Test May 30th

Question 1

sarcoidosis findings and labs

Answer 1

(Can happen in young AA, cough,sob) 
Bilateral hilar adenopathy****
1. Elevated ACE = elevated VitD = elevated Ca+2
2. Non-caseating granuloma 
3. CD4+ cells involved activating M

Question 2

Insulin activates what pathways

Answer 2

1. PI3K (glycogen/lipid/protein synthesis) : Protein phosphatase - glycogen making (dephospholylaed glycogen synthase)
2. RAS/MAPK (growth, dna synthesis)

Question 3

JAK kinase used for

Answer 3

GH, prolactin, cytokines

Question 4

Lipoxygenase

Answer 4

Arachidonic acid metabolism - synthesis of LEukotriens

Question 5

Phospholipids C does what

Answer 5

Activated by G protein /IP3/ Ca+2

PLC degrades phospholipids to IP3 + Diacylglycerol ( DAG and Ca+2 activated PKC)

Question 6

PKA used for

Answer 6

Glycogen breakdown when glucagon binds

= glycogen phosphorylase activated

Question 7

LIVER metabolism of

1. Fructose
2. Mannose
3. Galactose
4. Glucose

Answer 7

1. . Fructose = fructose 1-phosphate by fructokinase and then done
2. Enters as M6P —> F6P into glycolysis
3. Enters as G1P—> G6P into glycolysis
4. Enters glycolysis as G6P

Question 8

Classical PAthway
Alternative Pathway
Lectin pathway

Answer 8

1. Bacteria + IgG/IgM = C1(q,r,s) = C2, C4 = C3 (Common for SLE)**
2. C3 = C3a + C3b = Factor B/D and C3B = C3
3. Mannose rich + C1 like complex (MBL, MASP) = C2, C4 = C3

Question 9

CREST :

Ca, Raynauds, Esophageal dysmobility, Sclerodactyly, Telangiectasia

Answer 9

Esophageal dysmobility = atrophy and fibrous replacement of Muscularis in Lower Esophagus , dilating LES = heartburn

Question 10

Diffuse Esophageal spasm

Answer 10

Contractions of LES from impaired inhibitory innervation in myenteric plexus = dysphagia and CP (food not going down to stomach right)

Question 11

Microtubule drugs

Answer 11

1. Vinca alkaloids (veincristiene + Vinblasteine ) = bind to monomers = no mitosis separation
2. TAxanes (Paxlitaxel) = microtubule dysfunction

Question 12

Podophyllin

Answer 12

Treat genital warts

Question 13

Methotrexate

Answer 13

Inhibits dihydrofolate reductase

Question 14

1. Etoposide

2. Irinotecan + Topotecan

Answer 14

1. Inhibit Topoisomerase 2

2. Inhibit Topoisomerase 1

Question 15

Sofosbuvir + Ledipasvir

MOA and use

Answer 15

HepC
Inhibits viral genome replication and assembly 
1. Sofosbuvir = inhibit RNA polymerase 
2. Ledipasvir = inhibit NS5A 
3 . Simeprevir = inhibit protease

Question 16

Olsetavir MOA

Answer 16

Prevent Viron release from infected cells

= tx flu

Question 17

Pancreas

1. Secretin secretes what
2. Trypsinogen secreted by what stimulation

Answer 17

1. HCO-3 = lowering Cl-

2. CCK and Ach increases this

Question 18

O2 and CO2 pressures remain same and HR + CO increased when

Answer 18

Exercise

Question 19

Pregnancy
Elevated AFP
Lowered AFP

Answer 19

1. High AFT : tri 13, tri 18 (NTD, Ventral wall probs like omphalocele) + holoprosencepaly (tri13)
2. Low AFT : tri 21, Duodenal atresia (recanalization problem) + Hirschprungs (NCC, rectum, ) , T1D, VSD/ASD, early AD (APP), hypothyroid, atlantoaxial instability

Question 20

Brachial Plexus pneumonic of ends

Answer 20

MARMU (musculocutaneous, axial, radial, medial, ulnar)
1. Radial = humoral shaft injury, wrist and fingers down extend
2. Medial = pronation , first 3 fingers, thumb opposition
3, Ulnar = thumb abduction, finger abduction and abduction(not thumb)

Question 21

what is increased in ACE inh that causes cough

Answer 21

Bradykinin

Question 22

Kidney action

1. BB
2. ACE inh
3. ARBs

Answer 22

1. BB = block renin
2. Blocks ACE (increasing renin and angiotensin 1) (decreasing angiotensin 2 and aldosterone)
3. Blocks Angiotensin 2 (increase Angiotensin 2, angiotensin 1, renin) (decrease aldosterone)

Question 23

What nerves beyond splenic FLEXURE

Answer 23

S2-S4

External sphincter - puededal nerve branch

Question 24

Acute pericarditis causes

Answer 24

1. Viral MOST COMMON

2. .autoimmune (SLE, RA)

Question 25

What INCREASED in COPD And Bronchitis And Emphysema

Answer 25

Function Residual Capacity, Residual Volume, TLC

Question 26

UV light and Dietary vitD and liver does what and kidney

Answer 26

1. UV = 7-dehydrocholesterol —> Vit D2 /Vit D3 2. Diet = VitD2/ VitD3 3. Liver D3 /D2 —>25-hydroxyvitD (25-Hydroxylase) 4. Kidney : 1a-hydroxylase : 25-hydroxyvitD—> 1,25- dihydroxyvitD

Question 27

Meningitis in immunocompromised

Answer 27

``` Cryptococcal meningitis (cryptococcal neoformans) = yeast + polysaccharide capsule = Meningioencephalitis = India ink = Amphotericin B ```

Question 28

Germ tubes

Answer 28

Candida , true hyphe = oval budding yeast = normal oral flora

Question 29

Aortic Arches

Answer 29

``` 1 = Maxillary A 2 = Hyoid A, Stapedial A 3 = common carotid + proximal internal carotid 4 = left : aortic arch , right : proximal right subclavian A 6 = PDA, proximal pulmAs ```

Question 30

PDA closure drug

Answer 30

Indomethacin (PGE2 synthase inhibitor)

Question 31

Pseudomonas

Answer 31

Gram - bacilli , Oxidase + , green pigment Pyocyanin (oxidase - = BARTONELLA Henselae, car scratch ) Red itchy rash from hot tubs

Question 32

Sevelamer + lanthanum

Answer 32

Reduce phosphorous GI absorption (usually in CKD = cant excrete it) 1. Increases serum phosphate with low CA = secondary hyperthyroidism

Question 33

TX: 1. Vestibular N (motion sickeness) 2. Nausea with migraine 3. Normal N 4. Carcinoid D

Answer 33

1. H1 antagonist (diphenhydramine/ meclizine)+ anti-Ach (scopolamine) 2. Dopamine antagonist (metoclopramide, prochlorperazine) 3. 5HT antagonists (Odensetron) 4. Somatastatin agonist (octreotide)

Question 34

Hereditary Hemochromatosis

Answer 34

HFE gene inactivating mutation = X hepcidin ( Fe is always let into BVs from GI)

Question 35

ARDS risk factors

Answer 35

Pancreatitis Pneumonia , sepsis Trauma = high N

Question 36

ARDS what happens

Answer 36

Inflammation causing alveolar cap leakage (NEUTROPHILS** ROS and proteases) , il1, il6, TNF-a = pulm edema (intrapulmonary shunting) = LOW functional residual Volume (helped by + end expiratory pressure ventilation which opens closed alveoli)

Question 37

1. Long thoracic nerve innervates | 2. Thoracodorsal Nerve

Answer 37

1. Axilary LN dissection, Serratur Anterior (winging of scapula) 2. Altissimo dorsi (shoulder extension adduction and internal rotation)

Question 38

Histo

Answer 38

Ovoid yeast narrow based budding | = pneumonia

Question 39

CD40 is seen

Answer 39

1. APC presented to Th1 CD4 cell | 2. B cell presented to Th2 CD4 cell = class switch

Question 40

1. AML markers 2. Hodgkin lymphoma markers 3. ALL

Answer 40

1. CD33, CD13, auer rods (myeloid) 2. CD15, CD30 + Mediastinal MASS 3. Child : Bcells, Adult : Tcells ( CD3, Tdt+) + Mediastinal MASS Tdt = immature T cells and B cells

Question 41

``` Thrombotic Microangiopathy (Thrombocytopenic Thrombotic Purpura) TTP PENTAT ```

Answer 41

1. plt activation (thrombocytopenia) 2. Microvascular thrombosis (renal failure) 3. Fever + lethargy 4. Anemia 5. Schistocytes = LONG Bleeding time only Normal. PT/PTT

Question 42

Toxoplasmosis neonate SX

Answer 42

1. Chorioretinitis, Hydrocephalus, intracranial Calcifications