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TrueLearn Flashcards

1
Q

Obsessive Compulsive personality disorder

A

Pervasive pattern of preoccupation with orderliness, perfectionism and mental and interpersonal control, at the expense of flexibility, openness and efficiency.

Patients do not use compulsions as a way to relieve anxiety.

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2
Q

Obsessive compulsive disorder

A

Person is aware that obsession and compulsions are unreasonable and excess.

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3
Q

Sleep Stages EEG Waveform

A

BATS Drink Blood

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4
Q

Ebstein Anomaly

A

Displacement of tricuspid valve leaflets downward into RV, artificially atrializing the ventricle. Associated with tricuspid regurgitation and right HF. Can be caused by lithium exposure in utero.

Wide splitting of the first heart sound.

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5
Q

Anamnestic antibody response

A

When received O- positive blood though blood type is O-negative.

Reaction present with hemolysis and fever and are seen two to ten days after transfusion. Jaundice and indirect hyperbilirubinemia signify hemolysis.

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6
Q

Febrile nonhemolytic reaction

A

Occurs one to six hours following transfusion. Symptoms are self-limited and include fever, chills and dyspnea.

A reaction due to antibodies against leykocytes.

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7
Q

Exposure to IgA antibodies in donor blood

A

Anaphylactic reaction ocurring in IgA deficient recipients. Symptoms of hypotension, edema and respirarory distress occur immediately after exposure to donor blood.

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8
Q

IgM antibodies against donor ABO antigens

A

ABO incompatible blood transfusion. Result in fever, flank pain and hemoglobinuria and sometimes shock, disseminated intravascular coagulation, or renal failure. Immediate hemolytic reactions.

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9
Q

Reaction of IgE antibodies against allergens in donor blood

A

Results in urticaria.

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10
Q

Wernicke- Korsakoff Syndrome

A

B1 deficiency
Triad of confusion, ophthalmoplegia (nystagmus) and ataxia.

Associated with periventricular hemorrage/necrosis pf mammillary bodies.

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11
Q

Cystinuria

A

Hereditary defect of renal PCT and intestinal aminoacid transporter that prevents reabsorption of Cystine, Ornithine, Lysine and Arginine. Excess cystine in the urine can lead to recurrent precipitation of hexagonal cystine stones.
Can present with mio ardial infarction, trombosis, and downward and inward eye movement.

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12
Q

Hypocalcemia

A

Tetany, lethargy, seizures, and coma.

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13
Q

Di George syndrome is associated with:

A

Congenical cardiac abnormalities, most notably tetralogy of Falot (boot shaped heart) and truncus arteriosus.

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14
Q

In folate deficiency, thymidine supplementation is given to…

A

Decrease apoptosis of erythrocyte precursors.
Folate-deficient erythroblasts have a higher rate of apoptosis than those not deficient, and the cells can be rescued by administration of thymidine.

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15
Q

Esophageal lymph node involvement

A

Upper: Cervical

Middle: Mediastinal, Paratracheal, Tracheobronchial

Lower: Gastric and Celiac

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16
Q

DIC

A

Triggered via release of tissue factor.

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17
Q

Idiopathic thrombocytopenic purpura

A

Autoantibodies to platelet glycoproteins

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18
Q

ADAMTS 13

A

Causes thrombotic thrombocytopenic purpura and hemolytic- uremic syndrome. It degrades multimers of Von Willebrand factor. Without it, multimers promote platelet aggregation and lead to siffuse clotting.

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19
Q

Henoch- Schonlein puepura

A

Palpable purpura, arthralgias, abdominal pain, and renal failure. Leukocytoclastic vasculitis with IgA immune complex deposition.

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20
Q

Heroin user

A

Staph Aureus

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21
Q

Aspiration pneumonia in a Parkinson patient

A

Klepsiella sp

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22
Q 
Shingles
Petechia
Decreased breath sounds
Rhonchi bilaterally
Diarrhea
WBC: 3.05
A

HIV

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23
Q

Sigs of Parinaud’s Syndrome

A

Vertical gaze palsy and absent pupillary light reflex with intact accomodation. Most commonly due to lesions within the pineal gland.

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24
Q

Tay- Sachs disease

A

Accumulation of GN2 ganglioside, deficiency of hexosaminidase A. Cherry red spot on the macula.

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25
Q

Multiple myeloma

A

Amyliodosis (heart, liver and kidneys. Problems in the kidney (nephrotic syndrome), in the heart (increased jugular vein pressure and hepatomegaly).

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26
Q

MALT Translocation

A

t(11;18)

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27
Q

Bile acid sequestrants

A

Cholestyramine, colestipol and colesevelam

Decrease LDL, no effect on HDL or triglycerides.

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28
Q

Ethambutol

A

Increase activity of arabinosyltransferase.

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29
Q

Ubiquitin

A

Proteosome degradarion of cytoskeleton

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30
Q

Apocrine Metaplasia

A

Fibrocystic changes of the breast, does not lead to Cancer.

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31
Q

Keratomalacia

A

Thickening of the conjunctiva due to a deficiency of Vit A

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32
Q

Myositis ossificans

A

Inflammation of the skeletal muscle result in a metaplastic production of skeletal muscle; usually when healing from trauma.

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33
Q

Lafora bodies

A

AR
Many cells, including neurons, develop inclusion bodies known as Lafora bodies. The most common initiql presentation is new onset seizures in adolescents. The epilepsy progresses, and there is no treatment with the exception of attempting symptom control. Stain with PAS stain. It is used to demostrate glycogen, glycoproteins or other carbohydrates.

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34
Q

Minute ventilation

A

= tidal volume X respiratory rate

= tidal volume X (weight X breath per minute)

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35
Q

PArotid excretory ducts

A

Pseudostratified columnar epithelium

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36
Q

Hereditary hemorrhagic telangiectasia

Osler- Weber- Rendu Syndrome

A

AD
Recurrent epistaxis, skin discolorations, mucosal telangiectasia and gastrointestinal bleeds.

Pathophysiology: arteriovenous malformation of the small vessels.

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37
Q

Pleural effusions

A

Transudative= <1/2 the protein concentration of the patient’s serum, 60% the LDH concentrarion of the patient’s serum or <2/3 of the upper limits of normal for serum LDH.

Exudative= high protein and LDH concentration.

Etiologies= bacterial pneumonia, malignancy, pulmonary embolism, lupus, pancreatitis and Boerhaave’s syndrome.

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38
Q

Ankylosibg spondylitis

A

Chronic inflammatory disease of the spine and sacroiliac joints that is characterized by bilateral sacroiliitis and ankylosis or fusion of the spine in an ascending manner. Enthesitis or inflammation at tendinous insertions, is a common clinical finding. The spine is prone to fracture and injury. With involvement of the thoracic spine, patients experience diminished chest expansion and present with a restrictive pattern or pulmonary fibrosis, uveitis, renal disease and cardiac abnormalities.

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39
Q

Memory T cells needs……

A

CD28 on the T cell and B7 on the APC

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40
Q

Microarray

A

Is a technique that can be used to determine the relative differences in gene expression in one sample as compared to another. In this technique, nucleic acid sequences are affixed to a plate.

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41
Q

Borreloa hermsii

A

Relapsing fever/ zoonotic illness/ spirochetal organism. Tick-borne relapsing fever.

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42
Q

Chocolate blood agar

A

Is a variant of the common blood agar plate. Contains red blood cells which are slowly heated to 56*C in order to promote the lysis of the RBC.

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43
Q

Locus heterogeneity

A

Presence of the same phenotype due to mutations in genes at different loci.

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44
Q

Widely split S2

Fixed S2

A

Patent foramen ovale

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45
Q

Chediak-Higashi syndrome

A 
Microtubular function defect
Recurrent pyogenic infection by Staph and Strep
Partial albinism
Peripheral neuropathy
Nitroblue test positive
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46
Q

Wolf-Parkinson-White

A

Congenital (accessory) conduction pathway connecting the atria and ventricles, resulting in characteristic tachucardia on electrocardiogram.

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47
Q

Neurofibromatosis

A

Cr 22
AD
NF2 gene
Acoustic neuromas, dysequilibrium, hearing loss, and tinnitus.

High risk to develop meningiomas, perioheral neuropathy, cataracts and gliomas.

Cafe-au-lait spots may be present (most common on type 1)

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48
Q

Calcium bindings

A

Calcium binds to Troponin C in skeletal and cardiac muscle and binds to calmodulin in smooth muscle.

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49
Q

Ketogenic amino acids

A

Diets high in leucine and lysine are important for patients with pyruvate dehydrogenase deficiency in order to decrease the chronic lactic acidosis they would otherwise experience.

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50
Q

Chedial- Higashi syndrome

A

Recurrent Pyogenic infections, gray hair, and decreased skin pigmentation, neutropenia, thromblcytopenia and hypergammaglobulinemia. Deficit in microtubule polymerization, leading to impaired phagocytosis.
Tx: bone marrow transplant

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51
Q

Xeroderma pigmentosum

A

AR
Mutation in the nucleotiee excision repair proteins.
Extreme sun sensitivity, hyperpigmented lesions that appears as freckles. Can progress to telangectasias and can lead to multiple skin cancers. Ocular symptoms such as photophobia and conjunctivitis are common.

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52
Q

Scurvy syndrome

A

Due to deficiency of vitamin C. It is essential along with cooper, in the hydroxylation of dopamine to norepinephrine. It is also needed for adrenal steroids and reduction of Fe2+ in the GI tract and for the hydroxylation of proline and lysine residues in the endoplasmic reticulum during collagen synthesis. Symptoms and signs includes iron deficiency anemia, coagulopathies and poor wound healing.

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53
Q

Many CD14+ cells

A

Macrophages

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54
Q

Mast cells

A

Contains granules rich in histamine amd heparin. They are identified by staining for markers such as CD25 and CD117.

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55
Q

Creatinine clearance

A

(Urine Creatinine) x (volume)/serum creatinine

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56
Q

H influenza growth

A

Chocolate agar, NAD (factor V) and hematin.

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57
Q

POL

A

Gene that forms reverse transcriptase

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58
Q

NK Cells

A 
Kill cells with decreased levels of MHC class I expression.
CD13+ and CD16/56+
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59
Q

Cluster A Personality Disorder

A

Odd or eccentric

Paranoid personality disorder, schizoid personality disorder and schizotypal personality disorder.

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60
Q

Cluster B Personality Disorder

A

Emocional, dramatic and impulsive. These include antisocial disorder, borderline personality disorder, histrionic personality disorder and narcissistic personality disorder.

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61
Q

Splitting personality

A

Labeling people as all good or all bad.

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62
Q

Cluster C Personality Disorder

A

Dependent, Anxious and fearful disorder

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63
Q

Identification

A

Inmature mechanism that involves modeling behavior after someone else.

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64
Q

Sublimation

A

Mature defense mechanism where one converts unacceptable impulses into an acceptable form.

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65
Q

VACTERL

A

Mesodermal defect that includes:
Vertebral anomalies, Anal atresia, cardiac malformation, tracheoesophageal fistula, renal anomalies and radial limb defect.

Also in girls, vaginal septum and bicornate uterus. Cryptorchidism is reported in males.

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66
Q

Ehlers Danlos syndrome

A

Hyperextensible skin, joint hypermobility, multiple joint dislocations, translucent skin, POOR WOUND HEALING, easy bruising and unusual scars.

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67
Q

Kawasaki’s disease

A

Necrotizing medium sized vessel vasculitis which usually presents in children less than five years.

Physical exam will show erythema and edema of hands and feet, cervical lymphadenopathy and oral erythema with cracked lips.

May develop coronary artery aneurysm.

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68
Q

Tuberculosis possesses a resistance to…..

A

Mutation of the ribosomal protein S12. This mutation has beed demostrated in isolates with streptomycin resistance.

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69
Q

Binds to the 30S subunit of the bacteriañ ribosome and prevents protein translation…

A

Streptomycin

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70
Q

Certain M Tuberculosis strains have a mutation to the rpsL gene that codes for ribosomal protein S12, which causes…

A

Antibiotic resistance

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71
Q

Release of exotoxins released by bacteria that disrups desmosome in epidermis…

A

describes the parhophysiological mechanism of exfoliative toxin seen in Staphylococcal scalded skin syndrome, who typically occurs in newborns and children less than 1 year.

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72
Q

Atherosclerosis

A

Asoc with smoking, diabetes, hypotension and hyperlipidemia.

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73
Q

Acute tubular necrosis pathogenesis

A

Trying to reabsorb myoglobulin in the proximal convulated tubule, it suffers from free radical damage from the myoglobin, ending in necrosis.

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74
Q

Why does Statins can cause rhabdomyolisis?

A

By blocking the synthesis of mevalonic acid, it also stop the formation of Farnesyl, which is a intermediary step in the synthesis of cholesterol, and the one needed to form CoQ, an essencial enzyme in the electron transport chain.

⬇️CoQ ➡️⬇️ATP⬇️Sodium pump⬆️sodium swelling➡️cell death

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75
Q

Creatinine kinase

A

How much muscle breakdown has going on (statins use).

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76
Q

Bile acids resins can only be used in…

A

Pure hypercholesterolemia

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77
Q

Decrease in VLDL Production…

A

Hepatotoxicity

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78
Q

Statins synergistic rxn

A

With Ezetimibe

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79
Q

The most important virulence factor that S. epidermidis produces that allows it to establish a significant infection is…

A

…a biofilm - an extracellular polysaccharide slime which encases the bacteria

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80
Q

Cystinuria

A

cysteine kidney stones (hexagonal crystals), give acetazolamide to alkalize the urine.

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81
Q

Heteroplasmy

A

refers to the presence of both mutated and non-mutated mitochondrial DNA within the same cell, leading to differences in disease severity

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82
Q

mannose 6-p

A

ER to lysosomes

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83
Q

Concentric hypertrophy

A

S4
Marked ventricular concentric hypertrophy
Sarcomeres added in parallel

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84
Q

Point of maximum impulse that is displaced to the mid-axillary line

A

Left ventricular hypertrophy

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85
Q

Dilated cardiomyopathy

A

HF
S3
Systolic regurgitant murmur
Eccentric hypertrophy

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86
Q

Anabolic steroids mechanism of action

A

Increasing insulin-like growth factor-1 (IGF-1) signaling

Decrease luteinizing hormone (LH) release

Decrease glucocorticoid signaling

Enhance creatine phosphokinase activity.

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87
Q

Failures
Pre-Renal
Post- Renal
Intrinsic renal

A

Pre: 20:1 or more
Post: 10-20:1
Intrinsic: <10:1

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88
Q

Sleep stages

N3 and N4, REM in EEG

A

Delta waves
Lowest frequency
Highest amplitude

REM: low amplitude and high frecuency

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89
Q

Delusion

A

Disorders of thought content or perception.

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90
Q

Rocuronium

A

Belongs to the class of non-deolarizing relaxants and is used in the induction of general anesthesia. Is a competitive antagonist of Acetylcholine.

Give Neostigmine, atropine to be reversed.

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91
Q

Hurler’s syndrome

A

Is due to a deficiency in alpha-L-iduronidase, leading to accumulation of heparin sulfate and dermatan sulfate. Patients presents with developmental delay, airway compromise, clouded corneas and hepatosplenomegaly.

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92
Q

Lancet shaped gram +

A

Streptococcus pneumoniae

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93
Q

Meningitis by group

A

Neonates: group B strept and E Coli

Infants: H influenza type B, Strept pneumoniae or Neisseria meningitidis.

Adults: Streptococcus pneumoniae

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94
Q

Candida

A

Budding cells and pseudohyphae

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95
Q

Aphthous ulcers

A

Superficial ulcerarion within the mucous membrane of the inner mouth. Do not occur on the tongue.

Ulceras bucales

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96
Q

Cheilosis

A

Scarring of the corners of the mouth that is associated with vitamin B2 deficiency.

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97
Q

Leukoplakia

A

Associated with HIV, smoking, tobacco chewing, chronic alcohol use and Epstein-Barr virus. It occurs from marked hyperkeratosis, forming q rough, hairy surface and may lead to squamous cell carcinoma.

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98
Q

Pericarditis

A

Chest pain exacerbates with lying down.
Faint heart sound during both systole and diastole.
Fever and pericardial friction rub beast heard with the patient leaning foward.
EKG will classically show ST elevations in all leads.
Tx:NSAIDs

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99
Q

Neural tube defects

A

Folate deficiency

Anticonvulsants (carbamazepine and valproic acid)

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100
Q

Hirschsprung’s disease

A

Aganglionic segment of the colon due to failure of neural crest cell migration during embryologycal development. This result in distal intestinal obstruction and failure to pass stool in the newborn period.

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101
Q

Wilson disease

A

AR
Impaired cellular cooper transport
Choreiform movements, behavioral changes, liver failure.
Accumulation of cooper in the liver, brain, cornea and other organs.
Tx: penicillamine

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102
Q

Systemic lupus erythematous

A

Arthritis, oral ulcers, malar rash, and fatigue.

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103
Q

Systolic murmur at the 4th intercostal space left sternal border

A

Normal

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104
Q

Hyaline casts

A

Normal

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105
Q

Mild infection pO2 and A-a difference

A

pO2 of 70mmHg or greater or a A-a difference of less than 35mmHg.

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106
Q

HIV infections at:
CD 200
CD 100
CD 50

A

CD 200: Pneumocystis jirovecii
CD 100: Candidal esophagitis, toxoplasmosis and histoplasmosis.
CD 50: CMV retinitis and esophagitis, M. Avium.

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107
Q

Clomiphene

A

Estrogen modulator that is frequently used to induce ovulation in patients with a history of oligoovulation, such as polycystic ovarian syndrome, this medication binds to estrogen receptors within the hypothalamus, preventing negative feedback inhibition by endogenous estrogens. This stimulates the release of both follicle stimulating hormone and luteinizing hormone.

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108
Q

Osmotic agents

A

Works in the proximal convulated tubule, thin descending limb and collecting tubule.

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109
Q

Triamterene

A

Potassium-sparing diuretic

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110
Q

Linkage disequilibrium

A

This occurs when two genes are located closely on the same chromosome. During meiosis, genes that are more closely located on a chromosome are less likely to segregate than those that are on different chromosomes or further apart on the same chromosome. Linkage disequilibrium is useful for mapping of genes on chromosomes.

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111
Q

Dominant negative mutation

A

A dominant negative mutation occurs when a mutation in a single allele causes a non-functional protein that results in the new phenotype.

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112
Q

Codominance

A

In codominance, the two different alleles are expressed at the same time and neither allele is dominant. The ABO blood type system is an example. In this example, the ABO blood type is not the question, but it is the increased correlation between the presence of an A blood type and the disease in question

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113
Q

Myoglobin in urine

A

Myoglobin is a sign of rhabdomyolysis, which can occur after severe crush injuries.

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114
Q

Eosinophils

A

Eosinophils are often seen in drug-induced interstitial nephritis.

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115
Q

Oval fat bodies in urine

A

Oval fat bodies are seen accompanying nephrotic syndromes. It is not as likely as red blood cell casts in patients with lupus nephritis.

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116
Q

Triple phosphate crystals

A

Triple phosphate crystals are a sign of Proteus infection.

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117
Q

Osteoprotegerin function

A

Marrow stromal cells naturally produce WNT proteins that bind to osteoblast receptors, increasing β-catenin and osteoprotegerin secretion. Osteoprotegerin, in turn, acts as a “decoy” receptor for RANK ligand that slows osteoclast formation and action (Answer F). Estrogen deficiency increases secretion of IL-1, IL-6, and TNF-α, resulting in increased levels of RANK and RANK-L, and hence increasing osteoclast formation and action. Estrogen deficiency also results in decreased levels of osteoprotegerin. These are the reasons estrogen deficiency contributes to development of osteoporosis in post-menopausal women.

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118
Q

Common peroneal neck fracture

A

The common peroneal nerve can be injured following a fracture to the fibular neck. This nerve injury leads to the classic presentation of foot drop and sensory loss over the dorsal foot and lateral leg.

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119
Q

Clear cell adenocarcinoma of the vagina

A

The major risk factor is a mother who took diethylstilbestrol (DES) during pregnancy. The cancer typically presents in adolescence, but can also present in childhood. It is so-named because of the large clear cytoplasm of the malignant cells. DES was used by mothers who had chronic spontaneous abortions in an attempt to maintain their pregnancy.

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120
Q

Cavernous sinus

A

Cranial nerves III, IV, V1, V2, and VI pass through the cavernous sinus. A tumor within that area can lead to cavernous sinus syndrome due to a mass effect on these nerves. The internal carotid artery also passes through the cavernous sinus. The third branch of the trigeminal nerve is the only portion of the trigeminal nerve that does not pass through the cavernous sinus.

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121
Q

Elevated epsinophils

A

IL-5

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122
Q

Secretin

A

This hormone is released from the S cells of the duodenal mucosa and stimulates the release of bicarbonate from the pancreas.

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123
Q

Swallowing nerves

A

CN IX: taste of posterior 1/3 of the tongue and assists in swallowing.

CN X: responsible for taste in the epiglottis and assists in swallowing, elevarion of the palate and speech.

Both, with XI pass throw the yugular foramen

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124
Q

Reference Ranges of:

Hematocrit
Platelet
White blood cells (leukocyte count)

A

Reference Ranges of:

Hematocrit W 36-46 M 41-53
Platelet 150,000-400,00
White blood cells (leukocyte count) 4500-11000

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125
Q

Wilson disease

A

AR
Fatigue, memory loss( due to accumulation of copper in the brain)
Kayser-Fleischer rings (brown rings in the eye)
Can cause renal tubular acidosis type II which would lead to hypokalemic, hyperchloremic nonanion gap metabolic acidosis.

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126
Q

Infantile polycistic kidney disease

A

AR
Oligohydramnios
Pulmonary hypoplasia
Hepatic cysts and fibrosis

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127
Q

Adult polycystic kidney disease

A

Berry aneurism

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128
Q

Ibuprofen effect on renal function

A

By taking Ibuprofen, there was a constriction of the afferent arteriole, decreasing GFR and RPF causing acute kidney injury.

NSAIDS blocks the synthesis of prostaglandins which helps dilate the afferent arteriole.

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129
Q

Hypercalcemia

A

“Bones, stones, abdominal groans and psychiatric overtones”

Causes: metastatic breast cancer with has likely metastasized to her bones.

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130
Q

Hypocalcemia

A

Tetany, CHF, arrythmias and seizures.

Causes: Prostate cancer with metastasis to the bone.

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131
Q

Goodpasture’s syndrome

A

Is a disorder in which anti-glomerular basement membrane antibodies damage the glomeruli and the pulmonary alveoli. PAS- staining of a renal biopsy can show epithelial crests.

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132
Q

IgA nephropathy

A

Berger’s disease

Appears as immune complexes deposited in mesangium.

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133
Q

Fomepizole

A

Methanol and Ethylene glycol antidote, inhibiting alcohol dehydrogenase.

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134
Q

HIGH Anion Gap

MUDPILES

A

Methanol
Uremia
Dka

Propylene glycol
Iron tablets or INH
Lactic acidosis
Ethylene glycol 🔜 oxalic acid
Salicylates (late)
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135
Q

Normal anion gap

Hardass

A 
Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea
Acetazolamide
Spironolactone
Saline infusion
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136
Q

Respiratory acidosis

A

Opioids, sedatives

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137
Q

Respiratory alkalosis

A 
Kysteria
Hypoxemia (high altitude)
Salicylates (early)
Tumor
Pulmonary embolism
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138
Q

Metabolic alkalosis

A

Loop diuretics
Vomiting
Antacid use
Hyperaldosteronism

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139
Q

Signs of hyperkalemia

A

Metabolic acidosis, muscular weakness, fatigue, high T wave, low ST segment, eventually in severe hyperkalemia venteicular fibrillation.

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140
Q

Von Gierkes disease

A

Deficiency of glucose-6-phosphatase. Patients present within the first year of life with hepatosplenomegaly, lactic acidosis, thrombocytopenia, renal disease, hypertriglyceridemis and hypoglycemia.

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141
Q

McArdle disease

A

Muscle phosphorylase deficiency

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142
Q

Hemamgioblastoma

A

Are most commonly found within the cerebellum, arising from the vasculature. Patients may present with symptoms pf cerebellar ataxia due to the location of the lesion within the cerebellum.

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143
Q

Glioblastoma multiforme

A

Grade IV astrocytoma that occurs in adults. It occurs within the cerebral hemispheres and may cross the corpus callosum. It appears as a ring on MRI that enhances with contrast with a central hypodense region due to the presence of a central area of necrosis.

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144
Q

Medulloblastoma

A

Most common malignant primary brain tumor in children that occurs within the cerebellum and can lead to hydrocephalus due to compression of the fourth ventricle. Biopsy reveals rosettes.

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145
Q

Meningiomas

A

Second most common cause type of primary brain tumor and the most common benign tumor. These arise from the arachnoid cells within the meninges. Biopsy reveals spindles cells arranged in a whorled pattern with psammoma bodies.

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146
Q

Avoidant personality disorder

A

Cluster C personality

Patients desire interpersonal relationship but they are too insecure to establish them.

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147
Q

Schizoid personality

A

Socially withdrawn
No desire to establish relationships
They are happy being isolated and have flat or blunted affects.

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148
Q

Non seminoma tumors

A

Embryonal carcinoma, teratoma, choriocarcinoma, yolk sac tumors and mixed germ cell tumors.

BHCG is elevated and AFP.

Pure seminomas do not cause AFP elevation.

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149
Q

Leydig cell tumor

A

Benign testicular tumor, gynecomastia due to increased secretion of androgens.

No AFP or beta-HCG elevation.

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150
Q

Seminomas

A

Painless testicular masses that have large cell with abundant cytoplasm and central nuclei on biopsy.

No AFP elevation.

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151
Q

VWF

A

High PTT, high bleeding time, normal PT, normal platelet count.

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152
Q

Thrombotic thrombocytopenic purpura and idiopathic thrombocytopenic purpura

A

Neurologic manifestations such as altered mental status, fever and hemoglobinuria.

Normal PT, PTT and bleeding time with low platelets.

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153
Q

Disseminated intravascular coagulation

A

Abnormality in all coagulation parameters and thrombocytopenia.

154
Q

Chorion and amnion formation time

A

The chorion is formed on day 3, and the amnion is formed by day 8.

Dizygotic twins do not split since they are independent embryos at all timesduring development and would never share common membranes.

155
Q

Giant cell arteritis

A

Common vasculitis affecting medium and large sized vessels, particularly the temporal artery.

Diagnostic criteria:
55 years
New on set headache 
Temporal artery tenderness
Erythrocyte sedimentation rate greater than 50mm/h
Abnormal arterial biopsy
156
Q

Mechanism by which HBV leads to development of cancer

A

Viral integration into host genome

157
Q

Causes of oligohydramnios

A

Bilateral renal agenesis, polycystic kidney disease, hydronephrosis and other causes of ureter obstruction.

158
Q

Iodine 131 uptake

A

In a person with hyperthyroidism the uptake will be increased. In a person with exogenous hyperthyroidism it will be decreased.

159
Q

Most common cause of otitis media

A

Strep pneumo
Nontypable Haemophilus influenza
Moraxella catarrhalis

160
Q

HCV genomic heterogeneity

A

HCV RNA polymerase lacks 3’ to 5’ proofreading exonuclease. It can lead to variability to treatment response and prevents the development pf a vaccine because the virus can develop ways of evading the host immune response.

161
Q

Cold agglutinin disease

A

Monoclonal IgM antibodies are formed against red blood cell markers.

Usually idiopathic, however, there are associations between IgM formation and leukemia as well as viral infections, such as cytomegalovirus, infectious mononucleosis, HIV, and parvovirus B19 and mycoplasma pneumoniae.

162
Q

Used to treat preterm labor

A

Terbutaline

Beta 2 agonist

163
Q

Treatment for CMV

A

Gancyclovir

164
Q

Decompression syndrome

A

Due to ascending rapidly, creating bubbles of nitrogen in tissues and vessels. Patients present with a variety of complaints: pain joint and muscles, nausea, vomiting, altered mental status and seizures, respiratory distress.

Tx: 100% Oxigen

165
Q

Employment in shipyards

A

Increase risk of asbestos exposure. Can cause mesothelioma and presents with shortness of breath.

166
Q

Trypanosoma cruzi

A

Dilated carsiomyopathy, mega colon, megaesophagus, predominantly in South America. No bowel movement, dilated esophagus and colon.

Cell directed cytotoxicity.

167
Q

Lyme disease

A

Doxyxycline is the drug of choice, but in pregnancy and children give amoxicillin.

168
Q

Thromboxane

A

Is produced by activated platelets and has prothrombotic properties, it stimulates activation of new platelets as well as increases platelet aggregation.

169
Q

Aspirin

A

Inhibits production of prostaglandins and thromboxane by inhibiting cyclooxygenase system. It also irreversibly inhibits platelets aggregation.

170
Q

Why is aspirin an uncoupling agent of oxidative phosphorylation?

A

It increases the permeability of the inner mitochondrial membrane, this decreases the ability of the membrane to hold the proton gradient generated by the elctron transport chain.

171
Q

Teratogenecity of Isotretinoin…

A

Severe fetal malformations such as facil asymmetry, ear abnormalities and ocular hypertelorism.

172
Q

ACE inhibitors teratogenecity

A

Renal failure and renal dysplasia.

173
Q

Hypersensitivity pneumonitis

A

Type III/IV HS reaction to environmental antigen.
Dyspnea, cough, chest tightness, headache.
Often seen in farmers and those exposed to birds.

174
Q

Recruits neutrophils

A

IL-8 throw macrophages

175
Q

FGG receptor 3 mutation

A

Achondroplasia

176
Q

FMR1 gene mutation

A

Fragile X sybdrome

177
Q

NF2 gene

A

Neurofibromatosis type 2

178
Q

VHL inCr 3

A

Von Hippel Lindau disease

179
Q

Fibrillin 1

A

Marfan’s syndrome

180
Q

Collagen mutation

A

Ehler Danlos Syndrome

181
Q

Leydig cell tumor

A 
Reinke crystalloids (hexagonal prisms, produces testosterone in response to LH)
Painless testicular mass.
182
Q

Carcinoid tumor symptoms

A

Wheezing, flushing and diarrhea

On biopsy you will we multiple rosettes

183
Q

Melatonin

A

Screted by the pineal gland in order to regulate circadian rhythms.

184
Q

Mycoplasma pneumoniae

A

Atypical pneumonia
Stains poorly using Grams method
Do not have a peptidoglycan cell wall, rather it has a triple layered membrane that incorporates sterols.
Colonies are described as fried eggs.

185
Q

Conversion disorder

A

Classic reaction in young females to stressful life events in which they present with some deficit in neurologic function. This can manifest as paralysis/paresis, blindness ans seizure-like activity.

186
Q

I-cell disease

A

Lysosomal storage disorder
Defect in N-acetylglucosaminyl-1-phosphotransferase, failure of the Golgi to phosphorylate mannose residues, so, decrease mannose-6-phosphate, so proteins are secreted rather than being delivered to lysosomes.
Features: coarse facial features, clouded corneas, restricted joint movement and high plasma levels of lysosomal enzymes.

187
Q

Osteogenesis imperfecta gene defect:

A

COL1A1 and COL1A2

188
Q

Hereditary Spherocytosis

A

Spheroid erythrocytes due to spectrin or ankyrin defect.

189
Q

Biotin deficiency

A

myalgias, dermatitis, altered mental status, nausea, and anorexia.

190
Q

High levels of avidin

A

Avidin binds to biotin tightly, leading to decreased amounts of available biotin.

191
Q

Dextromethorphan

A

in combination with antidepressants can cause a serotonin syndrome.

192
Q

Vesicouretral reflux

A

congenital condition in which urine abnormally flows from the bladder back to the ureters.

193
Q

Blood supply to the different regions of the ureter?

A

Proximal: renal artery, middle: small branches from common iliac artery and distal: superior vesicle artery.

194
Q

CREST

A

Calcinosis, Reynaud phenomenon, Esophageal dysmotility, sclerodactily, telangiectasias.

195
Q

Scleroderma autoantibody (limited and diffuse)

A

anti-centromere (limited)

anti-scl-70 (anti-DNA topoisomerase 1)

196
Q

Fetal Alcohol syndrome

A

Smooth philtrum, a thin vermilion border of the upper lip and short palpebral fissures.

197
Q

Rotenone

A

found in insecticides and some rat poisons. It inhibits complex I in the mitochondria, leading to symptoms consistent with Parkinson disease in rat models. By inhibition of complex I in the electron complex chain in the brain, there is increased oxidative stress in the brain, leading to damage.

198
Q

Hydroxyurea

A

Decrease in concentration of Hemoglobin S in Sickle cell disease patient.

199
Q

Viral Meningitis

A

modestly elevated protein and normal glucose.

200
Q

V1, V2, V3 foramen

A

V1: Superior orbital fissure
V2: Foramen rotundum
V3: Foramen Ovale

201
Q

Brenner tumor

A

Rare ovarian tumor and is a part of the surface epithelial group of ovarian cancer.

202
Q

Phyllodes tumor

A

(Nonepithelial neoplasm) rarely, breast benign tumor, sharply demarcated, freely movable, display rapid growth, non tender, rarely involve the nipple or areola.

203
Q

Total cholesterol equation

A

TC= HDL+LDL+(TG/5)

204
Q

Epinephrine

A

B1=HEART RATE
B2=BRONCODILATION, DECREASE RELEASE OF MAST CELLS
A1=VASOCONSTRICTION AND DECREASE MUCOSAL EDEMA UN THE URT AND INCREASE AIR FLOW

205
Q

Vit E

A

Necessary for protect erythrocytes from hemolysis.

206
Q

Autoimmune enteropathy

A

anti-goblet or anti-enterocytes
chronic diarrhea and malabsorption
partial villous blunting with deep crypt lymphocytosis

207
Q

Anti-Ro

A

Sjogren Syndrome

208
Q

Autoimmune hepatitis

A

Anti nuclear antibody positive

fever, high transaminase levels, hepatosplenomegaly

209
Q

Inulin

A

GFR

Freely filtered, not reabsorbed nor secreted.

210
Q

PAH

A

RPF, freely filtered and poorly reabsorbed in the proximal tubules.

211
Q

Pill esophagitis

A

Asoc. w/Boorhave syndrome
caused by: iron, potassium, bit C, alendronate, risedronate, tetracycline, aspirin, NSAID’s, quinidine.

Severe retrosternal chest pain, retching, vomiting, cyanosis, fever, odynophagia, shock.

212
Q

Valsalva maneuver

A

Maneuver that reduce the left ventricular end diastolic (decreased preload, decreased after load) will worsen the outflow obstruction and intensify the murmur.
also asoc. with (squatting then standing), nitrates, vasodilators and diuretics.
Asoc with hypertrophic cardiomyopathy.

213
Q

Gabapentin

A

anti-seizure
tonic-clonic seizures
neuropathic pain
hot flashes and menopausal woman

214
Q

Hartnup disease

A

AR
Defective neutral amino acid transporter on renal and intestinal epithelial cells. This causes tryptophan excretion in urine and decreased tryptophan absorption from the gut. Some may present with sudden onset of skin eruptions, cerebellar ataxia and gross aminoaciduria.

215
Q

Chondrocytes function

A

Cartilage synthesis

216
Q

Osteomalacia and rickets

A

Decreased bone mineralization which is caused by vitamin D deficiency.

217
Q

Medications that precipitate digoxin?

A

Verapamil and diltiazem

218
Q

Vitamin B1 (thiamine) deficiency

A

Wet beri beri, a form of congestive cardiomyopathy.

219
Q

Vitamin B2 deficiency (riboflavin)

A

Corneal neovascularization

220
Q

Crescendo-decrescendo systolic murmur

A

Aortic valve stenosis

221
Q

Budd-Chiari syndrome

A

Is characterized by an oclussion of the intrahepatic veins leading to congestive liver disease. Patients with an increased risk pf thrombus, such as those with anti-phospholipid antibody syndrome, are more likely to develop this syndrome.

222
Q

Anti-centromere antibody

A

Scleroderma CREST

223
Q

Status epilepticus first line Tx

A

Benzodiazepines (Lorazepam)

224
Q

Ito cells

A

Hepatic stellate cells found in the space of Disse, involved in liver fibrosis and the formation of scar tissue. Are also responsible for absorbing Vitamin A.

225
Q

Medullary syndrome

A

Ipsilatetal paralysis of the tongue with deviation towards the side of the infarct, hypoglossal nerve fiber paralysis, hemiplegia on the contralateral side pf the infarct due to damage of the medullary pyramid and loss of discriminative touche, conscious propio eption and vibration sense on the contralateral side of the infarct due to damage of the medial lemniscus.

226
Q

Lateral medullary syndrome

A

Sensory deficits affecting the trunck and extremities on the opposite side of the infarction and sensory deficits affecting the face and cranial nerves on the same side with the infarct. There is a loss of pain and temperature sensation on the contralateral side of the body and ipsilateral side of the face.

227
Q

Klumpke’s palsy

A

Damage to the C8,T1 nerve roots and presents with isolated hand paralysis and Horner’s syndrome.

228
Q

Angioedema

A

Deficiency of C1 esterase inhibitor which deregulates many proinflammatory pathways. The disease manifests with very quick onset of edema in the face, limbs, tongue, larynx, throat and lips.

229
Q

Sensory receptors:

Free Nerve endings
Meissner corpuscles
Pacinian corpuscles
Merkel discs
Ruffini corpuscles
A
  • Pain and temperature
  • Fine touch and position sence
  • Vibration and pressure
  • Pressure, position sense
  • Pressure
230
Q

Lead intoxication

A

Dimercaprol

231
Q

Trimethoprim and benzocaine side effect:

A

Methemoglobinemia, give methylene blue and remove the inciting agent.

232
Q

Achondroplasia

A

Mutation in the Fgf-3 receptor with normal levels of GH and IGF-1.

233
Q

Sturge-Weber syndrome

A

Congenital port wine stain in the distribution of the trigeminal nerve. Common complications include seizure, mental retardation, and open angle glaucoma. Anomaly of neural crest derivatives.

234
Q

Henoch-Schonleim purpura

A

Palpable purpura of the buttocks ans lower extremities, arthralgias and abdominal pain, typically following an upper respiratory infection.

235
Q

Benzodiazepine overdose antidote:

A

Flumazenil

236
Q

Ethylene glycol overdose antidote:

A

Fomepizole

237
Q

Acetaminophen intoxication

A

N-acetylcysteine

238
Q

Cerebral vermis

A

Controls coordination of the trunk (truncal ataxia)

239
Q

Cerebellar hemispheres

A

Control limb propioception and coordination (ipsilateral limb ataxia)

240
Q

Inferior cerebellar peduncle

A

Propioceptive information (unilateral symptoms)

241
Q

Superior cerebellar peduncle

A

Efferent propioceptive information fron the cerebellum ti the midbrain and pond

242
Q

Cheyne-Stokes respirations

A

Type if respirations characterized by cyclic, crescendo-decrescendo breathing that can be seen in patients with heart failure.

243
Q

Cause contraction metabolic alkalosis through activation of the renin-angiotensin aldosterone system

A

Loop diuretics

244
Q

Cheyne-Stokes respirations

A

Type if respirations characterized by cyclic, crescendo-decrescendo breathing that can be seen in patients with heart failure.

245
Q

Cause contraction metabolic alkalosis through activation of the renin-angiotensin aldosterone system

A

Loop diuretics

246
Q

Cheyne-Stokes respirations

A

Type if respirations characterized by cyclic, crescendo-decrescendo breathing that can be seen in patients with heart failure.

247
Q

Cause contraction metabolic alkalosis through activation of the renin-angiotensin aldosterone system

A

Loop diuretics

248
Q

Cheyne-Stokes respirations

A

Type if respirations characterized by cyclic, crescendo-decrescendo breathing that can be seen in patients with heart failure.

249
Q

Cause contraction metabolic alkalosis through activation of the renin-angiotensin aldosterone system

A

Loop diuretics

250
Q

Chronic pancreatitis

A

Caused by fibrosis and acinar cell atrophy

251
Q

Polyarteritis nodosa

A

Immune complex mediated transmural vasculitis thatcan present with non-specific gastrointestinal complaints, fever, arthralgias, myalgias, weight loss and dermatologic complaints.

Biopsy show fibrinoid necrosis, and arteriogram usually shows multiple aneurysms and constrictions

252
Q

Omphalocele

A

Incomplete migration of the midgut, resulting in a peritoneal sac of bowel at the umbilicus.

253
Q

Gastroschisis

A

Lateral body walls failed to close, no peritoneum would be covering the bowel, which would likely be exposed to amniotic fluid.

254
Q

Reye syndrome

A

Liver biopsy: microvesicular steatosis

255
Q

Apneustic breathing

A

Prolonged inspirations alternating with a short period of expiration. It may result from a caudal pons lesion.

256
Q

Biot’s breathing

A

Irregular periods of apnea alternating with periods of several breaths of identical depth are taken. It is seen in patients with increased intracranial pressure and with certain lesions.

257
Q

Cheyne-Stokes breathing

A

Periodic type of breathing which has cycles of gradually increasing depth and frequency followed by a gradual decrease in depth and frequency between periods of apnea. It may result from midbrain lesions but aldo occurs in infants or during sleep particularly high altitude.

258
Q

FISH

A

Can be used to determine chromosome number or assess for areas of deletion or duplication.

259
Q

Adenosine effect on myocytes?

A

Detachment of myosin head from actin

260
Q

Specificity

A

Percentage of the population without the disease who have a negative test result.

261
Q

Dyskinesia

A

Involuntary movements, side effect of levodopa/carbidopa in Parkinson’s patients.

262
Q

IgA

A

Secreted as a dimer in comostrum

263
Q

Rheumatoid arthritis labs:

A

Rheumatoid factor, anti-ccp, ESR

264
Q

Neostigmine

A

Cholinesterase inhibitor that reverses the effects of the neuronuscular blocking agents prior to intubation.

265
Q

Daptomycin can not be given in pneumonitis because of….

A

it gets attached to the surfactant, damaging the lungs. Can not be given en pneumonia.

266
Q

Lamellar bodies

A

vesicles that keeps surfactant

267
Q

Club cells

A

produces surfactant

268
Q

Surfactant function

A

decrease the surface tension

269
Q

uterus didelphys

A

failed fusion of paramesonephric ducts

270
Q

alcoholic liver disease

A

high AST twice the ALT, and elevated GGT

271
Q

Mixed cellularity Hodgkin lymphoma

A

lacunar variant of Reed-Sternberg cells

272
Q

Clara cells

A

detoxification

273
Q

Globlet cells

A

secreting mucus cells

274
Q

ALA synthase

A

rate limiting enzyme, glucose can interfere in the HEME synthesis.

275
Q

fetal hemoglobin have more affinity for oxygen because…

A

2,3,BG, create less affinity for oxygen in the hemoglobin, 2,3,bg binds less avidly to the gamma chains of the fetal hemoglobin than to the beta chain of the human hemoglobin.

276
Q

Copper is a cofactor of which enzymes…

A

Lysyl oxidase
Cytochrome C oxidase
Tyrosinase

277
Q

Menkes disease

A

Cooper deficiency

Symptoms include osteoporosis, brittle bones, hypotonic, neurological abnormalities.

278
Q

Anastrozole

A

Aromatase inhibitor

279
Q

Von Gierke disease

A

glucose 6 phosphatase deficiency, glucose deficiency, hepatomegaly, hypoglycemia, hyperlipidemia.

280
Q

Parkinson triad

A

This patient is presenting with a resting tremor, micrographia and bradykinesia.

281
Q

PTH in the kidneys

A

stimulates the production of alpha 1-hydroxylase

282
Q

Acromegaly parasellar symptoms:

A

bitemporal hemianopsia, cavernous sinus compression, and sphenoid sinus invasion.

283
Q

amyloid light chain

A

Multiple myeloma,

284
Q

beta-amyloid

A

Alzheimer’s

285
Q

Transthyretin

A

Senile cardiac amyloidosis

286
Q

beta-2 microglobulin

A

dialysis patients

287
Q

I-CELL

A

I-cell disease is an autosomal recessive disorder in which there is a failure of adding a mannose-6-phosphate residue to proteins that should be directed to lysosome, and this leads to intracytoplasmic inclusions. Patients with I-cell disease can present at an early age with coarse facial features, clouded corneas and restricted joint movements.

288
Q

glioblastoma multiforme

A

poorly differentiated astrocytes.

289
Q

Neurocysticercosis

A

patients who consume undercooked pork, due to Taenia Solum,

290
Q

Toxoplasma Gondii

A

close exposure to cats, immunosuppressed patients,

291
Q

Jugular foramen

A

CN IX, 1/3 taste and swallowing, CN X, taste near the epiglotis, swallowing, elevation of the palate and speech. CN IX, turning of the head and shrugging the shoulders.

292
Q

46, XXY

A

Klinefelter

293
Q

45,XO

A

Turner

294
Q

5-FU overdose

A

thymidine

295
Q

Hypocalcemia

A

QT prolongation

296
Q

Cirrhosis findings:

A

spider angiomata, gynecomastia, ascites.

297
Q

Dapsone side effect

A

Methemoglobinemia, normal oxygen partial pressure, decreased saturation. Tx: methylene blue.

298
Q

Imatinib

A

tyrosine kynase inhibitor used in CML that targets the BCR ABL gene.

299
Q

Pulsus paradoxus

A

a decrease in systolic blood pressure of 10mmHG during inspiration.

300
Q

Pericarditis

A

Systemic lupus erythematous, rheumatoid arthritis, viral infection, and uremia are associated with serous pericarditis. Uremia, Dressler’s syndrome, and rheumatic fever are associated with fibrinous pericarditis. Tuberculosis and malignancy can be associated with hemorrhagic pericarditis

301
Q

NF type 1

A

Cr 17.

gliomas, pheochromocytomas, cafe au lait lesions, scoliosis, etc.

302
Q

AML M3 Tx

A

tretinoin

303
Q

Nitriprusside side effect

A

anti-hypertensive drug that can result in cyanide toxicity, cyanide inhibits the electron transport chain, preventing oxidative phosphorylation, binging to cytochrome C oxidase.

304
Q

Ghrelin

A

Stimulates the secretion of GH, ACTH, Cortisol and Prolactin.

305
Q

Myoclonus epilepsy and ragged red fibers

A

damage to the nervous system and skeletal muscle, presenting with jerking spams, and epileptic seizures. Myopathy, ataxia, dementia, hearing loss, short stature, and peripheral neuropathy.

306
Q

Idiopathic thrombocytopenic purpura

A

can show megakaryocytes.

307
Q

Sickle cell may also present with…

A

dactylitis (swollen of the hands and feet, painful, worse prognosis)

308
Q

Major source of transmission of hepatitis B from mother to fetus:

A

HBeAg

309
Q

Mosaicism

A

Mosaicism occurs when there are cell lines containing two or more different genetic makeups leading to different phenotypes

310
Q

Anatomic path of the ovum:

A

ovary, infundibulum, ampulla, isthmus and uterus.

311
Q

erythromelalgia

A

burning sensation in hands do to a small vessel occlusion, seen in essential thrombocytosis

312
Q

Choriocarcinoma symptoms:

A

Gynecomastia, hyperthyroidism, bHCG

313
Q

Can develop anticholinergic effects

A

The TCA’s. Some examples of TCAs include amitriptyline, imipramine, and nortriptyline.

314
Q

Schistosoma haematobium

A

trematode, blood sucker, that can cause bladder cancer, specifically squamous cell carcinoma, frequently in the middle east and east Africa.

315
Q

Benzodiazepines mechanism of action:

A

Increases GABA-A for anxiety
Increases GABA-B for anesthesia, analgesia and memory
Increases GABA-C by an unknown mechanism.

316
Q

Hallmark signs of opioids:

A

The hallmark signs of opioid withdrawal are sweating, rhinorrhea, GI upset and pupils dilation.

317
Q

Naloxone is use in which type of intoxication:

A

opioid

318
Q

Caseous necrosis

A

granuloma with central necrosis, seen in tuberculous infections

319
Q

liquefactive necrosis

A

rapid digestion of dead cells usually seen in the brain.

320
Q

Liver biopsy of alpha-1-antitrypsin

A

Alpha1-antitrypsin deficiency is an autosomal co-dominant disorder characterized by panacinar emphysema and liver cirrhosis. The defective alpha1-antitrypsin protein accumulates in the liver and stains red with PAS

321
Q

Liver biopsy in hemochromatosis

A

Blue granules with Prussian blue stain would be seen in hemochromatosis, an autosomal recessive disorder characterized by excess iron accumulation. Though hemochromatosis can cause liver cirrhosis, it is not associated with emphysema as seen in this patient.

322
Q

Grossly Black Liver biopsy

A

A grossly black liver is seen in Dubin-Johnson Syndrome, an autosomal recessive disorder characterized by defective secretion of conjugated bilirubin.

323
Q

Granulocyte colony stimulating factor (G-CSF) can be used to:

A

Granulocyte colony stimulating factor (G-CSF) can be used to prevent and treat neutropenia.

324
Q

Leukotrienes

A

increase bronchial tone (LTC, LTD, LTE)

increase neutrophil chemotaxis (LTB)

325
Q

Prostacyclin PGI2

A

decrease platelet aggregation,PROMOTES VASODILATION

decrease vascular tone

326
Q

Decrease vascular tone

A

PGI2 AND PGE1

327
Q

Increase uterine tone

A

PGE2 AND PGF2

328
Q

Thromboxane

A

TXA2: INCREASE PLATELET AGGREGATION AND INCREASE VASCULAR TONE

329
Q

Aortic stenosis

A

crescendo-decrescendo systolic ejection murmur

330
Q

Mitral/tricuspid regurgitation

A

holosystolic, high-pitched “blowing murmur”

331
Q

mitral valve prolapse

A

late systolic crescendo murmur with mid systolic click

332
Q

ventricular septal defect

A

holosystolic, harsh sounding murmur

333
Q

Aortic regurgitation

A

high-pitched blowing early diastolic decrescendo murmur

334
Q

mitral stenosis

A

follows opening snap

335
Q

patent ductus arteriosus

A

continous machine-like murmur

336
Q

positive IgA tissue transglutaminase

A

Celiac disease and also anti-gliadin

337
Q

Magnesium hydroxide side effects

A

Tx for GI. Diarrhea, hypotension, hyporeflexia, hypokalemia

338
Q

VHL

A

Renal cell carcinoma, hemangioblastoma and pheochromocytoma

339
Q

hereditary nonpolyposis colorectal cancer gene mutated

A

MSH2 (60%), MLH1 (30%), and MSH6 (7-10%)

340
Q

MALT (MUCOSA ASOC. LYMPHOID TISSUE

A

Etranodal marginal zone lymphoma

341
Q

Linezolid

A

acts as a weak MAO-1 inhibitor so it can not be given in a person taking SSRI

342
Q

BPH and Prostate cancer occurs at:

A

BPH occurs at the transitional zone, whereas prostate cancer occurs at the peripheral zone.

343
Q

acalculous cholecystitis

A

These risk factors include burns, childbirth, immunosuppression, major trauma, mechanical ventilation, multiple transfusions, sepsis, and total parenteral nutrition (TPN). Acalculous cholecystitis typically occurs as a result of gallbladder stasis as well as ischemia.

344
Q

Filtration factor

A

Filtration fraction is the fraction of RPF filtered across the glomerular capillaries (FF = GFR/RPF). When both GFR and RPF are decreased, the net result is no change in FF.

345
Q

Micturition muscles involved

A

relaxation of the elevator ani muscle and the contraction of detrusor muscle.

346
Q

Sexual developing

A

Until 8 weeks gestation, the human fetus is undifferentiated sexually and contains both male (wolffian or mesonephric) and female (mullerian or paramesonephric) genital ducts. The mullerian ducts are the primordial anlage of the female reproductive tract. They differentiate to form the fallopian tubes, uterine cervix, and the superior aspect, or upper one-third of the vagina.

347
Q

Wide QT interval

A

Another quicker way is identify QT prolongation is to see if the QT interval is longer than half of the RR interval.
Hypokalemia
To help reduce the chance of sudden death, beta-blockers are considered to be the first-line of therapy for people with long QT syndrome. Implantable cardioverter-defibrillator can also be considered in patients with long QT syndrome.

348
Q

Most common cause of lung metastasizes

A

colon, breast, prostate, and bladder cancers.

349
Q

Barrett metaplasia epithelial cells

A

The normal histology of the esophagus is a non-keratinized stratified squamous epithelium. With chronic irritation such as with GERD, metaplasia occurs and transforms the non-keratinized stratified squamous epithelium to intestinal epithelium, as it can better handle the stomach’s acidic contents. This can be seen on biopsy and will show a conversion to columnar epithelium with goblet cells.

350
Q

Elevation of the ESR can be due to…

A

he ESR, defined as the rate at which erythrocytes suspended in plasma settle in a conical tube, is a non-specific finding in patients with a high inflammatory state. It elevates as a result of increased fibrinogen, which slows the rate at which red blood cells settle. Inflammatory cytokines such as interleukin-1, interleukin-6, and tumor necrosis factor-α (TNF-α), and acute phase reactants such as C-reactive protein and fibrinogen elevation the ESR.

351
Q

Serum sickness?

A

Is a classic example of a type III, or immune complex-mediated hypersensitivity reaction. The disease results from administration of some foreign protein into the body, subsequent antibody response to the protein antigen, and formation of antibody-antigen complexes. The load of immune complexes overwhelms the body’s natural ability to clear them, and the immune complexes are deposited in tissue, which leads to inflammation and injury.

352
Q

Albright’s syndrome

A

a pediatric disease that causes precocious puberty mostly in girls as young as 4 months of age. They have abnormal development of secondary sex characteristics such as hair and breast. Vaginal bleeding is also common. Patients may develop Cushing’s syndrome, fibrous dysplasia of the bone, hyperthyroidism, and café-au-lait spots, even sudden death from arrhythmias. The lab results are consistent. Patient’s often will not have any effect on GnRH, as would a hypothalamic tumor. It is a gonadotropin-independent process, therefore FSH and LH will often be suppressed or even undetectable. They can be low normal, but estradiol is always increased.

353
Q

Boutonniere deformity

A

is seen in rheumatoid arthritis patients; it is a flexion of the proximal interphalangeal (PIP) joint along with hyperextension of the distal interphalangeal (DIP) of the finger.

354
Q

Caplan’s syndrome

A

is seen only in patients with both rheumatoid arthritis and pneumoconiosis related to coal, asbestos, and silica exposure. Patients have basilar nodules with same composition as nodules seen in other tissues in rheumatoid arthritis except that the nodules are surrounded by pigmented cells. Caplan’s syndrome has a good prognosis, but some patients can develop massive fibrosis.

355
Q

Dactylitis

A

Dactylitis, also called “sausage fingers,” is typical of psoriatic arthritis and signifies swelling of the soft tissues between joints.

356
Q

Xerostomia

A

dry mouth is characteristic of Sjogren’s disease

357
Q

Polyarteritis nodosa

A

Asoc. with Hepatitis B, presents with mononeuritis multiplex and livedo reticularis.

358
Q

Sturge-Weber syndrome

A

Congenital, noninherited (sporadic), developmental anomaly of neural crest derivatives due to somatic mosaicism for an activating mutation in one copy of the GNAQ gene.

STURGE-Weber: Sporadic, port-wine Stain; Tram track calci cations (opposing gyri); Unilateral; Retardation (intellectual disability); Glaucoma, GNAQ gene; Epilepsy.

359
Q

Ethambutol

A

Ethambutol inhibits the synthesis of the mycobacterial cell wall via inhibition of arabinosyl transferase, an enzyme that polymerizes arabinose into arabinan and then arabinogalactan, one of the constituents of the mycobacterial cell wall. Ethambutol is noted for causing optic neuritis that results in color blindness, central scotoma, and decreased visual acuity.

360
Q

Isoniazid

A

decrease synthesis of mycelia acids, bacterial catalase-peroxidase needed to convert INH to active metabolite.

361
Q

Pyrazinamide

A

adverse effect: hyperuricemia, hepatotoxicity

362
Q

Streptomycin

A

interferes with 30s component of ribosomes.

A.E.: tinnitus, vertigo, ataxia, nephrotoxicity.

363
Q

Succinylcholine mechanism of action and side effects:

A

Succinylcholine is the prototypical depolarizing muscle relaxant which is used for induction of general anesthesia. Succinylcholine binds to nicotinic acetylcholine receptors on the post-synaptic membrane to activate them.
The most common side effects of succinylcholine are hyperkalemia, muscle pain, and malignant hyperthermia.

364
Q

Osteopetrosis

A

Osteopetrosis is a disease caused by abnormal osteoclastic function, believed to be related to defective carbonic anhydrase function, leading to problems with bone resorption. Patients have dense bones, leading to compression of the cranial nerves, auditory canals, and nasal sinuses. The thickened bones can also compress the bone marrow, leading to pancytopenia.

365
Q

Parakeratosis

A

Parakeratosis is a benign skin condition characterized by dry, scaly skin that results from a variety of causes. Normally, the upper layer of the skin, known as the stratum corneum, consists of dead, keratinized cells that lie on each other. These cells lack nuclei and are high in keratin, allowing the skin to retain moisture. Patients with parakeratosis have cells in the stratum corneum that have retained their nuclei and are incompletely keratinized. As a result of this keratin deficiency, the skin does not retain moisture and becomes dry. Over time, these dry areas can develop cracks and fissures. Inflamed, tender, red lesions may sometimes develop over these areas of dry skin. Topical anti-inflammatories and moisturizers can be given to ease the redness and tenderness and to prevent skin dryness.

366
Q

epidermolysis bullosa

A

keratin dysfunction

367
Q

bcl-2

A

Follicular lymphoma

368
Q

c-myc

A

Burkitt’s lymphoma

369
Q

n-myc

A

neuroblastoma

370
Q

c-kit

A

encodes a receptor tyrosine kinase that is involved in cellular proliferation and differentiation

ex. gastrointestinal stroma tumor

371
Q

Abruptio placentae risk factors

A

Risk factors include pre-existing hypertension, cigarette smoking, clotting disorders, and advanced maternal age

372
Q

Alkylating agents mechanism of action

A

cross-links DNA

373
Q

Busulfan

A

CML

s.e.= pulmonary fibrosis

374
Q

Cyclophosphamide

A

leukemias, lymphoma

375
Q

Nitrosoureas

A

cross blood brain barrier, used in brain tumors, and can cause CNS toxicity

376
Q

anatomical positions of the pulmonary arteries

A

The anatomical positions of the pulmonary arteries in relation to their respective bronchi can be remembered with the acronym “RALS”: right is anterior and left is superior. Since the right pulmonary artery is anterior to the right mainstem bronchus, that means that the bronchus is posterior to the artery.

377
Q

yolk sac tumor

A

alpha-fetoprotein
child less than 3 years
schiller duvall bodies

378
Q

Cofactors needed in pyruvate dehydrogenase, α-ketoglutarate dehydrogenase, and branched-chain amino acid dehydrogenase pathways:

A

B1,B2,B3,B5 and lipoid acid.

379
Q

IFN-gamma in TB

A

Th1 cells and activated macrophages produce interferon-γ (IFN-γ), which activates macrophages and induces the differentiation of mononuclear cells into epithelioid cells.

380
Q

ankylosing spondylitis presentation

A

1) Chronic inflammatory disease of spine and sacroiliac joints - The pain associated with ankylosing spondylitis is typically worse in the morning or following periods of inactivity. Patients frequently note morning stiffness lasting around 30 minutes and improvement of their symptoms with physical activity. On imaging, the spine may appear “bamboo-like” due to the formation of bridging syndesmophytes (areas of ossification within the ligaments) that leads to near fusing of the spine (see image below).
2) Uveitis - Patients typically present with acute onset of unilateral eye pain, redness, photophobia, increased lacrimation, and blurred vision.
3) Aortic regurgitation - Patients with long-standing ankylosing spondylitis can develop cardiovascular complications such as aortic valvular insufficiency.

381
Q

Hashimoto’s thyroditis

A

Biopsy typically shows widespread destruction of follicles, lymphoid aggregates, and Hürthle cells. Hürthle cells contain an eosinophilic cytoplasm due to mitochondrial dysfunction.

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