UWorld

Question 1

IFN-gamma

Answer 1

released by T cells

use it to test for latent TB (how much IFN-gamma is released by T cells when exposed to TB antigens?)

Question 2

Enteric bacteremia = most likely to be caused by

Answer 2

E coli, Salmonella typhi, Klebsiella, proteus (shigella is rarely phagocytosed and destroyed when it enters bloodstream, so no bacteremia)

Question 3

DSM5 personality disorders

Answer 3

Paranoid = suspicious, distrustful, hypervigilant

Schizoid = loner, detached, unemotional

Schizotypal = eccentric; odd thoughts, perceptions and behavior

Antisocial = disregard and violation of rights of others

Borderline = chaotic relationships, labile mood, inner emptiness, self harm etc

Histrionic = dramatic, superficial, attention seeking

Narcissistic = grandiose, lack empathy

avoidant = avoid b/c of fears of criticism and rejection

Dependent = submissive, clingy

Obsessive-compulsive = rigid, controlling, perfectionistic

Question 4

To locate appendix intra-op?

Answer 4

follow tenia coli band of muscle to where it attaches to cecum

Question 5

Stimulation of pancreatic bicarb release?

Enzyme release?

Answer 5

Bicarb = from secretin (secreted by S-cels in response to increasing H+ conc)

Enzymes = from CCK and cholinergic stim

Question 6

Wiskoff-Aldrich

Answer 6

eczema, recurrent infxns, thrombocytopenia

mut on X chrom (males) - combo B and T lymphocyte disorder

tx = hla-matched bone marrow transplant

Question 7

HUS

Answer 7

microangiopathic hemolytic anemia, thrombocytopenia, acute renal failure

usually caused by enteroinvasive infxn –> toxin binds renal endothelium –> damage –> thrombosis and inactivation of ADAMTS13 (as in TTP) –> growing thrombi –> RBC lysis (schistocytes) and AKI (uremia)

Question 8

causes of aplastic anemia

Answer 8

chloramphenicol use

infection of SCD pts with parvo

Question 9

Chediak-Higashi syndrome

Answer 9

albinism, peripheral neuropathy, immunodeficiency

phagocyte dysfxn

Question 10

ataxia-telangectasia syndrome

Answer 10

B/T cell defect –> ataxia and telangectasia

Question 11

3’–> 5’ exonuclease vs 5’ –> 3’ exonuclease

Answer 11

Prokaryotes have 3 DNA polymerases and all have 5’-to-3’ polymerase and 3’ to 5’ proofreading exonuclease activity, but DNA pol 1 also has 5’ to 3’ exonuclease activity

5’–>3’ allows DNA pol1 to do nick translation (DNA repair and removal of RNA primers)

3’–>5’ is the usual virus-encoded proofreader; absent in HCV so it makes lots of replication errors –> lots of subspecies of HCV

Question 12

Lithium effects on kidney

Answer 12

induces DI by antagonizing vasopressin/ADH (–> polydipsia, polyuria, inappropriately dilute urine after water restriction)

in addition to kidney damage, can cause hypothyroidism (monitor BUN, Cr, and thyroid fxn)

*lithium toxicity enhanced by anything that decreases GFR –> increased PT lithium reabs (lithium follows Na) –> increased lithium floating around in the body, and it has a really narrow therapeutic window

**ACEi, NSAIDs and nondihydropyridine CCBs can also increase lithium conc and toxicity

Question 13

Abciximab is used for…

Answer 13

GPIIb/IIIa antag, used for unstable angina and ACS

Question 14

Direct thrombin inhibitors are used in

Answer 14

argatroban (HIT), dabigatran (afib, venous thromboembolism)

so anticoag

Question 15

clopidogrel vs abciximab

Answer 15

clopidogrel blocks ADP receptors on plts

abciximab blocks GPIIb/IIIa

Question 16

Symptoms of Patau syndrome

Answer 16

holoprosencephaly (ranging from cleft lip to cyclops), microceph, microphthalmia, ID

Question 17

Markedly elevated AFP levels associated with ___

Answer 17

open neural tube and ventral wall defects (eg opmhalocele, gastroschisis)

vs low AFP associated with Down syndrome

Question 18

Parinaud syndrome

Answer 18

dorsal midbrain problem (paralysis of upward gasze, kptosis and pupillary abnormalities) due to compression of pretectal region of midbrain, eg from pineal gland mass

Question 19

most common pineal gland mass?

Answer 19

germinoma (from embryonic germ cells); most common in young boys

also seen in suprasellar region (less common) –> endocrine problems

Question 20

Ventral vs dorsal pancreatic buds

Answer 20

dorsal forms majority of pancreatic tissue, + accessory duct (which usually fuses with ventral duct and rest of it usually degenerates, except in pancreas divisum, when the buds fail to fuse, so there are two ducts into duod; usu asymptomatic but can –> recurrent pancreatitis)

ventral = major duct + inferior/posterior portion of head and uncinate process

Question 21

Myotonia

Answer 21

abnormally slow relaxation of muscles

Question 22

Sx: difficulty loosening one’s grip, cataracts, frontal balding, gonadal atrophy

Answer 22

myotonic muscular dystrophy (second most common inherited muscle disorder, aut dom trinucleotide repeat expansion of gene for myotonia protein kinase)

type 1 fibers = esp atrophied

Question 23

Inflammatory myopathies

Answer 23

Dermatomyositis, polymyositis

Question 24

Ion channel myopathies

Answer 24

sx: myotonia (abnormally slow relaxation of mm) + episodes of hypotonoic paralysis, esp with exercise; no muscle atrophy

Question 25

mitochondrial myopathies

Answer 25

aka oxidative phosphorylation disease sx: myopathy, lactic acid buildup, CNS disease ragged red fibers mitochondrial inheritance

Question 26

Inheritance pattern of achondroplasia

Answer 26

autosomal dominant (homozygous form = lethal) usu starts as sporadic mutation due to advanced paternal age mech: GOF mutation in FGFR3 gene

Question 27

Patients with deficiencies in complement factors that form MAC get ...

Answer 27

recurrent Neisseria infxns

Question 28

Effect of pCO2 on cerebral blood flow

Answer 28

Increased pCO2 increases CBF via cerebral vasodil (vs pO2 has less effect on CBF)

Question 29

cystocele

Answer 29

prolapse of anterior vaginal wall, may occur with pelvic floor injury (levator ani muscle injury)

Question 30

Kegels

Answer 30

squeeze and release levator ani muscles to strengthen pelvic floor

Question 31

Causes of incontinence (urinary)

Answer 31

stress urinary incontinence (with increased abd pressure) - pelvic floor (levator ani) injury, external urethral sphincter injury (eg prolonged labor) urge incontinence (detrusor overactivity) overflow incontinence (detrusor underactivity)

Question 32

Control of urination

Answer 32

To urinate: Parasympathetics contract detrusor, relax internal urethral sphincter; somatic: pudendal relaxes external urethral sphincter To not urinate: Sympathetics relax detrusor, contract internal urethral sphincter; pudendal contracts external urethral sphincter

Question 33

STD ulcers - initial pain vs no pain

Answer 33

pain: chancroid, genital herpes (HSV1 and 2 - more common; lesions heal within 10 days) no pain: Klebsiella, syphilis (lesion self resolves within weeks), lymphogranuloma venereum

Question 34

Large, painful inguinal lymph nodes in which STD?

Answer 34

lymphogranuloma venereum (chlamydia) also painless initial ulcer, ulcers = small and shallow OBLIGATE INTRACELLULAR

Question 35

characteristic feature sof granuloma inguinale (Klebsiella)

Answer 35

extensive and progressive ulcerative lesions, nonpainful, with granulation tissue at base NO LAD (Distinguishes it from chlamydia buboes) deeply staining gram neg intracytoplasmic cysts (Donovan bodies)

Question 36

What do chancroid ulcers look like?

Answer 36

multiple, deep, painfull, with gray/yellow exudate at base histo: organisms = clumped in parallel strands (schools of fish) vs syphilis = single, indurated, well circ, painless ulcer with clean base and thin, corkscrew organismss on darkfield mic

Question 37

Cowdry bodies

Answer 37

pink/purple intranuclear (not cytoplasmic) inclusions seen in HSV also histo: multinucleated gina cells

Question 38

HbH vs Hb Barts

Answer 38

HbH is in alpha-thal 3 allele deletion, when have very little alpha and get excess beta in tetramers Hb Barts (lethal) = no alpha globin (4 allele deletion), so get gamma tetramers

Question 39

HbA vs HbA2

Answer 39

HbA = 2 alpha, 2 beta HbA2 = 2 alpha, 2 delta (increased in beta thal minor)

Question 40

Drug of choice for paroxysmal SVT

Answer 40

adenosine (blocks AV node), fast acting with short t1/2 side effects = flushing, chest burning (bronchospasm), hypotension, and AV block

Question 41

antiarrhythmic used for ventricular arrythmias

Answer 41

lidocaine (class IB) tox = neuro sx preferentially affects ischemic tissue, so often preferred post-MI

Question 42

Anti-serotonin drugs

Answer 42

Cyrpoheptadine (oral 5-ht1a and 2a antag used to treat ser syndrome) Ondansetron (5-ht3 antag to treat nausea/vomiting)

Question 43

Nitrite positive urine = what kind of organism causing the UTI?

Answer 43

gram negative

Question 44

arteriovenous nicking

Answer 44

funduscopic finding in patients with chronic htn (early manifestation of retinopathy due to exudative vascular changes from endothelial damage) looks like arteriole overlying squished vein

Question 45

end-organ damage in pre-eclampsia = due to ?

Answer 45

endothelial damage secondary to release of inflamm factors from abnormal placentation

Question 46

difference b/w clotting factor deficiency-induced bleeding and VWD bleeding

Answer 46

clotting factor def (eg hemophilia) = deep tissue bleeding vs VWD = skin and mucosal bleeding (gingivae, nasal mucosa, GI tract, endometrium) ITP bleeding also = mucocutaneous

Question 47

Cheyne-Stokes breathing

Answer 47

cyclic breathing pattern in which apnea is follwed by gradually increasing then decreasing tidal volumes until the next apneic period seen in CHF (chronic hypervent with ypocapnia induces apnea during sleep --> buildup of CO2 --> ventilation overshoots)

Question 48

Erythematous childhood rashes

Answer 48

Chickenpox (pruritic vesicles in different stages of dev) Erythemia infectiosum (parvo; malar rash) - worry about aplastic anemia as sequela in IC or SCD pts Rubella (occipital and postauricular lad; rash starts on head and moves down) Rubeola (measles) - rash from head down, cough, coryza, conjunc, koplik spots; can --> bronchopna, encephalitis roseola (HHV) - fever --> rash, self-lim; rash starts on trunk scarlet fever (strep pyogenes) - sandpaper like rash starts on neck and then generalizes; may --> RF, glomerulonephritis

Question 49

P450 inducers

Answer 49

barbs, rifampin, carbamazepine, griseofulvin, chronic alcohol

Question 50

p450 inhibitors

Answer 50

isoniazid, cimetidine/omeprazole, macrolides, azoles, grapefruit juice

Question 51

phenytoin toxicity

Answer 51

it's a p450 inducer, and will be metabolized faster in liver if administered with other p450 inducers it's breakdown is dose-dependent so if give higher doses and saturate the enzyme, can quickly get tox

Question 52

Cherry red spot

Answer 52

on macula with diffuse retinal ischemia of central retinal artery occlusion usually with acute monocular vision loss

Question 53

Hiatal hernia - two types?

Answer 53

para-esophageal (GE jxn stays attached at level of diaph, but part of stomach passes or bulges into chest) sliding (GE jxn protrudes into chest --> dysphagia, GERD but normal manometry)

Question 54

Phenotypic mixing in viruses

Answer 54

host cell is coinfected with 2 viral strains and progeny virions contain genome from one strain and nucleocapsid or envelope proteins from other BUT their offspring will go back to original traits, since genome is unchanged

Question 55

Reassortment vs recombination vs transformation in viruses

Answer 55

Reassortment requires segmented genomes, exchange whole genome segments (eg flu) - mechanism of genetic shift in flu Recombination = nonsegmented, dsDNA genomes (exchange genes between 2 chromosomes via crossing over of homologous regions); can result in traits in progeny that weren't present in either progeny strain Transformation = uptake of naked DNA by prokaryotic or eukaryotic host cell (doesn't change virus genome) - eg bacteria uptaking DNA from its environment, or host cell incorporating viral DNA into its own genome

Question 56

mold vs. yeast

Answer 56

mold = branching (eg germ tubes of candida in the body) yeast = spore-like (unicellular, can assemble into strings, aka "pseudohyphae") - most infxs fungi = "yeast in the heat" (aka in the human body), except candida

Question 57

ecological study

Answer 57

unit of analysis = populations, not individuals if try to make conclusions about individuals within the populations, that's the "ecological fallacy" vs. eg cross sectional study (exposures and outcomes in INDIVIDUALS at given pt in time)

Question 58

lab test for fat in stool

Answer 58

sudan III stain (stool should normally contain no measurable fat)

Question 59

Adverse effects of anthracyclines and prevention of that a/e

Answer 59

chemo drugs main a/e = cardiotoxicity due to generation of free radicals --> DCM (swelling of SR and loss of cardiomyocytes --> CHF sx) tx: dexrazoxane (Fe chelation)

Question 60

Mutation in SCD vs HbC defect

Answer 60

SCD: glutamic acid to valine in beta chain HbC: glutamic acid to lysine in beta chain

Question 61

Mechanism of action of most N. meng vaccines

Answer 61

target the polysaccharide capsule to facilitate bacterial opsonization, phagocytosis, and clearance of organism from blood to prevent hematogenous dissemination what would be even better is targeting pilus (mechanism of invading nasopharyngeal epithelium to get access to blood in first place)

Question 62

Diphenoxylate

Answer 62

opioid mu receptor agonist used in low doses to slow GI motility and decrease diarrhea symptoms in uncomplicated diarrhea often combined with atropine to lead to a/es if taken in high doses (discourage abuse)

Question 63

Three areas of portosystemic shunt in portal htn and veins involved

Answer 63

caput medusae: paraumbilical veins (portal) --> superficial and inferior epigastric veins (systemic) hemorrhoids: superior rectal vv (portal) --> middle and inferior rectal vv (systemic) esophageal varices: left gastric (portal) --> esophageal (systemic)

Question 64

Rare mu opioid a/e that causes abd pain

Answer 64

contraction of smooth muscle cells in sphincter of oddi --> spasm and increase in common bile duct pressure, may --> biliary colic in pressure in gallbladder increases d/c

Question 65

isolated atrial amyloidosis is due to ___

Answer 65

deposition of abnormally folded ANP-derived proteins (increased incidence with age) can also happen in pancreas with DM, in pituitary with prolactin-derived proteins, in thyroid with calcitonin-derived proteins in medullary thyroid cancer etc

Question 66

Urine is diluted in the ____ concentrated in the ____

Answer 66

diluted in ascending loop of henle (electrolytes, but not water, are reabs) - concentrated on way down LoH, diluted on way back up concentrated in collecting duct (via ADH --> aquaporin translocation and water reabs driven by high osm of medullary interstitium)

Question 67

porphyria

Answer 67

deficiencies in heme synthesis enzymes urinary porphobilingoen may = elevated

Question 68

HIT

Answer 68

IgG against heparin-platelet factor 4 --> Fc of IgG binds and activates plts --> clotting and depletion of plts

Question 69

hot tub folliculitis

Answer 69

pseudomonas

Question 70

Campylobacter can be acquired from...

Answer 70

domestic animals or contaminated food

Question 71

DRESS syndrome

Answer 71

drug rxn with eosinophilia and systemic symptoms rare, can be life-threatening, 2-8 weeks after start antiseizure, allopurinol, sulfonamides, abx (eg minocycline, vanc) prob causes herpesvirus reactivation --> clonal expansion of T cells that cross react with drug sx: fever, LAD, facial edema, skin rash tx: d/c drug

Question 72

drugs most commonly linked to anca-associated vasculitis

Answer 72

hyperthyroidism drugs and hydralazine

Question 73

mixed cryoglobulinemia

Answer 73

small- to medium-vessel vasculitis caused by circulating Ig-complement complexes often assoc with chronic inflamm state

Question 74

glucogenic amino acids vs ketogenic AAs

Answer 74

both: phenylalanine, isoleucine, tryptophan ketogenic: leucine, lysine glucogenic: alanine, serine, asparagine, aspartate glucogenic = producing intermiediates of TCA cycle or pyruvate

Question 75

2nd gen antipsychotics with greatest risk of... metabolic syndrome/weight gain? QT prolongation agranulocytosis? prolactin elevation?

Answer 75

onazapine and clozapine ziprasidone (QT) clozapine (agran) risperidone (prolactin)

Question 76

cervicofacial actinomycosis

Answer 76

slow growing mass that --> chronic face and neck abscesses complicated by cutaneous sinus tracts due to actinomyces infxn (often after dental work etc) tx: parenteral pcn and surgical debridement

Question 77

diuretics that can --> hypercalcemia and hyperuricemia

Answer 77

thiazides

Question 78

infliximab

Answer 78

anti-tnf-alpha used for RA, AS, Crohn's

Question 79

IL-2 as treatment

Answer 79

activates T cells to aid in tumor cell destruction, used in RCCA and melanoma T cells then secrete more IL-2 also promotes growth of B cells and activation of NK cells and monocytes

Question 80

aldosterone escape

Answer 80

high aldo levels --> increased intravasc volume --> increased RBF and increased ANP --> compensatory increase in Na excretion from kidneys, so net sodium in body doesn't increase much, and pt doesn't get too volume overloaded

Question 81

RPF vs RBF

Answer 81

RPF = RBF*(1-Hct) need RPF to calculate FF (=GFR/RPF)

Question 82

Alemtuzumab

Answer 82

anti-CD52 used to treat CLL (binds CD52 and initiates direct cytotoxic killing through complement and Ig-dependent, CMI)

Question 83

IFN-gamma

Answer 83

increases expression of MHC I and II --> improved antigen presentation

Question 84

symptoms of serotonin syndrome

Answer 84

abnormal mental status, autonomic hyperactivity, muscular rigidity with hyperreflexia seen with SSRIs

Question 85

Epistasis

Answer 85

allele of one gene affects phenotypic expression of alleles in another gene

Question 86

congenital torticollis

Answer 86

due to birth trauma (eg breech) or malposition of head in utero --> SCM injjury and fibrosis (may come with other MS anomalies, like hip dysplasia, clubfoot etc) clinical diag: noticed around 2-4 weeks, head = tilted toward affected side with chin pointed away and soft tissue mass over affected SCM tx = stretching exercises

Question 87

maternal htn can cause?

Answer 87

asymmetric IUGR (normal or almost-normal head size with reduced abdominal circumference)

Question 88

Pneumoconioses vs. hypersensitivity pneumonitis

Answer 88

Asbestosis - ferruginous bodies, pleural plaques, interstitial infiltrate in lower lobes (CXR) Berylliosis - ill-definednodular opacities on CXR; histo: noncaseating epithelioid granulomas (looks like sarcoid) Coal - nodualr interstitial opacities; histo: coal dust-laden macrophages Silica - eggshell calcification of hilar lymph nodes; histo: birefringent silica particles surrounded by fibrosis hypersensitivity pneumonitis - diffuse interstitial infiltrates on CXR; histo: noncaseating granulomas can all present with DOE

Question 89

E Coli feature that allows some strains to colonize and ascend urinary tract?

Answer 89

fimbriae (adhesive proteins) --> pyelo, bacteremia/sepsis

Question 90

PNH

Answer 90

sx: hemolytic anemia, pancytopenia, hypercoagulability pathophys: due to acquired mutation of PIGA gene within clonal population of multippotent hematopopietic stem cells, so can't make GPI anchor, and thus can't attach CD55 (DAF) and CD59 (MAC inhibitory protein) -- diag based on flow --, so can't inactivate complement, which will cause MAC to form on normal cells -->> comp-mediated hemolysis thrombotic complications (eg budd chiari) due to release of free hgb and oother prothrombotic factors from lysed RBCs and plts fundamentally a stem cell disorder, which is why you get pancytopenia tx: eculizumab (complement inhibitor)

Question 91

consequence of cardiac rupture and timing post-MI

Answer 91

usually 5-14 days, when coag necrosis, PMN/macrophage infiltration, and enzymatic lysis of CT is going on consequence: severe hypotension and shock --> pulseless electrical activity and death (due to tamponade and hemopericardium in free wall rupture - most common site of rupture) vs true aneurysm = late complication (>1month) - rarely rupture b/c surrounded by tough epicardium

Question 92

pre-op treatment of carcinoid

Answer 92

octreotide (decrease diarrhea since it inhibits GI hormones)

Question 93

cabergoline

Answer 93

DA agonist (used to treat GH-secreting or PRL-secreting tumors)

Question 94

only DNA pol ___ has 5' to 3' exonuclease

Answer 94

1, used to remove RNA primer all three DNA pols have 3' to 5' exonuclease for proofreading these = in prokaryotes

Question 95

if see bloody diarrhea with microangiopathic hemolytic anemia, thrombocytopenia, and renal insufficiency?

Answer 95

think HUS, usually due to E Coli O157:H7 usually undercooked ground beef, person-to-person contact, raw unpasteurized milk, sewage-contam water

Question 96

lysogenization

Answer 96

bacteriophage infects host bacterium and integrates its genome into host bacterium genome ex: Shiga-like toxin, botulinum toxin, cholera toxin, diphtheria toxin, erythrogenic toxin of Strep pyogenes (scarlet fever)

Question 97

Transformation

Answer 97

abitility to take up naked dna from environment eg Strep pneumo acquires its capsule machinery that way (thus becoming pathogenic) also H flu, Neisseria

Question 98

patients with inherited terminal complement defects (can't form MAC) have increased susc to ____

Answer 98

Neisseria

Question 99

patients with decreased CMI have increased susc to ___

Answer 99

intracellular bacteria (Salmonella, shigella, M TB, listeria), viruses, fungi

Question 100

Mallory Weiss vs. Boerhaave syndrome

Answer 100

Mallory-weiss = upper GI mucosal tear Boerhaave = esophageal transmural tear --> vomiting, chest/upper abd pain, and rapid fever, dyspnea and septic shock

Question 101

Three causes of nausea/vomiting with different antiemetcs

Answer 101

GI-related (eg traveler's diarrhea) - use serotonin antagonist (GI irritation --> ser release) - eg ondansetron Central nausea (eg migraines) = da induced, so can use DA antag (eg metoclopramide, promethazine) Vestibular nausea (eg motion sickness) - use first-gen (cross BBB) H1 receptor antag (eg diphenhydramine, meclizine) or mAChR antagonists (eg scopolamine)

Question 102

When would you use atropine in MI?

Answer 102

inferior MI (right coronary artery blockage --> decreased perfusion to SA and AV node), so give atropine to decrease vagal influence on AV and SA nodes and thus increase HR but comes with usual atropine a/es (eg angle closure glaucoma due to mydriasis) also used to treat other causes of bradycardia (eg heart block)

Question 103

Increased optic cup:disc ratio

Answer 103

sign of open angle glaucoma (pale disc, big cup) progressiv eloss of ganglion cell axons causes the change, causing progressive loss of peripheral visual fields tx: decrease aqueous production (eg CA inhibitors, alpha agonistis [eg brimonidine - vasocon in ciliary body], beta blockers [eg timolol]) or increase outflow (eg with prostaglandins)

Question 104

Drugs to decrease aqueous humor production

Answer 104

CA inhibitors (decrease formation of bicarb in ciliary body) alpha agonists (eg brimonidine) - vasocon of ciliary body beta antag (eg timolol)

Question 105

Drugs to increase aq humor drainage

Answer 105

topical prostaglandins (eg latanoprost) - ?mech

Question 106

HPV has predilection for _____ type of epithelium, so mostly found as warts on _____

Answer 106

stratified sq epithelium - anal canal, vagina, cervix, and true vocal cords (only part of resp tract with strat sq epith to protect from constant friction of speech) may see these vocal cord warts in babies born to infected moms

Question 107

Positive likelihood ratio

Answer 107

prob of diseased person testing positive (sensitivity) / prob of nondiseased person testing positive (1-specificity)

Question 108

Negative likelihood ratio

Answer 108

likelihood of having the disease given a negative result prob of diseased person testing negative (1-sensitivity) / prob of nondiseased person testing negative (specificity)

Question 109

Fragile X

Answer 109

physical sx: macroorchidism, dysmorphic (long) facies neuropsych: ID, dev delay, ASD, ADHD cause: mutation of FMR1 gene on X chrom (expanded trinucleotide repeat) --> gene hypermethylation (so gene is inactivated)

Question 110

Rheumatoid factor

Answer 110

IgM antibody specific for Fc component of self IgG binds IgG and forms ICs that circulate in serum and deposit in synovium and cartilage --> complement activation and chronic inflamm produced when CD4 cells are activated by collagen proteins and stimulate B cells to make RF

Question 111

anti-centromere vs anti-dsDNA

Answer 111

centromere = CREST dsDNA = SLE

Question 112

Effect of IFN-alpha and beta on virally infected cells

Answer 112

synthesized in most cells in response to viral infection, but antiviral enzymes that are made when they bind their receptors are only activated in presence of dsRNA (virally infected cells) --> prevent protein synth and thus viral replication

Question 113

IFN alpha, beta, gamma

Answer 113

alpha and beta are made by all cells in response to viral infection --> antiviral enzymes that are activated only in presence of dsRNA (viral) and decrease protein synth to stop viral replication - alpha and beta also induce MHC I expression --> more NK and cytotoxic T cells --> more apop of infected cells - gamma is produced by NK and T cells --> Th1 differentiation, increased MHC2 expression, and improved intracellular killing ability of macrophages

Question 114

anterolateral humeral fracture injures the ____

Answer 114

radial nerve (pushes humerus anterior and laterally, where radial runs, eg falling on outstretched hand/hyperextension) sx: wrist drop vs if injure the radial as it passes through supinator canal (eg due to repetitive pronation/supination, trauma, dislocation of radius), then get weakness on finger and thumb extension, but triceps and wrist extensor = OK (branches come off before the deep branch of the radial nerve passes around lateral epicondyle of humerus and into forearm through the canal)

Question 115

anteromedial humeral fracture - caused by what and injures what?

Answer 115

caused by hyperextension (eg falling on outstretched hand) that pushes humerus medially and forward injures brachial artery and median nerve

Question 116

hyperflexion injures what nerve?

Answer 116

ulnar (runs posterior to medial epicondyle, so when humerus is displaced posteriorly, it gets injured)

Question 117

biceps tendon injury happens how, usually?

Answer 117

older people who are lifting something (so biceps is flexed) and then rapidly extend

Question 118

hemorrhagic cystisis is side effect of what chemo?

Answer 118

Cyclophosphamide/ifosfamide

Question 119

chemo that can cause CHF?

Answer 119

doxorubicin (anthracycline + chemo)

Question 120

pulmonary toxicity induced by which chemo drug?

Answer 120

bleomycin (progressive pulm fibrosis)

Question 121

Cholestasis and hepatitis associated with which chemo drug?

Answer 121

mercaptopurine

Question 122

ToF is primarily a ____ defect

Answer 122

abnormal neural crest cell migration --> deviation of infundibular septum (so get malaligned VSD and overriding aorta)

Question 123

Endocardial cushion defect results in ___

Answer 123

ASD or VSD with left-to-right shunting; eventually reverses (Eisenmenger) and get late-presentation cyanosis

Question 124

Somatomedin C

Answer 124

insulin-like growth factor (released in response to GH a nd stimulates growth)

Question 125

POMC = precursor to ____

Answer 125

beta-endorphin, ACTH, MSH

Question 126

Spread of H. flu vs N. meng to brain

Answer 126

H. Flu: pharynx --> lymphatics --> meninges N. meng: pharynx --> blood via mucosal epithelium --> choroid plexus --> meninges

Question 127

Musculocutaneous innervates

Answer 127

biceps and brachialis (elbow flexion)

Question 128

Suprascapular n innervates

Answer 128

supraspinatus and infraspinatus (shoulder abduction and lateral rotation)

Question 129

grabbing from above -->

Answer 129

lower brachial plexus (ulnar and median) injury

Question 130

fall on outstretched hand

Answer 130

usually injures radial (anterolateral fracture; also with middle humerus fracture) anteromedial fracture can injure median nerve/brachial artery

Question 131

Zolpidem

Answer 131

short-acting hypnotic, used for insomnia b/c less addiction/tol potential, no anticonvulsant properties or muscle relaxing effects otherwise similar to benzos (and sometimes long-acting benzos like furazepam are used for insomnia, but increased risk of dependence)

Question 132

How does epi make glucose available?

Answer 132

- adipose: increased breakdwon of TGs --> gluconeo - liver: increased glycogenolysis and gluconeo - skel muscle: decreased glucose uptake and increased alanine release (source for gluconeo) with starvation, renal gluconeo starts (epi stimulates it more than glucagon)

Question 133

Side effects of TB drugs

Answer 133

Rifampin - red/orange fluids, GI, cytopenias Isoniazid - B6 deficiency, hepatotox Pyrazinamide - hepatotox, hyperuricemia Ethambutol - optic neuropathy (central scotoma, decreased acuity, color blindness)

Question 134

Viruses that acquire envelope by budding through host cell nuclear membrane (most bud through plasma membrane of host)

Answer 134

herpesviruses

Question 135

CD21

Answer 135

receptor for C3d on B cells (so CD21 b cells are infected with EBV and proliferate, though not as much as activated CD8 T cells)

Question 136

Thoracic outlet syndrome

Answer 136

compression of the lower trunk of the brachial plexus and/or subclavian vein and/or subclavian artery as it passes through scalene triangle (between scalene mm and first rib) --> UE nubmness, tingling, weakness +/- swelling (vein compression) +/- exertional pain (artery compression) may be caused by anomalous cervical rib, scalene muscle abnormalities, or injury (eg repetitive overhead arm mvmts)

Question 137

methylmalonic acidemia

Answer 137

aut rec deficiency in methylmalonyl-CoA mutase so threonine, methionine, valine, isoleucine, and odd-chain FAs are converted to propionyl CoA, which is converted to methylmalonyl CoA, but no enzyme to convert that to Succinyl CoA to run TCA --> buiild up of propionic and methylmalonic acid acidemia --> inhibits urea cycle and gluconeo also overall increased metabolic rate -> decreased glucose, increased FFA metabolism and ketone production overall: anion gap metabolic acidosis, hypoglycemia, ketosis, and hyperammonemia confirm diag with elevatred urine MMA and propionic acid

Question 138

Causes of sma syndrome

Answer 138

transverse duodenum gets stuck between aorta and SMA if angle between them decreases eg due to sudden weight loss, severe burns or othe rinducers of catabolism, prolonged bedrest, lordosis etc (all diminish fat between aorta and sma)

Question 139

Intrapartum infections

Answer 139

HSV, Chlaymydia, Neisseria, viruses (all can cause ophthalmia neonaturm/conjunctivitis), GBS sepsis

Question 140

Most common presentation of post-procedure atheroembolism?

Answer 140

acute kidney injury (chol-containing debris from deposits in bigger arteries is dislodged and lands in kidney vasculature)

Question 141

tumor like pheo but that's outside adrenal medulla?

Answer 141

paraganglioma Rule of 10's: 10% of pheos are: bilateral extra-adrenal (paragang) malignant

Question 142

acute, painless loss of vision is due to ___

Answer 142

central retinal artery occlusion findings: pale retina, cherry-red macula (fovea gets own blood supply from choroid, which you can see underneath)

Question 143

amaurosis fugax

Answer 143

painless, transiet (few sec), monocular vision loss due to small embolus to ephthalmic artery

Question 144

activation of glycogen phosphorylase in liver vs. muscle

Answer 144

to be activated, needs to be phosphorylated by phosphorylase kinase in liver, that happesn when epi and glucagon increase cAMP via Gs in skel muscle, no glucagon receptors, so epi --> increased cAMP but more potently, ACh with skeletal muscle contraction --> CICR from SR --> glycogen breakdown (synchronizing muscle contraction and glycogen breakdown so mm have adequate energy to contract)

Question 145

C1 esterase inhibitor deficiency causes _____? c/i drug?

Answer 145

hereditary angioedema ACEi are contraindicated (further increase bradykinin)

Question 146

Central regulator of Fe homeostasis and wher eis it made?

Answer 146

hepcidin, made in liver hepicidin (released with high Fe and inflamm) --> less ferroporptin --> decreased intestinal iron abs and less Fe released from macrophages

Question 147

Metyrapone stimulation test

Answer 147

indicator of HPA axis integrity give metyrapone, which prevents conversion of deoxycortisol to cortisol, so decreased cortisol should --> increased CRH and ACTH --> increased 11-deoxycortisol (trying to make cortisol) 11-deoxycortisol builds up in blood and is excreted in urine as 17-hydroxycorticosteroid, so measure these to make sure they increase; sign that axis works if they don't increase, either pituitary isn't releasing ACTH or adrenal isn't responding to it (2ary or 1ary adrenal insufficiency; distinguish by whether or not there's ACTH - if yes, then it's primary)

Question 148

Adenoma carcinoma mutation sequence in CRC

Answer 148

APC mut -> polyp --> KRAS mut (unregulated cell cycle prolif) --> bigger adenoma --> p53 and DCC/other tumor suppressor mutation --> carcinoma

Question 149

Three features that determine malig potential of adenomatous polyps

Answer 149

size, villous histo, dyplasia

Question 150

Nitrogen dioxide poisoning

Answer 150

toxic product of combustion (eg firefighters = at risk) sx: similar to asthma or COPD, imaging may reveal pulm edema

Question 151

Elderly pt with hip fracture - worry about osteonecrosis b/c of which vessel?

Answer 151

blood supply to femoral neck is mainly medial circumflex artery - esp vulnerable to damage from fractures

Question 152

____ forms from fusion of 2 medial nasal prominences; failure --> ______ the product of that fusion then fuses with the ______ to form the upper lip and primary palate; failure --> cleft lip cleft palate results from ____

Answer 152

intermaxillary segment from fusion of 2 medial nasal prominences; failure --> severe midline defects (eg holoprosencephaly) intermax segment then fuses with left and right maxillary prominences to form upper lip and primary palate cleft palate if maxillarty promeinences --> palatine shelves, and the shelves don't fuse

Question 153

Pierre-Robin sequence

Answer 153

Severe micrognathia from hypoplasia of mandibular prominence --> posterior displacement of tongue and no fusion of secondary palate (so cleft palate)

Question 154

"Ragged red fibers"

Answer 154

mitochondrial myopathies (can't run ox phos so present with myopathy, lactic acidosis, NS dysfxn) heteroplasmy

Question 155

IL-12 receptor deficiency - consequences and tx?

Answer 155

consequences: can't stimulate helper T to differentiate into Th1, so no IFN-gamma --> activated macrophages and thus can't defend against intracellular bugs (eg mycobacteria) tx = IFN-gamma

Question 156

How does TNF-alpha (and also catecholamines, glucocorticoids, and glucagon) induce insulin resistance?

Answer 156

active serine kinases --> phophorylation of serines on insulin receptor and its substrate --> inhibit downstream signaling upon insulin binding

Question 157

Vessels with lowest O2 content in the body?

Answer 157

Coronary sinus (coronary venous blood - myocardial O2 extraction is very high, so by the time it's done, O2 content is lower than in vena cavae)

Question 158

Sturge Weber syndrome

Answer 158

Enc phalotrigeminal angiomatosis Cut facial and leptomeningeal angiomas, ID, seizures, hemiplegic, skull radioopacities

Question 159

Tuberous sclerosis

Answer 159

CNS Hamartomas, cutaneous angiofibromas, visceral cysts, renal angiomyolipoma S, cardiac Rhabdomyomas, seizures Aut dom

Question 160

Bortezomib

Answer 160

proteasome inhibitor used to treat MM b/c B cells are pumping out lots of Ig (protein), so especially susc to proteasome inhib (--> accum of toxic proteins that can't be broken down + pro-apoptotic factors --> apop)

Question 161

____ inhibit macrophage elastase in the lungs ____ inhibit PMN elastase

Answer 161

TIMPs inhibit macrophages alpha1-antitrypsin inhibits PMNs when both PMNs and macrophages are releasing their elastases, can degrade each others' inhibitors and get excess protease activity --> emphysema

Question 162

Club cells

Answer 162

nonciliated cells mostly in terminal bronchioles; secrete protein that protects against airway inflamm and oxidative stress and surfactant components that prevent bronchiolar collapse

Question 163

Ras overexpression

Answer 163

Ras protein is part of MAP-kinase pathway; overexpression --> cells = more senstiive to mitogenic stimuli see mutations in pancreatic, gallbladder, colon, endometrial, thyroid, and lung cancer

Question 164

Prolactin is inhibited by ____

Answer 164

progesterone so lactation is suppressed during pregnancy b/c of high progesterone levels inhibiting anterior pituitary; at delivery, progesterone suddenly drops --> PRL stimulates lactation

Question 165

restless leg syndrome - tx and drugs that worsen sx?

Answer 165

tx: DA agonists (eg ropinirole, pramipexole) drugs that worsen: steroids, SSRIs, lithium

Question 166

Nutcracker effect

Answer 166

compression of left renal vein between aorta and SMA may elevate pressure in left renal vein --> left renal vein entrapment syndrome (elevated pressure, flank/abd pain, hematuria) can --> blood backup and varicocele

Question 167

Most common ankle sprain

Answer 167

anterolateral ligament (anterior talofibular ligament) - medial ligaments ("tibio-") = stronger and less commonly injured

Question 168

Terbutaline, ritodrine

Answer 168

beta 2 selective agonists relax the uterus (tocolysis)

Question 169

alpha 1 selective agonists

Answer 169

phenylephrine, methoxamine, mitodrine (used to dilate pupil during opthalm exam)

Question 170

Leucovorin

Answer 170

folinic acid given to reverse myelosupp from methotrexate or with sulfadiazine (antifolate abx)

Question 171

How to diagnose primary CNS lymphoma?

Answer 171

EBV PCR in CSF; definitive diag requires brain bx 2nd most common cause of ring-enhancing lesions with mass effect in HIV (after toxo)

Question 172

Langerhans cell histiocytosis

Answer 172

proliferative disorders of dendritic cells (APCs/macrophages of skin and mucosa) and macrophages cells contain tennis-racket shaped Birbeck granules sx: lytic bone lesions, skin rash, recurrent otitis media with mastoid mass (kids), defective antigen presentation

Question 173

Bohr vs. haldane effects

Answer 173

Bohr: in periphery, increased CO2 + H2) --> H+ and bicarb, and H+ --> O2 unloading Haldane (in lungs): increased O2 --> H+ pops off Hgb, combines with bicarb --> CO2 that's exhaled

Question 174

Treatment for beta blocker overdose

Answer 174

Glucagon --> G protein coupled receptor activation on cardiac myocytes --> act AC --> increased cAMP --> increased [Ca]i and contraction independent of adrenergic receptors

Question 175

Glaucoma - drugs that decrease aq humor secretion or increase outflow

Answer 175

decrease secretion: CA inhibitors (eg acetazolamide), beta blockers (eg timolol) increase outflow: prostaglandins, cholinomimetics (eg pilocarpine, carbachol)

Question 176

Ramelteon

Answer 176

melatonin agonist used for insomnia in elderly (very safe)

Question 177

Quetiapine

Answer 177

second-gen antipsychotic

Question 178

2 most common risk fx for ARDS

Answer 178

sepsis and pulmonary infections with sepsis (eg due to UTI) --> cytokines that circulate and activate pulmonary epithelium --> inflamm --> capillary damage and exudate in alveolar space --> hypoxia and respiratory failure usu presents fast

Question 179

achondroplasia

Answer 179

constitutive activation of FGFR3 --> too much inhibition of chondrocytes, so endochondral ossification is screwed up vs intramembranous ossification (skull, ribs, pelvis) = ok, since no cartilage precursor to bone autosomal dominant vs. GH deficiency --> proportional short stature (both long and flat bones = affected)

Question 180

CD7

Answer 180

T cell marker

Question 181

CD14

Answer 181

surface marker of monocyte-macrophage cell lineage

Question 182

Reaction formation

Answer 182

responding in a manner opposite to one's actual feelings (eg going to church when have sexual impulses)

Question 183

projection vs displacement

Answer 183

projection = coming up with outside cause for one's feelings (eg want to have an affair and so believe that partner is cheating on you, justifying your own desire) displacement = transferring feeling or idea to unrelated person (mom yells at kid because she's angry at dad) both immature defense mech

Question 184

sublimation

Answer 184

channeling impulses into socially acceptable behavior (action is similar to desire, but acceptable given personal values - eg feel aggressive toward parent, but channel that aggression into sports) vs. reaction formation is doing opposite of desire

Question 185

suppression vs. repression

Answer 185

suppression = conscious effort, temporary repression = involuntarily ignoring idea or feeling

Question 186

Why don't we mount effective immune response to Hep C?

Answer 186

b/c no proofreading 3'-->5' exonuclease, so infected with one genotype but high mutation rate --> many different "quasispecies" within given infected individual, esp in hypervariable genomic regions, eg those that code for envelope glycoproteins lots of new envelope proteins means host can't mount effective immuen response (just as kill off one quasispecies, new one appears)

Question 187

t(14; 18) t(8;14)

Answer 187

14;18 = follicular lymphoma (BCL2 act) 8;14 = Burkitt lymphoma (c-myc activation)

Question 188

Familial conditions that increase risk of ALL

Answer 188

Down syndrome, ataxia-telangectasia, NF1

Question 189

17 alpha hydroxylase deficiency

Answer 189

lots of aldo (high BP), ambig sexual char

Question 190

21-hydroxylase deficiency

Answer 190

lots of sex hormones, aldo and cortisol are down salt wasting, precocious puberty, virilization in girls

Question 191

Mutations in transthyretin gene cause ?

Answer 191

hereditary form of cardiac amyloidosis --> cardiomyopathy, progressive dyspnea, peripheral edema , ascites

Question 192

Quellung reaction

Answer 192

abs bind capsule of encapsulated bacterial organisms, and positive rxn turns capsule opaque and swollen allows bugs to be visualized under microscope used to diagnose strep pneumo

Question 193

Treatment of choice for strep pneumo in pt with pcn allergy

Answer 193

macrolides

Question 194

Most common cause of congenital adrenal hyperplasia (90%)

Answer 194

21-hydroxylase deficiency --> buildup of 17-OH progesterone (can test serum levels) shunted to androgens

Question 195

Long-chain FA degradation - how does it work and congenital defect?

Answer 195

carnitine shuttle gets Fatty acyl-CoA into mitochondria there, oxidation into acyl CoA --> ketone bodies or TCA cycle, if odd chain systemic primary carnitine deficiency --> can't get long-chain FAs into mitochondria, so get toxic accum of FAs --> weakness, hypotonia, hypoketotic hypoglycemia

Question 196

Sarcoid granulomas produce ____

Answer 196

ACE and 1,25-vitD (--> hypercalcemia)

Question 197

BAL results for sarcoidosis vs hypersensitivity pneumonitis

Answer 197

sarcoidosis: accum of CD4+ T cells and increased CD4:CD8 ratio hypersensitivity: accum of CD8+ T cells

Question 198

Chiari I vs. Chiari II

Answer 198

Chiari I = ectopic CBL that extends below foramen magnum into verebral canal; presents late with parox occipital headaches and CBL dysfxn vs. Chiari II = way worse - CBL and medulla herniate through foramen magnum --> aqueductal stenosis and hydrocephalus + sx from compression of medulla; may present neonatatlly with lumbar myelomeningocele that causes LE paralysis

Question 199

Lesion most commonly underlying stable angina (resolves within 5 min after exertion)

Answer 199

fixed atheromatous obstruction of coronary artery(ies) occluding >=75% of lumen vs ulcerated plaque or thrombus would --> unstable angina (single episode of prolonged pain)

Question 200

Factors that shift O2-hg dissociation curve to the left

Answer 200

Decreased H+ (increased pH) Decreased temperature (stabilizes bonds and thus increases O2 affinity) Decreased 2,3 DPG (vs at high altitude, RBCs make more 2,3 DPG --> O2 dumping)

Question 201

Where is H pylori colonization density the highest?

Answer 201

antrum of stomach (H pylori can only colonize gastric-like areas; may get gastric metaplasia in the duodenum due to increased acid production stimulated by H pylori, in which case bug can colonize that part of duod, but otherwise, not much bug in duod despite common ulcers there from increased acid)

Question 202

achrocordon

Answer 202

skin tag (often seen in areas of friction)

Question 203

beta blockers - mech of action in thyrotoxicosis

Answer 203

- decrease adrenergic excitation (excess thyroid hormones upregualate beta receptor expression, so block receptor activation with beta blockers) - decrease peripheral conversion of T4 to more potent T3 vs. propylthiouracil and methimazole decrease thyroid hormone SYNTHESIS vs. iodide can prevent I uptake and thyroid hormone release

Question 204

Ghon focus vs. Ghon complex

Answer 204

focus = initial infection (focal lesion in mid-to-lower lungs) complex = when TB spreads to hilar ln + lesion gets walled off and calcified (dormant infxn in lungs)

Question 205

Rhanke complex

Answer 205

benign, calcified complex that forms from resolution of Ghon complex

Question 206

bronchus more prone to aspiration?

Answer 206

R > L

Question 207

DNAase is produced by which bug

Answer 207

Strep pyogenes (GAS) degrades DNA in pus to facilitate spread of the organism

Question 208

serum tryptase

Answer 208

released from mast cells, so increased in anaphylaxis

Question 209

QRS vs QT effects in class 1A, 1B, and 1C anti-arrhythmics

Answer 209

1A (procainamide): prolong QRS and QT (block Na and some K) 1B (lidocaine): no effect on QRS or QT (block Na but very transiently) 1C (flecainide, propafenone): prolong QRS, no effect on QT (block Na; not K) vs class 3 (sotalol, amiodarone) specifically block K channels and thus work by prolonging QT

Question 210

use dependence vs. reverse use-dependence

Answer 210

use dependence - class I anti-arrhythmics (more effect with increased heart rate, esp class IC (flecainide, propafenone), which has slow dissociation, so with increased hr it's all still attached to receptors and having effect - so more prolonged QRS/depolarization time with increased HR) reverse use dependence - class III antiarrhythmics (K blockers) - the slower the heart rate, the more the QT prolongation

Question 211

Th1 vs Th2 CD4+ cells

Answer 211

Th1 --> cell mediated immunity (eg granulomas of sarcoidosis; driven by IL2 and IFN-gamma (--> macrophage activation)) Th2 --> humoral immunity (IgE [IL4] and IgA [IL5])

Question 212

polyarteritis nodosa mostly affects ___ and spares ____

Answer 212

affects medium-small vessels; generally spares pulmonary vasculature it's a segmental, necrotizing, transmural inflamm of arteries anywhere except lungs, but esp in heart, kidneys, liver, and GI tract with common cutaneous sx (eg livedo reticularis)

Question 213

Tocolytic drugs (to stop preterm labor)

Answer 213

nifedipine (CCB) and indomethacin (COX inhibitor so decreases PGs that --> cervical softening and uterine contractions) also terbutaline (beta ag --> increased cAMP, which inhibits MLCK and keeps myosin in inactive form)

Question 214

Partial opioid agonist that can provoke opioid withdrawal if taken with full opioids on board

Answer 214

buprenorphine (low efficacy, but high affinity/potency, so kicks out any full opioid and can bring person down from high with a crash) given with naloxone to treat heroin addiction - if taken orally, still get partial agonist effects ("half a high"), but if crush and inject, naloxone becomes bioavailable (opioid antagonist --> no effect/crash)

Question 215

Best drug to inhibit Xa vs thrombin?

Answer 215

Xa - LMWH (eg enoxaparin) thrombin - unfractionated heparin (long enough to bind both thrombin and antithrombin)

Question 216

enoxaparin

Answer 216

LMWH also dalteparin ("-parin")

Question 217

fondaparinux

Answer 217

direct factor Xa inhibitor (also apixaban, rivaroxaban) these don't inactivate thrombin, just inhibit Xa

Question 218

Calcipotriene

Answer 218

topical Vitamin D analog used to treat psoriasis others: calcitriol, tacalcitol bind to and activate vit D receptor --> inhibition of keratinocyte proliferation, stimulation of keratinocyte differentiation; also inhibits T cell proliferation and inflamm

Question 219

Ustekinumab

Answer 219

monoclonal antibody that targets IL-12 and IL-23, inhibiting differentiation and activation of CD4+ Th1 and Th17 cells tx of psoriasis

Question 220

Calcipotriene

Answer 220

topical Vitamin D analog used to treat psoriasis others: calcitriol, tacalcitol bind to and activate vit D receptor --> inhibition of keratinocyte proliferation, stimulation of keratinocyte differentiation; also inhibits T cell proliferation and inflamm

Question 221

Ustekinumab

Answer 221

monoclonal antibody that targets IL-12 and IL-23, inhibiting differentiation and activation of CD4+ Th1 and Th17 cells tx of psoriasis

Question 222

Kallmann syndrome

Answer 222

decreased synth of GnRH in HT + anosmia hypogonadotropic hypogonadism (rare in females - primary amenorrhea, no 2ary sexual char, olfaction deficit)

Question 223

embyronic vs fetal hgb

Answer 223

embryonic/Gower: 2 zeta, 2 epsilon fetal: 2 alpha, 2 gamma so fetal can make up for beta thal in late gestation and early postnatal life, when have lots of HbF; only when gamma chain production starts to wane does infant become symptomatic vs. HbA2 = 2 alpha, 2 delta (very low levels)

Question 224

Hypoglycemia with high insulin, low C-peptide Hypoglycemia with high insulin and C-peptide

Answer 224

high insulin, low C-peptide = exogenous insulin abuse both high = excess endogenous insulin due to sulfonylurea use or insulinoma

Question 225

somatostatin

Answer 225

inhibits release of insulin, gastrin, secretin, HCl in stomach, CCK (stimulates gastric motility)

Question 226

Before starting TNFalpha inhibitor, test for ____

Answer 226

TB TNF-alpha is necessary for CMI, especially for sequestration of mycobacteria in granulomas, so treating with inhibitor can --> reactivation (and increased susceptibility tofungi and other mycobacteria) TNFalpha inhibitors: infliximab, adalimumab [antibodies to TNF-alpha], etanercept (decoy receptor for TNF-alpha)

Question 227

Baseline and f/u: opthalmologic exams with ____ echo with ____ PFTs with ____ FOBT with ____

Answer 227

eye: hydroxychloroquine (retinal damage can occur with long-term use) heart: anthracyclines (eg doxorubicin) lung: amiodarone, methotrexate (lung + liver) GI bleed: NSAIDs

Question 228

Recurrent hemarthroses = Petechiae and ecchymoses = DVT, cerebral vein thrombosis, and recurrent pregnancy loss =

Answer 228

hemarthroses = hemophilia petechiae/bruising = plt problem DVT and other thrombotic stuff = FActor V leiden

Question 229

Polymyalgia rheumatica vs fibromyalgia

Answer 229

PR: pain and stiffness in shoulders and hips, often with fever, malaise, weight loss; age >=50yo; evidence of inflamm (increased ESR, CRP) Fibromyalgia: chronic, widespread stiffness, paresthesias, fatigue; often associated with neuropsych disturbances; no evidence of inflamm

Question 230

Coronary artery that supplies AV node

Answer 230

AV nodal branch off of PDA (usually arises from right coronary artery, except in left dominant people - 10% of pop)

Question 231

Supplies lateral/posterior walls of LV and anterolateral papillary muscle vs. posterior interventricular septum, posterior ventricles, posteromedial papillary muscle, AV node

Answer 231

left circumflex coronary artery = lateral/posterior LV PDA = posterior interventricular septum + posterior ventricles and AV node

Question 232

coronary artery that supplies anterior interventricular septum, anterolateral papillary muscle, anterior surface of LV

Answer 232

LAD - most commonly occluded in CAD aka the anterior interventricular artery

Question 233

coronary artery that supplies the SA node branches off the ?

Answer 233

right coronary (atrial branch) vs marginal branch supplies RV

Question 234

B12 CNS/PNS degeneration sites

Answer 234

dorsal columns lateral corticospinal tracts (so get UMN signs) axonal degeneration of peripheral nn (numbness/paresthesias) subacute COMBINED neurodegen

Question 235

Polio primarily affects the ___ of the spinal cord

Answer 235

anterior horns

Question 236

ovary torsion around ____ cuts off its blood supply

Answer 236

ovarian artery, vein, and nerve pleus run in infundibulopelvic ligament (aka suspensory ligament of the ovary) connects ovaries to lateral pelvic wall

Question 237

___ ligament connects the uterus to the pelvic walls bilaterally

Answer 237

broad ligament (peritoneal tissue mesosalpinx = part of it that connects fallopian tubes to pelvic wall mesometrium = part that connects uterus to pelvic walls mesovarium = part that connects ovary to lateral pelvic wall

Question 238

connects ovary to uterus

Answer 238

ovarian ligament

Question 239

ligament that maintains uterine anteflexion

Answer 239

round ligament (runs from lower uterus through inguinal ring to labia majora)

Question 240

lichen sclerosus

Answer 240

patchy, whitish thinning of the skin

Question 241

Serotonin is made in the _____ ACh is made in the ______ NE is made in the _______ DA is made in the _______

Answer 241

serotonin = raphe (midbrain, pons, medulla) ACh = nucleus basalis of meynert

Question 242

fast-acting insulins

Answer 242

aspart, glulisine, lispro used for postprandial glucose control, given subQ an dpeak within 45-75min

Question 243

give ____ insulin via IV in DKA

Answer 243

regular insulin (don't want to do subQ b/c pts are dehydrated, and IV regular insulin onsets as quickly as IV aspart, glulisine, and lispro, all of which are more expensive)

Question 244

Central vs. peripheral chemreceptors

Answer 244

Central = in medulla and sense increased PCO2 (not H+, which can't cross BBB); O2 has relatively small effect if PaO2 >70 (so only contributes significantly to resp drive in COPD pts with decreased sensitivity to PaCO2 and way decreased PaO2) Peripheral (aortic and carotid bodies) sense decreased O2, increased CO2, and increased H+

Question 245

Sx of beta blocker overdose

Answer 245

hypoglycemia (if nonspecific), bronchospasm, bradycardia

Question 246

sx of digoxin overdose

Answer 246

screwed up color vision, hyperkalemia (though hypokalemia increases risk of toxicity by facilitating Na/K blocking effects of digoxin), arrhythmia, n/v, abdominal pain, confusion etc

Question 247

Where does alanine come from and what does it do?

Answer 247

main fxn = transport nitrogen to liver for disposal 1. glutamine utilization in tissues --> alanine --> circulation 2. cahill cycle: skeletal muscle protein breakdown puts excess nitrogen in alanine, so that it can be transported to liver; N is added to pyruvate, making alanine (and that N comes off of glutamate, turning it into alpha ketoglutarate) - this is reversed in the liver, so alanine gives its N to alpha-ketoglutarate, forming glutamate; NH3 pulled off glutamate, regenerating alpha-keto and that NH3 enters the urea cycle in teh liver --> urea that can be excreted in the urine

Question 248

most common source of nosebleed (esp in kids)

Answer 248

anterior - most in anterior vascular watershed area of nasal septum known as kiesselbach's plexus (septum is highly vascular and that plexus has 3 anastamoses)

Question 249

immediate effect of ACEi that subsequently resolves?

Answer 249

GFR decreases b/c efferent arteriole can't constrict normalizes with time, and Cr will come back down; benefits outweigh risks unless Cr rises by >30%

Question 250

anterior 2/3 of posterior limb of IC is mostly ___ fibers posterior 1/3 of posterior limb is mostly ____ fibers

Answer 250

anterior = motor (from corticospinal, corticobulbar, corticopontine) posterior = sensory (from thalamocortical) so most IC lesions = pure motor or mixed

Question 251

lacunes

Answer 251

small cavitary infarcts in the BG, posterior limb of the IC, pons, and CBL from occlusion of small penetrating arteries (lenticulostriate), usu with chronic htn or DM

Question 252

primary cause of lacunary infarcts?

Answer 252

lipohyalinosis - plasma proteins leak through endothelium damaged by htn etc --> sclerosis, hyaline thickening of wall from collagen deposn, and accum of foamy macrophages microatheromas - accum of lipid-laden macrophages in intima of vessel where it branches off parent vessel together --> small vessel occlusion vs. embolisms usually cause cortical infarcts

Question 253

PCWP is an indirect measure of...

Answer 253

LA pressure

Question 254

Osteogenesis imperfecta - defect and mode of inheritance?

Answer 254

defect in type I collagen - bones have no flexibility, prone to fracture usually autosomal dominant

Question 255

mechanism of action of fibrates vs niacin

Answer 255

fibrates activate ppar-alpha, which activates LPL (breaking down TGs) and decreases VLDL production NB - fish oil supplements with lots of omega 3's also lower TGs by decreasing production of VLDLs and Apolipoprotein B (on VLDLs) Niacin - decreased hormone-sensitive lipase --> less free FA pulled off circulating chylomicrons --> less VLDL made; also decreases ApoA1 clearance --> increased HDL

Question 256

most common sites of nonocclusive ischemia in the colon

Answer 256

splenic flexure and rectosigmoid junction (esp in hypotensive state, eg during surgery, or with underlying arterial insufficiency) complications of ischemia = acidosis, sepsis, gangrene, perf; see pale mucosa and petechial hemorrhages on colonoscopy

Question 257

Three types of groin hernias

Answer 257

1. indirect inguinal - male infants, goes through deep inguinal ring, lateral to inferior epigastric vessels 2. direct inguinal - older men, goes through hesselbach's triantle, medial to inferior epigastric vessels 3. femoral - women, through femoral ring, inferior to inguinal ligament (medial to femoral artery and vein); prone to incarceration

Question 258

Coffee ground emesis

Answer 258

blood in vomit where heme iron is oxidized b/c it's exposed to gastric acid - sign of peptic ulcer

Question 259

Differences in presentation between PSGN and IgA nephropathy

Answer 259

PSGN: no recurrence, 1-3 weeks after strep pharyngitis IgA: also after mucosal infection (esp URI); hematuria for several days starting within 5 days of infxn, frequent recurrence every few months or with next infxn

Question 260

stain that gives dense black reaction?

Answer 260

osmium tetroxide - stains fat

Question 261

Humoral vs Cellular mediated acute rejection - histo

Answer 261

humoral: neutrophil infiltrate, necrotizing vasculitis, complement activation cellular: lymphocytic infiltrate, endothelitis

Question 262

"salt and pepper" chromatin

Answer 262

carcinoid tumors

Question 263

Treatment of peripheral artery disease

Answer 263

sx management: cilostazol/dipyridamole (PDE inhibitor to increase cAMP --> vasodil and decreased plt aggregation to relieve claudication sx) antiplt agent (aspirin, clopidogrel etc) to prevent coronary heart dz and stroke

Question 264

central line is placed where?

Answer 264

venous system and advanced into SVC for rapid infusion of fluids

Question 265

Treatment of pregnancy-related VTE

Answer 265

LMWH (best balance of risks and benefits to mom and fetus - easily reversed at delivery, good F, doesn't cross placenta) eg dalteparin, enoxaparin

Question 266

Treatment of pregnancy-related VTE

Answer 266

LMWH (best balance of risks and benefits to mom and fetus - easily reversed at delivery, good F, doesn't cross placenta) eg dalteparin, enoxaparin

Question 267

pralidoxime

Answer 267

"regenerates" AChE, so reverses effects of mACh and nACh overstimulation (eg with organophosphate poisoning) vs. atropine etc is a mAChR blocker, so only reverses effect of poisoning at mACh receptors

Question 268

SD vs SEM

Answer 268

SD = spread of individual values in given population; indication of how far the individual mean is from the sample mean SEM = SD/(n^1/2) to estimate true mean of underlying, whole population; indication of how far the sample mean is from the population mean

Question 269

Treacher-Collins syndrome

Answer 269

abnormal development of first and second pharyngeal arches -->craniofacial abnormalities (mandibular, maxillary, zygomatic bone hypoplasia that can --> airway compromise and feeding difficulty), absent/abnormal ossicles (conductive hearing loss)

Question 270

scrofula

Answer 270

cervical lymphadenitis in kids caused by mycobacterium scrofulaceum in/around environmental water sources

Question 271

Common variable immunodeficiency

Answer 271

defieciency of B and T cells --> hypogammaglobulinemia - many causes, usually becomes symptomatic in older kids/adults CMI isn't as affected as in SCID, don't see thymic aplasia

Question 272

Bupropion is contraindicated in ___-

Answer 272

pts with seizure disorders or eating disorders (lowers seizure threshold, esp bad if already have some kind of electrolyte imbalance) but pts like it because less likely to cause weight gain or sexual dysfxn than other depression treatments (eg SSRIs)

Question 273

most common cause of spontaneous lobar/cortical hemorrhage in the elderly?

Answer 273

cerebral amyloid angiopathy

Question 274

Charcot-Bouchard aneurysm rupture?

Answer 274

chronic htn = cause --> hemorrhagic cortical stroke of deep brain structures CT: hyperdense focus

Question 275

neprilysin

Answer 275

MMP that inactivates endogenous peptides (BNP, ANP, glucagon, oxytocin, bradykinin etc) inhibit it to increase levels of endogenous natriuretic peptides to treat HF

Question 276

Osgood-Schlatter disease

Answer 276

overuse injury of secondary ossification center of tibial tubercle, usually in adolescent after growth spurt and repetitive contraction of quads --> patellar tendon separates from tibial tubercle --> healing causes patella to become elevated and prominent

Question 277

pes anserinus bursitis

Answer 277

common injury in runners, causes anteromedial knee pain pes anserinus = where sartorius inserts on anteromedial tibia shaft

Question 278

Iron absorption occurs in _____

Answer 278

duodenum and proximal jejunum also B12 and folate

Question 279

vitamin C is abosrbed in the _____

Answer 279

distal small bowel (ileum) via active transport

Question 280

B6 absorption occurs in the ____-

Answer 280

jejunum and ileum

Question 281

B5 and B7 absorption occurs in the _____

Answer 281

small and large intestine via sodium-dependent multivitamin transporter, so deficiency with resection is rare

Question 282

Stomach ulcer vs erosion

Answer 282

erosion is confined to mucosa (doesn't go through muscularis mucosa) - usually due to acute, severe mucosal injury (eg burn, surgery, NSAIDs, smoking, alcohol) - can still cause upper GI hemorrhage and melena; usually pain, n/v that subside after withdrawing offending agent ulcer goes through mucosa into submucosa

Question 283

urticaria vs. angioedema - location of inflamm/edema

Answer 283

urticaria = superficial dermis edema and inflamm (with normal epidermis) angioedema = deep dermis edema and inflamm

Question 284

acantholysis

Answer 284

loss of cohesion between keratinocytes in the epidermis found in pemphigus

Question 285

nonbacterial thrombotic endocarditis is most commonly associated with _____

Answer 285

advanced malignancy, chronic inflamm disorders (eg APLS, SLE), and DIC usually asymptomatic, but thrombi = easier to dislodge than in IE --> infarction

Question 286

Most laryngeal muscles are innervated by the ____

Answer 286

recurrent laryngeal nerve (mm = cricoarytenoids, arytenoids, tyroarytenoids)

Question 287

Nerve at risk of injury during thyroidectomy?

Answer 287

external branch of superior laryngeal - runs with superior thyroid artery and vein, and innervates the cricothyroid muscle, so injuring it can --> hoarseness

Question 288

Barbiturates vs benzos - mechanism?

Answer 288

Barbiturates prolong Cl channel opening in response to GABA; at high conc, act as GABA receptor agonists Benzos --> increased frequency of Cl channel opening so both bind allosterically to GABA receptor and modulate effect of GABA on it

Question 289

GABA-A vs GABA-B receptors and drugs that modify each?

Answer 289

A = Cl- channels, modulated by benzos and barbs B = GPCRs on skeletal muscle, modulated by baclofen (muscle relaxant)

Question 290

theophylline - mech and use?

Answer 290

mech: adenosine antagonist and indirect adrenergic agent used for bronchodilation (increases intracellular cAMP), anti-inflamm, in asthma and COPD affected by P450 inhibitors and inducers

Question 291

treatment of drug-induced parkinsonism

Answer 291

centrally-acting antimuscarinic agent (eg benztropine, trihyxyphenidyl) levodopa, but not in psychosis! can induce psychosis

Question 292

Treatment for extrapyramidal symptoms of antipsychotics

Answer 292

dystonia from DA-cholinergic balance, so use M1 antagonists (eg benztropine or diphenhydramine)

Question 293

most common site of blunt aortic trauma (traumatic rupture)

Answer 293

aortic isthmus (where ligamentum arteriosum connects the aorta and the pulmonary trunk, making the aort relatively fixed and immobile there)

Question 294

route of spermatic cord

Answer 294

goes through deep inguinal ring (opening in transveralis fascia, which thus becomes internal spermatic fascia) --> through inguinal canal --> through suyperficial inguinal ring (formed by opening in external oblique muscel aponeurosis, which thus forms the external spermatic fascia) **cremasteric muscle (between internal spermatic fascia and external spermatic fascia) arises from internal oblique muscle

Question 295

Benzos should not be used with what other drugs? Indications for long-acting benzos?

Answer 295

Indications: GAD, insomnia, anticonvulsant in SE, muscle relaxant with UMN lesion Don't use with other drugs that can cause CNS depression/sedation: alcohol, barbs, neuroleptics, 1st gen antihistamines

Question 296

Promethazine, hydroxyzine, chlorpheniramine - drug type?

Answer 296

first-gen antihistamines often used to prevent/treat allergic rxns, motion sickness, anti-emetics despite sedation ae vs. loratadine = second-gen antihistamine (H1) - no CNS effects b/c doesn't cross BBB

Question 297

Live vaccines? Toxoid-based vaccines?

Answer 297

Live = zoster, varicella, yellow fever, BCG, typhoid Toxoids = Tdap (useful for dzs where toxin is the main cause of dz morbidity and mortality)

Question 298

Docosanol

Answer 298

topical agent that prevents viral entry and is used in herpes labialis (usually type 1)

Question 299

why is acyclovir only effective against viral (not host) cells?

Answer 299

- uptake into host cells is poor - has to be phosphorylated by viral thymidine kinase - host cell DNA pol has lower affinity for acyclovir than viral DNA pol

Question 300

bugs that can cause cellulitis related to freshwater or seawater exposure?

Answer 300

Vibrio vulnificans, Aeromonas (both bacteria)

Question 301

Vitamin E deficiency sx

Answer 301

hemolytic anemia and neuro abnormalities (eg ataxia)

Question 302

Parasites capable of autoinfxn?

Answer 302

strongyloides stool: rhab. larvae (noninfxs form) intestine: eggs + adults lungs: filariform (infxs) autoinfxn --> hyperinfxn, esp in those with compromised Th2 immunity --> multiorgan dysfxn and septic shock

Question 303

Detection of parasite eggs in stool is used to diag ___?

Answer 303

schistosoma

Question 304

Detect proglottids in the stool with ____?

Answer 304

intestinal tapeworms (eg taenia, diphyllobothrium)

Question 305

trophozoites and cysts in stool = used to diagnose ___?

Answer 305

intestinal protozoal infxns (giardia, entamoeba)

Question 306

C3 vs C4 in PSGN

Answer 306

Decreased C3 (alternative pathway activation); normal (or slightly decreased) C4 (classical pathway) IC deposition --> alternative pathway activation (not ag-Ig-mediated) vs in SLE, both C3 and C4 are down (activation of both classical and alternative pathways)

Question 307

Deficiency in aldolase B causes... vs. aldose reductase fxn?

Answer 307

fructose intolerance aldose reductase converts galactose to galactitol

Question 308

enzymes involved in galactose metabolism

Answer 308

galactokinase (deficiency = mild) then galactose 1phosphate uridyl transferase (GALT - causes classic galactosemia; very severe); get similar sx with much rarer deficiency in udp galactose-4-epimerase, which converts udp galactose to udp glucose, thus allowing galactose-1-p to be converted to glucose-1-p and enter glycolysis

Question 309

beta-2 microglobulin

Answer 309

little protein associated with MHC1 (non-transmembrane component) vs. invariant chain is associated with MHC2 and is lost when MHC2 finds antigen in phagolysosome, allowing complex to move to cell membrane

Question 310

germ tube test

Answer 310

candida test - grow out candida albicans on serum at body temp and it forms true hyphae from yeast (germ tubes) look like circles with long bits coming off them

Question 311

major basic protein

Answer 311

found in eosinophil granules, defends against parasites

Question 312

tartrate resistant acid phosphatase

Answer 312

hairy cell leukemia cell marker (B lymphocyte precursors)

Question 313

Auer rods stain positively for ___ and are found in ____

Answer 313

stain for myeloperoxidase indicate myeloid differentiation, seen in AML

Question 314

Fidaxomicin

Answer 314

related to macrolides oral drug, bacteriocidal, minimal systemic abs, and narrow spectrum so doesn't wipe out normal colonic flora as much as vanc or metronidazole, making it good for RECURRENT C DIFF (decreases recurrence rates than with vanc) vs use metronidazole for initial treatment of c diff or first recurrence and use oral vanc for severe initial or recurrent c diff

Question 315

skeletal system mets get there how?

Answer 315

hematogenous spread vertebral venous plexus is connected to lots of local venous plexuses and runs stragiht into venous supply of the brain

Question 316

neuroleptic malignant syndrome vs. serotonin syndrome

Answer 316

both: mental status changes, hyperthermia, autonomic instability NMS: diffuse rigidity and bradyreflexia; tx = direct muscle relaxant (dantrolene) serotonin synd: neuromusc hyperactivity (hyperreflxia, clonus), n/v/d; tx = serotonin antag (cyproheptadine)

Question 317

treatment of delirium

Answer 317

primary: treat underlying cause for acute treatment of agitation and psychosis associated with delirium: high-potency first-gen antipsychotics (eg haloperidos) DON'T USE BENZOS! can worsen confusion

Question 318

Fast acetylators of isoniazid also acetylate ____ quickly

Answer 318

dapsone, hydralazine, and procainamide --> need higher doses

Question 319

fever + tinnitus + tachypnea

Answer 319

suspect aspirin intoxication mixed resp alk + metabolic acidosis

Question 320

sequence of reproductive system development

Answer 320

1. gonadal (testes vs ovaries) 2. genital duct 3. external genitalia

Question 321

Infarct types from small vs. large PEs

Answer 321

small: go into peripheral branches of pulm artery and produce wedge-shaped infarct big: wedge in pulmonary artery bifurcation (saddle emboli) dual blood supply to lungs --> hemorrhagic infarcts (red) - bronchial blood hemorhagges into area infarcted by pulmonary arteries

Question 322

22q11 deletion - two syndromes

Answer 322

Di George - thymus, parathyroid (and hypoCa), and cardiac defects (ToF, interrupted aortic arch etc) Velocardiofacial syndrome - cleft palate, cardiac anomalies, dysmorphic facies (orbital hypertelorism, short palpebral fissures and philtrum, cleft palate, bifid uvula) mut = chromosomal microdeletion (see it with FISH)

Question 323

Liver synthetic fxn abnormal in acute hepatic failure

Answer 323

coagulation (b/c factor 7 has short t1/2, vs albumin has long t1/2)

Question 324

Effect of PPIs on serum Ca

Answer 324

decrease Ca and Mg abs --> increased risk of osteoporosis

Question 325

escitalopram

Answer 325

SSRI

Question 326

Factitious vs malingering vs conversion disorders

Answer 326

Factitious = intentional falsification or inducement of sx with goal of assuming SICK ROLE; no conscious awareness of why they're doing it malingering = falsification or exaggeration of sx to obtain EXTERNAL INCENTIVES conversion disorder = neuro sx incompatible with any known neuro dz; often onset with acute stress (genuine sx, no effort to deceive)

Question 327

Chronic renal vs pulm rejection

Answer 327

kidney: vascular damage lung: bronchiole damage - bronchiolitis obliterans, (vs acute rejection = CD8 T cell-mediated damage of vessels)

Question 328

marker for OB activity? OC activity?

Answer 328

OB: alk phos (distinguish from liver alk phos by electrophoresis, specific monoclonal Ig, and heat denaturation) OCs: urinary deoxypyridinoline (released into circ when collagen cross links are broken) and hydroxyproline (also collagen breakdown product, but not as specific b/c found in lots of meat products)

Question 329

chronic mesenteric ischemia

Answer 329

similar to exertional angina - atherosclerotic decrease in bloodflow to GI tract only presents as problem within an hour after meals when more blood is needed for digestion/absorption

Question 330

Medicare covers ?

Answer 330

pts > 65yo who are US citizens, residents, and have paid into system (taxes) also younger pts with disabilities, ESRD, and ALS vs. pregnant women and babies = covered by medicaid

Question 331

First line tx of essential htn and AEs

Answer 331

thiazide diuretics AEs: elevation of glucose, uric acid, and calcium, so don't use in DIABETICS, GOUT, OR HYPERCA

Question 332

cricothyrotomy goes through:

Answer 332

skin, superficial cervical fascia (subQ fat and platysma), investing and pretracheal layers of deep cervical fascia, and cricothyroid membrane

Question 333

Most common cause of viral gastroenteritis?

Answer 333

norovirus vs adenovirus is less common; more commonly causes pharyngoconjunctivitis and coryza vs. rotavirus was more common, esp in kids, but has decreased due to childhood vax

Question 334

Blunt trauma to the eye is most likely to cause herniation where?

Answer 334

through medial (ethmoid and lacrimal bones) and inferior (orbital floor) walls of orbit (weakest) into the MAXILLARY SINUS these = ORBITAL BLOWOUT FRACTURES if go through orbital floor, likely to damage infraorbital nerve (part of maxillary nerve that innervates upper cheek, upper lip, and upper gums --> lack of sensation there), may also entrap inferior rectus (can't look up) and get enophthalmos

Question 335

Mitral regurg is best heard at the _____ Tricuspid regurg is best heard at the _____ Aortic stenosis is best heard at the ______

Answer 335

MR = apex, radiates to axilla; best heard in LLD and decreases with insp TR = left 2nd and 3rd intercostal spaces, increases with insp AS = right 2nd interspace, radiates to carotids

Question 336

disorganized lamellar bone in mosaic pattern

Answer 336

Paget disease normal serum Ca, P, and PTH

Question 337

osteoid matrix accumulation around trabeculae

Answer 337

vitamin D deficiency (excess unmineralized osteoid)

Question 338

spongiosa filling medullary canals with no mature trabeculae

Answer 338

osteopetrosis (marble bone disease) - decreased OC bone resorption so accum of woven bone and skeletal thickening

Question 339

trabecular thinning with fewer interconnections

Answer 339

osteoporosis

Question 340

subperiosteal thinning of cortical (compact - outer layer) bone in appendicular skeleton (pelvic girdle, pectoral girdle, limbs) with osteolytic cysts in long bones

Answer 340

primary hyperparathyroidism unlike in osteoporosis, trabecular architecture of cortical bone is relatively preserved despite thinning

Question 341

Common cancer cell mech of resistance to chemo drugs, and drugs that inhibit it?

Answer 341

MDR1 gene --> P-glycoprotein (transmembrane protein that functions as ATP-dependent efflux pump, pumping out the drugs) - verapamil, diltiazem, ketoconazole reduce action of MDR pump

Question 342

Serotonin syndrome sx

Answer 342

autonomic instability (hyperthermia, htn, tachycardia) AMS (agitation, confusion) neuromuscular hyperactivity (tremor, hyperreflexia, myoclonus etc) GI sx diaphoresis very similar to sx of neuroleptic malignant syndrome

Question 343

Pre-op prophylactic antibiotic choice?

Answer 343

cephalosporin (good for normal skin flora, esp staph epidermidis and staph aureus)

Question 344

Sx of organophosphate poisoning

Answer 344

depolarizing blockade of NMJ (muscle weakness, fasciculations, paralysis) CNS effects (lethargy, seizures) muscarinic overstim (miosis, bradycardia, increased lacrimation and salivation)

Question 345

Hox genes encode ___?

Answer 345

transcription factors that regulate which parts of DNA are expressed where (resp for segmental organization of embryo)

Question 346

akathisia: definition + tx?

Answer 346

subjective restlessness with inability to sit still side effect of antipsychotics, usu starts days-weeks after starting drug tx: decrease antipsychotic dose or treat with beta blocker or benzo vs tardive dyskinesia = involuntary movements (eg lip smacking) with chronic use

Question 347

Symptoms of serum sickness drug hypersensitivity

Answer 347

fever, urticaria, arthralgias, proteinuria, LAD

Question 348

meng CSF findings: bacterial vs viral

Answer 348

bacterial: low glucose, high protein, PMNs viral: normal glucose, high protein, lymphocytes

Question 349

Causes of orchitis

Answer 349

Mumps - young adults/adolescents: chlamydia and gonorrhea - older adults: E Coli

Question 350

Treatment of postherpetic neuralgia

Answer 350

first-line: TCAs (decrease reuptake of ser and NE and thus inhibit pain signals), anticonvulsants (eg gabapentin - decrease CNS depolarization) nonsystemic options: topical capsaicin (loss of membrane potential in nociceptive fibers due to buildup of intracellular ca + release and then depletion of substance P), topical lidocaine (decreased depol of peripheral nn)

Question 351

neuropeptide Y

Answer 351

NT in CNS and ANS thought to play role in appetite and pain perception

Question 352

endorphins vs. dynorphins

Answer 352

endorphins act on mu opioid receptors dynorphins act on k opioid receptors

Question 353

Roth spots

Answer 353

edematous, hemorrhagic lesions of the retina; immuno from IC deposition in vv, usually in IE

Question 354

Long-term treatment of panic disorder

Answer 354

SSRIs and SNRIs vs. acute: benzos

Question 355

Angiogenesis is driven by what 2 substances?

Answer 355

VEGF (increase endothelial cell motility and prolif) FGF (endothelial cell proliferation, migration, and differentiation; also contribute to embryonic dev, hematopoiesis,a nd wound repair) vs. Epidermal growth factor has mitogenic influence on epith cells, hepatocytes, and fibroblasts; not as important in angiogen

Question 356

Barrier to angiogenesis in BM

Answer 356

laminin

Question 357

Concentric vs eccentric cardiac hypertrophy

Answer 357

concentric = pressure overload (eg HTN) eccentric = volume overload (eg aortic regurg, chronic HF)

Question 358

Throwing injury - which muscle?

Answer 358

lat (thoracodorsal nerve, used for extension, adduction, and internal rotation of humerus) injured by external trauma and anything that requires forceful downward movement of humerus (eg throwing, serving a tennis ball, climbing)

Question 359

whiplash typically injures which muscle?

Answer 359

trapezius fxn = elevation, rotation, and stabilization of scapula (innervated by CN11)

Question 360

pathogens most often responsible for secondary bacterial pna

Answer 360

1. strep pneumo 2. staph aureus 3. h. flu

Question 361

Drugs that improve long-term survival in chronic HF pts

Answer 361

BETA BLOCKERS (decrease cardiac work by slowing HR, also decrease circulating levels of vasocon hormones) also ACE-i, ARBs, aldo antagonists (spironolactone, eplerenone)

Question 362

Ligamenta flava

Answer 362

paired elastic ligaments that connect the vertebral laminae and form the posterior wall of the spinal canal

Question 363

erector spinae

Answer 363

large muscel group of the back that course longitudinally along the spinous processes (superficial back)

Question 364

Part of the spine involved in RA?

Answer 364

Cervical (may get subluxation, cord compression) hips and lumbosacral joints usually = spared vs lumbar spine = affected in OA and sacroiliac joints = affected in seroneg spondyloarthropathies

Question 365

Difference in sx between SAH and intracerebral hemorrhage

Answer 365

SAH - no focal neuro deficits! intracerebral: focal neuro deficits (hemiplegia, hemianesthesia, CN deficits, aphasia etc)

Question 366

Decorticate vs decerebrate posturing

Answer 366

Decorticate: high lesion (eg in cerebral hemispheres) above red nucleus --> decreased inhibition of rubrospinal tract --> excessive flexing of UE Decerebrate: lesion below the red nucleus --> no excitation of UE flexors, so extensors of vestibulospinal tract predominate vs. cervical spinal cord damage --> spinal shock (flaccid paralysis)

Question 367

sx of dorsal midbrain damage

Answer 367

vertical gaze palsy, pupils accommodate but don't respond to light (light-near dissociation) due to proximity of superior colliculus

Question 368

Nerve roots in the lumbosacral spine exit ____ their corresponding vertebral body level (below/above)?

Answer 368

below (eg L5-S1 foraminal stenosis will cause L5 problems)

Question 369

Causes of hyperacusis

Answer 369

facial nerve damage (stapedius branch innervates stapedius muscle, which stabilizes the stapes; mandibular branch of V3 innervates the tensor tympani, which contracts the TM medially to dampen sound transmission)

Question 370

exudation and alveolar hepatization happen in ____

Answer 370

pna, mostly Strep pneumo (red hepatization first when PMNs and RBCs accumulate in alv spaces, then gray hepatization when RBCs start to degrade)

Question 371

obliterative lower airway inflammation happens in ____

Answer 371

cryptogenic organizing pneumonia (inflamm causes granulation tissue proliferation --> obstruction of small airways and consolidation of airways) idiopathic, resolves with steroids

Question 372

topoisomerase I vs II

Answer 372

topo I - makes ss nicks to relieve negative supercoiling topo II - makes breaks in both DNA strands to relieve both positive and negative supercoiling irinotecan and topotecan inhibit topoI etoposide and podophyllin inhibit topoII by prevent it from resealing its nicks

Question 373

fxn of leukotrienes C4, D4, E4 vs fxn of leukotriene B4 and 5-HETE (precursor to leukotrienes)

Answer 373

C,D,E = bronchospasm and vasodilation B and HETE = PMN recruitment to site of inflamm

Question 374

Collagen is made up primarily of which AA?

Answer 374

GLYCINE (every third aa position is glycine) - smallest AA and only one that can fit in small space between the alpha chain cross-links = thanks to hydroxylysine alpha helix = thanks to proline

Question 375

thyroid peroxidase functions

Answer 375

1. catalyze oxidation of iodide into I2 2. catalyze iodination of thyroglobulin to form DIT and MIT 3. catalyze coupling reaction between 2 iodized tyrosine residues to form T3 or T4 Ig against this enzyme = present in autoimmune/hashimoto's thyroiditis

Question 376

iodotyrosine deiodinase vs iodothyronine deiodinase

Answer 376

iodotyrosine: removes I from unpaired DIT and MIT to be recycled inside thyroid follicular cells (ie DIT, MIT, T3 and T4 are made in lumen, reabsorbed, T3 and T4 are secreted, and I is pulled off of DIT and MIT to restart the cycle and make more T3 and T4) iodothyronine: pulls an I off of T4 in the periphery to make more potent T3

Question 377

Arcuate scotoma

Answer 377

damage to particular region of optic nerve head --> visual field defect that follows arcuate shape of nerve fiber pattern

Question 378

where is the area postrema and what does it do?

Answer 378

where: dorsal surface of medulla, at bottom of fourth ventricle what: no BBB, so samples chemicals in blood (chemoreceptor trigger zone) --> nausea and vomiting

Question 379

G6PD deficiency - mode of inheritance?

Answer 379

X-linked recessive

Question 380

vitamin D-resistant rickets - inheritance pattern?

Answer 380

x-linked dominant

Question 381

how to work up metabolic alk cause?

Answer 381

check volume status and measure urine Cl (low with vomiting/NG aspiration or past diuretic use; high with current diuretic use, bartter, gitelman, or excess mineralocorticoids [eg cushing, conn])

Question 382

how do you get damage to facial nerve via face trauma?

Answer 382

lateral head trauma (fracture of temporal bone) or zygomatic orbit fracture

Question 383

sx of basilar skull fracture?

Answer 383

hematomas over mastoid process (behind ear) + otorrhea (CSF out of ear) + periorbital ecchymosis

Question 384

What kind of GI ulcer is not itself a risk for cancer?

Answer 384

duodenal - may indicate H pylori infxn, which raises risk of cancer, but ulcer itself is rarely malignant and doesn't require biopsy vs. have to biopsy esophageal, gastric, and CRC, which frequently present as ulcerative lesions

Question 385

U/A findings with rhabdo

Answer 385

myoglobinuria --> positive urine dipstick for blood without RBCs

Question 386

Cholesterol lowering agent that increases TGs

Answer 386

bile acid-binding resins (increase hepatic production of TGs and release of VLDL particles from the liver, which contain lots of TGs)

Question 387

when does beta-hCG appear in the urine, and where does it come from?

Answer 387

appears after 6-8 days after fertilization when blastocyst implants and its outer cell mass (trophoblast) differentiates into cyto and syncytio syncytio invades endometrium and starts making beta-hCG to stimulate the CL to continue making progesterone to keep the lining nice and thick vs. urine preg test is less sensitive than serum; can detect beta-hCG only when it's > 20IU/L (around 14 days after fertilization)

Question 388

Asparaginase - what's it used for?

Answer 388

chemo drug - decrease conversion of aspartate to asparagine, which is used up so quickly by tumor cells that they can't produce it fast enough on their own, so have to use asparagine synthase to make more decreasing asparagine conc thus --> lysis of tumor cells

Question 389

paraneoplastic cerebellar degeneration - pathophys?

Answer 389

SCLC, breast, ovarian, and uterine ca - immune response against tumor cells, and those Ig (anti-Yo, anti-Hu, anti-P/Q) attack purkinje neurons --> dizziness, limb and trunk ataxia, dysarthria, visual disturbances

Question 390

uniform, diffuse capillary wall thickening on LM is a sign of ____

Answer 390

membranous nephropathy IF: granular deposits of IgG and C3 along GBM

Question 391

why do you get gallstones with malabs (eg Crohn)?

Answer 391

ileal inflamm or other cause of malabs --> decreased bile acid recycling, so less bile acid is present in bile made in liver --> increased chol: bile acid ratio increased ratio --> chol precipitates in bile of gallbladder and forms stones

Question 392

Drugs that cause sexual dysfxn

Answer 392

SSRIs, TCAs, and some anti-htns (eg thiazide diuretics, spironolactone, clonidine)

Question 393

Long-term use of pioglitazone may cause what adverse effect?

Answer 393

urinary bladder cancer

Question 394

Histo features of schwannoma

Answer 394

biphasic (dense areas with spindle cells that palisade (Antoni A) and loose, myxoid areas (Antoni B))

Question 395

S100

Answer 395

Neural crest marker Schwannomas and melanoma, also neuroblastomas (most common extracranial solid tumor in kids)

Question 396

Bonds in primary, secondary, and tertiary protein structure?

Answer 396

primary: peptide bonds secondary: H bonds (into alpha helix or beta pleated sheet) tertiary: ionic bonds, hydrophobic interactions, H bonds, disulfide bonds

Question 397

Bacteria with fibriae

Answer 397

Neisseria and E. Coli

Question 398

Bacteria that use hyaluronidase to invade tissue

Answer 398

staph, GAS, C diff

Question 399

Aneurysm arising from ____ will cause non-pupil-sparing third nerve palsy?

Answer 399

SCA or PCA (CN3 passes between them)

Question 400

Ototoxic agents

Answer 400

aminoglycosides, salicylates, cisplatin, loop diuretics (furosemide, torsemide, bumetanide)

Question 401

Drugs used to treat pseudomonas

Answer 401

ticarcillin and piperacillin, ceftazidime (3rd gen) and cefepime (4th gen), amikacin/gentamicin/tobramycin (aminoglycosides), cipro/levofloxacin (not moxi! used for lung infxns), aztreonam, impenem/meropenem

Question 402

How long do pts need to take RIPEs for active TB?

Answer 402

>= 6 months

Question 403

Direct thrombin inhibitors used for HIT vs DVT prevention/tx and stroke prevention in afib?

Answer 403

HIT: lepirudin, argatroban DVT prevention/tx and stroke prevention: dabigatran ("D" for Dvt)

Question 404

Symptoms of scurvy?

Answer 404

swollen gums, bruising, petechiae, hemarthrosis, anemia, poor wound healing, corkscrew hair due to defects in collagen (in blood vessel walls, skin etc)

Question 405

Organ susc to infarction, from greatest to least

Answer 405

CNS, myocardium, kidney, spleen, liver (not susc b/c of dual blood supply)

Question 406

Caudal regression syndrome - what is it, and with what maternal condition is it associated?

Answer 406

- rare condition in which baby is bortn with agenesis of sacrum +/- lumbar spine --> flaccid paralysis of legs, dorsiflexed feet, urinary incontinence (ranges in severity) - maternal association = uncontrolled DM

Question 407

Effect of cocaine abuse in mom on baby

Answer 407

cocaine --> vasocon, so denies baby of necessary blood --> IUgr, spontaneous abortion, placental abruption, prematurity

Question 408

Vitamin A overdose in preg --> ?

Answer 408

craniofacial abnormalities, posterior fossa defects, auditory defects, abnormalities of great vv similar to DiGeorge sx

Question 409

Benzos that don't depend on liver metabolism (use in pts with liver disease)

Answer 409

lorazepam, oxazepam, temazepam "LOT"

Question 410

Benzo used for short-term anxiety

Answer 410

lorazepam avoid long-term AEs (eg excessive daytime sleepiness)

Question 411

short-acting benzos

Answer 411

lorazepam, triazolam (liver-dependent metabolism)

Question 412

long-acting benzos

Answer 412

chlordiazepoxid, diazepam, flurazepam "beginning of the alphabet" vs short-acting start with letters at end of alphabet use these to treat alcohol withdrawal and prevent progression to seizures and delirium (preferred b/c they self taper, so smoother withdrawal - esp chlor and diaz - have active metabolites)

Question 413

intermediate-t1/2 benzos

Answer 413

alprazolam, clonazepam

Question 414

Characteristic histo/gross features of pilocytic astrocytoma vs medulloblastoma vs ependymomas

Answer 414

PA: CBL, brainstem, HT, or optic pathways; well-diff with SPINDLE cells with HAIR-LIKE GLIAL PROCESSES, MICROCYSTS, ROSENTHAL FIBERS Medulloblastoma: SMALL, BLUE CELLS, HOMER-WRIGHT ROSETTES, also in posterior fossa Ependymomas: PSEUDOROSETTES, GFAP+, blood vv both in kids

Question 415

Drugs that cause drug-induced lupus antibody present?

Answer 415

drugs metabolized by N-acetylation in the liver: ``` Procainamide Hydralazine Isoniazid MInocycline TNF-alpha inhibitors ``` especially in slow acetylators (increased concentration of drugs) **drug-induced SLE usually lacks cutaneous manifestations (eg rash), neuro or renal sx antibody = anti-histone

Question 416

Phase 1 rxn catalyzed by cytochrome P450?

Answer 416

oxidation

Question 417

Left vs. right-sided frontal lobe lesion sx

Answer 417

Left: apathy and depression Right: disinhibited behavior

Question 418

acute-onset, mid-chest pleuritic pain that improves on sitting up and leaning forward?

Answer 418

acute pericarditis, usually serofibrinous or fibrinous causes: MI, RF, uremia, viral infxn

Question 419

pericardial knock

Answer 419

early diastolic, high-freq precordial sound heard in chronic, constrictive pericarditis

Question 420

signs of chronic, constrictive pericarditis

Answer 420

Kussmaul's sign (anything that causes increased right heart pressure) pulsus paradoxus (again, anything that causes increased rh pressure, eg cor pulmonale, cardiac tamponade) pericardial knock

Question 421

acute-onset, mid-chest pleuritic pain that improves on sitting up and leaning forward?

Answer 421

acute pericarditis, usually serofibrinous or fibrinous causes: MI, RF, uremia, viral infxn

Question 422

pericardial knock

Answer 422

early diastolic, high-freq precordial sound heard in chronic, constrictive pericarditis

Question 423

signs of chronic, constrictive pericarditis

Answer 423

Kussmaul's sign (anything that causes increased right heart pressure) pulsus paradoxus (again, anything that causes increased rh pressure, eg cor pulmonale, cardiac tamponade) pericardial knock

Question 424

Ways to test executive function

Answer 424

Clock drawing

Question 425

Way to test concentration/attn

Answer 425

reciting months of year backwards, counting down from 100 by intervals of 3 or 7, spelling "world" backwards

Question 426

How to test STM

Answer 426

recalling 3 unrelated words after 5 min

Question 427

How to test comprehension

Answer 427

following multistep commands

Question 428

Cause of viral encephalitis with flaccid paralysis?

Answer 428

West nile virus

Question 429

Assessment of decision-making capacity - 4 key criteria

Answer 429

1. communicates a choice 2. understands info provided 3. appreciates consequences of choice 4. can give rationale for decision (can weigh risks/benefits) pts have right to refuse treatment based on principle of autonomy

Question 430

Cerebral perfusion pressure = ?

Answer 430

MAP - ICP

Question 431

Muscle that does arm abduction below the horizontal? Muscle that does shoulder abduction above the horizontal?

Answer 431

below horizontal = delt above horizontal = trap

Question 432

Spinal accessory nerve controls what muscles? how is it injured?

Answer 432

controls trap and SCM courses superficially through posterior triangle of neck, so easily injured, eg by ln dissection

Question 433

False aneurysm

Answer 433

rupture through all the walls of the vessel --> bleeding outside the vessel, with subsequent flap of connective tissue that walls off the hematoma and connects to vessel (so it just looks like bulge in the wall)

Question 434

how to decrease incidence of neonatal tetanus?

Answer 434

vaccinate moms with inactivated toxin so they will pass IgG to baby also hygienic cord care

Question 435

Causes of rectal prolapse

Answer 435

pregnancy, constipation, severe diarrhea, CF

Question 436

What initially prevents edema despite increased transudation from capillaries?

Answer 436

lymphatics - increased interstitial pressure --> increased lymphatic drainage; prevents edema until the lymphatics are overwhelmed

Question 437

What do mast cells release from their granules?

Answer 437

tryptase and histamine use serum tryptase levels as marker for anaphylaxis

Question 438

Muscle tissue IHC stain?

Answer 438

smooth muscle actin, caldesmon (calmodulin-binding protein - inhibits ATPase activity of myosin in smooth muscle), desmin (IF in sarcomeres)

Question 439

IHC markers for endothelium?

Answer 439

CD34, vWF

Question 440

Sx of lithium toxicity

Answer 440

acute: GI upset, then neuro chronic: gradual onset of neuromusc excitability, ataxia, confusion toxicity increased by anything that decreases glomerular filtration --> increased lithium reabs in PT

Question 441

Midline Episiotomy cuts through the ______ vs mediolateral episiotomy cuts through _____ muscle

Answer 441

midline: from posterior vaginal opening to perineal body, through the vaginal lining and submucosal tissue mediolateral: transverse perineal muscle improper repair --> pelvic organ prolapse, dyspareunia perineal body anchors bulbospong m (UG triangle), external anal sphincter, transverse perineal mm, external urethral sphincter, levator ani, and musc coat of rectum (anal triangle)

Question 442

Varicose veins - sx and mech

Answer 442

sx: dilated superficial veins and associated skin changes from stasis dermatitis (due to tissue ischemia) mech: increased pressure in veins --> dilation and incompetence of valves --> backflow and further increased pressure risk fx: obesity, preg (obstruction), sedentary lifestyle, prolonged standing, DVTs (damage valves)

Question 443

Kehr sign

Answer 443

referred pain to shoulder from peritoneal irritation (eg splenic laceration) via phrenic nerve innervation

Question 444

Dobutamine - when is it used?

Answer 444

refractory HF with severe LV systolic dysfxn, cardiogenic shock positive inotrope (increases cardiac contractility --> increased CO and decreased LV filling pressure), positive chronotrope (increased HR - can exacerbate MI, but benefits may outweigh risks), mild vasodilation (decreased systemic vascular resistance)

Question 445

IHC markers for mesenchymal tissue

Answer 445

vimentin (IF)

Question 446

IHC marker for neuroendocrine tumors

Answer 446

chromogranin A, neuron-specific enolase

Question 447

Myocardial hibernation

Answer 447

state of chronic myocardial ischemia --> reduction in myocardial metabolism and function to match decreased coronary blood flow; prevents myocardial necrosis, and fxn returns with reperfusions

Question 448

ischemic preconditioning

Answer 448

repeated, brief episodes of MI, followed by reperfusion, protect myocardium from subsequent prolonged ischemia (so more time to salvage the myocardium via revasc)

Question 449

McCune albright syndrome - triad of sx

Answer 449

cafe au lait spots, endocrine abnormalities (eg precocious puberty, hyperthyroid), fibrous dysplasia (bone lesions) mutation --> constitutive activation of GPCR/AC cascade, affecting many cells (eg autonomous endo fxn, melanocytes, fibroblasts, IL6, OCs)

Question 450

Legg-calve-perthes disease

Answer 450

young kids - isolated, idiopathic osteonecrosis of the hip

Question 451

Psoas sign

Answer 451

pain on passive extension of the hip (stretches the psoas) seen in psoas abscess (due to direct spread of infxn or from hematogenous/lymphatic seeding)

Question 452

Deficiency of ____ immune cells predisposes to superficial candida infxn. Deficiency of _____ immune cells predisposes to disseminated candidiasis

Answer 452

superficial: T lymphocytes (eg in HIV) disseminated: neutrophils (eg chemo)

Question 453

Bacitracin - mech of action?

Answer 453

prevents mucopeptide transfer into growing cell wall, so inhibits bacterial cell wall synthesis; effective in growing bacterial populations

Question 454

Cancers with propensity for bony mets

Answer 454

PB/KTL ("lead kettle"): prostate, breast, kidney, thyroid, lung

Question 455

Systemic mastocytosis - physio, mutation involved, and sx

Answer 455

clonal mast cell proliferation in the marrow, skin and other organs often associated with KIT receptor tyrosine kinase mutations sx = from release of histamine from mast cells degranulation (syncope, flushing, hypotn, pruritis, urticaria, gastric ulcers from increased stomach acid, diarrhea etc b/c stomach acid inactivates pancreatic and intestinal enzymes --> decreased abs)

Question 456

Contact precautions vs standard precautions vs. airborne precautions vs. droplet precautions

Answer 456

contact = gown and nonsterile gloves + handwashing with soap and water for cdiff standard = handwashing, gown and gloves as needed (eg body fluids), proper disposal of cleaning instruments and linens droplet (>5microns - eg neisseria meng, flu, bordetella pertussis, mycoplasma pna, rsv) = simple facemask airborne (

Question 457

Drugs/conditions that increase risk of osteoporosis

Answer 457

Steroids! (increase OCs, decrease OBs, inhibit Vit D-induced Ca absorption in the gut, increase PTH) Thyroid hormone (increased bone turnover) Anticonvulsants that induce P450 (increase Vit D breakdown) Aromatase inhib and progesterone, GnRH agonists (decrease estrogen) PPIs (decrease Ca absorption) Unfractionated heparin and thiazolidinediones (DM) - decrease bone formation

Question 458

How does estrogen --> stronger bones?

Answer 458

- induces production of OPG by OBs and stromal cells, which binds RANKL and prevents OC activation - decreases expression of RANK receptor on OCs - decreases apoptosis of OBs and osteocytes by activating extracellular signal-regulated kinases

Question 459

Causes of aplastic anemia

Answer 459

autoimmune, infxns (eg parvo, EBV), drugs (eg carbamazepine, chloramphenicol, sulfonamides), exposure to radiation or toxins (eg benzenes, solvents); often unknown etiology in kids (idiopathic) will have pancytopenia WITHOUT SPLENOMEGALY b/c problem is lack of available hematop. progenitor cells, so not doing extramedullary hematopoiesis

Question 460

RCCA originate from ____ cells vs. oncocytomas originate from _____ cells vs. transitional cell carcinoma in the kidney originates from ____ cells

Answer 460

RCCA: proximal convoluted tubule cells oncocytoma: collecting duct cells transitional cell: renal pelvis lining

Question 461

Closed-loop communication

Answer 461

sender transmits message to receiver, who repeats the message sender says "yes" to confirm that the message was understood way to ensure clear, concise info exchange in high-risk setting

Question 462

Acute chest syndrome

Answer 462

vaso-occlusive crisis localized to pulmonary vasculature, esp in sickle cell anemia commonly brought on by pulm infxn

Question 463

3'-->5' exonuclease vs 5' --> 3' exonuclease

Answer 463

3' --> 5' = proofreading for mismatches 5' --> 3' = remove RNA primers and damaged DNA

Question 464

relationship between RPF and RBF

Answer 464

RPF = (1-Hct) * RBF since renal plasma flow is the fraction of renal bloodflow that's not composed of RBCs

Question 465

Fanconi anemia

Answer 465

genetic loss of DNA crosslink repair sx = short stature, cafe au lait spots, thumb/radial defects, increased incidence of tumors/leukemia (may progress to AML), aplastic anemia

Question 466

Cytokine mediator of septic shock

Answer 466

TNF-alpha

Question 467

Air bronchogram

Answer 467

when you can see the outline of the bronchiole b/c alveoli around it are filled with fluid or gunk suggests infxs process or severe interstitial disease

Question 468

protective factors for ovarian cancer

Answer 468

anything that decreases ovulation frequency (OCPs, multiparity, breastfeeding) - decreased trauma to ovaries

Question 469

Signs of acute vs chronic kidney tpx rejection

Answer 469

acute: dense lymphocytic interstitial infiltrate and endotheliitis + complement and PMNs vs chronic: low-grade immune response over period of time --> gradual vessel intima thickening and luminal narrowing --> ischemia of kidney --> interstitial fibrosis and atrophy, HTN, increasing Cr, proteinuria

Question 470

How to change pH of urine to decrease risk of Ca or uric acid stones?

Answer 470

alkalinize it

Question 471

BRCA1 and 2 genes code for ?

Answer 471

DNA repair proteins

Question 472

APC/beta catenin codes for ?

Answer 472

Wnt signaling proteins so tumor suppressor

Question 473

RB codes for?

Answer 473

G1-->S inhibition proteins so tumor suppressor

Question 474

VHL codes for?

Answer 474

ubiquitin ligase tumor suppressor

Question 475

EGFR and HER2 code for?

Answer 475

receptor tyrosine kinases both proto-oncogenes EGFR mutated in lung adenocarcinoma, HER2 in some breast and ovarian cancers

Question 476

BRAF codes for?

Answer 476

Ras signal transduction proteins proto-oncogene mutated in some melanomas and hairy cell leukemia vemurafenib targets the mutation

Question 477

Ras codes for?

Answer 477

a GTP-binding protein so it's a proto-oncogene mutated in lung, colon, pancreatic, cholangio, renal, and bladder ca

Question 478

Functional hypothalamic amenorrhea - mechanism?

Answer 478

reduced circulating leptin b/c of decreased body fat --> inhibition of pulsatile GnRH release --> decreased LH and FSH --> decreased estrogen --> amenorrhea

Question 479

CD18 - what is it, and what happens if it's missing?

Answer 479

antigen on surface of PMNs, necessary for tight binding to ICAM and VCAM on endothelial surface without it, get LAD1, lots of PMNs but can't get where they need to go (so recurrent infxns without purulence)

Question 480

Carotid sinus baroreceptors - afferent and efferent nn? vs aortic arch baroreceptors - afferent and efferent nn?

Answer 480

carotid: afferent = glossopharyngeal (sense stretch) --> medulla --> parasymp efferent (vagus) --> decreased BP and decreased CO aortic: afferent = vagus

Question 481

Conus medullaris syndrome - level of lesion and sx? causes? vs cauda equina syndrome - difference?

Answer 481

level of lesion = L2 (at termination of spinal cord) sx: flaccid paralysis of bladder and rectum, impotence, saddle (S3-5) anesthesia may have mild leg weakness causes: disk herniation, tumors, spinal fractures vs cauda equina = caused by massive rupture of intervert disk or other injury that --> compression of >=2 nerve roots in cauda equina; sx = low back pain that radiates, saddle anesthesia, loss of anocuyt reflex, bowel and bladder dysfxn, loss of ankle-jerk reflex, plantarflex weakness

Question 482

imperforate hymen - cause and sx?

Answer 482

cause: mucus from mom's vaginal secretions can accumulate in baby's vaginal canal; if undiag/untx --> reabs and failure of degeneration of fibrous tissue band that connects walls of vagina at puberty, normal secondary sex char, but girl won't menstruate; blood accumulates and bulges, and has cyclic pelvic pain when she should be bleeding

Question 483

What do you use pudendal nerve block for and where do you inject the anesthetic?

Answer 483

- perineal repair eg during labor (if it's too late to give epidural); eliminate sensory innervation to perineum and genitals - landmarks = ischial spines (palpate intravaginally) and sacrospinous ligament - don't inject into the internal pudendal or inferior gluteal aa! run medially to pudendal nerve

Question 484

Jehovah's witness needs blood transfusion emergently and is incapacitated - what to do? what if it's a child?

Answer 484

if carrying a blood refusal card, don't give blood if next of kin surrogate decision maker says no, don't give blood if no next of kin and no card - give blood (don't need consent in emergency) **always give live-saving tx to minor, regardless of parents' wishes; if it's non-emergent, physician should try to reach agreement with parents, advocating for child's best interests

Question 485

effect of AV shunt on afterload?

Answer 485

decreased - since blood can bypass high resistance arterioles

Question 486

Only statin not metabolized by P450 (so use it if need P450 inhibitor to decrease risk of statin AEs like myopathy)

Answer 486

pravastatin

Question 487

Lung pathology in RA and causes?

Answer 487

interstitial lung dz that looks like idiopathic interstitial pna methotrexate treatment of RA can also cause interstitial pneumonitis and fibrosis

Question 488

CXR: bilateral, diffuse small, irreg opacities, esp in lower lobes with end-inspiratory crackles

Answer 488

pulmonary fibrosis

Question 489

key CXR findings in LV failure, obstructive dz, fibrosis, pulm htn

Answer 489

LV failure: big heart, hazy edema in lungs obstructive: hyperinflation, flattened diaphragm fibrosis: reticular, diffuse white lines, esp in lower lobes pulm htn: enlarged pulm arteries and RV

Question 490

Mesna mechanism of action

Answer 490

supplies thiol group to cyclophosphamide or ifosfamide to make them less toxic --> prevent hemorrhagic cystitis

Question 491

how to prevent tumor lysis syndrome?

Answer 491

allopurinol (decrease breakdown of nucleic acids into uric acid) rasburicase (recombinant urate oxidase, which breaks down uric acid into more soluble allantoin)

Question 492

Most common underlying valvular disease predisposing to development of infective endocarditis in developed countries

Answer 492

MVP in developing world, think rheumatic heart disease

Question 493

Injections where have a high probability of causing trendelenburg gait?

Answer 493

superomedial buttock - easy to injure superior gluteal nerve there, which serves the gluteus medius and minimus mm get hip drop contralaterally target anterolateral or superolateral hip for ventrogluteal injection to avoid nn

Question 494

Most important opsonins

Answer 494

IgG and complement C3b also mannose-binding lectin and C-reactive protein

Question 495

Most important opsonins

Answer 495

IgG and complement C3b also mannose-binding lectin and C-reactive protein

Question 496

AEs of amphotericin (all due to off-target binding to human cholesterol in cell membranes instead of fungal ergosterol)

Answer 496

``` most important: electrolyte abnmlities (hypoMg, hypokalemia) ``` dose-dependent nephrotoxicity from decreased GFR others: acute infusion rxn (fever, chills, rigors, hypotn; often decrease with subsequent doses and can be prevented with antihist etc) anemia (suppression of renal epo synth) - worsened by zidovudine in HIv (also suppresses bone marrow) thrombophlebitis at site of injection

Question 497

Most likely septal defect with fixed splitting?

Answer 497

ASD (not VSD) - equalization of left and right atrial pressures minimizes the effect of respiration on amount of blood cross P and A valves

Question 498

bifid carotid pulse is associated with?

Answer 498

HCM with dynamic LVOT obstruction

Question 499

Mechanism of action of opioid analgesics

Answer 499

bind opioid receptors (GPCRs) that open K channels and close Ca channels --> hyperpolarization and decreased pain transmission also inhibit AC and NT release

Question 500

Most important risk fx for developing aortic dissection?

Answer 500

HTN vs atherosclerosis predisposes to aortic aneurysm (esp abdominal)

Question 501

Amino acids that make up transmembrane domain of GPCRs

Answer 501

nonpolar, hydrophobic AAs (alanine, valine, leucine, isoleucine, phenylalanine, tryptophan, methionine, proline, glycine) - arranged in alpha helix with hydrophobic R groups out vs. extracellular domain of receptor = made of hydrophilic AAs

Question 502

petechiae vs. purpura vs. ecchymosis

Answer 502

petechiae: 1cm diam may be cut or subQ collection of extravasated blood; don't blanch under pressure since blood isn't in vv; petechiae and purpura are often associated with plt dysfxn or capillary fragility, usu in areas of increased venous pressure

Question 503

Typical presentation of Osler-Weber-Rendu syndrome, aka

Answer 503

aka hereditary hemorrhagic telangiectasia presentation = recurrent epistaxis or GI bleeding

Question 504

laryngomalacia

Answer 504

inspiratory stridor during infancy due to collapse of supraglottic structures during inspiration; worse in supine position

Question 505

Micro causes of septic abortion

Answer 505

gram neg, staph aureus (normal vag flora that seeds uterus during instrumentation) risk fx = preg termination with retained products of conception (that subsequently get infected) sx: fever, ab pain, uterine tenderness, foul-smelling vaginal discharge

Question 506

overproduction of ____ by gut microbes in small intestinal bacterial overgrowth? deficiencies?

Answer 506

gut bugs make vit K and folate; excess --> nausea, bloating, malabs esp common with roux-en-y bypass b/c bacteria can proliferate in closed-ended gastroduod limb deficiencies: all other vitamins due to malabs

Question 507

Central venous catheters - which site of insertion has higher risk of infxn?

Answer 507

femoral vein vs. subclavian and internal jugular = better

Question 508

Drugs used to treat MRSA and their mechanisms and AEs?

Answer 508

Vanc - blocks glycopeptide polymerization by binding D-ala-D-ala; AEs = red man, nephrotox Daptomycin - depolarizes cell membrane by creating transmem channels; AEs = myopathy, CPK elevation Linezolid - inhibits bacterial protein synthesis by binding 50S; AEs = thrombocytopenia, optic neuritis, ser synd

Question 509

Catabolism of which AAs makes propionyl CoA? Then what happens to propionyl CoA?

Answer 509

Isoleucine, valine, threonine, methionine, cholesteroal, and odd-chain FAs all make propionyl coa via oxidative decarboxylation propionyl coa is then converted to methylmalonyl CoA, which is made into Succinyl CoA --> TCA MOV(e)IT into the tca cycle

Question 510

Major AEs for HIV drugs

Answer 510

NRTIs: lactic acidosis, lipodystrophy, hypersensitivity, pancreatitis, bone marrow suppression NNRTIs: hepatotox, rash, neurotox and teratogenicity (efavirenz) PI: metabolic complications Integrase inhibitors: myopathy

Question 511

Disinfectants

Answer 511

alcohols (isoprop, ethanol) - disrupt cell membranes and denature proteins chlorhexidine - disrupt cell mem, coag of cytoplasm H2O2 - makes free radicals that oxidize cell components; SPORICIDAL Iodine - halogenation of proteins and nucleic acids; SPORICIDAL

Question 512

Difference between HMO and point-of-service plans?

Answer 512

health maint organization: low monthly premiums, copayments and deductibles, lowest total cost for pt but has to stay in network, need PCP referral for specialist services, and denied coverage for service that don't meet established guidelines POS: higher premiums and significant cost (but allowed) to see out-of-network providers

Question 513

Osteoblastic vs osteolytic lesions - which cancers cause which

Answer 513

osteoblastic: prostate, SCLC, HL osteolytic: MM, NSCLC, NHL, RCCA, melanoma

Question 514

Radial head subluxation

Answer 514

"nursemaid's elbow" - most commonly in kids 1-4yo from sharp pull on pronated, extended elbow --> annular ligament is torn from radial neck attachment and slips between radius and humerus after 5yo, ligament gets stronger, so injury is less likely tx: reduce by supinating and flexing

Question 515

sign of biceps tendon rupture?

Answer 515

"Popeye" deformity (visible or palpable mass in mid-upper arm)

Question 516

how does an ulnar collateral ligament injury happen?

Answer 516

pitching - tx = "tommy john surgery"

Question 517

Why do barbiturate anesthetics --> quick recovery?

Answer 517

barbiturate anes = thiopental high potency and lipid solubility, but rapidly redistributes into skeletal muscle and fat

Question 518

Coronary sinus empties into the _____ in the heart

Answer 518

right atrium, between the IVC and the tricuspid valve

Question 519

Strep that makes dextrans

Answer 519

Viridans (extracellular pollysacch that allow bug to adhere to damaged heart valves)

Question 520

Drugs used for smoking cessation

Answer 520

Bupropion (wellbutrin) Varenicline (partial ag at nAChR)

Question 521

enzyme that metabolizes excess fructose in essential fructosuria?

Answer 521

hexokinase (since deficiency in fructokinase)

Question 522

Hepatosplenomegaly and marrow fibrosis are seen in which leukemia?

Answer 522

hairy cell bone marrow infiltration and cytokine production --> marrow failure --> pancytopenia splenic red pulp infiltration --> splenomeg

Question 523

basophilic stippling vs. ringed sideroblasts

Answer 523

stippling = lead poisoning, thalassemias, MDS; accum of ribosomes b/c lead inhibits degradation of RNA ringed sideroblasts = abnormal RBC precursors in the MARROW; seen in heme pathway problems and MDS - iron precipitates

Question 524

From where is IGF-1 released?

Answer 524

Liver GH activates hepatocytes via JAK/STAT --> release of IGF-1, which acts via receptor tyrosine kinases

Question 525

In lac operon, the _____ binds to the operator region, and is inhibited by _____ Promoter binds ____ site and is transcribed when?

Answer 525

repressor protein binds operator and is inhibited by presence of lactose promoter binds CAP and is transcribed in absence of glucose

Question 526

Causes of suppurative parotitis (bugs)?

Answer 526

staph aureus, anaerobes findings: elevated serum amylase without pancreatitis (normal serum lipase, no sx of pancreatitis), CT shows inflamm risk fx: decreased salivary flow (meds, obstruction, dehydration), intubation

Question 527

Triad of sx in HUS

Answer 527

microangiopathic hemolytic anemia thrombocytopenia renal insufficiency

Question 528

Drugs that cause drug-induced SLE?

Answer 528

procainamide, hydralazine, isoniazide

Question 529

Lipid-lowering agent that increases risk of gallstones?

Answer 529

Fibrates

Question 530

Globus sensation

Answer 530

functional disorder of the esophagus - no structural or motility problem, but feel that there's something stuck in your throat if significant pain, dysphagia, vocal abnormalities, systemic sx, suspect something else is going on

Question 531

Warburg effect

Answer 531

malignant cells do lots of glycolysis to make the macromolecules they need to sustain rapid growth

Question 532

Drugs with anticholinergic effects

Answer 532

antipsychotics (clozapine, chlorpromazine, thioridazine, olanzapine) antispasmodics (dicyclomine, hyoscyamine) TCAs antihistamines (first gen)

Question 533

When genetic mutation is ID'd in offspring but not in the parents, what's the likely explanation?

Answer 533

germline mosaicism

Question 534

Granulocyte-macrophage colony-stimulating factor (GM-CSF) is secreted by what kinds of cells? Fxn?

Answer 534

secreted by macrophages, T cells, NK cells, mast cells, endoth cells, fibroblasts fxn: stimulates production of granulocytes (neutrophils, eos, mast cells, basophils) and monocytes (macrophages)

Question 535

molluscum bodies are made of what?

Answer 535

virus particles - form big, eosinophilic cytoplasmic inclusion see them in gunk from lesions

Question 536

What nerve/vessel is at greatest risk of injury with knee dislocation?

Answer 536

popliteal artery (deep in popliteal fossa and high traction) vs tibial n. is more superficial

Question 537

Mastitis is caused by ____

Answer 537

staph aureus from infant's oral flora --> breast infection during lactation

Question 538

most important risk factor for postpartum endometritis?

Answer 538

c-section (introduces microbes and foreign bodies into incised uterus) sx = fever, leukocytosis, uterine tenderness, foul-smelling vag discharge

Question 539

Vasomotor rhinitis

Answer 539

chronic nasal congestion that worsens with abrtupt change in temp, humidity, odor or alcohol exposure may also have h/a, anosmia, sinusitis

Question 540

rhinitis medicamentosum

Answer 540

chronic nasal congestion in pts who have become habituated to nasal decongestant sprays

Question 541

RBCs have increased osmotic fragility with ____ decreased osmotic fragility with ____

Answer 541

increased with hereditary spherocytosis (less SA:vol) decreased with sickle cell, target cells (more membrane to accommodate increased fluid inside)

Question 542

Hodgkin lymphoma paraneoplastic syndromes

Answer 542

cholestatic liver disease, alcohol-induced pain, skin lesions, neuro syndromes, nephrotic syndrome

Question 543

Risk fx for intraventricular hemorrhage in newborns

Answer 543

aka germinal matrix hemorrhage prematurity, low birth weight, alterations in cerebral blood flow (eg mechanical ventilation)

Question 544

germinal matrix - what is it and what pathology happens there?

Answer 544

dense cellular and vascular layer of subependymal zone of the brain from which neurons and glial cells develop in utero; should be totally involuted at term path: vv of germinal matrix are weak and susc to spon intraventricular hemorrhage in newborn; often opens into ventricles and --> hydrocephalus (eg indicated by bulging fontanelle) and clots

Question 545

cephalohematoma

Answer 545

subperiosteal bleed in a newborn that doesn't cross suture lines and presents as scalp swelling can occur after traumatic birth

Question 546

Most common sites of SCCA of the head and neck?

Answer 546

ventral tongue, floor of mouth, lower lip, soft palate, gingiva assoc with smoking and alcohol

Question 547

Palmitoylation

Answer 547

process in which FAs are covalently anchored to plasma membrane cysteine residues common in GPCRs

Question 548

Albright hereditary osteodystrophy - inheritance pattern, pathophys

Answer 548

autosomal dominant mut in GNAS1 --> faulty alpha unit of Gs that mediates effects of PTH, so don't respond to PTH sx: skeletal and developmental defects (short stature, short hand bones, etc) + end-organ resistance to LH, FSH, TSH **kidney expresses only mom's GNAS, so if mutation comes from dad, will have all of the skeletal abnormalities, but Ca, P, and PTH levels will be normal

Question 549

Latex agglutination test looks for ______ in patient serum vs ELISA looks for _____ in patient serum

Answer 549

Latex agg: presence of antigen in sample of interest add sample to beads with Ig on them and look for clumping of beads ELISA: looks for Ig in patient serum (fix antigen to surface and add pt serum)

Question 550

Complement fixation test - method?

Answer 550

goal: is there antibody or antigen of interest in pt serum? patient serum + standard complement proteins + antigen of interest + sheep RBCs prebound to anti-sheep RBC antibodies if the solution turns pink (lysed RBCs) when you add sheep RBCs, that means there was complement available to bind the sheep ag-Ig complex but if no rxn when add sheep RBCs, that means the complement has all been used up, which means that the pt serum bound the antigen of interest (ie there's antibody in the pt's serum)

Question 551

Shortened limbs and digits (trident hand) with macrocephaly, midface hypoplasia, and frontal bossing?

Answer 551

achondroplasia **increased risk of spinal stenosis and vertebral compression from dorsal kyphosis and lumbar lordosis ("S")

Question 552

COL1A1 mutation in what condition?

Answer 552

OI (collagen 1 defect)

Question 553

Ear anomalies, micrognathia, depressed nasal bridge, hypertelorism

Answer 553

Isotretinoin use during pregnancy

Question 554

smooth filtrum, shortened palpebral fissures, microcephaly

Answer 554

FAS

Question 555

alpha thal is most common in what ethnic population?

Answer 555

southeast asian

Question 556

surgical tx of hyperhidrosis of the axilla?

Answer 556

electrocoag of the thoracic sympathetic trunk around T2 **sweating is SYMPATHETIC, but uses mAChR, which is why it's inhibited by anticholinergics (eg atropine)

Question 557

17-ketosteroids - what are they and when are they elevated?

Answer 557

- metabolic breakdown products of steroid hormones, esp androgens (eg androstenedione, androsterone) - urinary levels are elevated in pts with androgen-secreting tumors

Question 558

penetrance vs. expression

Answer 558

penetrance - presence or absence of phenotypic expression of mutated gene expression - degree of phenotypic expression of mutation

Question 559

what causes "red man syndrome" and how do you prevent it?

Answer 559

cause: widespread histamine release via nonspecific mast cell degranulation from rapid infusion of vanc; NOT an allergic rxn prevention: decrease rate of infusion

Question 560

Two causes of ischemic colitis and histo stages

Answer 560

causes: diminished cardiac output (eg heart disease, shock), or occlusion of blood supply (eg atherosclerosis, thrombosis) histo stages: 1. hemorrhage, ecchymoses, and patchy necrosis of mucosa 2. injury extends into muscularis --> bowel wall thickens and becomes edematous 3. transmural infarction, which may --> perf

Question 561

Most common genetic defect in beta-oxidation and its symptoms?

Answer 561

medium-chain acyl-coa dehydrogenase deficiency hypoglycemia after prolonged fasting (often presenting with infection) with inappropriately low ketone bodies (can't make them)

Question 562

Shine-Dalgarno vs Kozak sequences in mRNA

Answer 562

Shine-Dalgarno: prokaryotic mRNA sequence that helps ribosome find place to start translation Kozak: eukaryotic mRNA sequence that ribosome finds after starting at 5' cap to start translation

Question 563

Tachyphylaxis

Answer 563

progressively diminishing response to a drug on repeated administration b/c of desensitization of target tissues to the drug eg with topical alpha agonists to treat nasal congestion, after a while, nerve terminals stop making NE --> relative vasodilation and more edema/congestion (rhinitis medicamentosa/rebound rhinorrea) another ex = nitroglycerine (decreased NO release with continued use)

Question 564

molecular chaperone heat shock protein - fxn?

Answer 564

with heat or other cell stressor, they interact with newly synthesized proteins to ensure their appropriate folding or if can't do that, then they facilitate the degradation of misfolded proteins

Question 565

arytenoid mm control ___ and are innervated by the ____ nerve

Answer 565

control intrinsic mm of larynx (sound production) and are innervated by recurrent laryngeal external laryngeal innervates cricothyroid (only larynx muscle not innervated by recurrent laryngeal)

Question 566

external laryngeal nerve branches into the ___ and the ___ nerves, which do what?

Answer 566

external laryngeal - innervates cricothyroid muscle in larynx internal laryngeal - sensation over supraglottic area

Question 567

only DNA virus that doesn't replicate in host cell nucleus using host machinery?

Answer 567

poxvirus - replicates in the cytosol using virally-encoded polymerases etc

Question 568

agrammatism - definition and with what condition do you see it? vs dysarthria - definition and with what condition do you see it?

Answer 568

agrammatism: defn: slow speech consisting primarily of nouns and verbs see it in Broca's aphasia vs. dysarthria (slurred speech) - happens with primary motor cortex lesion (also CBL lesions)

Question 569

Unmyelinated nerves in the body

Answer 569

- postganglionic ANS axons - afferent neurons that conduct heat and slow/dull/burning/visceral pain sensation - bipolar sensory neurons of olfaction

Question 570

Lichen sclerosus - pathophys, sx, and tx

Answer 570

autoimmune inflamm condition that can involve any part of body but usually involves genital and perineal region --> atrophic macules that coalesce into itchy, painful white plaques increase risk for SCCA and genital disfigurement tx: ultra high potency topical corticosteroids

Question 571

Antibiotics that bind bacterial 30s subunit Antibiotics that bind bacterial 50s subunit

Answer 571

30s: aminoglycosides (prevent initiation complex formation) and TCNs (prevent charged tRNA transfer) 50s: chloramphenicol (blocks binding of charged tRNA so no peptidyltransferase peptide bond formation), macrolides (block exit tunnel so no translocation)

Question 572

Hand-foot-genital syndrome - mutation in what gene? symptoms?

Answer 572

rare, AD condition mut in HOXA13 (homeobox gene) that --> developmental malformations of distal limbs and Mullerian fusion abnormalities (eg uterus didelphys)

Question 573

PAX genes do what?

Answer 573

important for embryologic specification of eye and brain development mut --> ocular defects (eg aniridia)

Question 574

what is acute rhinosinusitis, which sinus is most commonly affected and why?

Answer 574

mucosal edema, usu due to infxn or allergy, causes obstruction of paranasal sinus ostia, which imapris drainage and causes inflamm of sinus lining --> accum of mucus and transudative or purulent fluid maxillary sinuses = most commonly affected b/c drain through middle nasal meatus, which is superior to floor of sinus, so don't drain well when we're upright

Question 575

what opens into inferior nasal meatus?

Answer 575

lacrimal duct --> lacrimal sac --> inferior meatus

Question 576

First-line tx for esophageal variceal hemorrhage?

Answer 576

octreotide (inhibition of hormones that normally cause splanchnic vasodil (VIP, glucagon) --> splanchnic vasocon diverts blood away from portal circ)

Question 577

NAVL goes in what direction?

Answer 577

lateral to medial

Question 578

HLA-A, B, C, D correspond to which MHCs?

Answer 578

MHCI = HLA-A,B,C MHCII = HLA-Ds (DR, DP, DQ)

Question 579

Depression sx must be present most of the day, almost every day for >= how long to get depression diag?

Answer 579

>= 2 weeks of continuous symptoms

Question 580

Triad of sx in fat embolism syndrome?

Answer 580

respiratory distress, neuro sx (AMS, seizures), petechial rash (usually over upper body)

Question 581

How does HSV1 get into brain to cause temporal encephalitis?

Answer 581

- primary oropharyngeal infxn travels through olfactory tract - or latent virus reactivates in trigeminal ganglion and spreads into cerebral vault

Question 582

Marjolin's ulcer

Answer 582

SCCA that forms in area of previously traumatized or chronically inflamed skin, usually >10yrs after initial trauma

Question 583

Characteristics of drugs cleared by liver, not kidney

Answer 583

tend to be lipophilic (so high Vd, good penetration into CNS) lipophilicity means that when they're filtered by the kidney, they easily cross the tubular cell membranes to be reabsorbed, so not excreted by kidney vs. that same lipophilicity allows drug to easily cross into hepatocytes where it's excreted in bile etc vs. low Vd (low rate of redistribution) will be highly plasma protein bound and hydrophilic, so more readily available for renal excretion

Question 584

common sites of afib pathogenesis? vs common site of atrial flutter pathogenesis?

Answer 584

afib: AV node (where tricuspid meats orifice of coronary sinus) opening of pulm veins in left atrium both = common areas of radiofrequency ablation atrial flutter: isthmus between IVC and tricuspid annulus

Question 585

Effect of NE on heart rate

Answer 585

no effect or even slightly decreased b/c beta 1 stimulation of cardiac contractility, conduction and HR --> reflex bradycardia thanks to baroreceptors

Question 586

Opsoclonus-myoclonus

Answer 586

paraneoplastic syndrome of neuroblastoma (in kids

Question 587

Interal vs. external hemorrhoids - pain? and blood supply?

Answer 587

Internal - visceral innervation so NOT PAINFUL, and vein = superior rectal (part of portal system) External - somatic sensation via inferior rectal branch of pudendal n., so PAINFUL, vein = inferior rectal vein (--> internal pudendal vein --> internal iliac --> common iliac --> IVC)

Question 588

mechanism of zenker diverticulum formation

Answer 588

abnormal spasm or diminished relaxation of cricopharyngeal mm during swallowing --> food gets trapped in upper esophagus and pushes wall out into a false diverticulum (through mucosal tissue at killian triangle)

Question 589

what causes true diverticulum in the esophagus?

Answer 589

mediastinal lymphadenitis (eg due to TB, fungus) --> scarring/traction of mid-esophagus --> true diverticulum

Question 590

Mitral valve thickening with vegetations + coronary artery arteritis or thrombosis - underlying cause?

Answer 590

SLE is likely - thrombosis due to hypercoagulable APLS (in 10-30% of SLE pts) may cause ACS even with angiographically normal coronary aa + Libman-Sacks endocarditis (IC deposn)

Question 591

Why do statins reduce risk of ACS more than other lipid-lowering meds?

Answer 591

b/c they also have anti-inflamm properties, improve endothelial dysfxn, and stabilize atherosclerotic plaques

Question 592

How can cells not involved in reductive biosynth (ie that don't do the oxidative steps of the HMP shunt) synthesize ribose from F6P?

Answer 592

using transketolase and transaldolase, can make ribose from F6P and G3P (nonoxidative steps), thus bypassing the RLS using G6P and G6PD dehydrogenase need to make ribose for synthesis of nucleotides (so all cells need to be able to run the non-oxidative phase forwards and backwards)

Question 593

Prophylaxis of MAC in HIV pts? Treatment of MAC?

Answer 593

Prophylaxis: azithromycin Tx: azithromycin or clarithromycin + rifabutin + ethambutol

Question 594

how to distinguish disseminated MAC from M. TB?

Answer 594

MAC grows well at higher temperatures, clear lungs, marked anemia, HSM, elevated alk phos and LDH TB: lung findings, lower temp

Question 595

TMP-SMX is used as prophylaxis for ___ in HIV+ pts?

Answer 595

PJP and toxo

Question 596

viral hepatitis affects which zone in liver? alcoholic hepatitis? ischemia? ingested toxins?

Answer 596

viral hep and ingested toxins = periportal alcoholic hep and ischemia = centrilobular

Question 597

fourth intercostal space - what's at that level?

Answer 597

about nipple-level, so we're below the pulm aa and aorta, and at level of RV

Question 598

Most common mode of transmission of Hep B in developed world? vs Hep C?

Answer 598

Hep B: sexual Hep C: IVDU (sexual transmission is inefficient)

Question 599

First-line treatment for wilson disease? for lead poisoning?

Answer 599

wilson: d-penicillamine (free SH group chelates Cu) lead: edetate calcium disodium (increases urinary excretion of lead)

Question 600

solar lentigine vs ephelides

Answer 600

ephelides = freckles, caused by increased melanin production in melanocytes lentigines = bigger, from increased proliferation of melanocytes (more cells)

Question 601

Aldolase B vs Aldose reductase

Answer 601

aldolase B converts F1P to DHAP and glyceraldehyde (fructose metabolism - mutated in fructose intolerance) aldose reductase converts glucose to sorbitol

Question 602

Three enzymes involved in fructose metabolism (in order)

Answer 602

fructokinase, aldolase B, triokinase

Question 603

Physical sx of fanconi anemia

Answer 603

hypo/hyperpigmented patches, short stature, hypoplastic thumbs defect in DNA repair genes also pancytopenia and increased risk of malignancy

Question 604

Bronchopulmonary sequestration

Answer 604

congenital malformation with extra, non-fxal lung tissue that doesn't communicate with tracheobronchial tree can get recurrent pna in that tissue

Question 605

P bodies

Answer 605

cytoplasmic proteins that do mRNA quality control - may degrade (associated with miRNA) or store mRNA for later use

Question 606

Menarche

Answer 606

breast and endometrial

Question 607

Most common drug type causing overdose deaths?

Answer 607

opioids (prescription pain meds and heroin)

Question 608

Acetaminophen overdose causes ____ NSAID overdose causes _____

Answer 608

Acetaminophen --> acute hepatic failure NSAIDs --> metabolic acidosis and renal failure

Question 609

What treatment can precipitate korsakoff in wernicke pt?

Answer 609

if you give glucose/dextrose before IV thiamine (makes the B1 deficiency worse)

Question 610

capitation

Answer 610

arrangement in which payor pays fixed, predetermined fee to cover all medical services required by a patient this is the payment structure in HMOs (have to see in-network providers, get referrals for specialists, approval of care etc) usually payment is made to insurance company, which negotiates with individual physicians or networks to provide care

Question 611

global payment

Answer 611

insurer pays provider a single payment to cover all expenses associated with given incident of care (eg surgery + post-op visits)

Question 612

what makes up pseudogout crystals and what shape are they?

Answer 612

made of calcium pyrophosphate rhomboid-shaped, positively birefringent (blue with parallel light) sx = similar to gout, so need to do synovial fluid analysis to distinguish them (MSU crystals in gout = needle-shaped and negatively birefringent)

Question 613

penicillin binding protein - what type of protein is it?

Answer 613

transpeptidase (cross links cell walls)

Question 614

what is the pterion and why do we care?

Answer 614

region where frontal, parietal, temporal, and sphenoid bones meet - it's thin and susceptible to fracture, which could lacerate the middle meningeal artery (branch of the maxillary artery) --> epidural hematoma

Question 615

what is the pterion and why do we care?

Answer 615

region where frontal, parietal, temporal, and sphenoid bones meet - it's thin and susceptible to fracture, which could lacerate the middle meningeal artery (branch of the maxillary artery) --> epidural hematoma

Question 616

DBS of ____ for PD DBS of ____ for intractable essential tremor

Answer 616

PD: DBS of GPi or STN to decrease thalamic inhibition and increase cortical excitation essential tremor: DBS of ventral intermediate nucleus of the thalamus to decrease excessive movements

Question 617

Cause of ACE-i induced cough?

Answer 617

decreased breakdown of bradykinin, substance P, and prostaglandins so more bradykinin and substance P --> inflamm and lung irritation

Question 618

Cause of ACE-i induced cough?

Answer 618

decreased breakdown of bradykinin, substance P, and prostaglandins so more bradykinin and substance P --> inflamm and lung irritation

Question 619

Mechanism of hyaline arteriolosclerosis vs. hyperplastic arteriolosclerosis?

Answer 619

hyaline: deposition of homogeneous hyaline material (leaked plasma proteins etc) in the intima and media of small arteries and arterioles associated with DM, HTN, and advanced age hyperplastic: from severe HTN - onion-like concentric thickening of walls of arterioles (smooth muscle hypertrophy)

Question 620

High-output heart failure

Answer 620

heart is pumping lots of blood, but there's a circulatory overload that's still causing blood to back up (eg b/c of AV shunt, vasodilation that causes blood to pool etc)

Question 621

High-potency antipsychotics? Common AEs?

Answer 621

"TRy to FLy High" trifluoperazine fluphenazine haloperidol AEs: EPS

Question 622

Low-potency antipsychotics and their AEs?

Answer 622

Cheating THieves are LOW CHlorpromazine THioridazine AEs: anticholinergic, sedation (anti-hist), orthostatic hypotension (anti-alpha1)

Question 623

For which treatments do minors not need parental consent?

Answer 623

in most states, minors can consent to prenatal care, diagnosis/tx of STDs, contraception, and drug/alcohol rehab for all else that's non-emergent, need parental consent unless emancipated (homeless, parent, financially independent, married, in the military, high school grad) ABORTION: 2/3 of states require parental consent, 1/3 require parental notification

Question 624

Effect of MS vs MR on arterial pulses?

Answer 624

MR - bounding pulse with brisk upstroke b/c more blood fills LV, so increased CO MS - decreased arterial pulse amp b/c of decreased SV

Question 625

pulsus parvus et tardus

Answer 625

due to LV outflow tract obstruction (eg AS): slow-rising, low amplitude pulse due to decreased stroke volume (pulsus parvus) and prolonged LV ejection time through stenotic valve (tardus)

Question 626

why do you get pulsus paradoxus in severe asthma and COPD?

Answer 626

exaggerated intrathoracic pressure drop with inspiration (hyperinflated lungs) --> decreased blood return to left heart --> big drop in LV output and thus big drop in blood pressure with inspiration **NB - asthma and COPD exacerbation are most frequent causes of pulsus paradoxus in absence of significant pericardial disease

Question 627

Fever and sore throat in patient with hyperthyroidism treated medically - what do you worry about?

Answer 627

agranulocytosis (both methimazole and propylthiouracil can cause it; methimazole often preferred due to risk of severe hepatotox with propylthiouracil, but propyl used in pregnancy) get CBC with diff and d/c drug if agranulocytosis!! also: 50% of pts taking propyl develop ANCA antibodies; most = asymptomatic, but some --> vasculitis sx

Question 628

Ecthyma gangrenosum

Answer 628

increased risk with neutropenia (ANC destruction of surrounding tissue and insufficient bloodflow --> necrotic lesions

Question 629

Increased ESR - mechanism?

Answer 629

acute phase reactants made by liver in response to cytokines (IL-6, IL-6, TNF-alpha) and one of them - fibrinogen - causes erythrocytes to form stacks (rouleaux) that sediment faster non-spec marker of inflamm

Question 630

Ddx of chest pain - how do these present? CAD Pulmonary/pleuritic (pleurisy, pna, pericarditis, PE) Aortic (dissection, intramural hematoma) GI/esophageal chest wall/musculoskeletal

Answer 630

CAD: substernal, radiates, precipitated by exertion and relieved by rest or NG pulmonary/pleuritic: sharp/stabbing pain that's worse with inspiration and when supine, relieved when lean forward; PE and pneumothorax can --> resp distress, hypoxia aortic: tearing pain radiating to back, HTN and atherosclerosis = risk fx; also BP diff b/w arms GI/esophageal: pain often postprandial or at night, nonexertional, relieved by anatacids, often with regurg, nausea, dysphagia chest wall/MS (eg costotsernal syndrome, costochondritis, anterior chest wall syndrome): persistent, worse with movement and palpation, often follows repetitive activity

Question 631

Rb gene - how is it activated and inactivated?

Answer 631

activated = hypophosphorylated (prevents G1 --> S) inactivated = hyperphosphorylated

Question 632

Mechanism for adverse reaction to vanc, radiocontrast agents, opioids (eg morphine)?

Answer 632

IgE - INDEPENDENT mast cell degranulation by activation of PKA and PI3 kinase --> histamine, bradykinin, heparin, chemotactic fx etc

Question 633

Change in ABGs and pH at high altitude

Answer 633

immediate decrease in FiO2 --> decreased PaO2 --> hyperventilation --> decreased PaCO2 --> respiratory alkalosis over 24-48 hours, kidney compensates by losing bicarb --> compensatory metabolic acidosis pH will be up over time, compensation: increased 2,3-DPG (so Hgb dumps more O2 to decrease hypoxemia), increased Hgb production (increased Epo), increased DLCO, VEGF-induced angiogenesis to get more O2 to tissues, increased # of mt/cell, concentration of blood (due to bicarb loss and fluid shift)

Question 634

Post-exposure prophylaxis for meningococcal infxn? What about if you have vaccine?

Answer 634

Vaccine won't protect you in time - still need PEP drugs that work: rifampin, cirpofloxacin (may cause CT injury in kids), IM ceftriaxone (painful to administer)

Question 635

Hawthorne effect

Answer 635

= observer effect study subjects change their behavior when they know they're being studied

Question 636

Pygmalion effect

Answer 636

researcher's beliefs in efficacy of treatment can affect the outcome eg kids were randomly assigned IQ scores and those assigned high scores did better (likely b/c teacher treated them differently, had higher expectations etc)

Question 637

Relationship between visceral pleura/lungs, parietal pleura, and ribs

Answer 637

2 ribs between visc and parietal pleura so lungs/visc pleura come down to 6th rib (midclavicular), 8th rib (midaxillary), and 10th rib (paravertebral) +2 for corresponding parietal pleura borders *so do thoracentesis between 6th and 8th ribs along midclavic line, or 6th and 8th along midaxillary, or 10th and 12th along paravertebral (watch out for lung if go too high, or liver if go below 9th rib on midaxillary line)

Question 638

Rat poison contains?

Answer 638

superwarfarin give pts FFP with ingestion

Question 639

cryoprecipitate contains which clotting factors?

Answer 639

8, 13, vWF, prothrombin (2) these are the cold-soluble clotting factors

Question 640

Risks of second-hand smoke exposure in fetus/kids

Answer 640

in fetus/baby: abnormal placentation, decreased fetal oxygenation, prematurity/low birth weight, SIDS, middle ear disease, asthma, respiratory tract infxns why SIDS? probably has something to do with decreased arousal and abnormal CV responses to stimuli

Question 641

how are intracellular pathogens broken down to be displayed on MHC I?

Answer 641

by ubiquitin-proteasome system in the ER --> coupled to MHCI and displayed on the cell surface

Question 642

Parvo sx in kids vs adults?

Answer 642

kids: erythema infectiosum/fifth disease adults: acute arthropathy (symmetric, involves PIP, metacarpal, knee, and ankle joints; self-limited and non-destructive) get these sx once the heavy viremia/viral shedding phase is over (sx from active immune response with formation of ICs)

Question 643

order of hormones secreted in response to fast?

Answer 643

Glycogenolysis for first 12-18 hrs Then gluconeogenesis glucagon acutely (increase hepatic gluconeo and glycogenolysis) then epinephrine (also increase hepatic gluconeo and glycogenolysis, increase mobilization of gluconeo substrates) finally cortisol and GH to alter transcription of genes that conserve glucose (increase gluconeo, do lipolysis and proteolysis)

Question 644

Digoxin - mech and what is it used to treat?

Answer 644

slows ventricular rate by ENHANCING VAGAL TONE --> decreased ventricular response to atrial flutter/afib also blocks Na/K atpase so increases [Ca]i

Question 645

Fibronectin

Answer 645

high-molecular weight glycoprotein that binds components of ECM and to integrin receptors made in liver role in wound healing

Question 646

Differences in mechanism of buprenorphine and methadone?

Answer 646

methadone = full mu-opioid receptor agonist with long half life, so it suppresses cravings and withdrawal sx but can --> resp suppression, QT prolongation buprenorphine = partial agonist

Question 647

What happens to the aortic valves in different causes of AS?

Answer 647

calcific degeneration (more common in developed countries) - progressive leaflet thickening and ca --> restricted mobility of the valve rheumatic valve disease (developing world): fusion of valve commissures due to repetitive inflamm also congenital causes (eg bicuspid aortic valve --> accelerated valve degen)

Question 648

Risk fx for SCCA vs adenocarcinoma of the esophagus

Answer 648

SCCA: smoking, alcohol, and nitroso-containing foods are big causes; some association with low fiber/nutrient diet and Plummer-Vinson, very hot foods/beverages, achalasia adeno: Barrett's, GERD, obesity, tobacco

Question 649

Most common route of infxn in osteomyelitis in adults? most common bugs? sx? w/u?

Answer 649

usually hematogenous spread bugs = staph and G- sx: new or worsening localized back pain, fever, recent endocarditis or bacteremia, new neuro findings w/u: blood cultures and MRI of spine (then can isolate the bug via CT-guided bone bx)

Question 650

Two different sensory innervation sources of parietal pleura?

Answer 650

Phrenic: sensory innervation of diaphragmatic and mediastinal parietal pleura - pain in these areas = referred to shoulder etc (C3-5) Intercostal nn: sensory innervation of costal and cervical pleura (extends with apices of lungs into neck) - pain in these areas = local

Question 651

Why is hydralazine not used in htn emergency?

Answer 651

b/c it vasodilates --> reflex sympathetic activation (increased HR and contractility) use DA D1 agonists instead (eg fenoldopam) to save kidneys and decrease BP without affecting beta and alpha receptors use IV drugs b/c they can be quickly adjusted and act fast

Question 652

Metabolic effects of thiazides

Answer 652

decreased insulin secretion, increased LDL, increased TGs also raise serum Ca, uric acid; lower serum sodium, K, Mg

Question 653

Expression cloning

Answer 653

type of DNA cloning where signals necessary for transcription and translation are included in cloned DNA, so that DNA can be inserted into bacterial plasmid and the bacteria produces large amounts of protein of interest on its own

Question 654

Positive skew - where is the tail? RElationship of mean and median?

Answer 654

positive skew means tail is on the RIGHT (so higher values are less frequent) mode

Question 655

Carpal tunnel - what makes up its borders and what's inside it?

Answer 655

bordered by transverse carpal ligament/flexor retinaculum, which attaches to hamate and pisiform medially (ulnar side) and trapezium and scaphoid laterally (radial/median side) what passes through: flexor digitorum profundus, flexor digitorum superficialis, flexor pollicis longus tendons, and MEDIAN NERVE so compression of median n --> sx (weakness of thumb abduction and opposition, atrophy of thenar eminence, pain and paresthesias)

Question 656

Thayer martin media

Answer 656

SELECTIVE medium vanc (kills G+), nystatin (kills fungi), colistin and TMP (kills other G-) vs. differential medium allows bugs to grow but they grow differently (eg pink lactose fermenters on MacConkey) vs. ENRICHMENT media contain special growth factors (eg X and V factors for haemophilus)

Question 657

Somatic symptom vs illness anxiety disorder

Answer 657

somatic symptom - excessive anxiety and preoccupation with >=1 unexplained sx illness anxiety - few or no sx and negative evaluations, but persistent fear of having serious illness

Question 658

Two enzymes that degrade 6-MP to inactive form? Enzyme that activates 6-MP?

Answer 658

Xanthine oxidase, TPMT if block them (eg with allopurinol), can increase effect of 6-MP (good if intentional, bad if unintentional and --> bone marrow suppression) activating enzyme: HGPRT

Question 659

Cells that release proliferative factors key to atheroma formation?

Answer 659

platelets, endothelial cells, macrophages

Question 660

Key/specific findings in Legionnaire's disease

Answer 660

hyponatremia, grows on BCYE medium (selective), sputum shows lots of PMNs but not bugs, GI sx, neuro sx, fever with relative bradycardia also patchy infiltrates on CXR

Question 661

Why are pregnant ladies more prone to thrombosis?

Answer 661

virchow's triad: hypercoagulable from increased factors 7, 8, and 10 + vWF and fibrinogen stasis from preg-related venous dilation and uterine compression of IVC endothelial damage from birth **thrombosis often assumed to be infxn b/c presents with fever but then doesn't improve with abx

Question 662

Absolute contraindications for use of OCPs

Answer 662

- hx of thromboembolic event or stroke - history of estrogen-dependent tumor - >35 yo and/or heavy smoker - hyperTG - decompensated or active liver disease (impaired steroid metabolism) - pregnancy **no longer induce insulin resistance (low-dose estrogen)

Question 663

Copper reduction test

Answer 663

urine test to look for reducing sugar (fructose, glucose, galactose) vs. urine dipstick uses glucose oxidase to ID presence of sugar, so will only pick up glucose (not, eg, fructose in essential fructosuria)

Question 664

Charcot-Marie-Tooth disease

Answer 664

defective production of proteins involved in peripheral myelin sheath autosomal dominant often presents with weakness of foot dorsiflexion

Question 665

Where do anal fissures usually happen?

Answer 665

longitudinal tears in posterior midline of anal canal, distal to pectinate line probably posterior is most common b/c least perfusion, so slowest healing and more sensitive to trauma usu due to constipation; if not midline, consider IBD etc as cause

Question 666

Dystonia - definition and most common types?

Answer 666

sustained, invol muscle contractions cervical dystonia (torticollis) = most common, then blepharospasm (eyelid closure), then writer's cramp

Question 667

Sx of hypothyroidism (beside metabolic ones)

Answer 667

slowing of metabolic processes (eg weight gain) matrix glycosaminoglycan accum (coarse, dry skin; hoarseness, nonpitting edema, macroglossia) depression myalgia and arthralgia (get myoedema - focal mounding of muscle with percussion - due to slow reabs of Ca into SR) - CK may be elevated BEFORE OTHER SX OF HHYPOTHYROIDISM DEVELOP hypercholesterolemia

Question 668

Causes of elevated CK

Answer 668

hypothyroid autoimmune (eg polymyositis) muscular dystrophies meds (eg statins) vs. CK normal in glucocorticoid-induced myopathy and polymyalgia rheumatica

Question 669

Three kinds of creatine kinase

Answer 669

CK-MM (skeletal muscle) CK-MB (cardiac muscle) CK-BB (nervous system)

Question 670

Effect of beta blockers on K movement?

Answer 670

move K out of cells (vs beta agonists move K into cell)

Question 671

Chronic tic vs tourette

Answer 671

Tourette: multiple motor and one or more vocal tics (not necessarily concurrent) for > 1 year, onset before 18yo; tics may wax and wane, worse with fatigue/stress, preceded by urge and followed by relief Chronic tic: >=1 motor OR verbal (not both) tics for >=1 year

Question 672

pink frothy sputum and cough is a sign of ?

Answer 672

severe pulmonary edema that --> rupture of bronchial veins may be due to LV failure --> backup of blood into lungs and increased intrapulm pressure

Question 673

Enzymes that require thiamine?

Answer 673

pyruvate dehydrogenase and alpha-ketoglutarate dehydrogenase complexes

Question 674

Conditions that can cause carpal tunnel

Answer 674

anything that reduces carpal tunnel space pregnancy (fluid accum) hypothyroidism (glycosaminoglycan buildup, which also causes skin sx etc) DM (CT thickening) RA (tendon inflamm) dialysis (amyloidosis) MAY OCCUR BILATERALLY

Question 675

Conditions that can cause carpal tunnel

Answer 675

anything that reduces carpal tunnel space pregnancy (fluid accum) hypothyroidism (glycosaminoglycan buildup, which also causes skin sx etc) DM (CT thickening) RA (tendon inflamm) dialysis (amyloidosis) MAY OCCUR BILATERALLY

Question 676

Treatment of PCOS - general? for women who want to get pregnant? for women who don't want to get pregnant?

Answer 676

general: weight loss if that doesn't work, and want to get pregnant: clomiphene or other SERM (blocks estrogen negative feedback on HT --> increased GnRH release --> increased LH and FSH --> ovulation) if weight loss doesn't work and don't want to get pregnant: OCPs (progestin decreases endometrial proliferation, estrogen/progestin suppress LH secretion and increase SHBG synthesis in liver, which binds up free androgens and decreases their effects)

Question 677

Most susceptible vascular beds to atherosclerosis?

Answer 677

lower abdominal aorta, coronary arteries (bends and branch points --> turbulence that causes endothelial dysfxn and prolonged contact with cholesterol in blood) **predominantly plaques develop in big elastic and large/medium-sized muscular arteries (eg coronary) - in aorta, lesions = most prominent around ostia of branches (more turbulent) next most common: popliteal arteries, internal carotid arteries, and circle of willis

Question 678

Vessels that are resistant to developing atherosclerosis?

Answer 678

internal mammary arteries often used in CABG for that reason

Question 679

Progressive supranuclear palsy

Answer 679

form of parkinsonism from deposits of phosphorylated tau proteins --> neurodegen of MIDBRAIN AND FRONTAL SUBCORTICAL WM sx: gait dysfxn and falls, executive fxn loss, vertical gaze palsy

Question 680

How to distinguish CMV from EBV mono?

Answer 680

EBV --> positive monospot (heterophile antibody agglutination) also EBV more commonly causes pharyngitis and LAD both cause atypical lymphocytes, fever, fatigue, splenomegaly EBV infects B cells; CMV infects leukocytes (granulocyte-macrophage precursors) mono-like illness that's monospot neg can also be caused by HHV6, HIV, and toxo

Question 681

cardiovasc sx of SLE and what causes them?

Answer 681

serosal inflamm is common, and often manifests as pleuritis or PERICARDITIS (pleuritic pain that increases with inspiration and is relieved by sitting up and leaning forward) can hear friction rub also Libman-sacks endocarditis, pericardial effusion, increased risk of CAD

Question 682

Listeria - drug resistance?

Answer 682

develops resistant PBP, so resistant to PCN, cephalosporin etc susc to ampicillin (so empiric abx for infants and IC pts with meng often include ampicillin)

Question 683

Drugs that can prolong QT

Answer 683

class IA and III antiarrhythmics (quinidine, sotalol) antibiotics (eg macrolides, quinolones) methadone antipsychotics (eg haloperidol)

Question 684

If have to do horizontal transection of rectus abdominus, which vessels have to be ligated?

Answer 684

inferior epigastrics (don't have supporting posterior sheath surrounding rectus abdominus below the arcuate line, so no protection)

Question 685

Xanthelasma vs other xanthomas?

Answer 685

xanthelasma - in 50% pts, no associated lipid abnormality, no inflamm or fibrotic stroma around them other xanthomas - lipid-macrophages surrounded by inflamm cells and fibrotic stroma (can be eruptive and sudden, plane in PBC, tuberous/tendinous on achilles and extensor tendons)

Question 686

ovarian epithelium type? fallopian tube/uterus/upper cervix (endo) epith type? lower (ecto) cervix/vagina epith type?

Answer 686

ovary = simple cuboidal tubes/uterus/endocervix = columnar ectocervix/vagina = stratified squamous (nonkeratinized)

Question 687

Why is it bad to give glucose before thiamine in Wernicke?

Answer 687

b/c giving glucose ramps up glycolysis and TCA, which uses up what little thiamine is left and worsens the deficiency (since thiamine is used in pyruvate dehydrog and alpha-ketoglutarate dehydrog)

Question 688

Maple syrup urine disease is caused by deficiency in ....? and what are the cofactors of that enzyme complex?

Answer 688

deficiency in branched-chain alpha-ketoacid dehydrogenase complex - any of four genes that code for catalytic subunits of enzyme complex can be mutated similar to pyruvate dehydrog and alpha-ketoglutarate dehydrog (5 cofactors: thiamine, lipoate, CoA, FAD, NAD)

Question 689

Antibiotic resistance that occurs through drug modification by bug?

Answer 689

aminoglycosides

Question 690

Antibiotic resistance that occurs via influx/efflux pumps?

Answer 690

vanc, quinolones, TCNs, macrolides

Question 691

Antibiotic resistance that occurs via inactivating enzyme?

Answer 691

TCNs - bug enzyme allows ribosome to do translation even in presence of TCNs

Question 692

Most notorious side effect of amphotericin B? vs. azole side effect?

Answer 692

amph: renal toxicity (reduced GFR and renal vasocon + direct tubule damage) can --> hypokalemia and hypoMg azoles: hepatotoxicity

Question 693

Erythema multiforme - what is it and what causes it?

Answer 693

- red, round papules that become target lesions with dusky central area, red zone and pale ring around that; cell-mediated immune response with CD8 infiltrate - cause = infxn usually (esp HSV and mycoplasma) - may = due to immune response against bug antigens deposited in skin; also assoc with sulfonamides and other drugs, malig, collagen vasc dz - NOT systemic infxn, but systemic response to local infxn

Question 694

sx of TCA overdose and how to reverse it?

Answer 694

anti-cholinergic (dry mouth, blurred vision, dilated pupils, urinary retention, hyperthermia, flushing) sedation (AMS, respiratory depression) blockade of heart Na channels (arrhythmias, prolonged PR/QRS/QT intervals) alpha 1 receptor blocking (hypotension with reflex tachy) reversal: sodium bicarb to treat widened QRS and ventricular arrhythmias (it increases serum pH, which favors neutral form of drug, so it's less accessible to bind Na channels; also increases Na conc which helps overcome blockade)

Question 695

acetaminophen vs ibuprofen vs aspirin

Answer 695

acetaminophen = tylenol; antipyretic but NOT anti-inflamm ibuprofen = NSAID (reversible cox inhibitor) aspirin = NSAID (irreversible COX inhibitor)

Question 696

Classic presentation of benzo overdose and reversal

Answer 696

depressed CNS with normal vital signs reversal = flumazenil

Question 697

Bleeding time is a test of what?

Answer 697

Platelet function NOT COAG FACTORS

Question 698

What kind of colonic polyp causes watery diarrhea?

Answer 698

Villous adenoma - secretes watery mucus --> secretory diarrhea, hypovolemia, electrolyte abnormalities vs. hamartomatous polyps can cause bleeding and intussusception hyperplastic = asymptomatic carcinoids can cause diarrhea but also flushign, wheezing, telangiectasia

Question 699

Why do you get lactic acidosis with sepsis?

Answer 699

decreased end organ perfusion --> decreased tisue oxygenation and thus decreased ox phos also hepatic hypoperfusion means liver can't clear lactate by converting it back to glucose

Question 700

Damage to nucleus ambiguus causes ___?

Answer 700

myoclonus

Question 701

aplastic crisis vs aplastic anemia

Answer 701

crisis = just RBC problem (eg parvo infection of RBCs in sickle cell patient) aplastic anemia = bone marrow failure --> PANCYTOPENIA

Question 702

How to treat coag-negative staph?

Answer 702

common cause of infection in pts with catheters or foreign implants (create biofilm) most = methicillin-resistant, so start with vanc as empiric abx if susc results show susc to methicillin, use nafcillin or oxacillin (anti-staph pcns that resist staph beta lactamases)

Question 703

"Endoneural inflammatory inflammation"

Answer 703

think Guillain-Barre (ascending flaccid paralysis and hyporeflexia due to autoimmune attack of myelin sheath)

Question 704

Mechanism of AAA

Answer 704

chronic transmural inflammation of the aortic wall --> degradation of elastin and collagen and remodeling of the wall that --> weakness vs "fibrinoid necrosis" = immune process in vasculitis

Question 705

Jervell and Lange-Nielsen syndrome

Answer 705

one of most common congenital long-QT syndromes also congenital neurosensory deafness

Question 706

pituitary apoplexy - most common cause and tx?

Answer 706

cause = adenoma tx = glucocorticoid replacement (to prevent hypotension) and surgery

Question 707

Malformed teeth are a sign of congenital ______

Answer 707

syphilis

Question 708

Effect of Fe deficiency anemia on serum transferrin

Answer 708

Increased transferrin (liver makes more transferrin with Fe deficiency) Increased TIBC (decreased saturation with decreased Fe supply)

Question 709

Symptoms of HSP

Answer 709

young kids, usu after URI abdominal pain (+/- bleed), joint pain, LE purpura (from IC deposition in skin), hematuria (from IC deposition in mesangium)

Question 710

Symptoms of Kawasaki and tx

Answer 710

medium-vessel vasculitis, esp in young kids swollen ln, red eyes, high fevers, strawberry tongue, perioral erythema and fissuring, can develop coronary artery aneurysm --> thrombosis or rupture! tx = IVIG and aspirin

Question 711

WHich vessel do you ligate with postpartum hemorrhage?

Answer 711

internal iliac - uterine aa branch off the internal iliac enough collaterals to uterus (from ovarian arteries, which branch off abdominal aorta) to maintain uterine fxn after ligation

Question 712

Three drugs to treat alcohol dependence and mech of each?

Answer 712

- naltrexone (blocks mu opioid receptor, so blocks rewarding effects of alcohol and decreases craving) - disulfiram (inhibits alcohol dehydrogenase so acetaldehyde accumulates when you drink --> nausea, vomiting, flushing, sweating, headache, palp etc) - acamprosate (NMDAR modulator, decreases withdrawal sx; mech unknown)

Question 713

N. meng capsular polysaccharide vs outer membrane lipooligosaccharide (LOS)

Answer 713

capsule polysacch = important virulence factor that prevents phagocytosis LOS = endotoxin that --> systemic inflamm and sepsis (analogous to LPS; increased LOS --> worse prog)

Question 714

Broad- vs. narrow-spectrum anticonvulsants and uses?

Answer 714

broad: lamotrigine, levetiracetam, topiramate, valproic acid - use for generalized seizure disorders (both hemispheres involved) - tonic-clonic, myoclonic, absence narrow: carbamazepine, gabapentin, phenobarb, phenytoin (for simple and complex partial seizures)

Question 715

Lumbosacral plexopathy

Answer 715

injury during labor where fetus directly compresses lumbosacral trunk on its way out mom presents with foot drop and numbness of lateral aspect of leg and dorsum of foot (peroneal) - usually self resolves

Question 716

cause of fecal/urinary incontinence following labor?

Answer 716

stretch injury to pudendal nerve, which does sensory innervation fo external genitalia + skin around anus and perineum + motor innervation of pelvic floor mm and external urethral and anal sphincters

Question 717

alopecia areata + tx

Answer 717

autoimmune disorder that --> rapid onset patchy or diffuse hair loss tx: intralesional glucocorticoids

Question 718

high- vs low-grade CIN - how are they defined?

Answer 718

high: atypical cells extend beyond bottom 1/3 of cervical epithelium low: atypical cells are only in bottom 1/3 of epithelium (usually regress spontaneously)

Question 719

Effective abx for anaerobes

Answer 719

often produce beta lactamase, so Pip-tazo works, as does metronidazole, carbapenems, and clindamycin

Question 720

Tumor under the nail could be _ or __?

Answer 720

melanoma or glomus tumor (made of smooth muscle cells of thermoregulatory glomus body)

Question 721

complete hemithorax opacification on CXR - causes and how to tell them apart?

Answer 721

1. collapsed lung, usu due to mainstem bronchus obstruction --> alveolar collapse as air inside them is absorbed into blood --> pull trachea and other organs TOWARD affected side 2. pleural effusion, if really big --> tracheal deviation AWAY from affected side

Question 722

Mechanism of DIC in obstetrics?

Answer 722

placental injury (eg abruption) --> release of tissue factor from trophoblasts into maternal circulation --> activation of intravasc coag and microthrombi that circulate and --> organ ischemia, clotting and breaking up clots (increased d-dimer from fibrinolysis) most common cause is htn --> placental abruption --> fetal demise and DIC

Question 723

DIC in pregnant woman with hypotension and cardiogenic shock?

Answer 723

amniotic fluid embolism (fetal antigens in amniotic fluid --> clotting cascade)

Question 724

Bug that typically causes epididymitis?

Answer 724

Gonorrhea or Chlamydia

Question 725

Antivirals that don't require viral kinase?

Answer 725

foscarnet nucleotide analogs (cidofovir, tenofovir) - vs nucleoside analogs (acyclovir, famcyclovir, gancicylovir etc) need viral kinases so in thymidine-kinase deficient VZV strains (isolated mostly in HIV pts), use these drugs

Question 726

Use of terbutaline in mom has been linked to what AEs in baby?

Answer 726

used to delay labor by relaxing uterus AEs in baby: intraventricular hemorrhage, hypoglycemia, hypocalcemia, ileus

Question 727

Hemolysin

Answer 727

secreted by Staph aureus --> hemolysis, destruction of PMNs, macrophages, plts

Question 728

Fibronectin

Answer 728

glycoproteins in the ECM made by fibroblasts and epithelial cells that bind to integrins (transmembrane proteins) and collagen - link between cell and ECM collagen

Question 729

Two types of glycosaminoglycans in the ECM and their fxn?

Answer 729

hyaluronic acid - water retention and matrix stiffness keratan sulfate - maintaining type I collagen fibril organization

Question 730

Sentinel event

Answer 730

sort of red flag unexpected occurrence involving death or serious physical or psychological injury that requires immediate investigation

Question 731

definition of "preventable adverse event"

Answer 731

injury to a patient due to FAILURE TO FOLLOW EVIDENCE-BASED BEST PRACTICE GUIDELINES

Question 732

Dimpling of the breast in breast cancer indicates what?

Answer 732

invasion of suspensory ligaments of the breast

Question 733

How to treat ER+ tumor in pre- vs post-menopausal women?

Answer 733

pre: still have lots of aromatase in their ovaries, so use GnRH analog (continuous) like goserelin post: decreased granulosa cells so less aromatase in ovaries, and can use aromatase inhibitors (eg anastrozole, exemestane) to decrease extraovarian aromatase activity

Question 734

Mechanism of testicular torsion

Answer 734

inadequate fixation of lower pole of testis to tunica vaginalis --> twisting pampiniform plexus is compressed so no blood outflow, but testicular arteries are ok for a while --> blood inflow with no drainage --> engorgement --> hemorrhagic infarction sx: pain, high-riding testis, no cremasteric reflex, n/v

Question 735

Effects of TCAs

Answer 735

1. Inhibit reuptake of NE and serotonin 2. mAChR antag (tachy, delirium, pupil dilation, flushing, sweating, urinary retention etc) 3. alpha 1 antag (vasodil) 4. anti-hist (H1) --> sedation, increased app 5. block cardiac fast sodium channels (conduction problems, arrhythmias)

Question 736

Most common cause of death in TCA overdose?

Answer 736

cardiac arrhythmias from blocking Na channels (slowed cardiac depol)

Question 737

Most common cause of death in TCA overdose?

Answer 737

cardiac arrhythmias from blocking Na channels (slowed cardiac depol)

Question 738

Sx of glucagonoma

Answer 738

necrolytic migratory erythema DM (hyperglycemia) normocytic normochromic anemia GI sx (diarrhea, ab pain etc)

Question 739

necrolytic migratory erythema

Answer 739

erythematous papules/plaques on face, perineum, extremities that coalesce and form bronze-colored central indurated area with peripheral blistering and scaling seen with glucagonoma from low levels of circulating AAs (since they're all being used for gluconeo)

Question 740

p27

Answer 740

cell cycle inhibitor present in low quantities in many tumors, so decreased G1-->S inhibition

Question 741

Sx of theophylline intoxication? Tx?

Answer 741

Seizures - treat with benzos and barbs tachyarrhythmias - treat with beta blockers activated charcoal to decrease GI abs

Question 742

Sx of iron poisoning

Answer 742

hematemesis, melena (iron is toxic to gastric mucosal cells)

Question 743

Hyperplastic vs hyaline arteriolosclerosis?

Answer 743

hyperplastic = with super high BP, onion skinning hyaline = moderately high BP, deposition of hyaline material in intima and media

Question 744

Flow = ? Flow, vessel radius relationship?

Answer 744

Flow = P/R R = 8*nu*L/r^4 so flwo is directly proportional to vessel radius^4

Question 745

Pure red-cell aplasia causes

Answer 745

decreased RBCs and retics but normal granulopoiesis and thrombopoiesis causes: auto-IgG or cytotoxic Ts inhibit erythroid progenitors - associated with thymomas and lymphocytic leukemias, parvo

Question 746

Reverse T3

Answer 746

inactive form of thyroid hormone generated from peripheral T4

Question 747

Why don't we give hypothyroid patients T3?

Answer 747

short t1/2, so pts can have wide fluctuations in plasma T3 levels

Question 748

types of exocrine glands

Answer 748

merocrine (secrete via exocytosis) - salivary, eccrine sweat glands, apocrine sweat glands apocrine (secrete via membrane-bound vesicles) - mammary glands holocrine (secrete via cell lysis, releasing cell contents) - sebaceous glands, meibomian glands (eyelids)

Question 749

What causes urine leakage 5-10 days post-kidney transplant?

Answer 749

transplanted kidney is placed retroperitoneally with its ureter and the ureter is connected to recipient's bladder usually distal ureter has lots of anastomotic blood supply; proximal ureter has donor renal artery to supply it, but distal donor ureter is susc to ischemia --> leakage of urine

Question 750

effect of multiple myeloma on the kidney?

Answer 750

tubular obstruction (due to precipitation of free light chains [bence jones proteins] with tamm-horsfall protein --> tubular casts)

Question 751

E Coli virulence factor that causes meng? In E Coli that cause UTIs? In E Coli that cause sepsis?

Answer 751

neonatal meng: K1 capsular antigen UTIs: fimbriae LPS: sepsis (causes macrophage activation --> release of IL1, IL6, and TNFalpha)

Question 752

Mucicarmine stain

Answer 752

stains cryptococcal capsule red

Question 753

pathophys of photoaging? which UV and what happens to collagen?

Answer 753

UVA (vs UVB causes upper dermis damage and increases risk of malignancy) increased ROS --> decreased collagen fibril production, increased cross-linking of collagen that is there and increased MMPs, which break down that collagen and elastin --> deposition of collagen breakdown products also get thinning of epidermis and atrophy of dermis --> wrinkling

Question 754

How does the menotropin/hCG combo work?

Answer 754

induce ovulation menotropin mimics FSH --> follicle development then give hCG to mimic LH surge and stimulate ovulation of that follicle

Question 755

Order of tx in anaphylaxis?

Answer 755

epinephrine first then anti-histamines or steroids

Question 756

ubiquitination roles

Answer 756

antigen processing muscle wasting (atrophy) cell cycle regulation DNA repair disposal of misfolded proteins impaired in neurodegen dz (eg Parkin, PINK1, and DJ-1 mutations that --> aut recessive, early onset PD) need 4 ubiquitin tags on protein, added in ATP-dependent process, to degrade it

Question 757

IFN-alpha is used to treat what viruses?

Answer 757

hep B and C, Hairy Cell leukemia, condyloma acuminatum, kaposi's sarcoma

Question 758

CD31, aka?

Answer 758

PECAM1 expressed on surface of endothelial cells and functions in leukocyte migration through endothelium look for it to ID vascular tumors (eg angiosarcoma)

Question 759

Straight leg test - use?

Answer 759

pain elicited in supine patient with leg held straight and raised sign of sciatic nerve root irritation (L4-S3) usually from intervertebral disc herniation

Question 760

Primary route of copper excretion?

Answer 760

whatever is ingested and not incorporated into ceruloplasmin is secreted by liver into bile and excreted in stool

Question 761

aseptic (viral) vs bacterial meng: CSF findings and sx

Answer 761

CSF: - bacterial: low glucose, high protein - viral: normal-slightly low glucose, low/normal protein sx: aseptic is usually less severe (no focal neuro sx, seizures, or AMS; if yes, consider alternative diag, like bacterial meng, encephalitis, intracranial hemorrhage)

Question 762

What is a spacer and why do patients need it?

Answer 762

piece that fits on inhaler to ensure appropriate dose and inhalation technique with long-acting steroid inhaler for asthma helps prevent oropharyngeal candidiasis (also rinse the mouth)

Question 763

role of neurophysins

Answer 763

posttanslational processing and stabilization of oxytocin and vasopressin within their secretory vesicles in herring bodies (axons of HT neurons that descend into posterior pit)

Question 764

Through what area do direct inguinal ligaments protrude? Due to weakness in what?

Answer 764

through hesselbach's triangle (bordered by inguinal ligament, inferior epigastric vv laterally, and rectus abdominus medially) due to weakness in transversalis fascia (floor of triangle)

Question 765

cause and sx of: familial chylomicronemia familial hypercholesterolemia familial dysbetalipoproteinemia familial hyperTGemia

Answer 765

CM: LPL defect - can't break down CMs, so get acute pancreatitis, eruptive xanthomas, lipemia retinalis (milky retina) cholesterolemia: LDL receptor defect - tendon xanthomas, premature CAD dysbetalipoproteinemia: ApoE defect so can't clear CMs and VLDL remnants --> tuboeruptive and palmar xanthomas, premature CAD and peripheral vasc dz hyperTGemia: ApoA defect usually so can't clear VLDL --> increased risk of pancreatitis, associated iwth obesity and insulin resistance

Question 766

how do CD8 t cells kill infected cells?

Answer 766

induce apoptosis

Question 767

How does entamoeba histolytica get to liver to form cyst?

Answer 767

ingest it and it ascends from colon through portal venous sytem to liver

Question 768

how can enteric bugs cause liver abscess? (routes of access)

Answer 768

biliary tract infxn (ascending cholangitis) portal vein pyemia (from bowel or peritoneum) direct invasion from adjacent source (peritonitis, cholecystitis)

Question 769

Drug of choice for unruptured ectopic?

Answer 769

methotrexate hinder growth of rapidly dividing embryonic cells

Question 770

when do you see first histo signs of MI? when do you first see PMNs? macrophages? granulation tissue and neovascularization? Scar?

Answer 770

4 hours after onset of severe ischemia (start to see coag necrosis, edema, punctate hemorrhage, wavy fibers) PMNs at 1-3d Macrophages at >= 5 days Granulation tissue and neovasc >= 7 days scar >= 2 weeks - 2 months

Question 771

Cause of hypocalcemia with blood transfusion?

Answer 771

citrate anticoagulant in transfused blood can chelate Ca only causes problems with massive transfusions over 24 hrs (5-6L)

Question 772

Symptoms of cerebellar hemisphere lesion

Answer 772

impaired coordination and motor planning in IPSILATERAL extremities - dysdiadochokinesia (impaired RAMs) - limb dysmetria (over/undershoot) - intention tremor

Question 773

Most common cause of death in DM?

Answer 773

Coronary heart disease

Question 774

Three strongest risk fx for development of coronary heart disease?

Answer 774

DM, noncoronary atherosclerotic disease, CKD

Question 775

significance of monoclonality in B or T cell population in a lymph node?

Answer 775

indicates malignancy in lymph node (if responding to antigen, multiple genetically-distinct cells undergo limited monoclonal expansion --> overall polyclonal response, but malig = monoclonal) test with PCR to look at rearrangement of receptor genes (T cells) or Ig variable regions (B cells)

Question 776

What is "microsomal monooxygenase"?

Answer 776

cytochrome P450 mooxygenase in hepatic microsomes and ER - metabolizes toxins etc by making them soluble, but that can also convert pro-carcinogens to carcinogens (eg benzopyrene) so if have increased p450 activity (genetic), more susc to these pro-carcinogens

Question 777

Call-Exner body - what does it look like and what cancer?

Answer 777

Granulosa cell tumor granulosa cells gathered in microfollicular pattern around pink, eosinophilic center + coffee-bean nuclei other clues: yellow tumor (b/c of lipid content in theca cells) + endometrial hyperplasia from excess estrogen made by tumor vs. schiller-duval bodies of endodermal sinus tumor (increased AFP)

Question 778

what does it mean to have "decreased lung elastic recoil" in COPD?

Answer 778

decreased radial traction --> dynamic airway collapse

Question 779

histo finding in PML?

Answer 779

cytoplasmic inclusions in oligodendrocytes

Question 780

most common cause of spontaneous lobar hemorrhage?

Answer 780

amyloid angiopathy vs. charcot-bouchard aneurysm rupture causes hemorrhage of deep brain structures

Question 781

Mycotic aneurysm

Answer 781

local destruction and dilation of arterial wall due to infection (doesn't have to be fungal, despite the name)

Question 782

Basophils release?

Answer 782

Heparin (anticoag) and histamine (vasodil)

Question 783

Cardiac manifestations of systemic sclerosis

Answer 783

- cor pulmonale due to PAH - pericardial disease - myocardial fibrosis - conduction system disease

Question 784

Short- vs long-acting second-generation sulfonylureas

Answer 784

short: glipizide (decreased risk of hypoglycemia) long: glyburide, glimepride (higher incidence of hypoglycemia, esp in elderly)

Question 785

Role of indomethacin in treating nephrogenic DI?

Answer 785

PGs inhibit ADH, so inhibit PGs to increase effect of endogenous ADH

Question 786

Inheritance pattern for achondroplasia

Answer 786

Autosomal dominant

Question 787

Why must NSAIDs be avoided in hyperthyroid pts?

Answer 787

NSAIDs can displace thyroid hormones from binding proteins, thus increasing circulating levels of thyroid hormones

Question 788

Chorionic somatomammotropin, aka

Answer 788

human placental lactogen increases insulin resistance in mom during 2nd and 3rd trimesters

Question 789

Effect of nitroprusside on preload and afterload

Answer 789

Decreases both b/c it's a balanced venous and arterial vasodilator

Question 790

Otic ganglion

Answer 790

innervates parotid gland (salivation)

Question 791

Vascular dementia - ischemic lesions of what part of brain?

Answer 791

subcortical white matter

Question 792

Sx that distinguish Marfan and homocystinuria

Answer 792

Marfan - ectopia lentis (dislocated lens) = upward, aortic root dilation Homocystinuria - ectopia lentis = downard, ID, thrombosis, megaloblastic anemia, fair complexion

Question 793

Complementation

Answer 793

2 parents give rise to distinct phenotypic trait because they each have homozygous mutations in different genes that participate at different steps of same pathway

Question 794

Effect of Ca on QT interval

Answer 794

hypocalcemia --> QT prolongation hypercalcemia --> QT shortening

Question 795

Effect of K on EKG

Answer 795

hyperkalemia - peaked T, loss of P, prolonged PR, widened QRS, slowed HR, vfib if severe hypokalemia - U wave, QT prolongation, ST depression, torsades if severe

Question 796

Lateral gaze palsy usually results from lesion where? Vertical gaze palsy from lesion where?

Answer 796

Lateral = pontine lesion that affects abducens (or FEF lesion) Vertical = superior colliculus lesion (eg stroke, pinealoma)

Question 797

Mammary duct ectasia histo

Answer 797

ductal dilation and inspissation with breast secretions around the ducts, chronic granulomatous inflammation

Question 798

Why is the spleen so important in immune response to encapsulated bugs?

Answer 798

1. spleen's phagocytes clear bugs that haven't been opsonized (capsule protects these guys from opsonization) 2. spleen contains about 50% of body's B cells that make opsonizing antibodies so double whammy - can't opsonize and can't clear stuff that isn't opsonized

Question 799

Pathophys cause of lactose intolerance?

Answer 799

decreased lactase gene expression with age

Question 800

Risk factors for nasopharyngeal carcinoma?

Answer 800

EBV, nitrosamines, tobacco, alcohol

Question 801

What to do with patient with low back pain?

Answer 801

If have red flag sx (>50yo, history of cancer, constitiutional sx, nighttime pain, pain > 1 month, no response to nsaids etc, neuro deficits, positive straight leg test [suggests radiculopathy]) - plain film X ray and ESR (suggests malignancy or inflamm condition); f/u Xray with MRI if necessary else just NSAID or acetaminophen + moderate, regular physical activity SIGNS OF CORD COMPRESSION (eg bowel/bladder dysfxn, saddle anesthesia, motor weakness) - URGENT MRI to exclude cauda equina syndrome from infxn or tumor

Question 802

what nerve travels through spiral groove on humerus?

Answer 802

radial injured with midshaft humerus fracture triceps reflex, elbow extension, and sensation over posterior arm all are intact b/c nerves branch off radial before entering groove; only get wrist/finger extensor problems (wrist drop)

Question 803

what nerve travels through spiral groove on humerus?

Answer 803

radial injured with midshaft humerus fracture triceps reflex, elbow extension, and sensation over posterior arm all are intact b/c nerves branch off radial before entering groove; only get wrist/finger extensor problems (wrist drop)

Question 804

What and where in the brain are negri bodies?

Answer 804

- nucleocapsid material from rabies virus that looks like eosinophilic cytoplasmic inclusions - where? hippocampus

Question 805

xerosis

Answer 805

aka asteatotic dermatitis, or "winter's itch" indoor heaters lower humidity of ambient air --> defects in stratum corneum permeability barrier; common in elderly tx: maintain and replenish barrier - use lukewarm water to bathe with neutral or acidic cleansers and moisturize immediately after

Question 806

Similarities and differences b/w presentation of McArdle and FA metabolism defects?

Answer 806

FA metab defects --> buildup of TGs in muscle --> myalgias, but usually with prolonged exercise, and they don't improve with rest vs. McArdle - myalgia is basically immediate with exertion and improves with rest (increased blood to mm with FFAs etc for energy)

Question 807

First sign of cavernous sinus thrombosis?

Answer 807

lateral gaze palsy, from compression/involvement of CN6

Question 808

trophozoites with phagocytosed RBCs in their cytoplasm?

Answer 808

entamoeba histolytica oral-fecal (household contacts, sexual activity, water)

Question 809

Effect of probenecid on PCN

Answer 809

probenecid blocks organic anion transporters in the prox tubule, so on basolateral side, blocks PCN secretion (and thus excretion, raising plasma PCN levels) by blocking OAT - used in PCN resistance, neurosyphilis, gonorrhea on apical side, blocks urate transporter to decrease uric acid reabs

Question 810

general cause of syncope? mech of cough syncope?

Answer 810

generally: decrease in cerebral blood flow cough: increased intrathoracic pressure during cough --> decreased venous return to heart --> transient decrease in CO and cerebral perfusion

Question 811

what happens when you stimulate the vagus nerve in the external ear (auricular branch)?

Answer 811

reflex cough or vomiting

Question 812

Drugs used to coat coronary stents to prevent stent thrombosis and restenosis due to intimal hyperplasia?

Answer 812

- sirolimus - paclitaxel (inhibits cellular division so prevents intimal hyperplasia) risk of thrombosis continues for longer with drug-coated stents b/c takes longer to form new endothelium over them, so must keep pts on anti-plt agents for longer to prevent late stent thrombosis

Question 813

only RNA viruses that replicate in the nucleus? only DNA virus that replicates in the cytoplasm?

Answer 813

RNA: influenza, retroviruses DNA: pox

Question 814

mm that act on clavicle when it's fractured?

Answer 814

delt pulls lateral fragment inferolaterally SCM and trap pull more medial segments superiorly and medially net effect is increased separation of fractured bone, which increases risk of nonunion

Question 815

melanoma susceptibility locus

Answer 815

CDKN2A on chromosome 9p21 - gene encodes CDK inhibitor 2A/p16, which is a cell cycle inhibitor mutation there --> uncontrolled proliferation and increased susc to melanoma associated with dysplastic nevus syndrome

Question 816

Leucine zippers

Answer 816

class of eukaryotic TF - 2 alpha helices with leucine at every 7th position combine, and have lots of Arg and Lysine at the base of the complex (basic AAs) that can bind in major groove of DNA --> TFs other motifs seen in TFs: zinc finger structure, helix-loop-helix

Question 817

Causes of positive psoas sign

Answer 817

Appendicitis, psoas abscess

Question 818

Inheritance pattern for Alport syndrome?

Answer 818

X linked

Question 819

p57 significance with mole?

Answer 819

p57 is a paternally imprinted but maternally expressed gene, so in complete mole (no maternal genetic material, just double dad), negative staining for p57 vs partial mole - p57 positive

Question 820

Factor that causes greatest increase in risk of coronary artery disease?

Answer 820

Smoking

Question 821

Diaphragmatic apertures and what passes through them?

Answer 821

Vena caval aperture at T8 (IVC, right phrenic nerve) Esophageal hiatus at T10 (esoph, anterior and posterior trunks of vagus) Aortic hiatus at T12 (aorta, thoracic duct, azygous) ``` T10 = "oesophagus" T12 = "At T-1-2 it's the red, white, blue" ```

Question 822

pathophys of MODY?

Answer 822

maturity-onset diabetes of the young, usually in thin, young person often caused by mutation in glucokinase gene or associated TFs so t hat you need more glucose to get insulin release (decreased affinity of glucokinase in pancreatic beta cells) usually mild hyperglycemia that doesn't require medication

Question 823

straight leg raise test

Answer 823

to test for radiculopathy, usually due to herniated disk (esp at L5/S1) can also be due to skeletal problem (eg foraminal stenosis) or infection, tumor most cases resolve on their own in a few weeks-months

Question 824

Cytotoxic vs. vasogenic edema

Answer 824

cytotoxic - cellular injury impairs Na/K ATPase --> cells swell vasogenic: increased vascular permeability and plasma filtration into the interstitium; happens in brain from tumors due to disruption of BBB --> increased ICP

Question 825

Causes of increased ICP with brain tumor?

Answer 825

Disruption of BBB --> vasogenic edema CSF obstruction with tumors in third ventricle --> non-comm hydrocephalus

Question 826

anatomy of the cervix from out to in?

Answer 826

exocervix (external os) is lined with stratified non-keratinized squamous epith --> transformation zone/squamocolumnar junction --> simple columnar epithelium lining endocervical canal, which runs from external os to internal os/endocervix and contains mucus-secreting glands

Question 827

Blood sx of SLE?

Answer 827

warm AIHA and Ig to plts and WBCs --> pancytopenia