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UWORLD > Untitled spreadsheet - Sheet1 > Flashcards

Untitled spreadsheet - Sheet1 Flashcards

1
Q

Topic

A

Discussion

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2
Q

Lead-time Bias

A

earlier diagnosis does not = extended life expectancy

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3
Q

Female incidence & mortality of cancer

A

Incidence of cancer in women: breast > lung > colon; Mortality of cancer in women: lung > breast > colon

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4
Q

Confounding

A

blurs the exposure & outcome association when a THIRD variable correlates with both (EtOH use & bladder cancer, no link bc smoking is assoc. w/ bladder cancer & smokers are more likrely to drink)

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5
Q

Sensitivity & Specificity

A

Sn = A/(A+C) Sp = D/(D+B)

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6
Q

Positive-Skew

A

Mean > Median > Mode

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7
Q

Attributable Risk Percent

A

ARP = 100 x (RR-1)/RR

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8
Q

Prevalence vs Incidence

A

Incidence = new cases/at risk pop; Prevalence = # of cases/total pop; Prevalence = incidence x duration of disease

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9
Q

Relative Risk Reduction

A

RRR = ((AR:control)-(AR:tx))/AR:control

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10
Q

Positive Predictive Value

A

PPV = A/(A + B)

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11
Q

Cohort Study

A

Odds ratio = Odds of exposure in diseased/Odds of exposure in non-diseased

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12
Q

T-test

A

test compares the mean of 2 groups of subjects (regardless if groups are different or same)

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13
Q

Chi-Square test

A

Categorical data comparison; comparing >/= 3 groups

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14
Q

If RR b/w 2 studies is the same but the p-value varies

A

sample size may have been too small

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15
Q

Correlation coefficient

A

0: no correlation b/w the 2; 1: absolute correlation, -1: perfect inverse correlation

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16
Q

Hawthorne Effect

A

subjects change behavior knowing they are being studied

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17
Q

Observer Bias

A

double-blind studies reduce observer bias

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18
Q

Relative Risk

A

RR = (a/a+b) / (c/c+d)

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19
Q

Power

A

1-type II error (b)

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20
Q

Negative Predictive Value

A

Likelihood that a negative test means the patient does not have a disease NPV= D/(C+D)

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21
Q

Reliable tests

A

Reproducibility of a test

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22
Q

Reduction of risks

A

smoking is almost always the #1 reducible mortality risk

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23
Q

Statistical significance

A

if the 95% CI does not include 0 the Ho can be rejected

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24
Q

PPV is higher when the prevalence of ds increases

A

NPV is lower when the prevalence of ds increases

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25
Q

Which enzyme is capable of adding uracil to DNA?

A

Primase

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26
Q

24yo w/ UTI most commonly from

A

E. coli

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27
Q

Where would uric acid renal crystals most likely form?

A

In the collecting duct where there is an acidic pH

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28
Q

Tuberous sclerosis

A

renal angiomyolipoma (fat, blood v, & sm m.) + ash-leaf spots + brain hamartomas

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29
Q

Ureters course anterior to which structure

A

Internal iliac a. (& under the uterine a. or vas deferens)

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30
Q

The cause of death in an infant w/ Potters syndrome

A

pulmonary hypoplasia -> respiratory distress

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31
Q

Renal hypoplasia would likely result in hyperplasia of

A

modified SM cells, JG cells, that then increase their release of renin

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32
Q

Acute transplant rejection

A

weeks; Host T-cells attack donor MHC II molecules

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33
Q

Adrenal mass + low renin + high BP + hypokalemia

A

Aldosterone secreting tumor –> Tx w/ Spironolactone or Eplerenone

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34
Q

Post-streptococcal Glomerulonephritis - deposits of

A

C3, IgG, IgM

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35
Q

Elderly pt experiencing Digoxin toxicity d/t age-related

A

decrease in renal clearance

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36
Q

Tx for diabetic nephropathy

A

ACE-I or ARB

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37
Q

Investigator knows which participants are in experimental group

A

Observer bias

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38
Q

Tx for chronic renal failure

A

Loop diuretics

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39
Q

Acid/Base imbalance in Type I DM pt

A

Metabolic acidosis (low bicarb)

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40
Q

Alcoholic Wernicke-Korsakoff Syndrome + hypoglycemia

A

Which enzyme in the TCA cycle is most impaired? Alpha-ketoglutarate (thiamine pyrophosphate is a cofactor)

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41
Q

RNA w/ dihydrouracil, thymidine, acetylcytosine —>tRNA acceptor stem 3’

A

3’ CCA tail

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42
Q

Tumor Lysis Syndrome prevention

A

Allopurinol (xanthine oxidase inhibitor) or Rasburicase (urate oxidase: converts urate to allantoin)

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43
Q

Septic shock -> lactic acidosis

A

decreased oxidative phosphorylation

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44
Q

Aspiration pneumonia

A

superior region of lower lobe & posterior upper lobe; stroke, altered consciousness, etc increase risk

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45
Q

HbC

A

Glutamate is replaced by lysine (missense mutation) -> increased positive charge of Hb

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46
Q

Frameshift mutation

A

deletion or additions not in the multiple of 3

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47
Q

In glucokinase deficiency, what enzyme contributes to cataract formation?

A

Aldose reductase: converts galactose –> galactitol

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48
Q

Tyrosine kinase receptor - MTOR pathway

A

autophosphorylation of tyrosines -> PI3K activation -> Akt activation -> MTOR activation -> translocates to nucleus -> TF

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49
Q

Acyl-CoA dehydrogenase deficiency

A

impaired beta-oxidation, cannot utilize fats for energy or produce ketones -> severe hypoglycemia during starvation, low ketone bodies

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50
Q

What type of bond accounts for alpha-helix & beta-pleated sheets?

A

Hydrogen bonds

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51
Q

Thyroid hormone receptors

A

intranuclear receptors

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52
Q

Spoon nails (koilonychia) & dysphagia + anemia

A

Iron deficiency anemia

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53
Q

Treatment for HSV-2 infection

A

Acyclovir, Valacyclovir, Famciclovir: gets incorporated in viral DNA -> viral DNA replication termination

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54
Q

Type of mutation seen w/ HNPCC/Lynch Syndrome

A

abnormal mismatch repair enzyme (MSH2, MLH1 -> MutS, MutL homologs)

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55
Q

HbF

A

2-alpha, 2-gamma

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56
Q

Supplementation for Measles infection

A

Vitamin A

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57
Q

Leptin receptor K/O mouse

A

Leptin -> neuropeptide Y -> decrease appetite; Leptin levels - high, but mouse’s appetite remains high

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58
Q

Child w/ diarhhea exposed to puppy w/ diarrhea

A

Campylobacter

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59
Q

N. meningitidis meningitis prophylaxis for close-contacts

A

Rifampin

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60
Q

Downward displacement of the lens + renal infarcts + thrombosis

A

Homocystinuria –> Cystathionine synthetase deficiency –> Tx: Vitamin B6 (pyridoxine)

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61
Q

Suspected Asthma - Test for Dx

A

Methacholine

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62
Q

HTN medication S/E of hypercalcemia

A

Thiazide (Loops lose Ca)

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63
Q

Melanoma - embryonic derivative

A

Neural crest

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64
Q

N. passing through obturator foramen has what action

A

Obturator n. innervates adductors of the thigh

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65
Q

Location of enhancer segments

A

Variable location (same chormosome, w/in gene, another chromosome)

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66
Q

Chronic Granulomatous Disease (abn nitroblue tetrazolium test) -> susceptible to what agents

A

Catalase (+)

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67
Q

N. for eye adduction (CN3) & corneal reflex (nasociliary n.) enters the orbit via

A

Superior orbital fissure

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68
Q

Physician morally choosing not to perform abortions should

A

provide patient w/ referrals for providers who will perform abortions

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69
Q

At peak exercise, which wil be the same in the systemic & pulmonary circulation?

A

Blood flow/min (always true, exercise or rest)

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70
Q

If a test includes more false pos to capture all true positives, what will be altered

A

Lower the PPV - PPV = A/(A + B)

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71
Q

Alternative to aspirin for exertional chest pain

A

Clopidogrel

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72
Q

Holosystolic murmur heard at apex radiating to L axilla; what predicts severity?

A

MR - audible S3 indicates large volume of regurgitant flow

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73
Q

Diarrhea –> acute renal failure + schistocytes + hemolysis

A

HUS-TTP caused by EHEC 0157:H7 consumed in undercooked beef

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74
Q

Pt on Lithium begins new drug for HTN -> lithium toxicity, what’s the HTN med

A

Thiazides, ACE-I, NSAID will all increase Lithium conc

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75
Q

Ischemic injury to brain 12-24hrs post

A

Red Neurons (eosinophilic cytoplasm) w/ pyknotic nuclei

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76
Q

Incomplete GB emptying in response to CCK may lead to

A

Biliary sludge

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77
Q

Ingestion of toxin -> double vision, ptosis, nausea, dry mouth

A

C. botulinum (descending paralysis) acts by blocking the release of ACh in neuromuscular junctions

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78
Q

Tonsillar exudate + cervical LAD + splenomegaly + heterophile Ab +

A

No contact sports - inform coach of medical recommendation

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79
Q

Lung cancer rates in women

A

markedly rose from 1965-2000 when cigarette popularity increased

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80
Q

Bicornuate uterus is d/t

A

failure of the paramesonephric ducts to fuse

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81
Q

Gingival ulcers + swollen gums + cervical LAD + fever + irritability in 5yo

A

Herpetic gingivostomatitis d/t HSV-1 primary infection (secondary inf. Present as cold sores typically)

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82
Q

HIV genetics - which gene codes for p24 Ag

A

gag - p24; env - gp120, gp41; pol - RT, integrase

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83
Q

Adverse outcomes are more likely in smokers, this phenomenon is

A

Effect modification - effect of an exposure on an outcome is modified by another variable

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84
Q

Post-transcriptional modications

A

5’ guanosine cap + Poly-A tail (AAUAAA) + intron splicing

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85
Q

Cleft lip - failure of

A

maxillary prominence & medial nasal prominence to fuse

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86
Q

Patient in denial about terminal cancer

A

“hope for the best, but focus on maximizing time with family”

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87
Q

Pernicious anemia d/t Ab-mediated destruction of parietal cells found w/in the

A

Upper glandular layer (just deep to crypts) –> chronic atrophic gastritis

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88
Q

Valproate teratogenic effects

A

inhibits intestinal absorption of folate —> Neural tube defects

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89
Q

Kinesin protein

A

anterograde MT motor protein; in neurons kinesin carries vesciles and organelle toward the nn. Terminal

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90
Q

95% Confidence Interval

A

mean +/- 1.96*SD/_n

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91
Q

progressive neurodegeneration, startles easily, macrocephaly, red macular spot; Accumulated metabolite?

A

Tay-Sachs Ds: defective b-hexosaminidase A –> accumulation of GM2 ganglioside

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92
Q

F w/ low-volume vaginal bleeding + large cell w/ perinuclear clearing

A

HPV infection –> Koilocyte

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93
Q

High AFP, what should be r/o: _____________ & neural tube defects

A

Dating error

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94
Q

Attack rate

A

diseased/exposed

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95
Q

F experiencing insomnia, reliving stressful event, w/d

A

PTSD

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96
Q

Disease has earlier onset in successive generations

A

Anticipation

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97
Q

Number needed to harm NNH

A

NNH = 1/ARR & ARR = Adverse rate in Ctrl group - Adverse rate in Tx group

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98
Q

Ischemic injury to brain 3-5d post

A

Microglia infiltration –> abundance of lipids in microglia cytoplasm as they phagocytose myelin (~1 week post)

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99
Q

Aggressive behavior + confusion + agitation + nystagmus + ataxia are S/S of

A

Phencyclidine OD

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100
Q

Cardiac cell AP & ion flux

A
  1. Na rapid inward flux 2. slow K+ gates open and K+ exits 3. Ca2+ channels open and Ca2+ flows in
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101
Q

Odds Ratio

A

OR = (A/C)/(B/D) = (AD)/(BC)

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102
Q

Secretory form of IgA

A

Dimer attached tail-to-tail is found in mucus, tears, saliva, colostrum

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103
Q

Primary amenorrhea + shortened vagina + rudimentary uterus

A

Vaginal agenesis or Mullerian Aplasia or Mayer-Rokitansky-Kuster-Hauser Syndrome

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104
Q

Anti-snRNPs + mixed CT disease; snRNPs are found in?

A

Spliceosomes

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105
Q

Perforated ulcer on the posterior duodenal would effect which a.?

A

Gastroduodenal a.

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106
Q

Which stimuli would cause enlarged gastric rugal folds & parietal cell hyperplasia

A

Gastrin (Zollinger-Ellison)

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107
Q

Respiratory tract transition from ciliated pseudostratified

A

Terminal bronchioles: ciliated pseudostratified -> ciliated simple cuboidal (cilia remain until alveoli to propel mucus upward)

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108
Q

Cyst found in a fibrous band extending from ileum to umbilicus

A

Omphalomesenteric (vitelline duct) is asoc w/ Meckel diverticulum, cyst, fistula

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109
Q

Orotic aciduria + hyperammonemia

A

Ornithine Transcarbamoylase deficiency

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110
Q

Study w/ group A receiving Tx & group B receiving placebo then after 4 weeks they switch

A

Cross-over study

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111
Q

Women fears doctor (sweating, anxiety)–> women seens stethoscope & has anxiety, sweating

A

Classical conditioning

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112
Q

Infant w/ sublingual mass removed —> lethargy, poor feeding, constipation, dry skin; Defect in

A

Migration - failure of the thyroid to migrate from the lingual area down the thyroglossal duct pathway, removal -> hypothyroidism

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113
Q

Female w/ rib notching + diminished femoral pulses

A

Coarc of Aorta typically seen in Turner’s Syndrome

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114
Q

N. gonorrhaea infections reoccur w/ out future immunity because

A

Gonococcal surface antigens undergo high frequency variation

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115
Q

Alcoholic cirrhosis + portal HTN + ascites

A

Identify portal v. on CT (the one that looks like it is going straight into liver)

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116
Q

Centriacinar emphysema - what cell type is responsible for the damage/development of this condition?

A

Neutrophils & macrophages release proteases

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117
Q

What type of transmembrane protein in CFTR?

A

ATP-gated

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118
Q

Progressive dyspnea + liver biopsy showing cells filed w/ globules (stain pink w/ PAS)

A

Globules of unsecreted alpha-1-antitrypsin –> A1AT deficiency leading to panacinar emphysema & liver disease

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119
Q

Focal necrosis + crescent formation on renal biopsy; Crescent is formed form what substance?

A

Fibrin & plasma proteins (C3), monocytes, macrophages, parietal cells - Goodpasture’s would also have IgG

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120
Q

Conducting an interview in pt w/ language barrier in non-emergency setting

A

Call for & WAIT for intrepretor

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121
Q

Irradicating HBV would likely also irradicate

A

Delta agent infection

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122
Q

Med for BPH & HTN

A

alpha-1-blocker: Doxazocin, Prazocin, Terazosin

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123
Q

Fragile-X-Syndrome mutation

A

Trinucleotide repeat in FMR1 gene w/ >200 CGG repeats —> Hypermethylation –> Gene inactivation (fragile: thin, constricted X)

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124
Q

Microcytic Anemia resistant to iron, target cells + high HbF; the defect is most likely d/t

A

Beta-thal minor –> mutations are likely d/t transcription, processing, & translation of beta-globulin mRNA

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125
Q

Injured long thoracic n. can result from

A

Mastectomy

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126
Q

Abd fluid mass compressing psoas major (spontaneous retroperitoneal hematoma 2ndary to Warfarin use)

A

Psoas compression –> femoral n. neuropathy –> quadriceps weakness, “knee-buckling”, sensory loss over ant. & medial thigh + diminished patellar reflex

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127
Q

S/E of inhaled GA

A

CV depression, hypotension, respiratory depression, ICP d/t increased cerebral blood flow, low GFR, low RBF, low hepatic BF

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128
Q

Irregularly irregular ECG findings

A

Afib –> absent P waves, irregularly irregular rhythm, varying R-R intervals; Preceipitated by high SNS, acute illness, EtOH consumption

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129
Q

CO affects hemoglobin by

A

Competitively binding to heme

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130
Q

Attributable Risk

A

ARR = Erctrl - Ertx

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131
Q

Infant w/ normal testes & internal male genitalia has poorly dev. ext male genitalia

A

5-alpha-reductase def –> testosterone is responsible for internal genitalia, while DHT is responsible for external genitalia

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132
Q

Asthma diagnosis

A

Methacholine challenge

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133
Q

In Pheochromocytoma, what drug is used to lower vascular tension d/t excess catecholamines

A

Irreversible competitive alpha-1-antagonist —> PHENOXYBENZAMINE

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134
Q

Net Filtration Pressure

A

(Glomerular Phydro - Poncotic) - (Capsule Phydro - Poncotic)

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135
Q

Polyhydramnios could result from

A

Anencepahly, GI obstruction (anything that impairs swallowing)

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136
Q

Main contributer of symptomatic relief of Nitrates for angina

A

decreased cardiac preload (LV volume during diastole); decrease preload, cardiac work, & O2 demand

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137
Q

ERROR!

A

Acute HBV infection progressed to chronic HBV infection w/ high infectivity

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138
Q

pseudomembranous colitis

A

Risk factor: antibiotic therapy

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139
Q

MDD tx w/ Fluoxetine + Parkinsons; Tx for Parkinsons that is contraindicated

A

Selegiline (MAO Inhibitor - Serotonin Syndrome when given w/ SSRI)

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140
Q

Left lower face & left UE paralysis, what vessel is occluded?

A

Right MCA

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141
Q

Tx for panic ds + agoraphobia w/ MOA: activates Benzodiazepine binding sites on GABA receptor

A

Alprazolam

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142
Q

Seeks medical advise + fx to follow-through on own + guilt about inability

A

Dependent personality: fear self-care, need excessive reassurance, fear of disapproval

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143
Q

Gerstmann Syndrome (angular gyrus) - MCA

A

Dysgraphia, Dyscalculia, Finger agnosia, L/R-disorientation

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144
Q

Dejerine-Roussy Syndrome (dorsolateral thalamus) - PCA

A

numbness -> burning & tingling -> allodynia& neuropathic pain

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145
Q

Wallenberg Syndrome (lower medulla) - VA

A

pain&temp loss C/L of body & pain/temp loss I/L on face; nystagmus, Horner’s syndrome, diplopia, I/L ataxia, dysphagia

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146
Q

Weber Syndrome (lower midbrain)

A

I/L oculomotor n. palsy (down&out+ptosis) + C/L hemiplegia

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147
Q

D2-agonist Tx for restless leg

A

Ropinirole

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148
Q

Sensory to thenar eminence is supplied by

A

Palmar cutaneous branch of the Median n.

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149
Q

Solid area on brain cross-section that appears darkened

A

infarct/ischemia

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150
Q

Loss of pupillary light reflex in L eye when light is shone in either eye; Lesion of

A

Efferent pupillary defect: CN4 lesionon ipsilateral side

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151
Q

Alzheimers: low ACh, degeneration of the

A

Basal forebrain (basal nucleus of Meynart) & cerebral cortex

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152
Q

Why must mitochondria encode their own tRNA

A

mitochondria use non-standard genetic code

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153
Q

X-linked agammaglobulinemia - What would be sen on SPEP?

A

normal alpa, beta peaks, no gamma peak

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154
Q

2d post-strep infection + coca-cola urine + meangial deposits in kidney

A

IgA Nephropathy (distinguished from PSGN by the length of time b/w strep & GN, complement levels)

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155
Q

SLE + prolonged aPTT + false-neg RPR for Syphilis -> Antiphospholipid Ab Syndrome; Complications include

A

Recurrent miscarriages, hypercoaguable states (DVT, PE)

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156
Q

Protein necessary to prevent uterus dev

A

MIF

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157
Q

Always address a new patient by

A

Mr or Mrs

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158
Q

Southwestern blot

A

DNA-binding protein + dsDNA probe

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159
Q

What parameter is affected by a change in prevalence

A

PPV & NPV change with prevalence, sensitivity & specificity do not

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160
Q

When hydrostatic pressure of capillaries increase what process initially off-sets this to prevent edema?

A

Increased lymphatic drainage

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161
Q

b2-antagonist decrease HR and contraction +

A

decrease catecholamine-dependent renin release from the kidneys

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162
Q

Which substance would be metabolized the fastest?

A

Fructose-1-phosphate - enters glycolysis after the rate-limiting step

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163
Q

Which diabetic tx increases the C-peptide level?

A

Glyburide: increase pancreatic release of insulin

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164
Q

CHF pt w/ fluid overload –> Tx (diuretic) –> increased hematocrit; Why?

A

Relative erythrocytosis

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165
Q

Occlusion of ACA –>

A

LE motor dysfunction

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166
Q

Anastomoses resulting in esophageal varices

A

Left gastric v. -> esophageal v. (Hemorrhoids: sup. rectal -> middle&inf rectal; caput: paraumbilical -> superficial&inf epigastric)

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167
Q

Which enzyme is capable of 5’->3’ exonuclease activity

A

DNA pol I

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168
Q

Lithium-induced nephrogenic diabetes insipidus

A

antagonizes ADH -> impairing the collecting ducts ability to concentrate the urine

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169
Q

S. bovis infectious endocarditis

A

colon cancer

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170
Q

Dysphagia + megaesophagus + absent SM peristalsis + Peru

A

Chagas Disease (megacolon, megaesophagus) caused by Trypanosoma cruzi

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171
Q

Male w/ boobs, small testes, sparse body hair

A

Klinefelters(XXY) –> testicular atrophy, infertility, low testosterone, high FSH & LH, high estradiol (estradiol:testosterone determines extent of disorder)

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172
Q

Ca2+ release from SR in skeletal mm. does not produce contraction, what protein is defective

A

Troponin: troponin C binds Ca2+ -> conformation change -> exposes actin -> myosin binds

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173
Q

Feature of Clostridium botulinum

A

subterminal spore formation

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174
Q

What preents lactation in a pregnant patient?

A

high Progesterone & Estrogen levels

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175
Q

Myasthenia gravis Sx + mediastinal mass

A

Thymoma or thymic hyperplasia —> developed from the 3rd pharyngeal pouch (w/ inf. Parathyroid)

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176
Q

H. influenzae grows poorly on sheep agar, S. aureus inoculation promotes its growth, why?

A

Haemophilus requires chocolate agar + factor V (NAD+) + X (hematin); S. aureus secretes favtor V & hemolysis releases hematin

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177
Q

Why is C. trachomatis resistant to Ceftriaxone?

A

Lacks cell-wall peptidoglycan

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178
Q

Excretion rate for substance that is freely filtered & reabsorbed

A

rate of inulin clearance is used as a standard for free filtration, subtract the amount reabsorbed

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179
Q

Injury to the pterion, which vessel is affected

A

site where temporal, frontal, parietal, & sphenoid meet -> middle meningeal a. rupture (branch of maxillary a.) -> Epidural hematoma

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180
Q

Drainage to superficial inguinal nodes

A

Anal canal

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181
Q

Maple Sugar Urine Disease, pt should avoid which a.a.

A

Isoleucine, Leucine, Valine

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182
Q

What vitamins are not supplied in breast milk?

A

Vitamin D & K

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183
Q

X-linked agammaglobulinemia -> cells bearing which markers would be deficient

A

B-cells bearing CD19+ & CD20+ are deficient leading to pan-hypogammaglobulinemia

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184
Q

In an emergency + no advance directive

A

provide emergent life-saving healthcare

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185
Q

What pulmonary tests are increased in emphysema pts

A

TLC, FRC, RV

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186
Q

Which TB Tx requires an acidic pH & is most useful against intracellular organisms?

A

Pyrazinamide

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187
Q

C. Diff Tx

A

Metronidazole (mild-mod cases), Oral Vanco (severe), Fidaxomicin (recurrent C. Diff): inhibits sigma subunit of RNA pol, oral

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188
Q

Milrinone has what additional effects

A

Vasodilation in addition to increased contractility (PD-3 inhibitor)

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189
Q

G(+) bacteria subjected to abx followed by destruction when placed in a hypotonic solution, what was the abx?

A

Destruction in a hypotonic solution suggests cell wall disruption, Cefuroxime acts on G(+) cell wall synthesis

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190
Q

Turner Syndrome, what would bes een on ECG

A

most common heart defect -> Bicuspid aorta > Coarc of Aorta

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191
Q

Device measures glucose 299, 300, 300 when actual value is 260; the device is

A

precise (aka reliable) but not accurate

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192
Q

Opioid followed by severe abdominal pain

A

Opioids can cause SM contraction -> sphincter of Oddi obstruction -> biliary colic

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193
Q

RANK-L overexpression

A

RANKL on osteoclasts & Osteoprotegerin (OPG) ratio determines the rate of bone resorption. High RANKL = Increased resorption

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194
Q

Child experiences cyanotic episodes & squatting helps releive Sx, what is the defect

A

ToF, failure of neural crest cell migration

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195
Q

What immune cells are responsible for walling off a TB infection

A

CD4+ TH1 lymphocytes & Macrophages

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196
Q

Facial dysmorphia + cleft palate + chromosome 22

A

DiGeorge Syndrome

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197
Q

When a patient is hospitalized (esp if in bad condition) you must inquire about

A

Advance directives & end-of-life care wishes

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198
Q

Failure of the urethral folds to fuse in males results in

A

Hypospadias

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199
Q

Screening test for a lethal disease should have a high

A

Sensitivity

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200
Q

ERROR!

A

Vaccinated against HBV

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201
Q

Pregnant + bright red bleeding + no FHT + large uterus + thin-walled “grape-like” cysts of 46XX

A

Complete hydatidiform mole composed of only trophoblastic tissue & entirely paternal DNA

202
Q

Patient doesn’t take meds when she feels well, your response:

A

build alliance w/ pt by saying “I understand itcan be difficult to take meds when you feel fine”

203
Q

Internal Carotid a. is derived from

A

3rd aortic arch

204
Q

Suspected child abuse

A

Contact child protective services immediately

205
Q

Lung cancer cells w/ large nuclei w/ prominent, round, basophilic bodies; Which enzyme is most active?

A

prominent nucleolus -> high rRNA production -> RNA pol I (RNA pol II: mRNA, snRNA, miRNA; RNA pol III: tRNA)

206
Q

Infant w/ eczema, recurrent respiratory infections, increased bleeding time, low WBC & platelets

A

Wiskott-Aldrich: eczema, recurrent infections, thrombocytopenia

207
Q

Group A Smokers & Group B Non-smokers are followed 10 years for the development of cancer

A

Prospective cohort study

208
Q

ToF & TA result from what failed embryologic process

A

Septation

209
Q

T-cell binding to MHC molcules on medullary epithelial cells w/ HIGH affinity is part of

A

Negative Selection

210
Q

Neonate 46,XX w/ ambigous genitalia & high serum Testosterone & Androstenedione; Mom had virulization during pregnancy

A

Aromatase deficiency: high androgen & low estrogen -> neonate has normal internal genitalia & ambiguous external genitalia -> primary amenorrhea, tall , osteoporosis

211
Q

Myasthenia gravis is most similar to

A

other HSN type II rxn - Goodpasture’s Syndrome

212
Q

Attending tells you to order a drug and you remember is has a potentially harmful S/E to pt, you should

A

No administer drug until discussing your concerns

213
Q

Patient has U/L hearing loss, facial n. palsy suggests a

A

Intracranial Schwannomamost commonly located at the cerebellopontine angle (b/w cerebellum & lateral pons)

214
Q

Aspiration pneumonia in a supine pt is most likely to occur in which lobe

A

Right upper lobe’s posterior segment or superior segments of lower lobe; Upright aspiration -> basilar segments of the R lower lobes

215
Q

Apical holosystolic murmur radiating to axilla, how could you decrease pts forward flow volume?

A

decrease left ventricular afterload

216
Q

Naked +sense RNA virus causing cough, sore throat, fever

A

Rhinovirus

217
Q

Demyelination of nerves would directly decrease?

A

Length (aka space) constant: how far an impulse travels down an axon (demyelination would increase the time constant, conduction time)

218
Q

Intermittent jaundice + pigment inclusions in liver lysosomes of epinephrine metabolites

A

Dubin-Johnson Syndrome: defective hepatocellular excretion of billirubin gluuronides, Dx high coproporphyrin I in urine

219
Q

Murmur heard best when sitting + leaning forward, the murmur intensity peaks?

A

Aortic regurgitation peaks just after the aortic valve closes, diastolic, high-pitched, blowing decrescendo murmur

220
Q

Ca2+ released from SR during muscle contraction binds

A

Troponin-C

221
Q

Malaise + dark urine + UTI Tx + anemia + RBC fragmentation

A

G6PD deficiency: deficiency in the HMP shunt, converts G-6-P –> 6-phosphogluconate

222
Q

mAb anti-CD21R on B-cells would prevention to which virus

A

EBV

223
Q

Tx for Restless Leg Syndrome

A

DA agonist

224
Q

Mass in neck + head positioned to opposite side + pain w/ turning the neck, this is d/t

A

Congenital Torticollis d/t intrauterine malposition or birth trauma

225
Q

Unvaccinated child w/ cough, coryza, conjunctivitis, & white spots on buccal mucosa

A

Measles, these Sx will be followed by a maculopapular rash

226
Q

A drug w/ a Vd of 4.0

A

Highly charged - since the plasma volume is ~3L the drug primarily stays w/in the blood (large polar drugs cannot diffuse through tissues)

227
Q

Why is Methadone used in Heroine Tx?

A

Methadoen is a potent, long-acting opioid w/ good oral bioavailability. Long half-life allows prolonged suppression of w/d Sx

228
Q

Antiarrhythmic drug that prolongs QT interval but has a ower risk of TdP than other QT-prolonging agents

A

Amiodarone

229
Q

Tamoxifen S/E

A

Endometrial hyperplasia

230
Q

Vaginal bleeding +large uterus + high b-hCG + B/L lung nodules

A

Gestational Choriocarcinoma: malignant tumor arising from trophoblast (histo shows proliferation of cytotrophoblast & syncytiotrophoblasts)

231
Q

Why do hematomas or large bruises appear greenish days after formation?

A

Heme Oxygenase converts heme to biliverdin (green pigment)

232
Q

Features of GAS

A

beta-hemolytic, Pyrrolidonyl arylamidase positivity & bacitracin-sensitive

233
Q

Colleague is intoxicated while on duty, you should

A

report the incident to the hospital’s physician health program

234
Q

What hormone contributes most to fetal lung maturity

A

Cortisol

235
Q

Neonate w/ posterior neck mass composed of cystic spaces separated by CT + B/L nonpitting edema + diminished femoral pulses

A

Neck mass is a CYSTIC HYGROMA w/ lymphedema, coarc of aorta -> dimished femoral pulses —–> Turner Syndrome d/t loss of paternal X

236
Q

Primary source of serum glucose after a 2d fast

A

Gluconeogensis: pyruvate -> oxaloacetate -> PEP

237
Q

Pain sensation 1 cm anterior to the foramen cecum is sensed by what nerve

A

CN V3

238
Q

Anti-Rh(D) immunoglobulin is what type of IG class

A

IgG

239
Q

ED + morning erections + HTN + CAD + marital stress

A

Emotional stress causing ED

240
Q

Lactase deficiency + lactose challenge, what will decrease

A

stool pH: since bacteria hydrolyze lactose into short-chain fatty acids & H+; consumption of lactose will decrease pH (acidic) (high stool osmotic gap, high breath H+)

241
Q

Sensitivity

A

Sn = A / (A+C)

242
Q

Prolactinoma would be derived from what embryologic layer

A

Surface ectoderm

243
Q

Treatment for Giardia cysts

A

Metronidazole

244
Q

What class of drug could decrease uterine contractions & cause mydriasis

A

Alpha & Beta-Adrenergic Agonists

245
Q

Stop codons

A

UAA, UAG, UGA

246
Q

What is the sequence for base excision repair of non-bulky DNA base alterations

A

Glycosylase recognizes abnormal base, Endonuclease cleaves the 5’-end of the empty sugar site, Lyase completes the removal, DNA pol fills gap, Ligase seals

247
Q

Increased PaO2 resulting in hypoventilation is a result of decreased stimulation of which sensory receptor

A

Peripheral chemoreceptors: carotid body and aortic bodies

248
Q

Location of maxillary sinus on CT

A

inferior to eye

249
Q

Increased vagal activity has what effect on the lungs

A

ACh –>M3 –> bronchoconstriction & increased mucus secretion –> increased work of breathing

250
Q

Tx for Drug-Induced Parkinsonism

A

Anticholinergics (Trihexphenidyl, Benztropin) or Amantadine

251
Q

CMV viral genetics

A

Enveloped dsDNA virus

252
Q

Lesion of the R temporal lobe would produce what type of vision loss

A

Left homonymous superior quadrantopia

253
Q

V/Q mismatch in the base vs apex of the lung

A

since BF is lowest to the apex of the lung the V/Q is greatest in the apex

254
Q

How does Fructose-2,6-Bisphosphate affect the metabolism of glucose

A

High F-2,6-P stimulates PFK-1 to increase glycolysis & slows Gluconeogensis

255
Q

Hypoechoic nontender mass in testicle + high T3 & T4, which serum marker is probably high

A

Germ Cell Tumor secreting hCG, d/t alpha-subunit is causing paraneoplastic hyperthyroidism

256
Q

What percentage of people would fall outside 2SDs & be > than the mean

A

Enveloped dsDNA virus

257
Q

Polyarteritis nodosa most commonly affects which organs

A

kidneys, heart, liver, & GIT; but SPARES the lungs!

258
Q

CT shows ischemia in the central, upper frontal lobe –> defect?

A

Progressive leg weakness & spasticity

259
Q

Function on snRNPs

A

formation of spliceosomes necessary for RNA splicing

260
Q

Bupropion S/E

A

MOA: inhibit presynaptic reuptake of DA & NE, Use: MDD, Tobacco dependence, hypoactive sex d/o S/E: seizures (esp w/ eating d/o or prior seizure d/o)

261
Q

Smoker w/ long-standing HTN + Enalapril Tx —> rising serum Cr levels, why?

A

BP normalizes –> increases BF to kidneys, but dilates efferent a. –> reduction in renal filtration fraction –> decreased GFR

262
Q

Recurrent abd pain + anxiety, rapid improvement occurred w/ which Tx?

A

hepatic Porpyria d/t Uroporphyrinogen I Synthase deficiency resulting in the acummulation of ALA & Porphobilinogen; Tx involves repressing ALA synthase to decrease the accumulation of metabolic intermediates

263
Q

S3 heart sound can occur w/ which conditions

A

forceful, rapid filling of L ventricle, normal filling in a low compliance ventricle, or filling into an overfilled ventricle w/ high end-systolic V

264
Q

Blood transfusion –> hemolytic anemia; What type of rxn

A

HSN Type II –> complement-mediated lysis, ADCC by NK cells or macrophages, opsonization & phagocytosis

265
Q

Ulcerative Colitis findings

A

Rectal involvement, inflammation of mucosa & submucosa only, continuous damage, bloody diarhea

266
Q

Crohns Disease findings

A

Transmural inflammation, rectal sparing, perianal fistula, non-continuous, non-caseating granulomas, +/- bloody diarrhea w/ abd pain

267
Q

Which immune impairment would most likely lead to Giardia infections?

A

IgA deficiency, IgA & CD4+ cells are major contributors to fighting off Giardia (X-Linked agamma., IgA Def, & CVID - higher risk)

268
Q

Pancytopenia + CD55 & CD59 def + thrombosis + hemolytic anemia

A

Paroxysmal Nocturnal Hemoglobinuria –> complement-mediated hemolysis

269
Q

Guillain-Barre Syndrome + diarrhea; Culprit?

A

Campylobacter

270
Q

What blood test should be monitored for patient’s on Warfarin?

A

Warfarin: reduction in Vitamin K-dependent clotting factors (2, 7, 9, 10) —> Monitor PT (INR) - target INR 2-3 for Afib

271
Q

Young woman recently divorced –> weakness in left leg despite no PE findings

A

Conversion Disorder: stressor —> sudden loss of motor/sensory function not explained by neurology

272
Q

Neonate w/ oral thrush, interstial pneumonia, lymphopenia + mom w/o prental care, what prenatal care could have prevented this

A

Viral enzyme inhibitor drug —> Zidovudine!

273
Q

Colchicine provides gout relief by

A

Preventing Leukocyte attraction by inhibiting MT polymerization

274
Q

Isoniazid MOA

A

activated by Mycobacterial catalase-peroxidase to prevent mycolic acid synthesis; Resistance occurs via: decreased catalase or genetic mutation of mycolic binding site

275
Q

TB in cavitation in upper lung + corticosteroid use

A

Reactivation of latent TB d/t steroid use; Primary infection occurs in mid lung as a Ghon focus (Ghon complex: focus + hilar LAD)

276
Q

Sunlight provides what Vitamin D metabolic rxn

A

7-dehydrocholesterol –> Cholecalciferol

277
Q

Immediate Tx of Arsenic poisoning

A

Dimercaprol

278
Q

N./A./V. to the ovary are carried in which ligament

A

Suspensory ligament of the ovary

279
Q

The uterine a. must be ligated during a hysterectomy & is found in which ligament

A

Transverse cervical ligament

280
Q

Ketamine can reduce tolerance to Opioids via

A

by blocking the affects of Glutamate via NMDA antagonism

281
Q

Drugs capable of causing Drug-Induced Lupus

A

Hydralazine, Procainamide, Isoniazid

282
Q

Classic histologic findings in Alzheimer Dementia

A

Amyloid plaques & neurofibrillary tangles

283
Q

Relationship b/w GFR & Serum Cr

A

As GFR decreases significantly, serum Cr will begin to rise (non-linear relationship)

284
Q

HIV pt w/ EBV infection -> solitary mass w/in temporal lobe

A

Primary CNS Lymphoma is the most common CNS tumor in immunosuppressed pts

285
Q

Causes of Pulmonary Artery HTN

A

Genetics: AD BMPR2 mutation predisposes pt to vascular SM proliferation –> insults will cause PAH

286
Q

Cellular changes seen w/ axon injury followed by Axonal RXN

A

axonal rxn occurs in the proximal portion –> cellular swelling –> round cell, nucleus displaced to periphery, Nissl substance spread throughout cyto

287
Q

Absent vas deferens, bronchiectasis, azoospermia, infertility

A

Cystic Fibrosis - Dx w/ Cl- sweat test

288
Q

Cerebellar ataxia, recurrent pneumonia, telangiectasia

A

Ataxia Telangiectasia: mutation in ATM gene responsible for DNA break repair (hsn to X-ray radiation)

289
Q

If neural crest migration fails in the last week of migration to the intestine, which organ would be affected?

A

Rectum

290
Q

Anterior pituitary is derived from which structure

A

Rathke’s Pouch (surface ectoderm)

291
Q

Right homonymous hemanopsia w/ macular sparing, which a. is occluded?

A

Left PCA

292
Q

Follicle w/in ovary w/ developed antrum is in which stage

A

Secondary follicle

293
Q

The cerebellum is derived from what embryologic structure

A

Metencephalon

294
Q

Embryo implantation occurs in which stage

A

Blastocyst

295
Q

Injury to the lateral knee exposes the fibular hear + foot drop + inability to evert or dorsiflex foot

A

Common fibular n. injury

296
Q

Which coronary a. supplies the lateral LV

A

LCX supplies the lateral & posterior walls of the LV (LAD: ant 2/3 of IV septum, anterior papillary mm., ant LV)

297
Q

Tracheoesophageal fistula occurs d/t failure of

A

tracheoesophageal ridges to fuse

298
Q

What nerve supplies sensory to the scrotum & medial thigh

A

Ilioinguinal n.

299
Q

Compression of common carotid to stop bleeding would contact which vertebrae

A

6th cervical forms the posterior part of the root of the neck (vascular structures pass through: scalenes, sternum/rib1, & C6)

300
Q

Bifid ureters is a result from abnormal development of which structure

A

Ureteric bud: gives rise to collecting ducts -> ureters

301
Q

Brunner’s gland location

A

submucosa of duodenum

302
Q

Long-lasting numbness to the tip of the tongue d/t what N.?

A

Lingual n. (branch of CN 5-3)

303
Q

Cricothyrotomy insertion site

A

cricothyroid membrane b/w thyroid cartilage & criocoid cartilage, ut through superficial cervical fascia & cricothyroid membrane

304
Q

Location of ostium of maxillary sinus drainage

A

Hiatus semilunaris in the middle nasal meatus

305
Q

What nerve innervates sensation b/w toes 1-2

A

Deep fibular n.

306
Q

Ligament most easily sprained in inverted ankle sprain

A

Calcaneofibular

307
Q

Pain form the GB or Liver can be referred to

A

C3-C5 dermatome of the R. shoulder

308
Q

Bifid ureters + fistula into vagina

A

d/t early division of the ureteric buds

309
Q

Weak wrist extension + intact arm sensation

A

Injury to the deep branch of the radial n. at the head of the radius

310
Q

Treatment of friends & family by physician

A

is not recommended unless emergent, “uncomfortable prescribing to someone I am not treating”

311
Q

Wernicke aphasia caused by occlusion of

A

MCA

312
Q

Urethritis + Arthritis + conjunctivitis + vesicular rash on palms/soles

A

Reactive Arthritis (RF-neg spondyloarthropathy d/t infectious agent) assoc w/ HLA-B27 –> sacroiliitis in 20%

313
Q

Traveler’s diarrhea is d/t what toxin

A

ETEC: motile GNR, +fimbriae, plasmid-encoded LT & ST-toxins; LT: cholera-like toxin –>Gs–>AC–>increase cAMP; ST–GC–>increase cAMP; —>fluid & electrolyte secretion

314
Q

Cystic Fibrosis - defect in

A

post-translational protein folding of the transmembrane protein

315
Q

Which substances activate MAPk pathway upon binding their receptor?

A

Tyrosine Kinase receptor autophosphorylates -> phosphorylation of Ras -> MAPk (GF receptors: EGF, PDGF, FGF

316
Q

Which substances active JAK/STAT tyrosine-kinase associated receptor?

A

Receptor activates JAK -> phosphorylates STAT (Cytokine receptors, GH, Prolactin, IL-2)

317
Q

Fraternal twins

A

Dichorionic/diamniotic; Twinning after 1 week -> monochorionic-diamniotic, 0-4d: di-di, & 8-12d: m-m, >13: conjoined twins

318
Q

Pka

A

dissociate, when pH

319
Q

Primary hypothyroidism Tx w/ T3 administration would cause what lab values changes

A

TSH: decreased, T3: increased, rT3 (formed by peripheral conversion of T4): decreased, T4: decreased

320
Q

Involuntary loss of urine, nocturnal enuresis, difficulty starting stream, voiding w/o sensation of full bladder

A

Overflow incontinence d/t impaired detrusor contractility or bladder outlet obstruction, Sx: involuntary leakage + incomplete emptying

321
Q

Abd pain, nausea, confusion, red urine that darkens, improves w/ dextrose

A

Acute Intermittent Porphyria: ALA synthase -> accumulation of metabolites (Porphobilinogen & ALA), blocking ALA synthase reduces Sx (HEME & GLUCOSE negative feedback)

322
Q

Airway resistance is greatest in which point in the bronchial tree, at which point is it the lowest?

A

Highest in medium-sized bronchi; Lowest in terminal bronchi (although the radius decreases the summated cross-sectional area massively increases)

323
Q

N. menigitidis colonizes

A

nasopharynx epithelial cells via pilus-mediated adherence

324
Q

Before prescribing Metformin, check pts?

A

BUN/Cr; Kidney failure will decrease the ability to excrete Lactate generated in the intestine –> increased risk of Lactic Acidosis a rare but fatal S/E (Liver Ds, EtOHusers, & CHF)

325
Q

Mitral stenosis opening snap occurs?

A

Early diastole when the LV P

326
Q

Accepting gifts from patients

A

Unethical to accept gifts of monetary value

327
Q

Achondroplasia & risk of passing on trait

A

Autosomal dominant; 1 parent is normal & other is heterozygous for mutation —-> 50% risk of child

328
Q

Silicosis increases the risk of TB d/t

A

impaired macrophage killing d/t impaired phagolysosomes by internalized silica particles

329
Q

Elderly w/ fatigue + constipation + bone pain (back) + renal failure + renal biopsy: atrophic tubules + eosinophilic casts

A

Multiple Myeloma: anemia, hypercalcemia, osteoclast activation, Benc-Jones proteins (Ig light chain) -> preceipitate in tubules as Tamm-Horsefall proteins eosinophilic casts

330
Q

Polyuria + polydipsia + confusion + HIGH glucose + preceding viral inf + acidotic + paCO2 of 40

A

DKA w/ anion-gap acidosis: primary metabolis acidosis + compensatory respiratory alkalosis (Kaussmaul); High PaCO2 indicates respiratory failure

331
Q

Antiarrhythmic drug that rapidly resolves arrhythmia but causes severe crushing chest pain, flushing, & SOB

A

Adenosine

332
Q

Persistent erection + Med for treatment-resistant depression & insomnia

A

Trazodone - use: depression w/ insomnia S/E: priapism

333
Q

Artery injured in a humeral shaft fracture

A

Deep brachial a.

334
Q

Sickle Cell Disease mutation involves

A

Valine substitution for Glutamic Acid –> HbS polymerizes at low O2 tension –> sickling & hemolysis

335
Q

High pulmonary capillary wedge pressure would indicate would cardiac abnormality

A

Mitral Stenosis; PCWP ~LA P –> high LA pressure indicates pathology of the mitral valve

336
Q

Hoarseness, dysphagia, loss of gag reflex, uvula deviation, weakness in SCM & trapezius, anatomical structure lesioned?

A

CN10 & CN11 lesion, both exit skull via jugular foramen

337
Q

Which steps on Collagen synthesis occurs outside of the osteoblast

A

Terminal propeptides cleaved by N- & C- procollagen peptidases (tropocollagen) -> spontaneous assembly (fibrils) -> Lysyl Oxidase covalently cross-links fibrils

338
Q

Reabsorption of H2O occurs in which portion of the nephron

A

Proximal tubule + Thin ascending loop

339
Q

In water-deprivated state, the lowest urine osmolality would be seen in which part of the nephron

A

Distal Convoluted Tubule; The collecting duct contains the most concentrated urine

340
Q

Endometrial biopsy: carbohydrate-rich mucus + tortuous spiral aa. + edematous stroma; When was biopsy taken?

A

Mid-secretory phase (~21d) when progesterone has had time to exert its effects

341
Q

tRNA structure: which site binds to amino acids

A

3’ CCA tail

342
Q

Dysphagia + blurred vision + normal nerve conduction but decreased muscle AP

A

C. botulinum (descending paralysis) acts by blocking the release of ACh in neuromuscular junctions; Consumption of home-canned foods, honey

343
Q

Tx for Urge Incontinence

A

Antagonism of muscarinic cholinergic receptors; overactive detrusor contractility -> involuntary leakage just before reaching the toilet

344
Q

Which drug renders platelet surface receptors useless –> preventing platelet aggregation & clotting

A

Abciximab: blocks GP Iib/IIIa receptor (deficient in Glanzmann thrombasthenia)

345
Q

Potter Syndrome findings

A

B/L renal agenesis, lung hypoplasia, oligohydramnios, limb & face abnormalities

346
Q

Bacteria cell + bacterial cell lysate from another strain –> new bacteria d/t

A

Direct uptake of naked DNA from the environment

347
Q

Infant w/ poor feeding + large head + white-yellow chorioretinal lesions + enlarged ventricles + intracranial calcifications

A

Congenital Toxoplasmosis: intracranial calcifications, chorioretinitis, hydrocephalus; Toxoplasmosis is spread in-utero from mom w/ primary infection from cat feces (TORCH)

348
Q

Abd cramping & distention + vomiting + Xray w/ air in GB & biliary tree

A

Gallstoen ileus d/t long-standing cholelithiasis causing a cholecystenteric fistula, allowing intestinal gas to enter biliary tree

349
Q

Which virus generates its own protease used to cleave mRNA into multiple proteins (polycisteronic)

A

ssRNA, positive-sense, linear, non-segmented genome such as Echovirus

350
Q

Sequelae from an endocervical infection causing yellow discharge w/ neutrophils

A

N. gonorrhoeae can cause PID –> salpinitis, tuboovarian abscess, etc —> scarring of fallopian tubes –> infertility or ectopic pregnancy

351
Q

Contact dermatitis is mediated by

A

T-lymphocytes (Type IV HSN)

352
Q

Intermittent dyspnea + FEV1: 71% predicted value + eosinophils in sputum; patient should avoid

A

Animal dander; Sx suggest allergen-driven reversible Obstructive pulmonary process; Causes: animal dander, feathers, dust, mold,pollens

353
Q

What cell type increases in serum concentration following glucocorticoid administration?

A

Acute effects of steroids on CBC: increased NEUTROPHIL count, decreased lymphocyte, monocyte, basophil, & eosinophil; Neutrophil count increases d/t demargination

354
Q

Patient dies of heart failure and autopsy shows heart w/ large ventricular spaces & relatively thin LV walls

A

Chronic ischemic heart disease –> dilation of ventricles & contractile dysfunction (systolic dysfunction)

355
Q

Tx w/ Dapsone —> fatigue + jaundice + dark urine + RBC fragments + bite cells + microspherocytes

A

G6PD deficiency —> Anemia

356
Q

Ceftriaxone binds to

A

Transpeptidases irreversibly to inhibit peptidoglycan cross-linkage

357
Q

If Ceftriaxone + S. pneumo is ran on a gel & 5 bands appear, why may another strain of S. pneumo only have 2 bands

A

Change in protein structure of PBPs - 1 mechanis of bacterial resistance to cephalosporins

358
Q

MRSA Tx w/ S/E of Myopathy & CPK elevation

A

Daptomycin, MOA: depolarization of the cellular membrane, S/E: myopathy, high CPK, inactivated pulmonary surfactant

359
Q

Male + facial acne + bodybuilder + decreased testicular volume + high HCT; Reason for high HCT?

A

Steroid Abuse: Androgens stimulate RBC production, steroids inhibit GnRH –> decreased sperm production, small testes, & decreased endogenous Testosterone

360
Q

Gallstones - 5% cholesterol & black are likely a result of

A

Chronic Hemolysis —> Black Pigment Stones are composed of calcium carbonate & phosphate d/t unconjugated bilirubin precipitation as calcium bilirubinate

361
Q

Vasculitis w/ IgA & C3 deposition

A

Henoch-Schonlein purpura; Sx: purpuric rash, colicky abd pain, polyarthralgia, acute glomerulonephritis may occur

362
Q

Pulmonary abscess formation is d/t

A

Suppurative destruction of tissue w/in an abscess; tissue destruction occurs d/t neutrophil & macrophage release of lysosomal enzymes

363
Q

Atheroma formation - what cell provides proliferative stimuli for the cellular components of atherosclerotic plaques?

A

Vascular injury -> platelet & WBC adhesion -> PDGF is released by platelets, endothelial cells, & macrophages –> SM cells migration & proliferation; TGF-b -> collagen production

364
Q

Autopsy shows heart w/ increased LV wall thickness & decreased LV cavity size

A

Long-standing hypertension –> concentric LV Hypertrophy

365
Q

Patient w/ gait abnormality + incontinence + memory impairment & emotional blunting + CT w/ enlarged ventricular spaces

A

Normal Pressure Hydrocephalus: Sx: gait abnormality + urinary incontinence + dementia + emotional blunting + symmetrically enlarged ventricles d/t decline in resorptive capacity of arachnoid villi

366
Q

Glucagon works via what type of cell signaling pathway

A

Gs -> AC -> PKA -> cAMP

367
Q

Dysphagia + choking spells + coughing+ Zenker Diverticulum & narrowed esophagus

A

Cricopharyngeal mm. dysfunction occurs d/t diminished relaxation of pharyngeal mm. during swallowing -> inc force to force bolus down -> herniation (Zenker Diverticulum)

368
Q

Old cystic lesion months after cerebral vascular accident. Cyst is lined by?

A

Astrocytes

369
Q

The 3 genetic causes for Down Syndrome

A

Trisomy 21 d/t meiotic nondisjunction during maternal meiosis I, Robertsonian translocation, mosaicism

370
Q

Mass shrinks following chemo –> biopsy shows shrunken eosinophilic cells; what was released from the mitochondria

A

Cytochrome c –> activates caspases –> apoptosis (intrinsic pathway)

371
Q

Recurrent Neisseria infection

A

C5b-C9 deficiency –> inability to form MAC

372
Q

What heart structure lies directly anterior to the esophagus

A

Left atrium

373
Q

What heart structure lies directly posterior to the esophagus

A

Descending aorta

374
Q

Malabsorption + decreased proprioception + hyporeflexia + mild hemolytic anemia; Which deficiency exists

A

Vitamin E deficiency –> neuromuscular disease (ataxis, retinopathy, myopathy) d/t high risk of cell membrane oxidative injury via fatty acid oxidation

375
Q

Which supplement can somewht blunt the effects of folate deficiency & megaloblastosis

A

Thymidine –> replenishes the dTMP stores since folate inhibits thymidylate synthase production of dTMP

376
Q

Paroxysmal supraventricular tachycardia (heart palpitations, low BP, high HR) –> Valsalva requires which mm.

A

Rectus mm. are particularly important in raising intraabdominal pressure during the maneuver

377
Q

HTN + no secondary sex features + blind vagina + hypokalemia + low Testosterone & Estradiol + 46XY

A

17a-hydroxylase deficiency –> (pregnenolone -> 17-hydroxypregnenolone & progesterone -> 17-hydroxyprogesterone) –> impaired androgen&estrogen synthesis, high mineralcorticoids

378
Q

Aldolase B deficiency –> Tx involves avoidance of

A

Fructose & Sucrose (Sucrose —> Fructose + Glucose)

379
Q

14yoF + 6wk menstrual cycle + heavy bleeding for 7-10d + spotting

A

Anovulatory cycles –> seen in adolescents Sx: longer cycles, irregular bleeding patterns d/t high estrogen & no progesterone (absent ovulation) –> proliferative phase

380
Q

Tan fat-containing tissue around kidneys in a neonate –> removal would cause

A

Hypothermia; Brown adipose tissue mitochondria have uncoupled ETC & phosphorylation -> Proton gradient is utilized by Thermogenin (uncoupling protein) –> heat & no ATP

381
Q

What pulmonary defense clears particles

A

Phagocytosis; 10-15um - trapped in upper RT, 2.5-10um - mucociliary transport,

382
Q

The main mechanism for Copper excretion

A

Hepatic excretion into bile

383
Q

G6PD deficiency & what RBC enzyme deficiency can yield the same Sx

A

Glutathione Reductase; G6PD deficiency is a defect in the HMP shunt that impairs glutathione reduction d/t failure to produce NADPH

384
Q

HBV’s mechanism for causing liver injury

A

HBV-infected cells MHC class I presents HBsAg & HBcAg activating CD8+ T-cells resulting in liver damage

385
Q

Pharyngeal exudates + neck swelling + difficulty swallowing + heart failure; What is the mechanism of the toxin

A

C. diptheriae -> Diptheria toxin -> inactivates EF-2 via riboslation -> inhibition of host cell protein synthesis (similar to P. aeruginosa exotoxin A)

386
Q

Which Benzodiazepines are most likely to cause S/E & high risk of falling

A

Long-acting Benzos are more likely to cause daytime drowsiness, which increases the risk of poor judgment, poor concentration, ataxia, falling (Flurazepam, Chlordiazepoxide)

387
Q

Oxidase(+) GN comma-shaped rods + survival on alakaline media —> water-borne Gastroenteritis –> stool microscopy

A

Mucus & sloughed epithelial cells; Vibrio cholera causes noninflammatory (enterotoxin) watery diarrhea –> stool would show no RBCs or WBCs

388
Q

B/L tumors at the cerebellopontine angle + tinnitus + hearing loss + vertigo

A

B/L acoustic neuromas (schwannomas) are seen in Neurofibromatosis type 2, AD mutation in NF2 on chromosome 22 (gene encodes protein Merlin)

389
Q

Most common cause of bacterial meningitis in adults

A

S. pneumo: G(+) lancet-shaped cocci found in pairs (Alcoholics, Sickle cell, Asplenic, poor health pts are at greatest risk)

390
Q

HIV pt w/ CD4 of 800 –> fever + chills + productive cough + bronchial breath sounds over L lower lung

A

Lobar pneumonia in an HIV+ pt w/ a normal CD4 count —> S. pneumo is the most common cause of CA-pneumonia in immunocompetent pts

391
Q

Indurated, painless, single genital ulcer –> Tx is a structural analog of

A

Primary Syphilis -> 1st line Tx is Penicillin G; MOA: inhibit transpeptidase by blocking the D-Ala-D-Ala peptidoglycan binding site —> blocking cell wall synthesis

392
Q

HR 50 + confusion + lacrimal tearing + b/l wheezing + sweating + flushed + found in tool shed

A

Organophosphate insecticide poisoning –> irreversible AChE inhibition –> Cholinergic overstimulation; Tx w/ muscarinic antagonist (Atropine) + Pralidoxime

393
Q

A drug relaxes arteriole SM but not veins —> S/E?

A

Arteriolar vasodilation causes significant reduced BP –> stimulates baroreceptor-mediated activation of SNS –> reflex tachycardia & increased Renin (Na & H2O) -> Edema

394
Q

Acarbose MOA

A

Alpha-glucosidase inhibitor –> decreases disaccharidase activity on intestinal brush border -> prevents disaccharide breakdown into monosaccharides necessary for absorption

395
Q

Hypopigmented spots on tanned skin

A

Malassezia furfur –> Pytriasis versicolor; Fungal infection of the stratum corneum, Dx KOH test reveal spores & hyphae in “spaghetti&meatball” appearance & “cigar-butt” hyphae

396
Q

Fever + malaise + maculopapular rash including palms & soles + serum mixed w/ cardiolipin, lecithin, & cholesterol -> agglut.

A

RPR screening test for Syphilis: checks for aggregation of patients RBCs whne mixed w/ cardiolipin, cholesterol, & lecithin confirming the presence of anti-cardiolipiin Abs

397
Q

Elderly w/ chronic anemia w/o identifiable cause?

A

Vitamin B12 absorption: salivary gland - R protein binds free B12 -> in duodenum, pancreatic lipase cleaves R & IF(parietal cells) binds B12 -> absorption in distal ileum

398
Q

Dysplasia is differentiated from carcinoma by

A

reversibility of changes; dysplasia is abnormal cell growth confined to the epithelium

399
Q

Severe, U/L, throbbing HA + photophobia + n/v —> Abortive Tx involves a drug w/ what MOA

A

Sumatriptan MOA: Serotonin 5-HT1B/5-HT1D agonists -> postsynaptic serotonin receptor stimulation -> prevents release of substance P & CGRP & vasoactive amines

400
Q

Viral Meningitis CSF findings + response to Acyclovir

A

HSV meningitis –> Glucose - normal, Protein - increased, 90% lymphocytes

401
Q

Thyroid peroxidase enzyme function

A

Catalyzes the oxidation of Iodide, Iodination of thyroglobulin, & coupling rxn b/w 2 iodized tyrosine residues

402
Q

Microscopic changes seen in heart 12d after MI

A

Fibrovascular granulation tissue w/ neovascularization is seen b/w 5-10d post-MI

403
Q

Pain w/ defecation + bright red blood on TP –> Such tears are found where

A

Posterior midline & distal to the dentate line d/t lower perfusion making mucosa sensitive to hard fecal mass

404
Q

Which Nitrate has the highest bioavailability when given orally

A

Isosorbide mononitrate has 10% bioavailability orally

405
Q

Cirrhosis + thrombocytopenia + prolonged PT that does not resolve w/ Vit K; Reason for high PT?

A

Liver dysfunction often leads to coagulopathies —> Factor VII has the shortest half-life, so PT is the first to be prolonged in liver ds

406
Q

Parkinsons when genetic can be linked to what defective biochemical process

A

Defects in to ubiquitin-proteasome complex

407
Q

Abd discomfort + loose stools + weight loss + biopsy w/ intense PAS stain; What is stained pink

A

PAS oxidizes Carcbon-Carbon bonds to form aldehydes -> rxn w/ fuchsin-sulfurous acid -> magenta stain —> Tropheryma whippelii appears magenta w/ PAS

408
Q

Sympathetic output is transmitted using noradrenergic receptors on target organs, except?

A

SNS innervation to the adrenals (D1) & sweat glands (ACh)

409
Q

Abrupt chest pain radiating to the back + BP 220/130 in L arm & 180/100 in R arm

A

Intimal tearing assoc w/ aortic dissection

410
Q

Bloody diarrhea in HIV pt w/ low CD4 + hemorrhagic polypoidal lesions + spindle cells w/ blood vessel proliferation

A

Kaposi Sarcoma: vascular malignancy d/t HHV-8 extracutaneous spread to GI & lungs; Scopy shows reddish/violet flat maculopapular lesions to raised hemorrhagic polypoid mass

411
Q

Actin binding site in sarcomere

A

Z disk

412
Q

Case-fatality rate

A

Fatal cases/total number of cases

413
Q

Pancrease Divisum, the ventral bud gives rise to

A

Main pancreatic duct, inferior/posterior portion of head, & uncinate process

414
Q

Improper use of crutches & inability to extend wrist

A

Radial n. compression

415
Q

Histone linker protein

A

H1 histones participate in DNA packaging

416
Q

Delayed dev + hypotonia + self-mutilation, which enzyme activity is INCREASED

A

PRPP (Rate-limiting enzyme of purine synthesis) Phosphoribosyl pyrophosphate amidotransferase

417
Q

Omeprazole MOA

A

Inhibition of the H/K-ATPase (proton pump) for the Tx of GERD , PUD, or Zollinger-Ellison

418
Q

Abd pain, bloating, indigestion, NSAID use, fecal blood, ulcer detection in what segment would not be assoc w/ malignancy

A

Duodenum

419
Q

Situs inversus + recurrent respiratory infections –> What is the dysfunction

A

Dynein arms

420
Q

Elastase in lungs is produced by

A

Alveolar macrophages

421
Q

Physician payment that encourages preventative care & health counseling

A

Capitation: fixed budget per enrollee, incentives ro contain cost d/t fixed budget

422
Q

2:1 ration of what 2 substances in amniotic fluid determine lung maturity

A

Phosphatidylcholine/Lecithin & Sphingomyelin

423
Q

Elderly w/ AMS, skin flushing, high fever, low BP, high HR & RR –> Bacteremia, where was the initial infection

A

UTI

424
Q

abd pain + hypotension + high RR + metabolic acidosis w/ anion gap & high plasma lactate –> Enzyme w/ low activity

A

Pyruvate dehydrogenase (enters into TCA cycle) would have low activity & Lactate dehydrogenase would have high activity

425
Q

Broken 12 rib –> injured organ?

A

Left Kidney

426
Q

HA + Pigmented spots on trunk + rubbery tumors on neck –> Where did these cells originate?

A

Neurofibromatosis type 1: caf‚-au-lait spots, glioma, neurofibromas; Neurofibromas are derived from Schwann cells which arise from neural crest

427
Q

Airway pressure-volume curve - where is FRC located

A

center of the curve: resting state where airway pressure equals 0

428
Q

Dyspnea, orthopnea, fatigue, hx MI, S3 + holosystolic murmur over apex —> Diuretics resolve murmur

A

Functional Mitral Regurgitation

429
Q

Growth factor cell signaling pathway

A

Tyrosine Kinase receptor autophosphorylates -> phosphorylation of Ras-GTP -> Raf -> MAPk (GF receptors: EGF, PDGF, FGF)

430
Q

Immigrant w/o Sx has +HAV-IgG Ab

A

Anicteric viral infection as a toddler

431
Q

Gallstones during pregnancy –> What may have contributed to gallstones

A

E–>cholesterol hypersecretion & P—>gallbladder hypomotility

432
Q

3000kcal 30% protein —> protein kcal?

A

225; 1g of protein = 4cal

433
Q

Flat facies + posterior thick neck + VSD + Duodenal Atresia

A

Trisomy 21

434
Q

Child w/ bacterial meningitis & mom wants to bring home & not Tx

A

Mandate to Tx d/t risk posed to child & contacts

435
Q

When is total pulmonary vascular resistance the lowest

A

FRC; Large lung volumes expand & stretch blood vessels –> increased resistance; Decreased lung volumes -> narrow & compress blood vessels

436
Q

Increased Staph infections in hospitals over the last 30 years

A

d/t increased use of intravascular devices (S. epidermidis)

437
Q

Defective IG isotype switching —> Overproduction of Ig ?

A

IgM

438
Q

Methotrexate used for abortion –> what substance accumulates in fetal tissue

A

Dihydrofolate polyglutamate

439
Q

When is b-hCG detectable forllowing fertilization

A

In serum at day 8, urine by day 14

440
Q

Xeroderma Pigmentosum –> defective

A

Endonuclease: excision of thymine dimers

441
Q

Liver cyst in an immigrant shows white chalky filling –> If ruptured during resection —>

A

Echinococcus granulosus –> hydatid cyst w/ “eggshell calcification” –> dissemination –> Anaphylaxis

442
Q

Tetanus reaches spinal cord via

A

C. tetani toxin –> retrograde transport up motor neurons –> inhibition of inhibitory interneurons

443
Q

Great Saphenous vein graft to diseased coronary artery –> vein tissue is harvested from

A

Just inferolateral to the pubic tubercle

444
Q

Dilated heart + brownish pigment of the myocardium

A

Hemachromatosis: excess absorption of Iron, later onset in females d/t menstruation

445
Q

HIV protein synthesis

A

Env -> polyprotein -> glycosylated & cleaved into 2 proteins in the RER -> gp120 & gp41 -> mediate the fusion of virion into target cells

446
Q

In the presence of glucose & no lactose a mutation in what region would inhibit binding of a protein to a regulatory sequence

A

Operator: repressor is bound to operator when there is no lactose present

447
Q

Fever + chest pain + productive cough + lancer-shaped G(+) diplococcis —> Preventable by what vaccine

A

Outer polysaccharide covering (pneumococcal polysaccharide vaccine) or pneumococcal conjugate vaccine

448
Q

ALL Tx w/ 6-MP –> 6-MP is metabolized by

A

Xanthine Oxidase

449
Q

PaO2 of 70, normal PaCO2 – what is most likely increased

A

PAO2 - PaO2 difference

450
Q

Absence seizures & tonic/clonic seizure —> Tx

A

Valproate & Ethosuximide are used for absence seizures; although ethosuximide is not effective against tonic/clonic

451
Q

Vomiting + Vertigo —> which structure is dysfunctional

A

Inner ear

452
Q

Which med would cause QT interval prolonged + polymorphic QRS complexes that change in amplitude & length

A

TdP + prolonged Atcaused by antiarrhythmic agents: Quinidine, Procainamide, Disopyramide, Ibutilide, Dofetilide, Sotalol

453
Q

“Young appearing male” + poor 2nd sex dev + poor smell

A

Kallmann Syndrome: failure of GnRH-secreting neurons to migrate to from olfactory placode to the hypothalamus (mutation in KAL-1 gene or FGFR-1)

454
Q

HA, nausea, sweating, FHx of hyperparathyroidism + high BP + high urinary VMA; Cells of tumor share origin w/

A

Neural crest derivatives: thyroid parafollicular cells, adrenal chromafin cells MEN 2A or 2B syndromes

455
Q

Hx of viral esophagitis + pneumocystis pneumonia + meningitis –>

A

Crytococcus neoformans: budding yeast, latex agglutination positive for polysaccharide Ag,

456
Q

Double vision walking down stairs –> lesion to ?

A

Trochlear n. —> down & out movement of the eye —> lesion results in difficulty walking down stairs

457
Q

PaO2 - normal, %sat O2- normal, O2 content - low

A

Indicates that O2 is bound to all present RBCs just fine –> must have low RBCs —> Chronic blood loss

458
Q

Irradiation is used as cancer Tx, its MOA is

A

DNA double strand breaks & formation of free radicals

459
Q

Diastolic heart failure diagnostic findings

A

Normal EF since the failure involves decreased ventricular compliance rather than contractility; Reduced LV EDV so LV EDP is abnormally high to achieve normal LV EDV

460
Q

Hospice care requirement

A
461
Q

Tingling & loss of sensation over digit 5

A

Ulnar n. lesion

462
Q

Vaccine of polysaccharide conjugated to diptheria toxoid

A

H. infleunzae type B

463
Q

Streak Ovaries

A

Turner Syndrome Sx: streak ovaries, bicuspid aortic valve

464
Q

Viral protein that forms spheres & tubules ~22nm & poorly correlates w/ viral replication

A

Envelope component of HBV: HBsAg: noninfective envelope glycoprotein secreted in large amounts from hepatocytes, exceeding the amount of HBcAg produced

465
Q

Smoker w/ dyspnea + PaO2 50 & PaCO2 26

A

Alveolar hyperventilation: hypocapnia implies alveolar hyperventilation; V/Q mismatch -> low O2/CO2 exchange -> hypoxemia -> chemoreceptors increase ventilation

466
Q

Peripheral blood smear shows myeloblasts (large cells w/ basophilic cytoplasm + Auer rods)

A

Acute Promyelocytic Leukemia –> t(15;17), seen in young patients & may cause DIC

467
Q

Lidocaine injection near tip of ischial spine

A

Pudendal nerve block

468
Q

TG breakdown –> liver specific enzyme involved in TG breakdown & glucose synthesis

A

Glycerol kinase converts glycerol to Glycerol-3-phosphate in the liver

469
Q

Why is Cl- concentration lower in arterial blood than venous blood

A

Carbonic anhydrase converts CO2 from tissue into carbonic acid in RBCs –> HCO3- + H+ as bicarb diffuses out of RBCs into plasm,a Cl- is enters to maintain charge

470
Q

Long-term therapy for PE pts —> Warfarin MOA?

A

Inhibits epoxide reductase which activates Vitamin K –> inhibits Vitamin K-dependent carboxylation of glutamic acid residues of factors 2, 7, 9, 10

471
Q

Transplant pt w/ pneumonia, stain shows thick circular polysaccharide capsule

A

Crytococcus neoformans: budding yeast, latex agglutination positive for polysaccharide Ag (polysaccharide capsule)

472
Q

Prevention of lysosome acidification w/in APCs results in pooe interaction w/ T-cells upon Ag exp –>

A

prevents invariant chain removal from the MHC class II receptor upon fusion of lysosome & endosome –> MHC class II cannot bind Ag & will not interact w/ TCR

473
Q

Tx for n/v associated w/ chemotherapy

A

Ondansetron: 5-HT3 receptor antagonist –> blocks vagus-mediated n/v & blocks serotonin in the CTZ

474
Q

Reaction Formation

A

drug abuser works at a halfway house & gives motivational talks

475
Q

Ability of a Turner Syndrome pt to become pregnant?

A

She would require an oocyte donation

476
Q

IL-2 function

A

growth & differentiation of CD8+ & CD4+ T-cells, B-cells, monocytes & NK cells

477
Q

Pantothenic acid (coenzyme A) is necessary for what

A

acetylation reactions (TCA cycle)

478
Q

Decreases in Vitamin B12 or folate decreases the conversion of homocysteine to

A

Methionine, resulting in accumulation of homocysteine –> endothelial damage –> atherosclerosis

479
Q

PABA containing sunscreens prevent absorption of

A

UVB radiation

480
Q

Prodrome of fever, fatigue, pruritus –> AST/ALT elevation follows

A

HBV

481
Q

Clavicle fracture –> medial fragment displaced upward by

A

SCM

482
Q

Disseminated Candida infection would be most likely seen in

A

Patients w/ low neutrophil counts; T-cells are important in the prevention of superficial Candida infections, while Neutrophils are necessary in preventing dissemination

483
Q

HA, nausea, papilledema, dry skin, hepatomegaly, odd diet

A

Vitamin A toxicity

484
Q

pH, PaO2, PaCO2, Plasma HCo3- in a pt w/ a PE

A

PaO2 low –> hypoxemia –> increased respiratory drive –> hyperventilation –> respiratory alkalosis (inc pH, low PaCO2, low HCO3-)

485
Q

Organism found in abdomen following perforated appendicitis

A

B. fragilis (anaerobic, GNR, most common GIT NF)

486
Q

UTI in sexually active young female adult

A

S. saprophyticus: GPC, catalase(+), coagulase (-), Novobiocin resistant

487
Q

Low AFP, Low estriol, High b-hCG

A

Trisomy 21

488
Q

Delivering bad news to pt

A

SPIKES protocol: set the stage, perception, invitation, knowledge, empathy, summary/strategy

489
Q

Prolonged bleeding, hemarthrosis, what are the chances that his sister’s unborn child will also has this disease

A

Hemophilias A/B are characterized by hemarthoses & bleeding; X-linked sister has 50% chance of being a carrier, 50% chance of male infant, 50% chance of passing mut = 1/8

490
Q

Support

A

expression of concern & interest

491
Q

Dysphagia + esophageal biopy w/ unorganized cells or varying nuclear content

A

Malignancy w/ poor prognosis; Squamous cell carcinoma: solid nests of neoplastic cells w/ abundant eosinophilic cytoplasm

492
Q

S/E of Ethambutol

A

Optic neuritis (decreases visual acuity, central scotoma, color-blindness)

493
Q

Polyuria + polydipsia + LOW glucose + low urien osmolality that’s responsive to ADH (150 -> 550)

A

Complete Central DI: complete indicates ADH response >50%

494
Q

Weak forearm flexion & absent biceps reflex, sensation loss?

A

Musculocutaneous n. injury –> loss of sensation to lateral arm

495
Q

PCL tear –> identify it on CT

A

PCL attaches from the anterior femur —> posterior tibia

496
Q

Simvastatin & Cholestyramine effects on cholesterol synthesis

A

Simvastatin inhibits HNG-CoA reductase, blocking cholesterol synthesis; Cholestyramine binds bile acid to prevent reabsorption & leads to increased HMG-CoA reductase

497
Q

Lagging strand in synthesized 3’–>5’

A

Requires repetitive action of ligase to join DNA fragments

498
Q

Spastic paresis of LEs, choreoathetoid movements, HIGH arginine levels –> enzyme deficiency normally involved in

A

Urea production: Arginase converts Arginine –> Ornithine + Urea

499
Q

1 testicle + High FSH + normal LH –> production of what hormone is impaired

A

Inhibin B: produced by Sertoli cells normally feeds back to the pituitary to shut down FSH release (FSH–> Sertoli cells —> Inhibin B –| Pituitary)

500
Q

Confusion , lethargy, low pH, low HCO3-, low paCO2

A

Metabolic Acidosis

UWORLD (2 decks)

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