Untitled spreadsheet - Sheet1 Flashcards
1
Q
Topic
A
Discussion
2
Q
Lead-time Bias
A
earlier diagnosis does not = extended life expectancy
3
Q
Female incidence & mortality of cancer
A
Incidence of cancer in women: breast > lung > colon; Mortality of cancer in women: lung > breast > colon
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)
5
Q
Sensitivity & Specificity
A
Sn = A/(A+C) Sp = D/(D+B)
6
Q
Positive-Skew
A
Mean > Median > Mode
7
Q
Attributable Risk Percent
A
ARP = 100 x (RR-1)/RR
8
Q
Prevalence vs Incidence
A
Incidence = new cases/at risk pop; Prevalence = # of cases/total pop; Prevalence = incidence x duration of disease
9
Q
Relative Risk Reduction
A
RRR = ((AR:control)-(AR:tx))/AR:control
10
Q
Positive Predictive Value
A
PPV = A/(A + B)
11
Q
Cohort Study
A
Odds ratio = Odds of exposure in diseased/Odds of exposure in non-diseased
12
Q
T-test
A
test compares the mean of 2 groups of subjects (regardless if groups are different or same)
13
Q
Chi-Square test
A
Categorical data comparison; comparing >/= 3 groups
14
Q
If RR b/w 2 studies is the same but the p-value varies
A
sample size may have been too small
15
Q
Correlation coefficient
A
0: no correlation b/w the 2; 1: absolute correlation, -1: perfect inverse correlation
16
Q
Hawthorne Effect
A
subjects change behavior knowing they are being studied
17
Q
Observer Bias
A
double-blind studies reduce observer bias
18
Q
Relative Risk
A
RR = (a/a+b) / (c/c+d)
19
Q
Power
A
1-type II error (b)
20
Q
Negative Predictive Value
A
Likelihood that a negative test means the patient does not have a disease NPV= D/(C+D)
21
Q
Reliable tests
A
Reproducibility of a test
22
Q
Reduction of risks
A
smoking is almost always the #1 reducible mortality risk
23
Q
Statistical significance
A
if the 95% CI does not include 0 the Ho can be rejected
24
Q
PPV is higher when the prevalence of ds increases
A
NPV is lower when the prevalence of ds increases
25
Which enzyme is capable of adding uracil to DNA?
Primase
26
24yo w/ UTI most commonly from
E. coli
27
Where would uric acid renal crystals most likely form?
In the collecting duct where there is an acidic pH
28
Tuberous sclerosis
renal angiomyolipoma (fat, blood v, & sm m.) + ash-leaf spots + brain hamartomas
29
Ureters course anterior to which structure
Internal iliac a. (& under the uterine a. or vas deferens)
30
The cause of death in an infant w/ Potters syndrome
pulmonary hypoplasia -> respiratory distress
31
Renal hypoplasia would likely result in hyperplasia of
modified SM cells, JG cells, that then increase their release of renin
32
Acute transplant rejection
weeks; Host T-cells attack donor MHC II molecules
33
Adrenal mass + low renin + high BP + hypokalemia
Aldosterone secreting tumor --> Tx w/ Spironolactone or Eplerenone
34
Post-streptococcal Glomerulonephritis - deposits of
C3, IgG, IgM
35
Elderly pt experiencing Digoxin toxicity d/t age-related
decrease in renal clearance
36
Tx for diabetic nephropathy
ACE-I or ARB
37
Investigator knows which participants are in experimental group
Observer bias
38
Tx for chronic renal failure
Loop diuretics
39
Acid/Base imbalance in Type I DM pt
Metabolic acidosis (low bicarb)
40
Alcoholic Wernicke-Korsakoff Syndrome + hypoglycemia
Which enzyme in the TCA cycle is most impaired? Alpha-ketoglutarate (thiamine pyrophosphate is a cofactor)
41
RNA w/ dihydrouracil, thymidine, acetylcytosine --->tRNA acceptor stem 3'
3' CCA tail
42
Tumor Lysis Syndrome prevention
Allopurinol (xanthine oxidase inhibitor) or Rasburicase (urate oxidase: converts urate to allantoin)
43
Septic shock -> lactic acidosis
decreased oxidative phosphorylation
44
Aspiration pneumonia
superior region of lower lobe & posterior upper lobe; stroke, altered consciousness, etc increase risk
45
HbC
Glutamate is replaced by lysine (missense mutation) -> increased positive charge of Hb
46
Frameshift mutation
deletion or additions not in the multiple of 3
47
In glucokinase deficiency, what enzyme contributes to cataract formation?
Aldose reductase: converts galactose --> galactitol
48
Tyrosine kinase receptor - MTOR pathway
autophosphorylation of tyrosines -> PI3K activation -> Akt activation -> MTOR activation -> translocates to nucleus -> TF
49
Acyl-CoA dehydrogenase deficiency
impaired beta-oxidation, cannot utilize fats for energy or produce ketones -> severe hypoglycemia during starvation, low ketone bodies
50
What type of bond accounts for alpha-helix & beta-pleated sheets?
Hydrogen bonds
51
Thyroid hormone receptors
intranuclear receptors
52
Spoon nails (koilonychia) & dysphagia + anemia
Iron deficiency anemia
53
Treatment for HSV-2 infection
Acyclovir, Valacyclovir, Famciclovir: gets incorporated in viral DNA -> viral DNA replication termination
54
Type of mutation seen w/ HNPCC/Lynch Syndrome
abnormal mismatch repair enzyme (MSH2, MLH1 -> MutS, MutL homologs)
55
HbF
2-alpha, 2-gamma
56
Supplementation for Measles infection
Vitamin A
57
Leptin receptor K/O mouse
Leptin -> neuropeptide Y -> decrease appetite; Leptin levels - high, but mouse's appetite remains high
58
Child w/ diarhhea exposed to puppy w/ diarrhea
Campylobacter
59
N. meningitidis meningitis prophylaxis for close-contacts
Rifampin
60
Downward displacement of the lens + renal infarcts + thrombosis
Homocystinuria --> Cystathionine synthetase deficiency --> Tx: Vitamin B6 (pyridoxine)
61
Suspected Asthma - Test for Dx
Methacholine
62
HTN medication S/E of hypercalcemia
Thiazide (Loops lose Ca)
63
Melanoma - embryonic derivative
Neural crest
64
N. passing through obturator foramen has what action
Obturator n. innervates adductors of the thigh
65
Location of enhancer segments
Variable location (same chormosome, w/in gene, another chromosome)
66
Chronic Granulomatous Disease (abn nitroblue tetrazolium test) -> susceptible to what agents
Catalase (+)
67
N. for eye adduction (CN3) & corneal reflex (nasociliary n.) enters the orbit via
Superior orbital fissure
68
Physician morally choosing not to perform abortions should
provide patient w/ referrals for providers who will perform abortions
69
At peak exercise, which wil be the same in the systemic & pulmonary circulation?
Blood flow/min (always true, exercise or rest)
70
If a test includes more false pos to capture all true positives, what will be altered
Lower the PPV - PPV = A/(A + B)
71
Alternative to aspirin for exertional chest pain
Clopidogrel
72
Holosystolic murmur heard at apex radiating to L axilla; what predicts severity?
MR - audible S3 indicates large volume of regurgitant flow
73
Diarrhea --> acute renal failure + schistocytes + hemolysis
HUS-TTP caused by EHEC 0157:H7 consumed in undercooked beef
74
Pt on Lithium begins new drug for HTN -> lithium toxicity, what's the HTN med
Thiazides, ACE-I, NSAID will all increase Lithium conc
75
Ischemic injury to brain 12-24hrs post
Red Neurons (eosinophilic cytoplasm) w/ pyknotic nuclei
76
Incomplete GB emptying in response to CCK may lead to
Biliary sludge
77
Ingestion of toxin -> double vision, ptosis, nausea, dry mouth
C. botulinum (descending paralysis) acts by blocking the release of ACh in neuromuscular junctions
78
Tonsillar exudate + cervical LAD + splenomegaly + heterophile Ab +
No contact sports - inform coach of medical recommendation
79
Lung cancer rates in women
markedly rose from 1965-2000 when cigarette popularity increased
80
Bicornuate uterus is d/t
failure of the paramesonephric ducts to fuse
81
Gingival ulcers + swollen gums + cervical LAD + fever + irritability in 5yo
Herpetic gingivostomatitis d/t HSV-1 primary infection (secondary inf. Present as cold sores typically)
82
HIV genetics - which gene codes for p24 Ag
gag - p24; env - gp120, gp41; pol - RT, integrase
83
Adverse outcomes are more likely in smokers, this phenomenon is
Effect modification - effect of an exposure on an outcome is modified by another variable
84
Post-transcriptional modications
5' guanosine cap + Poly-A tail (AAUAAA) + intron splicing
85
Cleft lip - failure of
maxillary prominence & medial nasal prominence to fuse
86
Patient in denial about terminal cancer
"hope for the best, but focus on maximizing time with family"
87
Pernicious anemia d/t Ab-mediated destruction of parietal cells found w/in the
Upper glandular layer (just deep to crypts) --> chronic atrophic gastritis
88
Valproate teratogenic effects
inhibits intestinal absorption of folate ---> Neural tube defects
89
Kinesin protein
anterograde MT motor protein; in neurons kinesin carries vesciles and organelle toward the nn. Terminal
90
95% Confidence Interval
mean +/- 1.96*SD/_n
91
progressive neurodegeneration, startles easily, macrocephaly, red macular spot; Accumulated metabolite?
Tay-Sachs Ds: defective b-hexosaminidase A --> accumulation of GM2 ganglioside
92
F w/ low-volume vaginal bleeding + large cell w/ perinuclear clearing
HPV infection --> Koilocyte
93
High AFP, what should be r/o: _____________ & neural tube defects
Dating error
94
Attack rate
diseased/exposed
95
F experiencing insomnia, reliving stressful event, w/d
PTSD
96
Disease has earlier onset in successive generations
Anticipation
97
Number needed to harm NNH
NNH = 1/ARR & ARR = Adverse rate in Ctrl group - Adverse rate in Tx group
98
Ischemic injury to brain 3-5d post
Microglia infiltration --> abundance of lipids in microglia cytoplasm as they phagocytose myelin (~1 week post)
99
Aggressive behavior + confusion + agitation + nystagmus + ataxia are S/S of
Phencyclidine OD
100
Cardiac cell AP & ion flux
1. Na rapid inward flux 2. slow K+ gates open and K+ exits 3. Ca2+ channels open and Ca2+ flows in
101
Odds Ratio
OR = (A/C)/(B/D) = (A*D)/(B*C)
102
Secretory form of IgA
Dimer attached tail-to-tail is found in mucus, tears, saliva, colostrum
103
Primary amenorrhea + shortened vagina + rudimentary uterus
Vaginal agenesis or Mullerian Aplasia or Mayer-Rokitansky-Kuster-Hauser Syndrome
104
Anti-snRNPs + mixed CT disease; snRNPs are found in?
Spliceosomes
105
Perforated ulcer on the posterior duodenal would effect which a.?
Gastroduodenal a.
106
Which stimuli would cause enlarged gastric rugal folds & parietal cell hyperplasia
Gastrin (Zollinger-Ellison)
107
Respiratory tract transition from ciliated pseudostratified
Terminal bronchioles: ciliated pseudostratified -> ciliated simple cuboidal (cilia remain until alveoli to propel mucus upward)
108
Cyst found in a fibrous band extending from ileum to umbilicus
Omphalomesenteric (vitelline duct) is asoc w/ Meckel diverticulum, cyst, fistula
109
Orotic aciduria + hyperammonemia
Ornithine Transcarbamoylase deficiency
110
Study w/ group A receiving Tx & group B receiving placebo then after 4 weeks they switch
Cross-over study
111
Women fears doctor (sweating, anxiety)--> women seens stethoscope & has anxiety, sweating
Classical conditioning
112
Infant w/ sublingual mass removed ---> lethargy, poor feeding, constipation, dry skin; Defect in
Migration - failure of the thyroid to migrate from the lingual area down the thyroglossal duct pathway, removal -> hypothyroidism
113
Female w/ rib notching + diminished femoral pulses
Coarc of Aorta typically seen in Turner's Syndrome
114
N. gonorrhaea infections reoccur w/ out future immunity because
Gonococcal surface antigens undergo high frequency variation
115
Alcoholic cirrhosis + portal HTN + ascites
Identify portal v. on CT (the one that looks like it is going straight into liver)
116
Centriacinar emphysema - what cell type is responsible for the damage/development of this condition?
Neutrophils & macrophages release proteases
117
What type of transmembrane protein in CFTR?
ATP-gated
118
Progressive dyspnea + liver biopsy showing cells filed w/ globules (stain pink w/ PAS)
Globules of unsecreted alpha-1-antitrypsin --> A1AT deficiency leading to panacinar emphysema & liver disease
119
Focal necrosis + crescent formation on renal biopsy; Crescent is formed form what substance?
Fibrin & plasma proteins (C3), monocytes, macrophages, parietal cells - Goodpasture's would also have IgG
120
Conducting an interview in pt w/ language barrier in non-emergency setting
Call for & WAIT for intrepretor
121
Irradicating HBV would likely also irradicate
Delta agent infection
122
Med for BPH & HTN
alpha-1-blocker: Doxazocin, Prazocin, Terazosin
123
Fragile-X-Syndrome mutation
Trinucleotide repeat in FMR1 gene w/ >200 CGG repeats ---> Hypermethylation --> Gene inactivation (fragile: thin, constricted X)
124
Microcytic Anemia resistant to iron, target cells + high HbF; the defect is most likely d/t
Beta-thal minor --> mutations are likely d/t transcription, processing, & translation of beta-globulin mRNA
125
Injured long thoracic n. can result from
Mastectomy
126
Abd fluid mass compressing psoas major (spontaneous retroperitoneal hematoma 2ndary to Warfarin use)
Psoas compression --> femoral n. neuropathy --> quadriceps weakness, "knee-buckling", sensory loss over ant. & medial thigh + diminished patellar reflex
127
S/E of inhaled GA
CV depression, hypotension, respiratory depression, ICP d/t increased cerebral blood flow, low GFR, low RBF, low hepatic BF
128
Irregularly irregular ECG findings
Afib --> absent P waves, irregularly irregular rhythm, varying R-R intervals; Preceipitated by high SNS, acute illness, EtOH consumption
129
CO affects hemoglobin by
Competitively binding to heme
130
Attributable Risk
ARR = Erctrl - Ertx
131
Infant w/ normal testes & internal male genitalia has poorly dev. ext male genitalia
5-alpha-reductase def --> testosterone is responsible for internal genitalia, while DHT is responsible for external genitalia
132
Asthma diagnosis
Methacholine challenge
133
In Pheochromocytoma, what drug is used to lower vascular tension d/t excess catecholamines
Irreversible competitive alpha-1-antagonist ---> PHENOXYBENZAMINE
134
Net Filtration Pressure
(Glomerular Phydro - Poncotic) - (Capsule Phydro - Poncotic)
135
Polyhydramnios could result from
Anencepahly, GI obstruction (anything that impairs swallowing)
136
Main contributer of symptomatic relief of Nitrates for angina
decreased cardiac preload (LV volume during diastole); decrease preload, cardiac work, & O2 demand
137
#ERROR!
Acute HBV infection progressed to chronic HBV infection w/ high infectivity
138
pseudomembranous colitis
Risk factor: antibiotic therapy
139
MDD tx w/ Fluoxetine + Parkinsons; Tx for Parkinsons that is contraindicated
Selegiline (MAO Inhibitor - Serotonin Syndrome when given w/ SSRI)
140
Left lower face & left UE paralysis, what vessel is occluded?
Right MCA
141
Tx for panic ds + agoraphobia w/ MOA: activates Benzodiazepine binding sites on GABA receptor
Alprazolam
142
Seeks medical advise + fx to follow-through on own + guilt about inability
Dependent personality: fear self-care, need excessive reassurance, fear of disapproval
143
Gerstmann Syndrome (angular gyrus) - MCA
Dysgraphia, Dyscalculia, Finger agnosia, L/R-disorientation
144
Dejerine-Roussy Syndrome (dorsolateral thalamus) - PCA
numbness -> burning & tingling -> allodynia& neuropathic pain
145
Wallenberg Syndrome (lower medulla) - VA
pain&temp loss C/L of body & pain/temp loss I/L on face; nystagmus, Horner's syndrome, diplopia, I/L ataxia, dysphagia
146
Weber Syndrome (lower midbrain)
I/L oculomotor n. palsy (down&out+ptosis) + C/L hemiplegia
147
D2-agonist Tx for restless leg
Ropinirole
148
Sensory to thenar eminence is supplied by
Palmar cutaneous branch of the Median n.
149
Solid area on brain cross-section that appears darkened
infarct/ischemia
150
Loss of pupillary light reflex in L eye when light is shone in either eye; Lesion of
Efferent pupillary defect: CN4 lesionon ipsilateral side
151
Alzheimers: low ACh, degeneration of the
Basal forebrain (basal nucleus of Meynart) & cerebral cortex
152
Why must mitochondria encode their own tRNA
mitochondria use non-standard genetic code
153
X-linked agammaglobulinemia - What would be sen on SPEP?
normal alpa, beta peaks, no gamma peak
154
2d post-strep infection + coca-cola urine + meangial deposits in kidney
IgA Nephropathy (distinguished from PSGN by the length of time b/w strep & GN, complement levels)
155
SLE + prolonged aPTT + false-neg RPR for Syphilis -> Antiphospholipid Ab Syndrome; Complications include
Recurrent miscarriages, hypercoaguable states (DVT, PE)
156
Protein necessary to prevent uterus dev
MIF
157
Always address a new patient by
Mr or Mrs
158
Southwestern blot
DNA-binding protein + dsDNA probe
159
What parameter is affected by a change in prevalence
PPV & NPV change with prevalence, sensitivity & specificity do not
160
When hydrostatic pressure of capillaries increase what process initially off-sets this to prevent edema?
Increased lymphatic drainage
161
b2-antagonist decrease HR and contraction +
decrease catecholamine-dependent renin release from the kidneys
162
Which substance would be metabolized the fastest?
Fructose-1-phosphate - enters glycolysis after the rate-limiting step
163
Which diabetic tx increases the C-peptide level?
Glyburide: increase pancreatic release of insulin
164
CHF pt w/ fluid overload --> Tx (diuretic) --> increased hematocrit; Why?
Relative erythrocytosis
165
Occlusion of ACA -->
LE motor dysfunction
166
Anastomoses resulting in esophageal varices
Left gastric v. -> esophageal v. (Hemorrhoids: sup. rectal -> middle&inf rectal; caput: paraumbilical -> superficial&inf epigastric)
167
Which enzyme is capable of 5'->3' exonuclease activity
DNA pol I
168
Lithium-induced nephrogenic diabetes insipidus
antagonizes ADH -> impairing the collecting ducts ability to concentrate the urine
169
S. bovis infectious endocarditis
colon cancer
170
Dysphagia + megaesophagus + absent SM peristalsis + Peru
Chagas Disease (megacolon, megaesophagus) caused by Trypanosoma cruzi
171
Male w/ boobs, small testes, sparse body hair
Klinefelters(XXY) --> testicular atrophy, infertility, low testosterone, high FSH & LH, high estradiol (estradiol:testosterone determines extent of disorder)
172
Ca2+ release from SR in skeletal mm. does not produce contraction, what protein is defective
Troponin: troponin C binds Ca2+ -> conformation change -> exposes actin -> myosin binds
173
Feature of Clostridium botulinum
subterminal spore formation
174
What preents lactation in a pregnant patient?
high Progesterone & Estrogen levels
175
Myasthenia gravis Sx + mediastinal mass
Thymoma or thymic hyperplasia ---> developed from the 3rd pharyngeal pouch (w/ inf. Parathyroid)
176
H. influenzae grows poorly on sheep agar, S. aureus inoculation promotes its growth, why?
Haemophilus requires chocolate agar + factor V (NAD+) + X (hematin); S. aureus secretes favtor V & hemolysis releases hematin
177
Why is C. trachomatis resistant to Ceftriaxone?
Lacks cell-wall peptidoglycan
178
Excretion rate for substance that is freely filtered & reabsorbed
rate of inulin clearance is used as a standard for free filtration, subtract the amount reabsorbed
179
Injury to the pterion, which vessel is affected
site where temporal, frontal, parietal, & sphenoid meet -> middle meningeal a. rupture (branch of maxillary a.) -> Epidural hematoma
180
Drainage to superficial inguinal nodes
Anal canal
181
Maple Sugar Urine Disease, pt should avoid which a.a.
Isoleucine, Leucine, Valine
182
What vitamins are not supplied in breast milk?
Vitamin D & K
183
X-linked agammaglobulinemia -> cells bearing which markers would be deficient
B-cells bearing CD19+ & CD20+ are deficient leading to pan-hypogammaglobulinemia
184
In an emergency + no advance directive
provide emergent life-saving healthcare
185
What pulmonary tests are increased in emphysema pts
TLC, FRC, RV
186
Which TB Tx requires an acidic pH & is most useful against intracellular organisms?
Pyrazinamide
187
C. Diff Tx
Metronidazole (mild-mod cases), Oral Vanco (severe), Fidaxomicin (recurrent C. Diff): inhibits sigma subunit of RNA pol, oral
188
Milrinone has what additional effects
Vasodilation in addition to increased contractility (PD-3 inhibitor)
189
G(+) bacteria subjected to abx followed by destruction when placed in a hypotonic solution, what was the abx?
Destruction in a hypotonic solution suggests cell wall disruption, Cefuroxime acts on G(+) cell wall synthesis
190
Turner Syndrome, what would bes een on ECG
most common heart defect -> Bicuspid aorta > Coarc of Aorta
191
Device measures glucose 299, 300, 300 when actual value is 260; the device is
precise (aka reliable) but not accurate
192
Opioid followed by severe abdominal pain
Opioids can cause SM contraction -> sphincter of Oddi obstruction -> biliary colic
193
RANK-L overexpression
RANKL on osteoclasts & Osteoprotegerin (OPG) ratio determines the rate of bone resorption. High RANKL = Increased resorption
194
Child experiences cyanotic episodes & squatting helps releive Sx, what is the defect
ToF, failure of neural crest cell migration
195
What immune cells are responsible for walling off a TB infection
CD4+ TH1 lymphocytes & Macrophages
196
Facial dysmorphia + cleft palate + chromosome 22
DiGeorge Syndrome
197
When a patient is hospitalized (esp if in bad condition) you must inquire about
Advance directives & end-of-life care wishes
198
Failure of the urethral folds to fuse in males results in
Hypospadias
199
Screening test for a lethal disease should have a high
Sensitivity
200
#ERROR!
Vaccinated against HBV
201
Pregnant + bright red bleeding + no FHT + large uterus + thin-walled "grape-like" cysts of 46XX
Complete hydatidiform mole composed of only trophoblastic tissue & entirely paternal DNA
202
Patient doesn't take meds when she feels well, your response:
build alliance w/ pt by saying "I understand itcan be difficult to take meds when you feel fine"
203
Internal Carotid a. is derived from
3rd aortic arch
204
Suspected child abuse
Contact child protective services immediately
205
Lung cancer cells w/ large nuclei w/ prominent, round, basophilic bodies; Which enzyme is most active?
prominent nucleolus -> high rRNA production -> RNA pol I (RNA pol II: mRNA, snRNA, miRNA; RNA pol III: tRNA)
206
Infant w/ eczema, recurrent respiratory infections, increased bleeding time, low WBC & platelets
Wiskott-Aldrich: eczema, recurrent infections, thrombocytopenia
207
Group A Smokers & Group B Non-smokers are followed 10 years for the development of cancer
Prospective cohort study
208
ToF & TA result from what failed embryologic process
Septation
209
T-cell binding to MHC molcules on medullary epithelial cells w/ HIGH affinity is part of
Negative Selection
210
Neonate 46,XX w/ ambigous genitalia & high serum Testosterone & Androstenedione; Mom had virulization during pregnancy
Aromatase deficiency: high androgen & low estrogen -> neonate has normal internal genitalia & ambiguous external genitalia -> primary amenorrhea, tall , osteoporosis
211
Myasthenia gravis is most similar to
other HSN type II rxn - Goodpasture's Syndrome
212
Attending tells you to order a drug and you remember is has a potentially harmful S/E to pt, you should
No administer drug until discussing your concerns
213
Patient has U/L hearing loss, facial n. palsy suggests a
Intracranial Schwannomamost commonly located at the cerebellopontine angle (b/w cerebellum & lateral pons)
214
Aspiration pneumonia in a supine pt is most likely to occur in which lobe
Right upper lobe's posterior segment or superior segments of lower lobe; Upright aspiration -> basilar segments of the R lower lobes
215
Apical holosystolic murmur radiating to axilla, how could you decrease pts forward flow volume?
decrease left ventricular afterload
216
Naked +sense RNA virus causing cough, sore throat, fever
Rhinovirus
217
Demyelination of nerves would directly decrease?
Length (aka space) constant: how far an impulse travels down an axon (demyelination would increase the time constant, conduction time)
218
Intermittent jaundice + pigment inclusions in liver lysosomes of epinephrine metabolites
Dubin-Johnson Syndrome: defective hepatocellular excretion of billirubin gluuronides, Dx high coproporphyrin I in urine
219
Murmur heard best when sitting + leaning forward, the murmur intensity peaks?
Aortic regurgitation peaks just after the aortic valve closes, diastolic, high-pitched, blowing decrescendo murmur
220
Ca2+ released from SR during muscle contraction binds
Troponin-C
221
Malaise + dark urine + UTI Tx + anemia + RBC fragmentation
G6PD deficiency: deficiency in the HMP shunt, converts G-6-P --> 6-phosphogluconate
222
mAb anti-CD21R on B-cells would prevention to which virus
EBV
223
Tx for Restless Leg Syndrome
DA agonist
224
Mass in neck + head positioned to opposite side + pain w/ turning the neck, this is d/t
Congenital Torticollis d/t intrauterine malposition or birth trauma
225
Unvaccinated child w/ cough, coryza, conjunctivitis, & white spots on buccal mucosa
Measles, these Sx will be followed by a maculopapular rash
226
A drug w/ a Vd of 4.0
Highly charged - since the plasma volume is ~3L the drug primarily stays w/in the blood (large polar drugs cannot diffuse through tissues)
227
Why is Methadone used in Heroine Tx?
Methadoen is a potent, long-acting opioid w/ good oral bioavailability. Long half-life allows prolonged suppression of w/d Sx
228
Antiarrhythmic drug that prolongs QT interval but has a ower risk of TdP than other QT-prolonging agents
Amiodarone
229
Tamoxifen S/E
Endometrial hyperplasia
230
Vaginal bleeding +large uterus + high b-hCG + B/L lung nodules
Gestational Choriocarcinoma: malignant tumor arising from trophoblast (histo shows proliferation of cytotrophoblast & syncytiotrophoblasts)
231
Why do hematomas or large bruises appear greenish days after formation?
Heme Oxygenase converts heme to biliverdin (green pigment)
232
Features of GAS
beta-hemolytic, Pyrrolidonyl arylamidase positivity & bacitracin-sensitive
233
Colleague is intoxicated while on duty, you should
report the incident to the hospital's physician health program
234
What hormone contributes most to fetal lung maturity
Cortisol
235
Neonate w/ posterior neck mass composed of cystic spaces separated by CT + B/L nonpitting edema + diminished femoral pulses
Neck mass is a CYSTIC HYGROMA w/ lymphedema, coarc of aorta -> dimished femoral pulses -----> Turner Syndrome d/t loss of paternal X
236
Primary source of serum glucose after a 2d fast
Gluconeogensis: pyruvate -> oxaloacetate -> PEP
237
Pain sensation 1 cm anterior to the foramen cecum is sensed by what nerve
CN V3
238
Anti-Rh(D) immunoglobulin is what type of IG class
IgG
239
ED + morning erections + HTN + CAD + marital stress
Emotional stress causing ED
240
Lactase deficiency + lactose challenge, what will decrease
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
Sensitivity
Sn = A / (A+C)
242
Prolactinoma would be derived from what embryologic layer
Surface ectoderm
243
Treatment for Giardia cysts
Metronidazole
244
What class of drug could decrease uterine contractions & cause mydriasis
Alpha & Beta-Adrenergic Agonists
245
Stop codons
UAA, UAG, UGA
246
What is the sequence for base excision repair of non-bulky DNA base alterations
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
Increased PaO2 resulting in hypoventilation is a result of decreased stimulation of which sensory receptor
Peripheral chemoreceptors: carotid body and aortic bodies
248
Location of maxillary sinus on CT
inferior to eye
249
Increased vagal activity has what effect on the lungs
ACh -->M3 --> bronchoconstriction & increased mucus secretion --> increased work of breathing
250
Tx for Drug-Induced Parkinsonism
Anticholinergics (Trihexphenidyl, Benztropin) or Amantadine
251
CMV viral genetics
Enveloped dsDNA virus
252
Lesion of the R temporal lobe would produce what type of vision loss
Left homonymous superior quadrantopia
253
V/Q mismatch in the base vs apex of the lung
since BF is lowest to the apex of the lung the V/Q is greatest in the apex
254
How does Fructose-2,6-Bisphosphate affect the metabolism of glucose
High F-2,6-P stimulates PFK-1 to increase glycolysis & slows Gluconeogensis
255
Hypoechoic nontender mass in testicle + high T3 & T4, which serum marker is probably high
Germ Cell Tumor secreting hCG, d/t alpha-subunit is causing paraneoplastic hyperthyroidism
256
What percentage of people would fall outside 2SDs & be > than the mean
Enveloped dsDNA virus
257
Polyarteritis nodosa most commonly affects which organs
kidneys, heart, liver, & GIT; but SPARES the lungs!
258
CT shows ischemia in the central, upper frontal lobe --> defect?
Progressive leg weakness & spasticity
259
Function on snRNPs
formation of spliceosomes necessary for RNA splicing
260
Bupropion S/E
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
Smoker w/ long-standing HTN + Enalapril Tx ---> rising serum Cr levels, why?
BP normalizes --> increases BF to kidneys, but dilates efferent a. --> reduction in renal filtration fraction --> decreased GFR
262
Recurrent abd pain + anxiety, rapid improvement occurred w/ which Tx?
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
S3 heart sound can occur w/ which conditions
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
Blood transfusion --> hemolytic anemia; What type of rxn
HSN Type II --> complement-mediated lysis, ADCC by NK cells or macrophages, opsonization & phagocytosis
265
Ulcerative Colitis findings
Rectal involvement, inflammation of mucosa & submucosa only, continuous damage, bloody diarhea
266
Crohns Disease findings
Transmural inflammation, rectal sparing, perianal fistula, non-continuous, non-caseating granulomas, +/- bloody diarrhea w/ abd pain
267
Which immune impairment would most likely lead to Giardia infections?
IgA deficiency, IgA & CD4+ cells are major contributors to fighting off Giardia (X-Linked agamma., IgA Def, & CVID - higher risk)
268
Pancytopenia + CD55 & CD59 def + thrombosis + hemolytic anemia
Paroxysmal Nocturnal Hemoglobinuria --> complement-mediated hemolysis
269
Guillain-Barre Syndrome + diarrhea; Culprit?
Campylobacter
270
What blood test should be monitored for patient's on Warfarin?
Warfarin: reduction in Vitamin K-dependent clotting factors (2, 7, 9, 10) ---> Monitor PT (INR) - target INR 2-3 for Afib
271
Young woman recently divorced --> weakness in left leg despite no PE findings
Conversion Disorder: stressor ---> sudden loss of motor/sensory function not explained by neurology
272
Neonate w/ oral thrush, interstial pneumonia, lymphopenia + mom w/o prental care, what prenatal care could have prevented this
Viral enzyme inhibitor drug ---> Zidovudine!
273
Colchicine provides gout relief by
Preventing Leukocyte attraction by inhibiting MT polymerization
274
Isoniazid MOA
activated by Mycobacterial catalase-peroxidase to prevent mycolic acid synthesis; Resistance occurs via: decreased catalase or genetic mutation of mycolic binding site
275
TB in cavitation in upper lung + corticosteroid use
Reactivation of latent TB d/t steroid use; Primary infection occurs in mid lung as a Ghon focus (Ghon complex: focus + hilar LAD)
276
Sunlight provides what Vitamin D metabolic rxn
7-dehydrocholesterol --> Cholecalciferol
277
Immediate Tx of Arsenic poisoning
Dimercaprol
278
N./A./V. to the ovary are carried in which ligament
Suspensory ligament of the ovary
279
The uterine a. must be ligated during a hysterectomy & is found in which ligament
Transverse cervical ligament
280
Ketamine can reduce tolerance to Opioids via
by blocking the affects of Glutamate via NMDA antagonism
281
Drugs capable of causing Drug-Induced Lupus
Hydralazine, Procainamide, Isoniazid
282
Classic histologic findings in Alzheimer Dementia
Amyloid plaques & neurofibrillary tangles
283
Relationship b/w GFR & Serum Cr
As GFR decreases significantly, serum Cr will begin to rise (non-linear relationship)
284
HIV pt w/ EBV infection -> solitary mass w/in temporal lobe
Primary CNS Lymphoma is the most common CNS tumor in immunosuppressed pts
285
Causes of Pulmonary Artery HTN
Genetics: AD BMPR2 mutation predisposes pt to vascular SM proliferation --> insults will cause PAH
286
Cellular changes seen w/ axon injury followed by Axonal RXN
axonal rxn occurs in the proximal portion --> cellular swelling --> round cell, nucleus displaced to periphery, Nissl substance spread throughout cyto
287
Absent vas deferens, bronchiectasis, azoospermia, infertility
Cystic Fibrosis - Dx w/ Cl- sweat test
288
Cerebellar ataxia, recurrent pneumonia, telangiectasia
Ataxia Telangiectasia: mutation in ATM gene responsible for DNA break repair (hsn to X-ray radiation)
289
If neural crest migration fails in the last week of migration to the intestine, which organ would be affected?
Rectum
290
Anterior pituitary is derived from which structure
Rathke's Pouch (surface ectoderm)
291
Right homonymous hemanopsia w/ macular sparing, which a. is occluded?
Left PCA
292
Follicle w/in ovary w/ developed antrum is in which stage
Secondary follicle
293
The cerebellum is derived from what embryologic structure
Metencephalon
294
Embryo implantation occurs in which stage
Blastocyst
295
Injury to the lateral knee exposes the fibular hear + foot drop + inability to evert or dorsiflex foot
Common fibular n. injury
296
Which coronary a. supplies the lateral LV
LCX supplies the lateral & posterior walls of the LV (LAD: ant 2/3 of IV septum, anterior papillary mm., ant LV)
297
Tracheoesophageal fistula occurs d/t failure of
tracheoesophageal ridges to fuse
298
What nerve supplies sensory to the scrotum & medial thigh
Ilioinguinal n.
299
Compression of common carotid to stop bleeding would contact which vertebrae
6th cervical forms the posterior part of the root of the neck (vascular structures pass through: scalenes, sternum/rib1, & C6)
300
Bifid ureters is a result from abnormal development of which structure
Ureteric bud: gives rise to collecting ducts -> ureters
301
Brunner's gland location
submucosa of duodenum
302
Long-lasting numbness to the tip of the tongue d/t what N.?
Lingual n. (branch of CN 5-3)
303
Cricothyrotomy insertion site
cricothyroid membrane b/w thyroid cartilage & criocoid cartilage, ut through superficial cervical fascia & cricothyroid membrane
304
Location of ostium of maxillary sinus drainage
Hiatus semilunaris in the middle nasal meatus
305
What nerve innervates sensation b/w toes 1-2
Deep fibular n.
306
Ligament most easily sprained in inverted ankle sprain
Calcaneofibular
307
Pain form the GB or Liver can be referred to
C3-C5 dermatome of the R. shoulder
308
Bifid ureters + fistula into vagina
d/t early division of the ureteric buds
309
Weak wrist extension + intact arm sensation
Injury to the deep branch of the radial n. at the head of the radius
310
Treatment of friends & family by physician
is not recommended unless emergent, "uncomfortable prescribing to someone I am not treating"
311
Wernicke aphasia caused by occlusion of
MCA
312
Urethritis + Arthritis + conjunctivitis + vesicular rash on palms/soles
Reactive Arthritis (RF-neg spondyloarthropathy d/t infectious agent) assoc w/ HLA-B27 --> sacroiliitis in 20%
313
Traveler's diarrhea is d/t what toxin
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
Cystic Fibrosis - defect in
post-translational protein folding of the transmembrane protein
315
Which substances activate MAPk pathway upon binding their receptor?
Tyrosine Kinase receptor autophosphorylates -> phosphorylation of Ras -> MAPk (GF receptors: EGF, PDGF, FGF
316
Which substances active JAK/STAT tyrosine-kinase associated receptor?
Receptor activates JAK -> phosphorylates STAT (Cytokine receptors, GH, Prolactin, IL-2)
317
Fraternal twins
Dichorionic/diamniotic; Twinning after 1 week -> monochorionic-diamniotic, 0-4d: di-di, & 8-12d: m-m, >13: conjoined twins
318
Pka
dissociate, when pH
319
Primary hypothyroidism Tx w/ T3 administration would cause what lab values changes
TSH: decreased, T3: increased, rT3 (formed by peripheral conversion of T4): decreased, T4: decreased
320
Involuntary loss of urine, nocturnal enuresis, difficulty starting stream, voiding w/o sensation of full bladder
Overflow incontinence d/t impaired detrusor contractility or bladder outlet obstruction, Sx: involuntary leakage + incomplete emptying
321
Abd pain, nausea, confusion, red urine that darkens, improves w/ dextrose
Acute Intermittent Porphyria: ALA synthase -> accumulation of metabolites (Porphobilinogen & ALA), blocking ALA synthase reduces Sx (HEME & GLUCOSE negative feedback)
322
Airway resistance is greatest in which point in the bronchial tree, at which point is it the lowest?
Highest in medium-sized bronchi; Lowest in terminal bronchi (although the radius decreases the summated cross-sectional area massively increases)
323
N. menigitidis colonizes
nasopharynx epithelial cells via pilus-mediated adherence
324
Before prescribing Metformin, check pts?
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
Mitral stenosis opening snap occurs?
Early diastole when the LV P
326
Accepting gifts from patients
Unethical to accept gifts of monetary value
327
Achondroplasia & risk of passing on trait
Autosomal dominant; 1 parent is normal & other is heterozygous for mutation ----> 50% risk of child
328
Silicosis increases the risk of TB d/t
impaired macrophage killing d/t impaired phagolysosomes by internalized silica particles
329
Elderly w/ fatigue + constipation + bone pain (back) + renal failure + renal biopsy: atrophic tubules + eosinophilic casts
Multiple Myeloma: anemia, hypercalcemia, osteoclast activation, Benc-Jones proteins (Ig light chain) -> preceipitate in tubules as Tamm-Horsefall proteins eosinophilic casts
330
Polyuria + polydipsia + confusion + HIGH glucose + preceding viral inf + acidotic + paCO2 of 40
DKA w/ anion-gap acidosis: primary metabolis acidosis + compensatory respiratory alkalosis (Kaussmaul); High PaCO2 indicates respiratory failure
331
Antiarrhythmic drug that rapidly resolves arrhythmia but causes severe crushing chest pain, flushing, & SOB
Adenosine
332
Persistent erection + Med for treatment-resistant depression & insomnia
Trazodone - use: depression w/ insomnia S/E: priapism
333
Artery injured in a humeral shaft fracture
Deep brachial a.
334
Sickle Cell Disease mutation involves
Valine substitution for Glutamic Acid --> HbS polymerizes at low O2 tension --> sickling & hemolysis
335
High pulmonary capillary wedge pressure would indicate would cardiac abnormality
Mitral Stenosis; PCWP ~LA P --> high LA pressure indicates pathology of the mitral valve
336
Hoarseness, dysphagia, loss of gag reflex, uvula deviation, weakness in SCM & trapezius, anatomical structure lesioned?
CN10 & CN11 lesion, both exit skull via jugular foramen
337
Which steps on Collagen synthesis occurs outside of the osteoblast
Terminal propeptides cleaved by N- & C- procollagen peptidases (tropocollagen) -> spontaneous assembly (fibrils) -> Lysyl Oxidase covalently cross-links fibrils
338
Reabsorption of H2O occurs in which portion of the nephron
Proximal tubule + Thin ascending loop
339
In water-deprivated state, the lowest urine osmolality would be seen in which part of the nephron
Distal Convoluted Tubule; The collecting duct contains the most concentrated urine
340
Endometrial biopsy: carbohydrate-rich mucus + tortuous spiral aa. + edematous stroma; When was biopsy taken?
Mid-secretory phase (~21d) when progesterone has had time to exert its effects
341
tRNA structure: which site binds to amino acids
3' CCA tail
342
Dysphagia + blurred vision + normal nerve conduction but decreased muscle AP
C. botulinum (descending paralysis) acts by blocking the release of ACh in neuromuscular junctions; Consumption of home-canned foods, honey
343
Tx for Urge Incontinence
Antagonism of muscarinic cholinergic receptors; overactive detrusor contractility -> involuntary leakage just before reaching the toilet
344
Which drug renders platelet surface receptors useless --> preventing platelet aggregation & clotting
Abciximab: blocks GP Iib/IIIa receptor (deficient in Glanzmann thrombasthenia)
345
Potter Syndrome findings
B/L renal agenesis, lung hypoplasia, oligohydramnios, limb & face abnormalities
346
Bacteria cell + bacterial cell lysate from another strain --> new bacteria d/t
Direct uptake of naked DNA from the environment
347
Infant w/ poor feeding + large head + white-yellow chorioretinal lesions + enlarged ventricles + intracranial calcifications
Congenital Toxoplasmosis: intracranial calcifications, chorioretinitis, hydrocephalus; Toxoplasmosis is spread in-utero from mom w/ primary infection from cat feces (TORCH)
348
Abd cramping & distention + vomiting + Xray w/ air in GB & biliary tree
Gallstoen ileus d/t long-standing cholelithiasis causing a cholecystenteric fistula, allowing intestinal gas to enter biliary tree
349
Which virus generates its own protease used to cleave mRNA into multiple proteins (polycisteronic)
ssRNA, positive-sense, linear, non-segmented genome such as Echovirus
350
Sequelae from an endocervical infection causing yellow discharge w/ neutrophils
N. gonorrhoeae can cause PID --> salpinitis, tuboovarian abscess, etc ---> scarring of fallopian tubes --> infertility or ectopic pregnancy
351
Contact dermatitis is mediated by
T-lymphocytes (Type IV HSN)
352
Intermittent dyspnea + FEV1: 71% predicted value + eosinophils in sputum; patient should avoid
Animal dander; Sx suggest allergen-driven reversible Obstructive pulmonary process; Causes: animal dander, feathers, dust, mold,pollens
353
What cell type increases in serum concentration following glucocorticoid administration?
Acute effects of steroids on CBC: increased NEUTROPHIL count, decreased lymphocyte, monocyte, basophil, & eosinophil; Neutrophil count increases d/t demargination
354
Patient dies of heart failure and autopsy shows heart w/ large ventricular spaces & relatively thin LV walls
Chronic ischemic heart disease --> dilation of ventricles & contractile dysfunction (systolic dysfunction)
355
Tx w/ Dapsone ---> fatigue + jaundice + dark urine + RBC fragments + bite cells + microspherocytes
G6PD deficiency ---> Anemia
356
Ceftriaxone binds to
Transpeptidases irreversibly to inhibit peptidoglycan cross-linkage
357
If Ceftriaxone + S. pneumo is ran on a gel & 5 bands appear, why may another strain of S. pneumo only have 2 bands
Change in protein structure of PBPs - 1 mechanis of bacterial resistance to cephalosporins
358
MRSA Tx w/ S/E of Myopathy & CPK elevation
Daptomycin, MOA: depolarization of the cellular membrane, S/E: myopathy, high CPK, inactivated pulmonary surfactant
359
Male + facial acne + bodybuilder + decreased testicular volume + high HCT; Reason for high HCT?
Steroid Abuse: Androgens stimulate RBC production, steroids inhibit GnRH --> decreased sperm production, small testes, & decreased endogenous Testosterone
360
Gallstones - 5% cholesterol & black are likely a result of
Chronic Hemolysis ---> Black Pigment Stones are composed of calcium carbonate & phosphate d/t unconjugated bilirubin precipitation as calcium bilirubinate
361
Vasculitis w/ IgA & C3 deposition
Henoch-Schonlein purpura; Sx: purpuric rash, colicky abd pain, polyarthralgia, acute glomerulonephritis may occur
362
Pulmonary abscess formation is d/t
Suppurative destruction of tissue w/in an abscess; tissue destruction occurs d/t neutrophil & macrophage release of lysosomal enzymes
363
Atheroma formation - what cell provides proliferative stimuli for the cellular components of atherosclerotic plaques?
Vascular injury -> platelet & WBC adhesion -> PDGF is released by platelets, endothelial cells, & macrophages --> SM cells migration & proliferation; TGF-b -> collagen production
364
Autopsy shows heart w/ increased LV wall thickness & decreased LV cavity size
Long-standing hypertension --> concentric LV Hypertrophy
365
Patient w/ gait abnormality + incontinence + memory impairment & emotional blunting + CT w/ enlarged ventricular spaces
Normal Pressure Hydrocephalus: Sx: gait abnormality + urinary incontinence + dementia + emotional blunting + symmetrically enlarged ventricles d/t decline in resorptive capacity of arachnoid villi
366
Glucagon works via what type of cell signaling pathway
Gs -> AC -> PKA -> cAMP
367
Dysphagia + choking spells + coughing+ Zenker Diverticulum & narrowed esophagus
Cricopharyngeal mm. dysfunction occurs d/t diminished relaxation of pharyngeal mm. during swallowing -> inc force to force bolus down -> herniation (Zenker Diverticulum)
368
Old cystic lesion months after cerebral vascular accident. Cyst is lined by?
Astrocytes
369
The 3 genetic causes for Down Syndrome
Trisomy 21 d/t meiotic nondisjunction during maternal meiosis I, Robertsonian translocation, mosaicism
370
Mass shrinks following chemo --> biopsy shows shrunken eosinophilic cells; what was released from the mitochondria
Cytochrome c --> activates caspases --> apoptosis (intrinsic pathway)
371
Recurrent Neisseria infection
C5b-C9 deficiency --> inability to form MAC
372
What heart structure lies directly anterior to the esophagus
Left atrium
373
What heart structure lies directly posterior to the esophagus
Descending aorta
374
Malabsorption + decreased proprioception + hyporeflexia + mild hemolytic anemia; Which deficiency exists
Vitamin E deficiency --> neuromuscular disease (ataxis, retinopathy, myopathy) d/t high risk of cell membrane oxidative injury via fatty acid oxidation
375
Which supplement can somewht blunt the effects of folate deficiency & megaloblastosis
Thymidine --> replenishes the dTMP stores since folate inhibits thymidylate synthase production of dTMP
376
Paroxysmal supraventricular tachycardia (heart palpitations, low BP, high HR) --> Valsalva requires which mm.
Rectus mm. are particularly important in raising intraabdominal pressure during the maneuver
377
HTN + no secondary sex features + blind vagina + hypokalemia + low Testosterone & Estradiol + 46XY
17a-hydroxylase deficiency --> (pregnenolone -> 17-hydroxypregnenolone & progesterone -> 17-hydroxyprogesterone) --> impaired androgen&estrogen synthesis, high mineralcorticoids
378
Aldolase B deficiency --> Tx involves avoidance of
Fructose & Sucrose (Sucrose ---> Fructose + Glucose)
379
14yoF + 6wk menstrual cycle + heavy bleeding for 7-10d + spotting
Anovulatory cycles --> seen in adolescents Sx: longer cycles, irregular bleeding patterns d/t high estrogen & no progesterone (absent ovulation) --> proliferative phase
380
Tan fat-containing tissue around kidneys in a neonate --> removal would cause
Hypothermia; Brown adipose tissue mitochondria have uncoupled ETC & phosphorylation -> Proton gradient is utilized by Thermogenin (uncoupling protein) --> heat & no ATP
381
What pulmonary defense clears particles
Phagocytosis; 10-15um - trapped in upper RT, 2.5-10um - mucociliary transport,
382
The main mechanism for Copper excretion
Hepatic excretion into bile
383
G6PD deficiency & what RBC enzyme deficiency can yield the same Sx
Glutathione Reductase; G6PD deficiency is a defect in the HMP shunt that impairs glutathione reduction d/t failure to produce NADPH
384
HBV's mechanism for causing liver injury
HBV-infected cells MHC class I presents HBsAg & HBcAg activating CD8+ T-cells resulting in liver damage
385
Pharyngeal exudates + neck swelling + difficulty swallowing + heart failure; What is the mechanism of the toxin
C. diptheriae -> Diptheria toxin -> inactivates EF-2 via riboslation -> inhibition of host cell protein synthesis (similar to P. aeruginosa exotoxin A)
386
Which Benzodiazepines are most likely to cause S/E & high risk of falling
Long-acting Benzos are more likely to cause daytime drowsiness, which increases the risk of poor judgment, poor concentration, ataxia, falling (Flurazepam, Chlordiazepoxide)
387
Oxidase(+) GN comma-shaped rods + survival on alakaline media ---> water-borne Gastroenteritis --> stool microscopy
Mucus & sloughed epithelial cells; Vibrio cholera causes noninflammatory (enterotoxin) watery diarrhea --> stool would show no RBCs or WBCs
388
B/L tumors at the cerebellopontine angle + tinnitus + hearing loss + vertigo
B/L acoustic neuromas (schwannomas) are seen in Neurofibromatosis type 2, AD mutation in NF2 on chromosome 22 (gene encodes protein Merlin)
389
Most common cause of bacterial meningitis in adults
S. pneumo: G(+) lancet-shaped cocci found in pairs (Alcoholics, Sickle cell, Asplenic, poor health pts are at greatest risk)
390
HIV pt w/ CD4 of 800 --> fever + chills + productive cough + bronchial breath sounds over L lower lung
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
Indurated, painless, single genital ulcer --> Tx is a structural analog of
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
HR 50 + confusion + lacrimal tearing + b/l wheezing + sweating + flushed + found in tool shed
Organophosphate insecticide poisoning --> irreversible AChE inhibition --> Cholinergic overstimulation; Tx w/ muscarinic antagonist (Atropine) + Pralidoxime
393
A drug relaxes arteriole SM but not veins ---> S/E?
Arteriolar vasodilation causes significant reduced BP --> stimulates baroreceptor-mediated activation of SNS --> reflex tachycardia & increased Renin (Na & H2O) -> Edema
394
Acarbose MOA
Alpha-glucosidase inhibitor --> decreases disaccharidase activity on intestinal brush border -> prevents disaccharide breakdown into monosaccharides necessary for absorption
395
Hypopigmented spots on tanned skin
Malassezia furfur --> Pytriasis versicolor; Fungal infection of the stratum corneum, Dx KOH test reveal spores & hyphae in "spaghetti&meatball" appearance & "cigar-butt" hyphae
396
Fever + malaise + maculopapular rash including palms & soles + serum mixed w/ cardiolipin, lecithin, & cholesterol -> agglut.
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
Elderly w/ chronic anemia w/o identifiable cause?
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
Dysplasia is differentiated from carcinoma by
reversibility of changes; dysplasia is abnormal cell growth confined to the epithelium
399
Severe, U/L, throbbing HA + photophobia + n/v ---> Abortive Tx involves a drug w/ what MOA
Sumatriptan MOA: Serotonin 5-HT1B/5-HT1D agonists -> postsynaptic serotonin receptor stimulation -> prevents release of substance P & CGRP & vasoactive amines
400
Viral Meningitis CSF findings + response to Acyclovir
HSV meningitis --> Glucose - normal, Protein - increased, 90% lymphocytes
401
Thyroid peroxidase enzyme function
Catalyzes the oxidation of Iodide, Iodination of thyroglobulin, & coupling rxn b/w 2 iodized tyrosine residues
402
Microscopic changes seen in heart 12d after MI
Fibrovascular granulation tissue w/ neovascularization is seen b/w 5-10d post-MI
403
Pain w/ defecation + bright red blood on TP --> Such tears are found where
Posterior midline & distal to the dentate line d/t lower perfusion making mucosa sensitive to hard fecal mass
404
Which Nitrate has the highest bioavailability when given orally
Isosorbide mononitrate has 10% bioavailability orally
405
Cirrhosis + thrombocytopenia + prolonged PT that does not resolve w/ Vit K; Reason for high PT?
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
Parkinsons when genetic can be linked to what defective biochemical process
Defects in to ubiquitin-proteasome complex
407
Abd discomfort + loose stools + weight loss + biopsy w/ intense PAS stain; What is stained pink
PAS oxidizes Carcbon-Carbon bonds to form aldehydes -> rxn w/ fuchsin-sulfurous acid -> magenta stain ---> Tropheryma whippelii appears magenta w/ PAS
408
Sympathetic output is transmitted using noradrenergic receptors on target organs, except?
SNS innervation to the adrenals (D1) & sweat glands (ACh)
409
Abrupt chest pain radiating to the back + BP 220/130 in L arm & 180/100 in R arm
Intimal tearing assoc w/ aortic dissection
410
Bloody diarrhea in HIV pt w/ low CD4 + hemorrhagic polypoidal lesions + spindle cells w/ blood vessel proliferation
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
Actin binding site in sarcomere
Z disk
412
Case-fatality rate
Fatal cases/total number of cases
413
Pancrease Divisum, the ventral bud gives rise to
Main pancreatic duct, inferior/posterior portion of head, & uncinate process
414
Improper use of crutches & inability to extend wrist
Radial n. compression
415
Histone linker protein
H1 histones participate in DNA packaging
416
Delayed dev + hypotonia + self-mutilation, which enzyme activity is INCREASED
PRPP (Rate-limiting enzyme of purine synthesis) Phosphoribosyl pyrophosphate amidotransferase
417
Omeprazole MOA
Inhibition of the H/K-ATPase (proton pump) for the Tx of GERD , PUD, or Zollinger-Ellison
418
Abd pain, bloating, indigestion, NSAID use, fecal blood, ulcer detection in what segment would not be assoc w/ malignancy
Duodenum
419
Situs inversus + recurrent respiratory infections --> What is the dysfunction
Dynein arms
420
Elastase in lungs is produced by
Alveolar macrophages
421
Physician payment that encourages preventative care & health counseling
Capitation: fixed budget per enrollee, incentives ro contain cost d/t fixed budget
422
2:1 ration of what 2 substances in amniotic fluid determine lung maturity
Phosphatidylcholine/Lecithin & Sphingomyelin
423
Elderly w/ AMS, skin flushing, high fever, low BP, high HR & RR --> Bacteremia, where was the initial infection
UTI
424
abd pain + hypotension + high RR + metabolic acidosis w/ anion gap & high plasma lactate --> Enzyme w/ low activity
Pyruvate dehydrogenase (enters into TCA cycle) would have low activity & Lactate dehydrogenase would have high activity
425
Broken 12 rib --> injured organ?
Left Kidney
426
HA + Pigmented spots on trunk + rubbery tumors on neck --> Where did these cells originate?
Neurofibromatosis type 1: caf‚-au-lait spots, glioma, neurofibromas; Neurofibromas are derived from Schwann cells which arise from neural crest
427
Airway pressure-volume curve - where is FRC located
center of the curve: resting state where airway pressure equals 0
428
Dyspnea, orthopnea, fatigue, hx MI, S3 + holosystolic murmur over apex ---> Diuretics resolve murmur
Functional Mitral Regurgitation
429
Growth factor cell signaling pathway
Tyrosine Kinase receptor autophosphorylates -> phosphorylation of Ras-GTP -> Raf -> MAPk (GF receptors: EGF, PDGF, FGF)
430
Immigrant w/o Sx has +HAV-IgG Ab
Anicteric viral infection as a toddler
431
Gallstones during pregnancy --> What may have contributed to gallstones
E-->cholesterol hypersecretion & P--->gallbladder hypomotility
432
3000kcal 30% protein ---> protein kcal?
225; 1g of protein = 4cal
433
Flat facies + posterior thick neck + VSD + Duodenal Atresia
Trisomy 21
434
Child w/ bacterial meningitis & mom wants to bring home & not Tx
Mandate to Tx d/t risk posed to child & contacts
435
When is total pulmonary vascular resistance the lowest
FRC; Large lung volumes expand & stretch blood vessels --> increased resistance; Decreased lung volumes -> narrow & compress blood vessels
436
Increased Staph infections in hospitals over the last 30 years
d/t increased use of intravascular devices (S. epidermidis)
437
Defective IG isotype switching ---> Overproduction of Ig ?
IgM
438
Methotrexate used for abortion --> what substance accumulates in fetal tissue
Dihydrofolate polyglutamate
439
When is b-hCG detectable forllowing fertilization
In serum at day 8, urine by day 14
440
Xeroderma Pigmentosum --> defective
Endonuclease: excision of thymine dimers
441
Liver cyst in an immigrant shows white chalky filling --> If ruptured during resection --->
Echinococcus granulosus --> hydatid cyst w/ "eggshell calcification" --> dissemination --> Anaphylaxis
442
Tetanus reaches spinal cord via
C. tetani toxin --> retrograde transport up motor neurons --> inhibition of inhibitory interneurons
443
Great Saphenous vein graft to diseased coronary artery --> vein tissue is harvested from
Just inferolateral to the pubic tubercle
444
Dilated heart + brownish pigment of the myocardium
Hemachromatosis: excess absorption of Iron, later onset in females d/t menstruation
445
HIV protein synthesis
Env -> polyprotein -> glycosylated & cleaved into 2 proteins in the RER -> gp120 & gp41 -> mediate the fusion of virion into target cells
446
In the presence of glucose & no lactose a mutation in what region would inhibit binding of a protein to a regulatory sequence
Operator: repressor is bound to operator when there is no lactose present
447
Fever + chest pain + productive cough + lancer-shaped G(+) diplococcis ---> Preventable by what vaccine
Outer polysaccharide covering (pneumococcal polysaccharide vaccine) or pneumococcal conjugate vaccine
448
ALL Tx w/ 6-MP --> 6-MP is metabolized by
Xanthine Oxidase
449
PaO2 of 70, normal PaCO2 -- what is most likely increased
PAO2 - PaO2 difference
450
Absence seizures & tonic/clonic seizure ---> Tx
Valproate & Ethosuximide are used for absence seizures; although ethosuximide is not effective against tonic/clonic
451
Vomiting + Vertigo ---> which structure is dysfunctional
Inner ear
452
Which med would cause QT interval prolonged + polymorphic QRS complexes that change in amplitude & length
TdP + prolonged Atcaused by antiarrhythmic agents: Quinidine, Procainamide, Disopyramide, Ibutilide, Dofetilide, Sotalol
453
"Young appearing male" + poor 2nd sex dev + poor smell
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
HA, nausea, sweating, FHx of hyperparathyroidism + high BP + high urinary VMA; Cells of tumor share origin w/
Neural crest derivatives: thyroid parafollicular cells, adrenal chromafin cells MEN 2A or 2B syndromes
455
Hx of viral esophagitis + pneumocystis pneumonia + meningitis -->
Crytococcus neoformans: budding yeast, latex agglutination positive for polysaccharide Ag,
456
Double vision walking down stairs --> lesion to ?
Trochlear n. ---> down & out movement of the eye ---> lesion results in difficulty walking down stairs
457
PaO2 - normal, %sat O2- normal, O2 content - low
Indicates that O2 is bound to all present RBCs just fine --> must have low RBCs ---> Chronic blood loss
458
Irradiation is used as cancer Tx, its MOA is
DNA double strand breaks & formation of free radicals
459
Diastolic heart failure diagnostic findings
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
Hospice care requirement
461
Tingling & loss of sensation over digit 5
Ulnar n. lesion
462
Vaccine of polysaccharide conjugated to diptheria toxoid
H. infleunzae type B
463
Streak Ovaries
Turner Syndrome Sx: streak ovaries, bicuspid aortic valve
464
Viral protein that forms spheres & tubules ~22nm & poorly correlates w/ viral replication
Envelope component of HBV: HBsAg: noninfective envelope glycoprotein secreted in large amounts from hepatocytes, exceeding the amount of HBcAg produced
465
Smoker w/ dyspnea + PaO2 50 & PaCO2 26
Alveolar hyperventilation: hypocapnia implies alveolar hyperventilation; V/Q mismatch -> low O2/CO2 exchange -> hypoxemia -> chemoreceptors increase ventilation
466
Peripheral blood smear shows myeloblasts (large cells w/ basophilic cytoplasm + Auer rods)
Acute Promyelocytic Leukemia --> t(15;17), seen in young patients & may cause DIC
467
Lidocaine injection near tip of ischial spine
Pudendal nerve block
468
TG breakdown --> liver specific enzyme involved in TG breakdown & glucose synthesis
Glycerol kinase converts glycerol to Glycerol-3-phosphate in the liver
469
Why is Cl- concentration lower in arterial blood than venous blood
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
Long-term therapy for PE pts ---> Warfarin MOA?
Inhibits epoxide reductase which activates Vitamin K --> inhibits Vitamin K-dependent carboxylation of glutamic acid residues of factors 2, 7, 9, 10
471
Transplant pt w/ pneumonia, stain shows thick circular polysaccharide capsule
Crytococcus neoformans: budding yeast, latex agglutination positive for polysaccharide Ag (polysaccharide capsule)
472
Prevention of lysosome acidification w/in APCs results in pooe interaction w/ T-cells upon Ag exp -->
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
Tx for n/v associated w/ chemotherapy
Ondansetron: 5-HT3 receptor antagonist --> blocks vagus-mediated n/v & blocks serotonin in the CTZ
474
Reaction Formation
drug abuser works at a halfway house & gives motivational talks
475
Ability of a Turner Syndrome pt to become pregnant?
She would require an oocyte donation
476
IL-2 function
growth & differentiation of CD8+ & CD4+ T-cells, B-cells, monocytes & NK cells
477
Pantothenic acid (coenzyme A) is necessary for what
acetylation reactions (TCA cycle)
478
Decreases in Vitamin B12 or folate decreases the conversion of homocysteine to
Methionine, resulting in accumulation of homocysteine --> endothelial damage --> atherosclerosis
479
PABA containing sunscreens prevent absorption of
UVB radiation
480
Prodrome of fever, fatigue, pruritus --> AST/ALT elevation follows
HBV
481
Clavicle fracture --> medial fragment displaced upward by
SCM
482
Disseminated Candida infection would be most likely seen in
Patients w/ low neutrophil counts; T-cells are important in the prevention of superficial Candida infections, while Neutrophils are necessary in preventing dissemination
483
HA, nausea, papilledema, dry skin, hepatomegaly, odd diet
Vitamin A toxicity
484
pH, PaO2, PaCO2, Plasma HCo3- in a pt w/ a PE
PaO2 low --> hypoxemia --> increased respiratory drive --> hyperventilation --> respiratory alkalosis (inc pH, low PaCO2, low HCO3-)
485
Organism found in abdomen following perforated appendicitis
B. fragilis (anaerobic, GNR, most common GIT NF)
486
UTI in sexually active young female adult
S. saprophyticus: GPC, catalase(+), coagulase (-), Novobiocin resistant
487
Low AFP, Low estriol, High b-hCG
Trisomy 21
488
Delivering bad news to pt
SPIKES protocol: set the stage, perception, invitation, knowledge, empathy, summary/strategy
489
Prolonged bleeding, hemarthrosis, what are the chances that his sister's unborn child will also has this disease
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
Support
expression of concern & interest
491
Dysphagia + esophageal biopy w/ unorganized cells or varying nuclear content
Malignancy w/ poor prognosis; Squamous cell carcinoma: solid nests of neoplastic cells w/ abundant eosinophilic cytoplasm
492
S/E of Ethambutol
Optic neuritis (decreases visual acuity, central scotoma, color-blindness)
493
Polyuria + polydipsia + LOW glucose + low urien osmolality that's responsive to ADH (150 -> 550)
Complete Central DI: complete indicates ADH response >50%
494
Weak forearm flexion & absent biceps reflex, sensation loss?
Musculocutaneous n. injury --> loss of sensation to lateral arm
495
PCL tear --> identify it on CT
PCL attaches from the anterior femur ---> posterior tibia
496
Simvastatin & Cholestyramine effects on cholesterol synthesis
Simvastatin inhibits HNG-CoA reductase, blocking cholesterol synthesis; Cholestyramine binds bile acid to prevent reabsorption & leads to increased HMG-CoA reductase
497
Lagging strand in synthesized 3'-->5'
Requires repetitive action of ligase to join DNA fragments
498
Spastic paresis of LEs, choreoathetoid movements, HIGH arginine levels --> enzyme deficiency normally involved in
Urea production: Arginase converts Arginine --> Ornithine + Urea
499
1 testicle + High FSH + normal LH --> production of what hormone is impaired
Inhibin B: produced by Sertoli cells normally feeds back to the pituitary to shut down FSH release (FSH--> Sertoli cells ---> Inhibin B --| Pituitary)
500
Confusion , lethargy, low pH, low HCO3-, low paCO2
Metabolic Acidosis
