step1 must know stuff Flashcards
1
Q
which one is the small intestine (jejunum), why?
A
X = because feathery appearance
which is d/t larger surface area for absorption
2
Q
Which cranial nerves are involved in the pupillary light reflex
A
II, III
3
Q
normal PaO2
A
75 - 105 mmHg
4
Q
What is non-maleficence?
A
first do no harm. ex: if risks > benefits, do not prescribe medication
5
Q
Which coronary artery supplies the AV node?
is this dependent on dominance?
A
posterior descending artery
Yes- it’s dependent on dominance
6
Q
Which type of leukemia has auer rods?
A
AML
7
Q
antidote for atropine overdose
A
physostigmine
8
Q
ANP is released in response to _________ and leads to _______?
A
released in response to stretched cardiac myocytes in the atria (increased blood volume)
it acts via cGMP and causes vasodilation and decreased sodium reabsorption
9
Q
How does the level of glucose change in CSF analysis in a bacterial infection vs viral?
A
Viral –> glucose is normal
Bacterial –> glucose is decreased (bc bacteria like to eat glucose)
10
Q
normal A-a gradient
A
< (age / 4) + 4
i.e. 40 yo –> normal A-a = less than 14
11
Q
FEV1/FVC in COPD increases or decreases?
A
decreases
12
Q
Schizoaffective disorder vs MDD/Bipolar with psychotic features
A
Schizoaffective– must have >2 weeks of psychotic symptoms WITHOUT a mood episode
or else it’s mood disorder w/ psychotic features
13
Q
normal PTT?
A
25 - 40 seconds
14
Q
MCC of bloody nipple discharge?
A
Intraductal papilloma -benign -typically presents with no lumps or skin changes -also the MCC of nipple discharge in general (bloody or serous)
15
Q
Major virulence factor of strept pneumoniae and its function
A
polysaccharide capsule
–> prevents opsonization and phagocytosis
16
Q
Antidote for Neuroleptic Malignant syndrome
A
Dantrolene (to decrease muscle contraction)
Bromocriptine (dopaminergic)
17
Q
the cardiac index parameter of shock is another way of saying…..
A
cardiac index = cardiac output (= LV output)
18
Q
Which type of study design measures odds ratio?
A
Case-control
(CONTROL the CASE in the OR)
- like opposite of RR– which looks at odds of developing dz
Odds ratio looks at diseased patients to see if there is a correlation with last exposure
OR = patients with disease are 3x more likely to have an exposure history
19
Q
presence of an opening snap on cardiac auscultation indicates which valvular defect?
A
Mitral stenosis
(decreased interval from S2 to OS indicates increased severity of dz)
20
Q
Which type of observational study design uses a washout perior between treatments?
A
crossover study
(note- do not confuse with cross-sectional study)
21
Q
Where is the T-cell zone in a lymph node
A
paracortex (region between follicles and medulla)
note- this is the zone that enlarges (paracortical hyperplasia) in extreme cellular immune response (viruses) causing lymphadenopathy
22
Q
How would a dysfunction of sertoli cells in a male child affect the levels of: testosterone LH FSH Inhibin
A
Testosterone and LH levels would be normal (would be affected by leydig dysfunction) Low inhibin High FSH (d/t no negative feedback from inhibin)
23
Q
What happens the murmurs of MVP and HCM with the maneuvers of:
passive leg raise
squatting
valsalva
A
passive leg raise and squatting: murmur decreases in intensity (d/t increased left ventricular blood volume)
with valsalva: murmurs will increase in intensity (d/t decreased preload –> decreased LV volume)
24
Q
Rhabdomyolysis can lead to acute kidney injury, which type/mechanism?
A
Acute Tubular Necrosis
(in rhabdo, nephrotoxic myoglobin is released and damages kidneys –> loss of tubular epithelium – see granular muddy casts on urinalysis)
25
What what happens to the following hormones in Klinefelters disease?
LH, FSH, testosterone, estrogen, inhibin, sperm count
atrophic testes --\> dysfunctional sertoli and leydig cells
## Footnote
low testosterone --\> increased LH --\> increased estrogen
Low inhibin B --\> increased FSH
Absesnt sperm count
26
An enlarging mass in the 3rd part of the duodenum will compromise which blood vessel?
super mesenteric artery
27
bounding peripheral pulses + head bobbing + murmur
aortic regurgitation
note: head bobbing + carotic pulsations (de Mussets sign)
28
Tx for organophosphate poisoning
atropine first, then pralidoxime (d/t transient AChE inhibition which can temporarily worsen sxs)
29
From where exactly in the kidney does renal cell carcinoma (clear cell type) arise
tubular epithelial cells of the proximal convoluted tubule
30
At what ages do kids view death as temporary & reversible?
ages 3-5 yo
31
What is the action of the following extraoccular muscles:
superior oblique
inferior oblique
action is opposite
superior oblique --\> moves eye inferior and medial
inferior oblique --\> moves eye superior and medial
32
Sides effects of Pioglitazone
weight gain, edema, heart failure
33
Which type of study design measures relative risk?
Cohort study
- also measures disease incidence
- 2 groups; RF/exposure(+), RF/exposire(-)
- Who will develop dz?
so people with exposure are how much more likely to develop dz vs people without exposure? = RR
34
Hemidesmosome
- What structures does it include?
- What is the function?
- How would an impairment of hemidesmosomes manifest?
Structures included:
**-Integrins:** connect the intracellular cytoskeleton (_keratin_) with molecules of the _basement membrane (laminin, fibronectin, collagen)_
**Function:**
- to anchor keratinocytes of the epidermis to the dermis @ the dermal-epidermal junction
- to anchor cells to ECM
Any **Impairment** of Hemidesmosomes: cause the basal keratinocytes to separate from the dermis --\> causing a BLISTER to form (these will be tense blisters)
**Epidermolysis Bullosa** = impairment in anchoring fibrils of hemidesmosomes
**Bullous Pemphigoid** (dz that affects hemidesmosomes)-- _vs pemphigus vulgaris_ which affects _desmosomes_ (what maintains cell-to-cell adhesion in the epidermis-- which is more superficial, so blisters formed are more fragile and flaccis
35
In chronic kidney disease, what happens to the levels of the following:
## Footnote
1, 25- dihydroxy Vitamin D
25- hydroxy vitamin D
Calcium
Phosphate
Parathyroid hormone
1, 25- dihydroxy Vitamin D: low
25- hydroxy vitamin D: normal/high
Calcium: low
Phosphate: high
Parathyroid hormone: high (secondary hyperparathyroidism)
36
How do you identify a pedigree of an x-linked recessive disease?
1. no male-to-male transmission (because it's the X chromosome that's diseased, and the Y is the one given to male child)
2. skips generations
- note: sons of heterozygous moms (X', X) have a 50% chance of being affected
37
What's the equation for disease prevalence
(# existing cases) / (total # people in the population)
38
How to calculate renal plasma flow?
it's equal to clearance of PAH
so calculate clearance
(urine PAH) x (flow rate) / (serum PAH)
39
In Lesch Nyhann, there is a defect in the salvage if which two bases
guanine and hypoxanthine
40
Describe appearance of condylomata lata what condition is it seen in?
large grey wart-like growths, usually on genital/perineal region seen in secondary syphilis (vs condyloma acuminata --\> which causes anogenital warts d/t human papilloma virus)
41
How long do symptoms need to last to be diagnosed with PTSD
\> 1 month
(vs- Acute stress disorder if between 3 days- 1 month)
42
most common overall leukemia regardless of age
CLL
43
How to calculate filtratio fraction
(GFR) / (RPF)
=
(CL of creatinine) / (CL of PAH)
note-- CL of a substance = (urine conc x flow rate) / (plasma/serum conc)
44
40-59 year old age range-- which leukemias are most likely?
AML, CML
45
What is allelic heterogeneity?
Different types of mutations in the same locus --\> still produce the same phenotype (even though the mutations are different)
46
What's the equation for disease incidence?
(# new cases) / (# people at risk)
47
What type of collagen is in a fibrous scar?
type I
48
no change in urine osmolarity with water deprivation, but increased urine osmolarity with desmopressin administration
Diagnosis?
central diabetes insipidus
49
Most common leukemia in children
ALLL
50
Papules that look like molluscum contagiosum but no central umbillication
HPV
51
Location of the SA node
posteroinferior part of **interatrial septum**
52
Which enzyme functions as the glucose sensor in pancreatic beta-cells controlling the rate of entry of glucose into the glycolytic pathway, thereby controlling insulin release
glucokinase (after glucose taken up into pancreatic-beta cell, glucokinase metabolized glucose into G6P which then enters glycolysis, ultimately making ATP leading to insulin release)
53
someone with lipoprotein lipase deficiency is @ risk for developing what?
acute pancreatitis
-lipoprotein lipase deficiency is Type I of the inherited hyperlipoproteinemias
54
55
Which antibodies may be present in a person with rheumatoid arthritis? Which one is more specific?
Rheumatoid factor (IgM antibody against Fc portion of IgG) Anti-citrillinated protein (Anti-CCP) = more specific!
56
During the first 7-10 weeks of pregnancy (~1st trimester) progesterone is secrete by what?
corpus luteum (which is stimulated by beta-hcG)
57
Enlargement of which heart chamber can compress the esophagus?
left atrium (most posterior chamber)
58
What step in thyroid hormone synthesis does thyroperoxidase catalyze?
iodination (iodine molecules attach to thyroglobulin)
59
Which type of study wants to examine disease incidence?
Cohort study (both prospective and retrospective)
- 2 groups; RF-positive, RF-negative
- either watch them in the future and see who develops dz,
- or review past medical records
60
Which coronary artery supplies the interventricular septum?
left anterior descending
61
normal PT
11 - 15 seconds
62
Which category of antidepressants can act as a migraine prophylaxis?
SNRI (NOT SSRI)
63
Through which foramine does each branch of the trigeminal nerve exit out of?
V1 = **S**uperior orbital fissure
V2 = foramen **R**otundum
V3 = foramen **O**vale
(**S**tanding **R**oom **O**nly)
64
What is the prone position
lying down on abdomen
65
Holosystolic murmur that radiates to the axilla
Mitral regurgitation
66
What is the concept of absolute risk reduction (ARR)
compare group that got standard intervention (control) with the group that had new additional intervention --\> see which group had less people developing disease
drug X to prevent proteinuria in HTN patients
control group had just standard HTN tx --\> 10 people develop proteinuria (out of group of 100)
experiment group has standard HTN tx + drug X --\> only 3 people develop proteinuria (out of group of 100)
So drug X reduces the risk of HTN patients developing proteinuria!
(10/100 (control develop proteinuria-- 10%)) - (only (3/100 (drugX group develop proteinuria-less risk 3%))
so 0.07 (7%) difference in risk bw control & drug X developing dz
67
The organism Bartonella Henslae causes which two diseases?
**Bacillary angiomatosis** (DON'T confuse with kaposi sarcoma- AIDs patient, HHV-8)
## Footnote
**Cat scratch Disease**
68
Vessels in esophageal varices
left gastric and azygous vein
69
Which viruses use dynein for retrograde transport to the neuronal cell body?
Clostridium tetani Rabies HSV Poliovirus Dynein does retrograde transport (-) --\> (+)
70
Pure T-cell dysfunction (i.e. DiGeorges) leads to recurrent infections of what kind?
viral and fungal infections
(whereas B-cell dysfunction ---\> bacterial)
71
What does the mesonephric/wolffian duct develop into?
male internal structures-- (except prostate) seminal vesicles, epididymus, ejaculatory duct, ductus deferenss
72
Medullary thyroid cancer is part of which MEN syndrome(s)?
MEN2A and MEN2B
73
Which nerve risks injury in a posterior hip dislocation?
sciatic nerve
74
Leukemia in someone 0 - 14 years old
which type is most likely?
ALL
75
Most important type of Hodgkins lymphoma?
nodular sclerosis
76
In urge incontinence (detrusor instability), which receptor is targeted in pharmacotherapy and is it stimulated or inhibited?
Muscarinic receptors, inhibited (so antimuscarinic drug)
- receptor is M3 specifically
- ex of antimuscarinic is oxybutinin
77
What does positive leukocyte esterase indicate on urinalysis?
Pyuria
78
Which muscle does arm ABduction from 0 to 15 degrees
supraspinatus (innervated by suprascapular Nerve)
79
FSH stimulates which cells in the testes and which in the ovaries to secrete which hormones?
Sertoli cells --\> inhibin (neg feedback FSH), MIF, aromatase Granulosa cells --\> estrogens
80
MOA for dantrolene
Inhibition of calcium release from the sarcoplasmic reticulum of skeletal muscle (from inhibiting ryanodine receptor in SR)
--\> thereby inhibiting muscle contraction
81
which organisms will stain acid-fast?
mycobacterium
nocardia
Cryptosporidium (acid-fast cysts in stool)
(stains red with Ziehl Neelsen stain--identifies myocolic acid in cell walls)
82
MCC meningitis in AIDs/immunocompromised patients
Cryptococcus neoformans
83
PCWP is a measure of?
left atrial pressure (aka left sided preload)
84
Botulinum toxin inhibits release of which neurotransmitter(s)?
stimulatory acetylcholine
85
Which muscle is the most commonly injured rotator cuff muscle?
how do we assess this injury?
Supraspinatus
assess by empty can test
86
what is the most anterior chamber of the heart (and most commonly injured in trauma)?
right ventricle
87
Women 20-55
Fatigue, difficulty concentrating
widespread musculoskeletal pain
pain improves with exercise
Diagnosis?
fibromyalgia
88
normal PaCO2
33 - 45 mmHg
89
Which location in the heart is the most likely source for thrombus formation in A-fib?
left atrial appendage
90
Inferior parathyroids are derived from which pharangeal pouch?
third pharyngeal pouch
(where as superior parathyroids from fourth pouch)
91
FOXP3 is expressed by which cell?
T regulatory cells
92
Tetanospasmin inhibits release of which neurotransmitter(s)?
inhibitory GABA and Glycine
93
Common nerve injured in thyroidectomy
recurrent laryngeal nerve (courses near inferior thyroid artery)
Superioir laryngeeal nerve (courses near superior thyroid artery- which is further up in the neck)
94
DPP-4 inhibitors
MOA?
Drug name?
**MOA:**
inhibiting the inhibitor (DPP-4) of GLP-1/incretin
--\> thereby stimulating GLP-1
GLP-1 job is to: stimulate (glucose-dependant) insulin release, and inhibit glucagon release
--\> thereby reducing blood glucose levels
Drug class is the '-gliptins' (i.e. sitagliptin, linagliptin, saxagliptin)
95
Which nerve(s) is/are injured in a supracondylar fracture of the humerus?
Median nerve
or
Radial neve
depends if anteroLATERAL (radial nerve) or anteroMEDIAL (median nerve) displacement of the proximal fragment of humerus
96
enoxaparin
form of LMWH
(that is administered subQ usually used to prevent and treat DVTs)
-also ideal for pregnant women
97
Chlorpheniramine
first generation H1 blocker
98
Location of the SA node
junction of the right atrium and SVC
99
Which pneumoconioses affect the upper lobes vs lower lobes of the lung
Lower lobe: asbestosis
Upper lobe: silicosis, coal dust, silicosis
100
What happens in the skin with normal aging?
decreased _synthesis_ of collagen and elastin (NOT decreassed degradation, also cross-linking is still normal)
101
Patient in shock given drug that causes:
increased peripheral vascular resistance
increased blood pressure
decreased heart rate
Which drug?
phenylephrine
peripheral vasoconstruction (increased SVR + BP) --\> reflex bradycardia + reflex-mediated decreased contractility
102
what are the only anti-inflammatory cytokines
Il-10 and TGF-beta
103
most common type of Non-Hodgkins Lymphoma?
follicular lymphoma
notes:
- B-cell
- t(14;18)
104
How is an ulnar injury caused?
How does it present?
injured by:
- traction placed on the brachial plexus (like grabbing a tree branch to break a fall in adults, or upward force on arm during deliver of baby)
- _fracture of medial epicondyle_ of humerus ("funny bone", proximal lesion)
- Fractured hook of the hamate (distal lesion), from _fall on outstretched hand_
innervates intrinsic hand muscles
- loss of flexion of medial fingers and wrist, ABduction + ADduction of fingers
- loss sensation medial 1 1/2 fingers including hypothenar eminence
105
106
If the 95% confidence interval includes 0 in the range, would the results be statistically significant or no statistically difference?
if it includes 0 --\> then there is NO statistical significance
107
Obturator nerve is responsible for which movement?
ADduction of the thigh (located on lower/distal medial thigh) bc it innervates thigh adductor muscles: adductor longus, brevis, and magnus. also does sensation of medial thigh
108
MOA for triptans
5HT1 agonists --\> inhibit trigeminal nerve activation, prevent VIP release, induce vasoconstriction.
Use for acute migraine abortion
109
which murmurs decrease with squatting
MVP (d/t increased LV volume) HCM (d/t increased LV volume) bc squatting causes increased afterload (increased LV vol) and increased preload
110
The pentose phosphate pathway makes NADPH. what are the 3 pathways that then use this NADPH?
1. glutathione antioxidant pathway: cells experiencing high oxidative stress (i.e. RBC's) use NADPH to regenerate glutathione- which helps maintain cell integrity. G6PD deficiency causes normocytic anemia 2. fatty acid, cholesterol, and steroid synthesis 3. phagocytic cells generating a respiratory burst. NADPH oxidase catalyzes 1st step --\> deficiency leads to chronic granulomatous dz
111
Most common cause of jaundice in a newborn?
ABO incompatibility
(NOT physiologic neonatal jaundice--that starts on day 3)
112
Which enzymes are inhibited in lead poisoning?
Ferrochelatase
and
ALA (delta-aminolevulinic acid) dehydratase
113
Where is the B-cell zone in the lymph node
**follicles** (in outer cortex)
- primary and secondary follicles. Secondary has the germinal centers
note: T-cell zone is the paracortex
114
What are the subunits of fetal hemoglobin?
alpha-2, gamma-2
115
What type of collagen is in granulation tissue?
type III
116
Congenital CMV vs congenital toxoplasmosis
Congenital CMV--
- **periventricular** calcifications
- **microcephaly**
- hearing loss
- chorioretinitis
Congenital Toxoplasmosis --
- chorioretinitis
- Enlarged ventricles, **macrocephaly** - (hydrocephalus)
- **diffuse** intracranial calcifications
117
Which pathway of the coagulation cascade has only 1 clotting factor? which factor is this?
extrinsic pathway- has factor vII
118
Which germ layer gives rise to the anterior pituitary gland?
which to the posterior pituitary gland?
surface ectoderm (anterior pituitary-adenohypophysis)
Neural crest (posterior pituitary- neurohypophysis)
119
Leukemia in someone 60+ year old
which type?
CLL
120
The muscles of mastication are all innervated by which cranial nerve?
Trigmenal (V3-mandibular)
121
Which type of drug can mask the symptoms of hypoglygemic
non-selective beta blocker (i.e. propranolol)
122
function of the M-protein in Group A Strept
inhibits phagocytosis, inhibits complement binding, and mediates bacterial adherence
123
What is granuloma inguinale?
Painful beefy red ulcer that bleeds readily on contact (uncommon in US) d/t klebsiella granulomatis Gram staining of the lesions shows rod-shaped intracytoplasmic inclusions (Donovan bodies)
124
which extraoccular muscles are not innervated by the occulomotor nerve? which nerve then?
lateral rectus: cranial nerve VI
superior oblique: cranial nerve IV
(LR6 SO4)
125
What are Auer rods exactly?
- rod shaped inclusion in seen in AML
- they are actually abnormall lysosomes
126
It takes 2 signals to make a th2 cell secrete B-cell activating cytokines (aka B-cell activation)
1. B-cell CD40 interacts with th2 CD40-L 2. B-cell MHCII with its Ag is recognized by th2's TCR
127
presence of a mid-systolic click on cardiac auscultation indicates which valvular defect?
mitral valve prolapse
128
What is transposition of the great vessels?
2 separate circulations (separation of systemic and pulmonary circulations
RV --\> aorta
LV --\> pulmonary artery
EXTRA INFO:
- incompatible with life unless shunt present to mix the two circulations (PDA, VSD, patent foramen ovale)
- d/t failure of aorticopulmonary septum to _spiral_ (vs- fail to form- in truncus arteriosis)
129
What type of collagen is in tendons?
type 1
130
Rheumatoid Arthritis spares which joint in the fingers?
DIP
131
Hepatitis A vs Vibrio vulnificus
both caused by consumption of raw shellfish
but Vibrio is distinguished from HAV by its rapid onset (HAV evolves over several weeks), lack of jaundice, and generally severe presentation
132
What does DNA methylation do to it's transcriptional activity?
**decreases transcription**
(DNA methylation makes DNA mute!)
so does decreased acetylation (or increased deacetylation)
133
What does the paramesonephric/mullerian duct develop into?
female internal structures--fallopian tube, uterus, upper vagina
134
LH stimulates which cells in the testes and which in the ovaries to secrete which hormones?
Leydig cells --\> androgens/testosterone Theca cells --\> androgens (which stimulate granulosa cells to secrete estrogen)
135
How do you tell the difference between acute vs chronic leukemia
Acute has \> 30% blasts
Chronic has \< 30% blasts
136
Which muscles do arm ABduction for greater than 100 degrees?
Which nerves innervate?
137
Which muscle does arm ABduction from 15 to 100 degrees
What nerve is it innervated by?
Deltoid (innervated by axillary nerve)
138
What is locus heterogeniety?
The same mutations at different loci --\> produce similar phenotype
139
Which cranial nerves are injured in a stoke of the posterior cerebral artery?
CNs III and IV
140
Which chamber of the heart is most commonly injured in trauma? why?
**right ventricle** because it makes up most of the anterior surface of the heart
141
Which type of study wants to examine disease prevalence?
cross-sectional
- 2 groups; RF-positive, RF-negative
- then compare disease prevalence
- all done in the present (i.e. measurements in 1 week)
142
Which coronary artery supplies the SA node?
is this dependent on dominance?
right coronary artery
143
factitious disorder vs malingering
in factitious disorder--deliberate deception, causing their own illness no no reason other than attention and wanting to be in the sick role. This is like the fucked up psych patient malingering-- can seem like factitious disorder but it's all for a reason, like getting a sick note for work or financial benefits
144
Categorize Neisseria Gonorrhea
| (gram +/-, shape, etc...)
gram negative
intracellular
diplococci
145
Leukemia in someone 15-39 years old
which type is most likely?
AML
| (myeloblast with Auer rods)
146
Argatroban
direct thromobin (IIa) inhibitor (so anticoagulant)
147
MCC of transudative pleural effusion?
heart failure
148
Which two conditions are seen in both MEN2A and MEN2B?
Medullary thyroid cancer and pheochromocytoma
149
What does the present of ATP cause in the cross-bridge cycle of muscle contraction?
ATP binds to myosin head and causes its **detachment** from actin
150
lower lip cancer d/t \_\_\_
upper lip cancer d/t \_\_\_\_\_
lower lip- squamous cell
upper lip- basal cell
151
why would you give a patient fresh frozen plasma (vs normal saline)
for multiple coagulation deficiencies -- like to replace consumed clotting factors (i.e. DIC)
152
_The genetic code is:_
Degenerate/ redundant
Unambiguous
Nonoverlapping/ commaless
universal
Explain what each term means regarding the genetic code
**Degenerate** because more than 1 codon can code for a certain tRNA/amino acid (most amino acids are coded by multiple codons). Note- this is due to difference in the 3rd **("wobble")** position--
(For ex- the codons CUC and CCU both code for leucine. This is bc the tRNA molecule is able to recognize 2 codons bc the first two nucleotide positions are "CU" which form traditions watson-crick base pair bonds, and the 3rd wobble position forms less stringent nontraditional bonds )
**Unambiguous** because each codon can only code for 1 amino acid (even though most amino acids are coded _for_ by more than 1 codon...a single codon may NOT code for more than one amino acid)
**Nonoverlapping** because read from a fixed starting point as a continuous sequence of bases. Basically, has no internal punctuation because each codon is adjacent to the next w/o any spacer nucleotides in between. (note- exception is some viruses)
**Universal** because the genetic code is conserved throughout evolution. Basically, amino acid codons are identical across species (note- mitochondria DNA deviates from this)
153
what are the 2 main components of amniotic fluid?
describe have the concentration of each changes throughout the pregnancy
Describe the difference in concentration between the 2 components
1. phosphatidylcholine (lecithin)
2. Sphingomyelin
synthesis of both begins around 20th week. phosphatidylcholine levels peak ~ 35th week
by this time (35th week), the lecithin:sphingomyelin ratio should be 2:1... indicating fetal lung maturity
154
normal behavior
vs
acute stress disorder
vs
schizophreniform
In a 5 yo child grieving the loss of a loved one
**Normal behavior:**
- hallucinations and conversations with the deceased are normal in the absence of other psychotic symptoms, severe mood symptoms, or social/academic problems
- childen \< 6 yo don't understand the finality of death, but age 7 they usually understand the person isn't coming back.
Childhood-onset psychotic disorders are VERY rare, but _Classify psychotic disorders in term of duration:_
**(Brief Psychotic Disorder:** lasts \< 1 month)
vs
**Schizophreniform**: lasts 1-6 months
Must differentiate hallucinations from nightmares and flashbacks. These are trauma disorders that usually involved exposure to actual threatened death, sexual violence or serious injury.
**Acute Stress Disorder:** lasts 3 days to 1 month
vs
**(PTSD:** lasts \> 1 month)
155
In the setting of high ADH, different segments of the nephron will have different tubular fluid osmolarity values.
Which section(s) of the nephron will lowest osmolarity (most dilute) and which the highest (most concentrated)?
**lowest is DCT**
(the DCT remins impermeable to water, so urine is hypotonic to water, about ~100 mOsm/L)
**highest** is descending limb/**tip of loop of henle** and **collecting duct** (both reaching 1200 mOsm/L)
_-in presence of ADH_--collecting ducts is now highly permeable to water, making hypertonic (\> 300 mOsm) urine with values ~1200 mOsm
-However, in _absence of ADH-_- impermeable to water and thus becomes VERY hypotonic (like ~50 mOsm) as solutes also continue to be removed. Note- if ADH not present then DCT is the most hypotonic/dilute.
156
Explain how the tubular fluid osmolarity changes across each segment of the nephron in the presence of ADH (dehydration):
1. PCT
2. descending limb/tip of loop of henle
3. thick & thin ascending limb of loop of henle
4. DCT
5. collecting duct
is the fluid hypo-, hyper-, or isotonic with plasma (and whats the numeric osmolarity value corresponding with each of these)
**1. PCT:**
-water and electrolytes reabsorbed here, so fluid remains isotonic (300 mOsm/L)
**2. descending limb/tip of Loop of Henle:**
-free water is reabsorbed and tubular fluid becomes hypertonic (\> 300 mOsm/L) but typically reaches 1200 mOsm/L (when ADH levels are high)
**3. thick & thin ascending limb of Loop of Henle:**
- the primary site of urine dilution. Its impermeable to water and Na + Cl are reabsorbed. Tubular fluid becomes increasingly hypotonic (\< 300 mOsm/L)
**4. DCT:**
-also impermeable to water, so fluid remains hypotonic (\< 300 mOsm/L) from ascending loop. Solutes continue to get reabsorbed so DCT is the MOST hypotonic/dilute (~ 100 mOsm/L)
**5. Collecting duct:**
- in presence of ADH, is highly permeable to water --making hypertonic (\> 300 mOsm) urine with values ~1200 mOsm
- However, when ADH is LOW, collecting duct remains impermeable to water and thus can becomes the MOST hypotonic (like ~50 mOsm) while solutes continue to be removed. Note- if ADH not present then DCT is the most hypotonic/dilute.
157
Depending on the presence or absence of ADH, different segments of the nephron will have different tubular fluid osmolarity values.
Which section will be most dilute and which most concentrated
the collecting duct will either becomes the most dilute or most concentrated, just depends on ADH
DCT is typically the most dilute (water impermeable), but _when ADH is absent_ _collecting duct is most dilute_ (water impermeable).
Descending/tip loop of henle is typically most concentrated, but _when ADH present, collecting duct is most concentrated_ (lots of water reabsorbed)
158
Image of right knee posteriorly
which ligament is marked?
PCL
- posteriorly PCL attaches medially (vs ACL- attaches laterally)
159
Which drug treats CMV?
**Ganicyclovir**
dont confuse withacyclovir, valacyclovir and famicyclovir which
- treat HSV and VZV
- with weak activity against EBV
- and NO activity against CMV
160
side effects of ganicyclovir
- bone marrow suppression (leukopenia, neutropenia, thrombocytopenia)
(because blocks viral DNA polymerase, but also host DNA polymerase which can lead to the heme side effects)
- renal toxicity
161
162
cardiac pacemaker implantation may cause ______ (regurgitation or stenosis) of the ________ (mitral, pulmonic, aortic, or tricuspid) valve.
Why? and
what is the route of insertion of the pacemaker/structures it passes through?
and what symptoms would you see that leads you in this direction?
**mitral regurgitation**
**because** the right ventricular lead passes through the tricuspid valve and can disurpt valve closure.
**Route of insertion:**
passes through SVC --\> RA --\> tricuspid valve --\> RV
**Symptoms:**
mitral regurg murmur is holosystolic at left lower sternal border
may cause symptoms of **right-sided heart failure** (like JVD, tender hepatomegaly, abdominal distention/ ascites, bilateral peripheral edema) **in the absence of pulmonary edema** (like crackles on auscultation)
163
164
Which cranial nerve is commonly affected in TMJ disorder?
What symptoms does it produce?
**Trigeminal nerve (V3 branch-- mandibular)**
**Symptoms from irritated V3:**
- _ear pain & muffled hearing_ despite normal otoscopic exam (V3 innervates tensor tympani in middle ear which tenses tympanic membrane--damening loud sounds)
- _Jaw pain and dysfunction_ (V3 innervates pterygoid muscles and causes pathological contraction when irritated)
165
IL-12 and IL-23 are produced by ____ and play a role in the pathogenesis of \_\_\_\_\_\_
activated T-cells
psoriasis
166
IL-4 and IL-5 are involved in ____ (type of cell)....and play a role in the pathogenesis of \_\_\_\_\_\_
mast cells
atopic disorders (like asthma)
167
IL-2 and interferon-gamma are produced by ____ and play a role in the pathogenesis of \_\_\_\_\_\_
activated Th1 cells
granulomatous diseases (like TB, sarcoidosis)
168
Which anti-epileptic drug treats both absence seizures and tonic clonic seizures?
valproate
169
Fenoldopam
**Dopamine agonist** (D1R)
causes vasodilation of arterioles to lower BP while also increasing **renal** perfusion, and naturesis
used in treatment of HTN, HF
great for patients with HTN emergency with renal insufficiency
170
homomcystinuria with high methionine levels
which amino acid becomes essential?
cysteine
(bc high methionine and homocysteine levels means homocystinuria is due to problem with cystathionine synthase, and can't synthesize cysteine)
171
Failurre of which embryologic process is the cause of Meckel's Diverticulum
failure of obliteration of the vitelline (omphalomesenteric) duct
172
Which bases are required at both splice sites in order for the intron to be spliced out
**G T/U** (at the 5' splice site)
**A G** (at the 3' splice site)
173
pyridostigmine
inhibits acetylcholinesterase --\> increased ACh
treats myasthenia gravis (Py**rid**osti**gm**ine gets **rid** of **m**yasthenia **g**ravis)
174
nondiabetic drugs that treats diabetic nephropathy?
Antidepressants: SNRI's (ex- duloxetine, venlafaxine), TCA's
anti-epileptics: gabapentin, pregabalin
opioids
capsacin (topical)
lidocaine (topical)
175
176
Common spore-forming bacteria?
bacillus
and
clostridium
note- spore-forming bacteria can survive in boiling temperatures
177
ixodes tick is the vector for which 3 orgaisms/diseases?
Borrelia (Lyme disease)
Babesia (Babesiosis)
Anaplasma
178
Chlamydia trachomatis can cause which 4 conditions
1. Trachoma
2. Conjunctivitis
3. Cervicitis (can cause PID)
4. Lymphogranuloma venereum
179
Giemsa stain is used for which 6 organisms?
1. borrelia
2. trypanosomes
3. plasmodium
4. chlamydia
5. rickettsia
6. H. pylori
note- img shows trypanosomes
180
**Ziehl Neelson stain**:
what's another name for it?
wht is is staining exactly in bacteria and protozoa?
which organisms?
aka Carbol fuscin
Stains the m_yocolic acids_ in cell wall (acid-fast)
So identifies acid-fast bacteria: myocbacteria, nocardia
Also stains protozoa (cryptosporidium's oocysts)
note- img shows acid-fast mycobacteria
181
left img vs right
left: 1 owl eye nucleus in CMV
right: 2 eyes are reed-sternberg cells in Hodgkins lymphoma
182
Treatment for anticholinergic toxicity
**physostigmine**
(anti-AChE --\> increased ACh, crosses BBB)
183
if the 95% confidence interval range for _odds ratio or relative risk_ **includes 1**
what does this mean?
that the null is accepted and results ARE significant
vs
if the range excludes 1 --\> the null is rejected and results are significant
184
thrombocytopenia with small platelets
eczema
recurrent pneumonia
Wiskott-Aldrich
185
Clonidine
| (and which drug is almost identical?)
**alpha-2 agonist**
(treats ADHD, tourettes, sometimes hypertensive urugency, symptom control in opioid withdrawal)
Guanfacine is almost identical
186
In prostate cancer, metastasis to the spine occurs via \_\_\_
Batson (vertebral) venous plexus
187
What are the two low molecular weight heparins?
MOA
dalteparin
enoxaparin
MOA: act mainly on factor Xa (vs normal heparin-- acts on factor IIa and Xa)
188
Whats the difference between high and low potency typical antipsychotics?
list the high potency drugs
**High potency**:
- have more neuro side effects (i.e. extrapyramidal symptoms)
- drugs: haloperidol, trifluoperazine, pimozide, fluhenazine
**Low potency:**
-have more anti-histamine, anti-alpha1-adrenergic, and anti-muscarinic side effects
189
Zolpidem
non-benzodiazepine hypnotic
GABA receptor agonist
190
sample swab from oral ulcer base
diagnosis?
the image depicts a tzank smear where epithelial cells are scraped from ulcer base
multinucleated giant cells suggest a dx of HSV
191
In adrenal crisis due to long-term glucocorticoid use, what happens to the levels of:
CRH
ACTH
cortisol
**all decrease**
(glucocorticoids suppress CRH release from hypothalamus --\> which suppresses ACTH from pituitary --\> long term suppression leads to atrophy of zona reticularis (androgen zone) and zona fasciculata (cortisol zone) and can't release it in times of stress)
192
Inhibition of ____ can improve drug delivery to the CNS
P-glycoprotein
193
List the gram negative curved rods
campylobacter jejuni
helicobacter pylori
vibrio cholerae
194
Most common type of anke sprain
inversion sprain
195
most common ligament damaged in ankle sprain
anterior talofibular ligament
196
list the cranial nerves and 1 artery that is present in the cavernous sinus
**Cranial nerves:**
- occulomotor (III)
- trochlear (IV)
- Abducens (VI)
- trigeminal (V): ophthalmic branch (V1) and maxillary branch (V2)
**Artery:**
-internal carotid artery
197
Which neurocutaneous disorder would present with a palpable renal mass composed of fat, smooth muscle, and blood vessels
Tuberous sclerosis
| (has renal angiomyolipomas)
198
In which neurocutaneous syndrome would you find:
ash-leaf spots?
describe what these look like
**Tuberous sclerosis**
-ash-leaf spots look like _hypopigmented_ spot
199
In which neurocutaneous syndrome would you find:
CNS hamartomas?
Tuberous sclerosis
200
In which neurocutaneous syndrome would you find:
cafe-au-lait spots?
what do these look like
**neurofibromatosis type 1**
-ccafe-au-lait spots look like large _hyperpigmented_ regions
201
What is this called?
which condition?
this is a cate-au-lait spot
seen in neurofibromatosis type I
\*do not confuse with ash-leaf spots seen in tuberous sclerosis-- which are hypopigmented
202
what is this called?
what condition is it seen in?
what do you not want to confuse this with?
this is an ash-leaf spot seen in tuberous sclerosis
do not confuse with cafe-au-lait spot in neurofibromatosis type I
203
In which neurocutaneous syndrome would you find:
bilateral acoustic neuromas?
neurofibromatosis type II
204
In which neurocutaneous syndrome would you find:
bilateral renal cell carcinomas
von hippel-Lindau
205
In which 2 neurocutaneous syndromes would you find:
pheochromocytomas
neurofibromatosis I
and
von Hippel-Lindau
206
multiple telangiectasias of the skin and mucosa
+
recurrent epistaxis or GI bleeding (melena)
Hereditary hemorrhagic telangiectasia (also called Osler-weber-Rendu syndrome)
207
In which neurocutaneous syndrome would you find:
optic gliomas
neurofibromatosis type I
208
enlarged lateral and 3rd ventricle with a normal sized 4th ventricle.
where is the brain blockage?
cerebral aqueduct (of sylvius)
209
obstructruction of the foramen of luschka and magendie would cause enlargement of which cerebral ventricles?
enlargement of all 4 ventricles
210
Pseudotumor cerebri:
describe tthe type of patient its seen in and how it presents.
- aka idiopathic intracranial hypertension
- seen in young obese women
- presents with signs of increased intracranial pressure
211
list some structures are derived from neural crest cells
- arachnoid mater and pia mater
- schwann cells
- adrenal medulla (chromaffin cells)
- **melanocytes**
- PNS ganglia ( DRG, crabuakm autonomic)
- spiral membrane (aorticopulmonary septum)
- skull bones
\*basically think PNS and non-neuronal structures nearby
212
What is the embryologic derivative of:
melanocytes
neural crest
213
list some pathologies that are due to failure of migration of **neural crest** cells:
either due to one of two things:
1. **failure of migration** of neural crest cells:
- _congenital heart defects_ involving problems with the _aorticopulmonary septum_: transposition of the great vessels, tetrology of fallot, persistant truncus arteriosis
- hirschprungs
2. **tumor** of cells derived from neural crest, include:
neuroblastoma
melanoma
schwannoma
langerhan cell histiocytosis
214
What is the embryologic derivative of the:
adenohypophysis (anterior pituitary)
surface ectoderm
| (note- from rathke pouch)
215
What is the embryologic derivative of:
the neurophyophysis (posterior pituitary)
neuroectoderm (neural tube)
note- brain structures are derived from here including neurohypophysis, CNS neurons, oligodendrocytes, astrocytes, ependymal cells, pineal gland)
216
craniopharyngioma is a tumor from which embryologic germ layer?
surface ectoderm (because from adenohypophysis)
217
What is the embryologic derivative of the:
dermis
and
epidermis
epidermis = surface ectoderm
dermis = mesoderm
218
In respiratory alkalosis, what happens to the:
pH
renal H+ secretion
renal bicarb reabsorption
pH = increases
renal H+ secretion = decreases
renal bicarb reabsorption = decreases
\*note- renal compensatioin is delayed-- but only takes a few hours to begin (and then several days to complete)
219
high altitude caues which acid-base disturbance and why?
auuses respiratory alkalosis because of hypoxeia (low partial pressure of inspired oxygen) which causes hyperventilation
220
Difference between crohns and ulcerative colitis in terms of:
gross morphology of the colonic wall
**Crohns:**
- transmural inflammation --\> fistulas
- cobblestone mucosa
- creeping fat
- wall thickening ("string sign")
- fissures
- ulcers are linear
**UC:**
- mucosal & submucosal inflammation ONLY
- friable mucosa
- ulcers can be deep or superficial
- loss of haustra ("lead pipe")
221
Difference between crohns and ulcerative colitis in terms of:
regions of the GIT affected
**Crohns:**
can affect ANY part of the GIT, except the rectum!! but most commonly affects the ileum and colon.
- note lesions are noncontinuous (skip lesions)
**UC:**
affects the colon, and _always involves the rectum!_
-note- lesions are continuous and do not skip portions (unlike crohns)
222
Difference between crohns and ulcerative colitis in terms of:
ccomplications
**crohns:**
- fistulas (enterovesical fistula may lead to recurrent UTIs)
- abscesses
- structures (--\> may lead to obstruction)
- PERIanal disease (of skin around)
**UC:**
- fulminant colitis
- toxic megacolon
- perforation
223
Difference between crohns and ulcerative colitis in terms of:
extra-intestinal associated pathologies
**Crohns:**
- kidney stones (usually calcium oxalate), or gall stones
**UC:**
- primary sclerosing cholangitis (fun fact- assoc with MPO-ANCA/p-ANCA)
224
list the 2 non-dihydropyridine calcium channel blockers.
where do they act?
diltiazem and verapamil
they act on the heart
(note- dihydropyridine CCBs act oon vascular smooth muscle)
225
list some drugs associated with constipation adverse effect (4 classes listed)
1. non-dihydropyridine calcium channel blockers (diltiazem, verapamil)
2. drugs with anti-muscarinic properties (1st gen antipsychotics, anti-histamines, tricyclics
3. 5HT3 antagonists (ondansetron)
4. opioids- both central acting (hydrocodone, morphine) and peripherally acting (loperamide)
226
which 3 substances increase gastric acid secretion?
**1. histamine** (from enterochromaffin-like cells that were stimulated by gastrin--and acts on parietal cells)
**2. acetylcholine** (from vagus nerve-- and acts on parietal cells too)
**3. gastrin** (from G-cells-- acts on ECL cells to secrete histamine)
(fun fact- histamine acts on Gs --\> leading to increased cAMP. ACh and gastrin act on Gq --\> leads to eventual increase in intracellular calcium. cAMP & calcium activating protein kinases --\> then stimulate and improve transport of H+ by hydrogen/potassium ATPase into the gastric lumen)
227
228
229
what do proton pump inhibitors do to calcium levels?
what can this lead to?
decrease calcium levels
may lead to osteoporosis and increased fracture risk
(secondary hyperparathyroidism?-- break down bone to increase calcium levels?)
230
which drug lowers the slope of the AV nodal funny current, prolonging it?
what affect does this have on the heart?
**adenosine**
prolonging the phase 4 funny current decreases the heart rate
(note- acetylcholine also works the same way, where as sympathetic drugs do the opposite)
231
what are 3 important neutrophil chemotactic agents?
1. C5a
2. leukotriene B4
3. IL-8
232
auto-antibodies against the alpha-3 chain of type IV collagen
goodpastures
233
In kallman syndrome, what happens to the levels of:
GnRH
LH
FSH
testosterone
all decrease
(due to decreased synthesis of GnRH in the hypothalamus)
234
Which cytokine is responsible for class switching to IgE?
IL-4
235
- difficulty standing up from a seated position
- erythematous rash on upper eyelids
- dysphagia
dermatomyositis
236
What are the 2 nerves that the sciatic nerve branches into?
1. common fibular (peroneal) nerve
2. tibial nerve
237
manifestations of common fibular/peroneal nerve injury?
1. foot drop (unable to evert and dorsiflex-- so at rest, foot is inverted and plantarflexed
2. loss sensation of foot dorsum and lateral calf
238
manifestations of a tibial nerve injury?
1. loss sensation of sole of the foot
2. inability to plantar flex
3. absent ankle reflex
239
which nerve is commonly injured in a femoral neck fracture?
sciatic nerve
(because of proximity to hip joint, also injured in hip replacement and posterior hip dislocation)
240
which landmark is used for giving a pudendal nerve block?
ischial spine
241
The diaphragm is innervated by which nerve? which roots is it composed of?
phrenic nerve = C4, C4, C5 keeps the diaphragm alive!
242
Which nerve roots are involved in the anal wink reflex?
S3, S4 ("winks galore")
243
absent biceps reflex
Which nerve is injured?
Musculocutaneous nerve
(note- does forearm flexion and sensation lateral forearm)
244
MC neurologic complication of shingles?
post-herpetic neuralgia
(exta- this is neuropathic pain in affected region- tingling, burning... from hypersensitive nerve function)
245
Pathophys of clostridium tetani vaccine
toxoid vaccine against toxin (tetanospasmin)
--\> generates anti-toxin antibodies (stimulates humoral immune system)
246
Which spinal cord condition affects both the DCML and lateral corticospinal tract?
B12 deficiency --\> subacute combined degeneration
(note- also affects spinocerebellar tract causing ataxia)
247
which tracts are affected here?
which disease is this?
DCML and lateral corticospinal tracts
B12 deficiency (subacute combined degeneration)
248
In cerebral circulation, which artery is a branch of the vertebral artery?
PICA
249
Which artery is this?
What structure does it supply?
PICA
supplies the dorsolateral medulla
(extra- infarction causes Wallenberg {lateral medullary} Syndrome)
250
Wallenberg Sydrome
- aka Lateral Medullary syndrome
- Infarct of the PICA (supplies dorsolateral medulla)
Structures affected:
1. spinal trigeminal nucleus (_ipsilat_ loss of _face_ pain/temp of )
2. Spinothalamic tract (_contralat_ loss of _trunk & extremity_ pain/temp)
3. inferior cerebella peduncle (ataxia)
4. vestibular nerve nucleus (diplopia, vertigo, vomit, _nystagmus_)
3. Nucleus ambiguus (bulbar weakness ---diminished gag reflex/dysphagia, dysarthria)
may also get Horners (damaged descending sympathetics)
251
PCA infarct
aka webers syndrome
PCA supplies midbrain
Manifestations:
eye in down-and-out gaze (CN III damage)
+
contralat lower facial weakness
+
hemiplegia
252
age-related changes in bone marrow:
why the decrease in function?
- increased bone marrow fat (its impaired because of more fat, NOT fibrosis)
so takes longer to regenerate blood cells lost if there's acute blood loss
253
improper fitting crutches causes injury to which nerve?
radial nerve
(crutches--\> repetitive pressure in axilla region)
254
Patient with REM sleep behavior disorder:
neurodegeneration occurs due to accumulation of \_\_\_\_\_?
alpha-synuclein
255
accumulation of alpha-synuclein occurs in which neurodegenerative conditions?
- parkinsons
- dementia with lewy bodies
(sometimes REM-sleep behavior disorder--- and 90% of these patients later develop one of the two above)
256
male infertility in cystic fibrosis is due to?
bilateral absence of the vas deferens
257
What are the subunits in fetal hemoglobin (HbF)
alpha-2, gamma-2
258
the dashed line represents an increase in what?
left shift = caused by factors that increase the affinity of O2 to hemoglobin, so will see increased:
- HbF
- pH
259
what is the only immunoglobulin that crosses the placenta?
IgG
260
What does the enzyme 5-alpha-reductase do?
converts testosterone to DHT
261
gram positive vs gram negative bacteria:
which is pink and which is purple on gram stain
gram positive --\> purple (bc thick peptidoglycan layer retains crystal violet dye)
gram negative --\> pink
262
which cephalosporins are usually used for pseudomonas
ceftazidme
cefipime
263
what are the anti-pseudomonal penicillins?
pipericillin
ticarcillin
264
25M
small testes
decreased sperm count
normal testosterone levels
normal axillary and facial hair
Dx?
anabolic steroids
265
what 2 nerves innervate muscles in the middle ear canal?
1. facial nerve (cranial nerve VII)
2. trigeminal nerve-mandibular branch (cranial nerve V3)
266
pinnk on mackonkeys agar, oxidase positive, non-lactose fermenter
which organism is this?
pseudomonas
267
Fondiparinux
a type of heparin and indirectly inhibits factor 10
268
Bivalirudin
direct thrombin (factor II) inhibitor
| (note- also argatroban, dabigatran)
269
Argatroban
direct thrombin (factor II) inhibitor
270
which of the 4 mechanisms of bacterial genetics is responsible for transmission of bacterial antibiotic resistance?
conjugation
(extra- via direct transfer of plasmids from one bacteria to another via a pilus)
271
mild 21-hydroxylase deficiency
this is nonclassical (late onset) congenital adrenal hyperplasia
- seen in adolescent girls
- increased levels of testosterone (pathway shunted toward androgen production)
- signs of hyperandrogenism (i.e. hirsutism, acne, menstrual irregularities)
272
metolazone
a thiazide diuretic
273
SIADH is paraneoplastic syndrome for which type of lunng cancer?
small cell lung cancer
274
Which lung cancer(s) are centrally located
1. small cell lung cancer
2. squamous cell lung cancer
3. \*bronchial carcinoid (\*central OR peripheral)
275
Which lung cancers are neuroendocrine tumors?
1. small cell lung cancer
2. broncial carcinoid tumor
276
Which lung cancer can present with hypercalcemia?
why?
squamous cell lung cancer
because the tumor can produce parathyroid hormone related peptide --\> which works to increase body calcium levels
277
Which lung cancer can present with signs of cushing syndrome, SIADH, muscle weakness and ataxia?
why?
small cell lung cancer
because the tumor can produce
1. ACTH --\> cushings
2. ADH --\> SIADH
3. Antibodies against pre-synaptic calcium channels --\> lamber-eaton (muscle weakness)
4. paraneoplastic myelitis or cerebellar degeneration --\> ataxia
278
Which type of lung cancer may present with clubbing?
why?
Adenocarinoma
because it can cause hypertrophic osteoarthropathy (clubbing)
279
Which lung cancer(s) present as a hilar mass?
why?
squamous cell carcinoma
because it arises from the bronchus
280
What types of extrapulmonary manifestations can adenocarcinoma of the lung present with specifically?
1. Clubbing (hypertrophic osteoarthropathy
2. symmetric proximal muscle weakness or heliotrope rash (dermatomyositis/ polymyositis)
3. trousseaus sign (migratory thrombophlebitis)
281
Blastomycosis (broad based bud)
282
Aspergillus (septate hyphae, acute angle branching)
283
Where does the mitral valve open?
D
(at the end of isovolumetric relaxation)
284
285
286
Mitral regurgitation
(extra-left ventricular systole corresponds to the time of passive filling of the left atrium-- atrial diastole. MR leads to markedly elevated left atrial pressure during this period, creating the characteristic early and large V wave on the left atrial pressure tracing)
287
which lymph node drains the prostate?
internal iliac nodes
288
which lymph node drains the testes vs scrotum?
para-aortic nodes --\> testes
superficial inguinal nodes --\> scrotum
289
Diagnosis?
Small bowel obstruction
(see multiple loops of dilalted small bowel with air fluid levels)
290
Colonoscopy
Pseudomembranous colitis
| (yellow plaques)
291
Diagnosis?
Duodenal atresia
| (D-duodenum, S-stomach)
292
Reed-sternberg cells seen in Hodgkin's Lymphoma
(bilobed nucleus with eosinophilic inclusions of nucleoli, "owl eyes")
293
**Basal cell carcinoma**
lesion shows- central crusting, ulcerations, telangiectasias, _rolled borders_
294
Many **seborrheic keratoses**
- have "stuck-on" appearance
- Lessser Trelat sign (sudden onset multiple seborrheic keratoses indicates GI adenocarcinoma)
295
osteosarcoma
296
**Osteoarthritis**
- Herbeden nodes (PIP)
- Bouchard nodes (DIP)
297
Basal cell carcinoma
298
Depigmentation of the substantia niagra --\> Parkinsons
299
**Alzheimers**
intracellular _hyperphosphorylated Tau_ proteins --\> **neurofibrillary tangels**
300
Bacillary Angiomatosis
301
Meningioma
| (compressing parenchyma)
302
Craniopharyngioma
| (supretentorial)
303
Diagnosis?
what structure is this next to that's pathognomonic?
**Meningioima**, which is found by the **4th ventricle**
304
**Papilledema**
(elevation of optic disc with pronounced disc margins and hemorrhage)
305
cherry red spot on macula
-seen in Tay Sachs and Niemann Pick
306
**Cherry Hemangioma**
(benign vascular tumor in adults, does not regress)
do not confuse with Strawberry hemangioma (in infants, will spontaneosly regress)
Both are types of capillary hemangiomas
307
vitamin C deficiency
308
White patch/plaque on lateral tongue that cannot be scrapped off.
Diagnosis?
Does this have malignant potential?
**leukoplakia**
(hyperplasia of squamous mucosa that can evolve into dysplasia --\> cancer)
Do not confuse with thrush (Candida) which CAN be scraped off
309
Diagnosis?
What is the cause?
**HFMD** (vesicular lesions, feet/hands, buccal mucosa, tongue)
caused by **Coxackie A virus**
Do not confuse with Herpes simplex-1 (vesicles on hard palate and lips with swollen gums)
310
Impetigo
311
Psoriasis
312
Generalized maculopapular rash seen in seconary syphilis
(image here shows another example)
313
itchy
**Erythema multiforme**
= a hypersensitivityy reaction following infection with **HSV**)
- target shaped lesions @ distal extremities, that are pruritic!)
314
Diagnosis? what is it caused by?
what do you not want to confuse this with?
**Bacillary angiomatosis** (immunocompromised/HIV patient, multiple lesions)- caused by **bartonella henslae**
Do not confused with **Cat-scratch disease** (immunocompetent patient, one local papular, associated **lymphadenopathy**)- image attached
315
Which structures in the brain are involved in parkinsons?
316
anti-thyroid peroxidase antibodies
Hashimotos
317
signal transduction pathway for glucagon
Gs --\> cAMP
318
gram positive bacilli
**Aerobic:**
1. Listeria
2. Bacillus
3. Corynebacteriumm
**Anaerobic:**
4. clostridium
(5. proprionibacterium)
319
gram positive branching filaments
Nocardia and actinomyces
320
321
Pericarditis
yellow arrow- shows effusion
322
**Koilocytes** --\> pathognomonic for **HPV.**
(slight enlargement of nuclei with perinuclear halo and clumped chromatin)
- pink cells are normal
- the greenish/blue cells clumped together in the middle are koilocytes
323
atypical lymphocytes --\> seen in infectous mononucleosis
324
auer rods are seen in which type of leukemia
AML
325
lipoprotein lipase (LPL)
vs
hormone sensitive lipase (HSL)
LPL --\> upregulated by insulin. breaks down triglycerides in adipose tissue into mannny FFAs. the liberated FFAs are taken up by the adipose cells, lowering serum triglyceride levels.
HSL --\> downregulated by insulin. suppressing release of FFAs
326
treatment for actinomyces
penicillin
327
Which 3 conditions could this been seen in?
1. HFMD
2. secondary syphilis
3. RMSF
328
When MEN do you find mucosal neuromas?
MEN2B
329
What part of the aortais most likely to be damaged or ruptured?
aortic isthmus (just after left subclavian artery)
330
The ureters risk injury during both an oophorectomy and hysterectomy:
why? during ligation of which arteries do you risk injury to the ureters?
as they cross the pelvic brim, the ureters are in close proximity to the **ovaries** --\> take caution during oophorectomy when ligating **ovarian arteries**
further distally the ureter runs below the uterine artery ('water under the bridge') --\> take caution during a hysterectomy the uterus and **uterine artery** are removed
331
In the pelvis, what ligament does the ureters pass along?
**Uterosacral ligament**
(then goes under uterine artery and inserts in bladder trigonge)
332
which nerve can be compressed by the inguinal ligament?
Femoral nerve
333
What part of the duodenum can be compressed by the superior mesenteric artery?
Part 3/transverse part
334
Which one is IVC?
B
335
Which cranial nerve is this?
abducens (CN VI)
336
What type of receptor does thyroid hormone bind to?
nuclear receptor
(other hormones with similar binding: retinoic acid, steroids, vitamin D, estrogen, testosterone)
337
What type of receptor does vitamin D bind to?
nuclear receptor
338
filtration fraction =
GFR/RPF
339
which contains only thick filaments?
E (this designates the H-band)
(note- thick filaments = myosin)
340
MCC of mitral stenosis
Rheumatic fever
341
Where does actin bind to its support structure?
**A** (actin/thin filaments in the _I-band_ bind to structural proteins in the _Z-line_)
(whereas, myosin/thick filaments in the _A-band_ bind to structural elements in the _Z-line_)
342
anti-centromere antibodies
CREST syndrome (limited scleroderma)
343
image findings
+
progressive muscle weakness
dermatomyositis
-image shows grotton's papules
344
image findings
+
progressive proximal muscle weakness
**dermatomyositis**
-image showos heliotrope rash
345
anti-Jo-1 antibodies
dermatomyositis
346
anti-mitochondrial antibodies
primary biliary cirrhosis
347
supracondylar fracture:
which nerve and which artery are at risk of injury
Median Nerve and brachial artery
| (these course together here)
348
Injury involving which artery will lead to osteonecrosis in this patient?
MEDIAL circumflex
-injured due to displaced femoral neck fracture
349
which enzyme is deficient in Alkaptonuria?
**Homogentisic acid deoxygenase**
- note- this is the pathway of tyrosine metabolism
- excess homogentisic acid casues diffuse blue black depsoits in connectie tissue
350
Decreassed numbers of functional _____ in affected muscle fibers, lead to uncoordinated contraction of myofibrils, which manifests are muscle weakness.
**transverse-tubules**
(responsible for synchronized contraction of myofibrils)
351
Which 2 bones in the wrist articulate with the radius?
which one is more medial in an x-ray
scaphoid and lunate
-lunate is more medial
352
Colchicine affects which step? why?
F
- it inhibits leukocyte migration by blocking tubulin polymerization
- note- it treats acute gouty arthritis in patients who can't take NSAIDs
353
354
where does the ACL originate?
lateral femoral condyle
355
is the fibula on the medal or lateral leg?
lateral
356
Patient with low BMI had a compression fracture.
on the graph area C shows normal calcium and PTH levels
Which letter is patient?
C
because patient has osteoporosis. Lab values are normal in osteoporosis.
357
Motor and sensory functions of superficial peroneal nerve.
358
nerve and artery damaged in midshaft humerus fracture
Radial nerve
and
deep brachial artery
(they course posteriorly to the midshaft humerus)
359
In supracondylar fracture, when proximal humeral fragment gets displaced _anteriorly_ it can go more medially or more laterally:
Which structures risk injury in medial vs lateral displacement of humeral fragment?
_Anteromedial:_
Median nerve and brachial artery
_Anterolateral:_
Radial nerve and deep brachial artery
(note- the distal fragment here is either the medial or lateral epicondyly)
360
Which nerve descends through the psoas muscle?
Femoral nerve
361
What are 2 ways the femoral nerve can be damage while descenting through pelvis?
1. retroperitoneal hematoma
2. psoas abscess (femoral nerve courses through psoas)
also childbirth or surgery
362
manifestations of femoral nerve injury
1. quadriceps weakness
2. decreased patellar reflex
3. loss sensation anterior/medial thight and medial leg
363
which muscle is weak in a person with hip drop?
gluteus medius
364
which nerve innervates the gluteus medius
superior gluteal nerve
365
which quadrant is considered safe for gluteal injections?
why?
superolateral is ok, anterolateral is safest
because superomedially risk injury to superior gluteal nerve and sciatic nerve
366
Osteocytes remain connected to each other by use of which type of junction?
gap junnction
367
Inskeletal muscle contraction, the calcium released from the sarcoplasmic reticulum binds to what?
Troponin C
368
Which step is inhibited in vitamin D deficiency
A
369
What are all these muscles?
A. Deltoid
B. Infraspinatus
C. Lat dorsi
D. Trapezius
E. triceps
370
Osgood Schlattlers
what's it due to?
how does it present?
-Due to Repetitive quadriceps contraction (**jumping**, basketball) in **adolescents**.
(the quadriceps muscle group is connected to the patella superiorly, and inferiorly the patella is attached to the tibial tubercle via the patellar ligament
-presents with focal **anterior knee pain** and swelling due to chronic avulsion of **tibial tubercle**
371
What lab value is raised in osteoblastic bone lesions?
ALP
372
image shows MRI at the level of the tibial plateau
which one is ACL and which is PCL
A = ACL
D = PCL
373
Where does the PCL originate and insert?
originates- in medial femoral condyle (seen in posterior view of knee)
inserts- in posterior intercondylar area of tibia
374
what are the 3 major hip flexors?
1. rectus femoris
2. iliopsoas
3. sartorius
375
Tamoxifen vs raloxifene:
how to they act in
bone
vs
breast
vs
uterus
**Tamoxifen**--\>
- strong estrogen **antagonist in BREAST** and used to treat ER-positive breast cancer
- estrogen-like effects in bone (so reduces risk osteoporosis)
- estrogen agonist in uterus (**increases risk of endometrial hyperplasia/cancer**)-which is why it's not appropraite for use in treating osteoporosis
**Raloxifene** --\>
- estrogen **agonist in BONE** (so decrease resorption and improves bone density to **decrease fracture risk in osteoporosis**).
- Estrogen **antagonist in uterus** (so doesn't increase rick of endometrial cancer)
376
Leuprolide
GnRH analog that stimulates LH and FSH release --\> and subsequent estrogen production when given in **pulsatile** manner (given for chronic anovulation)
## Footnote
when given continuously --\> suppresses release
377
Alendronate MOA
(is a bisphosphonate)
inhibits osteoclast-mediated bone resorption
378
Patella fracture results in inability to \_\_\_\_
extend the knee
379
Methotrexate MOA
competitively Inhibits **dihydrofolate reductase** in degradative pathway of folate
(--\> now can't produce one carbon donors needed to for synthesis of DNA/RNA)
380
which two bones does the ulnar nerve course through?
which canal does this form?
Pisiform and hamate
-forms Guyon canal
381
fracture of the hook of the hamate causes injury to which nerve?
Ulnar
382
patient fell directly on lateral hip
Which muscle will most likely be impaired
**Gluteus medius** (does hip abduction and stabilization of hip during ambulation)
## Footnote
(xray shows avulsion fracture of greater trocanter of the femur, note-this is the insertio site of the gluteus medius )
383
what is the primary hip flexor?
where does it insert?
**iliopsoas**
inserts on lesser trocanter of femur
(note- gluteus medius inserts on greater trocanter)
384
What is this?
In what condition is it seen?
Erythema marginatum
seen in rheumatic fever
385
What are all these muscles?
A. rectus abdominus
B. Iliacus (hip flexor that lies over the iliac fossa)
C. Gluteus minimus
D. Gluteus medius
E. Gluteus maximus (major extensor of the thigh)
386
During wound healing, excess of which 2 things result in conntracture
1. matrix metalloproteinase
2. myofibroblasts
387
Which nerve can get injured during a mastectomy with axillary lymph node dissection?
long thoracic nerve
(injured serratus anterior --\> winged scapula)
388
damage to the recurrent laryngeal nerve during thyroidectomy results in impairment of whicch muscle?
posterior cricoarytenoid
| (causes hoarseness)
389
sunlight exposure catalyzes the conversion of ______ to _____ in the skin?
7-dehydrocholesterol
to
cholecalciferol (D3)
390
NFKB (RANK)/RANK-L interaction is esssential for the formation and differentiation of\_\_\_\_?
**osteoblasts**
| (forms mature osteoblasts)
391
**Osteoprotegerin:**
- is secreted by\_\_\_\_\_
- MOA
- which drug works similarly
secreted from **osteoBlasts**
- acts as a decoy receptor for RANK-L, preventing it from interacting with RANK --\> reduced proliferation of osteoclasts (decr bone resorption)
- **Denosunab** (monoclonal antibody, treats post-menopausal osteoporosis)
392
renal subepithelial immune complex deposits
PSGN
393
linear deposition of IgG antibodies in glomerular basement membrane
**goodpastures**
(note- associated with pulmonary hemorrhage/hemoptysis)
394
developed cough and wheezing after traveling abroad
Image of stool microscopy
Ascaris
395
which type of organism is capable of undering ressortment
viruses with **segmented genomes** can undergo _genetic shifts_ though _reassortment_
(note-this is a much more severe process than the _point mutations_ responsible _for genetic drift_)
396
23M with 3 ulcers on shaft of penis after sexual intercourse.
Images shows scraping form base of ulcer
-describe what the histology shows
diagnosis?
Herpes simplex
-image shows multinucleated giant cells with intracytoplasmic ground-glass
(note-this is a Tzank smear)
397
treatment for herpes simplex?
acyclovir
398
describe the bacteria based on the image
(cultured on Mackonkeys agar)
gram negative rod
399
gram negative rod thats oxidase positive and does not ferment lactose?
pseudomonas
400
very itchy rash predominantly on the palms and axilla, is due to?
scabies
401
20F vaginal discharge and pruritis
image is vaginal swab
**candida vulvovaginitis**
(diagnose via wet mount mmicroscopy --\> pseudohyphae with budding yeast. Treat with azoles)
402
lymph from the uterus drains into which nodes?
external iliac
403
lymph from the cervix drains into which nodes?
internal iliac
404
lymph from the vagina drains into which nodes?
proximal vagina --\> internal iliax
Distal vagina --\> inguinal
405
lymph from the vulva drains into which nodes?
inguinal nodes
406
lymph from the ovaries drains into which nodes?
para-aortic nodes
407
ALA dehydratase catalyzes the conversion of what to what?
ALA --\> porphobilinogen
408
Lead inhibits which two enzymes in the heme synthesis pathway?
1. ALA dehydratase
2. Ferrochelatase
409
ALA synthase catalyzes the conversion of what to what?
glycine + succcinyl-coA
--\>
ALA
410
Uroporphyrinogen decarboxylase catalyzes the conversion of what to what?
uroporphyrinogen III
--\>
coproporphyrinogen
(note- defect in this enzyme causes porphyria cutanea tarda)
411
Porphobilinogen deaminase catalyzes the conversion of what to what?
porphobilinogen --\> hydroxymethylbilane
(note- deficiency of this enzyme causes acute intermittent porphyria- 5P's)
412
Famotidine
H2-receptor blocker (2nd generation) used in the treatment of GERD.
(note- this is reversible competitive antagonist. the GERD med that's irrev are PPIs)
413
Misoprostol
prostaglandin-E1 analog that is used to prevent peptic ulcer formation (usually in the setting of NSAID use- because NSAIDs decrease prostaglandins by blocking COX)
414
Sucralfate
drug that reacts with HCl in the stomach --\> forms thick viscous coating, that acts as physical buffer
415
Erlichiosis
| (whatever you can remember about it)
- mainly rocky mountains, sometimes central USA
- flu-like symptoms (fever, myalgias, headache), sometimes rash, hepatomegaly (incr LFTs), anemia, thrombocytopenia
- vector is tick bite
- Histo --\> morulae within neutrophils
416
Francisella
- fastidious gram negative bacteria
- acquired through rabbits
- presence of a local eschar through site of entry, and LAD near site
417
what are the 4 conditions caused by strep pneumoniae
"MOPS"
- **M**eningitis
- **O**titis media
- **P**neumoniae
- **S**inusitis
418
actions of the latissimus dorsi
shoulder aDduction and internal rotation
419
actions of the teres major
internal rotation and aDduction of the shoulder
(note- same actions as lat dorsi)
420
Which spinal tracts are affected in B12 deficiency?
what is this called
**subacute combined degeneration**
## Footnote
these tracts get demyelinated:
- DCML
- spinocerebellar
- lateral corticospinal tract
421
Deficiency of which vitamin can cause neuro symptoms that are similar to B12 deficiency?
vitamin E
422
cutaneous manifestatio of Pseudomonas
| (list as many as you can)
1. folliculitis
2. infection of the nail
3. ecthyma gangrenosum (rapid progression severe ulcers)-see in img
423
Pasturella
- a gram negative cocobacillus
- due to cate bit, and lesser extent dog bite
424
most common nephrotic syndorme in caucasian adults
membranous nephropathy
(note- can be idiopathic, or secondary to SLE or HBV and HCV)
425
Thyroxine uses which type of receptor
nuclear receptor
| (note- steroids do too)
426
What is A?
aortic valve
(posterior to pulmonic valve, and anterior to the left atrium)
427
what is B?
pulmonic valve
(separates the right ventricle from the pulmonary trunk. It is just anterior to the aorta)
428
What is C?
tricuspid valve
(separates right atrium from right ventricle, remember right atrium is most anterior and inferior part of hard)
429
what is D?
mitral valve
(separates left atrium from left ventricle, remember left atrium is most posterior part of the heart)
430
5-alpha reductase catalyse the reaction of what to what?
testosterone
--\>
DHT
431
what happens to the following in normal age related changes in the lungs:
1. total lung capacity
2. residual volume
3. FVC
4. FEV1
1. TLC --\> remains unchanged (decreased chest wall compliance balances with increased lung complaince)
2. RV --\> increased
3. FVC --\> decreased
4. FEV1 --\> decreased
(note- these changes are almost exactly like emphasema EXCEPT- there is decreased chest wall compliance with aging making TLC normal!!)
432
categorize H. influenzae based on the algorithm
gram negative cocobacilli
433
4 things causing avascular necrosis of the femoral head?
1. sickle cell disease
2. high-dose systemic corticosteroids
3. vasculitis
4. femoral neck fracture --\> disrupts medial circumflex femoral artery (which is the main supplier of the femoral head)
434
Nevirapine
non-nucleoside reverse transcriptase inhibitor -- drug for HIV
(note- doesn't need to be phosphorylated)
435
what are the 3 NNRTIs?
1. nevirapine
2. efavirenz
3. Relavirdine
436
antifungal that binds ergosterol and alters cell membrane permeability
Amphotericin B
(incr cell membrane permeability because it forms pores allowing electrolyte leakage)
437
prophylaxis for pulmonary embolism
low molecular weight heparin
438
Entcapone
MOA and what it treats
inhibits COMT ---\> this decreases the peripheral metabolism of levodopa, making more available for the brain
Treatment for Parkinsons
439
Effect of Leuprolide on the following hormone levels
E
because inhibits GnRH
440
What's the function of the
genitofemoral nerve
branches to innervate sensation of:
1. scrotum/labia majora
2. medial thigh
441
the most common HPV strains are:
1-4
6 & 11
16 & 18
what do they each cause?
1-4 --\> skin warts (verruca vulgaris)
6 & 11 --\> anogenital warts (condylomata acuminata)
16 & 18 --\> cervical, vaginal, vulvar, anal cancer
442
img from vaginal swab
Diagnosis?
this is a koilocyte
--\> it's the hallmark of HPV infection
443
List the structures found inside the cavernous sinus?
(5 cranial nerves, 1 artery)
**Cranial nerves:**
- III (occulomotor)
- IV (trochlear)
- VI (Abducens)
- V1 (trigeminal- ophthalmic branch)
- V2 (trigeminal- maxillary branch)
**Artery:**
-Posterior communicating artery
444
the uterine artery is a branch of?
internal iliac artery
445
how do vasodilators like nitroprusside affect preload?
increases preload
446
Which point would represent the end-systolic pressure point after a patient is given nitroprusside (with blocked reflexes)
**point D**
**nitroprusside** —\> vasodil (arterioles \> ven)
—\>
decr afterload (w/o sig affect on preload). so isolated decr afterload
—\>
less ventricular pressure needed to open aortic valve (shortened PV loop)
—\>
incr SV & EF (decr LV-ESV) so low end-systolic pressure.
447
What is another name for NFKB
RANK-L
448
Patient is 5 weeks pregnant, which structure is responsible for production of progesterone at this stage?
**corpus luteum**
(placenta doesn't take over progesterone production until about week 7-10)
449
Most common infecting organisms in chronic granulomatous diseease
all catalase positive organisms:
- staphylococcal sp
- Aspergillus
- Burkholderia cepacia
- Nocardia
450
enlarged 3rd and lateral ventricle, but normal sized 4th ventricle.
Mechanism of hydrocephalus in this patient?
stenosis of cerebral aqueduct
451
