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1
Q
  • Complete digestion and removal of necrotic tissue
  • Caused by release of lysosomal enzymes from ischemic tissue
  • Phagocytic cells migrate, formation of a cystic cavity
  • Hypoxic CNS injury often precedes this
A

Liquefactive necrosis

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2
Q
  • Implies relative preservation of the architecture of the necrotic tissue
  • Hypoxia leads to buildup of lactic acid and denatured proteins
  • Denatured proteins look coagulated
A

Coagulative necrosis

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3
Q
  • Blood entry into a necrotic area
  • Occurs in organs with a dual blood supply (lung)
  • Occurs in reperfusion injury of the CNS
A

Hemorrhagic infarcts (871)

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4
Q

Lithium toxicity

A
  • Narrow therapeutic index
  • Acute toxicity: GI upset, and neurologic findings (NMJ excite, delirium)
  • Chronic toxicity preceded by volume depletion
  • Chronic tox: involuntary mvmt, tremor, and ataxia
  • Excreted exclusively by kidneys, filtered by PCT
  • Thiazides limit Na+ reabs in DCT→+reabs in PCT
  • ACEi’s and NSAIDs also impair clearance
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5
Q
  • Risk factors present for airborne antigen exposure

- CD8+ cells predominate in BAL

A

Hypersensitivity pneumonitis (796)

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6
Q
  • Sxs of wheezing, fever, and BAL eosinophilia
  • Pt from Indian subcontinent
  • Clinical manifestation of lymphatic filariasis (roundworms)
A

Tropical pulmonary eosinophilia (TPE)

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7
Q

Tyramine hypertensive crisis (572)

  • Which MAO?
  • Which transporter:
  • What causes sxs?
A
  • Cheese, draft beer, sausage contain this
  • MAO-A inhibition increases concentration
  • Gets taken up via NE transporter and vesicular monoamine transporter
  • NE is displaced and increases sympathetic activity and HTN
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8
Q
  • Increased V and P of endolymph, defective resorption
  • Dmg to vestibule and cochlea
  • Episodic triad: tinnitus, with feeling of ear fullness; vertigo without motion and n/v; sensorineural hearing loss with variable severity
A

Meniere disease (308)

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9
Q
  • Otoliths in semicircular canals
  • Brief episodes brought on by head mvmd
  • No auditory sxs
A

BPPV

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10
Q
  • Inflammation of vestibular nerve (viral, post viral)
  • Single episode lasting days
  • Severe vertigo, no hearing loss
A

Vestibular neuritis (labyrinthitis)

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11
Q
  • Overuse of diuretics leading to volume loss
  • Compensatory increase in aldosterone production
  • Na+ and water retention, K+ and H+ wasting
  • High pH, high HCO3-, and high pCO2
A

Contraction alkalosis

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12
Q
  • From C1-C3, innervates sternohyoid, sternothyroid, and omohyoid mm
  • Penetrating injury to the neck above cricoid cartilage can injure
A

Ansa cervicalis

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13
Q
  • May be injured during surgery of posterior triangle

- SCM, traps, and clavicle

A

Accessory nerve

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14
Q
  • Thyrocervical trunk goes posterior to carotid and jugular
  • Serves inferior pole of thyroid
  • Injury common with hoarseness due to proximity to recurrent laryngeal
A

Inferior thyroid artery

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15
Q
  • Acid labile: pts with achlorhydia or taking PPI’s (omeprazole) are sensitive to IFX
  • Grows on highly alkaline selective media
A

Vibrio cholera (977)

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16
Q
  • Increased risk with chronic liver disease
  • Occurs in setting of open wound infected by contaminated water
  • Also in raw seafood like oysters
  • GI illness, shock after raw seafood ingestion or seawater
  • Culture wound/stool–>fastidious, salt loving bacteria
  • Sp?
  • Tx?
A

Vibrio vulnificus

-Doxycycline and 3rd get cephalosporin

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17
Q
  • Tremors, agitation, anxiety, delirium, psychosis

- Seizures, tachycardia, palpitations

A

Alcohol Withdrawal

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18
Q
  • Tremors, anxiety, perceptual disturbances, psychosis, insomnia
  • Seizures, tachycardia, palpitations
A

BDZ withdrawal

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19
Q
  • N/V, cramping, mm aches

- Dilated pupils, yawning, piloerection, lacrimation, hyperactive bowel sounds

A

Heroin withdrawal

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20
Q

-Increased appetite, hypersomnia, intense psychomotor retardation, severe depression “crash”

A

Stimulants (cocaine, amphetamines) withdrawal

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21
Q

-Dysphoria, irritability, anxiety, increased appetite

A

Nicotine withdrawal

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22
Q

Pt sxs:

  • At least 2 weeks
  • At least 5/9 SIGECAPS
  • Fx impairment
  • No history of mania
  • Not due to other condition or drugs
A

MDD

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23
Q

Pt sxs:

  • Identifiable stressor
  • Onset within 3 months of stressor
  • Marked distress
  • Fx impairment
A

Adjustment disorder with depressed mood

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24
Q
  • Clinical triad: acute onset neurologic abn, hypoxemia, petechial rash
  • Pt. with long bone/pelvic fx
  • Fat globules occlude pulmonary microvessels→shunting
  • Some escape, get to CNS and skin
A

Fat embolism syndrome

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25
Q

Five phases of inflammatory leukocyte accumulation

A
  • Margination
  • Rolling: Sialyl Lewis X or PSGL-1 to L-Selectin on N or E/P selectin on endothelial cells (cytokines increase)
  • Activation: slow rolling activates integrins
  • Tight adhesion and crawling: N binds with CD18 beta 2 integrins (mac-1 and LFA-1) to ICAM-1 on endothelial cells
  • Transmigration: squeeze out via integrins and PECAM-1
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26
Q

-Delayed detachment of the umbilical cord
-Recurrent skin IFX without pus formation
-Poor wound healing
Which CD marker is deficient?
Inheritance pattern?

A

Leukocyte adhesion deficiency (LAD) type 1

  • Absence of CD18 part of beta 2 interns–> low Mac-1 and LFA-1
  • AR
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27
Q

DX? Name 2 sequelae

  • Relaxation of pharyngeal mm→closure
  • Loud snoring/apnea
  • Daytime somnolence
  • Non-restorative sleep, frequent awakenings
  • Morning HAs
  • Affective, cognintive sxs
A

Obstructive sleep apnea
HTN
pHTN and RHF

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28
Q
  • Restricted expansion of thorax due to severe obesity
  • DX?
  • pCO and pO2?
A

Obesity hypoventilation syndrome (Pickwickian syndrome)

-Chronically elevated pCO2, low pO2

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29
Q

3 vaccines with protein carriers

3 proteins

A
  • S pneumo, N meningitides, H flu

- Diphtheria toxin, N meningitides outer membrane complex, tetanus toxoid

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30
Q

Etanercept, Infliximab, Adalimub

  • MOA
  • Use
  • ADRs
A
  • Decoy receptor for TNF-alpha
  • Tx moderate to severe RA, esp in pts who fail MTX
  • Increase susceptibility to TB, fungi, and atypical mycobacteria
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31
Q

MTX

-Tests at baseline and why

A

-Lung and lvier toxicity: CXR and LFTs recommended at baseline

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32
Q

Hydroxychloroquine

  • Use
  • MOA
  • ADRs*
A
  • antimalarial, also for SLE and rheumatic dz (RA, sjogrens)
  • Decreases TLRs, reducing dendritic signaling
  • Irreversible retinal dmg
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33
Q

Murmur

  • Wide fixed split S2
  • Mid systolic murmur over P, mid diastolic murmur over T
  • Risk for what?
A

ASD

-Paradoxical embolism occurs with transient reversal due to straining in coughing or defecation

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34
Q

Murmur

  • Early diastolic decrescendo over upper left sternal border
  • Effect of amyl nitrite?
A

Aortic regurgitation

-amyl nitrite–>vasodilation–>low TPR–>less regard–>softer murmur

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35
Q

Murmur

  • Systolic ejection murmur heard simultaneously over A and M
  • Diamond shaped
  • Increases with standing
A

HOCM

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36
Q

Murmur

  • Systolic ejection murmur
  • Decreases in intensity upon standing
A

Valvular aortic stenosis

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37
Q

Murmur

  • Wide splitting of S1 accentuated by inspiration
  • MCC?
A

Delayed closure of tricuspid valve

-Right bundle branch block

38
Q

SIGECAPS

at least 5 for at least 2 weeks

A 
Sleep changes
Interest
Guilt
Energy decrease
Cognition/concentration
Appetite changes
Psychomotor retardation
Suicide
39
Q
  • Dz due to lack of phenylalanine hydroxylase
  • Important molecules in pathway: phenylalanine, tyrosine, DOPA, dopamine, NE, and epinephrine
  • What cofactor/coenzyme do phenylalanine hydroxylase and tyrosine hydroxylase require?
A
  • Phenylketonuria

- DHF/dihydropterin reductase

40
Q

Pes anserinus (3 mm)

A
  • Semitendinosus
  • Gracillis
  • Sartorius
41
Q

Most medial leg flexor

-Insertion

A

Semimembranosus

-medial condyle of tibia

42
Q

Most lateral leg flexor

-Insertion

A

Biceps femoris

-head of the fibula

43
Q

Gabapentin

  • MOA
  • Effect
A
  • blocks VG Ca+ channels

- attenuates excitatory NT release

44
Q

Phenytoin

  • MOA
  • Use
A
  • blocks presynaptic VG-Na+ channels

- prevents recurrence of status epilepticus

45
Q 
Pt presentation:
Thin, off white vaginal discharge with fishy odor
No inflammation
Clue cells on LM
-Sp?
-Tx?
-pH > or
A
  • Gardnarella
  • Metronidazole/clindamycin
  • pH > 4.5
46
Q 
Pt presentation:
Thin, yellow-green, malodorous, frothy
Vaginal inflammation
-Sp?
-Tx?
-pH > or
A

Trichomonas
Metronidole + PPx sexual partner
pH > 4.5

47
Q 
Pt presentation:
Thick, cottage cheeses discharge
Vaginal inflammation
-Sp?
-Tx?
-pH > or
A

Candida albicans
fluconazole
pH

48
Q

Abacavir, tenofovir, emtricitabine, didanosine, stavudine, lamivudine, zidovudine

  • Class?
  • General ADR’s
  • Which causes: HS rxn? Pancreatitis? BM suppression?
A 
-Nucleoside Reverse Transcriptase I
inhibitors
-lactic acidosis, lipodystrophy
-abacavir
-didanosine
-zidovudine
49
Q

Efavirenz and nevirapine

  • Class?
  • General ADR’s
  • Unique ADR: efavirenz
A

NNRTIs
Rash, SJS
Hepatotoxicity
*Neuropsych sxs

50
Q

Atazanavir, Darunavir, Indinavir, ritonavir

  • Class?
  • General ADR’s
A

Protease inhibitors

Metabolic complications lipodystrophy, dyslipidemia, insulin resistance

51
Q

Dolutegravir, raltegravir

  • Class?
  • General ADR’s
A
  • Integrase inhibitors

- myopathy

52
Q

CD4 Th1 cells

  • Cell or humoral
  • cytokines released
A
  • cell
  • IL-2
  • IFN-gamma
53
Q

CD4 Th2 cells

  • Cell or humoral
  • cytokines released
A
  • humoral
  • IL-4
  • IL-5
  • IL-12
54
Q

Which artery has been occluded?

  • L Tongue hemiparesis (WHY)
  • R Loss of proprioception on half of body
  • R hemiparesis
A

Medial medullary syndrome

  • L Anterior spinal artery or paramedian branches
  • hypoglossal nucleus
55
Q

Which artery is involved?

  • Vertigo, n/v
  • hoarseness, dysphagia (WHY)
  • decreased pain and temp on L face and R body
  • L Horner syndrome
A

Lateral medullary syndrome (Wallenberg)

  • L PICA
  • nucleus ambiguous
56
Q

Which artery is involved?

  • vertigo, n/v
  • decreased pain and temp on L face and R body
  • paralysis of entire L face (what else should be missing?)
  • L Horner syndrom
A

Lateral pontine syndrome
L AICA
-L/O taste to anterior 2/3 of L tongue, lacrimation to L eye, salivation to submandibular and sublingual glands,
-L/O function of L stapedius mm (hyperacusis)

57
Q

Which artery is involved?

-L hemianopsia with macular sparing

A

R posterior cerebral artery

58
Q

Which chromosome?

  • cafe au-lait spots
  • neurofibromas on or under the skin
  • Lisch nodules
  • mental retardation
  • brain tumors
A

Neurofibromatosis 1

-chromosome 17

59
Q
  • tumors of both auditory nerves
  • gliomas
  • multiple tumors in the brain and spinal cord
A

Neurofibromatosis 2

-chromosome 22

60
Q

-sxs

A

Hemochromatosis

-deposition of iron salts

61
Q

-sxs

A

Glycogen storage diseases

62
Q

-sxs

A

Sphingolipidoses

63
Q

-sxs

A

Wilson dz

64
Q

-sxs

A

Albinism

65
Q

-sxs

A

Phenylketonuria

66
Q 
DX?
Tx?
-Neurologic symptoms
-low BUN
-hyperammonemia
A

Ornithine transcarbamylase deficiency

  • XR deficiency in ornithine transcarbamoylase
  • Normally adds carbamoyl phosphate to ornithine to make citrulline for the urea cycle
  • This causes a buildup of orotic acid
  • Blocked urea cycle–>hyperammonemia
67
Q

-sxs

A

Fabry dz

68
Q

-sxs

A

Wiskott-Aldrich syndrome

69
Q

-sxs

A

G6PD deficiency

70
Q

-sxs

A

Hunter syndrome

71
Q

-sxs

A

Hemophilia A

72
Q

-sxs

A

Hemophilia B

73
Q 
What metabolite is built up in this pt?
Which enzyme is deficient?
Tx?
-Looks like cerebral palsy
-self-mutilation
A

Lesch-Nyan syndrome–>uric acidemia
HGPRT
allopurinol to block xanthine oxidase

74
Q

-sxs

A

Duchenne MD

75
Q

-sxs

A

Becker MD

76
Q 
DX?
Tx?
-Baby presents with failure to thrive and MR
-Crystals in the diaper
-Megaloblastic anemia (why?)
A

Orotic acuduria
Give uridine (UMP) to bypass UMP synthase
-UMP synthase deficiency
-Can’t produce pyrimidines

77
Q

3 week old boy brought due to lethargy. Does not interact very much. Has lost weight.

  • megaloblastic anemia
  • yellow crystals found in his diaper
  • What is the most likely tx?
  • What is the deficiency?
A
  • UMP

- orotic acid phosphribosyltransferase or oritidine 5’ phosphate decarboxylase

78
Q

Deficient pro collagen peptidase

A

Ehlers-Danlos

79
Q

ADR’s of SSRIs

A
  • Sexual: decreased libido, anorgasmia in women, ejaculatory delay
  • QT prolongation, low risk of arrhythmia when used properly
80
Q

TCA ADRs

A
  • Seizures

- Anticholinergic: urinary hesitancy and orthostatic hypotension

81
Q

dermatitis, diarrhea, dementia

-Source

A

Pellagra (low niacin)

-Obtained from diet or synthesized from tryptophan

82
Q

Attributable risk

A

event rate (treatment)-event rate (placebo)

83
Q

Number needed to harm

A

1/attributable risk

84
Q

Sub epithelial deposits of IgG, IgM, C3

A

PSGN

85
Q
  • mTOR signaling pathway

- Binds FK-506 binding protein (FKBP) and inhibits mTOR→interrupts IL-2 signal transduction

A

Sirolimus

86
Q

bind cyclophilin or FKBP→inhibit calcineurine→decrease NFAT activitiy→no IL-2 gene txn

A

-Cyclosporine, tacrolimus

87
Q
  • L1 nerve root→upper psoas major→behind kidney to quadratus lumborum
  • Fx to anterolateral ab wall mm
A

Iliohypogastric nerve

88
Q
  • L1-L2 roots
  • Sensation to upper anterior thigh
  • Motor to parts of genitalia
A

Genitofemoral nerve

89
Q
  • L1 root
  • Goes through sup ring with spermatic cord
  • Sensation to upper and medial thigh, parts of genital s
  • Inward part of cremasteric reflex
A

Ilioinguinal nerve

90
Q

This drug is a nucleoside analog used to inhibit HIV reverse transcriptase.
-ADR: associated with HLA-B*57:01

A

Abacavir

-AHR: fever, malaise, GI, and delayed rash

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