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UWorld > Set 2 (Derm, MSK) > Flashcards

Set 2 (Derm, MSK) Flashcards

1
Q

Cutaneous mycoses

A

Dermatophytosis

Pityriasis versicolor

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2
Q

Subcutaneous mycosis

A

Sporotrichosis

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3
Q

Mycoses w/ systemic involvement

A

Histoplasmosis
Blastomycosis
Coccidioidoses

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4
Q

Opportunistic mycoses

A

Candida
Aspergillus
Mucor and Rhizopus

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5
Q

Hypo or Hyper-pigmented skin patches that become more visible after tanning

A

Pityriasis versicolor (Malassezia furfur)

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6
Q

Spaghetti and meatball appearance

A

Malassezia furfur

Pityriasis versicolor

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7
Q

Etanercept

A

Recombinant form of TNA-receptor (binds TNF-alpha)

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8
Q

Cyclosporine MOA

A

Inhibits NFAT from entering nucleus –> inhibit release of IL-2 (thus: less activation of resting T cells)

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9
Q

Calcipotriene

A

VitD analog
(binds vitD receptor –> activate nuclear TF –>inhibit keratinocyte proliferation, stimulate keratinocyte differentiation)

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10
Q

Ustekinumab

A

Human monoclonal antibody used in psorasis that targets IL-12 and IL-23
(inhibits differentiation and activation of CD4+ Th1 and Th17 cells)

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11
Q

Gas gangrene: think of this organism

A

Clostridium perfringens

Gram + rod, spore-forming, abundant in soil

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12
Q

C. perfringens: causes?

A

Gas gangrene

Late-onset food poisoning (toxin-mediated): transient watery diarrhea

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13
Q

Hypotonia, Jaundice, Macroglossia
Constipationm, Umbilical hernia, Poor feeding
Risk of mental retardation if untreated
Increased incidence of CHD

A

Congenital HYPOthyroidism

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14
Q

Newborns are screened for?

A

Congenital HYPOthyroidism
PKU
Galactosemia

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15
Q

Developmental delay, Mental retardation
Mousy body odor
Fair skin coloring

A

PKU

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16
Q

Essential for normal brain development and myelination during early life

A

T4

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17
Q

Examples of postural skeletal m. rich in Type I (slow twitch, red) muscle fiber

A

Soleus

Paraspinal

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18
Q

Thyroidectomy: risk of injuring what nerves?

A

Recurrent laryngeal n. (ligature of inferior thyroid artery)

External br. of superior laryngeal n. (ligature of superior thyroid artery)

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19
Q

Anterior dislocation of shoulder joint

Fracture of NECK of humerus

A

Axillary n. damage:
Paralysis of deltoid, teres minor
Sensory loss of upper lateral arm

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20
Q

Violent stretch between head and shoulder (trauma, delivery)

A

Erb-Duchenne palsy

musculocutaneous and suprascapular nerves damage –> waiter’s tip posturing of arm

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21
Q

Common cause of long thoracic n. injury

A

Mastectomy or surgery in axillary region

Winging of scapula, inability to abduct shoulder PAST 90 degree

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22
Q

Role of ATP in skeletal and cardiac muscle contraction

A

RELEASE myosin head from its actin binding site

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23
Q

Calcium release in skeletal muscle results in?

A

Ca2+ –> binds troponin –> shift tropomyosin away from myosin binding site ON ACTIN

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24
Q

Phosphorylation of myosin light chain

A

ACTIVATING myosin to bind acting filament in SMOOTH MUSCLE

NOT seen in skeletal muscle

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25
Q

This is associated with temporal arteritis

A

Polymyalgia rheumatica

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26
Q

Preceding damage to myocytes
w/ subsequent over-expression of MHC-1 proteins on sarcolemma –>
infiltration with CD8+ T lymphocytes and myocyte damage

A

Polymyositis

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27
Q

Tabes dorsalis

A

Tertiary syphilis manifestation:

Demyelination and atrophy of medial dorsal roots and posterior columns –> SENSORY ATAXIA

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28
Q

Reactive arthritis: Syphilis

A

NO!!!!!!!!!!!

Caused by: Chlamydia, Campylobacter, Salmonella, Shigella, Yersinia etc.

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29
Q

Recurrent otitis media suggests?

A

HUMORAL immunodeficiency

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30
Q

Pneumocystis infection
Chronic mucocutanous candidiasis
Indicate?

A

Underlying T-cell deficiency

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31
Q

Recurrent infections caused by EXTRAcellular, ENCAPsulated organisms

A

Agammaglobulinemia

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32
Q

Phagocytic defects

A

Chronic granulomatous disease (recurrent abscess)

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33
Q

Increased susceptibility to infection by Neisseria

A

Complement deficiencies of C5-C9

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34
Q

C1, C3, C4 deficiencies

A

Lupus-like syndrome

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35
Q

Recurrrent infections by bacteria/virus/fungi/opportunistic pathogens
Failure to thrive
Chronic diarrhea
1st year of life

A

SCID

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36
Q

Candida skin tests gauges?

A

Type 4 hypersensitivity reaction

GOOD TEST OF CELL-MEDIATED immunity

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37
Q

Cells of cell-mediated immunity

A

CD4, CD8 T cells
NK cells
Macrophages

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38
Q

Extracellular glycoprotein that is abundant in:
Zonular fibers of lens
Periosteum
Aortic media

A

Fibrilin

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39
Q

Nodules that spread along lymphatics (subcutaneous)

Thorn prick

A

Sporothrix schenckii

Dimorphic fungi, gardner

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40
Q

Mental retardation
Eczema
Mousy/musty body odor

A

PKU

Autosomal recessive

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41
Q

Decreased proximal tubular uric acid reabsorption

A

Probenecid

Gout

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42
Q

Inhibition of phospholipase A2 activity

A

Glucocorticoid

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43
Q

Excessive metalloproteinase acitivity and myofibroblast accumulation during wound healing

A

Contracture

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44
Q

Trendelenburg sign

A

Hip dips TOWARD UNaffected side.

SUPERIOR gluteal n. (supplies gluteus minimus and medius)

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45
Q

Inferior gluteal n. injury

A

Difficulty rising form seated position and climbing stairs

Gluteus maximus

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46
Q

Femoral nerve

A

Flexion of thigh (iliacus, sartorius)
Extension of leg (quadriceps femoris)
Sensory to anterior thigh, medial leg

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47
Q

Sciatic nerve

A

All knee flexors (hamstrings) EXCEPT biceps femoras SHORT head

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48
Q

Lysyl hydroxylase deficiency

A

EDS w/ kyphoscoliosis and ocular fragility

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49
Q

Collagen containing disulfide-rich globular domains

A

EDS w/ procollagen peptidase deficiency
(Resulting in MORE soluble collagen that does NOT x-link properly with other collagen molecules)
(Joint laxity, loose skin, easy bruisability)

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50
Q

Tibial n.

A

Flexors of lower leg
Extrinsic digital flexors of toes
Skin of SOLE of foot

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51
Q

Cutaenous branches of saphenous nerve

A

Skin of MEDIAL leg

branch of femoral nerve

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52
Q

Medial aspect of foot innervated by?

A

Superficial peroneal n.

Br. of common peroneal n.

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53
Q

Calcaneovalgocavus position: dorsiflexed and everted foot.

A

Injury to tibial n.

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54
Q

Chronic lymphedema: risk factor for?

A

Angiosarcoma

Stewart-Traves syndrome

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55
Q

Hemangiomas

A

Benign congenital vascular neoplasms
Affect INFANTS
Often enlarge in months following birth before spontaneously involuting

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56
Q

T-tubules

A

Invaginations of sarcolemma
@ A-I junction
Coordinated contraction of all myofibrils.

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57
Q

Poor contractile forth on repeated muscle stimulation

A

Myasthenia gravis

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58
Q

Impaired relaxation after single contraction

A

Myotonic dystrophy

AD, trinucleotide repeat, abnormal myotonin protein kinase

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59
Q

Impaired energy production during muscle contraction

A

McArdle disease (glycogen storage disease type 5)

Muscle weakness and cramping DURING exercize; failure of muscle glycogen breakdown due to mutated myophosphorylase

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60
Q

Gram + cocci, Beta-hemolytic
Coagulase negative, Catalase negative
PYR positive

A

GAS

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61
Q

Necrotizing fasciitis bugs

A

GAS
S. aureus
C. perfringens
(GBS, Aeromonas hydrophila)

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62
Q

S. agalatiae can cause?

A

Skin and soft-tissue infection

NEWBORN SEPSIS AND MENINGITIS

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63
Q

CAMP test positive

A

S. agalatiae (GBS)

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64
Q

Succinylcholine: A/E

A

Significant K+ release
Life-threatening arrhythmia
In patients @ high risk of hyperkalemia (burns, myopathies, crush injuries, denervating injury/dz)

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65
Q

Succinylcholine

A

Depolarizing NMJ blocking agent (unlike Ach, NOT degraded by ACE)
(Phase I and Phase II block)

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66
Q

Atracurium

A

NON-depolarizing NMT blocker
(release histamine –> decreased BP, flushing, bronchoCONSTRICTION)

(metabolized by landanosine –> provoke seizure)

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67
Q

Baclofen

A

Muscle relaxant: GABA(B) receptors @ level of spinal cord

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68
Q

Dantrolene

A

Muscle relaxant for MALIGNANT HTN.

Acts on ryanodine receptors on SR –> prevent Ca2+ release into cytoplasm of muscle cell

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69
Q

Psoas muscle

A

Anterior surface of transverse processes and lateral surface of vertebral bodies T12-L5

Flex thigh
(and lateral rotation/abduction of hip)

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70
Q

Nafcillin
Methicillin
Oxacillin

A

Penicillinase-resistant penicillins

active against isolates of S. aureus and S. epidermidis that are resistant to other PCNs

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71
Q

Empirical tx for skin/soft tissue infections

folliculitis, abscesses

A

Nafcillin

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72
Q

Bacterioid species

A

Gram - rods
Anaerobic
Beta-lactamase producer

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73
Q

Tazobactam
Clavulanic acid
Sulbactam

A

Beta-lactamase inhibitor

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74
Q

Piperacillin-tazobactam

A

Extended-spectrum penicillin
+
Beta-lactamase inhibitor

(effective against most Gram negative rods- Pseudomonas, Bacterioides)

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75
Q

Ciprofloxacin: works against?

A

Gram negative rods (including Pseudomonas, Legionella)

NOT effective against anaerobes

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76
Q

Azithromycin

A

Binds 50s

For: Chlamhydia, Mycoplasma, H. influenza, M. catarrhalis

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77
Q

Vancomycin for?

A

MRSA
MRSE
C. diff

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78
Q

Dermatitis (rough, thick, scaly)
Diarrhea (atrophy/ulceration of GI tract)
Dementia (neuronal degeneration)

A

Pellagra

Niacin, B3, deficiency

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79
Q

Niacin: precursor

A

Tryptophan

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80
Q

NADP is essential for?

A

Hexose-monophosphate shunt of glucose metabolism

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81
Q

Population susceptible to pellagra?

A 
Population that primarily subsist on CORN
Alcoholics, HIV patients
Carcinoid syndrome
Hartnup disease
Isoniazid for long periods
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82
Q

Arginine is a precursor for?

A 
NO
Urea
Ornithine
Agmatine
Creatine
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83
Q

Tyrosine precursor

A

Phenylalanine

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84
Q

M/c dislocation of shoulder

A

Anterior dislocation of humerus

fall on outstretched hand, forceful external rotation and aBduction

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85
Q

Axillary nerve

A

Deltoid, Teres minor

Sensory to LATERAL arm; skin over deltoid

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86
Q

DOWNwd blow on TIP of shoulder

A

Acromioclavicular joint subluxation

swelling, upward displacement of clavicle, NO nerve damaged

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87
Q

Rotator cuff injury: nerve damaged

A

NONE

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88
Q

Flattening of deltoid muscle after shoulder injury

A

Anterior shoulder injury

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89
Q

Ehlers-Danlos: mutation

A

Collagen type I

lysyl-hydroxylase or pro-collagen peptidase mutation

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90
Q

Marfan syndrome mutation

A

AD: fibrillin-1 (MF that form sheath around ELASTIN)

Fibrillin abundant in BV, and suspensory ligament of LENS

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91
Q

Epidermolysis bullosa simplex

A

Defect in keratins 5 and 14

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92
Q

Metronidazole effective against?

A

Anaerobes (C. diff, Bacteroides)

Parasites (Enatamoeba, Giardia, Trichomonas)

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93
Q

Mefloquine is for?

A

Prevention and Tx. of P. falciparum infections

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94
Q

Tx. of Lyme disease

A

Doxycycline or PCN-type antibiotics

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95
Q

Lyme disease manifestation

A

Early localized: flu-like, erythema chronicum migrans
Early disseminated: AV block; Bell’s palsy
Chronic: asymmetric large joint arthritis, encephalopathy

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96
Q

Lamivudine

A

Nucleoside reverse transcriptase inhibitor

HIV

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97
Q

Neuroectoderm

A

CNS
Preganglionic autonomic neurons
Retina
Posterior pituitary

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98
Q

Surface ectoderm

A

Epidermis, appendages
Mammary glands (modified SWEAT glands)
Lens of eye
Adenohypophysis (Anterior pituitary)

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99
Q

M/c metastatic tumor to brain

A

Lung cancer
Renal cancer
Melanoma

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100
Q

Melanocyte: embryological origin

A

Neural crest cells

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101
Q

OI: inheritance

A

Mostly autosomal dominant

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102
Q

Defective mineralization of bone matrix

A

VitD deficiency

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103
Q

Associated with myasthenia gravis

A

Thymoma

Thymic hyperplasia

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104
Q

HPV: virus description

A

Double strand DNA virus
NON-enveloped
Icosahderal nucleocapsid

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105
Q

High AFP

A

NT defect
Abdominal wall defect
Multiple gestation

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106
Q

How does eosinophil kill parasite?

A

Antibody-dependent cellular toxicity (ADCC)

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107
Q

Eosinophil: functions

A

Defense against parasite

Regulate type 1 hypersensitivity rxn (histaminase, leukotrienes, peroxidase)

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108
Q

Parasite destruction by eosinophils: involvement of complement

A

NOPE!!!

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109
Q

Complement activation important in which hypersensitivity reaction?

A

Cytotoxic (type 2)

Immune complex mediated (type 3)

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110
Q

Important clues of AIN

A

Peripheral eosinophilia

Eosinophiluria

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111
Q

Berkson’s bias

A

Selection bias created by selecting hospitalized patients as control group.

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112
Q

Pygmalion effect

A

Researcher’s belief in the efficacy of tx THAT can potentialy affect the outcome

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113
Q

Hawthorne effect

A

Tendency of study population to affect an outcome due to knowledge of being studied.

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114
Q

Inhibit DHFR

A

TMP
Methotrexate
Pyrimethamine (antimalarial, toxoplasmosis)

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115
Q

Structural analog of PABA

Compete w/ PABA to inhibit dihydrofolic acid synthesis

A

SMX

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116
Q

Binds to DNA
Unravel DNA’s helical structure and break its strands
Inhibits protein synthesis

A

Metronidazole

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117
Q

Cilastatin used in conjunction w?

A

Imipenem (which binds PBP; inhibit final step in peptidoglycan synthesis)

Cilastatin prevents renal metabolism of imipenem (competitively inhibiting dehydropeptidase on renal tubule brush border)

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118
Q

Bacitracin

A

Prevent mucopeptide transfer into GROWING cell wall (inhibit cell wall synthesis)

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119
Q

Muscarinic cholinergic AGONIST

Post-surgery urinary retention

A

Bethanechol

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120
Q

Finasteride

A

5-alpha reductase inhibitor

for bladder outlet obstruction 2/2 to prostate hypertrophy

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121
Q

Phenylephrine

A

Alpha-agonist w/ some selectivity for alpha1 receptor

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122
Q

Oxybutynin

A

ANTI-muscarinic agent

for URGE incontinence

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123
Q

Imipramine: cholinergic vs. anti-cholinergic

A

ANTI-cholinergic

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124
Q

Postoperative urinary retention: tx w?

A 
Muscarinic AGONIST (bethanechol)
alpha-1 blocking drug (relax sphincter)
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125
Q

ill-fitting crutch (crutch palsy)

A

Radial nerve injury
(courses in axilla before entering posterior arm)
(paralysis/weakness of extensor muscle of forearm, wrist, finger –> wrist drop)

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126
Q

Suprascapular nerve

A

Supraspinatus: aBduct arm
Infraspinatus: laterally rotate arm

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127
Q

Most abundant amino acid in collagen molecule

A

Glycine

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128
Q

Sitting up from supine position: hip flexor or extensor

A

Flexor
(Iliopsoas mostly)

(+ rectus femoris, tensor fascia lata, sartoerius, medial thigh compartment))

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129
Q

Activate phospholipase-c

A

DAG –> Protein kinase C

IP3 –> calcium –> protein kianse C

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130
Q

Nerves, Arteries, Veins, Lymphatics of ovary are delivered by?

A

Suspensory ligament of ovary

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131
Q

Cardinal ligament contains?

A

Uterine artery

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132
Q

Hydroxychloroquine

A

SLE
or early mild seronegative RA
A/E: permanent retinal damage

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133
Q

Minocycline: A/E

A

Minimal

Include: photsensitivity

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134
Q

Tx of RA that causes stomatitis and liver function abnormality

A

Methotrexate

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135
Q

Recurrent infections w/o formation of pus
Delayed separation of umbilical cord
Poor wound healing

A

Leukocyte adhesion deficiency

AR, absence in CD18 antigen that is necessary for formation of INTEGRIN

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136
Q

Survival of BOTH catalase positive and catalase negative organism

A

Myeloperoxidase deficiency

vs. chronic granulomatous disease: some phagocytosed organism CAN be killed b/c they make their own hydrogen peroxide

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137
Q

Recurrent infection by Neisseria species

A

Deficiency of late complement components (C5b –> C9)

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138
Q

Wilson’s diease: lab

A

Ceruloplasmin is LOW

serum carrier protein for copper

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139
Q

alpha-2 globulins

A

Produced by liver and kidney

Haptoglobin, Ceruloplasmin, alpha2-macroglobulins

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140
Q

Mucupurulent cervicitis w/ cervical motion tenderness

A

PID

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141
Q

IL-2

A

Produced by helper T
Stimulates: CD4+/CD8+, B cells, NK and Monocytes.

T cells and NK cells –> anti-cancer (metastatic melanoma, renal cell carcinoma)

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142
Q

Alemtuzumab

A

anti-CD52

CLL treatment, direct cytotoxic effect through complement fixation and ADCC

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143
Q

Interferron gamma

A

Increase expression of MHC-I and II –> improving antigen presentation

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144
Q

Muscle spindle system

A

Muscle LENGTH

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145
Q

Golgi tendon system

A

Muscle FORCE/tension
(relatively insensitive to passive stretch)

In series w/ muscle (Ib sensory neurons)

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146
Q

A-delta fibers

A

Temperature and nociceptive stimuli

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147
Q

Muscle spindles (intrafusal)

A

Sensitive to changes in LENGTH (streth reflex)

Parallel w/ extrafusal fibers (Ia and II sensory neurons)

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148
Q

Pacinian vs. Ruffini’s end organ

A

Pacinian: rapidly adapting mechanoreceptors
Ruffini’s: slowly adapting mechanoreceptors

A-beta fibers!

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149
Q

Tx: giardiasis, trichomonas vaginitis, bacterial vaginosis

A

Metronidazole

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150
Q

Wool business

Ulcer w/ black eschar and significant surrounding edema

A

Bacillus anthracis

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151
Q

B. anthracis: toxin

A

Anthrax toxin:
Protective, Lethal, Edema factor
(Lethal factor: increased cAMP by acting as adenylate cyclase)

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152
Q

Bordetella pertusis: toxin

A

Pertussis toxin (disinhibit adenylate cyclase)

Adenylate cyclase toxin (increase cAMP –> edema, phagocytic dysfunction)

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153
Q

Ulnar nerve

A

C8-T1

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154
Q 
Palmar and dorsal interosseus muslce
Hypothenar
Palmaris brevis
3rd and 4th lumbricals
Adductor pollicis muscle
A 
Ulnar nerve
(which also does flexor carpi ulnaris and flexor digitorum profundis-medial section)
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155
Q

Ulnar nerve injury at elbow

A

Claw hand deformity

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156
Q

Ulnar nerve injury at Guyon’s tunnel

Between hook of hamate, and pisiform bone

A

Dysesthesia of ulnar side of hand

Weakness to INTRINSIC m. of hand

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157
Q

Difficulty w/ fine motor control of THUMB

A

Carpal tunnel: median nerve compression

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158
Q

Coracobrachialis muscle

A

Arm flexor

Innervated by musculocutaneous n.

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159
Q

Gram - rod
NON-lactose fermenting
Oxidase positive

A

Pseudomonas aeruginosa

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160
Q

Gram - rod
Lactose fermenting
Extensive antibiotic resistance
Nosocomial infections

A

EnteroBacter cloacae

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161
Q

Gram + cocci
Opportunistic infections
VRE

A

EnteroCoccus afecalis

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162
Q

Gram - rod
Lactose fermenting
Leading cause of UTI

A

E. coli

163
Q

Gram - rod
Lactose fermenting
Sponatneous bacterial peritonitis
Nosocomial pneumonias, UTIs

A

Klebsiella pneumoniae

164
Q

Gram + cocci
Catalase +
Coagulase -
UTI in sexually active women

A

Staphlococcus saprophyticus

Novobiocin RESISTANT

165
Q

Inhibit phospholipase A2

A

Glucocorticoid

166
Q

Zileuton

A

Inhibit 5-lipoxygenase

no LTB4, LTC4, LTD4, LTE4 formation

167
Q

Inhibit LTD4 receptor

A

Montelukast

168
Q

Leukotriene modifers are used for?

A

Preventing recurrence of:
Asthma attacks
Allergic rhinitis

169
Q

Etanercept

A

Soluble receptor decoy protein (for TNF-alpha)

170
Q
  • mab
  • cept
  • nib
A 
mab= monoclonal antibody
cept= receptor
nib= kinase inhibitor
171
Q

Rituximab

A

Chimeric
Anti-CD20 (surface of B cells)

Tx: CD20+ Non-HL, excessive B-cell function

172
Q

Infliximab

A

Chimeric
Anti-TNF-alpha

Tx: Autoimmune disease (RA, Crohn’s)

173
Q

Certolizumab

A

humanized
Anti-TNF-alpha and LACKS Fc region (prevent complement activation, cell mediated cytotoxicity)

Tx: AI disease w/ elevated TNF-alpha levels

174
Q

Imatinib

A

Tyrosine kinase receptor inhibitor

Tx:
philadelphia chromosome + CML
kit-positive GI stromal tumors

175
Q

Female
Male
What ducts makes most of the internal genitalia?

A

Female: PARAmesonephric
Male: mesonephric

176
Q

Mesonephric duct in female

A

Gartner’s duct

177
Q

Paramesonephric duct in males

A

Vestige appendices of testes

178
Q

Failure of urethral folds to fuse in males

A

HYPOspadias

179
Q

Which bands have ONLY thick myofilaments, ONY actin thin filament?

A

Only thick: H band

Only thin: I band

180
Q

A band

A

WHOLE thick myosin thick filament

181
Q

Vaginal adenosis

A

Squamous –> Columnar
a/w DES exposure in utero
Precursor for clear cell adenocarcinoma of vagina

182
Q

PCOS: at increased risk of?

A

DM TYPE 2
Lipid profile abnormality
Endometrial adenocarcinoma

183
Q

Periportal “pipestem” fibrosis

A

Hepatic schistosomiasis

184
Q

Bats are major reservoir for?

A

Rabies virus

185
Q

Echinococcus granulosus

A 
Dog tapeworm (sheep = intermediate host)
m/c/c of hydatid cyst
186
Q

Diphyllobothrium latum

A

Human tapeworm
Larvae from RAW FRESHWATER rISH

Results in: B12 deficiency and megaloblastic anemia

187
Q

Cysticercosis

A

Taenia solium

188
Q

Schistosomiasis

A

Contact w/ freshwater that contain SNAILS (larvae)

189
Q

Schistosoma japnicum
Schistosoma mansoni
Schistosoma haematobium

A

JM: intestinal (IDA) and hepatic schistosomiasis (portal HTN)

H: urinary schistosomiasis (hematuria, hydrocephrosis, squamous cell carcinoma of bladder)

190
Q

Sublimation

A

Mature defense mech

Angry –> Work out at gem

191
Q

Projection

A

IMmature defense mech

Cheat –> accuse classmate as cheaters

192
Q

Reaction formation

A

IMmature defense mech

Ignore feelings –> opposite sentiment adopted

193
Q

Displacement

A

IMmature defense mech

Angry at wife –> throw things

194
Q

Contraindicated in urethral injury

A

Placement of Foley catheter

195
Q

Inability to void w/ full bladder sensation
High riding boggy prostate
Blood at urethral meatus

A

Urethral injury

196
Q

Pelvic fracture

A

Anterior or Posterior urethra injury

Posterior MOST common

197
Q

Straddle injury

A

Anterior urethra injury

198
Q

Weakest part of posterior urethra

A

Membranous urethra

199
Q

Wrist drop

A

Radial nerve injury

200
Q

Limited hand flexion, thumb opposition

A

Median n.

201
Q

Limited finger ABduction

A

Median n.: recurrent branch

Ulnar n. deep branch

202
Q

Responsible for EXTENSION of hand

A

Radial n. (C5-T1)

203
Q

Hesselbach’s triangle

A

Inferior epigastric vesselsF
Inguinal ligament
Rectus abdominis

204
Q

Femoral hernia: location

A

BELOW inguinal ligament
Lateral to pubic tubercle
Medial to femoral artery/vein

205
Q

Femoral hernia: predisposition

A

Women
Right side
PRONE to incarceration!!!

206
Q

Direct vs. Indirect inguinal hernia: location w/ respect to inferior epigastric vessels

A

Direct: medial to vessels
Indirect: lateral to vessels

207
Q

Transversalis fascia

A

POSTERIOR wall of inguinal canal
Opening w/i = deep inguinal ring
Site of protrusion of INdirect inguinal hernias

208
Q

Hmologous to round ligament in females

A

Spermatic cord in males (pass through inguinal canal, leaves pelvis through deep inguinal ring)

209
Q

Unhappy triad

A

ACL
MCL
Lateral meniscus

210
Q

ACL prevents?

A

Anterior motion of tibia

211
Q

Patellar ligament

A

Inferior projection of quadriceps femoris tendon

Difficulty w/ leg EXTENSION when injured

212
Q

Anterior drawer test is for?

A

ACL

213
Q

Medial condyle of femur to posterior head of tibia

A

PCL

214
Q

Ulcer w/ central black eschar surrounded by edema

A

Bacillus anthracis (cutaneous)

215
Q

Bacillus anthracis: P2P

A

NO!

spores

216
Q

Nosense mutation

A

Single base substitution that introduces a PREMATURE STOP CODON.

217
Q

Prostate: rubbery

A

BPH

vs. nodular/firm of prostate cancer

218
Q

BPH: leads to renal parenchyma?

A

ATROPHY

Reflux nephropathy

219
Q

Glomerular sclerosis and hyalinosis

A

Diabetic nephrosclerosis

220
Q

Caudal regression syndrome associated with?

A

Poorly controlled maternal diabetes

221
Q

VitA overdose in pregnancy

A 
Craniofacial abnormalities
Posterior fossa CNS defects
Auditory defects
Great vessel abnormalities
(similar to DiGeorge syndrome)
222
Q

Strict vegetarians, at risk for?

A

Iron and VitB12 deficiencies

223
Q

Sacral agenesis: lower extremity paralysis and urinary incontinence

A

Caudal regression syndrome

224
Q

WBC cast w/ UTI

A

Pyelonephritis

225
Q

WBC cast form by?

A

WBC precipitated by Tamm-Horsfall protein secreted by tubular epithelial cells

226
Q

Fas receptor

A

Initiate EXTRINSIC pathway of apoptosis

227
Q

Anergy: occurs in T or B cells

A

T cells (immune tolerance)

228
Q

Isotype switching of B cells requires?

A

CD40 on activated B cells

CD40 ligand on activated T cells

229
Q

Th1 T cells

A

Cell-mediating

INF-gamma and IL12 induce Th1

230
Q

Th2 T cells

A

Antibody-mediating

IL-4 stimulates Th2 development

231
Q

1st pharyngeal pouch, membrane, groove

A

Pouch: epithelium of MIDDLE ear and auditory tube

Membrane: tympanic membrane

Groove:epithelium of EXTERNAL ear canal

232
Q

2nd pharyngeal pouch

A

Epithelium of palatine tonsil cryps

233
Q

3rd pharyngeal pouch

A

Thymus

Inferior parathyroid gland

234
Q

4th pharyngeal pouch

A

Superior parathyroid glands

Ultimobranchial body

235
Q

Primary abnormality in Paget’s disease of bone

A

Osteoclastic bone resorption

236
Q

Mosaic pattern of lamellar bone

Old man + bone pain + high AlkPhos

A

Paget’s disease of bone

237
Q

Beriberi

Wernicke syndrome

A

B1 (thiamine) deficiency

238
Q 
Cheilosis
Stomatitis
Glossitis
Dermatitis
Cornela vascularization
Ariboflavinosis
A

B2 (riboflavin) deficiency

239
Q

Cheilosis
Glossitis
Dermatitis
Peripheral neuropathy

A

B6 (pyridoxine) deficiency

240
Q

Bleeding diathesis

A

VitK deficiency

241
Q

Acrodermatitis enteropathica
Growth retardation
Infertility

A

Zinc deficiency

242
Q 
Hemorrhages
Subperiosteal hamartomas
Gingival swelling 
Bleeding gums
Hyperkeratotic papular rashes
Impaired wound healing
A

Vitamin C deficiency (scurvy)

243
Q

Calmodulin

Myosin light-chain kinase are elements of?

A

Smooth muscle!

244
Q

Decrease in acetylcholine receptors on postsynaptic terminal of muscle end plate results in?

A

Decreased end plate potential

Seen in myasthenia gravis

245
Q

Pyridostigmine

A

Cholinesterase inhibitor

for Myasthenia gravis

246
Q

Scopolamine

A

SELECTIVE muscarinic cholinergic receptor ANTAgonist (@gut)

Hyoscyamine is another agent that is similar

247
Q

Skeletal muscle utilize what type of receptor?

A

Nicotinic

248
Q

Prazosin

A

Alpha-1 adrenergic antagonist

249
Q

Fluoxetine

A

SSRI

250
Q

Pilocarpine

A

NONselective muscarinic receptor AGONIST.

251
Q

Myasthenia gravis tx

A

Cholinesterase inhibitor
(may result in overstimulation of muscarinic receptor –> use antimuscarinic agents like scopolamine)

Immunosuppressants
Thymectomy

252
Q

VitD synthesis

A

Sunlight: 7-dehydrocholesterol –> cholecalciferol (VitD3)
Liver: 25-hydroxylation
Kidney: 1-alpha hydroxlase

253
Q

Accurately reflect status of dietary and skin production of VitD

A

25-hydroxy vitamin D

254
Q

Type I hypersensitivity reaction: upon initial allergen exposure

A

Antibody class switching to IgE

255
Q

Ecthyma gangrenosum

A

Vascular destruction and cutaneous necrosis seen in Pseudomonas aeruginosa bacteremia and septicemia.

256
Q

. aeruginosa:virulence factors

A 
Exotoxin A (protein synthesis inhibitor)
Elastase (degrades elastin; BV destruction)
Phospholipase C (degrades cellular membrane)
Pyocyanin (generates ROS)
257
Q

m/c a/w necrotizing pneumonia in elderly or IMC-

A

Klebsiella

258
Q

Cystathionine beta-synthase deficiency

A

Homocystinuria

ectopic lentis, mental retardation, marfanoid habitus, osteoporosis, in addition to vascular problems

259
Q

Diffuse skin thickening
Cutaneous HYPOpigmentation in plaques (often accompanied by hair loss)
Leonine facies
Paresis and regional anesthesia of motor and sensory nerves
Testicular destruction
Blindness

A

Lepromatous leprosy

260
Q

Severity of Leprosy depends on?

A

Strength of cell-mediated immune response

tuberculoid MILDER than lepromatous

261
Q

Cold agglutinins are characteristc of?

A

Mycoplasma infection

262
Q

Rheumatoid factor is a ?

A

IgM antibody toward Fc component of self IgG

263
Q

Antimitochondrial antibody

A

Primary biliary cirrhosis

264
Q

Postauricular and occipital LAD

A

Rubella

LAD caused by togavirus

265
Q

“Slapped cheek” appearance + maculopapular rash on extremities and trunk

A

Erythema infectiosum

Parvovirus

266
Q

Febrile maculopapular rash that begins on face and spreads to trunk/extremity

A

Rubeola (measles) —-additional finding of postauricular LAD
Rubella (German measles)

267
Q

Enzyme deficiencies of early steps in porphyrin synthesis

A

Abdominal pain
Neuropsychiatric manifestation
W/O photosensitivity (which is present w/ deficiencies of late steps)

268
Q

Defects in URO decarboxylase, COPRO oxidase, PROTO oxidase, Ferrochelatase

A

Enzyme deficiencies of LATE porphyrin synthesis: results in photosensitivity

269
Q

ALA synthase deficiency

A

Decrease in formation of ALL porphyrins

Decrease in heme synthesis –> concucrrent HYPOchromic, MICROcytic anemia

270
Q

ALA synthase requires?

A

Cofactor: Pyridoxal phosphate (Vit B6)

271
Q

Capitation

A

Paid fixed amount per patient, NOT per service

more incentives to CONSERVE cost

272
Q

PRPP synthase activating mutation can lead to?

A

Too much synthesis of activated ribose (for purine/pyrimidine synthesis)

Too much PRPP synthase –> Gout

273
Q

von Gierke disease

A

G6PD deficiency

274
Q

Pompe disease

A

Acid maltase deficiency

275
Q

M/C cuase of malignant acanthosis nigricans

A

Gastric adenocarcinoma

276
Q

Hypersecretion of serotonin can occur in what type of tumor?

A

Carcinoid

277
Q

Loss of knee jerk

A

Femoral nerve damage

278
Q

Difficulty w/ plantar flexion

A

Tibial nerve damage (popliteus, flexor of foot)

279
Q

Sensation to calf

A

Lateral sural cutaneous (br. of tibial n.)

280
Q

Center of wrist: which bone?

A

Capitate

281
Q

Bones that articulate with radius

A

Scaphoid
Lunate
(injured by fall on outstretched, dorsiflexed hand)

282
Q

Thumb swings on the ?

A

Trapezium

283
Q

IL-4

A

Produced by Th2 (T helper)

Facilitates: B cells and Th2 lymphocyte
Stimulates: antibody isotype switching –> particularly to IgE

284
Q

IL-1

A

Produced by macrophages
Activates naive T cell –> Th1 and Th2
Endogenous pyrogen

285
Q

IL-2

A

Secreted by Th1

Stimulate development of CD4+, CD8+, B cells.

286
Q

IL-3

A

Produced by T-helper cells

Stimulates growth and differentiation of bone marrow stem cell

287
Q

IL-12

A

Synthesized by macrophages

Stimulates growth and development of Th1 cells

288
Q

IL-5

A

B cell differentiation

Stimulates IgA production and Eosinophil activity (host defense against parasites)

289
Q

Housemaid’s knee

A

Prepatellar bursitis

290
Q

Popliteal and gastrocnemius bursitis can be a/w?

A

Formation of Baker’s cysts

291
Q

Anserine bursitis (pes anserinus bursitis)

A

Pain along medial aspect of knee

Overuse in atheletes or from chronic trauma (heavy body habitus)

292
Q

Latissimus dorsi

A

Thoracodorsal n.

aDduct and extend humerus

293
Q

Rhomboid major

A

Dorsal scapular n.

Draw scapula medially at medial border

294
Q

Teres major

A

Subscapular n.

aDuct and Medially rotate arm

295
Q

Deltoid

A

Axillary n.

Flex, Extend, aBduct arm

296
Q

Valsalva maneuver

A

Increase vagal tone
Abolish paroxysmal SVT
Rectus abdominis (increase abdominal and thoracic pressure)

297
Q

Raloxifene

A

SERM
Estrogen agonist at bone, CDV, blood lipoproteins
Estrogen ANTAgonist at breast

298
Q

Aledronate

A

Synthetic bisphosphonate analog of pyrophosphate

299
Q

Leuprolide

A

GnRH analog

agonist and antagonist depending on method of administration

300
Q

Antipsychotics act primarily at what receptors?

A 
D2 receptors (mesolimb-mesocortical pathway)
BUT
Simultaneously block dopamine in nigrostriatal pathway (imbalance between D2 and M1 receptor)
301
Q

GABA(a) antagonist

A

Inhibit action of GABA

Counteract acute overdose of benzodiazepine

302
Q

Flumazenil

A

GABA(a) antagonist

303
Q

Terbinafine

A

Oral anti-fungal

squalene epoxidase inhibitor

304
Q

3 m/c/c of hair loss

A

Male pattern baldness
Tinea capitis
Telogen effluvium

305
Q

Alopecia areata

A

AI dz that causes patchy or diffuse hair loss

306
Q

Psoas sign

A

Pain when hip is extended.

307
Q

Psoas sign

A

Pain when hip is extended.

308
Q

Alkaptonuria

A

AR, black urine, onchronisis (blue-black pigmentation)
Lack of homogentisic oxidase (phenylalnine –> tyrosine –> fumarate; accumulation of homogentisic acid –> black urine)

309
Q

Ankylosing spondylitis: MSK, Respiratory, CDV, Eye involvement

A

MSK: peripheral enthesitis
Respiratory: chest wall expansion (costovertebral/sternal jxn)
CDV: ascending aortitis –> dilatation of aortic ring –> aortic insufficiency
Eye: uveitis

310
Q

Accumulation of homogentisic acid

A

Alkaptouria

311
Q

Lepromin skin test

A

+ in pts. w/ TUBERCULOID leprosy (STRONG CD4+ Th1 cell-mediated immune response)

  • in pts. w/ LEPROMATOUS leprosy (weak cell-mediated response)
312
Q

Parvovirus B19

A

Erythema infectiosum in kids

Arthritis in adults (self-resolving)

313
Q

Albinism

A

HAVE melanocytes

do NOT produce melanin (b/c defective TYROSINASE)

314
Q

Lentigo

A

Benign LINEAR melanocytic hyperplasia

315
Q

Avascular necrosis of femoral head a/w?

A

Sickle cell disease
Steroid therapy
SLE
Alcoholism

316
Q

Acute onset of hip pain exacerbated by weight bearing.

NO swelling, erythema, temperature change

A

Avascular necrosis of femoral head.

MRI diagnostic modality of choice

317
Q

Succinylcholine

A

Depolarizing NMJ BLOCKER.

318
Q

Dantrolene

A

Relax skeletal muscle by reducing Ca2+ release from SR

Tx: malignant HTN, neuroleptic malignant syndrome

319
Q

Pancuronium

Tubucurarine

A

NON-depolarizing NMJ blocker.

competitive antagonist of nicotinic acetylcholine receptor

320
Q

Reverses NON-depolarizing NMJ blockade.

A

Neostigmine

321
Q

Neostigmine reverse DEPOLARIZING NMJ blockade (ex: succinylcholine)?

A

If given during phase I: BAD (augments blockade)

If given during phase II: Good

322
Q

Duration of paralysis caused by succinylcholine depends on?

A

Catabolism by plasma cholinesterase

323
Q

Neostigmine

A

Cholinesterase inhibitor

324
Q

Fine skin wrinkles occurs 2/2 to?

A

Decreased synthesis and net loss of dermal collagen and elastin

325
Q

Pseudogout most likely involves what joint (50%)?

A

Knee

vs. first metatarsophalangeal in gout

326
Q

Langhans cell

A

Multinucleated giant cell w/ horseshoe-shaped arrangement of multiple nuclei derived from monocyte cell line
(Granulomatous inflammation)

327
Q

Langerhans cell

A

Dendritic cells in skin (professional APC)
Myeloid cell line
Racquet shaped intracytoplasmic granules (Birbeck granules)

328
Q

Birbeck granules

A

Langerhans cells (racquet shaped intracytoplasmic granules)

329
Q

Risus sardonicus

A

Facial muscle spasm (seen in Tetanus)

330
Q

Tetanospasmin MOA

A

Binds ganglioside receptors on neuronal membrane: inhibiting release of glycine and GABA from inhibitory neurons

331
Q 
Immunodeficiency
Albinism
Neurologic defect (nystagmus, peripheral/cranial neuropathy)
A

Chediak-Higashi syndrome

AR, defect in neutrophil phagosome lysosome fusion

332
Q

NADPH oxidase deficiency

A

Chronic granulomatous disease

Neutrophils unable to kill catalase producing organisms

333
Q 
CNS abnormalities (developmental delay, Mental retardation)
Features of albinism
Mousy body odor
A

PKU

Deficiency of phenylalanine hydroxylase

334
Q

Wiskott-Aldrich syndrome

A

X-linked
Immunodeficiency, Eczema, Thrombocytopenia
(Combined B and T lymphocyte disorder)

335
Q

DiGeorge syndrome occurs due to?

A

Deletion on chromosome 22 (maldevelopment of 3rd and 4th pharngeal pouches)

336
Q

Thymic and Parathyroid hypoplasia
Abnormal facies
Cardiac defects

A

DiGeorge syndrome

337
Q

Recurrent viral, fungal, protozoal infection

A

T cell defect (ex: thymic hypoplasia in DiGeorge)

338
Q

Defective neutrophil function

A

Recurrent pyogenic infections m/c caused by Staph and Strep.

339
Q

Ataxia
Episodic erythematous and pruritic skin lesions
Photosensitivity
Loose stools
Aminoaciduria: restricted to NEUTRAL a.a.

A

Hartnup Disease

340
Q

Clinical manifestation of Hartnup is primarily due to?

A

Niacin (Vit B3) deficiency

due to malabsorption of tryptophan

341
Q

Niacin is synthesized from?

A

Tryptophan (essential amino acid)

342
Q

FMN and FAD are synthesized from?

A

Riboflavin (Vitamin B2)

343
Q 
Cheilosis
Glossitis
Keratitis
Conjunctivitus
Photophobia
Lacrimation
Corneal vascularization
Seborrheic dermatitis
A

Riboflavin deficiency (Vitamin B2)

344
Q

Folic acid vs. B12 deficiency

A

Both: megaloblastic anemia
B12: degeneration of posterior and lateral columns

345
Q

Anemia
Peripheral neuropathy
Dermatitis

A

Pyridoxine deficiency

346
Q

D-glutamate capsule seen in?

A

Bacillus anthracis

347
Q

Serpentine or Medusa head in culture

A

Bacillus anthracis

348
Q

Protein A virulence factor

A

Bind Fc portion of IgG

prevent opsonization and complement-mediated killing of bacteria

349
Q

Intracellular polyphosphate granules

A

Cornyebacterium diptheriae

Loeffler medium, stain w/ methylene blue

350
Q

Peritrichous flagella

A

Flagella distributed uniformly over entire surface of bacteria
HIGHLY motile organisms (ex: Proteus mirabilis)

351
Q

Posterior cruciate ligament: anatomy

A

Femur: MEDIAL condyle (anterolateral surface)
to
Tibia: posterior intercondylar area

352
Q

Cervical cytology: multinulceated giant cell w/ intranuclear inclusion

A

HSV (particularly HSV2)

353
Q

Yellow-green, foamy, foul smelling discharge

A

Trichomonas vaginitis

Motile trophozoites w/ flagellae

354
Q

TNF-alpha inhibitors

A

Infliximab
Etanercept
Adalimumab

355
Q

TNF-alpha: crucial A/E

A

Decrease macrophage function –> reactivation of latent TB

356
Q

Plane xanthomas

A

Linear lesions in skin folds

strongly suggests Primary Biliary Cirrhosis

357
Q

Treating Measles: vitamin that can be of benefit?

A

Vitamin A

358
Q

PABA containing sunscreen: protect against?

A

UVB only

359
Q

Sunscreen with this ingredient is BROAD spectrum: UVB, UVAI, UVAII

A

Zinc oxide

360
Q

UVA blocking agent

A

Avobenzone

361
Q

2 most important factors for osteoClastic differentiation

A

M-CSF
RANK-L
(Both secreted by osteoBlasts)

362
Q

Multinucleated cell with OVER 100 nuclei

Positive for tartrate resistant acid phosphatase

A

OsteoClasts seen in Paget’s Disease of bone

normally, osteoclasts have ~5 nuclei

363
Q

Irreversible retinal damage with this drug.

A

Hydroxychloroquine

364
Q

Fibroblast growth factors and bone

A

Increase bone formation by stimulating osteoblasts (increase bone matrix formation)

365
Q

TGF-beta

A

Increase formation of mature osteoblasts
Increase collagen synthesis
Decrease bone resorption (increase osteoclast apoptosis)

366
Q

Net effect of IGF-1 on bone

A

ANABOLIC (formation)

Increase osteoblast replication and collagen synthesis, decrease collagen degradation by inhibiting MMP-13

367
Q

Marker of bone formation

A

Osteocalcin

368
Q

Granulomatous disorder
Bilateral hilar LAD
Hypercalcemia

A

Sarcoidosis

369
Q

Hypercalcemia in sarcoidosis arise due to?

A

Increased EXTRArenal formation of 1,25-dihydroxy vitD (via activated macrophages).

Hypercalcemia –> suppress PTH.

370
Q

Increase activity of 1-alpha hydroxylase activity in macrophages

A

Gamma interferron from T lymphocytes

Sarcoidosis, Hodgkin’s lymphoma

371
Q

Alkaline phosphatase: important sources

A

Bone (easily denatured by heat)
Liver
(Intestine)

372
Q

What secretes calcitonin

A

Parafollicular C cells of thyroid gland

373
Q

Calcitonin is a marker for?

A

Medullary thyroid cancer

374
Q

M/c used method in assessing osteoclastic activity

A

Urinary deoxypyridinoline excretion

pyridinoline convalently x-link collagen fiber, x-links are m/c used method in assessing osteoclastic activity

375
Q

Tartrate-resistant acid phosphtase
Urinary hydroxyproline
Urinary deoxypyridinoline

A

Reflects osteoclastic activity

urinary deoxypyridinoline is MOST reliable

376
Q

Sudden upward jerking of arm at shoulder

A

Injury to LOWER trunk of brachial plexus (C8-T1)

Median and Ulnar nerve –> hand clumsiness/paralysis

377
Q

Posterior arm numbness

Paralysis of arm and forearm extensors

A

Radial nerve injury

378
Q

Upper trunk of brachial plexus injury

A

When head and shoulder are violently stretched

musculocutaneous n.: weakness of forearm flexion @ elbow

379
Q

Musculocutaneous n. innervate?

A

Biceps brachii and brachialis muscle

Flexion of forearm @ elbow

380
Q

Innervate all intrinsic muscle of hand

A

Median and Ulnar n.

381
Q

Superficial and deep peroneal n.

A

Branches of common peroneal.

Superficial: lateral compartment of leg (evert), sensory to most of foot.
Deep: anterior compartment of leg (dorsiflex), sensory only to region btwn 1st and 2nd digits

382
Q

Inverted

Plantarflexed foot

A

Common peroneal n. injury (near fibular head m/c)

383
Q

Sandpaper like rash (erythematous, adherent scale)
Sun-exposed areas
Basal cell layer atypia

A

Actinic keratoses
(hyperkeratosis, parakeratosis)
(at risk for squamous cell carcinoma)

384
Q

Superficial benign firous histiocytoma
(Benign proliferation of fibroblast)
Lower extremities as solitary nodules

A

Dermatofibroma

385
Q

Nests of basaloid cells

Peripheral palisading nuclei

A

Basal cell carcinoma

386
Q

m/c elbow injury in children (1-4)

A

Radial head subluxation (annular ligament injury)

Elbow extended, forearm pronated: nursemaid’s elbow

387
Q

Popeye deformity

A

Biceps tendon rupture

palpable mass in mid-upper arm

388
Q

Throwers (baseball pitchers)

Intense valgus stress at elbow

A

Ulnar collateral ligament injury

389
Q

Midshaft humerus injury

A

Radial nerve

Deep brachial artery

390
Q

Supracondylar fracture of humerus

A

Brachial artery injury

391
Q

Sporicidal

A 
Hydrogen peroxide (destructive free radicals)
Iodine (halogenation of proteins & nucleic acid)
392
Q

Chlorhexidine (disinfectant)

A

Disruption of cell membrane
Coagulation of cytoplasm

Contraindicated in neurologic/otologic/opthalmologic procedures due to neurotoxicity

393
Q

Type 4 hypersensitivity are mediated by?

A

T lymphocytes

394
Q

BRAF mutation

A

Tyrosine kinase mutation (BRAF V600E)

40-60% of melanoma

395
Q

Herpes zoster ophthalmicus

A

VZV infection of TRIGEMINAL ganglion (CN5 V1)

396
Q

M/c neurological complication of varicella zoster infection

A

Post-herpatic neuralgia

397
Q

Herald patch on trunk, neck, extremities
Pink or brown scaly plaque w/ central clearing
“Christmas tree” pattern along skin tension lines

A

Pityriasis rosea

398
Q

Wickham’s striae

A

Lichen planus

polygonal, planar, pruritic, purplish plaques

399
Q

Accumualtion of neutrophils on tips of dermal papillae (microabsesses)

A

Dersmatitis herpetiformis

400
Q

Molluscum contagiosum

A

Poxvixurs
Eosinophilic cytoplasmic inclusions (molluscum bodies)
Dome-shaped umbilicated papules

401
Q

Intranuclear inclusions in keratinocytes
Multinucleated giant cells
(positive Tzanck smear)

A

Herpes zoster (shingles)

402
Q

Duchenne muscular dystrophy: inheritance

A

X-linked recessive

403
Q

Calcium sparing diuretic

A

Hydrochlorothiazide

UWorld (17 decks)

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