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USMLE® Step 1 flashcards
1
Q

boggy, soft, raised, pruritic, erythematous lesions with wheal and flare eruptions

A

Type 1 hypersensitivity

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2
Q

Locations of RA

A

Small joints (PIP, MCP, MTP); and cervical spine

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3
Q

Influenza virus signs:

A

Acute fever, muscle pains, malaise, during winter

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4
Q

Carnitine deficiency

A

prevents fatty acids from being transported into the mitochondria for beta-oxidation

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5
Q

What happens in the maintenance stage of ATN?

A

Decreased urine output, fluid overload, increased creatinine/BUN, hyperkalemia

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6
Q

What type of diarrhea is present in cholera?

A

Mucous and some sloughed epithelial cells

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7
Q

hydroxycabalmin - use

A

cyanide poisoning

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8
Q

Common causes of noncaseating granulomas?`

A

Sarcoidosis, reaction to foreign material, beryllium exposure

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9
Q

Pindolol MoA?

A

Partial beta agonist; intrinsic sympathominetic activity (epinephrine-like activity)

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10
Q

Statin-MoA

A

Increased LDL receptor turnover

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11
Q

What does the radial nerve innervate?

A

Sensory-posterior arm, forearm, and dorsal lateral hand Motor- all extensor muscles to the upper limb, below the shoulder

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12
Q

beaded, branching filaments with ring-enhancing lesion

A

Norcardia

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13
Q

What cancers are EBV associated with?

A

Nasopharyngeal carcinoma, Burkitt’s, and Hodgkin’s

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14
Q

Pathognomionic for a large PDA complicated by Eisenmenger syndrome

A

Differential clubbing and cyanosis without blood pressure or pulse discrepancy

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15
Q

Reactive Arthritis

A

Conjunctivitis, Urethritis, oligoarthritis HLA-B27

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16
Q

Agartoban-MoA

A

Direct thrombin inhibitor (binds thrombin active site)

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17
Q

Dobutamine- receptor activation

A

B1> a1 + b2

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18
Q

Lambert-Eaton presentation

A

hyporeflexia or areflexia, autonomic symptoms, incremental response to repeated stimulation

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19
Q

What part of the heart is closest to the diaphragm? How does blood get there? Assume left dominant.

A

Left ventricle, Left coronary -> circumflex -> posterior interventricular (posterior descending)

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20
Q

snap, followed by a rumbling diastolic murmur hear over the cardiac apex

A

Mitral stenosis

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21
Q

Drug Induced Lupus: cause

A

slow liver acetylation

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22
Q

Steps to base excision repair?

A

glycoslase, endonuclease, lyase, polymerase, ligase

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23
Q

Emigrant from SE Asia presents with fever, night sweats and weight loss? Diagnosis? What factors helps for the characteristic lesion? Giant multinucleated cells?

A

TB, interferon-y -> activates macrophages.

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24
Q

Atropine: Role in Glaucoma

A

muscurinic receptor blockage -> mydriasis -> narrowing of anterior chamber angle -> diminished outflow

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25
Q

Atropine overdose - Tx

A

physostigmine

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26
Q

Response to smoking in the lungs…cilia? Macrophages? Mucous?

A

Cilia-down Macrophages/mucous - up

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27
Q

Cardiac problems with changes in vision….

A

Digoxin; look for elevated extracellular potassium

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28
Q

SERM used?

A

Inhibit the effect of estrogen in breast tissue; prevents gynocomastia

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29
Q

Dermatomyositis: Associations

A

paraneoplastic syndrome- ovarian, lung, colorectal, non-Hodgkin Lymphoma

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30
Q

Mental retardation, self-mutilation, nail biting, spasicity

A

Lesch-Nyhan Syndrome- HMGRT deficiency, leads to buildup or uric acid in the body, X-linked recessive

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31
Q

torticollis

A

uncontrollable contract of the SCM

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32
Q

What factors promote osteoclast activity -> bone resorption

A

interleukin-1 and TNF-alpha

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33
Q

Presentation to CD8+ cells is mediated through which pathway

A

Ubiquitin proteasome pathway

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34
Q

E6

A

gene product inhibits p53 syooressir gene

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35
Q

koilocyte

A

Sign of HPV, an immature squamous cell with dense irregularity in staining cytoplasm and perinuclear clearing, resulting in a halo

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36
Q

What is the MoA of Erythromycin?

A

Inhibit protein synthesis by blocking translocation; bind to 23S rRNA of the 50S ribosomal unit; bacteriostatic

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37
Q

Signs of ischemic colitis?

A

History of strokes indicitative of atherosclerosis, site of injury is located around watershed area

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38
Q

Low stage vs high stage

A

High-lymphadenopathy, mets, invasion low- lacks above

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39
Q

C. perfingens toxin

A

alpha toxin- Lecinthinase (Phospholipase C); phospholipid splitting

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40
Q

Zidovudine- Side effects

A

Bone Marrow suppression via inhibition of DNA polymerase (mammalian)

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41
Q

decubitus

A

laying down

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42
Q

Effects on an arteriovenous shunt

A

Acute- decreased TPR, -> increased CO/venous return Chronic- sympathetic compensation->dec. TPR, Inc. mean resistance pressure

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43
Q

How is cholesterol converted to estrogen?

A

LH stumulated Theca cells to synthesize androgens (progesterone leaves) and the androgens are processed to Estrogial by granulosa cells via aromatase

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44
Q

CEA

A

Colorectal

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45
Q

What is reverse T3?

A

inactive form that is generated entirely from peripheral conversion of T4

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46
Q

What is down syndrome associated with?

A

Early-onset Alz and ALL

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47
Q

Perinaud syndrome

A

limitation of upward gaze with a downward gaze preferential

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48
Q

Candidemia

A

systemic Candida infection, blood grows infection -results from low necrophilia counts

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49
Q

Undifferentiated somatoform disorder

A

Physical complaints for more than 6 months that cannot be contributed to a medical condition

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50
Q

How to calculate expected pCO2 compensation?

A

[pCO2] = 1.5*[HCO3-]

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51
Q

silver stain with slow growth on buffered charcoal extract medium (suplemented with L-cysteine and iron): organism?

A

Legionella pneumonia

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52
Q

How does an aneurysm of the PCA effect vision?

A

Applies pressure to CNIII (and sympathetic ganglion)

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53
Q

conjunctival injection

A

red eyes

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54
Q

Large cells with abundant basophilic cytoplasm?

A

Myelolasts- contain Auer rods Stain positive for peroxidase

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55
Q

Gluathione reduction: function?

A

catalyzes the reduction of oxidized glutathione.; Absence leads to the inability to reduce NADPH to reduce glutathione; similar to glucose-6-phosphotase

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56
Q

Hemolytic Uremic Syndrome: Signs:

A

Diarrhea illness (often bloody), hemolytic anemia with schistocytes, thrombocytopenia, acute kidney injury

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57
Q

Goodpasture Syndrome

A

Type II hypersensitivity, crescent moon shaped (fibrin and plasma proteins (c3b) with glomerular parietal cells, monocytes and macrophagesl antibodies specificially against GBM and alveolar basement membrane -> linear IF; Presents with hematureia/hemoptysis, Rx - emergent plasmapheresis

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58
Q

Most common cause of cancer death in men and wome?

A

Lung cancer

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59
Q

Chronic worry, feeling on edge, muscle tension, incomnia

A

generalized anxiety disorder

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60
Q

Fever and sore throat in a patient with hyperthyroidism

A

Thionamide-induced agranulocytosis

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61
Q

What enzyme is Vit K a cofactor for?

A

gamma-glutamyl carboxylase

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62
Q

Lung: wedge shaped hemorrhage: Diagnosis? Cause?

A

Pulmonary emboli, cause by tricuspid endocarditis

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63
Q

Thiazide- MoA

A

Inhibits Na-Cl transporter; leads to increased calcium resorption Hyper GLUC Glucose Lipidemia Urecemia Calcemia

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64
Q

Hereditary orotic aciduria: Signs,

A

Signs: physical and mental retardationm megaloblastic anemia, elevated urinary orotic acid levels

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65
Q

Clopidogrel - MoA

A

blocks P2Y12 component of ADP receptors

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66
Q

What is the role of Ghrelin?

A

Mediated hunger, decreases when food in consumed

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67
Q

Rhizomelia

A

proximal limb shortening

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68
Q

Cocaine MoA

A

Norepinephrine reuptake in the presynaptic terminals

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69
Q

Eisenmenger syndrome

A

Heart failure (shortness of breath, fatigability) and cyanosis -reversibility of a left to right shunt to right to left

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70
Q

Odds ratio

A

a*d/b*c

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71
Q

How would vitamin K deficiency present?

A

Intracranial, gastrointestinal , cutaneous, umbilical @ surgical site bleed

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72
Q

Cellular damage in Sarcoidosis is caused by

A

TH1 helped 2 cells

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73
Q

Signs of Acute inflammation

A

Neurophils and Monocytes

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74
Q

ST elevation in lead 1 and aVL?

A

Lateral limb leads MI and left circumflex

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75
Q

Marijuana signs:

A

Mild euphoria increase, inappropriate laughter, slowed reaction time,

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76
Q

Where is the cardia of the stomach location?

A

At the top of the stomach (by the gastroesophageal junction). It is next to the lesser omentum.

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77
Q

What is the most effective dietary changes to reduce someones risk of developing type II diabetes?

A

Reducing caloric intake

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78
Q

C5a: function

A

Neutrophil recruitment

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79
Q

Recurrent TB infections during childhood

A

Interferon-gamma signalling IL-12 (macrophages) -> activate T-cells -> secrete TNF-gamma-> Janus Kinase 1&2 -> STAT1 -> enhances intracellular killing

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80
Q

Blastomyces: Characteristics

A

Broad-based bud in yeast form branching hyphae in mold form

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81
Q

How does a protease affect HIV replication?

A

HIV will lack a mature core

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82
Q

Severe anemia following minor febrile illness?

A

Aplastic anemia

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83
Q

Action and lcation of loop diuretics

A

NA-K-2CL symporter in the think ascending limb of the loop of henle

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84
Q

Role of p53

A

Stops progression from G1 to S and induces apoptosis if there is a problem with the cell

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85
Q

Cyanide toxicity: Presentation?

A

altered mental status, seizures, CV collapse, lactic acidosis, bright red venous blood

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86
Q

Tumor staging

A

Stage A-confined to mucosa Stage B- enters muscularis Stage C- lymph node involvement

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87
Q

Role of IkB?

A

Dephosphorylated (inactivated) state limits access of NFkB into the nucleus

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88
Q

Atropine:

A

antimuscurinic- “Hot as a hare, red as a beat”

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89
Q

Calcitriol

A

Activated vitamin D- increases Ca2+ absorption

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90
Q

TCA overdose- signs

A

Mental status changes, sinus tachycardia, hypotension, dry mouth, blurred vision, urinary retention, arrhythmias

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91
Q

Acute hemolytic transfusion reaction

A

fever, chills, hypotension, chest/back pain; Complement mediated cell lysis

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92
Q

Classical galactosemia-inheritance pattern?

A

Autosomal recessive

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93
Q

how is glucose regenerated during fasting?

A

Malate -> oxaloacetate (Phosphoenolpyruvate carboxykinase) -> Phosphoenolpyruvate

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94
Q

What enzyme can covert a pro-carcinogen to a carcinogen?

A

Microsomal monooxygenase (Cytochrome p450 system)

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95
Q

Inhaled amyl nitrite- MoA

A

Oxidized Fe2+ to Fe3+ to generate methylhemaglobin to reduce cyanide binding to Cytochrome C oxidase

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96
Q

Pulsus paradoxus

A

> 10mm Hg drop in blood pressure during inspiration; difference between Korotokoff’s sounds during expiration and throughout respiration quantifies pulsus paradoxus

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97
Q

Pulsion diverticulum

A

increased luminal pressure created during strained bowel movements (chronic constipation)

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98
Q

Dopaminergic receptor signal transducers

A

d1 - Gs d2 - Gi

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99
Q

Polycystic Ovarian Disease-Hormoney levels

A

Inc. LSH, FS, Androgens Hyperinsulemia or insulin resistance

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100
Q

How does N. meningitis spread once infected?

A

Pharynx -> blood -> choroid plexus -> meninges

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101
Q

Cyanide toxicity: antidote

A

Sodium Thiosulfate -> provides sulfur groups for Rhonadese, to inc. cyanide detoxification Used in conjunction with hydroxocalbalamin and sodium nitrite

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102
Q

Pseudomonas- method of infection

A

water sources (hot tub folliculitis

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103
Q

nighttime dyspnea, family history of atopic dermatitis: Diagnosis?

A

Asthma

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104
Q

Draw the brachial plexus

A

Insert drawing here

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105
Q

Abciximab-Moa

A

Glycoprotein IIb/IIIa antagonist

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106
Q

Describe the characteristics of bacterial vaginosis?

A

Anaerobic, gram-variable rod

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107
Q

Isoniazid can lead to a deficiency of which vitamine?

A

B6, pyridoxine

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108
Q

Acute promyelocytic leukemia

A

Auer rods, t(15:17) translocation (RARalpha:PML); tx is all-trams retinoic acid

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109
Q

What causes milky opacity of the senses that is a glucose metabolite?

A

Sorbitol; formed froom glucose via aldose reductasel; aldose reductase is faster than sorbitol dehydrogenase with converts sorbitol to fructose

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110
Q

Arsenic- first line chelator

A

dimercaprol

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111
Q

Function of the proteosome

A

degrades damaged or ubiquitin-tagged proteins,

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112
Q

Camplobacter infection sources?

A

animals, undercooked food

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113
Q

Effect of metronidazole on Alcohol metabolism?

A

Inhibits acetaldehyde dehydrogenase (similar to bisulfram)

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114
Q

Tumor with augmentation of strength in repeated tests

A

Small cell Lung Cancer (lambert Eaton)

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115
Q

Decidua basalis

A

maternal blood flow in the lucanae; attached placenta to womb

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116
Q

What effect does long-term steroid have on the adrenal gland?

A

Long-term steroids can lead to bilateral cortical atrophy

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117
Q

What cell types for the aorticopulmonary septum and endocardial cushion?

A

Neural crest cells

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118
Q

Sporotrichosis..contraction?

A

fungus dound in natural environment (bank of trees, shrubs, etc.) enters the body through breaks in the skin (thorns, etc.) Common in gardeners

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119
Q

Auer rods

A

purple-red inclusion in blasts cells - think AML

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120
Q

Signs of Wegener’s?

A

Hematuria, RBC casts, mld proteinuria, oliguria, and hypertension

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121
Q

Small of absent lymph nodes

A

X-linked Agammaglobulinemia

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122
Q

Small intestinal bacterial overgrowth - signs

A

nausea, bloating, abdominal discomfort, absorption

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123
Q

What drugs should be avoided in hypertrophic cardiomyopathy?`

A

vasodilators, diuretics

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124
Q

What nerve is responsible for a winged scapula

A

Long Thoracic, c5,6,7, seratus anterior muscle

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125
Q

Antibiotic that binds to D-Alanine-D-Alanine? Method of Resistance?

A

Vancomycin Convert to D-Alanine-D-Lactate

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126
Q

Blunt abdominal trauma in a MVA, think?

A

Splenic repture; increased risk of encapsulated organs

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127
Q

PAS staining-detects

A

Live fungus

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128
Q

adenovirus Signs:

A

Conjunctivitis, fever, cough, congestion

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129
Q

Schistosomiasis damage

A

ulceration of scarring of the bowel and bladder/uterus and oeriportal “pipestem” fibrosis ) from eggs)

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130
Q

Bicornuate uteris characteristics? Cause?

A

Indentation in the center of the fundus, failed lateral fusion of the paramesonephric ducts

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131
Q

TRAP

A

Hairy Cell Leukemia

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132
Q

What artery runs on the posterior aspect of the duodenal bulb?

A

Gastrointestinal

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133
Q

Function of the superior gluteal nerve?

A

Innervated gluteus medius and minimus, tensor fasciae latae; trendelberg sign

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134
Q

Antithyroid drugs

A

methimazole, propylthiouracil

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135
Q

Teen male patient comes in with painless swelling of left breast for 1 month

A

Normal

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136
Q

Tricuspid regurgitation- murmur

A

Increases with inspiration best heart left 2nd and 3rd intercostal space

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137
Q

Affect on ventricular size with aging

A

decreased left ventricular chamber size, sigmoid shaped

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138
Q

Non-selective alpha and beta antagonists

A

Labetalol, Carvedilol

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139
Q

Cardiac conduction velocity

A

Fast > purkinje system > atrial muscle > ventricular muscle > AV node “Park at Venture Avenue”

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140
Q

Anti-centromere

A

Limited Scleroderma (CREST)

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141
Q

What is found in the Lymph node outer cortex?

A

B cells and T cells, diminished in agammaglobulinemia

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142
Q

Flunisolide

A

Inhaled glucocorticoid

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143
Q

Health maintenance organization: benefits

A

low monthly premium, low copayments, and deductibles, and low total cost for the patient

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144
Q

Prolonged QRS with little QT interval effects?

A

Class IC antiarrhythmics (Flecainide, propafenone)

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145
Q

ADHD tx

A

methylphenidate, amphetamines

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146
Q

Hepatitis Genome

A

Partially double stranded DNA

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147
Q

TMP/SMX-MoA

A

Inhibits tetrahydrofolic acid -> decreased synthesis of purines and pyrimadines

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148
Q

Lesch-Nyhan syndrome-inheritance

A

X-linked recessive

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149
Q

Most common cause of meningitis in children? 6-60? elderly?

A

S. Pneumoniae

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150
Q

How does an ectopic pregnancy look on histology?

A

dilated, coiled endometrial glands and vascularized edematous stroma

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151
Q

High levels of 5=ALA and porphobilinogen, deficiency?

A

Porphobilinogen deaminase

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152
Q

Nasal polyps

A

CF and Aspirin sensitivity

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153
Q

Temporal summation

A

Addition of multiple impulses over time; (ie, dendrites, cell body, axon hillock

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154
Q

Repeated splenic infarcts leads to

A

fibrosis and atrophy of the slpeen

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155
Q

Specific test for acute cholecystitis?

A

Failed visualization on radionuclide biliary scan

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156
Q

Eisenmenger syndrome

A

Reverse of left-to-right shunt due to pulmonary vascular sclerosis, resulting from chronic pulmonary hypertension

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157
Q

Signs of cardiomyopathy

A

Heart failure, S3 heart sound, enlarged heart, regurgitation sound

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158
Q

B2-adrenocrepectors functions

A

Smooth muscle relaxation in uterus, decreased GI motility, decreased bladder contraction, bronchi relaxation, increased blood profusion, insulin secretion, skeletal muscle tremor, contraction speed, glycogenolysis

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159
Q

Predominant hemoglobin form innewborn

A

Fetal hemoglobin (HbF and alpha2, gamma 2)

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160
Q

The paramesonephric ducts give risk to what?

A

Fallopian tube,s uterus, cervix, and upper vagina Also knows as the mullerian ducts

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161
Q

Contemplation

A

Acknowledge a problem, but not yet willing or able to commit

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162
Q

What is the start codon?

A

AUG

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163
Q

Edwards syndrome

A

Trisomy 18, fetal growth retartation, hypertonia, micrognathia, and conjenital heart defects, clenched hands with overlapping fingers, merkel’s diverticulum, and malrotation

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164
Q

Organisms that increase the risk of ectopic pregnancy?

A

Gonorrhea, Chlmydia

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165
Q

Chronic mesenteric ischemia

A

Atherosclerosis of the mesenteric arteries; presents with postprandial epigastric pain “intestinal angina”

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166
Q

Proteus Mirabilis

A

Urease positive, common cause of struvite stonesl classically results in staghorn calculi in renal calyces

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167
Q

What causes Polycythemia Vera

A

C617F mutation involving the JAK2 gene. This makes the hemotopoietic cells more sensitive to growth factors such as erythropoietin and thrymopoietin

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168
Q

Isolated Hypertension

A

systolic > 140 with diastolic

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169
Q

First order kinetics elimination

A

Constant percentage of drug is eliminated each time

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170
Q

Intussusception: presentation

A

intermittent severe colicky abdominal pain, “cureant jelly” stools, and sometimes a palpable mass in the right, lower quadrant

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171
Q

HFE mutation: MoA

A

reduced endocytosis of iron-tranferrin complex

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172
Q

Post-streptococcal glomerulonephritis- risk for poor long-term prognosis?

A

Increasing age

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173
Q

What is the rol eof fructose-6-phosphate?

A

control the balance between gluconeogenesis and glycolysis by activating PFK-1, which converts Fructose-6-phosphate to Fructose-2,6-bisphosphate

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174
Q

Lebes herditary optic neuropathy-inheritance

A

mitochondrial

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175
Q

myoclonic epilepsy with ragged -red fibers

A

myoclonic seizures with myopathy associated with red fibers with exercises Irregular shaped muscle fibers on biopsy

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176
Q

Midgut Volvulus: Cause

A

Mesentery twisting around the superior mesenteric artery

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177
Q

Celiac disease and multiple pneumonias. Diagnosis?

A

IgA deficiency

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178
Q

Small Cell Lung Cancer associations

A

SIADH, Lambert-Eaton,

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179
Q

Fabry Disease: Cause

A

-linked recessive lipid storage disorder alpha-galactosidase A deficiency (breakdown globotriaosylceramide)

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180
Q

Organophosphates-MoA

A

Acetylcholinesterase inhibitors- acts in the gap junction,

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181
Q

What is responsible for the green colored sputum in bacterial pneumonia infections?

A

myeloperoxidase from neutrophils

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182
Q

RBS with dark, intracellular inclusions that stain with supravital stain

A

Heinz bodies in G6PD

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183
Q

High fever, confusion, headache, watery diarrhea, mildly productive diarrhea: Diagnosis?

A

Legionella pneumoniaphilae

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184
Q

Where is the bladder located?

A

Extraperitoneal, touches the anterior abdominal wall when expanded

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185
Q

Budding + catheter think?

A

Candida Albicans

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186
Q

Cross-sectional study?

A

Data from a particular point in time. What is happening?

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187
Q

What can onddansetron treat?

A

Chemotherapy=induces emesis Also use, Granisetron

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188
Q

Prostate cancer is associated with what psychological condition?

A

Depression

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189
Q

Pannus

A

Proliferative granulation tissue –> observed in RA

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190
Q

Triad of congenital toxoplasmosis:

A

hydrocephalus, intracranial calcification, chorioretinitis

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191
Q

Enveloped viruses are inactivated by what?

A

Ether, organic solvents

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192
Q

craniopharyngeoma- large growth

A

Compresses stalk of pituitary stops hypothalamus dopamine from reaching the pituitary -> inc. prolactin secretion

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193
Q

Reyes Syndrome

A

hepatic encephalopathy, associated with viral infection (VZV and influenza B) that has been treated with aspirin

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194
Q

Wide, fixed splitting of S2

A

Atrial septal defect -> could potentially lead to pulmonary HTN is untreated

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195
Q

Thiamine is a necessary cofactor for which reactions in

A

pyruvate dehydrogenase, alpha-ketagluterate dehydrogenase

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196
Q

Inhibitor of fatty acid metabolism

A

Maloyl-CoA, which inhibits carnitine acyltransferase

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197
Q

c-Jun

A

nuclear binding factors; also c-FOS

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198
Q

Signs of neostigmine overdose

A

difficult breathing, severe muscle weakness; high doses cause desensitizing of nicotonic receptors Cholinesterage inhibitor

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199
Q

Hammer toes:

A

Friedreich Ataxia

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200
Q

What is increased in Lesch-Nyhan?

A

PPRP- Phosphoribosyl phosphate phoshoriribosylransferase

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201
Q

Antisocial personality description:

A

repetitive and pervasive behavior that violated the baseic rights of others or social norms, destruction of property, aggression towards animals

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202
Q

Platelet aggregation in response to Ristocetin is normal in whhich deficiency?

A

Glycoprotein IIb-IIIa receptors

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203
Q

Hepatitis B liver slide

A

finely granular, homogeneous, dull eosinophilic inclusions (filled with hepatitis B surface antigen)

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204
Q

What effect does alcohol have on acetaminophen metabolism?

A

Alcohol induces CYP2E, which in turn metabolized increased amounts on acetaminophen to NAPQI, which is detoxified by GSH. Decreased levels of GSH increase the risk of ROS injury

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205
Q

Dihydroergotamine-dx and MoA

A

Dx- migraine headaches MoA- constrict blood vessels

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206
Q

Where in the kidney does lithium have an effect?

A

Collecting ducts.

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207
Q

Portion of the urethra most susceptible to damage

A

Membranous portion, just below prostate

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208
Q

Metanephric mesoderm: Forms?

A

AKA blastema- gives rise to the glomeruli, Bowman’s space, proximal tubule, loop of Henle, and distal convoluted tubules

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209
Q

Aplastic anemia

A

pancytopenia from toxins r t-cell issues

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210
Q

Anti-Jo-1

A

Polymyositis, dermamyositis

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211
Q

Acetazolamide MoA

A

carbonic anhydrase inhibitor: self-limited NaHCO3; diuresis, and decreases total body HCO3- stores; acts in the proximal tubule

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212
Q

Side effects pf Thiazide diuretics

A

hyponatremia, hypokalemia, hypercalcemia, hyperglycemia, hypercholesterolemia, hyperuricemia

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213
Q

What forms the superficial inguinal ring?

A

External oblique muscle aponeurosis

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214
Q

Dyspnea, bibasilar crackles and s3 heart sounds post-MI

A

Left ventricular heart failure -> dec. lung compliance

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215
Q

What valve is in danger after a myocardial infarct?

A

Mitral

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216
Q

4th aortic arch

A

Left- aortic arch Right- proximal right subclavian

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217
Q

Tuberculoid leprosy-test?

A

PPD, TH1 response is intact, allowing the recruitment o IL-2 and interferon-gamma to produce a reaction

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218
Q

parethesias and numbness in the dorsum of the right foot- nerve? and damage location?

A

Common peroneal nerve Fibular neck

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219
Q

Motor end plate potential- receptor effect

A

Increased receptor availability increases potential; decreased receptor availability decreases potential

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220
Q

Low grade vs. High grade

A

Low grade- well differentiated High grade- poorly differentiated

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221
Q

What is length constant?

A

aka-space constant How far along a nerve a signal can propigate

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222
Q

Mitral Stenosis-Left Atrium pressure changes

A

Increased left atrium pressure. Normal is the same as LVEDP

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223
Q

ADHD neurotransmitter deficiencies

A

Norepinephrine and dopamine

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224
Q

How is niacin synthesized

A

Primary- Nicotinamide (from diet) Secondary- Tryptophan -> Quinolinate -> Niacin or nicotininc acid minonucleotide (NAD)

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225
Q

Polycythemia Vera: Lab presentation

A

Increased RBC mass, plasma, platelet volume with low erythropoietin

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226
Q

Budding yeast with thick capsule?

A

Cryptococcus neoformans

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227
Q

Drug-induced lupus: anti-bodies

A

anti-ANA, anti-histone

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228
Q

TNF-alpha affect on insulin

A

Increases insulin resistance through the activation of serine kinase Catecholmines, glucagon, corticosteroids work in the same manner

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229
Q

germinoma

A

midline malignant tumor of embryonic germ origin of the pineal gland

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230
Q

What substances competitively inhibit iodine uptake in the thyroid?

A

perchlorate and pertechnetate; competitive inhibition

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231
Q

Nitrates MoA

A

Increased cGMP -> decreased intracellular Ca2+ -> decreased myosin light-chain kinase -> myosin light-chain dephosphorylation -> vascular smooth muscle relaxation

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232
Q

Fluoxetine-MoA

A

Selective Serotonin reuptake inhibitor

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233
Q

Cyt a + a3

A

Cytochrome C, AKA Complex IV of the electron transport chain

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234
Q

Protein M

A

Inhibits phagocytosis and the activation of complment

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235
Q

When the peak potassium permeance the greatest in nerve depolarization?

A

During repolarization

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236
Q

Blood gas coefficent

A

describes solubility of inhaled anesthetics in blood

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237
Q

Diffuse muscle cramps, especially after exercising?

A

Statin-induced myopathy

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238
Q

BNP signaling pathway

A

guanylyl cyclase converts GTP to cGMP; cGMP activated cGMP protein kinase

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239
Q

What is the active thyroid hotmone?

A

T3

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240
Q

pinpoint pupils and decreased respiration?

A

Opiods -> Ie. heroin

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241
Q

meromelia

A

failure on part of a limb to develop; thalidomide

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242
Q

Fibronectin: Used?

A

cell adhesion, growth, migration

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243
Q

Drugs that can cause drug induced lupus

A

Procainamine, Hydralazine, Isoniazid, Minocycline, quinidine

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244
Q

Where is ADH synthesized

A

paraventricular and supraoptic nuclei of the hypothalamus, eventually secreted by the posterior pituitary

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245
Q

You have to add primaquine to treat hypnozoites for which 2 species?

A

F. Vivax and Ovale

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246
Q

2nd aortic artch

A

Hyoid artery, stapedial artery

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247
Q

rivaroxban- MoA

A

Inhibits Factor Xa, used in venous thromboembolism and A. fib.

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248
Q

Cardiogenic shock signs:

A

Loss of consciousness, sudden and ongoing rapid heart beat, sweating, pale skin, weak pulse, rapid breathing, decreased or no urine output

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249
Q

Drug treatment for anaphylactic shock?

A

Epinephrine (alpha 1, beta 1) stimulation

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250
Q

Heroin withdrawal signs

A

hypersensitivity, increased sympathetic discharge

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251
Q

What does von Willibrand factor bind to?

A

Glycoprotein iB receptors, carried factor VIII Binds to exposed collagen underneath damaged endothelium

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252
Q

Polyarteritis Nodosa

A

Transmural wall inflammation of arterial wall with fibroid necrosis

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253
Q

Jugular Venous pressure tracing

A
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254
Q

Primary amenorrhea

A

absence of menses by age 15 in someone who has normal growth and secondary sex characteristics

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255
Q

Spherocytosis

A

AD hemolytic anemia -> look for spherical RBCs without a center pallor zone; Defect is in spectrin and ankyrin, a cytoskeletal protein

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256
Q

Treatment for COPD?

A

beta 2-agonists; activates Gs to increase cAMP concentration -> relaxation

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257
Q

Well differentiated, dysplastic columnar cells with growth along intact alveolar septae

A

Adenocarcinoma in Situ

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258
Q

Medulloblastoma: histology

A

Solid with tiny blue cells

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259
Q

Which drug lengths QT, but has a low incidence of torsades de pointes

A

Amiodarone

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260
Q

Calcium channel blocker- side effects

A

Constipation, edema, flushing, CV (HF, AV block sinus node depression)

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261
Q

Carbidopa-MoA

A

Stop peripheral degridation of L-Dopa reduces peripheral affects, however, does not stop neurological (anxiety, agitation)

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262
Q

Andrenergic receptor signal transducers

A

a1 - Gq a2 - Gi b1 - Gs b2 - Gs

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263
Q

Does not aggregate in the presence of ristocetin?

A

Von Willebrand factor

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264
Q

Filtered fraction equation

A

GFP/renal plasma flow rate

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265
Q

Terbinafine: MoA

A

inhibits synthesis of fungal membrane ergosterol via squalene epoxidase

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266
Q

Sensitive vs Specific

A

Sensitivity-rules out a disease Specificity- rules in a diease

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267
Q

Agitation, disorientation, pharyngospasm, photophobia leading to coma, death..

A

Rabies encephalitis

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268
Q

Method of resistance for fluoroquinones

A

DNA gyrase mutation

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269
Q

Polycystic Ovarian Syndrome presentation

A

amenorrhea/oligiomenorhea, hirsutism, acne, decreased fertility; associated with obesity

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270
Q

How does HbS cause symptoms?

A

Causes hydrophobic interactions among hemoglobin molecules

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271
Q

Lowest pH in the nephron

A

Distal tubules and collecting ducts

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272
Q

Where does thyroxine act?

A

Thryoxine binds to nuclear receptors

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273
Q

What drugs can help speed up the development of sulfactant pre-delivery?

A

Dexamethasone, bethamethasone

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274
Q

Liquifactive necrosis

A

Lysosomal digestion of the necrotic tissue in the brain

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275
Q

Varicocele

A

backup of blood into the testicular pampiniform plexus

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276
Q

Renal plasma flow rate calculate

A

RBF*(1-hematocrit)

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277
Q

Milrinone

A

phosphodiesterase 3 inhibitor; stops cAMP degradation, inc. heart contractility Also increases dilation in arteries, causes BP reduction

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278
Q

Tumor Homing

A

Recognition of “exit sites” on blood vessels in target tissues; i.e. breast cancer targets brain cells

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279
Q

DVT is pregnancy, treatment?

A

Low molecular weight heparin (enoxaparine

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280
Q

How to calculate maintenance dosage?

A

[Steady state concentration x clearance]/bioavailability

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281
Q

Treatment for PTSD

A

Cognitive therapy, SSRI

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282
Q

Sporotrichosis, organism?

A

Sporothrix schenckii

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283
Q

abrupt hemoturia with sickle cell disaese?

A

Acute tubular necrosis

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284
Q

Does the cerebellum control contralateral or ipsilater?

A

Ipsilateral

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285
Q

How is an aneurysm formed?

A

Transmural inflammation -> defredation of elestin and collagen by proteases -> loss of eslastin -> abnormal collagen remodeling -> weakening aortic wall

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286
Q

Placenta Accreta

A

Placenta attaches to myometrium without penetrating it

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287
Q

Holosystolic murmurs

A

tricuspid, mitral regurgitation; ventricular septal defect

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288
Q

Hemophilia B-inheritance/

A

X-linked recessive

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289
Q

Dobutamine- MoA

A

Gs -> increase cAMP, Ca2+ increase, increased contractility, and HR (inc. myocardial oxygen consumption)

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290
Q

Most common cause of UTI?

A

E. Coli

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291
Q

M. pneumoniae: additional risks

A

Hemolytic anemia from the cross-reaction of IgM with erythrocytes

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292
Q

What enzymes neutralize reactive oxygen species?

A

superoxide dismutase, peroxidase, catalase

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293
Q

anti-HBs

A

indicated resolution of acute infection or vaccination (negative HBsAg -confers long-term immunity

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294
Q

Radial traction

A

increased outward pulling, restrictive lung disease

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295
Q

Stain to turn fat black

A

Osmium tetroxide

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296
Q

Fasting leads to critically low glucose levels

A

defect in beta- oxidation in the mitochondria -> acyl-CoA dehydrogenase

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297
Q

Long slender microvilli containing tonofilaments

A

mesothelioma, tonofilaments are desmosomes

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298
Q

Organophosphate- Tx

A

Atropin, pralidoxine

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299
Q

Function of c3b

A

Opsonization and activation of the MAC complex works with IgG

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300
Q

Indirect inguinal Hernia: Site, lower, median border

A

Site: Deep inguinal ring lower- inguinal ligament medial - inferior epigastric vessels

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301
Q

parvovirus B19: characteristics

A

non-enveloped single-stranded DNA

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302
Q

Bambesin

A

Neuroectodem tumors (carotid body,)

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303
Q

What composes a splceosome?

A

snRNPs, proteins, pre-mRNA; removes introns

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304
Q

Acute Salicylate overdose

A

Respiratory alkylosis, followed by metabolic anion-gap acidosis

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305
Q

With abuse patients, what is the physicians primary goal?

A

Make sure they have a safe place to go

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306
Q

“bursts of coughing” with vomiting afterwards: suspect?

A

Pertussis, a gram negative coccobacillus

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307
Q

What is the role of negative selection?

A

Eliminate high affinity cell; reduce self-immune reactions

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308
Q

What structures drain into the IVC via the left renal vein?

A

Left testicular artery and renal vein

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309
Q

H. influenzae virulence factors?

A

Hib- polysaccharide capule: polyribosylribitol phosphate Prevents phagocytosis by inhibiting factor H

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310
Q

What test is used to monitor Warfarin

A

Prothrombin time

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311
Q

Where are parietal cells location

A

Upper glandular layer

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312
Q

In alcohol metabolism, what reaction consumes NAD+

A

alcohol dehydrogenase; increases NADH to NAD+ ratio

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313
Q

22q11 deletion: Dx name

A

DiGeorges Syndrome

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314
Q

Na, Cl, Ca storage

A

extracellular

315
Q

What is Rheumatoid Factor and what does it target?

A

RF is an IgM autoantibody that targets the Fc portion of IgG

316
Q

Most common cause of prostatitis?

A

E. coli

317
Q

Patient with pneumonia receives blood transfusion and develops facial swelling, etc.? Diagnosis? Why?

A

IgA deficiency -> leads to over production of IgE that reacts with donor blood

318
Q

B. fragilis- characteristics

A

gram negative, bacillus, anaerobic

319
Q

Brown granular casts

A

Acute tubular necrosis;most common cause of acute kidney damage in hospitalized patients; usually resolves spontaneously; location: proximal convoluted tubule, ascending limb

320
Q

Patau- cytogenetic studies

A

meiotic nondisjunction

321
Q

Endothelial nitric oxide synthasis: Location and substrates

A

Location: vascular endothelial cells Substrates: arginine, O2, NADPH

322
Q

Mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes

A

MELAS- stroke-like episodes with residual neurological deficit, muscle weakness, seizures

323
Q

How do you evaluate the suseptability of Ankylosing Spondylitis?

A

Analysis of Class 1 MHC Allele expression

324
Q

Cushing syndrome workup test

A

Dexanethasone suppression test

325
Q

Natural Transformation

A

Uptake and incorporation of foreign DNA into a bacterium- requires the bacterium to become competent

326
Q

Breast milk lacks what?

A

Vitamin D and K

327
Q

What is the most effective preventive intervention to improve health outcomes?

A

Smoking cessation

328
Q

Chronically ill individual with low hemoglobin/hemoatocrit. How to treat?

A

EPO

329
Q

Alcohols effects of p450?

A

Induces it

330
Q

What is contained in the paracortical lymph node?

A

T-lymphocytes and dendritic cells

331
Q

Hypocretin-1 alternative name

A

Orexin-1

332
Q

Treatment for DVT?

A

Warfarin

333
Q

Define gastric erosions vs. gastric ulcer

A

Mucosal defects that do not extend fully into the muscularis mucosa vs. gastric ulcers that extend into the submucosa

334
Q

Signs of a manic episode?

A

Distractibility Impulsivity/indiscretion Grandiosity Flight or fight activity increase Sleep decrease Talkativeness with/without dilusion Diagnosed as bipolar 1 disorder

335
Q

Tumbling rods

A

Listeria

336
Q

Congenital toxoplasmosis: infection route?

A

In utero infection; only if mother is affected during the first six months

337
Q

What is at risk for damage in the 3rd part of the duodenum?

A

Superior mesenteric artery

338
Q

Cutaneous neurofibromas

A

Early adolescence, multiple, raised fleshy tumors (

339
Q

What factors use cAMP signaling?

A

FSH, LH, ACTH, CRH, hCG, ADH, MSH, PTH, calcitonin, GHRH, glucagon (FLAT ChAMP)

340
Q

Cholchicine-MoA

A

second-line therapy; inhibition of microtubular formation

341
Q

Acute Interstitial nephritis: Causes

A

Diuretics, NSAIDS, Penicillin and cephalosporins, proton pump inhibitors, and rifampin

342
Q

Wiskott-Aldric

A

Thrombocytopenia, recurrent infections, eczemia

343
Q

Acute Intermediate porphyria: Tx

A

Inhibit ALA synthase, glucose and heme Limit use of P450 induces

344
Q

What type of epithelium is contained in the r eminent thyroid duct cysts?

A

Thyroid follicles

345
Q

JAK2 signal type

A

tyrosine kinase

346
Q

Fish oil -MoA

A

Decreases VLDL and triglycerides production via antagonism of receptors

347
Q

Fabry Disease: Signs

A

neuropathic pain, hypohidrosis (dec. sweating), severe distal extremity pain, angiokertomas, and telangiectasis, proteinuria and polyuria (leading to renal failure)

348
Q

Federoxamine

A

iron overload and overdose

349
Q

Hemochromatosis: Effects

A

Dilated cardiomyopathy (reversible), hypogonadism, HCC (cause of death)

350
Q

P450 inducers

A

Carbemazepines
Rifampicin
Alcohol (chronic)
Phenytoin

Griseofulvin
Phenobarbitone
Sulphonylureas

351
Q

Function of the inferior gluteal nerve?

A

Gluteus maximus, extention and external rotation; trouble rising from a seated position and climbing stairs

352
Q

Coffee ground emesis

A

peptic ulcer disease

353
Q

What artery runs with the radial nerve at the mishaft of the humerus?

A

Deep brachial (AKA profundi brachii) after it branches from the brachial artery

354
Q

Leukomoid Reaction

A

Increased white blood cell count, or leukocytosis, which is a physiological response to stress or infection

355
Q

Pilocarpine-MoA

A

non-specific muscarinic receptor antagonist

356
Q

What are the risks associated with congenital rubella?

A

sensorineural deafness, cataracts, and cardiac malformation (PDA_

357
Q

-melia

A

limbs

358
Q

Sumatriptan

A

Serotonin agonist; inhibits trigeminal nerve activation prevents vasoactive peptide release’ induce vasoconstriction; Rx- acute migraine, cluster headache attacks

359
Q

How to calculate resistance in parallel?

A

1/R1 + 1/R2 + 1/Rn

360
Q

Dermatomyositis

A

bilateral proximate muscle weakness violaceous eruption on eyelids and knuckles

361
Q

Multiple myeloma- characterics

A

hyperCalcemia Renal failure Anemia Bone/Back pain

362
Q

What are brown pigment stones characteristic of?

A

Infection-formed gallstones

363
Q

Wants due to HPV?

A

Condyloma acuminata

364
Q

Clavulanic acid

A

beta-lactimase inhibitor; expands antibiotic spectrum to include beta-lactamase synthesizing bacteria

365
Q

“honeycomb uterus” “cluster of grapes”

A

Complete hydatidiform mole

366
Q

Shiga toxin - MoA

A

Phage encoded -> inhibits 60s ribosomal subunit -> inhibition of protein synthesis -> cell death

367
Q

Leading cause of death in women is

A

CVD

368
Q

“serpentide” pattern in TB

A

Cord factor (virulence)

369
Q

Scopolamine- side effects

A

anticholinergics, blurry vision, dry mouth, urinary retention,, constipation

370
Q

What area of the lymph nodes do T-lymphocytes and dendritic cells populate?

A

paracortex

371
Q

Zinc finger motif: function

A

Located with hormones that directly bind to DNA Steroids, thyroid and fat-soluble vitamins

372
Q

Loading Dose Calculation

A

Volume of distribution X serum concentration X body weight

373
Q

Transplant patient with pneumonia and intranuclear and cytoplasmic inclusions (owl’s eyes)

A

CMV- double stranded enveloped virus

374
Q

What is a marker for testicular cancer?

A

b-HCG

375
Q

Endoneural arterioe hylanization

A

Associated with DM (diabetic microangiopathy), distal symmetric peripheral polyneuropathy, starting in feet

376
Q

What should be monitored with Lithium

A

BUN, Creatinine, thyroid function

377
Q

Where does the trigeminal nerve exit the brainstem?

A

Lateral aspect of the mid-pons at the level of the middle cerebral peduncles

378
Q

What does the 1st pharyngeal arch develop into?

A

maxillary processes, and mandibular processes, bones of the lower 2/3 of the face and jaw

379
Q

Cytokeratins

A

keratin-containing intermediate filaments that make up the exoskeleton of almost all epithelial cells.

380
Q

Early Signs of GVHD

A

maculopapular rash (palms and soles- desquamate (flaky) GI- diarrhea, intestinal bleeding, abdominal pain Transplanted organ remains unaffected

381
Q

What organism is associated with gastric cancer?

A

H. pylori

382
Q

Myasthenia Gravis- organ abnormalities

A

Thymoma, and other thymus disorders

383
Q

E7

A

inhibits RB supression gene

384
Q

HER2/ney oncogene encodes?

A

185-kD transmembrane glycoprotein that has tyrosine kinase activity

385
Q

Fibromyalgia-signs

A

widespread musclulocutaneous pain with fatigue, impaired mental attention; multiple tender points in various locations

386
Q

SLE signs? specific antibody?

A

skin rash, photosensitivity, arthraglia anti-dsDNA, anti-Smith

387
Q

Schizophrenia signs? Tx?

A

social isolation, disorganized behavior, delusions, thoughts disorder Tx- atypical antipsychotic, Olanzapine

388
Q

Acute Intermittent Porphyria: Signs

A

variable gastrointestinal and neurologic symptoms, reddish urine

389
Q

Where is the pulmonary vascular resistance the lowest?

A

@ the functional residual capacity line (ending TV)

390
Q

What is alpha?

A

The significant level, the likelihood of detecting something significant when it is not

391
Q

Signs of hydronephrosis?

A

Increased volume in renal pelvis

392
Q

How do atherosclerotic plaques grow?

A

release of PDGF -> smooth muscle cell migration from media to intima -> SMC proliferation

393
Q

Pyrophosphate analog

A

bisphosphonates

394
Q

Blood vessls involved with epistaxis

A

Anterior- Nasal Septum (Kiesselback plexus-anterior ethmoidal artery, sphenopalatine artery, superior labial artery) Posterior- Posterior Wall (Sphenopalatine artery)

395
Q

Drugs to prolong mortality in HF patients

A

Spironolactone, eplerenone; any potassium sparing diuretics

396
Q

Signs on neurosyphilis

A

headaches and memory loss

397
Q

Where to colonic lymph nodes drain?

A

inferior mesenteric to internal iliac

398
Q

Chlorpheniramine: side effects

A

Dizziness, drowsiness

399
Q

Signs of femoral nerve injury

A

Inability to extend quadriceps muscle, loss of patella reflex, and loss of sensation of anterior and medial thigh and medial leg

400
Q

Hodgkin’s lymphoma- signs

A

Reed Steinberg cells *large cells with 2 nuclei), non-tender lymphadenopathy

401
Q

Atypical cells with abundant lacey cytoplasms in peripheral blood smear?

A

Reactive cytotoxic T-cells (reacting to EBV infected B-cells.

402
Q

Muscle ridgity with very high fever

A

Malignant hyperthermia, syccinylcholine

403
Q

Intraductal papilloma vs pituitary adenoma

A

Intradutal piapilloma is unilateral, whereas pituitary adenoma is bilateral

404
Q

What are the side effects of long-term alcohol abuse?

A

Thiamine deficiency -> Vermin degeneration -> Gait Ataxia

405
Q

Phelan sign

A

Flexion of wrist reproduces carpel tunnel syndrome

406
Q

Gower Sign

A

using hands to rise from a squat

407
Q

What regulated the hypothalamus-pituitary-thyroid axis negative feedback?

A

T3

408
Q

What is normagonadotrophic an-ovulation?

A

Normal cycle with normal levels of FHS and estrogen, associated with PCOS, treat with Clomiphene

409
Q

Ecological study

A

Study of populations, not people (tropical studies)

410
Q

How does estrogen effect the thyroid?

A

Increased estrogen = increased Tyroxine-bound globulin

411
Q

Signs of cocaine withdrawal

A

depression, fatigue, hypersomnia, hyperphagia, vivid dreams Acute binge- severe depression with suicidal ideation, lassitude (lack of energy), and drug craving

412
Q

Neurophysin

A

Carrier protein for oxytoxin and vasopressin

413
Q

Opiod analgesics effects on the sphincter of Oddi

A

cause contraction via the activation of mu receptors; Tx- discontinue use

414
Q

Treatment for bulimia?

A

Behavioral therapy, SSRI

415
Q

Febrile illness in Massachusetts?

A

Ixodies; babesiosis

416
Q

Atrial septal defect sound

A

wide and fixed splitting of s2 mild-systolic ejection murmur over left upper sternal border

417
Q

Vincristine

A

Inhibit polymerization into microtubules

418
Q

Polythycemia Vera: Presentation

A

piethoric, ruddy face and splenomegaly

419
Q

Somatic symptom disorder: signs and tx

A

Sings: preoccupation with unexplained medical symptoms and excessive health case Tx: schedule regular outpatient visits

420
Q

Impaired memory recall, area of brain affected?

A

Hippocampal area

421
Q

Spindle cells with surrounding blood vessel proliferation?

A

Kaposi Sarcome

422
Q

Signs of congenital hypothyroidism

A

lethargy, hoarse cry, poor feeding, constipation, jaundice, dry skin, umbilical hernia, large fontanelles (soft spot) Symptoms starts week after birth (material T4)

423
Q

Preferred benzodiazapines for people with impaired hepatic metabolism

A

“LOT” Lorazepam, Oxazepam, Temazepam

424
Q

Golgi tendor reflex

A

receptors that measure stretch in tendons and muscles; protective mechanisms to stop overstretching a muscle

425
Q

What should you limit use of alpha-1 decongestants?

A

Body compensated by reducing normally produced hormones to negate benefit.

426
Q

Sexually active individuals - Hepatitis risk

A

Hep. B

427
Q

Function of beta-glucuroidase

A

hydrolyzes bilirubin glucuronides and increases the amount of unconjugated bilirubin -> increasing stone formation

428
Q

What occurs in the damaged portion of the brain after glios

A

Lysosomal digestion of the necrotic tissue

429
Q

Organophosphate poisoning- signs

A

salvation, lacrimation, disphoresis, bradycardia, bronchospasm

430
Q

Signs of West Nile Virus

A

febrile, rash, neurological manifestations (encephalitis, flaccid paralysis)

431
Q

What codons code for “stop”

A

UAA, UAG , UGA

432
Q

McArdles disease: Signs

A

Muscle cramps, myoglobinuria with strenuous exercise, Deficiency is Myophosphorylase

433
Q

Zidovudine- MoA

A

competitively binds to reverse transciptase and is incorporated into the viral genome as a thymidine analog -prevents DNA chain elongation

434
Q

T-cells that express neither CD4 or CD8 are?

A

Pre-B lymphocyte progenitors in bone marrow

435
Q

Nitroprusside- effect

A

causes venous and arterial vasodilator causes decreased preload and afterload

436
Q

Osteoclast Activation Factor

A

Alternative name for IL-l; overproduction leads to osteoporosis

437
Q

In most individuals what vessels gives rise to the Posterior descending artery?

A

Right coronary-supplies posterior portion of right ventricle and 1/3 interventricular surface

438
Q

Hemochromatosis: risk factors?

A

Hepatocellular carcinoma

439
Q

Where are the myosin heads located in the sarcomere

A

A band

440
Q

Thrombotic thrombocytopenic purpura: Signs? Defect?

A

hemolytic anemia, thrombocytopenia Defect: Dec. ADAMS13, large vWF monomers

441
Q

Interleukin-1 inducible 1 enzyme that is highly expressed in inflamed tissue, but absent in normal

A

Celecoxib

442
Q

Signs of succylcholine poisoning?

A

Severe Kyperkalemia, myopathies

443
Q

What ligament contains the ovarian vessels?

A

Suspensory ligament; connects ovaries to lateral pelvic wall

444
Q

Viridans streptococci: Characteristics

A

Found in the human mouse and contribute to dental cavities; synthesize dextrose from sucrose; attach to pre-damaged heart valves

445
Q

Norepinephrine-MoA

A

a1 stimulation- inc. IP3 -> vasoconstriction in peripheral vessels b1 stimulation - inc. cAMP -> inc. contractility, conduction, HR (limited by baroreceptor response)

446
Q

Recurrent sinopulmonary infections and congenital absence of the vas deferens

A

CF, also as obstruction of the pancreatic duct -> pancreatic insufficiency

447
Q

Warfarin uses

A

DVT, A. fib., pulmonary thromboembolism

448
Q

How to determine the number need to treat?

A

NNT = 1/absolute risk reduction Lower NNT is more beneficial

449
Q

Acute Interstitial nephritis

A

Hapten induced hypersensitivity

450
Q

Microfold cells

A

M-cells Base of the Peyer patch Site of entry for Shigella

451
Q

Endomysial inflammatory disease

A

Polymyslitis; presents with proximal muscle weakness, no distal weakness

452
Q

Signs of pituitary hemorrhage

A

Bilateral hemianopia, CV collapse, impaired CNIII

453
Q

Polycystic astrocytoma: Imaging

A

Solid and cystic components on MRI

454
Q

Causes of acute tubular necrosis?

A

Sickle cell disease, acute pyelonephritis, analgesics, diabetes mellitus

455
Q

Clopidogrel-MoA

A

prevents platelet aggregation by blocking P2Y12 on platelet ADP receptors

456
Q

What receptors does low dose dopamine target systemically?

A

b1- increased heart contractility D1- vasodilation of renal and mesenteric vessels **At high does, dopamine will induce vasoconstriction via alpha 1 receptors.

457
Q

anti-cyclic citrulinated antibody

A

Rheumatoid arthritis

458
Q

What forms from the 3rd aortic arch?

A

proximal internal carotid, common carotid and glossharyngeal nerve

459
Q

What part of the ECG is affected by beta blockers?

A

increases PR interval by decreasing AV nodal conduction

460
Q

C. perfringes can cause

A

Food poisoning (watery diarrhea and abdominal discomfort) and gas gangrene

461
Q

normal phenylalanine and elevated prolactin? Co-factor?

A

tetrabihydrobiopterin (BH4) deficiency; co-factor for tyrosine hydroxylase and phenylalanine hydroxylase

462
Q

Placental ALP

A

Seminoma

463
Q

Function of primaquine?

A

Treat hypnozoites to stop disease relapse

464
Q

P450 Inhibitors

A

Sodium valproate
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Alcohol..binge drinking
Chloramphenicol
Erythromycin
Sulfonamides
Ciprofloxacin
Omeprazole
Metronidazole
Grapefruit juice

465
Q

Short stature, high arched palate, Tanner 1 breasts, and widely spaced nipples

A

Turner syndrome (45, XO)

466
Q

Anicteric

A

subclinical (i.e. no clinical presentation)

467
Q

How do you minimize wrong site errors in surgery?>

A

Dual identifiers

468
Q

Heteroplasmy

A

Presence of both normal and abnormal mtDNA; results in variable expression in mitochondrially inherited disease

469
Q

Sildenafil MoA

A

Phosphodiestease-5 Inhibitor; decreases degradation of cGMP

470
Q

What enables “-rubicin” drugs to cause cardiotoxicity?

A

Generation of free radicals

471
Q

What is the effect of a prolactinoma in men? in women?

A

Men- infertility, decreased libido, impotence Women-oligo/amenorrhea, galactorrhea, decreased bone density (estrogen suppression)

472
Q

Function of S cells?

A

Secretion of secretin, inc. bicarbonate, dec. gastric acid secretion

473
Q

Glioblastoma: Histological presentation

A

bizarre glial cells with multiple mitotic figures, pseudopalisading

474
Q

Tacrolimus

A

calcineurin inhibitor, stops T-lymphocyte proliferation

475
Q

What gastric vessels are supplied by the splenic artery?

A

Short gastric (no anastemosis), left gastroepiploic (anastemosis with right gastric)

476
Q

Why is irradiate blood given to SCID patients?

A

To prevent GVHD later in life

477
Q

Handgrip maneuver

A

Increases systemic resistance to increase afterload -> increases sounds of reverse blood flow (i.e. VSD)

478
Q

Cholesterol granulomas

A

bluish-black gelatinous material behind the tympanic membrane

479
Q

How is homocysteine processed? Cofactors?

A

metabolized to methionine via methionine synthase (Vit. B12, with folate) OR cystathionine via cystathionine synthase (B6)

480
Q

How to treat hypertensive emergency with poor renal perfusion?

A

Fenoldopam

481
Q

Systemic Mastocytosis

A

Mast cell proliferation (KIT receptor tyrosine kinase) in skin, bone marrow, and other organs. Causes excessive histamine release leading to flushing, syncope, hypotension, pruritis, and urticaria (hives). Inc. histamine stimulates gastric acid secretion -> gastric ulcer formation

482
Q

Arsenic poisoning- signs

A

severe watery diarrhea, hypotension, QTc prolongation, garlic orod on breath or stool

483
Q

metyrapone stimulation test

A

HPA integrity test -> blocks conversion of 11b-hydroxylase, which converts 11b-deoxycortisol to cortisol -> urinary excretion of 17b-hydroxycorticosteroid Failure to inc. signifies problem with HPA axis

484
Q

Equation for flow rate:

A

Flow rate = area x volume

485
Q

How does acute tubular necrosis present?

A

cell ballooning and vacuolar degeneration

486
Q

What parts of the cortex are absent in agammaglobulinemia?

A

Primary lymphoid follicles and germinal centers

487
Q

MEN1

A

Pancreas, pituitary, parathyroid

488
Q

Thioamides - MoA

A

inhibits throid peroxidase

489
Q

Hereditary orotic aciduria: Cause

A

uridine 5’-monophosphate synthase

490
Q

Speed of movement on gel elecrophoresis?

A

Hemoglobin A > Hemoglobin S, Hemoglobin C

491
Q

fever, bleeding gums, sore throat?

A

Acute myelogenous leukemia

492
Q

Sign of marijuana infection?

A

conjunctival injection, tachycardia, increased appetite, dry mouth

493
Q

Lupus signs:

A

Rash, arthritis, serositis,hematological disorders, oral.nasopharynx disorders, renal disease, photosensitivity, anti-ANA antibodies, neurologic disorders

494
Q

Carbonic Anhydrase MoA

A

self-limited NaHCO3; diuresis, and decreases total body HCO3- stores; acts in the proximal tubule

495
Q

Tigeminal neuralgia

A

sudden, severe pain in the distribution of CNV; treat with Carbamazapine

496
Q

Where to muscles involved in hip adduction originate?

A

Pubis and Ischium

497
Q

Signs of an ectopic pregnancy

A

abdominal pain, bloody vaginal discharge, orthostatic hypotension

498
Q

TCA overdose- Tx

A

sodium bicarbonate; if widened QRS and/or ventricular arrhythmias are present bicarb increases pH and extracellular sodium availability.

499
Q

Ipratropium

A

anticholinergic agent and derivative of atropine

500
Q

What is metanephrine? Where does it come from?

A

metabolite of epinephrine Medulla of the adrenal cortex (secretion of catecholamines)

501
Q

Elastin: structure

A

interchain crosslinks involving Lycine

502
Q

MEN 2B

A

Marfanoid, Mucosal Neuromas, and Medullary thyroid cancer, Pheochromocytomas

503
Q

Budding yeasts that form germ tubes @37 degrees?

A

Candida Albicans

504
Q

Where is the adenohyphysis derived from?

A

Surface ectoderm (Week 3, during gastrulation)

505
Q

Jimsen Weed

A

Belladonna alkaloid toxin, strong anti-cholinergic effects

506
Q

Dysostosis multiplex: description, cause

A

Course facial features, short stature, neurodegeneration, gait problem. Caused by abnormal targeting of enzymes to the lysosomes

507
Q

What cells derive the digestive tract?

A

Endothelium

508
Q

Lymph node cortex

A

site of B-cell proliferation during immune response (germinal centers) site of isotype switching (required CD40 receptor

509
Q

What developmental milestones should be reached by age 2?

A

50+ word vocab, 2 word phrases, follow 2-step commands, parallel play, build six-bloack tower

510
Q

Friedreich ataxia: problem

A

Absence of Schwann Cells

511
Q

Rationalization- defense mechanism

A

Making excuses for unpleasant things or events

512
Q

Signs of maternal rubella

A

low-grade fever, maculopapular rash (head to body) posterior auricular and suboccipital lymphadenopathy

513
Q

SCID characteristics

A

Severe bacterial and viral infections in infancy chronic diarrhea mucocutaneous candidiasis

514
Q

What is the initiation stage of tubular necrosis?

A

Ischemi injury to renal tubules, precipitated by hemorrhage, acute MI, sepsis, surgery, etc.

515
Q

Carboxyhemoglobin

A

Form of hemoglobin bound with CO instead of O2. Causes decreased O2 binding capacity. Inhibits complex IV of the electron transport chain

516
Q

Signs of chronic inflammation

A

Lymphocytic infiltration with collagen deposition

517
Q

Acute intermittent porphyria: Cause

A

AD, disorder of the heme synthesis cause by porphobilinogen deaminase deficiency

518
Q

Cromolyn sodium

A

inhibits mast cell degranulation and release of histamine

519
Q

Gut bacteria can produce which vitamins?

A

Folate and vitamin K

520
Q

Reaction formation

A

Responding in a manner opposite to one’s actual feelings

521
Q

Sheets of granular cells embedded in a hyaline stroma?

A

Medullary

522
Q

What is the physiological response to heart failure?

A

Heart failure -> reduced perfusion of tissue -> dec. renal blood flow -> inc. renin -> arteriolar constriction

523
Q

Increased thirst and urinary frequency in a person with metabolic syndrome, think?

A

Diabetes Mellitus

524
Q

What nerve passes through the interscalene shealth?

A

Phrenic nerve

525
Q

Renal ammoniagenesis

A

metabolism of glutamine to ammonium in the PCT to connect sodium

526
Q

Supinator Canal

A

Between superficial and deep parts of the supinator canal Cause by repetitive supination/protination; Presents with “finger drop”

527
Q

Primary Carnitine deficiency signs

A

muscle weakness, cardiomyopathy, hypoketotic hypoglycemia, elevated muscle triglycerides

528
Q

Ragged red fibers signify

A

mitochondrial dysfunction

529
Q

1 aortic arch

A

Part of maxilaary artery

530
Q

Myoglobin o2 saturation

A

single unit of globin (hemaglobin (hemaglobin = 4 subunits). Must stronger attraction to oxygen than hemaglobin; hyperbolic saturation curve

531
Q

Bacterial toxin strongly associated with the development of sepsis?

A

LPS

532
Q

Human recombinant form of BNP

A

Nesiritide

533
Q

Signs of Neuroleptic Malignant Syndrome

A

hyperthermia, muscle rigidity (“lead-pipe”), altered mental status, autonomic instability

534
Q

What type of receptors are baroreceptors?

A

stretch receptors, inactivated at lower BP

535
Q

Hep A-clincal signs

A

fever, anorexia, dark-colored urine

536
Q

Patau Signs

A

holoprosencephaly, microcephaly, microphthalmia, cleft lip.palate, and omphalocele

537
Q

Glucagon 2nd messanger system?

A

Glucagon -> GTP -> cAMP -> protein kinase A -> serine-threonine residue phosphorylation and phosphorylation of proteins that bind regulatory genes on DNA

538
Q

Medullary thyroid carcinoma: Gene mutation association

A

RET-activation mutation

539
Q

Risk factors for pancreatic cancer?

A

smoking, chronic pancreatitis

540
Q

anterolateral displacement of the proximal fracture fragment at supracondylar humerus? posterior displacement?

A
  1. Radial nerve injury 2. Ulnar
541
Q

How is the Lac operon regulated?

A

Negatively by binding of the protein to the operator locus Positively by cAMP binding upstream from the promoter region

542
Q

Primary Ciliary Dyskinesia: manifestations

A

Upper and Lower respiratory track infections, randomization of left-right body asymmetry, infertility

543
Q

Methanol exposure signs

A

metabolic acidosis, opthamanologic, neurologic signs

544
Q

Spinal muscular atrophy

A

SMN-1 mutation, with encodes snRNPs

545
Q

Oeay d’orange define? association?

A

generalized erythematous rash that is often itche Skin texture is firm and course. The presence of breast edema is characteristic of inflammatory breast cancer Associated with lymphatic obliteration

546
Q

Bosentan-MoA

A

Endothelin antagonist- used to treat pulmonary artery hypertension

547
Q

What should be monitored with Olanzapine?

A

Dislipidemia, hyperglycemia Also, monitor them with Clozapine

548
Q

Baclofen

A

GABA-B receptor agonist used to treat spasticity, secondary to brain and spinal cord lesions, in MS patients Also use Tizamide

549
Q

Carple tunnel syndrome: signs and nerve

A

Palmer surface of first three digits, thenar weakness, tinel sign, Phelan sign Median nerve

550
Q

Renal Cell Carcinoma-neoplastic syndomes

A

EPO, ACTH PHTrP

551
Q

How does anxiety lead to “passing out”

A

Decreased pCO2 -> dizziness, weakness, blurred vision

552
Q

Bacteriostatic drugs that inhibit binding of aminoacyl-tRNA to the 30s subunit

A

Tetracyclins

553
Q

Peroxisomes-function

A

beta-oxidation of VLCFA, amino acids, etc.

554
Q

Fluoxetine

A

selective serotonin reuptake inhibitor

555
Q

Histopathological presentation of hepatitis B

A

accumulation of surface antigen within hepatocytes described at finely granular, pale pink cytoplasm with dull eosinophilic inclusion

556
Q

Who does medicare cover?

A

65 year and older, disabled individuals, end-stage renal disease, or ALS

557
Q

Most deoxygenated blood location?

A

Coronary sinus-> myocardial cells extract 60+75% of oxygen from blood

558
Q

Bullous Pemphigoid antibody?

A

Hemidesmosomes; bullous pemphigoid antigen

559
Q

Streptococcus Mitis:

A

Alpha-hemolytic organism living in the mouth

560
Q

Where is airway resistance maximum?

A

Generations 2-5, including the segmental bronchi

561
Q

Leydig cells

A

Male testes similar to the theca interna cells of the ovarian follicles -> secrete testosterone in response to LH

562
Q

How does a PE affected V/Q

A

Areas of ventilation with areas of absent profusion

563
Q

What joints are affected in RA?

A

Cervical spine, DIP, MCP, MTP

564
Q

Role of the ventromedial nucleus?

A

mediated satiety, destruction leads to hyperphagia

565
Q

Function of infraspinatus? teres minor?

A

infraspinatus- Laterally rotates arm Teres minor- adducts and laterally rotates arm

566
Q

What binds to the platelet IIb/IIIa receptor?

A

Fibrinogen

567
Q

What occurs in long-term topical corticosteroid use?

A

Dermal atrophy; loss of dermal collagen, cracking, drying, tightening, etc.

568
Q

Absolute risk reduction

A

Control rate - Treatment rate (in percent)

569
Q

Physical sings of bulimia nervosa?

A

Bilateral enlarged parotid glands, eroded enamel

570
Q

What receptors does atropine target?

A

Muscarinic, do not affect nicotinic (GI tract)

571
Q

Cerebral amyloid angiopathy

A

most common cause of lobar hemorrhage in the elderly, mostly in the occipital and parietal lobes

572
Q

Bronze diabetes

A

late stage hemochromatosis; skin hyper pigmentation, diabetes mellitus, and pigment cirrhosis with hepatomegaly

573
Q

Which cholesterol lowering agents cause gallstones?

A

Fibrates

574
Q

What is the function of the spleen?

A

Remove abnormal RBCs Clearance of circulating bacteria Production of opsonizing antibodies which clear encapsulated organisms.

575
Q

Scopolamine-MoA

A

muscuranic cholinesterase receptor antagonist

576
Q

How does the esophagus present on a CT of the upper thorax?

A

Collapsed with no visible lumen

577
Q

G to T mutation in p53

A

Hepatocellular carcinoma Aflatoxin-caused

578
Q

colic

A

cramping stomach pain

579
Q

Spongiosis

A

accumulation of edema fluid in the intercellular spaces of the epidermis

580
Q

sella turcica

A

Sphenoid bone depression that contains the pituitary

581
Q

Mucormycosis description?

A

90 Degree wide angle branching, nonseptate, proliferates in blood vessels, Diabetic Ketoacidosis, black escar (necrotic tissue); Rx- surgical debridement, amphotericine B

582
Q

Cisplatin

A

MoA-cross-links DNA; Uses- testicular, bladder, ovary, lung carcinomas; AE- nethrotoxicity, peripheral neuropathy, ototoxicity; prevent nephrotoxicity with amifostine (free radical scavenger) and chloride (saline) diuresis

583
Q

Tc-pertechnetate test

A

Merkels Diverticulum

584
Q

signs of steroid abuse?

A

Inc. hematocrit, acne, testicular atrophy, gynocomastia, deepening of voice

585
Q

Bulimia Nervosa-electorlyte abnormalities

A

hypokalemia, hypochloremia, metabolic alkylosis

586
Q

Cholesteatomas

A

collection of squamous cell debris that form a round, pearly mass behind the tympanic membrane

587
Q

NPH urinary incontinence: Cause

A

stretching of descending cortical fibers

588
Q

Organism suspected in intraabdominal abcesses

A

Bacteoides fragilis E. Coli

589
Q

What is the function of the seminal vescicles?

A

Alkaline fluid secretion that neutralized vaginal tract pH, contains enzymes, fructose, mucus, Vit. C. Fructose is important because it nourished the spermatozoa

590
Q

E. Coli virulence factors

A

P-pili (cystitis and pyelonephritis) -> adhesion; K capsule (pneumonia, neonatal meningitis), LPS endotoxin - septic shock

591
Q

Name the functions of IL-1-6

A

1- fever, 2-T-cells, 3-bone marrow, 4- IgE, 5- IgA, 6-Acute phase protein production

592
Q

Low serum C1 esterase: diagnosis

A

hereditary angioedema; Avoid ACE inhibitors

593
Q

Meglitenides- MoA

A

close ATP-dependent K+ channels-> opening L-type Ca2+ channel -> insulin release

594
Q

Chronic transplant rejection MoA

A

CD4+ T-cells respond to APCs presenting donor peptides, secrete cytoKines -> activate complement

595
Q

What gives rise to the collecting system of the kidney?

A

Ureteric bud

596
Q

Enfuvirtide-MoA

A

Gp41- Stops viral entry into cells

597
Q

Progesterone is increase when?

A

After ovulation remember pro-gestation

598
Q

Chronic tic disorder

A

Either motor or vocal tic (but not both) for greater than 1 year

599
Q

What affect does smoking have on the stomach?

A

dec. mucous production, inc. acid production (from nicotine), inc. risk of H. pylori infection

600
Q

Signs of Hypothyroidism

A

Weight gain, irregular menstrual periods, fatigue, increased difficulty concentration, dry skin, memory loss

601
Q

Cilostazol

A

Phosphodiesterase inhibitor that inhibits platelet affregation and causes direct arterial vasodilation. Treats PAD.

602
Q

Serotonin sickness

A

nausea, vomiting, diarrhea, muscle hyperactivity (clonus, shivering, hyperreflexia)

603
Q

Decreasing measurements does what to the SD?

A

Increase the width

604
Q

What does hypocapnia imply?

A

alveolar hupercentilation

605
Q

Fever, pruritic skin rash, joint pain, 7-14 days after antigen exposure

A

Serum sickness -> decreases serum C3, C4 levels Type III sensitivity Caused by nonhuman proteins

606
Q

What passes inferior to the ovaries?

A

Ureter

607
Q

Electrolyte abnormalities in patients with adrenal insufficiency?

A

hyponatremia, hyperkalemia, hypercholidemia, non-anion gap metabolic acidosis

608
Q

5p deletion: Dx and Signs

A

Cri-Du-Chat Signs: cat-like cry, hypotonia, failure to thrive, microcephalt, low-set ears, hypertelorism, road nasal bridge

609
Q

Signs of multiple myeloma?

A

bone pain, fatigue, anemia, kidney disease, and hypercalcemia

610
Q

Suppression- defense mecahnism

A

mature, defensively puts aside unpleasant thoughts/feelings

611
Q

What is Praziquartel?

A

Anthelmintic used for treatment of tapeworm and flukes; MoA increases permeability of membrane to calcium ions –> increasing contraction and resulting in paralysis in the contracted state

612
Q

What nerve is responsible for lateral sensation of the arm and elbow flexion?

A

Musculocutaneous

613
Q

Associatedion with Small Cell Lung Cancer

A

SIADH, Lambert-Eaton, Cushing, Amplification of Myc

614
Q

Where is riboflavin used?

A

succinate dehyrdogenase (Complex II) (FAD) and complex I (FMN)

615
Q

Side effects of statins

A

Myopathy, cholesterol gallstones

616
Q

Shortened vaginal canal with rudimentary uterus

A

Mullerian syndrome (Mayer-Rokitansky syndrome)

617
Q

Panic attack: pharmocotherap

A

SSRI

618
Q

S-100

A

Neural Crest Tumors

619
Q

Chorionic vili with focal edema and trophobastic prolieferation

A

Partial hydatidiform mole

620
Q

Sotalol: MoA; side effects

A

K+ blocker; prolongs qt; beta-blocker Inc. risk for torsades de pointes; bradycardia

621
Q

Trisomy 13

A

Patau syndrome- defect in the fusion of prechordal mesoderm -> severe midline defects

622
Q

Anatomic location, AV node?

A

near septal leaflet of the tricuspid valve and the orifice of the coronary sinus

623
Q

Myoedema

A

characteristic finding in hypothyroid myopathy due to slow reabsorption of Ca from the SR

624
Q

Use for a southwestern blot?

A

DNA-binding proteins

625
Q

What is serotonin derived from?

A

Tryptophan

626
Q

Diphenoxyate-MoA

A

Opiod that targets mu receptors in the gut, slowing motility

627
Q

What artery supplies the posterior wall of the right ventricle?

A

Right coronary artery

628
Q

What protective immunity type is the diptheria vaccine?

A

Purified, inactivated toxin

629
Q

Muddy brown casts

A

Acute tubular necrosis; due to decreased renal perfusion; proximal convoluted tubule (outer medulla)

630
Q

Signs of botulism:

A

Diplipia, dysphagia, dysphonia “Three D’s”

631
Q

Stains for Cry[tpcpccus neoformans

A

India ink-unstained zone macicarmine- stains red

632
Q

Pharmacological treatment for Serotonin syndrome?

A

Cyproheptadine

633
Q

anti-DNA topoisomerase 1

A

Diffuse Scleroderma -anti-SCL70

634
Q

How is acetaminophen cleared by the liver?

A

NAPQI- with adequate glutathione (non-toxic metabolite

635
Q

Signs of hypoglycemia:

A

sweating, disorientation, tremors, palpitations

636
Q

Trichomonas vaginalis: Tx

A

Metronidizol

637
Q

Signs of primary hyperaldosterism?

A

hypertension, hyperkalemic alkalosis, muscle weakness, and paresthesias

638
Q

anti-muscarinic toxicity

A

dry and flushed skin, hyperthermia, mudriasis, cyclopplegia, bronchodilation, tachycardia,

639
Q

Pericarditis that radiates to the neck?

A

Phrenic involvement (inferior portion of the heart

640
Q

Preferred initial test for acute cholecystitis?

A

Ultrasonography

641
Q

Tc- pertechnetate test

A

Merkel’s diverticulum

642
Q

Aminoglycosides- method of resistance

A

additional of chemical groups (acetyl, etc) to the aminoglycoside antibiotic molecule outside of the bacterium -> decreasing the ability to bind to ribosomes

643
Q

Lebes hereditary optic neuropathy

A

mitochondrial inheritance, leads to bilateral vision loss

644
Q

Where does traffic flow to get to/from the Golgi

A

To Golgi-RER From Goli-Lysosome

645
Q

hepatic encephalopathy- cause

A

Continual absorption of bacterial-produced ammonia without the ability of the liver to convert it to useful metabolites. Leads to increased inhibitory neurotransmitters and decreased excitation

646
Q

Fibrates- MoA

A

PPAR-alpha receptor (peroxisome poliferator activated receotor alpha) -> dec. VLDL production and lipoprotein B, inc. lipoprotein lipase

647
Q

What happens in central retinal artery occlusion

A

Destruction o fthe retinal ganglion cells in the left eye Painless vision loss

648
Q

Major cause of duodenal peptic ulcer disease

A

H. Pylori

649
Q

Primary ciliary dyskinesia

A

AR disease, caused by mutations in the genes responsible for normal flagella and ciliary function

650
Q

Infection risk after clindamycin?

A

C. Diff

651
Q

What is the most effective preventive intervention to improve health outcomes?

A

Smoking cessation

652
Q

When should a physician intervene and request a court order?

A

When the children are placed at significant harm.

653
Q

Red blood cell inclusions on Giemsa stain?

A

Malaria

654
Q

peroxisome-proliferator activator receptor-gamms: Fucntion

A

decrease insulin resistance

655
Q

VIPoma signs

A

watery diarrhea, hypokalemia, achlorhydra

656
Q

Cholinergic receptor signal transducers

A

m1 - Gq m2 - Gi m3 - Gq

657
Q

What factors drive angiogenesis

A

VEGF, fibroblast growth factor-2

658
Q

What is wobble?

A

The first two nucleotide require tradition pairing, the third is a fudge factor

659
Q

Shiga toxin - MoA

A

Phage encoded -> inhibits 60s ribosomal subunit -> inhibition of protein synthesis -> cell death

660
Q

3rd aortic arch

A

Common carotid artery, proximal internal carotid artery

661
Q

Secondary bacterial pneumonia are

A

S. pneumoniae, S. Aureus, H. Influenzae

662
Q

Dupuytren’s contracture

A

slowly progressive fibroproliferative disease of the palmar fascia, nodules form eventually resulting in contractures that draw the fingers into the hands.

663
Q

Type 1 Interferon

A

alpha and beta, secreted in response to viral infection, halts protein synthesis, only activated in the presence of dsRNA

664
Q

Mitral regurgitation? What reflects severity?

A

holosystolic murmur best heart at the apex of the heart; radiated to the axilla; S3 sound intensity is a predictor of severity

665
Q

Where are ketones utilized?

A

Mitochondria, hence RBC’s cannot use them

666
Q

What receptors do the pupil dilator muscles of the eye respond to?

A

Alpha 1`

667
Q

Hypochondriasis

A

Hypochondriasis is a hypochondriac (i.e. disproportionate fear of serious disease

668
Q

Greatest risk factor for death in a patient with pericardial friction and quiet heart sounds

A

Pericarditis

669
Q

sirenomelia

A

mermade syndrome

670
Q

Large nucleated cells with scant cytoplasm think?

A

Blasts

671
Q

Alternative name for the suspensory ligament of the overy?

A

infundibulopelvic ligament

672
Q

What is the role of eosoniphils in parasitic infection?

A

Degranulation of Major Basic protein- antibody-dependent cytotoxicity

673
Q

What happens in the recovery phase of ATN?

A

Gradual increase in urine output leading to high-volume diuresis Electrolyte abnormalities may include decreased concentration of K, MH, PO4, and Ca due to slowly recovering tubular function

674
Q

What is population-based sampling?

A

Selection of participants based on national census data that is indicative of the national population

675
Q

What enzyme processes methanol

A

Formaldehyde Dehydrogenase

676
Q

vertebral osteomyelitis

A

bacterial infection of bone resulting from distal infection and spread via hematologic spread

677
Q

What substance promoted the deamination of cytosine, adenine, and guanine to form?

A

dietary nitrites Form: uracil, hypoxanthine , xanthine

678
Q

Condensed body composed on methylated DNA

A

Lyonization: inactivation of an X chromosome; called heterochromatin -> low transcription activity

679
Q

Cryptococcus neoformans: typical infection target?

A

Immunocompromised pateints

680
Q

Niemann-Pick disease

A

sphingomyelinase deficiency -> decreased lipid breakdown. spingomyeline accumulation within lysosomes leads to foamy and vacuolated electron microscope -> deposit in brain and liver -> mental regression and death by 3. Significant finds are a cherry-red macular spot

681
Q

Parvo B19 anemia-

A

Erythrocytes only

682
Q

what is dysdiadochokinasia?

A

impaired rapid alternating movements; cause by cerebellar lesions

683
Q

CA 19-9

A

Pancreated Adenocarcinoma

684
Q

Arsenic- MoA

A

Binds to sulfhydryl groups, impairing cellular respiration via inhibition of pyruvate dehydrogenase

685
Q

Ladd’s bands

A

fibrous bands-connect RLQ retroperitoneum to the right cecum, cause cause duodenal obstruction when malrotate

686
Q

Orlistat: side effects

A

Weight loss, decreases triglyceride absorption, LDL, cholesterol

687
Q

Doxorubicin cardiotoxicity prevention

A

Dexrazoxane

688
Q

Signs of riboflavin deficiency

A

angular stomatitis, cheilitis, flossitis, seborrheic dematitis, eye changes, anemia

689
Q

Role of the Lateral nucleus?

A

Mediates hunger, destruction leads to anorexia

690
Q

PAS stain- intense pink coloration

A

glycoprotein

691
Q

Neimann-Pick Disease: Causes, sign

A

AR, sphingomyelinase deficiency neurodegeneration, hypotonia, hepatomegaly

692
Q

What stage are oogonia arrested in before fertilization?

A

Prophase of meiosis 1

693
Q

Carvello sign

A

Increased tricuspid valve murmur during inspiration

694
Q

Tetrodotoxin

A

Pufferfish neurotoxin, functions by blocking voltage-gated sodium channels in nerve cell membranes.

695
Q

What is the electrolyte that causes CF’s symptoms?

A

hyponatremia

696
Q

How to strengthen bones and reduce fracture risk?

A

Weight bearing exercise

697
Q

Incomplete penetrance

A

Clinical features are not always present in individuals who have the mutation

698
Q

How to mitochondrial diseases spread?

A

maternal inheritance

699
Q

Cardiac output (Fick principle)

A

rate of o2 consumption/arteriovenous o2 content difference

700
Q

Phenytoin-MoA

A

reduces sodium channels ability to recover from inactivation

701
Q

Affects on irregular pregnancies on dating?

A

Inaccurate prediction and tests at the wrong time

702
Q

Germline mosaicism

A

more than one set of genetic information is found specificaly within the gametes

703
Q

Growth factors activation cascade

A

Growth factor ->receptor tyrosine kinase -> autophosphorylation -> Ras-GDP-> Ras-GTP -> MAPK -> enters nucleus

704
Q

Turner Syndrome: overies

A

dysgenesis; appear underdeveloped and strophic (“streak gonads”)

705
Q

Follicular thyroid cancer- gene mutation

A

RAS

706
Q

Diseases associated with HLA-B27?

A

Ankylosis spongyitis, psoriatic arthritics, IBS-arthritis, reactive (reiter’s arthritis). HLA-Class 1 associated

707
Q

discharge from the umbilicus in a newborn, think?

A

patent urachus (allantoid remnant)

708
Q

Phyostigmine:

A

Cholinesterase inhibitor; used for atropine poisoning (antimuscurinic antidote)

709
Q

Signs of niacin deficiency?

A

Dermatitis (bilateral, sun exposed areas), diarrhea (atrophy of columnar cells), dementia - > pellagra

710
Q

What percentage of students are within 1 SD unit? 2 SD? 3 SD?

A

1 SD - 68% 2 SD - 95% 3 SD - 99.7%

711
Q

Infections with lytic bone lesions, think?

A

Mycobacterium species

712
Q

Deficiency in LAD

A

Cells lack CD-18, essential for integrin formation; leukocytes are unable to adhere or migrate to sites of inflammation.

713
Q

Disulfram effects on alcohol consumption

A

Abdominal cramps, nausea, headache Inc. alcohol dehydrogenase production

714
Q

DiGeorges Syndrome

A

Congenital heart disease dysmorphic facies hypocalcemia

715
Q

Grancyclovir- MoA

A

interferes with host cell DNA synthesis

716
Q

How long does type 1 sensitivity take?

A
717
Q

Hypertrophic cardiomyopathy: characteristics

A

Outflw tract obstruction and asymmetric septal hypertrophy, compared with progressive heart failure, which is symmetrical

718
Q

open angle glaucome: Signs and Tx

A

peripheral vision loss, elevated intraocular pressure, Tx: Non-specific beta blockers- decrease aqueous humor secretion by the ciliary epitherlium

719
Q

What cells deposit extracellular matrix and collagen matrix in atherosclerotic plaques

A

Smooth muscle cells

720
Q

Direct Inguinal Hernia site, lower, median, lateral border

A

Hesselback triangle Inguinal ligament- lower Rectus abdominis - medial Inferior epigastric - lateral

721
Q

What does relative risk mean?

A

Relative risk is equals risk exposure/risk without exposure; 1 is neutral, 1 increased risk of disease

722
Q

Homogenistic Acid Dioxygenase deficiency

A

Alkaptouria; pigment deposits in connective tissues (sclera, ear cartilage), urine turns black after exposure to air “Al Kapone; everything turns black homo gentleman sex”

723
Q

Common causes of caseating granulatomas?

A

TB and fungal infections

724
Q

Pringle maneuver

A

occlusion of the portal triad

725
Q

Flexible skin, multiple ecchymoses?

A

Ehlers-Danlos sydrome -> defective collagen synthesis caused by deficiency in pro-collagen petidase

726
Q

Effect of oxytocin in pregnany?

A

Causes uterine contraction

727
Q

binds fibrin and supports platelet aggregation?

A

glycoprotein IIb/IIIa

728
Q

How to calculate michaelis constant Km?

A

1.2 maximum velocity -> concentration of substrate at that Km

729
Q

What is the function of IL-1

A

Fever

730
Q

What effects do loop diuretics have acid base?

A

Metabolic alkylosis, with volume contraction

731
Q

Proton pump inhibitors- side effect`

A

decreased calcium absorption, Mg absorption, inc. C. diff infections

732
Q

Proteasome, function?

A

Recycling center for proteins, breaking down misfolded, damaged and cytotoxic proteins for reuse Additionally, they regulate pro- and antiapoptotic prroteins, inhibition leads to acculumation of pro-apoptotic enzymes

733
Q

CHF treatment

A

ACE/ARBs- improve blood flow and also inhibit chronic angiotensin II-mediated cardiac remodeling Significantly reduce mortality in systolic heart failure

734
Q

Schwanoma: Histological presentation

A

biphasic with highly cellular areas with myxoid regions of less cellularity

735
Q

Diastolic heart failure parameters

A

Increased LVED pressure with normal LVED volume, and ejection fraction

736
Q

Warfarin-MoA

A

Inhibitor of vitamin K reductase

737
Q

Thick, cottage-cheese vaginal discharge, organism? Cause

A

Organism- Candida Albicans Cause- decreased lactobacteria (gram-positive)

738
Q

Hemangioma tissue derivation?

A

mesenchymal cells (blood vessels) are a part of the endothelium

739
Q

Defects in patella fracture?

A

inability to extend the knee against gravity

740
Q

MoA of nitroglycerin?

A

Venous dilatory, greatest affect on large veins; reduced pre-load

741
Q

When flow decreases by a factor of 16, radius has decreased by?

A

2

742
Q

Azathioprine - breakdown product

A

6-mp, acts on HGPRT (active metabolite) and TPMT (inactive metabolite); allopurinol blocks conversion to TPMT, increasing active metabolite

743
Q

Causes of edema:

A
  1. Elevated Capillary hydrostatic pressure 2. Decreased plasma oncotic pressure 3. Sodium an water retention 4. ymphatic obstruction
744
Q

Cause of hemolytic anemia after medication-induced oxidative stress?

A

Glucose-6-phosphate dehydrogenase deficiency

745
Q

What arteries are at the greatest burden for developing atherosclerosis?

A

Coronary and abdominal aortic

746
Q

Murmur best heart sitting up and leaning forward

A

Aortic regurgitation

747
Q

Cataplexy

A

Conscious, brief episodes of sudden bilateral muscle tone

748
Q

Most common childhood cause of epiglottitis?

A

Haemophilus influenzae b; cherry-red epiglottisis

749
Q

Hemochromatosis: Cause and Signs

A

Cause: excess Iron absorption due to AR Ch6 mutation in HFE Signs: DM, cirrhosis, and hyperpigmentation of the skin

750
Q

What is the most common amino acid in collagen?

A

Glycine, occupies ever third amino acid position in the alpha chain; Allows for the cross-linking helical structure

751
Q

Marfanoid Habatus

A

Arm-span greater than height, long fingers, joint laxity

752
Q

What happens as prevalence increases on PPV and NPV

A

PPV and NPV increase as prevalence increases

753
Q

APO B100

A

Function- binds LDL receptor; deficiency leads to fast soluble metabolite deficiencies

754
Q

Propranolo-Thyroid affects

A

decreases peripheral conversion of T4 to T3 (iodothyronine deionidase), and decreasing sensitivity to catecholamines

755
Q

Dysthymic disorder

A

Mild, long-term form of despression

756
Q

Freely mobile, soft, cystic mass with cutaneous surface opening

A

persistent cervical sinus; malformation; anterior to the SCM

757
Q

Gardy-Weinberg Equations

A

p + q - 1 p^2 + 2pq + q^2 = 1 Sqrt(q^2) = q

758
Q

Signs of Sarcoidosis

A

AA woman, cough, dyspnea, bilateral hilar lymphadenophathy, noncaseating granulomas.

759
Q

Norepinephrine- autonomic function?

A

alpha 1 (increased dia/sys BP, vasoconstriction) > alpha 2 > beta 1 (increased heart rate);

760
Q

beriberi

A

Thiamine- B1 deficiency; peripheral neuropathy, heart failure)

761
Q

How does myasthenia gravis present?

A

Muscle weakness that progressively gets worse throughout the day

762
Q

linkage disequilibrium

A

a pair of alleles are inherited together in the same gamete more or less often than would be expected by random chance

763
Q

Where to B cells reside in the lymph node?

A

Germinal centers and lymphoid follicles

764
Q

Patient presents with recurrent Neisseria infections defect?

A

Inability to form the MAC complex, c5b-9

765
Q

Small Cell Carcinoma: neoplastic syndromes

A

ACTH, SIADH, Lambert-Eaton, Amplification of myc

766
Q

Tinel sign

A

Tapping over the flexor surface of the wrist reproduces symptoms

767
Q

What are the risk factors for cocaine use during pregnancy?

A

Prematurity

768
Q

When is the sodium permeance the greatest in nerve depolarization?

A

At the peak of depolarization

769
Q

Most common bacteremia-causing organisms in sickle cell patients?

A

S. pneumoniae, H. influenza

770
Q

Kartagener Syndrome

A

Chronic upper/lower respiratory infections, immotile sperm, situs inversus on imaging, autosomal recessive ==> result from defective cilia motility

771
Q

Phenytoin side effects

A

Gingival hyperplasia (PDGF activation -> gingival marcophages -> gingival cell and alveolar bone poliferation) coarsening of facial features, and hirsutism

772
Q

Interstitial lung disease presentation?

A

progressive dyspnea, fine crackles, clubbing, and diffuse reticular opacities

773
Q

6th aortic arch

A

Proximal pulmonary arteries Left-ductus arteriosus

774
Q

What does treating Hodgkin’s lymphome increase the risk for?

A

secondary cancers

775
Q

Portal Triad

A

hepatic artery, portal vein, common bile duct

776
Q

Steps in wound repair

A
  1. inflammation-clot formation, vascular regeneration 2. Proliferation-collagen 3 deposition 3. Remodeling- Collagen 3 replaced with Collagen 1
777
Q

Which hepatitis B antigen is the most infective

A

HBeAg

778
Q

Nitrate MoA

A

Vasodilation of peripheral veins and arteries -> decreases preload (left end-diastolic volume and wall stress) modest reduction in afterload, some coronary dilation effects

779
Q

When traveling to Africa, what shots should you receive?

A

Anti-malaria

780
Q

Edwards Syndrome: Alt. name, signs

A

Trisomy 18, inherited as meitic nondisjunction\ Signs: rocker bottom feet, clenched hands, overlapping fingers, cardiac issues

781
Q

hypotension, cool extremities, tachycardia

A

hypovolemic shock

782
Q

Anaplastic thyroid cancer- gene mutation

A

p53

783
Q

What hemotological signs are involved with lupus?

A

thrombocytopenia, or any other cytopenia

784
Q

Adult rubella- complications

A

polyarthritis and polyarthralgia

USMLE (2 decks)

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