Test May 29th

Question 1

Answer 1

Kaposi Sarcoma HHV-8
= usually immunosuppressive or corticosteroid use
= skin red papules + pulmonary disease nodular cheery red

Question 2

Answer 2

Adenocarcinoma pulmonary

Question 3

Answer 3

Pneumocystis Jirovecii

Question 4

Answer 4

Carcinoid Tumor pulmonary

Question 5

Small Cell Carcinoma

1. Type of cells
2. Associated diseases

Answer 5

1. Sheets of small blue cells, neuroendocrine markers (NCAM, Neural cell adhesion molecule CD56, Chromogranin)
2. SIADH, Cushing, Lambert Eaton (proximal muscle weakness improves by day or stimulation)

Question 6

Epidermal GF receptor gene mutation

1. Causes what
2. Responds to what drug

Answer 6

1. Non small cell cancer ADENOCARCIOMA

2. Responsiveness to Tyrosine kinase inh. (Erlotinib, Afatinib)

Question 7

1, Vimentin

2. KRAS

Answer 7

1. Sarcoma

2. Prostate or colorectal cancer

Question 8

2 types of gout

Answer 8

1. Ca Pyrophosphate ( square, + bifringent)

2. Monosodium urate (needle like , - bifringent)

Question 9

Answer 9

Ca Oxalate crystal

Question 10

HIV :

1. Attachment
2. Bind to T-cell
3. Fusion
4. Tat, Rev, Nef, Vpu, Vpr, Vif

Answer 10

1. gp120
2. CCK5 + CHEMOKINE RECEPTOR **
3. gp41
4. Tat = viral transcription, REv = unsliced viral transcription from nuc to cyto, Nef = down reg CD4 cells recognition, Vpu = viral assemble release, VPR = nuclear enters + stop division, VIF = increase viral infectivitity

Question 11

HIV : drugs

1. Block CCK5 chemokine receptor
2. Block GP 41
3. Protease inh.
4. Integrase Inh.
5. Reverse Transcriptase Inh.
6. Non-reversible Transcriptase inh.

Answer 11

1. Maraviroc = inhibit fusion
2. Enfuviritide = inhibit fusion
3. • navir (hyperglycemia, Cushing like), Darunavir
     4 . -gravir , Raltegravir
4. Abacavir = hypersensitivity, Emtricitabine (macular rash palms soles) , Zidovidine (anemia, BM toxic)
5. Efavirenze + Nevirapine ( Steven Johnson syndrome, Epidermal necrosis)

Question 12

Paroxysmal supraventricular Tachy due to

Answer 12

No organized AV conduction = reentrant circuit formed (from slow circuit not getting blocked by fast circuit)

1. Hypotension = ventricular diastole shortens = less filling

Question 13

Atria remodeling causing

Answer 13

Atrial fib, (ectopic foci in pulmonary vein ostia)

Question 14

1. Sick sinus syndrome

2. Delayed repolarization pf ventricular cardiomyocytes can casue

Answer 14

1. SN node degeneration,

2. Torsades

Question 15

Long QT syndrome

Answer 15

Abnormal K+ channels outward flow,

= die from ventricular arrhythmias and torsades

Question 16

HCM mutations

Answer 16

Sarcomere genes (myosin binding protein C, Beta myosin heavy chain gene) 
AD

Question 17

Dilated cardiomyopathy mutation + 3 other causes

Answer 17

Titin mutation ,

can also happen from chagas, doxyrubicin , coxsackie virus

Question 18

Drug against PD-1
Drug against Poly-ADP ribose polymerase (repairing single stranded dna breaks)
Rituximab moa

Answer 18

1. Pembrolizumab
2. Olaparib
3. Against B-cells

Question 19

Innervation to glut max and glut med/min

Answer 19

1. Glut max = Inferior Gluteal N ( X climb stairs or rising from chair)
2. Glut men/min = Superior glut N (trendelenburg sign)

Question 20

Antifungals

1. Cell membrane
2. Cell wall
3. Dna

Answer 20

1. a = inhibit ergosterol synthesis (AZOLES + they also uppers P450)
   B= bind to ergosterol ( Amphotericin B, Nystatin + cause pore /cell lysis)
2. -Fungins, (prevent 1,3-beta D GLUCAN synthesis
3. Flucytosine ( increases Amphotericin B = Cryptococcal meningitis)

Question 21

Desmopressin MOA 2 of them

Answer 21

1. Increase vWF + F8

2. Bind to V2 on renal tubular cells, increasing aquaporin channels (DI and nocturnal enuresis) = helps reabsorb water

Question 22

Laryngeal obstruction = tripod posture means

Answer 22

Inspiratory stridor **
Expiratory stridor ( Tracheomalacia, treachery construction)

Question 23

1. Phenylketonuria
2. Alkaptonuria
3. Cystinuria
4. Maple syrup syndrome

Answer 23

1. X phenylalanine Hydroxylase ( Phenalalanine —x—> Tyrosine) intellectual probs, (can also be due to dihydropteridine reductase = no BH4 —> BH2)
2. X Homogenrisic Acid Dioxygenase (Tyrosine —x—> Fumarate) Homogentisic acid accumulation happens giving BLACK color and black urine
3. X renal cystine transport ( flank pain and kidney stones child, or itching lysine arginine also) , tx: alkaline urine
4. X break down branched AA ( Leucine, Isoleucine, VAline) , sweet urine sweat, seizures cerebral edema

Question 24

Plt rich thrombi on heart valves due to

Answer 24

Malignancy ( Mucinous. Adenocarcinoma ) burns, Anti-phospholipid syndrome, DIC

Question 25

Giant cell arthritis risk of

Answer 25

Venous thromboembolic disease (Temporal A) + Anterior ischemic optic neuropathy ( CN2 ischemia supplying posterior ciliary As) TX : glucocorticosteroids

Question 26

CN 1-12 (where it comes from and foramen)

Answer 26

CN1. Cribiform plate CN2. . Optic canal CN3 . MIDBRAIN, Superior Orbital fissure (asym pupils) 4 = MIDBRAIN , Superior Orbital fissure (vertical diplopia) 5 = PONS V1(Superior Orbital fissure) V2 (foramen rotundum) V3 (foramen ovale) 6= PONS, Superior Orbital fissure 7= PONS, Internal Auditory Meatus , facial canal 8= PONS Internal Auditory Meatus ( head position stabilize gaze and movement NYSTAGMUS causing) 9 = MEDUALLA Jugular Foramen 10 = MEDUALLA Jugular Foramen 11 = MEDUALLA Jugular Foramen 12 = MEDUALLA Hypoglossal canal

Question 27

Least oxygenated area vessel in entire body

Answer 27

Coronary sinus draining coronary As into RA ( only increases coronary BF can increase heart coronary A oxygenation)

Question 28

DM causes

Answer 28

Metabolic Acidosis

Question 29

Group A vs Group B strep

Answer 29

Group A : Complete hemolysis = beta hemolytic, expresses cytolysins (Streptolysin O) (M- protein virulence factor) , TX : AMOXICILLIN Group B : incomplete hemolysis

Question 30

HPV causing warts and what do you check next

Answer 30

1. HPV 6, 11 | 2. Check HIV

Question 31

Condylomata Lata what and DX how

Answer 31

1. Syphilis , dense lymphoplasmacyic infiltrate | 2. Dark field Microscopy

Question 32

Trisomy 21 proteins

Answer 32

APP (Amyloid Precursor Protien )*** = causes AD (chr 21 has this gene) Amyloid Beta plaques

Question 33

CAG gene repeats

Answer 33

HTT (huntingtin)

Question 34

Apolipoprotein E epsilon 4

Answer 34

High risk of late onset AD

Question 35

Black gallstones cause

Answer 35

Increase bilirubin = B-glucuronidase increased = increase in unconjugated bilirubin = CA biliruinate precipitaion ( infection or hemolytic anemia)

Question 36

Fibrates

Answer 36

Inhibit 7a-Hydroxylase = cholesterol —> bile acids, increase cholesterol stones risk (nonpigmented gallstones)

Question 37

Low bone density and high calcium = anemia

Answer 37

Malignancy or osteoclasts (multiple myeloma) = lower OPG which increases RANK activity

Question 38

Osteomyelitis DX how

Answer 38

MRI gold standard ( staph aureus usually)

Question 39

``` MESSENGERS A1 A2 B1 B2 M2 M3 ```

Answer 39

A1 : increases IP3 (vasoconstrict, pupil dilation, urethral constriction) A2 : decrease cAMP (de GI motility + insulin) B1 : increase cAMP (In HR, renin) B2 : increase cAMP (bronchodilate, vasodilate) M2 : decrease cAMP (de HR) M3 : increase IP3 (bronchoconstrict, INC GI motility + insulin, pupil dilation)

Question 40

Mycophenolate

Answer 40

Inh inosine 5-monophosphate dehydrogenase (X de novo purines) = prevent lymphocyte proliferation AD EF: lymphopenia, D

Question 41

Allopurinol and Febuxostat

Answer 41

Xanthine Oxidase inhibitor (inh cellular proliferation with 6-mercaptopurine accumulation)

Question 42

Tacrolimus and Cyclosporine

Answer 42

Inhibit IL2 transcription ,

Question 43

Glucocorticoids (prednisone) MOA

Answer 43

Inhibit NF-kB = low IL2 and other cytokine transcription

Question 44

Siroliumus MOA

Answer 44

mTOR inhibition (rapamycin) interruption IL2 signaling transduction

Question 45

Tumor Lysis Sydnrome TX

Answer 45

Allopurinol (only prevent further crystals) , if uric acid is over 8 give Rasburicase (gets rid of current crystals) = give fluids

Question 46

Anti bacterial inh 50s and 30s

Answer 46

1. 50s MACROLIDES | 2. 30s TETRACYCLINES