Step

Question 1

Most reliable ausculatory finding indicating mitral stenosis severity

Answer 1

A2-OS interval. As the pressure increases it becomes more difficult to push blood out of the LA, so the OS occurs sooner to provide more time to generate the pressure.

Question 2

Chemoprophylaxis for meningococcal disease, Mechanism

Answer 2

1) Rifampin -penetrates well into all tissues. Inhibits DNA dependent RNA polymerase
2) Ciprofloxacin -risk of CT pathology
3) IM ceftriaxone -pnful route
4) sulfamethoxazole- Resistance

Question 3

Bounding femoral and carotid pulses w/ head bobbing

Early blowing, diastolic decrescendo murmur best at left 3 or 4 ICS

Answer 3

Aortic Regurgitation
Wide pulse pressure (water-hammer)
Stroke volume increases due to increased preload, when the LV relaxes during diastole blood flows backwards and out of the arteries (collapsing arteries)

Question 4

Lithium interaction with a hypertensive med leading to nonspecific T wave abnormalities

Answer 4

Hydrochlorothiazide

Volume depletion leads to increased reabsorption of Lithium in the PCT.

Question 5

Chronic Lithium toxicity DDI

Answer 5

(volume depletion) Thiazides, ACEI, and NSAIDS

confusion, ataxia, neuromuscular excitability

Question 6

Hyperosmotic volume contraction

Answer 6

osmol increase, ECF decreased, ICF decreased

Diabetes insipidus or decreased fluid intake, increased sweating

Question 7

Central DI

Answer 7

Decreased ADH released -> water is not reabsorbed and the urine is very dilute

Question 8

Isosmotic volume contraction

osmol same, ECF decreased, ICF same

Answer 8

osmol same, ECF decreased, ICF same

Acute GI hemorrhage or diarrhea -fluid is only lost from the ECF (blood vessels)

Question 9

Hyposmotic volume contraction

Answer 9

osmol decreased, ECF decreased, ICF increased
Adrenal insufficency - lack of aldosterone
NaCl not reabsorbed-> ECF decreased.
ECF is low on solutes, so water shifts into cells (ICF)

Question 10

Hypertonic volume expansion

Answer 10

osmol increased, ECF increased, ICF decreased
Hypertonic saline infusion- ECF volume and osmolarity increase
Water leaves the ICF to dilute the ECF

Question 11

Hyposmotic volume expansion

Answer 11

osmol decrease, ICF increase, ECF same
Primary polydipsia and SIADH
Increased water intake or reabsorption shifts into ICF to dilute with the ECF staying the same. The increased water leads to overall decreased osmolarity

Question 12

Onion-like concentric thickening of arteriolar walls

Answer 12

Hyperplastic arteriolosclerosis

Malignant HTN pathology

Question 13

Homogenous acellular thickening of arteriolar walls

Answer 13

Hyaline arteriosclerosis

Lower HTN

Question 14

Granulomatous inflammation of the media

Answer 14

Giant cell arteritis

Question 15

Transmural inflammation of the arterial wall w/ fibrinoid necrosis

Answer 15

Polyarteritis nodosa

Question 16

Smooth transition for impatient to outpatient

Answer 16

Discharge checklist

Question 17

Down Syndrome Fetal Markers

Answer 17

AFP low
B-Hcg high
Inhibin A high

Question 18

Chediak Higashi: What is it? Signs

Answer 18

Microtubule Disorder of neutrophil phagolysosome fusion

Partial albinism, peripheral neuropathy, recurrent pyogenic infxns

Question 19

Proximal muscle weakness and Gottron’s papules (ertythematous plaques over hand joints)

Answer 19

Dermatomyositis

Question 20

Dermatomyositis association

Answer 20

Often paraneoplastic to lung, colorectal, and ovarian CA

Question 21

Blistering cutaneous photosensitivity

Uroporphorinogen decarboxylase deficency

Answer 21

Porphyria cutaenous tardia

Question 22

Paraventricular tumor

Perivascular rosettes

Answer 22

Ependymoma

Question 23

Cerebral hemisphere tumor

Hypercellular areas of atypical astrocytes bordering regions of necrosis (pseudopalisading)

Answer 23

Glioblastoma

Question 24

Cerebellar tumor in kids
Small blue cells surrounding a neurophil
Homer-Wright Rosettes

Answer 24

Medulloblastoma

Question 25

White matter of cerebral hemispheres | Round nuclei w/ halo of clear cytoplasm (Fried egg cells)

Answer 25

Oligodendroglioma

Question 26

Cerebellar tumor in kids | eosinophilic granular bodies and elongated hairlike fibers (Rosenthal fibers)

Answer 26

Pilocytic astroocytoma

Question 27

Spindle cells w/ palisading nuclei arranged around Verocay bodies composed of eosinophilic cores (antoni A) Cerebelloponite angle

Answer 27

Schwannoma

Question 28

Benign suprasellar tumor in kids | cords/nests of palisading squamous epithelium w/ internal areas of lamellar "wet keratin"

Answer 28

Adamantinomatous craniopharyngioma

Question 29

Moldy grains in China w/ substance causing G to T mutation in p53 increase risk of what cancer?

Answer 29

Aflatoxins from aspergillus -> increased risk of HCC

Question 30

Lac P

Answer 30

Promoter region where RNA polymerase binds

Question 31

Lac I

Answer 31

gene for repressor -binds operator to prevent RNA polymerase binding. Constitutively on

Question 32

Lac O

Answer 32

Operator- where the repressor binds, downstream of promoter region

Question 33

Lactose (inducer)

Answer 33

Binds to the repressor to prevent it from binding to the operator and preventing RNA polymerase

Question 34

Lac operon regulation

Answer 34

1) negative - repressor binds to operator preventing RNA polymerase from binding the promoter 2) cAMP-CAP binding upstream from the promoter. High glucose-> decreased cAMP. Low glucose-> high cAMP-> binding to CAP-> cAMP-CAP binding to promoter

Question 35

Patient is using herbal supplements that have not caused them SE

Answer 35

Advise on safety, quality, and efficacy

Question 36

Conduct Disorder vs. Antisocial personality disorder

Answer 36

Conduct before 18, antisocial after 18 | Persistent pattern of violating societal norms and other's rights

Question 37

Ligated IMA, which artery provides collateral circulation to the descending colon (not rectum)

Answer 37

SMA via marginal artery of Drummond

Question 38

AIDS pt w/ working memory problem, executive dysfxn, and slow information processing

Answer 38

HIV associated dementia

Question 39

HIV associated dementia histology

Answer 39

Microglial nodules, groups of activating macrophages and microglial cells around small areas of necrosis. They may fuse to form multinucleated giant cells

Question 40

Mycobacterial Drug resistance due to non-expression of catalase-peroxidase enzyme

Answer 40

Resistance to INH. INH must be processed by mycobacterial catalase-peroxidase to be activated

Question 41

Post-streptococcal glomerulonephritis complication risk increases for which pts?

Answer 41

Adults have poor prognosis due to higher risk of chronic HTN and renal insufficiency

Question 42

Enzyme deficiencies of early steps in porphyrin synthesis

Answer 42

Neuropsych w/o photosensitivity due to metabolite accumulation

Question 43

Uroporphyrinogen decarboxylase deficiency

Answer 43

Vesicles and blisters on sun exposed areas, edema, pruritus, pain, and erythema

Question 44

Inflammatory arthritis, ulcer of the hard palate, butterfly rash

Answer 44

SLE- | ANA, anti-smith (spliceosome snRNP), anti-dsDNA

Question 45

ALS microscopic

Answer 45

Loss of anterior horn - LMN lesions - muscle weakness and atrophy Demyelnation of lateral corticospinal tracts - UMN lesion -spasticity and hyperreflexia Can affect CN 5,9,10,12

Question 46

ALS mutation

Answer 46

SOD1 -gene that codes for copper-zinc superoxide dismutase

Question 47

Synovial WBC >100,000 and no crystals

Answer 47

Septic arthritis Tx w/ abx to prevent joint destruction, osteomyelitis, and sepsis

Question 48

Acutr tx of gout when pt has peptic ulcer dz

Answer 48

Colchicine

Question 49

Colchicine mechanism

Answer 49

Binds to intracellular tubulin and inhibits MT polymerizaton. Disrupts chemotaxis and phagocytosis

Question 50

Colchicine SE

Answer 50

diarrhea, nausea, abd pn

Question 51

Primary biliary cirrhosis classic pt

Answer 51

Pruritus and fatigue in middle aged woman Cholestasis - jaundice, pale stool, dark urine hypercholesterolemia - xanthelesmas

Question 52

What does spironolactone due with K and H

Answer 52

Spironolactone blocks Na reabsorption and increases K and H reabsorption. Fewer hydrogen ions are secreted from the collecting tubules

Question 53

PCT osmolarity

Answer 53

300 isotonic w/ plasma regardless of final urine concentration

Question 54

Descending loop of Henle osmolarity

Answer 54

Water leaves the tubule and the filtrate becomes concentrated, >300. ADH is high it will =1200

Question 55

Ascending loop of henle osmolarity

Answer 55

Water comes back in to dilute the filtrate. <300

Question 56

Distal convoluted tubule osmolarity

Answer 56

Most dilute section, impermeable to water, 100 osmol

Question 57

Collecting duct osmolarity

Answer 57

Water leaves the tubule to dilute the hypertonic interstitium. So the somolarity is around 1200

Question 58

Thyroid cytology - clusters of overlapping cells w/ large nuclei containing sparse, finely dispersed chromatin Intranuclear inclusion bodies and grooves

Answer 58

Thyroid papillary carcinoma Ground glass -Orphan Annie eyes Psammoma bodies

Question 59

Thyroid cytology - markedly pleomorphic cells, including irregular giant cells and biphasic spindle cells

Answer 59

Anaplastic cancer

Question 60

Thyroid cytology - colloid nodule

Answer 60

Benign hyperplasia

Question 61

Thyroid histology- Polygonal to spindle shaped cells w/ slightly granular cytoplasm. Stains for calcitonin. Adjacent amyloid deposits

Answer 61

Medullary thyroid cancer - from parafollicular C cells | MEN 2A and 2B

Question 62

Homeless male w/ abd pn, Develops acute confusion, nystagmus and b/l abducens palsy b/l lesions in the mamillary body and Periaqueductal gray matter in the hospital

Answer 62

Wernicke's encephalopathy triad - ataxia, ophthalmoplegia, confusion

Question 63

Thiamine deficient pt given glucose

Answer 63

Develop Wernicke encephalopathy -added glucose worsens thiamine deficiency. Thiamine is cofactor for glucose metabolism (decarboxylase rxns)

Question 64

Car accident pt develops excessive thirst and frequent urination that continues weeks later

Answer 64

Central DI - hypothalmic nuclei injury. Posterior pituitary injury would be transient

Question 65

How is INH metabolized?

Answer 65

Acetylation to N-acetyl-INH

Question 66

Bimodal distribution of metabolism

Answer 66

Fast and slow acetylators

Question 67

Large mass surrounding the intestines | Uniform, round, medium-sized tumor cells w/ basophilic cytoplasm and proliferation fraction (Ki-67 fraction) of >99%

Answer 67

EBV - Burkitt Lymphoma (starry sky)

Question 68

Chronic non-atrophic gastritis affecting the antrum: cause

Answer 68

H. Pylori infxn

Question 69

Atrophic chronic gastritis of the body

Answer 69

Pernicious anemia

Question 70

Most common benign liver tumor

Answer 70

Cavernous hemangioma - cavernous blood filled vascular spaces lined by a single epithelial layer

Question 71

Which liver tumor can regress w/ d/c OC

Answer 71

hepatic adenoma

Question 72

NOD2 mutation -> NF -KB decrease. What will be impaired

Answer 72

Cytokine production will be impaired -> impaired innate barrier fxn Bugs get in and cause exagerated immune response

Question 73

Fever, neuro sx (progressive lethargy), renal failure, anemia, and thrombocytopenia in setting of GI illness

Answer 73

Classic pentad of thrombocytopenic thrombotic purpura

Question 74

Plt activation in arterioles and capillaries Diffuse microvascular thrombosis Microangiopathic hemolytic anemia w/ schistocytes Thrombocytopenia

Answer 74

Clinical and pathologic features of thromobocytopenic thrombotic purpura

Question 75

S-shaped bacteria causes decreased somatostatin-producing antral cells, what will this lead to

Answer 75

Duodenal ulcer as decreased somatostatin will lead to decreased inhibition of gastrin. The loss of somatostatin does not lead to gastric lymphoma, even though MALTs are possible with prolonged infxn

Question 76

s/p coronary artery stent, livedo reticularis, hx of hyperlipidemia and CAD. What does biopsy of the kidney look like?

Answer 76

Cholesterol clefts in the arterial lumen. Cholesterol debris gets lodged leaving needle shaped clefts in intralobular renal arteries

Question 77

Polycystic kidney dz w/ bone pn and weakness - Levels of Phosphate, PTH, and Calcitriol

Answer 77

-Phosphate is increased due to decreased GFR (less phosphorus filtered) -Calcitriol is decreased, Hyperphosphatemia stims osteoclasts to secrete FGF, which is meant to decrease Phosphate reabsorption, but also decreases calcitriol synthesis PTH is increase due to low Ca and high phosphate

Question 78

Pulmonary histology - columnar mucin secreting cells that line the alveolar spaces w/o invading the stroma. How would you classify?

Answer 78

Malignant neoplasm, adenocarcinoma in situ (formerly bronchioalveolar carcinoma)

Question 79

Why does a rt mainstem bronchus obstruction present as a u/l completely opacified lung

Answer 79

All of the alveoli collapse (atelectasis) - there is no air in the lung. It condenses into what looks like a solid organ.

Question 80

Why is pancreatitis a risk factor for ARDS?

Answer 80

Pancreatitis leads to release of inflammatory cytokines and pancreatic enzymes that lead to neutrophils attacking the pulmonary interstitium and alveoli

Question 81

ARDS Pathology

Answer 81

interstitial and alveolar edema, inflammation, and fibrin deposition cause the alveoli to become lined with waxy hyaline membranes

Question 82

ARDS impact on the lungs: capillary permeability, lung compliance, WOB, V/Q match, PCWP

Answer 82

Decreased capillary permeability-> edema and decrease lung compliance, increased WOB, and atelectasis->V/Q mismatch, not ventilated, but perfused (shunt) PCWP is NL

Question 83

Why is Pulmonary capillary wedge pressure NL in ARDS

Answer 83

Noncardiogenic pulmonary edema | The problem is in the lungs not the heart, so the LA pressure is NL

Question 84

Bright red hematemesis, splenomegaly, no liver biopsy abnormalities

Answer 84

Hepatic vein thrombosis - The obstruction is before the liver, so it is not affected. Blood spills back into anastamoses w/ systemic circulation

Question 85

Budd-Chiari liver biopsy

Answer 85

Occlusion of hepatic vein leaving the liver. Centrilobular congestion and fibrosis

Question 86

Porcelain gallbladder pathology

Answer 86

Chronic cholecystitis. Dystrophic intramural deposition of Ca salts.

Question 87

Porcelain gallbladder increases risk of what?

Answer 87

Galbladder adenocarcinoma

Question 88

Anti- tissue transglutaminase, where do you biopsy to confirm dx?

Answer 88

Celiac dz, biopsy the duodenum. | Duodenum and jejunum see highest level of gliadin

Question 89

Crohn dz, where do you biopsy?

Answer 89

terminal ileum

Question 90

Ischemia induced ventricular arrhythmias, tx w/?

Answer 90

Class IB antiarrhythmics, mexiletine lidocaine

Question 91

Weakest Na channel blocker, dissociates the fastest, small effect on QRS, prefer inactivated channels

Answer 91

Class IB antiarrhythmics mexiletine lidocaine

Question 92

Hypotension baroreceptor response

Answer 92

Low BP -> decreased stretch -> decreased baroreceptor signal -> increased SNS stimulation -> increased HR, increased contractility, increased bp

Question 93

HTN baroreceptor response Carotid massage

Answer 93

High BP -> increased stretch -> increased baroreceptor signal -> increased PNS stim -> decreased HR, decreased contractility, decreased bp

Question 94

Arteriolar vasodilators

Answer 94

minoxidil and hydralazine

Question 95

SE of hydralazine and minoxidil

Answer 95

Na and fluid retention Arteriolar vasodilators cause hypotension -> decreased stretch -> increase SNS -> increase RAAS -> increased Na and water reabsorption

Question 96

Maintenance dose formula

Answer 96

MD = (Cpss X Cl)/bioavailability fraction

Question 97

Half life formula

Answer 97

t1/2= (0.7 X Vd) / Cl

Question 98

Loading dose formula

Answer 98

LD = (Cpss X Vd)/ bioavailability fraction

Question 99

Overweight woman OD on antiseizure meds w/ PMH of abortion of fetus w/ spina bifida. She is confused. What lab abnormaltiy would you expect?

Answer 99

Increased liver transaminases. Rare, but fatal hepatotoxicity (measure LFTs) Would cause respiratory depression -> respiratory acidosis

Question 100

Valproic acid SE

Answer 100

``` Teratogenic -NTD Hepatotoxicity Pancreatitis tremors wt gain ```

Question 101

Mechanism of nitrates

Answer 101

NO activates guanylate cyclase -> increased cGMP-> activates myosin light chain phosphatase (MLCP) -> vascular smooth muscle relaxation Also increased cGMP decreases intracellular Ca

Question 102

NL Smoothe muscle contraction

Answer 102

Ca flows in and binds to myosin light chain kinase (MLCK) -> smooth muscle contraction

Question 103

Phentolamine mechanism

Answer 103

Blocks alpha 1 -> vasodilation

Question 104

Class 1 Na channel binding strength

Answer 104

1C>1A>1B 1B has the weakest Na binding. Dissociates quickly. Prefers ischemic tissue due to delayed switch from inactivated to resting state

Question 105

Class 1C properties

Answer 105

Most use dependence Has the greatest binding to Na channels Slow dissociation allows the effects to accumulate -> arrhythmias

Question 106

Opioid MOA - pre-synapse

Answer 106

Opiods bind to Mu receptors on presynaptic - block Ca channels -> decreased Ca-> decreased NT release

Question 107

Opioid MOA post synapse

Answer 107

Bind to Mu receptors | Stimulate K efflux out of the cell -> hyperpolarization ( less likely to depolarize

Question 108

Increased release of DA and NE from presynaptic nerve terminals. SE due to increased NE. Which sympathetic output will be affected: adrenal, eccrine sweat glands, bladder?

Answer 108

Sympathetic output to the bladder will be most affected. Eccrine sweat glands and the adrenals get Ach released presynaptically to stimulate them. Other visceral organs get NE released presynaptically to stimulate them

Question 109

Acute MI tx leads to wheezing. Which part of NT release is affected?

Answer 109

Epi is prevented from binding to B2-R to stimulate bronchodilation B blockers block B2 -> bronchoconstriction -> asthma exacerbation

Question 110

Nitroglycerin primarily affects which vessels

Answer 110

Large veins | Primary venodilator -> decreased preload

Question 111

Constipation, bradycardia, AV block, and worsening heart failure after Afib txmnt

Answer 111

``` nondihydropyridine CCB (diltiazem and verapamil) SE AV block (chronotropic effect) worse Hf- negative inotropic effect ```

Question 112

Dilitiazem and verapamil MOA

Answer 112

Block L-type Ca channels-> decrease phase 0. Slow Av conduction -> AV block

Question 113

Canagliflozin MOA

Answer 113

blocks SGLT, which normally would reabsorb glucose

Question 114

What should be checked before starting canagliflozin?

Answer 114

Check serum CR, should be avoided in pts w/ moderate or severe renal impairment

Question 115

SE of SGLT inhibitors

Answer 115

UTI, increased sugar in the urine for bugs

Question 116

Pt undergoes general anesthesia and has fever, jaundice, tender HM, centrilobular necrosis, and elevated LFT, and bili. What med caused this?

Answer 116

Desflurane, halothane, enflurane | Metabolized by CYP450 in the liver that creates active metabolites or immune-mediated hepatocellular damage

Question 117

anti-u1RNP

Answer 117

MCTD -mixed connective tissue dz

Question 118

Mixed connective tissue disease

Answer 118

Sx of SLE, systemic sclerosis, RA and polymyositis

Question 119

Anti-La

Answer 119

anti SSB | Sjogren's

Question 120

anti ro

Answer 120

anti-SSA | Sjogrens

Question 121

Pulsus alterans: What is it? What causes it?

Answer 121

Beat to beat variation in pulse amplitude | Commonly severe LV dysfxn

Question 122

Dicrotic pulse: What is it? What causes it?

Answer 122

Pulse w/ 2 peaks, 1 for systole and 1 for diastole | Severe systolic dysfxn and high systemic arterial resistance

Question 123

Hyperkinetic pulse: What is it? What causes it?

Answer 123

Rapidly rising pulse w/ high amplitude. Large SV against decreased afterload Aortic regurg, AVM

Question 124

Pulsus parvus et tardus What is it? What causes it?

Answer 124

``` Diminished SV (parvus) and prolonged LV ejection time (tardus) LVOT obstruction - Aortic stenosis ```

Question 125

What causes angioedema in a woman who just started taking lisinopril?

Answer 125

ACEI leads to increased bradykinin, which increases vascular permeability

Question 126

What should you suspect in a kid w/ angioedema?

Answer 126

C1 esterase inhibitor deficiency. Complement is hyperactive-> unregulated activation of kallikrein-> increased bradykinin

Question 127

Kawasaki dz complication

Answer 127

coronary artery aneurysms

Question 128

Rt arm and rt side of face swelling

Answer 128

Brachiocephalic vein obstruction

Question 129

Face and arms swelling b/l

Answer 129

SVC syndrome

Question 130

What defects can lead to a paradoxical embolus?

Answer 130

PFO, ASD, VSD

Question 131

Why does a reperfusion injury lead to increased creatinine kinase

Answer 131

The cell membrane is damaged by reactive oxygen species and creatinin kinase is able to leak out of the cell

Question 132

Murmur at the apex radiates to the axilla

Answer 132

Mitral regurg. The blood flows back to the pulmonary vessels

Question 133

Murmur at the RSB radiates to the neck

Answer 133

Aorti stenosis- Increased flow of blood out to the carotids

Question 134

Aorti regurg sound

Answer 134

Diastolic high pitched=twangy | "blowing" murmur. The blowing is subtle

Question 135

What is transthyretin's normal role?

Answer 135

Transport thyroxine and retinol

Question 136

What can a mutation of TTR lead to?

Answer 136

Transthyretin can then misfold and become an amyloid that causes restrictive dz in the heart

Question 137

3 day onset of progressive cough, orthopnea, dyspnea, and LE edema

Answer 137

Acute decompensated heart failure

Question 138

CXR: Cephalization of pulmonary vessels, perihilar alveolar edema (batwing), costophrenic angle blunting, Kerley B lines

Answer 138

Acute decompensated heart failure w/ secondary pulmonary edema

Question 139

Causes of ADHF

Answer 139

MI, severe HTN, valvular abnl, arrhtymias, cocaine

Question 140

AV Fistula - Preload and afterload

Answer 140

Preload is increased - more blood coming back to the heart | Afterload is decreased - the fistula allows for some of the arterial pressure to be transferred to veins

Question 141

What medication can increase peripheral vascular resistance, increase systolic bp, decrease pulse pressure, and decrease HR?

Answer 141

Phenylephrine (Alpha 1 agonist) Vasoconstricts to increase peripheral resistance and systolic bp. The HTN is sensed by baroreceptors, which activate PNS to decrease HR and SV -> decreased pulse pressure (smaller difference btwn systolic and diastolic)

Question 142

What is decreased in the post-synaptic cells of pts w/ Myasthenia gravis?

Answer 142

The have Ab against Ach-R, so fewer ACh-R exist (removed due to complement) -> decreased motor end plat potential. A synapse still has the same potential, but the potential of the whole end-plate is reduced.

Question 143

What would you use to improve diarrhea, nausea and abd cramping in a MG patient given pyridostigmine?

Answer 143

Scopolamine (anti-cholinergic)

Question 144

Pilocarpine MOA

Answer 144

Muscarinic agonist

Question 145

Hyoscamine MOA

Answer 145

Muscarinic antagonist like scopolamine

Question 146

Carbonic monoxide findings: Carboxy Hgb, PaO2, methemoglobin

Answer 146

Carboxy Hgb increased PaO2 NL Methemoglobin NL

Question 147

What can cause methemoglobinemia?

Answer 147

Dapsone (Dihydropteroate synthesis inhibitor-similar to sulfonamides. Use in leprosy), nitrites

Question 148

RPF equation

Answer 148

RPF = RBF X (1-hematocrit)

Question 149

Length constant of an AP?

Answer 149

Distance at which the originating potential decreases to 37% of its original amplitude

Question 150

What does myelination do to the length constant?

Answer 150

Myelination lengthens the length constant so that a potential can get farther before it dissipates

Question 151

Why would you hypoventilate a pt w/ cerebral edema?

Answer 151

Hypoventilation would decrease PaCO2, which is a potent vasodilatoer. Decreasing PaCO2 -> vasoconstriction and increased cerebral vascular resistance, Preventing further edema

Question 152

Major causes of hypoxemia: | alveolar hypoventilation

Answer 152

NL A-a gradient, there is not enough O2 inspired in the air

Question 153

Cause of hypoxemia: | V/Q mismatch

Answer 153

Increased A-a gradient. Obstruction in airway leads to decreased ventilation w/ NL perfusion

Question 154

Cause of hypoxemia: Diffusion impairment

Answer 154

ie. alveolar hyaline membrane dz. Diffusion is prevented by a thickened alveolar capillary membrane

Question 155

Cause of hypoxemia: right to left shunt

Answer 155

Deoxygenated blood from the right heart flows into systemic circulation -> decreased PaO2

Question 156

In what cases is PaO2 decreased?

Answer 156

It is decreased in high altitude. There is less oxygen in the blood. Anemia, CO, and CN poisoning have nl PaO2

Question 157

In what cases is SaO2 decreased?

Answer 157

CO poisoning and high altitude CO competes with the O2 binding High altitude there is just very little O2 to bind Nl in anemia, CN poisoning, and polycythemia

Question 158

In what cases is oxygen content (Hgb content and oxygen saturation) decreased?

Answer 158

High altitude - low O2 able to bind available Hgb CO poisoning - Hgb is bound to CO, so very little O2 is bound to Hgb Anemia - There is a low amount of Hgb, so even though O2 may be available there isn't Hgb to bind to

Question 159

Conductive hearing loss in right ear (describe PE)

Answer 159

BC>AC -abnl Rinne. The ear drum does not vibrate when the fork is put in the air, but does vibrate when put on the mastoid bone. Localize to the right - Weber The rt ear does not get ambient noise conduction and so it is better able to hear the resonation through bone

Question 160

Sensorineural hearing loss on the right ear

Answer 160

AC> BC - NL Rinne Test. The nerve hears the sound just as poorly from the ear drum as direct contact Localizes to the left -Weber The rt ear has a damaged nerve, so it does not transmit the nerve impulse from bone conduction as well as the Nl ear

Question 161

K percentages in Bowman's, PCT, ascending loop, and collecting duct in NL person

Answer 161

Bowman's -100% PCT- 35% Ascending- 10% Collecting duct - 110%

Question 162

What kind of receptors are Ca sensing receptors? What is a disorder of these receptors?

Answer 162

GPCR Familial hypocalciuric hypercalcemia Ca binds to CaSR and inhibits PTH Normally

Question 163

Intrinsic Tyrosine kinase Receptors

Answer 163

Insulin | IGF- Insulin like growth factor

Question 164

JAK STAT receptors

Answer 164

EPO GH cytokines PRL

Question 165

Marker of osteoblast activity

Answer 165

Bone specific alkaline phosphatase- synthesizing bone matrix leads to release of alkaline phosphatase

Question 166

Markers of osteoclast activity

Answer 166

Tartrate resistant acid phosphatase Urinary hydroxyproline Urinary deoxypyridinoline

Question 167

What does increased lung volume due to alveolar resistance?

Answer 167

Increased lung volume lengthens and narrows the alveoli - > increased alveolar vessel resistance

Question 168

What does decreased lung volume due to extra-alveolar resistance?

Answer 168

Decreased lung volume | Extraalveolar lung vessels narrow due to chest cavity compression -> increased extra-alveolar resistance

Question 169

Pulmonary vascular resistance equation

Answer 169

PVR= alveolar + extra-alveolar resistance | increased or decreased lung volumes increase PVR, lowest at FRC

Question 170

RBF equation

Answer 170

RPF/ (1-hematocrit)

Question 171

Deficient IL-12 would lead to a decrease in which cells and what cytokine could make up for it?

Answer 171

IL-12 activates Th1 cells. You could give IFN-gamma, which helps stimulate differentiation to Th1 and also is secreted by Th1

Question 172

Nitroprusside's effects on preload and afterload

Answer 172

Nitroprusside decreases preload and afterload through equal arteriole and vein dilation

Question 173

Oval or round yeasts inside macrophages, Many small yeasts

Answer 173

Histoplasmosis is smallest btwn blasto and coccidiodes

Question 174

Milrinone MOA

Answer 174

PDE-3 Inhibitor Cardiac - Increased cAMP leads to increased cardiac muscle contraction Vasculature - Increased cAMP leads to vasodilation

Question 175

Which med would cause a greater increase in QRS complex at a higher HR?

Answer 175

Class 1C has the greatest use dependence. Will block Na channels more rapidly at higher HR and lengthen the QRS more at higher HR

Question 176

22 yo ruptured cerebral anuerysm w/ extensive intracranial hemorrhage? Most likely congenital cardiac anomaly/

Answer 176

Adult type Aortic coarctation | increased risk of berry aneursyms and aortic HTN

Question 177

Hyperlipidemia drug causes flushing, what mediates the SE?

Answer 177

``` Niacin causes flushing via PGD2 and PGE2. Give aspirin (Cox inhibitor) before niacin to decrease flushing ```

Question 178

How to prevent Group B strep in an infant?

Answer 178

There is no vaccine for GBS. You give the mom ampicillin to clear the infxn during pregnancy

Question 179

Bosentan MOA

Answer 179

Endothelin receptor antagonist. Blocks vasoconstricting effects of endothelin

Question 180

Bosentan used for?

Answer 180

Idiopathic Pulmonary artery HTN

Question 181

What pt dz would cause anaphylaxis when giving O negative RBCs?

Answer 181

IgA deficiency | Develop IgE against IgA (anti-IgA). The RBCS may have a small amount of IgG that triggers anaphylaxis

Question 182

Chronic rejection of a lung allograft damages where?

Answer 182

Small airways, Bronchiolitis obliterans. Solid organs-vascular obliteration

Question 183

Which segment in the lungs has the greatest airway resistance?

Answer 183

The medium sized bronchioles - due to highly turbulent flow

Question 184

Which segment has the lowest airway resistance?

Answer 184

Terminal bronchioles - increased cross-sectional area

Question 185

Cough reflex afferent and efferent

Answer 185

Afferent is internal laryngeal n. (sensory-branch of CN 10) in piriform recess Efferent is CN 10

Question 186

Hyperoxia in COPD pt leads to what effect on V/Q?

Answer 186

Hyperoxia leads to vasodilation, which creates alveoli that are now ventilated with poor perfusion. Increased physiologic dead space

Question 187

Hypoxia affect in COPD on vasculature

Answer 187

Hypoxia causes vasoconstriction of vessels supplying alveoli w/ low O2 content, perfusion is saved for the alveoli that are well ventillated

Question 188

Whats causes a brown pigment stone?

Answer 188

Biliary tract infxn Injured hepatocytes and bacteria release beta-glucuronidase, which breaks down bilirubin glucuronide ->increased Unconjugated bili

Question 189

What causes black pigment stones?

Answer 189

``` Chronic hemolysis (SCA or spherocytosis) Ileal dz - increased enterohepatic cycling of bili ```

Question 190

Inhibition of 7 alpha hydroxylase, what drug and MOA?

Answer 190

Fibrates inhibit 7-alpha-hydroxylase | Reduce conversion of cholesterol to bile acids -> lower solubility of cholesterol stones

Question 191

What kind of liver dz has decreased serum albumin?

Answer 191

Chronic end stage liver dz | The remaining hepatocytes have reduced fxn, albumin has long half life (20 days)

Question 192

What kind of liver dz causes distended abdominal veins, ascites, and palmar erythema?

Answer 192

End stage liver dz (cirrhosis), due to portal HTN and increased estrogen

Question 193

What kind of liver dz causes splenomegaly?

Answer 193

Portal HTN causes blood to flow to Splenic vein since portal vein is blocked

Question 194

What kind of liver dz causes a prolonged PT time, elevated aminotransferases, leukocytosis, and eosinophilia, and NL albumin?

Answer 194

Acute fulminant hepatitis | Halothane hepatotoxicity is indistinguishable from acute fulminant viral hepatitis on histology

Question 195

Pt has any kind of surgery somewhere besides USA and develops and dies from liver issues. What pattern of injury?

Answer 195

Hepatocellular pattern | Rapid liver atrophy (shrunken)

Question 196

Hepatocellular pattern of injury on histo

Answer 196

Widespread centrilobular necrosis | Inflammation of the portal tracts and parenchyma

Question 197

Mechanism of halogenated anesthetic heptotoxicity

Answer 197

Hypersensitivity to the drug causes immune mediated attack against hepatocytes

Question 198

Nerves innervating EAC

Answer 198

Posterior is auricular branch of vagus, and the rest is auriculotemporal of mandibular (V3)

Question 199

Medical Tx of biliary colic

Answer 199

Ursodeoxycholic acid (hydrophilic bile acids) increase bile solubility and reduce cholesterol secretion

Question 200

Cholestyramine and risk of gallstones

Answer 200

No net risk Decrease enterohepatic recirculation of bile acids (less soluble cholesterol increased risk) Stim conversion of cholesterol to bile acid and increase gallbladder motility (decreased risk)

Question 201

Fibrate MOA

Answer 201

Upregulate LPL -> clear LDL Activate PPAR-gamma to increase HDL synthesis Inhibit 7-alpha-hydroxylase -> decreased conversion of cholesterol to bile acid (increased cholesterol stone risk)

Question 202

Diphenoxylate MOA

Answer 202

Mu opioid -decrease GI motility

Question 203

What drugs is diphenoxylate combine with? Why?

Answer 203

It is combined w/ atropine to cause dry mouth, blurry vision, and nausea (anticholinergic) at high doses to discourage excessive use

Question 204

Meperidine MOA

Answer 204

Mu opioid- decrease GI motility

Question 205

Loperamide MOA

Answer 205

Low dose Mu opioid agonist

Question 206

Hepatic abscess via hematogenous seeding, what bug

Answer 206

Staph Aureus

Question 207

Total gastrectomy requires lifelong administration of?

Answer 207

``` Vitamin B12 (water soluble) Lack of IF to bind B12 and facilitate absorption ```

Question 208

Kid gets recurring giardiasis what enzyme will be deficient due to inflammation and infxn?

Answer 208

Secondary lactase deficiency | Also possible w/ celiac dz

Question 209

Theophylline MOA and toxicity

Answer 209

PDEI - similar to cortical stimulant effects of caffeine, used for bronchodilation Can cause sz and tachyarrhythmia due to caffeine like effects

Question 210

Months of fatigue, rash (worse after hot showers), flushing, abd cramps, dizziness, syncope, and mast cells positive for KIT

Answer 210

Systemic mastoytosis | Increased mast cells w/ KIT (tyrosine kinase) mutation. Excessive tryptase and histamine

Question 211

What does excess histamine cause in systemic mastocytosis?

Answer 211

Syncope, flushing, hypotension, pruritus, urticaria, and increased gastric acid secretion

Question 212

What is the mechanism behind Zenker's diverticulum?

Answer 212

Cricopharyngeal motor dysfxn | Cricopharyngeus doesn't relax leading to increased oropharyngeal intraluminal pressure-> herniation-> false diverticulum

Question 213

Anti-mitochondrial Ab

Answer 213

Primary biliary cholangitis

Question 214

Lymphocytic infiltration and destruction of small intrahepatic bile ducts (2 possible causes)

Answer 214

Primary biliary cirrhosis | Graft versus host dz

Question 215

Acetaminophen OD histo

Answer 215

Centrilobular necrosis that can extend to include the entire lobe

Question 216

Acetaminophen OD tx

Answer 216

N-acetyl-cysteine, regenerates the decreased glutathione

Question 217

Acetaminophen common drug name and where it acts

Answer 217

Tylenol, mostly in the CNS Cox3, less GI SE

Question 218

Acetaminophen OD pathology

Answer 218

Acetaminophen metabolite (NAPQI) depletes glutathione and forms toxic byproducts in the liver

Question 219

Hepatocellular swelling and necrosis, Mallory bodies, neutrophilic infiltration, and fibrosis. What caused this?

Answer 219

Alcoholoic hepatitis

Question 220

What is a mallory body?

Answer 220

Cytoplasmic inclusion in heptocytes made up of damaged intermediate filament

Question 221

Hepatomegaly w/ tense capsule and reddish-purple parenchyma, severe centrilobular congestion and necrosis

Answer 221

Budd-Chiari Syndrome | Hepatic vein obstruction

Question 222

Non-inflammatory hepatocyte necrosis w/ fibrosis

Answer 222

Hemochromatosis

Question 223

Liver histo - Panlobular microvesicular steatosis

Answer 223

Reye Syndrome

Question 224

What is reye syndrome?

Answer 224

Give aspirin to a kid w/ a viral infxn | encephalopathy and liver dz

Question 225

Reye syndrome mechanism

Answer 225

Aspirin metabolites decrease beta oxidation by reversible inhibition of mitochondrial enzymes

Question 226

Reye Syndrome findings

Answer 226

Mitochondrial abnormalities, microvesicular fatty liver, hypoglycemia, vomiting, hepatomegaly, coma

Question 227

What viruses is Reye syndrome associated with?

Answer 227

VZV and Influenza B

Question 228

Pernicious anemia effect on gastrin, gastric pH, and parietal cell mass

Answer 228

Parietal cell mass low -> decreased gastric acid (high gastric pH) and decreased IF (B12 deficiency) Leads to increased gastrin secretion from gastric G cells

Question 229

What part of HDV life cycle is supported by previous HBV?

Answer 229

HBV provides the coating of HDV particles allowing it to penetrate a hepatocyte

Question 230

Name products of TCA cycle

Answer 230

Pyruvate -> acetyl CoA-> citrate->isocitrate->alpha-ketoglutarate->succinyl Coa->succinate-> fumarate->malate-> oxaloacetate

Question 231

Pyruvate kinase

Answer 231

PEP to pyruvate

Question 232

Pyruvate dehydrogenase and what cofactors are required

Answer 232

Pyruvate to acetyl CoA requires thiamine (decarboxylase) B2-riboflavin, B3- niacin, B5-pantothenic acid, lipoic acid

Question 233

Citrate Synthase

Answer 233

Oxaloacetate + acetyl CoA to citrate

Question 234

Aconitase

Answer 234

Citrate to isocitrate

Question 235

Isocitrate dehydrogenase | What Cofactor

Answer 235

Isocitrate to alpha-ketoglutarate | requires niacin as NAD+ -> NADH

Question 236

Alpha-ketoglutarate dehydrogenase. What cofactors?

Answer 236

Alpha-ketoglutarate to succinyl CoA Requires Thiamine(B1) B2-riboflavin, B3-niacin (NAD+-> NADH), B5-patothenic acid, and lipoic aicd

Question 237

Succinate thiokinase | Cofactor

Answer 237

AKA Succinyl-CoA synthetase Succinyl-CoA to succinate Requires GDP-> GTP

Question 238

Succinate dehydrogenase | What Cofactor

Answer 238

Succinate to fumarate Requires B2-riboflavin FAD+->FADH

Question 239

Fumarase

Answer 239

Fumarate to malate

Question 240

Malate dehydrogenase | Cofactor?

Answer 240

``` Malate to oxaloacetate Requires niacin (NAD+-> NADH) ```

Question 241

Pyruvate carboxylase | Cofactor?

Answer 241

``` Pyruvate to oxaloacetate for gluconeogenesis Requires Biotin (carboxylase) ```

Question 242

What are the defense mechanisms against giardiasis?

Answer 242

IgA prevents adherence | and CD4 Th Cells

Question 243

2 Major causes of polyhydramnios

Answer 243

Impaired fetal swallowing or increased fetal urination

Question 244

2 main Causes of decreased fetal swallowing leading to polyhydramnios

Answer 244

GI obstruction - esophageal, duodenal, or intestinal atresia | Anencephaly - No brain to coordinate swallowing

Question 245

Pregnant pt w/ epilepsy what is the baby at risk for

Answer 245

Valproate, carbamazepine, phenytoin -> increase risk of NTD

Question 246

Pulmonary hyoplasia is cause or result of what?

Answer 246

It is a result of oligohydramnios, possibly due to renal agenesis. Low volume of urine made leads to low amount of amniotic fluid-> poor lung development

Question 247

Ipratropium MOA

Answer 247

Anti-muscarinic - bronchodilation

Question 248

Magnesium sulfate in asthma MOA

Answer 248

Inhibits Ca influx -> bronchodilation Stabilizes T cells Inhibits mast cell degranulation

Question 249

What does pulmonary edema due to compliance and surface tension, and FRC?

Answer 249

Fluid in the alveoli increases air resistance -> decreased compliance Surface tension increases w/ fluid in the alveoli->decreased compliance-> alveoli more likely to collapse -atelectasis The decreased compliance means the lungs can't fill as well-> decreased FRC and decreased TLC

Question 250

Atrialization of the right ventricle (Epstein's anomaly) is associated with what med?

Answer 250

Lithium used for bipolar

Question 251

General classes used to treat bipolar disorder, schizophrenia, and epilepsy

Answer 251

Bipolar - lithium and mood stabilizers like valproic acid, carbamazepine, and atypical antipsychotics Schizophrenia - antipsychotics (haloperidol, fluphenazine) atypicals (aripiprizole, clozapine) Epilepsy (valproate, phenytoin, carbamazepine)

Question 252

Bipolar tx

Answer 252

Lithium Carbamazepine Valproate Atypical antipsychotics(aripiprazole and zapines)

Question 253

Schizophrenia Tx

Answer 253

Haloperidol, fluphenazine | atypical - apiprazole, clozapine

Question 254

Epilepsy Tx

Answer 254

Valproate, carbamazepine, phenytoin

Question 255

Child has vascular lesions w/ IgA and C3 deposition

Answer 255

Henloch Schonlein Purpura - Purpuric rash (butt) colicky abd pn, polyarthralgia

Question 256

Vasculitis: Saddle nose and olguria

Answer 256

Granulamatosis with polyangitis

Question 257

Vasculitis: Weak upper extremity pulses

Answer 257

Takayasu arteritis - aorta and its branches

Question 258

Vasculitis: HA and blurred vision

Answer 258

GCA

Question 259

What cells release histamine and tryptase?

Answer 259

Histamine- basophils and mast cells | Tryptase - Mast cells only

Question 260

Multiple cystic edematous hydropic villi, P57 negative

Answer 260

Complete mole,p57 negative=absence of maternal genome, all dad

Question 261

Carcinoembryonic antigen

Answer 261

colorectal maliignancy

Question 262

CA-125

Answer 262

Ovarian CA

Question 263

Sarcoma botryoides in a young girl

Answer 263

Bunch of grapes out of vagina | rhabdomyosarcoma arising from the bladdeer or vaginal mucosa

Question 264

CA 19-9

Answer 264

Pancreatic CA

Question 265

C3b fxn

Answer 265

Opsonin and activates MAC

Question 266

5-HETE (5-hydroxyicosatetraenoic acid) fxn

Answer 266

LT and lipoxin precursor Neutrophil and Macrophage chemotaxis Neutrophil degranulation

Question 267

C5A fxn

Answer 267

Chemotaxis and increased phagocytosis directly

Question 268

LTB4

Answer 268

Chemotaxis

Question 269

Opsonins

Answer 269

IgG, C3B, CRP, and mannose binding lectin

Question 270

Which hormones have the same alpha subunit?

Answer 270

Hcg, TSH, FSH, LH

Question 271

Which hormones have beta subunits with significant homology?

Answer 271

Hcg and TSH

Question 272

Painless scrotal mass, increased sweating and heat intolerance, increased T4 and T3, hypoechoic mass w/in the testicle

Answer 272

Testicular germ cell tumor secreting Hcg which can bind TSH -R if excessive enough

Question 273

How do cancers met to the skeletal system?

Answer 273

Hematogeneous spread not lymphatic

Question 274

Prostatic venous plexus receives blood from where?

Answer 274

Prostate, penis, bladder

Question 275

Preventable adverse event

Answer 275

Harm to pt due to failure to follow EBM

Question 276

Near miss

Answer 276

No harm to pt, prevented before harm could take place

Question 277

Atypical endometrial cells, disorganized glands, and multiple mitoses

Answer 277

Endometrial adenocarcinoma commonly in post-menopausal women

Question 278

Dilated, coiled endometrial glands and edematous stroma

Answer 278

Common during the luteal phase Pathologic- ectopic pregnancy will stimulate this luteal phase due to the corpus luteum, but no implantation in the uterus

Question 279

Enlarged chorionic villi and avascular edematous stroma

Answer 279

Molar pregnancy

Question 280

Inflammatory infiltration of endometrial glands

Answer 280

Endometritis -infxn of the decidua

Question 281

Straight, short endometrial glands, and compact stroma

Answer 281

Proliferative phase of the menstrual cycle

Question 282

Anaphylactic schock tx

Answer 282

1-epinephrine - Alpha 1 vasoconstricts to increase bp B1- Increases cardiac contractility, HR, and AV conduction B2-bronchodilates -improving breathing 2-Diphenhydramine

Question 283

Why not use NE to tx anaphylaxis?

Answer 283

Mostly an alpha 1 agonist - high vasoconstriction can limit CO stimulate carotid sinus to decrease bp and HR

Question 284

Aspirin intoxication (acute salicylate toxicity) ABG

Answer 284

1) Respiratory alkalosis - stim medullary respiratory center to increase ventilation leading to decreased PaCO2 2) After 12 hrs - metabolic acidosis- salicylates uncouple oxidative phosphorylation leading to increased organic acids-> decreased bicarb

Question 285

Aspirin intoxication ABG

Answer 285

1) 1st 12 hours respiratory alkalosis, pH up, PaCO2 down, HCO3 NL 2) after 12 hours mixed respiratory alkalosis and metabolic acidosis pH close to NL, PaCO2 down (not compensated), HCO3 down

Question 286

Layers in cricothyrotomy

Answer 286

Skin superficial cervical fascia (SQ fat and platysma) Deep cervical fascia (investing and pretracheal layers) Cricothyroid membrane

Question 287

What is RT-PCR used to detect?

Answer 287

mRNA, you take the RNA and RT back to DNA (cDNA) and make copies of mRNA containing exons w/o introns

Question 288

CML RT-PCR

Answer 288

would show mRNA with both BCR and ABL exons

Question 289

What do Southwestern blots detect?

Answer 289

Proteins that bind DNA

Question 290

What does RAS code for?

Answer 290

Codes for GPCR, activates MAP kinase pathway -> affects transcription

Question 291

What are c-Jun and c-Phos?

Answer 291

Nuclear transcription factors that bind DNA via a leucine zipper motif Proto-oncogenes

Question 292

S-100 marks waht cells?

Answer 292

Neural crest cells | Melanocytes, Schwann cells, Langerhans (DC)

Question 293

Why eat carb rich food before workout?

Answer 293

Increased Ca release from SR->activate phosphorylase kinase to stim glycogen phosphorylase to break down glycogen Synchronizes muscle contraction w/ glycogen breakdown, less anaerobic metabolism

Question 294

3 fluid compartments and volumes

Answer 294

Total body water = 41 L ECF= 14L Plasma 3L

Question 295

Low molecular weight molecule, which compartment

Answer 295

ECF 14L

Question 296

Lipophilic molecule, which compartment

Answer 296

Total body water 41L

Question 297

Not bound to albumin

Answer 297

Not in Plasma, ECF or TBW

Question 298

Most abundant AA in collagen

Answer 298

glycine (Gly-X-Y) | also proline and lysine

Question 299

DNA Pol I

Answer 299

Old school, It synthesizes the lagging strand and has 5'-3' and 3' to 5' exonuclease proofreading

Question 300

DNA pol III

Answer 300

New kid, Synthesizes leading strand and has 3'-5' exonuclease proofreading

Question 301

To avoid wrong site surgery

Answer 301

2 separate people identify the site individually

Question 302

On effect/drug concentation grafts what do x and y axis mean?

Answer 302

X axis -lower the value the greater the affinity and potency | y axis- higher the value the greater the efficacy

Question 303

Potency and affinity go together, what does not necessarily mean increased affinity?

Answer 303

lower Km does not necessarily mean that affinity is greater

Question 304

CMV in a pregnant women can lead to a child w/

Answer 304

chorioretinitis

Question 305

Ataxia, telangectasia, and sinopulmonary infxns are classic triad

Answer 305

Ataxia telangectasia ATM gene mutation -> DNA break repair IgA deficiency

Question 306

Fragile X syndrome | What is the mutation and what does it do to DNA?

Answer 306

FMR mutation leads to FMR1 hypermethylation

Question 307

How would you determine methylation and number of repeats?

Answer 307

Use Southern blot to determine number of CGG

Question 308

MOA of botulinum toxin

Answer 308

Cleaves SNAREs preventing NT release from vesicles (pre-synaptic)

Question 309

Antipsychotic OD - diffuse muscle rigidity, high fever, tachycardia, HTN, and altered sensorium Name syndrome and tx

Answer 309

Neuroleptic malignant syndrome | Tx w/ dantrolene to block Ryanodine receptors

Question 310

What NT is produced in the posterior rostral pons at the lateral floor of the fourth ventricle?

Answer 310

Locus ceruleus produces NE

Question 311

What NT at ventral tegmental area and substantia nigra pars compacta

Answer 311

DA

Question 312

3 DA pathways

Answer 312

Mesolimbic and mesocortical - cognition and behavior Nigrostriatal - coordination of voluntary movements Tuberoinfundibular - inhibit PRL

Question 313

NT produced from Periaqueductal gray, rostral ventral medulla, and dorsal horn of the spinal cord

Answer 313

Dynorphin (opioid)

Question 314

NT from posterior hypothalamus

Answer 314

Histamine and orexin - arousal and wakefulness

Question 315

Transamination rxns require which vitamin?

Answer 315

Vit B6

Question 316

What is the major AA responsible for transferring nitrogen to the liver?

Answer 316

alanine

Question 317

What happens to alanine once it reaches the liver?

Answer 317

Alanine transfers the amino group to alpha ketoglutarate to form glutamate

Question 318

What happens to glutamate in the liver?

Answer 318

Glutamate is transformed to regenerate alpha ketoglutarate and free ammonia by glutamate dehydrogenase

Question 319

Morbilliform rash on trunk and arms, fever, encephalitis, and flaccid paralysis in the summer

Answer 319

WNV - Positive sense ssRNA flavivirus transmitted by Culex female mosquitos

Question 320

Main features of a glucagonoma

Answer 320

Diabetes GI- diarrhea, anorexia, abd pn Necrolytic migratory erythema

Question 321

Describe necrolytic migratory erythema

Answer 321

Erythematous plaques/papules on face. perineum, and extremities Lesions coalesce leaving bronze colored, central indurated area w/ peripheral blistering and scaling

Question 322

What is arginine a substrate for?

Answer 322

Arginase producing urea

Question 323

Spastic diplegia, abnl movements, and growth delay

Answer 323

Arginase deficiency- arginine is not changed to ornithine and urea

Question 324

Arginase deficiency- hyperammonemia?

Answer 324

Mild or no hyperammonemia

Question 325

Thyroid histo: Nests of polygonal cells with Congo red positive deposits

Answer 325

Medullary thyroid CA

Question 326

Why does medullary thyroid CA have Congo red positive deposits?

Answer 326

Tumor from calcitionin secreting C cells. The amyloid depositis are calcitonin secreted from the c cells

Question 327

Thyroid histo: branching structures with interspersed calcified bodies

Answer 327

Papillary thyroid CA | calcified bodies are psammoma bodies

Question 328

Follicular hyperplasia with tall cells forming intrafollicular projections

Answer 328

Papillary thyroid CA - intrafollicular projections = papilla. Don't forget Orphn annie eyes- pale nuclei with thin rim of peripheral chromatin

Question 329

Pleomorphic giant cell nests w/ occasional multinucleated cells

Answer 329

Anaplastic thyroid carcinoma

Question 330

Sheets of uniform cells forming small follicles

Answer 330

Benign follicular adenom

Question 331

Neonatal intraventricular hemorrhage in premature baby will have bleeding from where?

Answer 331

Germinal matrix - highly cellular and vascularized layer in the subventricular zone. neuron an glial cells migrate out of during development

Question 332

What adrenergic receptor affects uterine contractions?

Answer 332

B2 agonists -decreases uterine contractions, tocolytic

Question 333

What adrenergic receptor causes mydriasis?

Answer 333

Alpha 1 agonists-> mydriasis

Question 334

In DKA which enzyme provides substrate for gluconeogenesis?

Answer 334

Glycerol kinase

Question 335

TG breakdown in DKA

Answer 335

FA undergo beta oxidation to provide energy and ketone bodies, but not glucose The glycerol backbone goes to DHAP to provide energy and glucose

Question 336

Manifestations of pineal tumor (germinoma)

Answer 336

Obstructive hydrocephalus and dorsal midbrain syndrome (Parinaud)

Question 337

What is Parinaud syndrome?

Answer 337

Limited upward gaze, downward gaze preference, b/l eyelid retraction and accomodation w/o pupil rxn

Question 338

What is required for glycolysis? Glyceraldehyde-3-phosphate to 1,3-bisphosphoglycerate

Answer 338

NAD+

Question 339

In anaerobic conditions what does pyruvate to lactate accomplish?

Answer 339

NADH transfers e- to pyruvate to make lactate and regenerates NAD+ to continue glycolysis

Question 340

What substrate activates pyruvate carboxylase and inhibits pyruvate dehydrogenase? Promotes gluconeogenesis over TCA cycle

Answer 340

Acetyl CoA When Acetyl CoA is low pyruvate dehydrogenase is disinhibited to make more When Acetyl-CoA is high it prevents more by activating pyruvate carboxylase

Question 341

Trazodone MOA

Answer 341

5HT modulator | 5HT post-synaptic blocker and inhibits 5HT reuptake

Question 342

Besides 5HT what does trazodone act on?

Answer 342

Alpha 1 block - orthostatic hyypotension H1 block- sedation 5HT - insomnia associated w depression

Question 343

Trazodone SE

Answer 343

TrazoBONE- priapism | orthostatic hypotension

Question 344

Gastric erosions, what layer

Answer 344

Up to but not throught muscularis mucosa

Question 345

Gastric ulcers, what layer?

Answer 345

Extend into submucosa or deeper

Question 346

Duration of trazolam, oxazepam, and midazolam

Answer 346

Short acting < 6 hrs half-life

Question 347

Duration of alprazolam, lorazepam, and temazepam

Answer 347

Intermediate 6-24 hrs half-life

Question 348

Duration of chlordiazepoxide, diazepam, and flurazepam

Answer 348

Long > 24 hr half-life

Question 349

To avoid undesirable daytime effects take short or intermediate acting benzos

Answer 349

short- oxazepam, midazolam, trazolam | intermediate - alprazolam, lorazepam, and temazepam

Question 350

Narcolepsy tx

Answer 350

Psychostimulant like modafinil

Question 351

Modafinil MOA

Answer 351

Non-amphetamine psychostimulant thought to enhance DA signaling

Question 352

Tx of tx-resistant schizophrenia

Answer 352

Clozapine - 2nd gen antipsychotic

Question 353

Clozapine SE

Answer 353

Agranulocytosis, metabolic syndrome, seizures, myocarditis

Question 354

Aripiprazole and ziprasidone, risperidone

Answer 354

2nd gen antipsychotics

Question 355

Tx of drug-induced Parkinsonism

Answer 355

D/c drug and centrally acting anti-muscarinic - benztropine | Don't use carbidopa/levodopa - could precipitate psychosis

Question 356

Most common cause of death in TCA OD

Answer 356

arrhythmia from inhibtion of fast acting Na channels in cardiac myocytes

Question 357

TCA effects what receptors

Answer 357

Presynaptic NE and 5HT prevent reuptake - antidepressant Muscarinic Ach-R block- tachycardia, hyperthermia H1 -sedation Alpha 1 block- vasodilation Cardiac Na channels

Question 358

Panic disorder tx emergent and long term

Answer 358

Emergent- benzo | Long term SSRI/SNRI

Question 359

TCA blocks what receptors

Answer 359

``` NE and 5HT reuptake H1 Alpha 1 Muscarinic Cardiac fast acting Na channels ```

Question 360

Venlafaxine, duloxetine, ddesvenlafaxine, levomilnacipran, milnacipram MOA

Answer 360

SNRI

Question 361

High potency 1st gen antipsychotics

Answer 361

Haloperidol and fluphenazine - more likely EPSE

Question 362

Low potency 1st gen antipsychotics

Answer 362

Chlorpormazine and thioradizine -more likely sedation (H1), orthostatic hypotension (Alpha 1), anticholinergic (muscarinic)SE

Question 363

11-beta hydroxylase deficiency (hypokalemic metabolic acidosis) : cortisol, renin, and aldosterone

Answer 363

Cortisol is low as 11-deoxycortisol can't become cortisol -> Increased ACTH -> increased 11-deoxycorticosterone (MC) -> increased Na reabsorption -> HTN Renin and aldosterone would be low as the pt is HTN

Question 364

What family of virus does RSV fall in?

Answer 364

Paramyxovirus - Negative sense ssRNA helical w/o envelope

Question 365

dsDNA, enveloped, icosahedral

Answer 365

Hepadnavirus-HBV | Herpes virus - HSV

Question 366

dsDNA, naked, icosahedral

Answer 366

Adenovirus - conjunctivitis, pharyngitis Papillomavirus- warts Polyomavirus- JC-progressive multifocal leukoencephalopathy (PML) in AIDS BK-transplant pt, targets kidneys

Question 367

ssDNA, naked, icosahedral

Answer 367

Parvovirus- B19 targets RBC- hydrops fetalis or aplastic crisis in SCA

Question 368

Negative sense ssRNA, bullet shaped, enveloped virus

Answer 368

Rhabdovirus - Rabies

Question 369

Negative sense ssRNA, helical enveloped virus in kid w/ wheezes

Answer 369

Paramyxovirus - measles, mumps, parainfluenza-croup, and RSV

Question 370

Positive sense ssRNA, icosahedral, enveloped virus

Answer 370

Togavirus - Rubella, equine encephalitis Flavivirus- Hep C, WNV, Dengue Coronavirus - common cold, SERS Retrovirus - HIV, HTLV

Question 371

Positive sense ssRNA, icosahedral, naked

Answer 371

Calicivirus - Norovirus | Picornavirus (PERCH) - Polio, echo, rhino, cocksackie, and HAV

Question 372

Picornaviruses (PERCH)

Answer 372

``` Polio Echo Rhino Cocksackie HAV ```

Question 373

D-ALA dehydratase and ferrochetalase are affected

Answer 373

Lead poisoning - microcytic anemia, Basophilic stippling, GI and kidney dz

Question 374

Uroporphorinogen decarboxylase is affected

Answer 374

Porphyria cutanea tarda - blistering cutaneous photosensitivity

Question 375

Porphobilinogen deaminase is affected

Answer 375

Acute intermittent porphyria - Pnful abd, psycho disturbance, port wine stain, polyneuropathy

Question 376

D-ALA synthase is affected

Answer 376

Sideroblastic anemia (X-linked) or B6 (pyridoxine) deficiency

Question 377

What substrates accumulate in lead poisoning?

Answer 377

Protoporphyrin, D-ALA in the blood

Question 378

What substrates accumulate in acute intermittent porphyria?

Answer 378

Porphobilinogen, D-ALA, coporphobilinogen (urine)

Question 379

What substrates accumulate in porphyria cutanea tarda?

Answer 379

Uroporphyrin (tea colored pee)

Question 380

What is believed to be the cause of endometrial carcinoma in post-menopausal women? tX

Answer 380

Unopposed estrogen | Tx w/ estrogen combined with progesterone to dampen the effects of estrogen

Question 381

Diphenhydramine MOA and receptors affected

Answer 381

H1 blocker anti-muscarinic anti-alpha

Question 382

Why would diphenydramine cause vision issues?

Answer 382

anti-muscarinic properties cause mydriasis aggravating acute angle-closure glaucoma. Alpha block would cause miosis not mydriasis

Question 383

Things that can cause digoxin toxicity

Answer 383

Quinidine, amiodarone, verapamil - displace digoxin and decrease clearance Hypokalemia

Question 384

Yellow vision, premature ventricular contractions, curved ST segment

Answer 384

Digoxin toxicity

Question 385

Kidney: Filter load equation

Answer 385

FL=GFR (L/day) X plasma concentration (mEq/L)

Question 386

Kidney: Fractional excretion equation

Answer 386

FE = Excretion rate (mEq/day)/ filtered load | mEq/day

Question 387

To get the fraction excreted

Answer 387

how much is secreted over how much is filtered - how much is in the plasma times the GFR

Question 388

Fluphenazine vs phenelzine

Answer 388

Fluphenazine - 2nd gen antipsychotic | phenelzine - MAOI

Question 389

Meperidine MOA

Answer 389

Opioid that also blocks 5HT reuptake. Can cause Serotonin syndrome when combined w/ MAOI

Question 390

What does partial emancipation at age 15 allow for?

Answer 390

STI screening and tx -including HIV substance abuse tx Prenatal care and birth control

Question 391

Agents that can cause lupus

Answer 391

Hydralazine - arteriole dilation Procainamide - Class 1A anti-arrhythmic INH - Prevents mycolic acid synthesis Methyldopa - alpha 2 agonist (pregos) Chlorpromazine - 1st gen low potency antipsychotic Quinidine - Class 1A anti-arrhythmic Minocycline - tetracycline Terbinafine - Inhibits fungal squalene epoxide Phenytoin - Anti-sz, blocks Na channels, also Class 1B antiarrhythmic Sulfasalzine-Combo of sulfapyridine (anti-bx) and 5-aminosalicylic acid (anti-inflamm)

Question 392

Treating HTN and pt gets SLE, what drug. What if the pt is pregnant?

Answer 392

Hydralazine -arteriole vasodilator | Methyldopa- alpha 2 agonist -decrease adrenergic

Question 393

Treating an atrial arrythmia and the pt gets SLE, what if you were treating a ventricular arrhythmia post-MI

Answer 393

Class 1A anti-arrythmics Quinidine or procainamide Post-MI likely Class 1B - phenytoin

Question 394

Treating a tonic-clonic sz and pt gets SLE

Answer 394

Phenytoin

Question 395

Treating tuberculosis and pt gets SLE

Answer 395

Isoniazid

Question 396

Tx pt for schizophrenia and pt gets SLE

Answer 396

Chlorpromazine

Question 397

Tx for borrelia burgdorferi and pt gets SLE

Answer 397

minocycline

Question 398

Tx for onchomycosis (nail fungus) and pt gets SLE

Answer 398

Terbinafine

Question 399

Tx UC or Crohn dz and pt gets SLE

Answer 399

Sulfalazine

Question 400

The most common solid tumor in childhood

Answer 400

Wilms tumor not neuroblastoma appear the same on CT -heterogeneous

Question 401

3 Syndromes associated w/ Wilms tumor

Answer 401

Denys-Drash - gonadal dysgenesis, early-onset nephropathy Beckwith-Wiedmann-organomegaly, macroglossia, hemihypertrophy, omphalocele WAGR- WT, aniridia, GU malformation, retardation

Question 402

Acid fast organisms

Answer 402

Mycobacteria (TB, leprosy) Nocardia Cryptosporidium

Question 403

What characteristic is most important to the spread of cryptosporidium?

Answer 403

Resistance to Cl

Question 404

How do you tx Cryptosporidium parvum?

Answer 404

Nitozoxanide - healthy | Azithromycin - immunocompromised

Question 405

Posterior dislocation of the femur at the hip, what nerve is injured and what muscles would be weak?

Answer 405

Inferior gluteal n. | Loss of hip extension and lateral rotation of the thigh -gluteus maximus

Question 406

Superior gluteal n injury. What movement is affected and which muscles

Answer 406

gluteus medius, gluteus minimus, and tensor fascia latae | Abduction of the hip

Question 407

What characteristics of a protein make it more likely to be filtered?

Answer 407

small 7,000 Da | neutral - negative proteins get repelled by heparan

Question 408

Alpha-synuclein is found in what?

Answer 408

Lewy bodies

Question 409

Anemia compared to NL: CO, arterial PO2, Mixed venous PO2, 2,3-DPG

Answer 409

Right shift CO increased to make up for low O2 delivery due to low Hgb Arterial PO2 and arterial oxygen concentration -NL (independent of Hgb) Mixed venous PO2 - increased O2 extraction by the tissues due to right shift 2,3-DPG increased to increased O2 extraction

Question 410

What is chylothorax?

Answer 410

Accumulation of lymph in pleural space

Question 411

Acute pleural masses w/ effusion w/ hx of installing fire-resistant tiles

Answer 411

Mesothelioma due to asbestos | Silicosis doesn't have acute pleural masses or effusions

Question 412

What is a carbuncle?

Answer 412

Cluster of boils draining pus to the skin, S. Aureus. Neck, face, and chest, doesn't persist for years

Question 413

What is a furuncle?

Answer 413

Painful boil due to hair follicle inflammation. Neck, face, and chest, doesn't persist for years

Question 414

What is an erythrasma?

Answer 414

Scaling, fissuring, and maceration. Brown scaly superficial infxn

Question 415

What is hidradenitis suppuritiva

Answer 415

Local inflamm of apocrine sweat glands-> obstruction and rupture of ducts. Persists for decades. No abx

Question 416

What kind of hypersensitivity is contact dermatitis and what things are important to that kind of rxn?

Answer 416

Secretion of Th1 cytokines like IFN gamma and TNF-alpha

Question 417

Anti-microsomal Ab

Answer 417

Hashimoto's thyroditis also anti-thyroglobulin

Question 418

What type of hypersensitivity is Hashimoto's thyroiditis?

Answer 418

Type 4- T cells get sensitized to antigens

Question 419

Poultry processing worker w/ flu sx and elevated LFT, What dz and what tx

Answer 419

Chlamydophila psittaci | tx w/ tetracycline

Question 420

Hypothyroid w/ breast d/c. Is TRH or TSH low?

Answer 420

If there is breast d/c then PRL is being stimulated by TRH, so the hypothyroidism must be at the level of the pituitary, TSH is low, but TRH is high

Question 421

O father, B daughter, and A mother. What's up?

Answer 421

Dad is not the father, could not have given B. Keep it simple

Question 422

Chemotaxis agents

Answer 422

C5A, LTB4, IL-8

Question 423

Cleft lip/palate, omphalocele, polydactyly, and cutis aplasia

Answer 423

Patau Syndrome Trisomy 13

Question 424

VACTERL is an association what does it stand for?

Answer 424

``` Vertebral defects Anal atresia Cardiac defects Tracheo-esophageal fistula Renal anomalies Limb anomalies ```

Question 425

Nontender GB, obstructive jaundice, and wt loss

Answer 425

Pancreatic adenocarcinoma at the head

Question 426

Greatest risk factor for pancreatitis

Answer 426

Smoking

Question 427

What happens to copper in the body?

Answer 427

In the liver it is incorporated into alpha2 globulin to form ceruloplasmin, which is then resecreted in the plasma

Question 428

How is copper eliminated?

Answer 428

Secreted into the bile and out through the stool

Question 429

RAS MAPK pathway

Answer 429

GF ligand binds receptor tyrosine kinase->autophosphorylation-> GTP binding->MAPK influencing gene expression in the nucleus

Question 430

How is RAS regulated?

Answer 430

RAS has its own GTPase to remove GTP so that too much RAS doesn't build up. RAS mutations -> decreased GTPase activity -> more activated RAS

Question 431

Lost in desert for 3 days: | ADH, plasma osmolarity, and water excretion

Answer 431

ADH up Plasma osmolarity up water excretion down Water continues to get lost even w/ low water excretion, so the plasma osmolarity increases w/ low volume and ADH increases to compensate

Question 432

Buprenorphine characteristics

Answer 432

Partial Mu agonist

Question 433

Why would using morphine not be effective after buprenorphine had been administered?

Answer 433

Buprenorphine is less efficacious as a partial agonist so it takes up receptors preventing morphine from having full effects

Question 434

HA, vision problems, frontal bossing, sausage fingers, diaphoresis, hypoglycemia, sx improve w/ octreotide

Answer 434

Acromegaly- excess GH | GH antgonizes insulin

Question 435

Professor has trouble speaking in front of people, NL in other situations

Answer 435

Social phobia-specific situations are stressful

Question 436

Complications of multiple myeloma

Answer 436

Frequent sever infxns (monoclonal plasma cells), renal failure, anemia, and neuro dz

Question 437

Pacemaker lead becomes dislodged into adjacent artery, which artery runs alongside the coronary sinus?

Answer 437

LCA - circumflex runs with coronary sinus

Question 438

What kind of lung dz is asbestosis?

Answer 438

Restrictive, FEV1/FVC is close to nl. Make sure to look at FEV1 and FVC in graphs

Question 439

Colicky RUQ pn, xanthomas, scleral icterus, hypercholesterolemia, prolonged PT, elevated conjugated bili, decreased Vit D

Answer 439

Extrahepatic cholestasis Bile is not making it to the small intestine to help absorb fat soluble vitamins, Vit K, so you get prolonged PT, Low Vit D absorption Too much bile so synthesis is turned off, cholesterol builds up in the liver, and LDL-R decrease

Question 440

Constant severe RUQ pn, fever, nausea, vomiting, elevated WBC, and slightly elevated LFTs

Answer 440

Acute cholecystitis - | stone lodged in the cystic duct

Question 441

Postprandial Colicky RUQ pn radiating to the rt shoulder, jaundice, and elevated alk phos, slightly elevated LFT

Answer 441

Choledochlithiasis -stone in CBD

Question 442

Choledocholithiasis vs cholecystitis

Answer 442

In the CBD the pn occurs after eating when CCK is secreted. In the cystic duct it hurts continually

Question 443

Leading cause of death in a AA male police officer age 25-34

Answer 443

Unintended accident, doesn't matter that he's a cop

Question 444

Leading cause of death in AA male age 15-24

Answer 444

Homicide

Question 445

Goal of Tx in Wolf-Parkinson White

Answer 445

Stop conduction of accessory pathway, not AV conduction-this will push more signal through accessory pathway

Question 446

Goal of txing Isolated supraventricular arrythmias

Answer 446

Block AV node so atrial arrythmia is not transferred to the ventricle

Question 447

Shortened PR interval, wide QRS, and delta wave

Answer 447

WPW- Myocyte loop in the bundle of Kent Shortened PR interval as atria fire more quickly, ventricles start to fire sooner (delta wave) and the QRS gets lengthened due to the presence of multiple pathways

Question 448

What medications should be used to prevent v-fib in WPW?

Answer 448

``` Class 1A - relatively nonselective (diffuse mycoytes) and dissociate slowly. Something that does not affect the AV node (rhythm control) No class 2 or 4, digoxin, or adenosine ```

Question 449

Adenosine MOA

Answer 449

Increased K+ out of pacemaker cells leads to hyperpolarization. Slows AV conduction through pacemaker cells

Question 450

Digoxin CI in which heart pts

Answer 450

V-fib and WPW

Question 451

Digoxin MOA

Answer 451

Inhibits Na/K pump so Na and then Ca build up in the cell-> increased contractility Stims vagus n to decrease HR at the AV node

Question 452

1st degree heart block

Answer 452

PR interval is lengthened, it takes longer for atrial depolarization has delay to ventricle

Question 453

Mobitz Type 1 Heart block (2nd degree)

Answer 453

The PR lengthens progressively until a beat is dropped and a QRS is not transmitted.

Question 454

Mobitz Type 2 Heart Block (2nd degree)

Answer 454

PR interval is constant and then there is a sudden dropped beat (no QRS)

Question 455

3rd degree heart block (complete)

Answer 455

Atria and ventricle beat independently. Possible w/ myomectomy

Question 456

Drugs that can exacerbate MG

Answer 456

aminoglycosides-decreased presynaptic release and decreased post-synaptic sensitivity

Question 457

Pregnant teen, what do you tell her

Answer 457

You can do prenatal care w/o informing pts, encourage to talk to parents, but don't insist

Question 458

Alcoholism, anterograde amnesia, and confabulations

Answer 458

Korsakoff syndrome-neuropsych manifestation o Wernicke Encephalopathy Lesion of the mamillary bodies

Question 459

Where is the lesion in Wernicke aphasia?

Answer 459

Superior temporal gyrus of the temporal lobe

Question 460

AL amyloidosis (primary or secondary) what disease is an example

Answer 460

AL amyloidosis is primary like multiple myeloma | Made up of Ig Light chains

Question 461

AA amyloidosis (primary or secondary) what dz is an example

Answer 461

Secondary amyloidosis | Chronic inflammatory dzs like RA, IBD. Fibrils made of Amyloid A

Question 462

Kappa, Lambda, and M proteins

Answer 462

Products of whole Ig released by plasma cells | Seen in primary amyloidosis and MM

Question 463

Multiple discrete lesions in the brain

Answer 463

Likely metastasis. Often located at gray-white jxn

Question 464

Limited oxygen uptake (peak oxygen uptake of 15 mL/kg/min) and increased bp during stress test indicate what?

Answer 464

The pt has stable HF/deconditioning. Fatigue is a direct result of deconditioning

Question 465

Tx for ischemic cardiomyopathy/stable HF/deconditioning

Answer 465

Closely monitored exercise regimen

Question 466

Posterior stab in the 8th ICS , hydropneumothorax w/ high TG

Answer 466

Thoracic duct injury- leaks TG

Question 467

Adrenal medulla vs. adrenal cortex

Answer 467

Medulla has glomerulosa, fasciculata, and reticularis | Cortex has NE and Epi

Question 468

Elderly person w/ pneumonia. Hypofxn of what endo organ prevents improvement?

Answer 468

Thyroid-hypothyroidism | Adrenal cortex-cortisol deficiency

Question 469

Kid w/ posterior fossa tumor and Rosenthal (corkscrew fibers)

Answer 469

Pilocytic astrocytoma also has pink blobs

Question 470

Kid w/ posterior fossa tumor, small blue cells and Homer-Wright rosettes

Answer 470

Medulloblastoma

Question 471

Radiodense bony spike covered with a radiolucent cap

Answer 471

Osteochondroma

Question 472

Arterial O2 saturation, what does it mean

Answer 472

The % of Hgb that is saturated. NL in anemia, as the Hgb available has Nl binding

Question 473

Arterial PO2, what does it mean

Answer 473

The partial pressure of O2 in the blood. Unaffected by Hgb. This is dissolved O2

Question 474

Arterial O2 content, what does it mean

Answer 474

It includes Hgb O2 saturation (saO2) and PaO2. Decreased in anemia

Question 475

Anemia: SaO2, PaO2, Arterial O2 content, venous O2

Answer 475

SaO2 - Nl, the available Hgb bin NLy PaO2-NL independent of Hgb Arterial O2 content - decreased as it depends on Hgb Venous O2- decreased as more O2 will be extracted due to low Hgb

Question 476

What is similar and different btwn Squamous cell CA and keratoacanthoma?

Answer 476

Both: abnl epithelial maturation, acanthosis, loss of basal cell layer Different: Keratoacanthomas have central crater (volcano)

Question 477

Low IFG binding protein, what will happen to IGF?

Answer 477

IGF will also be decreased. Low GH -> Low IGF and IGFBP

Question 478

Lethargy, constipation, depression, shortened QT, ocular band keratopathy, HTN, duodenal ulcer, and pancreatitis. What could be a cause?

Answer 478

Primary hyperPTH | All signs of hypercalcemia from PTH excess

Question 479

What condition is often associated with Meneire's dz?

Answer 479

Permanent low frequency hearing loss

Question 480

Dry, yellowish skin, low pulse, and slow shallow respirations, low sodium, low glucose, high cholesterol. What hormone is deficient?

Answer 480

T4 Decreased cardiac stim Decreased LDL-R Decreased GFR

Question 481

What keeps RBF and GFR constant from 80 to 180 mmHG?

Answer 481

Changes in glomerular vascular resistance (constricting or dilating glomerular arterioles)

Question 482

Metoclopramide MOA

Answer 482

Increase tone, contractility, and motility Facilitates cholinergic effect D2-R block

Question 483

With what kind of vomiting would you use ondansetron?

Answer 483

Cancer chemotherapy and hyperemesis w/ pregnancy | 5HT block

Question 484

Tx diabetic gastroparesis with?

Answer 484

Metoclopramide- D2-R blocker w/ cholinergic effect- facilitates motility

Question 485

MAP equation

Answer 485

MAP = SVR X CO

Question 486

Lymphocytes that are most increased in the blood in EBV are?

Answer 486

T cells attacking EBV | They are the atypical lymphocytes

Question 487

CYP450 Inhibitors -> increased drug level in blood

Answer 487

``` Acute alcohol abuse Ritonavir Amiodarone Cimetidine/ciprofloxacin Ketoconazole Sulfonamides Isoniazid Grapefruit Quinidine Macrolides (erythro and clarithromycin) ```

Question 488

CYP450 Inducers

Answer 488

``` Chronic alcoholics St Johns wort Phenytoin Phenobarbital Nevirapine Rifampin Griseofulvin Carbamazepine ```

Question 489

Nizatadine MOA

Answer 489

H2 blocker used for GERD. No CYP450 interaction like cimetidine

Question 490

Sucralfate MOA

Answer 490

Form polymer that protects stomach from acid. Not compatible w/ acid lowering meds. It needs the acidic environment

Question 491

What type of selection? T cells w/ thymic cortical epithelial cells.

Answer 491

Positive selection in the cortex, must have affinity for self-MHC

Question 492

What type of selection? T cells w/ thymic medullary epithelial and DC.

Answer 492

Negative selection in the medulla, not too strong an affinity for self-MHC

Question 493

How does INH lead to microcytic, sideroblastic anemia?

Answer 493

INH decreases B6, which is a cofactor for D-ALA synthase. Low D-ALA synthase means low production of heme and the iron builds inside the RBC

Question 494

Poor Plt aggregation in the presence of ristocetin

Answer 494

VWF deficiency. Ristocetin activates Gp1 for NL VWF to bind. low VWF leads to low aggregation

Question 495

What does GpIIb/IIIa bind to?

Answer 495

Binds to fibrinogen, which can bind to another Plt via gpIIb/IIIa

Question 496

Lithium SE

Answer 496

Hypothyroidism Nephrogenic DI Tremor Ebstein anomaly- atrialization of RV

Question 497

Valproate SE

Answer 497

NTD | hepatotoxicity

Question 498

Carbamazepine SE

Answer 498

Agranulocytosis SIADH NTD

Question 499

Lamotrigine SE

Answer 499

Steven-Johnson syndrome | benign rash

Question 500

Fxn of the proteasome

Answer 500

Recycle proteins, breakdown apoptotic proteins

Question 501

Bortezomib MOA

Answer 501

Boronic acid dipeptide that inhbits the proteasome -> increased pro-apoptotic proteins and toxic proteins-> apoptosis

Question 502

Severe hypoplasia of erythroid precursors w. NL granulopoeisis and thrombopoiesis

Answer 502

Pure red cell aplasia Caused by thymomas lymphocytic leukemia, and parvovirus B19

Question 503

What occurs in the nucleolus?

Answer 503

Ribosomal subunit maturation and assembly

Question 504

Which RNA Polymerase fxns exclusively in the nucleolus

Answer 504

RNA Pol I - transcibre 45S pre-rRNA gene that codes for most of the RNA components

Question 505

RNA Pol II synthesizes what?

Answer 505

mRNA snRNA miRNA most highly regulated of the RNA polymerases

Question 506

RNA polymerase III synthesizes what>

Answer 506

tRNA and 5s rRNA (genes of this part of rRNA are made outside the nucleus)

Question 507

Cause of megaloblastic anemia in chronic alcoholic?

Answer 507

Diminished thymidine synthesis due to folic acid and B12 deficiency ( also deficient due to pancreatitis)

Question 508

Citalopram MOA

Answer 508

SSRI

Question 509

Bupropion MOA

Answer 509

NDRI- smoking cessation and MDD. Not used for GAD

Question 510

Buspirone tx what

Answer 510

Tx GAD. 5HT activator

Question 511

SE of olanzapine and clozapine

Answer 511

Metabolic - wt gain, dyslipidemia, hyperglycemia, increased risk of diabetes

Question 512

Cloazpine 1% SE

Answer 512

Agranulocytosis, not seen w/ olanzapine

Question 513

Mycoplasma pneumonia and cold agglutinins whats the link?

Answer 513

Mycoplasma has antigen in cell membrane that is similar to I antigen in RBC membranes, cross-rxn occurs w/ IgM (cold agglutinins)

Question 514

Tx of alcoholism

Answer 514

Disulfiram- inhibits aldehyde dehydrogenase leading to build up of aldehydes, which makes you feel sick Acamprosate - Modulates glutamate at NMDA-R (once abstinent) Naltrexone- block mu opioid-R inhibiting rewarding effects

Question 515

PR interval 0.09 | widened QRS

Answer 515

WPW, short PR and wide QRS | Nl PR interval is <200 ms

Question 516

QRS complexes followed by inverted P waves?

Answer 516

AV reentry tachycardia due to WPW. signal travels down AV node and back up Bundle of Kent to the atrium, where the atria are stimulated after the ventricles in retrograde fashion-Inverted P

Question 517

Bx reducing nitrate to nitrite means what?

Answer 517

Oxidase negative bacteria | enterobacteria. Don't use oxidative phosphorylation

Question 518

Pseudomonas makes what?

Answer 518

glycocalyx and blue-green pigment pyocyanin | Encapsulated organism

Question 519

Why would opioid administration cause RUQ pn?

Answer 519

Contracts smooth muscle of sphincter of Oddi (spasm) increasing CBD and GB pressure. Opioids inhibit release of Ach

Question 520

b/l lens opacities in a kid w/o other sx

Answer 520

Galactokinase deficiency-> increased galactitol, which accumulates in the lens

Question 521

Rhabditiform larvae in the stool and eggs and adult parasites on an intestinal biopsy. Tx?

Answer 521

Strongyloides stercoralis | Tx w/ ivermectin

Question 522

Parasite eggs in the stool?

Answer 522

Schistosoma mansoni or japonicum

Question 523

Perianal egg deposition?

Answer 523

Enterobius vermicularis (scotch tape) Pinworms

Question 524

Proglottids in the stool

Answer 524

``` Intestinal tapeworms (flatworms) made of multiple segments (proglottids) Taenia solium, T saginata, and diphyllobothrium lata ```

Question 525

Trophozoites and cysts in the stool

Answer 525

Giardia lamblia and entamoeba histolytica

Question 526

Oxidase +, Gram -, comma shaped rods that can survive on alkaline media

Answer 526

Vibrio cholera

Question 527

S-shaped, motile, gram -, oxidase + rod, grows at 42 degrees

Answer 527

C. jejuni | microaerophilic and thermophilic

Question 528

Most likely hepatitis from sexual transmission

Answer 528

HBV more commonly than HCV (usually asx and not very efficient sexual transmission)-more commonly IVDU

Question 529

Serum sickness-like syndrome: joint pain lymphadenopathy, pruritic urticarial rash, RUQ pn, hepatomegaly, elevated LFTs

Answer 529

HBV | HCV is usually asx and transmitted by IVDU, less commonly sex

Question 530

Asterixis

Answer 530

flapping tremor commonly seen in cirrhosis

Question 531

Elevated LFTs mean what?

Answer 531

Hepatocyte injury

Question 532

Elevated alk phos and GGT (gamma glutamyl peptidase) mean what?

Answer 532

Biliary injury or cholestasis

Question 533

Elevated bilirubin means what?

Answer 533

Impaired transport and metabolic capacity

Question 534

Elevated PT time and hypoalbuminemia mean what?

Answer 534

Impaired biosynthetic capacity

Question 535

What labs predict prognosis in cirrhosis?

Answer 535

Indicators of liver fxn Low albumin Prolonged PT Elevated bilirubin

Question 536

Glutamine-glutamatae cycle w/ hyperammonemia

Answer 536

Nl: astrocyte takes up glutamate from the synapse (preventing excess excitation) and ammonia from the blood to make glutamine via glutamine synthase Too much ammonia causes accumulation of glutamine and swelling of the astrocyte so it no longer takes up glutamate -> excess excitation (asterixis)

Question 537

What do amatoxins in poisonous mushrooms do?

Answer 537

Inhibit RNA polymerase II (mRNA)

Question 538

Colonoscopy- multiple polypoidal, hemorrhagic lesions. | Biopsy-spindle cells w/ surrounding blood vessel proliferation

Answer 538

Kaposi's sarcoma

Question 539

Colonoscopy: non-ulcerative inflammation Biopsy: basophilic cluster seen on the surface of intestinal mucosal cells

Answer 539

Cyptosporidium

Question 540

Ribavirin MOA

Answer 540

1. Hypermutation during RNA dependent RNA replication 2. Direct inhibition of HCV RNA polymerase by ribavirin triphosphate 3. Inhibit IMP dehydrogenase 4. Defective 5' cap formation 5. Enhance Th1>Th2 for more effective immune response

Question 541

Why does signet ring gastric adenocarcinoma have diffuse infiltration?

Answer 541

Loss of E-cadherin | linitis plastica

Question 542

HypoPTH - where is phos reabsorption increased and the absorption of Ca decreased

Answer 542

Phos has increased reabsorption in the PCT, so phos increases Ca is not reabsorbed in the Distal convoluted tubule so Ca decreases

Question 543

Why would uric acid stones form in a pt who has an ileostomy and is dehydrated and has chronic diarrhea?

Answer 543

Dehydration and chronic diarrhea lead to decreased HCO3 reabsorption from the gut, kidney excretes more H+ and reabsorbs more HCO3. So the tubule becomes acidic allowing for the formation of uric acid crystals

Question 544

What type of cell does renal cell carcinoma originate from?

Answer 544

Epithelial cells of the proximal convoluted tubule

Question 545

4 y/o girl, colicky abd pn, vomiting, and loose bloody stools. Red urine, anemic, thrombocytopenia

Answer 545

Hemolytic uremic syndrome like due to O157:H7

Question 546

What is the mechanism of AKI in HUS?

Answer 546

Shig toxin injures endothelium of preglomerular arterioles -> Plt activation and microthrombi

Question 547

HUS triad

Answer 547

Microangipathic hemolytic anemia thrombocytopenia Acute kidney injury (microthrobi in the renal vasculature)

Question 548

Henloch Schonlein Purpura presentation

Answer 548

Abd pn, palpable purpura, arthralgias, acute glomerulonephritis, Nl Plt and coagulation studies

Question 549

Non-lactose fermenting gram - rod causing pyelonephritis in a man w/ urinary catheter

Answer 549

Psuedomonas aeruginosa - Oxidase +

Question 550

Enterobacter cloacae, What is it?

Answer 550

Gram - rod, lactose fermenter, extensive abx resistance

Question 551

What does increased selective filtration of proteins mean in the kidney?

Answer 551

Increased filtration of proteins, ignore selective. It means more protein is filtered due to foot process effacement

Question 552

Sodium cyanide-nitroprusside test on the urine, what dx?

Answer 552

Cystinuria | Detects cystine in the urine

Question 553

How is digoxin eliminated?

Answer 553

Renally, decreased clearance in elderly

Question 554

What do anti-phospholipid Ab due to coagulation studies?

Answer 554

Prolong PTT on lab test, but the pt is actually hypercoagulable

Question 555

What causes muscle weakness and cramps in pt taking chlorthalidone?

Answer 555

Hypokalemia from thiazide diuretic. Also, causes metabolic alkalosis. Does not effect phosphate

Question 556

Where are the JG cells?

Answer 556

The JG cells are modified smooth muscle cells around the afferent arteriole that secrete renin when stimulated by macula densa cells that surround the DCT

Question 557

Which arteriole is affected by the RAAS system?

Answer 557

The efferent arteriole. Don't get confused that JG cells are around the afferent arteriole and secrete renin

Question 558

Multiple injuries in MVA gets txed w/ a diuretic and develops pulmonary edema, what was the med?

Answer 558

Mannitol. helps decrease cerebral edema by drawing fluid into the vasculature. If too aggressive the fluid will start to leak in the lungs and cause pulmonary edema

Question 559

Bumetanide MOA

Answer 559

Loop diuretic

Question 560

Clinical manifestations of schistomosiasis result from what immune response

Answer 560

Th2 granulomatous response to the eggs-> marked fibrosis, ulceration and scarring of the bladder or bowel

Question 561

Where else can shistosoma deposit in the body besides the bladder?

Answer 561

Presinusoidal radicals of the portal vein -> periportal "pipestem" fibrosis

Question 562

DM1, Inability to sense a full bladder, difficult starting and maintaining urine, nocturnal enuresis? What kind of incontinence and what other finding?

Answer 562

Overflow incontinence | Increased post-void residual volume

Question 563

What causes overflow incontinence in a DM1?

Answer 563

DM autonomic neuropathy impaired detrusor contractility Loss of autonomic afferents telling the brain the bladder is full

Question 564

What does increased post-void residual volume tell you?

Answer 564

Weak detrusor contraction

Question 565

What kind of depression should you definitely use MAOI for?

Answer 565

Treatment resistant Atypical depression - increased appetite and sleep, leaden paralysis, mood reactivity, and rejection sensitivity.

Question 566

Increased urinary frequency and not controlling urge to urinate w/ MS and other UMN signs

Answer 566

Urge incontinence - overactive or spastic bladder

Question 567

Urodynamic studies of urge incontinence in MS

Answer 567

Little or no urine after void. Nl contraction, but poor distensability -

Question 568

Why does the bladder have poor ability to distend in MS?

Answer 568

Loss of descending inhibitory control from UMN. Once it starts to fill it is hyperreactive and contracts the detrusor.

Question 569

Earliest manifestation of diabetic nephropathy

Answer 569

Microalbuminuria, glycosuria comes later

Question 570

What happens to the kidneys w/ acyclovir tx?

Answer 570

Acyclovir gets concentrated in the collecting duct and forms crystals causing renal tubular damage

Question 571

How do you prevent nephrotoxicity from acyclovir?

Answer 571

Aggressive IV hydration

Question 572

What does acidosis cause in the kidney?

Answer 572

Stimulates renal ammoniagenesis Renal tubular epithelial cells take glutamine and make ammonium and bicarb (CO2 comes from alpha ketoglutarate as it gets broken down, which acts against the acidosis)

Question 573

Skin biopsy- scattered areas of fibrinoid necrosis and neutrophil infiltration involving small blood vessels

Answer 573

Serum sickness - Type III hypersensitivity | Also hypocomplement, low C3 and C4

Question 574

Signs of serum sickness

Answer 574

Fever, pruritic skin rash,and arthralgias 7-14 after antigen exposure

Question 575

Causes of serum sickness

Answer 575

chimeric mabs -rituximab and inflixamab nonhuman Ig - venom antitoxins Non protein drugs - TMP/SMX, penicillin

Question 576

Ankylosing spondylitis complications of: respiratory, cardio, eye

Answer 576

Respiratory: costovertebral and costernal jxn enthesopathies can limit chest wall expansion Cardio: ascending aortitis Eye: Anterior uveitis

Question 577

What should be monitored to track disease progression in ankylosing spondylitis?

Answer 577

Chest wall expansion

Question 578

Drug induced lupus is more common in what kind of pt?

Answer 578

Slow acetylators

Question 579

What drugs commonly cause drug induce SLE in slow acetylators?

Answer 579

INH procainamide Hydralazine

Question 580

Acute right knee pain with swelling and redness that has happened before, polycythemia vera. What would you see in the synovial fluid?

Answer 580

Monosodium urate crystals -Gout- polycythemia vera (myeloproliferative disorder will increase urate production predisposing to gout)

Question 581

Synovium shows numerous RBCs, nontraumatic

Answer 581

Hemophilia or pts taking warfarin

Question 582

mab to Il-6

Answer 582

Tocilizumab

Question 583

Ab to myeloperoxidase and proteinase-3

Answer 583

ANCA associated vasculitides

Question 584

B cell activating factor belongs to what family

Answer 584

TNF family

Question 585

Muscle biopsy: transmural inflammation of mid-sized arteries w/ areas of amorphous, eosin-staining arterial wall necrosis (fibrinoid necrosis), and internal elastica lamina disruption

Answer 585

Polyartertitis nodosa

Question 586

What is the most likely predisposing factor for PAN?

Answer 586

HBV infxn

Question 587

Nervous system clinical features of PAN

Answer 587

Mononeuritis multiplex

Question 588

2 mo baby, progressives floppiness and poor feeding, sleepy, constipated, large anterior fontanelle, large tongue, reducible umbilical hernia

Answer 588

Congenital hypothyroidism

Question 589

What dz process in mom is associated w/ caudal regression syndrome?

Answer 589

Uncontrolled DM | agenesis of sacrum and lumbar spine, LE paralysis

Question 590

Action of supraspinatus and innervation

Answer 590

Abduction (initiates) | suprascapular n.

Question 591

Action of infraspinatus and innervation

Answer 591

External rotation | suprascapular n.

Question 592

Action of teres minor

Answer 592

Adduction and external rotation | Axillary n.

Question 593

Action of subscapularis and innervation

Answer 593

Adduction and internal rotation | upper and lower subscapular n.

Question 594

Anteromedial displacement of supracondylar humeral fracture. What n. is injured?

Answer 594

median n. crosses over anteromedial aspect of humerus

Question 595

Anterolateral displacement of supracondylar humeral fracture. What n. is injured?

Answer 595

Radial n. crosses anterolateral aspect of humerus

Question 596

Medication given in gout that selectively binds to an Il-1 inducible enzyme highly expressed by inflammatory cells exclusively

Answer 596

Cox-2 inhibitor - celecoxib Also induced by TNF-alpha Preferred if pt has PUD

Question 597

Which Cox is secreted by all cells and which one is only secreted by inflammatory cells?

Answer 597

Cox-1 -all cells used for housekeeping fxns | Cox-2 secreted by inflammatory cells after being induced by Il-1 and TNF -alpha

Question 598

What will parvovirus in a kid look like?

Answer 598

Slapped cheek-bright red rash on the cheeks w/ circumoral pallor and fever Generalized reticular rash on trunk, arms, and legs Erythema infectiosum

Question 599

Parvovirus in an adult

Answer 599

Acute arthropathy Symmetric polyarthritis RA-like

Question 600

``` Sarcomere: H band A band M line I band Z line ```

Answer 600

H- myosin only (heavy chain)-shrinks A- all myosin including overlap w/ actin (heavy chain)-constant length M- Where the myosin anchors to structural filaments I- Actin only (light chain)- shrinks Z- Where actin binds structural elements (Z-Z shrinks)

Question 601

Difficulty combing hair, endomysial mononuclear infiltrate, patchy muscle fiber fibrosis, what dz and what Ab

Answer 601

Polymyositis ANA Anti-Jo-1 = anti-histidyl tRNA synthase

Question 602

What enzymes are increased in polymyositis?

Answer 602

Creatinine kinase | Aldolase

Question 603

Anti-mitochondrial Ab

Answer 603

Primary biliary cirrhosis-pruritus, jaundice, diarrhea

Question 604

Anti-smooth muscle Ab

Answer 604

Autoimmune hepatitis - middle aged women w/ chronic progressive hepatitis

Question 605

Anti-CCP (most specific) and Anti-IgG Ab

Answer 605

Rheumatoid arthritis | Inflammation causes arginine to be converted to citrulline. The citrullinated proteins trigger immune response

Question 606

Anti-centromere Ab

Answer 606

``` CREST syndrome C-calcinosis Raynaud phenomenon Esophageal dysmotility Sclerodactyl Telangiectasia ```

Question 607

Anti-dsDNA

Answer 607

SLE (specific)

Question 608

3 drugs that decrease bone formation

Answer 608

Glucocorticoids unfractionated heparin Thiazolidinediones

Question 609

Drug that decreases calcium absorption

Answer 609

Long term PPI

Question 610

Drugs that increase Vit D catabolism via CYP450 induction

Answer 610

Phenobarbital phenytoin carbamazepine

Question 611

New back pain, fever, recent endocarditis or bacteremia. What is it and what is the initial evaluation?

Answer 611

Vertebral osteomyelitis | Blood cultures and spinal MRI to visualize the bacteria

Question 612

3 phases of Lyme dz

Answer 612

Early: Erythrema chronicum migrans (bulls eye) Early disseminated: facial palsy and AV nodal block Late (mo or yrs) asymmetric arthritis or subacute encephalopathy

Question 613

Tx of lyme dz

Answer 613

Doxycylcine or ceftriaxone

Question 614

Osteoid matrix accumulation around trabeculae

Answer 614

Vit D deficiency | Increased osteoid w/o mineralization

Question 615

Trabecular thinning w/ fewer interconnections

Answer 615

Osteoporosis-decrease in osteoblasts and increase in osteoclasts

Question 616

Subperiosteal resorption w/ cystic degeneration

Answer 616

HyperPTH- subperiosteal thinning is classic

Question 617

Lamellar bone structure resembling a mosaic

Answer 617

Paget's dz | Irregular sections of bone linked by cement lines

Question 618

Spongiosa filling the medullary canal w/ no mature trabeculae

Answer 618

Osteopetrosis-defective osteoclasts, CA mutation | Too much osteoblast activity

Question 619

What does digital clubbing signify?

Answer 619

``` Chronic hypoxemia Large cell lung CA TB CF Empyema Bronchiectasis Chronic lung abscess ```

Question 620

Adverse effects of succinylcholine

Answer 620

Malignant hyperthermia Severe hyperkalemia - burns, crush injuries, and denervation- upregulated AchR during stage II block -> increased K efflux Bradycardia or tachycardia

Question 621

Which class I antiarrhythmics prefer activated or inactivated cells?

Answer 621

``` All 3 types of class I prefer activated or inactivated. Class Ib prefers ischemic, because it is slower to go to resting and it has the fastes dissociation ```

Question 622

What cell jxn uses connexins?

Answer 622

Gap junctions-connects

Question 623

What cell jxn uses claudins and occludins?

Answer 623

Tight junctions-occludes

Question 624

What cell junctions use cadherins?

Answer 624

Adherens junctions and desmosmomes | Adhere cells together

Question 625

What cells jxn uses integrins?

Answer 625

Hemidesmosomes-integrates cell into BM

Question 626

Atypical cells infiltrating the nipple skin

Answer 626

Paget dz of the nipple-ductal spread of malignant cells

Question 627

Cysts lined by metaplastic aprocrine cells

Answer 627

Fibrocystic change of the breast

Question 628

Liquefactive necrosis of the adipocytes w/ hemorrhage

Answer 628

Fat necrosis due to trauma

Question 629

Stroml proliferation compressing the ducts to slits

Answer 629

Fibroadenoma

Question 630

Papillary cells w/ fibrovascular core

Answer 630

Intraductal papilloma | blood d/c due to twisting of vascular stalk of the papilloma in the duct

Question 631

Benign myometrial smooth muscle cell proliferation

Answer 631

leiomyoma-uterus irregularly enlarged. irregular bleeding

Question 632

Blastocyst implantation in the fallopian tube

Answer 632

Ectopic pregnancy + pregnancy test Amenorrhea w/ or w/o abd pn

Question 633

Endometrial tissue in the myometrium, uniformly enlarged uterus, secretory endometrium

Answer 633

Adenomyosis-middle aged parous females w/ heavy menstrual bleeding Secretory endometrium is a NL finding

Question 634

Hyperplastic growth of tissue from endometrial surface

Answer 634

Endometrial polyps

Question 635

Greater increase in endometrial gland proliferation compared to the stroma

Answer 635

Endometrial hyperplasia-irregular but not painful menstrual bleed

Question 636

Fever, abd pn, uterine tenderness, foul-smelling d/c after pregnancy termination

Answer 636

Septic abortion | Instrumentation S. Aureus and E. coli

Question 637

Edema: capillary hydrostatic pressure, plasma oncotic pressure, sodium and water and lymphatics

Answer 637

``` More fluid in the capillaries, increases volue and dilutes osmolarity Increased capillary hydrostatic pressure Decreased plasma oncotic pressure Na and H20 retention Lymphatic obstruction ```

Question 638

If there is increased CVP what prevents peripheral edema?

Answer 638

Lymphatic drainage works against edema until it becomes overrun

Question 639

Clomiphene MOA

Answer 639

Blocks estrogen-R in the hypothalamus so pituitary continues to produce FSH and LH -> promotes fertility in PCOS

Question 640

PCOS tx for pt wanting pregnancy and not wanting pregnancy

Answer 640

Pregnancy- clomiphene to stim FSH and LH | Non-pregnancy - Estrogen and progestin OC-reduced androgens and endometrial proliferation

Question 641

Where will blood pool if you puncture the common femoral artery above the inguinal ligament?

Answer 641

It will pool in the retroperitoneum.The vessel sits just under the peritoneum

Question 642

Sebaceous glands in acne are what kind of glands?

Answer 642

Holocrine glands

Question 643

Salivary and eccrine glands are what kind of glands?

Answer 643

Merocrine

Question 644

DCIS ductal carcinoma in situ looks like

Answer 644

Swollen mushroom hat

Question 645

Breast: orderly row of cells due to decrease E-cadherin

Answer 645

Invasive Lobular carcinoma

Question 646

15 yo female w/ amenorrhea, fully developed secondary sexual characteristics (pubic hair), shortened vaginal canal w/ rudimentary uterus

Answer 646

Mullerian aplasia Mayer-Rokitansky-Kuster-Hauser No upper vagina (short vagina) Variable uterus and NL ovaries

Question 647

Does androgen insensitivity have a uterus?

Answer 647

No uterus, XY, Mullerian duct is degraded

Question 648

Vagina has what kind of cells

Answer 648

Squamous epithelial cells

Question 649

Cervix has what kind of cells

Answer 649

Ectocervix-squamoues | Endocervix-columnar

Question 650

Fallopian tube has what kind of cells?

Answer 650

Columnar w/ cilia

Question 651

Ovaries have what kind of cells?

Answer 651

Cuboidal (germinal) rapidly proliferate

Question 652

Hemosiderin deposits and endometrial glands or stroma outside the uterus

Answer 652

Endometriosis

Question 653

Most important risk factor for intimal tears like aortic dissection

Answer 653

HTN

Question 654

Copious green vaginal discharge burning on urination w/o CMT

Answer 654

Trichomonas vaginalis

Question 655

How to confirm trichomonas vaginalis?

Answer 655

Saline microscopy- wet mount to identify trichomonads

Question 656

What do you use cervial cytology to identify?

Answer 656

HPV

Question 657

KOH test reveal what?

Answer 657

Amine-whiff test confirms gardnerella vaginosis

Question 658

How do combined OC prevent pregnancy?

Answer 658

Reduce gonadotropin levels | prevent LH spike

Question 659

How do locally acting progestins prevent pregnancy?

Answer 659

Thickens cervical mucus and impair sperm penetration

Question 660

Common dermal finding of ulcerative colitis

Answer 660

Erythema nodosum | Pyoderma gangrenosum

Question 661

Derm findings of DM

Answer 661

skin tags, acanthosis nigricans, and necrobiosis lipoidica diabeticorum

Question 662

How does INH lead to sensory ataxia and decreased pain sensation in the distal extremities

Answer 662

INH decreasese B6, which is a part of the synthesis of NT

Question 663

Deficiency of methylmalonyl-CoA mutase

Answer 663

Lethargy, vomiting, tachypnea of the newborn, | Hyperammonemia, ketotic hypoeglycemia, and metabolic acidosis

Question 664

Elevated urine methylmalonic acid and propionic acid

Answer 664

Methylmalonic acidemia

Question 665

Pathway for Threonine, methionine, valine, and isoleucine to enter TCA

Answer 665

All converted to propionyl CoA-> methylmalonyl CoA via propionyl CoA carboxylase w/ biotin (CO2) Methylmaonyl CoA goes to succinyl CoA via methylmalonyl CoA mutase w/ Vit B12. Succinyl Coa cna enter TCA

Question 666

Where is atrophy most pronounced in Alzheimer's dz?

Answer 666

Temporoparietal lobes and hippocampus

Question 667

Clasp-knife spasticity, what is it?

Answer 667

Initial resistance to passive extension followed by a sudden release of resistance

Question 668

What does clasp-knife spasticity mean?

Answer 668

UMN lesion

Question 669

Internal capsule stroke would have what signs?

Answer 669

Pure motor weakness affecting the c/l arm, leg, and lower face, c/l clasp-knife spasticity and hyperreflexia

Question 670

Putamen lesion signs

Answer 670

C/l tremor, bradykinesia, and rigidity

Question 671

Globus pallidus external segment lesion

Answer 671

Decreased movement, external segment inhibits STN which stims Gpi to inhibit the thalamus Gpe Lesion: STN is not inhibited so it stims Gpi to inhibit the thalamus. no motion

Question 672

Globus palidus internal segment lesion

Answer 672

Excessive movement | Internal segment inhibits thalamus, so lesion would disinhibit thalamus

Question 673

Direct pathway does what to Gpi?

Answer 673

Inhibits Gpi-> disinhibits thalamus to move

Question 674

Indirect pathway does what to Gpi?

Answer 674

Decreases stim of Gpi-> disinhibits thalamus to move

Question 675

Direct pathway of basal ganglia

Answer 675

Substantia nigra -> increase (+) putamen -> increase (-) Gpi -> decrease (-) thalamus -> motion

Question 676

Indirect pathway of basal ganglia

Answer 676

Substantia nigra -> increase (-) putamen -> decrease (-) Gpe -> increase (-) STN -> decrease (+) Gpi -> decrease (-) Thalamus

Question 677

Spastic diplegia, growth delay, frequent choreoathetoid movements

Answer 677

Arginase deficiency - Increase urea and ornithine from arginine

Question 678

What is the adrenergic receptor on the uterus?

Answer 678

B2 agonists relax uterine muscle

Question 679

What nerves innervates the external genitalia, the perineum, and the anus ?

Answer 679

Pudendal n.

Question 680

What nerve innervates the pelvic floor muscles, external anal and urethral sphincters

Answer 680

Pudendal n.

Question 681

Fecal and urinary incontinence following prolonged delivery due to what?

Answer 681

Pudendal n. stretch

Question 682

Horner's syndrome w/ u/l arm pn

Answer 682

Pancoast tumor

Question 683

Which RNA polymerase is responsible for many mistakes in HCV?

Answer 683

RNA Pol III | Decreased 3'-5' exonuclease proofreading

Question 684

Prevent cerebral vasospasm following SAH w/ what med?

Answer 684

Nimodipine (CCB)

Question 685

AchE in the amniotic fluid means what?

Answer 685

NTD, AchE and AFP are leaking out of the CSF

Question 686

Tetrodotoxin MOA

Answer 686

Binds NA channels in nerve and cardiac cells. Flaccid paralysis

Question 687

Tx of tetrodotoxin

Answer 687

Gut lavage and charcoal

Question 688

What immune cells protect from local candidiasis?

Answer 688

T cells

Question 689

What immune cells protect from systemic candidiasis?

Answer 689

Neutrophils

Question 690

Result of Liddle Syndrome

Answer 690

``` Gain of fxn of ENaC in collecting duct HTN Hypokalemia Metabolic alkalosis Low aldosterone ```

Question 691

ENac in collecting duct is constitutively turned on, what will be the level of aldosterone and the tx

Answer 691

Aldosterone will be low as Liddle syndrome acts like hyperaldosteronism, so RAAS is turned down Tx w/ amiloride, which blocks ENac

Question 692

What is in the capsule of pseudomonas?

Answer 692

P. aeruginosa has exopolysaccharide capsule (alginate)

Question 693

What does alginate form pseudomonas do?

Answer 693

Inhibits ciliary clearance, allows for bacteria to adhere to one another and prevents phagocytosis. Ab to alginate do not clear it

Question 694

X, Y, and Z in the kidney, the plasma conc is increased, The clearance changes with constant GFR: X up, Y constant, Z down. What are the substances

Answer 694

X- As glucose plasma conc increases the glucose transporter becomes saturated (limited reabsorption) and more glucose gets filtered Y- Inulin, not secreted or reabsorbed, independent of plasma concentration, only depends on GFR Z- PAH, secreted into the lumen, when plasma conc increases the secretion transporter gets saturated and clearance decreases

Question 695

What part of the esophagus is affected in dermatomyositis?

Answer 695

Upper 1/3 of the esophagus. Preference for striated muscle under voluntary control