review

Question 1

enlargement of the frontal horns of the lateral ventricles

Answer 1

Huntington Disease (atrophy of caudate and putamen)

Question 2

nystagmus, agitation, hallucinations, violent behavior

Answer 2

Phencyclidine

Question 3

diabetic mononeuropathy

Answer 3

often CN3, down and out
ptosis due to loss of innervation to levator palpebrae superioris

Question 4

which artery lateral medullary syndrome?

Answer 4

PICA – posterior inferior cerebellar artery

Question 5

vertigo, contralateral loss of pain and temp, ipsilateral horner’ syndrome

Answer 5

lateral medullary syndrome

Question 6

pyramidal tract, medial lemniscus (contralateral position and vibration) & ** ipsilateral tongue deviation – nucleus of hypoglossal, corticospinal (contralateral hemiparesis)

Answer 6

Medial Medullary Syndrome

Question 7

hypersensitivity of V3 (mandibular branch of trigeminal)
Ear pain that is referred from jaw joint

Answer 7

Temporomandibular joint disorder TMD

Question 8

mature adipocytes with a fibrous capsule
benign tumors that arise from subcutaneous fat

Answer 8

lipoma

Question 9

pontine stroke caused by

Answer 9

basilar artery or osmotic demyelination syndrome

Question 10

Transient ischemic attack tx

Answer 10

aspirin/clopidogrel, statin, lifestyle

Question 11

iatrogenic wernicke encephalopathy

Answer 11

admin of glucose-containing fluids in alcohol/deficient pts uses up remaining thiamine and causes focal hemorrhage/atrophy in areas of high metabolic demand like mamillary bodies

Question 12

vitamin B1

Answer 12

thiamine

Question 13

rapid onset of beta waves

Answer 13

Narcolepsy

Question 14

meningismus and Kernig sign

Answer 14

subarachnoid hemorrhage – rupture of saccular aneurysm
painful knee extension and neck stiffening

Question 15

tx to prevent vasospasm after subarachnoid hemorrhage

Answer 15

nimodipine: dhp Ca+ blocker

Question 16

cortical bridging veins
crescent shape hematoma
shaking baby
bilateral retinal hemorrhages

Answer 16

subdural hemorrhage

Question 17

anesthesia: higher blood solubility =

Answer 17

large arteriovenous gradient, slower onset of action, greater amt needed to saturate blood

Question 18

drug rash w/eosinophilia and systemic sx : rash, facial edema, hepatomegaly, diffuse lymphadenopathy

Answer 18

DRESS syndrome – Caused by antiepileptics: lamotrigine, phenytoin, carbamazepine; allopurinol, and sulfonamide antibiotic

Question 19

CNS iron deficiency and abnormalities in dopamine transmission

Answer 19

Restless Leg syndrome

Question 20

tx for restless leg syndrome

Answer 20

dopamine agonist – ropinirole and pramipexole

Question 21

ropinorole

Answer 21

dopamine agonist for restless leg

Question 22

pramipexole

Answer 22

dopamine agonist for restless leg

Question 23

most common malignant childhood neuro tumor

Answer 23

medulloblastoma

Question 24

café au lait spots + optic gliomas + pilocytic astrocytomas
Cutaneous neurofibromas comprised of Schwann cells derived from neural crest

Answer 24

NF1

Question 25

Increased activation of Trigeminal afferents cause release calcitonin gene-related peptide (CGRP) – neuropeptide involve in pain transmission + local vasodilation + inflammation

Answer 25

migraine

Question 26

abort migraines and cluster headaches

Answer 26

**Triptans (5-HT1B/1D rc agonist) decrease CGRP release

Question 27

tx for narcolepsy

Answer 27

stimulants: modafinil or amphetamine

Question 28

tx for cataplexy in narcolepsy; nighttime intake

Answer 28

sodium oxybate

Question 29

shoulder and pelvic girdle pain, morning stiffness, and fever + fatigue

Answer 29

polymyalgia rheumatica

Question 30

cape-like distribution of pain and temp loss

Answer 30

Syringomyelia

Question 31

lesion to cerebellar vermis

Answer 31

affects medial structures truncal ataxia and downbeat nystagmus, also involves head bobbing

Question 32

suprachiasmatic nucleus of hypothalamus

Answer 32

circadian rythm

Question 33

lateral nucleus of the hypothalamus

Answer 33

regulates hunger

Question 34

Serotonin syndrome antibiotic drug

Answer 34

linezolid

Question 35

toxin works in CNS, causes spastic paralysis

Answer 35

tetanus

Question 36

toxin works @NMJ, results in flaccid paralysis

Answer 36

botulin

Question 37

pneumonic for skull foramena

Answer 37

Sharmili Rakhit OS
Sup Orbital, Foramen Rotundum, Foramen Ovale (V3), Foramen Spinosum (middle meningeal)

Question 38

cause of presbyopia

Answer 38

denaturation of lens protein leading to loss of lens elasticity
loss of ability to contract, fixes near-sightedness

Question 39

lack of cerebellar vermis and cystic dilation of fourth ventricle and enlargement of posterior fossa

Answer 39

Dandy-Walker

Question 40

caudal displacement of cerebellar tonsils

Answer 40

arnold chiari I

Question 41

caudal displacement of cerebellar vermis and tonsils even medulla; associated with myelomeningocele

Answer 41

Chiari II

Question 42

increases rx of holoprosencephaly

Answer 42

maternal alcohol consumption/fetal alcohol syndrome

Question 43

Wet, wacky, wobbly – urinary incontinence, wide based gait, dementia

Answer 43

normal pressure hydrocephalus

Question 44

common cause of internuclear ophthalmoplegia

Answer 44

lacunar strokes

Question 45

nerves involved in internuclear opthalmoplegia

Answer 45

abducens VI starts lateral gaze contralateral CN III follows;
contralateral nystagmus

Question 46

long term use of prostaglandins for glaucoma

Answer 46

darkening of iris and elongation of lashes
prostaglandins increase outflow

Question 47

primary side effect of mannitol for cerebral edema

Answer 47

pulmonary edema

Question 48

spinal disc herniation is prolapse of

Answer 48

nucleus pulposus through anulus fibrosus

Question 49

upper facial nerve innervates (palsy)

Answer 49

contralateral lower

Question 50

anterior spinothalamic tract

Answer 50

crude touch and pressure
lateral is pain and temp

Question 51

Down’s syndrome is associated with which neuro condition

Answer 51

early onset Alzheimer’s
mutation in APP - amyloid precursor protein gene

Question 52

alpha-synuclein buildup

Answer 52

parkinson’s

Question 53

benign vascular tumor involving leptomeninges; port-wine stain; seizures, atrophy and calcifications of cerebral cortex, recurrent stroke-like episodes

Answer 53

Sturge-Weber

Question 54

antiexcitotoxic drug used for ALS, inhibits glutamate

Answer 54

Riluzole

Question 55

hemiballismus (uncontrolled, large amplitude mvmts) caused by

Answer 55

lacunar stroke in subthalamic nuclei

Question 56

aneurysm of Posterior Communicating Artery results in compression of

Answer 56

CN 3

Question 57

demyelinating disease involving internuclear ophthalmoplegia, pyramidal tract involvement, and Romberg

Answer 57

multiple sclerosis

Question 58

cause of multiple sclerosis

Answer 58

autoimmune rx triggered by EBV, HHB 6, UV radiation, Vit D def, smoking

Question 59

Weber Test: sound lateralizes to

Answer 59

Effected ear in conductive loss

Opposite ear in sensorineural loss ( positive Rinne test)

Question 60

Rinne test: positive test means

Answer 60

air > bone

can be sign of sensorineural loss

negative test = bone > air; conductive loss

Question 61

Cause of death in ALS

Answer 61

atrophy of the diaphragm

Question 62

superior temporal gyrus

Answer 62

primary auditory cortex and auditory association cortex

Question 63

subclavian steal involves atherosclerotic disease where

Answer 63

subclavian artery proximal to origin of vertebral artery

Question 64

diminished posterior cerebral circulation: vertigo and lightheadedness w/arm workout

Answer 64

subclavian steal

Question 65

CNS neurons, oligodendrocytes, and astrocytes are derived from

Answer 65

neuroectoderm

Question 66

Why do oligodendrocytes and CNS neurons not regenerate after injury?

Answer 66

secretion of inhibitory factors that prevent neural regeneration

Question 67

prosencephalon consists of

Answer 67

telencephalon and diencephalon

Question 68

telencephalon

Answer 68

cerebral hemispheres and lateral ventricles

Question 69

diencephalon

Answer 69

thalamus, hypothalamus, third ventricle

Question 70

Mesencephalon

Answer 70

midbrain

Question 71

Rhomboencephalon

Answer 71

metacephalon and myelencephalon

Question 72

metencephalon

Answer 72

pons, cerebellum, and fourth ventricle

Question 73

myelencephalon

Answer 73

medulla

Question 74

Dandy-Walker malformation

Answer 74

malforamation of cerebellar vermis and fourth ventricle resulting in cystic enlargement of fourth ventrice and posterior fossa

Question 75

most common cause of neonatal meningitis

Answer 75

E.coli (K1 capsular polysacharide

Question 76

commonest cause of meningitis in elderly

Answer 76

Strep pneumo (optochin-sensitive, gram +)

Question 77

aseptic viral meningtiis in children and teenagers @ summer camp, etc.

Answer 77

echovirus and enterovirus

Question 78

pancoast tumor compresses which group of neurons

Answer 78

preganglionic sympathetic stellate ganglion resulting in ipsilateral Horner’s syndrome

Question 79

Benign Paroxysmal Position Vertigo is due to

Answer 79

disologed otoliths

Question 80

endolymphatic hydrops causing vertigo and sensorineural hearing loss

Answer 80

Meniere’s disease

Question 81

Pure motor stroke (upper and lower motor weakness) is caused by

Answer 81

infarction to posterior limb of internal capsule (lenticulostriate)

Question 82

Gracilis is located

Answer 82

on the inner part of the dorsal column, does lower body

Question 83

cuneatus is located

Answer 83

on the outer portion of dorsal column; proprioception of upper body

Question 84

tx for merury or arsenic poisoning

Answer 84

dimercaprol

Question 85

mercury poisoning vs arnsenic poisoning

Answer 85

mercury poisoning involves inflammation of gums and buccal mucosa

arsenic = “garlic breath”

Question 86

brain ischemia 12-24hrs

Answer 86

eosinohilic neuronal cytoplasm and pyknosis

Question 87

brain ischemia 1-3 days after

Answer 87

neutrophilic invasion w/central necrosis

Question 88

brain ischemia 7-14 days

Answer 88

reactive gliosis and neovascularization

Question 89

most common location for mets to brain

Answer 89

lung cancer

then breast

Question 90

Ruffini corpuscles

Answer 90

fingertips and joints

slow-adapting

Question 91

Meissner corpuscles

Answer 91

dynamic, fine and light touch

low-frequency

fast acting

Question 92

Merkel disc

Answer 92

deep static touch

small receptive field - edges, corners, and shapes

slow adapting

Question 93

Pacinian corpucles

Answer 93

high frequency vibrations

discrimination of fine surface textures

Question 94

uncal brian herniation

Answer 94

ipsalateral oculomotor nerve and PCA and contralateral cerebral peduncle

Question 95

subfalcine herniation

Answer 95

cingulate gyrus herniation

compression of foramen of Monro and ACA = contralateral limb weakness

Question 96

swelling of neuronal cell body, dispersion of Nissle boides, displacement of nucleus to periphery

Answer 96

increased protein synthesis for Wallerian degen

Question 97

Primary CNS lymphoma associated with

Answer 97

EBV

Question 98

Fredriech’s Ataxia is due to which genetic mutation

Answer 98

AR GAA trinucleotide repeat expansion on chrom 9

Question 99

Bilateral limb ataxia, kyphoscoliosis, pes cavus, hammer toes, staggering gait in children

Answer 99

Freidrich’s Ataxia

Question 100

Commonest cause of death w/Freidrich’s Ataxia

Answer 100

Heart Failure ( hypertrophic cardiomyopathy or arrythmia)

Question 101

pharm trigger for acute-angle glaucoma

Answer 101

atropine - muscarninc antagonist

pupillary dilatation

Question 102

lower extremity paralysis following a flu-like prodrome

Answer 102

poliovirus

Question 103

involntary contraction of sternocleidomastoid mucle

Answer 103

spasmodic torticollis

Question 104

Prolonged, episodic, involuntary muscle contractions

Answer 104

dystonia

Question 105

seizure prophylaxis for pre-eclampsi

Answer 105

magnesium sulfate

Question 106

tx for magnesium tox (hyporeflexia, oliguria, resp depression, cardiac arrythmia) following seizure prophylaxis

Answer 106

calcium gluconate

Question 107

tx for essential tremor

Answer 107

primidone (type of barbiturate)

Question 108

rabies exposure tx

Answer 108

chemically-inactivated virus (killed vaccine)

rabies immunoglobin

Question 109

Watershed area of the brain

Answer 109

occipitally at border of PCA and MCA – causes blindness

often occurs after cardiac surgery due to hypoperfusion

Question 110

tx for postherpetic neuralgia

Answer 110

tricyclic antidpressants

-ipramine and -tryptilline

Question 111

floppy baby syndrome

Answer 111

inherited degeneration of ant horn motor neuron

Werdnig-Hoffman Disase

Question 112

ischemic strokes result in

Answer 112

liquefactive necrosis

Question 113

lacunar strokes occur secondary to

Answer 113

hyaline arteriosclerosis from HTN

Question 114

rupture of Charcot-Bouchard microaneurysms is due to

Answer 114

HTN

Question 115

Charcot-Bouchard microaneurysms occur where

Answer 115

lenticulostriate vessels

often effect basal ganglia

Question 116

subarachnoid hemorrhage

“worst headache of my life”

lumbar puncture?

Answer 116

xanthochromia (yellow hue due to bilirubin)

Question 117

subarachnoid hemorrhage most likely due to

Answer 117

rupture of berry aneurysm

other can be AV malformation or anticoag state

Question 118

most likely location of subarachnoid hemorrhage (rupture of Berry aneurysm)

Answer 118

anterior circle of Willis at branch points of the Ant Communicating Artery

Question 119

subarachnoid hemorrhages and Berry aneurysms are associated w/

Answer 119

Marfan syndrome and AD Polycystic Kidney Disease

Question 120

Tonsillar herniation results in

Answer 120

compression of brain stem = cardiopulmonary arrest

Question 121

subfalcine herniation results in:

Answer 121

compression of ACA + infarction

Question 122

Uncal herniation results in:

(displacement of temporal lobe uncus under tentorium cerebelli)

Answer 122

compression of CN II

copmression of PCA- contrlateral homonymous hemianopsia

Rupture of paramedian artery leads to Duret hemorrhage

Question 123

meningioma location

Answer 123

round mass attached to dura

Question 124

CNS tumor: whorled pattern and possibly psammoma bodies

Answer 124

meningioma

Question 125

key marker for Schwannoma

Answer 125

S-100+,

benign,

typically at cerebellopontine angle

Question 126

CNS tumor: “fried-egg” appearance

Answer 126

Oligodendroglioma

Question 127

calcified tumor in white matter usually in frontal lobe

Answer 127

Oligodendroglioma

Question 128

biopsy shows Rosenthal fibers and eosinophilic granular bodies

Answer 128

Pilocytic astrocytoma

Question 129

Pilocytic astrocytoma stain positive for

Answer 129

GFAP

Question 130

CNS tumor: small, round blue cells; Homer-Wright rosettes

Answer 130

medulloblastoma

Question 131

CNS tumor: Perivascular pseudorosettes

Answer 131

Ependymoma

Question 132

Craniopharyngioma arises from

Answer 132

remnant of Rathke’s pouch

compress optic chiasm

calcification seen on imaging

Question 133

CNS histo: necrosis surrounded by tumor cells (pseudopalisading) and endothelial proliferation

Answer 133

Gliobastoma Multiforme

GFAP + (in addition to child, benign pilocytic astrocytoma)

Question 134

CNS tumor

Answer 134

oligodendroglioma

Question 135

CNS tumor

Answer 135

meningioma

**also can be psammoma bodies present

Question 136

CNS tumor

Answer 136

Pilocytic astrocytoma

**Rosenthal fibers

Question 137

CNS tumor

Answer 137

Medulloblastoma

malignant tumor in children, arising from cerebellum

Homer-Wright Rosettes**

Question 138

Tx resistant schizo is treated w/

Answer 138

clozapine

Question 139

psych med with rx of low leukocytes only

“agranulocytosis”

Answer 139

clozapine

Question 140

quetiapine

Answer 140

2nd gen antipsychotic

Question 141

risperidone

Answer 141

2nd gen antipsychotic

Question 142

olanzapine

Answer 142

2nd gen antipsychotic

Question 143

aripiprazole

Answer 143

2nd gen antipsychotic

Question 144

decreased REM latency

(time between onset of REM)

Answer 144

Depression

Question 145

neonates <1500g or <32wks at rx of what in first 1-5 days

Answer 145

germinal matrix hemorrhage

Question 146

widespread muscle/bone pain, fatigue, and psychiatric issues, common in women

Answer 146

Fibromyalgia

tx is exercise

Question 147

acute extrapyramidal effects (within hours)

Answer 147

dystonia

Question 148

1-8wks extrapyramidal effects

Answer 148

akathisia: restlessness, inability to sit still

Question 149

extrapyramidal side effect (months to years)

Answer 149

tardive dyskinesia: involuntary contractions of mouth and tongue

**Lip smacking**

Question 150

carbamazepine

Answer 150

anticonvulsant: voltage-gated Na+ blocker

Question 151

first line for focal seizures

Answer 151

carbamazepine

Question 152

first line for Trigeminal neuralgia

Answer 152

chronic shooting pain at the angle of jaw – triggered by brushing, chewing, cold

Question 153

first line treatment for trigeminal neuralgia

Answer 153

carbamzepine

(or lamotrogine, more liable for Steven Johnson)

Question 154

first line for tonic-clonic seizures and status epilepticus

Answer 154

Phenytoin

Question 155

Tx for status epilepticus:

Answer 155

lorazepam then fosphenytoin IV (prodrug of phenytoin)

Question 156

chlorpromazine

Answer 156

1st gen antipyschotic

antihistaminergic and anticholinergic side effects: drowsiness, blurred vision, dry mouth

Question 157

life threatning disease w/ antipsych meds

altered mental status, hypothermia, autonomic dysfunction, rigidity + myolysis

Answer 157

neuroleptic malignant syndrome

Question 158

which meds can cause neuroleptic malignant syndrome

Answer 158

antipsychotics: haloperidol, fluphenazine, and chlorpromazine

(1st gen)

Question 159

tx for neuroleptic malignant syndrome

Answer 159

dantrolene

Question 160

buproprion MOA

Answer 160

inhibits dopamine and NE reuptake

Question 161

antidepressant that can be used to help reduce cravings for smoking

Answer 161

buproprion

Question 162

bupruprion is contraindicated in which pts

Answer 162

with seizure rx – lowers threshold for seizures

anorexia/bulimia, epilepsy, alcohol withdrawal

Question 163

venlafaxine and desvenlafaxine

Answer 163

SSRI

Question 164

duloxetine and paroxetine

Answer 164

SSRI

Question 165

milnacipran

Answer 165

SSRI

Question 166

abrupt cessation of SSIR can lead to

Answer 166

headache, depressed mood, insomnia, ataxia, tremor, myalgia in 1-4 days

Question 167

MOA-B inhibitor used for unipolar depression and Parkinson’s Disease

Answer 167

Selegine

can cause serotonin syndrome: includes GI sx + tremor, hyperreflexia, myoclonus

Question 168

used as initial short-term monotherapy in Parkinson’s to treat tremor

Answer 168

amantadine: increases dopamine release, decreases reuptake, and inhibits NMDA rc

Question 169

side effect of amantadine

Answer 169

orthostatic hyPOtension, livedo reticularis (web like rash), peripheral edema

Question 170

peripheral COMT inhibitor that reduces methylation of levodopa and dopamine

Answer 170

entacapone

increases plasma concentration of levodopa

Question 171

nonstimulate medication for ADHD

Answer 171

atomoxetine: selective norepinephrine reuptake inhibitor (NRI) that increases the concentration of norepinephrine in the synaptic cleft (increased rx of suicide)

**used for adolsecents w/ substance abuse disorder

clonidine and guanfacine = both alpha 2 agonists; sympathomimetic agents

Question 172

Schizoid

Answer 172

prefer to be alone

does not desire/enjoy relationships

Question 173

Schizotypical

Answer 173

odd/magical thinking + social isolation

Question 174

Power of a study =

Answer 174

1-B

B probability of commiting a Type II error

(false negative)

Question 175

Type I error

Answer 175

false positive

Question 176

increased statistical power also means

Answer 176

lower likelihood of Type II errors, or false negatives

Question 177

Cohort organized based on

Answer 177

exposure status

RR

Question 178

determine “relative risk” means

Answer 178

risk ratio

Question 179

statistical skew – mean follows

Answer 179

mean follows the tail!, most extreme direction

Question 180

How does positive predictive value change with prevalence

Answer 180

directly proportional

negative predictive value is indirectly proportional

(lower prevalence means higher negative predictive value)

Question 181

MI changes 4-24hrs:

Answer 181

early coag necrosis: edema, release of cytokines, neutrophil recruitment

hypercontraction of myofibrils: wavy fibers

**no gross changes

12-24hrs: *gross dark mottling

Question 182

MI changes 1-3 days

Answer 182

extensive coag necrosis: dense neutrophils

gross yellow pallor

Question 183

MI changes 3-14 days

Answer 183

macrophage infiltration w/granulation tissue and hyperemia (red, vascularized)

gros: yellow-brown spot surrounding by hyperemia

Question 184

MI changes 14+ days

Answer 184

granulatio tissue turns to fibrosed scar tissue

gray-white fibrous appearance grossly

Question 185

strong marker of Digoxin Tox

Answer 185

hyperkalemia

(also see yellow-tinting)

Question 186

dofetilide and ibutilide

Answer 186

K+ blocker, antiarrythmic

prolongs repolarization/refractory period

Question 187

K+ blockers like sotolol and amiodarone are used for

Answer 187

AFIB and Tachyarrythmias

Question 188

epinepherine and catecholamines stimualate the heart how:

Answer 188

B1 rc activation - increase Ca2+ influx in SA and AV node and increase Na in funny channels

Question 189

alpha-1 rc work via

Answer 189

Phospholipase C, IP3/DAG, and protein kinase C

(vasoconstriction)

Question 190

B-1 and B-2 work via

Answer 190

increas cAMP

Question 191

drug used for cardiogenic shock, B1 rc agonist

Answer 191

dobutamine

at higher doses: agonism at B2 and a1

Question 192

Dyprimadole stress test used for

Answer 192

coronary steal syndrome

adenosine analog results in coronary artery vasodilation

dilation causes more blood to go to healthy pathways, mimicking ischemia and resulting in ST changes in stenotic areas

Question 193

cause of subacute infective endocarditis in pts who undergo GI and GU surg

Answer 193

Enterococcus faecalis

gram +, PYR positive, gamma-hemolytic

Question 194

Loop + Thiazide decrease Na and Cl, activating RAAS and releasing aldosterone, tx is

Answer 194

give K+ sparing diuretic

Question 195

directly inhibit ENac

Answer 195

amiloride and triamterene

Question 196

aldosterone antagonists:

Answer 196

spirinolactone and eplerenone

Question 197

tricuspid regurg (IV user) increases rx of what

Answer 197

PE

Question 198

best antiarrythmic for post-MI

Answer 198

1B: lidocaine

binds Na+ channels in the inactivated state, good for ischemic tissue

Question 199

B-blockers work as an anti-arrythmic by:

Answer 199

prolonging diastolic spontaneous depolarization phase of pacemakers in the SA and AV node

Question 200

How do myocytes repolarize/end contraction

Answer 200

Na+ Ca2+ exchanger

Question 201

sx of hypocalcemia

Answer 201

prolonged QT interval, Chvostek and Trosseau (cuff) sign

Question 202

non-bacterial endocarditis

Answer 202

Libman-sacks endocarditis associated w/SLE, antiphopholipid and malignancy

Question 203

drugs to improve long term survival in HF

Answer 203

B-blocker, ARB/ACEi, aldosterone antag

Question 204

heart changes w/hyperthyroidism

Answer 204

increased contractility (increased SV and EF)

reflex decrease in SVR

tachycardia and Afib possible

Question 205

heart changes w/hypothyroidism

Answer 205

myocardial atrophy

Question 206

Pulsus paradoxus

Answer 206

cardiac tamponade

decreased pulse pressure : <10mg drop in systolic during inspiration

also can occur in asthma or COPD

Question 207

De musset sign (head bobbing) in sychrony w/heart

Answer 207

Aortic regurg

Question 208

“bounding pulse”

Answer 208

due to rapid upstroke into arteries followed by prompt collapse of vessels

in Aortic Regurg

Question 209

Brown-pigment in alveoli / hemosidern-laden macrophages is a sign of

Answer 209

Heart Failure (chronic lung congestion breaks epithelium, RBC extravasate and macrophages eat)

Question 210

retinal artery / opthalmic artery supplied by

Answer 210

internal carotid artery

Question 211

cardiac myxoma can cause which type of murmur

Answer 211

mitral stenosis

also systemic embolism

Question 212

cardiac myxoma histo

Answer 212

amorphous extracellular matrix within mucopolysaccharide

Question 213

aortic dissection begins w/

Answer 213

weakened media/media cystic degeneration

followed by intimal tear

Question 214

Type A aortic dissection

Answer 214

originates in ascending aorta **proximal to brachiocephalic artery

requires surgery

Question 215

Type B aortic dissection

Answer 215

originates distal to left subclavian artery

can be tx w/pharm B-blockers and vasodilators

Question 216

PE can lead to (cardiac)

Answer 216

RV failure and shock

Question 217

tx for sinus bradycardia

Answer 217

atropine

Question 218

tx for claudication (leg pain w/exertion due to stenotic arteries)

Answer 218

cilostazil: phophodiesterase inhibitor

antiplatelet and vasodilatory effects

Question 219

stress induced cardiomyopathy

Answer 219

takotsubu – LV becomes shape of octupus trap

due to catecholamine surge causing microvascular spasm/ischemia

Question 220

rx factors for abdominal aortic aneurysm

Answer 220

>65, male, smoker

due to chronic transmural inflammation of aorta– matrix metalloproteinases and elastases degrade elastin and collagen

Question 221

recurrent angina w/ no coronary occlusion

Answer 221

prinz metal angina

Question 222

cause of prinz metal angina

Answer 222

endothelial dysfunction and excess vagal tone – commonly occurs at night

Question 223

tx for prinz metal angina

Answer 223

caclium channel blockers - Diltiazem

abortive = NO

Question 224

most common cause of paradoxical emboli

Answer 224

patent foramen ovale

Question 225

Right Coronary Artery supplies

Answer 225

SA and AV node, Bundle of His, some of RBB, LBB

right atrium and RV

Question 226

Left Coronary Artery

Answer 226

Posterolateral left atrium and ventricle

Anterolateral papillary muscle (also receives blood from the LAD)

Question 227

hypertrophic cardiomyopathy is caused by

Answer 227

AD genetic disorder of myocardial contractile proteins - myosin-binding protein C and beta-myosin heavy chain

Question 228

hypertrophic cardiomyopathy involves

Answer 228

LV Outflow Obstruction

abnormal systolic motion of the ant leaflet of mitral valve

Question 229

cardiac amyloidosis is caused by mutation

Answer 229

transthyretin

Question 230

cardiac amyloidosis causes

Answer 230

restrictive or dilated cardiomyopathy

Question 231

purulent pericarditis caused by

Answer 231

hematologic spread /direct extension from pneumo, penetrating chest injury/surg

Staph aureus - portal from skin

Strep pneumo - adjacent pneumo

candida - parenteral feeding, immunosuppression- pseudohyphae w/blastoconidia

Question 232

how to improve mitral regurg

Answer 232

reduce SVR

Question 233

face, neck, conjuctival swelling, distended veins in upper body, headache, dyspnea, and layrgneal edema

Answer 233

superior vena cava syndrome: caused by compression via *mediastinal mass, often malignancy

Question 234

hypertensive emergecy causes what in kidneys

Answer 234

malignant nephrosclerosis: fibrinoid necrosis of arteriolar walls and hyperplastic arteriosclerosis –> can cause microangiopathic hemolytic anemia

Question 235

tx for hypertensive emergency

Answer 235

labetolol

nonselective beta 1 and alpha antagonist – lower HR and decrease vasoconstriction

also can give carvedilol or diltiazem/verapamil

Question 236

side effect of doxorubicin

Answer 236

dilated cardiomyopathy

tx. dexrazoxane chelator

Question 237

Transposition of great arteries is associated with

Answer 237

Maternal diabetes

Question 238

lower cyanosis + clubbing

Answer 238

PDA;

occurs after upper branches of aorta, upper half gets oxygenated blood

Question 239

tx to maintain PDA

Answer 239

prostoglandin E1 analog

alprostadil

Question 240

reason to maintain PDA

Answer 240

transposition of great vessels

Question 241

tx to close PDA

Answer 241

indomethacin - inhibits prostoglandin synthesis

Question 242

cardiac drug: phosphodiesterase inhibitor in heart – increases cAMP

causing increased contractility and smooth muscle relaxation in vessels

Answer 242

milrinone

Question 243

tx for systolic HF

Answer 243

milrinone: decreased preload and afterload

risk of tachycardia and hypotension

Question 244

ADHD stimulants

Answer 244

Methylphenidate, dextroamphetamine, methamphetamine, lisdexamfetamine

Question 245

ADHD stimulants MOA

Answer 245

indirect and central sympathomimetic activity → increased release and blocked reuptake of norepinephrine and dopamine (minor effect on serotonin)

Question 246

carotid sinus is located where

Answer 246

internal carotid artery

Question 247

afferent and efferent limb of carotid reflex

Answer 247

afferent: 9
efferent: 10

Question 248

syncope w/head turning, shaving, wearing a tight collar/tie

Answer 248

carotid sinus hyperesensitivity

baro rc sensitive to external pressure – causes sudden onset bradycardia and hypotension

Question 249

innervation of parotid gland

Answer 249

glossopharyngeal 9

Question 250

thymic aplasia and hypoparathyroidism disease associated w/which heart conditions

Answer 250

Conotruncal abnormalities: tetralogy of Fallot or persistent truncus arteriosus)

Ventricular septal defect (VSD)

Atrial septal defect (ASD)

Question 251

cardiac defect associated w/Downs

Answer 251

complete AV canal defect

Question 252

degeneration of SA node on right atrial wall

delayed P waves

Answer 252

sick sinus syndrome

Question 253

S3 sound is commonly associated w/

Answer 253

mitral regurg – ventricle filling

Question 254

troponin remains increased for

Answer 254

7-10 days post MI

due to increase plasma membrane permeability

Question 255

Ebstein’s anomaly

Answer 255

atrialization of right ventricle due to very low tricuspid valve

also associated w/PDA or ASD

regurgitant RV results in R to L shunt

Question 256

sensitive marker for CHF

Answer 256

BNP - overworked/stretched ventricle

Question 257

pulmonary edema from CHF causes what change in lungs

Answer 257

decreased lung compliance

fluid in lungs makes lungs stiffer

Question 258

ortner syndrome

Answer 258

compression of recurrant laryngeal nerve = hoarseness + dysphagia

and hemoptysis from compression of bronchial arteries

due to enlargment of LA from mitral stenosis

Question 259

which cardiac drugs cause constipation

Answer 259

non-dihydropyridine Ca blockers: verapamil and diltiazem

slowed contractions of colonic smooth muscle

Question 260

changes w/arteriovenous fistula

Answer 260

decreased SVR

increased venous return + preload = increased CO and RA pressure

Question 261

paradoxical splitting of S2

Answer 261

delayed LV outflow

LBBB or aortic stenosis

Question 262

pulsus parvus et tardus

Answer 262

delayed radial pulses

due to aortic stenosis

Question 263

aortic stenosis is associated w/

Answer 263

angiodysplasia in ascending colon – intermittent GI bleeds

Question 264

Valsalva manuever =

Answer 264

decreased RV preload, LV preload, decreased LV afterload

Question 265

used for long term anticoag in AFIB pts

Answer 265

warfarin

Question 266

tx for beta-blocker overdose

Answer 266

IV fluids and atropine

if not working —> glucagon - increases cAMP, increasing contractility

Question 267

Downs syndrome is associated w/which cardiac defect

Answer 267

atrioventricular valve defect (AVSR)

Question 268

adenosine (endogenous) promotes which coronary change?

Answer 268

coronary artery vasodilation, allowing for increased perfusion

Question 269

adenosine drug causes

Answer 269

transient AV block

used for supraventricular tachycardia and pharm stress test

Question 270

infarction to RCA and PDA can lead to ischemia where

Answer 270

posteromedial papillary muscle – resulting in rupture and mitral regurg

Question 271

carotids are made from which aortic arch

Answer 271

3

Question 272

aortic arch 4

Answer 272

subclavian

Question 273

aortic arch 6

Answer 273

pulmonary arteries

Question 274

septic shock = ?SVR ?CO

Answer 274

decreased SVR, increased CO - warm extremeties

Question 275

reasons to discontinue metformin

Answer 275

renal, hepatic insufficiency or decompensated HF

Question 276

type III immune complex HS, 2-10wk post MI – acute pericarditis, elevated troponins, pleural effusion

Answer 276

Dressler Syndrome

Question 277

Dressler syndrome is caused by

Answer 277

type III immune response to cardiac antigen

Question 278

which nerve courses along the pericardium near the RA

Answer 278

right phrenic nerve

Question 279

Nitroglycerin decreases preload and therefore

Answer 279

End Diastolic Pressure

Question 280

causes of restrictive cardiomyopathy

Answer 280

amyloidosis, hemochromatosis, and post radiation fibrosis

Question 281

why is Platelet Derived Growth Factor implicated in atherosclerosis

Answer 281

released by platelets and macrophages –> induce smooth muscle proliferation

Question 282

tetrology of fallot 4 changes

Answer 282

1. overriding aorta
2. VSD
3. pulmonary stenosis
4. RV hypertrophy + right axis deviation

Question 283

what determines severity of cyanosis in Tet of Fallot

Answer 283

RV outflow obstruction

Question 284

endocarditis following dental procedure

Answer 284

Strep Viridans (alpha-hemolytic)

Question 285

Roth spots

Answer 285

red splothes on eyes - endocarditis

Question 286

Osler nodes

Answer 286

small red dots on hands

endocarditis

Question 287

janeway lesions

Answer 287

microabsecces w/neutrophilic infiltration - endocarditis

Question 288

viridans strep species

Answer 288

mitis, sanguinis, mutans, sobrinus

Question 289

sign/effect of Righ Heart Failure

Answer 289

dilation of coronary sinus

Question 290

high frequency mid-systolic click

Answer 290

mitral valve prolapse – sudden tensing of chordae tendinae

Question 291

what causes an increased in the mid-sytolic click associated with mitral valve prolapse

Answer 291

when preload is decreased, increased intensity

ie. when standing

Question 292

Cushing triad

Answer 292

bradycardia, HTN, and irregular respiratory pattern

sign of increased intracranial pressure and impending brain herniation

Question 293

PR interval should be <

Answer 293

200ms or 5 little boxes

Question 294

supraventricular arrythmias display ?QRS

Answer 294

narrow QRS, rapid excitation of ventricles @ or above Bundle of His

Question 295

Any SVT with a narrow QRS complex and an abrupt onset

Most commonly caused by AV nodal reentry

Answer 295

Paroxysmal suprventricular tachycardia

Question 296

tx for paroxysmal supraventricular tachy

Answer 296

carotid massage - stimulates vagal manuever

otherwise adenosine – decreases AV node conduction

Question 297

side effects adenosine

Answer 297

bronchospasm, chest pain, facial flushing

inhibited by theophylline

Question 298

atrial flutter

Answer 298

very fast atrial rythm >3:1 ratio of P to QRS

**saw-tooth appearance

Question 299

hundreds of reentrant circuits scattered around atria

Answer 299

atrial fibrillation

no P-waves seen, irregularly irregular rythm

Question 300

multifocal atrial tachycardia

Answer 300

3 different P-wave morphologies

associated with asthma and COPD

Question 301

accessory Bundle of Kent

Answer 301

Wolff-Parkinson-White

delta wave, shortened PR interval, widening of QRS

Question 302

ventricular arrythmias demonstrate ?QRS

Answer 302

wide QRS

Question 303

monomorphic ventricular tachycardia is due to

Answer 303

myocardial scarring

polymorphic not associated w/mycardial scarring

Question 304

causes of Torsades de Pointes

Answer 304

• ABCDE: AntiArrhythmic (1A, 1C, III) antiBacterials (macrolides), antipsyCOtics: haloperidol, olanzapine, ziprasidone, antiDEpressants: Tricyclic (TCAs), antiemetic: ondansetron

Question 305

torsades de pointes electrolyte change causes

Answer 305

• **hypokalemia (diarrhea), hypercalcemia, or hypomagnesemia

Question 306

tx for torsades de pointes

Answer 306

IV magnesium sulfate

Question 307

tx of ventricullar fibrillation

Answer 307

defibrillation

Question 308

AD mutation in cardiac Na+ channels

asian descent

Answer 308

Brugada syndrome

Question 309

V1-V3 shows pseudo RBB (RSR config), widened QRS, some ST elevations

Answer 309

Brugada syndrome

Question 310

1st degree heart block

Answer 310

prolonged PR interval, asymptomatic, no tx required

Question 311

Mobitz 1

Answer 311

PR interval gets progressively longer till QRS drops

Question 312

Mobitz 2

Answer 312

normal PR interval followed by a sudden drop

random QRS dropped, no progressive elongation

can progress to 3rd degree AV

Question 313

3rd degree heart block

Answer 313

no relationship b/w P wave and QRS – complete heart block

need pacemaker

Question 314

which disease is associated w/ 3rd degree heart block?

Answer 314

Lyme Disease

Question 315

congenital heart block caused by

Answer 315

mom has SLE –> anti-Ro and anti-LA crossing placenta and effect conduction system

Question 316

QRS for Bundle branch block

Answer 316

wide

Question 317

RsR configuration “M”/rabbit ears

in leads V1, V3, V3

Answer 317

RBB

Question 318

causes of Right Bundle Branch Block

Answer 318

RV hypertrophy, right HF, pulmonary embolism, normal heart w/fibrous tissue

Question 319

ECG for LBB

Answer 319

I, aVL, V5, V6: tall R waves

V1: deep S waves

Question 320

causes of LBB

Answer 320

HTN, ischemia, dilated cardiomyopathy, aortic stenosis

Question 321

QRS meaning

Answer 321

Q: depolariztion of interventricular septum and Bundle of His

R: depolarization of ventricle

S: depolarization of upper lateral ventricles via Purkinje fibers

Question 322

repro: Meiosis I is arrested in

Answer 322

prophase

Question 323

Meiosis II arrested in

Answer 323

metaphase after ovulation

Question 324

progesterone’s effects post-pregnancy (incontinence)

Answer 324

relaxes external urinary sphincter and levator ani muscle complex

Question 325

chorioretinits, hydrocephalus, intracranial calcifications

Answer 325

toxoplasmosis

Question 326

runny nose, desqaumating rash, long-bone abnormalities: periosteal thickening and metaphyseal erosion

Answer 326

syphilis

Question 327

abscess-like foci of necrosis on umbilical cord

Answer 327

congenital syphilis

Question 328

cataracts, Patent Ductus Arteriosus, hearing loss

Answer 328

rubella

mother has rash, postauricular lymphadenopathy

Question 329

microcephaly, hearing loss, periventricular calcifications

Answer 329

CMV

Question 330

drug causes discoloration of teeth and bones in neonate and inhibition of bone growth

Answer 330

tetracycline

Question 331

neonatal cartilage damage caused by which drug

Answer 331

ciprofloxacin - fluoroquinolones

Question 332

antibiotic causes ototoxicity

Answer 332

aminoglycosides

Question 333

gray baby syndrome: hypotension, cyanosis, hypotonia, ashen gray discoloration of skin, abdominal distension

Answer 333

chloramphenicol - inactivates bacterial 50s subunit

used to be used as an antibiotic

Question 334

injury/fibrosis of sternocleidomastoid muscle – head tilted + palpable mass due to

Answer 334

congenital torticollis due to birth trauma/malrotation

Question 335

rx factor for congenital torticollis

Answer 335

macrosomia and breech position (feet out first_

Question 336

cause of maternal insulin resistence

Answer 336

increase in 2/3rd trimester human placental lactogen

increases maternal glucose levels, proteolysis, and lipolysis

Question 337

effect of human placental lactogen

Answer 337

stimulates pancreatic beta-cell proliferation – increases insulin and causes gestational diabetes

Question 338

pregnancy ?ADH ?GFR ?CO murmur?

Answer 338

increased ADH, decreased Na concentration

increased GFR from increased BM permeability

pulmonic flow murmur from increased CO and S3

Question 339

heme changes in pregnancy

Answer 339

increased procoagulants, decreased anticoagulants, decreased fibrinolysis

Question 340

pregnancy cholelithiasis caused by

Answer 340

estrogen increases cholesterol secretion + progesterone causes gallbladder hypomotility

Question 341

cause of amniotic fluid embolism

Answer 341

fetal squamous cells and mucin in maternal pulmonary arteries

Question 342

supine hypotension in pregnancy

Answer 342

due to compression of IVC, decreased venous return

Question 343

polyhydramnios is caused by

Answer 343

impaired swallowing (GI obstruction) or anencephaly (defect in cranial neural tube)

Question 344

placenta accreta is due to defects in

Answer 344

decidua basalis

Question 345

criteria for preeclampsia

Answer 345

new onset HTN w/proteinuria and/or sings of end-organ damage

Question 346

cause of truncus arteriosus

Answer 346

failure of neural crest cell migration

Question 347

cause of tet of fallot

Answer 347

abnormal placement of the infundibular septum

Question 348

cause of ASD and VSD

Answer 348

isufficient growth of endocardial cushions

Question 349

periventricular hyperintensities

Answer 349

suggest demyelination - mutliple sclerosis

Question 350

defense mech: individual responds to an undesired idea or feeling by acting in a manner that is diametrically opposed to their feelings

Answer 350

reaction formation

Question 351

dizygotic twins require

Answer 351

two different sperm

Question 352

monozygote <4days =

Answer 352

dichorionic/diamniotic

Question 353

monozygote 4-8 days =

Answer 353

monochorionic/diamniotic

Question 354

monozygote 8-12 days

Answer 354

monochorionic/monoamniotic

Question 355

monozygote twins >13 days

Answer 355

monochorionic/monoamnioitic conjoined twins

Question 356

preeclampsia due to

Answer 356

abnormal cytotrophoblast invasion -> chornic placental ischemia –> release of antiangiogenic factors - inhibited angiogenesis

Question 357

end-organ vasospasm w/preeclampsia can cause what in liver

Answer 357

subcapsular hematoma

Question 358

fetal parts palpable, no firm uterus

Answer 358

uterine rupture

Question 359

tender, firm uterus

maternal vessels rupture at decidua

Answer 359

placental abruption

Question 360

p-57 positive bc contains maternal genome (XXY/XXY)

Answer 360

partial mole

**monitor BhCG for neoplastic conversion to choriocarcinoma

Question 361

pregnancy loss <20wks and low B-hCG

Answer 361

miscarriage

Question 362

stabilizes clots by inhibiting plasmin formation (conversion of plasminogen to plasmin)

Answer 362

Tranexamic acid (TXA)

Question 363

uses of Tranexamic acid

Answer 363

antifibrinoyltic

used to reduce blood loss after delivery/ c-section

and reversal of tPA (alteplase)

Question 364

oxytocin moa

Answer 364

stops post-delivery bleeding

phospholipase C —–> Ca2+ rlease, binds calmodulin, myosin light chain kinase–> contraction of smooth muscle

Question 365

tx for opioid withdrawal in neonate after exposure from mother

Answer 365

low stim environment and opioid replacement

Question 366

? AFP w/neural tube defects, wall defects (gastroschisis and omphalocele), multiple gestations

Answer 366

increased

Question 367

neonate: excessive irritability, sneezing, diarrhea, tremors + hypertonia

Answer 367

neonatal abstinence syndrome

Question 368

paraumbilical herniation of intestine through abdominal wall - no herniated sac; failed formation of large peritoneal cavity

Answer 368

gastrochisis

Question 369

lab /imaging findings from gastrochisis

Answer 369

increased AFP from spillage and **free floating fetal viscera on U/S

Question 370

?AFP in aneuoploidies, trisomies

Answer 370

low

Question 371

rocker bottom feet, clenched hands, overlapping fingers, VSD, horseshoe kidney, low-set ears

Answer 371

Trisomy 18, Edward’s

Question 372

midline facial abnormalities, holoprosencephaly, cleft palate, polydactyly, GI

Answer 372

trisomy 13

Question 373

cat-like cry involves which mutation

Answer 373

5q microdeletion- Cru-de-chat

Question 374

sx of Cru-de-chat

Answer 374

VSD, microcephaly, intellectual disability, singal palmar crease, dysmorphic facial features

Question 375

which cells secrete B-hCG in pregnancy

Answer 375

synctiotrophoblasts – promote corpus luteum

Question 376

hCG initially doubles, then peaks at

Answer 376

8-10wks gestation

Question 377

hCG is structurally similar to

Answer 377

LH

maintains corpus luteum which produces progesterone and estrogen

Question 378

after hCG and corpus leteum decline, which tissue acconts for production of progesterone and estrogen

Answer 378

placental tissue

Question 379

cause of hyperemesis gravidarum

Answer 379

increased B-hCG

Question 380

avoid use of which drug for GERD/NSAID ulcers in pregnancy

Answer 380

misoprostol (prostaglandin analog that increases gastric mucus)

increases rx of abortion due to increased contractions

Question 381

triad: ovarian fibroma (fibroblast spindle cells), ascites, and pleural effusion

Answer 381

Meigs sydnrome

Question 382

cause of physiologic neonatal juandice

Answer 382

UDP-glucronyosyltransferase deficiency

indirect hyperbilirubinemia

Question 383

neonatal jaunce + anemia + hepatosplenomegaly

Answer 383

IgG antibody formation against Rh antigen

Question 384

**Black Liver

+

elevated conjugated biliribin in adolescent

Answer 384

dubin-johnson

defective transport of conjugated bilirubin

impairs excretion of epinephrine metabolites - black liver

Question 385

baby - leg shorter and externally rotated due to

Answer 385

abnormal development of acetabulum

developmental dysplasia of the hip

Question 386

cause of atrophic vaginitis w/breastfeeding

Answer 386

increased prolactin –> inhibition of GnRH –> decreased estrogen

Question 387

HELLP syndrome

Answer 387

preeclampsia w/severe features

Hemolysis, elevated liver enzyes, low platelets = widespread endothelial damage

Question 388

chocolate colored ovarian cysts (endometriomas) are caused by

Answer 388

Endometriosis: chronic pain and infertility due to endometrial cells implanted on various pelvic organs

Question 389

menopause is associated w/which lab

Answer 389

elevated FSH** from lack of response from follicles and no inhibin release

Question 390

role of inhibin

Answer 390

directly inhibits FSH in pituitary in both men and women

Question 391

theca interna is innervated by?

Answer 391

LH binds, produces androgens and progesterone

migrates to nearby granulosa cells

Question 392

granulosa cells function

Answer 392

aromatase converts androgens from theca cells into estradial

Question 393

granulosa cells are controlled by

Answer 393

FSH

Question 394

levator ani and external urethral sphincter controlled by

Answer 394

s3-s4

Question 395

pudendal nerve

Answer 395

s2-s4

Question 396

drug for PCOS infertility

Answer 396

letrozole = inhibits aromtase and suppresses ovarian estradil production allowing FSH and LH to rise to stimulate ovulation

Question 397

infertility therapy

Answer 397

menotropin – provides FSH and LH

Question 398

clomiphene

Answer 398

estrogen rc antagonist – depletes estrogen rc in the hypothalamus and pituitary –> decreases ability for estrogen feedback

used for infertility treatment

Question 399

? peaks right before ovulation, ? is increased after ovulation

Answer 399

LH before, progresterone after = indicator for ovulation happened

Question 400

PCOS increases rx of

Answer 400

endometrial hyperplasia, and therefore endometrial carcinoma

Question 401

role of insulin resistance in PCOS

Answer 401

hyperinsulinemia causes increased androgen production in theca cells and increased conversion to estrogen in granulosa cells

Question 402

? LH in PCOS

Answer 402

increased release – results in disrupted follicle maturation, cysts development and anovoluation

Question 403

tx for hirsutism in PCOS

Answer 403

spironolactone or ketoconazole

Question 404

ovarian torsion occurs around

Answer 404

infundibulopelvic or suspensory ligament carrying ovarian vessels

Question 405

which ligament holds uterine arteries and site of ligation for hysterectomy

Answer 405

cardinal ligament

Question 406

rx of ___ injury w/hysterectomy

Answer 406

ureter, near cardinal ligament

Question 407

damage to this ligament results in uterine prolapse

suspends the uterus and vaginal apex from the sacrum and lateral pelvis

Answer 407

uterosacral ligament

Question 408

femoral hernia occurs between

Answer 408

lacunal ligament and femoral vein (comprise femoral canal)

Question 409

short stature, delayed growth, webbed neck, widely spaced nipples, bicuspid aortic valve, coarctation of aorta,

**streaked/atrophic ovaires - primary amenorrhea, though not always

**swelling of hands - lymphedema

Answer 409

Turner syndrome (45,X)

Question 410

cystic hygromas occur where?

and are associated w/

Answer 410

occur in posterior triangle of neck - malformation of fetal lymphatic system

associated with Turner syndrome, trisomy 21, and aneuploidy

Question 411

fish vaginal odor and white discharge

Answer 411

Gardnerella vaginalis

Question 412

clue cells on wet mount

Answer 412

Gardnerella vaginalis

Question 413

tx for Gardnerella vaginalis

Answer 413

metronidazole or Clindamycin

Question 414

yellow/green frothy discharge and motile, flagellated protozoan

Answer 414

trichomonas vaginalis

Question 415

tx for trichomonas vaginalis

Answer 415

metronidazole

Question 416

white, curd like vaginal discharge

Answer 416

Candida albicans

Question 417

tx for vaginal candidiasis

Answer 417

fluconazole

Question 418

Tx for pelvic inflammatory disease

Answer 418

Need broad-spec antibiotic: ceftriaxone (gram -), doxycycline (gram+ and atypical), and metronidazole (anaerobes)

Question 419

initial small shallow genital ulcer that results –> then painful adenitis/buboes about 3 wks later w/prululent discharge

Answer 419

chlamydia trachomatis serovars L1-L3 - lymphogranuloma venereum

Question 420

histo of lymphogranuloma venereum

Answer 420

intracytoplasmic inclusion bodies

Question 421

peu d’orange is associated w/

Answer 421

inflammatory breast carcinoma - due to block of lymphatic drainage

Question 422

painless breast mass, cells organized in a single file

Answer 422

lobular breast carcinoma

Question 423

custy, scaly redness of nipple and oozing and bleeding

Answer 423

Paget disease – manifestation of ductal carcinoma

Question 424

benign tumor within mammary duct - spontaneous discharge

Answer 424

intraductal papilloma

Question 425

pleomophic cells with central necrosis in ducts (breast)

Answer 425

ductal carcinoma in situ

Question 426

rx factors for breast cancer

Answer 426

nulliparity and age

breastfeeding and OC have protective effect

Question 427

benign, mobile mass breast mass, estrogen sensitive

young women 15-35

Answer 427

fibroadenoma

Question 428

skin retractions from breast cancer are due to

Answer 428

malignant invasion of suspensory ligament

Question 429

cause of menstruation

Answer 429

progesterone withdrawal –> prostoglandin increase –> increase uterine contraction, compression of spiral arteries

Question 430

which cells undergo apoptosis during menstruation

Answer 430

stratum functionalis undergo apoptosis

Question 431

regular, heavy, painful menses

global enlargment of uterus

dark red endometrial tissue within myometrium

Answer 431

adenomyosis

Question 432

benign proliferation of the myometrium

appears grossly yellow-gray

Answer 432

uterine leiomyoma

Irregular uterine enlargement puts pressure on surrounding organs

Fibroids in posterior uterus can pressure colon and lead to constipation

Ant subserosal can obstruct ureter

Question 433

bacteria causing acute cystitis

Answer 433

E.coli

klebsiella pneumo + proteus mirabilis

Question 434

how does E.coli cause cystitis

Answer 434

P-fimbriae to colonize urothelium

Question 435

viral cause of acute cystitis and possibly hemorrhagic cystitis

Answer 435

adenovirus

Question 436

linear, ds DNA and isocahedral capsid causes cystitis

Answer 436

adenovirus

Question 437

female tract lymph drainage:

Ovaries

Uterus

Cervix

Upper vagina

Distal vagina

Vulva

Answer 437

• Ovaries: paraaortic
• Uterus: external iliac
• Cervix: internal iliac
• Upper vagina: internal iliac
• Distal vagina: inguinofemoral **
• Vulva: inguinofemoral **

Question 438

right ovarian vein drains to

Answer 438

IVC

Question 439

left ovarian vein drains to

Answer 439

left renal vein

Question 440

krukenberg tumor

Answer 440

primary gastric cancer that has metastazied to the ovary - **bilateral ovarian lesions

**signet ring cells in ovary

Question 441

signet ring cells in ovary

Answer 441

krukenberg - gastric cancer metastasized to the ovary

Question 442

sperm fills empty ovum

Answer 442

complete mole

Question 443

complete mole has what chromosomes

Answer 443

XX, 46

duplication of single male haploid chromosome

Question 444

increased testosterone production in women can be caused by

Answer 444

Sertoli-Leydig cell tumor possible

Question 445

histo shows leaf-life pattern, rapidly-growing, painless breast mass

Answer 445

Phylloides tumor

Question 446

atypical squamous cells arising from the basal layer above BM and moving up

Answer 446

cervial intraepithelial neoplasia

Question 447

what is the most likely outcome of Low-grade cervical dysplasia

Answer 447

spontaneously regresses

Question 448

Histo = Koilocytes – cells with clearing around small nucleus (blue stain/pap smear)

Answer 448

HPV

Question 449

pap smear

Answer 449

HPV - koilocytes

Question 450

MOA of copper IUD

Answer 450

** induces sterile inflammation of the endometrium

inflammation is spermicidal, inhibits sperm motility and acrosomal rxn

also increases cervical mucus

Question 451

MOA hormonal IUDs

Answer 451

increase mucous thickening and glandular atrophy of the endometrium - prevents future implantation

Question 452

fallopian tubes empty where

Answer 452

in peritoneal cavity

Question 453

XXY due to nondisjunction of sex chromosomes

Answer 453

Klinefelter’s

Question 454

tall stature, gynecomastia, learning disabilites, hypergonadotropic hypogonadism

Answer 454

Klinefelter’s

Question 455

lab results in Klinefelter’s

Answer 455

increased FSH and LH

• Testicular dysgenesis: Seminiferous tubules dysgenesis –> loss of Sertoli cells –> decreased inhibin B –> increased FSH
  
  • Leydig cell dysfunction à decreased testosterone –> increased LH
    
    • Increased LH and FSH leads to increased conversion of testosterone to estrogen

Question 456

high rx of breast cancer and testicular cancer in males associated w/

Answer 456

Klinefelters

XXY

Question 457

testicular arteries come off of aorta and anastamose w/

Answer 457

artery of the ductus deferens from internal iliac

Question 458

hereditary hemochromatosis has what effect on pituitary

Answer 458

deposition of iron in pituitary gland –> secondary hypogonadism

Question 459

antidepressant used to treat insomnia, high risk of priapism

Answer 459

trazadone

Question 460

spirinolactone effect on repro

Answer 460

decreases testosterone synthesis and inhibits testosterone rc

Question 461

ketoconazole effect repro

Answer 461

decreases synthesis of steroid hormones

Question 462

most common cause of acute prostatitis

Answer 462

E.coli – gram neg, lactose fermenting rod, grows in pink colonies

Question 463

sildenafil

Answer 463

PDE5 inhibitor, increased cGMP and muscle relaxation for erection

Question 464

hydrocele can be caused by

Answer 464

patent processus vaginalis

communicating hydrocele caused by patent processus vaginalis and collection of fluid into tunica vaginalis

Question 465

gonadal arteries arise from aorta @

Answer 465

below level of renal artery (L1/L2)

just below SMA

Question 466

hypospadias caused by

Answer 466

bottom

urogenital folds

Question 467

epispadias

Answer 467

on top

genital tubercle

Question 468

loss of cremateric reflex

Answer 468

testicular torsion

Question 469

injury to prostate plexus can cause

Answer 469

erectile dysfunction

Question 470

injury to which segment of urethra is most common in traumatic/car injury

Answer 470

posterior urethra/membranous segment

Question 471

drainage of scrotum, perineum, ant abdominal wall underneath umbilicus, buttocks, skin of penis

Answer 471

superficial inguinal

Question 472

drainage of glans penis and penile urethra

Answer 472

deep inguinal

Question 473

prostate adenocarcinoma often metastasizes to

Answer 473

bone

Question 474

bone findings in metastatic prostate adenocarcinoma

Answer 474

sclerotic, osteoblastic bone lesions, disordered trabecular growth w/irregular gland like formations

Question 475

prostate adenocarcinoma is ? sensitive

Answer 475

androgen-sensitive tumor

Question 476

in advanced prostate adenocarcinoma – ? intervention

Answer 476

orchiectomy – prevents production of more androgens; prostate in androgen-sensitive tumor

Question 477

flutamide

Answer 477

competitive testosterone rc inhibitor - useful for testosternoe-dependent prostate cancer

Question 478

Benign Prostatic Hyperplasia occurs where

Answer 478

transition zone that surrounds urethra

Question 479

tamsulosin

Answer 479

a-adrenergic blocker

relax smooth muscle in bladder neck – allows sx improvement in BPH

also effective for spastic neurogenic bladder

Question 480

finasteride

Answer 480

decreasess size of prostate – works on epithelium

Question 481

BPH can have what lab finding

Answer 481

microscopic/gross hematuria due to friable prostate vessels

Question 482

BPH increases rx of

Answer 482

UTI, does not increase rx of prostate adenocarcinoma

Question 483

bethanecol

Answer 483

muscarinic agonist

used for bladder hypomotility

Question 484

infertility, chronic sinusitius, recurrent otitis media

Answer 484

primary ciliary dyskinesia

Question 485

agings effect on male repro

total T?

free T?

hepatic synthesis of SHBG

Answer 485

decreased total T and free T

increased hepatic synthesis of SHBG

Question 486

hCG has similar structure to (not LH)

Answer 486

thyroxine and can cause hyperthyroidism, especially in malignant forms

Question 487

increased B-hCG, placental Alk phosph, normal AFP, fried-egg appearance on histo

Answer 487

seminoma

Question 488

how are testosterone levels kep high in seminiferous tubules

Answer 488

sertoli cells produce androgen-binding protein via FSH – ABP keeps levels high

Question 489

five P’s of acute intermittent porphyria

Answer 489

painful abdomen, polyneuropathy, psych distrubance, precipitated by drugs/alcohol, and Purple pee

Question 490

asteroid bodies – needle-shaped structures shaped in star-like pattern, consists of lipids + non-caseating granulomatous inflammation

Answer 490

sarcoidosis

Question 491

fatigue, dyspnea, arthralgia, hepatomegaly, erythema nodosom (tender red nodules on shin), lupus pernio (rash on face), dry cough, uveitis

Answer 491

sarcoidosis

Question 492

CNS: parallel bundles of cells with eosinophilic corkscrew-like processes

Answer 492

Pilocytic astrocytoma (Rosenthal fibers)

Question 493

metyrapone

Answer 493

inhibits cortisol production via inhibitation of 11beta hydroxylase,

should result in increased serum CRH and ACTH

Question 494

ethambutol

Answer 494

impaired synthesis of cell wall polysaccharides

tx for tuberculosis

Question 495

side effect of ethambutol

Answer 495

reversible optic neuropathy w/red-green color blindness

Question 496

blistering cutaneous photosensitivity

Answer 496

porphyria cutanea tarda

Question 497

buildup of ? in porphyria cutanea tarda

Answer 497

uroporphyrinogen III

Question 498

porphyria cutanea tarda caused by defect in

Answer 498

uroporphyrinogen decarboxylase

Question 499

primary hyperparathyroidism can cause which cardiac sx

Answer 499

HTN - affects vascular reactivity

interrupting day/night blood pressure changes

ex. elevated nocturnal blood pressure

Question 500

Apo B deficiency caused by

Answer 500

mutation in microsomal triglyceride transfer protein – required for assembly and secretion of ApoB in liver

Question 501

Apo B def associated w/

Answer 501

peripheral neuropathy, retinitis pigmentosa (breakdown of loss of retina), mental retardation, diarrhea

Question 502

vinyl chloride exposure in pipes

Answer 502

hepatic angiosarcoma

Question 503

napthylamine in dyes

Answer 503

bladder cancer

Question 504

cadmium in batteries, plastics, and pigments

Answer 504

lung, renal, prostate cancer

Question 505

benzenes in plastics inc rx of

Answer 505

AML

Question 506

Triad: fibrous dysplasia (multiple osteolytic-appearing lesions of the hip and pelvis), endocrine abnormalities, *precocious puberty, *unilateral café-au-lait spots

Answer 506

McCune-Albright syndrome

Question 507

McCune-Albright syndrome

Answer 507

GNAS mutation – activating mutation in the G protein/cAMp/ AC pathway

Question 508

HER2 and RET are what kind of rc

Answer 508

intrinsic tyrosine kinase

Question 509

HER2 drug

Answer 509

trasuzumab

Question 510

trastuzumab associated w/

Answer 510

cardiotoxicity; dilated cardiomyopathy

Question 511

BRAF is what kind of gene

Answer 511

protein kinase; serine/threonine kinase

implicated in melanoma

Question 512

mutations associated w/prostate cancer

Answer 512

BRCA1 and 2

Question 513

decreased E-Cadherin2

Answer 513

means loss of cell-cell-adhesion

moa of tumor invasion

Question 514

type IV collagenases

Answer 514

destroy BM, leading to breaking of b vessels and opening into lymph

moa of tumor invasion

Question 515

RB gene controls

Answer 515

G1 to S

Question 516

when phosphorylated RB (retinoblastoma)…

Answer 516

releases E2F transcription factor to initiate DNA replication

Question 517

what phosphyrlates and therefore inactivates RB

Answer 517

cyclin-dependent kinase 4

Question 518

Tumor suppressors

(name 4)

Answer 518

APC, BRCA1, RB, TP53

Question 519

BRCA gene

Answer 519

DNA repair protein that conducts homologous end joining to repair DS DNA breaks

Question 520

oncogenes (5)

Answer 520

KRAS, MYC, ERBB, ABL, BRAF

Question 521

KRAS

Answer 521

g-protein, activates epidermal growth factor rc

Question 522

ABL is what type of mutation

Answer 522

non-rc tyrosine kinase

Question 523

Li Fraumeni

Answer 523

TP53 mutation: sarcomas, breast cancer, brain tumors, leukemia, adrenocortical carcinoma

Question 524

situs inversus (dextrocardia), respiratory infx, infertility in men caused by:

Answer 524

Kartagener’s syndrome: caused by defect in dynein arms

Question 525

fibrosis =

Answer 525

homogenization of dermal collagen

Question 526

Reid Index

Answer 526

measure for COPD, thickness of mucus glands vs. bronchial wall between epithelium and cartilage

= thickness of glands / thickness of wall

normal <0.4

Question 527

Lynch syndrome mutations

Answer 527

MSH2, MLH1, MHS6, PMS2

AD, DNA mismatch repair genes

Question 528

nonpolyposis colon cancer (no polyps), endometrial cancer, ovarian cancer

Answer 528

Lynch syndrome

Question 529

VHL disease is what inheritance?

Answer 529

AD neurocutaneous disorder

Vascular tumors (hemangioblastoma or angiomatosis)

Pheochromocytoma, Renal Cell Carcinoma, cerebellar/retinal hemangioblastomas

Question 530

phentolamine

Answer 530

a1 rc antagonist – counteracts a1 rc mediated vasoconstriction

Question 531

string of beads on angiogram

webs of aneurysms

lack of intimal layer in blood vessels

Answer 531

fibromuscular dysplasia

Question 532

cause of cleft lip

Answer 532

failure of maxillary and nasal prominencet to fuse

Question 533

cause of cleft palate

Answer 533

failure of palatine prominence to fuse

Question 534

keloids caused by

Answer 534

excessive TFG-B hyperproliferation of fibroblasts

Question 535

common places for keloids

Answer 535

earlobes, face, chest, and neck

Question 536

which enzyme important for scar formation

Answer 536

matrix metalloproteinases

Question 537

thiopental

Answer 537

barbiturate: CV depression, bronchoconstriction

parenteral anesthetic

Question 538

midazolam

Answer 538

benzo - parenteral anesthetic

Question 539

propofol

Answer 539

short duration,

vasodilation and CV depression

Question 540

propofal infusion syndrome

Answer 540

inhibits mitochondria FA metabolism – causes bradycardia, HF, met acidosis, rhabdo, enlarged/fatty liver

Question 541

ketamine

Answer 541

NMDA rc antagonist - rapid onset, longer duration

increases cerebral blood flow and increased ICP

sympathomimetic: increase BP and CO

+dissociative amnesia - dont remember pain

Question 542

inhaled anesthetic: increase lipid solubility means

Answer 542

increased potency

Question 543

inhaled anesthetic, increased blood solubility

Answer 543

slower onset and recovery

Question 544

moa of NO inhaled anesthetic

Answer 544

NMDA rc antagonist

Question 545

NO inhaled anesthetic: low lipid and blood solubility means

Answer 545

rapid induction but effects are weaker

Question 546

halothane and enflurance moa

Answer 546

NMDA rc antagonist

Question 547

halothane tox:

enflurane tox:

Answer 547

halothane: hepatotox
enflurane: contraindicated in epilepsy

all can cause malignant hyperthermia

Question 548

amplified oncogenes

Answer 548

N-myc for neuroblastomas and ERBB1/HER1 for breast+gastric cancer

and ERBB2/HER2 for colorectal and lung adenocarcinoma

Question 549

alemtuzumab

Answer 549

binds CD52 on T cells, B cells, Natural Killer Cells, monocytes

Question 550

celecoxib

Answer 550

selective COX 2 inhibitor

Question 551

indication for celecoxib

Answer 551

for RA and ankylosing spondylitis for people with PPI

less GI bleed rx

Question 552

tumor marker: Desmin

Answer 552

muscle tumor, rhabdomyosarcoma

Question 553

tumor marker: cytokeratin

Answer 553

epithelial

Question 554

vimentin tumor marker

Answer 554

sarcomas/primary bone tumors: osteosarcoma, Ewing, chondrosarcoma

Question 555

tumor marker for neural crest cells

Answer 555

Schwann cells and melanocytes

S100

Question 556

reversible cell changes to hypoxia/ischemia

Answer 556

cell and mitochondrial swelling – due to lack of ATP for Na+/K+ ATPase, Na+ remains in cell and draws water

Question 557

a-1 rc controls

Answer 557

vascular smooth muscle, pupils, pylorus, urinary sphincter, and prostate

Question 558

a-2 rc

Answer 558

works in CNS, activation of rc = decreased sympathetic flow

Question 559

clonidine

Answer 559

alpha 2 agonist

used for

Hypertensive urgency

ADHD

Tourette syndrome

Symptomatic control of opioid withdrawal

Question 560

yohimbine

Answer 560

a-2 blocker

Question 561

methyldopa

Answer 561

alpha-2 agonist

used for hypertension in pregnancy

Question 562

gaunfacine

Answer 562

same as clonidine, alpha 2 agonist

Hypertensive urgency

ADHD

Tourette syndrome

Symptomatic control of opioid withdrawal

Question 563

timolol

Answer 563

non-selective B-blocker

used for glaucoma - decreased aq humor production

Question 564

side effects of timolol

Answer 564

asthma exacerbation, bradycardia, erectile dysfunction, masking of hypoglycemia

Question 565

nasal congestion can be treated w/

Answer 565

phenylephrine - alpha-1 agonist, vasoconstricts nasal mucosa and mitigates edema

Question 566

B2 rc:

Answer 566

smooth muscle dilation in bronchi and blood vessels

uterine relaxation

insulin release and glycogenolysis

Question 567

resection of lymph nodes after surgury leads to

Answer 567

collection of lymph in interstitial space – lipid-rich, protein rich fluid

non-pitting edema

Question 568

moa of ANP, BNP, and NO

Answer 568

all increasd cGMP via protein kinase G

ANP and BNP also inactivates Na+ channels in DCT and collecting duct

Question 569

anti-histone Ab’s

Answer 569

drug-induced SLE

Question 570

drugs associated w/ Drug-Induced SLE

Answer 570

procainamide, isoniazide, hydralazine

all due to lack of liver acetylation

Question 571

substitution of one differentiated epithelial cell type for another in response to adverse environmental conditions

Answer 571

metaplasia

Question 572

metaplasia can lead to

Answer 572

dysplasia: abnormal cells, ex. keratin pearls

Question 573

anaplasia

Answer 573

loss of cell polarity, change in shape and size of cell and nuclei, large Nuc to Cyt ratio, hyperchromatic, giant, multinucleated tumor cells

Question 574

coagulative necrosis is a sign of

Answer 574

irreversible ischemia

ie renal papillary necrosis

Question 575

liquefactive necrosis occurs where

Answer 575

CNS or gangrene – necrotic tissue is hydrolyzed by enzymes into a fluid/pus

Question 576

dystrophic calcification is a form of

Answer 576

necrosis

Question 577

baclofen

Answer 577

GABA-B agonist

used for muscle spasticity (multiple sclerosis)

Gpc-rc increases efflux of potassium and hyperpolarizes skeletal muscle cells – decrease AP frequency = increased muscle relaxation

Question 578

atracurium; -curar

Answer 578

non-depolarizing competitive antagonist @ nicotinic rc @NMJ

relaxes muscles before surgery

Question 579

succinylcholine MOA

Answer 579

neuromuscular blocker

depolarizing block

phase 1: prolonged depolarization: K+ leaves cell and can cause hyperkalemia and arrythmia

phase 2: desensitiization

Question 580

one cause of malignant hyperthermia caused by succinylcholine

Answer 580

deficiency of pseudocholinesterase (breaks down succinylcholine)

Question 581

etomidate indicated for

Answer 581

parenteral anesthetic;lower CV risk

rapid onset, acts on GABA rc

does cause adrenal suppression/acute adrenal insufficiency from reduced cortisol production

also can cause myoclonus

Question 582

drugs subject to chelation via iron, calcium, magnesium, aluminum supplements

Answer 582

tetracycline, levothyroxine, fluoroquinolones

Question 583

more lipophilic = ? minimal alveolar concentration

Answer 583

lower

less needed to accumulate in brain

Question 584

methadone

Answer 584

long-acting, long-half life full mu rc agonist – long term binding causes reduction in cravings

Question 585

? = 97% steady-state concentration

Answer 585

5 half-lives

Question 586

AChEI work in CNS

Answer 586

rivastigmine and donepezil

Question 587

AChEI used for myasthenia gravis

Answer 587

neostigmine and pyridostigmine

Question 588

drug to counteract anticholinergic effects of atropine

Answer 588

physostigmine - AChEi

Question 589

Glycopyrrolate

Answer 589

anticholinergic agent used to stop excessive sweating

Question 590

risk of statin-associated myopathy is increased w/addition of:

Answer 590

fibrates: gemfibrozil

and CYP 450 inhibitors

Question 591

acronym for CYP inducers (7)

Answer 591

Barb’s Funny Mom Refuses Greasy Carb Shakes

• Barb’s: barbiturates
• Funny: phenytoin
• MoM: Modafinil—stimulant used for narcolepsy
• Refuses: Rifampin
• Greasy: Griseofulvin
• Carb: Carbamazepine
• Shakes: St. John’s Wart

Question 592

CYP inhibitors:

Answer 592

Potent inhibitors of CYP3A4 include clarithromycin, erythromycin, diltiazem, itraconazole, ketoconazole, ritonavir, verapamil, goldenseal and grapefruit.

Question 593

Anticonvulsants (ie phenytoin, carbamazepine) + rifampin and isoniazid =

Answer 593

increased metabolization of active vit D into inactive form - osteomalacia

Question 594

cyclophosphamide chemo agent can cause

Answer 594

hemorrhagic cystitis

Question 595

cyclophosphamide (chemo agent) metabolized by kidneys into

Answer 595

acrolein

Question 596

tx of toxic acrolein buildup from cyclophosphamide

Answer 596

Mesna - bind and inactivates acrolein

Question 597

calculation for maintanence dose

Answer 597

= Steady state plasma concentration * Drug Clearance * dosing interval

Question 598

loading dose calculation

Answer 598

volume of distribution x steady-state plasma concentration

Question 599

high molecular weight, high plasma protein binding, high charge, hydrophilic = ? Vd

Answer 599

low volume of distribution

Question 600

high Vd:

Answer 600

lipophilic, low molecular weight, low plasma protein binding

• Vd = amount drug give/plasma concentration

Question 601

medication induced esophagitis presents as

Answer 601

burning pain in chest and dysphagia

Question 602

Heberden nodes (dorsal DIP)

Bouchard Nodes (dorsal PIP)

Answer 602

osteoarthritis

Question 603

joint space narrowing, subchondral sclerosis, osteophyte formation

Answer 603

osteoarthritis

Question 604

Barr bodies on peripheral blood smear

Answer 604

DNA methylation of X chromosome

small-dark staining spot in nucleated RBCs

tightly-packed heterochromatin

present in Klinefelters

Question 605

rx for osteosarcoma

Answer 605

Li Fraumeni, radiation injury, bone infarcts, **Paget disease of bone

Question 606

waiter’s tip position

disease? and injury where?

commonly assocaited with shoulder dystocia

Answer 606

Erb palsy: injury to upper trunk of brachial plexus

Question 607

what is necessary for acyclovir and valacyclovir to work

Answer 607

phosphorylation by virally-encoded thymidine kinase to activate guanosine analogs

Question 608

catheter associated gram + infx, novobiocin susceptible

tx?

Answer 608

Staph epidermidis

vancomycin

Question 609

joint aspiration

Answer 609

calcium pyrophosphate

typically knee joing

rhombus crystals

Question 610

type 2 white, fast-twitching fibers consist of ?ATPase

Answer 610

high myosin ATPase

ex. lateral rectus muscle

Question 611

type 1 fibers

?fast/slow

?ATPase

?respiration ?mito

Answer 611

slow, red

high-endurance muscles

aerobic respiration, high mitochonrdia and myoglobin

low myosine ATPase activity – speed depends on how quicly myosin can hydrolyze ATP, means slow

Question 612

headaches, abdominal pain, nausea, parethesias, dark urine in setting of elevated porphobiliogen and ALA (&-aminolevulinic acid)

inheritance?

Answer 612

acute intermittent porphyria

AD

Question 613

omalizumab

Answer 613

binds to free IgE, reduces stimulation of mast cells and basophils

Question 614

muscle weakness, blood in urine but negative RBCs, flat venous lactate curve

Answer 614

McArdle diseas- no glycogenolysis

increased accumulation of glycogen in muscle cells

Question 615

McArdle histo

Answer 615

subsarcolemmal acid-Schiff-positive deposits

Question 616

moa daptomycin

side effect?

Answer 616

potassium ion efflux and rapaid membrane depolraization

rhabdomyolysis

Question 617

role of topoisomerase

Answer 617

cleaving DNA to relieve supercoils

aka gyrase

inhibited by fluoroquinolones

Question 618

why

Answer 618

no cooperativity

high oxygen affinity at low O2 concentrations

Question 619

binding ? to myosin head causes myosin to detach from actin filaments

Answer 619

ATP

ends muscle contraction

Question 620

Desmopressin MOA

Answer 620

increased adenylate cyclase –> cAMP –> PKA –> insertion of aquaporin-2 channles in DCT and collecting ducts

Question 621

pancytopenia, short stature, hyperpigmented macules, congenital bone anomalies - absent radial bones/hypoplastic thubms

Answer 621

fanconi anemia

AR bone marrow fialure system

Question 622

how does angiosarcoma of the breast develop?

Answer 622

chronic lymphedema, often from pts who have undergone breast radiation and have lymph node sclerosis

Question 623

lung tumor: glandular cells with papillary components and signet ring cells that stain positive for mucin

Answer 623

lung adenocarcinoma

Question 624

pain during empty can test

Answer 624

supraspinatus

Question 625

moa of platinum-based chemo

cisplatin and carboplatin

Answer 625

cross-linking of DNA

Question 626

toxicity of platinum-basec chemo

Answer 626

ototoxicity

others can be nephrotoxicity and peripheral neuropathy

Question 627

valganciclovir used for

Answer 627

prodrug form of ganciclovir with better oral bioavailability

used for CMV in immunocompromised

Question 628

valganciclovir along with other HIV drugs (nucleoside reverse transcriptase inhibitors) cause

Answer 628

pancytopenia

Question 629

loss of APC leads to

Answer 629

impaired degradation of B-catenin – tf that influences cellular proliferation

Question 630

exfoliative toxin A causes

Answer 630

staph scalded skin syndrome (in babies)

toxin cleaves desmosomal proteins responsible for keeping keratinocytes bound to one anoterh in the stratum granulosum

Question 631

characterized by: deposition of lamellar bone interspersed with woven bone

Answer 631

paget disease of bone

Question 632

loss of cortical bone mass and thinning of trabeculae

Answer 632

osteoporosis

Question 633

VHL is what type of gene?

Answer 633

tumor suppressor gene: Deletion of VHL gene → impaired ubiquitination and elimination of hypoxia-inducible factor 1a → loss of function → tumor and cyst development

Question 634

absorption velow dentate line

Answer 634

middle and inferior rectal viens which drain to internal iliac

Question 635

medications that can induce esophagitis (4)

Answer 635

bisphosphonates

tetracylcines

aspirin/NSAIDS

potassium chloride and iron

Question 636

opioids are metabolized by?

excreted by?

Answer 636

liver

excre: kidney

Question 637

neonates have

? proportion of water

? CYP enzyme activity

? renal blood flow

Answer 637

increased proportion of water, decreased CYP enzyme activity, decreased renal blood flow

Question 638

use for linezolid

Answer 638

gram + infections that are vancomycin-resistant and MRSA

Question 639

drugs that are excreted by liver into bile and feces have what properties?

Answer 639

High in lipophilicity and high Vdistribution

Question 640

equation for bioavailability

Answer 640

AUC oral dose/ AUC IV dose

Question 641

buprenophine or butorphanol

Answer 641

partial opoid agonist

In the presence of full agonists it functions as an antagonist and therefore can precipitate acute withdrawal – occurs in pts who abuse opioids and are given drugs in hospital

Question 642

tx for acetominophen tox

Answer 642

N-acetylcysteine

increases glutathione to help metabolize NAPQI into excretable form

Question 643

how does NAPQI damage cells

Answer 643

NAPQI has strong oxidizing property and damages hepatocytes through peroxidation of lipids in cell membranes, damage to proteins, and DNA strand breaks

Question 644

tx for methanol tox

Answer 644

fomepizole

competitive antagonist of aldehyde dehydrogenase

Question 645

fomepizole moa

Answer 645

competitive antagonist of aldehyde dehydrogenase

for methanol and ethylene glycol

Question 646

methanol can cause ?

Answer 646

blindness

Question 647

ethylene glycol can cause?

Answer 647

AKI due to cytotoxicity

Question 648

tx for aspirin poisoning

Answer 648

sodium bicarb

increases urinary excretion; ionizes acid, forms lipohilic form

Question 649

acid-based changes with aspirin poisoning

Answer 649

Primary resp alkalosis – triggers medullary center causing hyperventilation

Primary met acidosis (salicylic acid reduces bicarb

Question 650

tx for benzo overdose

Answer 650

flumazenil

Question 651

organophosphates in insecticides have what effect?

tx?

Answer 651

function as acetylcholinesterase inhibitors

tx is atropine

Question 652

what is given after atropine for organophosphate tx?

Answer 652

Pralidoxime after as a cholinesterase-reactivating agent

Regenerate acetylcholinesterase by dephosphorylation

AcHE inactivated by phosphorylation by organophosph

Question 653

sx of beta-blocker overdose (3)

Answer 653

hypoglycemia, heart block, bronchospasm (wheezing)

Question 654

chocolate-colored blood that does not change when exposed to oxygen

Answer 654

Acquired methemoglobinemia

Question 655

what is methemoglobinemia

Answer 655

Altered form of Hgb which ferrous (Fe2+) is oxidized to ferric form (Fe3+)

Question 656

what can cause aquired methoglobinemia (3)

Answer 656

topical anesthetics, dapsone (TB drug), antibiotics

Question 657

tx for methemoglobinemia

Answer 657

methylene blue or ascorbic acid

Question 658

what is amatoxin?

Answer 658

found in mushrooms, inhibit RNA polymerase II, mRNA production

Question 659

RNA polymerase I?

II?

III?

Answer 659

RNA polymerase I: ribosomal RNA

II: mRNA

III: tRNA

Question 660

drugs commonly affected by CYP inducers/inhibitors (3)

Answer 660

antiepileptics, theophylline, warfarin

Question 661

theophylline moa

Answer 661

adenosine rc antagonist and phosphodiesterase inhibitor

Increased cAMP causes bronchodilation

Alternate therapy for asthma and COPD

Question 662

Methylxanthine (like caffeine) overdose w/theophylline

Answer 662

seizures and tachyarrhythmias

Question 663

reverse NE a1 effects

Answer 663

phenoxybenzamine

alpha antagonist

Question 664

phentolamine

Answer 664

nonselective a-adrenergic antagonist blocking agent

used for HTN emergency induced by cocaine, pheocytochroma, tyramine ingestion w/MAOi

Question 665

rocuronium

(curare)

Answer 665

competitive antagonist at the postsynaptic ACh rc in neuromuscular jct

Question 666

why is atracurium used for surgical procedures?

Answer 666

its metabolism is organ-independent – does not rely on renal or hepatic fct

Question 667

Neostigmine

Answer 667

AChEi (increases available ACh)

Question 668

Edrophonium

Answer 668

AChEi – was used to diagnose myasthenia gravis]

sx improve after administration

Question 669

Lineweaver Burkplot

y-intercept = ?

x-intercept = ?

Answer 669

y-intercept = 1/Vmax; x-intercept =1/Kmax , absolute value

Question 670

asian “glow” / flushing due to deficiency in

Answer 670

aldehyde dehydrogenase

Accumulation of aldehyde leads to histamine release from mast cells

Question 671

which drugs have disulfuram like rxn

Symptoms include flushing, tachycardia, and hypotension

(flushing)

Answer 671

Metronidazole, ketoconazole, and nitrofurantoin

when taken with alcohol

Question 672

target of fomepizole

Answer 672

alcohol dehydrogenase

Question 673

Ethylene glycol metabolized to?

metabolites are toxic how?

Answer 673

glycolic acid and oxalic acid

direct renal tubular cytotoxicity and oxaloacetate crystals seen

Question 674

moa of Vinca alkaloids

Answer 674

inhibit tubulin polymerization

Question 675

moa of taxanes (paclitaxel)

Answer 675

hyperstabilization of polymierzied microtubules

Question 676

muscarinic effects

? sweat, saliva, lacrimation

? liver

?pupils

? ciliary muscle

Answer 676

increase secretions: sweat, saliva, lacrimation

increase glucose storage in liver

constriction of pupils - miosis

contraction fo ciliary muscle = increase outflow of aq humor

Question 677

oxybutynin

Answer 677

anti-muscarinic

work in bladder, decreased detrusor muscle spasms for urge incontinence and involuntary urination

Question 678

Ipratropium and Tiotropium

Answer 678

muscarinic antagonist

bronchodilators for COPD and asthma (**inhaler), ipra is short acting, tiotropium is long acting

Question 679

Scopolamine

Answer 679

CNS active muscarinic antagonists

works on vomiting center, prevents motion sickness or n/v after surgery

Question 680

benzotropine and trihexyphenidyl

Answer 680

works in striatum

muscarinic antagonist

helps restore balance of doapmine and ACh in Parkinson’s disease

Question 681

low blood gas partition coeffecient means

Answer 681

low blood solubility

Question 682

pleural thickening w.spindle cells positive for cytokeratin

Answer 682

mesothelioma

Question 683

pleural plaques are a sign of

Answer 683

asbestos exposure; shipbuilder, insulation worker; often shows 20/30yrs later

Question 684

nodules on upper lobes

Answer 684

silica exposure

Question 685

silica impairs?

Answer 685

silica impairs macrophage fct, also increases rx for lung cancer, cor pulmonare from pulm HTN, and RA

Question 686

most common site of aspirated foreign bodies

Answer 686

Right main bronchus

Question 687

contributes most to total airway resistance in lungs

Answer 687

segmental bronchi

Question 688

pulmonary HTN treated with

Answer 688

Tadalafil – PDE5 inhibitor à improves action of NO à prevents breakdown of cGMP allowing more smooth muscle relaxation

Question 689

bilateral hilar adenopathy ; noncaseating granuloma

+ constitutional sx: night sweats, arthralgia, and weight loss

Answer 689

Sarcoidosis

Question 690

Activated macrophages in sarcoidosis produce

Answer 690

Vit D, lead to hypercalcemia

Question 691

Restrictive Lung Disease, hypercalcemia, dry cough

Answer 691

sarcoidosis

Question 692

greatest rx factors for sarcoidosis

Answer 692

women and African American

Question 693

pathogenesis involved in sarcoidosis?

(enzyme)

Answer 693

increased angiotensin converting enzyme activity

T-cell dysfunction and increased B-cell activity result in local immune hyperactivity and inflammation.

Macrophages activate Th1 cells.

Th1 cells stimulate the formation of epithelioid cells and multinucleated giant cells by releasing IFN-γ.

Epithelioid cells produce angiotensin-converting enzyme (ACE) and release cytokines, which recruit more immune cells.

Question 694

COPD X-ray findings

Answer 694

flattened diaphragm and hyperinflated lung from air trapping

Question 695

primary tx of asthma

Answer 695

inhaled glucocorticoids (budesonide)

reduces bronchial inflammation and edema

Question 696

what happens with O2 delivery in COPD

Answer 696

decrease in RR

O2 sensed by carotid bodies and aortic bodies; rapid O2 infusion decreases peripheral chemorc firing à decreases in RR

Question 697

tx for obstructive sleep apnea

Answer 697

continuous positive airway pressure (CPAP) decreases number of apneic events during night, decreases degree of blood pressure variability and HTN

Question 698

rx of untreated sleep apnea

Answer 698

Untreated apnea increases BP, CVD rx and stroke

Question 699

child in: tripod position, leaning forward, head up; inspiratory stridor

Answer 699

Epiglottis (H. influ)

Question 700

Epiglottis (H. influ) what sound?

Answer 700

inspiratory stridor

Question 701

rhonchi mean

Answer 701

excessive secretion in bronchi

Question 702

wheezing

Answer 702

constriction of smaller airways in lungs, heard most during expiration due to increased intrapleural pressure

Question 703

Expiratory stridor means

Answer 703

obstruction in lower trachea path

Question 704

Idiopathic pulm fibrosis involves

? type 1 pneumocytes

? type 2 pneumocytes

? fibroblasts

Answer 704

decreased Type 1 pneumocytes, reactive hyperplasia of type 2 pneumocytes, abnormal BM, and increased fibroblasts

Question 705

which drug is associated with pulmonary fibrosis?

Answer 705

amiodarone for AFIB pts

Question 706

type 2 pneumocytes appear

Answer 706

foamy from lecithin, and cuboidal

Question 707

eosinophils produce which protein

Answer 707

major basic protein - destroys endothelial and epithelial cells;

Question 708

Watery Diarrhea and Pneumo in group settings

Answer 708

Legionella

Question 709

most common lab finding with legionella

Answer 709

hyponatremia from volume loss

Question 710

Stains poorly with gram stain – intracellular pathogen

silver stain and contaminates water supply

Need Charcoal yeast extract agar (buffered with cysteine and iron)

Answer 710

legionella

Question 711

4 sounds in pneumothorax

Answer 711

Decreased breath sounds

Decreased tactile fremitus

Hyperresonance

Subcutaneous crepitus, crackling during palpation

Question 712

what is an empyema?

Answer 712

bacterial invasion of intrapleural space, pus accumulation, and fibrosis

Question 713

GRAM POS, beaded, or branching bacteria

Partially acid-fast (has some mycolic acid)

causes pneumo or brain abscess in immunocompromised

Answer 713

nocardia

Question 714

tx for nocardia

Answer 714

TMP-SMX

Question 715

tx for legionella

Answer 715

levofloxacin (fluorquinolone) or macrolide

Question 716

Haldane effect

Answer 716

“inHALe” @ lungs: Hb releases Co2 and H+ and allows more O2 loading

Question 717

effect @periphery: Hb accepts Co2 and H+ and increases O2 releasing

Answer 717

Bohr “Body” effect

Question 718

age-related lung changes:

compliance? elastin? deadspace?

chest wall stiffness?

work of breathing?

Answer 718

decreased elastin, increased compliance

increased dead space ventilation

increased chest wall stiffness

greater work of breathing

Question 719

secondhand smoke in children causes what impairment?

Answer 719

Impaired mucociliary clearance and impaired phagocytosis by alveolar macrophages– pneumo and asthma, and recurrent otitis media

Question 720

lung abscesses are caused by which type of bugs?

Answer 720

anaerobes like Peptostreptococcus and Fusobacterium

Question 721

cause of lung abscesses, most commonly

Answer 721

aspiration

dysphagia, esophageal motility disordres, altered mental status

periodontal infection

can occur due to SEIZURES, which causes impaired swallowing

or alcohol use disorder

Question 722

Gram-positive anaerobe that typically colonize the mouth—poor dentition can cause aspiration and lobar consolidation

Filamentous branching

Answer 722

actinomycosis

Question 723

treatment of actinomycosis

Answer 723

Pen G

Question 724

Ventilation equation

Answer 724

means exhange of CO2

= RR x Tidal Volume

Question 725

oxygenation depends on which two factors?

Answer 725

fraction of inspired 02 and positive-end-expiratory pressures

Question 726

Positive End Pressure has what effect?

Answer 726

decreases intrapulmonary shunting – prevents atelectasis

Question 727

X-ray: tram-track lines and honey-combing

Answer 727

Chronic Bronchiectasis

Question 728

which patho?

Answer 728

chronic bronchiectasis

X-ray: tram-track lines and honey-combing

form of obstructive disease; would see sputum and blood

Question 729

bacterial sinusitis is most often caused by

Answer 729

strep pneumo following viral upper respiratory infx

Question 730

three causes of bacterial sinusitis

Answer 730

H. flu, strep pneumo, or m. catarrhalis

Question 731

peripheral lung cancer w/short microvilli

Answer 731

adenocarcinoma

Question 732

peripheral lung cancer with long microvilli

Answer 732

mesothelioma

Question 733

flushing, diarrhea, wheezing, tumor has what histo?

Answer 733

uniform sheets of cells

Carcinoid

Question 734

hilar mass; chromogranin and synaptophysin positive, neural cell adhesion

Answer 734

small-cell lung carcinoma

Question 735

small cell lung cancer stain for (3)

Answer 735

neuron-specific enolase

chromogranin and synaptophysin positive

Question 736

3 syndromes associated with small cell lung cancer

Answer 736

SIADH: hyponatremia

Cushing syndrome: ectopic ACTH = osteoporosis, HTN, **hyperglycemia, **proximal muscle weakness, amenorrhea, truncal obesity

Lambert-Eaton syndrome – muscle wasting and atrophy

Antibodies to voltage gated Ca channels at NMJ, less release of ACh

Question 737

muscle weakness improves with stimulation

Answer 737

Lambert-Eaton syndrome

More stimulation leads to buildup of ACh in synaptic cleft

Question 738

small, round or oval cells with scant cytoplasm and hyperchromatic blue nuclei

lung histo

Answer 738

small cell lung cancer

Question 739

squamous cell carcinoma of lung is often located where?

Answer 739

major bronchi

Question 740

lung histo:

Large solid mass w/central necrosis

Answer 740

Squamous cell carcinoma

Question 741

common features of squamous cell carcinoma

Answer 741

keratin pearls; PTHrP – hypercalcemia

Question 742

Most common lung cancer, most common in women and non-smokers as well

Answer 742

adenocarcinoma

Question 743

Hypertrophic osteoarthropathy is associated w/ which cancer?

**arthritis, digital clubbing, periosteal thickening of diaphysis of long bones

Answer 743

lung adenocarcinoma

Question 744

3 conditions associated with lung adenocarcinoma

Answer 744

Hypertrophic osteoarthropathy

**arthritis, digital clubbing, periosteal thickening of diaphysis of long bones

Dermatomyositis/polymyositis

Migratory thrombophlebitis **moving red spot

Question 745

Panacinar emphysema with destruction of intralveolar septa ​

Answer 745

Alpha antitrypsin 1 deficiency

LIVER and LUNGS, presents acutely

Question 746

how does alpha antitrypsin 1 def affect liver

Answer 746

Liver disease from intrahepatocyte accumulation of abnormal AAT

Question 747

barrel chest, lung hyperinflammation, flattened diaphragm, widened intercostal spaces

Answer 747

Emphysema

Question 748

Non-selective B-blocker contraindicated for COPD

Answer 748

labetalol

Question 749

metoprolol

Answer 749

Beta 1 selective beta-blockers

Question 750

atenolol

esmolol

Answer 750

Beta 1 selective beta-blockers

Question 751

commonest reason for COPD exacerbation

Answer 751

viral infx (rhinovirus or influenza virus)

Question 752

tx for COPD exacerbation

Answer 752

Tx with short course of corticosteroids (Prednisone) and Albuterol/anticholinergic bronchodilator (ipratropium)

Question 753

common cold, non-enveloped RNA virus w/icosahedral capsid

Answer 753

Rhinovirus

Question 754

virus binds to ICAM-1 – expressed on respiratory epithelial cells

Answer 754

rhinovirus

IL-1 and TNF-a lead to further expression of ICAM-1 and allows viral progeny to infect neighboring cell

Question 755

chronic inflammation of small airways leads to scarring and OBStructive lung disease—commonly caused after adenovirus or toxic fumes

Answer 755

Bronchiolitis obliterans

Question 756

Prolonged mechanical ventilation in premature infants leads to:

Answer 756

Bronchopulmonary dysplasia

Question 757

most common cause of death in premature infants

Answer 757

Neonatal respiratory distress syndrome (due to surfactant deficiency)

Question 758

Hyaline membranes lining the alveoli on lung biopsy

Answer 758

Neonatal respiratory distress syndrome (due to surfactant deficiency)

Question 759

Hypoxic pulmonary vasoconstriction is ? in inflammatory states

Answer 759

decreased/impaired

community acquired pneumo

Antibiotics improve vasoconstriction

Question 760

Allergic bronchopulmonary aspergillosis is caused by?

Answer 760

Allergic rxn – increased IL-4 and eosinophilia

Occurs in 5-10% of asthmatics and those with cystic fibrosis

Question 761

? in peanuts, corn, and soybean produce aflatoxin

Answer 761

Aspergillus

Question 762

afltatoxin from aspergillus increases rx of

Answer 762

hepatocellular carcinoma

think farmer who cultivates soy/peanuts

Question 763

pathogenesis of aflatoxin (hepatocellular carcinoma)

Answer 763

Cytochrome p450 converts aflatoxin into a carcinogen à interferes with DNA transcription (tp53)

Question 764

Asthma caused by inflammation where?

Answer 764

terminal bronchioles

Question 765

First test for diagnosing Asthma

Answer 765

Spirometry

Question 766

spirometry diagnosis of asthma

Answer 766

See if FEV1 improves w/bronchodilators (<12%)

Question 767

how to test for asthma if spirometry negative

Answer 767

Methacholine

common in people who only have sx from triggers like pollen, pet dander, or smoke

Question 768

Kerley B lines – horizontal lines, present in what disease?

Answer 768

pleural effusion?

Question 769

Malignancy causes what type of pleural effusion from obstruction

Answer 769

exudative

RBCs and atypical cells; from obstruction of pleural lymphatic stroma

Question 770

cause of chylothorax

Answer 770

Obstruction of Thoracic duct

milky, white effusion; high triglycerides

Question 771

wede-shape lung opacity

Answer 771

atelectasis

Question 772

atelectasis improved by

Answer 772

increasing PEEP

Question 773

respiratory zone consists of?

Answer 773

respiratory bronchioles and alveolar sacs

Question 774

which way is medisastinum shifted in pleural effusion?

Answer 774

tension pneumothorax and pleural effusion pushes on opposite side

Question 775

which way is mediastinum shifted in atelectasis?

Answer 775

Mediastinum is shifted to same side

Question 776

Aspirin-exacerbated respiratory disease triad?

Answer 776

triad of asthma, nasal polyps, exacerbation of sx w/aspirin ​

Question 777

Lungs contain dual circulatory supply from?

Answer 777

pulmonary circulation + bronchial circulation: perfuses bronchi, lung parenchyma, and visceral pleura

Question 778

where is work of breathing minimized in restrictive?

obstructive?

Answer 778

Restrictive: rapid shallow breathing where work of breathing is minimized

Obstructive: lower respiratory rate and higher tidal volumes; slow deep breathing

Question 779

Obesity related restrictive lung disease

Answer 779

Diminished chest wall expansion and micro-atelectasis

Reduction of expiratory reserve volume – maximal expiration

Results in decreased FEV1, FRC, TLC, but spared RV ​

Question 780

neutrophils in pulmonary interstitium, leaky alveolocapilary membrane, and alveolar hyaline membranes

Answer 780

Acute Respiratory Distress Syndrome

Question 781

moa of magnesium sulfate given for IV acute asthma flare up

Answer 781

inhibits Ca2+ in airway smooth muscle = bronchodilation

Question 782

tx for severe asthma exacerbation

Answer 782

Supplemental O2 + Short acting beta agonist (albuterol, terbutaline, fenoterol) + short acting muscarinic antagonist (ipatropium) + oral/IV corticosteroids; consider IV magnesium

Question 783

long term asthma tx

Answer 783

low/medium dose inhlaed corticosteroid + long acting beta agonist (albuterol) if needed

Question 784

pulmonary artery HTN caused by which mutation

Answer 784

Due to proliferative vasculopathy caused by BMPR2 mutation

increased endothelin

Question 785

pulm art htn caused by increase in

Answer 785

Endothelin is a vasoconstrictor that promotes sm proliferation

Question 786

treatment of pulmonary artery HTN

Answer 786

bosentan and ambrisentan

block endothelin rc

Question 787

pleural pain is carried by which nerve

Answer 787

phrenic nerve

Phrenic nerve innervates ipsilateral diaphragm, and sensory supply to fibrous pericardium and mediastinum and diaphragmatic pleura

Question 788

which bronchi pose the greatest resistance to air

Answer 788

Medium sized bronchi pose greatest resistance to air

Question 789

normal A-a gradient

Answer 789

4-15mmHg

Question 790

normal A-a gradient indicates?

Answer 790

efficiency of gas exchange between the alveoli and the blood is intact

Question 791

Hypoxemia with normal A-a gradient is caused by?

Answer 791

alveolar hypoventilation or low partial pressure of inspired O2 (environmental)

Question 792

viral cause of pericarditis

Answer 792

coxsackievirus B and echovirus

Question 793

ss, positive-sense RNA virus can cause acute pericarditis

Answer 793

Coxsackievirus

Question 794

bacterial cause of constrictive pericarditis

Answer 794

Tuberculosis

compliance of RV is decreased

results in JVD w/inspiration = Kussmaul sign

Question 795

Kussmaul sign

Answer 795

decreased compliance of Right Ventricle results in JVD w/inspiration

caused by constrictive pericarditis, restrictive cardiomyopathy, RV infarction, trisuspic stenosis

Question 796

Kussmaul breathing

Answer 796

hyperventilation, long deep breaths seen in respiratory compensation to metabolic acidosis

Question 797

hypersensitivity pneumonitis is?

Answer 797

hypersensitivity to inhaled antigens - often environmental allergens

**diagnosed by occupational history: exposed to birds, hay, chemicals + evidence of fibrosis on imaging + bronchoalveolar lavage w/lymphocytosis

acute: fever, flu-like sx and leukocytosis
subacute: insidious onset of cough, dyspena, fatigue over weeks to months
chronic: progressive dyspnea, weight loss, cough, and fatigue

Question 798

bronchoalveolar lavage w/hypersensitivity pneumonitis shows

Answer 798

lymphocytosis

chronic histo: poorly formed noncaseating granulomas/mononuclear cell infiltrate

Question 799

O2 delivery to neonate can cause?

Answer 799

retinal damage from neovascularization

Question 800

benign lung tumor of connective tissue (collagen and fat)

Answer 800

pulmonary hamartoma

Question 801

Most common cause of benign solitary pulmonary lesion

Answer 801

pulmonary hamartoma

Question 802

Lung Histo: cartilage lobules that calcify or undergo osseous changes and fibromyxoid tissue with clefts of ciliated epithelium

Answer 802

Pulmonary Hamartoma

Question 803

Chest pain improves when leaning forward is associated w/?

Answer 803

acute pericarditis

Question 804

which lung condition: shortness of breath that worsens when supine (standing)

Answer 804

Congestive Heart Failures

Platypnea is the sensation of dyspnea while in the upright position that improves or resolved while laying supine.

Question 805

Prone position used for ARDS has what effect?

Answer 805

reduces V/Q mismatching; increases lung compliance

Question 806

which cells are involved in pneumonia clearance?

Answer 806

Neutrophils and monocytes

(use NADPH oxidase + phagocytosis)

Question 807

muscles involved in exertional expiration

Answer 807

internal intercostals and abdominal muscles

Question 808

muscles invovled in inspiration

Answer 808

diaphragm, C3,C4,C5

Question 809

green sputum from pneumonia is due to

Answer 809

myeloperoxidase release from neutrophils – involved in phagocytic respiratory burst ​

Question 810

after bacterial infx (pneumo) or PE, inflammation causes capillary vasodilation that leads to deposition of fibrinous exudate on pleura

Answer 810

Fibronous pleuritis

Question 811

high-pitched, scratchy sound on lung auscultation

Answer 811

Fibronous pleuritis

Question 812

Increased V/Q caused by?

Answer 812

Pulmonary Embolism, CV Shock, Exercise (vasodilation of apical capillaries, also exercise recruits additional lung zones not used at rest)

decreased perfusion

Question 813

Decreased V/Q (shunt) caused by

Answer 813

decreased ventilation; caused by airway obstruction, pneumonia, atelectasis, cystic fibrosis, **pulmonary edema

Question 814

pulmonary edema was what effect on V/Q

Answer 814

decreased

Question 815

atelectasis has what effect on V/Q

Answer 815

decreased

Question 816

exercise has what effect on V/Q

Answer 816

increased - vasodilation of apical capillaries

also exercise recruits additional lung zones not used at rest

Question 817

leiomyosarcoma - malignant proliferation of smooth mucle in myometrium arise from?

Answer 817

de novo, spontaneous; not arise from leimyomas (fibroids)

usually in postmenopausal women

gross exam shoes areas of necrosis and hemorrhage

Question 818

most common type of ovarian tumor

Answer 818

surface epithelial tumors

Question 819

two types of surface epithelial tumors and where do they arrise from?

Answer 819

fallopian tubes (serous cells)

endocervix (mucinous cells)

Question 820

ovarian tumor filled with watery fluid

Answer 820

serous surface epithelial tumor

Question 821

BRCA1 increases risk of which type of ovarian cancer?

Answer 821

serous surface epithelial tumors

Question 822

· form of surface epithelial tumor that are composed of bladder-like epithelium and are usually benign

Answer 822

brenner tumor

Question 823

ovarian tumor filled with mucous

Answer 823

mucinous surface epithelial tumors

Question 824

benign surface epithelial tumors are characterized by?

Answer 824

single cyst with a simple, flat lining

premenopausal women

Question 825

characterization of malignant surface epithelial tumors

Answer 825

complex cysts with thick, shaggy ining

most common in post-menopausal women

Question 826

germ cell tumors - fetal tissue

Answer 826

fetal tissue- cystic teratoma

Question 827

cystic tumor composed of fetal tissue from 2/3 embryologic layers - skin, hair, bone, cartilage

Answer 827

cystic teratoma

form of germ cell tumor

Question 828

what is struma ovarii

Answer 828

cystic teratoma (germ cell tumor) composed primarily of thyroid tissue

Question 829

repro tumor composed of large cells with clear cytoplasm and central nuclei

Answer 829

dygerminoma from oocytes

counterpart to seminoma

Question 830

prognosis for dysgerminoma ?

serum findings?

Answer 830

malignant, but responsive to radiotherapy, good prognosis

increased LDH

Question 831

choriocarcinoma is risky because?

Answer 831

early hematogenous spread

Question 832

high B-hCG in choriocarcinoma may lead to?

Answer 832

thecal cysts in the ovary

Question 833

malignant tumor that mimics the yolk sac

most common in children

Answer 833

endodermal sinus tumor

Question 834

schiller-duval bodies seen in this repro tumor (glomerulus-like structures) seen on histo

Answer 834

endodermal sinus tumor (germ cell tumor)

Question 835

embryonal carcinoma

? appearance

? malignant

Answer 835

aggressive with early metastaiss

composed of large primitive cells

Question 836

neoplastic proliferation of granulosa and theca cells present how?

Answer 836

granuolsa-theca cell tumor

**produce estrogen

early puberty/ menorrhagia/ endometrial hyperplasia + bleeding for postmenopausal

Question 837

benign tumor of fibroblasts associated with?

Answer 837

fibroma; meig’s syndrome: + pleural effusions and ascites

Question 838

tumor w/characteristic Reinke crystals

may produce androgens in females

Answer 838

Sertoli-Leydig tumor

composed of Sertoli cells that form tubules and Leydig cells between tubules

Question 839

moa of clindamycin?

indication?

Answer 839

binds and inhibits 50s ribosomal unit

used for aspiration pneumo

covers aneorobes

Question 840

calretin stain positive for which tumor?

Answer 840

mesothelioma

Question 841

moa dextromethorphan

Answer 841

NMDA antagonist that desensitizes medullary cough center from signaling cough rc in respiratory tract

Question 842

dextromethorphan is contraindicated w/?

Answer 842

SSRI’s, has partial serotonin rc agonist and block reuptake activity

can cause serotonin syndrome

Question 843

commonest cause of superior vena cava syndrome (cervicofacial swelling and venous distension)

Answer 843

mediastinal lymphoma

Question 844

ARDS increases rx of developing?

Answer 844

interstitial lung diease – ARDS repaired by proliferation of type II pneumocytes and infiltration of fibroblasts

Question 845

associated with nasopharyngeal carcinoma

Answer 845

EBV

Question 846

pneumothorax results in which physiological change?

Answer 846

increased pulmonary shunting

Question 847

3 features of chronic bronchitis

Answer 847

increased goblet cell proliferation, mucus hypersecretion, and impaired ciliary function

Question 848

causes lung abscess after recent or current influenza virus

Answer 848

Staphylococcus aureus

gram +, catalase positive cocci

Question 849

first line for acute exacerbation of COPD or asthma

can be drug induced as well (propanolol ex)

Answer 849

albuterol , short acting beta 2 agonist

Question 850

neurovascular bundle runs ? each rib

Answer 850

below

Question 851

emergency decompression of a tension pneumo. needle thoracostomy should be placed where in adults?

children?

Answer 851

2nd intercostal space at midclavicular line

4/5th intercostal space between ant and midaxillay line

Question 852

nasolacrimal duct drians where

Answer 852

into inferior nasal meatus

blockage: congenital dacryostenosis ; persistant watering of the eyes

Question 853

chronic hypoxemia stimulates release of ?

Answer 853

EPO

increasd hemotocrit

Question 854

DNA virus - pharyngoconjunctival fever

Answer 854

adenovirus

Question 855

stages of pneumonia: day 1-2

Answer 855

congestion: alveolar lumens with serous exudate, bacteria, and rare inflammatory cells

Question 856

stages of pneumonia: day 3-4

Answer 856

red hepatization: exudate rich in fibrin, bacteria, erythrocytes, and inflammatory cells

Question 857

stages of pneumonia: day 5-7

Answer 857

gray hepatization: suppurative exudate w/neutrophils and macrophages

erythrocytes and bacteria have been mostly degraded

Question 858

stages of pneumonia: day 8 to week 4

Answer 858

enzymatic fibrinolysis

macrophages remove exudate/resorbed

Question 859

pneumonia detected by specific urine antigen testing

Answer 859

legionella

Question 860

nebulized N-acetylcysteine moa?

Answer 860

breaks disulfide bonds in mucous

Question 861

exposure to nocardia from?

actinomyces?

Answer 861

nocardia from exposure to contaminated soil

actinomyces from poor oral hygiene

Question 862

most common location of lung apsiration, while supine

Answer 862

superior segment of right lower lobe

Question 863

diethylproprion, a sympathomimetic appetite suppressant can cause?

Answer 863

pulomonary arterial HTN,

hyperplasia and hypertrophy of pulmonary vasculature

Question 864

normal bronchial epithelium composed of what type of cells?

Answer 864

pseudostratified ciliated columnar epithelium w/goblet ccells

Question 865

chronic smoking can cause what change in bronchi

Answer 865

squamous metaplasia (reversible)

Question 866

izoniazid moa

resistance?

Answer 866

effects pyridoxine metaboism

decreased production of catalse-peroxidase which converts izoniazide to its active metabolite

Question 867

in reponse to lung dmage, type ? pneumocytes ?

Answer 867

type II pneumocytes proliferate, can differentiate into type I pneumocytes

Question 868

fat emboli entering circulation after long bone fracture/surgury signs (2)

Answer 868

sudden onset petechial rash, signs of respiratory/neuro failure

Question 869

granulomatous w/polyangitis titer?

Answer 869

elevated c-ANCA

Question 870

microscopic polyangitis titer

Answer 870

p-ANCA

Question 871

granulomatosis w/polyangitis vs. microscopic polyangiitis

Answer 871

involvment of the nasopharynx is much more common in GPA

both involve lungs, kidneys, and skin (palpable purpura)

Question 872

lung changes w/exercise

Answer 872

decreased physiologic deadspace

vasodilation in apex + increased CO results in opening of apical blood vessels that were collapsed at rest

Question 873

apical V/Q vs base V/Q at rest

Answer 873

apical high V/Q= 3, more perfusion to base

at base V/Q = low

perfusion increases to a greater degree than ventilation

Question 874

azathioprine moa

Answer 874

6-thioguanine metabolites that inhibit de novo purine synthesis, disrupt DNA and RNA replication

Question 875

azathioprine needs what enzyme to function:

Answer 875

need functioning Hypoxanthine-Guanine Phosphoribosyl Transferase (HGPRT)

HGPRT converts azathioprine to active 6-MP

Question 876

rituximab moa

Answer 876

binds CD20 on B-lymphocytes, causing apoptosis

Question 877

calcineurin inhibitors inhibit which enzyme?

Answer 877

inhibit NFAT = decreased IL-2 transcription -> decreased T-cell growth and differentiation

Question 878

name of calcineurin inhibitors

Answer 878

Cyclosporin and Tacrolimus

Question 879

tacrolimus toxicity

Answer 879

nephrotoxic

Question 880

sirolimus moa

Answer 880

inhibits mTOR interrupting IL-2 signal transduction

Question 881

Anaphylaxis is characterized by?

Answer 881

widespread mast cell and basophil degranulation

clumping of IgE rc on surface of mast and basophil cells cause activation of non-rc tyrosine kinase, intracellular cascade and degranulation

Question 882

epinephrine inhibits which cell degranulation?

Answer 882

inhibits mast cell degranulation

used for emergent situations

Question 883

how does histamine cause edema?

Answer 883

causes seperation between endothelial cells

Question 884

how does alcohol protect against pathogens?

Answer 884

dissolves lipid bilayer membranes of bacteria, fungus, and enveloped viruses **ex. Influenza – causes abrupt onset of sx, requires droplet precaution

Question 885

cromolyn moa

Answer 885

prevents mast cell degranulation

Question 886

omalizumab moa

Answer 886

anti IgE antibodies

Question 887

Conjugate vaccines boost immune response via?

Answer 887

recruitment of T-cells à subsequent T-cell activation of B lymphocytes results in memory B cells

Question 888

CD? for macrophages

CD? for natural killer cells

Answer 888

NK cells = CD56

Macrophages = CD14

Question 889

which cells are activated to induce apoptosis in cells that do not express MHC class I

Answer 889

natural killer cells

Question 890

serum sickness from monoclonal antibodies and nonhuman immunoglobulins is what type of HS

Answer 890

Type III

fever, myalgia, rash occurs 1-2wks after drug exposure

Question 891

histo of serum-sickness

Answer 891

**fibrinoid necrosis and neutrophil invasion of small vessels

Question 892

Contact dermatitis and reactive skin testing (TB) are which type of HS?

Answer 892

Type IV: delayed, T-cell mediated

Question 893

what occurs during induration?

which cell predominates?

Answer 893

Induration from PPD is from dendritic cells presenting to Th1 memory cells and then Th1 releasing cytokines and attracting macrophages to site

**induration shows predominance of macrophages

Question 894

wheal and flare rxn

IgE antibodies induce basophil and mast cell degranulation

which HS?

Answer 894

type I

Question 895

graft vs host moa?

most likely which type of surg?

Answer 895

Donor T lymphocytes trigger a type IV hypersensitivity reaction in the host organs, leading to severe organ damage.

happens often with stem cell transplantation

any immune rich donor organ

Question 896

lab finding with Type III HS

Answer 896

immune complex deposition à hypocomplementemia

Question 897

Deficiency in IFN-y causes what infections?

Answer 897

intracellular infx like **mycobacterial and **salmonella

Question 898

which cells produce IFN-y

Answer 898

T-cells to activate macrophages

Question 899

INF-y binding causing

Answer 899

IFN-y binds to macrophages and trigger JAK kinase cascade to allow macrophages to eliminate intracellular pathogens

Question 900

giant granules in neutrophils

Answer 900

Chediak-Higashi

Question 901

Chediak-Higashi is caused by:

Answer 901

AR, lysosomal trafficking disorder à impaired neutrophil phagosome-lysosome fusion

Question 902

sx involved in Chediak-Higashi (3)

Answer 902

recurrent infection

oculocutaneous albinism - impaired mvmt of melanin

nystagmus + impaired development of optic structures - def of melanin

giant granules in neutrophils

Question 903

bullet-shaped lesions, cytotoxic T-cell response to phagocytosed bacteria brought to skin

what type of HS?

Answer 903

erythema multiforme

Type IV HS rxn

Question 904

erythema multiforme occurs post?

Answer 904

Mycoplasma pneumo or Herpes Simplex

Question 905

neutrophil migration steps (5)

Answer 905

**MRATT

margination, rolling, activation, tight binding, transmigration

Question 906

neutophil margination involves:

Answer 906

endothelial damage exposes more endothelium for contact

Question 907

rolling involves

Answer 907

loose binding of sialylated carbs – L-selectin or E/P-selectin **selectins

Question 908

neutrophil activation involves

Answer 908

slow rolling allows cytokines to bind and activate neutrophil

Question 909

neutrophil tight binding:

Answer 909

CD18 B2 integrins and **intracellular adhesion molecules (ICAM-1)

Question 910

neutrophil transmigration involves:

Platelet endothelial cell adhesion molecule 1 — pulls neutrophil through vasculature

Question 911

MHC I consists of 2 items?

Answer 911

single heavy chain and B2-microglobulin - binds CD8

Question 912

MHC II consist of ? and bind to ?

Answer 912

alpha and beta polypeptide bind to CD4+ T helper

Question 913

MHC I exists where?

Answer 913

in endoplasmic reticulum

Question 914

? brings pathogen-derived proteins to the ER where MHC I exist

Transporter associated with antigen processing

Answer 914

TAP proteins

Question 915

costimulatory T-cell CD28 rc binds to?

Answer 915

CD80/86 on Dendritic Cells

Question 916

? on T-cells is important for binding to B-cells and initiating class switching

Answer 916

CD40L

Question 917

what causes Hyper-IgM syndrome?

Answer 917

T-cells lack CD40L -> necessary to activate B-cell secondary germinal centers, no secondary B-cell germinal centers, nonpalpable lymph nodes

Question 918

IL - ? important for class-switching to IgE

Answer 918

IL-4

activates more Th2 T-cells and induces B cell proliferation and class switching to IgE

Question 919

IL-? recruits more eosinophils

Question 920

IgA deficiency results in which infx?

Answer 920

Giardia

Giardia causes injury to duodenal and jejunal mucosa, secretory IgA impairs adherence

Question 921

moa of glucocorticoids

promote?

Answer 921

inhibit transcription of proinflammatory mediators and promote **apoptosis of eosinophils, T cells, monocytes

Question 922

glucorticoids have what effect on neutrophils?

IL-10?

NF-kB?

Answer 922

***Increased neutrophils but ** due to impaired migration ; this is due to neutrophils demarginating from previously attached vessel walls

Increased production of anti-inflammatory cytokines (IL-10)

Bind cytosolic rc, migrate to nucleus, **inhibit NF-kB transcription factor

Question 923

catalase positive, coag negative staph differentiated by:

Answer 923

novobiocine

Question 924

which staph is novobiocin sensitive?

resistant?

Answer 924

S. epidermidis: prosthetic valve endocarditis, catheter infx, prosthetic joint septic arthritis – SENSITIVE (prosthetics, means they are sensitive)

S. saprophyticus: UTI in sexually active women – Novobiocin RESITANT

Question 925

UTI in sexually active women – Novobiocin RESITANT

Answer 925

Staph. saprophyticus

Question 926

genetic mutations that result in the defective development of functional B cells and T cells is called?

Answer 926

SCID

Question 927

3 mutations involved in SCID?

Answer 927

X-linked recessive: mutations in the gene encoding the common gamma chain → defective IL-2R gamma chain receptor linked to JAK3 (most common SCID mutation)

AR: Adenosine deaminase (ADA) deficiency = toxic builduip of adenosine, toxic to mitotically active cells (lymphocytes)

RAG mutation results in faulty VDJ recombination

Question 928

anatomic feature of SCID?

Answer 928

Lymph nodes and tonsils may be absent; as well as absent thymus

Question 929

migratory arthralgias, pancytopenia, glomerulonephritis

Answer 929

SLE

Question 930

cause of pancytopenia in SLE

Answer 930

Type II HS- IgG against erythrocytes

Question 931

antibodies in SLE

Answer 931

ANA, **anti-dsDNA, anti-SMITH

Question 932

immune lab findings in SLE

Answer 932

Low complements (low c3 and c4)

Also see lymphocytopenia – low lymphocyte levels during active disease

Question 933

most common nephritic pattern for SLE

Answer 933

diffuse proliferative is most common pattern

Type III HS—immune complex deposition in mesangium, subendothelial, subepithelial spaces

Question 934

thrombocytopenia in SLE commonly due to

Answer 934

immune thrombocytopenic purpura (ITP)-autoantibody-mediated destruction of circulating platelets

Question 935

lab findings with immune thrombocytopenic purpura

Answer 935

Diagnosis of exclusion, Hgb and Leukocytes normal, only low platelets

See megakaryocyte hyperplasia as compensation

Question 936

Alternative complement pathway is?

Answer 936

C3 is autoactivated by interacting with surface of bacteria

Question 937

role of C3a and C5a

Answer 937

recruit immune cells

Question 938

role of C3b

Answer 938

opsonin that binds to complement rc 1 on erythrocytes and phagocytes

Question 939

uptake of naked DNA or viral DNA, typically causes NO genomic change in progeny

Answer 939

Transformation

Question 940

X-linked agammaglobulinemia is ?

caused by?

Answer 940

impaired B-cell maturation and Ig production

Bruton Tyrosine kinase mutation ​

Question 941

X-linked ammaglobulinemia

start?

which infx?

anatomy?

Answer 941

1. Symptoms develop between 3 and 6 months of age when maternal IgG levels in fetal serum start to decrease
2. Hypoplasia of lymphoid tissue (e.g., tonsils, lymph nodes)
3. Recurrent, severe, pyogenic infections (e.g., pneumonia, otitis media), especially with encapsulated bacteria (S. pneumoniae, N. meningitidis, and H. influenzae)

Hepatitis virus and enterovirus (e.g., Coxsackie virus) infections

Chronic **Enteroviral infection

Enterovirus causes herpangina, hand-foot-mouth disease, aseptic meng

Recurrent sinopulmonary infx by encapsulated bac which require Ab opsonization

Question 942

anthrax toxin causing bacillary anthracis consists of 3?

Answer 942

Edema toxin, Lethal factor, Protective antigen

Question 943

moa edema and pertussis toxin

Answer 943

increase cAMP –> causes edema and phagocyte dysfunction

Question 944

some tumors overexpress ? that binds to cytotoxic T-cells and prevent apoptosis

Answer 944

PD-1

programmed death rc

Question 945

new generation antihistamines

Answer 945

loratadine and cetirizine

do not have as much antimuscarinic, serotonergic, cholinergic

Question 946

triad: ****eczema, recurrent infx, purpura *thrombocytopenia—platelets are abnormally shaped and deficient

Answer 946

Wiskott-Aldrich

Question 947

mutation in Wiskot Aldrich

inheritance?

Answer 947

mutated WASp gene (X-linked recessive inheritance) → impaired signaling to actin cytoskeleton reorganization → defective antigen presentation

Question 948

Fas rc are located

Answer 948

on T-lymphocytes

Question 949

activation of Fas rc on T-cells

Answer 949

leads to T lymphocyte producing Fas ligand which binds to Fas on same cell or adjacent lymphocytes and initiates apoptosis

Question 950

mutation in Fas rc causes

Answer 950

accumulation of autoreactive T-cells

Question 951

benefit of live attenuated poliovirus vs inactivated

Answer 951

produces stronger mucosal secretory IgA immune response compared to inactivated – from exposure of antigen to B cells in mesenteric lymph nodes and Peyer’s patches ​

Question 952

leukotriene B4

Answer 952

major attractant of neutrophils

stimulates neutrophil migration

Question 953

positive T-cell selection occurs where?

Answer 953

cortex of thymus

Question 954

negative selection occurs where?

Answer 954

medulla of thymus

Question 955

Sjogren’s chronic B-cell proliferation increases risk of

Answer 955

non-Hodgkin lymphoma

Question 956

viral causes of myocarditis

Answer 956

Coxsackie B, parvovirus B19, HHV-6, HIV, adenovirus

Question 957

murmur of PDA

Answer 957

continuous machinery murmur best heard at left upper sternal border/infraclavicular area

Question 958

moa of verapamil and diltiazem

Answer 958

prolongation of AV node repolarization

decreases SA/AV node automaticity

non-dihydropyrmidine Ca+ blockers

**used for afib

Question 959

side effect of non-dihydropyridine ca 2+ blockers

Answer 959

gingival hyperplasia

Question 960

? are responsible for breaking down fibrous cap of atheroma and causing occlusion

Answer 960

matrix metalloproteinases

Question 961

What is it? (in cardiac myocyte)

Answer 961

lipofuscin granules – formed by oxidation of phospholipid molecules

found in heart, liver, kidneys

Question 962

inhaled nitrous oxide can cause

Answer 962

oxidization of Fe2+ to Fe3+, methologlobin formation

Question 963

beck triad: hypotension, distended neck veins, muffled heart sounds

Answer 963

= cardiac tamponade

Question 964

strongest predisposing rx factor for aortic dissection

Answer 964

hypertension

Question 965

sterile vegetations (easily removed) on heart are often caused by

Answer 965

adenocarcinomas excreting procaogulant factors

or autoimmune conditions like RA, SLE

Question 966

thromboxane A2 promotes?

how is aspirin involved?

Answer 966

platelet aggregation, vasoconstriction, activation of new platelets

Question 967

fatty streaks appear how grossly?

Answer 967

flat-yellow-white discoloration with irregular border on luminal surface

Question 968

sotolol moa

Answer 968

blocks B1 rc (also B2, B3) slowing AV node conduction

and blocks cardiac potassium channels (increased myocyte action potential duration, due to delayed repolarization caused by decreased K+ efflux), increased effective refractory period

Question 969

chronic suprventricular tachycardia can cause what heart change?

Answer 969

dilated cardiomyopathy

increased end systolic voluem increased wall stress, eccentric hypertrophy

Question 970

carvedilol moa + risk

Answer 970

nonselective beta blocker with additional a-blocking action

rx of hypotension

Question 971

pulsus paradoxus

Answer 971

pathalogic decreased in systolic BP during inhalation

Question 972

what diseases cause pulsus paradoxus

Answer 972

constrictive cardiac disease: cardiac tamponade, constrictive pericarditis, tension pneumothorax

or severe obstructive lung disease: COPD/asthma

**increase RV preload results in bulging into LV, decreasing LV filling

Question 973

Takayasu arteritis histo

Answer 973

granulomatous infalmmation of the arterial wall affecting larger arteries like aorta and its branches

common in women of Asian ancestry

**fever, malaise, arthraliga + decreased brachial and radial pulses

+ raynaud phenomenom, carotid bruit, erythema nodosum

Question 974

Fick principle/equation

Answer 974

CO = rate of O2 consumption / (arterial O2 content - venous O2 content)

Question 975

moa of amiodarone and added benefit

Answer 975

blocks outward potassium channels during myoctye repolarization

in addition blocks sodium and calcium channels

**no delay in conduction velocity, thus it carries lower risk of arrythmia and torsades de pointes than other drugs of the same class

Question 976

rheumatic fever can occur after what illness?

what type of HS?

Answer 976

after group A streptococcus infection

type II HS rxn induced by molecular mimicry to cardiac myosin proteins

Question 977

cardiac feature that is most vulnerable to rapid deceleration injury/ chest smashes against steering wheel/seatbelt

Answer 977

aortic isthmus

final section of aortic arch distal to origin of left subclavian art

Question 978

triphasic scratchy/squeaky heart sound on auscultation suggests?

Answer 978

pericardial friction rub –> pericarditis

Question 979

positive selection involves differentiation into

Answer 979

binding of MHC I or MCH II – determines whether CD4 or CD8

if doesnt bind MHC - fails to recognize, apoptosis

Question 980

negative selection

Answer 980

developing cells are presented peptides bound to MHC molecules

bind too strongly = apoptosis

AIRE induces expression of many proteins that are not typically expressed in thymic cells

Question 981

changes in immune system w/aging

Answer 981

decreased naïve B and T, phagocytosis, cytokines, and antigen-presenting capability

levels of memory B and T cell from prior infx remain

Question 982

4 features of acute rheumatic fever after strep pyogenes

Answer 982

arthritis, pancarditis (MR), and Sydenham Chorea ***restless and purposeless jerking movements, mitral stenosis

Question 983

Myeloperoxidase deficiency

Answer 983

inability to produce **hydroxy-halide radicals

inability to produce hypochlorous acid within phagolysosomes

**preserved respiratory burst – NADPH oxidase is intact

Question 984

MPO deficiency presents as

Answer 984

recurrent Candida infx (oral thrus, vulvovaginitis)

Question 985

MPO deficiency has which staining?

Answer 985

positive nitroblue tetrazolium: intact NADPH oxidase

absent myeloperoxidase staining

Question 986

Chronic granulomatous disease which deficiency?

Answer 986

NADPH oxidase deficiency = abnormal nitroblue tetrazolium reduction test

Question 987

NADPH oxidase deficiency presents as

Answer 987

impaired killing of ***catalase-positive organisms: Staph aureus, Aspergillus, Burkholderia, Nocardia, Serratia –recurrent pneumo

Question 988

Delayed detachment of umbilical cord, recurrent infx, impaired wound healing

Answer 988

Leukocyte adhesion deficiency

Question 989

cause of Leukocyte adhesion deficiency

Answer 989

**lack of CD18 due to B2 integrin def ​

Question 990

no chemotactic response to formyl-MetLeuPhe is characteristic of what disease?

Answer 990

Leukocyte adhesion deficiency

Question 991

? and ? promote increase in cellular adhesions in endothelial cells– to attract leukocytes ​

Answer 991

IL-1 and TNF-a

Question 992

NFkb is normally bound by

Answer 992

Ikb inhibitory protein

Question 993

how is NFkB activated

Answer 993

bacteria attached to-toll like rc activate Ikb kinase –> ubiquitinates and degrades Ikb, releasing/activating NfKb

Question 994

asian female under 40

granulomatous thickening of the aortic arch

Answer 994

takayasu arteritis

Question 995

claudication w/ absent peripheral pulses and cold extremities –>leads to ulcerations + migratory thrombophlebitis + Raynauds

Answer 995

Thromboangiitis obliterans

Question 996

what is the patient profile for Thromboangiitis obliterans?

Answer 996

male smoker

Question 997

necrotizing granulomatous vasculitis with eosinophilia

+ hx of recurrant ashtma attacks

Answer 997

Eosinophilic granulomatosis with polyangiitis (Churg-Strauss syndrome)

+ purpura, nephritis, carditis

Question 998

recurrent Neisseria infx

Answer 998

C5-C9 deficiency, no membrane attack complex

Question 999

tx for chemotherapy induced neutropenia

Answer 999

GM-CSF: analog is filgastrim

Question 1000

what is Ranibizumab?

use?

Answer 1000

VEGF blocker

used for wet age-related macular degeneration which is caused by new friable blood vessels in the choriocapillaries, prone to bleeding

Question 1001

ionizing radiation has what effect?

Answer 1001

produces DNA ds breaks and generates reactive oxygen species

Ionization of water creates ROS that further cause cellular and DNA damage ​

Question 1002

antibodies in granulomatosis w/polyangiitis:

Answer 1002

anti-proteinase 3 Abs

Question 1003

how does granulomatosis w/polyangiitis present:

Answer 1003

begins with constitutional sx (arthralgia, fatigue, low-fever)

+

Nasopharyngeal unique **Upper resp: otitis/sinusitis

Lower: pulmonary infiltrates

Renal: RPGN

Question 1004

transmural inflammation with fibrinoid necrosis of medium-sized arteries arteries & leukocytic infiltration

negative p-ANCA

Answer 1004

polyarteritis nodosa

Question 1005

vasculitis w/aneurysms and renal artery stenosis spares?

Answer 1005

polyarteritis nodosa; spares pulmonary arteries/lungs

Question 1006

vasculitis associated w/Hep B and Hep C

Answer 1006

polyarteritis nodosa

Question 1007

prolonged high fever, not responsive to antipyretics

presents as conjunctivits, mucositis (strawberry tongue), rash, extremity redness in children

Answer 1007

Kawasaki disease

vasculitis of medium sized vessels

Question 1008

cause of death w/Kawasaki

Answer 1008

sudden death from coronary artery aneurysms

Question 1009

immune dysregulation, Poly endocrinopathy, enteropathy, X-linked syndrome

Poly endocrinopathy: type 1 DM, autoimmune thyroid dsease

Answer 1009

IPEX syndrome

Question 1010

mutation associated w/IPEX syndrome

Answer 1010

FOXP3 mutation – required for normal development of regulatory T cells

Question 1011

autoimmune disorder, collagen deposition and fibrosis; multiple organ systems damaged

+ cardiac, pulmonary, esophageal fibrosis

Answer 1011

systemic sclerosis

Question 1012

diffuse systemic sclerosis antibodies

Answer 1012

Anti-Scl-70 (anti-topoisomerase I antibody)

Anti-RNA polymerase III

Question 1013

tuberous sclerosis what inheritance?

which genes?

Answer 1013

AD condition

tumor supressors hamartin and tuberin

Question 1014

hamartomas are?

Answer 1014

benign overgrowth of disorganized tissue

Question 1015

first presenting signs of Tuberous Sclerosis

Answer 1015

**seizures and developmental delay and **infantine spasms are first presenting signs and ***ash leaf spots ​

Question 1016

growths seen in tuberous sclerosis

Answer 1016

Cortical glioneuronal hamartomas and subependymal nodules—often calcified

Bilateral renal angiomyolipomas: benign tumor of blood vessels, smooth muscles, and fat

Subependymal hamartomas in brain

Cardiac rhabdomyomas, facial angiofibroma, leaf-shaped patches

Question 1017

what is CTLA4?

Answer 1017

immune checkpoint protein rc – binds to B7 on Antigen Presenting Cell (normally binds to CD28 on T cells), suppresses T-cell function

Question 1018

CTLA4 competes w/

Answer 1018

CD28 which activates T-cells

Question 1019

ipilimumab moa

Answer 1019

CTLA4 blocker, upregulated in cancers to cause T-cell suppression

Question 1020

most acute hemolytic transfusion tx -5min: dyspnea, chills, fever, tachycardia

due to?

Answer 1020

ABO incompatibility transfusion rxn

due to preformed IgM antibodies

Question 1021

delayed hemolytic transfuions - mild fever and jaundice

several days or weeks after infusion due to?

Answer 1021

Anti-RH IgG

Question 1022

germ cell tumor of oocytes

Answer 1022

dysgerminoma

Question 1023

germ cell tumor of yolk sac

Answer 1023

endodermal sinus tumor

Question 1024

germ cell tumor of placental tissue

Answer 1024

choriocarcinoma

Question 1025

tanner stages (age)

Answer 1025

1: <8
2: 8-11.5
3: 11.5-13
4: 13-15
5. 15 onward

Question 1026

aromatase is expressed in which cells of the ovary

Answer 1026

granulosa cells

converts androgens into estrogen

Question 1027

aromatase in ovaries is controlled by which horomone

Answer 1027

FSH

Question 1028

three arteries in spermatic cord:

Answer 1028

testicular artery (branch of aorta), cremasteric artery, artery of ductus deferens

Question 1029

Carbamazepine can result in maternal ? deficiency

Answer 1029

folate

can result in neural tube defects

Question 1030

Vertebral, anal, cardiac, tracheoesophageal fistula, renal, and limb abnormalities

VACTERL due to?

Answer 1030

defect during the development of embryonic mesoderm

Question 1031

most common cause of abnormal α-fetoprotein (AFP) levels

Answer 1031

Incorrect estimation of the gestational age

Question 1032

ruptured ovarian cyst would drian into

Answer 1032

rectouterine pouch (pouch of douglas)

lowest point of the peritoneal cavity and therefore a common site of fluid collection (e.g., blood, serous fluid) in supine patients

Question 1033

hydrocele in adult male

vs. cause of hydrocele in young child

Answer 1033

adult: Imbalance of fluid secretion and resorption by tunica vaginalis
child: Failure of processus vaginalis to obliterate

Question 1034

Nonhormonal intrauterine devices (IUDs) release copper into the uterine cavity, which induces?

Answer 1034

sterile inflammation of the endometrium

local inflammatory reaction has spermicidal effects and prevents fertilization.

use for hx of venous thrombosis or smoker

Question 1035

MTX is a folate antimetabolite that competitively inhibits ?

Answer 1035

dihydrofolate reductase

Question 1036

chlymidia conjucitivitis vs. gonorrheal conjunctivitis in neonate

Answer 1036

chlamydial is watery, has longer onset

gonorrheal has discharge and quicker onset

Question 1037

VDRL tests for ? and indicates ?

need what to confirm

Answer 1037

tests for nonspecific anticardiolipin antibodies

VDRL tests for syphilis

confirmatory test: Fluorescent treponemal antibody absorption test (FTA-ABS)

Question 1038

herniation of the posterior vaginal wall + protrusion of the rectum into the vaginal canal (rectocele) is caused by:

Answer 1038

Rectovaginal fascia

Question 1039

benign ovarian cysts often occur bilaterally, have thin walls and clear content, and usually resolve spontaneously within 2–4 months

Answer 1039

Theca lutein cysts

Question 1040

Theca lutein cysts arise from

Answer 1040

increased gonadotropins, most likely B-hCG

common finding in complete moles, multiple pregnancies, infertility treatment with gonadotropins, or PCOS.

Question 1041

tx for HTN and BPH

moa

Answer 1041

Terazosin

a-1 adrenergic rc antagonist

decrease bladder outlset obstruction and decreases vasoconstriction

Question 1042

quad screen includes which four

Answer 1042

HCG, AFP, Estriol, and Inhibitn

Question 1043

quad screen for Trisomy 21

Answer 1043

HCG: high

AFP: low

Estriol: low

Inhibin A: high

Question 1044

Trisomy 18 quad screen

Answer 1044

HCG: low

AFP: very low

Estriol: very low

Inhibin A: normal or low

Question 1045

quad screen neural tube defects and abdmoninal wall defects

Answer 1045

HCG: normal

AFP: increased

Estriol: normal

Inhibin A: normal

Question 1046

what is Pregnancy Associated Protein-A (PAPP-A)?

Answer 1046

used in first trimester screen for Trisomy

decreased in Trisomy 21, 18, 13

Question 1047

amniotic band syndrome is an example of

Answer 1047

disruptions

autoampuation of right lower arm due to a constriction ring

Question 1048

PCOS LH: FSH ratio?

Sex Hormone-binding globulin concentration?

Answer 1048

high LH:FSH ratio

low SHBG: hyperinsulinemia inhibits production in liver, and increase in androgens suppress synthesis

Question 1049

oligomenhorrhea combined w/low progesterone levels

Answer 1049

anovulatory cycles

common in adolescent girls in few few months/year of menarche

caused by immaturity of HPA axis

Question 1050

timing of first trimester screen vs quad screen test

Answer 1050

first: 1-13wks
quad: 15-22wks

Question 1051

diagnostic test for suspected Down syndrome in first-trimester screening

Answer 1051

chorionic villus sampling

shows additional chromosome in placental tissue

Question 1052

moa of glucose entering beta cells

Answer 1052

glucose enters cell–> glucokinase initiates glycolysis, produces ATP –> ATP closes ATP-gated K+ channels leading membrane depolarization –> vg Ca+ open –> release of insulin via exocytosis

Question 1053

most commonly injured structure in men w/straddle injuries or direct trauma to groin (urethral injury)

Answer 1053

bulbous urethra

Question 1054

defect in which enzyme results in oculocutaneous albinimism

Answer 1054

tyrosinase

oxidates DOPA (dihydroxyphenylalanine) to

Question 1055

raloxifene moa?

increased rx?

Answer 1055

estrogen rc agonist in bone, breast, and endometrium

increased rx of thromboembolic evens

Question 1056

tamoxifen moa

increased rx?

Answer 1056

competitive estrogen antagonist at breast

agonist for bone, endometrium, and myometrium

increases rx of endometrial cancer, uterine sarcoma, and thromboembolic events

Question 1057

Multiple, painless, indurated genital ulcers with a vascular beefy-red base and elevated margins

Answer 1057

klebseilla granulomatis

Granuloma inguinale

Question 1058

Call-Exner body: ? arranged in clusters surrounding a central cavity with eosinophilic secretions, resembling primordial follicles

what tumor?

Answer 1058

granulosa cell tumor

produces estradiol

Question 1059

indirect inguinal hernia that can manifest with a communicating hydrocele caused by?

Answer 1059

Failure of processus vaginalis to close

Question 1060

Weakening of the transversalis fascia can lead to a ?

Answer 1060

direct inguinal hernia

Question 1061

dopamine 1 rc effect on renal

Answer 1061

renal arteriolar vasodilation

Question 1062

muation leading to polycystic kidney disease

Answer 1062

PDK1 mutation on short arm of chromosome 16

genetic mutation in polycystin

Question 1063

renal cell carcinoma arises from which type of cell

Answer 1063

epithelium of proximal renal tubules

Question 1064

rx factors for RCC

Answer 1064

smoking important rx factor, also toxin exposure, obesity, and HTN, and **VHL

Question 1065

renal cell carcinoma histo often looks like

Answer 1065

Clear cells with lots of glycogen and lipids

Question 1066

triad: hematuria, flank pain, palpable mass

Answer 1066

renal cell carcinoma

Question 1067

paraneoplastic syndromes of renal cell carcinoma

Answer 1067

EPO, renin, PTHrP, or ACTH

Question 1068

mets of renal cell carcinoma to?

Answer 1068

mets to lung and also bone (osteolytic)

Question 1069

how does VHL lead to renal cell carcinoma

Answer 1069

VHL is a tumor suppresor, loss results in increased IGF-1 and increased HIF transrciption factor which increases VEGF and PDGF

Question 1070

hereditary vs. sporadic renal cell carcinoma

Answer 1070

hereditary: male ~60yrs; single tumor in upper kidney associated w/ ***SMOKING

Sporadic: AD VHL, younger adults + **BILATERAL

Question 1071

renal cell carcinoma left vs right drainage?

Answer 1071

left renal vein blocks drainage of left spermatic vein = varicocele

right renal vien drains directly to IVC - can obstruct IVC

Question 1072

uretal obstruction effect on GFR?

Answer 1072

decreased GFR (increased hydrostatic pressure in Bowman’s space, opposing output from glomeruli)

Question 1073

carbamazepine side effect?

Answer 1073

SIADH

Question 1074

Acid buffers in Urine?

Answer 1074

HPO4-2, and NH3 (ammonia)

Question 1075

in acidic states, more ? in urine and ?

Answer 1075

H2PO4-

ammonium NH4+

Question 1076

Kidneys metabolize ? to produce ? for buffer

Answer 1076

Kidneys metabolize ***Glutamine to produce **Ammonia for buffer

Question 1077

hexagonal, flat

cause?

Answer 1077

Cystine kidney stones – caused by impaired intestinal absorption of cysteine and other AAs

Question 1078

diamond/rhombus in urine?

Answer 1078

uric acid stones

most commonly seen in patients with gout

hyperuricemia also in leukemia and myeloproliferative disorders

tx with allopurinol in patients with gout

Question 1079

most common type of kidney stone

Answer 1079

calcium oxalate/calcium phosphate

most common cause is idiopathic hyercalciuria

*seen in Crohn disease

Question 1080

urine finding in kidney stone

Answer 1080

gross hematuria

Question 1081

tx for calcium oxalate stone

Answer 1081

thiazide diuretic

(calcium-sparing diuretic)

can also be potassium citrate: combines calcium in tubular lumen to form soluble complex

Question 1082

“dumbell-shaped” stones

Answer 1082

calcium oxalate

Question 1083

coffin lid stones ?

Answer 1083

Struvite: *mg, ammonium, phosphorus

Question 1084

which organisms cause struvite stones?

Answer 1084

urease-positive organisms

Proteius vulgaris or Klebsilla

alkaline urine leads to formation of stone

Question 1085

common sites for kidney stones (3)

Answer 1085

1. Ureter pelvic jct 2. uterovesical jct 3. pelvic inlet when ureter crosses the external iliac vessels

Question 1086

tx for nephrogenic diabetes: not responsive to ADH, vasopressin

Answer 1086

THIAZIDE: causes volume depletion that paradoxically causes Na and water reabsorption in PCT

*Also can give Indomethacin – inhibit synthesis of renal prostaglandins, which inhibit effect of ADH in collecting ducts

Question 1087

chlorthalidone and hydrochlorothiazide

moa?

Answer 1087

thiazides that blocks Na/Cl- co transporter in DCT

loss of volume activates RAAS –> aldosterone causes K+ and H+ loss =

hypokalemia = muscle weakness, cramps, rhabdo

Question 1088

thiazide effect on calcium?

Answer 1088

Thiazides also increase Ca2+ reabsorption (decreased stone rx)

Decreased Na+ in DCT activate basolateral Na/Ca antiporter, Na into cell, Ca out to serum/circulation

Question 1089

Deposition of IgA in small vessels – follows upper resp infx

Palpable purpura, arthralgia, GI bleed/intussusception

Question 1090

Type 3 HS; autoantibodies to IgA immunoglobulin forms **immune complexes that deposit

Answer 1090

IgA nephropathy

nephritic syndrome

Question 1091

side effect of loop diuretics

Answer 1091

OTOTOXIC – vertigo, tinnitus; loops put you in a loop

Question 1092

side effect of spirinolactone

Answer 1092

causes gynecomastia, impotence and decreased libido – androgen rc blocker

Question 1093

3 signs of rhabdomyolysis

Answer 1093

Myoglobinuria – dark urine – released from damaged muscle cells

Elevated creatine kinase

AKI – heme pigment release causes acute tubular necrosis – **ATN = granular MUDDY BROWN CASTS

skeletal muscle necrosis – caused by trauma, sepsis, drugs, overexertion

Question 1094

most dilute segment of nephron in low ADH settings

high ADH (dehydrated states)

Answer 1094

collecting duct in low ADH settings; no reabsorption of water, lots of water remains in tubules

DCT in high ADH, dehydrated states

Question 1095

1 risk factor for transitional cell type carcinoma of the bladder

Answer 1095

smoking

Question 1096

rx factors for transitional cell type carcinoma of the bladder

Answer 1096

cyclophosphamide, benzidine, anililine dyes

**smoking

Question 1097

Pleomorphic modified smooth muscle cells in the renal cortex

Answer 1097

juxtaglomerular tumor

Increased renin and aldosterone, frequent headaches

Question 1098

cause of renal artery stenosis in younger pts vs older

Answer 1098

caused by fibromuscular dysplasia in younger pts, atherosclerosis in older pts

Question 1099

kidneys, ureters, vessels, bone, muscles and cartilage from which embryo layer

Answer 1099

mesoderm

Question 1100

intracellular shift of potassium can be caused by?

moa?

Answer 1100

Glycogenesis during total parenteral nutrition or enteral hyperalimentation (stimulating insulin release)

Beta-adrenergic activity (also increases Na/K ATPase)

Insulin**

moa:

promotes the entry of K+ into skeletal muscles and hepatic cells by increasing the activity of the Na+-K+-ATPase pump

Question 1101

Type 1 or 4 Renal Tubular Acidosis:

Answer 1101

impaired secretion of H+; builds up in cells and enters bloodstream

Question 1102

Type 2 Renal Tubular Acidosis

Answer 1102

impaired PCT reabsorb of bicarb; leading to loss of bicarb

Question 1103

spike and domes, silver stain

Answer 1103

membranous glomerulopathy

Thickening of glomerular capillary loops and basal membrane

Question 1104

90% of tumors in renal pelvis and ureter are which type?

Answer 1104

urothelial carcinomas

Large pleomorphic urothelial cells w/ severe nuclear atypia

Question 1105

most liable renal portion to damage from hypoperfusion

Answer 1105

Straight portion of PCT and Thick Ascending Limb in the medulla

Question 1106

progressive sensorineural hearing loss (loss of organ of Corti) and hematuria – nephritis

Answer 1106

Alport Syndrome: X-linked defect in type IV collagen

Question 1107

where are bilateral uretral orifice openings

Answer 1107

base of trigone

Question 1108

Tubular fluid: plasma ratio >1 means?

Answer 1108

solute is secreted

Question 1109

proximal ureter supplied by?

distal ureter supplied by?

Answer 1109

Proximal ureter supplied by renal artery; distal ureter supplied by superior vesicular artery; middle is variable and involves anastomosis

Question 1110

what do hyaline casts mean?

Answer 1110

Composed of Tamm-Horsfall mucoproteins, which are secreted by renal tubular cells in order to prevent urinary tract infections

Nonspecific finding in chronic renal disease or diuretic therapy

Can be found in healthy individuals (e.g., in dehydration and/or after strenuous physical exercise)

Question 1111

eRPF

estimated renal plasma flow

Answer 1111

= Upah x V / Plasma pah

Question 1112

eGFR

Answer 1112

FF/eRPF

Question 1113

muddy-brown casts mean

Answer 1113

acute tubular necrosis

Question 1114

contrast-induced nepthropathy due to

Answer 1114

to direct cytotoxicity of IV contrast on tubular cells à necrosis of PCT, muddy brown casts

acute rise in Cr and BUN 24-48 hr after contrast administration

Question 1115

lab finding in pyelonephritis

Answer 1115

WBC casts – casts made in renal tubules

Can be caused by gram neg E.coli or gram + Enterococcus faecalis

Question 1116

renal plasma flow RPF =

Answer 1116

Renal Blood Flow * (1-hemotocrit)

RBF = 20% of CO

Question 1117

renal infarction grossly appears

Answer 1117

white + yellow on borders; often due to embolism

Question 1118

how does renal infarction present

Answer 1118

Presents with flank pain, low-grade fever, and HTN – hypoxic renal cells release renin

Question 1119

Bethanechol

Answer 1119

cholinergic agonist helps with bladder voiding—release of urine from bladder

Question 1120

Patiromer

Answer 1120

tx for hyperkalemia (CKD), binds colonic K+ in exchange for Ca2+

Question 1121

Acute Tubular Necrosis results in death of

Answer 1121

PCT cells

Question 1122

In the recovery months to acute tubular necrosis, what can occur

Answer 1122

impairment of renal function, wasting of electrolytes: K+, Mg, Phosphorus, Ca2+

Question 1123

renal changes in pregnancy

Answer 1123

increase in RAAS + decrease in SVR = increase in volume à increased RPF, and thus increased GFR (lower Cr)

Question 1124

angiotensin II causes what change in renal tubules

Answer 1124

increased reabsorption of Na+ in PCT

Question 1125

nephrotic syndrome has what effect on liver

Answer 1125

loss of protein à loss of oncotic pressure à stimulates liver to produce more lipoproteins and lipids, results in hyperlipidemia

Question 1126

euvolemic hyponatremia occurs in

Answer 1126

SIADH

“euvolemic” = normal blood volume

Increased in blood volume causes secretion of ANP and BNP –> decreases aldosterone, resulting in loss of Sodium

increased BNP results in natriuresis: high urine sodium

Question 1127

renal changes with aging

Answer 1127

Normal aging: reduced renal mass and functional glomeruli (50% reduction), lower RBF, reduced hormonal responsiveness

Question 1128

leaden paralysis is a common feature of

Answer 1128

atypical depression

arms and legs feel heavy

Question 1129

timeframe for Persistent complex bereavement disorder

(complex grief)

Answer 1129

adult >12 months

adolescents > 6mo

includes suicide, hallucination

Question 1130

mirtazapine

side effect

Answer 1130

atypical antidepressant, 2nd line, moa =

Selective α2-adrenergic antagonist → ↑ serotonin and norepinephrine release

5-HT2 and 5-HT3 receptor antagonists → ↑ effect of serotonin on free 5-HT1 receptor is the likely cause of antidepressant action

side effect is **weight gain, increase in appetite

Question 1131

methylphenidate

Answer 1131

1st line ADHH

sympathomimetic, increased NE and dopamine

Question 1132

GFR is estimated by clearance of (2)

RPF?

Answer 1132

inulin and creatine

RPF = clearance of PAH

Question 1133

ADH causes what change in medulla

Answer 1133

causes urea reabsorption in medullary collecting ducts –> makes surrounding medullary concentration gradient higher to draw in more water

Question 1134

PTH causes which change in phoshpate

Answer 1134

kidney to decrease phosphorus absorption = increased urinary phosphate

hyperPTH = serum hypophosphatemia

Question 1135

Refeeding syndrome causes which electrolyte change

Answer 1135

introduction of carbs causes insulin release –>

increased displacement of magnesium, potassium, and phosphate (shift from extracellular to intracellular) → ↓ phosphate, ↓ potassium, ↓ magnesium (serum levels)

sx: Edema, Tachycardia (torsades de pointes), Seizures, Ataxia, Rhabdomyolysis

Question 1136

marker for diabetic nephropathy

Answer 1136

urine albumin

Question 1137

lisinopril effects on kidney

Answer 1137

can cause hyperkalemia

decrease in GFR (dilation of efferent arteriole, and decreased SVR)

Question 1138

EPO is produced where in the kidneys

Answer 1138

produced by peritubular fibroblasts in kidney in response to hypoxia

Question 1139

lithium effect on renal system

Answer 1139

antagonizes ADH rc, results in nephrogenic diabetes insipidus

Question 1140

which drugs counteract the effects of Loop diuretics

Answer 1140

NSAIDS: block prostoglandin release in kidneys blocking afferent dilation

Question 1141

loss of Cl- with loop diuretics causes?

Tx?

Answer 1141

causes retention of HCO3- for electronegativity – results in metabolic alkalosis

Give carbonic anhydrase inhibitor (acetazolamide): inhibit bicarb reabsorption in PCT

Question 1142

carbonic anhydrase moa

Answer 1142

Carbonic anhydrase tuns H+ and Bicarb into H20 and CO2 which can diffuse into cells; second carbonic anhydrase converts back to bicarb and H+; bicarb gets reabsorbed in blood via Na+ co-transporter; H+ gets pushed into tubule by Na+ antiporter (Na+ into cell from tubule)

Question 1143

Excessive saline, increased Cl- can cause?

Answer 1143

intracellular shifting of bicarb resulting in metabolic acidosis ​

Question 1144

beta-blocker effect on renal system

Answer 1144

B1: release renin in juxtaglomerular

a1: renal vasoconstriction

B2: renal vasodilation

overall beta-blockers reduce RPF and GFR due to blockage of renin

Question 1145

Acute Interstitial Nephritis often caused by

Answer 1145

NSAIDS + antibiotics + infx + chronic disease

Infections: Mycoplasma, Streptococci, Brucella, Legionella, hantavirus, Leptospira, CMV, EBV, Mycobacterium tuberculosis

Antibiotics (e.g., rifampin, penicillins, cephalosporins, sulfonamides), NSAIDs, diuretics, allopurinol, proton pump inhibitors (PPIs), phenytoin, quinolones

Systemic diseases: Sjogren syndrome, systemic lupus erythematosus (SLE), sarcoidosis

Question 1146

acute interstitial nephritis definition:

Answer 1146

inflammatory infiltration of interstitium, due to IgE or T-cell hypersensitivity

Question 1147

fever, rash, WBC casts, sterile pyuria (WBC in urine in the absence of bacteria

Answer 1147

Acute Interstitial Nephritis

Question 1148

Prerenal azotemia

FeNa ?

BUN/Cr ratio ?

Urine osmolality?

Answer 1148

Prerenal azotemia (often hemorrhage/volume depletion)

FeNa <1% ; BUN/Cr >20 ; Urine osmolality > 500

FeNa < 1 suggests most of sodium is being reabsorbed by a working kidney – prerenal

Question 1149

mesangial deposits that exhibit apple-green birefringence

nephritic or nephrotic?

Answer 1149

Due to systemic amyloidosis or chronic inflammatory disease like Crohn’s (amyloid deposits)

**nephrotic syndrome

Question 1150

renal disease: segmental sclerosis w/podocyte foot process effacement

common in African Americans and Hispanic

Answer 1150

Focal segmental

nephrotic syndrome

Can be caused by **obesity, heroin use, sickle cell disease, or HIV

Question 1151

long-standing posternal azotemia

FeNa?, BUN:CR? Urine osmolality (ability to concentrate urine)

Answer 1151

BUN: CR < 15

FeNa >2%

urine osm < 500mOsm/kg

Question 1152

minimal change disease occurs in which pt population?

Answer 1152

younger children; follows resp infx, immunizations, insect sting/bite à podocyte effacement and loss of neg charge in BM

Question 1153

lab findings minimal change disease

Answer 1153

Albumin and fatty casts in urine

selective proteinuria

Question 1154

Alpha 1 Rc (epi and NE) and Prostaglandins work on where in the kidney?

Answer 1154

AFFERENT arteriole

Alpha 1 rc constrict

prostaglandins dilate (anti-inflammatory drugs constrict afferent, decreased RBF)

Question 1155

tx for minimal change disease

Answer 1155

responds well to corticosteroids

Question 1156

most common cause of nephrotic syndrome in Caucasians

Answer 1156

membranous glomerulopathy

Usually idiopathic; can be caused by chronic infx, tumors (lung cancer), SLE, and HEP B and C

Question 1157

in diabetic nephropathy which arteriole is more effected?

Answer 1157

efferent arteriole; leads to high GFR, hyperfiltration leads to microalbuninuria

**Kimmelstein-Wislon nodules — nodular scleroses of measangium

Question 1158

idiopathic cause of membranous nephropathy

Answer 1158

anti-phopholipase A2 rc antibodies

primary membrnous nephropathy

Question 1159

Chronic Kidney Disease effect on phosphate

Answer 1159

Hyperphosphatemia (lack of filtration) results in less vit d –> hypocalcemia –> causes hyper PTH**** ​

Question 1160

anion changes in CKD

Answer 1160

Accumulation of **unmeasured acidic compounds increases anion gap

results in anion-gap met acidosis w/resp compensation

Question 1161

lab findings in CKD

Answer 1161

Azotemia (inc BUN, CR)

salt and water retention - HTN

decreased EPO - anemia

hyperkalemia, hypocalcemia, hyperphophatemia

Question 1162

renal osteodystrophy is caused by

Answer 1162

secondary hyperparathyroidism

osteomalacia – decreased 1-alpha hydroxylation of Vit D in Proxiaml renal tubule results in less Vit D

osteoporosis

Question 1163

x-ray findings w/ renal osteodystrophy (CKD complication)

Answer 1163

Salt-and-pepper skull, Rugger-jersey spine sign, brown tumors

Question 1164

tram-track appearance on H&E

thick glomerular BM

Answer 1164

membranoproliferative glomerulonephritis

Question 1165

two types of membranoproliferative glomerulonephritis

Answer 1165

type 1: subdenothelial - associated w/HBV and HBC

type II- dense deposit disease, intermembranous

associated with C3 nephritic factor – autoantibody that stabilizes c3 convertase, leading to overactivation of complement inflammation, and low levels of circulating C3

Question 1166

cause of Type II membranoproliferative glomerulonephritis

Answer 1166

associated with C3 nephritic factor – autoantibody that stabilizes c3 convertase, leading to overactivation of complement inflammation, and low levels of circulating C3

Question 1167

how to differentiate 3 types of RPGN

Answer 1167

1. Goodpastures - linear deposition anti-bm, collagen antibody
2. immune complex deposition - most common type is SLE
3. Pauci immune : no immunoglobulin/complement, can be Wegner’s (c-ANCA), Churg-Strauss (p-ANCA), or microscopic polyangiitis (p-ANCA)

Question 1168

crescents in RPGN are composed of

Answer 1168

fibrin and macrophages

Question 1169

how does Goodpasture’s present?

Answer 1169

presents with both hemoptysis (lung) and nephritis (RPGN)

Anti-GBM

Question 1170

nephropathy sx occur following or during febrile illness

often following mucosal infx. gastroenteritis

Answer 1170

IgA nephropathy

Question 1171

most common form of nephropathy worldwide

Answer 1171

IgA nephropathy (berger’s disease)

Question 1172

Escitalopram

Answer 1172

SSRI

1/10,000 get suicidal thoughts

Question 1173

malignant kidney tumor: presents as large, unilateral flank mass w/hematuria, and HTN

Answer 1173

Wilms Tumor

Question 1174

composition of Wilm’s tumor

Answer 1174

comprised of blastema - immature kidney mesenchyme

primitive glomeruli, tubules, and stromal cells

most common malignant renal tumor in **CHILDREN

Question 1175

WAGR syndrome?

Answer 1175

Wilms, tumor, aniridia, genital abnormalities, mengal and motor retardation

WT1 tumor suppressor gene

Question 1176

Beckwith-Wiedemann

gene?

Answer 1176

Wilms tumor, neonatal hypoglycemia, muscular hemihypertrophy, organomegaly

**WT2 gene cluster, IGF-2

Question 1177

which type of work hazard leads to urothelial cancer?

Answer 1177

exposure to aromatic armines

like benzidine, in rubber, oil, dye-making industries

other rx: smoking, arsenic, cyclophosphamide

Question 1178

Type 4 renal tubular acidosis is?

Answer 1178

aldosterone deficiency or aldosterone resistance

Question 1179

GnRH agonist commonly used to treat androgen-sensitive prostate cancer

Answer 1179

Leuprolide

Question 1180

losartan, valsartan, cadesartan moa

Answer 1180

angiotensin II rc antagonists

result in decreased PVR, increased urinary sodium, increased renin and Angiotensin II, decreased aldosterone

Question 1181

ureteric bud forms?

Answer 1181

collecting duct, tubules, ureter, renal pelvis, minor calyces

Question 1182

glomerulus, PCT, loop of henle, and DCT arise from?

Answer 1182

metanephric mesenchyme/blastema

Question 1183

how does AKI resolve?

lab finding 3 wks later?

Answer 1183

GFR returns after two weeks

tubular reabsoprtion remains distrubed and can result in polyuria

(also leads to hypokalemia, from excessive loss)

Question 1184

pain from kidney stone radiates?

Answer 1184

ipsilateral lower abdomen, groin, testicles/labia majora, and perinium

renal colic: pain reaches plateu 1-2hrs, intermittent

Question 1185

mechanical bowel obstruction (tumor, adhesions, incarceration) would have what auscultary findings?

Answer 1185

increased bowel sounds

Question 1186

allergic interstitial nephritis can occur how? how long?

Answer 1186

diffuse interstitial T-cell and monocyte infiltration due to a hypersensitivity reaction that can occur DAYS to WKS after initiation of NSAIDs

drug acts as haptens and elicit uncontrolled immune response

Question 1187

effect of renal artery stenosis on kidney

systemic?

Answer 1187

results in unilateral atrophic kidney

decreased renal persusion activates RAAS and causes 2nd HTN

Question 1188

urine osmolality in postrenal azotemia

Answer 1188

< 350mOSM/kg

bc tubular system continues to concentrate urine and filter sodium

Question 1189

urine osmolality in prerenal azotemia

Answer 1189

>500 mOsm/Kg

also urine Na+ <20mEq/L

Question 1190

equation + interpretation of FeNa

Answer 1190

Question 1191

prolonged exposure to NSAID effect on kidney

Answer 1191

inhibition of prostaglandin I2, which normally dilates

less PI2 results in vasoconstriction, less RBF, and subsequent *Renal Papillary Necrosis

Question 1192

injury to 10-12 ribs

Answer 1192

liver, spleen, or kidney laceration

right side: more likely liver

left: spleen or kidney

Question 1193

squamous metaplasia and ocular disorders/night blindness are a sign of which vitamin def

Answer 1193

Vit A

Question 1194

renal biopsy for post strep glomerulonephritis

Answer 1194

granular deposits of IgG, IgM, C3 along bm, mesangium

nephritis - RBC present

Question 1195

which change in diet should be recommended for calcium stones?

Answer 1195

low-protein diet

animal protein produces increased urinary calcium, which can preciptate more stones

Question 1196

potassium citrate has what effect on stones

Answer 1196

alkalizes urine

Question 1197

moa of Probenecid

Answer 1197

gout drug

inhibits reabsorption of uric acid at PCT, promoting its excretion

increases r of uric acid stones

Question 1198

acceptable prophylaxis for uric acid stones in tumor lysis syndrome, etc.

Answer 1198

urinary alkalinizing agent

or rasburicase or allopurinol

Question 1199

rasburicase moa

Answer 1199

recombinant uricase that catalyzes the conversion of uric acid to water-soluble allantoin

preventio of tumor lysis syndrome

Question 1200

deletions of ? gene are a common cause of both sporadic and familial RCC

Answer 1200

VHL tumor suppressor

Question 1201

expansion of mesangial matrix occurs in

Answer 1201

diabetic nephropathy

Question 1202

which type of renal disease

Answer 1202

RPGN

crescent shape

Question 1203

which renal disease

Answer 1203

diabetic nephropathy

kimmelstein nodules

nodular sclerosing

Question 1204

which of the following is the L ACA

Answer 1204

B

Question 1205

ovarian teratoma causes which paraneoplastic syndrome in CNS

Answer 1205

paraneoplastic encephalomyelitis

prodrome: fever, headache, fatigue lasting weeks to months

anti-NMDA antibodies

small cell lung cancer - anti-Hu

Question 1206

parotid gland salivation is controlled by

Answer 1206

parasympathetic fibers of glossopharyngeal IX (9)

Question 1207

closing of eyelids controlled by which nerve and muscle

Answer 1207

CN 7

orbicularis oculi muscle

Question 1208

innervation of lacrimal gland, submandibular gland, sublingual gland

Answer 1208

CN 7

Question 1209

multiple sclerosis caused by

Answer 1209

Th1 cells react to myelin basic proteins and initate inflammatory response

Question 1210

lamotrigine moa

Answer 1210

anticonvulsant, sodium (Na+) channel blocker

Question 1211

antidepressant that increases appetite

moa

Answer 1211

mirtazapine

a2-adrenergic rc: increase synaptic release of NE and serotonin

*causes weight gain

Question 1212

positive Trendelenburg sign means injury where

Answer 1212

superomedial quadrant of buttok,

superior gluteal nerve

Question 1213

apart from acoustic schwannomas, which are possible with NF2?

Answer 1213

meningiomas

Question 1214

cerebellar ataxia, recurrent sinopulmonary infx

labs: decreased immune competency and increased alpha-fetoprotein (AFP)

Answer 1214

ataxia telangietasia

will also see telangiectasias on skin, face, conjunctiva

Question 1215

mutation involved in ataxia telangectasia

Answer 1215

AR mutation in ATM gene, assists in DNA break repair, nonhomologus end joining

Question 1216

similarity of lateral pons lesion vs lateral medulla lesion

Answer 1216

both cause loss of pain and temp on ipsilateral face + Horners, and contralateral body

Lateral medullary lesion: PICA

lateral pons lesion: AICA

Question 1217

artery occluded in lateral pons syndrome

Answer 1217

AICA

ant inf cerebellar artery

Question 1218

CN palsies involved in lateral medulla vs. lateral pons

Answer 1218

lateral pons (AICA): CN 7 and 8, facial, cochlear

lateral medullary (PICA): CN 9, CN 10

Question 1219

Freidrich ataxia is progressive degeneration of spinocerebellar tract, lateral corticospinal, dorsal column, dorsal root gangial due to

Answer 1219

intramitochondrial accumulation of iron

manifests in 1st or 2nd decade of life

Question 1220

histo of neuroblastomas

Answer 1220

small, blue cells arranged in rosettes around a central neuropil

Homer-Wright rosettes

Question 1221

where can neuroblastomas occur

Answer 1221

anywhere along sympathetic chain

**majority in abdomen

Question 1222

paraneoplastic syndrome of neuroblastoma

Answer 1222

opsoclonus-myoclonus ataxia

Question 1223

lab finding in neuroblastoma

Answer 1223

increased homovanillic acid and vanillymandelic acid in urine

due to neuroblastoma cells metabolizing catecholamines

Question 1224

traumatic brain injury can cause brain where

Answer 1224

subarachnoid hemorrhage

between arachnoid mater and pia mater

Question 1225

area of auditory system effected by presbycusis (high frequency sounds)

Answer 1225

base of the cochlea/basilar membrane responds to high freq

degen w/age

Question 1226

first line for trigeminal neuralgia:

stabbing jaw pain when washing face, brushing, eating

Answer 1226

Carbamazepine

Question 1227

tx for Listeria meningitis

Answer 1227

ampicillin

gentamicin (aminoglycoside) can be added for synergistic effect

Question 1228

tx for Cryptococcus neoformans (india ink)

Answer 1228

IV amphoterecin B and oral flucytosine

Question 1229

innervation of lateral forearm

Answer 1229

lateral cutaneous nerve which is a branch of musculocutaneous nerve (also supplies biceps)

Question 1230

Phytanic acid buildup occurs in

Answer 1230

peroxisome def

lack of a-oxidation of branched chain fatty acids

phytanic acid is a branched chain fatty acid

Question 1231

increased phytanic acid, scaly skin, shortening of 4th toe, impaired vision, sensorineural hearing loss, ataxia, peripheral neuropathy

Answer 1231

Refsum disease

defective a-oxidation of branched chain fatty acids in peroxisomes

Question 1232

pyridoxine impairs synthesis of ?

Answer 1232

neurotransmitters; GABA, serotonin, epi, NE, dopa

also inhibits synthesis of myelin via increased SAM

Question 1233

CNS tox of isoniazid

Answer 1233

causes pyridoxine def –> dec nt’s –> peripheral polyneuropathy

Question 1234

pure sensory stroke - unilateral face and body, lack of proprioception, pain, pressure, and temp

caused by lesionwhere?

Answer 1234

posterolateral thalamus

often caused by lacunar/thalamic strokes (HTN)

Question 1235

Galantamine use/moa

Answer 1235

AChEi in CNS used to treat Alzheimer’s

same as donepezil and rivastigmine

Question 1236

side effects of ondansetron

Answer 1236

5-HT3 antagonist

headaches, constipation/diarrhea, elevated LFTs, severe cases QT prolongation/torsades and serotonin syndrome

Question 1237

tx for prolactinoma

Answer 1237

dopamine agonists: bromocriptine or cabergoline

Question 1238

sx of congenital hypothyroidism (6)

Answer 1238

Umbilical hernia

Prolonged neonatal jaundice

Hypotonia

Decreased activity, poor feeding, and adipsia

Hoarse cry

macroglossia

Question 1239

when do sx of congenital hypothyroidism present

Answer 1239

do not have symptoms at the time of birth because the placenta supplies the fetus with maternal thyroid hormone

Question 1240

causes of congenital hypothyroidism

Answer 1240

often caused by mom taking propylthiouracil, or maternal iodine deficiency, or TSH rc blocking antibodies **ALL TRANSIENT

Question 1241

what is congenital iodine deficiency syndrome?

Answer 1241

a complication of congenital hypothyroidism

impaired development of the brain and skeleton

short stature and delayed fontanelle closure and intellectual disabilities

Question 1242

how does congenital hyperthyroidism present

Answer 1242

poor weight gain and stridor

Question 1243

cause of congenital hyperthyroidism

Answer 1243

from untreated Graves

transplacental TSH rc stimulating Abs

Question 1244

Basophil cells of anterior pituitary produce?

Answer 1244

ACTH, FSH, LH, and TSH

Question 1245

Acidophils in ant pituitary produce

Answer 1245

GH and prolactin

Question 1246

what is Nelson syndrome?

Answer 1246

development of pituitary tumor following bilateral adrenalectomy for Cushing syndrome

tumor compresses on optic chiasm; secretes ACTH and melanocyte-stimulating hormone (hyperpigmentation)

Question 1247

sx of acute adrenal insufficiency

Answer 1247

hypotension and shock + n/v bc adrenals cannot respond to stress

Question 1248

causes of acute adrenal insufficiency (3)

Answer 1248

sudden discontinuation of glucocorticoids, Waterhouse-Fredrickson Syndrome (bilateral hemorrhage), pituitary dysfunction

Question 1249

Waterhouse-Frederickson syndrome is a rare complication of?

Answer 1249

meningococcal meningitis ​

Question 1250

skin finding in Waterhouse-Friderichsen

Answer 1250

Nonblanching, petechial rash (mostly on trunk and legs); in severe cases, even purpura fulminans with extensive necrosis of the skin

Question 1251

tx for acute adrenal insufficiency

Answer 1251

Give corticosteroids: hydrocortisone or dexamethasone

Question 1252

Addison’s disease

name two findings

Answer 1252

primary adrenal insufficiency: cortisol and aldosterone def

Lack of aldosterone = loss of Na, loss of volume, and increased K+ in solution

“hypovolemic, hyponatremia”

Increased reflexive ACTH results in hyperpigmentation

Question 1253

most common cause of primary, chronic adrenal insufficiency

Answer 1253

autoimmune adrenalitis – atrophy of the bilateral adrenal glands

Often associated w/other autoimmune conditions like hypoparathyroidism

Question 1254

Long term use of glucocorticoids can result in suppression of ? and bilateral adrenocortical atrophy

Answer 1254

ACTH``

Question 1255

Normal polyol pathway: glucose to sorbitol to fructose; in overwhelmed states (diabetes) ? accumulates

Answer 1255

sorbitol

Question 1256

diabetic ketoacidosis has what effect on potassium

Answer 1256

hyperglycemia causes hyperosmolality – shifts K+ out of intracellular compartment and into extracellular compartment and urine –

**total loss of K+ despite normal serum values

Question 1257

alendronate moa/binds to?

Answer 1257

bisphosphonate that binds to hydroxyapatite and inhibits osteoclast function

Question 1258

cinacalcet

Answer 1258

calcimimetic that binds to Ca-sensing rc in parathyroid gland and decreases PTH release ​

Question 1259

PTH induces what in bones?

Answer 1259

induces IL-1 release in osteoblasts which activates osteoclasts

Question 1260

what is the connection b/w hypothalamus and pituitary gland?

compression causes?

Answer 1260

infundibulum

decrease the amt of dopamine delivery from hypothalamus to Ant Pit Gland results in increased secretion of prolactin

Question 1261

insulin increases glycolysis by activating which enzyme?

Answer 1261

Phophofructokinase-2 à produces fructose 2,6 biphosphate which is regulator of PFK1, which converts fructose 6-phosphate to fructose 1,6 biphosphate in rate-limiting step of glycolysis

Question 1262

excessive emotionality and attention seeking behavior is which disorder

Answer 1262

histrionic personality disorder

Question 1263

OCPD vs OCD

Answer 1263

personality disorder: inflexibility, excessive perfectionism, preoccupation w/order and control

OCD: recurrent worries that cause disress and insomnia, have very intrusive and time-consuming thoughts, images, or urges

Question 1264

OCD is ego?

Answer 1264

egodystonic: person does not believe their behavior is appropriate

OCpersonality disorder is egosyntonic: pt who believes their actions are appropriate

Question 1265

>6 months of excessive thoughts, feelings, behaviors related to a somatic sx (heartburn, fatigue, pain)

previous diagnostic workups revealed no medical cause

Answer 1265

somatic symptom disorder

Question 1266

def of primary prevention and some examples

Answer 1266

measures to prevent onset of disease such as lifestyle modifications (healthy diet, smoking cessation, exercise), vaccinationas, and health laws (seat-belt)

Question 1267

what is secondary prevention

examples?

Answer 1267

to detect early-stage disease before onset of signs and sx

ex. checking BP for HTN, fasting glucose for DM, colonoscopy, mammography, breast selfe-exam

Question 1268

non benzo sedatives useful for sleep-onset insomnia

(non-drowsy)

Answer 1268

Zaleplon (1 hr half-life)

Zolpidem (4.5hrs)

Question 1269

tx for TCA overdose (prolonged QRS, tachycardia, hypotension, dry skin, urinary retention)

Answer 1269

sodium bicarbonate

TCA block fast sodium channels in myocardium

IV sodium bicarb alkalizes plasma, preventing TCA from binding to fast sodium channels; also adds more sodium for Na channels

Question 1270

tx for stimulant intoxication (amphetamine or cocaine overdose)

Answer 1270

benzo such as lorazepam

Question 1271

what test to monitor for Lithium use

Answer 1271

serum TSH

causes hypothyroidism

lithium blocks coupling of thryoid hormone precurosrs, release of T3 and T4, and conversion of T4 to T3

Question 1272

insulin effects are generally characterized as?

Answer 1272

anabolic- promotes glycogenesis and lipogenesis

inhibits lipolysis and gluconeogenesis

Question 1273

Glucagon binds to what type of rc in hepatocytes

Answer 1273

G-protein rc on hepatocytes – increase cAMP and PKA (promotes glycogenolysis and gluconeogenesis)

Question 1274

Glucagon binds to what type of rc in skeletal muscle

Answer 1274

skeletal muscle cells: AC, cAMP, PKA causes increases glycogen phosphorylase via kinase

Question 1275

Hypothyroidism effect on LDL

Answer 1275

decreases LDL rc expression in Liverà decreased clearance of LDL, (increased LDL in serum)

Question 1276

Testosterone and estrogen have what effect on MSK

Answer 1276

vital for bone growth, ossification and closure, especially in children

Question 1277

name of dopamine agonists used to treat hyperprolactinemia

Answer 1277

cabergoline and bromocriptine

Question 1278

Graves dermopathy caused by:

Answer 1278

pretibial myxedema

B and T cell activation cause dermal fibroblast stimulation and deposition of glycosaminoglycans in connective tissue

Question 1279

causes of Graves opthalmology

Answer 1279

caused by thyrotropin rc antibodies that activate THS stimulating orbital fibroblasts and inflammatory infiltration

tx: glucocorticoides

Question 1280

what antibodies are associated with Graves

Answer 1280

TSH receptor antibodies (TRAb)

thyrotropin rc antibodies *TSH = Thyrotropin

antibody against the TSH receptor, which can be found on thyroid epithelial cells, adipose tissue, and fibroblasts

Question 1281

radioactive iodine ablation of Graves depends on ?

Answer 1281

sodium/iodine symporter - transmembrane carrier that transports radioactive iodine and destroys thyroid tissue

Question 1282

tx for radioactive iodine exposure

Answer 1282

administer potassium iodide; competitively inhibits thyroid uptake of radioactive iodine

Question 1283

Technetium-99m scan showing thyroid tissue within the tongue/at base is caused by?

Answer 1283

ectopic thyroid tissue

Due to arrested endodermal migration from the pharyngeal floor

Question 1284

hyperthyroidism associated w/ upregulation of ?

Answer 1284

beta-adrenergic rc

contributes to thyrotoxosis: tremor, sweating, tachycardia, palpitations

Question 1285

tx for sx of thyroxicosis/hyperthyroidism

Answer 1285

Beta-blockers

block effect + reduce peripheral conversion of T4 to T3

Question 1286

Hyperthyroidism effect on MSK

Answer 1286

bone loss —> T3 stimulates osteoclasts differentiation, increased bone resorption (increase calcium controlled by decreased PTH)

Question 1287

preferred tx of Graves/hyperthyroidism

Answer 1287

methimazole: inhibits TPO

Question 1288

tx for Graves/hyperthyroidism in first trimester pregnancy

Answer 1288

PTU (propylthiouracil), inhibits TPO

methimazole is teratogenic : aplasia cutis, esophageal atresia, facial anomalies

Question 1289

neck mass on lateral neck, ant to sternocleidomastoid

immobile while swallowing

Answer 1289

Branchial cyst

Question 1290

cause of branchial cyst

Answer 1290

remnants of the embryological second branchial cleft or cervical sinu

failure of** fusion of mesodermal branchial and obliteration of ectodermal branchial***

Question 1291

Secondary amenorrhea due to excessive weight loss/exercise/anorexia due to?

Answer 1291

decrease leptin stores in adipose tissue causes less activation of hypothalamus, ****less GnRH pulsatile secretion***

Question 1292

Ezetimibe

Answer 1292

decreases brush-border absorption of cholesterol

Question 1293

PCSK9 inhibitors (alirocumab, evolocumab)

Answer 1293

blocks degradation of LDL rc (removes more LDL)

used for high LDL

Question 1294

cholestyramine, colestipol, colesevelam moa

Answer 1294

bile acid sequestrant—binds bile in intestine, results in more cholesterol to bile conversion (used to decrease cholesterol)

Question 1295

17 alpha-hydroxylase def =

Answer 1295

low cortisol, low androgen, high aldosterone

Question 1296

11B-hydroxylase def = ?

Answer 1296

^2nd most common

Results in excess androgens and 11-deoxycorticosterone (weak mineralocorticoid = HTN and hypokalemia)

No conversion of 11-deoxycortisol to cortisol

Question 1297

21-hydroxylase deficiency =

Answer 1297

Decreased aldosterone, decreased glucocorticoids, increased androgens

Buildup of 17 hydroxyprogesterone

Question 1298

estrogen has what effect on TBG?

TSH? T3 and T4?

Answer 1298

increases TBG levels -> decreased serum T4 and T3 –> reflexive TSH, increased T4 and T3

Question 1299

TBG def lab findings

total T4? serum T4? TSH?

Answer 1299

low total T4, but normal TSH and normal free T4 due to normal feedback****

Question 1300

Acromegaly caused by increased growth hormone in adults causes what cardiac change?

Answer 1300

left ventricular hypertrophy

Also carpal tunnel syndrome and peripheral neuropathy

Question 1301

thyroid hormone resistance has what lab findings?

Answer 1301

high TSH, T4, and T3

decreased tissue sensitivity to thyroid hormone action usually caused by germline mutations of the thyroid hormone receptor beta (THRB) gene.

Question 1302

lactorophs express which other rc

Answer 1302

Thyrotropin-Releasing Hormone

TRH from hypothalamus causes increased prolactin release from lactotrophs in pituitary

Question 1303

Post-partum thyroiditis histo:

Answer 1303

lymphocytic infiltration of thyroid gland <12 mo after pregnancy

Question 1304

how does post-partum thyroiditis present

Answer 1304

Begins with hyperthyroidism (release of thyroid hormone store), then hypothyroidism, then normal levels

Question 1305

histo of hashimoto’s

Answer 1305

lymphocyte infiltrate with well-developed germinal centers

Question 1306

Subacute granulomatous thyroiditis histo:

Answer 1306

Inflammatory infiltrate with macrophages and **giant cells

Question 1307

what does a Hurthle cell mean?

Answer 1307

can be present in Hashimoto thyroiditis, Graves disease, previously-irradiated thyroid glands

Also Hurthle cell carcinoma: subtype of follicular carcinoma

Question 1308

painful goiter onset following a viral illness , **decreased radioiodine intake

Answer 1308

Subacute granulomatous thyroiditis

Question 1309

course of subacute granulomatous thyroiditis

Answer 1309

self-limited, lasts for a few weeks to many months

triphasic: transient thyrotoxicosis, hypothyroidism, and then a return to normal thyroid function in >90% of patients

Question 1310

initial presentation of subacute granulomatous thyroiditis

Answer 1310

initial thyrotoxic phase is associated with thyroid pain, high serum thyroid hormone levels with a low radioiodine uptake

Question 1311

most common cause of death in patients with DM

Answer 1311

Coronary heart disease

Question 1312

skeletal muscle cell energy use in first 10s vs 60s

Answer 1312

Phosphocreatine shuttle (first 10s)/anaerobic glycolysis and glycogen breakdown (60s)

Question 1313

Skeletal muscle cell energy use >1min

Answer 1313

oxidative phosphorylation (>1min)

Question 1314

r/ship between beta-blockers and hypoglycemia

Answer 1314

Beta-blockers attenuate cholinergic response to hypoglycemia and mask sx ​

Question 1315

Glucagon primarily increases ?

Answer 1315

glycogenolysis

also increases gluconeogenesis and lipolysis and inhibits glycolysis and lipogenesis

Question 1316

? used in emergency kits for hypoglycemia

Answer 1316

glucagon

Question 1317

which organelle is involved in synthesis of hydrophobic compounds including phospholipids and steroid hormones

well-developed in **adrenal cortex*

Answer 1317

Smooth endoplasmic reticulum

Question 1318

Rough ER produces ? hormones

Answer 1318

peptide hormones

(insulin, ADH, prolactin, gastrin)

Question 1319

Overflow incontinence due to inability to sense full bladder—aspect of diabetic neuropathy

what study finding?

Answer 1319

Increased post void residual volume ​

Question 1320

insulin rc is what type of rc?

Answer 1320

intrinsic tyrosine kinase —PI3K activation

Question 1321

how does inhibition of insulin rc work

Answer 1321

inhibition/phophorylation of serine and threonine residues

causes insulin resistance

caused by TNF-a, catecholamines, glucocorticoids (cortisol)

Question 1322

low dose dexamethasone test

low vs normal/high cortisol

Answer 1322

low levels = normal; ACTH is inhibited

normal/high cortisol = Cushing **syndrome (either pituitary or adrenal cause)

Question 1323

high dose dexamethasone returns low levels of cortisol

means?

Answer 1323

Cushing disease **

pituitary adenoma, high ACTH release causes high cortisol

Question 1324

high dose dexamethasone results in normal/high cortisol ?

Answer 1324

Ectopic ACTH (small cell lung cancer) or Adrenal adenoma

differentiate via ACTH

ectopic (high ACTH) adrenal adenoma (low ACTH)

Question 1325

lab findings in adrenal tumor

Answer 1325

**Low ACTH, high cortisol

no suppression via high dose dexamethasone

Question 1326

characteristic skin finding in glucagonoma, bronchogenic carcinoma, and hep B

Answer 1326

necrolytic migratory erythema – painful, pruritic plaques with ****brown/bronze centers***

Question 1327

most common thyroid cancer?

histo?

Answer 1327

papillary

Psammoma bodies, w/large oval cells with empty appearing nuclei – Orphan ANNIE

Question 1328

rx factor for papillary cancer

Answer 1328

exposure to ionizing radiation in childhood/prior radiation exposure

Question 1329

can fine need aspiration differentiate between follicular adenoma and carcinoma

Answer 1329

no; cannot show invasion of fibrous capsule

Question 1330

thyroid tumor, deadly, >60 yr

histo?

Answer 1330

anaplastic

large pleomorphic cells

Question 1331

medullary thryroid cancer stains for

Answer 1331

for calcitonin + amyloid deposits, associated with MEN2A and B

Question 1332

tx post removal of thyroid cancer

Answer 1332

high dose Levo to inhibit TSH production and growth of residual malignant cells

Question 1333

mutation causing familial Medullary carcinoma

Answer 1333

RET mutation in MEN1 and MEN2

Question 1334

cortisol has what effect on liver enzymes

Answer 1334

cortisol causes increased liver enzymes —> increased gluconeogenesis and glycogenesis

Question 1335

how does cortisol cause stretch marks

Answer 1335

Inhibit fibroblast proliferation and collagen formation in the skin – **stretch marks ​

Question 1336

RET proto-oncogene is what type of gene

Answer 1336

membrane-bound tyrosine kinase rc unregulated cellular proliferation​

causes medullary thyroid cancer

Question 1337

which cells produce testosterone in males

Answer 1337

Leydig cells

Question 1338

Leydig cells are activated by?

Answer 1338

LH, produce testosterone

Question 1339

Parathyroid adenomas, Pituitary tumors, Pancreatic endocrine tumors (Zollinger-Ellison), no involvement of adrenal glands

Answer 1339

MEN1

Question 1340

medullary thyroid cancer, pheochromocytoma, and parathyroid hyperplasia

Answer 1340

MEN2A

RET oncogene

Question 1341

medullary thyroid cancer, pheochromocytoma, oral/intestinal neuromas, and marfanoid habitus

Answer 1341

MEN2B

AD RET mutation

Question 1342

tx for pheocytochroma (catecholamine release, episodic headaches)

Answer 1342

phenoxybenzamine

Question 1343

glucokinase is specific for which cells?

low or high glucose affinity

Answer 1343

specific for pancreatic beta-cells

low glucose affinity; functions well as a glucose sensor

Question 1344

insulin is cleared by

effect of CKD

Answer 1344

cleared by kidneys in PCT and Liver

CDK impairs breakdown of insulin in PCT, can result in hypoglycemic episodes

Question 1345

exogenous steroid use has what effect on hematocrit

Answer 1345

testosterone stimulates RBC production, increased hematocrit**

Question 1346

lipoprotein lipase is located where? and has what effect

Answer 1346

enzyme on endothelial cells that degrades triglycerides on chylomicrons and VLDL in circulation —> send free fatty acids to adipocytes for storage

Question 1347

deficiency of lipoprotein lipase can lead to

Answer 1347

acute pancreatitis

Question 1348

hormone sensitive lipase is activated by

Answer 1348

activated in fasting states

by stress hormones: glucagon, epi, ACTH; inhibited by insulin

Question 1349

action of hormone sensitive lipase

Answer 1349

Breaks down Triglycerides into Glycerol (for glucose) and Fatty Acids (Ketone bodies)

Question 1350

indication for tamoxifen vs raloxifene

Answer 1350

Tamoxifen: adjuvant tx for breast cancer; increased Rx for endometrial hyperplasia and carcinoma, and uterine sarcoma

Raloxifene: used for postmenopausal osteoporosis; Adverse effects: hot flashes, venous thromboembolism

Question 1351

GLUT 4 only in skeletal muscle and adipocytes

translocation can occur via (2)

Answer 1351

insulin and independent of insulin via muscle contraction/exercise

Question 1352

hallmark of osteoporosis

Answer 1352

thinned trabeculae

Question 1353

which Apo used for chylomicron remnant uptake by liver

Answer 1353

ApoE3 and E4

Question 1354

sx of excessive vit D hypercalcemia

caused by sarcoidosis/granulomatous disease = activated macrophages express 1-a-hydroxylase to activate Vit D

Answer 1354

mental status changes, muscle weakness, constipation, polyuria

constipation —> inhibits nerve depolarization and impairs smooth muscle contraction ​

Question 1355

Caloric restriction results in
?Ghrelin, ?Leptin, ?insulin

Answer 1355

increased Ghrelin (hunger), decreased Leptin, decreased insulin

Question 1356

which cells produce Leptin

Answer 1356

adipocytes and enterocytes in fed state

Question 1357

Neuropeptide Y involved in signaling

Answer 1357

hunger

Question 1358

Injury to hypothalamus (head trauma or surgery) can result in ? central diabetes insipidus—damage to posterior pit causes ? DI

Answer 1358

hypothalamus: permanent central DI

post pituitary: transient DI

Question 1359

orlistat moa

Answer 1359

gastric and pancreatic lipase inhibitor – prevents triglycerides from being absorbed, increased fecal triglycerides = weight loss pill**

Question 1360

phenylalanine to tyrosine ?

tyrosine to DOPA ?

DOPA to dopamine?

Answer 1360

phenylalanine hydroxylase

tyrosine hydroxylase

dopa decarboxylase

Question 1361

dopamine to NE?

NE to EPI?

Answer 1361

dopamine B-hydroxylase

phenylethanolamine-N-methyltransferase (PNMT) (activated by cortisol in adrenal medulla)

Question 1362

metformin functions

toxicity? clearance?

Answer 1362

increases insulin sensitivity, inhibiting liver gluconeogenesis, decreases serum free fatty acid concentration

weight loss

tox: lactic acidosis

renally cleared, thus rx increased w/contrast agents

Question 1363

sulfonylureas (-IDE drugs)

moa

side effects

weight?

contradindication

Answer 1363

MOA: Block ATP-sensitive potassium channels of the pancreatic β cells → depolarization of the cell membrane → calcium influx → insulin secretion

Sidex: hypoglycemia, Alcohol intolerance (first-generation agents: disulfiram-like reaction)

Weight gain

Contraindications: Beta blockers (can mask hypoglycemic symptoms while lowering serum glucose levels)

Question 1364

Thiazolidinediones (-glitazones)

moa

Answer 1364

activates PPARy transcription factor – increased transcription of adiponectin = decrease insulin resistance/increased sensitivity

“Party Zone”

decrease insulin resistance (increased GLUT4 transporter and adiponectin: cytokine released from fat tissue that increase insulin-responsive adipocytes)

Question 1365

effect of adiponectin

Answer 1365

↑ storage of fatty acids in adipocytes, ↓ products of lipid metabolism (e.g., free fatty acids) → ↓ free fatty acids in circulation → ↑ glucose utilization and ↓ hepatic glucose production

Question 1366

meglitinides are analogs of

Answer 1366

sulfonyureas, same moa and rx

Question 1367

Thiazolidinediones (pioglitazone, PPAR-y) and sulfonylureas and meglitinides cause weight ?​

Answer 1367

weight gain

Question 1368

-gliflozin drugs effect which rc

Answer 1368

reversible inhibition of SGLT-2 in the proximal tubule of the kidney → ↓ glucose reabsorption in the proximal convoluted tubule of the kidney → glycosuria and polyuria

Question 1369

acarbose inhibits which enzyme

Answer 1369

Inhibit alpha-glucosidase (a brush border enzyme expressed by intestinal epithelial cells)

Question 1370

moa of exanatide and liraglutide

Answer 1370

GLP-1 agonists

Incretin mimetic drugs bind to the GLP-1 receptors and are resistant to degradation by DPP-4 enzyme → ↑ insulin secretion, ↓ glucagon secretion, slow gastric emptying (↑ feeling of satiety, ↓ weight)

Question 1371

moa of linaglipton

Answer 1371

both GLP agonists increase glucose-dependent insulin release

indirectly increase the endogenous incretin effect by inhibiting the DPP-4 that breaks down GLP-1 → ↑ insulin secretion, ↓ glucagon secretion, delayed gastric emptying

Question 1372

pramlintide moa

Answer 1372

amylin analog: Decrease glucagon release, Slow gastric emptying, Increase feeling of satiety

Question 1373

cause of islet cell destruction (decreased insulin) in DM2

Answer 1373

buildup of islet amyloid polypeptide

from increased production of proamylin and proinsulin – accumulation and amyloid formation

Question 1374

urine metanephrines are a sign of

Answer 1374

increased levels of catecholamine metabolites (often pheocytochroma)

Question 1375

increased urine 5-hydroxyindoleacetic acid

Answer 1375

increased levels of serotonin metabolites

Question 1376

pyruvate carboxylase and Phosphoenolpyruvate carboxykinase involved in which process

Answer 1376

gluconeogenesis

Question 1377

hard fixed anterior neck swelling with features suggestive of retroperitoneal fibrosis (decreased lower limb pulsations, low backache, lower limb swelling)

can cause euthyroidism/hypothyroidism

associated with other autoimmune conditions

Answer 1377

Riedel thyroiditis

Collagen deposition and decreased number of follicles

Question 1378

Which intervention is recommended in diabetic patients to prevent cardiovascular disease (diabetic nephropathy and retinopathy).

Answer 1378

early HTN medication like lisinopril

The target blood pressure is generally considered to be < 130/90 mm Hg in patients with diabetes mellitus. All first-line antihypertensive agents are effective in adults with diabetes

Question 1379

lab findings in Graves

TSH? T4? T3? TBG?

Answer 1379

low TSH

high T4 and T3

normal

Question 1380

Lymphocytic infiltration of the thyroid gland, germinal centers within the thyroid tissue, and Hürthle cells are characteristic hist for

Answer 1380

Hashimoto’s thyroiditis

Question 1381

manifestation of carcinoid heart disease

Answer 1381

pulmonic valve stenosis, tricuspid insufficiency, right-sided HF

serotonin enters via IVC and reaches right side of heart

Question 1382

elevated plasma free fatty acids has what effect on DM development

Answer 1382

decrease insulin-mediated glucose uptake into tissues, contributing to insulin resistance

Question 1383

preferred tx for uncontrolled gestational diabetes

Answer 1383

insulin

binds to transmembrane tyrosine kinase rc

Question 1384

tx for essential fructosuria/diet change

reducing sugar in urine

Answer 1384

no diet change needed

Question 1385

how is testicular mass and hyperthyroidism possible

Answer 1385

elevated b-HCG in testicular choriocarcinoma, weakly binds to TSH rc and causes hyperthyroidism sx

Question 1386

effect of increased phosphate infusion

total serum calcium? PTH? Vit D?

Answer 1386

phosphate binds calcium and lowers serum calcium

causes increase PTH, increase calcitriol (vit D), increased total calcium, increased urine phosphate

Question 1387

cushing disease cause on MSK

Answer 1387

pathologic fractures due to osteoporosis

Excess cortisol inhibits calcitriol and osteoblasts maturation while simultaneously increasing production of RANKL, which stimulates osteoclasts and results in increased levels of bone resorption

Question 1388

toxic multiple goiter vs Graves

Answer 1388

scintigraphy: Graves disease: diffuse uptake on scintigraphy

toxic multiple goiter: focal areas of uptake; usually caused by chronic iodine def resulting in increased pituitary TSH, results in hyperplasia (lab findings will be increased T3 and decreased TSH however)

Question 1389

pheochromocytoma is a tumor of which cell

Answer 1389

chromaffin cells (produce catecholamines in adrenal meduall)

Question 1390

V(D)J (heavy chain) recombination promotes ?

where?

Answer 1390

antibody diversity during the very early stages of B cell and T cell maturation

occurs in primary lymph node organs (bone marrow, thymus)

Question 1391

C3 def results in repeated infx of ? type of bacteria and where?

Answer 1391

encapsulated bacteria (Strep, Neisseria)

in upper respiratory tract: recurrant sinusitis, pneumonia, meningitis

Question 1392

AIDS, low CD4 cell count (< 50 cells/mm3), constitutional symptoms, cough, hepatosplenomegaly, lymphadenopathy, and acid-fast organisms in his blood culture

Answer 1392

disseminated Mycobacterium avium complex (MAC) infection

Question 1393

tx for disseminated Mycobacterium avium complex (MAC) infection

Answer 1393

Azithromycin and ethambutol

Question 1394

moa of aldesluekin

used for malignant melanoma and RCC

Answer 1394

recombinant interleukin-2 (IL-2)

activates natural killer cells and cytotoxic T cells

Question 1395

potential late and serious finding in acute rheumatic fever

Answer 1395

dilated cardiomypathy

Question 1396

IL-1, IL-?, and TNF-α stimulate the synthesis and secretion of positive acute phase proteins such as fibrinogen, ferritin, serum amyloid A, hepcidin, and C-reactive protein.

Answer 1396

IL-6

Question 1397

which immune cell mediates Crhon’s pathology

Answer 1397

Type 1 T helper cell (Th1 cell)

Question 1398

abnormal dihydrorhodamine flow cytometry test

Answer 1398

indicates neutrophils cannot mount normal respiratory burst

NADPH def/Chronic Granulomatous Disease

Question 1399

bone healing involves which cytokine

(secreted by osteoblasts to promote osteoclast proliferation; allows tissue degradation and subsequent osteoblastic tissue formation)

Answer 1399

Macrophage colony-stimulating factor (M-CSF)

Question 1400

virus infected cells produce which cytokines

Answer 1400

interferon alpha and interferon beta

Question 1401

effect of interferon a and interferon b (2)

(in virus-infected cells)

Answer 1401

upregulate MHC I expression to facilitate the recognition and destruction of infected cells

& downregulate protein synthesis to prevent viral replication

Question 1402

infx @ CD4 200-500 count for HIV

Answer 1402

oral hairy leukoplakia, oral thrush, HHV-8 infx, squamous cell carcinoma, Mycobacterial infx, HIV-wasting/dementia

Question 1403

<200 CD4 count

tx/proph

Answer 1403

pneumocystis pneumonia

TMP/SMX

trimethoprim/sulfamethoxazole

Question 1404

<250 CD4

tx/proph

Answer 1404

coccidiomyocosis

fluconazole

Question 1405

CD4<100

tx/proph

Answer 1405

cerebral toxoplasmosis

esophageal/pulm candidiasis

HSV, ulcers, bronchitis, pneumonitis, esophagitis

Primary CNS lymphoma

Question 1406

<50 CD4

tx/proph

Answer 1406

disseminated MAC

Cytomegalovirus: CMV retinits, colitis

Question 1407

CD4 <150

tx/proph

Answer 1407

Histoplasmosis

itraconazole

Question 1408

which two conditions give false positive to rapid plasma reagin test (RPR/VDRL test)

Answer 1408

both SLE and antiphopholipid syndrome have anticardiolipin antibodies

Question 1409

first and second steps for immunoglobulin class switching

Answer 1409

1. B-cell activation of antigen presenting MHC II to CD4 rc on T helper cells
2. binding of CD40 rc on B cells and CD40L on surface of T helper cells

Question 1410

hyperacute transplant rejection occurs when and under what conditions

Answer 1410

<48 hrs **

preformed antibodies would usually have a history of blood transfusion in the past or a failed organ transplantation

widespread infarction, necrosis, and thrombosis

Question 1411

CD 95 =

Answer 1411

Fas Rc (death rc)

Fas-FasL signaling is essential for proper thymic medullary negative selection,

Question 1412

organ rejection 48hrs>6mo

Answer 1412

acute cellular rejection caused by host T lymphocytes and acute humoral rejection by circulating antibodies.

Question 1413

decreased responsiveness to vaccines in elderly t/f?

Answer 1413

true

Question 1414

which vaccines elicit maximum immunogenecity

Answer 1414

Live attenuated vaccine

both cellular and humoral response

contraindicated in those w/weakend immune sx

Question 1415

Dense aggregates of leukocytes with basophillic granules on biopsy and KIT mutation

Answer 1415

systemic mastocytosis

Question 1416

Rouleaux formation meaning

Answer 1416

stacked RBCs on blood smear due to elevated proteins disrupting the electrorepulsive forces on RBCs—present in multiple myeloma and RA