**

Question 570

HLA-B27 (+) patient w/ sx suggesting ankylosing spondylitis should be continuously monitored for...

Answer 570

* **enthesitis** (inflammation at the insertion sites of tendons into bone) * **pulmonary/chest expansion** - since involvement of the costovertebral + costosternal junctions may cause limited chest movements and resulting hypoventilation * **ascending aortitis** - dilation of aortic ring + aortic regurgitation

Question 571

NT impt for induction of REM sleep

Answer 571

ACh

Question 572

RNA dependent DNA polymerase what is a form that is present in humans?

Answer 572

aka Reverse Transcriptase in humans: **Telomerase**

Question 573

hypophosphorylated Rb protein does what

Answer 573

prevents **G1 -\> S** transition allows damaged cells time to repair stuff

Question 574

damage to inferior gluteal n. (L5-S2) can result in what motor deficit?

Answer 574

impaired thigh extension this nerve exits the pelvis through the **greater sciatic foramen** (below the piriformis m.)

Question 575

what should you think of when a MI occurs in the setting of normal coronary arteries?

Answer 575

coronary arteritis hypercoabulability w/ acute thrombosis coronary vasospasm

Question 576

thoracentesis is usually performed between which ribs

Answer 576

**5th and 7th** ribs along midclavicular line **7th and 9th** ribs on the midaxillary line **9th and 11th** ribs along the paravertebral line any higher or lower, there is a risk of injurying the lung or the liver

Question 577

ab with valence of 4

Answer 577

IgA

Question 578

man loses consciousness while buttoning a tight shirt collar. what nerve is stimulated?

Answer 578

CN 9 - buttoning a tight shirt places **external pressure on the carotid sinuses**, causing the baroreceptors to react as if there is an incrase in systemic BP Afferent fibers from carotid sinus stretch receptors (**Hering's nerv, branch of CN9**) sends signals to the NST of the medulla.

Question 579

type of hernia that is covered by all 3 layers of spermatic fascia

Answer 579

indirect inguinal hernia; passes **laterally** to the inferior epigastric a/v

Question 580

what do you expect the testicles of someone with Klinefelter to look like?

Answer 580

hyalinization + fibrosis of the seminiferous tubules + subsequent lack of testosterone synthesis (ie testes are small + firm) ø T = eunuchoid body habitus (tall, gynecomastia, ø facial/body hair, low muscle mass)

Question 581

how does a femoral hernia occur?

Answer 581

protrudes through the **femoral ring**, medial to the femoral vessels (NA**V**-L) and inferior to the inguinal ligament. Patients see a "tender buldge **below** the inguinal ligament, and just **lateral** to the pubic tubercle) common in women because the femoral canal is small, femoral hernias are prone to **incarceration** (can't be reduced and cause N/V, abd pain, distension) and/or **strangulation** (leading to ischemia and necrosis)

Question 582

nitrates have a paradoxical effect - what is it? what drugs are effective in preventing this?

Answer 582

nitrates cause **arteriolar + venous vasodilation** -\> decreased BP -\> the body senses this and produces a **reflex tachycardia** via catecholamines, thus increasing mVO2. prevent by giving **ß blockers** to slow conduction through AV node and cardiac conduction system by preventing catecholamines from stimulating ß1 receptors can also use **diltiazem** or **verapamil** since they can also slow AV nodal conduction

Question 583

**depolarizing** neuromuscular junction blockers? **non-depolarizing** neuromuscular junction blockers? what does this all mean? both can be reversed by:

Answer 583

**depolarizing** * succinylcholine - strong ACh receptor agonist * produces sustained depolarization; prevents muscle contraction * antidote * ​phase I - none * phase II - AChEi * ADR: malignant hyperthermia, hyperCa, K **non-depolarizing** * pancuronium and tubocuarinine - * competitive ACh-R antagonist* * antidote: Neostigmine (AChEi), edrophonium, AChEi

Question 584

Pneumocystis infx + chronic mucocutaneous candidiasis indicates this

Answer 584

underlying T cell deficiency (ie SCID)

Question 585

newborn born at 37wks has puple splotches on the skin, hepatosplenomeagly, and jaundice. CT shows periventricular calcifications. Diagnostic test?

Answer 585

CMV note that retinal inflammation, sensorineural deafness, and microcephaly are common manifestations can cause mono-like sx, but the **heterophile test is negative** (unlike that of EBV)

Question 586

white cottage cheese-like discharge. Culprit?

Answer 586

candida albicans

Question 587

drugs that can cause nephrogenic DI

Answer 587

lithium demeclocycline (ADH antagonist)

Question 588

how does KI administration prevent thyroid absorption of radioactive iodine isotopes?

Answer 588

competitive inhibition, resulting in less radioactive material entering the thyroid, there therefore reduce the amount of tissue damage

Question 589

kneeling all day is expected to result in...

Answer 589

**pre-patellar bursitis "housemaid's knee"** common in roofers, plumbers, and carpet layers

Question 590

prophylaxis for meningococcal meningitis in patients who have come in close contact with a patient with active disease

Answer 590

**Rifampin ** | (NOT vaccination)

Question 591

ribavirin MoA clinical use? what is it normally used in conjunction with?

Answer 591

nucleoside analog that inhibits synthesis of guanine nucleotides, thereby **intefering w/ the duplication of viral genetic** material via several mechanisms used in chronic **HepC (adults)** and **RSV (viral bronchiolitis in** HepC used in conjunction with **IFNa**

Question 592

release of thyroid hormone is regulated through (-) feedback inhibition by....

Answer 592

T3 on hypothalamic TRH-secreting neurons and thyrotroph cells of the anterior pituitary

Question 593

why is only physostigmine used to reverse atropine OD while neostigmine and edrophonium, both with the same MoA, are not?

Answer 593

physostigmine is the only one that can cross the BBB to alleviate teh CNS sx (psychosis, delirium)

Question 594

Which pathogens produce factors that inactivate 60S ribosome by removing adenine from the tRNA, thereby preventing binding of tRNA?

Answer 594

Shigella and EHEC 0157:H7

Question 595

You're performing an eye exam on a patient and notice this. What d/o does this patient have?

Answer 595

NF-1 (von Recklinghausen disease) these are lisch nodules (iris hamartomas - asymptomatic) manifests w/ skin nodules (neurofibromas that contain **schwann cell proliferations**), cafe-au-lait macules, axially freckling **AD - 100% penetrance, variable expression**

Question 596

what is PEG used for?

Answer 596

osmotic laxative others: MgOH, Mg Citrate

Question 597

patient receiving broad-spectrum for extended periods of time are at risk of what and why?

Answer 597

blood in stool because vitamin K is made by bacteria in the gut c. diff

Question 598

adjustable gastric band (around cardiac part of stomach) must pass through which of the following ligaments? what is contained within this particular ligament?

Answer 598

lesser omentum - dbl layer of peritoneum that extends from the liver to the lesser curvature of the stomach (divided into hepatogastric + hepatoduodenal ligament) contains portal triad

Question 599

pathogenesis of ascites in patients with cirrhosis (2)

Answer 599

1. mechanical compromise of portal vein flow by fibrotic tissue -\> increased hydrostatic pressure 2. decreased systemic perfusion pressure -\> RAAS activation -\> avid Na/H2O retention therefore the treatment for ascites secondary to cirrhosis is actually **furosemide + spironolactone**

Question 600

What is the metabolic profile of patients with osteoporosis like for Ca PTH Phosphorus

Answer 600

all normal b/c osteoporosis is generally due to micro-architectural deteriorartion of bone tissue, resulting in decreased bone strength

Question 601

F w/ gray discharge

Answer 601

think bacterial vaginosis due to gardnerella vaginalis, usually has fishy odor + Clue cells (epithelial cells covered w/ garnerella bacteria)

Question 602

what does a persistence of HBsAg and HBeAg over a long window period indicate with low to moderate levels of anti-HBcAg IgG + no detectable anti-HBsAg indicate?

Answer 602

acute hepB that progressed to chronic hepatitis with **HIGH infectivity**

Question 603

crytococcus primary site of entry

Answer 603

lungs

Question 604

23yoF w/ who developed irregular menses after having normal menses, negative pregnancy test, normal pelvic exam. What does she have and what test will confirm diagnosis?

Answer 604

anovulation - likely cause of dysfunctional uterine bleeding *(due to an interruption of the normal sequence of the follicular and luteal phases of the menstrual cycle)* preogestin challenge - causes breakthrough bleeding and can be used to confirm anovulation

Question 605

isolated epithelial cells in crypts with fragmented, hyperchromatic nuclei and small discrete blebs containing both cytoplasm + nuclear fragments

Answer 605

apoptosis GVHD menstruation embryogenesis

Question 606

several episodes of **migratory thrombophlebitis** involving various sites in both arms + legs should make you think of....

Answer 606

**Trousseau sign** **(lung adenocarcinoma or pancreatic carcinoma)** adenocarcinomas produce thromboplastin-like substance that is capable of causing chronic intravascular coagulations that are both disseminated + tend to "migrate" -\> produces redness + tenderness on palpation of extremities could also be small vessel hypersensitivity type of vasculitis

Question 607

palpitations that start/stop abruptly suspicions: abnormal conduction pathway in the patient that bypasses the AV node affects which part of the EKG?

Answer 607

Wolf-Parkinson-White accessory pathway: **Bundle of kent -** allows recurrent temporary tachyarrhythmias by "pre-exicting" the ventricles ahead of the normal conduction pathway and results in: * shortened PR interval * delta wave (early upslope of each QRS complex) * widened QRS complex - which conversts to a narrow QRS during tachyarrhythmias bc the accessory pathway no longer pre-excites the ventricles, but instead forms a re-entrant circuit back to the atria

Question 608

Which one does this graph represent? (choose one) Aortic insufficiency Aortic Stenosis Mitral Stenosis Mitral regurgitation

Answer 608

Mitral Stenosis

Question 609

what should patients be tested for prior to starting methotrexate or leflunomide?

Answer 609

baseline LFTs since hepatoxocity is a major ADR of these agents

Question 610

Interpret this: HBsAg negative anti-HBc negative anti-HBs negative

Answer 610

Susceptible

Question 611

musculocutaneous nerve courses directly between these two muscles injury to this will result in:

Answer 611

biceps brachii _and_ coracobrachialis injury: paralysis of biceps + brachialis = inability to flex arm

Question 612

agratroban MoA and use other Rx in the same class?

Answer 612

inds to **thrombin** active site directly and inhibits its function use in treatment of HIT or patients w/ established HIT other Rx in the same class: hirudin, lepirudin, and agratroban

Question 613

NF-kB stimulates what?

Answer 613

cytokine production in immune response against infectious pathogens

Question 614

where are ethmoid air cells located?

Answer 614

medial to the orbit

Question 615

Omalizumab MoA and use

Answer 615

mAb that prevents IgE binding to mast cells use: allergen-induced bronchial constriction; uncontrolled severe allergic asthma

Question 616

interpret this HBsAg positive anti-HBc positive IgM anti-HBc positive anti-HBs negative

Answer 616

Acutely infected

Question 617

∆ btwn Mallory bodies and Councilman bodies? what do they lookl ike on histology?

Answer 617

Mallory - intracytoplasmic; damaged cytokeratin filaments Councilman - extracellular; apoptosed (shrunken) hepatocytes BOTH **eosinophilic**

Question 618

62F w/ cough, dyspnea + CXR w/ pulmonary infiltrate Hx shows columnar mucin secreting cells that fill alveolar spaces w/o invasion of stroma or vessels

Answer 618

Bronchioalveolar carcinoma - subtype of lung adenocarcinoma. arises in the periphery; multifocal

Question 619

what should you suspect if the pH of 7.**xx** is less than PCO₂=**xx**?

Answer 619

that there is a respiratory failure (or lack of respiratory compensation to some metabolic disease); normally the last two letters should be relatively the same

Question 620

tat and rev genes

Answer 620

genes required for HIV replication

Question 621

tenderness in anatomic snuff box - why does this usually occur and what should you worry about

Answer 621

cause: falling on an outstretched hand -\> fracture of scaphoid bone concern: **avascular necrosis** of the scaphoid bone (due to how the blood supply is oriented

Question 622

median nerve courses between these two muscles in the forearm and in between these two muscles in the arm denervation results in...

Answer 622

forearm: biceps brachii and brachialis arm: flexor digitorum superficialis and flexor digitorum profundus denervation = ape hand deformity" + loss of sensation on the palmar surface of the first 3 1/2 fingers

Question 623

which two drugs has the highest risk of causing drug-induced lupus? How do you tell that apart from actual SLE?

Answer 623

**Procainamide, hydralazine** DIL + SLE both have (+) ANA and (+) anti-histone antibodies but unlike SLE, anti-dsDNA are not seen in DIL

Question 624

sharp mid-chest pain that increases w/ deep inspirations and decreases when sitting up what physical findings are associated with this?

Answer 624

acute pericarditis - presence of friction rub manuevers decrease the pressure on the parietal pericardium

Question 625

eye field looks like this: where is the lesion?

Answer 625

partial lesion in the retina, optic disk, optic nerve A

Question 626

trigger words: painless homogenous testicular enlargement

Answer 626

seminoma - placental ALP

Question 627

patients w/ cirrhosis - what are 3 indicators of poor prognosis?

Answer 627

basically things that measure the liver's functional reserve: albumin levels Prothrombin time (PT) bilirubin levels

Question 628

when ATP attaches to the sarcomere, \_\_\_\_\_\_\_\_\_ if ATP is not available, \_\_\_\_\_\_\_\_\_\_\_\_\_

Answer 628

when ATP attaches to the sarcomere, **myosin head deatches from the actin filament** and then it energies a conformational change in that resets the myosin head to "contract' again the next time it binds to actin if ATP is not available, the **actin/myosin cross-bridge will persist, resulting in rigor mortis**

Question 629

muromonab MoA + clinical uses

Answer 629

anti-CD3 mAb that inhibits T cells treatment of acute rejection in patients w/ kidney, heart, and liver transplant

Question 630

IgG4 antibodies to phospholipase A2

Answer 630

membranous nephropathy

Question 631

T/F cardiac myocytes can divide in response to increased mechanical loads

Answer 631

**F -** cardiac myocytes are terminally differentiated cells and can no longer divide. They respond to increased mechanical loads by undergoing hypertrophy (increase sarcomere content and volume of individual ventricuar myocyte)

Question 632

eye field looks like this: where is the lesion?

Answer 632

R primary visual cortex (occipital lobe); usually due to **posterior cerebral artery** occlusion; macula spared due to collateral blood flow from the choroid arteries (middle cerebral arteries) H

Question 633

S-100

Answer 633

marker for melanoma, neural-derived tumors, and astrocytomas

Question 634

drug used to lower intraocular pressure in glaucoma

Answer 634

carbachol pilocarpine

Question 635

leucovorin - when is it used?

Answer 635

prevent ADR of MTX

Question 636

prednisone causes an increase in protein synthesis where? why?

Answer 636

LIVER - stimulate gluconeogenesis + glycogenesis (increase reserves in times of stress) ## Footnote (note that it antagonizes action of insulin in muscle and adipose, thus favoring catabolism in these tissues, which provides substrates for the anabolic reactions in the liver. Results in - skin thinning - muscle weakness - impaired wound healing - osteoporosis - immunosuppression

Question 637

how does celiacs lead to rickets or osteomalacia? How does it affect serum Ca, serum PO4, serum PTH?

Answer 637

atrophic intestinal mucosa -\> malabsorption of vitamin D, Ca, PO4 low vitamin D -\> impaired Ca/PO4 absorption from GI, impaired Ca absorption from kidneys, impaired excretion of PO4 low Ca -\> increased PTH * net: * serum Ca = decreased * serum PO4 = decreased * serum PTH = increased

Question 638

2 diseases that we've learned of that have strawberry tongues

Answer 638

scarlet fever (pyogenes) kawasaki disease also Toxic shock syndrome

Question 639

most likely outcome for HepB infection? HepC?

Answer 639

* **HepB:** acute hepatitis w/ _complete resolution_ (\>95% of cases) * **HepC:** acute hepatitis that develops into _stable chronic hepatitis_ (55-85% of patients)

Question 640

sabouraud's agar is used for..

Answer 640

culturing **coccidioides immitis**

Question 641

triad of - non-gonococcal urethritis - conjunctivitis - arthritis

Answer 641

reactive arthritis

Question 642

potency of inhaled anesthetic is determined by?

Answer 642

minimum alveolar concentration potency = 1/mac the lower the MAC, the more potent the anesthetic

Question 643

common side effect of HIV protease inhibitors

Answer 643

* **lipodystrophy** - fat redistribution from extremities to the trunk * **hyperglycemia, hyperlipidemia, and hyperinsulinemia** (likely due to impair hepatic chyloµ uptake and Tg clearance) * nephropathy * hematuria (indinavir)

Question 644

best treatment for * vascular diseases (coronary, peripheral, and cerebrovascular disease) * percutaneous coronary intervention (PCI) * treatment of unstable angina and non-Q wave MI

Answer 644

clopidogrel - inhibits ADP mediated platelet aggregation

Question 645

cryptorchidism - how does it affect sperm count FSH LH inhibin Testosterone

Answer 645

cryptorchidism (undescended testes) - if not surgically moved to the scrotal sac, the seminiferous tubules can become atrophic/hyalinized over time, resulting in: sperm count - decrease FSH - increase (loss of neg. inhibition by inhibin) LH - normal inhibin - decrease (due to eventual loss Sertoli cells) Testosterone - normal

Question 646

pheochromocytoma treatment

Answer 646

alpha blocker (phenoxybenzamine) BEFORE ß blocker to avoid HTN crisis

Question 647

on a cellular level, how does hepB virus cause hepatitis?

Answer 647

presence of viral HBsAg and HBcAg on the cell surface stimulates the host cytotoxic CD8+ T cells to destroy infected hepatocytes

Question 648

Based on the RFLP, at which stage did the non-disjunction occur? Maternal meiosis I Maternal meiosis II Paternal meiosis I Paternal meiosis II

Answer 648

Paternal Meiosis I upper band = mother middle + lower bands = father

Question 649

treatment for nephrogenic DI

Answer 649

HCTZ indomethacin amiloride hydration duh...

Question 650

PKU - what a..a becomes essential?

Answer 650

tyrosine (since it can no longer be synthesized from phenyalanine)

Question 651

IL-10 function

Answer 651

anti-inflammatory function by limiting the production of pro-inflammatory cytokines (ie IFNg, IL2, IL3, TNFa) produced by macrophages and Th2 cells

Question 652

what exits the jugular foramen?

Answer 652

IX, X, XI, jugular v.

Question 653

dead pt w/ alveolar cells containing golden cytoplasmic granules that turn dark with Prussian blue staining

Answer 653

granules can be lipofuscin or hemosiderin, but prussian blue stain indicates that it is **Fe** - hemosiderin. its presence in lung parenchyma indicates increased intravascular pressure that caused RBC to leak from congested capillaries, phagocytosed by alveolar macrophages and converted into hemosiderin "**heart failure cells" -** associated w/ **chronic L heart failure**

Question 654

renal: effect of cholera in the small intestines

Answer 654

massive loss of ISOtonic fluid from the GI - decr. in EC volume without significant effect on the IC volume

Question 655

fracture at the junction of frontal, parietal, temporal, and sphenoid will sever this artery

Answer 655

middle meningeal a. (br of maxillary a.) - can cause an epidural hematoma site: pterion

Question 656

low-pitched holosystolic murmur best heard at the L sternal border w/ accentuation during the hand-grip exercise

Answer 656

VSD accentuated because it increases afterload, which results in an increased movement of blood from the LV to RV (across the VSD)

Question 657

patient w/ lung transplant complains of fatigue and exertional dyspnea. lung bx shows fibrotic obstruction of terminal bronchioles. Why?

Answer 657

chronic rejection - affects the small bronchioli producing the obstructive lung disease "bronchiolitis obliterans" - lymphocytic inflammation of the bronchiolar walls leads to the development of granulation tissue that is later replaced by connective tissue

Question 658

F w/ purulent discharge ^{(has been described as white, or yellow-green on Uworld)}

Answer 658

N. gonorrhoeae or C. trachomatis usually accompanied w/ cervicitis, can progress to PID

Question 659

conversion disorder how does it differ from somatization disorder?

Answer 659

**voluntary motor or sensory functions** that are unexplained by any medical condition; often **precipitated by psychological stressors** somatization = multiple physical complaints before 30yo, including 4 pain sx, 2 GI sx, 1 sexual sx, and 1 pseudoneurological sx

Question 660

pathogenesis + biochemical abnormality in Alzheimers

Answer 660

conversion of ß-amyloid from an a-helical configuration -\> ß-sheets, which are less soluble and more prone to aggregating and subsequent formation of **extracellular** senile plaques **decr. ACh** in the hippocampus (impt for new memories) + nucleus **basalis** (impt for memory + cognition)** **due to deficiency of **choline acetyltransferase**

Question 661

metformin MoA clinical use? contraindications? what should patients on metformin be monitored for every year?

Answer 661

clinical use: **Type II DM** MoA **- increase sensitivity of target tissues to insulin** ADR: GI upset + **lactic acidosis ** CI: **renal failure **or any situtation that my preciptate lactic acidosis: * liver dysfunction * CHF * OHlism * sepsis therefore all patients on metformin are monitored yearly for **creatinine**

Question 662

what enzyme is responsible for allowing patients with ∆fructokinase to be able to allow dietary fructose to enter the glycolytic pathways?

Answer 662

Hexokinase

Question 663

6 day old infant with (+)HBsAg + HBeAg. risk of chronic infection? viral replication rate? histologic findings of live injury? how did this happen?

Answer 663

high, high, mild vertical transmission occurs via passage of fetus through birth canal or transplacental mild because the HBV is not inherently cytotoxic and the neonates immune system is still immature. But since they're at risk of chronic dz, they can progress to cirrhosis and/or HCC

Question 664

Which part of the nephron does renal cell carcinoma arise from? Most common metz site of renal cell carcinoma?

Answer 664

Origin: renal tubular cells Metz: lungs

Question 665

LH, FSH, estradiol, and estrone in anorexic women?

Answer 665

ALL LOW Why? % body fat decreases --\> estrogen low --\> cyclic LH surge does not occur --\> hypogonadoic amenorrhea

Question 666

patient with recurrent episodes of SOB + wheezing has a CBC that shows eosinophilia. Best Rx?

Answer 666

atopic (extrinsic allergic asthma) - mediated by LTs and ACh treat w/ zafirlukast + montekast to reduce LT synthesis by **mast cells, eosinophils, and basophils,** etc that infiltrate the bronchial mucosa in asthmatics

Question 667

long term OH uses causes what in the CNS treatment?

Answer 667

downregulaton of GABA receptors inhibits NMDA receptors, leading to upregulation of these recepotors increase NE, 5HT, and DA all lead to **tolerance** - which cause withdrawal sx **"Delirium tremens" =**"shakes"/tremors, autonomic dysfunction, anxiety, agitation trmt: benzos

Question 668

5yo w/ acute colicky abd. pain + loose stools has ∆ mental status, urinated once in the past 10 hrs and urine was red in color; conjunctival pallor. Dx?

Answer 668

HUS triad of anemia, thrombocytopenia, acute renal failure

Question 669

T/F - ejection fraction is preserved in diastolic dysfunction.

Answer 669

**TRUE** because diastolic function is a matter of decreased ventricular compliance rather than impaired myocardial contractility. Therefore EF and LV-ED**V** is normal but LV-ED**P** is increased

Question 670

what is CEA level used for?

Answer 670

sensitive indicator of CRC recurrence - measure preop and at regular intervals post-op CANNOT BE USED TO DIAGNOSE CRC... duh

Question 671

artificial active immunity vs artificial passive immunity

Answer 671

artificial active - stimulus (vaccination with an antigen) was medically applied artificial passive - stimulus (vaccination with an antibody) was medically applied

Question 672

oocyte surrounded by several layers of follicular cells with a small antrum

Answer 672

secondary follcile

Question 673

F w/ yellow-green foamy, foul smelling discharge

Answer 673

trichomonas - flagellated protozoan

Question 674

gangciclovir clinical use ADR

Answer 674

CMV-induced retinitis severe neutropenia

Question 675

ADPKD pt w/ blood in subarachnoid space complains of weakness in in his R arm and leg 5 days after the incident. What would've prevented this?

Answer 675

Ca channel blockers,esp **Nimodipine** can prevent cerebral vascular spasms following SAH. (cerebral vascular spasms occur due to degradation products of blood clots)

Question 676

what causes hypoglycemia in both a diabetic and non-diabetic

Answer 676

exercise

Question 677

anaphylaxis to a particular drug - what is most likely to be elevated in the serum

Answer 677

tryptase - released by mast cell degranulation

Question 678

woman with nipple inflammation, pigmentation and eczematoid changes are at risk of..?

Answer 678

paget disease - presence of individual adenocarcinoma cells within the squamous epithelium of the skin near the nipple.

Question 679

respiratory symptoms in an HIV patient

Answer 679

pneumocystis jirovecii (CD4

Question 680

Aa-gradient calculation

Answer 680

Aa = PAO2-PaO2 PAO2 = 150 - (PaCO2/0.8) = (FiO2 \* (PB-PH2O)) - PaCO2/R) PaO2 = usually given

Question 681

what should you suspect in a smoker w/ chronic bronchitis with recent onset of confusion, high fever, water diarrhea, and a mildly productive cough. Sputum gram stain shows numerous neutrophils but ø bacteria. What test should you perform?

Answer 681

Legionella - GN and facultative intracellular perform urine antigen test

Question 682

areas of the kidney that is most susceptible to injury in ATN

Answer 682

PCT and LOH (NOT renal papillae - necrosis in this area is usually associated with DM, analgesic nephropathy, sickle cell disease)

Question 683

pulsus alternans

Answer 683

**LV dysfunction -** beat to beat variation in the magnitude of pulse pressure in the presence of a regular cardiac rhythm

Question 684

which two drugs are strongly associated with fat-redistribution from the _extremities and gluteal region_ to the _abdominal viscera (trunk) and neck (buffalo hump)_

Answer 684

glucocorticoids HIV - protease inhibitors (-navirs)

Question 685

aortic valve calcifications can be associated with what heart sounds?

Answer 685

mid-systolic click followed by creschendo/decreschendo mumur S4 - due to chronically elevated LV pressures +/- systemic HTN

Question 686

how does taking NTG help with angina? ADR?

Answer 686

it acts primarily as a _ve**N**o_dilator (ie decrease in LV volume), causing a decrease in cardiac work and decreasing their symptoms ADR: throbbin HA + cutaneous flushing (due to vasodilatory properties)

Question 687

mid-humerus fracture can injure which nerve?

Answer 687

radial n. damage - can result in wrist drop (inability to extend the hand)

Question 688

nevirapine, efavirenz, delaviridine

Answer 688

**NNRTI** - non-nucleoside RT inhibitors that do not require activation via intracellular phosphorylation ADR: abrupt flu-like sx, abd pain, jaundice, fever (life-threatening hepatic failure w/ encephalopathy), SJS

Question 689

What is acute calculous cholecystitis? how does this happen? how is the diagnosis made?

Answer 689

acute inflammation of the gallbladder initiated by the obstruction of the gall bladder neck or cystic duct; stones disrupt the protective mucus layer, leaving the epithelium exposed to the detergent action of the bile salts. Prostaglandins released in the GB wall further incite inflammation of the mucosa and deeper tissues, and GB hypomotility ensues **increasing distension + internal pressure** within the GB eventually results in ischemia. Bacteria then invades the injured and **necrotic tissue**, causing an infection

Question 690

What is acute acalculous cholecystitis? how does this happen? how is the diagnosis made?

Answer 690

acute inflammation of the gallbladder in the **absence** of gallstones; common in the hospitalized and severely ill thought to arise secondary to GB stasis and ischemia, which causes inflammation of and injury to the gallbladder wall US: signs of acute cholecystitis (edematous and enlarged GB) and no gallstones

Question 691

cause of tenosynovitis and pharyngitis

Answer 691

neisseria gonorrhoeae

Question 692

tongue innervation sensory motor taste

Answer 692

somatic sensations (pain, touch, temperature, pressure) * anterior 2/3: **CN V**₃ (lingual branch) **5=S** * posterior 1/3: **CN 9** * posterior area of the tongue root: CN **10** taste * anterior 2/3: **CN 7 **(chorda tympani) **7=T** * posterior 1/3: **CN 9** * posterior area of the tongue root: CN **10** motor * CN **12** (except palatoglossus m., which is innervated by CN 10)

Question 693

ANP's actions

Answer 693

peripheral vasodilation increased urinary excretion of Na/H2O

Question 694

how does e. coli transfer plasmids from one bacteria to anotehr?

Answer 694

**conjugation** occurs via pili (often transfers genes for antibiotic resistance)

Question 695

woman w/ ketosis, hypoglycemia, and increased serum levels of propionic acid. what enzyme is inhibited and what a.a. contributes to this patient's condition?

Answer 695

∆ propionyl CoA carboxylase - converts propionyl CoA -\> methylmalonyl CoA catabolism of **isoleucine, leucine valine, threonine,** and **methionine **contributes to this problem "_**I** **L**ove **V**ermot_ **M**aple **T**rees" (underline - branch chain a.a. involved in maple syrup urine disease)

Question 696

endocarditis after prosthetic valve placement

Answer 696

s. epidermidis

Question 697

carbon tetrachloride - what does it do?

Answer 697

toxic substance that causes free radical damage. How? it gets metabolized by P450 in the liver, resulting in the formation of a free-radical CCL3 which reacts w/ structural lipids of cell membranes (**lipid peroxidation) --\> fatty change and hepatocyte necrosis **

Question 698

Epileptic patient w/ bipolar d/o complains of a "lump" on her neck; admits to feeling "hot" from time to time. PE shows generalized lymphadenopathy. Rx responsible for this and its MoA, ADR

Answer 698

**phenytoin** - reduces ability of Na channels to recover from inactivation -\> increases refractory period, thereby inhibiting neuronal high-frequency firing ADR: **hirsutism, coarsening of facial features, acneiform skin rash, gingival hypertrophy, generalized lymphadenopathy**

Question 699

macroorchidism

Answer 699

fragile X affected individuals also have tall stature, large ears, long face, and mental retardation

Question 700

carcinoid syndrome labs? typical presentation?

Answer 700

excess production of 5-hydroxytryptamine facial flushing, bronchospasm, diarrhea somatostatin analog (octreotide) or resection

Question 701

bone changes consistent w/ osteoporosis

Answer 701

trabecular thinning w/ fewer interconnections; total bone mass is decreased, normal bone architecture is disrputed

Question 702

box-car shaped bacterium

Answer 702

anthrax

Question 703

tensor veli palitini and stylopharyngeus is derived from

Answer 703

4th pharyngeal arch

Question 704

fragile x syndrome genetic finding

Answer 704

trinucleotide repeats

Question 705

cauda equina syndrome (saddle anesthesia + loss of anal wink) affects which nerve roots

Answer 705

S3, S4 (winks galore)

Question 706

aspirin alternative

Answer 706

clopidogrel - blocks ADP receptors on platelets and is just as efficacious as aspirin in preventing thromboembolic disease

Question 707

T/F PPV and NPV are not influenced by disease prevalence

Answer 707

False. PPV and NPV **are** influenced by disease prevalence but specificity and sensitivity are not.

Question 708

32yo F w/ hx of osteocarcoma presents w/ malignant breast mass. Family hx is (+) for brain tumors, rhabdomyosarcomas. This story should make you think of...

Answer 708

Li-Fraumeni syndrome * mutation of P53, which makes one genetically predisposed to early development of cancers * family hx is usually positive for multiple cancers * autosomal dominant inheritance.

Question 709

acute lymphoblastic leukemia translocation

Answer 709

ALL t12;21 ∆ = 9 = bALLerina has 9 letters; kids do ballet = kids dz.

Question 710

corynebacterium diphtheriae virulence factor has the same mechanism as..di

Answer 710

c. diphtheriae - diphtheria toxin pseudomonas aeruginosa - exotoxin A both inactivate EF-2 via ribosylation

Question 711

this particular vitamin has been shown the inhibit mycolic acid synthesis in mycobacterial cells

Answer 711

**Vitamin B6** - remember that it is chemically related to isoniazid, which functions to inhibit mycolic acid in mycobacterial cells

Question 712

4 tumors associated w/ AFP

Answer 712

HCC yolk sac tumors Teratoma Embryonal carcinoma

Question 713

30yoM w/ exertional calf pain + painful foot ulcers demonstrates hypersensitivity to intradermally injected tobacco extract. Dx? hx? sx?

Answer 713

**Buerger's dz** hypersensitivity to a component of tobacco smoke hx: segmental vasculitis extending into contiguous veins and nerves sx: intermittent claudication + Raynaud's, later: ulceration/gangrene toes, feet, fingers

Question 714

MoA for diazoxide

Answer 714

blocks closure of K channels on pancreatic ß cells --\> hyperglycemia (due to ø insulin release)

Question 715

desmopressin

Answer 715

ADH analog - desmopressin treatment for central DI

Question 716

Purpose of liver sulfate conjugation (Phase II)?

Answer 716

metabolic pathway that transforms drugs into more polar drugs that can be excreted (ie phenol + chloramphenicol)

Question 717

difference between theca interna vs theca externa?

Answer 717

interna = cells that convert cholesterol -\> T under the influence of LH externa = connective tissue capsule

Question 718

two studies - one with a p value of 0.03 and a second study with a p value of 0.07 - what should you conclude about the second p value if no other information is given? bastards....

Answer 718

problem with sample size - if the sample study of the second study is small, then it is underpowered to detect a difference in outcome between HRT treated and untreated patients.

Question 719

patient w/ hypochromic megaloblastic anemia + very high urine orotic acid secretion diagnosis? treatment?

Answer 719

**orotic aciduria** - ∆ in UMPS (orotidine phosphoribosyl transferase and orotidine-5-phosphate decarboxylase) trmt: **uridine **(inhibits CPS II)

Question 720

F w/ frothy yellow-green malodorous discharge with reddening of the cervix mucosa. Culprit?

Answer 720

**Trichomonas vaginalis** - flagellated protozoa w/ corkscrew motility

Question 721

T/F Black females have lower bone densities than caucasian females.

Answer 721

FALSE. Blacks actually have **higher** bone densities than caucasian females. ^{Why do we care? dunnoooo}

Question 722

prophylaxis in a pregnant woman patient with HIV ADR?

Answer 722

nucleoside analog **zidovudine (ZDV, AZT) - inhibits reverse transcriptase (NRTI);** lacks 3'OH group, thereby preventing transcription once its incorporated into the chain ADR: bone marrow toxicity-\>anemia

Question 723

how do L sided colon cancers present? R sided colon cancers?

Answer 723

* L side: * tend to infiltrate the intestinal wall + encircle the lumen. * sx of partial intestinal obstruction. change in stool caliber, constipation, cramping abd. pain, abd distension, nausea, vomiting * R side: * tend to grow as exphytic masses; don't tend to develop intestinal obstruction because the lumen is larger on the R than it is on the L. * sx of IDA due to ongoing blood loss (anorexia, malaise, weight loss)

Question 724

which of these drugs would account for these changes? isoproterenol atropine phentolamine propranolol atropine NE

Answer 724

agonist = **NE** = raises BP via vasoconstriction. Decreased HR is a compensatory response via baroreceptor reflex. antagonist = **atropine** = blocks muscarinic receptors; will HR via M2 receptors in SA node (due to removal of parasympathetic tone) has no effect on BP administring NE after atropine will still lead to a1-vasoconstriction (incr. BP), but atropine is still blocking the muscarinic receptors in the SA node when NE is administered, therefore NE actions on ß1 receptors on the SA node act to increase HR. isoproterenol = ß agonist - would decrease in BP via vasodilation phentolamine = a-antagonist - decreases BP by blocking sympathetic tone to arterioles. Propranolol = ß antagonist - small decrease in BP and decrease in HR **FYI -** when looking at drug traces, always look at BP first, then HR second since BP will be due to a direct effect on blood vessels and and changes in HR may be due to either a baroreceptor effect or direct effect on the heart.

Question 725

3 ß blockers w/ intrinsic sympathomimetic activity in what patient population are they contraindicated in?

Answer 725

**a**cebutolol **p**enbutalol **p**indolol that are **_not_** recommended for patients w/ **angina**

Question 726

3 common causes of acute pancreatitis? labs? complications?

Answer 726

common causes: **gallstone + ethanol + HyperTg** labs: **increase amylase, lipase**, diffuse fat necrosis + **calcium deposits **(-\> hypocalcemia), fat malabsorption complications: **pancreatic pseudocyst** - proteolytic enzymes may disrupt the walls of the pancreatic ducts and cause leakage of the pancreatic secretions into the peripancreatic space --\> results in collection of fluid rich in enzymes and inflammatory debris. Walls consist of **granulation tissue and fibrosis **(not epithelium)

Question 727

common causes of chronic pancreatitis? labs/findings? complications?

Answer 727

common causes:** ethanol abuse** labs: amylase and lipase may or may not be elevated findings: atrophied/**calcified pancreas** complications: pancreatic insufficiency - **steatorrhea, deceased DEAK, DM, pancreatic aenocarcinoma**

Question 728

thiamine particpiates in these 4 reactions

Answer 728

transketolase (PPP) pyruvate DH a-KG DH (TCA) a-ketoacid DH (branched chain)

Question 729

faintly erythematous macules on the abdomen, fever, abdominal pain, diarrhea

Answer 729

Tyhoid fever (Salmonella typhi) macules are actually called "rose spots"

Question 730

glucocorticoid administration will **increase** - which cells in a blood cell count? - protein synthesis in which organ?

Answer 730

* **neutrophils** - glucocorticoid administration results in demargination of leukocytes previously attached to vessel wall * **liver -** esp enzymes involved in gluconeogenesis + glycogenesis (contributes to the development of hyperglycemia

Question 731

mAb that blocks CD21 on B cells can prevent infection by which virus?

Answer 731

EBV - its glycoprotein binds to the cellular receptor for the C3d complement component (CR2 or CD21). CD21 is present on the surface of B cells AND nasopharyngeal epithelial cells

Question 732

how do these factors change with Hemophiliac A d/o? Platelet Count Bleeding time PT PTT clotting factor

Answer 732

Platelet Count = NC Bleeding time = NORMAL (differentiates it from vWF, which is increased!!) PT = NC PTT = increase Factor 8 \*also presents w/ hemoarthroses\*

Question 733

osmotic fragility test is used for..?

Answer 733

hereditary spherocytosis

Question 734

oocytes in ovaries are in which phase of meiosis? oocytes after ovulation?

Answer 734

oocytes in ovaries = 1˚ oocyte = **prophase** of meiosis I ^{FSH stimulation during ovarian cycle causes some oocytes in the ovaries to complete meiosis I, forming secondary oocytes (+ polar bodies), which begin meiosis II but halts in metaphase.} oocytes after ovulation = 2˚ oocyte = **metaphase** of meiosis **II** ^{remains in this phase until fertilization occurs, at which point it divides into a mature oocyte (+2nd polar body)}

Question 735

resting membrane potential is determined by

Answer 735

permeabiilty to K+ via leak channels

Question 736

what do eosinophils produce to help defend against worms? limit reactions following mast cell degranulation?

Answer 736

worms defense: **major basic protein** limit mast cell degranulation: **histaminase and arylsulfatase**

Question 737

muscles used when sitting up from supine position sans hands

Answer 737

external abd. obliques rectus abdominis hip flexors (iliopsoas)

Question 738

isoniazid MoA how does resistance to this drug occur? clinical use?

Answer 738

* MoA: pro-drug; **requires activation** by the **mycobacterial catalase-peroxidase** *before* it can **inhibit MYCOLIC ACID** **synthesis** * Resistance: decreasing the activity of catalase-peroxidase * clinical use: TB

Question 739

2 symptoms that are **specific** for Graves disease (hyperthyroidism)

Answer 739

**infiltrative dermopathy** (pretibial myxedema/ nonpitting edema) **ophthalmopathy (proptosis, exophthalmos) **- due to lymphocytic infiltrates that that secrete cytokines to stimulate fibroblasts to secrete glycosaminoglycan ground substance (ie hyaluronic acid), which draws water into the orbit resulting in extraocular muscle edema; sensations of grittiness + excess tearing occurs because the lids do not completely cover the prototic globe; can be controlled by *_high-dose glucocorticoids_* both due to autoimmune response directed against ***thyrotropin receptor*** that results in accumulation of glycosaminoglycans within the affected tissues

Question 740

MoA of misoprostol

Answer 740

Prostaglandin E1 analog -\> uterine contractions + cervical dilation used as an abortifactant

Question 741

germ tubes should make you think of...

Answer 741

candida albicans

Question 742

32yoF w/ abnormal uterine bleeding + endometrial hyperplasia + R-adnexal mass. Pregnancy test is negative. Dx?

Answer 742

**Granulosa cell tumor** - estrogen-secreting tumor -\> endometrial hyperplasia, which can progress to endometrial carcinoma. (can also cause precocious puberty) Should see **Call-Exener** bodies (small follicle-like structures filled w/ eosinophilic secretions)

Question 743

3 Stones that are radiolucent *(what does this even mean?!)* how else can they be visualized?

Answer 743

**URIC acid (kidney) stones** **Brown Pigment Stones** (GB stones due to Clonorchis Sinesis) **Cholesterol (Gall bladder) Stones ** cannot be visualized via Xray "radiolucent" **U R I***nvisible*...**Be** **C**ool visualize via abdominal US or CT

Question 744

Niacin MoA clinical use ADRs

Answer 744

decrease hepatic VLDL and LDL production and raise HDL. clinical use: lower TGs to avoid risk of pancreatitis ADR: **flushing** (*prevent w/ aspirin, since the flushing reaction is partially mediated through prostaglandin synthesis), **chemical hepatitis***

Question 745

best treatment family members or close contacts of persons w/ meningococcal disease: vaccine _or_ antibiotics?

Answer 745

prophylaxtic antibiotics - esp. **rifampin** for Neisseria meningitidis post-exposure prophylaxis with vaccine is not recommended bc there is no effective vaccine aganist GBS and children

Question 746

You're performing an eye exam on your patient and you notice this. What d/o does he have? What is it caused by? typical findings? trmt?

Answer 746

**Wilson's disease** ∆ATP7B = ø Cu excretion into bile (for elimination) = Cu accumulation **Kayser-Fleischer rings** (corneal Cu deposits), **low ceruloplasmin**, Cirrhosis/**HCC** **basal-ganglia atrophy (**parkinsonian-like tremor, asterixis, dyskinesia) Dementia, Dysarthria trmt: **penicillamine or trientine**

Question 747

cardiomeagly + severe generalized hypotonia hx: abnormal glycogen accumulation in lysosomes dx?

Answer 747

Pompe disease - ∆ acid maltase (alpha1,4 and alpha1,6 glucosidase activity)

Question 748

What is Osler-Weber-Rendu Syndrome? typical presentation?

Answer 748

**hereditary hemorrhagic telangiectasi - AD** inheritance - congenital telangiectasis of skin + mucous membranes **recurrent epistaxis or GI bleeding** (**melena**)

Question 749

MAO-Type B inhibitor

Answer 749

Selegiline MAO-type B preferentially metabolizes dopamine over NE and 5-HT; inhibition of this results in increased dopamine availability to the brain ADR: may enhance effects of L-dopa - arrhythmias, dyskinesia/akinesia

Question 750

Rx to prevent perioperative venous thrombosis?

Answer 750

**unfractionated heparin or LMWH** - increases effect of endogenous anti-thrombin III

Question 751

what exits the formaen rotundum

Answer 751

v2

Question 752

PECAM1 (CD31)

Answer 752

transmigration into area of injury ("PlEAse-COME" IN) present on both endothelial cells and leukocytes

Question 753

cause of acute orchitis in young adults/adolescents? elderly?

Answer 753

young: C. trachomatis, N. gonorrhoeae elderly: E. coli

Question 754

when necrotic changes are first noticeable in ischemic MI

Answer 754

4-12 hrs

Question 755

what factors act through steroid hormone receptors (cytoplasmic receptors)?

Answer 755

glucocorticoids mineralocorticoids androgens estrogens

Question 756

a high transepithelial potential difference is usually measured in what d/o? What causes this elevation?

Answer 756

Cystic fibrosis high transepithelial potential difference (measured in nasal mucosa) is high due to **increased Na absorption** due to *lack of inhibitory effect* from the mutated CFTR protein.

Question 757

first symptoms of normal pressure hydrocephalus?

Answer 757

urinary incontinence ataxic gait dementia **"wack, wobbly, and wet"**

Question 758

**Cholestyramine, Colestipol, ****Colesevelam** Clinical Use MoA ADR What increases ADR?

Answer 758

* Clinical Use: **Elevated cholesterol** * MoA: **bile acid resins** that **reduce reabsorption** **of bile acids in the intestines** (interferes w/ enterohepatic circulation) -\> hepatic cholesterol is used to resynthesize bile acids -\> increases LDL uptake from circulation to do this -\> **decreases LDL** * ADR * **_HyperTg_** * contraindicated in patients with hyper-Tg * _**Cholesterol Gall-stones** (_esp. when used with gemfibrozil) * decrease nutrients/drugs absorption * ​statins must be taken at least 4 hours apart since the bile acid binding resin can impair its absorption * **_Constipation, bloating_** * CI in patients w/ diverticulosis (*constipation worsens the underlying diverticulosis*)

Question 759

hematogenous osteomyelitis usually occurs where?

Answer 759

metaphysis of long bones - contains slow-flowing sinusoidal vasculature that is conducive to microbial passage

Question 760

among women, name the highest to lowest for: greatest incidence of cancers greatest deaths from cancer

Answer 760

greatest incidence of cancers: **breast, lung**, colon greatest deaths from cancer: **lung**, **breast,** colon

Question 761

endometrial bx w/ wavy glands w/ subnuclear vacuolization of epithelial cells and stroma that show prominent edema w/ widely separated stromal cells. dx?

Answer 761

**asynchronous secretory endometrium** - form of dysfunctional ovulatory bleeding that can cause infertility, where the secretory endometrium w/ a mismatch of 2 or more days between glands and stroma * wavy glands w/ subnuclear vacuolization of epithelial cells = usually ocur around d17 * stroma that show prominent edema w/ widely separated stromal cell = usually occur on d22

Question 762

impaired **tetrahydrobiopterin** synthesis affects which neurotransmitters?

Answer 762

NO, Serotonin, Tyrosine, Dopa ## Footnote **"say NO to STDs w/ THB"**

Question 763

how does high altitude affect PaO₂ and PaCO₂?

Answer 763

PaO2 and PaCO2 = **both lower** than normal due to hypoxemia and resulting hyperventilation and respiratory alkalosis

Question 764

effect of muscarinic agonists on blood vessels

Answer 764

stimulate release of EDRF - endothelium derived relaxation factor endothelium has receptors for muscarinic receptors --\> causes release of NO (aka EDRF) --\> increases cGMP --\> activates Ca pump to cause Ca efflux --\> decrease intracellular conc. --\> VSM relaxation

Question 765

newborn w/ hyperphenylalanemia receives tyrosine supplementation and is on a phenylalanine-restricted diet. Several months later, his serum phenylalanine is normal, but his prolactin levels are elevated. What is deficient?

Answer 765

**dihydrobiopterin reductase -** involved in the conversion of * phenylalanine -\> tyrosine (via phenylalanine hydroxylase) * tyrosine -\> DOPA (via tyrosine hydroxylase) ∆ dihydrobiopterin reductase -\> both rxns are compromised, but since the patient is given tyrosine, only tyrosine -\> DOPA is compromised ø DOPA = ø Dopamine = increased **prolactin**

Question 766

dIgital clubbing is usually associated with these d/o's

Answer 766

any chronic d/o that causes hypoxia large cell lung cancer, TB, CF, suppurative lung disease (empyema, bronchiectasis, chronic lung abcesss)

Question 767

diagnose

Answer 767

koilocytes - HPV

Question 768

Which one does this graph represent? (choose one) Aortic insufficiency Aortic Stenosis Mitral Stenosis Mitral regurgitation

Answer 768

Aortic Stenosis

Question 769

when is isoniazid monotherapy recommended? multi-agent therapy?

Answer 769

**monotherapy**: pts w/ PPD(+) and negative CXR / no evidence of clinical disease **multi-agent therap**y: active TB

Question 770

calculation for maintenance dose?

Answer 770

( ( Cp \* CL ) / bioavailability fraction ) \* # minutes ``` Cp = steady state plasma conc. CL = clearance ``` net units: **mg** for IV Rx, bioavailability fraction = 1

Question 771

HIV ELISA/WB tests in infants

Answer 771

falsely (+) in babies born to HIV+ mothers (anti-gp120 crosses placenta)

Question 772

7yo w/ acute renal failure + bloody diarrhea. Smear shows schistocytes. What is the cause of his anemia?

Answer 772

HUS - likely due to EHEC shiga-like toxin and damaged endothelial cells, which activates platelets and microthrombic formation --\> schistocytes. BUT coagulation cascade is _not_ activated and therefore PT/PTT is normal in HUS

Question 773

superior laryngeal has an external br. and an internal br. - what do they each innervate?

Answer 773

external br: **cricothyroid m.** internal br: **sensory innervation above vocal cords**

Question 774

treatment for central DI

Answer 774

intranasal DDVAP hydration duh...

Question 775

16yo boy w/ painless, firm mobile mass beneath the nipple in his L breast. Dx?

Answer 775

**gynecomastia** benign proliferation of ductal and stromal elements of the breast; idiopathic condition related to pubertal hormonal changes.

Question 776

what kind of withdrawal: lack of concentration, HA

Answer 776

caffeine

Question 777

2 anti-hypertensive that causes dyslipidemia

Answer 777

metroprolol thiazides

Question 778

inulin purposes

Answer 778

marker of extracellular volume (EC = IS + PV) measure of GFR bc it is freely filtered and not reabsorbed or not secreted

Question 779

treatment of choice for anaphylaxis?

Answer 779

epinephrine - because it can stimulate * **a1 receptors** - counteract the vasodilation of cutaneous + visceral vasculature -\> increase BP * **ß1 receptors** - increase cardiac contractility/CO * **ß2 receptors** - bronchodilation (reverse the dyspnea caused by increase in smooth muscle tone in the bronchial wall) ^{do not use NE - because it has mostly a1 effects and can cause intense vasoconstriction, which may limit CO (since it doesn't really have a big effect on ß1 receptors) and it does not reverse the increased bronchial wall tone)}

Question 780

angiogenesis is driven by two factors

Answer 780

VEGF and FGF **FGF =** ** fluids grow first**

Question 781

How does systolic and diastolic heart differ in terms of ventricular contractile performance? In each scenario, what must the heart do in order to achieve a near normal stroke volume?

Answer 781

* **Systolic HF (impaired myocardial contractility)** - _decrease_ in ventricular contractile performance (decreased EF) * requires increased LV-ED**P** _and_ LV-ED**V** to improve stroke performance * **Diastolic HF (decreased ventricular compliance) -** decrease in ventricular diastolic compliance but _normal_ ventricular contractile performance * LV-ED**P** must be increased (a-\>b) in order to achieve a normal LV-EDV and keep CO at baseline

Question 782

what part of the cell cycle does griseofulvin affect? what is this drug usually indicated for?

Answer 782

cell mitosis at **metaphase** indicated for dermatophytoses

Question 783

eye field looks like this: where is the lesion?

Answer 783

R temporal lobe (Meyers loop) F

Question 784

stones that form under increased pH stones that form under decreased pHs

Answer 784

increased pH **(basic = phosphate)** * calcium **phosphate** * ammonium magnesium **phosphate ** decreased pH (**acidic = OUCH -** the H indicates H+!!!) * calcium oxalate * uric acid * cystine

Question 785

heart findings in XO patients

Answer 785

coarctation of aorta bicuspid aortic valve

Question 786

T cell associated with Crohns? UC?

Answer 786

Crohns = Th1 Ulcerative Colitis = Th2 (2 words)

Question 787

lamivudine MoA ADR

Answer 787

**cytosine** (nucleoside) analog RT inhibitor (**NTRI**) - inhibits HIV RT via **chain termination** must be phosphorylated to its active form ADR: **L**actic acidosis + peripheral neuropathy

Question 788

∆ btwn type I and type II muscle fibers?

Answer 788

**Type I = slow twitch ** * performs actions that require low-level **sustained force** *(ie postural maintenance)* * ​paraspinal m. * aerobic metabolism *(high myoglobin + mitochondrial concentrations)* **Type II = fast twitch (two-fast)** * generating rapid forceful pulses of movement * latissimus dorsi, pec major, biceps, deltoid * anerobic metabolism

Question 789

role of eosinophils in host defense during parasitic infections?

Answer 789

**ADCC** (when stimulated by IgE bound to a parasitic cell) via m**ajor basic protein** **Type I** **HSR**

Question 790

genetic abnormality of patient with macular pallor with cherry red dot, no hepatomeagly

Answer 790

Tay sach's - frameshift

Question 791

typical labs in a patient with sickle cell: haptoglobin LDH bilirubin

Answer 791

abnormally low due to sickling + destruction of RBC results in decreased haptoglobin increased LDH increased indirect bilirubin

Question 792

Quellung reaction is used to identify what

Answer 792

S. pneumo - capsule swells when specific anti-capsular antibodies are added

Question 793

antibiotic that causes thrombocytopenia, optic neuritis and has a high risk of serotonin syndrome

Answer 793

linezolid - inhibits bacterial protein synthesis by binding to a 50s subunit

Question 794

IL3 function

Answer 794

growth/differentiation of stem cells in bone marrow

Question 795

thickened whitish plaque w/ slightly ulcerated crusted surface vs multiple reddish-brown papular lesions on penis vs single or multiple red-shiny plaques

Answer 795

**Bowen disease** - thickened whitish plaque w/ slightly ulcerated crusted surface **Bowenoid papulosis -** multiple reddish-brown papular lesions on penis **Erythroplasia of Queyrat -** single or multiple red-shiny plaques A. Bowen B, Erythroplasia of Queyrat. C, Bowenoid papulosis.

Question 796

cause of pharyngitis and glomerulonephritis

Answer 796

streptococcus

Question 797

what will decrease the effects of Iodide that is used to treat hyperthyroisim?

Answer 797

perchlorate and pertechnetate - both are taken up by the thyroid via same mechanism that is used to transport iodide "competitive inhibition"

Question 798

chemoRx associated w/ dry cough and exertional dyspnea

Answer 798

Bleomycin

Question 799

Holiday heart syndrome

Answer 799

binge OH consumption that results in a-fib - irregularly irregular series of QRS complexes and absent P waves

Question 800

What is this and what is it caused by? aspiration of this puts the patient at risk of? What do surgeons do to prevent this? 2

Answer 800

liver **hydatid cyst**; commonly caused by ingestion of **Echinococcus granulosus** eggs from dog feces... can cause **anaphylaxis** if antigens are released prevent by **pre-injecting ethanol** to kill cysts and treating with **albendazole**

Question 801

thyroidectomy can injure these particular nerve branches w/ respect to specific arteries

Answer 801

recurrent laryngeal n. = inferior thyroid a. external br. of superior laryngeal n. = superior thyroid a.

Question 802

70M elevated Alk Phos + haphazardly-oriented cement lines that create a pattern of lamellar bone cell type involved in the initial lesion?

Answer 802

Paget's disease osteo**C**lasts

Question 803

how does a defect in sertoli cells affect LH and testosterone? defect in leydeg cells?

Answer 803

defect in sertoli cells -\> decreased inhibin + spermatogenesis -\> increased FSH but normal LH/Testosterone (*since inhibin only feedsback to FSH)* defect in leydig cells -\> increased GnRH (since there's no negative feedback) -\> increased LH, FSH, but decreased testosterone *(since there's no leydig conversion of cholesterol -\> testosterone)*

Question 804

hepatic adenomas are usually caused by? how do you treat them?

Answer 804

typically found in patients w/ a long **hx of OC or anabolic steroid use** trmt: stop OC...duh

Question 805

drug that prolong QT but does not predispose to torsades

Answer 805

amiodarone - via K-mediated repolarization on myocardial cells

Question 806

losartan does what to * arterial pressure * TPR * Na excretion * Aldosterone levels

Answer 806

arterial pressure - decr TPR - decr Na excretion - incr Aldosterone levels - decr

Question 807

a positive Rinne test is considered..

Answer 807

NORMAL - if the sound is best heard at the EAM (compared to the mastoid; ie air counducted sound is normally louder and heard longer than bone-conducted sound) ^{(a negative Rinne test is abnormal if the patient hears the vibration better at the mastoid)}

Question 808

verapamil should not be prescribed to patients with...

Answer 808

**heart failure** because the (-) ionotropic effects- causes AV nodal block - of the Rx leads to a decrease in teh force/velocity of myocardial contraction, thereby exacerbating the patient's heart failure also causes constipation and gingival hyperplasia

Question 809

typical anti-psychotic side effects

Answer 809

**EPS** * akathisia - subjective *restlessness, inability to sit still; may pace frequently or demonstrate other restless behaviors* * acute dystonia - sudden onset, sustained muscle contractions * drug-induced parkinsonism - tremor, rigidity, bradykinesia **Tardive dyskinesia** **NMS**

Question 810

bone changes consistent w/ Paget's disease of the bone

Answer 810

mosaic pattern of lamellar bone w/ irregular sections of lamellar bone; linked by cement lines (represent previous areas of bone resorption)

Question 811

Indinavir Clinical Use ADR

Answer 811

**Protease inhibitor** (enz. requierd for the final step of HIV replication) * general ADR * **Lipodystrophy** - increased fat deposition on the back and abdomen "buffalo humb" with decreased adipose adipose tissue on the extremities "peripheral wasting" * **Hyperglycemia **- due to increased insulin resistance * **_nephrolithiasis + hematuria_**** - unique to indinavir** ***NAVIR Put SUGAR into LIPs - too much can cause kidney failure***

Question 812

General ADR of 'navirs Clinical Use ADR

Answer 812

**Protease inhibitor** (enz. requierd for the final step of HIV replication) * **Lipodystrophy** - increased fat deposition on the back and abdomen "buffalo humb" with decreased adipose adipose tissue on the extremities "peripheral wasting" * **Hyperglycemia **- due to increased insulin resistance ***NAVIR Put SUGAR into LIPs - too much can cause kidney failure***

Question 813

during the inflammatory response, a particular enyme is upregulated (that is normally undetectable in most normal tissues). What Rx would bind to this enzyme?

Answer 813

**COX2** - inducible enzyme that is normally undetectable in most tissues except in cases of inflammation bound to it by **aspirin**

Question 814

16S rRNA - function?

Answer 814

**rRNA** in the **prokaryotic 30S ribosome**, contains a sequence that binds the **Shine-dalgarno sequence on mRNA**, which is impt **for initiation of protein translation**

Question 815

Interpret this HBsAg negative anti-HBc negative anti-HBs positive

Answer 815

Immune due to hepatitis B vaccination

Question 816

location of fatty acyl coa synthetase

Answer 816

outer-mitochondrial matrix

Question 817

patient w/ acute onset of hip/groin pain that is exacerbated by weight bearing; no swelling, erythema, or temperature change to the affected area. dx? how to diagnose?

Answer 817

avascular necrosis of the femoral head use MRI

Question 818

why is it that someone with prolactinoma can develop low bone density?

Answer 818

bc high levels of prolactin suppress GnRH, leading to hypogonadism, anovulation, and amenorrhea prolonged hypogonadism can cause accelerated bone loss and increase risk of fractures

Question 819

type II non-cytotoxic hypersensitivity

Answer 819

autoantibodies without complement or neutrophil-mediated destruction of the affected tissues (ie Graves, Myasthenia Gravis)

Question 820

how does acute intravascular hemolysis affect these labs: haptoglobin total bilirubin direct bilirubin

Answer 820

haptoglobin = decreased total bilirubin = high direct bilirubin = low

Question 821

What does this represent? (choose one) Increase preload Increase afterload Systolic dysfunction Increased ejection Fraction Normal Saline Infusion

Answer 821

Normal Saline Infusion

Question 822

rupture of tympanic membrane causes what type of hearing loss

Answer 822

condutive

Question 823

picorna virus that is acid labile

Answer 823

rhinovirus (compare to rhinovirus that is acid-stable and can pass through the stomach to colonize the GI tract)

Question 824

how does **exercise** affect PaO₂ and PaCO₂?

Answer 824

normal PaO2 and PaCO2 since there is increased HR, CO, and RR in to balance the increased total O2 consumption and CO2 production

Question 825

lesions of macula are called

Answer 825

scotomas

Question 826

polyvinyl chloride or arsenic exposure causes this tumor to form of CD31 positivity

Answer 826

**liver angiosarcoma ** CD31 is an endothelial cell marker

Question 827

F w/ serosanguinous or watery discharge

Answer 827

atrophic vaginitis (post-menopause)

Question 828

Smoking has a lower incidence of fibrocystic breast disease and uterine cancer. Why is that?

Answer 828

smoking has anti-estrogenic effects

Question 829

**Ezetimibe** Clinical Use MoA ADR What increases its effects?

Answer 829

* clinical use: **Hyper-LDL – 2nd line** * MoA: Decrease intestinal absorption of dietary cholesterol + bile acids -\> decrease serum LDL (cholesterol) * Additive effects of reducing LDL when used in combination w/ **statins**

Question 830

recurrent laryngeal nerve of the vague innervates all laryngeal muscles EXCEPT

Answer 830

cricothryoid (innervated by EXTERNAL br. of superior laryngeal n.)

Question 831

patient w/ coronary stent is placed on aspirn + other Rx. What is the risk of this other drug MoA and what are the associated risks?

Answer 831

ticlopidine - blocks ADP receptors ADR: neutropenia

Question 832

62yo immigrant from Asia has acute cholecystitis w. numerous dark stones in the gall bladder. Cause?

Answer 832

infection w/ **E. coli, Ascaris lumbricoides,** or** Opisthorchis sinensis** Brown pigment stones usually arise secondary to infection of the biliary tract, which results in ß-glucuronidase release from injured hepatocytes, which hydrolyzes bilirubin glucuronides -\> unconjugated bilirubin in bile

Question 833

typical presentation of glucoagonoma

Answer 833

DM anemia necrolytic erythema glucagonomas are rare pancreatic tumors

Question 834

two factors that stimulate the development of osteoclastic precursors into mature, multinucleated osteoclasts. What is the stimulator of both of these signals?

Answer 834

RANKL and Monocyte-CSF

Question 835

which viruses buds through and acquires the lipid bilayer envelope from the host** _cell_** membrane?

Answer 835

most enveloped nucleocapsid viruses ## Footnote *(except the herpesviruses, which bud through and acquire their envelope from the host cell nuclear membrane)*

Question 836

patient w/ fever, back pain or flank pain, inguinal mass, and difficulty walking. Currently lying supine with knee bent and resists extension of the leg and thigh, particularly at the hip.

Answer 836

**Psoas abscess** * likely due to hematogenous or lymphatic seeding or spread from an adjacent site. * **pain exacerbated by movements that cause the psoas to be stretched or extended (ie hip extension)** * arises from T12-L5 and inserts on the lesser trochanter of the femur via tendon shared with the iliacus muscle; **major flexor of the hip.**

Question 837

resected liver mass with this pattern is diagnostic of what d/o?

Answer 837

**cavernous hemangioma** congenital malformations that enlarge via **ectasia** (dilation or distension of a tubular structure), resulting in **cavernous, blood-filled vascular spaces** lined by a single epithelial layer. **benign;** 30-50yo. **biopsy is contraindicated** due to risk of hemorrhage

Question 838

cisplatin MoA ADR - how to prevent?

Answer 838

* platinium containing compound that exerts its chemotherapeutic effect by forming ROS that can crosslink DNA * ADR: nephrotoxicity - acute tubular injury * prevent w/ **amifostine **- free radical scavenging agent that prevents radicals from

Question 839

lymphadenopathy can represent inflammatory changes within the LN (reactive hyperplasia) or malignant transformation. How do you tell which is which?

Answer 839

_reactive_ - benign, **reversible** enlargement of lymphoid tissue secondary to antigenic stimulus; **polyclonal** proliferation (many different cell types) within the LN _malignant_ - proliferation of malignant lymphocytes; evidence of **monoclonality**

Question 840

GN spiral shaped bacteria associated with a decreased number of somatostatin producing antral cells. leads to what?

Answer 840

duodenal ulceration loss of these somatostatin producing antral cells -\> high gastrin levels -\> increase histamine production -\> increase gastric parietal cells to secrete acid when this very low pH gastric fluid enters the duodenum, it is not adequately neutralized by local bicarb production, which causes duodenal ulceration

Question 841

LT-B4 function

Answer 841

neutrophil chemotaxis to the site of inflammation

Question 842

tiotropium, ipratropium MoA

Answer 842

muscarinic ACh antagonists - causes bronchodilation useful for COPD, asthma

Question 843

patient w/ thyroid that shows mononuclear parenchymal infiltration w/ well-developed germinal centers. Dx? sx?

Answer 843

Hashimotos thyroidtis -\> hypothyroidism due to presence of **anti-thyroid peroxidase antibody** (also note, Hurtle cells are also present) sx: fatigability, weight gain, constipation, cold intolerance

Question 844

denosumab

Answer 844

mAb that prevents osteo**clast** activation by binding to **RANKL** and preventing its interaction with RANK

Question 845

auditory tube originates from... shares its embryologic origin with..

Answer 845

originates from **1st** pharyngeal pouch shares its origin with **middle ear epithelium**

Question 846

what is asterixis and what patients would you find them in?

Answer 846

flapping tremor of the hand when the wrist is extended - caused by abnormal function of the **diencephalic** motor centers in the brain as a result of **ammonia accumulation** in the body (since less is detoxified to urea) common in patients w/ cirrhosis

Question 847

where are most dietary lipids digested? absorbed?

Answer 847

Digested: duodenum Absorbed: Jejunum (includes ADEK)

Question 848

match enzymes w/ numbers carnitine acyltransferase II Fatty acyl-CoA synthetase G6P DH hexokinase Pyruvate Kinase Smooth ER Citric Acid cycle

Answer 848

1 = carnitine acyltransferase II 2 = Fatty acyl-CoA synthetase 3 = G6P DH, hexokinase, Pyruvate Kinase 4 = Smooth ER 5 = Citric acid cycle

Question 849

patient w/ L sided heart failure develops significant pulmonary arterial HTN. How does this develop?

Answer 849

L side heart failure -\> LA pressure rises -\> hydrostatic pressures in pulmonary circuit rise -\> capillary leak -\> pulmonary edema edema causes collapse + results in decreased ventilation, which in turn, causes hypoxemia. **Reactive vasoconstriction** occurs to shunt blood toward areas where ventilation is less compromised -\> pulmonary arterial HTN

Question 850

first-line therapy for acute gouty arthritis

Answer 850

high dose NSAIDs

Question 851

varicose veins pathophysiology

Answer 851

incompetent valves

Question 852

most common hepatic lesion? what does this look like on a CT scan?

Answer 852

metz from a primary tumor (breast, lung, colon) - usually shows **multiple** hypodense masses in the liver

Question 853

how do these affect DNA? irradiation alkylating agents UV radation

Answer 853

**irradiation**: double-strand breaks and ROS formation **alkylating agents**: cross-linking **UV radation**: thymine dimers

Question 854

dx of patient with weakness, gait disturbance, diffiulty releasing doorknob/handshake cataracts, frontal balding, gonadal dystrophy

Answer 854

myotonic dystrophy - AD w/ anticipation; due to unstable trinucleotide repeats (CTG) that affects muscle maturation hx: atrophy of muscle fibers, esp. type I (compare to duchenne's - necrosis + fibrofatty replacement of muscle fibers)

Question 855

pain purely in the posterior thigh and leg as well as decr. ankle jerk reflex should make you think of..

Answer 855

sciatica - compression of S1 nerve root

Question 856

NE binds these receptors

Answer 856

a1, a2, b1

Question 857

plasma lipoprotein lipase activity after heparin injection is substantially lower than normal. what is the heparin challenge? what does the tests mean?

Answer 857

heparin causes release of endothelium bound lipases, encouraging the clearance of Tgs from circulation lower-than-normal activity levels of lipoprotein lipase = deficiency = **increased serum chyloµ** (dietary lipids)

Question 858

How does heroin affect pupil size + RR?

Answer 858

Miosis (smaller) Respiratory depression

Question 859

bcl-2

Answer 859

follicular lymphoma t14;18

Question 860

what are these cells?

Answer 860

sertoli cells * form tight junction (line = blood testes barrier) * below the line = cells start meiosis I * above the line (toward lumen) - cells are in prophase of meiosis I * have **prominent nucleoli**

Question 861

ectopia lentis buzzword for..

Answer 861

homocystinuria - defect in cystathionine ß synthase deficiency; characterized by **ectopia lentis**, mental retardation, marfanoid habitus, and osteoporosis

Question 862

diagnose

Answer 862

CMV - owl eye inclusions

Question 863

cytokine produced from tumor that causes cachexia

Answer 863

TNFa (aka cachectin) - main mediator of paraneoplastic cachexia by suppressing appetite in the hypothalamus

Question 864

rapid correction of hyponatremia results in? rapid correction of hypernatremia results in?

Answer 864

HypO = central pOntine demyelination HypER = cERebral edema

Question 865

differential cyanosis (cyanosis of lower extremities, but not of upper body) in a kid should make you think of....

Answer 865

differential cyanosis is the result of reduced arterial saturation in the distal aorta compared to the proximal aorta most likely cause**: PDA** (initial L-\> R shunting, but over time the resultant pulmonary HTN can cause pulmonary vascular sclerosis, increase PVR, and reversal of shunt flow across the ductus)

Question 866

what drains into the inferior mesenteric nodes?

Answer 866

anything supplied by the inferior mesenteric a.: L colon, sigmoid colon, upper part of rectum)

Question 867

oseltamivir MoA

Answer 867

neuraminidase inhibitor - prevents release of newly formed influenza A/B virions

Question 868

virilization of genetically female infants w/ normal BP should make you think of...

Answer 868

**aromatase deficiency** - inability to convert androgens to estrogens in the gonads and peripheral tissues. Infant should have high levels of T/androstenedione. (mother also likely experienced increased facial hair growth and some voice deepening during pregnancy)

Question 869

cinacalcet

Answer 869

used to treat 2˚ hyperparathyroidism - increases sensitivity of CaSr to Ca

Question 870

Filgrastim - when is it used?

Answer 870

G-CSF - used to stimulate proliferation/differentiation of granulocytes; used to minimize granulocytopenia after myelosuppressive chemoRx

Question 871

which viruses buds through and acquires the lipid bilayer envelope from the host cell **_nuclear_ **membrane?

Answer 871

all herpes viruses (1-8)

Question 872

how does lactulose work?

Answer 872

acidifies colonic contents, which converts absorbable ammonia into non-absorbable ammonium ion (ammonia trap)

Question 873

unfractionated heparin MoA

Answer 873

binds to **thrombin + anti-thrombin** to accelerate inactvation of factor Xa

Question 874

how does amitriptyline cause death?

Answer 874

CARDIC death is most common TCA inhibits fast Na channel conduction in cardiac myocytes and His Purkinje system --\> arrhythmias + refractory hypotension trmt: NaHCO3

Question 875

why is skeletal muscle resistant to the effects of Ca channel blockers (ie verapamil)

Answer 875

bc skeletal muscle does NOT require an influx of extracellular Ca for excitation-contraction coupling whereas cardiac and smooth muscle cells depend on the extracellular Ca entering the cell via VG L-type Ca channels for excitation-contraction coupling.

Question 876

39F w/ palpable nodularity in the R breast. Hx shows ducts distended by pleomorphic cells w/ prominent central necrosis; lesion does not extend beyond the ductal BM

Answer 876

**comedocarcinoma** (subtype of DCIS)

Question 877

recent organ transplant recipient develops F, HA, V; lumbar puncture shows CSF pleocytosis and normal CSF glucose concentration. CSF microscopy shows GPR with tumbling motility. Dx? How was it acquired?

Answer 877

**Listeriosis** cause: listeria monocytogenes - facultative intraccellular parasite that grows within macrophages in immunocompromised hosts; able to multiply at 4˚ = acquired by eating contaminated foods (unpasteurized milk/milk products, undercooked meats, unwashed raw veggies)

Question 878

part of the placenta that is derived from maternal origin

Answer 878

decidua basalis

Question 879

follicle that extends through the entire cortex and bulges out at the ovarian surface

Answer 879

Graafian follicle

Question 880

blood vessels most impt for minimizing the decrease in MSFP caused by blood loss?

Answer 880

venules + veins = impt blood reservoir for circulation during blood loss. Sympathetic activation of these vessels cause them to constrict in order to restore blood volume.

Question 881

99mmTc pertechnetate is used to detect what?

Answer 881

presence of gastric mucosa (ie Meckel's diverticulum)

Question 882

primary amenorrhea in a patient w/ fully developed secondary sexual characteristics can be due to

Answer 882

anatomic defect in the genital tract: imperforate hymen Mullerian duct abnormalities

Question 883

tumor cell that can appear in different locations (breast, stomach, ovary, colorectal areas, etc) and contains abundant mucin

Answer 883

signet ring cell carcinoma - do not form glands but contains abundant mucin that pushes nuclei to one side

Question 884

S100 immunoreactivity

Answer 884

schwannomas melanomas (both neural crest cell origin)

Question 885

gluteus medius + minimus functions in

Answer 885

hip ABduction

Question 886

test to perform to confirm dx of acromeagly or gigantism

Answer 886

increase IGF1 failure to suppress GH following oral glucose test

Question 887

when is ßhCG levels detectable after fertilization?

Answer 887

8 days post-ovulation (after the blastocyst implants)

Question 888

what is the acoustic reflex?

Answer 888

dampens the effects of loud noise by causing contraction of the **stapedius + tensor tympani m.**, thereby lessening the responsiveness of the ossicles to sound

Question 889

8yo w/ a hx of fever, abd pain, and diarrhea; hx shows that the patient's puppy also had diarrhea 1 week ago. which one is the most likely culprit? s. aureus shigella bacillus cereus vibrio parahemolyticus giardia lamblia campylobacter

Answer 889

campylobacter - only one in the list that can be transitted from domestic animals to humans; occurs via F/O

Question 890

**simple partial seizure** description (consciousness, postictal state)? first line treatment?

Answer 890

one body part is involved, consciousness is **intact**, ø post-ictal confusion carbamazepine

Question 891

maculopapular rash on head that progresses down only on the trunk occipital + post-auricular lymphadenopathy

Answer 891

german measles (rubella)

Question 892

Tetanospasmin MoA

Answer 892

neurotoxin released by c. tetani - causes **inhibition** of **inhibitory interneurons** (which use glycine and GABA) in the spinal cord that regulate the firing of primary motoer neurons --\> net increased activation of nerves innervating muscles (spasms, spastic paralysis, hyperreflexia)

Question 893

what happens to screening test values when prevalence declines?

Answer 893

sens + specific = unchanged increase NPV = NPV / (TN+FN) decrease PPV

Question 894

35yo w/ sickle cell anemia. What pathogens is he most suscetible to? What should he do to prevent his demise?

Answer 894

likely is **asplenic** - therefore he is at risk of encapsulated organisms (Ie S**. pneumo, H. influenza, N. meningitidis**) Salmonella is common in osteomyelitis therefore patients should get **penicillin prophylaxis + pneumococcal**

Question 895

what mediates adhesion of cells to the BM and ECM?

Answer 895

binding of **integrins **to **fibronectin, collagen, and laminin**

Question 896

**Craniopharyngioma** Location Appearance Prognosis, presentation

Answer 896

Pituitary (Rathke’s pouch) Thick brownish fluid that is rich in cholesterol crystals; may have calcifications Kids, Bitemporal hemianopia

Question 897

how does PE affect PaO₂ and PaCO₂?

Answer 897

**low PaO2** - due to V/Q imbalances (hypoxemia and stimulation of lung vagal irritant receptors causes hyperventilation, resulting in **low PaCO2 **

Question 898

STEMI in V1, V2 leads

Answer 898

anteroseptal (LAD) infranodal Mobitz type II second deg or third deg block would be possible

Question 899

what molecules signal through TK receptors

Answer 899

Insulin Growth factors (EGF, TGFß, PDGF, FGF etc) all act via **MAPK, Ras**

Question 900

why is the pO2 in the L atrium lower than that in the pulmonary veins?

Answer 900

admixture of deO2 bronchial blood (*from the bronchial v.*) that mixes with the oxygenated blood in the pulmonary veins

Question 901

actin/myosin is to __________ as calmodulin and myosin light chain kinase are to \_\_\_\_\_\_\_\_\_

Answer 901

actin/myosin is to **skeletal muscles** as calmodulin and myosin light chain kinase are to **smooth muscles** both are contractile elements

Question 902

this is a liver bx. What is the diagnosis and what causes this appearance??

Answer 902

**Hep B infection** notice the eosinophilic ground glass appearance, which is due to **HBsAg** filling the cytoplasm

Question 903

calculations for half-life maintenance dose loading dose

Answer 903

**half-life (hrs) = Vd \* 0.7 / CL** ^{a drug is virtually eliminated after 5 half-life intervals; 75% removal = 2 half-life intervals} **Maintenance dose: CPss \* CL / bioavailability fraction** **loading dose = CPss \*Vd / bioavailability fraction** VD = volume of distribution CL = clearance CPss = steady state plasma conc. Bioavailability fraction = 1 if given IV

Question 904

ergonovine test

Answer 904

ergot alkaloid that constricts vascular smooth muscle by stimulating both a-adrenergic and serotonergic receptors in patients with angina, low doses of ergonovine can induce coronary spasms, chest pain, and STElevation

Question 905

why does squatting help in tetralogy of fallot?

Answer 905

increase in systemic vascular pressure (SVP) reduces the amount of R-\>L shunting through the VSD, thereby increasing pulmonary flow

Question 906

cox enzyme responsible for GI ulcers + bleeding solution?

Answer 906

COX1 inhibition causes GI ulcers + bleeding solution - use a COX2 inhibitor

Question 907

Patients receiving kidney transplant usually receives cyclosporine + tacrolimus. Why? What do these Rx inhibit?

Answer 907

both **inhibit calcineurin activation**, which is essential to the activation of IL2 (promotes growth and differentiation of T cells)

Question 908

necrotic cell histology

Answer 908

nuclei are washed out, pyknotic (very compact) or fragmented (karyorrhexis) Necrotic = Nucleus

Question 909

target of: * enoxaparin * unfractionated heparin * fondaparinux * rivaroxaban * apixaban * agratroban * bivalruin * dabigatran

Answer 909

target of: * **enoxaparin (LMWH) = AT** only * enoxaparin is an **AT**ypical anticoagulant - it is NOX your typical anticoagulant!! * unfractionated heparin = **AT** + **thrombin (factor 2)** * fondaparinu**x** = **factor x** * rivaro**x**aban = **factor x** * api**x**aban = **factor x** **rule of thumb - X = factor 10 is involved (except enoxaparin)** * a gratroban = thrombin * bivalruin = thrombin * dabigatran = thrombin

Question 910

25yoF w/ erythematous, painful, ulcerated lesions on labia and perineum. Rx? MoA?

Answer 910

Acyclovir - inhibits viral DNA polymerase; must e activated by viral TK

Question 911

damage to tibial n. will result in

Answer 911

weakness of inversion and plantarflexion of foot

Question 912

cause of this graph?

Answer 912

**chronic AVM**. evidence: * increased CO * decreased TPR (increased slope of both cardiac function curve + venous return curve) * increased MSFP (acutely, an AV fistula causes decreased TPR, which results in increased CO and increased VR, but the VR curve does not immediately shift along the x axis - see graph below. Compensatory responses from the sympathetic nervous system and kidneys results in the effects listed above)

Question 913

small cavities in the deep structures of the brain (basal ganglia, posterior limb of internal capsule, pons, and cerebellum) filled with clear fluid are also known as... what are they usually caused by?

Answer 913

lacunar infarcts due to occlusion of small penetrating arteries that supply these structures; common chronic uncontrolled HTN or DM vessels have **lipohyalinosis **and **microatheromas**

Question 914

pathogenesis of CF

Answer 914

∆508 that cause abnormal protein folding and failure of glycosylation -\> CFTR is degraded before it reaches the cell surface

Question 915

definitive sign of heart failure and what can be done to accentuate this?

Answer 915

S3 - accentuated by having the patient lie in the L lateral decubitus position and fully exhale

Question 916

patients with DM - type I is more prone to developing what

Answer 916

other autoimmune d/o (ie autoimmune adrenalitis)

Question 917

how does simvastatin and cholestyramine affect hepatic cholesterol synthesis? what if they're used together?

Answer 917

decrease, increase if used together, then it will result in a net decrease in cholesterol synthesis and plasma LDL (since LDL will be used to resynthesize bile acids)

Question 918

patient who experienced sudden onset of focal numbness + tingling that fully resolved with a non-remarkable medical history other than hypercholesteremia what Rx to give her? MoA / ADR?

Answer 918

She had TIA - give low dose aspirin to prevent 1˚ or 2˚ coronary artery events and ischemic strokes MoA = irreversibly acetylating and inhibiting COX enzymes. at low dose it predominantely affects COX1, whereas at high doses, it inhibits COX1/2. ADR: GI ulcers

Question 919

hormones produced by pheochromocytoma are derived from which a.a.?

Answer 919

tyrosine!

Question 920

increased appetite, hypersomnia, intense psychomotor retardation, severe depression patient is undergoing withdrawal of...? PE findings?

Answer 920

stimulants (cocaine, amphetamines) PE: none

Question 921

viral Rx that inhibits DNA polymerase _AND_ reverse transcriptase, but does _NOT_ require intracellular activation

Answer 921

**Foscarnet** - pyrophosphate analog used to treat * acyclovir-resistant **herpesvirus** * ganciclovir-resistant **CMV** virus * advanced **AIDS** patients

Question 922

ovary eggs are arrested in what phase of the cell cycle?

Answer 922

**DIPLOTENE** stage of **PROPHASE I** stage of the **FIRST MEIOTIC** division remains at this stage from before birth until ovulation; 2nd meiotic stage is completed at fertilization

Question 923

what receptor type is the antagonist directed against

Answer 923

M2 cholinergic receptors - present on SA node, which acts to decrease HR Blocking the M2 receptors on the SA node removes the parasympathetic tone --\> increase HR (^{note that during the carotid occlusion, there is less stretch of the carotid baroreceptors and less afferent nerve activity is sent to the medulla by CN9; ie carotid occlusion tricks the body into thinking that it has a lower BP than ita ctually has})

Question 924

folic acid is impt in in generating which two factors? deficiency can result in?

Answer 924

**thymidine** (dTMP) synthesis (*via thymidylate synthetase*) conversion Homocysteine -\> **methionine** ∆ = megaloblastic anemia + hypersegmented PMNs

Question 925

cross-sectional study

Answer 925

data from a group of ppl to ASSESS FREQUENCY

Question 926

what innervates the submandibular and sublingual gland?

Answer 926

CN 7

Question 927

thymus originates from... shares its embryologic origin with..

Answer 927

originates from 3rd pharyngeal pouch shares its origin with the inferior parathyroid glands

Question 928

atrial septal defects are common in..

Answer 928

down syndrome patients | (these patients also have VSD)

Question 929

tumors in the lung apices are also known as what can they cause?

Answer 929

pancoast tumors - often form in the **superior sulcus (groove of subclavian vessels) **can cause * ipsilateral horner syndrome (ispi ptosis, miosis, anhydrosis) * edema of upper extremity (compression of subclavian vessels) * rib destruction * atrophy of hands muscles * pain in the distribution of C8, T1, and T2 nerve roots (pain in shoulder that radiates towards axialla and scapula)

Question 930

hydralazine MoA ADR?

Answer 930

**selective arteriolar vasodilation** reduces MAP -\> causes** reflex sympathetic activation**, leading to: **1) increased HR, contractility** **2) increased renin activity -\> Na/H2O retention**

Question 931

bony changes consistent w/ osteopetrosis

Answer 931

marble bone disease (decreased osteo**C**lastic resorption) persistence of primary, unmineralized spongiosa in medullary canals (in normal individual, bone marrow replaces the primary spongiosa)

Question 932

ETEC - mechanism of disease

Answer 932

Heat-labile (LT) and heat-stable (ST) enterotoxins LT is very similiar to cholera toxin in that it **increases intracellular cAMP **in gut mucosal cells by activating the Gs membrane, thus activating adenylate cyclase ST - increass cGMP both result in fluid/electrolyte loss /watery diarrhea _NOT_ due to endotoxin release, which is LPS. REMEMBER THIS!!!

Question 933

24yo patient w/ ulcerated, painful lesion on precpuce and unilateral inguinal adenopathy Culprit?

Answer 933

Haemophilus ducreyi - pleomorphic GNR that displays a characteristic "school of fish" pattern on gram stains (parallel short chains) same growth conditions as H. influenza

Question 934

amassed actin-containing fibroblasts and increased MMP activity after a skin laceration indicates...

Answer 934

**actin containing fibroblasts = MYOfibroblasts** **fxn: wound contraction** MMPs is not only involved in scar tissue remodeling, but also encourages myofibroblast accumulation at the wound edges, which would initiate wound contraction during healing by second intention

Question 935

patients on diazepam should avoid what drugs?

Answer 935

drugs that cause sedation: 1st gen anti-histamines: **chlorpheniramine, diphenhydramine, promethazine, hydroxyzine **

Question 936

what are choledochal cysts ?

Answer 936

congenital dilation of the common bile duct

Question 937

mediastinal widening on CXR

Answer 937

anthrax; max spore production occurs during stationary phase

Question 938

GABA is derived from which a.a.?

Answer 938

glutamate

Question 939

MoA + 2 major ADR of valproic acid

Answer 939

suppresses abnormal electrical activity in the cortex by affecting GABA and NMDA receptors, as well as Na/K channels ## Footnote **severe hepatotoxicity (measure LFTs)** **neural tube defects (spina bifida)**

Question 940

enzyme affected by citrate

Answer 940

**PFK-1** citrate is produced by citrate synthase from acetyl coA and oxaloacetate, when the CAC slows down, citrate accumulates and acts as a negative allosteric regulator of PFK1 (catalyzes committed step of glycolysis)

Question 941

Enoxaparin MoA

Answer 941

LMWH that binds to **anti-thrombin** only to accelerate inactivation of factor Xa

Question 942

kuassmaul sign

Answer 942

**paradoxical rise in JVP with inspiration** - occurs because the volume restricted RV is unable to accomodate the inspiratory increase in VR occurs in patients w/ **constrictive pericarditis** (thick fibrous tissue in the pericardial space that restricts venticular filling - increases JVP, low CO, and RHF that is resistant to medications)

Question 943

where is folate absorbed

Answer 943

jejunum (even though it's not really a fat-soluble vitamin....)

Question 944

cryptorchidism

Answer 944

undescended testes

Question 945

general effects of ß1 blockers

Answer 945

act on ß1 receptors to: decrease HR decrease renin release from JG cells

Question 946

treatment of atropine OD

Answer 946

physostigmine - AChE inhibitor - increases ACh availability to counteract atropine's blockade of muscarinic cholinergic receptors

Question 947

MTX is specific for which part of the cell cycle?

Answer 947

S phase because it prevents the synthesis of purine and thymidylic acid

Question 948

48F received opioid analgesics suddenly feels severe abdominal pain. Why?

Answer 948

it causes **contraction** of the **smooth muscles of the sphincter of oddi**, leading to constriction and spasm, which increases pressure in the common bile duct, which increases biliary colic.

Question 949

suspect this if ventricular myocytes express mRNA for ANP

Answer 949

ventricular hypertrophy (results in both MORPHOLOGIC + GENE changes)

Question 950

non-bacterial thrombotic endocarditis (NBTE) causes

Answer 950

vegetations of bland thrombus w/o accompanying inflammation or valvular damage causes: * hypercoagulable states (dissemminated cancer "marantic" endocarditis) * endothelial injury

Question 951

histological finding in patients w/ temporal arteritis

Answer 951

focal granulomatous inflammation, esp. of the cranial arteries

Question 952

Right anopia has damage to

Answer 952

R optic nerve - retinal artery/central retinal vein occlusion

Question 953

squamous cell carcinoma lung histology shows

Answer 953

keratin pearls + intracellular bridges

Question 954

surgeon w/ shaky hand was trying to ligate the superior thyroid a. and accidently severed this nerve and its innervation to this muscle

Answer 954

external branch of superior laryngeal nerve innervation: cricothyroid m.

Question 955

treatment of CAH?

Answer 955

low does exogenous corticosteroids to suppress excessive ACTH secretion and reduce stimulation of the adrenal cortex

Question 956

F w/ white curd-like discharge

Answer 956

candida albicans - yeast forms w/ pseudohyphae

Question 957

Follicular cell lymphoma translocation

Answer 957

follicular t14;18; 4 = “four”llicular _OR_ diffuse large b-cell lymphoma t14;18 = 4 words

Question 958

glucagon MoA give a scenario in which you would administer this?

Answer 958

* increases** hepatic glycogenolysis** AND **gluconeogenesis **to restore glucose levels, usually within 10-15min of administration * stimulates **insulin secretion** from pancreas administer to a little old lady who loses consciousness in a supermarket with a blood glucose of 34mg/mL (in a hospital, you'd just give IV glucose)

Question 959

polycythemia can be subdivided into absolute vs relative. What does this mean?

Answer 959

absolute - true increase in RBC mass (likely due to polycythemia (1˚) or hypoxia/EPO tumors (2˚) relative - normal RBC mass; likely due to excess diuresis or dehydration

Question 960

how is REM affected in persons with major depressive d/o?

Answer 960

increased REM sleep (even though they complain of insomnia) decreased REm latency decreased N3 (deep) sleep

Question 961

pathophysiology of hemochromatosis complications of this d/o? why do women tend to present signicantlly later?

Answer 961

AR d/o where HFE protein is NOT expressed on the basolateral surface of intestinal cells (where it normally binds to transferrin receptor and regulates traCopyright (c) USMLEWorld, LLC., Please do not save, print, cut, copy or paste anything while a test is active.nsferrin/Fe complex endocytosis into cells) øHFE = unregulated uptake of dietary Fe = abnormally high levels of intestinal absorption = mildly elevated LFTs, elevated plasma Fe w. \>50% TIBC, elevated serum ferritin Complications: cirrhosis, HCC Women tend to present later due to blood loss during menstruation + pregnancy

Question 962

wide fixed splitting of S2 long-term sequelae if not treated?

Answer 962

ASD - creates a L-\>R shunt due to high pressures in the LA, resulting in increased blood flow through the pulmonary artery long-term: hypertrophy of the muscular pulmonary arteries to accommodate the extra flow (increased pulmonary vascular resistance, pulm HTN) results in a switch to R-\>L shunt "Eisenmenger's syndrome"

Question 963

Bombesin

Answer 963

marker for neuroblastoma, small cell carcinoma, gastric carcinoma

Question 964

endocarditis due to s. bovis

Answer 964

colon cancer

Question 965

case fatality rate is calculated as

Answer 965

of fatal cases / total # of people with the disease

Question 966

difference between omphalocele and gastroschisis

Answer 966

* **omphalocele** - protrusion of abdominal contents that is covered by peritoneum * **gastroschisis** - protrusion of abdominal contents that is NOT covered by peritoneum

Question 967

A 30-year-old woman is brought into the emergency room. The patient had been dining in a local restaurant, and while eating dessert she noted the following symptoms. Initially there was a tingling sensation that affected the mouth and lips, but then it spread to the face and neck. Then the tingling spread down the arms and legs to the fingers and toes. Cause?

Answer 967

The rapid onset (~30min) of symptoms, as well as the patient's neurologic deficits, are most consistent **paralytic shellfish poisoning**. Saxitoxin, with actions similar to those of tetrodotoxin (puffer fish), **blocks the opening of VG Na+ channels**. Recovery is slow due to the extremely tight binding of the toxin to the Na+ channels; but once dissociated, it can be excreted in the urine.

Question 968

phentolamine when is it given?

Answer 968

a1 blocking drug - usually leads to vasodilation usually given to coutneract the NE-mediated vasoconstriction

Question 969

patient w/ R leg numbness lifts R foot higher than he does on the L; R foot slaps to the ground w/ each step. PE: unable to evert R foot (keeps foot plantarflexed + inverted) damaged nerve?

Answer 969

**common peroneal n.** paralysis of peroneus longus + brevis (mediates foot eversion) paralysis of tibialis anterior (mediates dorsiflexion) paralysis of extrinsic extensors of the toes loss of sensation to the anterolateral leg NET: **foot drop + high stepping gait**

Question 970

patients w/ HTN and dyslipidemia has total occlusion of L main coronary artery + diffuse atherosclerotic disease characterized by intimal thickening + collagen deposition. What cells produce this intimal response?

Answer 970

**smooth muscle cells** - migrate from the media, across the IEL, into the intima where they proliferate and produce collagen to produce a neointima (in respons eto intimal injury)

Question 971

why is pregnancy an independent risk factor for DVTs?

Answer 971

increased production of clotting factors decreased fibrinolysis reduced protein S pressure of gravid uterus on IVC -\> venous stasis

Question 972

∆ btwn cherry hemangioma and strawberry hemangioma?

Answer 972

**cherry**: adults, #'s often increase and do _not_ regress **strawberry:** kids; size often increases, but spontaneously regresses

Question 973

Lead inhibits

Answer 973

ALA**D** + ferrochetolase

Question 974

2 risk factors for infective endocarditis

Answer 974

prosthetic valves prior valvular inflammation and scarring (FIBRIN deposition allows bacteria to bind to it)...duh

Question 975

why does prolactin cause vaginal dryness and bone fractures?

Answer 975

it inhibits GnRH --\> hypogonadism --\> anovulation, amenorrhea low extrogen --\> vaginal dryness, low bone density

Question 976

amytriptyline ADR

Answer 976

**potent anti-cholinergic effects ** (may mimic atropine toxicity - fever, mucosal/axillary dryness, cutaneous flushing, mydriasis, and cycloplegia an delirium)

Question 977

medical student begins to dress and act like an attending physician

Answer 977

identification

Question 978

patient presents w/ difficulty swallowing and this (see pic) diagnosis + treatment?

Answer 978

koilonychia (spoon nails) + difficulty swallowing (dysphagia) are specific for **IDA - iron deficiency anemia** treatment: **Fe prep**

Question 979

cleft palate results from

Answer 979

occurs hwen the **palatine shelves of the maxillary prominence** fails to properly fuse with **one another** or with the **primary palate**

Question 980

Tadalafil is indicated for two diseases. What are they?

Answer 980

erectile dysfunction pulmonary artery HTN

Question 981

Fredreich ataxia chromosome

Answer 981

9p (drawing out 9P looks like a walker)

Question 982

what is myelophthisic anemia?

Answer 982

space-occupying lesion in bone marrow -\> pancytopenia (most common = metz to the bone with associated fibrosis)

Question 983

MTX treatment causes an accumulation of.. prevents synthesis of..

Answer 983

accumulated substrate: Dihydrofolate polyglutamate ^{(polyglutamation prevents movement of these substrates out of the cell)} prevents synthesis of: purines + thymidlyate synthesis

Question 984

decreased lung compliance is caused by...3

Answer 984

pulmonary fibrosis insufficient surfactant pulmonary edema

Question 985

type II cytotoxic hypersensitivity

Answer 985

autoantibodies that bind to specific tissues or cells and cause destruction (ie rheumatic fever, hemolytic disease of newborn)

Question 986

difference btwn communicating + non-communicating hydrocephalus?

Answer 986

communicating: no obstruction to CSF flow; usually occurs 2˚ to dysfunction or obliteration of subarachnoid villi that is caused by meningeal infections or subarachnoid/IVH. ALL ventricles are enlarged non-communicating - ventricles above the obstruction are enlraged, those below are normal (usually due to aqueductal stenosis, arnoid chiaris or dandy walker malformations)

Question 987

marker of high infectivity in Hepatitis B? low infectivity?

Answer 987

* high infectivity = HBeAg (**e for elevated, emergency**) * low infectivity = anti-HBeAg

Question 988

Cimetidine MoA ADR

Answer 988

MoA: H2 receptor antagonist --\> decreass HCl production ADR: **gynecomastia, inhibits P450** and may increase levels of warfarnin, phenytoin, propranolol, metoprolol, quinidine, and theophylline

Question 989

F w/ ambigious genitalia, hypotension, and hyperkalemia deficient enzyme?

Answer 989

21-hydroxylase deficiency * decreases cortisol production * decreased mineralocorticoid production -\> hypotension+hypokalemia * increased androgen production -\> F have ambigious genitalia

Question 990

how does citrate work in treating calcium kidney stones?

Answer 990

citrate = binds to free (ionized) Ca and prevent its precipitation, thereby allowing it to be excreted.

Question 991

where is amyloid (AA) made? AL?

Answer 991

AA = liver AL = bone marrow (Ig light chains)

Question 992

**Niacin** Clinical Use MoA ADR

Answer 992

* clinical use: **hyperTg – 2nd line**, or** low HDL** * MoA: **decrease VLDL + Tg** (by suppressing FFA release from peripheral tissues and by decreasing VLDL conversion to LDL), **increase ****HDL** * ADR: * **Flushing, itchiness (prevent w/ aspirin)** * **Hepatotoxicity** * **Hyperglycemia (acanthosis nigricans)** * **increase uric acid (gout)**

Question 993

Clozapine Clinical use ADR

Answer 993

helpful in treating NEGATIVE symptoms of schizophrenia ADR: agranulocytosis and seizures

Question 994

3 drugs that inhibit dihydrofolate reductase

Answer 994

**T**rimethoprim **M**TX **P**yrimethamine **TMP**

Question 995

intracellular signaling factors for a1, a2, ß1, ß2

Answer 995

a1 = increase IP3 -\> vasoconstriction a2 = decrease cAMP -\> decrease NE/insulin release ß1 = increase cAMP -\> increase contractility ß2 = increase cAMP -\> bronchodilation/vasodilation

Question 996

most internal component fo the anterior abdominal wall musculature

Answer 996

transversus abdominis (transversalis) ^{(lies immediately deep to the internal oblique)}

Question 997

which monosaccharide has the highest rate of metabolism in the glycolytic pathway and why?

Answer 997

**F-1-P **(derived from dietary frutose) is rapidly metabolized because it **bypasses PFK-1,** the rate limiting enzyme of glycolysis ## Footnote *(other sugars enter glycolysis before this rate limiting step and are therefore metabolized more slowly due to the regulation of PFK-1)*

Question 998

what should patients be tested for prior to starting hydroxychloriquine?

Answer 998

baseline + follow-up ophthalmologic exams since it can result in irreversible retinal damage w/ long-term use

Question 999

patients with influenza is at risk for what and why? What pathogens are most common in this particular illness?

Answer 999

bacterial pneumonia (recurrent fever, dyspnea, and productive cough) because influenza damages the mucociliary clearance mxns of the respiratory epitehlium ## Footnote **S. pneumo \> S. aureus, \> H. influenza**

Question 1000

most specific marker for diagnosing acute hepB infection? most specific marker of viral replication/increased infectivity?

Answer 1000

**IgM anti-HBc** - remains elevated during the window period (disappearance of HBsAg and appearance of anti-HBs) HB**e**Ag **= e** for **e**mergency!!

Question 1001

bioavailability fraction for an IV drug

Answer 1001

1

Question 1002

3 main causes of HIV-associated esophagitis - how do you tell them apart?

Answer 1002

* **candida** - white pseudomembrane; yeast cells + pseudohyphae that invades mucosal cells * **HSV1** - small vesicles that evolve to "punched out" ulcers; forms Cowdry type intranuclear inclusions in multi-nuclear squamous cells at the margins of ulcers * **CMV** - LINEAR ulceration (intranuclear + cytoplasmic inclusions)

Question 1003

what kind of withdrawal: Sweating, dilated pupils, piloerection (“cold turkey”), fever, rhinorrhea, yawning, nausea, stomach cramps, diarrhea (“flu-like” symptoms).

Answer 1003

heroin withdrawal

Question 1004

what should you monitor for patients on Thiazolidinediones?

Answer 1004

LFTs, specifically ALT, because they cause severe hepatotoxicity (although the newere versions do not)

Question 1005

cardiac findings in friedreich's ataxia other findings?

Answer 1005

hypertrophic cardiomyopathy, CHF "big heart" **kyphoscoliosis, pes cavus **(foot defomities), **diabetes mellitus** **ataxia **(degeneration of ascending + descending spinocerebellar tracts) (note that this is a trinucleotide d/o on chromosome 9 that results in degeneration of the posterior columns and spinocerebellar tracts)

Question 1006

patient in the ER with complaints of increasing SOB - treat w/...?

Answer 1006

high dose IV glucocorticoids - used for acute asthma exacerbations that cause patients to end up in the ER Albuterol is good for mild episodic symptoms

Question 1007

65yo w/ sudden onset of L eye blindness and L jaw pain that starts in the middle of a meal

Answer 1007

**temporal arteritis** - arterial lumens narrow and cannot respond to increased blood requirements during the meal. patients may also experience muscle pain + morning stiffness (polymyalgia rheumatica) get **ESR**!!

Question 1008

polyarteritis nodosa (PAN) affects which arteries? spares which arteries? histology? cause?

Answer 1008

affects: medium - small size arteries (kidneys, heart, liver, GI tract) spares: pulmonary arteries histology: transmural inflammation w/ fibrinoid necrosis cause: **HepB **

Question 1009

Nesiritide What is it? Who do you use it in?

Answer 1009

recombinant BNP (brain natriuretic peptide) CHF due to decompensated LV dysfunction

Question 1010

what can reverse vagally-mediated bronchoconstriction?

Answer 1010

anti-muscarinics (ipratropium)

Question 1011

milrinone MoA clinical uses?

Answer 1011

phosphodiesterase inhibitor -\> **increases cAMP** **in heart**: increased cAMP -\> increased Ca -\> increased cardiac contractility **in VSM**: increased cAMP -\> vasodilation

Question 1012

central DI usually results from damage to:

Answer 1012

hypothalamic nuclei or pituitary stalk (don't answer posterior pituitary because the neuron axons project there, but it's not actually made there...)

Question 1013

Nitroprusside clinical use? General Metabolism? OD trmt

Answer 1013

anti-HTN w/ mixed arterial + venous vasodilatory effects metabolized to **cyanide** w/ subsequent conversion to thiocyanate (via rhodanase) OD: thiosulfate - donates sulfur to liver rhodanase to enhance conversion of cyanide -\> thiocyanate

Question 1014

Nifedipine, Verpamil, and Diltiazem are all Ca channel blockers

Answer 1014

* **_Nifedipine_ -** similar to **n**itrates in effect - it causes peripheral vasodilation (**vasculature-specific effects**), which may result in reflex tachycardia. Good anti-HTN agent for patients with bradycardia * **_verapamil and diltiazem_** - similar to ß blockers in effect - slows conduction through the AV node (**cardiac-specific effects**) and is used for rate control in a-fib w/ rapid ventricular response

Question 1015

battery factory should make you think of what type of poisoning

Answer 1015

LEAD - abd colic, constipation, HA, lead line, peripheral neuropathy, microcytic hypochromic anemia + basophilic stippling

Question 1016

how does resistance to penicillins, aminopenicillins, cephalosporins, and monobactams occur?

Answer 1016

* _penicillin_: upregulation of **ß lactamase (penicillinase)** that destroy the ß-lactam ring of penicillins * _cephalosporins + penicillinase-resistant penicillin (nafcillin/methicillin)_: **modified penicillin binding proteins (PBP)** that prevent the binding * (thus infections caused by organisms expressing ß lactamases require a ß lactamase inhibitor (ie clavulanic acid, sulbactam, or tazobactam)

Question 1017

part of the placenta that is derived from fetal origin

Answer 1017

cytotrophoblast syncytiotrophoblast (both form the chorion) primary villi = earliest projection of the chorion

Question 1018

why is surgery not indicated for small cell carcinoma of the lungs?

Answer 1018

it is highly invasive and the majority have distant metz at the time of diagnosis and surgery proves futile. These tumors are sensitive to chemoRx and radiation.

Question 1019

how does glucocorticoids cause hyperglycemia? 2

Answer 1019

it it increases hepatic synthesis of enzymes involved in gluconeogenesis + glycogenolysis it antagonises the effect of insulin in muscle + adipose tissue, thus favoring catabolism in these tissues (to ultimately provide substrates for gluconeogenesis + glycogenolysis in the liver)

Question 1020

an undescended testes is at risk of what later on in life?

Answer 1020

testicular carcinoma

Question 1021

MALES FSH is to _________ as LH is to \_\_\_\_\_\_\_\_\_

Answer 1021

FSH is to **_Inhibin B AND Androgen Binding Protein, Sertolic cells_**** ** as LH is to **_testosterone, Leydig cells_**

Question 1022

serum sodium levels for someone with central DI nephrogenic DI primary polydipsia

Answer 1022

central: \>142 nephrogenic: \>142 primary polydipsia:

Question 1023

what should be considered before **ramipril **is prescirbed to a patient w/ a hx of MI + coronary artery bypass surgery for stable angina?

Answer 1023

if the patient has **bilateral RAS**. Why? patients w/ atherosclerotic cardiovascular + peripheral vascular disease can also develop renovascular disease (RAS). Patients w/ RAS are dependent on ACE-mediated **efferent** arteriole vasoconstriction to maintain renal perfusion + GFR. Use of ACEi will block this effect and reduce renal perfusion, potentially leading to ARF.

Question 1024

"wrist drop" is usually due to compression of which nerve? what type of injury usually causes this?

Answer 1024

radial n. improperly fit crutches or mid-shaft humerus fracture

Question 1025

antibiotic that causes red man syndrome + nephrotoxicity

Answer 1025

vancomycin - blocks glycopeptide polymerization by binding tightly to D-ala/D-ala

Question 1026

pulmonary hamartoma

Answer 1026

aka coin lesions excessive growth of a tissue type native to the organ of involvement hx: popcorn calcifications, islands of mature hyaline cartilage, fat, smooth muscle cells and clefts lined by respiratory epithelium

Question 1027

reverse NE effects (intense vasoconstriction)

Answer 1027

phentolamine mesylate (a-receptor blocker)

Question 1028

52 F w/ a hand tremor that is alleviated by drinking small amounts of alcohol. Dx, best treatment for this patient and why?

Answer 1028

* Dx: **essential tremor** (AD, + family history) * treatment: **propranolol ** - non-selective ß receptor antagonist is throught to lessen the tremor via its CNS efffects

Question 1029

low potency anti-psychotics ADR?

Answer 1029

chlorpromazine, thirordazine anticholinergic effects (confusion, dry mouth, urinary retention) due to their strong blockade of central + peripheral muscarinic cholinergic receptors

Question 1030

what is the purpose of adding carbidopa to levodopa? what ADRs will improve?remain the same?

Answer 1030

**carbidopa** inhibits peripheral decarboxylase, thereby reducing peripheral conversion of levodopa, making more of it available to the brain and less peripheral ADR improve: **N/V, tachyarrhythmias, postural hypotension + hot flashes** remain the same or worsen: **anxiety + agitation** (since more dopamine becomes available to the brain)

Question 1031

diuretics that cause hypercalcemia? hypocalcemia?

Answer 1031

hyper: thiazides hypo: loops

Question 1032

what is a ghon complex? when does it occur?

Answer 1032

when the lower lobe lesion (ghon focus) is accompanied by ipsilateral hilar adenopathy = ghon complex occurs during initial infection with MTB

Question 1033

causes of Mitral valve prolapse

Answer 1033

sporadic myxomatous degeneration of the mitral valve Marfan Ehlers-Danlos

Question 1034

a1 blockers are generally used for?

Answer 1034

treatment of concomitant BPH + HTN examples are prazosin, terazosin, doxazosin

Question 1035

23yo F in her 3rd trimester develops fever, weakness, and diarrhea; delivers baby at 34wks. Physical exam of the neonate shows disseminated granulomas. Culprit? Treatment?

Answer 1035

Listeria Monocytogenes - cause of granulomas in-utero; fatal GPR that is acquired by eating delicatessan food Trmt: Ampicillin

Question 1036

patient w/ Conn syndrome

Answer 1036

spironolactone eplerone

Question 1037

genetic cause of familial hypercholesterolemia

Answer 1037

hepatocyte under-expression of functional LDL receptors

Question 1038

how does panic attack affect PaO₂ and PaCO₂?

Answer 1038

raises HR and CO via sympathetic stimulation of the heart; however, there is an associated hyperventilation and respiratory alkalosis, thus a slight rise in PaO2 and fall in PaCO2

Question 1039

eye field looks like this: where is the lesion?

Answer 1039

R optic nerve B

Question 1040

Alz treatment

Answer 1040

Cholinesterase inhibitor - Donepezil Antioxidants - Vit E NMDA receptor antagonist - memantine

Question 1041

how does HRT affect thyroid hormone levels?

Answer 1041

serum levels of TSH is normal serum levels of T4 and T3 are also normal increase TBG levels increased total T4 and total T3 PREGNANCY/oral coontraceptives also do the same thing...

Question 1042

Amantidine has 3 clinical uses. What are they? what is its MoA? ADR?

Answer 1042

**Parkinson's** - increase DA release **Influenza** - impairs uncoating of virus after host-cell endocytosis (note that this is no longer used due to increased resistance) **Rubella** MoA: inhibits M2 ion channel, thereby blocking viral uncoating after host cell endocytosis ADR: **ataxia**

Question 1043

where is iron absorbed? where cells regulate the total iron content of the body?

Answer 1043

duodenum hepatic cells - secretes hepcidin (APR)

Question 1044

Enfuvirtide

Answer 1044

**fusion inhibitor -** binds Gp41 and blocks conformational changes necessary for fusion of viral + cellular membranes **FUSION FUVVVV** GP-**FOUR**-1

Question 1045

woman treated with x hormone - FSH declines initially but later dramatically increases. What is hormone X?

Answer 1045

Estrogen low levels inihibit FSH secretion via negative feedback, higher sustained estrogen levels produce (+) feedback, leading to estrogen surges in FSH/LH secretion. LH surge induces ovulation

Question 1046

tremors, agitation, anxiety, delirium, psychosis patient is undergoing withdrawal of...? PE findings?

Answer 1046

OH PE: seizures, **tachycardia**, palpitations

Question 1047

STEMI in V4-V6 leads

Answer 1047

anterolateral wall (LAD or LCX)

Question 1048

lancet-shaped Gram (+) diplococci

Answer 1048

**s. penumo**

Question 1049

carnitine function deficiency will cause what to happen? patient will also be deficient in what substrate?

Answer 1049

**transport long-chain FA into mitochondria** deficiency: impaired FA transport into the mitochondria, **restricting ketone body production** patient will also be deficient in **acetoacetate**

Question 1050

how does resistance to fluoroquinolones develop?

Answer 1050

structural alterations in topoisomerases **II** /DNA gyrase

Question 1051

ab with two epsilon chains

Answer 1051

IgE

Question 1052

key anatomic landmarks for locating the trigeminal nerve

Answer 1052

middle cerebellar peduncles

Question 1053

student stealing from a wealthy friend and thinking that he is rich enough that he can afford to lose it

Answer 1053

rationalization

Question 1054

patient has esophageal varices + splenic enlargement + normal liver histology. What's going on?

Answer 1054

**portal vein thrombosis**

Question 1055

patient w/ difficulty walking; leands towards R while walking. When asked to stand on his L foot, his R hip tilts downards.

Answer 1055

(+) Trendelenburg sign - hip dips towards the unaffected side when the patient stands on the affected leg. superior gluteal n. - innervates the gluteus medius + gluteus minimus (both function to pull the pelvis down and abduct the thigh)

Question 1056

reginal adenopathy with LNs containing granulomas filled with necrotic debris causal agent + treatment?

Answer 1056

bartonella henslae trmt: azithromycin or dox

Question 1057

achondroplasia - mutation and effect?

Answer 1057

**FGF-receptor 3 gene** -\> abnormal chondrocyte proliferation at the growth plates of long bones result: **short-limb dwarfism**

Question 1058

Patient on Isoniazid develops peripheral neuropathy. Why? how do you prevent this?

Answer 1058

Isoniazid is structurally similar to B6 and therefore causes * "extra B6" to be excreted, often resulting in B6 deficiency. * compete with B6 in the synthesis of multiple neurotransmitters, resulting in defective end products (NTs that do not work) prevent w/ B6 supplementation

Question 1059

Suggest antibiotics that work at each step of mRNA synthesis ## Footnote **formation of initiation complex** **Aminoacyl-tRNA binding** **Peptide bond formation** **translocation**

Answer 1059

* Initiation complex = **Aminoglycosides **(gentamicin, amikacin, tobramycin, streptomycin), **Linezolids** * Aminoacyl-tRNA binding **= Tetracyclines **(doxycyline) * Peptide bond formation = **Chloramphenicol** (*inhibits peptidyltransferase)* * translocation = M**acrolides** (azithromycin, erythromycin), **clindamycin**

Question 1060

terbinafine MoA

Answer 1060

inhibits **squalene epoxidase** **"TSE"** = Tiffany's aunt last name

Question 1061

what Rx is best used to address the infertility issues in patients with PCOS?

Answer 1061

**Clomiphene** - a SERM that prevents negative feedback on the hypothalamus by circulating estrogen -\> results in increased LH/FSH production and subsequent ovulation

Question 1062

brain tumor that has sheets of small, blue cells

Answer 1062

medulloblastoma - located in teh cerebellum

Question 1063

role of cyclin D1 present in what dz

Answer 1063

promotes G1-\>S transition present in mantle cell lymphoma

Question 1064

How does BNP work?

Answer 1064

acts along with ANP to cause vasodilation (and decreased preload) and diuresis; both ANP + BNP activate guanylate cyclase, which induces an _increase_ in cGMP

Question 1065

how do these factors change with vWF d/o? Platelet Count Bleeding time PT PTT plasma fibrinogen levels ristocetin challenge smear

Answer 1065

Platelet Count = NC Bleeding time = increased (differentiates it from vWF) PT = NC PTT = increase plasma fibrinogen values = normal ristocetin = abnormal smear = normal

Question 1066

IM injection into the buttocks result in ispilateral hip drop every time the ipsilateral foot is raised. where was the injection done and what causes these sx?

Answer 1066

**gluteus medius gait - **caused by injury to the **superior gluteal n.** (L4-S1) or injury to the **gluteus medius** Injection was probably done in the _supero-medial quadrant_ of the gluteal region, which caused damage to the **gluteal n.** All injections are usually done in the superolateral quadrant to avoid this

Question 1067

Zafirlukast and Montelukast MoA and use

Answer 1067

inhibit leukotriene-receptors chronic asthma prophylaxis

Question 1068

diphenoxylate MoA use? why is it manufactured with atropine?

Answer 1068

**opiate** binds to **µ opiate receptors** in GI tract -\> **slows motility** use: **anti-diarrhea** (low doses) manufactured w/ atropine because it **discourages abuse** - patients who decide to take higher doses of diphenoxylate wil result in higher doses of atropine, which will produce adverse sx (dry mouth, blurry vision, nausea)

Question 1069

what factor causes an **increase** in the thermoregulatory set point in the anterior hypothalamus (results in a higher core body temperature)

Answer 1069

PGE2

Question 1070

MEN 2B gene mutation? what does it affect?

Answer 1070

activating mutation of RET protooncogene pheochromocytoma Medullary thyroid cancer (MTC, calcitonin) oral/intestinal ganglioneuromatosis (**mucosal neuromas**) **marfanoid habitus**

Question 1071

in 90% of patients, the posterioinferior wall of the L ventricle is supplied by?

Answer 1071

posterior descending branch of R coronary artery (RCA)

Question 1072

marker of pancreatic cancer

Answer 1072

CA 19-9

Question 1073

what forms the SVC

Answer 1073

L/R brachiocephalic v.

Question 1074

drug that causes a dose-dependent increase in cardiac contractility + dose-dependent decrease in systemic vascular resistance

Answer 1074

isoproterenol * increases cardiac contractility via ß1 receptors * at lower doses, it selectively binds to ß2 receptors, causing relaxation of VSM * negligible effects on a-receptors

Question 1075

hemolytic anemia is usually due to defects in these two pathways. Associated enzymes?

Answer 1075

glycolysis = **pyruvate kinase** pentose phosphate shunt = **Glucose-6-phosphate DH**

Question 1076

blotchy red muscle fibers on Gomori trichome stain are buzzwords for this particular d/o

Answer 1076

mitochondrial myopathies

Question 1077

why is propranolol given to patients with thyrotoxicosis? why is it never given to patients with diabetes? (what are some alternate options)

Answer 1077

ß blockers like propranolol has dual effects in thyrotoxicosis * decreased effect of sympathetic adrenergic impulses reaching target organs * decreased rate of peripheral conversion of T4 -\> T3 in patients with diabetes, non-specific ß blockers like propranolol can * inhibit the Epi/NE-mediated compensatory reactions to hypoglycemia (tremor, palpitations, sweating) * blockade of ß2 receptors inhibit hepatic gluconeogenesis + peripheral glycogenolysis and lipolysis * **treat w/ SELECTIVE ß1 blockers instead because they do not block metabolic sympathetic effects**

Question 1078

what should you consider when initiating chronic hypouricemic therapy with either xanthine oxidase inhibitors (allopurinol) or uricosuric agents (probenecid or sulfinpyrazone)?

Answer 1078

it may precipitate an acute gouty arthritis attack, thereofre it is advisable to initiate chronic NSAID therapy to prevent this.

Question 1079

how does typical antipsychotics differ from atypical antipsychotics?

Answer 1079

typical: haliperidol, trifluoperazine, fluphenazine, etc typical = only + sx of schizo ex: **clozapine, risperidone, olanzapine, quetiapine** atypical = both + and - sx of schizo

Question 1080

**leptin** and **adiponectin** where is it from? what type of factor is it? what does it do? what happens if you have a mutation in leptin?

Answer 1080

both are secreted from **fat cells** * **leptin** = hormone --\> decreases food intake via * **decrease** production of **neuropeptide Y** (appetite stimulant) in the arcuate nucleus * **stimulate** production of **POMC** (appetite suppression) * _decrease_ insulin resistance * ∆ leptin = **hyperphagia + obesity** * **adiponectin** = cytokine, _decrease_ insulin resistance

Question 1081

how do various parts of the choclea differ in terms of their fluid content?

Answer 1081

scala **vestibul**_i_**** + **tympan**_i_**** = **per**_i_**lymph** (high Na) scala **media** = **endolymph** (high K)

Question 1082

patient w/ acute epididymitis and orchitis w/ white discharge. Culprit?

Answer 1082

Neisseria gonorrhoeae - can cause abscesses within the epididymis (white discharge) GN (diplo)cocci

Question 1083

cardiac findings marfan's syndrome

Answer 1083

cystic medial necrosis of the aorta

Question 1084

lamellar bodies of type II pneumocytes

Answer 1084

store and release pulmonary surfactant; deficiency can result in patchy atelectasis

Question 1085

neonatal jaundice should be given what therapy + vitamin supplement?

Answer 1085

likely due to conjugation problem (think Craig Najjar or Gilbert d/o) trmt: phototherapy (but this can destroy riboflavin, so you need to supplement this!!)

Question 1086

stimulating afferent portions of CN9 and CN10 will cause what to HR and BP?

Answer 1086

bradycardia + hypotension CN 9 and CN 10 carry afferent information from carotid sinus + aortic arch baroreceptors, respectively, to the medulla. Both receive input from the **NTS** by incresaing the firing rate of these neurons, the NTS receives a "**false signal"** that the **"BP is too high"**, resulting in a **baroreceptor reflex,** resulting in **decreased sympathetic outflow** and **increase parasympathetic outflow.** Net: **bradycarida + hypotension**

Question 1087

reaction formation

Answer 1087

replacement of an unpleasant or unacceptable thought or desire (*recovering drug addict who wants to use drugs*) w/ an emphasis on its opposite (*advocating against drug use*)

Question 1088

onset of BP 160/110 and 3+ proteinuria at 16wks gestation suggests:

Answer 1088

Hydatidiform mole note that diagnostic criteria for pre-eclampsia is after 20 weeks gestation; before this, the sx are likely due to the hydatidiform mole

Question 1089

dysphoria, irritability, anxiety, increased appetite patient is undergoing withdrawal of...? PE findings?

Answer 1089

OH PE: seizures, **tachycardia**, palpitations

Question 1090

facial swelling and dark urine following a recent skin infection

Answer 1090

post-strep GN

Question 1091

bipolar patient presents w/ polydipsia, polyuria, and very low specific gravity **_after_** water restriction should make you think of... ADR of this Rx? 3 major ones

Answer 1091

LITHIUM antagonizes ADH -\> nephrogenic DI hypothyroidism Ebstein's anonmaly of the tricuspid valve

Question 1092

patient started on an antiplatelet drug comes in with fever + mouth ulcers. the first drug that should come to mind is...

Answer 1092

ticlopidine - neutropenia (often presents as mouth ulcers + fever)

Question 1093

37yo w/ fibrocystic changes of her breast is at increased risk of breast cancer when there is....

Answer 1093

**epithelial hyperplasia ** (ie florid hyperplasia, atypical ductal hyperplasia, and ductal carcinoma in situ, all of which have increasing risks of invasive ductal carcinoma)

Question 1094

pericardial knock

Answer 1094

occurs in constrictive pericarditis, where there is reduced ventricular compliance via an external force (sharper, more accenutated heart sound that is heard earlier in diastole than S3)

Question 1095

what antihypertensive Rx can cause this?

Answer 1095

**ß blockers** ## Footnote ex: metoprolol - selective ß1 antagonist, which can cause bradycardia + varying degrees of AV block (in this case, a 2nd deg. AV block of 2:1 or 3:1)

Question 1096

Rifampin MoA how is resistance acquired?

Answer 1096

MoA: inhibits **DNA-dependent RNA-polymersase** (prevents transcription) Resistance: modification of the rifampin binding site on the bacterial **DNA-dependent RNA polymerase**, thereby preventing transcription of DNA -\> mRNA

Question 1097

cause of greenish sputum in a patient with high fever, chills, and productive cough

Answer 1097

myeloperoxidase - blue-green heme-based pigmented molecule (don't confuse with pseudomonas sputum, which is blue-green)

Question 1098

Purpose of using desmopressin in patients with hemophilia A

Answer 1098

XLR d/o in Factor 8 DDVAP stimulates release of **Factor 8** and **vWF** from **endothelial cells**

Question 1099

C1 esterase inhibitor deficiency what Rx is absolutely contraindicated?

Answer 1099

**Hereditary angioedema** C1 esterase inhibitor normally degrades C1 and prevents excessive complement activation and inflammation; also inactivates kallikrein (which converts kiniogen -\> bradykinin). ø C1 esterase = active kallikrein + bradykinin are increased **bradykinin + C3a + C5a cause angioedema via ** vasodilation/vascular permeability **contraindicated: Captopril** (since ACEi can result in bradykinin accumulation)

Question 1100

NT responsible for induction of REM sleep

Answer 1100

ACh

Question 1101

Nystatin MoA

Answer 1101

binds to **ergosterol** in the fungal cell membrane and causes **pore-formation** and subsequent leakage of fungal cell contents

Question 1102

L homonymous superior quandrantanopia has damage to

Answer 1102

R temporal lobe (meyer's loop)

Question 1103

how do these factors change with HUS d/o? Platelet Count Bleeding time PT PTT plasma fibrinogen levels smear

Answer 1103

Platelet Count = decrease Bleeding time = increase PT = NC PTT = NC plasma fibrinogen levels = normal smear = RBC fragmentation follows infection with shigella or Ecoli 0157:H7

Question 1104

what bony landmark would be most appropriate to locate the pudendal nerve.

Answer 1104

ischial spine pudendal nerve innervates the perineum; originates from S2, S3, S4 and leaves through the pelvis through the **greater sciatic foramen** and then wraps around the **ischeal spine** and **sacrospinous ligament** to enter the **lesser sciatic foramen** and eventually reach the perineum.

Question 1105

buzzword: mucicarmine stain

Answer 1105

CRYPTOCOCCUS neoformans - it's the only fungus that contains a polysaccharide capsule. can also use silver stain

Question 1106

virulence factor of s. epidermidis

Answer 1106

ability to form **biofilms** (extracellular polysaccharide matrix) on fibrinogen, fibronectin, prosthetic devices, IV catheters biofilms functions as a barrier to antibiotic penetration, interferes with host defenses (opsonization, neutrophilm igration, even T cell activation)

Question 1107

5mo boy with sx consistent w/ viral bronchiolitis (low grade fever, runny nose, progressive cough, tachypnea, agitation) bug? treatment? what other disease can you use this treatment for?

Answer 1107

**Ribavirin - **nucleoside analog that inhibits synthesis of guanine nucleotides; active aganist **RSV + HepC**

Question 1108

how does MTB cause tissue distruction?

Answer 1108

result of host immune response via **Type IV** **DTH HSR **- **Th1 specific cells - **results in granulomatous inflammation + caseous necrosis

Question 1109

PDA is common in...

Answer 1109

premature infants, esp. those with RDS

Question 1110

no PERIPHERAL CD19+ cells

Answer 1110

Bruton X-linked agammaglobulinemia - bc the cells in circulation (though there are immature CD19+ cells in the bone marrow)

Question 1111

Where nodes do the prostate gland drain into?

Answer 1111

internal iliac nodes minor drainage into external iliac + sacral nodes

Question 1112

ADR of carbamazepine

Answer 1112

agranulocytosis or aplastic anemia

Question 1113

biochemical profile of 1˚ adrenal insufficiency in terms of Na, K, Cl, and HCO3 what does this patient look like? what would cause this patient to suddenly undergo adrenal crisis? what would you give this person?

Answer 1113

_ø aldosterone** **or cortisol:_ **Hyponatremia, Hyperkalemia**, **Metabolic Acidosis**, HypOchloremia _signs of adrenal insufficiency_: **hyperpigmentation,** vomiting, weight loss, abd pain _crisis_: stressful situations (infection, surgery) normally cause adrenals to screte large quantities of cortisol, since it is essential to cardiovascular + metabolic adaptations to stress; but since this patient can't mount that response -\> **hypotensive, tachycardic, hypoglycemic "shock-like states"** _treatment_: corticosteroid

Question 1114

Rx that requires an acidic environment to kill mycobacterium tuberculosis

Answer 1114

**pyrazinamide (PZA) - **works best in acidic pH (ie phagolysosome); best for **intracellular** MTB (compare to rifampin, isoniazid, and ethambutol, which have better activity against **extracellular** MTB

Question 1115

what does this patient have and which area corresponds to the opening snap?

Answer 1115

**Mitral Stenosis** **OS** occurs at the point where the LAP line first crosses w/ LV line - when the LV pressure drops below the LAP (towards the L side of the graph) **diastolic murmur**

Question 1116

2yo F (46XX) w/ ambigious genitalia, clitoral enlargement and partial fusion of labioscrotal folds. high BP, hypokalemia enzyme deficiency? net effects of this enzyme deficiency?

Answer 1116

**11 hydroxylase** deficiency -\> * excessive adrenal androgen -\> ambigious genitalia, etc * excessive 11-DOC production -\> hypokalemia, high BP * high ACTH (due to ø cortisol), which further augments the production of T and 11-DOC * ø aldosterone note that this enzyme mutation is the second most common cause of CAH

Question 1117

L homonymous inferior quandrantanopia is due to a lesion in..

Answer 1117

R parietal lobe (dorsal optic radiation)

Question 1118

tenderness of the calf muscle on dorsiflexion of the foot

Answer 1118

Homan's sign = DVT

Question 1119

MoA of rifampin?

Answer 1119

blocks protein synthesis by inhibiting DNA -dependent RNA polymerase, thereby preventing transcription of DNA -\> mRNA

Question 1120

I decrease GI absorption of calcium, inhibit collagen synthesis by osteoblast, decrease gonadotropin releasing hormone, and increase urinary calcium loss. What am I

Answer 1120

glucocorticoids description describes a side effect of glucocorticoids: **lower bone mineral density**

Question 1121

what is lysyl oxidase?

Answer 1121

enzyme that catalyzes the conversion of lysine residues to an aldehyde in collagen fibers (thus strengthening collagen fibers)

Question 1122

role of bcl-2 mutated in what disease

Answer 1122

apoptosis inhibitor follicular lymphoma

Question 1123

**Schwannoma** Appearance Prognosis, presentation

Answer 1123

S100(+) Acoustic schwannoma, (if bilateral gNF2) Adults

Question 1124

8yoF w/ breast development + pubic hair PE shows mass in RLQ, CT shows ovarian mass. Dx?

Answer 1124

Granulosa cell tumor - sex-cord/stromal tumor - produce excess estrogen hormones that can cause precocious sexual development, as seen in this child

Question 1125

Meckel diverticulum is caused by: where is it generally located? is it a true or false diverticula? most common sx? diagnostic test?

Answer 1125

failure of obliteration of the **omphalomesenteric duct (vitelline duct)** located 2 feet from ileocecal valve (**distal ileum)** **true diverticula** = covered by all 3 layers (mucosa, submucosa, muscularis) **RLQ pain + lower GI bleed (black, tarry stool)** due to presence of **ectopic gastric (or pancreatic) mucosa**; can cause ulceration of adjacent mucosa **pertechnetate study** - accumulates in RLQ

Question 1126

Why are patients on ACEi predisposed to angioedema and cough?

Answer 1126

bradykinin (produced by the kidney when RAAS is activated) acts locally to - constrict veins and dilate arterioles to increase renal perfusion - induce dry cough normally metabolized by ACE; ACEi prevent its metabolism and increases bradykinin's persistence in the body.

Question 1127

condylomata acuminata

Answer 1127

genital warts due to HPV 6, 11

Question 1128

diuretic that causes pulmonary edema

Answer 1128

mannitol

Question 1129

Charcot-Bouchard aneurysms why do they form? where are they located? rupturing of these results in...

Answer 1129

occur due to long-standing HTN basal ganglia, pons, internal capsule, pons intracerebral hemorrage

Question 1130

hCG is most similar to these 3 hormones

Answer 1130

TSH, LH, FSH

Question 1131

oocyte surrounded by one or several cuboidal follicular cells

Answer 1131

secondary follcile

Question 1132

what does this patient have?

Answer 1132

mitral regurgitation

Question 1133

40F with worsening fatigue, no remarkable medical/social/family history, vitals and PE are normal, lab shows alk phos level of 180 U/L What is the next step in evaluation? Justify.

Answer 1133

AlkPhos is present in bone _and_ liver and therefore you want to determine origin of the elevated AlkPhos by assessing **GGT levels**, which is present in the liver, but _not_ in the bone

Question 1134

bacillis anthracis virulence factor has the similar mechanism of action as...

Answer 1134

* **b. anthracis** - _edema factor acts as an adenylate cyclase_ -\> increased cAMP -\> edema + phagocyte dysfunction * **bordetella pertussis** - _pertussis toxin disables Gi_ -\> disinhibits adenyl cylase -\> increased cAMP levels -\> edema + phagocyte dysfunction

Question 1135

burkett lymphoma translocation

Answer 1135

burkitt t8;14 ∆ = 6 looks like a b

Question 1136

what do each one represent?

Answer 1136

W = hCG X = hPL Y = CRH

Question 1137

middle aged women with Sjogren's complains of severe pruritis over the palms and soles and is unbearable during the night. Diagnosis? labs? typical associations?

Answer 1137

**1˚ biliary cirrhosis (PBC) - **autoimmune rxn that results in destruction of intralobular bile ducts and subsequent cholestasis _labs_: anti-mitochondrial antibodies; elevated conjugated bilirubin, elevated Alk phos _associations_: middle aged women with insidious onset of pruritis, esp at night. autoimmune conditions (CREST, Sjogrens, RA, Celiacs')

Question 1138

marker for monitoring cystadenocarcinoma (serous and mucinous) recurrence

Answer 1138

CA-125

Question 1139

unilateral swollen, tender and erythematous breast w/ an induration present at the edge of the erythematous area. Dx + Hx changes?

Answer 1139

**inflammatory breast cancer ** hx: dermal lymphatic invasion by cancer cells -\> blocked lymphatic drainage -\> lymphedema and w/ overlying skin swollen, red, tender, and peau d'orange appearance

Question 1140

presbyopia what is it? what causes it? what does it develop into?

Answer 1140

age-related condition in which the **lens is unable to focus on near objects because of denaturation of structural proteins within the lens, leading to loss of lens elasticity** (difficulty w/ reading fine print, eye strain after reading, need to hold objects farther from the eye in order to see them clearly) presbyopia develops into **myopia**** (near-sightededness),** where patients retain teh ability to see up close and can also experience some improvement in distance vision

Question 1141

only antidepressant that does not cause sexual dysfunction

Answer 1141

buopropion (but ADRs include agitation, insomnia, and seizures)

Question 1142

why do patients w/ Klinefelter's syndrome have mild mental retardation?

Answer 1142

risk and severity of mental retardation increases with each additional X chromosome (what does that say about women?!)

Question 1143

R homonymous hemianopia has damage to

Answer 1143

L optic tracts

Question 1144

patient with painful palpable masses in the grown. PE shows multiple enlarged, abscessed LN draining through the skin through indolent sinuses. dx?

Answer 1144

buboes = lymphogranuloma venereum - chlamydia trachomatis 1˚ lesion = **PAINLESS** self-healing papule or shallow ulcer, but draining LN becomes really **PAINFUL**

Question 1145

woman complaining of diarrhea containing a lot of mucoid material. colonoscopy shows cauliflower-like mass in the sigmoid colon. she also has hypoK. what does she have?

Answer 1145

**villous adenoma -** large + sessile (compared to tubular adenomas that tend to be smaller + pedunculated) * can cause lower intestinal bleeding + microcytic hypochromic anemia * partial intestinal obstruction -\> crampy abd. pain, constipation, distension * can **secrete lots of mucus**, leading to secretory diarrhea (if stool volume is large --\> hypovolemia + electrolyte imbalances * risk of adenocarcinoma

Question 1146

how is potency measured?

Answer 1146

1/MAC potent anesthetics have low MAC

Question 1147

name this please

Answer 1147

blastomycosis large, round yeast w/ **doubly refractile wall** and **broad-based bud** common in Ohio / Mississippi River Valleys, Great Lakes Pulmonary form: pneumonia disseminated form: severe...

Question 1148

what is this?

Answer 1148

downey cell (infectious mono, EBV)

Question 1149

valproate MoA major ADR

Answer 1149

Increase Na channel inactivation; Increase GABA concentration **neural tube defects** - it inhibits intestinal folic acid absorption hepatotoxicity (get LFTs) weight gain use: tonic clonic seizure (genearlized) and myoclonic seizures

Question 1150

what exits the foramen spinosum?

Answer 1150

MMA

Question 1151

HFMD

Answer 1151

coxsackie type A - a PERCH (picornavirus)

Question 1152

platelets - contents of: alpha granules dense granules

Answer 1152

alpha granules - Fibrinogen, vWF "FaV" dense granules - ADP, Calcium "CA**D"**

Question 1153

patient w/ a crush injury receives a skeletal m. relaxant for resusscitation and undergoes cardiac arrest (v-fib); serum K levels are 10mEq/L. What was he given and why does this occur? what would've been a better Rx to give this patient?

Answer 1153

**Succinylcholine ** * depolarizing neuromuscular-blocking agent; **not** degraded by AChE * binds **nACh-R (non-selective cation channel that will allow Na influx/K efflux) **and causes continuous end-plate stimulation that ultimately results in inactivation of these channels better to give **vercuronium + rocuronium**, which are non-depolarizing agents

Question 1154

patient with increased AG acidosis was given treatment X. within several hrs, the patient's mental status improves, serum HCO3 + Na levels increase, serum osmolality decrease, and K decreases. Which was the dx? treatment?

Answer 1154

DKA (most common) trmt: hydration + insulin _insulin * _{allows cells to use glucose as an energy source, thereby decreasing lipolysis and the production of ketone bodies. Decreased ketone production -> increase plasma HCO3} * _{intracellular shift of K -> decrease serum K rehydration - normalize serum Na and decrease serum osmolality}

Question 1155

cause of kidney stones in crohns ileocolitis type of stones?

Answer 1155

oxalate kidney stones impaired bile acid absorption in the terminal ileum, leading to the loss of bile acids in the feces w/ subseqent fat malabsorption fat binds Ca -\> soap complex free oxalate is absorbed and is filtered and collected in the kidneys --\> urinary calculi

Question 1156

∆ between thrush and leukoplakia

Answer 1156

thrush = can be scraped off; usually due to candida leukoplakia = precancerous, cannot be scraped off

Question 1157

F w/ stretching/pulling sensation in her groin with R pleural effusion + SOB and fluid in her abdominal cavities. Dx?

Answer 1157

**Meigs' Syndrome** - triad of hydrothorax, ascites, and ovarian tumor **(Ovarian Fibroma)**

Question 1158

high potency anti-psychotics ADR? trmt for ADR?

Answer 1158

haloperidol, fluphenazine extrapyramidal sx due to D2 blockade (inhibition of the inhibitory effects of dopaminergic neurons, resulting in unopposed M1 cholinergic activation) trmt: M1 receptor antagonists (diphenhydramine and benztropine) to re-establish balance

Question 1159

45F w/ hx of SLE is generally treated with what? what do you expect her body habitus to be? what do you expect her adrenal glands to be? if she suddenly stopped her Rx, what do you think will happen?

Answer 1159

* usually treated w/ **glucocorticoids** * body habitus - **Cushing syndrome** - truncal obesity, mild hirsutism, facial plethora, proximal muscle weakness * adrenals: **bilateral cortical atrophy** due to suppression of the HPA axis by the glucocorticoids * sudden cessation after prolonged use -\> adrenocortical insufficiency + **adrenal crisis**

Question 1160

What should you give a patient w/ rabies?

Answer 1160

Killed vaccine (of entire viral particles)

Question 1161

how does nephritic and nephrotic syndrome differ in term of proteinuria + RBC casts + lipiduria + renal function

Answer 1161

nephritic: nephrotic: \>3.5g/day, ø RBC casts, lipiduria, normal renal function

Question 1162

acute onset of neurologic ∆s, hypoxemia, and petechial rash in a patient w/ severe long bone or pelvic fractures

Answer 1162

fat embolism syndrome

Question 1163

neonate w/ a continuous machine like murmur + an ECHO that shows an aorta lying anterior to and to the right of the pulmonary artery is diagnostic of....

Answer 1163

transposition of the great arteries - failure of aorticopulmonary septum to spiral normally during fetal development. continuous machine like murmur is due to PDA - connection that allows this neonate to survive

Question 1164

Why is primaquine often added to chloroquine?

Answer 1164

vivax or ovale = both establish a latent hepatic infection in the form of hypnozoites. chloroquine = kills plasmodia in the blood stream primaquine kills the hyponozoites and prevents relapses

Question 1165

why are reticulocytes "bluer" than a mature RBC?

Answer 1165

the basophilic reticular mesh-like network is **residual ribosomal RBA **(stained with Wright-Giemsa stain)

Question 1166

effets of anti-cholinergic toxicity examples of Rx that does this?

Answer 1166

fever, mucosal/axillary dryness, cutaneous flushing, mydriasis, and cycloplegia an ddelirium ^{hot as a hare dry as a bone red as a beet blind as a bat mad as a hatter} examples: BIOGAS: benztropine, ipratropium, oxybutynin, glycopyrrolate, atropine, scopolamine

Question 1167

Match choice w/ each line: Normal enzyme control Mutation producing increased Km Mutation decreasing amt of functional enzyme

Answer 1167

X = mutation decreasing amt of functional enzyme Y = Mutation producing increased Km Z = Normal enzyme control

Question 1168

lesions of these 2 areas of the brain are responsible for the confabulation + memory loss

Answer 1168

**mammillary bodies** = memory loss **anterior + dorsomedial thalamic nuclei** = confabulation (when unsure of a fact, they fill in the memory gap w/ a fabricated story they themselves believe to be true)

Question 1169

MTB isolateds treated w/ Rx lose their acid-fast rapidly and stop porliferating. What Rx?

Answer 1169

isoniazid - blocks mycolic acid synthesis

Question 1170

short-acting insulin (post-prandial

Answer 1170

regular (best for DKA) Lispro Aspart Glulisine No "LAG" \*be careful not to mix Glulisine with Glargine - remember "Glaarrrrrrrrrrr" sounds long

Question 1171

causes of low Ca, low PTH?

Answer 1171

Hypoparathyroidism (surgical removal, autoimmune destruction)

Question 1172

dobutamine MoA clinical use

Answer 1172

ß adrenergic agonist (**mostly ß1;** little ß2 and a1) ß1 = incr. cAMP -\> **(+) ionotropy/contractility** (incr MVO2, HR) ß2 = = decrease peripheral vascular resistance clinical use: acute heart failure due to cardiogenic shock (decreased myocardial contractility)

Question 1173

biochemical features of Alzheimers

Answer 1173

decreased ACh decreased GABA

Question 1174

WBC casts are pathognomonic for...

Answer 1174

pyelonephritis (UTI)

Question 1175

37yo w/ cyclic pelvic pain, normal sized uterus, dyschezia

Answer 1175

e**n**d**o**met**r**iosis - presence of normal endometrial tissue in abnormal locations (outside uterus) which undergo menstrual type bleeding to form chocolate cysts "**nor**mal size"

Question 1176

what Rx should you prescribe to a patient w/ an acute gouty attack? What dont you want to prescribe in these cases?

Answer 1176

**colchicine** inhibits microtubule formation in leukocytes, thereby reducing neutrophil chemotaxis and migration to inflammatory sites impairs GI mucosal function (due to microtubule disruption), leading to D, N, V, abd. pain DO NOT prescribe allopurinol or probenecid since they can mobilize tissue stores of uric acid and precipitate/worsen acute attacks

Question 1177

someone who undergoes excessive weight loss by consuming water and vitamin pills only will have an increased of what in their serum?

Answer 1177

ketone bodies - **acetoacetate + 3-hydroxybutyrate**

Question 1178

name this please

Answer 1178

mucormycosis - broad, non-septate hyphae that branch at right angles

Question 1179

(+) VDRL + pleocytosis of CSF is diagnostic of:

Answer 1179

neurosyphilis (3˚ syphilis!!) presence of gumma

Question 1180

Pancreatic cancer chromosome

Answer 1180

18q (patrick swayze died of this - he was born 8-18)

Question 1181

in 10% of cases, chronic aortic stenosis can preciptiate into...

Answer 1181

**a-fib.** Why? Cause the atrial contraction is impt for maintaining adequate filling of a non-compliant LV (sequelae of aortic stenosis) **reducing** **LV preload + CO** --\> systemic hypotension **decreased forward filling of LV** -\> increased LAP -\> acute pulmonary edema

Question 1182

∆ btwn icteric vs anicteric viral infection

Answer 1182

anicteric = silent or subclinical; ø jaundice observed icteric = jaundice, malaise, fatigue, etc

Question 1183

what should patients be tested for prior to starting enteracept?

Answer 1183

PPD - latent TB (since TNFa inhibitors can cause reactivation)

Question 1184

newborn w/ flaccid lower extremities and bilateral absent ankle reflexes. XRay shows poorly developed lumbar spine + sacrum. Diagnosis? What causes this?

Answer 1184

**Caudal regression syndrome** - **sacral agenesis** causing lower extremity paralysis and urinary incontinence (hard to tell in an infant...) due to **poorly controlled-MATERNAL DIABETES**

Question 1185

how do these factors change with liver disease? Platelet Count Bleeding time PT PTT clotting factors

Answer 1185

Platelet Count = NC Bleeding time = NC PT = increase PTT = increase (decreased all clotting factors)

Question 1186

Diagnosis cause? commin in what patient population?

Answer 1186

**Dupuytren's contracture** - benign and slowly progressive fibro-proliferative d/o of the palmar fascia. As the scarring progresses, nodules form on the palmar fascia and the fingers gradually lose their flexibility, eventually resulting in contractures that draw the finger into flexion common in: **ALCOHOLICS**

Question 1187

difficulty of plantar flexion is usually due to damage to which nerve?

Answer 1187

tibial nerve (branch of sciatic nerve; provides innervation for popliteus + flexors of the foot)

Question 1188

33 yo sexually active woman develops painful, swollen right knee. What should you consider and what is the pathogenic feature of this organism?

Answer 1188

septic arthritis, likely due to neisseria gonorrhoeae; major pathogenic feature = **PILI **(convers adherence properties, protects aganist phagocytosis, and undergoes antigenic variation)

Question 1189

mental retardation, eczema, musty body odor in toddler

Answer 1189

PKU

Question 1190

patient who receives several units of packed RBC begins to complain of tingling sensation in his toes and fingers. Ca levels are 7.2mg/dL (normal 8.4-10) Why?

Answer 1190

paresthesias due to hypocalcemia. Packed RBCs contain **citrate** anticoagulant, which **chelates** **serum Ca + Mg**; usually occurs with multiple transfusions of more than 5-6L of blood.

Question 1191

patient w/ fever, fatigue, joint pain, and urticaria-type skin rash suddenly develops a surge of serum ALT and AST what is the diagnosis?

Answer 1191

Hep B ^{say wha....blows my mind, but according to Uworld:} prodromal period: "serum sickness-like" w/ patients experiencing malaise, fever, rash, pruritis, lymphadenopathy, and joint pain acute viral hepatitis: significant rise in ALT, AST (followed by rise in bilirubin and AlkPhos) NOT hepC infection because it is usually asymptomatic, though some may complain of malaise, nausea, or RUQ pain

Question 1192

patient w/ R foot that is **dorsiflexed and everte**d and is **unable to stand on tip toes**. What nerve is affected + what is the likely area of sensory loss

Answer 1192

**tibial nerve** - innervations/fxns * gastrocnemius, soleus, plantaris -\> plantar flexion of the foot * digitorum longus + flexor hallucis longus -\> toe flexion * tibialis posterior muscle -\> inversion of the foot * area of sensory loss: skin of the **distal plantar surface of the foot**

Question 1193

fomepizole - when is it used?

Answer 1193

antidote in suspected MeOH or ethylene glycol poisioning acts as a competitive antagonist of alcohol dehydrogenase and thereby prevents the conversion of methanol/ethanol into their toxic metabolites

Question 1194

diagnose

Answer 1194

cowdry type A inclusions - herpes virus

Question 1195

ab with shortest half-life

Answer 1195

IgD

Question 1196

arachnodactyly, scoliosis, aortic root dilation

Answer 1196

Marfan (fibrillin1 defect)

Question 1197

acarbose MoA ADR clinical use

Answer 1197

**acarbose** - decreases activity of ***a-glucosidase*** on the **intestinal brush border** -\> prevents hydrolysis of disaccharides, thereby allowing **delayed carbohydrate absorption** (remember that carbs are absorbed as monosacchardies) Same class: **miglitol** ADR: flatulence, bloating, abd. pain, rash clinical use: type II DM

Question 1198

CN 3 emerges between these two vessels

Answer 1198

posterior cerebral (PCA) superior cerebellar (SCA)

Question 1199

stylopharyngeus m. is derived from?

Answer 1199

3rd branchial arch - innervated by the CN9 also from this arch is portions of hyoid bone and posterior 1/3 of the tongue

Question 1200

interpret this HBsAg positive anti-HBc positive IgM anti-HBc negative anti-HBs negative

Answer 1200

Chronically infected

Question 1201

nausea, vomiting, abd. cramps, muscle aches, dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds patient is undergoing withdrawal of...? PE findings?

Answer 1201

Heroin

Question 1202

ABG typically seen of heroin overdose pH pCO2 HCO3

Answer 1202

heroin suppresses respiratory centers, resulting in hypoventilation with retention of Co2. An overdose is an acute event. ``` pH = low pCO2 = high HCO3 = normal ```

Question 1203

what would increase one's susceptibility to an organism that GP, oxidase + that grows on highly alkaline media?

Answer 1203

omeprazole/PPI's vibrio cholera - note that it grows well on highly alkaline media and it must survive passage through the acidic pH of the stomach to colonize the small intestines to cause disease

Question 1204

what nodes drain the testes? what nodes drain the scrotum?

Answer 1204

testes: paraaortic nodes scrotum: superficial inguinal nodes

Question 1205

autopsy of 21yo shows atrophy of basal ganglia, increased brain Cu dx?

Answer 1205

Wilson's disease - Cu accumulates within organ tissues (esp. liver, brain, and eye; at risk for: hepatitis, cirrhosis, portal HTN neuropsychiatric sequelae: basal ganglia atrophy - parkinson-like tremor, rigidity, ataxia, slurred speech, personality ∆s, depression or paranoia

Question 1206

what is the basis behind warfarin-induced skin necrosis?

Answer 1206

Protein C levels has a shorter half-life than the other vitamin K dependent factors (2, 9, 10), resulting in a **transient hypercoagulable state**

Question 1207

patient w/ dorsiflexed + everted foot w/ sensory loss over the sole of the foot injured nerve?

Answer 1207

tibial

Question 1208

drugs w/ high intrinsic hepatic metabolism + hepatic clearance tend to have these two properties:

Answer 1208

**high lipophilicity** (allows Rx to cross cell membranes and enter hepatocytes and then excreted into bile) **high volume of distribution **(wide distribution to many different tissues, such as the brain, liver, adipose)

Question 1209

malar rash on cheeks appearance followed by a an erythematous rahs in a reticular pattern on the trunk + extremeities

Answer 1209

parvoB19 (erythema infectiosum)

Question 1210

infarcts involving anterior pons results in...

Answer 1210

corticospinal tract damage: contralateral hemiparesis + babinski corticobulbar tract damage: contralateral lower face palsy + dysarthria pontine nuclei + pontocerebellar fibers damage: contralateral dysmetria + dysdiadochokinesia ATAXIC HEMIPARESIS

Question 1211

honey + constipation, mild weakness, lethargy, poor feeding should make you think of this

Answer 1211

infant botulism - spores in honey

Question 1212

chemoRx associated with burning on urination + urgency

Answer 1212

cyclophosphamide, ifosfamide hemorrhagic cystitis reverse w/ mesna

Question 1213

What is a "lucid interval" and it is often seen in what type of brain injury

Answer 1213

transient period of feeling well after the head injury followed by a rapid declind in mental function that can progress to coma/death epidural hematoma

Question 1214

organism associated w. progressive difficulty walking, weakness in lower extremities and absent DTR + recent hx of diarrhea

Answer 1214

campylobacter GN, motile, corkscrew appearance; oxidase +

Question 1215

43yo African American F complains of bilateral paresthesias of her thumbs, index, and middle fingers; no problems w/ legs. Hx of chronic renal failure due to uncontrolled HTN and requires hemodialysis on a regular basis Dx?? (be specific)

Answer 1215

**carpal tunel syndrome** due to **ß2 mucroglobulin** deposition (dialysis associated amyloidosis)

Question 1216

most common cardiac cause of sudden death in young, seemingly healthy individuals w/o signs pathophysiology behind this? murmur that is associated with this d/o?

Answer 1216

hypertrophic cardiomyopathy **dynamic ventricular outflow tract obstruction** caused by abnormal systolic anterior motion of the **anterior leaflet of the mitral valve** toward the **hypertrophied interventricular septum** **systolic ejection murmur** produced by the LV outflow tract obstruction

Question 1217

cardiac findings in down syndrome

Answer 1217

endocardial cushion defects (ASD, regurgitant AV valves)

Question 1218

lung bx shows alveolar growth pattern w/o invasion. dx?

Answer 1218

**bronchioloalveolar carcinoma (variant of adenocarcinoma)** arises along alveolar septae w/o vascular or stromal invasion on cxr, it appears as a peripheral mass or pneumonia-like consolidation

Question 1219

how do you differentiate btwn chronic HepB hepatitis of **low** or **high** infectivity?

Answer 1219

* **low** - low or undetectable levels of HBeAg (marker of high infectivity) and detectable anti-HBeAg * **high** - high or persistent levels of HBeAg and low or undetectable levels of anti-HBeAg in other words, **HBeAg is a marker of high infectivity**

Question 1220

32 yoF w/ LN that fluctuates in size over time. Dx?

Answer 1220

Follicular lymphoma (t14;18, bcl-2) - indolent non-Hodgkins lymphoma; indolent course marked by painless waxing and waning lymphadenopathy (ie remissions and recurrences)

Question 1221

what is the purpose of the washout period between treatment w/ MAOi and treatment w/ SSRI??

Answer 1221

**allow for MAO regeneration**, since MAOi (ie tranylcypromine, phenelzine, and selegiline) irreversibly inhibit MAO (whhch normally functions to breakdown monoamine neurotransmitters ie serotonin)

Question 1222

eosinophil infiltrates in bronchial bx should make you think of..

Answer 1222

allergic asthma

Question 1223

patient w/ difficulty rising from seated position and climbing stairs. injury to what nerve?

Answer 1223

inferior gluteal n. - innervates the gluteus maximus

Question 1224

what happens to bile acids before they are secreted into the canaliculi?

Answer 1224

they are conjugated to **glycine or taurine** (improves solubility/emulsifying ability) to create bile salts, which are actively secreted into the bile canaliculi

Question 1225

**Medulloblastoma** Location Appearance Prognosis, presentation

Answer 1225

Cerebellar vermis (posterior fossa) Solid tumor w/ sheets of small blue, hyperchromatic nuclei + scant cytoplasm; homer-wright rosettes can be seen in 1/5 of cases Kids Malignant

Question 1226

hemosiderosis vs hemochromatosis

Answer 1226

**hemosiderosis** - iron accumulation in parenchymal tissues **hemochromatosis** - defect that results in abnormally high Fe absorption of dietary iron that results in * mildly elevated LFTs * elevated plasma Fe w/ \>50% TIBC * elevated serum ferritin (storage)

Question 1227

TTP is due to typical labs?

Answer 1227

∆ ADAMTS13, which cleaves vWF multimers labs: **increased bleeding time** **decreased platelet count** **increased indirect bilirubin and ****LDH** **schistocytes** ø fibrin split products (d-dimers, DIC would have elevated levels), PT/PTT is normal (whereas in DIC, both are prolonged)

Question 1228

patient develops HIT after given heparin for DVT (platelets are 85k). What is an alternative?

Answer 1228

Argatroban, bivali**rudin** or lepi**rudin**

Question 1229

BM splitting is seen in which two renal disease

Answer 1229

membranoproliferative glomerulonephritis and Alport Syndrome

Question 1230

where does the scala vestibuli and scala tympani meet?

Answer 1230

helicotrema

Question 1231

gram (+) filamentous rod in sulfur granules

Answer 1231

actinomyces isrealii

Question 1232

1yo african american boy who acutely developed tender swelling of both hands and feet.

Answer 1232

think sickle cell - dactylitis (painful swelling of hands/feet) AR d/o in african americans

Question 1233

combination of **low MCV** **low serum Iron** **high TIBC** should make you think of...

Answer 1233

iron deficiency anemia - body iron stores are reduced and the TIBC increases as the body attempts to accumulate more Fe

Question 1234

MEN 2A gene mutation? what does it affect?

Answer 1234

activating mutation of RET protooncogene parathyroids (hyperplasia) pheochromocytoma Medullary thyroid cancer (MTC, calcitonin)

Question 1235

flung transplant - chronic rejection affects which part of the transplant specifically and presents with what sx?

Answer 1235

small airways - causes bronchiolitits obliteratans syndrome sx: dyspnea, wheezing

Question 1236

pathophysiology of direct inguinal hernias

Answer 1236

protrusion of abd. contents through the Hesselbach ∆ on the anterior abdominal wall

Question 1237

macrophages with Pas(+) granules in the lamina propria of the GI is indicative of? how should you treat it?

Answer 1237

infection with tropheryma whippelii (GPR actinomycete) - affects small intestines, joints, and CNS trmt: obviously antibiotics..

Question 1238

High MCV Normal Serum Fe Normal TIBC should make you think of..

Answer 1238

megaloblastic anemia due to folate or B12 deficiency - DNA synthesis lags behind cytoplasm formation so mitosis is relatively delayed and RBCs are larger than normal. *Iron metabolism is usually not directly affected*

Question 1239

anaplasia v. dysplasia vs. neoplasia vs metaplasia

Answer 1239

**neoplastic** - morphologically and architecturally similar to normal cells; usually in well-differentiated/low grade tumors **dysplastic** - REVERSIBLE expansion of immature cells that is confined to the epithelium **anaplastic -** neoplastic cells that demonstrate a complete lack of differentiation; may contain *abnormal mitoses + giant tumor cells* **metaplasia** - reversible differentiation of cells

Question 1240

active immunity vs. artificial active immunity

Answer 1240

when one is stimulated to produce their own immune response artificial - stimulus (vaccination) was medically applied to induce immune response

Question 1241

severe starvation effect on a.a. levels

Answer 1241

essential amino acids become deficient PVT TIM HALL

Question 1242

T/F - adults can have anti-HAV IgG antibodies without ever experiencing an icteric illness (jaundice, malaise, fatigue, anorexia, etc)

Answer 1242

T.

Question 1243

how do differentiate CMT from friederich ataxia?

Answer 1243

* charcot marie tooth * scoliosis * pes cavus * **muscle wasting** of the anterior compartment of the lower limbs due to dis-myelination of the deep peroneal nerve * friedrich ataxia * **kypho**scoliosis * pes cavus * **ataxic gait, freqent falling** * **cardiomyopathy =** frequent cause of death

Question 1244

GLP-1 (exenatide) clinical use MoA

Answer 1244

**incretin hormone;** secreted by intestinal L cells in response to food intake; clinically used for Type II DM acts through GPCR -\> **decreases blood glucose** by **inducing satiety** **decreasing gastric emptying increasing insulin release from pancreatic ß cells**

Question 1245

This is a lung biopsy. What's the diagnosis?

Answer 1245

**pulmonary chondroma (hamartoma; coin lesion)** contain islands of mature hyaline cartilage, fat, smooth muscle, and clefts lined by respiratory epithelum

Question 1246

radial n. pierces through this structure injury to this nerve results in:

Answer 1246

supinator injury: wrist drop (innervates extensors of the hand)

Question 1247

Pt w/ BPH has allergies and wants Rx. What drugs are appropriate and why?

Answer 1247

H1 blockers * 1st gen: Diphenhydramine, dimenhydrinate, chlorpheniramine. * 2nd gen: Loratadine, fexofenadine, desloratadine, cetirizine. but 1st gen has **anti-muscarinic** and anti-alpha side** **effects should be **avoided** since it reduces the contractility of bladder smooth muscle --\> acute urinary retention **Also - decongestants with alpha-1 agonist ativity (pseudoephedrine) should also be avoided for the same reason**

Question 1248

Argatroban, Bivalirudin, Dabigatran MoA?

Answer 1248

inhibits **thrombin (IIa) **directly

Question 1249

23yoM w/ myoclonic epilepsy of recent onset has a muscle bx that shows blotchy red muscle fibers on Gomori trichome stain. Risk of transmission to his offspring?

Answer 1249

0% - this is a mitochondrial myopathy "MERRF" and only maternal mitochondria are transmitted to the fetus.

Question 1250

feature that is common to both sickle cell anemia + ß thalassemia

Answer 1250

bone marrow expansion in the calvarium

Question 1251

aachondroplasia what is it? defect in? what type of inheritance pattern does it follow?

Answer 1251

"midgets" - disproportionately short arms and legs, large head, saddle nose defect: activating mutation in FGF-R3 Autosomal Dominant _or_ Sporadic Mutation

Question 1252

genetically female fetus w/ virilized genitalia + hyponatremia + hyperkalemia + hypotension should make you think of...

Answer 1252

21 hydroxylase deficiency (corticosteroid precursors are shunted toward androgen production)

Question 1253

definition of interference

Answer 1253

inhibition of one viruse's replication and/or release of a second virus that is infecting the same cell; doe snot result in new progeny phenotype

Question 1254

why is it that central retinal artery occlusion results in a pale retina w/ a "cherry-red" spot on the macula?

Answer 1254

macula has a separate blood supply from the choroid artery, while the rest of the retina is supplied by the central retinal artery (arises from the ophthalmic artery, which arises from the ICA)

Question 1255

amphotericin B MoA ADR

Answer 1255

**binds to ergosterol** (fungal version of cholesterol; present on cell membranes) ^{ampho and ergo both start w/ vowels + have "O" as their second syllable} however, they **can also bind to human cholesterol** to some degree and cause toxicity to human tissues and result in **nephrotoxcity** **-\> hypokalemia + hypomagnesemia occur due to increased distal tubular membrane permeability** ^{(hypokalemia manifests as weakness and arrhythmias; ECGs show T-wave flattening, ST-depression, prominent U waves, and premature atrial/ventricular contractions)}

Question 1256

∆ between condyloma lata and condyloma acuminata

Answer 1256

**condyloma lata** = 2˚ syphilis (large gray wart-like growths) **condyloma acuminata** = anogenital warts caused by HPV 6/11

Question 1257

∆ between chancre, condyloma lata, gumma?

Answer 1257

**chancre** = 1˚ syphillis = painless ulcer w/ raised borders **condyloma lata** = 2˚ syphilis (large gray wart-like growths) **gumma** = 3˚ syphilis = painless, granulomatous lesions that progress to gray-white rubbery lesions that may ulcerate

Question 1258

antibiotic that causes myopathy and CPK elevation and is inactivated by pulmonary surfactant

Answer 1258

daptomycin - depolarizes the cellular membrane

Question 1259

cytokeratin is a marker of

Answer 1259

**epithelial origins** (keratin-containing intermediate filaments that make up the cytoskeleton of almost all epithelial cells)

Question 1260

**myoclonic seizure** description (consciousness)? first line treatment?

Answer 1260

brief arrythmic jerking movements; no loss of consciousness ## Footnote **valproate**

Question 1261

what thyroid state causes myopathy (increase CPK)?? and why?

Answer 1261

HYPOTHYROID - get serum TSH levels

Question 1262

BM that shows this is indicative of...

Answer 1262

ALL - hypercellular bone marrow with a high % of lymphoblasts

Question 1263

Caspofungin MoA

Answer 1263

blocks synthesis of ß (1,3)-D-glucan ^{(main component of Candida + Aspergillus)} CaB (**c**andida+**a**spergillus, **ß **(1,3)-D-glucan)

Question 1264

L-selectin Siaylyl-Lewis E-selectin P-selectin

Answer 1264

Selectins = involved in **rolling & margination** ^{(selectin' a place to bind to!)} Neutrophi**L**s = **L**-selectin, Siaylyl-**L**ewis **E**ndothelial cells = **E**-selectin, **P**-selectin

Question 1265

greatest regulator of cerebral circulation

Answer 1265

CO2 - potent cerebral vasodilator someone who hyperventilates (panic attacks) - develops hypocapnia, which can cause cerebral vasoconsriction --\> neurological sx

Question 1266

serum findings for exercise-induced amenorrhea in terms of FSH LH Estrogen

Answer 1266

all decreased bc this is a form of hypothalamic amenorrhea

Question 1267

pt w/ holosystoic mumur w/ blowing quality over the cardiac apex w/ hemorrhagic macules on the sole of the feet

Answer 1267

mitral regurg janeway lesions - septic embolization from infected cardiac valve vegetations. tends to localize on palms and soles. painless

Question 1268

pulsus paradoxus

Answer 1268

cardiac tamponade (also presents with hypotension)

Question 1269

**tonic clonic seizure** description (consciousness, post-ictal state)? first line treatment?

Answer 1269

generalized tonic extension of the extremities, followed by clonic rhythmic movements; _loss of conscious + prolonged post-ictal confusion_ phenytoin, carbamazepine, valproate

Question 1270

antidepressant that can induce mania

Answer 1270

Venlafaxine (SNRI) or any antidepressants

Question 1271

breast tumor with “indian file” cell organization

Answer 1271

**Invasive lobular breast tumor**; bilateral, multiple lesions

Question 1272

in what cases would you give rifampin as a monotherapy? or multi-agent therapy?

Answer 1272

monotherapy: **H influenza or N. meningitidis exposure** multi-agent therapy: **mycobacterial exposure**

Question 1273

How does the L/R testicular vein differ in terms of their drainage? What about the L/R suprarenal veins?

Answer 1273

* Testicular vein * L = L renal vein * R = IVC * suprarenal vein * L = L renal vein * R = IVC summary: L = L renal vein, R = IVC

Question 1274

midshaft humeral fracture can damage these 2 structures

Answer 1274

radial n. + deep brachial a. (results in wrist-drop due to paralysis of the forearm extensors and wrist)

Question 1275

poliomyelitis what is another d/o that can present the same way?

Answer 1275

symptoms of **fever, malaise, aseptic meningitis** occur first, followed by loss of neurons in the anterior horn of the spinal cord (LMN lesion -\> **flaccid paralysis, atrophy, areflexia, and muscle fasciculations** Werdnig-Hoffman Syndrome - congenital degeneration of anterior horn of spinal cord.

Question 1276

tamoxifen effects

Answer 1276

SERM (selective estrogen receptor modulator - antagonist effects in breast - agonist effects in endometrium -\> endometrial cancer - decrease bone loss

Question 1277

how does an **indirect** inguinal hernia occur?

Answer 1277

enters via **internal/deep inguinal ring** (L**ateral** to inferior epigastric vessels; **above** the inguinal ligament) and exit out the external inguinal ring; can continue into scrotum! caused by **failure of the processus vaginalis ot obliterate** common in male infants

Question 1278

rust colored urine, facial swelling (periorbital edema), BP 150/90, elevated BUN/creatinine, urinalysis w/ hematuria, RBC casts, mild proteinuria (1+ = 1g/day) what determines prognosis?

Answer 1278

PIGN prognosis determined by **AGE!! ** young children = good; most recover completely w/ conservative Tx adults = not so good; only 50% will resolve completely; rest will develop chronic GN or RPGN

Question 1279

how does non-pathogenic strains of S. pneumo acquire pathogenicity?

Answer 1279

transformation

Question 1280

eye field looks like this: where is the lesion?

Answer 1280

optic chiasm C

Question 1281

cytarabine

Answer 1281

leukemia, lymphomas (ie AML) inhibits DNA polymerase ADR: leukopenia, anemia, megaloblastic anemia

Question 1282

how does sleep patterns change with the elderly?

Answer 1282

more awakenings and arousal at night awakens earlier less total sleep **REM remains constant up to around 80yo and then declines** **Stage 4 and then stage 3 NREM (slow wave) vanishes**

Question 1283

what drains into the superficial inguinal nodes?

Answer 1283

all skin from the umbilicus down (external genitalia, anus (up to pectinate line)), but excluding the posterior calf

Question 1284

purpose of using glucose + heme in the treatment of acute intermittent porphyria

Answer 1284

both lead to ALA**S inhibition**

Question 1285

34 M with bitemporal visual deficit; labs show elevated prolactin. how do you expect these to change: GnRH, LH, T

Answer 1285

suspect pituitary tumor, most likely **prolactinoma** - inhibits entire axis of GnRH-LH/FSH, causing impotence in men, amenorrhea in women of reproductive age **GnRH = decrease** **LH = decrease** **T = decrease**

Question 1286

MoA of dopamine in the H-P axis

Answer 1286

inhibits prolactin

Question 1287

role of c-myc mutated in what dz

Answer 1287

nuclear **transcrptional activator** of genes involved in proliferation, differentiation, and apoptosis burkitts

Question 1288

of these, which one has the highest oral bioavailability? NTG isosorbide dinitrate isosorbide mononitrate amyl nitrate Na nitroprusside

Answer 1288

isosorbide mononitrate

Question 1289

severing the glossopharyngeal afferent fibers will cause what to HR and BP?

Answer 1289

HTN w/ tachycardia CN9 and CN10 carry afferent informaton to the medulla from teh carotid sinus and aortic arch baroreceptors, respectively; firing rate of these neurons increase w/ increasing BP severing either one of these -\> false signal to the medulla, signaling that the animal suddenly had a decrease in BP, thus eliciting a baroreceptor reflex that results in an increase in sympathetic outflow and decrease in parasympathetic outflow net: HTN + tachycardia

Question 1290

ATP yield from conversion of glucose to 2 pyruvates ATP yield if you add arsenic?

Answer 1290

2 ATP / glucose molecule w/ Arsenic: 0 ATP/ glucose because it competes w/ glyceraldehyde-3-phosphate dehydrogenase

Question 1291

"moldy" grains in china should make you think of what bug? what do these bugs produce? what is this person at risk for?

Answer 1291

Aspergillus **flavus** and Aspergillus **parasiticus** produces **aflatoxins**, which produces **p53 mutations** **hepatocellular carcinoma**

Question 1292

pathophysiology of claudication

Answer 1292

atherosclerosis (lipid filled **intimal** plaque)

Question 1293

diuretics that cause angioedema

Answer 1293

ACEi

Question 1294

pregnant woman in her 2nd trimester has glucose in her urine and glucose levels of 147mg/dL, with no hx of diabetes. what factor is responsible for this?

Answer 1294

increased **hGH** - growth hormone variant produced by the placenta (that acts like GH) to * **stimulate IGF-1** in the mother and largely regulates maternal intermediary metabolism to allow the fetus to receive more glucose and a.a. * has **anti-insulin** effects, resulting in increased circulating glucose levels in the mother

Question 1295

What does this represent? (choose one) Increase preload Increase afterload Systolic dysfunction Increased ejection Fraction Normal Saline Infusion

Answer 1295

Increased preload

Question 1296

purpose of N-acetylcysteine in CF patients

Answer 1296

mucolytic agent - cleaves disulfide bonds within mucus glycoproteins

Question 1297

most common location for colorectal cancer

Answer 1297

rectosigmoid colon (followed by ascending colon)

Question 1298

2 yo w/ spontaneous bursts of non-rhythmic conjugate eye movements + hypotonia + myoclonus. has an abdominal mass. dx? markers? histology?

Answer 1298

**neuroblastoma** - common extracranial tumor that develops from neuroblasts in the **adrenal medulla**. associated with **N-myc amplification** markers: **neuropil, S100, synaptophysin, chromogranin** hx: looks like solids sheets of small cells w/ dark nuclei and scant round cells labs: i**ncr. homovanillic acid (HVA) +/- vanillylmandelic acid (VMA)** **retropertional abdominal mass**, HTN, anorexia, weight loss

Question 1299

treatment for acromeagly or gigantism

Answer 1299

octreotide (somatostatin analog) pegvisomant (GH receptor antagonist)

Question 1300

"presence of smoothly marginated, submucosal, rounded 5cm mass in the uterus fundus" dx + histological pattern?

Answer 1300

leiomyomas - whorled pattern of smooth muscle in bundles w/ well-demarcated borders

Question 1301

patient w/ fever, thrombocytopenia, microangiopathic hemolytic anemia (schistocytes on smear), renal insufficiency, and neurological manifestations have..?

Answer 1301

TTP - likely caused by antibodies that recognize the metalloprotease (ADAMST13) that cleaves vWF multimers all 5 sx are not often seen, but the most common triad is thrombocytopenia microangiopathic hemolytic anemia (schistocytes on smear) neurological manifestations

Question 1302

cleft lip results when

Answer 1302

**maxillary prominences** fail to fuse properly w/ the **intermaxillary segment** (**philtrum**) during early embryonic development

Question 1303

Erythematous ulcerating lesion of nipple has a bx that shows large, clear mucin-filled cells w/ abundant cytoplasm w/ intraepidermal spread of these cells. Dx?

Answer 1303

**Paget disease -** ductal carcinoma in situ - malignant cells (paget cells) extnd intraepidermally within the ductal system into the nipple w/o crossing the BM

Question 1304

what would you do if someone needed an emergency airway but couldn't be intubated?

Answer 1304

perform a cricothyrotomy - involves making an incision of superficial fascia, pretracheal fasica, and **cricothyroid membrane** (between thyroid + cricoid cartilages)

Question 1305

15 yo boy dies in a car accident, his younger brother begins to wear his jacket all of the time, no matter how warm the weather is

Answer 1305

identification - unconscious adoption of the characteristics or activities of another person (often a mxn for reducing the pain of separation or loss)

Question 1306

Clinical use + ADR of acyclovir

Answer 1306

HSV 1/2 VZV ADR: **crystal** **nephropathy** (renal toxicity), **neurotoxicity** (delirium + tremor)

Question 1307

thrombasthenia

Answer 1307

AR - defective platelet aggregation that causes prolonged bleeding time normal # of platelets

Question 1308

34yoM died of internal hemorrage inherited a defect of an elastin-associated glycoprotein that is abundant in zonular fibers of the lens, periosteum, and aortic media. Dx?

Answer 1308

**Marfans - fibrillin-1** fibrillin1 is a major component of the microfibrils that forms a sheath around elastin fibers; serves as a scaffold for elastin deposition.

Question 1309

macrophage marker

Answer 1309

CD14

Question 1310

sudden upward jerking of the hand at the level of the shoulder can cause injury to which part of the brachial plexus?

Answer 1310

lower trunk of the brachial plexus (C8-T1) - both of which contribute to the median + ulnar nerves *(together, these nerves innervate all of the intrinsic muscles of the hand)* results in "hand clumsiness or paralysis"

Question 1311

Rivaroxaban, Apixaban MoA?

Answer 1311

inhibits **Factor Xa** directly

Question 1312

diabetic Rx that causes increased insulin release

Answer 1312

sulfonylurea (Glyburide, Glipizide) - causes K channel closure in ß cells ADR: disulfram-like rxn

Question 1313

patient with ø T tubules in some muscle fibers will experience what?

Answer 1313

uncoordinate contraction of myofibrils

Question 1314

of these, which ions are intracellular? extracellular? Na, Cl, Ca, K

Answer 1314

**only K is intracellular! ** rest is extracellular

Question 1315

Trousseau sign

Answer 1315

occlusion of brachial artery with BP cuff (triceps)--\> carpal spasms

Question 1316

VHL chromosome

Answer 1316

3p (3 letter word, as siedlecki said..)

Question 1317

net vasopressin effects

Answer 1317

V2-receptor mediated increase in **H₂O** _and_ **urea** in the CD (ie renal clearance of these substances are reduced!)

Question 1318

**Gemfibrozil, ****Fenofibrate** Clinical Use MoA ADR What increases ADR?

Answer 1318

* Clinical use: **HyperTG (hVLDL) – 1st line** * MoA: Actvate **PPAR-a* ****(and somehow suppresses cholesterol **7a-hydroxylase** activity), ultimately reducing the conversion of cholesterol into bile acids)* * ADR: **Gallstones** (*since it increases cholesterol content of bile!*), * increased risk of cholesterol gallstones w/ **concomitant use of bile-acid binding resins**

Question 1319

how does leuprolide affect testosterone and DHT levels? how does this compare to finasteride?

Answer 1319

* Leuprolide - transient increase, then decrease in both T and DHT * Finasteride - decrease in DHT

Question 1320

serotonin syndrome caused by: anti-emetic? analgesic? antibiotic? migraine Rx? cancer?

Answer 1320

ondansetron tramadol linezolid triptans carcinoid tumor when it metz the the liver (b/c secretory products are no longer degraded)

Question 1321

staghorn calculi seen in

Answer 1321

ammonium mg phophsate (struvite) stones cysteine stones

Question 1322

bone marrow that shows this should make you think of..

Answer 1322

myelophthisic anemia - anemia caused by space-occupying lesions (fibrosis, granuomas, etc) in the bone marrow. all lineages are affected -\> pancytopenia.

Question 1323

how does dehydration affect RPF, GFR and FF?

Answer 1323

dehydration --\> decr. RPF + decr. GFR RAAS activation --\> efferent arteriole constriction to maintain GFR FF = GFR/RPF = **increases** (bc RPF drops proportionately more than GFR)

Question 1324

mucicarmine staining of bronchoalveolar fluid shows budding yeast forms w/ thick capsules at risk for what?

Answer 1324

cryptococcus neoformans - stains red on **mucicarmine stain** at risk for **meningitis** - esp those with HIV, sarcoidosis, or leukemia, immunocompromised

Question 1325

biopsy of the myocardium is indicative of..

Answer 1325

**viral myocarditis - lymphocytic** interstitial infiltrate w/ focal necrosis of myocytes adjacent to to the inflammatory cells

Question 1326

JVD , hypotension, tachycardia could be either one of two things

Answer 1326

cardiac tamponade ^{_{(look for Beck's triad: hypotension, distended neck veins, distant or muffled heart sounds, as well as tachycardia; also pulsus paradoxus)}} tension pneumothorax

Question 1327

elevated JVP + low BP + tachycardia

Answer 1327

cardiac tamponade

Question 1328

What's estrogen's effect on bone?

Answer 1328

anabolic effect: increase osteoBlastic and decrease osteoClastic activity

Question 1329

decreased lung compliance may be caused by these 3 factors

Answer 1329

pulmonary fibrosis pulmonary edema (L ventricular failure, inflammation) insufficient surfactant

Question 1330

cardiac manifestation of lupus

Answer 1330

inflammation of serous membranes (pericardial inflammation) - results in chest pain that radiates to the neck and shoulders/back, increases with inspiration, and is relieved by sitting up auscultate by having the patient sit upright and leaning forward - should hear a scratchy sound

Question 1331

CF patients are most likely to die from..?

Answer 1331

pneumonia NOT malabosrption due to pancreatic insufficiency b/c this can be fixed w/ pancreatic enzyme supplemnetation

Question 1332

what would be a potential cause for variegated, mottled appearance of the liver (hemorrhage + necrosis in the centrilobular regions)?

Answer 1332

**Chronic CHF **- causes blood stasis in the central veins and central sinusoids of hepatic lobules + subsequent central hemorrahgic necrosis. not acute RHF because this typically leads to acute congestion of the liver, which does not cause the typical nutmeg appearance of chronic congestion

Question 1333

What is primidone?

Answer 1333

antiepileptic that is metabolized to phenobarbital + phenylethylmalonamide (PEMA), both of which are also anticonvulsants. consider this Rx when a patient has elevated blood phenobarbital levels

Question 1334

verapamil MoA / ADR

Answer 1334

Ca channel blocker - **slows diastolic depolarization that occurs in phase 0 and the latter part of phase 4 -\> decreased**** rate of firing of the SA node**and**slows**** AV node conduction** ADR * cause prolongation of PR interval and as well as AV block (1st, 2nd, or 3rd) * gingival hyperplasia * constipation

Question 1335

point of takeing nitrates at AM, noon, but _NOT_ PM

Answer 1335

wavoid tolerance development (decreased vascular sensitivity to nitrates)

Question 1336

patient w/ persistent cough + pulmonary infiltrate has cold agglutinins

Answer 1336

**Mycoplasma pneumoniae -** causes high levels of IgM that clumb when exposed to cold temperatures other d/o that cause cold agglutinin formation: EBV or hematologic malignancies

Question 1337

what will continuous administration of leuprolide do?

Answer 1337

GnRH agonists - continuous infusion -\> inhibit LH/FSH -\> diminished testosterone production

Question 1338

Zileuton Use and MoA

Answer 1338

inhibits 5-lipooxygenase (prevents conversion of arachadonic acid to LT)

Question 1339

mono-like sx can be caused by which two bugs?

Answer 1339

CMV (-) or EBV (+) differentiate with monospot test

Question 1340

Bony metz = if **osteoblastic**, you should think of...

Answer 1340

prostate cancer

Question 1341

bone marrow that shows this is indicative of...

Answer 1341

myelodysplastic syndrome - BM shows disordered/dysplastic differentiation affecting all non-lymphoid (erythryoid, granulocytic, monocytic, and megakaryocyte lineages)

Question 1342

calculation for loading dose?

Answer 1342

Vd \* CP / bioavailability fraction in patients w/ renal or hepatic impairment: loading dose = unchanged, maintenance dose = decreased

Question 1343

damage to superior gluteal nerve (L4-S1) can result in what motor deficit?

Answer 1343

weak thigh abduction

Question 1344

only difference btwn minute ventilation and alveolar ventilation calculations?

Answer 1344

dead space minute ventilation: Vt \* RR alveolar ventilation: (VT-VD)\*RR

Question 1345

liver cells that have a high concentration of fructose-2,6-bisphosphate will have a low rate of conversion of...

Answer 1345

fructose-2,6-bisphosphate helps to control the balance between gluconeogenesis + glycolysis via ## Footnote **activates PFK1 -\> glycolysis** **inhibits fructose-1,6-bisphosphatase -\> ø gluconeogenesis** **net: decreases gluconeogenesis (ie conversion of alanine to glucose)**

Question 1346

destruction of the hypothalamus results in elevation of which hormone?

Answer 1346

**prolactin** (since it is no longer under the inhibitory effects of dopamine produced by the hypothalamus)

Question 1347

Rapid association: Mitral Stenosis

Answer 1347

chronic rheumatic heart disease

Question 1348

∆ btwn first-order kinetics and 0-order kinetics

Answer 1348

* **_first-order kinetics_** = constant **fraction** (proportion) of drug that is metabolized per unit time based on the serum concentration * **_zero-order kinetics_** = constant **amount** of drug metabolized per unit time, independent of concentration

Question 1349

What is the ortner syndrome?

Answer 1349

**Mitral stenosis** that causes **LA dilation** sufficient enough to impinge on the **L recurrent laryngeal n**., resulting in **hoarseness** _{(remember, this nerve innervates all of the intrinsic muscles of the larynx except the cricothryoid)}

Question 1350

cytogenetic defect: 'immature myeloid cells with giant cytoplasmic granules'

Answer 1350

acute promyelocytic leukemia (APL) - subtype of AML cytoplasmic granules = auer rods t15;17 chromosomal translocation that causes fusion of alpha retinoic acid receptor gene to PML gene

Question 1351

cyclin D1, CD5

Answer 1351

mantle cell lymphoma t11;14

Question 1352

diagnose

Answer 1352

negri bodies - rabies virus

Question 1353

ulcer location that is least least likely to be associated with malignancy: esophagus stomach duodenum sigmoid rectum

Answer 1353

duodenum - most ulcers here are due to H pylori or NSAIDs and are rarely associated wiht malignancy

Question 1354

alcoholic w/ poor dentition and a foul smelling sputum. CT shows lung abscess. what should you treat him with?

Answer 1354

think aspiration pneumonia **clindamycin** - oral _anerobes_ and gram + _aerobes_ (ie S. penumo); binds to the 50S subunit and disrupts protein synthesis

Question 1355

how does a PE cause hypoxemia

Answer 1355

V/Q mismatch - because it creates a sudden drop in perfusion of the corresponding areas of the lung parenchyma, therefore while air enters the alveoli, the amt of blood that passes through the affected areas is not sufficient for normal gas exchange

Question 1356

what is physiologic jaundice?

Answer 1356

occurs after the first 24hrs of life and subsides by the end of the first week; associated with a relatively mild unconjugated hyperbilirubinemia

Question 1357

lung mass for which surgery is NOT indicated

Answer 1357

small cell carcinoma - it is the most aggressive, highly invasive and most patients have metz at the time of diagnosis BUT they are **SENSITIVE to chemoRx and radiation**

Question 1358

what is a porcelain gallbladder? Patients w/ this particular Xray finding are at risk of...?

Answer 1358

rim of Ca deposits that outline the gallbladder condition is associated with chronic cholecystitis; can progress to **gallbladder carcinoma**

Question 1359

46XY infant w/ small phallus, hypospadias, and testes that reside in the inguinal area. BP + serum T is normal. Deficient enzyme?

Answer 1359

5a reductase - converts T -\> DHT T -\> male internal reproductive system DHT -\> development of external genitalia ø 5a reductase = internal genitalia develop normally under influence of T, but external genitalia do not develop properly due to lack of DHT -\> female pseudohermaphroditism

Question 1360

what does it mean when the arteriovenous concentration gradient of a gas anesthetic is HIGH in terms of tissue solubility time to reach blood saturation brain saturation

Answer 1360

* HIGH tissue solubility (ie a large amt of anesthetic is taken up from arterial blood, which results in a low venous concentration) * time to reach blood saturation = longer * brain saturation = delayed because of the factors above

Question 1361

weak R forearm flexion + absent biceps reflex will develop a loss of sensation where?

Answer 1361

lateral forearm - bc the patient has sx consistent w/ musculocutaneous n. injury (C5-C7) - innervates the upper major arm flexors + forms the lateral cutaneous nerve of the forearm (sensory information to the skin of the lateral forearm)

Question 1362

dipyridamole + adenosine

Answer 1362

Rx used in myocardial perfusion imaging studies selective vasodilators of coronary vessels --\> redistributes flow away from ischemic areas, thus exacerbating the MI

Question 1363

**giant cell arteritis** clinical sx treatment histological findings

Answer 1363

\>50yo, HA, facial pain, jaw claudication, vision loss (due to ophthalmic artery occlusion, increased ESR trmt: prednisone hx: granulomatous inflammation of the **media** w/ fragmentation of the **internal elastic lamina (IEL)** branches of the carotid artery

Question 1364

Which one does this graph represent? (choose one) Aortic insufficiency Aortic Stenosis Mitral Stenosis Mitral regurgitation

Answer 1364

Aortic Insufficiency

Question 1365

why is it that IgG against HepC envelop do not conver effective immunity against the infection?

Answer 1365

HepC envelop proteins vary in their antigenic structure b/c there is **no proofreading 3'-5' exonuclease activity** built into the virion-encoded RNA polymerase!!

Question 1366

Why are those with A1AT deficiency strongly adviced to avoid smoking?

Answer 1366

smoking plays a synergistic role in the disease process by pemanently inactivating A1AT through oxidation of a methionine residue, resulting in dyspnea decades earlier

Question 1367

EMG reading that is DECREASED by multiple sclerosis (demyelination) INCREASE?

Answer 1367

**decrease: length constant** = measure of how far along an axon an electrical impulase can propagate **increase: time constant -** time it takes for a charge in the membrane to achieve 63% of its original value (lower value = faster ∆'s in membrane potential = faster conduction speed) \*myelination increases length constant and decreases time constant

Question 1368

anastrozole MoA clinical use

Answer 1368

**decreases androgen (androstenedione) aromatization to estrone** (in liver, muscle, fat), thereby minimizing the growth and development of malignant breast tumors trmt: post-menopausal women w/ breast cancer

Question 1369

**atherosclerotic plaques** where are mostly develop? what factors determine their ability to produce acute coronary syndrome?

Answer 1369

develop in large elastic arteries + large/med sized muscular arteries (abdominal, coronary, popliteal, internal carotids, circle of willis) **plaque stability**, which depends on the mechanical strength of the overlying fibrous cap (which is continuously being remodeled by macrophages via collagen synthesis and degradation/MMPs)

Question 1370

"patient complains of a dark tan despite avoiding sun exposure" should make you think of...

Answer 1370

**Hemochromatosis** AR, **ø HFE** (*normally regulates transferrin/Fe uptake*) = unregulated uptake of dietary Fe = abnormally high levels of intestinal absorption = mildly elevated LFTs, elevated plasma Fe w. \>50% TIBC, elevated serum ferritin presentation: skin pigmentation, DM secondary to pancreatic islet destruction, pigment cirrhosis w/ hepatomeagly Complications: cirrhosis, HCC ^{Women tend to present later due to blood loss during menstruation + pregnancy}

Question 1371

pathophysiology of gallstone ileus? what are some physical findings of this?

Answer 1371

occurs when a large gall stone erodes into the intestinal lumen through a cholecysto-enteric fistula, thereby allowing * **air** from the lumen to enter the biliary tree "pneumobilia" * the stone to travel down the intestines, causing a **waxing and waning of abdominal pain, nausea, vomiting**

Question 1372

immunity to reinfection with influenza is predominately mediated by

Answer 1372

anti-HEMAGGLUTININ IgA and IgG

Question 1373

Methotrexate ADR How to reduce ADR?

Answer 1373

**somatitis** (painful mouth ulcers) **hepatotoxicity** (hepatitis, fibrosis, cirrhosis) **myelosuppression** (increased risk of opportunistic infections) **Alopecia** reverse effects w/ **folinic acid**

Question 1374

which of these proteins are outside the nucleosome core that faciliate nucleosome packaging into a more compact structure? TopoII snRNP Ubiquitin HIstone H1 Histone H3 HIstone H4

Answer 1374

Histone H1

Question 1375

NO is derived from which a.a.?

Answer 1375

Arginine

Question 1376

brain tumors that are prevalent in kids

Answer 1376

pilocytic astrocytoma medulloblastoma ependymoma PEM

Question 1377

37yoF at 12 weeks gestation comes in with elevated glucose and Tgs. Why is this?

Answer 1377

**human placental lactogen (hPL)** is to blame - it is secreted from syncytiotrophoblasts and has similar biologic properties to prolactin + growth hormone. It functions to **maintain adeqate fetal glucose supply** via: * **increases insulin resistance** (so that more glucose can be shunted towards the fetus * **stimulates proteolysis + lipolysis - ** resulting FFA + ketones provide energy to the mother, thus freeing more glucose for fetal use * **inhibits gluconeogenesis**

Question 1378

before alanine is converted to glucose, its amino group is transferred to what molecule?

Answer 1378

**alpha-ketoglutarate** (note that this molecule is the key amino-group acceptor in transamination reactions) occurs via transamination reaction that requires B6

Question 1379

17yo boy begins to develop enuresis

Answer 1379

regression

Question 1380

purpose of extracellular polysaccharides (dextrans) produced by strep viridans

Answer 1380

dextrans facilitate adherence to fibrin platelet aggregates deposited at sites of endothelial trauma (provides a site for bacterial adherence and colonization during bacteremia)

Question 1381

sweating, dilated pupils, piloerection, yawning, fever/rhinnorhea patient is undergoing withdrawal of...? PE findings?

Answer 1381

opioids

Question 1382

patients undergoing total gastrectomy will require life-long supplementation with what nutrient??

Answer 1382

water soluble vitamins = B12 due to IF deficiency

Question 1383

daycare center where several children develop dysuria and hematuria. Genome of pathogen?

Answer 1383

hematuria indicates hemorrhagic cystitis due to **adenovirus** genome: **linear dsDNA, non-enveloped**

Question 1384

person with aggressive impulses participates in contact sports

Answer 1384

sublimation - diversion of unacceptable impulses into acceptable outlets

Question 1385

rapid association: mitral regurgitation

Answer 1385

infective endocarditis (leads to destruction of the valve leaflets)

Question 1386

VSD is common in...

Answer 1386

Down syndrome patients

Question 1387

chemoRx associated w/ abd. pain and jaundice

Answer 1387

mercaptopurine (causes cholestasis + hepatitis)

Question 1388

benz(o)pyrene - what is it and what does it do?

Answer 1388

pro-carcinogen that is metabolized by **P450 MICROSOMAL MONOOXYGENASE** into a carcinogen; cause lung cancers etc

Question 1389

what maintains progesterone during the first trimester of pregnancy? what happens if there is a deficiency of this enzyme?

Answer 1389

hCG - secreted by syncytiotrophoblasts lining the placental villi; deficiency --\> increased risk of miscarriage

Question 1390

what is ceruloplasmin and how is it affected in Wilson diseae?

Answer 1390

major copper-carrying protein in the blood (also plays a role in iron metabolism) Wilson's disease = LOW

Question 1391

floppy baby + mild jaundice + enlarged tongue + general hypotonia + umbilical hernia

Answer 1391

congenital hypothyroidism - T4 is impt for normal brain development and myelination during early life and undiagnosed congenital hypothyroidism produces irrversible mental retardation.

Question 1392

what kind of withdrawal: prolonged anxiety, irritability, depression

Answer 1392

cannabis

Question 1393

renal plasma flow equation

Answer 1393

RPF can be calculated as (1-hct)/RBF or use clearance of PAH

Question 1394

Filtration fraction equation be specfic in terms of how you calculate each term

Answer 1394

FF = **GFR/RPF** *FF is essentially = creatinine or inulin clearance **/** PAH clearance* OR RPF can be calculated as (1-hct)/RBF

Question 1395

why are nitroglycerin administered sublingually?

Answer 1395

because it has a very high first-pass metabolism and not enough of the drug reaches the systemic circulation to be effective. therefore it is administered sublingually, where it enters the systemic circulation directly via sublingual capillaries and arterioles (same for propranolol and lidocaine)

Question 1396

hemisphere dominant for visual-spatial functions (map reading, locating oneself in space)

Answer 1396

Right hemisphere

Question 1397

hypoglossal nerve innervates all intrinsic muscles of the tongue EXCEPT

Answer 1397

palatoglossus muscle (innervated by vagus, CN10)

Question 1398

5HT and melatonin are derived from which a.a.?

Answer 1398

tryptophan

Question 1399

∆ in intestinal absorption of cystine, ornithine, arginine, and lysine is indicative of which dz? What is the clinical manifestation of this d/o?

Answer 1399

**Cystinuria - **inborn defect of the transporter responsible for transporting these 4 dibasic a.a.; as a result, these 4 substances are excreted via urine and feces clinical manifestation: **hexagonal cystine stones **(presents as renal colic)

Question 1400

Patient comes in complaining of a sensory deficit (green). What is the nerve injury and accompanying motor deficits? What is the usual cause of injury?

Answer 1400

Obturator n. ∆ thigh adduction anterior hip dislocation, or iatrogenic (pelvic surgery)

Question 1401

treatment for trigeminal neuralgia

Answer 1401

carbamazepine (also used in seizure d/o, and bipolar d/o)

Question 1402

cardiac findings in tuberous sclerosis

Answer 1402

valvular obstruction due to cardiac rhabdomyomas

Question 1403

diabetic Rx that increases insulin sensitivity

Answer 1403

Glitazones (TZD) - binds PPAR-gamma transcription factor Metformin - exact mxn unknown

Question 1404

common sx in temporal arteritis histological findings?

Answer 1404

polymyalgia rheumatica (AM stiffness, pain in torso, shoulder, pelvic girdle) monocular vision loss (permanent) segmental **GRANULOMATOUS inflammation of the media** (abnormal areas interspersed w/ segmental normal appearing arterial walls); commonly involves branches of the carotid a., esp the temporal arteries!

Question 1405

38 F w/ sudden severe episodes of severe R sided facial pain, usually precipitated by a meal or teeth-brushing. Dx and trmt?

Answer 1405

Trigeminal neuralgia (tic douloureux) - sudden + severe pain, usually in the distribution of CN V (esp. V2, V3) triggered by any stimulus to CN V Carbamazepine

Question 1406

patient w/ gonorrhea should be treated with ...

Answer 1406

**ceftriaxone** **_PLUS_ Azithromycin or Doxycycline **for chlamydia trachomatis since co-infection is VERY common

Question 1407

major limiting factor for coronary blood flow under normal conditions

Answer 1407

since most of blood flow to the heart occurs during **diastole**, the **duration** or **length of diastole** determines CBF

Question 1408

eye field looks like this: where is the lesion?

Answer 1408

R peri-chiasmal lesion (usually due to calcification or aneurysm of the ICA impinging on the uncrossed, lateral retinal fibers) D

Question 1409

renal interstitial infiltrate w/ **plasma cells + eosinophils** should make you think of... drugs that can cause this?

Answer 1409

**acute interstitial nephritis -** likely due to drug-induced HSR such as **ß** lactam abx, **r**ifampin, **N**SAIDs, **D**iuretics, **S**ulfonamides **BR**a**NDS**

Question 1410

**Pituitary Adenoma** Prognosis, presentation

Answer 1410

Prolactinoma, bitemporal hemianopia Adults

Question 1411

mediator of niacin-induced skin flushing and warmth how to avoid this?

Answer 1411

prostaglandins evidenced by the fact that aspirin taken 30-60min before administration significantly reduces these symptoms (however, note that over time, patients develop a tachyphylactic response, and pretreatment w/ aspirin becomes unnecessary)

Question 1412

methimazole MoA ADR

Answer 1412

inhibits TH synthesis by suppressing iodination and coupling of iodine agranulocytosis, edema, rash

Question 1413

bioavailability fraction for an oral drug

Answer 1413

depends on the absorptive properties and first-pass metabolism _measure of fraction of administered Rx that reaches systemic circulation_ how much was delivered orally

Question 1414

Myeloperoxidase is a marker of....

Answer 1414

myeloid cells

Question 1415

treatment for chlamydia trachomatis

Answer 1415

**Azithromycin** or **Doxycycline ** but must **ADD CEFTRIAXONE **for potential Neisseria coinfection

Question 1416

15 yo M w/ kyphoscoliosis + high plantar arch dx? pathophysiology? what other sx does this normally present w/?

Answer 1416

Friedriech ataxia - AR, trinucleotide repeat d/o (GAA) on chromosome 9 in frataxin gene (Fe binding protein) also presents with degeneration of **spinocerebellar tracts **-\> muscle weakness + ø DTR, vibratory sense, and proprioception staggering gait, frequent falls hypertrophic cardiomyopathy

Question 1417

mantle cell lymphoma translocation

Answer 1417

mantle cell lymphoma, t11;14 ∆ = 3 rotated 90˚ will look like an m. Also, m forms two semi-circles = **cyclin** (bicycle wheel)

Question 1418

ETEC virulence factor has the similar mechanism of action as...

Answer 1418

* **ETEC**: Heat-labile toxin _activates adenylate cyclase_ -\> increase cAMP -\> increase Cl/H2O efflux * **Vibrio cholera -** cholera toxin activates Gs -\> increase cAMP -\> increase Cl/H2O efflux

Question 1419

neutrophil rich discharge + erosions of the vaginal mucosa

Answer 1419

Neisseria gonorrhoeae

Question 1420

What pathogens produce a factor that inactivate EF-2 via ribosylation?

Answer 1420

Corynebacterium diphtheriae + Pseudomonas Aeruginosa

Question 1421

in general, how many bands would show on an RFLP analysis if non-dysunction occured in meiosis I vs meiosis II?

Answer 1421

**meiosis I** = 3 bands **meiosis II **= 2 bands, with one band darker ^{(either from mother or father, signifies inheritance of 2 sister chromatids)}

Question 1422

patients w/ influenza are at increased risk of?

Answer 1422

secondary bacterial pneumonia caused by **S. pneumo, S. aureus, and H. influenza**

Question 1423

F w/ microcalcifications seen on mammography. Pathology indicates that she has what type of breast cancer?

Answer 1423

**DCIS** - Neoplastic cells confined to ductal lumen (ø BM penetration)

Question 1424

L hemonymous hemianopia has damage to:

Answer 1424

R optic tract or optic radiation

Question 1425

male w/ undervirilized and does not undergo puberty. develops HTN and hypokalemia enzyme deficiency?

Answer 1425

**17a-hydroxylase deficiency** * ø sex steroid production -\> females are OK, males are undervirilized, both do not undergo puberty (no sex steroids) * ø cortisol synthesis * increased production of mineralocorticoids -\> HTN, hypokalemia

Question 1426

ECG shows QT prolongation and polymorphic complexes that change in amplitude and cycle length what drugs normally cause this?

Answer 1426

torsades de pointes quinidine, procainamide, disopyramide (class IA) ibutilide, defetilide, and sotalol (class III)

Question 1427

cause of urinary incontinence in a elderly patient with enlarged ventricular system, poor memory, and gait abnormalities

Answer 1427

distortion of periventricular WM bladder controlled by descending cortical fibers that run in the paraventricular area. Loss of these fibers as a result of the hydrocephalus results in urge incontinence

Question 1428

What should you do before initiating therapy with either infliximab, entanercept, or adalimumab?

Answer 1428

get a PPD to screen for latent TB since treatment with these can cause reactivation!

Question 1429

definition of an erosion vs ulcer

Answer 1429

* **EROSIONS** - defects limited to **mucosa only (do not fully extend through the muscularis mucosa)** * **ULCERS** - can extend _through_ the **muscularis layer**

Question 1430

oocyte surrounded by a single layer of flattened follicular cells

Answer 1430

primordial follicle

Question 1431

isoproterenol

Answer 1431

non-selective ß agonist increases HR, CO, PP decreases PVR and diastolic BP

Question 1432

drug of choice for ß blocker OD

Answer 1432

glucagon acts on GPCRs to increase cAMP and thus increase intracellular Ca during muscle contraction -\> incr HR and cardiac contractility

Question 1433

mitral stenosis is common in..

Answer 1433

rheumatic heart dz

Question 1434

How is it that a patient receiving TPN after extensive jejunal resection develops biliary stones?

Answer 1434

TPN causes * since nutrients are administered via IV, there is **no enteral stimulation (ø food passing through GI = ø CCK = biliary stasis)** * ileal resection may disrupt enterohepatic bile acid circulation, resulting in supersaturation of hepatic bile with cholesterol.

Question 1435

patient on anti-pyschotics develops prolonged QT. Rx?

Answer 1435

Ziprasidone

Question 1436

small bluish lesions under the nail of finger that is extremely tender to touch. what is it?

Answer 1436

glomus tumor (glomangioma) or sub-ungual melanoma (pigmentation) depends on the answer choices

Question 1437

if patient has elevated HbA2, what should that make you think of?

Answer 1437

ß thalassemia normal adults: there is 97% HbA1 , 2.5% HbA2, and 1% HbF HbA2 is elevated in ß thalassemia (trait or intermedia) to compensate for the decreased synthesis of HbA1 that results from ß globin chain underproduction

Question 1438

name this please

Answer 1438

aspergillus - acute V shaped angles

Question 1439

patients w/ suspected MEN 2 (A/B) has likely has a thyroid that has these histological features

Answer 1439

MTC of thyroid gland = extracellular **amyloid** deposits formed by **calcitonin** secreted from neoplastic parafollicular C-cells

Question 1440

How does AST, ALT levels change in alcoholics?

Answer 1440

AST is \>\> ALT

Question 1441

26yoF new onset of constipation, dry skin, hair loss, weight gain and fatigue, BP 110/70, P 55 after starting Rx for her mood swings and sleep problems should make you think of this particular drug. What are other ADRs of this drug?

Answer 1441

**hypothyroidism** due to **lithium** therapy other ADR: **nephrogenic DI, Ebstein's anomaly of tricuspid valve**

Question 1442

What is DHEA sulfate?

Answer 1442

weak androgen produced by the adrenal cortex.

Question 1443

fetus with 46XY has functioning Leydig cells but total absence of Sertoli cells. will the internal + external genitalia develop?

Answer 1443

internal: **M + F** reproductive organs * ^{sertoli cells produce MIF, which cause paramesonephric ducts to involute; absence of this causes persistence and subsequent development into female internal genitalia} * *presence of Y chromosome = SRY - produces testes determining factor, which causes gonadal differentiation into testes.* * *Leydig cells secrete T, which stimulates the Wolffian ducts to develop into the male internal genitalia. It is also converted to DHT, which induces development of male external genitalia * external: **M **

Question 1444

where is the main site of digestion of dietary lipids? absorption?

Answer 1444

**d**igestion = **d**uodenum absorption = jejunum

Question 1445

20yo M w/ testicular torsion - due to occlusion what arteries?

Answer 1445

spermatic cord w/ occlusion of **testicular arteries**, both which originate directly from the **aorta** R testicular v -\> IVC L testicular v -\> L renal vein

Question 1446

compare DIC to TTP/HUS in terms of whether patients bleed what's activated PT/PTT fibrinogen levels, FDP levels

Answer 1446

* DIC * patients bleed * coagulation cascade is activated * PT/PTT prolonged * low fibrinogen + increased FDP * TTP-HUS * usually ø bleeding * only platelets are activated * normal PT/PTT * normal fibrinogen

Question 1447

dx and tumor marker?

Answer 1447

seminoma elevated levels of **placental ALP**

Question 1448

clinical/laboratory indication of premature menopause

Answer 1448

**reduced inhibin levels** - ovary fails to respond to pituitary hormones and secrete hormones.

Question 1449

hypoglycemia, lactic acidosis, hyperlipidemia, hyperuricemia. hx: hepatic steatosis

Answer 1449

Von Gierke's - ∆ glucose-6-phosphatase deficiency

Question 1450

how to identify patient with primary polydipsia

Answer 1450

urine osmolarit is \>500 (compared to normal \>800 and compared to nephrogenic and central DI, whose urine osmoarlity is steady, reliable and prompt increase in urine osmolarity during a water deprivation study paltry response to vasopressin administration ( (ADH normally increases aquaporin channels) trmt: water restriction

Question 1451

T/F patient w/ Bell's palsy do not have problems w/ tearing, as it is not a function of CN 7

Answer 1451

FALSE. paresiss of CN 7 will affect tearing, as well other processes * motor output to facial m -\> **facial drooping** * parasympathetic innervation to lacrimal, submandibular, and sublingual salivary glands (7-LSS) -\> **decreased tearing, salivation** * taste afferent fibers from anterior 2/3 of tongue -\> **loss of taste sensation ** * somatic afferent from pinna and external auditory canal -\> **hyeracusis**

Question 1452

MoA for methyldopa and clonidine

Answer 1452

a2 receptors -\> decreased sympathetic outflow -\> decreased BP

Question 1453

Interpret this HBsAg negative anti-HBc positive anti-HBs negative

Answer 1453

Interpretation unclear; four possibilities: 1. Resolved infection (most common) 2. False-positive anti-HBc, thus susceptible 3. “Low level” chronic infection 4. Resolving acute infection

Question 1454

diuretic that causes hyperkalemia

Answer 1454

anything that acts on the CD - K sparing diuretics - ACEi/ARBs

Question 1455

how does craigler-najjar syndrome affect these labs: haptoglobin total bilirubin direct bilirubin

Answer 1455

haptoglobin = normal total bilirubin = high direct bilirubin = low (means that bilirubin is mostly unconjugated)

Question 1456

What are H2 receptor antagonists commonly used for?

Answer 1456

block gastric acid secretion by parietal cells

Question 1457

patient w/ a lesion that impinges upon the **superior orbital fissure** will result in what type of sx?

Answer 1457

* **diplopia** (due to CN 3, 4, 6) * loss of **ipsilateral corneal reflex** - afferent sensory via nasociliary branch of CN V1 (opthalmic br.) * superior ophthalmic v.

Question 1458

what is the purpose of drug suppositories? ^ewwwww

Answer 1458

partially bypasses first-pass metabolism Superior rectal veins --\> inferior mesenteric vein --\> portal circulation --------------------------------------pectinate line--------------------------------------- middle rectal vein --\> internal iliac --\> systemic circulation inferior rectal vein --\> internal pudendal vein --\> systemic circulation

Question 1459

patient on anti-pyschotics develops extrapryamidal sx/Drug-induced parkinsonism What was he treated with? Treatment for this?

Answer 1459

Rx: 1st generation antipsychotics that cause D2 receptor blockade in the nigrostriatal pathway (ie **haloperidol**) Trmt: **Benztropine** or **Trihexyphenidyl** **^{DO NOT treat w/ levodopa or bromocriptine - both can precipitate or exacerbate psychosis}**

Question 1460

Patient comes in complaining of a sensory deficit (green). What is the nerve injury and accompanying motor deficits?

Answer 1460

**Tibial nerve (L4-S3)** ∆ = foot inversion, plantar flexion, toe flexion

Question 1461

diabetic patient treated with amitriptyline for peripheral neuropathy can suddenly develop what?

Answer 1461

acute urinary retention due to anticholinergic effects of this drug (same as other TCAs); must use with caution in pts with BPH

Question 1462

how does non-pathogenic strains of C. diphtheriae acquire pathogenicity?

Answer 1462

bacteriophage-mediated integration of the **Tox gene** (encodes for diphtheria AB exotoxin) into the genome = **lysogenization**

Question 1463

"myxomatous changes" in arteries should make you think of...

Answer 1463

**aortic aneurysm in Marfans** myxomatous ∆s in media of large arteries = cystic medial degeneration due to lack of fibrillin-1 (major component of ECM microfibrils that form the scaffolding for elastic fibers)

Question 1464

precursor for serotonin diagnostic test for patients w/ serotonin syndrome

Answer 1464

tryptophan test for serotonin metabolite 5-HIAA (5-hydroxyindoleacetic acid) in a 24hr urine sample

Question 1465

patient w/ poorly managed ulcerative colitis comes in w/ fever, bloody diarrhea, abd. distension. what is the next best step in the patient's workup?

Answer 1465

toxic megacolon - get xray to diagnose (not colonoscopy or barium contrast studies b/c it may cause perforation of TMC)

Question 1466

pulsus parvus et tardus

Answer 1466

**aortic stenosis** - pulse of low magnitude w/ a delayed peak

Question 1467

RItonavir what is this drug used for other than HIV? ADR??

Answer 1467

**protease inhibitor - **prevents assembly and maturation of the virus, thereby non-functional, non-infectious forms are produced instead. RT is not affected **inhibits CYP450** - therefore it is manufactured as a single drug w. lopinavir to _reduce dosing frequency_! (can also increase concentrations of drugs metabolized by the same enzyme) ADR * **Lipodystrophy** - increased fat deposition on the back and abdomen "buffalo humb" with decreased adipose adipose tissue on the extremities "peripheral wasting * **Hyperglycemia** - due to increased insulin resistance

Question 1468

puncture wound into the posterior fornix of the vagina enters what space

Answer 1468

rectourterine space (pouch of douglas) - located between the uterus and rectum

Question 1469

how to accentuate S3 sound?

Answer 1469

having the patient lie in the L lateral and decubitus position and fully exhale presence of a S3 is common in patients with LV systolic failure

Question 1470

SIADH in terms of plasma Na plasma osmolality urine concentration urine Na body fluid volume

Answer 1470

* plasma Na: LOW * plasma osmolality: low * urine concentration: very concentrated * urine Na: very high * body fluid volume: **normal**

Question 1471

patient w/ HTN and ADPKD should be place on what drug?A

Answer 1471

ACE inhibitor or ARBs pts w/ ADPKD has cysts that impair glomeruli perfusion, which triggers RAAS. ACEi not only interrupts this system, but also increases RBF and may provide renoprotective effects

Question 1472

it is important to have high _________ in all screening tests

Answer 1472

sensitivity

Question 1473

atropine binds to these receptors

Answer 1473

competitive antagonist at post-junctional muscarinic receptors (in the heart, it would block vagal influences, thereby increasing HR)

Question 1474

cardiac tamponade findings

Answer 1474

pulsus paradoxus arterial hypotension when pericardial P \>10mmHg -\> collapsed atria -\> increased systemic venous pressure -\> reduced ventricular preload -\> decreased CO death due to cardiogenic shock

Question 1475

how does estrogen influence cholesterol synthesis? how does giving a women fibrates for dyslipidemia preciptate the risk of gall stones?

Answer 1475

increases hepatic HMG-CoA reductase activity -\> net increase in cholesterol biosynthesis fibrates can suppress cholesterol 7a-hydroxylase activity, which reduces the conversion of cholesterol to bile acids, thereby resulting in excess cholesterol secretion into bile and subsequent gallstone formation!!

Question 1476

during starvation, 2 substrates required for gluconeogenesis what is an allosteric activator of this process?

Answer 1476

**glycerol** from fat breakdown **glucogenic a.a. + lactate** -\> oxaloacetate + pyruvate allosteric activator of gluconeogenesis: **acetyl-coA** - increases activity of pyruvate carboxylase (B7)

Question 1477

∆ btwn suppression and repression?

Answer 1477

* **suppression** = **voluntary** withholding of unpleasant thoughts or feelings from one's mind * **repression** = **unconscious** removal of disturbing psychologic material from conscious awareness

Question 1478

patient with hypothyroidism (high TSH, low T4 and low T3) is given T3 supplements. how will TSH, T3, rT3, and T4 change? most sensitive test to assess hypothyroidism?

Answer 1478

high TSH, low T4, low T3 indicates inadequate thyroid response to circulating TSH (1˚ hypothyroidism) * **TSH = decrease** (T3 feedsback to inhibit release) * **T3 = increase **(duh) * **rT3 = decrease** (due to inhibited TSH release) * **T4 = decrease **(due to inhibited TSH release) \***_T3 cannot be converted into T4 or rT3; but T4 can be converted into T3 or rT3_**. T3 supplementation will reduce TSH levels and therefore cause decreased secretion of T4 from the thyroid gland, which will also reduce levels of rT3. TEST: **serum TSH **

Question 1479

why would opioid analgesics cause severe abd pain shortly after administration?

Answer 1479

because it causes **contraction of smoot muscles cells** in the sphincter of oddi, leading to constriction and spasm -\> increased CBD pressures -\> **biliary coli**

Question 1480

causes of high Ca, low PTH?

Answer 1480

PTH-independent hypercalcemia (e.g., excess Ca2+ ingestion, cancer)

Question 1481

hyperkinetic pulse

Answer 1481

rapid ejection of a large stroke volume aganist a decreased afterload can occur during **fever** or **exercise** in normal subjects, or in patients with high output conditions (**PDA, AV fistula)**

Question 1482

parotitis, orchitis, aspetic meningitis. genome of pathogen that does this

Answer 1482

mumps paramyxovirus: (-) ssRNA, linear, enveloped

Question 1483

"bag of worms"

Answer 1483

varicocele (pooling of blood into testicles); usually due to upstream compression of the veins that drain the testes by abd. or pelvic masses. ^{L testicle is usually more affected, bc the L renal vein passes between the aorta and the SMA; if there is an enlargement or hardening of the SMA, this may cause compression of the L renal vein, ultimately leading to pooling of blood in the testicle}

Question 1484

cardiac findings in turner syndrome

Answer 1484

coarctation of aorta

Question 1485

organism cultured on charcoal yeast extract w/ cysteine

Answer 1485

legionella pneumophilia outbreaks have been associated w/ contaminated water that is used to humidfy air (in a commercial, residential, or hospital setting)

Question 1486

µ receptors excessive stimulation (ie via opiates) will result in best treatment?

Answer 1486

physical dependence euphoria sedation respiratory + cardiac depression reduced GI motility **naloxone - high affinity for µ opioid receptors; for opiate OD**

Question 1487

"black liver" should make you think of this dx

Answer 1487

Dubin-Johnson * defect in hepatic excretion of bilirubin glucuronides across the canalicular membrane * patients usually have conjugated hyperbuilirubinemia (**direct bilirubin fraction \>50% of total; normal LFT)** * hx: dense pigment composed of **epinephrine metabolites** **within lysosomes** of the liver

Question 1488

2 treatment of Burrelia burgdorferi

Answer 1488

doxycycline Ceftriaxone

Question 1489

ingestion of raw oysters

Answer 1489

Vibrio vulnificus

Question 1490

black pigment stones within the gallbladder is evidence of

Answer 1490

**CHRONIC hemolysis** ^{increased unconjugated bilirbuin precipitates in bile as Ca-bilirubinate} usually associated w/ sickle cell anemia, ß thalassemia, hereditary spherocytosis

Question 1491

purpose of giving heme prep to patients with recurrent abd. pain, anxiety? dx?

Answer 1491

Acute intermittent porphyria can be precipitated by Rx such as phenobarbital, griseofulvin, and phenytoin, OH, or low calorie diet; all of which can be precipitated by increasing ALAS, which decrease the hepatic concentration of heme inhibits the synthesis of ALAS

Question 1492

arthroconidia

Answer 1492

dermatophytes that cause ringworm or tinea

Question 1493

R/L confusion, dysgraphia, dyscalculia, and finger agnosia dx? damage to which hemisphere? part of the brain?

Answer 1493

**Gerstmann Syndrome** damage to **parietal-temporal** lobe of **dominant** (L) hemisphere ^{(note that damage to the R parietal-temporal cortex will result in spatial neglect syndrome - ie agnosia of the contralateral side of the world)}

Question 1494

bone changes consistent w/ Vitamin D deficiency?

Answer 1494

excessive unmineralized osteoid and widened osteoid seams; low bone mineral densities

Question 1495

what is the genome of this?

Answer 1495

CMV - enveloped dsDNA virus see epithelial cell w. intranuclear + cytoplasmic inclusions

Question 1496

bone-specific alkaline phosphatase reflects activity of which cell type?

Answer 1496

osteo**B**lasts

Question 1497

in the late follicular stage, what happens? (be specific in terms of cell type + receptors)

Answer 1497

granulosa cells increase expression of receptors for LH

Question 1498

widow who takes over her husband's voluntary work after he dies

Answer 1498

identification - unconscious adoption of the characteristics or activities of another person (often a mxn for reducing the pain of separation or loss)

Question 1499

where are parietal cells relative to chief cells in the gastric mucosa?

Answer 1499

parietal cells are more superficial to chief cells **parietal cells** - oxyntic pale pink, round pink like cells - secrete HCl and IF **chief cells -** more basophilic, granular - secrete pepsinogen

Question 1500

tzanck smear is used for...

Answer 1500

diagnosing HSV - should see multi-nucleated giant cells

Question 1501

14yoF w/ failure to menstruate. PE: downy hair in armpits and genital area, no breast development. Pelvic E: vagina but no palpable uterus. Genetic studies: 46XY dx?

Answer 1501

Male pseudohermaphrodite most are due to testicular feminization (T is produced but the body fails to respond to it). Patients usually have testes, epididymis, vas deferens, and seminal vesicles and a prostate that remain small in the absence of T stimulation

Question 1502

3yo M w/ spastic paresis of lower extremities and choreoathetoid movements has very high argninine levels in plasma + CSF. Deficient enzyme?

Answer 1502

**∆ Arginase **- urea cycle enzyme that converts arginine -\> urea and ornithine

Question 1503

**bronchiectasis** what is it and what is it associated with?

Answer 1503

chronic necrotizing infection of bronchi -\> permanently **dilated airways, purulent sputum, recurrent infections, hemoptysis** associations: bronchial obstruction, smoking (poor ciliary motility), Kartagener's, CF, ABPA

Question 1504

6mo w/ hypoglycemia, hyperTg, ketoacidosis PE shows: hepatomeagly hx: accumulation of small-chain dextrin-like material within the cytosol dx? mutated enzyme?

Answer 1504

Cori disease - ∆ debranching enzyme

Question 1505

ketoconazole MoA

Answer 1505

weak anti-androgen that decreases production of steroid hormones in gonads and adrenals

Question 1506

chromolyn MoA and use

Answer 1506

bronchial asthma - prevention MoA: inhibit mast cell degranulation other Rx: nedocromil

Question 1507

drug used to stimulate peristalsis in postop ileus side effects?

Answer 1507

bethanechol - cholinergic agonist for - post-op ileus - atonic bladder (non-obstr. urinary retention) ADR: nausea, vomiting, abd. cramps, diarrhea, dyspnea, increased secretions (sweating, lacrimation, salivation)

Question 1508

a rare metabolic dz, if detected early, can be treated effectively and the severe sequelae can be prevented. It is most important for a test to be used in all newborns to have high .. PPV sensitivity specificity

Answer 1508

**sensitivity - **represents the ability of a test to r/o those with the disease impt in screening!! test with high senstivity is one which identifies most patients w/ the disease (ie most sick patients will have a + test result) *(not PPV because it measures the test's ability to correctly identify those with the disease from all those who had (+) test results; depends on disease prevalence)*

Question 1509

56yo w/ hx of gallstones has cramping + mid-ab pain, ab distension + vomiting for 12 hrs. xray reveals air in GB + biliary tree - where is gallstone most likely lodged?

Answer 1509

Ileum gallstone ileus occurs in patients w/ longstanding cholelithliasis, where a large gallstone in the GB causes persistent pressure on the GB wall and results in the formation of a cholecystenteric fistula btwn the GB and adjoining adjoining gut tissue, thereby **1) air from the gut to enter the GB and biliary tree** **2) allowing the gallstone to enter the Gut.** gallstone gets stuck at ileocecal valve **-\> abd pain + distension + vomiting + tenderness, + tinkling bowel sounds**

Question 1510

palpable but non-tender gall bladder + weight loss + jaundice + anorexia + dark urine + pale stool dx si vous plait

Answer 1510

enlarged but non-tender GB = courvoisier sign with the other signs, this points to adenocarcinoma of the head of the pancreas compressing the bile duct

Question 1511

origin of Krukenberg tumor typical cells seen w/ this type of tumor?

Answer 1511

GI, usually the **stomach** ## Footnote **signet ring cells**

Question 1512

HBV antigen that poorly correlates with viral replication

Answer 1512

HBsAg - non-infective envelope glycoproteins that forms spheres

Question 1513

injecting 2L of saline into a pt w/ hypovolemic shock would _increase_ which of the following factors: * TPR * ventricular muscle contraction velocity * end diastolic sarcomere length * HR * Diastolic ventricular compliance

Answer 1513

* **TPR/ventricular contraction velocity** is high in a pt w/ hypovolemic shock due to sympathetic activation to maintain organ perfusion and to shunt blood towards vital organs. Adding 2L of fluids will reduce sympathetic activation and decrease both * **end diastolic sarcomere length** - fluid resuscitation increases preload , which extends the end diastolic sarcomere length in the ventricles, incraesing SV and CO * **HR** will decrease due to fluid resuscitation * **diastolic ventricular compliance** - unaffected (since compliance is affected by things affecting the myocardium itself)

Question 1514

bug that requires cholesterol to grow

Answer 1514

MYCOPLASMA PNEUMONIAE - becasue their cell membrane is composed of cholesterol

Question 1515

gram negative, curved rod grown on alkaline medium

Answer 1515

Vibrio vulnificus

Question 1516

marker produced by malignant ovarian epithelial tumors

Answer 1516

CA-125

Question 1517

why does a 65yo M lose consciousness while buttoning a tight shirt collar?

Answer 1517

external pressure on the **carotid sinus** causes: - \> baroreceptors to react as if there was a systemic BP increase - \> increase inhibitory discharge in response - \> bradycardia, hypotension, syncope

Question 1518

Bony metz = if **osteolytic**, you should think of...

Answer 1518

lung, renal, thyroid cancer

Question 1519

69yoF w/ a past medical hx of MI 3 years ago has SOB + swelling of the legs, generalized weakness, and a S3 heart sound after starting a 3rd anti-hypertensive Rx. What could this agent be?

Answer 1519

patient likely has CHF, which is a complication of both her past MI and **verapamil**, a Ca blocker w/ strong negative ionotropic effects that has been associated w/ an accelerated progression/exacerbation of heart failure in certain patients

Question 1520

trmt for acute asthma exacerbations

Answer 1520

ß adrenergic agonists - stimulate ß2 receptors (Gs) -\> activates adenylyl cyclase -\> incr. intracellular cAMP

Question 1521

What does this represent? (choose one) Increase preload Increase afterload Systolic dysfunction Increased ejection Fraction Normal Saline Infusion

Answer 1521

Increased ejection fraction

Question 1522

va

Question 1523

3 month old boy with delayed motor development. 9 months later develops spasticity and writhing movements and exhibits compulsive biting of fingers and lips and constantly bangs his head. teens - develops arthritis and renal failure

Answer 1523

Lesch Nyhan syndrome - increased monosodium urate

Question 1524

endotoxin

Answer 1524

LPS

Question 1525

IM injection into the buttocks result in weak knee flexion, weak foot movements, difficulty in foot inversion and weak plantar flexion . where was the injection done and what causes these sx?

Answer 1525

**sciatic n. injury** Injection was probably done in the _inferior-medial quadrant_ of the gluteal region, which caused damage to the **sciatic n.** All injections are usually done in the superolateral quadrant to avoid this

Question 1526

myotonia definition

Answer 1526

abnormally slow relaxation of muscles (or sustained muscle contraction)

Question 1527

recent oliguria + high serum creatinine + intranasal ulcer that failed to heal Dx? Labs?

Answer 1527

dx**: Wegener's, c-ANCA (neutrophil proteinase 3)** nasal mucosal ulcerations, sinusitis, hemoptysis + glomerulonephritis

Question 1528

how do differentiate between PIGN and pyelonephritis?

Answer 1528

* PIGN * enlarged glomeruli w/ infiltrating leukocytes * tubular infiltration w/ inflammatory cells is **NOT** seen * pyelonephritis * interstitial + tubular lumen infiltration by PMNs * tubular epithelial disruption may be seen * microabscesses in the interstitium may be seen * WBC casts

Question 1529

when do glycogen stores become depleted? (ie at what point does the switch from glycogenolysis -\> gluconeogenesis occurs?)

Answer 1529

after 12-18hrs of fasting

Question 1530

patient with a hct of 64% and platelets genetic mutation associated with this?

Answer 1530

**Jak2** - mutation - a non-receptor tyrosine kinase (meaning it's an cytoplasmic kinase) ## Footnote **polycythemia vera **

Question 1531

CN 9 and CN 10 carry afferent information from...

Answer 1531

CN 9 = carotid sinus CN 10 = aortic arch baroreceptors firing rate of these neurons increases with increasing BP

Question 1532

hepatosplenomeagly + retinal pallor sparing of the macula in the L eye. Enzyme?

Answer 1532

Niemann Pick Disease ∆ lysosomal **Sphingomyelinase** in histiocytes "NPS = National Park Service"

Question 1533

LDH inhibited in strenuously exercising muscle would eventually lead to an inhibition of glycolysis due to an intracellular depletion of..

Answer 1533

**NAD+** present in limited amts in most cells; must be regenerated from NADH for glycolysis to continue (so that G3P DH can convert G3P -\> 1,3-BPG via NAD+ -\> NADH) Anaerobic glycolysis: NAD+ is regenerated via LDH conversion of pyruvate -\> lactate

Question 1534

M w/ hx of ulcerative colitis that presents w/ fatigue + high alkaline phosphatase

Answer 1534

**primary sclerosing cholangitis** unknown cause of "onion skin" bile duct fibrosis -\> alternating strictures and dilation w/ beading of intra- and extra-hepatic bile ducts hypergammaglobulinemia (IgM) can lead to 2˚ biliary cirrhosis and cholangiocaricinoma

Question 1535

role of bcr-abl present in what disease

Answer 1535

fusion protein that inhibits apoptosis while promoting mitogenesis and increased TK activity CML

Question 1536

Which one corresponds to this graph? Acute GI bleed Pyschogenic polydipsia Diabetes insipidus Hypertonic saline infusion

Answer 1536

**Diabetes Insipidus -** see hyperosmotic volume contraction when the loss of free H2O exceeds the loss of electrolytes, resulting in increased osmolarity, decreased volumes in ICF and ECF similar graphs with profuse sweating (due to hypotonic nature of sweat)

Question 1537

macroorchidism, law jaw, mental retardation

Answer 1537

Fragile X | (X-linked)

Question 1538

surgical removal of a R ovarian mass - involves ligation of what structure? what must you be careful of?

Answer 1538

**suspensory ligament of the ovary (aka infundibulopelvic ligament)** - carries the nerves/blood vessels that supply the ovary be careful not to ligate the **ureter**!! (otherwise can lead to hydronephrosis....bad)

Question 1539

ethambutol MoA? clinical use? ADR? how does resistance to ethambutol develop?

Answer 1539

clincal use: **TB** MoA: inhibits synthesis of the **CELL WALL** *(ie polymerization of the carbohydrates, NOT the mycolic acid synthesis)* side effect: **optic neuritis** *(use an ethane-butane torch to my eye)* Resistance: increased production/activity of **arabinosyl transferase (**involved in cell wall synthesis) (remember that ethambutol intereferes specifically w/ mycobacterial peptidoglycan cell wall synthesis via an unknown mxn that appears to differ from that of isoniazid)

Question 1540

important cytokine mediator of sepsis

Answer 1540

**TNFa**

Question 1541

how do these factors change with Vit K deficiency? Platelet Count Bleeding time PT PTT

Answer 1541

Platelet Count = NC Bleeding time = NC PT = increase PTT = increase ristocetin = abnormal

Question 1542

RBC - why is Cl levels much lower in arterial blood than in venous blood?

Answer 1542

cause in venous blood, CO diffuses into RBC -\> converted to carbonic acid -\> spontaneous conversion to HCO3- and H+. As the bicarb diffuses out of the RBC into the plasma, Cl diffuses **into** the cell to maintain electroneutrality "chloride shift"

Question 1543

myocardial biopsy is indicative of

Answer 1543

recent bacterial infection - see "**interstitial granuomas**" - presence of **anitschkow cells** (plump, red macrophages) + **aschoff giant cells** (multinucleated cells) surrounded by fibrosis in the interstitium usually due to acute rheumatic fever

Question 1544

N-acetylcysteine (NAC) - when is it used?

Answer 1544

* **acetaminophen OD** - enhances glutathione production and conjugation of toxic NAPQI metabolite * **mucolytic agent** (CF, bronchitis, influenza) * **radiocontrast-induced nephropathy**

Question 1545

dicrotic pulse

Answer 1545

pulse w/ two distinct peaks - one during systole, other during diastole. best palpated at the carotid arteries typically occurs in patients w/ severe systolic dysfunction

Question 1546

cabergoline

Answer 1546

dopamine agonist to treat prolactinoma

Question 1547

how does resistance to nafcillin develop? (ie MRSA)

Answer 1547

alterations in **penicillin binding proteins (PBP)** ^{(NOT due to ß lactamases because these semi-synthetic drugs have more complex (bulky) side chains and therefore prevent access of ß lactamases to the ß lactam ring)} other semi-synthetics**: dicloxacillin, oxacillin, methicillin**

Question 1548

what is somatomedin C

Answer 1548

**= IGF-1**; serves to stimulate cell growth and multiplication

Question 1549

ADR of thiazides

Answer 1549

HYPER-**CLUG** * **hyperuricemia** -\> gouty arthritis * **hypercalcemia** -\> *good for treating nephrolithiasis secondary to hypercalcicuria* * **hyperglycemia ** * **hyperlipidemia** (cholesterol + LDL) HYPO-**NMTK** * **hypokalemia/hypomagnesemia** * **hyponatremia** * **hypotension** ((via decreasing blood volume and PVR)

Question 1550

Gag reflex involves which two nerves? if the L afferent is defective, what will happen if you stimulate that side? the opposite side? if the L efferent is defective, what will happen if you stimulate that side? the opposite side?

Answer 1550

afferent: CN 9 efferent: CN 10 * L **afferent** is defective: * stimulate ispilateral side --\> no gag, no uvula response - logical cause no signals are going through * stimulate opposite side --\> gag w/o uvula deviation * L **efferent** is defective: * stimulate ispilateral side --\> uvula deviates ***away*** from lesion * stimulate opposite side --\> uvula deviates ***away*** from lesion

Question 1551

case-control study

Answer 1551

compares group of ppl w. and w.o disease to LOOK FOR PRIOR EXPOSURE or RISK FACTOR use **O**dds **R**atio

Question 1552

sx of L sided CHF

Answer 1552

dyspnea on exertion orthopnea PND (waking from sleep gasping for air)

Question 1553

why do patients have low-intracellular K and normal-high extracellular K levels?

Answer 1553

because they lose significant amts of K in the urine, primarily through * glycosuria-induced osmotic diuresis * hypovolemia-mediated increase in aldosterone secretion

Question 1554

patient w/ paroxysmal supraventricular tachycardia can be treated with what manual manuevers and why?

Answer 1554

1. Valsalva manuever 2. carotid massage both **increase vagal tone** to **increase the refractory period** in the AV node to **prevent a reentrant circuit from conducting.**

Question 1555

ab with valence of 10

Answer 1555

IgM

Question 1556

how do these factors change with DIC? FDP fibrinogen PT PTT platelet count Total bleeding time smear

Answer 1556

FDP = increase (also known as D-dimer) fibrinogen = decrease PT = prolonged PTT = prolonged plaetlet count = decrease Total bleeding time = increase smear: RBC fragmentation

Question 1557

this a.a. is a precursor for epinephrine, norepinephrine, and melanin

Answer 1557

tyrosine

Question 1558

otitis media pathogens otitis externa pathogens

Answer 1558

media = strep pneumo, h. influenza, moraxella externa = pseudomonas (esp. in diabetics)

Question 1559

best anticoagulant for DVTs? what if the patient is pregnant?

Answer 1559

warfarin pregnant? heparin

Question 1560

46 M that does not seem to care about his family anymore and smoetimes becomes aggressive. Also have periodic jerky momvents of his arms.

Answer 1560

Hungtington - loss of GABA-containing neurons - bilateral atrophy of the caudate + putamen ( = striatum)

Question 1561

how many half-lives does it take for a drug to reach steady state concentration?

Answer 1561

4-5 half-lives

Question 1562

patients w/ evidence of prolonged cholestasis (pale grey stool, bile deposition within the hepatic parenchyma, presence of green-brown plugs in teh dilated bile canaliculi) will usually suffer from...

Answer 1562

intestinal fat malabsorption + nutritional deficiencies (esp. D, E, A, K) due to reduction in bile flow osteomalacia (usually due to Vit. D deficiency)

Question 1563

viral protein p24 and p7 viral protein p120 and gp41

Answer 1563

HIV **gag** (p24, p7) = nucleoside capsid proteins **env** (gp120, gp41) = envelope proteins

Question 1564

apoptotic cell histology

Answer 1564

cytoplasmic blebbing + nuclear blabbing

Question 1565

examples of k-sparing diuretics?

Answer 1565

**S**pironolactone **E**plerone **A**miloride **T**riamterene

Question 1566

torticollis (acute dystonic reaction) is likely due to: treatment?

Answer 1566

**high potency** antipsychotic Rx (**haliperidol, fluphenazine)** use - ***inhibition of Dopaminergic D₂ Receptors*** inhibition effects of D2 neurons _are_ balanced by the excitatory cholinergic M1 neurons, therefore blockade of dopaminergic neurons result in unopposed cholinergic stimulation, resulting in extrapyramidal ADR *(torticollis, akathisia, parkinsonism)* (therefore M₁ receptor antagonists - diphenhydramine, benztropine) re-establish dopaminergic-cholinergic balance and are effective remedies for acute extrapyramidal symptoms)

Question 1567

morphine mOA

Answer 1567

binds to µ receptors that cause GPCR activation of K channels to increase **K efflux** --\> hyperpolarization of post-synaptic neurons and termination of pain transmission

Question 1568

Why do patients w/ sarciodsis have elevated Ca levels?

Answer 1568

in patients w/ granulomatous d/o (ie sarcoidosis or NHL), the activated T cells secrete IFNg, which **increases the activity of 1-alpha hydroxylase in macrophages**, thus resulting in an inappropriate elevation of 1,25-dihydroxy Vitamin D; the rest is history...

Question 1569

when does secondary erythrocytosis due to hypoxia usually occur?

Answer 1569

when SaO2

Question 1570

acute viral hepatitis is characterized by 3 histological features

Answer 1570

1) diffuse ballooning degeneration (hepatocyte swelling) 2) Councilman bodies (eosinophilic apoptotic hepatocytes) 3) mononuclear cell infiltrates

Question 1571

name the 3 walls of the orbit which ones are the weakest ones (ie the ones that are most likely to fracture w/ blunt trauma0

Answer 1571

superior wall: thick orbital plate of frontal bone **inferior wall: thin bone separating the orbit from maxillary sinus** lateral wall: thick bone of zygoma + sphenoid **medial wall: thin ethmoid + lacrimal**

Question 1572

congenital QT prolongation causes these 2 things

Answer 1572

sudden death neurosensory deafness

Question 1573

what kind of withdrawal: flashbacks

Answer 1573

hallucinogenic - can occur later in life even when no additional Rx has been taken

Question 1574

37yo F w/ abd. discomfort has a uniformly enlarged uterus + normal appearing endometrial glands

Answer 1574

**ad**enomyosis - presence of endometrial glandular tissue within the myometrium; sx: menorrhagia and dysmenorrhea "size is **ad**ded to the uterus"

Question 1575

in what diseases would you see an elevated ßhCG? (3)

Answer 1575

hydatidiform moles choriocarcinomas gestational trophoblastic tumor

Question 1576

oval-to-round intracytoplasmic hepatocyte inclusions that appear eosinophilic on H&E should make you think of this d/o

Answer 1576

A1AT deficiency

Question 1577

What is biliary sludge? What causes it? Who is at greatest risk of this?

Answer 1577

mixture of particulate solids that have preciptated from bile; usually caused by gallbladder hypomotility (ie slow/incomplete response to CCK) at risk: pregnancy, rapid weight loss, **octreotide (somatostation analog)**, high spinal cord injuries

Question 1578

Causes of low Ca, high PTH?

Answer 1578

2˚ hyperparathyroidism (vitamin D deficiency, chronic renal failure)

Question 1579

how does the liver take up and secrete bilirubin?

Answer 1579

take up: organic anion transporting polypeptide (OATP) secretes: MRP2 (an **ATP**-dependent organic anion transporter)

Question 1580

Role of Golgi-tendon organs?

Answer 1580

**Golgi-tendon organs (GTO)** - receptors at the junction of muscle + tendon; innervated by sensory axons (Grp Ib) GTOs are activated when a muscle actively contracts against resistance, results in stimulation of inhibitory interneurons in the spinal cord, which _inhibit_ contraction of the m. -\> results in sudden muscle relaxation ***(prevents damage to musculoskeletal system, esp when a muscle exerts too much force)***

Question 1581

test used to dx confirm cystinuria

Answer 1581

sodium-nitroprusside test (+)

Question 1582

H band of the sarcomere contains\_\_\_\_\_\_\_\_ while the A band corresponds to \_\_\_\_\_\_\_\_

Answer 1582

H band of the sarcomere contains **only myosin thick filaments** while the A band corresponds to** length of the whole myosin filament (including those overlapped by thin actin filaments)**

Question 1583

SIADH treatment

Answer 1583

fluid restriction IV hypertonic saline vaptans demeclocycline (ADH antagonist)

Question 1584

general antipsychotic effects on prolactin

Answer 1584

dopamine antagonist -\> galactorrhea

Question 1585

why are oral hypoglycemic Rx generally avoided in gestational diabetes mellitus (GDM)

Answer 1585

risk of fetal hyperinsulinemia and hypoglycemia

Question 1586

Bosentan MoA and clinical use

Answer 1586

competitive antagonist of **endothelin receptors -\> vasodilation -\>** decrease pulmonary arterial pressure (thereby lessening risk of RHF) clinical use: 1˚ (idiopathic) pumonary arterial HTN

Question 1587

giving patients gangciclovir + zidovudine is likely to preciptate what?

Answer 1587

**neutropenia and anemia** Ganciclovir = neutropenia, anemia, thrombocytopenia, impaired renal function zidovudine = bone marrow suppression (anemia, granulocytopenia)

Question 1588

**complex partial seizure** description (consciousness, postictal state)? first line treatment?

Answer 1588

almost always originates from the **temporal lobe** (mood ∆, illusions, hallucinations); _impaired consciousness + post-ictal state_ carbamazepine

Question 1589

PDA originates from which embryonic aortic arch? carotid arteries? subclavian arteries

Answer 1589

PDA: 6th (also the pulmonary arteries) carotid arteries: 3rd subclavian arteries: 4th

Question 1590

posterior stimulation of the external auditory meatus results in syncope. why?

Answer 1590

vagal stimulation --\> decreased HR and BP --\> faint

Question 1591

bone marrow that shows this is indicative of

Answer 1591

**aplastic anemia -** BM is devoid of hematopoietic elements and is filled with fat, fibrous stroma, and scattered clusters of lymphocytes and palsma cells that replace the normal tissue.

Question 1592

name this please

Answer 1592

mucormycosis - broad, non-septate hypahe that branch at right angles (90˚)

Question 1593

papillary necrosis of the kidneys can be due to these 5 things histologically, what does it look like?

Answer 1593

sickle cell anemia phenacetin (analgesic) pyelonephritis (acute) urinary tract obstruction diabetes **SPPUD** hx: coagulative infarct necrosis w/ preserved tubule outlines

Question 1594

recurrent nephrolithiasis in a young patient should alert the doc of...

Answer 1594

**Cystinuria** - defect in the PCT, which causes decreased reabsorption of COLA; though only the cystine precipitates into hexagonal stones (pathognomonic for this dz) diagnose w/ **Na (cyanide) nitroprusside solution**, which turns purple

Question 1595

patients with what type of d/o tend to have hypercalcemia and hypercalciuria?

Answer 1595

granulomatous d/o sarcoidosis tuberculosis hodgkins non-hodgkins

Question 1596

what nodes do the bladder drain into?

Answer 1596

superior portion = external iliac nodes **i**nferior portion = **i**nternal iliac nodes

Question 1597

disease prevalence affects what epidemilogical parameter?

Answer 1597

PPV

Question 1598

patient with persistent foot drop after prolonged compression of which nerve

Answer 1598

**common peroneal n*.*** ^{lateral br. of sciatic n.; splits into the deep + superficial n. deep -> extensor + great dorsiflexors (inability to dorsiflex the foot = foot drop) superficial -> peroneal muscles + skin of most of the toes}

Question 1599

How does 15 minutes/day in the sun help with Vitamin D metabolism?

Answer 1599

It promotes conversion of: **provitamin D3 (7-dehydrocholesterol) --\> vitamin D3 (cholecalciferol)** the latter gets shunted to the liver, where 25-hydroxylation occurs, and then to the kidneys, where alpha-hydroxylation catalyzes the second hydroxylation step to make active **1,25 OH Vitamin D3**

Question 1600

Which one corresponds to this graph? Acute GI bleed Pyschogenic polydipsia Diabetes insipidus Hypertonic saline infusion

Answer 1600

psychogenic polydipsia - causes ECF+ICF expansion and a decreased osmolarity of both (hypo-osmotic volume expansion of both ICF, ECF)

Question 1601

before starting Rx w/ alendronate, what must you caution the patient?

Answer 1601

bisphophonates - alen**dronate**, rise**dronate**, iban**dronate** makes hydroxyapatite more insoluble; decrease bone resorption by interfering w/ osteoclasts function \***patients must stay upright for at least 30 minutes to prevent reflux because these agents can cause stomach/esophageal inflammation + erosions\***

Question 1602

most common cause of fetal hydronephorsis?

Answer 1602

ureteropelvic junction (btwn kidney and ureter) - failure to recanalize

Question 1603

match afferents carotid sinus CN9 aortic arch baroreceptors CN10

Answer 1603

* **carotid sinus - CN 9**/glossopharyngeal * **aortic arch - CN 10**/vagus

Question 1604

How does TNFa decrease glucose uptake by cells?

Answer 1604

**TNFa** - proinflammatory cytokine that induces insulin resistance via **activation of serine kinases**, which result in phosphorylation of * **IRS-1 serine residues**, thereby preventing IRS-1 interaction with the insulin receptor * **ß subunit of insulin receptors**, thereby hindering downstream signaling catecholamines, glucocorticoids, and glucagon also induce insulin resistance by this mechanism.

Question 1605

Rx that are selective vasodilators of coronary arterioles

Answer 1605

adenosine + dipyridamole

Question 1606

abduct arms to 90˚, flex them to 30˚, thumbs down, and apply downward on warms force to elicit pain and weakness What muscle is this manuever called and what is it testing?

Answer 1606

supraspinatus m. - tendon is vulnerable to injury due to its positioning btwn the acromion and head of humerus this is called the **"empty-can supraspinatus test"**

Question 1607

TdT (+), CD1, CD2, CD5

Answer 1607

ALL - precursor T cell leukemia

Question 1608

urea's nitrogen is derived from what?

Answer 1608

NH3 + aspartate

Question 1609

what vitamin should not be taken by those on levodopa therapy?

Answer 1609

B6 - it increases the peripheral metabolism of levodopa and decreases its effectiveness

Question 1610

meckel's diverticulum is a remnant of what?

Answer 1610

omphalomesenteric /vitelline duct 2 ft from ileocecal valve, 2", males are 2x more likely to be affected

Question 1611

doxazosin MoA clinical use

Answer 1611

**a1 blocker **- smooth muscle relaxation ^{same as prazosin, terazosin} leads to * decreased PVR -\> can lead to orthostatic hypotension/vertigo (can cause first-dose effect; therefore should start with a small first dose) * decreased urinary obstruction caused by BPH clinical use: HTN + BPH

Question 1612

Zidouvine (AZT), Zalcitabine MoA, ADR

Answer 1612

**NRTI** - must be converted to its monophosphate form by cellular thymidine kinase before it can be converted into a pharmacologically active triphoshate form AZT MoA: **RT transcriptase inhibitor -** competitively binds to RT and is incorporated into the viral genome as a thymidine analog, has an **3' "azido" group** (instead of the usual 3'OH group), thereby blocking 3'-5' phosphodiesterase bond formation and ultimately DNA chain elongation AZT ADR: **bone marrow toxicity + anemia**

Question 1613

vaginal Rx that contains **prostaglandin** **E2** induce cervical softening

Answer 1613

Dinoprostone (prostaglandin **E2)** do not confuse with * **M**isoprostol (Prostglandin **E1**) * **A**lprosta dil (prostaglandin **E1**), a vasodilator used to treat erectile dysfunction * **L**atanoprost (prostaglandin **F2a**) - for glaucoma * **E**poprostenol (prostaglandin **I2**) - trmt for pulmonary HTN

Question 1614

patient undergoes surgery for open cholecystectomy but 2 days later, she develops sudden nausea, fatigue, and anorexia and is slightly icteric. She worsens acutely and dies 3 d later. What happened? What labs do you expect?

Answer 1614

key \*buzz\* words = surgery patient presents w/ HSR drug reaction (likely **HALOTHANE**), and is presenting of signs of hepatotoxicity, where the liver rapidly atrophies and has widespread CENTRI-lobular hepatocellular necrosis and inflammation of the portal tracts and parenchyma labs of liver failure: markedly elevated AST/ALT, prolonged PT, leukocytosis, eosinophilia

Question 1615

unilateral renal artery stenosis is usually due to...

Answer 1615

atherosclerotic changes in the arterial intima fibromuscular dysplasia

Question 1616

causes of high PTH, high Ca?

Answer 1616

1˚ hyperparathyroidism (hyperplasia, adenoma, carcinoma)

Question 1617

where is bile/ B12 absorbed?

Answer 1617

ileum

Question 1618

when are rank receptors overexpressed?

Answer 1618

HYPO-estrogenic states - causes increased bone resorption due to increased osteoclastic activity low estrogen = low bone mass

Question 1619

ß blockers affect which part of the EKG?

Answer 1619

ß blockers slow AV conduction -\> prolonged PR interval (p to beginning of q)

Question 1620

what innervates the parotid gland?

Answer 1620

CN 9

Question 1621

lungs - small cell carcinoma stains + for what IHC marker

Answer 1621

these cells secrete **ACTH, ADH**, and **antibodies against presynaptic Ca channels (LES)** **chromogranin** and **synaptophysin** neuroendocrine marker hx: **kulchitsky cells** (small dark blue cells) ^{Note: bronchial carcinoid lung tumor is  also + for chromogranin (neuroendocrine tumor)}

Question 1622

**Statins** Clinical Use MoA ADR What increases ADR?

Answer 1622

* Clinical use: **Hyper-LDL – 1st line** * MoA: Inhibit HMG CoA reductase (hepatocytes respond by **increasing LDL-R** to increase uptake of circulating LDL) * ADR: **Myositis** (increase CK), **Hepatitis** * increased risk of myopathy w/ concomitant use of **fibrates or niacin**, since fibrates increase the concentrations of most statins

Question 1623

indicator of severity in mitral stenosis

Answer 1623

**S2-to-opening snap interval** - the shorter the interval, the more severe the stenosis

Question 1624

ø hx of major medical illness but develops heavy menstrual periods + mucosal petectiae + non-palpable ecchymoses in legs from trauma. Labs show decreased platelets. Smear shows normal cell morphology in other lines and few large young platelets

Answer 1624

think ITP - anti-platelet antibodies does NOT cause splenomeagly

Question 1625

non-septate hyphae should make you think of...

Answer 1625

Mucor + Rhizopus species - both cause mucormycosis in immunosuppressed patients branches at 90˚ (compared to aspergillus, which branches at 45˚)

Question 1626

type of necrosis that happens in the brain? all other tissues?

Answer 1626

brain: liquefactive other: coagulative

Question 1627

patient's w/ paroxysmal episodes of breathlessnes + wheezing has suptum that shows many "granule containing cells and crystalloid masses" - what cytokine is involved?

Answer 1627

eosinophilic bronchitis eosinophils + charcot-leyden crystals infiltrates are due to IL-5 secreted by Th2 cells

Question 1628

SPINK1 mutation results in...?

Answer 1628

hereditary pancreatitis SPINK1 prevents trypsinogen from being prematurely activated in the pancreas

Question 1629

distal ileum winding down a thin vascular stalk "apple core peel" due to

Answer 1629

vascular occlusion - diminished intestinal perfusion leads to ischemia of bowel + subsequent narrowing of lumen

Question 1630

torticollis (twisting of neck) - cause and treatment

Answer 1630

acute dystonic reaction - usually occurs within 5d of taking a new antipsychotic Rx (**D2 receptor antagonist** - haloperidol, fluphenazine) trmt: benztropine (anti-muscarinic)

Question 1631

elderly patients presenting with chronic anemia w/o any identifiable underlying cause (ie they eat a balanced diet, they have no relevant surgical history)

Answer 1631

assume B12 deficiency, since elderly patients may have poor absoprtion secondary to gastric atrophy, causing achlorhydria and decreased release of B12 from food proteins. Other potential causes: Pernicious anemia, terminal ileal disease (IBD, ileal resection, etc)

Question 1632

62yo w/ uterine bleeding and L solid, ovarian mass has an endometrial bx that shows marked endometrial hyperplasia

Answer 1632

granulosa cell tumor (how we can figure out that is beyond my knowledge, perhaps age + solid tumor??)

Question 1633

Maraviroc

Answer 1633

**CCR5 receptor inhibitor** - prevents HIV from binding to the host cell

Question 1634

how does serum Mg affect PTH

Answer 1634

low levels of Mg stimulate PTH secretion very low levels of Mg inhibit PTH secretion

Question 1635

role of BRCA

Answer 1635

tumor suppressor gene; encodes a protein that acts to control the cell cycle and play a role in gene repair and transcription.

Question 1636

warfarin affects PT or PTT? Heparin affects PT or PTT?

Answer 1636

warfarin = PT Heparin = PTT *remember that Audrey **Hep**burn **HITs** on Brad **PiTT***

Question 1637

naloxone has the greatest affinity for what type of receptors? clinical use?

Answer 1637

antagonizes **µ opioid** receptors opioid OD - competes w/ narcotics and displaces them from the opioid receptors

Question 1638

case series

Answer 1638

observational study that uses a group (all with the disease) and does NOT include control

Question 1639

drugs used to treat BPH

Answer 1639

alpha blockers - terazosin, doxazosin, tamulosin alpha-reductase inhibitors - finasteride

Question 1640

what kind of withdrawal: depression, hypersomnolence, fatigue, increased appetite over several days, and nightmares

Answer 1640

cocaine

Question 1641

Foscarnet MoA clinical use, ADR

Answer 1641

**pyrophosphate analog** that is commonly used to **treat HIV patients** w/ acyclovir-resistant herpesvirus or gangciclovir-resistant CMV infections does _NOT_ require cellular or viral activation, but it inhibits DNA polymerase _and_ reverse transcriptase in HIV ADR: **nephrotoxicity**, reduce PTH secretion, electrolyte ∆ **(hypo-Ca, Mg, K)**, which can cause **generalized seizures**

Question 1642

how do you tell based on measuring pressure differences that a patient has mitral stenosis?

Answer 1642

normally, the PWP (measure of LAP) is equal to the LV-EDP. A pressure gradient of \>25mmHg across the mitral valve is a clear indication of stenosis

Question 1643

metroprolol effects

Answer 1643

ß1 selective - activates ß1 receptors on - heart -\> decr. HR - JG cells -\> decr. renin

Question 1644

diuretics that cause hyperuricemia?

Answer 1644

loop diuretics and HCTZ

Question 1645

complication of hydatidiform mole

Answer 1645

**choriocarcinoma** - abnormal proliferation of trophoblastic tissue - 2% risk of development

Question 1646

pt w/ anemia, bone marrow biopsy that shows ø erythroid precursors but preserved myeloid + megakaryocytic elements dx? associations?

Answer 1646

**pure red cell aplasia** - due to inhibition of erythropoietic precursors and progenitors by IgG autoantibodies or cytotoxic T cells (associated w/ **thymomas + lymphocytic leukemia)**

Question 1647

patient with this kind of bone marrow is at risk of what?

Answer 1647

multiple myeloma - pt is at risk of * amyloidsois due to AL amyloid * anemia (due to bone marrow infilration) * bone resorption (lytic leions) w/ resultant osteopenia * hypercalcemia * increased suceptibility to infection * renal failure

Question 1648

28 yo F who is 28 wks pregnant develops a flu-like illnes w/ fever, HA, and myalgias. Several days later, she has a spontaneous aborption that shows severe amnionitis. Most likely cause: handling cats eating soft cheese rat bite STD Tick bite

Answer 1648

eating soft cheese - Listeria monocytogenes trmt: ampicillin or TMP/SMX in patients w/ penicillin allergy

Question 1649

hypospadias is due to

Answer 1649

incomplete closure of the **urethral folds**, resulting in urethral opening that is located on the ventral surface of the penis

Question 1650

pathologic process of sheehan syndrome? why does this occur?

Answer 1650

**ISCHEMIC NECROSIS** of the pituitary. high Estrogen levels during pregnancy stimulates growth of the pituitary, causing it to enlarge and become more vascular. If significant hypotension occurs (ie after giving birth) while the pituitary is still enlarged, **Sheehan syndrome** can result. do not confuse w/ pituitary apoplexy - hemorrage into a preexisting adenoma

Question 1651

5yo M treated for allergic rhinitis has flushed cheeks and dilated pupils. What was he treated with?

Answer 1651

**H1 receptor antagonists **- binds to receptors on the vascular endothelium and bronchial smooth muscle, where it helps to mediate vascular permeability and bronchoconstriction note that this class **_also_ has anti-cholinergic effects** (ie antagnoist of muscarinic receptors inhibition of eccrine sweat glands -\> fever inhibition of pupillary constrictor + ciliary muscles -\> pupil dilation

Question 1652

sx of R sided CHF

Answer 1652

lower extremity edema hepatomeagly commonly due to LHF

Question 1653

increased total bilirubin + LDH + decreased haptoglobin after TMP-SMX. Smear shows RBC w/ inclusions. What are these inclusions?

Answer 1653

acute hemolysis, likely related to sulfonamide ingestion. inclusions: oxidized and denatured hemoglobin "Heinz bodies', indicates G6PD deficiency, in which hemolysis occurs following exposure to oxidants or infections

Question 1654

Type I HSR - cytokine involved

Answer 1654

IL4 (produced by TH2) induced isotype switching in B cells

Question 1655

Patient comes in complaining of a sensory deficit (green). What is the nerve injury and accompanying motor deficits?

Answer 1655

**Common Peroneal (L4-S2)** ∆ foot eversion, dorsiflexion, toe extension ( superficial peroneal n. provides sensory innervation to the majority of the foot; deep peroneal n. provides sensory innervation only to the region btwn the 1st and 2nd digits of the foot)

Question 1656

name this please

Answer 1656

candida albicans - budding yeast with pseudohyphae "germ tubes"

Question 1657

most important prognostic factor in breast cancers

Answer 1657

axially LN involvement (indicates metz)

Question 1658

54yo smoker w/ recent weight gain despite no changes to his diet/exercise reports bruses + darker skin + epigastric pain. CXR shows mass in R lung field. Dx? what is responsible for his sx?

Answer 1658

small cell carcinoma - produces ACTH + vasopressin excess ACTH * excess cortisol production (Cushing syndrome) * melanotropin receptors activation (a-MSH homology) -\> skin hyperpigmentation

Question 1659

why is it that an Rx of a specific dose is subtherapeutic w/ oral ingestion therapeutic w/ rectal administration ?

Answer 1659

because oral bioavailability of an Rx depends on the **absorptive properties** of the Rx as well as the **first pass metabolism** ^{(hepatic metabolism after gaining access to the systemic circulation from the GI tract)}

Question 1660

brain histology - what does this patient have?

Answer 1660

Pick disease - note the circular cytoplasmic inclusions of the microtubule associated protein tau)

Question 1661

labetalol

Answer 1661

non-selective ß blocker that also has alpha1-recepter blocking effects; both contractility and SVR would decrease

Question 1662

how does a direct inguinal hernia occur?

Answer 1662

buldges through **hesselbach's ∆,** due to weakness in **transversalis fascia**, and out the superficial inguinal ring (**medial** to inferior epigastric vessels, **above** the inguinal ligament **lateral** to rectus abdominis m.); do _not_ protrude into the scrotum common in older men

Question 1663

What part of the spinal cord are we in?

Answer 1663

cervical

Question 1664

What part of the spinal cord are we in?

Answer 1664

thoracic

Question 1665

What part of the spinal cord are we in?

Answer 1665

lumbar

Question 1666

What part of the spinal cord are we in?

Answer 1666

sacral

Question 1667

What part of the spinal cord are we in?

Answer 1667

cervical

Question 1668

8 yo M presents w/ recurrent multiple respiratory + skin infections. PE shows light skin with silvery hair, photophobia, nystagmus labs show pancytopenia and increased PTT dx and pathophysiology of the defect?

Answer 1668

**Chediak-Higashi Syndrome** **∆LYST** - defect in lysosomal trafficking and phagosome-lysosome fusion; also causes abnormal melanin storage in melanocytes leads to recurrent pyogenic infections (Staph + Strep)

Question 1669

middle ear cavity, eustachian tube, mastoid air cells derives from what embryological orign?[Add](https://www.brainscape.com/decks/2224175/cards/new)

Answer 1669

1st **pouch**

Question 1670

epithelial lining of palatine tonsil derives from what embryological origin?

Answer 1670

2nd **pouch**

Question 1671

in what situations can the equilibration of O2 and CO2 becomes perfusion limited? what does this mean anyway?

Answer 1671

**perfusion-limited gas** = rate of alveolar capillary perfusion determines the speed with which the alveolar air equilibrates with venous blood gases ex; pulmonary embolism (results in tracheal pO2 _~_ alveolar pO2)

Question 1672

in what situations can the equilibration of O2 and CO2 becomes diffusion limited? what does this mean anyway?

Answer 1672

**diffusion-limited gas** = alveolar gas does not equilibrate with the blood gas by the time that a given volume of blood reaches teh end of the alveolar capillary. ex; emphysema, pulmonary fibrosis, exercise

Question 1673

why do patients with silicosis have higher rates of TB infection?

Answer 1673

macrophages ingest the inhaled silica particles, which then affect the macrophage's phagolysosomes by causing it to release both the silica particles and mycobacteria macrophage autolysis -\> release of lysosomal enzymes contributes to alveolar + interstitial lung injury.

Question 1674

how do you calculate the absolute rate reduction?

Answer 1674

ARR = Event Rate_control - Event Rate_treatment Event Rate (%) = # events/ total # arm subjects

Question 1675

which one is more important to have in a screening test? sensistivity? specificity? PPV? NPV?

Answer 1675

high sensitivity = want to make sure the test will identify the most patients with the disease

Question 1676

high serum alkaline phosphatase in a patient w/ Paget's disease of the bone is mediated by which cell type? these patients are at increased risk of? 2

Answer 1676

osteo**C**last = high **AP** **osteosarcoma + fractures ** **CAP OF Paget's**

Question 1677

virluence factor of E. coli that invades the blood stream? uropathogenic strains or diarrhoegenic E. coli?

Answer 1677

* blood stream: **K1 capsule** - inhibits complement, phagocytosis, etc. * uropathogenic/diarrheogenic: **pili**

Question 1678

Verotoxin?

Answer 1678

shiga-like toxin that is made by EHEC

Question 1679

how does lipid A cause septic shock?

Answer 1679

it activates macrophages, leading to a widespread release of **IL-1 and TNFa**, which causes the signs + sx of septic shock

Question 1680

HgA₂ is indicative of? HgA₁ is indicative of?

Answer 1680

A2 = (a2d2) = ß thalassemia A1 = (a2b2) = glycemic control

Question 1681

patients w/ aldolase B deficiency should avoid what?

Answer 1681

fructose + sucrose (glucose+fructose dipeptide)

Question 1682

acoustic neuromas usually arise from which CN? where is this intracranial mass usually located? what other nerves may be affected?

Answer 1682

CN8 CN7, and CN5 may also be affected via compression due to its proximity found btwn cerebellum + lateral pons

Question 1683

what innervates the supinator m?

Answer 1683

radial n.

Question 1684

person receives several units of blood and develops signs of hypocalcemia. why?

Answer 1684

whole blood contains **citrate,** which chelates Ca, resulting in hypocalcemia

Question 1685

vancomycin MoA? ADR? how does resistance develop?

Answer 1685

binds to **D-alanyl-D-alanine **in the cell wall peptide precursors and **prevents formation of peptidoglycan** ADR: Red man syndrome, nephrotoxicity resistance: VRE - changes in the peptide precursors from D-alanyl-D-alanine to D-alanyl-D-**lactate**

Question 1686

Name + MoA antibiotic that causes myopathy and CPK elevation

Answer 1686

**D**aptomycin creates transmembrane channels, which causes leakage of intracellular ions, leading to **D**epolarization of the membrane; does not work against GN infections since it can't permeate LPS! inactivated by pulmonary surfactant (not good for treating pneumonias)

Question 1687

name + MoA antibiotic that causes optic neuritis + thrombocytopenia

Answer 1687

Linezolid binds 50S (by at 30, CEL**L **at 50) also increases risk of serotonin syndrome

Question 1688

ApoA-1 function ∆ results in?

Answer 1688

LCAT actviation (leads to cholesterol esterification) ∆ results in low HDL and increased circulating free cholesterol levels

Question 1689

ApoB48 function

Answer 1689

chyloµ assembly and secretion by the intestines

Question 1690

ApoB100 function

Answer 1690

LDL particle uptake by extrahepatic cells

Question 1691

ApoCII function ∆ results in?

Answer 1691

Lipoprotein lipase activation ∆ results in hyperchylomicronemia

Question 1692

ApoE3 and ApoE4 function

Answer 1692

VLDL and chyloµ remnant uptake by liver cells (∆ = liver can't remove chyloµ+VLDL remnants from circulation, causing their accumulation in the serum, resulting in elevated cholesterol + Tg levels)

Question 1693

patient treated w/ an antibiotic that develops pancytopenia (aplastic anemia)

Answer 1693

chloramphenicol - binds 50S subunit and inhibits the peptidyl transferase enzyme, thereby suppressing bacterial protein synthesis.

Question 1694

continual use of opioids can result in tolerance (decrease in effectiveiness + physiological response). What two side effects are most resistant to tolerance development?

Answer 1694

**constipation** = due to opioid stimulation of µ receptors in the GI tract, causing decreased secretions + gastric motility **miosis** = due to opioid stimulation of parasympathetic tracts of the pupil, leading to pupil constriction

Question 1695

gentamicin MoA + ADR how is resistance acquired?

Answer 1695

binds to 30S subunit **vestibular + choclear ototoxicity** **nephrotoxicity, neuromuscular paralysis ** resistance - acquired plasmid/transposons that modify the aminoglycoside Rx via acetylation, adenylation, phosphorylation

Question 1696

67yo w/ trouble seeing an a gray subretinal membrane. dx & trmt?

Answer 1696

age-related "wet" macular degeneration - abnormal BV w/ subretinal fluid/hemorrhage, gray subretinal membrane, or neovascularization trmt: anti-VEGF, laser, or phototherapy - limits the choroidal neovascular membrane formation compared to dry MD = subretinal drusen deposits or pigment ∆s, usually progresses to wet

Question 1697

how to determine the prognosis of a patient w/ N. meningitidis?

Answer 1697

serum **lipooligosaccharide (LOS) **= endotoxin; plasma levels are closely associated with morbidity and mortality of the disease LOS activates TLR4, resulting in production of TNFa, IL1ß, IL6, and IL8, resulting in sepsis LOS also causes cutaneous pepteciae + hemorrhagic bullae + bilateral adrenal cortical hemorrhage (Waterhouse-Friderichsen Syndrome)

Question 1698

signs of HSV encephalitis?

Answer 1698

affects TEMPORAL lobe, therefore can result in aphasia (damage to speech area) olfactory hallucination (olfactory cortex involvement) personality ∆ (amygdala involvement)

Question 1699

parotitis is associated with which viral infection?

Answer 1699

mumps

Question 1700

calculation of A-a gradient? normal values?

Answer 1700

Aa = P**A**O2 - **PaO2** PAO2 = 150 - (**PaCO2** / 0.8) ^{(bolded = what is normally given)} normal values are 10-15mmHg

Question 1701

shingles is due to what type of virus? histology should show what? trmt?

Answer 1701

herpes - **VZV** - enveloped, dsDNA virus hx: intranuclear inclusions in keratinocytes + multinucleated giant cells (+Tzanck smear), acantholysis (loss of intercellular connections ) of keratinocytes and intraepidermal vesicles trmt: **gabapentin for post-herpetic neuralgia**

Question 1702

dermatitis herpetiformis presents with what kind of physically? histology?

Answer 1702

PE: pruritic grouped vesicles on extensor surfaces hx: PMN accumulations at the tips of dermal papillae (microabscesses)

Question 1703

males = bifid scrotum is due to malformation of? what does this strcture form in females?

Answer 1703

failure of the **labioscrotal folds** to come together, resulting in two separate scrotal sacs... in females, this forms the labia majora

Question 1704

causes of: hypospadias epispadias

Answer 1704

hypospadias: incomplete fusion of urethral (urogenital) folds, resulting in an opening of the urethra along the ventral shaft of the penis epispadias:

Question 1705

loss of this protein is associated with metastasis

Answer 1705

e-cadherin

Question 1706

what is alpha-amanitin?

Answer 1706

produced by in Amanita phalloides (aka death cap mushrooms) inhibits RNA pol III (makes tRNAs), therefore no mRNA is made. Can cause severe hepatotoxicity if ingested

Question 1707

which part of the tRNA carries the CCA sequence? amino acid?

Answer 1707

both at the 3' end (the CCA is where the actual tRNA binds)

Question 1708

what is reponsible for making sure that the tRNAs are charged with the right a.a.?

Answer 1708

aminoacyl-tRNA synthetase (each a.a. has its own!) - scrutinizes a.a. before AND after it binds to tRNA and if it is incorrect it hydrolyzes the bond and replaces it for the right one.

Question 1709

what cytoskeletal element comprises microvilli cilia flagella

Answer 1709

microvilli = actin + myosin "m&m" cilia + flagella = microtubules

Question 1710

what type of collagen are these made of? granulation tissue scar tissue

Answer 1710

granulation = type III scar = type I

Question 1711

the cornea, lens, and vitreous body of the eye are all made of different types of collagen. what are they?

Answer 1711

cornea = Type I ( I looks like a cob of corn) vitreous body = Type II (two words!) lens = Type III (lens = 3 letters)

Question 1712

pupil deviations occur in 3 CN palsies and what are they?

Answer 1712

CN 3 = down and out CN 4 = upward CN 6 = medially

Question 1713

lens subluxation occur in 3 disorders. what are they?

Answer 1713

upward and temporally = Marfan down and inward = homocystinuria lens disolocation (ectopia lentis) = marfans

Question 1714

why do CF patients present with contraction alkalosis + hypokalemia

Answer 1714

whenever you see alkalosis + hypokalemia in the same sentence, consider the presence of **aldosterone** CF patients lose a lot of fluids due to Na/H2O losses in their sweat ^{(remember, usually Na is reabsorbed and water follows but in CF patients this does not occur)} Decr. ECV -\> RAAS -\> Aldosterone -\> **Na/H2O reuptake + H/K excretion**

Question 1715

what drug do you want to avoid using in a patient with **azathioprine **and why?

Answer 1715

xanthine oxidase inhibitors - since 6MP is degraded by it! Using it will increase toxicity of pancytopenia (leukopenia,

Question 1716

symptoms associated wtih cholinergic agonists?

Answer 1716

* increase **nausea, vomiting, abd. cramps, diarrhea** by increasing GI smooth muscle tone * cause **dyspnea** via bronchoconstriction by increasing bronchial smooth muscle tone * cause **bradycardia, hypotension** (perpiheral vasodilation) * incraese secretions: **sweating, salivation, lacrimation, bronchial secretions** * cause: **miosis** basically, **PARASYMPATHETHIC EFFECTS (rest & digest)**

Question 1717

drug that is usually administered post-op - causes flushing, diaphoresis and nausea, miosis, HR55, BP 100/70

Answer 1717

**bethanchol** - cholinergic agonist used to stimulate peristalsis in post-op ileus; also used to treat non-obstructive urinary retention (atonic bladder)

Question 1718

how do benzodiazepines + barbiturates similar in terms of their MoA? how are they different? how does tolerance to either drug work?

Answer 1718

both bind to **GABA_A (ion channels)** to increase flux of **Cl- ions,** thereby hyperpolarizing the cell and stablizing the cell membrane, rendering it less excitable. _Benzos_ - increase _frequency_ of Cl- channel openings _barbiturates_ - prolongs _duration_ of Cl- channel opening tolerance: prolonged stimulation -\> decrease # of GABA_A receptors in the synaptic clefts

Question 1719

inactivated/killed vaccines

Answer 1719

**C**holera **H**epA **I**nfluenza (**Inj**) **R**abies **P**olio (sal**K**) **kill** that **CHIRP**ing bird (rest are inactivated)

Question 1720

clues on CT scan for constrictive pericarditis aortic dissection ischemic heart disease

Answer 1720

* **constrictive pericarditis** - thickening/calcifications of the pericardium * **aortic dissection** - double aortic lumen * **ischemic heart disease** - calcifications in the coronary arteries + aorta

Question 1721

∆ btwn conversion d/o and somatization d/o?

Answer 1721

**conversion** = somatoform d/o where there are **motor/sensory deficits** (ie **symptoms are neurologic** **in nature - blindness, aphonia, weakness, pseudoseizure**) that suggest a neurologic or general medical illness, even though all of the appropriate tests and labs are normal * typically affect young women who with an emotional stress **somatization =** somatform d/o where there are numerous** physical complaints** over where there are no physical explanations for (ie pain sx, GI sx, sexual sx, pseudoneurologic sx) and have **impacted their social or occupational functioning** * patients typically have a high use of medical resoruces

Question 1722

patient presents to be a hemiplegic to get disability benefits

Answer 1722

malingering - purpose of faking symptoms for secondary gain (financial)

Question 1723

woman with gas pain is convinced that she has colon cancer

Answer 1723

Hypochondriasis - somatoform d/o that refers to the **irrational fear of having** or **belief that one has a serious physical disease**; usually due to misinterpretation of bodily sx or normal functions typically seen in patients with anxiety d/o

Question 1724

patient w/ hx of HTN, asthma, diabetes that comes to ER w/ chest pain is treated. Chest pain disappears, but SOB develops. What was he given specifically?

Answer 1724

Non-selective ß blocker ß1 blockade - decreases HR ß2 blockade = bronchoconstriction + wheezing

Question 1725

virus with phopholipid composition that resembles the host cell nuclear membrane

Answer 1725

**HERPESviruses** - unique among viruses in that it buds through and acquire the lipid bilayer envelope from the **host cell nuclear membrane**

Question 1726

what is this ECG a description of? "polymorphic QRS complexes of varying amplitude and cycle length with evidence of QT prolongation" what can cause this?

Answer 1726

**Torsades "twisting of points"** - type of v-tach that is always associated with an underlying QT prolongation Class IA - **quinidine, procainamide, disopyramide**) Class III (K channel blockers - **ibutilide, dofetilide, sotalol** - **dis-K**) TCAs

Question 1727

most common location of colon cancers?

Answer 1727

* **rectosigmoid **- most common - tend to presesent with obstructing sx (∆ bowel habits, constipation, abd. distension, N, V) * **ascending** - 2nd most common - tend to present with iron deficient anemia, anorexia/weight loss, malaise * **descending** + transverse - relatively rare

Question 1728

buzzwords

Question 1729

Answer 1729

HBsAg first virological marker detected in the serum after inoculation; suggests infectivity

Question 1730

Answer 1730

HBeAg antigen detectable shortly after the appearance of HBsAg; indicates active viral replication and infectivity and is associated w/ the presence of HBV DNA if it persists for \>3mo, there is an increased likelihood of chronic HepB

Question 1731

Answer 1731

Anti-HBc IgM = acute phase of disease; present during the window period! IgG = recovery from disease

Question 1732

Answer 1732

Anti-HBe

Question 1733

Answer 1733

Anti-HBs indicates _successful vaccination_ OR _clearance of HBsAg_ remains detectable for life; indicator of immunity lag period from which HBsAg disappears and anti-HBs appears = WINDOW period

Question 1734

Colonic diverticulum true or false diverticula?

Answer 1734

false diverticula - contains only mucosa and submucosa since these layers herniate through defects in the muscularis layer (compared to Meckels, which contain mucosa, submucosa, and muscularis)

Question 1735

sequences involved in transcription initiation? translation initation?

Answer 1735

transcription initiation = TATA translation initation = AUG

Question 1736

ADR of furosemide

Answer 1736

**hypoK, hypoMg, hypoCa** volume depletion, **hypoNa**, decreased GFR, hypotension, **ototoxicity**

Question 1737

otoxic agents 5

Answer 1737

**s**alicyclates **c**isplatin aminoglycosides **l**oop diuretics (**e**thacrynic acid, **f**urosemide) SCA**LE-F**

Question 1738

Triamterene

Answer 1738

**K sparing diuretic** - blocks the ENaC in the DCT and CD, thereby resulting in **increased Na/H2O loss and hyperkalemia**

Question 1739

what is effect modification?

Answer 1739

occurs when the effect of a main exposure on an outcome is modified by another variable (ex: **effect**: SERM on DVT; **variable**: smoking status) NOTE can be confused with confounding - if the variable was a confounding factor, then when the data is stratified in terms of the variable (SERM on DVT in smokers and non-smokers), then the effect should either be greater or disappear

Question 1740

what are these nuclei involved in nucleus ceruleus raphe nucleus nucleus basalis of meynert red nucleus caudate nucleus substantia nigra

Answer 1740

* **nucleus ceruleus** - **NE** secreting neurons that participiate in the fight or flight response; located in dorsal pons * **raphe nucleus** - **serotonin** secreting neurons, sleep wake cycle, arousal; lesions can result in insomnia and depression * **nucleus basalis of meynert** - **cholinergic** neurons; in Alzheimers, these neurons secrete very low levels of ACh * **red nucleus** - anterior midbrain, participate in motor coordination * **caudate nucleus** - functions in motor activities; in huntingtons, there is a loss of cholinergic + GABA neurons * **substantia nigra** - **dopaminergic** neurons; in parkinsons, these neurons are gone

Question 1741

first-line Rx in treating HTN during pregnancy

Answer 1741

methyldopa

Question 1742

what provides innervation to the lacrimal glands? ie stimulation of what nerve will make you cry?

Answer 1742

CN 7 also provides motor output to **facial muscles** parasympathetic innervation to **submandibular + sublingual** glands taste from **anterior 2/3 of tongue** somatic afferents from the **pinna + external auditory canal**

Question 1743

patient is lying supine with R knee flexed and externally rotated and resists extension of the leg and thigh, esp at the hip what muscle is affected?

Answer 1743

Psoas major injury to this muscle (ie abscess) will cause patients to be in a position that will minimize stretching (supine w/ knees bent); most likely wont allow you to extend the muscle via extension of the hip

Question 1744

stop codons

Answer 1744

UGA = u go away UAG = u are gone UAA = u are away

Question 1745

why is it that someone who drinks often have low glucose levels and fatty liver?

Answer 1745

EtOH conversion to acetaldehyde and acetate requires reduction of NAD+ -\> **NADH** excess NADH favors conversion of * pyruvate -\> lactate * oxaloacetate to malate * glyceraldehyde-3-phosphate -\> glycerol-3-phosphate (thus regenerating NAD+) the first two reactions prevent gluconeogenesis from occuring, thus resulting in fasting hypoglycemia the last reaction combines with FA to make TGs, resulting in hepatosteatosis

Question 1746

Herpes diagnostic test? treatment?

Answer 1746

**Tzanck test** (tzanck god I dont have herpes!!) acyclovir -nucleoside analogs, that when incorporated into newly replicating viral DNA, terminates DNA synthesis

Question 1747

Benzodiazepines (BDZ) have various half-lives and people take them depending on their symptom severity. **Which ones are short-acting?** **Which ones are intermediate acting?** **Which ones are long-acting?**

Answer 1747

Short acting: Triazolam, Alprazolam, and Oxazepam = **TAO** Intermediate acting: Lorazepam, Estazolam, and Temazepam = **LET** Long acting: **Chlo**rdiazepoxide, **Clo**razepate, **D**iazepam, and **F**lurazepam **TAO - LET -** the **CDC F**ail

Question 1748

Benzodiazepines (BDZ) have various half-lives and people take them depending on their symptom severity. Which BDZ should one take to avoid to minimize risk of falling? Which BDZ should one take to avoid day-time drowsiness? Which ones put the patient at highest risk of physical dependence? which ones are best?

Answer 1748

in all 3 cases, the short acting ones (Triazolam, Alprazolam, and Oxazepam = **TAO**) have relatively short half-lives and therefore cause less daytime drowsiness + less risk of falls. However, rapid clearance of th edrug can leads to severe withdrawal sx and therefore **increase the risk of physical dependence**!! Best ones to use are the intermediate ones: Lorazepam, Estazolam, and Temazepam = **LET** Longacting ones are **Chlo**rdiazepoxide, **Clo**razepate, Diazepam, and Flurazepam are associated wtih daytime somlence **TAO LET** the **CDC F**ail

Question 1749

non-compliant HIV+ patient comes in with a single ulcerated mass in the anal canal; no palpable regional lympadenopathy dx and pathogen?

Answer 1749

squamous cell carcinoma of the anus - HPV 16/18 immunodeficiency states increase the host's susceptiblity to HPV infection and a more severe infection ^{HIV homosexual males are more prone to developing anal squamous cell carcinoma  HIV females are more prone to developing cervical squamous cell carcinoma} 

Question 1750

where is most of the fluid filtered by the glomerulus reabsorbed?

Answer 1750

PCT - duh!!!!!!! \>60% of the fluid filtered by the glomerulus is reabsorbed in the PCT regardless of the patient's hydration status not the CD - even when the patient is suffering from dehydration; only 20% of the original fluid filtered is reabsorbed here.

Question 1751

lacunar infarcts what are they and what are they caused by? where are they typically located? histological findings?

Answer 1751

**small, ~5mm cavities** caused by occlusion of small penetrating arteries (lenticulostriate arteries) in the **basal ganglia, internal capsule, pons,** usually **2˚ to unmanaged HTN and DM** **Hx: lipohalinosis** (wall necrosis) and **microatheromas** (accumulation of lipid-laden macrophages within the intimal layer of the vessel wall)

Question 1752

what the heck is the difference btwn **tight** junctions, **intermediate** junctions, and **gap** junctions

Answer 1752

* **tight** = zonula occludens - tightly adheres the membrane of two cells together * **intermediate** = zonula adherens - cytoplasmic filaments that radiate from the cell membrane to hold adjacent cells together * **gap** = how cells communicate with each other

Question 1753

which dietary substrate has the highest rate of metabolism in the glycolytic pathway? glucose mannose galactose fructose

Answer 1753

**fructose** it bypasses PFK-1 (rate limiting enzyme of glycolysis), while other sugars enter glycolysis before this rate limiting enzyme and are therefore metabolized more slowly due to regulation of PFK-1

Question 1754

how do differentiate btwn anorexia nervosa (binge-purge type) vs bulimia nervosa? 2

Answer 1754

in binge-purge anorexia nervosa, there are two distinguishing features: abnormally low body weight \<85% of ideal amenorrhea

Question 1755

febrile respiratory illness followed by the sudden appearance of red, flushed cheeks approx 2-5d later is characteristic of virus? genome? where does it like to replicate?

Answer 1755

erythema infectiosum - parvovirus B19 **non-enveloped, ss DNA** (highly tropic for erythroid precursor cells and replicates predominantly in the bone marrow)

Question 1756

concomitant use of statins + gemfibrozil increases one's risk of?

Answer 1756

**myopathy + hepatitis** gemfibrozil inhibits CYP450, thereby resulting in an increased serum levels of statins

Question 1757

concomitant use of fibrates with a bile acid binding resin increase one's risk of?

Answer 1757

cholesterol gallstones

Question 1758

which statin is NOT metabolized by cytochrome P450?

Answer 1758

pravastatin

Question 1759

1 mo with mild jaundice, enlarged tongue, general hypotonia and an umbilical hernia is brought into the ER. Parents also complain that the baby seems "floppy" and has not been feeding well dx?

Answer 1759

congenital hypothyroidism key: hypotonia, enlarged tongue, umbilical hernia, myxedema, mental retardation

Question 1760

difference btwn facticious d/o and malingering d/o?

Answer 1760

**facticious** - intentional production or feigning of physical or psychological sx for the purpose of assuming the sick role **malingering** - voluntary fabrication of sx for the purpose of obtaining an external reward (avoiding difficult situations, obtaining Rx, acquiring financial compensation)

Question 1761

what kind of gene are these and what diseases are they implicated in? c-myc bcl2 c-abl cyclin D1

Answer 1761

* **c-myc** = oncogene - **Burkitts** - inhibits apotosis * **bcl2** = oncogene - **Follicular** - inhibits apotosis * **c-abl** = oncogene - **CML** - inhibits apotosis * **cyclin D1** = promotes G1-S - **mantle**

Question 1762

homeless alcoholic brougth to teh ER w/ vomiting and prolonged oliguria has a renal bx that shows ballooning + vacuolar degeneration of PCT + multiple oxaalate crystals. what should you think of?

Answer 1762

ETHYLENE GLYCOL rapidly absorbed in the GI tract; metabolized to glycolic acid (toxic to renal tubules) and oxalic acid (preciptates as CaOx crystals in the renal tubules) signs of high AG acidosis + high osmolar gap

Question 1763

granular casts are pathognomonic for typical signs?

Answer 1763

also known as muddy brown casts **Acute Tubular Necrosis (ATN)** due to prolonged hypotension that triggers hypoxic changes in tubular epithelial cells (esp the **PCT** and **TALH**) signs: **increased BUN, creatinine,** and **oliguria**

Question 1764

muddy brown casts are pathognomonic for typical signs?

Answer 1764

can also be called "granular casts" **Acute Tubular Necrosis (ATN)** due to prolonged hypotension that triggers hypoxic changes in tubular epithelial cells (esp the **PCT** and **TALH**) signs: **increased BUN, creatinine,** and **oliguria**

Question 1765

RBC casts are pathognomonic for 3 things

Answer 1765

**Glomerulonephritis** **ischemia** **malignant HTN**

Question 1766

WBC casts are pathognomonic for 3 things

Answer 1766

**tubulointerstitial inflammation** **acute pyelonephritis** **transplant rejection**

Question 1767

fatty casts are pathognomonic for 3 things

Answer 1767

**nephrotic syndrome**

Question 1768

waxy casts are pathognomonic for 2 things

Answer 1768

**advanced renal disease** **chronic renal failure**

Question 1769

which is more common in alcoholics: folate or B12 deficiency

Answer 1769

**folate deficiency is more common** both show hypersegmented PMNs ^{(if the patient description says that the patient has DCML-sx, then consider B12 deficiency)}

Question 1770

esophageal cancer squamous cell is usually due to: adenocarcinoma is usually due to:

Answer 1770

squamous cell * EtOH use * **tobacco** * N-nitroso-containing foods Adenocarcinoma * Barrett's esophagus * GERD * obesity * **tobacco**

Question 1771

5'-phosphoribosyl-1'-pyrophosphate synthetase (PRPP) activating mutation in this gene results in?

Answer 1771

**PRPP = de novo purnine synthesis** activating mutation results in increased purine production -\> hyperuricemia

Question 1772

tenderness of the calf muscle on dorsiflexion of the foot is a sign of?

Answer 1772

homan's sign - DVT!! trmt: heparin

Question 1773

# define and give an example of each spongiosis acanthosis dyskeratosis hyperparakeratosis hypergranulosis

Answer 1773

* **spongiosis** - _epidermal_ accumulation of edematous fluid in intercellular spaces; intercellular bridges become more distinctive * ​eczematous dermatitis/contact dermatitis * **acanthosis** - increase thickness of stratum _spinosum_ * psoriasis * **dyskeratosis** - abnormal, _premature keratinization_ of individual keratinocytes * squamous cell carcinoma * **hyperparakeratosis** - retention of nuclei in the stratum _corneum_, which signals incomplete keratinization * normal on mucous membranes * actinic keratosis * **hypergranulosis** - excessive granulation in the stratum _granulosum_ of the epidermis * lichen planus

Question 1774

Pathogenesis btwn rheumatic fever vs PIGN (even though they're caused by the same pathogen?

Answer 1774

**rheumatic fever** = shared bacterial + human epitope homology that results in formation of autoantibodies against self **PIGN** = immune complex deposition w/ subsequent complement fixation (Type III HSR)

Question 1775

what are the processes involved in apoptosis? why is there no inflammation observed in apoptosis?

Answer 1775

2 pathways * intrinsic pathway - mitochondria becomes more permeable and releases caspase-actvating substances (ie **cytochrome C**) * extrinisic pathway - **TNFR1** or **FasL (CD95)** activation with subsequent **FADD** formation and **caspase** activation ø inflammation because * cell membrane remains intact and no cell contents are leaked into the surrounding tissue

Question 1776

how to caclculate false negative ratio?

Answer 1776

1-sensitivity

Question 1777

Laron dwarfism is due to what? typical lab findings in these patients?

Answer 1777

defective GH receptors - leading to a decrease in linear growth GH = high IGF1 = low

Question 1778

major functions of these hypothalamic nuclei: ventromedial lateral anterior posterior

Answer 1778

* **ventromedial - satiety**; if you stimulate this constantly, you will grow ventrally and medially (skinnier) * ​*destruction -\> hyperphagia* * **lateral - hunger**; if you stimulate this constantly, you will grow laterally (fatter) * *destruction -\> anorexia * * **anterior - heat dissipation (cooler)** = AC * destruction -\> hyperthermia * **posterior - heat conservation (warmth)** * destruction -\> hypothermia

Question 1779

major functions of these hypothalamic nuclei: arcuate paraventricular supraoptic suprachiasmatic

Answer 1779

* **arcuate** - dopamine, GHRH, gonadotropin secretion * **paraventricular** - _ADH, oxytocin_, CRH, thyrotropin-releasing hormone** ** * **supraoptic **- _ADH,oxytocin_ * **suprachiasmatic** - circadian rhythm regulation + pineal gland function

Question 1780

crohns vs ulcerative colitis in terms of location, wall involvement, and clinical manifestations

Answer 1780

**Crohns** * anywhere from mouth-anus (skipped) * transmural inflammation + noncaseating granulomas * Abd pain + diarrhea **Ulcerative Colitis** * colorectal (continuous) * mucosal + submucosal inflammation * bloody diarrhea + abd pain

Question 1781

complications of crohns vs ulcerative colitis

Answer 1781

crohns = **fistulas and intestinal strictures** * fistulas can form btwn two adjacent bowel loops or in between the bowel and another organ (ie bladder, vagina, skin). Perianal fistulas and abscesses are common!! * intestinal strictures can lead to intestinal strictures ulcerative colitis = **toxic megacolon**

Question 1782

∆ btwn tetanospasmin and botulinum toxin? similarities?

Answer 1782

both are **proteases** that **cleave SNARE** proteins required for NT release * **tetanospasmin** = prevents release of inhibitory (GABA + glycine) NTs from inhibitory Renshaw cells in the spinal cord -\> spasticity, risus sardonicus, and lockjaw * **botulinum** = prevents release of stimulatory (ACh) NT at NMJ -\> flaccid

Question 1783

for each one, name the culprit wound -\> neuron axons -\> salivary gland wound -\> motor neurons -\> spinal cord fibrinous exudate -\> systemic circulation -\> cortical neurons food -\> systemic circulation -\> meninges food -\> systemic circulation -\> peripheral nerves

Answer 1783

wound -\> neuron axons -\> salivary gland: **rabies** wound -\> motor neurons -\> spinal cord: **C tetani** fibrinous exudate -\> systemic circ. -\> cortical neurons:** C diphtheria** food -\> systemic circ. -\> meninges: **L. monocytogenes** food -\> systemic circ. -\> peripheral nerves: **botulinum**

Question 1784

varenicline MoA clinical use?

Answer 1784

partial agonist of nicotinic ACh receptors assist patients w/ smoking cessation by reducing withdrawal cravings and attenuating the rewarding effects of nicotine (ie its partial agonist activity causes minimal DA release, resulting in less stimulation of the reward pathway than nicotine)

Question 1785

patients with retinoblastoma are at increased risk of?

Answer 1785

osteosarcomas

Question 1786

SVC syndrome is commonly associated with? how does it present?

Answer 1786

small cell lung cancer HA, facial + upper extremity edema + dilated veins of upper torso

Question 1787

what is lipofuscin? how does it develop?

Answer 1787

"wear and tear" pigment yellowish-brown, perinuclear pigment composed of lipid polymers and protein-complexed phospholipids; is the product of free radical injury and lipid peroxidation

Question 1788

differentiate btwn delusional d/o and paranoid personality d/o

Answer 1788

* **delusional d/o** - one or more delusions in the absence of other psychotic symptoms; behaviors are not obviously bizzare; functioning is _not_ significantly impaired apart from the direct impact of the delusions * **paranoid d/o** - persistant patterns of behavior that are pervasive across a broad range of situations; characterized by suspiciousness or distrust

Question 1789

two cytokines involved in PMN recruitment

Answer 1789

IL-8 and C5a

Question 1790

organ that is not a forgut derivative but is supplied by an artery of the foregut

Answer 1790

**spleen - mesoderm-derived** organ that originates from dorsal mesentary supplied by **splenic artery - branch of celiac trunk** (artery of the foregut)

Question 1791

why not treat a patient w/ sx of c. diphtheriae infection with antibiotics, such as penicillin or erythromycin first?

Answer 1791

antibiotics kill the bacteria, thereby halting the release of new exotoxin into the blood stream, but it doesn't affect the toxins that may have already gained access to the blood stream the antitoxin is a neutralizing antibody (passive immunization) that sequesters the toxin that may have already gained access into the blood stream **diphtheria AB exotoxin =** predilection for neural + cardiac tissue; it ribosylates and deactivates EF-2 in these tissues, therefore inhibiting protein synthesis

Question 1792

acute manic episode is treated with

Answer 1792

mood stabilizing agent (lithium, valproate, carbamazepine) + atypical antipsychotic (olanzapine)

Question 1793

∆ btwn first and second generation antihistamines?

Answer 1793

* 1st generation = **lipophilic/****can cross BBB**and block**muscarinic**(blurry vision, dry mouth, urinary retention),**sertonergic** (appetite stimulation), and**a-adrenergic** (postural dizziness) pathways, and can cause sedation * **diphenhydramine, chlorpheniramine, dimenhydrinate, promethazine, hydroxyzine** * 2nd generation = **do not cross the BBB** and therefore have minimial sedative and anti-muscarinic effects and are usually non-sedating * **fexofenadine, loratadine,** des**loratadine, cetirizine**

Question 1794

Zollinger-Ellison Syndrome is due to a tumor that develops in what organ?

Answer 1794

pancreatic islet cell tumor is a gastrin secreting tumor that causes hypersecretion of gastric acid, leading to peptic ulcers commonly in the **duodenum**, abd pain, GERD, and diarrhea

Question 1795

infant w/ dystonia, poor feeding, and urine that smells of burnt sugar should avoid which 3 amino acids?

Answer 1795

**leucine**, iso**leucine**, and valine ∆ a-keto acid dehydrogenase -\> inability to degrade branched chain a.a. -\> accumulation can lead to neurotoxicity

Question 1796

definition of a **permissive** Rx vs **additive** Rx vs **synergistic** Rx

Answer 1796

* **permissive** - Rx1 itself does not have an effect, but when it is added to another Rx2, it augments the effect of Rx2 (ie allows it to reach its full potential) * **additive** - combined effect of Rx1 + Rx2 is **equal to the sum** of the effects expected from the individual Rx effects * **synergistic** = combined effects of Rx1 + Rx2 **exceeds the sum** of the effects expected from the individual Rx effects

Question 1797

∆ btwn Myasthenia gravis and Lambert Eaton Syndrome in terms of the muscles affected?

Answer 1797

**MG**: extraocular muscles are affected first (ptosis, diplopia) **LES**: proximal muscles (hip girdle weakness)

Question 1798

histology of a vessel in a patient with buerger's disease is likely to show what

Answer 1798

**segmental thrombosing vasculitis** that extends into contiguous veins and nerves; due to direct endothelial cell toxicity from tobacco products or hypersensitivity to them inflammation may eventually encase all 3 structures (NAV) in fibrous tissue (unique!!)

Question 1799

artery damaged in: epidural hematoma subdural hematoma subarachnoid hematoma hypertensive strokes

Answer 1799

epidural hematoma = MMA subdural hematoma = bridging cortiacl veins subarachnoid hematoma = berry aneurysms hypertensive strokes = lateral striate "penetrating arteries"

Question 1800

stimulation of acid secretion in the stomach is caused by these 3 phases. what mediates each phase and what are their appropriate triggers?

Answer 1800

1) **cephalic stage** - stimulate gastric acid secretion - mediated by **vagal + cholinergic mxns**; triggered by thought, sight, smell, taste of food 2) **gastric phase** = stimulate gastric acid secretion mediated by **gastrin,** which stimulates histamine secretion, and therefore acid secretion; triggered by chemical stimulus of food and stomach distension 3) **intestinal phase** = *downregulate acid secretion* after a meal via **Peptide YY**, which binds to ECL cells and inhibiting thier release of histamine

Question 1801

diffuse increased thickness of the glomeruluar BM w/o increase in cellularity; "spike and dome" apperance on silver stain, granular deposits on immunofluorescence

Answer 1801

membranous glomerulopathy thickness is caused by irregular dense deposits laid btwn the BM and the epithelial cells - resemble spikes when stained with silver (nephrotic syndrome)

Question 1802

cardinal manifestations in patients with 1˚ hyperparathyroidism

Answer 1802

bone loss = **bones ** ^{subperiosteal thinning of cortical (ie compact) bone in the appendicular skeleton;
and w/ salt + pepper appearance of the skull} renal stones = **stones** GI upset (ulcers) = **groans** psychiatric d/o = **psychiatric overtones **

Question 1803

HIDA scan - what is it used for?

Answer 1803

radionuclide scan that visualizes hepatic uptake of the radionuclide + excretion into the CBD and proximal small bowel in patients w/ acute calculous cholecystitis (stone that impacts the cystic duct), you will see an absence of radionuclide filling in the GB

Question 1804

cytokines involved in sarcoidosis?

Answer 1804

sarcoidosis = formation of **non-caseating granulomas** w/ a central collection of epithelioid macrophages (+ giant cells) surrounded by a rim of monocytes Th1 CD4+ cells - secrete IL2, IFNg IL2 -\> stimulates proliferation of TH1 **IFNg -\> stimulates macrophages **(only TH1 secrete IFNg)

Question 1805

patient receiving an agent that inhibits glucose reabsorption in the PCT will have a glucose clearance that approximates...

Answer 1805

Inulin or mannitol (the agent will basically cause all of the filtered glucose to be excreted; thus the glucose = GFR)

Question 1806

GLUT4 is the **_only_** transporter that is responsive to insulin. where is it predominately expressed?

Answer 1806

muscle cells + adipocytes

Question 1807

∆ btwn physiological dead space anatomic dead space alveolar dead space

Answer 1807

**physiological** = anatomic + alveolar **anatomic** = volume of air in conducting airway that is not available for gas exchange **alveolar** = volume of air in alveoli that does not participate in gas exchange due to insufficient blood flow (perfusion limited)

Question 1808

how does **hereditary spherocytosis **affect MCHC?

Answer 1808

increase MCHC - indicates membrane loss and RBC dehydration

Question 1809

patients w/ "burning feet syndrome" is usually deficient in what vitamin? What is this vitamin used for? It is also important in this one particular biochem pathway (of all the ones we have to know...)

Answer 1809

pantothenic acid (B5) - cofactor in CoA and fatty acid synthase; impt in the **first step of the TCA cycle** where it binds with oxaloacetate to form citrate + succinyl CoA

Question 1810

what Rx would you use in a patient w/ thymidine-kinase deficient VZV isolate?

Answer 1810

Pyrophosphate analog - **foscarnet** no phosphorylation necessary: **Tenofovir + Cidofovir** ^{phosphorylation is necessary for acyclovir, valacyclovir, famciclovir, gangciclovir, and would therefore not be effective in this patient}

Question 1811

patient w/ mild heaptomeagly, pancreatic calcifications, and macrocytic anemia should make you think of...

Answer 1811

**Alcoholism** **heaptomeagly** (steatosis) + **pancreatic calcifications** (chronic pancreatitis) = both most commonly caused by ethanol abuse) **macrocytic anemia** = folate deficiency -\> diminished Thymidine synthesis

Question 1812

"pruritus after showering" + "ruddy appearance" should make you think of.. typical blood findings?

Answer 1812

polycythemia vera - JAK2 mutation that causes hematopoietic cells more sensitive to growth factors (EPO + thrombopoietin) _increased:_ RBC mass, plasma volume, platelet/WBC count, thrombotic events (hyperviscosity), peptic ulceration, pruritus, gouty arthritis (incerased cell turnover) _decreased:_ EPO levels

Question 1813

dapsone clinical use and ADR

Answer 1813

clincal use: **leprosy, PCJ** ADR: **agranulocytosis**

Question 1814

leading cause of chronic bronchitis

Answer 1814

**smoking** others (inhaled substances - air pollutants, grain, cotton, silica dust) _{(note: genetic factors are not known to strongly predispose one to chronic bronchitis)}

Question 1815

fungal antibiotics - which one affects DNA & RNA synthesis? cell membrane synthesis? cell wall synthesis?

Answer 1815

DNA & RNA synthesis *(the nucleotide is part of the name)* * flu**cytosine** cell membrane synthesis ***"tears a-hole finely"*** * ampho**ter**icin B + Nystatin bind ergosterol -\> pore formation * -**azoles +** terbina**fine **- inhibit synthesis of ergosterol cell wall (1,3-ß-D-glucan) synthesis *"**casp**er the friendly ghost can go through the great wall"* * caspo**fungin**

Question 1816

mutation in trypsin that prevents it from being permanently degraded will increase one's risk to?

Answer 1816

**hereditary pancreatitis** - due to mutation in **SPINK1** all pancreatic enzymes (except amylase + lipase) are synthesized + secreted in inactive form to protect the pancreas from autodigestion and are activated by trypsin in duodenal lumen (after trypsinogen is converted to its active form, trypsin, by enterokinase) SPINK1 acts as a trypsin inhibitor in the pancreas (prevents trypsin-mediated activation of other zymogens; ie it prevents autodigestion of pancreatic tissue) trypsin also inhibits itself by cleaving other trypsin molecules (and therefore preventing active trypsin from forming within the pancreatic tissue)

Question 1817

depressed person started on this antibiotic experiences these sx: agitation + confusion severe abd cramps + diarrhea increased T + BP + HR, regular tremulous dilated pupils bilateral hyperreflexia + ankle clonus

Answer 1817

**Linezolid** ADR: serotonin syndrome - neuromuscular excitation, autonomic stimulation, altered mental status

Question 1818

these are the two main factors that can cause the bronchoconstriction that is seen in allergic asthma What drug targets them to relieve these patients?

Answer 1818

leukotrienes - zafirlukast, montelukast ACh - ipratropium

Question 1819

how does acute salicyclate intoxication affect pH PaCO2 plasma HCO3

Answer 1819

**respiratory alkalosis** - it stimulates the medullary respiratory center, resulting in *hyperventilation **-\>** CO2 loss**,** increase pH* **AG metabolic acidosis - **accumulation of organic acids in the blood = decrease pH, low HCO3 net: pH = close to normal, slightly acidic net: PaCO2 = low plasma HCO3 =

Question 1820

6 mo infant w/ poor feeding + irritability has diffuse skin erythema with + Nikolsky sign. What is the diagnosis?

Answer 1820

**SSSS** - caused by **exfoliatin** exotoxin, which cleaves **desmoglein**

Question 1822

patient with pancytopenia, very low reticulocyte count, and normal PE should make you think of...

Answer 1822

**aplastic anemia** - causes pancytopenia as the BM is replaced by fat cells and fibrous stroma; **an absence of splenomeagly is characteristic. ** **other causes: B12/Folate deficiency, aleukemic leukemia, myelodysplastic syndrome**

Question 1823

how does afferent arteriole constriction affect GFR FF RPF bonus: how do you calculate FF?

Answer 1823

GFR = decrease RPF = decreases FF = unchanged ^{(afferent afteriole constriction results in relatively equal decreases in GFR and RPF)} remember that **FF = GFR / RPF**

Question 1824

how does efferent arteriole constriction affect GFR FF RPF bonus: how do you calculate FF?

Answer 1824

GFR = increase RPF = decerase FF = increase remember that **FF = GFR / RPF**

Question 1825

antibodies against polyribitol ribose phosphate will protect against what?

Answer 1825

H. influenza - type B

Question 1826

what part of the GI tract do these appear? Brunner glands Peyer's patches crypts of lieberkuhn largest # of goblet cells

Answer 1826

Brunner glands = **duodenum = "Brudder"** Peyer's patches = **Ileum = "Pi" ** crypts of lieberkuhn = **duodenum --\> colon** largest # of goblet cells = **Ileum / colon **

Question 1827

Sx that occur w/ occlusion of the MCA on the L side of the brain? R side?

Answer 1827

**LEFT** side (**dominant** hemisphere): hemiparesis w/ the arms affected more than the legs + **APHASIA** RIGHT side (dominant hemisphere): hemiparesis w/ the arms affected more than the legs

Question 1828

Zollinger Ellison Syndrome Diagnostic test?

Answer 1828

Secretin injection normally will inhibit gastrin secretion, but in ZES, there is a paradoxical increase in gastrin secretion

Question 1829

GI ligaments which one contains the portal triad? which one may be cut during surgery to visualize the pancreatic head? which one contains the short gastrics? which one contains the ligamentum teres hepatis? which one is a part of the greater omentum? which one contains the splenic artery?

Answer 1829

portal triad = **hepatoduodenal** cut to visualize the pancreatic head = **gastrohepatic** short gastrics = **gastrosplenic** ligamentum teres hepatis = **falciform** part of the greater omentum = **gastrocolic** splenic artery **= splenorenal**

Question 1830

where are these structures located and what is their function? meissner's plexus auerbach's plexus

Answer 1830

Mei**SS**ner's plexus * **S**ubmucosa * controls **S**ecretory activity Auerbach (aka **M**yenteric) plexus * **M**uscularis externa * controls **M**uscle contractions

Question 1831

at what level of the spinal column is the celiac trunk SMA + L renal arteries IMA Aortic bifurcation

Answer 1831

celiac trunk = T12 SMA + L renal arteries = L1 \<

IMA = L3

Aortic bifurcation = L4

Question 1832

posterior duodenal ulcer is likely to erode into which artery?

Answer 1832

gastroduodenal a. - lies along the posterior wall of the duodenal bulb

Question 1833

which part of the stomach is the most vulnerable to ischemia bc it does not have a strong anastomatic arterial supply?

Answer 1833

short gastric a.

Question 1834

How does the vagus n. affect stomach secretions? be specific w/ the type of NT used

Answer 1834

ACh -\> M3 receptor -\> stimulates parietal cells to secrete HCl and IF GRP -\> stimulates G cells to secrete gastrin (which stimulates ECL cells to produce histamine to ultimately stimulate parietal cells)

Question 1835

what is the pectinate line? what are some pathologies above/below this line?

Answer 1835

formed where **endoderm meets ectoderm** above: internal hemorrhoids, adenocarcinoma below: external hemorrhoids, squamous cell carcinoma, anal fissures

Question 1836

patient w/ steatorrhea is given a d-xylose test what do low urine excreton values mean? 5 normal urine values?

Answer 1836

D-xylose is a monosaccharide that is absorbed in the intestines, mostly in duodenum and jejeunum (ie it requires a normal, intact mucosal wall for absorption) * **low values = defect in intestinal wall that leads to malabsorption** * baterial overgrowth -\> corrects w/ antibiotics * tropical sprue -\> correct w/ antibiotics * whipple -\> does not correct w/ antibiotics * celiacs -\> does not correct w/ antibiotics * crohns = affects w/ bile salt reabsorption and therefore fat malabsorption * **normal values = intestinal wall is intact; malabsorption is due to other factors** * pancreatic insufficiency

Question 1837

peyer's patches where are they found? what cells are present and what do they produce? there is one specific bug that likes to infect these cells in particular - what is it?

Answer 1837

sumucosa of ileum contain **M cells** (APC) and **B cells** (-\> plasma cells that produce **IgA)** **Shigella** infects M cells via endocytosis and causes death of these cells -\> ulceration w/ hemorrhage and diarrhea

Question 1838

mechanism of cholesterol excretion in the body? mechanism of Fe excretion in the body? mechanism of bilibrubin excretion in the body?

Answer 1838

cholesterol = bile Fe = enterocytes store Fe as ferritin but are sloughed off adn elimited bilirubin = conjugated w/ glucuronate; bile

Question 1839

esophagitis is associated w/ reflux infection in immunocompromised. What would you see specifically for these bugs? Candida HSV1 CMV

Answer 1839

Candida = white pseudomembrane - duh HSV1 = **punched out** ulcers (herpes produces vesicles that when pierced -\> "punched out lesions") CMV = **linear** ulcers

Question 1840

how is LES pressure affected in patients w/ achalasia? Scleroderma?

Answer 1840

achalasia = increased (failure of relaxation) scleroderma = decrease (smooth muscle atrophy due to replacement w/ collagen)

Question 1841

pentagastrin test is used for?

Answer 1841

tests gastric acid secretion by parietal cells (remember that gastrin stimulates both 1) gastric acid release by parietal cells directly and 2) histamine release from ECL cells (which stimulates parietal cells to secrete gastric acid) low-than-expected increase in gastric acid secretion is indicative of gastritis because there is a loss of parietal cells (therefore less H+ is secreted)

Question 1842

2 yo w/ failure to thrive, steatorrhea, acanthosis, ataxia, night blindness Diagnosis?

Answer 1842

**aß lipoproteinemia** loss of MTP gene - decrease synthesis of aß-lipoprotein B -\> inability to generate chyloµ -\> decrease cholesterol + VLDL into blood stream -\> fat accumulates in enterocytes

Question 1843

ddx of pneumaturia ddx of brownish yellow urine + GN rods/mixed flora

Answer 1843

* **passage of gas in urine = ****ddx: diverticulitus = **colonic diverticulitis that formed a fistula w/ the bladder * ** brownish yellow urine + GN rods/mixed flora = ddx: crohns** = transmural inflammation that formed a fistula btwn the bowel wall and bladder

Question 1844

newborn infant w/ bilious vomiting, progressive abdominal distension w/ multiple air fluid levels and fecal obstruction should make you think of?

Answer 1844

CF patient - meconium plug obstructs intestines, preventing stool passage at birth

Question 1845

elderly patient who present w/ abrupt severe abdominal pain should make you think of....

Answer 1845

ischemic colitis - due to reduction of intestinal blood flow that results in ischemia; common at the splenic flexture + distal colon

Question 1846

when would you expect AST \> ALT ALT \> AST

Answer 1846

**AST** \> ALT = Alcoholic hepatitis (to**ast** w/ alcohol) A**L**T \> AST = NASH - due to metabolic syndrome (insulin resistance and subsequent fatty infiltration of hepatocytes) (L = lipids)

Question 1847

budd-chiari syndrome physical exam finding? associations?

Answer 1847

IVC occlusion (post-hepatic) w/ centrilobular congestion + necrosis PE: ABSENT JVD associations: hypercoagulable states, polycythemia vera, pregnancy, HCC

Question 1848

primary sclerosing cholangitis histological features lab findings? associations? risks?

Answer 1848

concentric onion skinning of bile ducts -\> alternating strictures and dilation w/ beading of intra- and extra-hepatic bile ducts on ERCP labs: increased conj. bilirubin, cholesterol, ALP, **hyper-IgM** associations: **ulcerative colitis** 2˚ biliary cirrhosis + cholangiocarcinoma

Question 1849

patient comes with jaundice, fever, RUQ pain

Answer 1849

**cholangitis** - infection of biliary tree proximal to an obstruction

Question 1850

air in the biliary tree sequelae?

Answer 1850

fistula formed btwn the gall bladder and small intestines caused by gallstone may lead to obstruction of the ilecocecal valve "gallstone ileus"

Question 1851

MoA of Shiga toxin + Shiga-like toxin (EHEC)?

Answer 1851

**inactivates 60S ribosomal subunit** in human cells, leading to an inhibition of protein synthesis and eventual cell death

Question 1852

ductus arteriosus is a remnant of which embryological derivative?

Answer 1852

6th aortic arch

Question 1853

delta wave what is the d/o? what else would you see? what do patients usually complain of?

Answer 1853

**Wolff-Parkinson-White Syndrome** - accessory conduction pathway (Bundle of Kent) that allows recurrent temporary tachyarrhythmias due to an re-entry circuit that involves the AV node and accessory pathway should also see a shortened PR-interval and a widended QRS interval patients complain of repeated episodes of palpitations that start and stop abruptly "recurrent temporarly arrhythmias"

Question 1854

what are janeway lesions?

Answer 1854

painless lesions that are the result of septic embolization from infected cardiac valve vegetations; tend to localize on the palms and soles found in bacterial endocarditis

Question 1855

IgA protease - produced by...

Answer 1855

**S. pneumo + N. gonorrhoeae ** causes cleavage of IgA, therefore preventing them from interfering wtih bacterial adhesions to mucous membranes

Question 1856

virulence factor of staph aureus

Answer 1856

**protein A** part of the outer peptidoglycan layer that binds Fc of IgG at the complement binding site, therefore preventing complment binding and activation

Question 1857

4yo w/ difficulty walking + hx of respiratory infections. cells demonstrate high rate of radiation-induced genetic mutations. dx?

Answer 1857

**ataxia-telangiectasia - **AR d/o that causes cerebellar atrophy -\> ataxia telangiectasia -\> shows up later in life severe immunodeficiency -\> repeated sinopulmonary infections ineffective DNA repair -\> increased risk of cancer

Question 1858

how much energy (kcal) per gram does each one of these yield? protein fat ethanol

Answer 1858

protein = 4 fat = 9 ethanol = 7

Question 1859

what is the length constant? time constant? how does demyelination affect these values?

Answer 1859

**length constant** - measure of how far along an axon an electrical impulse can propagate (ie distance at which the original potential decreases to 37% of its original amplitude demylination _decreases_ the length constant since there is increased charge dissipation along a nerve axon (myelin normally reduces charges from dissipating); net: it reduces the distance an impulse can travel **time constant** - time it takes for a change in membrane potential to achieve 63% of its new value demyelination _increases_ the time constant (leads to a slower impulse conducton since it takes longer for the membrane to build up charges)

Question 1860

most abundant a.a. in collagen and its function? two other a.a. that are abundant and their functions?

Answer 1860

**glycine** (impt for triple helix to form) other - **proline** (impt for a-helix formation) and **lysine** (impt for hydrophobic interactions)

Question 1861

true vocal cords are covered by what type of epithelium?

Question 1862

2 studies w/ similar RR values, but p values are different. What can account for this?

Answer 1862

sample size - the power of a study increases proportionally w/ the same size. the larger a sample size, the greater the ability to detect a difference when one truly exists.

Question 1863

¹³C-labeled urea is used for what?

Answer 1863

detect H pylori infection - breath is monitored for ¹³C-labeled CO2, which would indicate the presence of **urease** in the stomach

Question 1864

patients taking hydroxychloroquine should be monitored for? who should you avoid giving choroquine to? Rx alternatives?

Answer 1864

irreversible retinal damage - get baseline+followup eye exams avoid giving hydroxychloroquine to patients w/ psoriasis - can make it worse! Alternative is to give atovaquone or proguanil

Question 1865

infant w/ recurrent otitis media, bronchiolitis, candidiasis, and poor growth suggests what d/o?

Answer 1865

**SCID** recurrent otitis media (bacterial), bronchiolitis (viral), candidiasis, and poor growth suggests** defect in both cell mediated (T cells) AND humoral (B cells) immunity** consider DiGeorge if there are other features (facial abnormalities, hypoparathyroidism, cardiac defects) are present

Question 1866

∆ btwn CVID and SCID?

Answer 1866

* **CVID** - ∆ Igs secondary to failed B cell differentiation (cell mediated immunity is not severely impaired) * frequent bacterial infections * **SCID** - ∆ B cells + ∆ T cells * frequent bacterial, viral, and fungal infections

Question 1867

reliable vs accurate precise vs accurate reliable vs precise

Answer 1867

reliable = precise = measure of reproducibility accuracy = degree to which the measured value matches that of the gold standard

Question 1868

what are ephelides? what are polythelia?

Answer 1868

**ephelides = freckles** **polythelia = accessory nipple** due to failure of involution of the mammary ridge

Question 1869

bilateral parotid gland enlargement in a young woman should make you think of....

Answer 1869

bulimia nervosa

Question 1870

muffled heart sounds, elevated JVP, profound hypotension

Answer 1870

pericardial tamponade - usually due to rupture of the ventricular free wall as a consequence of a transmural MI usually occurs 3-7d after MI, when coagulative necrosis, neutrophil infiltration, and enzymatic lysis of CT have sufficiently weakened the myocardium

Question 1871

B cell development where does VD/VDJ recombination occur? where does isotype switching occur? where does somatic hypermutation occur?

Answer 1871

VD/VDJ recombination = bone marrow isotype switching = germinal centers in LN somatic hypermutation = germinal centers in LN

Question 1872

where does the ascending aorta lie? descending aorta?

Answer 1872

**ascending = posterior** and to the **right** of the main pulmonary artery **descending** = **abuts the L anterior** **surface of the vertebral column** and lies **posterior to the esophagus and the L atrium**

Question 1873

GN rods that are oxidase positive and non-lactose fermenting trmt?

Answer 1873

**psuedomonas** penicllins: Ticarcillin, Piperacillin Cephalosporins: Ceftaxidime, Cefepime aminoglycosides: amikacin, gentamicin, tobramycin Fluoroquinolones: ciprofloxacin, levofloxacin monobactams: azetreonam carbapenems: imipenem, meropenem

Question 1874

why is it that someone infected w/ mycoplasma pneumonia has mild anemia + serum LDH?

Answer 1874

due to antigenic similarity btwn antigens in mycoplasma pneumoniae and the RBC cell membrane - immune system mounts a response "**Cold agglutinins**" aganist pathogen also destroys RBCs, resulting in mild anemia. remember that cold agglutinins can agglutinate RBCs in vitro at low temps

Question 1875

ecthyma gangrenosum

Answer 1875

bacteremia/septicemia w/ **pseudomonas aeruginosa** - lesions result from perivascular bacterial invasion of arteries/veins in the dermis + subcu tissue w/ subsequent release of exotoxins that are destructive to the tissue; usually in **neutropenic patients, hospitalized patients, burns, chronic indwelling catheters** ## Footnote **Exotoxin A, Elastase, Phospholipase C, Pyocanin**

Question 1876

methacholine

Answer 1876

**muscarinic cholinergic receptor agonist** - causes bronchoconstriction and increased airway secretions used to dx asthma - decrease in FEV1 by \>20% indicates bronchial asthma bethany please call **m**e

Question 1877

thiopental how are its effects terminated?

Answer 1877

barbituate - GABAa action - increase duration of Cl- opening general anesthetic that is administered IV; **highly lipid soluble (high potentcy)** and equilibrates w/ the brain within 1 min of administration; and is used for the **induction** of anesthesia for short procedures **rapid redistribution into skeletal m. + adipose** -\> awakening...eek.. short-acting barbiturate - acts at GABA receptors and increases their inhibitory potential

Question 1878

woman w/ hx of PID, hypothyroidism, and appendectomy has LMP 9 weeks ago has abd pain, vaginal bleeding, signs of hemorrhagic shock (low BP, tachycardia, clammy hands, oliguria). endometrial bx will show..

Answer 1878

decidual (gestational changes in the endometrium (no chorionic villi) because she has an ectopic pregnancy that probably ruptured

Question 1879

earliest lesion of atherosclerosis

Answer 1879

**intimal fatty streak** composed of intimal lipid filled foam cells (macrophages + smooth muscles filled with LDL) that insudate into the intima through an injured/leaky endothelium

Question 1880

earliest lesion of dissecting aortic aneurysm

Answer 1880

intimal **tear**

Question 1881

trmt for patients w/ CAH

Answer 1881

ACTH why? because dececreased cortisol levels is sensed by the hypothalamus, which causes a consequential increase in ACTH production by the anterior pituitary, which further drives the conversion of cholesterol -\> T by giving exogenous steroids, this suppresses the HPA axis, thereby reducing this conversion!

Question 1882

equation for filtration rate of a substance X Net excretion rate of a substance?

Answer 1882

**filtration rate of a substance X** = GFR x plasma concentration of X (GFR = inulin clearance) **Net excretion rate of a substance X** = GFR x plasma concentration of X - tubular reabsorption of substance X

Question 1883

someone with sudden onset of transient numbness and tingling that resolves within 20 minutes should make you think of? what should you treat these patients w/?

Answer 1883

TIA trmt: low dose aspirin - prevents coronary events and ischemic strokes ADR: GI bleeds (inhibition of COX1 -\> lack of PGI2 + decreased mucous production)

Question 1884

what happens when aspirin is used in asthmatics?

Answer 1884

MAKES IT WORSE because aspirin blocks the COX pathways, leading to the overproduction of LTs that cause bronchoconstriction

Question 1885

pathophysiology of narcolepsy trmt?

Answer 1885

**depletion of hypocretin1**-secreting neurons in the **lateral** hypothalamus involved in maintaining wakefulness net: **shortened sleep latency +** **entry REM sleep immediately, ****hypnagogic + hypnopompic hallcuinations + sleep paralysis** trmt: **scheduled daytime naps + psychostimulants (modafinil - 1st line, amphetamines - 2nd line)**

Question 1886

hydrocele vs indirect hernia?

Answer 1886

both caused by an incomplete obliteration of the processus vaginalis * hydrocele - connection btwn the scrotum and abdominal cavity that allows for the leakage of fluid * hernia - opening allows for the protrusion of abdominal organs along the inguinal canal

Question 1887

Schizoaffective d/o diagnostic criteria - 3

Answer 1887

patient must meet criteria for 1) major depressive or manic episode CONCURRENT w/ 2) active symptoms of schizophrenia AND 3) period in which schizophrenia occurs in the _absence_ of mood sx

Question 1888

neisseria gonorrhoeae why is it that patients keep getting re-infectioned w/ the same bug? 2 trmt?

Answer 1888

1) n. gonorrhoeae can undergo a high frequency of antigenic variation of their gonococcal surface antigens (not due to resistance to antibiotics) 2) patient can be deficient in C5-C9, and is unable to form MAC complex trmt: ceftriaxone

Question 1889

recurrent otitis media suggests chronic mucocutaneous candidiasis suggests pneumocystis infection suggests patient that has all 3?

Answer 1889

recurrent otitis media = ∆ humoral immunity chronic mucocutaneous candidiasis = ∆ T cell deficiency pneumocystis infection = ∆ T cell deficiency patient w/ all 3 = **SCID = typically present w/ failure to thrive and chronic diarrhea within the first year of life**

Question 1890

ape hand deformity

Answer 1890

denervation of the median nerve also - sensation is lost on the palmar surface of the first 3 1/2 fingers

Question 1891

inability to flex the forearm

Answer 1891

damage to the musculocutaneous nerve - paralysis of biceps + brachialis

Question 1892

claw hand deformity

Answer 1892

ulnar n. damage - paralysis of most of the intrinsic muscles of the hand

Question 1893

wrist drop

Answer 1893

damage to radial n. - innervates the extensors of the hand at the forearm

Question 1894

∆ btwn these holocrine eccrine apocrine merocrine paracrine

Answer 1894

**holocrine **- found in sebaceous glands; cells breakdown to release product; think "holocrine = holocaust = death of cells" **eccrine **= **merocrine **= present throughout most of the body; secrete watery fluid in Na/Cl directly onto the skin surface (guessing these cells contain CFTR!!!) **apocrine** - dermis + subcu fat of breast areolae, axilla, genitals - secrete into the hair follicles rather than directly to the skin surface; undergo cyclical ∆s secondary to hormonal fluctuations; odorless when secreted, but *becomes malodorous due to skin flora* **paracrine **= secretions reach target cells via diffusion through the extracellular space (similar to endocrine glands)

Question 1895

patient w/ heavy calcification of the aortic valve w/o any other significant findings

Answer 1895

dystrophic calcification due to cell injury + necrosis

Question 1896

role of alanine + glutamine in metabolism

Answer 1896

alanine transports nitrogen to the liver (to alpha-ketoglutarate to form glutamate) for disposal glutamate is processed in the liver to form urea (primary disposal form of nitrogen)

Question 1897

∆ btwn arnold chiari type I and type II?

Answer 1897

**type I - tonsils** herniate below foramen magnum into the vertebral canal; manifests w/ HA and cerebellar sx (ataxia) **type II - cerebellum + medulla** herniate below the foramen magnum; results in aqueductal stenosis * **difficulty swallowing, dysphonia, stridor, apnea (due to compression of the medulla) ** * **leg paralysis (due to lumbar myelomeningocele)**

Question 1898

common complication of hemolytic anemia

Answer 1898

**pigmented** gallstones - increased bilirubin from lysed RBC preciptates as Ca bilirubinate, forming pigmented stones in the GB

Question 1899

infant w/ recurrent otitis media, muco-candidiasis + chronic diarrhea + failure to thrive within the first year of life

Answer 1899

SCID - ∆ humoral + ∆ cell-mediated immunity

Question 1900

Candida skin guages what type of HSR reaction? what cell types are involved in this reaction? failure to generate a response to this test indicates?

Answer 1900

Type IV HSR macrophages, CD4/8, and NK cells failure to response = anergy/ø cell mediated immune response failure is expected in SCID, where there is a hypoplasia of both B and T cells

Question 1901

"refractory" peptic ulcer dx should make you think of.. gross examination of the stomach should look...

Answer 1901

Zollinger-Ellison excessive gastrin causes - increased gastric acid secretion from parietal cells -\> PUD + diarrhea - induces parietal cell proliferation/hyperplasia -\> increased mass of fundic glands (gastric rugal folds look like brain gyri

Question 1902

important determinant of insulin resistance

Answer 1902

visceral deposition of fat - ie fat surrounding internal organs, measured as **waist:hip ratio**

Question 1903

increase in liver fat suggests increase in liver glycogen suggests

Answer 1903

liver fat = insulin resistance live glycogen = increased insulin action, since insulin increases glycogen synthesis in the liver and skeletal muscles

Question 1904

where should a thoracentesis be performed if done at the mid clavicular line? mid axillary line? paravertebral line? where should the needle be inserted at the ribs?

Answer 1904

mid clavicular line = 1 rib above **7** mid axillary line = 1 rib above **9** paravertebral line = 1 rib above **11** needle should be inserted along the UPPER border, since insertion of the needle on the inferior margin of the rib risks striking the subcostal neurovascular bundle any higher = risk of penetrating lungs any lower = risk of penetrating abdominal organs

Question 1905

viruses that have polycistronic sequences (ie it generates a polyprotein product that must be cleaved into monocistronic mRNA)

Answer 1905

ss (+) RNA viruses, non-segmented Echovirus (picornavirus)

Question 1906

where are these normally seen in the lung asbestosis slicosis berylliosis coal workers organic dust

Answer 1906

**LASU = SULA** dunno** ** **a**sbestosis = **L**OWER lobe, interstitial plaques w/ ferruginous bodies **s**licosis = **U**PPER lobe - calcified hilar nodes w/ birefringent particles surrounded by dense collagen fibers berylliosis = hypersensitivity pneumonoitis = non-caseating granulomas coal workers = perilymphatic accumulation of coal dust-laden macrophages organic dust = hypersensitivity pneumonitis = non-caseating granulomas

Question 1907

galactosyl ß-1,4-glucose is also known as?

Answer 1907

LACTOSE ∆ in ß galactosidease (converts galactosyl ß-1,4-glucose -\> galactose + glucose) = lactose intolerance can be due to: genetics (1˚) or viral gastroenteritis/celiac sprue (2˚)

Question 1908

transient central DI vs permanent central DI

Answer 1908

**transient central DI = damage to the pituitary gland**; temporary because the surviving neurons undergo hypertrophy and axonal regeneration, allowing them to produce and release functional quantities of ADH into the criculation after a certain period of time **permanent central DI = damage to hypothalamic nuclei** (SOVP nuclei) or pituitary stalk

Question 1909

trmt for acute opioid withdrawal in neonates

Answer 1909

**tincture of opium** - contains morphine; titrated to the patient's sx and eventually tapered off do not use nalxone since that is a pure opioid receptor antagonist; rather this is used in acute opioid intoxication, overdose, or for diagnosing opioid dependence. Administering this to a patient going through opioid withdrawal can result in even more severe withdrawal sx (ie seizures)

Question 1910

diplopia, dysphagia, dysphonia

Answer 1910

3 D's of botulism trmt: **antitoxin** - blocks effect of circulating toxin, supportive (intubation/mechanical ventilation for diaphragmatic

Question 1911

ejection fraction is synonymous with

Answer 1911

stroke volume

Question 1912

twinning cleavage on d2? cleavage on d5? cleavage on d9?

Answer 1912

cleavage on d2 = dichorionic - diamniotic cleavage on d5 = monochorionic - diamniotic cleavage on d9 = monochorionic -monoamniotic impt dates to note: **chorion forms on D3,** **amnion forms on d8 (C3, A8)**

Question 1913

justification for giving glucagon for ß blocker OD?

Answer 1913

glucagon - acts on GPCR to increase cAMP, thereby releasing intracellular Ca -\> increases contractility + HR; improves within minutes

Question 1914

brain tumor that has S100 positivity

Answer 1914

**schwannomas** tumor of the PNS that arise from schwann cells; usually occur within a few mm from the surface of the brain and spinal cord (common at the cerebellopontine angle at CN 8 - at this location it is called an "acoustic neuroma" and can cause tinnitus, vertigo, and sensorineural hearing loss) (other S100+ tumor = melanoma; both derived from neural crest cells)

Question 1915

why would a patient w/ sickle disease develop macrocytosis? what role does extramedullary erythropoiesis have?

Answer 1915

predisposed to folic acid (B9) deficiency due to increased RBC turnover extramedullary erythropoiesis should be considered when the reticulocyte count is really high *(indicates that the bones are producing RBC as fast as they can pump them out)* if the reticulocyte count is low \<5%, then consider B9 deficiency

Question 1916

pathophysiology of liquefactive necrosis in the brain

Answer 1916

irreversible ischemic neurons release **lysosomal enzymes** that results in the degradation of tissues in the ischemic region phagocytic cells migrate into the area and remove the necrotic tissue, leaving a cavity astrocytes proliferate around necrotic area with the formation of a gliotic scar

Question 1917

acetaminophen how is it metabolized and eliminated?

Answer 1917

acetaminophen hepatic metabolized via **sulfation + glucuronide conjugation**; remainder is eliminated via oxidation by CYP450 pathway (generates NAPQI - a highly toxic and reactive compound) and by urinary excretion by unmetabolized drugs. Excess doses saturates the normal hepatic in excess NAPQI

Question 1918

cardiac bx shows: myofibrillar disarray + fibrosis

Answer 1918

hypertrophic cardiomyopathy

Question 1919

3 sx of RHF? LHF?

Answer 1919

**RHF:** Hepatomeagly, peripheral edema, JVD **LHF:** pulmonary edema (hemosiderin-laden macrophages), orthopnea, paroxysmal nocturnal dyspnea

Question 1920

what do these terms with regard to anesthetic properties: low solubility in blood low solubility in lipids

Answer 1920

**low solubility in blood** = rapid induction + recovery times **low solubility in lipids** = low potency = higher MAC (conc. needed to basically induce sedation)

Question 1921

N2O has a low blood and lipid solubility. what does this mean in terms of induction, potency, and MAC?

Question 1922

Halothane has a high blood and lipid solubility. what does this mean in terms of induction, potency, and MAC?

Answer 1922

slow induction high potency lower MAC

Question 1923

Risperidone ADR

Answer 1923

atypical antipsychotic that has anti-dopaminergic actions **Hyperprolactinemia** (galactorrhea + amenorrhea) ris**P**eridone

Question 1924

neurophysin where are they producd and what are their functions?

Answer 1924

produced in hypothalamic **SO (ADH) PV (oxytocin) **nuclei involved in the post-translational processing of oxytocin + vasopressin (ADH) while it's traveling down from the hypothalamus to the posterior pituitary; released into circulation

Question 1925

exogenous T use LH FSH T Sperm count

Answer 1925

LH = decreased FSH = normal T = increased Sperm count = decreased (high LOCAL androgns are necessary for spermatogenesis)

Question 1926

central hypogonadism LH FSH T Sperm count

Answer 1926

LH = decreased FSH = decreased T = decreased Sperm count = decreased

Question 1927

cryptorchidism/orchitis LH FSH T Sperm count

Answer 1927

damages ONLY the seminiferious tubules (Leydig cells are fine) LH = normal FSH = increased T = normal Sperm count = low

Question 1928

kleinfelter LH FSH T Sperm count

Answer 1928

hypogonadism (damage to both leydig + seminiferous tubules) LH = increased FSH = increased T = decreased Sperm count = decreased

Question 1929

rationale of prescribing potassium-citrate to patients w/ recurrent kidney stones?

Answer 1929

citrate binds to free (ionized) calcium, preventing its precipitation and facilitating its excretion

Question 1930

Anti-arrhythmia that has an ADR of transitory flushing, chest burning in the chest and SOB

Answer 1930

adenosine

Question 1931

woman with pale conjunctivae, fatigue, irregular menstrual cycles, and Hb of 9.2 g/dL and no other findings ferritin transferrin MCV Hypersegmented PMN? serum folate

Answer 1931

suspect **iron deficiency** ferritin: **low** transferrin: **high** MCV: **low/microcytic** Hypersegmented PMN: **none** serum folate: **normal**

Question 1932

Alzheimer Rx?

Answer 1932

**Donepezil** (AChEi - enhances cholinergic neurotransmission) **Vit E** (antioxidants - neuroprotection) **Memantine** (NMDA receptor antagonist)

Question 1933

E. coli virulence factors for UTI Watery Gastroenteritis Bloody Gastroenteritis Bacteremia/Septic Shock Neonatal meningitis

Answer 1933

UTI: **P. fimbrae*** (adherence to epithelial cells, uroepithelial cells, and enterocytes)* Watery Gastroenteritis: **heat-stable (ST-**cGMP), **heat-labile (LT-**cAMP) enterotoxins Bloody Gastroenteritis: **Verotoxin** (shiga-like toxin) Bacteremia/Septic Shock: **LPS-Lipid A** Neonatal meningitis: **K1** capsular polysaccharide

Question 1934

why would someone w/ aortic stenosis suddenly develop syncope + acute pulmonary edema?

Answer 1934

**a-fib** the LA can't pump sufficient blood into the LV, which resulted in * decrease in LV preload -\> **severe hypotension** * increased mean pulmonary venous pressure due to backup of fluids -\> **pulmonary edema**

Question 1935

CMV features

Answer 1935

enveloped, dsDNA

Question 1936

3 week old infant has dark urine, light colored stools, and palpable enlarged and firm liver dx? what would labs show in terms of bilirubin, AP, GGT? what will liver biopsy show? sequelae if not treated

Answer 1936

**biliary atresia** labs: increased bilirubin, AP, GGT biopsy: cholestasis, intrahepatic bile duct proliferation, portal tract edema + fibrosis sequelae if not treated: biliary cirrhosis

Question 1937

bilirubin conjugation d/o? secretory d/o?

Answer 1937

**C**onju**G**ation d/o * **C**raig Najjar * **G**ilbert Secretory d/o * Dubin Johnson * Rotor

Question 1938

Scleroderma antibodies found in limited? diffuse?

Answer 1938

limited (CREST): anti-centromere diffuse: anti-topo I (Scl-70)

Question 1939

where in the nephron does uric acid preciptation tend to occur?

Answer 1939

distal tubules + CD because these have the lowest pH (acidic) Jullet's mnemonic for stones that preciptiate at low pH: **OUCH!** **O**xalate **U**ric acid **C**ysteine **H** = H+

Question 1940

47 M w/ sinusitis treated w/ ampicillin develops fever, maculopapular rash, and oliguria; creatinine is 2.4mg/mL. Urine sediment shows RBC, PMN, and eosinophils. Dx? other drugs that can do the same?

Answer 1940

Drug-induced **Acute Interstitial Nephritis (AIN) **that is causing his acute renal failure damage to the interstitium results in interstitial edema + inflammatory infiltrate diagnostic: eosinophils and IgE in serum NSAIDs, Sulfonamides, Rifampin, Diuretics

Question 1941

Type of cells that Shigella likes to infect

Answer 1941

M cells in Peyer's patches in the ileum once endocytosed into the cell, shigella lyses the endosomes, multiplies, and spreads laterally into other epithelial cells, causing death and ulceration w/ hemorrhage and diarrhea

Question 1942

Asplenic patients are prone to infections by _______ organisms because...

Answer 1942

encapsulated organisms (**S. pneumo, H. influenza, N. meningitidis)** **SpHiNE** spleen serves as a site of **antibody synthesis** and **reservoir of phagocytic cells** capable of removing circulating pathogens

Question 1943

49 M patient w/ STEMI is treated w/ streptokinase, IV fluids, and low dose ß blocker. Several hours later, he develops asymmetric pupils and irregular breathing pattern. Why?

Answer 1943

common ADR of streptokinase is **hemorrhage. ** patient described has signs of intracerebral hemorrhage (decreased level of consciousness, asymmetric pupils, irregular breathing). ^{Don't confuse the symptoms with an embolic stroke - dude was treated w/ thrombolytic, and therefore no clots should theoretically form - making hemorrhage a more likely possibility}

Question 1944

Patients w/ ADPKD tend to have this in addition to their renal cysts outcome of this dz?

Answer 1944

LIVER cysts diagnosed on a CT scan - see multiple renal + hepatic cysts that are homogenous w/ regular outline + non-enhancing w/ contrast CT (differentiates it from a solid metz) outcome: ESRD

Question 1945

Anytime you see PrP, what disease should you think of?

Answer 1945

Prion protein (PrP) Creutzfeldt-Jakob Disease Bovine Spongiform Encephalopathy features: vacuoles in gray matter (spongiform encephalopathy) w/ NO inflammatory changes

Question 1946

painless gross hematuria should make you think of? most important factor for prognosis?

Answer 1946

"urothelial" or transitional cell carcinoma of the bladder; often grows as a papillary or sessile mass **stage -** depends on the degree of its invasion into the bladder wall and adjacnent tissues

Question 1947

patient w/ CD4 count of 40cells/µL has elevated AP, LDH, and hepatosplenomeagly Dx? What could've prevented this?

Answer 1947

MAC acid-fast bacteria that grows optimally at 41˚C Azithromycin

Question 1948

How do catecholamines, glucocorticoids, and glucagon, TNFa induce insulin resistance?

Answer 1948

Insulin receptor (IR) is a TYROSINE KINASE receptor - binding insulin to its receptor on target cells causes auto-phosphorylation of IR, followed by phosphorylation of IRS, which goes on to activate PI3K and RAS/MAP pathways involved in cell growth These factors all activate **SERINE kinases**, which phosphorylate IR (prevents downstream signaling) and IRS1 (prevents it from being phosphorylated by IR); **net: insulin resistance**

Question 1949

bilateral renal masses compsed of fat, smooth muscle, and blood vessels should cue you to which d/o?

Answer 1949

**TUBEROUS SCLEROSIS - AD d/o - renal angiomyolipomas** is a benign tumor of BV, smooth muscle, and fat. other findings: cortical tubers, subependymal hamartomas, seizures, mental retardation, ash leaf patches ^{(be careful not to confuse them with pheochromocytomas in NF1)}

Question 1950

patient w/ RA that is refractory to treatment develops exertional dyspnea and cough; CXR shows reticulonodular pattern of opacities that are most pronounced in the lower lobes

Answer 1950

Pulmonary fibrosis - restrictive lung d/o sx: gradual-onset of dyspnea, first w/ exertion -\> at rest Labs: normal-increased FEV1/FVC ratio, dcreased DLCO CXR: **reticulonodular** opacities; most pronounced in the **lower lobes** progressive fibrosis can lead to the formation of cysts that later coalesce to form "honeycomb" lung appearance on CXR and histopathology

Question 1951

picornavirus that is the most acid labile

Answer 1951

Rhinovirus only PERCH virus that is inactivated in the stomach and therefore infection is limited to the upper respiratory tract (all others can pass through the stomach and into the small intestines w/o being degraded in the acid environment and colonize the GI tract)

Question 1952

patient w/ a history of well-controlled hyperthyroidism comes in complaining of fever + sore throat. What labs should you order?

Answer 1952

WBC count w/ differential why? **PTU and Methimazole - **both inhibit thyroid peroxidase (responsible for iodine organification + coupling of iodotyrosinase), but both can cause **agranulocytosis**

Answer 1953

because

Question 1954

where do most duodenal ulcers occur? what if they're found in an aytpical location?

Answer 1954

most occur in the duodenal bulb = peptic ulcer disease ulcer found in the distal duodenum or atypical location = ZES (pancreatic gastrinomas that stimulate gastric acid secretion by parietal cells and increases parietal cell volume)

Question 1955

chronic gastritis w/ antral sparing vs chronic gastritis w/ antral involvement

Answer 1955

chronic gastritis w/ antral _sparing_ = autoimmune gastritis (may lead to pernicious anemia) vs chronic gastritis w/ antral _involvement_ = H. pylori infection (also causes PUD)

Question 1956

sigmoid shaped ventricular septum in a 78yo M

Answer 1956

part of aging...

Question 1957

reduced partoid gland secretion is due to which CN?

Answer 1957

CN 9

Question 1958

pathophysiology of Myasthenia Gravis? trmt? what if the patient accidently took too much?

Answer 1958

autoantibodies aganist post-synaptic nicotinic ACh receptors, resulting in **decreased # of functional ACh receptors at the NMJ** net: **reduces end plate potential following ACh release** - ie the threshold potential is not reached, therefore the muscle clls do not polarize. Trmt: **AChE inhibitors** too much? treat with anti-muscarinics (ie **scopolamine**)

Question 1959

∆ btwn Mallory-Weiss tear and Boerhaave Syndrome in terms of etiology? clinical presentation?

Answer 1959

Mallory-Weiss tear * upper GI **mucosal** tear that occur secondary to rapid increase of intra-abdominal + intra-luminal gastric pressure * presentation * vomiting and retching (loss of gastric acid -\> metabolic alkalosis) * hematemesis * epigastric pain Boerhaave Syndrome? * esophageal **transmural** tear * vomiting and retching * chest + upper abd. pain * fever, dyspnea, and septic shock rapidly ensues

Question 1960

Sorbitol is metabolized to _______ in the seminal vesicles? Sorbitol is metabolized to _______ in the lens? Sorbitol is metabolized to _______ in the retina? Sorbitol is metabolized to _______ in the renal papilla? Sorbitol is metabolized to _______ in the schwann cells?

Answer 1960

**seminal vesicles, lens**: Sorbitol is metabolized to **fructose** via action of sorbitol dehydrogenase **retina, ****renal papilla, schwann cells**: sorbitol is not metabolized because there is much less sorbitol dehydrogenase activity in these tissues

Question 1961

volume status in a patient with SIADH

Answer 1961

**EUVOLEMIC HYPONATREMIA** Why? excess ADH causes excess water reabsorption -\> hypervolemia, which leads to decreased RAAS + increased ANP -\> Na excretion in urine low plasma Na low osmolality inappropriately concentrated urine increased urine Na

Question 1962

∆ btwn bethanechol, oxybutynin and phenylephrine in the treatmetn of bladder dysfunction??

Answer 1962

**bethanechol = muscarinic agonist -** stimulates contraction of the detrusor muscle, therefore iimproving bladder emptying in patients w/ post-op urinary retention "blessing that you can go!" **oxybutynin = anti-muscarinic agent - **used for urge incontinence (ie promotes urinary retention) **phenylephrine = alpha1 agonist** = stimulation of a1 receptors in the bladder causes the trigone and sphincter to contract, thereby promoting urinary retention * a1 blocking agent would improve bladder emptying

Question 1963

nucleolus

Answer 1963

site of ribosomal subunit maturation + assembly RNA pol I synthesizes the majority of rRNA from within the nucleolus

Question 1964

drug that you can use to prevent NSAID-induced ulcer disease

Answer 1964

misoprostol - prostaglandin E1 analog

Question 1965

Quick associations: joint pain + cardiac murmur nasal ulcer + hematuria malar rash + pleural effusion hemoptysis + oliguria dysphagia + sclerodactyly

Answer 1965

* **joint pain + cardiac murmur = rheumatic heart disease** * ab against M proteins that cross-react w/ glycoproteins in the heart and joints * **nasal ulcer + hemoptysis + hematuria = Wegener's polyangiitis** * cANCA; pauci-immune staining in kidneys * **malar rash + pleural effusion = SLE** * immune complex d/o; ANA (+), anti-dsDNA, anti-smith * **hemoptysis + oliguria = Goodpasture** * anti-GBM (alpha3 chain of collagen type IV) * **dysphagia + sclerodactyly = CREST** * anti-centromere

Question 1966

3 treatments for hirsutism?

Answer 1966

1. **spirnolactone** - K sparing diuretic + anti-androgen effects (receptor blocker, decreases T production) 2. **flutamide -** inhibits binding to T receptors 3. **finasteride **- 5a reductase inhibitor

Question 1967

Schistosomiasis that can cause: squamous cell of the bladder? intestinal ulceration? liver cirrhosis (periportal pipestem fibrosis)

Answer 1967

squamous cell of the bladder = **S. Haematobium** * acquired via freshwater snails intestinal ulceration + liver cirrhosis (periportal pipestem fibrosis) **= S. mansoni** * **periportal pipestem fibrosis** clinical manifestations of both result from a Th2 mediated immune response directed against the **eggs,** resulting in a **granulomatous **inflammation and fibrosis, which causes ulceration + scarring of the bowel or bladder/ureters

Question 1968

worm that causes B12 deficiency and megaloblastic anemia

Answer 1968

Diphyllobothrium latum ingestion of larvae from raw freshwater fish

Question 1969

cysticercosis

Answer 1969

taenia solium - human tapeworm consumption of infected, undercooked pork

Question 1970

"moldy grain" - aflatoxin exposure bug? MoA of the toxin? sequelae?

Answer 1970

Aspergillus flavus + Aspergillus parasiticus aflatoxin causes a mutation in p53 sequelae: **hepatocellular carcinoma**

Question 1971

PAS(+) granules in macrophages found in an intestinal bx

Answer 1971

**Tropheryma whippelii - Whipple disease** hx: enlarged, foamy macrophages packed w/ rod shaped bacilli and PAS+, diastase-resistant granules presentation: diarrhea and weight loss due to malabsorption arthropathy, polyarthritis, psychiatric, and cardiac ∆s trmt: antibiotic

Question 1972

∆ btwn metanephric blastema and metanephric diverticula?

Answer 1972

metanephric blastema = glomeruli -\> DCT metanephric diverticula (aka ureteric bud) = collecting ducts -\> ureters

Question 1973

What d/o these related to? Kussmaul's sign Pulsus Paradoxus Friction rub Pericardial knock which ones are acute? chronic?

Answer 1973

**Kussmaul's sign (**paradoxical increase in JVP w/ inspiration) * usually in patients w/ _chronic_ constrictive pericarditis **Pulsus Paradoxus** (∆ systolic BP \>10mmHg during inspiration) * cor pulmonale, constrictive chronic pericarditis, pericardial disease, and cardiac tamponade * patients usually have muffled heart sounds, JVD, and hypotension **Friction rub** (high pitched, leathery, scratchy sound) * **_acute_** pericarditis * sharp, pleuritic and decreases when the patient sits up and leans forward (to decrease pressure on the parietal pericardium) **Pericardial knock** (early diastole precordial sound) * constrictive chronic pericarditis

Question 1974

middle meningeal artery branches off of what artery? where does this enter the skull?

Answer 1974

**maxillary a.**, which itself is a branch of the **external carotid a.** mma enters the skull at **foramen spinosum**

Question 1975

slowly growing mass that drains yellow pus in the setting of a recent oral trauma dx and treatment?

Answer 1975

**actinomyces israelii** GP that is notorious for causing cervicofacial actinomycosis in patients following dental mainpulation; trmt: **pencillin** + surgical debridement

Question 1976

5a reductase deficiency who does it affect; typical phenotypical presentation

Answer 1976

**5a-reductase deficiency** DHT normally mediates the development of the external genitalia (penis+scrotum) in the embryo, growth of prostate, facial hair, and temporal recession of the hairline 46XY infant w/ small phallus + hypospadias + testes in the inguinal area. Serum BP + T are normal

Question 1977

21 hydroxylase deficiency who does it affect; typical phenotypical presentation

Answer 1977

salt wasting and hypotension + hyperkalemia XX = virilized

Question 1978

11ß hydroxylase deficiency who does it affect; typical phenotypical presentation

Answer 1978

HTN, salt wasting XX = virlization

Question 1979

17a hydroxylase deficiency who does it affect; typical phenotypical presentation

Answer 1979

XY = undervirilized

Question 1980

Aromatase deficiency who does it affect; typical phenotypical presentation

Answer 1980

XY = virlized

Question 1981

d/o's that have "endomysial" vs "endoneural" inflammatory infiltrate

Answer 1981

* **"endomysial" = polymyositis** - inflammatory dz of skeletal muscle; bilateral symmetric weakness of proximal muscles w/ _normal_ reflexes * **"endoneural" = Guillain Barre** - acute demyelinating peripheral neuropathy that results in ascending paralysis + _areflexia_

Question 1982

acute onset JVD + 80/60mmHg + pulse of 120bpm

Answer 1982

cardiac tamponade _or_ tension pneumothorax hx of chest trauma + abnormal lung auscultation -\> TP hx of viral infection-\> CT

Question 1983

What does this dude have? How do you know?

Answer 1983

Myasthenia Gravis see **decreasing amplitude** of cyclic intrapleural pressure changes during deep, rapid breathing (ie progressively weakening diaphragmatic contractions during maximal voluntary ventilation) with **intact phrenic nerve stimulation**

Question 1984

cells involved in local defense aganist candida? systemic defense?

Answer 1984

Local: T cells Systemic: PMN * HIV patients have localizd candidiasis but not systemic candidiasis * Neutropenic patients are more likely to have systemic disease

Question 1985

Hemoglobin C vs Hemoglobin S which one causes a more serious disease and why?

Answer 1985

Hemoglobin S charged glutamic acid -\> hydrophobic valine causes aggregation of hemoglobin molecules under anoxic conditions (compare to HbC, where glumatic acid is replaced w/ lysine, a basic a.a.)

Question 1986

rationale for treating female infertility w/ menotropins followed by ßhCG?

Answer 1986

**menotropins** = human menopausal gonadotropin - acts like FSH and leads to the development of a dominant ovarian follicle **ßhCG** = simulates the LH surge

Question 1987

what confers elastin its plasticity and ability to recoil upon release of tension?

Answer 1987

desmosine cross-linking btwn **lysine** residues on four different elastin chains (via lysyl hydroxylase, Cu)

Question 1988

which part of the heart forms the most diaphragmatic surface of the heart? what artery supplies this area? In most individuals, what artery does this derive from?

Answer 1988

inferior wall of the LV PDA derived from RCA

Question 1989

3 mo infant - irritable, feeds poorly, vomits frequently PE: large head circumference, white-yellow chorioretinal lesions, enlarged ventricles w/ scattered intracranial calcifications

Answer 1989

Toxo - usually acquired in utero (transplacental infection - mother likely infected during the first 6 mo of pregnancy) expecting mothers should avoid cat feces to help prevent exposure to toxo

Question 1990

How does NTG lead to vasodilation?

Answer 1990

NTG is converted to NO in cells - \> NO stimulates guanylate cyclase - \> increased cGMP - \> decreased Ca - \> decrease MCLK activity - \> decreased MLC phosphorylated - \> smooth muscle relaxation

Question 1991

what does a cavernous hemangioma of the liver look like?

Answer 1991

**let the name tell you** **cavernous, blood filled** vascular spaces of variable sizes lined by a single epithelial layer most common benign liver tumor bx is NOT recommended due to risk of fatal hemorrhage

Question 1992

Antidepressant ADRs SSRIs TCAs (imipramine, doxepin, amitriptyline, clomipramine)

Answer 1992

SSRIs = sexual dysfunction TCAs (imipramine, doxepin, amitriptyline, clomipramine) = LOTS * urinary retention due to anticholinergic effects (TCAs relax the bladder) * cardiac arrhythmias (QT prolongation) * seizures = comipramine, bupropion * orthostatic hypotension

Question 1993

class IA anti-arrhythmics? class IB anti-arrhythmics? class IC anti-arrhythmics?

Answer 1993

``` **class IA anti-arrhythmics** = Disopyramide, Quinidine, Procainamide Double Quarter Pounder; some K channel interaction ``` ``` **class IB anti-arrhythmics** = Lidocaine, Tocainide, Mexiletine Lettuce, Tomato, Mayo; come Ca channel interaction ``` ``` **class IC anti-arrhythmics** = Moricizine, Flecainide, Propafenone More Fries Please; pure Na channel interaction ```

Question 1994

Lethal side effects associated w/ PCP cocaine opioids

Answer 1994

PCP = trauma due to violent behavior cocaine = stroke, MI opioids = respiratory depression

Question 1995

patient w/ dyspnea, distended JVD, pitting edema, and fatigue has activation of these two processes

Answer 1995

think of congestive heart failure sympathetic + RAAS activation

Question 1996

enzyme involved in the breakdown of heme -\> biliverdin

Answer 1996

Heme oxygenase

Question 1997

Ca and PTH levels in a patient w/ chronic renal failure (BUN 75, creatinine 5.8)??

Answer 1997

**think 2˚ hyperparathyroidism due to CRF** decreased renal activity of 1a hydroxylase -\> **less 1,25-VitD3** made less 1,25-Vit D3 -\> decreased intestinal absorption of Ca **decreased serum Ca** -\> **PTH elevates** in response impaired renal excretion of PO3 -\> **elevated serum PO3**

Question 1998

osteoclasts differentiate under these two factors: what do these osteoclasts look like?

Answer 1998

RANKL + MCSF osteoclasts in paget's disease are (+) for tartrate-resitant acid phosphatase and are multinucleated (up to \>100 nuclei)

Question 1999

how to calculate OR? how to calculate RR? RRR?

Answer 1999

OR = a/c / b/d = ad/bc RR = a/(a+b) / c/(c+d) RR reduction = 1 - RR

Question 2000

what does the carotid massage to the AV node?

Answer 2000

**prolongs** the AV node **refractory** period

Question 2001

patient w/ impaired transport of ornithine from the cytosol to the mitochondria should restrict what in their diet?

Answer 2001

restrict **proteins** from diet ornithine transport into mitochondria is an essential step for urea formation (ornithine combines w/ carbamoyl phosphate to form citrulline in the urea cycle)

Question 2002

patient w/ hypoglycemia after a prolonged fasting period w/ inappropriately low ketone bodies

Answer 2002

impaired ß oxidation due to **∆ acyl-coA dehydrogenase **- catalyzes the first step in the ß oxidation pathway

Question 2003

prolonged \>3mo consumption of appetite suppressants (dexfenfluramine, fenfluramine, or phentermine) causes what? associated sx?

Answer 2003

pulmonary HTN manifests as dyspnea on exertion and can progress to cor pulmonale w/ RVH, potentially leading to sudden cardiac death

Question 2004

what bugs do these make you think of? rhabditiform larvae in stool parasite eggs in stool perianal egg deposition proglottids in stool trophozoites and cysts in stool

Answer 2004

* **rhabditiform larvae in stool - Strongyloides stercoralis** * ^{can cause hyperinfection syndrome (massive dissemination of the organisms, leading to multiorgan dysfunction and septic shock)} * **parasite eggs in stool = schistosoma mansoni or japonicum** * ^{s. stercoralis eggs hatch in the intestinal mucosa and are not found in stool} * **perianal egg deposition = enterobius vermicularis** * **proglottids in stool = Taenia solium, Diphyllobothrium latum** * **trophozoites and cysts in stool = Giardia lamblia, Entamoeba histolytica**

Question 2005

∆ btwn phenoxybenzamine vs phentolamine in terms of their effects on norepinephrine on the dose response curve?

Answer 2005

**phenoxybenzamine** - **irreversible, non-compettive** antagonist - even very high NE concentrations cannot overcome its inhibitory effects, therefore the dose-response curves, pretreatment w/ phenoxybenzamine will cause the graph to **shift down** **phentolamine** - **reversible, competitive** antagonist; high doses of NE can overcome its inhibitory effects, therefore the graphs will **shift right** **^{phenoxybenzamine, irreversible = LONGER words}** **^{phentolamine, reversible = SHORTER words}**

Question 2006

man with weight loss + epigastric discomfort after meals w/ occasional nausea should make you think of?

Answer 2006

signet ring carcinoma of the stomach cells contain lots of mucin droplets that push the nucleus to the side; often infiltrate the stomach wall

Question 2007

patients present w/ signs of acute decompensated CHF (SOB, inability to lie down, edema, lung crackles). which diuretic to use? ADR of this particular class of diuretics?

Answer 2007

Loop diuretics = agent of choice in acute settings because it has potent diuretic effects ADR: hypoK, hypoMg, hypoCa

Question 2008

second most common cause of all UTIs what tests can you use to differentiate it from other bacteria?

Answer 2008

S. saprophyticus GP cocci catalase +, coagulase -, novobicin resistant

Question 2009

dantrolene what is it used for? how does it work?

Answer 2009

* used to treat **malignant hyperthermia** (fever+muscle rigidity) that occurs after administration of **inhalation anesthetics +/- succinylcholine** in susceptible individuals * Malignant hyperthermia is caused by defective **ryanodine (Ca) receptors** on the sarcoplasma reticulum * ryanodine receptors normally release small amounts of Ca into the cytoplasm during muscle contraction * abnormal ryanodine receptors release large amounts of Ca, which stimulates ATP-dependent reuptake by the SR, where the excess ATP consumption -\> generates heat + muscle damage * muscle damage -\> release of K, myoglobin, and CK into circulation * **Dantrolene acts on the ryanodine receptor and prevents further Ca release into the cytoplasm**

Question 2010

GNR, oxidase +, pigment

Answer 2010

Pseudomonas DUH

Question 2011

patient w/ well-controlled HTN develops hypercalcemia and low PTH levels. Why?

Answer 2011

**thiazides -** increases distal tubular reabsorption of Ca, leading to **HyperCa**, which leads to a suppressed PTH

Question 2012

what is 2-PAM and what is it used in?

Answer 2012

**pralidoxime** - muscarinic receptor antagonist; used in organophosphate (AChEi) poisoning to reverse the effects of both N + M overstimulation

Question 2013

pathophysiology of vitiligo vs abinism?

Answer 2013

* **_vitiligo_** - autoimmune destruction of melanocytes in the epidermis, resulting in **lower #s of melanocytes** * **_albinism_ **- decreased tyrosinase activity or defective trysoine transport, or normal neural crest cell migration, results in **normal # of melanocytes w/ decreased melanin production **

Question 2014

damage to Brocas Area or Wernicke's area is likely due to occlusion of this artery

Answer 2014

MIDDLE CEREBRAL ARTERY

Question 2015

trendelenburg gait cause? what does it look like?

Answer 2015

injury to** superior gluteal n.** _or_ **gluteus medius m.** when one lifts the leg contralateral to the injury, the hip (on the same side as the leg lift) drops down because the **ipsilateral gluteus medius + gluteus minimus cannot contract **

Question 2016

best Rx to prevent recurrent Ca-Oxalate stone formation ADR of this Rx?

Answer 2016

**Thiazides** - inhibits apical NaCl cotransporter, which decreases intracellular Na. this ativates the basolateral Na/Ca antiporter, which pumps Na into the cell in exchange for Ca, thereby enhancing the luminal Ca absorption thorugh an ion channel on the apical membrane **net: decreases urine Ca excertion** **ADR: hypONa, hypOK, metabolic alkalosis, hypER-Ca**

Question 2017

patients w/ galactosemia without any other defect have cataract formation due to activity of which enzyme? d/o? trmt?

Answer 2017

enzyme: **Aldose reductase - **converts galactose -\> **galacticol**, which accumulates and cause osmotic damage in the lens d/o: **mild galactosemia (∆ galactokinase)** trmt: avoid lactose (metabolized to galactose + glucose)

Question 2018

DiGeorge vs Agammaglobulinemia what cells are affected? where in the LN does it affect?

Answer 2018

DiGeorge * ø **T** cells * ø paracor**T**ex Agammaglobulinemia * ø B cells * ø 1˚ lymphoid follicles and germinal centers

Question 2019

patient prescribed diphenhydramine for skin rash subsequently experiences blurred vision. Why?

Answer 2019

diphenhydramine (as well as chlorpheniramine) are **1st generation antihistamines** (block H1 receptors) that ALSO have **anti-muscarinic, anti-alpha adrenergic, and anti-serotonergic** properties that are responsible for the majority of their side effects

Question 2020

patients on typical antipsychotics develop extrapyramidal side effects - what do you treat them with?

Answer 2020

benztropine _or_ diphenhydramine

Question 2021

maple syrup urine disease a.a. affected?

Answer 2021

isoleucine, leucine, and valine trmt: high-dose **thiamine**

Question 2022

45yo w/ 20pack history comes in with low PaO2 and low PaCO2 dx?

Answer 2022

PE or pneumonia - both which can lead to hypoxemia hypoxemia stimulates peripheral arterial chemoreceptors to increase respiratory drive, resulting in hypocapnia however, the hypoxia continues due to the underlying disease process result: increased Aa trmt: O2 and correction of underlying dz process

Question 2023

In elderly patients presenting with anemia w/o any identifiable underlying cause, assume this vitamin deficiency

Answer 2023

B12

Question 2024

F neonate swelling of hands + posterior neck mass that is composed of cystic spaces separated by CT rich in lymphoid aggregates

Answer 2024

Turner Syndrome - lymphadema and cystic hygromas are common manifestations

Question 2025

ataxia, episodic erythematous and pruritic skin lesions and loose stools. Lab shows loss of neutral a.a. in urine

Answer 2025

Hartnup disease - pellagra - 3 D's of B3 (niacin): diarrhea dementia (ataxia) dermatitis

Question 2026

Ristocetin aggregation test how does it work?

Answer 2026

it is used to measure vWF dependent platelet aggregation activates GP 1b-IX on platelets, making them available for vWF binding if vWF is decreased, there is poor platelet aggregation in the presence of ristocetin

Question 2027

why is it that NSAIDs can decrease the effects of loop diuretics?

Answer 2027

loop diuretics inhibit NaK2Cl symporters in TALH _and_ stimulate prostaglandin release to increase RBF/GFR NAIDs inhibit the prostaglandin synthesis, therefore resulting in a decreased loop diuretic effect (also prostaglandins vasodilate the afferent arteriole; decreasing the production will result in afferent arteriole constriction, resulting in decreased RBF/GFR as well)

Question 2028

Patient receiving TMP/SMX complains of joint pain and pruritic skin rash. Areas of fibrinoid necrosis + PMN infiltration in his arteries and small arterioles. Dx? lab findings?

Answer 2028

Serum sickness - Type III HSR formation of ICs (IgG/IgM w/ antigens) w/ complement activation wherever the ICs deposit - thus results in hypOcomplementemia (**decreased C3 level**) typically occurs 5-10d after exposure common culprits: sulfonamide Rx

Question 2029

what is sydenham chorea? patients w/ this are at increased risk of?

Answer 2029

hyperkinetic extrapyramidal movement d/o - a neurologic manifestation of **acute rheumatic fever (grp A ß hemolytic stre)** caused by autoimmune rxn to neurons in the caudate and subthalamic nuclei; usually occurs after a latency of 2-3 mo post-strep throat increased risk of rheumatic heart disease (mitra/aortic valve involvement)

Question 2030

cocaine MoA

Answer 2030

inhibits presynaptic reuptake of NE, Dopamine, and serotonin net: increased BP, HR, chest pain secondary to coronary artery vasoconstriction, agitation from CNS activation, and symmetric pupil dilation that is responsive to light (mydriasis)

Question 2031

treatment for diabetic peripheral neuropathy what would patients normally complain of?

Answer 2031

**Amytriptyline - TCAs - ** has anticholinergic ADRs, so patients will complain of urinary retention _other option:_ Duloxetine - SSRI - do not cause obstructive voiding symptoms

Question 2032

patient w/ double vision can't adduct his left eye and has no corneal reflex where is the lesion located?

Answer 2032

**CN III** = loss of eye **ad**duction via MR **CN V1** / VII = loss of corneal reflex lesion: superior orbital fissure, where CN 3, V1, IV, VI and superior ophthalmic vein enters the orbit

Question 2033

Treatment for normal patients with isolated systolic HTN (ie 170/70) Treatment for diabetic patients with isolated systolic HTN (ie 170/70)

Answer 2033

normal patients: thiazides or dihydropyridine Ca antagonists (amlodipine) diabetic patients: ACEi or ARB

Question 2034

general ADR of non-selective ß blockers

Answer 2034

exacerbate broncial asthma perpiheral vascular disease bradycardia mask hypoglycemic symptoms of diabetic Rx

Question 2035

patients recovering from ATN may encounter this complication

Answer 2035

**dehydrated + hypokalemia** due to high volume diuresis + renal tubules that are not yet fully functional (thereby resulting in altered electrolyte balances)

Question 2036

treatment for bradycardia ADR of this Rx?

Answer 2036

atropine - decreases vagal influences on the SA/AV nodes common ADR: increased intraocular pressure (may precipitate acute closed-angle glaucoma since it causes mydriasis, which narrows the angle of the anterior chamber and diminishes outflow of the aqueous humor)

Question 2037

broad based buds vs narrow based buds

Answer 2037

broad based buds = blastomyces dermatitidis narrow based buds = cryptococcus

Question 2038

hyponatremia, hyperkalemia, hypoglycemia

Answer 2038

**Adrenal Crisis ** ## Footnote ∆ aldosterone -\> hyponatremia, hyperkalemia ∆ cortisol -\> hypoglycemia

Question 2039

attributable risk %

Answer 2039

excess risk in a population that can be explained by exposure to a particular risk factor ## Footnote **ARP = (risk in exposed - risk in unexposed) / risk in exposed** **or** **ARP = (RR - 1) / RR**

Question 2040

45yo man w/ chronic fatigability, mild weight gain, and elevated CK dx?

Answer 2040

**hypothyroidism** (say wha...?) hypothyroid myopathy is a common manifestation of hypothyroidism and can sometimes be the first manifestation!

Question 2041

prostate drains into these LN

Answer 2041

internal iliacs

Question 2042

bladder LN drainage

Answer 2042

superior portion - external iliac **in**ferior portion - **in**ternal iliac

Question 2043

what happens if you correct serum Na too fast in these scenarios from low -\> high from high -\> low

Answer 2043

**from low -\> high**: your pons will die - central pontine myelinolysis **from high -\> low:** your brains will blow - cerebral edema, herniation

Question 2044

2 reasons why the HMP shunt exist

Answer 2044

produce NADPH for 1) anabolic reactions - **cholesterol + fatty acids **synthesis 2) **reduce glutathione** (thus repairing oxidative damage) in RBC

Question 2045

2 causes of locked in syndrome

Answer 2045

1) central pontine myelinolysis - overly rapid correction of Na * (usually from low-\>\>high "your pons will die")* 2) basilar artery infarction

Question 2046

clomiphene MoA clinical use

Answer 2046

SERM - selective estrogen receptor modulator that prevents negative feedback inhibition on the hypothalamus by circulating estrogen -\>\> increased gonadotropin production (FSH/LH) and ovulation clinical use: infertility (esp in PCOS patients)

Question 2047

vertebral artery can be accessed via which triangle?

Answer 2047

suboccipital ∆

Question 2048

circle of willis develops from which two pharyngeal arches?

Answer 2048

3 (ICA) 4 (Subclavian)

Question 2049

occlusion of this artery will cause **lateral inferior pontine syndrome** symptoms?

Answer 2049

_AICA - anterior inferior cerebellar artery_ vomiting, vertigo, nystagmus **face - paralysis, decreased pain/T ** **decreased lacrimation, salivation, taste, corneal reflex, hearing** islateral horner syndrome, ataxia, dysmetria \*bold - differentiating sx from PICA\* **AICA = LIPS = facial droop (including the LIPS) means AICA's pooped - all facial functions are impaired)**

Question 2050

occlusion of this artery will cause lateral medullary syndrome symptoms?

Answer 2050

PICA - posterior inferior cerebellar vomiting, vertigo, nystagmus **decreased pain T from ispilateral face + contralateral body** **dysphagia, hoarseness, loss of gag reflex** islateral horner syndrome, ataxia, dysmetria \*bold - differentiating sx from AICA\* "Don't **PICA horse** that can't **eat"**

Question 2051

occlusion of this artery will cause medial medullary syndrome symptoms?

Answer 2051

_ASA - anterior medullary syndrome_ tongue deviation towards injured side contralateral hemiparesis + loss of proprioception ASA = MMS = Tongue

Question 2052

signs of MCA occlusion on the dominant hemisphere? non-dominant hemisphere?

Answer 2052

dominant hemisphere (L): **aphasia ** non-dominant (R): **hemi-neglect**

Question 2053

_direct vs indirect pathway_ receptors excitatory or inhibitory net influence on motion How does Parkinsons affect these pathways?

Answer 2053

**Di**rect * **D1** receptors * excitatory - increase motion **IN**direct * D2 receptors * **IN**hibitory - decrease motion **Substantia nigra (SN) has a (+) effect on the direct pathway and an (-) effect on the indirect pathway**. In Parkinsons, loss of the SN results in a loss of direct pathway activation and an uninhibited inhibitory effect of the indirect pathway, resulting in akinesia, shuffling gait, rigidity, cogwheel tremor

Question 2054

patient presents w/ fever, night sweats, weight loss, and painless waxing and waning lymphadenopathy that developed over the last few months

Answer 2054

**Follicular lymphoma (NHL - t14;18; bcl2)** key to diagnosis is the painless waxing/waning of lymphadenopathy

Question 2055

∆ btwn nucleus solitarius and nucleus ambiguus in terms of the information they carry and the CNs involved?

Answer 2055

nucleus solitarius * carries sensory information (taste, baroreceptors, gut distension) * CN 7, 8, 10 nucleus ambiguus * carries motor innervation of the pharynx, larynx, and upper esophagus (swallowing, palate elevation) * CN 9, 10, 11

Question 2056

what do each of these carry? optic canal superior orbital fissure formanen rotundum foramen ovale foramen spinosum

Answer 2056

**optic canal =** **CN 2, opthalmic _artery_, central retinal vein** ****_S_**uperior orbital fissure = CN 3, 4, V1, 6, opthalmic vein** ^{note the contents are very similar to the cavernous, except the cavernous also has the addition of V2}  **formanen **_R_**otundum = V2** **foramen **_O_**vale = V3** **foramen spinosum = middle meningeal artery** Standing Room Only = V1, V2, V3

Question 2057

what are the contents of the cavernous sinus? which nerve is most susceptible to injury and why?

Answer 2057

CN 3, 4, V1, V2, 6, and ICA most susceptible is CN6 because it's is most central similar contents to superior orbital fissure, except it doesn't contain V2 * (note that they both begin with S?!)*

Question 2058

what do these d/o affect? astigmatism glacuoma cataract papilledema scotoma

Answer 2058

astigmatism = cornea glacuoma = optic disk atrophy papilledema = optic disk swelling (due to increased ICP) cataract = lens scotoma = macula

Question 2059

∆ btwn open and closed angle glaucoma in terms of: cause pain treatment

Answer 2059

open-angle * cause: blocked trabcecular meshwork due to WBC/RBC or retinal elements * pain**LESS** * trmt: latanprost or epinephrine closed angle glaucoma * cause: iris bows forward and blocks fluid access to the trabecular meshwork- fluid builds up behind iris, pushing it forward and against the cornea * pain**FUL** * trmt: acetazolamide, mannitol, ß blocker, pilocarpine * do NOT give epinephrine due to its mydriatic effects

Question 2060

Lesion in CN3 Lesion in CN4 Lesion in CN6

Answer 2060

CN 3 = down and out pupil, ptosis, pupil dilation, ø accomodation CN 4 = eye moves upward w/ contralateral gaze; head tilt toward side of lesion ^{problem going down stairs; may present w/ compensatory head tilt toward the opposite side} CN 6 = pupil directed medially

Question 2061

Pathophysiology of Marcus Gunn Pupil

Answer 2061

damage to **OPTIC NERVE** or **SEVERE RETINAL INJURY** therefore there is no afferent signaling = no bilateral constriction when light is shown in the affected eye

Question 2062

INO what disease is it in? what CN are involved? what structure is involved? what happens?

Answer 2062

MS CN 3, 6 **MLF** lesion when looking left, CN 6 activates the ipsi LR, but contralateral CN 3 does not stimulate contra MR to fire, therefore contra eye (abducting eye) undergoes nystagmus (since CN 7 overfires in attempt to stimulate CN 3) net: nystagmus in ipsilateral eye, ø movement in contralateral eye note: convergence is OK

Question 2063

buzzwords: leukemia w/ lots of lymphoblasts age? type of cells? associations? trmt?

Answer 2063

ALL kids disease high B _or_ T lymphoblasts in circulation **TDT+** (T lymphoblasts present as a **mediastinal mass -\> hoarsness/dysphagia sx**) associated w/ Down syndrome; t12:21 = better prognosis trmt: chemo

Question 2064

buzzwords: leukemia w/ smudge cells age? type of cells? trmt?

Answer 2064

CLL elderly B cell neoplasm (CD19, CD20, CD5) trmt: alemtuzumab (binds CD52)

Question 2065

buzzwords: TRAP (+) age? type of cells? trmt?

Answer 2065

Haircy cell leukemia adults mature B cell neoplasm - hairy cells trmt: cladribine (2-CDA adenosine analog)

Question 2066

buzzwords: leukemia w/ myeloblasts w/ rods age? type of cells? associations? trmt?

Answer 2066

AML - M3 subtype (t15;17) \>60 myeloblast neoplasm w/ auerods (peroxidase +) associations: alkylating chemRx, radiation, Downs, myeloproliferative d/o trmt: Vitamin A ^{(DO NOT USE CHEMO bc that can cause the rods to lyse -> DIC)}

Question 2067

buzzwords: leukemia w/ high basophils age? type of cells? associations trmt?

Answer 2067

CML elderly myeloid stem cell proliferation due to 9;22 bcr-abl (increased tyrosine kinase) results in lots of basophils, PMNs (but very low activity of leukocyte AP), metamyeloblasts can transform to AML or ALL "blast crisis" trmt: imatinib (Gleevec - TK inhibitor)

Question 2068

leukemia? age? type of cells? associations? trmt?

Answer 2068

ALL kids disease high B _or_ T lymphoblasts in circulation **TDT+** (T lymphoblasts present as a **mediastinal mass -\> hoarsness/dysphagia sx**) associated w/ Down syndrome; t12:21 = better prognosis trmt: chemo

Question 2069

leukemia? age? type of cells? associations? trmt?

Answer 2069

CLL elderly B cell neoplasm (CD19, CD20, CD5) trmt: alemtuzumab (binds CD52)

Question 2070

leukemia? age? type of cells? trmt?

Answer 2070

Haircy cell leukemia adults mature B cell neoplasm - hairy cells trmt: cladribine (2-CDA adenosine analog)

Question 2071

leukemia? age? type of cells? associations? trmt?

Answer 2071

AML - M3 subtype (t15;17) \>60 myeloblast neoplasm w/ auerods (peroxidase +) associations: alkylating chemRx, radiation, Downs, myeloproliferative d/o trmt: Vitamin A ^{(DO NOT USE CHEMO bc that can cause the rods to lyse -> DIC)}

Question 2072

leukemia? age? type of cells? associations trmt?

Answer 2072

CML elderly myeloid stem cell proliferation due to 9;22 bcr-abl (increased tyrosine kinase) results in lots of basophils, PMNs (but very low activity of leukocyte AP), metamyeloblasts can transform to AML or ALL "blast crisis" trmt: imatinib (Gleevec - TK inhibitor)

Question 2073

Diagnosis? 5 typical findings associated w/ this?

Answer 2073

Multiple Myeloma * CRABi * Hyper**C**alcemia * **R**enal insufficiency * **A**nemia * **B**one lytic lesions/Back pain * **I**infections * Multiple Myeloma: Monoclonal M protein spike

Question 2074

RA: patient lies in the L lateral decubitus position and exhales fully - you hear a low-pitched sound, mid-diastolic murmur at the cardiac apex

Answer 2074

mitral stenosis = **RHEUMATIC FEVER**

Question 2075

systolic crescendo-decrescendo mumur along the L sternal border that intensifies upon standing; radiates to the suprasternal notch becomes quieter w/ increased preload

Answer 2075

hypertrophic cardiomyopathy (HCM) AD, mutation in ß-myosin heavy chain protein that results in hypertrophy of the LV and disordered arrangement of cardiac myofibrils, which can cause **diastolic dysfunction** **LV outflow obstruction** **increased cardiac work/myocardial ischemia** patients usually present during physical activity because HR is incrased and the time provided for diastolic filling is insufficient to maintain an apporpiate CO

Question 2076

intracellular accumulation of what ion is the hallmark of ischemic injury?

Answer 2076

cytoplasmic **Ca **accumulation (should also see high extracellular K due to reduced fxn of Na/K ATPase and subsequent leak of K and low extracellular Na, Ca, HCO3)

Question 2077

Tamm-Horsfall glycoprotein

Answer 2077

secreted by renal tubular epithelial cells in the TALH; aggregates to form **hyaline casts** in patients w/ pre-renal azotemia and low urine flow rate

Question 2078

presence of AChE in amniotic fluid indicates this

Answer 2078

open neural tube defects (AChE is present in blood cells, muscle, and nerve tisuse)

Question 2079

cystathione-ß-synthase defect in this enzyme causes what disease? what is this enzyme important for? what two factors accumulate in this d/o? what becomes an essential a.a. in these patients?

Answer 2079

**Homocystinuria** enzyme is essential for degradation of **methionine** accumulation of **Methionine + homocysteine** **Cysteine** becomes an essential a.a.

Question 2080

virluence factor for neisseria gonorrhoeae

Answer 2080

**pili **- adherence factor that is required for N. Gonorrhoeae to establish an infection (do not confuse w/ the virulence factor of N. meningitidis, which has an anti-phagocytic capsule that enhances its survival to epithelial cells)

Question 2081

RA: peaked T waves + loss of P waves + prolonged PR interval, widening of QRS complex + slow HR

Answer 2081

hyperkalemia

Question 2082

Rx that increases PVR and systolic BP, decreases PP and HR

Answer 2082

phenylephrine - selective a-1 agonist causes arterial vasoconstriction -\> increased PVR and systolic BP baroreceptor mediated increase in vagal tone -\> decrease SV + HR PP (Systolic - Diastolic) = decreased bc of the reflex decrease in stroke volume and the increased afterload

Question 2083

where can you find GI stem cells?

Answer 2083

Crypts of Lieberkuhn stem cells reside in the deepest parts of these crypts; functions to regenerate mucosal epithelium

Question 2084

Thiamine deficiency, as that seen in chronic alcoholics, can damage what two structures in the brain?

Answer 2084

FA: **_mamillary bodies + medial dorsal nucleus of thalamus_** --\> triad of **confusion, ophthalmoplegia, ataxia ** Uworld: **_cerebellum_** - loss of Purkinje cells in the anterior lobs + cerebellar vermis --\> wide-based gait ataxia, truncal instability, intention tremor of hands and fingers, rhythmic postural tremor of hands and fingers

Question 2085

erythromycin MoA how does resistance to this Rx develop?

Answer 2085

binds to the **23S rRNA** component of the **50S ribosome** and block translocation of the ribosome on the mRNA, thereby inhibiting protein synthesis resistance: methylation of 23s rRNA hinders macrolide binding

Question 2086

chloramphenicol MoA how does resistance to this Rx develop?

Answer 2086

binds 50S ribosome and inhibits the 50S peptidyltranserase resistance: **acetylation of the antibiotic** (methylation of the 50S subunit is not a major mxn of resistance)

Question 2087

aminoglycosides MoA how does resistance to this Rx develop?

Answer 2087

binds **30S ribosome** and inhibits formation of **initiation complex** resistance: **acetylation, adenylation, or phosphorylation of the antibiotic**

Question 2088

Tetracycline MoA Resistance?

Answer 2088

bind **30S subunit** and prevent **aminoacyl-tRNA from binding** to the **A** site on the ribosome, thereby **inhibiting elongation** Resistance: **decreased** **uptake** + **increased efflux** of the antibiotic

Question 2089

linear erythematous rash on hands, legs, and arms that develops shortly after a hiking trip. patient had sore throat 1 wk ago and took penicillin

Answer 2089

clue: **LINEAR** Type IV HSR - DTH due to poison ivy/oak exposure

Question 2090

53 yo w/ hx of radiation therapy for enlarged adenoids as a child is at greatest risk of?

Answer 2090

**thyroid neoplasm** thyroid is the most sensitive to radiation: see a linear dose-response relationship btwn external radiation exposure and the development of thyroid cysts, nodules, and cancer

Question 2091

exit point of urea in the urea cycle?

Answer 2091

arginase-mediated hydrolysis of arginine to form ornithine + urea urea is excreted ornithine is recycled back into the urea cycle, where it combines w/ carbamoyl phosphate (via ornithine transcarbamoylase, OTC) to generate L-citrulline

Question 2092

tardive dyskinesia is seen w/ typical antipsychotics. why is this?

Answer 2092

antipsyhotics antagonize D receptors, thereby causing an **upregulation of D receptors,** which result in a concomitant decrease in cholinergic tone in the striatum

Question 2093

∆ btwn oral and inactivated polio vaccine

Answer 2093

* **inactivated/**_k_**illed polio (Sal**_k_**)** * cannot cause vaccine-associated paralytic poliomyelitis * **intramsucular vaccine** * **live attenuated polio (Sabin)** * **​**can revert to virulent form * oral vaccine - _better_ at inducing a prolonged mucosal IgA secretion

Question 2094

adenovirus enveloped? genome? what does it use to replicate its genome?

Answer 2094

dsDNA virus, non-enveloped DNA-dependent DNA polymerase

Question 2095

reducing renal artery by 75% will do what to the FF?

Answer 2095

FF increases when renal blood flow decreases

Question 2096

rationale behind administering **penicillin + gentamicin** together

Answer 2096

pencillin impair cell wall synthesis, thereby resulting in membrane instability. by disrupting the cell wall, ß lactam drugs can allow aminoglycosides to enter the cell and exert their bactericidal effects (binds 30S ribosome = ø protein synthesis)

Question 2097

patient w/ DKA complains of face pain + bloody nasal discharge. Ocular movement is reduced and there is necrosis of nasal turbinates. dx? complications?

Answer 2097

**dx: mucurmycosis** **complication: cavernous sinus thrombosis** only dural sinus that can receive blood from the cerebral veins AND facial veins (superior + inferior ophthalmic veins) acute infection of the central face may spread through the valveless facial veinous sytem into the cavernous sinus, resulting in inflammation + thrombosis. Lateral gaze palsy (∆CN6) is one of the first signs of this disease

Question 2098

someone with severe hypothyroidism can experience this

Answer 2098

galactorrhea due to TRH (stimulates prolactin release)

Question 2099

24yoM w/ fever, malaise, bilateral parotid gland swelling + swollen tender scrotum. Later states that he has no interest in sex dx? at risk of?

Answer 2099

Mumps (**parotitis + orchitis)** orchitis = tender swelling of the testes, often results in seminiferous tubule atrophy, which can cause infertility and Leydig cell atrophy, which causes decreased T production -\> sexual dysfunction

Question 2100

lumbar lordosis is caused by excessive contraction of?

Answer 2100

hip flexors

Question 2101

why is it that oral glucose results in higher insulin levels than IV glucose?

Answer 2101

GLP1 = incretin produced by gut mucosa that stimulate pancreatic insulin secretion in response to sugar containing meals

Question 2102

where is ApoB100 produced? ApoB48?

Answer 2102

ApoB100 = liver ApoB48 = intestinal cells
^{(truncated version)}

Question 2103

gram stain of urethral discharge that reveals PMNs but no organisms dx? trmt?

Answer 2103

dx: chlamydia trachomatis - obligate intracellular org that does not stain w/ gram stain trmt: azithromycin (note: must also give a ceftriaxone for n. gonorrhoe, cause coinfections are high)

Question 2104

purpose of giving imipenem w/ cilastatin?

Answer 2104

imipenem is a ßlactam antibiotic cilastatin prevents renal tubules from hydrolyzing imipenem, thereby prolonging the antibacterial effects note that this has the similar moa to probenecid, where the latter inhibits renal tubular secretion of pencillin, cephalosporins

Question 2105

RA: lymphocytes w/ "cleaved nuclei"

Answer 2105

Follicular lymphoma - t14;18, overexpression of bcl-2 protein, which inhibits tumor cell apoptosis

Question 2106

crypt abscesses

Answer 2106

Ulcerative colitis | (2 words)

Question 2107

pathogenesis of atretic follicles in ovaries in a 43yo

Answer 2107

without adequate FSH, the oocytes + granulosa cells within primordial follicles undergo apoptosis

Question 2108

urine is added to a glass containing anti-hCG antibodies; latex particles coated w/ bhCG is added to the urine and agglutination is observed. interpretation?

Answer 2108

(+) agglutination inhibition test = not pregnant if pregnant, then urine contains ßhCG, the anti-hCG antibodies will bind the ßhCG and the latex agglutination will not occur because there aren't any anti-hCG antibodies remaining to react with the ß-hCG coated latex particles

Question 2109

paclitaxel MoA why is it present on coronary artery stents?

Answer 2109

paclitaxel - antineoplastic agent that binds ß tubulin and prevents microtubule braekdown, thereby causing arrest of the cell cycle in M phase present on coronary stents to prevent retenosis due to intimal hyperplasia (common complication of stents)

Question 2110

only two RNA viruses that replicate in the nucleus

Answer 2110

influenza HIV

Question 2111

abnormal proline hydroxylation will result in

Answer 2111

abnormal triple helix formation of collagen molecules hydroxylation is essential for proper association of pro-alpha chains into procollagen chains

Question 2112

T/F ranitidine (H2 blockers) used to treat peptic ulcers, gastritis, etc are associated with hip fractures

Answer 2112

FALSE - **hip fractures are actually associated w/ proton pump inhibitors** (omeprazole, lansoprazole, etc, etc)

Question 2113

patient w/ psoriasis catches malaria while traveling through africa trmt?

Answer 2113

Atovaquone or Proguanil ^{(chloroquine can aggravate the psoriasis)}

Question 2114

43 yo F presents w/ shingles. why?

Answer 2114

advanging age or immunosuppression (HIV) increases risk of VZV reactivation

Question 2115

cause of microstatellite instability d/o that this is present in?

Answer 2115

HNPCC (lynch syndrome) - caused by ∆ mismatch repair genes that result in microsatellite instability (repeating sequences of bases - CACACACACA)

Question 2116

9p21

Answer 2116

dysplastic nevi syndrome - numerous dysplastic nevi in a young person who has a family hx of melanoma in \>3 1˚ relatives due to mutations in CDKN2A gene on chromosome9p21

Question 2117

dx me please

Answer 2117

**Aortic dissection** note the cardiomeagly, abnormal aortic contour, wide superior mediastinum predisposing factors: **chronic HTN, marfans**

Question 2118

which two drugs increase chloride conductance by binding to the GABAa receptor on neurons? which one is inhibited by flumazenil?

Answer 2118

**B**enzodiazepines \*\*inhibited by flumazenil\* **B**arbiturates

Question 2119

how does pregnancy, OCP, or estrogen use affect: sex hormone-binding glboulins? Thyroxine-binding globulin?

Answer 2119

sex hormone-binding glboulins = decrease ^{(SHBG normally binds testosterone; free estrogen is unchanged)}   Thyroxine-binding globulin = decrease in women, a lower SHBG = increased free Testosterone = more converted to DHT = hirsutism!

Question 2120

function of thyroid hormones? 4

Answer 2120

incr ß1 receptors on heart -\> incr HR incr. Na/K ATPase -\> incr. basal metabolic rate (incr. O2, incr. RR, incr T) incr bone growth incr brain maturation

Question 2121

why is it that peripheral edema is not seen in Conn syndrome? 2

Answer 2121

aldosterone escape * excess aldo -\> excess Na/H2O reabsorption -\> volume expansion -\> increase renal perfusion pressure -\> decrease PCT Na reabsorption = increased Na delivery to the distal nephron -\> increased delivery of Na overrides the enhanced aldosterone-mediated Na reabsorption * volume expansion -\> increases ANP/BNP -\> both have an inhibitory effect on Na reabsorption in the collecting duct

Question 2122

alcoholic w/ horizontal nystagmus + broad-based, undsteady gait damage to where? what embryological part of the brain does it derive from?

Answer 2122

alcoholic cerebellar degeneration - condition caused by Purkinje cell degeneration within the cerebellar vermis and anterior cerebllar lobes signs: wide based gait, truncal instability, ataxia, nystagmus, dyarthria derived from **rhombencephalun** **(metencephalon + myelencephalon)**

Question 2123

how do these factors ∆ with excercise? HR LV ESV LV EDV LV EDP

Answer 2123

**HR = increased =** increased sympathetic stimulation **LV ESV = decreased = **because PVR (afterload) is reduced during exercise as a result of vasodilation in muscles, thereby allowing the heart to empty more completely during systole **LV EDV** = **increased **= if HR increases to increase CO, then stroke volume must also increase (remember that CO = HR\*SV) **LV EDP = unchanged =** increased CO cancels out the vasodilation in exercising muscles

Question 2124

how does EDV and ESV change with **LV systolic dysfunction**

Answer 2124

large dilated ventricles - CO is limited EDV = increased ESV = increased

Question 2125

how does EDV and ESV change with **LV diastolic dysfunction**

Answer 2125

thickened ventricular walls; filling is limited due to decreased compliance EDV = decreased ESV = decreased

Question 2126

how does EDV and ESV change with **global LV ischemia**

Answer 2126

decreased contractility of LV myocardium EDV = increased ESV = increased

Question 2127

how does HR, EDV and ESV change with **pericardial constriction**

Answer 2127

decreased ability of the heart to expand during diastole EDV = decreased ESV = decreased due to low EDV HR = increased in order to maintain CO in the setting of decreased preload

Question 2128

30 a.a. fragment of a nuclear protein w/ a coiled structure similar to an alpha helix; contains repeated leucine residues at every 7th position. What am I?

Answer 2128

key word to note: **nuclear** this is a **leucine zipper domain** found in **transcription factors (TF)**; functions in facilitating the interaction of the TF with DNA to allow for ∆s in gene expression similar examples - helix-loop-helix and zinc finger motifs

Question 2129

Initial reactants, enzyme, and location involved in the first step of pyrimidine synthesis? urea cycle?

Answer 2129

**Pyrimidine synthesis** = **Carbomoyl phosphate synthase II ** * **CO2 **+ glutamine + 2ATP -\> carbomyl phosphate * cytosolic **Urea cycle = Carbomoyl phosphate synthase I ** * **NH3 +** CO2 + 2ATP -\> carbomyl phosphate * mitochondria

Question 2130

radiolabeled CO2 molecules are incorporated into nuclear DNA. How is this possible?

Answer 2130

**Carbomoyl phosphate synthase II ** cytosolic enzyme that catalyzes initial step in pyrimidine synthesis (CO2+glutamine -\>carbomyl phosphate)

Question 2131

Flexon of the hip against resistance (applied by examiner) causes extreme pain. Dx?

Answer 2131

iliopsoas test (+) psoas sign = usually the result of inflammation of psoas muscle (psoas abscess) or its overlying peritoneum (appendicitis)

Question 2132

what structures pass through the diaphragm?

Answer 2132

_I ate (8)_ **_10 EGGs_ _AAT =_**_ 12_ T8 = **I**VC T10 = **E**sopha**g**us, Va**g**us T12 = **A**orta, **A**zygous, **T**horacic duct

Question 2133

24 yo has moderate post-prandial hyperglycemia bc his pancreatic islet cells have a high set point for insulin secretion in response to blood glucose levels dx? what enzyme is involved?

Answer 2133

MODY ∆ glucokinase * present on the pancreas + liver * catalyzes 1st step in glycolysis (glucose -\> G6P, which then allows it to be metabolized in glycolysis/TCA to produce ATP, which causes insulin release) * has a high Km and therefore requires a higher glucose conc. for activation * functions as the glucose sensor for insulin secretion

Question 2134

infant w/ hypotonia involving bulbar muscles, macroglossia, and enlarged + systolic murmur heard over the apex. Muscles reveal abundant PAS+ intracellular granules. Dx? enzyme deficient?

Answer 2134

Pompe disease ∆ lysosomal enzyme a-1,4-glucosidase findings: hypotonia, macroglossia, massive hypertrophic cardiomyopathy, early death

Question 2135

patient w/ dark discoloration of sclera and knee cartilage/ligaments that appear dark brown in color dx? impairment of what process?

Answer 2135

Alkaptonuria - AR, ∆ **homogentisic acid oxidase** (enz. required for degradation of **tyrosine** and **phenylalaine**)

Question 2136

most common cause of osteomyelitis in the general population? patients w/ sickle cell?

Answer 2136

the general population = **S. aureus (GPC)** patients w/ sickle cell = **Salmonella (GNR)**

Question 2137

how can brain neoplasms increase ICP? 2

Answer 2137

1) mass effect that cuases obstruction of normal CSF flow 2) disruption in the BBB, leading to increased vascular permeability and plasma infiltration into the cerebral interstitum "vasogenic edema"

Question 2138

what part of the female reproductive system has both columnar + stratified squamous epithelium?

Answer 2138

**cervix** the site described is the **squamocolumnar junction**; most common site of cervical malignancy (HPV loves this area for some reason....)

Question 2139

construction worker w/ TMJ diagnosis?

Answer 2139

clostridium tetani (GPR, spore forming) usually contracted via puncture wound from a **rusty nail **

Question 2140

fungus - where is the cell wall relative to the cell membrane?? bonus - what antifungal agents work on both

Answer 2140

**Cell wall = OUTSIDE** (think of it as the great wall, protecting everything on the inside) Rx: caspofungin **Cell membrane = INSIDE** Rx: amphotericin B, nyastatin - bind ergosterol; azoles inhibit ergosterol synthesis

Question 2141

what drug is a short peptide medication that is an analog of the carboxy terminal of the delta chain of fibrinogen?

Answer 2141

in other words, what rx looks like fibrinogen? and what is its role? know that **GP IIb/IIIa** (an integrin receptor) present on platelets that **binds to fibrinogen to enable a bridge to form btwn 2 platelets** GP IIb/IIIa inhibitors bind to GP IIb/IIIa receptors, thereby preventing fibrinogen from binding and preventing platelet aggregation

Question 2142

why does administering omeprazole + clopidogrel result in an increased risk of thrombosis?

Answer 2142

clopidogrel is a **prodrug** that _must_ be **activated by CYP450** in order for it to exert its antiplatelet effects coadministration with an inhibitor of CYP450 results in a decreased conversion of the inactive prodrug to its active metabolite, thereby increasing the patients risk of thrombosis.

Question 2143

how does the JG cells differ than the Macula densa

Answer 2143

JG = modified SM of the afferent arteriole; secretes renin MD = NaCl sensor on the DCT

Question 2144

RTA Type I Type II Type IV what are the defects and what is the net effect on K?

Answer 2144

_all result in **NON-AG hyperchloremic metabolic acidosis**:_ * Type I - CD - a-ICC can't secrete H (therefore new HCO3 is not generated); **hypo**kalemia, increased risk of stones * Type II - PCT - defect in HCO3 reabsorption; **hypo**kalemia *(more Na/ions delivered distally)* * Type IV - PCT - **hypo**aldosteronism; **hyper**kalemia

Question 2145

gingival ulcers, swollen gums, cervical lymphadeophaty

Answer 2145

Herpes should see multi-nucleated giant cells w/ intranuclear inclusions on oral ucler base scrapings on Tzanck preparation

Question 2146

AIDs patients are at greatest risk of which viral-induced malignancy?

Answer 2146

EBV-associated NHL lymphoma | (aggressive diffuse large B cell lymphoma and Burkitt's lymphoma)

Question 2147

which NT has been shown to modulate morphine tolerance? what can reverse this tolerance?

Answer 2147

**glutamate** - excitatory NT -\> activates NMDA receptors -\> ***increased phosphorylation** **of opioid receptors*** -\> ***increased NO levels*** -\>\>\> morphine/opioid tolerance **dextromethorphan** - NMDA-receptor antagonist -\> reverse opioid tolerance

Question 2148

patient w/ low serum Na and low osmolarity + low urine osmolarity should make you suspicious of..... what should you see on the water deprivation test?

Answer 2148

psychogenic polydipsia - excessive H2O intake steady, reliable increase in urine Osm + paltry response \<10% to vasopressin administration

Question 2149

how to differentiate btwn partial and complete central DI using the water restriction test?

Answer 2149

**complete** central DI = the rise in urine osmolality is **\>50%** after vasopressin is administered (ie it will go from 160 --\> 550 Osm)

Question 2150

neurofibromas found in NF-1 are derived from what embryological structure

Answer 2150

Schwann cells - neural crest cells

Question 2151

ESRD patients are at greatest risk of..?

Answer 2151

renal osteodystrophy - renal retention of PO4 + decreased renal synthesis of 1,25OH D3 (+ resultant hyperPTH)

Question 2152

patient w/ 101˚F, leukocytosis, BP 78/62, pulse 125/min, and lactic acidosis should make you think of?

Answer 2152

101˚F, leukocytosis, BP 78/62, pulse 125/min = SEPTIC SHOCK lactic acidosis = due to either overproduction or impaired clearance; in the case of septic shock, there is *impaired tissue oxygenation, which decreases oxidative phosphorylation.* This causes the shunting of ** pyruvate -\> lactate** **after glycolysis**

Question 2153

most common cause of aortic stenosis in patients over 70 yo

Answer 2153

senile, degenerative calcification of the aortic valve ^{DONT confuse w/: 1) rheumatic heart disease, which presents at an earlier age and usually the mitral valve is afected 2) infective endocarditis - targets abnormal aortic valves (bicuspid, calcified, prosthetic, or valves deformed by chronic rheumatic heart disease) and causes aortic regurgitation due to valve leaflet destruction}

Question 2154

90yo M w/ amyloid deposits in cardiac atria; no other organs are involved. What are the deposits made of?

Answer 2154

abnormally folded **ANP -** results in localized amyloidosis confined to the cardiac atria.

Question 2155

bupropion benefits over other Rx? ADR?

Answer 2155

excellent alternative Rx for treatment of depression since it does not cause sexual dysfunction (like SSRis) increased risk of **seizures**, esp in a patient who is anorexic

Question 2156

15yo CF patient w/ decreased proprioception and hyporeflexia over lower extremities with labs that show mild hemolytic anemia. Cause?

Answer 2156

Vitamin E deficiency

Question 2157

∆G˚ = + 400 will have a Keq of \>1 \<1 0 1

Answer 2157

** Less than 1 ** ^{if ∆G˚ was a negative #, then Keq wil be greater than 1 if ∆G˚ was 0, then Keq wil be 1 Keq of 0 is not mathematically possible}

Question 2158

patient develops diabetes, anemia, and an erythematous indurated rash w/ crusting and scaling. What does she have?

Answer 2158

glucagonoma - pancreatic tumor

Question 2159

PCOS patients are at risk of?

Answer 2159

developing endometrial adenocarcinoma and type II DM

Question 2160

anaphylaxis is mediated through which cell + cytokine?

Answer 2160

**mast** cell degranulation + **histamine** (also **tryptase)**

Question 2161

Primary CNS lymphomas in HIV patient are typically of what cell type?

Answer 2161

B cells latent EBV is strongly associated w/ AIDs-related primary CNS lymphoma

Question 2162

rationale behind giving spironolactone to a patient with CHF?

Answer 2162

prevents **aldosterone**-mediated ventricular remodeling (that leads to cardiac fibrosis)

Question 2163

why would someone 1˚ biliary cirrhosis develop xanthelasmas?

Answer 2163

chronic cholestatic processes (ie obstructive biliary lesions or 1˚ biliary cirrhosis) results in subsequent hypercholesterolemia, leading to the formation of xanthelasmas

Question 2164

patient involved in a car accident is obtunded but responds to painful stimuli. BP is 160/90, pulse is 72/min, respirations are 10/min Few hours after initial treatment and stabilization, he develops severe tachypnea and decreased O2. CXR shows pulmonary edema. Drug?

Answer 2164

mannitol - osmotic diuretic used to treat cerebral edema and increased ICP; works by * rapidly increasing plasma or tubular fluid osmolality, which causes H2O to move from the interstitial space into the vascular space or tubular lumen ***(mannitol can't cross BBB, therefore water is drawn out from the brain, thereby reducing cerebral edema)*** * osmotic diuretics work in the PCT and LOH to produce diuresis ADR: **pulmonary edema** - occurs

Question 2165

pt w/ abd. distension, periodic diarrhea, difficulty gaining weight has a duodenal biopsy that looks like the bottom picture. History and PE is unremarkable otherwise. Diagnosis? (top is normal for comparison)

Answer 2165

celiac's disease

Question 2166

patient w/ hypochromic microcytic anemia is treated w/ Fe. Several weeks later, blood smear shows numerous enlarged RBC that appear blue on the wright-giemsa stain. What are these cells and why are they blue?

Answer 2166

**reticulocytes** contain a ***basophilic***, reticular (mesh-like) network of residual ribosomal RNA

Question 2167

most common reasons for elevated AFP in a pregnant woman

Answer 2167

dating error - underestimation of gestional age

Question 2168

∆ btwn aspirin, ibuprofen, and acetaminophen? OD treatments for all 3?

Answer 2168

* **aspirin** = **acetylsalicyclic acid** = *IRREVERSIBLE* cox1/cox2 inhibitor * activated charcoal - absorbs it before it can enter the systemic circulation * HCO3 - combines w/ the acid to form a salt * **ibuprofen** = *REVERSIBLE* cox1/cox2 inhibitor * active charcoal - absorbs it before it can enter the systemic circulation * **acetaminophen** = MoA is unknown but it is metabolized by glutathione; * N-acetylcysteine

Question 2169

anticoagulant taht prolongs both PTT and PT, but not the TT

Answer 2169

direct factor Xa inhibitors (idraparinux, rivaroxaban, apixaban) without significant anti-thrombin activity - therefore only affect PT and PTT but not TT (thrombin time)

Question 2170

patient w/ acute rheumatic fever develops a new holosystolic murmur. If she dies, what is the most likely cause of death?

Answer 2170

severe myocarditis - may produce cardiac dilation that can evolve into functional mitral regurgitation (as is what is present in this patient) and even heart failure

Question 2171

where is very-long chain FA acids metabolized? sequelae if this system malfunctions?

Answer 2171

**peroxisomes** ^{these do NOT undergo mitochondrial ß-oxidation} dz lead to neurological defects from improper CNS myelination

Question 2172

hepatic encephalopathy - what two factors are depleted? what is the net effect of this?

Answer 2172

hyperammonemia in hepatic encephalopathy leads to a depletion **a-KG**, resulting in **inhibition of Krebs cycle** **glutamate**, resulting in **glutamine accumulation **and subsequent astrocyte swelling and dysfunction

Question 2173

logic behind using IL2 to treat melanomas and RCC? trade name of this drug??

Answer 2173

**aldesleukin** stimulates growth of CD4, CD8, B cells, NK cells, and monocytes increased activity of T cells and monocytes -\> responsible for IL2's anti-cancer effect on metastatic melanoma and RCC, resulting in tumor regression

Question 2174

what are the names of the NNTRIs? what is soooooooo special about these guys?

Answer 2174

**D**elavirdine **E**favirenz **N**evirapine spells "**DEN"** these **DEN'** require intracellular phosphorylation!

Question 2175

hemosiderin what is it common in what patients treatment?

Answer 2175

yellow-brown pigment that is composed of an aggregation of ferritin micelles in resident mononuclear phagocytes in tissues involved in RBC degradation (LN, BM, spleen, liver); **marker of Fe accumulation** patients w/ hemolytic anemia or receive many blood transfusions Iron chelation therapy

Question 2176

56yoM has a brain biopsy done 1 week after his stroke. myelin stain of the infarcted area has large cells stained w/ pink (myelin+). what are they?

Answer 2176

microglia presents 3-5d after the onset of ischemia (note the timing of the bx) and engulf the disintegrated myein

Question 2177

34yo w/ membranous glomerulopathy suddenly experiences a L sided varicocele. Why?

Answer 2177

**Renal vein thrombosis on the L side** _why?_ hallmark feature of nephrotic syndrome: proteinuria _how?_ increased permeability of the glomerular capillary wall results in a loss of lots of proteins, including the anticoagulant factors, especially **antithrombin III**, which is responsible for the thrombotic complications.

Question 2178

why do patients w/ membranous glomerulopathy experience increased risk of thromboembolism?

Answer 2178

hallmark feature of nephrotic syndrome: proteinuria increased permeability of the glomerular capillary wall results in a loss of lots of proteins, including the anticoagulant factors, especially **antithrombin III**, which is responsible for the thrombotic complications.

Question 2179

initial evaluation of patient who presents w/ signs of iron deficiency anemia should include:

Answer 2179

looking for **blood loss** (esp in the GI tract)

Question 2180

person has this type of breathing pattern. dx?

Answer 2180

**Cheyne Stokes** - cyclic breathing in which apnea is followed by gradually increasing tidal volumes and then gradually decreasing tidal volumes until the next apneic period common in patients w/ **CHF** or **neurologic diseases (stroke, brain tumor, TBI)** (compare to normal below)

Question 2181

Patient being treated for allergic rhinitis has flushed skin + pupil dilation. What drug was he given?

Answer 2181

**Rx with anticholinergic effects (mostly muscarinic receptors)** inhibition of eccrine sweat glands can result in fever + compensatory cutaneous vasodilation inhibition of pupillary constrictor and ciliary muscles can cause pupillary dilation

Question 2182

5 classes of drugs with anti-muscarinic effects?

Answer 2182

atropine TCAs H1 receptor antagonist (diphenhydramine) neuroleptics antiparkinsonian Rx

Question 2183

morphine what channels does it bind to? which ions does it increase the flux of?

Answer 2183

**µ receptors** (GPCR) activation -\> activation of K channels -\> **increase** **K efflux** -\> hyperpolarization of post-synaptic neurons and termination of pain transmission

Question 2184

amatoxins found in amanita phalloides (wild poisonous mushrooms) can affect synthesis of this particular molecule in the cell

Answer 2184

amatoxins are potent inhibitors of **RNA pol II,** thereby inhibiting **mRNA synthesis**

Question 2185

pramipexole and ropinirole what is it and what is it used for?

Answer 2185

dopamine agonists that preferentially stimulate D2 receptors do not have to be metabolized in order to be active, plus they have a long half-life and prolong the effects of methyldopa, thus limiting motor fluctuations

Question 2186

do cholinergics agonists cause vasoconstriction or vasodilation? what signaling factors do they mediate this through?

Answer 2186

vasodilation binds to muscarinic receptors on endothelial cells and promote the relelase of **NO (EDRF**), which activates guanylate cyclase and diminishes endothelium Ca concentration

Question 2187

infant w/ delayed separation of the umbilical cord should cue you into this disease sequelae of this dz?

Answer 2187

**Leukocyte Adhesion Deficiency ** inability to synthesize integrins, which are necessary for leukocytes to exit the blood stream sequelae: recurrent skin infections WITHOUT pus formation, delayed detachment of the umbilical cord and poor wound healing

Question 2188

Downey cells seen in EBV are what cells?

Answer 2188

Activated Cytotoxic **CD8+** T cells - function to destroy virally-infected B cells

Question 2189

cause of cyanotic toe discoloration and increased creatinine in an elderly patient following a coronary angioplasty

Answer 2189

atheroembolic disease caused by cholesterol-containing debris (needle shaped crystals) that gets pushed from larger arteries and lodges in smaller vessels, causing ischemia and decreased perfusion

Question 2190

patients w/ abetalipoproteinemia is likely to have what kind of small intestinal histology?

Answer 2190

inherited ability to synthesize apolipoprotein B (component of chyloµ and VLDL) lipids absorbed by the small intestines can't be transported into the blood and accumulate in the intestinal epithelium, resulting in enterocytes w/ clear or foamy cytoplasm

Question 2191

drugs that block skeletal muscle nicotinic cholinergic receptors

Answer 2191

tubocurarine succinylcholine

Question 2192

patient has double vision when coming down the stairs. which CN is affected?

Answer 2192

CN 4 - Trochlear nerve

Question 2193

MHC I and MHC II are made up of what chains?

Answer 2193

MHC I - heavy chain + ß2 microglobulin MHC II - alpha + ß polypeptide chains

Question 2194

Pathogens with really low infectious dose

Answer 2194

Shigella Campylobacter Entamoeba histolytica Giardia

Question 2195

54yo smoker comes in with recent weight gain despite no changes in diet/exercise unusually large # of bruises skin seems to be getting darker epigastric abd pain that is relieved by OTC antacids BP is 160/100mmHg, pulse is 90/min CXR has an irregular mass in R lung field Diagnosis?

Answer 2195

**Cushings Syndrome** due to **Small Cell Carcinoma** excess ACTH directly stimulates * melanotropin receptors due to significant sequence homology w/ a-MSH (darker skin) * adrenals to release excess cortisol (weight gain, bruising) and mineralocorticoids (note his high BP)

Question 2196

defense? directing anger toward a family member toward a hard workout at the gym

Answer 2196

sublimation

Question 2197

mixed cryoglobulinemia is associated with which d/o?

Answer 2197

Hep C likely due to IgM deposits that lead to BM thickening and cellular proliferation

Question 2198

IgG4 antibodies against the phospholipase A1 receptor (PLA2R) is associated with which disease?

Answer 2198

**Idiopathic membranous nephropathy** (glomerulonephritis)

Question 2199

how does timolol work?

Answer 2199

ß blocker used in glaucoma (increased IOP) to decrease aqueous humor production by the **ciliary epithelium**

Question 2200

narrow angle glaucoma what causes it? what can precipitate painful attacks?

Answer 2200

occurs when the anterior chamber of the eye narrows, obstructing the trabecular meshwork preciptated by anti-cholinergics ^{(anti-parasympathetic = sympathetic = pupil dilation)}

Question 2201

CSF features of bacterial meningitis viral meningitis

Answer 2201

bacterial meningitis * **low** glucose (bacterias got to eat) * high protein * **PMN** predominance viral meningitis * **normal** glucose * high protein * **lymphocytic** predominance

Question 2202

60yo M smoker comes in w/ high fever, confusion, HA, watery diarrhea, and mildly productive cough. Sputum gram stain shows numerous neutrophils but ø bacteria. Dz? What can you use to diagnose this patient? Treatment?

Answer 2202

Fever + pneumonia + GI sx = Legionella pneumophilia (GNR) Gram stain often shows few or no bacteria since a unique polysaccharide chain on the outer membrane inhibits gram staining dx test: urine antigen

Question 2203

circulating RBCs are unable to synthesize heme. why?

Answer 2203

because they lack a **mitochondria,** which is necessary for the last 3 steps of heme synthesis (they obv. dont have a nucleus, but the mitochondria is the location of the heme biosynthetic pathway and I guess the most important??)

Question 2204

A 78yo patient w/ a BP of **180/70** should make you consider what? A 78yo patient w/ a BP of **180/140** should make you consider what?

Answer 2204

180/70 = diastolic BP is within normal range, so he has **isolated systolic HTN **caused by age-related decreases in the compliance of the aorta and its proximal major branches **180/140** = consider renal artery stenosis, since excess RAAS activation will result in hypervolemia +/- incrased TPR, which would increase both systolic + diastolic

Question 2205

patient w/ testicular malignancy + elevated T3 and T4 dx?

Answer 2205

teratoma - elevated **hCG** **hCG is similar to FSH, LH, and TSH**, therefore elevating the T3/T4 levels

Question 2206

patients w/ sickle cell anemia are at risk of infections with which organisms?

Answer 2206

_encapsulated organisms_ * **SEPSIS =** think **S. penumo** (most common) or **H. influenza** (second most common) * **OSTEOMYELITIS** = think **Salmonella**

Question 2207

How would these factors change with 1˚ mineralocorticoid excess? Na K HCO3 when should you suspect this?

Answer 2207

Na = normal (due to aldosterone escape) K = low HCO3 = high ^{(since K and H+ are being excreted in exchange for Na uptake - base must be high)} suspect when patients present w/ HTN in the setting of suppressed renin

Question 2208

1 week old neonate w/ HBsAg and HBeAg Risk of chronic infection? Viral replication rate? Lab markers of liver injury?

Answer 2208

HBsAg + HBeAg suggests acute hepatitis infection likely acquired during pregnancy Risk of chronic infection = **high** Viral replication rate = **high** (due to immaturity of the infant's immune system to defend against the virus) Lab markers of liver injury = **low **(HBV infects cells, but rarely causes hepatocyte damage - it is the T cells cause hepatocyte injury. since the immune system is immature at this time, there is minimal hepatic damage)

Question 2209

How do OCPs prevent pregnancy? 3

Answer 2209

1. suppress FSH/LH, which inhibits ovulation (ø LH surge) 2. thickening of cervical mucus - prevents sperm from accessing the uterus 3. progestin - prevents growth of the endometrium, making it unsuitable for embryo implantation

Question 2210

RA: amyloid deposition in the temporal cortex, hippocampus, and cerebral arteries

Answer 2210

Alzheimers - amyloid is actually Aß amyloid, a product synthesized by the cleavage of APP (a normal component of neuronal membranes) forms senile plaques and amyloid angiopathy (amyloid deposition in the media and adventitia

Question 2211

SLE patient has cushing-like symptoms is found dead at home. Why? What do you expect her adrenal glands to look like?

Answer 2211

SLE patients are likely to be treated with **high doses of glucocorticoids**, which can **suppress the entire HPA axis (low CRH, ACTH, and cortisol)**, resulting in **bilateral atrophy of adrenal cortices** sudden cessation of glucocorticoids after prolonged use can cause adrenocortical insufficiency and adrenal crisis

Question 2212

SLE patient being treated with chronic corticosteroid therapy suddenly develops a BP of 70/40 and pulse 120/min What's going on and what do you expect her CRH, ACTH and Cortisol to be?

Answer 2212

**Acute adrenal crisis** - caused by suppressed HPA axis (values below) that occurs as a result of chronic steroid use - return to normal function takes weeks-months after withdrawal of corticosteroid CRH = decreased ACTH = decreased Cortisol = decreased

Question 2213

These are pathognomonic for which type of vasculitis? tranasmural inflammation with fibrinoid necrosis granulomatous inflammation of the media

Answer 2213

* tranasmural inflammation with fibrinoid necrosis = polyarteritis nodosa * granulomatous inflammation of the media = temporal (giant cell) arteritis **(giant cells are common in granulomas....duhhhh)**

Question 2214

Excess Hydration Acute Hemorrhage Chronic Anemia MI Anaphylaxis

Answer 2214

Anaphylaxis widespread venous + arteriolar dilation w/ increased capillary permeability and 3rd spacing of fluid; results in a serious drop in VR (shifted down and leftwrd) and an increased cardiac contractility as the body attempts to maintain BP

Question 2215

Excess Hydration Acute Hemorrhage Chronic Anemia MI Anaphylaxis

Answer 2215

increase in blood volume causes an increase in the circulatory capacity of the system (therefore, increased MSFP)

Question 2216

Excess Hydration Acute Hemorrhage Chronic Anemia MI Anaphylaxis

Answer 2216

acute hemorrhage decreased blood volume decreases the degree of filling in the circulatory system

Question 2217

Excess Hydration Acute Hemorrhage Chronic Anemia MI Anaphylaxis

Answer 2217

MI sharp decrease in CO due to loss of function in a zone of the myocardium

Question 2218

Excess Hydration Acute Hemorrhage Chronic Anemia MI Anaphylaxis

Answer 2218

Chronic Anemia incrase in CO in an effort to meet metabolic demands of the tissues VR also increases a little bit due to decreased blood viscosity

Question 2219

ligament that attaches to the cervical region of the uterus and extends posteriorly?

Answer 2219

ureterosacral ligament

Question 2220

brown pigment gallstones should make you think of....

Answer 2220

infection of the biliary tract with either E. coli, Ascaris lumbricoides, or Opisthorchis sinensis all cause release of **ß glucuronidase** by injured hepatocytes and bacteria, which **hydrolyzes the bilirubin glucuronides** and **increases the amt of unconjugated** bilirubin in bile, leading to an increased risk of developing brown pigment stones

Question 2221

patient w/ HbA = 60% and HbS = 40% is he homozygous or heterozygous for the sickle cell?? what are they normally protected from?

Answer 2221

heterozygous for sickle cell **trait** patients w/ sickle cell _trait_ are **protected from features that are common to sickle cell disease** (sickle cell crises, aplastic crises and sequestration crisis) as well as **protection from plasmodium falciparum**

Question 2222

Hepatitis virus associated with pregnant woman Genome of this? how is it spread? biggest concern about this?

Answer 2222

HepE ssRNA, unenveloped spread via F/O big concern: high mortality rate

Question 2223

Portacaval anastomoses in cirrhosis Esophageal varices Hemorrhoids caput medusae

Answer 2223

Esophageal varices = **L gastric** Hemorrhoids = **superior** rectal vein caput medusae = **paraumbilical** veins

Question 2224

MoA of sumitriptans?

Answer 2224

**5HT**_1B/1D agonist - **post**-synaptic receptor stimulation to inhibit trigenminal n. activation (blocks pain pathways in brainstem) prevent vasoactive peptide release induce vasoconstriction

Question 2225

32yoF w/ persistent tea-colored and odorless diarrhea has no gastric acid secretion. Somatostatin trmt relieves the diarrhea. Why?

Answer 2225

**VIPoma** - increases Cl loss in the stool, which causes: * an excess loss of accompanying H2O, Na, and K * inhibits gastric acid secretion somatostatin administration inhibits VIP secretion

Question 2226

Top 3 Major risk factors for adenocarcinoma of the pancreas head?

Answer 2226

Age (highest incidence at 65-75yo) Smoking (doubles the risk) Diabetes (risk increases w/ duration)

Question 2227

diagnosis?

Answer 2227

MTB serpentine cords - indicates the presence of **cord factor**, which correlates with **virulence** because it inactivates neutrophils, damages mitochondria, and induces release of TNF

Question 2228

pure RBC aplasia (ie only RBC counts are low; all other cell types are fine) is due to? 3

Answer 2228

**IgG autoantibodies, cytotoxic T cells,** and **ParvoB19** that inhibit precursors and progenitors; often associated w/ **thymomas & lymphocytic leukemias**

Question 2229

definition of dysuria what is it associated with?

Answer 2229

**painful urination** associated with **UTIs**

Question 2230

Best Rx for a patient w/ HTN and concomitant renal insufficiency?

Answer 2230

Fenolodopam - selective D1 receptor agonist D1 receptor stimulation activates adenylyl cyclase and raises intracellular cAMP, resulting in vasodilation of most arterial beds, esp **renal + coronary + mesenteric** arteries; results in: causes arteriolar dilation + natriuresis -\> decrease SVR + BP improves renal perfusion

Question 2231

expected ABG of someone with a acute PE?

Answer 2231

acute PE -\> hypoxemia -\> hyperventilate -\> respiratory alkalosis high pH \>7.4 low CO2 low O2 (due to VQ mismatch) HCO3 22-26 (takes a few days for the kidneys to compensate)

Question 2232

pancreatic pseudocyts occur due to? are lined by what?

Answer 2232

**complication of pancreatitis**, where the proteolytic enzymes disrput the walls of pancreatic ducts and cause leakage of pancreatic secretions into the peripancreatic space w/ subsequent inflammatory rxn in the walls of the surrounding organs **granulation tissue** forms to encapsulate the fluid collection to form a pseudocyst

Question 2233

why is it that patients with Crohns develop multiple kidney stones?

Answer 2233

b/c there is reduced CaOx binding within the intestines why? bc most bile acids are lost in the feces, which impairs fat absorption; excess lipids in the bowel lumen bind to Ca²⁺ and the soap complexes are then excreted into feces. Free oxalate (normally bound by Ca ions to form an unabsorbable complex) is absorbed, filtered, and forms urinary calculi

Question 2234

why is it that MEN 2A have problems with both pheochromocytoma AND parathyroid gland?

Answer 2234

chromaffin cells of the _adrenal medulla_ and _parafollicular cells_ of the thyroid originate from the **neural crest** cells

Question 2235

hyperacusis is due to?

Answer 2235

hyperacusis = increased sensitivity to sound paralysis of stapedius muscle, which is innervated by **CN 7** **^{stapedius stamps on sounds to make it softer.
staples look like two 7's put together}**

Question 2236

∆ btwn clonidine, a-methyldopa, and mirtazapine?

Answer 2236

**clonidine, a-methyldopa = STIMULATE a2** used in HTN (clonidine) and HTN during pregnancy (a-methyldopa) **mirtazapine = BLOCK a2** used in depression

Question 2237

type of nerve damage in diabetic neuropathy

Answer 2237

**ischemia of somatic nerve fibers ** ^{(usually with preservation of parasympathetic fibers)}

Question 2238

name the disease where there is pathology in the spinal cord, specifically in: posterior columns + lateral corticospinal tracts dorsal columns + dorsal roots of the spinal cord lateral cortical spinal tracts + anterior horns anterior horns

Answer 2238

* **posterior columns + lateral corticospinal tracts = B12 deficiency** (or when B12 is given to a folate-deficient patient) * **dorsal columns + dorsal roots of the spinal cord = tabes dorsalis ** * **lateral cortical spinal tracts + anterior horns = ALS** * **anterior horns = poliomyelitis**

Question 2240

why is methadone the drug of choice for treating heroin addicts and abuse?

Answer 2240

potent, long-acting w/ good oral bioavailability long half life = prolonged effects to suppress withdrawal sx

Question 2241

How are these levels affected by OC use or pregnancy? TBG total T4 total T3 free TH

Answer 2241

TBG = increased total T4 = increased total T3 = increased free TH = **normal**

Question 2242

rose-colored spots on the periumbilical area is pathognomonic for which bug?

Answer 2242

Salmonella typhi other fun facts about this bug: **carrier state in GALL BLADDER** ^{(think of the spotted salmon swimming in the small fish tank "gall bladder")}

Question 2243

Rx to prevent HIV transmission from infected mother to infant?

Answer 2243

**ZIDOVUDINE (ZDV, AZT)** nucleoside analog that inhibits RT

Question 2244

which part of the bone aids in the healing of fractures

Answer 2244

PERIOSTEUM contains fibroblasts + progenitor cells that develop into osteoblasts and chondroblasts that aid in healing

Question 2245

treatment of premature ejaculations? | (sucks for the girl....)

Answer 2245

SSRI - causes anorgasmnia + delayed ejaculation