Set 2 (Derm, MSK) Flashcards
1
Q
Cutaneous mycoses
A
Dermatophytosis
Pityriasis versicolor
2
Q
Subcutaneous mycosis
A
Sporotrichosis
3
Q
Mycoses w/ systemic involvement
A
Histoplasmosis
Blastomycosis
Coccidioidoses
4
Q
Opportunistic mycoses
A
Candida
Aspergillus
Mucor and Rhizopus
5
Q
Hypo or Hyper-pigmented skin patches that become more visible after tanning
A
Pityriasis versicolor (Malassezia furfur)
6
Q
Spaghetti and meatball appearance
A
Malassezia furfur
Pityriasis versicolor
7
Q
Etanercept
A
Recombinant form of TNA-receptor (binds TNF-alpha)
8
Q
Cyclosporine MOA
A
Inhibits NFAT from entering nucleus –> inhibit release of IL-2 (thus: less activation of resting T cells)
9
Q
Calcipotriene
A
VitD analog
(binds vitD receptor –> activate nuclear TF –>inhibit keratinocyte proliferation, stimulate keratinocyte differentiation)
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)
11
Q
Gas gangrene: think of this organism
A
Clostridium perfringens
Gram + rod, spore-forming, abundant in soil
12
Q
C. perfringens: causes?
A
Gas gangrene
Late-onset food poisoning (toxin-mediated): transient watery diarrhea
13
Q
Hypotonia, Jaundice, Macroglossia
Constipationm, Umbilical hernia, Poor feeding
Risk of mental retardation if untreated
Increased incidence of CHD
A
Congenital HYPOthyroidism
14
Q
Newborns are screened for?
A
Congenital HYPOthyroidism
PKU
Galactosemia
15
Q
Developmental delay, Mental retardation
Mousy body odor
Fair skin coloring
A
PKU
16
Q
Essential for normal brain development and myelination during early life
A
T4
17
Q
Examples of postural skeletal m. rich in Type I (slow twitch, red) muscle fiber
A
Soleus
Paraspinal
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)
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
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
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
22
Q
Role of ATP in skeletal and cardiac muscle contraction
A
RELEASE myosin head from its actin binding site
23
Q
Calcium release in skeletal muscle results in?
A
Ca2+ –> binds troponin –> shift tropomyosin away from myosin binding site ON ACTIN
24
Q
Phosphorylation of myosin light chain
A
ACTIVATING myosin to bind acting filament in SMOOTH MUSCLE
NOT seen in skeletal muscle
25
This is associated with temporal arteritis
Polymyalgia rheumatica
26
Preceding damage to myocytes
w/ subsequent over-expression of MHC-1 proteins on sarcolemma -->
infiltration with CD8+ T lymphocytes and myocyte damage
Polymyositis
27
Tabes dorsalis
Tertiary syphilis manifestation:
| Demyelination and atrophy of medial dorsal roots and posterior columns --> SENSORY ATAXIA
28
Reactive arthritis: Syphilis
NO!!!!!!!!!!!
| Caused by: Chlamydia, Campylobacter, Salmonella, Shigella, Yersinia etc.
29
Recurrent otitis media suggests?
HUMORAL immunodeficiency
30
Pneumocystis infection
Chronic mucocutanous candidiasis
Indicate?
Underlying T-cell deficiency
31
Recurrent infections caused by EXTRAcellular, ENCAPsulated organisms
Agammaglobulinemia
32
Phagocytic defects
Chronic granulomatous disease (recurrent abscess)
33
Increased susceptibility to infection by Neisseria
Complement deficiencies of C5-C9
34
C1, C3, C4 deficiencies
Lupus-like syndrome
35
Recurrrent infections by bacteria/virus/fungi/opportunistic pathogens
Failure to thrive
Chronic diarrhea
1st year of life
SCID
36
Candida skin tests gauges?
Type 4 hypersensitivity reaction
| GOOD TEST OF CELL-MEDIATED immunity
37
Cells of cell-mediated immunity
CD4, CD8 T cells
NK cells
Macrophages
38
Extracellular glycoprotein that is abundant in:
Zonular fibers of lens
Periosteum
Aortic media
Fibrilin
39
Nodules that spread along lymphatics (subcutaneous)
| Thorn prick
Sporothrix schenckii
| Dimorphic fungi, gardner
40
Mental retardation
Eczema
Mousy/musty body odor
PKU
| Autosomal recessive
41
Decreased proximal tubular uric acid reabsorption
Probenecid
| Gout
42
Inhibition of phospholipase A2 activity
Glucocorticoid
43
Excessive metalloproteinase acitivity and myofibroblast accumulation during wound healing
Contracture
44
Trendelenburg sign
Hip dips TOWARD UNaffected side.
| SUPERIOR gluteal n. (supplies gluteus minimus and medius)
45
Inferior gluteal n. injury
Difficulty rising form seated position and climbing stairs
| Gluteus maximus
46
Femoral nerve
Flexion of thigh (iliacus, sartorius)
Extension of leg (quadriceps femoris)
Sensory to anterior thigh, medial leg
47
Sciatic nerve
All knee flexors (hamstrings) EXCEPT biceps femoras SHORT head
48
Lysyl hydroxylase deficiency
EDS w/ kyphoscoliosis and ocular fragility
49
Collagen containing disulfide-rich globular domains
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)
50
Tibial n.
Flexors of lower leg
Extrinsic digital flexors of toes
Skin of SOLE of foot
51
Cutaenous branches of saphenous nerve
Skin of MEDIAL leg
| branch of femoral nerve
52
Medial aspect of foot innervated by?
Superficial peroneal n.
| Br. of common peroneal n.
53
Calcaneovalgocavus position: dorsiflexed and everted foot.
Injury to tibial n.
54
Chronic lymphedema: risk factor for?
Angiosarcoma
| Stewart-Traves syndrome
55
Hemangiomas
Benign congenital vascular neoplasms
Affect INFANTS
Often enlarge in months following birth before spontaneously involuting
56
T-tubules
Invaginations of sarcolemma
@ A-I junction
Coordinated contraction of all myofibrils.
57
Poor contractile forth on repeated muscle stimulation
Myasthenia gravis
58
Impaired relaxation after single contraction
Myotonic dystrophy
| AD, trinucleotide repeat, abnormal myotonin protein kinase
59
Impaired energy production during muscle contraction
McArdle disease (glycogen storage disease type 5)
| Muscle weakness and cramping DURING exercize; failure of muscle glycogen breakdown due to mutated myophosphorylase
60
Gram + cocci, Beta-hemolytic
Coagulase negative, Catalase negative
PYR positive
GAS
61
Necrotizing fasciitis bugs
GAS
S. aureus
C. perfringens
(GBS, Aeromonas hydrophila)
62
S. agalatiae can cause?
Skin and soft-tissue infection
| NEWBORN SEPSIS AND MENINGITIS
63
CAMP test positive
S. agalatiae (GBS)
64
Succinylcholine: A/E
Significant K+ release
Life-threatening arrhythmia
In patients @ high risk of hyperkalemia (burns, myopathies, crush injuries, denervating injury/dz)
65
Succinylcholine
Depolarizing NMJ blocking agent (unlike Ach, NOT degraded by ACE)
(Phase I and Phase II block)
66
Atracurium
NON-depolarizing NMT blocker
(release histamine --> decreased BP, flushing, bronchoCONSTRICTION)
(metabolized by landanosine --> provoke seizure)
67
Baclofen
Muscle relaxant: GABA(B) receptors @ level of spinal cord
68
Dantrolene
Muscle relaxant for MALIGNANT HTN.
| Acts on ryanodine receptors on SR --> prevent Ca2+ release into cytoplasm of muscle cell
69
Psoas muscle
Anterior surface of transverse processes and lateral surface of vertebral bodies T12-L5
Flex thigh
(and lateral rotation/abduction of hip)
70
Nafcillin
Methicillin
Oxacillin
Penicillinase-resistant penicillins
| active against isolates of S. aureus and S. epidermidis that are resistant to other PCNs
71
Empirical tx for skin/soft tissue infections
| folliculitis, abscesses
Nafcillin
72
Bacterioid species
Gram - rods
Anaerobic
Beta-lactamase producer
73
Tazobactam
Clavulanic acid
Sulbactam
Beta-lactamase inhibitor
74
Piperacillin-tazobactam
Extended-spectrum penicillin
+
Beta-lactamase inhibitor
(effective against most Gram negative rods- Pseudomonas, Bacterioides)
75
Ciprofloxacin: works against?
Gram negative rods (including Pseudomonas, Legionella)
| NOT effective against anaerobes
76
Azithromycin
Binds 50s
For: Chlamhydia, Mycoplasma, H. influenza, M. catarrhalis
77
Vancomycin for?
MRSA
MRSE
C. diff
78
Dermatitis (rough, thick, scaly)
Diarrhea (atrophy/ulceration of GI tract)
Dementia (neuronal degeneration)
Pellagra
| Niacin, B3, deficiency
79
Niacin: precursor
Tryptophan
80
NADP is essential for?
Hexose-monophosphate shunt of glucose metabolism
81
Population susceptible to pellagra?
```
Population that primarily subsist on CORN
Alcoholics, HIV patients
Carcinoid syndrome
Hartnup disease
Isoniazid for long periods
```
82
Arginine is a precursor for?
```
NO
Urea
Ornithine
Agmatine
Creatine
```
83
Tyrosine precursor
Phenylalanine
84
M/c dislocation of shoulder
Anterior dislocation of humerus
| fall on outstretched hand, forceful external rotation and aBduction
85
Axillary nerve
Deltoid, Teres minor
| Sensory to LATERAL arm; skin over deltoid
86
DOWNwd blow on TIP of shoulder
Acromioclavicular joint subluxation
| swelling, upward displacement of clavicle, NO nerve damaged
87
Rotator cuff injury: nerve damaged
NONE
88
Flattening of deltoid muscle after shoulder injury
Anterior shoulder injury
89
Ehlers-Danlos: mutation
Collagen type I
| lysyl-hydroxylase or pro-collagen peptidase mutation
90
Marfan syndrome mutation
AD: fibrillin-1 (MF that form sheath around ELASTIN)
| Fibrillin abundant in BV, and suspensory ligament of LENS
91
Epidermolysis bullosa simplex
Defect in keratins 5 and 14
92
Metronidazole effective against?
Anaerobes (C. diff, Bacteroides)
| Parasites (Enatamoeba, Giardia, Trichomonas)
93
Mefloquine is for?
Prevention and Tx. of P. falciparum infections
94
Tx. of Lyme disease
Doxycycline or PCN-type antibiotics
95
Lyme disease manifestation
Early localized: flu-like, erythema chronicum migrans
Early disseminated: AV block; Bell's palsy
Chronic: asymmetric large joint arthritis, encephalopathy
96
Lamivudine
Nucleoside reverse transcriptase inhibitor
| HIV
97
Neuroectoderm
CNS
Preganglionic autonomic neurons
Retina
Posterior pituitary
98
Surface ectoderm
Epidermis, appendages
Mammary glands (modified SWEAT glands)
Lens of eye
Adenohypophysis (Anterior pituitary)
99
M/c metastatic tumor to brain
Lung cancer
Renal cancer
Melanoma
100
Melanocyte: embryological origin
Neural crest cells
101
OI: inheritance
Mostly autosomal dominant
102
Defective mineralization of bone matrix
VitD deficiency
103
Associated with myasthenia gravis
Thymoma
| Thymic hyperplasia
104
HPV: virus description
Double strand DNA virus
NON-enveloped
Icosahderal nucleocapsid
105
High AFP
NT defect
Abdominal wall defect
Multiple gestation
106
How does eosinophil kill parasite?
Antibody-dependent cellular toxicity (ADCC)
107
Eosinophil: functions
Defense against parasite
| Regulate type 1 hypersensitivity rxn (histaminase, leukotrienes, peroxidase)
108
Parasite destruction by eosinophils: involvement of complement
NOPE!!!
109
Complement activation important in which hypersensitivity reaction?
Cytotoxic (type 2)
| Immune complex mediated (type 3)
110
Important clues of AIN
Peripheral eosinophilia
| Eosinophiluria
111
Berkson's bias
Selection bias created by selecting hospitalized patients as control group.
112
Pygmalion effect
Researcher's belief in the efficacy of tx THAT can potentialy affect the outcome
113
Hawthorne effect
Tendency of study population to affect an outcome due to knowledge of being studied.
114
Inhibit DHFR
TMP
Methotrexate
Pyrimethamine (antimalarial, toxoplasmosis)
115
Structural analog of PABA
| Compete w/ PABA to inhibit dihydrofolic acid synthesis
SMX
116
Binds to DNA
Unravel DNA's helical structure and break its strands
Inhibits protein synthesis
Metronidazole
117
Cilastatin used in conjunction w?
Imipenem (which binds PBP; inhibit final step in peptidoglycan synthesis)
Cilastatin prevents renal metabolism of imipenem (competitively inhibiting dehydropeptidase on renal tubule brush border)
118
Bacitracin
Prevent mucopeptide transfer into GROWING cell wall (inhibit cell wall synthesis)
119
Muscarinic cholinergic AGONIST
| Post-surgery urinary retention
Bethanechol
120
Finasteride
5-alpha reductase inhibitor
| for bladder outlet obstruction 2/2 to prostate hypertrophy
121
Phenylephrine
Alpha-agonist w/ some selectivity for alpha1 receptor
122
Oxybutynin
ANTI-muscarinic agent
| for URGE incontinence
123
Imipramine: cholinergic vs. anti-cholinergic
ANTI-cholinergic
124
Postoperative urinary retention: tx w?
```
Muscarinic AGONIST (bethanechol)
alpha-1 blocking drug (relax sphincter)
```
125
ill-fitting crutch (crutch palsy)
Radial nerve injury
(courses in axilla before entering posterior arm)
(paralysis/weakness of extensor muscle of forearm, wrist, finger --> wrist drop)
126
Suprascapular nerve
Supraspinatus: aBduct arm
Infraspinatus: laterally rotate arm
127
Most abundant amino acid in collagen molecule
Glycine
128
Sitting up from supine position: hip flexor or extensor
Flexor
(Iliopsoas mostly)
(+ rectus femoris, tensor fascia lata, sartoerius, medial thigh compartment))
129
Activate phospholipase-c
DAG --> Protein kinase C
| IP3 --> calcium --> protein kianse C
130
Nerves, Arteries, Veins, Lymphatics of ovary are delivered by?
Suspensory ligament of ovary
131
Cardinal ligament contains?
Uterine artery
132
Hydroxychloroquine
SLE
or early mild seronegative RA
A/E: permanent retinal damage
133
Minocycline: A/E
Minimal
| Include: photsensitivity
134
Tx of RA that causes stomatitis and liver function abnormality
Methotrexate
135
Recurrent infections w/o formation of pus
Delayed separation of umbilical cord
Poor wound healing
Leukocyte adhesion deficiency
| AR, absence in CD18 antigen that is necessary for formation of INTEGRIN
136
Survival of BOTH catalase positive and catalase negative organism
Myeloperoxidase deficiency
| vs. chronic granulomatous disease: some phagocytosed organism CAN be killed b/c they make their own hydrogen peroxide
137
Recurrent infection by Neisseria species
Deficiency of late complement components (C5b --> C9)
138
Wilson's diease: lab
Ceruloplasmin is LOW
| serum carrier protein for copper
139
alpha-2 globulins
Produced by liver and kidney
| Haptoglobin, Ceruloplasmin, alpha2-macroglobulins
140
Mucupurulent cervicitis w/ cervical motion tenderness
PID
141
IL-2
Produced by helper T
Stimulates: CD4+/CD8+, B cells, NK and Monocytes.
T cells and NK cells --> anti-cancer (metastatic melanoma, renal cell carcinoma)
142
Alemtuzumab
anti-CD52
| CLL treatment, direct cytotoxic effect through complement fixation and ADCC
143
Interferron gamma
Increase expression of MHC-I and II --> improving antigen presentation
144
Muscle spindle system
Muscle LENGTH
145
Golgi tendon system
Muscle FORCE/tension
(relatively insensitive to passive stretch)
In series w/ muscle (Ib sensory neurons)
146
A-delta fibers
Temperature and nociceptive stimuli
147
Muscle spindles (intrafusal)
Sensitive to changes in LENGTH (streth reflex)
Parallel w/ extrafusal fibers (Ia and II sensory neurons)
148
Pacinian vs. Ruffini's end organ
Pacinian: rapidly adapting mechanoreceptors
Ruffini's: slowly adapting mechanoreceptors
A-beta fibers!
149
Tx: giardiasis, trichomonas vaginitis, bacterial vaginosis
Metronidazole
150
Wool business
| Ulcer w/ black eschar and significant surrounding edema
Bacillus anthracis
151
B. anthracis: toxin
Anthrax toxin:
Protective, Lethal, Edema factor
(Lethal factor: increased cAMP by acting as adenylate cyclase)
152
Bordetella pertusis: toxin
Pertussis toxin (disinhibit adenylate cyclase)
Adenylate cyclase toxin (increase cAMP --> edema, phagocytic dysfunction)
153
Ulnar nerve
C8-T1
154
```
Palmar and dorsal interosseus muslce
Hypothenar
Palmaris brevis
3rd and 4th lumbricals
Adductor pollicis muscle
```
```
Ulnar nerve
(which also does flexor carpi ulnaris and flexor digitorum profundis-medial section)
```
155
Ulnar nerve injury at elbow
Claw hand deformity
156
Ulnar nerve injury at Guyon's tunnel
| Between hook of hamate, and pisiform bone
Dysesthesia of ulnar side of hand
| Weakness to INTRINSIC m. of hand
157
Difficulty w/ fine motor control of THUMB
Carpal tunnel: median nerve compression
158
Coracobrachialis muscle
Arm flexor
| Innervated by musculocutaneous n.
159
Gram - rod
NON-lactose fermenting
Oxidase positive
Pseudomonas aeruginosa
160
Gram - rod
Lactose fermenting
Extensive antibiotic resistance
Nosocomial infections
EnteroBacter cloacae
161
Gram + cocci
Opportunistic infections
VRE
EnteroCoccus afecalis
162
Gram - rod
Lactose fermenting
Leading cause of UTI
E. coli
163
Gram - rod
Lactose fermenting
Sponatneous bacterial peritonitis
Nosocomial pneumonias, UTIs
Klebsiella pneumoniae
164
Gram + cocci
Catalase +
Coagulase -
UTI in sexually active women
Staphlococcus saprophyticus
| Novobiocin RESISTANT
165
Inhibit phospholipase A2
Glucocorticoid
166
Zileuton
Inhibit 5-lipoxygenase
| no LTB4, LTC4, LTD4, LTE4 formation
167
Inhibit LTD4 receptor
Montelukast
168
Leukotriene modifers are used for?
Preventing recurrence of:
Asthma attacks
Allergic rhinitis
169
Etanercept
Soluble receptor decoy protein (for TNF-alpha)
170
- mab
- cept
- nib
```
mab= monoclonal antibody
cept= receptor
nib= kinase inhibitor
```
171
Rituximab
Chimeric
Anti-CD20 (surface of B cells)
Tx: CD20+ Non-HL, excessive B-cell function
172
Infliximab
Chimeric
Anti-TNF-alpha
Tx: Autoimmune disease (RA, Crohn's)
173
Certolizumab
humanized
Anti-TNF-alpha and LACKS Fc region (prevent complement activation, cell mediated cytotoxicity)
Tx: AI disease w/ elevated TNF-alpha levels
174
Imatinib
Tyrosine kinase receptor inhibitor
Tx:
philadelphia chromosome + CML
kit-positive GI stromal tumors
175
Female
Male
What ducts makes most of the internal genitalia?
Female: PARAmesonephric
Male: mesonephric
176
Mesonephric duct in female
Gartner's duct
177
Paramesonephric duct in males
Vestige appendices of testes
178
Failure of urethral folds to fuse in males
HYPOspadias
179
Which bands have ONLY thick myofilaments, ONY actin thin filament?
Only thick: H band
| Only thin: I band
180
A band
WHOLE thick myosin thick filament
181
Vaginal adenosis
Squamous --> Columnar
a/w DES exposure in utero
Precursor for clear cell adenocarcinoma of vagina
182
PCOS: at increased risk of?
DM TYPE 2
Lipid profile abnormality
Endometrial adenocarcinoma
183
Periportal "pipestem" fibrosis
Hepatic schistosomiasis
184
Bats are major reservoir for?
Rabies virus
185
Echinococcus granulosus
```
Dog tapeworm (sheep = intermediate host)
m/c/c of hydatid cyst
```
186
Diphyllobothrium latum
Human tapeworm
Larvae from RAW FRESHWATER rISH
Results in: B12 deficiency and megaloblastic anemia
187
Cysticercosis
Taenia solium
188
Schistosomiasis
Contact w/ freshwater that contain SNAILS (larvae)
189
Schistosoma japnicum
Schistosoma mansoni
Schistosoma haematobium
JM: intestinal (IDA) and hepatic schistosomiasis (portal HTN)
H: urinary schistosomiasis (hematuria, hydrocephrosis, squamous cell carcinoma of bladder)
190
Sublimation
Mature defense mech
| Angry --> Work out at gem
191
Projection
IMmature defense mech
| Cheat --> accuse classmate as cheaters
192
Reaction formation
IMmature defense mech
| Ignore feelings --> opposite sentiment adopted
193
Displacement
IMmature defense mech
| Angry at wife --> throw things
194
Contraindicated in urethral injury
Placement of Foley catheter
195
Inability to void w/ full bladder sensation
High riding boggy prostate
Blood at urethral meatus
Urethral injury
196
Pelvic fracture
Anterior or Posterior urethra injury
| Posterior MOST common
197
Straddle injury
Anterior urethra injury
198
Weakest part of posterior urethra
Membranous urethra
199
Wrist drop
Radial nerve injury
200
Limited hand flexion, thumb opposition
Median n.
201
Limited finger ABduction
Median n.: recurrent branch
| Ulnar n. deep branch
202
Responsible for EXTENSION of hand
Radial n. (C5-T1)
203
Hesselbach's triangle
Inferior epigastric vesselsF
Inguinal ligament
Rectus abdominis
204
Femoral hernia: location
BELOW inguinal ligament
Lateral to pubic tubercle
Medial to femoral artery/vein
205
Femoral hernia: predisposition
Women
Right side
PRONE to incarceration!!!
206
Direct vs. Indirect inguinal hernia: location w/ respect to inferior epigastric vessels
Direct: medial to vessels
Indirect: lateral to vessels
207
Transversalis fascia
POSTERIOR wall of inguinal canal
Opening w/i = deep inguinal ring
Site of protrusion of INdirect inguinal hernias
208
Hmologous to round ligament in females
Spermatic cord in males (pass through inguinal canal, leaves pelvis through deep inguinal ring)
209
Unhappy triad
ACL
MCL
Lateral meniscus
210
ACL prevents?
Anterior motion of tibia
211
Patellar ligament
Inferior projection of quadriceps femoris tendon
Difficulty w/ leg EXTENSION when injured
212
Anterior drawer test is for?
ACL
213
Medial condyle of femur to posterior head of tibia
PCL
214
Ulcer w/ central black eschar surrounded by edema
Bacillus anthracis (cutaneous)
215
Bacillus anthracis: P2P
NO!
| spores
216
Nosense mutation
Single base substitution that introduces a PREMATURE STOP CODON.
217
Prostate: rubbery
BPH
| vs. nodular/firm of prostate cancer
218
BPH: leads to renal parenchyma?
ATROPHY
| Reflux nephropathy
219
Glomerular sclerosis and hyalinosis
Diabetic nephrosclerosis
220
Caudal regression syndrome associated with?
Poorly controlled maternal diabetes
221
VitA overdose in pregnancy
```
Craniofacial abnormalities
Posterior fossa CNS defects
Auditory defects
Great vessel abnormalities
(similar to DiGeorge syndrome)
```
222
Strict vegetarians, at risk for?
Iron and VitB12 deficiencies
223
Sacral agenesis: lower extremity paralysis and urinary incontinence
Caudal regression syndrome
224
WBC cast w/ UTI
Pyelonephritis
225
WBC cast form by?
WBC precipitated by Tamm-Horsfall protein secreted by tubular epithelial cells
226
Fas receptor
Initiate EXTRINSIC pathway of apoptosis
227
Anergy: occurs in T or B cells
T cells (immune tolerance)
228
Isotype switching of B cells requires?
CD40 on activated B cells
| CD40 ligand on activated T cells
229
Th1 T cells
Cell-mediating
| INF-gamma and IL12 induce Th1
230
Th2 T cells
Antibody-mediating
| IL-4 stimulates Th2 development
231
1st pharyngeal pouch, membrane, groove
Pouch: epithelium of MIDDLE ear and auditory tube
Membrane: tympanic membrane
Groove:epithelium of EXTERNAL ear canal
232
2nd pharyngeal pouch
Epithelium of palatine tonsil cryps
233
3rd pharyngeal pouch
Thymus
| Inferior parathyroid gland
234
4th pharyngeal pouch
Superior parathyroid glands
| Ultimobranchial body
235
Primary abnormality in Paget's disease of bone
Osteoclastic bone resorption
236
Mosaic pattern of lamellar bone
| Old man + bone pain + high AlkPhos
Paget's disease of bone
237
Beriberi
| Wernicke syndrome
B1 (thiamine) deficiency
238
```
Cheilosis
Stomatitis
Glossitis
Dermatitis
Cornela vascularization
Ariboflavinosis
```
B2 (riboflavin) deficiency
239
Cheilosis
Glossitis
Dermatitis
Peripheral neuropathy
B6 (pyridoxine) deficiency
240
Bleeding diathesis
VitK deficiency
241
Acrodermatitis enteropathica
Growth retardation
Infertility
Zinc deficiency
242
```
Hemorrhages
Subperiosteal hamartomas
Gingival swelling
Bleeding gums
Hyperkeratotic papular rashes
Impaired wound healing
```
Vitamin C deficiency (scurvy)
243
Calmodulin
| Myosin light-chain kinase are elements of?
Smooth muscle!
244
Decrease in acetylcholine receptors on postsynaptic terminal of muscle end plate results in?
Decreased end plate potential
| Seen in myasthenia gravis
245
Pyridostigmine
Cholinesterase inhibitor
| for Myasthenia gravis
246
Scopolamine
SELECTIVE muscarinic cholinergic receptor ANTAgonist (@gut)
| Hyoscyamine is another agent that is similar
247
Skeletal muscle utilize what type of receptor?
Nicotinic
248
Prazosin
Alpha-1 adrenergic antagonist
249
Fluoxetine
SSRI
250
Pilocarpine
NONselective muscarinic receptor AGONIST.
251
Myasthenia gravis tx
Cholinesterase inhibitor
(may result in overstimulation of muscarinic receptor --> use antimuscarinic agents like scopolamine)
Immunosuppressants
Thymectomy
252
VitD synthesis
Sunlight: 7-dehydrocholesterol --> cholecalciferol (VitD3)
Liver: 25-hydroxylation
Kidney: 1-alpha hydroxlase
253
Accurately reflect status of dietary and skin production of VitD
25-hydroxy vitamin D
254
Type I hypersensitivity reaction: upon initial allergen exposure
Antibody class switching to IgE
255
Ecthyma gangrenosum
Vascular destruction and cutaneous necrosis seen in Pseudomonas aeruginosa bacteremia and septicemia.
256
. aeruginosa:virulence factors
```
Exotoxin A (protein synthesis inhibitor)
Elastase (degrades elastin; BV destruction)
Phospholipase C (degrades cellular membrane)
Pyocyanin (generates ROS)
```
257
m/c a/w necrotizing pneumonia in elderly or IMC-
Klebsiella
258
Cystathionine beta-synthase deficiency
Homocystinuria
| ectopic lentis, mental retardation, marfanoid habitus, osteoporosis, in addition to vascular problems
259
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
Lepromatous leprosy
260
Severity of Leprosy depends on?
Strength of cell-mediated immune response
| tuberculoid MILDER than lepromatous
261
Cold agglutinins are characteristc of?
Mycoplasma infection
262
Rheumatoid factor is a ?
IgM antibody toward Fc component of self IgG
263
Antimitochondrial antibody
Primary biliary cirrhosis
264
Postauricular and occipital LAD
Rubella
| LAD caused by togavirus
265
"Slapped cheek" appearance + maculopapular rash on extremities and trunk
Erythema infectiosum
| Parvovirus
266
Febrile maculopapular rash that begins on face and spreads to trunk/extremity
Rubeola (measles) ----additional finding of postauricular LAD
Rubella (German measles)
267
Enzyme deficiencies of early steps in porphyrin synthesis
Abdominal pain
Neuropsychiatric manifestation
W/O photosensitivity (which is present w/ deficiencies of late steps)
268
Defects in URO decarboxylase, COPRO oxidase, PROTO oxidase, Ferrochelatase
Enzyme deficiencies of LATE porphyrin synthesis: results in photosensitivity
269
ALA synthase deficiency
Decrease in formation of ALL porphyrins
| Decrease in heme synthesis --> concucrrent HYPOchromic, MICROcytic anemia
270
ALA synthase requires?
Cofactor: Pyridoxal phosphate (Vit B6)
271
Capitation
Paid fixed amount per patient, NOT per service
| more incentives to CONSERVE cost
272
PRPP synthase activating mutation can lead to?
Too much synthesis of activated ribose (for purine/pyrimidine synthesis)
Too much PRPP synthase --> Gout
273
von Gierke disease
G6PD deficiency
274
Pompe disease
Acid maltase deficiency
275
M/C cuase of malignant acanthosis nigricans
Gastric adenocarcinoma
276
Hypersecretion of serotonin can occur in what type of tumor?
Carcinoid
277
Loss of knee jerk
Femoral nerve damage
278
Difficulty w/ plantar flexion
Tibial nerve damage (popliteus, flexor of foot)
279
Sensation to calf
Lateral sural cutaneous (br. of tibial n.)
280
Center of wrist: which bone?
Capitate
281
Bones that articulate with radius
Scaphoid
Lunate
(injured by fall on outstretched, dorsiflexed hand)
282
Thumb swings on the ?
Trapezium
283
IL-4
Produced by Th2 (T helper)
Facilitates: B cells and Th2 lymphocyte
Stimulates: antibody isotype switching --> particularly to IgE
284
IL-1
Produced by macrophages
Activates naive T cell --> Th1 and Th2
Endogenous pyrogen
285
IL-2
Secreted by Th1
| Stimulate development of CD4+, CD8+, B cells.
286
IL-3
Produced by T-helper cells
| Stimulates growth and differentiation of bone marrow stem cell
287
IL-12
Synthesized by macrophages
| Stimulates growth and development of Th1 cells
288
IL-5
B cell differentiation
| Stimulates IgA production and Eosinophil activity (host defense against parasites)
289
Housemaid's knee
Prepatellar bursitis
290
Popliteal and gastrocnemius bursitis can be a/w?
Formation of Baker's cysts
291
Anserine bursitis (pes anserinus bursitis)
Pain along medial aspect of knee
| Overuse in atheletes or from chronic trauma (heavy body habitus)
292
Latissimus dorsi
Thoracodorsal n.
| aDduct and extend humerus
293
Rhomboid major
Dorsal scapular n.
| Draw scapula medially at medial border
294
Teres major
Subscapular n.
| aDuct and Medially rotate arm
295
Deltoid
Axillary n.
| Flex, Extend, aBduct arm
296
Valsalva maneuver
Increase vagal tone
Abolish paroxysmal SVT
Rectus abdominis (increase abdominal and thoracic pressure)
297
Raloxifene
SERM
Estrogen agonist at bone, CDV, blood lipoproteins
Estrogen ANTAgonist at breast
298
Aledronate
Synthetic bisphosphonate analog of pyrophosphate
299
Leuprolide
GnRH analog
| agonist and antagonist depending on method of administration
300
Antipsychotics act primarily at what receptors?
```
D2 receptors (mesolimb-mesocortical pathway)
BUT
Simultaneously block dopamine in nigrostriatal pathway (imbalance between D2 and M1 receptor)
```
301
GABA(a) antagonist
Inhibit action of GABA
| Counteract acute overdose of benzodiazepine
302
Flumazenil
GABA(a) antagonist
303
Terbinafine
Oral anti-fungal
| squalene epoxidase inhibitor
304
3 m/c/c of hair loss
Male pattern baldness
Tinea capitis
Telogen effluvium
305
Alopecia areata
AI dz that causes patchy or diffuse hair loss
306
Psoas sign
Pain when hip is extended.
307
Psoas sign
Pain when hip is extended.
308
Alkaptonuria
AR, black urine, onchronisis (blue-black pigmentation)
Lack of homogentisic oxidase (phenylalnine --> tyrosine --> fumarate; accumulation of homogentisic acid --> black urine)
309
Ankylosing spondylitis: MSK, Respiratory, CDV, Eye involvement
MSK: peripheral enthesitis
Respiratory: chest wall expansion (costovertebral/sternal jxn)
CDV: ascending aortitis --> dilatation of aortic ring --> aortic insufficiency
Eye: uveitis
310
Accumulation of homogentisic acid
Alkaptouria
311
Lepromin skin test
+ in pts. w/ TUBERCULOID leprosy (STRONG CD4+ Th1 cell-mediated immune response)
- in pts. w/ LEPROMATOUS leprosy (weak cell-mediated response)
312
Parvovirus B19
Erythema infectiosum in kids
| Arthritis in adults (self-resolving)
313
Albinism
HAVE melanocytes
| do NOT produce melanin (b/c defective TYROSINASE)
314
Lentigo
Benign LINEAR melanocytic hyperplasia
315
Avascular necrosis of femoral head a/w?
Sickle cell disease
Steroid therapy
SLE
Alcoholism
316
Acute onset of hip pain exacerbated by weight bearing.
| NO swelling, erythema, temperature change
Avascular necrosis of femoral head.
| MRI diagnostic modality of choice
317
Succinylcholine
Depolarizing NMJ BLOCKER.
318
Dantrolene
Relax skeletal muscle by reducing Ca2+ release from SR
| Tx: malignant HTN, neuroleptic malignant syndrome
319
Pancuronium
| Tubucurarine
NON-depolarizing NMJ blocker.
| competitive antagonist of nicotinic acetylcholine receptor
320
Reverses NON-depolarizing NMJ blockade.
Neostigmine
321
Neostigmine reverse DEPOLARIZING NMJ blockade (ex: succinylcholine)?
If given during phase I: BAD (augments blockade)
| If given during phase II: Good
322
Duration of paralysis caused by succinylcholine depends on?
Catabolism by plasma cholinesterase
323
Neostigmine
Cholinesterase inhibitor
324
Fine skin wrinkles occurs 2/2 to?
Decreased synthesis and net loss of dermal collagen and elastin
325
Pseudogout most likely involves what joint (50%)?
Knee
| vs. first metatarsophalangeal in gout
326
Langhans cell
Multinucleated giant cell w/ horseshoe-shaped arrangement of multiple nuclei derived from monocyte cell line
(Granulomatous inflammation)
327
Langerhans cell
Dendritic cells in skin (professional APC)
Myeloid cell line
Racquet shaped intracytoplasmic granules (Birbeck granules)
328
Birbeck granules
Langerhans cells (racquet shaped intracytoplasmic granules)
329
Risus sardonicus
Facial muscle spasm (seen in Tetanus)
330
Tetanospasmin MOA
Binds ganglioside receptors on neuronal membrane: inhibiting release of glycine and GABA from inhibitory neurons
331
```
Immunodeficiency
Albinism
Neurologic defect (nystagmus, peripheral/cranial neuropathy)
```
Chediak-Higashi syndrome
| AR, defect in neutrophil phagosome lysosome fusion
332
NADPH oxidase deficiency
Chronic granulomatous disease
| Neutrophils unable to kill catalase producing organisms
333
```
CNS abnormalities (developmental delay, Mental retardation)
Features of albinism
Mousy body odor
```
PKU
| Deficiency of phenylalanine hydroxylase
334
Wiskott-Aldrich syndrome
X-linked
Immunodeficiency, Eczema, Thrombocytopenia
(Combined B and T lymphocyte disorder)
335
DiGeorge syndrome occurs due to?
Deletion on chromosome 22 (maldevelopment of 3rd and 4th pharngeal pouches)
336
Thymic and Parathyroid hypoplasia
Abnormal facies
Cardiac defects
DiGeorge syndrome
337
Recurrent viral, fungal, protozoal infection
T cell defect (ex: thymic hypoplasia in DiGeorge)
338
Defective neutrophil function
Recurrent pyogenic infections m/c caused by Staph and Strep.
339
Ataxia
Episodic erythematous and pruritic skin lesions
Photosensitivity
Loose stools
Aminoaciduria: restricted to NEUTRAL a.a.
Hartnup Disease
340
Clinical manifestation of Hartnup is primarily due to?
Niacin (Vit B3) deficiency
| due to malabsorption of tryptophan
341
Niacin is synthesized from?
Tryptophan (essential amino acid)
342
FMN and FAD are synthesized from?
Riboflavin (Vitamin B2)
343
```
Cheilosis
Glossitis
Keratitis
Conjunctivitus
Photophobia
Lacrimation
Corneal vascularization
Seborrheic dermatitis
```
Riboflavin deficiency (Vitamin B2)
344
Folic acid vs. B12 deficiency
Both: megaloblastic anemia
B12: degeneration of posterior and lateral columns
345
Anemia
Peripheral neuropathy
Dermatitis
Pyridoxine deficiency
346
D-glutamate capsule seen in?
Bacillus anthracis
347
Serpentine or Medusa head in culture
Bacillus anthracis
348
Protein A virulence factor
Bind Fc portion of IgG
| prevent opsonization and complement-mediated killing of bacteria
349
Intracellular polyphosphate granules
Cornyebacterium diptheriae
| Loeffler medium, stain w/ methylene blue
350
Peritrichous flagella
Flagella distributed uniformly over entire surface of bacteria
HIGHLY motile organisms (ex: Proteus mirabilis)
351
Posterior cruciate ligament: anatomy
Femur: MEDIAL condyle (anterolateral surface)
to
Tibia: posterior intercondylar area
352
Cervical cytology: multinulceated giant cell w/ intranuclear inclusion
HSV (particularly HSV2)
353
Yellow-green, foamy, foul smelling discharge
Trichomonas vaginitis
| Motile trophozoites w/ flagellae
354
TNF-alpha inhibitors
Infliximab
Etanercept
Adalimumab
355
TNF-alpha: crucial A/E
Decrease macrophage function --> reactivation of latent TB
356
Plane xanthomas
Linear lesions in skin folds
| strongly suggests Primary Biliary Cirrhosis
357
Treating Measles: vitamin that can be of benefit?
Vitamin A
358
PABA containing sunscreen: protect against?
UVB only
359
Sunscreen with this ingredient is BROAD spectrum: UVB, UVAI, UVAII
Zinc oxide
360
UVA blocking agent
Avobenzone
361
2 most important factors for osteoClastic differentiation
M-CSF
RANK-L
(Both secreted by osteoBlasts)
362
Multinucleated cell with OVER 100 nuclei
| Positive for tartrate resistant acid phosphatase
OsteoClasts seen in Paget's Disease of bone
| normally, osteoclasts have ~5 nuclei
363
Irreversible retinal damage with this drug.
Hydroxychloroquine
364
Fibroblast growth factors and bone
Increase bone formation by stimulating osteoblasts (increase bone matrix formation)
365
TGF-beta
Increase formation of mature osteoblasts
Increase collagen synthesis
Decrease bone resorption (increase osteoclast apoptosis)
366
Net effect of IGF-1 on bone
ANABOLIC (formation)
| Increase osteoblast replication and collagen synthesis, decrease collagen degradation by inhibiting MMP-13
367
Marker of bone formation
Osteocalcin
368
Granulomatous disorder
Bilateral hilar LAD
Hypercalcemia
Sarcoidosis
369
Hypercalcemia in sarcoidosis arise due to?
Increased EXTRArenal formation of 1,25-dihydroxy vitD (via activated macrophages).
Hypercalcemia --> suppress PTH.
370
Increase activity of 1-alpha hydroxylase activity in macrophages
Gamma interferron from T lymphocytes
| Sarcoidosis, Hodgkin's lymphoma
371
Alkaline phosphatase: important sources
Bone (easily denatured by heat)
Liver
(Intestine)
372
What secretes calcitonin
Parafollicular C cells of thyroid gland
373
Calcitonin is a marker for?
Medullary thyroid cancer
374
M/c used method in assessing osteoclastic activity
Urinary deoxypyridinoline excretion
| pyridinoline convalently x-link collagen fiber, x-links are m/c used method in assessing osteoclastic activity
375
Tartrate-resistant acid phosphtase
Urinary hydroxyproline
Urinary deoxypyridinoline
Reflects osteoclastic activity
| urinary deoxypyridinoline is MOST reliable
376
Sudden upward jerking of arm at shoulder
Injury to LOWER trunk of brachial plexus (C8-T1)
| Median and Ulnar nerve --> hand clumsiness/paralysis
377
Posterior arm numbness
| Paralysis of arm and forearm extensors
Radial nerve injury
378
Upper trunk of brachial plexus injury
When head and shoulder are violently stretched
| musculocutaneous n.: weakness of forearm flexion @ elbow
379
Musculocutaneous n. innervate?
Biceps brachii and brachialis muscle
| Flexion of forearm @ elbow
380
Innervate all intrinsic muscle of hand
Median and Ulnar n.
381
Superficial and deep peroneal n.
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
Inverted
| Plantarflexed foot
Common peroneal n. injury (near fibular head m/c)
383
Sandpaper like rash (erythematous, adherent scale)
Sun-exposed areas
Basal cell layer atypia
Actinic keratoses
(hyperkeratosis, parakeratosis)
(at risk for squamous cell carcinoma)
384
Superficial benign firous histiocytoma
(Benign proliferation of fibroblast)
Lower extremities as solitary nodules
Dermatofibroma
385
Nests of basaloid cells
| Peripheral palisading nuclei
Basal cell carcinoma
386
m/c elbow injury in children (1-4)
Radial head subluxation (annular ligament injury)
| Elbow extended, forearm pronated: nursemaid's elbow
387
Popeye deformity
Biceps tendon rupture
| palpable mass in mid-upper arm
388
Throwers (baseball pitchers)
| Intense valgus stress at elbow
Ulnar collateral ligament injury
389
Midshaft humerus injury
Radial nerve
| Deep brachial artery
390
Supracondylar fracture of humerus
Brachial artery injury
391
Sporicidal
```
Hydrogen peroxide (destructive free radicals)
Iodine (halogenation of proteins & nucleic acid)
```
392
Chlorhexidine (disinfectant)
Disruption of cell membrane
Coagulation of cytoplasm
Contraindicated in neurologic/otologic/opthalmologic procedures due to neurotoxicity
393
Type 4 hypersensitivity are mediated by?
T lymphocytes
394
BRAF mutation
Tyrosine kinase mutation (BRAF V600E)
| 40-60% of melanoma
395
Herpes zoster ophthalmicus
VZV infection of TRIGEMINAL ganglion (CN5 V1)
396
M/c neurological complication of varicella zoster infection
Post-herpatic neuralgia
397
Herald patch on trunk, neck, extremities
Pink or brown scaly plaque w/ central clearing
"Christmas tree" pattern along skin tension lines
Pityriasis rosea
398
Wickham's striae
Lichen planus
| polygonal, planar, pruritic, purplish plaques
399
Accumualtion of neutrophils on tips of dermal papillae (microabsesses)
Dersmatitis herpetiformis
400
Molluscum contagiosum
Poxvixurs
Eosinophilic cytoplasmic inclusions (molluscum bodies)
Dome-shaped umbilicated papules
401
Intranuclear inclusions in keratinocytes
Multinucleated giant cells
(positive Tzanck smear)
Herpes zoster (shingles)
402
Duchenne muscular dystrophy: inheritance
X-linked recessive
403
Calcium sparing diuretic
Hydrochlorothiazide
