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UWorld Journal Flashcards

1
Q

blood supply to the liver

A

celiac –> common hepatic

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2
Q

uncomplicated umbilical hernia pathophys

A

incomplete closure of umbilical ring (doesn’t become linea alba)

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3
Q

long term asthma tx

A

glucocorticoids (like fluticasone)

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4
Q

what kind of volume contraction is diabetes insipidus

A

hyperosmotic vol contraction (lose more water than electrolytes, up osm, down ECF and ICF)

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5
Q

filtration rate of substance X (equation)

A

filtration rate of X = inulin clearance/plasma X

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6
Q

excretion rate of substance X (equation)

A

excretion rate of X = (inulin clearance)(plasma X) - (reabsorption of X)

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7
Q

amanita (mushroom) pathophys

A

bind to RNA polymerase I –> halt mRNA synth –> apoptosis

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8
Q

which cells make elastase in the lungs?

A

alveolar macrophages and neutrophils

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9
Q

where is the vomiting center of the brain?

A 
chemoreceptor trigger zone
dorsal medulla (area postrema)
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10
Q

agent present in perforated appendicitis

A

bacteroides fragilis (or other normal flora like E. coli, enterococci, streptococci)

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11
Q

how does pCO2 affect ICP

A

pCO2 down –> vasoconstriction (up vasc resistance) –> down ICP

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12
Q

gaussian distribution: SDs and %data

A

w/in 1 = 68%
w/in 2 = 95
2/in 3 = 99

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13
Q

hyperlipid med causes flushing

A

niacin

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14
Q

enzyme responsible for green sputum

A

myeloperoxidase from neutrophils

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15
Q

drug with AE of gingival hyperplasia

A

phenytoin

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16
Q

tx for DM with nephropathy

A

glycemic control + ACE inhibitors (-prils)

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17
Q

what is hot tub folliculitis

A

pseudomonas infection of skin from pool –> puritic papulopustular rash

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18
Q

what does the vitaline duct connect

A

ileum and umbilicus

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19
Q

abnormalities w/ vitaline duct

A

persistent (meconium from umbilicus)
meckel diverticulum (MC)
sinuses/cysts

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20
Q

when to use a chi-square test

A

association btwn 2 categorical variables

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21
Q

pathophys of trisomies

A

usually due to meiotic nondisjunction

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22
Q

what is used for MAC prophylaxis in AIDS pts?

A

azithromycin

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23
Q

Tx status epilepticus

A

IV benzos (lorazepam)

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24
Q

whats in MEN1

A

primary hyperparatyroidism
pit tumors
panc tumors

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25
Q

whats in MEN2A

A

medullary thyroid CA (calcitonin)
pheo
parathyroid hyperplasia

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26
Q

whats in MEN2B

A

medullary thyroid CA
pheo
mucosal neuromas

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27
Q

oral candida vs leukoplakia

A

candida scrapes off

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28
Q

e. coli pathophys –> septic shock

A

lipid A (of LPS) –> septic shock

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29
Q

septic shock sx

A 
fever
hTN
diarrhea
oliguria
DIC
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30
Q

what nerve is hurt if you lose plantar flexion and foot inversion?

A

tibial nerve

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31
Q

what are the deficits a/w tibial nerve injury?

A

cant plantarflex or invert

sensory: sole of foot (not big toe)

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32
Q

GH signaling pathway

A

JAK-STAT

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33
Q

where does heme synth take place

A

mitochondria

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34
Q

sx of congenital hypothyroidism

A

floppy baby, puffy face, umbilical hernia, protruding tongue, large anterior fontanelle

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35
Q

whats used in making NO

A

arginine, NADPH, O2

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36
Q

when do you see overlapping fingers in a newborn

A

edwards (tri18)

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37
Q

when do you see air in the biliary tree

A

gallstone ileus

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38
Q

when do you hear high pitched bowel sounds

A

small bowel obstruction

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39
Q

how do you get vibrio parahemolyticus

A

contaminated shellfish

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40
Q

what are the crescents in RPGN made of

A

fibrin

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41
Q

how to measure mitral regurge severity

A

time from S2 (A2) to opening snap

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42
Q

when do you see a liver w/ lymphocytic infiltration and destruction of small intrahepatic bile ducts?

A

primary biliary cholangitis

graft vs host disease

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43
Q

find out wtf azathioprine is

A

i dunno, look it up

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44
Q

cause of different clinical manifestations of a mitochondrial disorder

A

heteroplasmy (diff mitochondrial genomes in same cell)

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45
Q

pathophys cleft palate

A

maxillary prominence fails to fuse w/ intermaxillary segment (5th/6th week)

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46
Q

enzymes involved in regulating hypoglycemia due to fasting

A

glucagon (up hepatic glycogenolysis)
E/NE
cortisol (increases gluconeogenesis, lipolysis, proteolysis)

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47
Q

vitamin changes in SI bacterial overgrowth

A

more vit K, folate

less B12, iron, vit ADE

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48
Q

anticholinergic effects on vision/eyes

A

limit accomodation (blur close vision)
mydriasis
dry eyes

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49
Q

big P gap btwn aortic and LV P during systole indicates

A

aortic stenosis

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50
Q

chronic renal allograft rejection path

A

obliterative intimal thickening
tubular atrophy
interstitial fibrosis

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51
Q

hyperacute rejection of renal allograft path

A

vascular fibrinoid necrosis

neutrophil infiltration

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52
Q

COPD effects on kidney

A

hypoxia –> increased EPO production

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53
Q

capsofungin mechanism

A

suppress fungal cell wall synthesis

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54
Q

what karyotype is most common in partial mole

A

46XX (1 sperm duplicate)

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55
Q

how do you know if the CI is statistically significant?

A

95% does not include null

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56
Q

how to avoid acyclovir nephrotox

A

aggressive IV hydration

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57
Q

chest pain reproduced with palpation or changes in position

A

costosternal syndrome

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58
Q

bronchi vs bronchioles, cell differences

A

both have cilia

bronchioles lack goblet cells, glands, cartilage

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59
Q

pathophys of finger drop

A

repetitive movements –> damage to supinator canal –> radial nerve/deep branch/posterior interosseus nerve injury –> cant extend fingers/thumb

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60
Q

complication of reactive arthritis

A 
feratoderma blennorrhagicum (vesicles on palms/soles)
sacroiliitis
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61
Q

cause of caudal regression syndrome in newborns

A

uncontrolled DM (+other unknown)

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62
Q

AE levels in thiazide diuretic use

A

hypo: Na, K
hyper: Ca, glucose, cholesterol, urea

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63
Q

nerve compressed in saturday night palsy

A

radial

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64
Q

cytokines involved in granuloma formation (TB)

A

macs secrete IL-12 (activate TH1)

TH1 make IFN-alpha (recruits macs)

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65
Q

pathophys of S3

A

turbulent blood flow in ventricles from increased volume

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66
Q

pathophys of S4

A

blood hits stiff ventricle

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67
Q

which ulcers are rarely malignant

A

duodenal

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68
Q

whats the defect in Ehlers-Danlos

A

collagen synthesis

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69
Q

problem in scurvy

A

no vit C –> cant hydroxylate proline and lysine

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70
Q

where do you get the saphenous vein

A

inferolateral to pubic tubercke = femoral triangle: inguinal lig (sup), sartorius (lat) and adductor longus (med)

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71
Q

emphysema mechanism

A

oxidative injury –> macs/neuts make proteases –> degrade matrix + make more free radicals that mess with protease inhibitors –> proteases go wild (protease-antiprotease imbalance) –> acinar wall destruction –> irreversible airspace dilation

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72
Q

liquefactive necrosis pathophys

A

ischemia –> neurons release lysosomal enzymes which degrade tissue –> phagocytes come and remove necrosis –> cavity –> astrocytes proliferate around area to make scar (gliosis)

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73
Q

deltaF508 mutation –> ?

A

CF

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74
Q

what exactly happens w/ an RPR

A

mix serum w/ cardiolipin, cholesterol, lecithin
if it aggregates there are Abs present from cell destruction from treponema
(note: NOT testing for Abs against treponema)

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75
Q

difference btwn AF conduction and purkinje conduction

A 
AF = tachy (more common)
purkinje = brady
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76
Q

things made from POMC

A

ACTH
MSH
some endorphins apparently that act @ opioid receptors

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77
Q

pneumonia post flu (MC organisms)

A

strep pneumo
staph aureus
H flu

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78
Q

where (exactly) do beta blockers work

A

inhibit NT binding to receptor in adrenergic synapses

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79
Q

MC aortic rupture after blunt trauma

A

aortic isthmus

ascending is next but v rare

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80
Q

enzyme defect in xeroderma

A

defect in nucleotide excision repair
can’t take out thymine dimers
defective UV-specific ENDONUCLEASES

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81
Q

what does a virus need to do genetic shift?`

A

segmented genes

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82
Q

what is a/w absent CD18?

A

leukocyte adhesion deficiency

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83
Q

AEs of dopamine

A 
anxiety
agitation
confusion
delusions
hallucinations
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84
Q

what is IP3

A

inositol triphosphate

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85
Q

how does silicosis make someone more susceptible to TB?

A

silicosis impairs macrophage fxn (phagolysosomes disrupted by internalized silica, maybe)

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86
Q

liver and lungs?

A

alpha-1-antitrypsin deficiency

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87
Q

sx of pellagra

A

dermatitis
diarrhea
dementia

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88
Q

internal hemorrhoid drainage

A

middle rectal vein –> internal iliac

superior rectal vein –> inferior mesenteric

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89
Q

external hemorrhoid drainage

A

inferior rectal vein –> internal pudendal vein

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90
Q

what is pulsus paradoxus

A

fall in systolic BP > 10 w/ inspiration (cardiac tamponade, constrictive pericarditis, COPD, asthma, PE)

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91
Q

boggy uterus

A

uterine atony

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92
Q

surgery to stop uterine bleeding: which arteries?

A

bilateral internal iliacs

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93
Q

how do you dx parotitis

A 
increased amylase (w/o pancreatitis)
US/CT
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94
Q

parotitis sx

A

swelling
trismus
dysphagia
fever/chills

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95
Q

effects of prolactinoma on women

A

amenorrhea
galactorrhea
decreased bone density (less E)

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96
Q

prolactin inhibitory effects

A

suppress LH (and FSH, but less)

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97
Q

dx gout

A

synovial fluid crystal analysis (same as synovitis)

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98
Q

major AE w/ lamotrigine

A

stevens-johnson-syndrome

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99
Q

watershed areas of gut

A

splenic flexure

resctosigmoid jxn

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100
Q

what O2 thing stays the same in methemoglobinemia

A

PO2 (measure of dissolved O2, not whats on Hb)

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101
Q

opioid mechanism

A 
bind to mu receptors
G-protein coupled activation of K channels
up K efflux
hyperpolarization of neurons
termination of pain transmission
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102
Q

lack CD 55

A

paroxysmal noctural hemoglobinuria

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103
Q

paroxysmal noctural hemoglobinuria kidney things

A

hemoglobinuria (duh)

chronic hemolysis –> iron deposition in kidneys (hemosiderosis) –> mess with PCT fxn

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104
Q

Abs that react with tissue transglutaminase

A

celiac (tissue transglutaminase IgA)

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105
Q

dx for celiacs

A

check tissue transglutaminase IgA/antiendomysial Abs

biopsy duodenum or jejunum (flattened villi, increased intraepithelial lymphocytes)

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106
Q

ovary + stomach

A

krukenberg tumor

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107
Q

krukenberg tumor histo

A

mucin secreting signet cells

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108
Q

genes involved in colon adenoma to carcinoma

A

p53 and DCC

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109
Q

long QT mechanism

A

mutations in K channels –> prolong action potentials

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110
Q

hereditary pattern of NF1

A

AutoDom, chromosome 17

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111
Q

hemolysis of enterococcus

A

gamma…..no hemolysis

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112
Q

class I vs class II HLAs

A 
class I: B
class II: DP, DQ, DR
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113
Q

narrowing of the sacroiliac joints

A

ankylosing spondylitis

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114
Q

HLA a/w ankylosing spondylitis

A

HLAB27

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115
Q

drug abuse: nystagmus

A

PCP

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116
Q

what type of muscle fiber are postural muscles

A

type I: slow twitch: red, high myoglobin, high mitochondrial

mostly aerobic metabolism

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117
Q

wheres the vision loss with a right temporal lobe lesion

A

pie in the sky on L

meyers loop

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118
Q

recombination vs reassortment vs phenotypic mixing

A

recombination: non segmented viruses (progeny can have all new traits)
reassortment: segmented viruses (progeny can have either or both traits)
phenotypic mixing: 2 viruses in 1 host, released virions can have mix of phenotypes, next generation goes back to original

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119
Q

sertoli cells do what

A

make inhibin in response to FSH (inhibin inhibits FSH)

help with spermatogenesis

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120
Q

leydig cells do what

A

make T in response to LH (T inhibits LH and GnRH)

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121
Q

wtf are zinc fingers

A

DNA binding domain found on hormones that bind to DNA

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122
Q

which hormones have zinc fingers

A

steroids, thyroid hormone, fat soluble vitamin receptors (i know that isnt a hormone, leave me alone)

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123
Q

what does CO do to Hb

A

binds crazy strong (Hb is now carboxyhemoglobin)

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124
Q

CO on the O2 curve

A

left shift

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125
Q

marcus gunn pupil

A

lesion optic nerve

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126
Q

number needed to harm equation

A

1/attributable risk

AR = rate of tx - rate of placebo

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127
Q

causes of primary polydipsia

A

MDMA

psych d/os

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128
Q

complication of cavernous hemangioma

A

intracerebral hemorrhage

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129
Q

tx for adrenal crisis

A

glucocorticoid: hydrocortisone or dexamethasone

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130
Q

NO mechanism

A

NO –> up cGMP –> decrease intracellular Ca –> decrease myosin light chain kinase activity –> myosin light chain dephosphorylation –> muscle relaxation

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131
Q

what converts heme into biliverdin

A

heme oxygenase

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132
Q

when do you see postherpetic neuralgia

A

VZV (not HSV)

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133
Q

when to use the two sample t-test

A

comparing means of 2 pops

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134
Q

organophosphate mechanism

A

acetylcholinesterase inhibitor

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135
Q

where do you absorb fat

A

jejunum

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136
Q

abnormal ristocetin test

A

von Willebrand disease (poor platelet agg w/ ristocetin, agg w/ normal plasma)
Bernard-Soulier/GP Ib def (poor platelet agg w/ ristocetin, doesn’t fix w/ normal plasma)

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137
Q

mucocutaneous bleeding

A

von Willebrand (vWF)
Bernard-Soulier (GP IIb)
Glanzmann (GP IIb-IIIa)

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138
Q

diff btwn true and pseudo diverticula

A

true: include mucosa, submucosa, muscularis and serosa layers (Meckels, appendix)
pseudo: mucosa, submucosa, serosa (zenker, colon ticks)

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139
Q

what cells do Ab-dependent-cell-mediated-cytotox

A

eosinophils
macs
neuts
NK cells

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140
Q

when to use MAO-Is

A

atypical depression

Tx-resistant depression

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141
Q

atypical depression features

A

mood reactivity
leaden paralysis
rejection sensitivity
increased sleep/appetite

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142
Q

axonal rxn

A

changes in neuron after its severed

swollen, rounded, nuc displaced, nissl substance is granular and dispersed (central chromatolysis)

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143
Q

blood Abs: types

A

usually IgM (O moms have IgG – can cross placenta)

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144
Q

pharmacodynamic potentiation

A

more than the sum of its parts

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145
Q

Ca levels in metastatic bone cancer

A

hypercalcemia from destruction of bone

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146
Q

dopaminergic pathways

A

mesolimbic (+ schizo sx)
mesocortical (- schizo sx)
nigrostriatal (movement)
tuberoinfundibular (inhibit prolactin)

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147
Q

tx for postprandial hyperglycemia

A

lispro
aspart
glulisine

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148
Q

tx for TCA cardiotox

A

sodium bicarb (more basic serum – neutralizes TCA, increases extracellular sodium to overcome competitive inhibition)

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149
Q

vit def –> pancreatic gland metaplasia

A

vit A

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150
Q

vit E def –> ?

A

infertility

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151
Q

vit D def –> ?

A

rickets (kids)

osteomalacia (adults)

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152
Q

interscalene nerve block affects brachial plexus and…

A

ipsilateral diaphragm (avoid in pts w/ chronic lung dz or contralateral phrenic nerve dysfxn)

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153
Q

where does collagen production take place in the cell?

A

RER

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154
Q

cells involved in delayed type hypersensitivity

A

CD4, CD8, macs

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155
Q

what does DNA polymerase III do

A

5-3 DNA synthesis

3-5 exonuclease activity (proofreading)

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156
Q

what does DNA polymerase I so

A

5-3 DNA synthesis
3-5 exonuclease activity (proofreading)
5-3 exonuclease activity (remove RNA primer)

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157
Q

why do preggers have increased insulin resistance

A

syncytiotrophoblast makes human placental lactogen (hPL)

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158
Q

making catecholamines

A

adrenal medulla

symp release Ach –> chromaffin cells –> make catecholamines (80% epi, 20% NE)

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159
Q

muscles worked in kegels

A

levator ani (iliococcygeus, pubococcygeus, puborectalis)

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160
Q

wheres the problem: weakness in dorsiflexion and eversion, impaired dorsal foot/lateral shin sensation

A

common peroneal nerve

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161
Q

hypertrophic scarring mechanism

A

elevated transforming growth factor (TGF-beta) increases fibroblast proliferation/activity

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162
Q

likely blood problems with cirrhosis

A

less clotting factors (liver makes II, VII, IX, X) (DisCo was born in 1972) –> VII has shortest half life
less albumin –> edema

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163
Q

R vs L sided colon CA

A

R: more space, bigger, bulkier –> occult bleeding, anemia
L: smaller, narrow lumen –> obstruction, changes in bowel habits

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164
Q

drug that lengthens QT but doesnt have high risk of torsades

A

amiodirone

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165
Q

muscle biopsy shows ragged red fibers

A

mitochondrial myopathy

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166
Q

sx of mitochondrial myopathy

A

muscle weakness, myalgia, lactic acidosis, neuropathy, seizures

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167
Q

1st/2nd gen antihistamines (list)

A

1st: diphenhydramine, hydroxyzine, promethazine, clorpheniramine
2nd: loratadine, cetirizine

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168
Q

diff btwn 1st/2nd gen antihistamines

A

2nd: better for old folk: less anti-Ach, anti-5HT, anti-alpha-adrenergic –> minimal side effects; less lipophilic –> dont cross BBB

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169
Q

deficiency common in sickle cell anemia (or other hemolytic anemias)

A

folic acid deficiency due to increased RBC turnover

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170
Q

folic acid def –> macrocytic anemia path

A

low folic acid –> impair DNA synth –> slows diving rate –> cytoplasmic components build up –> big cells

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171
Q

mediator of cachexia (wasting in systemic dz)

A

TNF-alpha
IL-1 beta
IL-6

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172
Q

MCC renal infarction

A

thromboembolism (from atrium or ventricle)

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173
Q

bladder things in MS

A

spastic bladder from UMN lesion
bladder hypertonia –> does not relax/distend
full emptying

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174
Q

phenotypic mixing

A

2 viruses in one cell
released virions have shared features
progeny are first generation
(no genetic changes, just pheno)

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175
Q

cells responsible for inflammation in gout

A

neutrophils

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176
Q

whats damaged in the ear with prolonged exposure to loud noises

A

organ of corti

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177
Q

retinal artery occlusion mechanism

A

usually from bruit
internal carotid
ophthalmic artery
retinal artery

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178
Q

white/yellow scars on the retina

A

toxo in utero

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179
Q

uretal obstruction does what to GFR and FF?

A

GFR goes down

FF goes down

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180
Q

consequences of treating NARDS

A

O2 given during treatment can –> retinal damage

retinopathy of prematurity or retrolental fibroplasia

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181
Q

deficiency in SCID

A

def adenosine deaminase –> no T or B cells

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182
Q

acyclovir mechanism

A

nucleoside analog
phosphorylated by virus
gets incorporated into viral DNA
terminates synthesis

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183
Q

ortner syndrome

A

mitral stenosis –> atrial dilation –> impinge left recurrent laryngeal nerve –> hoarseness

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184
Q

fibrates –> gallstones: mechanism

A

inhibit bile acid synth
decreased cholesterol solubility, increased microcrystal formation
–> gallstones

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185
Q

etanercept mechanism

A

TNF-alpha inhibitor

acts as decoy receptor?

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186
Q

vermiis lesion –>

A 
truncal ataxia (wide, unsteady gait)
maybe vertigo and nystagmus
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187
Q

Hep B/C vs steatosis histo

A

Hep B: granular, homogenous eosinophilic inclusions
hep C: lymphoid aggregates, focal areas of macro-steatosis
steatosis: large and small vesicles of fat

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188
Q

signet ring in stomach

A

gastric adenocarcinoma

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189
Q

gastric adenocarcinoma lesion characteristics

A

diffuse involvement of stomach wall (lose E-cadherin)

plaque-like appearance, ill defined

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190
Q

what immune cell increases with corticosteroid use

A

neutrophils (demargination - they fall off tissues into blood, but can’t fight stuff there –> increased risk of infection)

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191
Q

MC complication of bicuspid aortic arch

A

aortic stenosis

then endocarditis, then dissection

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192
Q

which joints are affected by rheumatoid arthritis

A

small joints: PIP, MCP, MTP (spares DIP)

cervical spine

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193
Q

where are very long chain fatty acids oxidized?

A

peroxisomes

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194
Q

what nerve innervates sensation on posterior part of external auditory canal?

A

vagus (X)

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195
Q

what drugs reactivate TB

A

TNF-alpha inhibitors

enantercept, infliximab, adalimumab

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196
Q

age changes that can –> isolated systolic HTN

A

increased arterial stiffness (decreased elastin, increased collagen)

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197
Q

MC renal stones

A

Ca stones (oxalate, phosphate)

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198
Q

MC Ca levels that –> stones

A

hypercalciuria w/ normocalcemia (vit D and PTH regulate serum)

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199
Q

where in the body is the oxygenation of blood lowest?

A

coronary sinus (heart extracts more O2 than the tissues do)

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200
Q

what mediators are responsible for coronary blood flow?

A

adenosine and NO

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201
Q

deficiency in Fabry dz

A

alpha-galactosidase A (X-linked)

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202
Q

part of bacteria that allows it to go into different -tonic solns

A

cell wall (use of ABX against cell wall takes away this ability)

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203
Q

enoxaparin mech

A

LMWH

bind ATIII, which binds to factor Xa so it cant convert prothrombin to thrombin

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204
Q

clavulanic acid mech

A

beta lactamase inhibitor (protects beta-lactamase susceptible ABX)

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205
Q

agents responsible for recurrent infections in pt w/ CGD

A

catalase positive

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206
Q

areas of gut involved in Hirschsprung dz

A

rectum and anus (always)

usually sigmoid colon too

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207
Q

markers for small cell lung cancer

A

neural cell adhesion molecules (NCAM, aka CD56)

all are signs of neuroendocrine differentiation

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208
Q

signs of vit E def

A

neuron/RBCs susceptible to oxidative stress –>

ataxia (neuromusc dz), impaired prop/vibe, hemolytic anemia

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209
Q

causes of frothy, foamy urine

A

proteinuria or bile salts in urine

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210
Q

deficiency in Lesch-Nyhan syndrome

A

hypoxanthine-guanine phosphoribosyltransferase (HGPRT): purine salvage pathway

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211
Q

latissimus dorsi movements

A

extension
adduction
internal rotation

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212
Q

innervation of latissimus dorsi

A

thoracodorsal nerve

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213
Q

schizophreniform time frame

A

> 1 month

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214
Q

bipolar I vs II

A

I: mania > 1 wk, may or may not have psychosis
II: hypomania and MDE (no psychosis)

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215
Q

testicular tumor that could also stimulate thyroid

A

non seminomatous germ cell (secrete beta-hCG)

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216
Q

detrusor mvmt

A

contraction –> urination

relaxation –> retention

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217
Q

lymphatic drainage of rectum

A

proximal to anal dentate line –> inferior mesenteric and internal iliac lymph nodes
distal to anal dentate line –> inguinal

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218
Q

things that increase ammonia

A

gut bacteria make ammonia from nitrogen degradation
GI bleed –> Hb breakdown –> up ammonia
excess dietary protein –> up ammonia
or infection, sedatives, metabolic things (hK)

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219
Q

tx for hepatic encephalopathy

A

rifaximin

lactulose

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220
Q

rifaximin mechanism to treat hepatic encephalopathy

A

antibiotic (inhibit bact RNA synthesis by binding to DNA dependent RNA polymerase)
hurt gut flora –> they cant make ammonia from nitrogen

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221
Q

lactulose mechanism to treat hepatic encephalopathy

A

catabolized by gut flora to short chain fatty acids –> lower colonic pH –> increase conversion of ammonia to ammonium

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222
Q

when will you see a high QRS voltage in precordial (V) leads

A

ventricular hypertrophy

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223
Q

QRS complex in AF

A

narrow

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224
Q

irregularly irregular heart rhythm

A

AF

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225
Q

why higher dose for oral nitrates?

A

high first pass metabolism

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226
Q

ADE of thionamides

A

agranulocytosis

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227
Q

presentation of pt w/ thionamide induced agranulocytosis

A

sore throat
fever
oral ulcerations
infection

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228
Q

uniformly enlarged uterus

A

adenomyosis (endometrial glandular tissue in myometrium)

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229
Q

white reflex in kids

A

retinoblastoma

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230
Q

tumors a/w retinoblastoma

A

osteosarcomas (mutation in each of the two Rb genes)

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231
Q

MC congenital adrenal hyperplasia deficiency

A

21-hydroxylase deficiency

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232
Q

HIV structural genes and proteins

A

gag –> p24, p7 –> core proteins
pol –> proteases, reverse transcriptase, integrase
env –> glycosylated –> gp160 –> cleaved in ER –> gp120, gp41 –> attachment

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233
Q

what drains into the superficial inguinal lymph nodes?

A

all skin below umbilicus + anus below dentate line, including scrotum
EXCEPT testes, glans penis, posterior calf

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234
Q

pancreatic pseudocyst formation mechanism

A

acute pancreatitis –> enzymes disrupt walls of ducts –> panc enzymes leak into peripancreatic space –> inflammatory rxn –> granulation tissue encapsulates the fluid –> pseudocyst (fibrose w/ time)

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235
Q

MC pseudocyst location

A

lesser peritoneal sac (btwn stomach, duo and transverse)

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236
Q

pathogenesis of acute calculous cholecystitis

A

persistent obstruction (stone) –> hydrolysis of luminal lecithins to lysolecithins –> disrupts protective mucus membrane –> bile salts irritate –> PG release –> inflammation –> hypomotility –> up P/distension –> ischemia –> bacteria invade (usually E.coli, enterococcus, kleb or enterobacter)

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237
Q

actions of BNP

A

dilate arterioles and veins
promote diuresis/natriuresis
(lower BP)

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238
Q

what is kinesin

A

motor protein a/w microtubles

in neurons: bring vesicles to nerve terminal

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239
Q

what cells do fetal corticosteroids affect

A

type II pneumocytes (accelerate maturity –> increased surfactant)

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240
Q

genes a/w APML

A

t(15; 17)
PML gene on 15
RARA (retinoic acid receptor alpha) on 17

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241
Q

cancers w/ epidermal GF receptors (ERBB1/2)

A

ERBB1 = certain lung

ERB2 (aka HER2/neu) = ovarian, gastric tumors

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242
Q

order of heavy Ig chains (letters)

A

M, D, G, E, A

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243
Q

immune defense against candida

A

superficial candida: T cells

disseminated: neutrophils

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244
Q

CNs for tongue

A

motor: XII, X (palatoglossus only)
sensory: V3 (ant 2/3) IX (post 1/3), X (tongue root)
taste: VII (ant 2/3), IX (post 1/3), X (throat)

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245
Q

what can you give infants with MSUD to improve (besides diet)

A

high dose Thiamine

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246
Q

where does renal clear cell carcinoma originate?

A

proximal renal tubules (epithelial cells)

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247
Q

what to think when there’s candida in sputum sample

A

its just from the oral cavity

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248
Q

condition of fetus –> maternal virilization during pregnancy

A

aromatase deficiency

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249
Q

what does secretin do?

A

get panc to secrete bicarb

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250
Q

hormone levels in klinefelters

A

LH and FSH up
inhibin, T down
sperm count none

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251
Q

sildenafil mechanism

A

phosphodiesterase-5 inhibitor (up cGMP –> vasodilation)

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252
Q

defect in Marfan synd

A

defect in fibrillin-1 gene (microfibril that forms sheth around elastin fibers)

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253
Q

eggshell calcification on cysts

A

echinococcus granulosus (or multicularis w/ multiple) hydatid cysts

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254
Q

complication of surgery on echinococcus cysts

A

anaphylaxis

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255
Q

graves dz sx that arise as a result of increased expression of beta adrenergic receptors

A 
HTN
tachycardia
sweating
heat intolerance
weight loss
hyperreflexia
(NOT exopthalmos which is from like a 1000 other things)
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256
Q

why do you get exopthalmos in Graves dz

A

lymphocytic infiltration, enlargement of extraocular muscles (myositis), fibroblast proliferation, and overproduction of mucopolysaccharides in response to anti-thyroid Abs

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257
Q

where is a saddle emboli

A

pulmonary artery bifurcation

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258
Q

fungus: spherules packed with endospores

A

coccidiodes immitis (spherules bigger than RBCs)

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259
Q

colon adenomas most likely to undergo malignancy

A

villous (vs tubular or tubulovillous)

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260
Q

UV damage to DNA

A

covalent bond formation btwn adjacent pyrimidines

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261
Q

blood gases @ high altitude (2 days)

A

alkalosis
low PaO2
low CO2 (hypervent)
low bicarb

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262
Q

high altitude changes (short)

A

lower partial pressure of O2 in air –> hypoxemia –> trigger hyperventilation –> CO2 drops –> resp alkalosis (acute) –> renal excretion of bicarb (24-48 hrs later)

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263
Q

long term altitude changes

A 
increased 2,3-DPG
increased EPO/Hb production
increased pulm diffusing capacity
up angiogenesis (VEGF)
up mitochondria
hemoconcentration (HCO3 diuresis)
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264
Q

Tc-perechnetate scan is for….

A

has an affinity for parietal cells

if its taken up in the RLQ suspect Meckel diverticulum

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265
Q

cells in Meckel diverticula

A

it has ectopic gastric mucosa that secretes acid –> ulceration/bleeding

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266
Q

red blood cells without central pallor

A

spherocytes

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267
Q

increased mean corpuscular Hb concentration

A

spherocytosis

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268
Q

polymyalgia rheumatica

A

neck, torso, shoulder and pelvic girdle pain
morning stiffness
see in giant cell vasculitis

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269
Q

cholesterol gallstones description

A

yellow/grey/hard

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270
Q

pigment stones description

A

brown/black/soft

made of calcium salts (from unconjugated bilirubin)

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271
Q

stop codons

A

UAA
UAG
UGA

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272
Q

what happens at a stop codon

A

releasing factor proteins bind to ribosomes, release polypeptide and ribosome

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273
Q

cardiac tissue conduction velocity

A 
fastest to slowest
purkinje
atrial
ventricular
AV
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274
Q

prolactin –> osteoporosis mechanism

A

high prolactin –> suppress GnRH from hypothalamus –> hypogonadism –> low E –> low bone density

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275
Q

causes of accelerated bone loss

A 
hi prolactin
low E
hi PTH
hi thyroid
low vit D
chronic glucocorticoids
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276
Q

what is celecoxib

A

selective COX-2 inhibitor

anti-inflammatory effects w/ less risk of GI bleeds/ulcers

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277
Q

ornithine is a/w what

A

urea cycle

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278
Q

vertebral subluxation

A

usually AA joint
malalignment –> cord compression (posterior odontoid)
–> neck pain, stiffness or neuro findings, hTN (loss of symp)
extension from intubation can exacerbate

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279
Q

where are the serotonergic neurons in the CNS

A

raphe nuclei in brainstem

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280
Q

cardiac ischemia and contractility by time

A

complete ischemia stops contractility w/in 60 s

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281
Q

how do you know if a carcinoid tumor has metastasized?

A

while in intestines they dont make syndrome (liver metabolizes stuff)
if they make mets outside –> syndrome

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282
Q

Bcl-2

A

apoptosis inhibitor

a/w folliciuilar cell lymphoma

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283
Q

calcineurin

A

protein phosphatase in T cells
dephosphorylates nuclear factor of activated T cells (NFAT)
part of T cell immune response

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284
Q

retinoblastoma protein (Rb)

A

regulator of G1–>S
active when hypophosphorylated –> binds to E2F transcription factor –> STOPS transition
inactive when phosphorylated –> cycle goes on

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285
Q

where do testes drain to?

A

para-aortic nodes

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286
Q

Guillain Barre light microscopy description

A

segmental demyelination of peripheral nerves

endoneural inflammatory infiltrate

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287
Q

lung rejection: acute

A 
1-2 wks post transplant
rxn to HLA - cell mediated (CD8s)
--> vascular damage
sx: dyspnea, dry cough, low fever
CXR: perihilar and lower lobe opacities
path: perivasc/peribronch lymphocytic infiltrates
prevent w/ immunosuppression
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288
Q

lung rejection: chronic

A

months-years

  • -> inflammation of small bronchioles (bronchiolitis obliterans)
    path: inflammation and fibrosis of bronchial wall –> narrow/obstruct
    sx: dyspnea, non-productive cough and wheezing
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289
Q

broad chest with wide spaced nipples/inverted nipples

A

turners

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290
Q

where do you find peptostreptococcus

A

normal mouth flora (anaerobic)

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291
Q

where do you find fusobacterium

A

normal mouth flora (anaerobic)

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292
Q

causes of lung abscesses

A

aspiration (think normal flora or nosocomial)

complication of pneumonia, endocarditis, septicemia

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293
Q

necrotizing pneumonia agents

A

staph aureus
e coli
klebsiella
pseudomonas

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294
Q

speed of Hb mvmt during gell electrophoresis

A

fast (far) to slow (close)

HbA > HbS > HbC

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295
Q

dystrophin

A

component of skeletal muscle

links cytoskeleton to transmembrane proteins

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296
Q

Gilbert bilirubin

A

unconjugated hyperbilirubinemia

297
Q

Dubin Johnson bilirubin

A

conjugated hyperbilirubinemia

298
Q

dx of acute cholecystitis w/ nuclear medicine hepatobiliary scan

A

radiotracer is given IV
taken up by hepatocytes and put into bile
if bile duct is obstructed you never visualize the gallbladder

299
Q

hypothyroid myopathy sx

A

muscle pain, cramps: proximal muscles

delayed reflexes and myoedema

300
Q

myoedema

A

focal mounding of muscle following percussion (found in hypothyroid myopathy)

301
Q

what impacts coronary blood flow (heart-wise)

A

duration of diastole: blood only goes into coronaries (during diastole) because the ventricle relaxes enough to lower the pressure so it’s lower than the aortic pressure
increased HR makes that less possible

302
Q

features of methylmalonic acidemia

A

newborn w/ lethargy/vomiting
hyperammonemia, ketotic hypoglycemia, metabolic acidosis
urine: elevated methylmalonic acid and propionic acid

303
Q

maple syrup urine disease defect

A

cant breakdown branched chain amino acids (leucine, isoleucine, valine)

304
Q

defect in Niemann Pick

A

sphingomyelinase (–> extra sphingmyelin)

305
Q

Osgood-Schlatter dz

A

overuse injury of knee (secondary ossification center (apophyisis) f tibial tubercle)
problem @ patellar ligament

306
Q

dysfunction in Kartagener synd

A

dynein arms

307
Q

types of exocrine gland

A

merocrine
apocrine
holocrine

308
Q

merocrine secretion mechanism

A

via exocytosis

309
Q

apocrine secretion mechanism

A

via membrane bound vesicles

310
Q

holocrine secretion mechanism

A

cell lysis releases entire contents

311
Q

where do you put the filter to prevent PEs

A

IVC

312
Q

H. flu capsule

A

type B is made of polyribitol phosphate (PRP)

prevents phagocytosis

313
Q

type B and non type B H flu

A

type B: capsule, causes epiglottitis, meningitis and bacteremia, vaccine now
non type B: more common since vaccine –> non invasive dz like sinusitis, bronchitis, otitis media and conjunctivitis

314
Q

ankylosing spondylitis extraskeletal sx

A

resp: limited chest expansion –> hypovent (monitor chest expansion)
CV: ascending aortitis –> dilation of aortic ring and aortic insufficiency
eye: anterior uveitis –> blurred vision, pain, photophobia, red eyes

315
Q

type of necrosis after irreversible ischemic injury

A 
most tissues (not brain): coagulative necrosis
brain: liquefactive
316
Q

MCC of transmural infarction

A

fully obstructive thrombus superimposed on a ruptured atherosclerotic coronary artery plaque
(less occlusion on plaque –> unstable angina)
(stable atheromatous w/o overlying thrombus, occluding 75% –> stable angina)

317
Q

treatment for congenital adrenal hyperplasia (21-hydroxylase def)

A

give steroids (–> less ACTH –> less androgen)

318
Q

most common twin bags (fraternal)

A

dichorionic

diamniotic

319
Q

most common twin bags (identical)

A

monochorionic

diamniotic

320
Q

ecological studies

A

analysis of populations, not individuals

321
Q

main RFs for adenocarcinoma of the pancreas

A 
age
smoking
DM
chronic panc
genetics
322
Q

signs of pancreatic adenocarcinoma

A

palpable but nontender gallbladder (Courvoisier sign)
obstructive jaundice (pruritus, dark urine, pale stools)
weight loss

323
Q

how does ionizing radiation work

A

DNA double-strand breakage

free radical formation

324
Q

diff in Abs in sabin vs salk vaccine

A

Sabin: live attenuated –> stronger mucosal secretory IgA

325
Q

status epilepticus management

A

`benzos to stop
phenytoin to prevent recurrence
if doesnt stop: phenobarbital

326
Q

phenytoin mechanism

A

reduce sodium current in cortical neurons

327
Q

how to tell tuberculoid from lepromatous leprosy

A

lepromin skin test (+ –> tuberculoid)

328
Q

tuberculoid vs lepromatous leprosy T cell involvement

A

Th1: tuberculoid
Th2: lepromatous

329
Q

livedo reticularis means…

A

sign of embolism

330
Q

lesion of which hypothalamic nucleus makes you fat

A

ventromedial

331
Q

ring enhancing lesion in brain

A

toxoplasmosis (HIV, multiple)
aspergillus (lungs more likely, immunocomp)
glioblastomas (solitary/butterfly)
neurocysticercosis (travel, multiple)
TB (travel, multiple)
nocardia (immunocomp, branching filaments)

332
Q

pyrrolidonyl arylamidase (PYR) positive

A

strep pyogenes

replaced bacitracin sensitive-ness

333
Q

ecthyma gangrenosum agent

A

pseudomonas aeruginosa

334
Q

what cells make the fibrous cap in atheromas

A

vascular smooth muscle cells (VSMCs)

335
Q

tumor a/w Paget

A

Osteosarcoma

periosteal elevation

336
Q

gouty arthritis

A

neutrophils

negatively bindingent MSU crystals

337
Q

positive nasopharyngeal swab

A

influenza

338
Q

germ line mosaicism

A

mutation in sperm / eggs only

339
Q

cadherins

A

bind epi cells together

340
Q

hemidesmosomes

A

cells attached to BM

integrins

341
Q

firm, fles-Colore Papules
umbilicated
pruritic

A

Molluscum Contagiosum

large eosin inclusions

342
Q

Knee dislocation vessel / nerve injury

A

popliteal artery

343
Q

cocaine nasal signs

A

chronic discharge

per for ation / ulcers/ sinusitis

344
Q

craniopharyngioma vision loss

A

bi temporal hemianopsia

compress optic chiasm

345
Q

winged scapula muscle / nerve

A

Serratus anterior

long thoracic nerve

346
Q

acute stress disorder vs PTSD

A

ASD: >1 week,

347
Q

acute intermittent porphyria defect

A

porphobiligen deaminase

348
Q

increased RBC osmotic fragility

A

spherocytosis

sickle / thal = decreased

349
Q

why remove spleen in spherocytosis

A

less anemia, jaundice, bilirubin gallstones

350
Q

osteocytes connected by

A

gap junctions

351
Q

other cardiac output equation

A

CO = rate os 02 cons upton/ arterio venous 02 Content difference

352
Q

polycythemia vera gene

A

JAK2

353
Q

fatigable Chewing

A

myasthenia gravis

354
Q

myasthenia gravis mechanism

A

Ab mediated T cell dependent attack on post-synaptic NMJ (nicotinic-ACh receptors)
often hyper plastic thymic tissue
maybe thymoma

355
Q

metabolic levels in DKA

A

glucose up
K up
Na down

356
Q

Chiari malformation MRI

A

downward displacement of elongated arebellar tonsils thru foramen. Magnum

357
Q

misoprostol Mech

A

PGE 1 analog

up gastric mucus

358
Q

palmitoylation

A

add fatty acid
up hydrophobicity
anchor to membranes

359
Q

nitrate heart effect

A

venodilation

reflex tachy

360
Q

why is skin bronze in hemochromatosis

A

hemosiderin in dermal macs and increased melanin production

361
Q

where else do you see HTN in portal HTN

A

splenic vein → splenomegaly

NOT IVC

362
Q

Causes of impetigo

A 
Strep B
Staph aureus (may have bulla)
363
Q

why N-terminal peptide signaling sequences

A

get them to RER

w /o end up in cytosol

364
Q

coenzyme needed for branch chain amino acid catabolism

A

thiamine

365
Q

what maintains high T levels in semi nitrous tubules and epididymus

A

Leydig (makeT)

Sertoli (make androgen binding protein)

366
Q

What to ablate in hyperhidrosis

A

hands: Stellate ganglion
axillary: thoracic sympathetic trunk (T 2)

367
Q

What do you stain w / red safarin O

A

cartilage, mast cell granules and mucin

368
Q

What female structure goes thru inguinal canal

A

round ligament

369
Q

blood gases in PE

A

V/Q mismatch → hypoxemia → hyperventilation → hypocapnia →alkalosis

370
Q

when do you see red man synd

A

Vancomycin

fast infusion → mast cells release histamine

371
Q

defect in osteo genesis imperfecta

A

type I collagen (bones)

COL 1A1 and CoL 1 A2

372
Q

hypoglycemia after prolonged fasting W / low ketones suggests

A

impaired beta-oxidation

MC def acyl-CoA dehydrogenase

373
Q

octreotide Mech

A

somatostatin analog

inhibit release of bio-active peptides

374
Q

how to make proteins during apoptosis

A

internal ribosome entry

Start in the middle of sequences

375
Q

Complications of Crohn dz

A 
apthous mouth ulcers
bowel obstruction
fistulae / abscesses/ fissures
erythema nodosum
arthritis/ankylosing spondylitis
uveitis
gallstones/kidney stones
B12/folate def → anemia
up risk adenocarcinoma and cholangiocarcinoma
376
Q

Crohn in which part of Gl

A

terminal ileum MC

any possible

377
Q

Warfarin and P 450

A

P 450 inducers → up Warfarin metabolism → down efficacy

inhibitors → down Warfanin metabolism→ up bleeding risk

378
Q

malnutrition → what bone problems

A

osteomalacia

379
Q

what is Osteomalacia

A

decreased mineralization of osteoid

from vitD deficiency

380
Q

signs of peripheral artery dz

A

pain when moving
cramping
thin skin
ulcers

381
Q

muscles innervated by recurrent laryngeal

A

all intrinsic larynx muscles for sound production

EXCEPT Cricothyroid

382
Q

Broca’s aphasia

A

expressive aphasia (w/ agrammatism)
frustration ( aware )
preserved comprehension

383
Q

Wernick’s aphasia

A

receptive aphasia
not aware
impaired comprehension
fluent aphasia (word salad)

384
Q

insulin levels indicative of insulin resistance

A

high baseline during fasting

385
Q

detect in Lesh- Nyhan Synd

A

hypoxanthine-guanine phosphoribosyltransf erase

386
Q

long term Tx w/ mechanical valve

A

warfarin

387
Q

leuprolide Mech

A

GnRH analog

continuous → inhibits FSH/ LH → less T

388
Q

cardio problems in DiGeorge

A

conotruncal defects → persistent truncus arteriosus, tetra logy of Fallot, interrupted aortic arch

389
Q

hormones causing trouble in esophageal Varices

A

VIP, glucagon → vasodilate splanchnic veins

inhibited by octreotide

390
Q

more likely to have folate or B12 def in alcoholics

A

folate (B12 only after a long time)

391
Q

rib levels of lungs (bottom)

A

midclavicular: 6
midaxillary: 8
paravertebral: 10

392
Q

nerve damaged in supracondylar humeral frx with anterolaterral displacement

A

radial

393
Q

ACE inhibitor effects on kidney

A

lower angiotensin II levels
(angiotensin II usually vasoconstricts efferent arteriole and ups GFR)
increases GFR, ups creatinine
don’t use in pts w/ bilat renal artery stenosis (–> acute renal failure)

394
Q

part of resp tract affected by HPV

A

only affects stratified squamous epithelium

true vocal cords

395
Q

signs of aplastic anemia

A

pancytopenia w/o splenomegaly

bone marrow bx: dry tap, hypocellular made of mostly adipose

396
Q

ether kills which viruses?

A

enveloped

397
Q

narrow hyphae branch @ 45 degrees

A

aspergillus

398
Q

median nerve course in forearm

A

thru pronator teres
between flexor digitorum superficialis and profundus
under flexor retinaculum

399
Q

TATA box purpose

A

promoter region for transcription initiation

400
Q

hemiballismus mech

A

injury to contralateral subthalamic nucleus → decrease excitation of globus pallidus → reduce inhibition of thalamus → extra movement

401
Q

myasthenia gravis hypersensitivity

A

type II (IgG autoantibodies)

402
Q

HTN drug that also treats BPH

A

alpha-1 antagonists (doxazosin, prazosin)

403
Q

MCC coronary sinus dillation

A

increased R heart P from pulmonary hypertension

404
Q

arginase deficiency vs other urea cycle d/os

A

arginase def has mild or no hyperammonemia

405
Q

anemia to think of with low B6

A

sideroblastic (ALA synthase uses is as cofactor)

406
Q

bone marrow in sideroblastic anemia

A

stain w/ Prussian blue
microcytic, hypochromic RBCs
ring sideroblasts

407
Q

basophilic cotton candy on pap

A

actinomyces

408
Q

crohn histo

A 
transmural inflammation
noncaseating granulomas (may → occult bleed)
409
Q

MCC malignant otitis externa

A

pseudomonas aeruginosa

410
Q

amaurosis fugax

A

transient monocular vision loss

411
Q

labs for giant cell (temporal) arteritis

A

C-reactive protein (CRP)

erythrocyte sedimentation rate (ESR)

412
Q

likely bursa from kneeling

A

prepatellar bursitis (housemaid’s knee)

413
Q

likely bursa from obesity or overuse in athletes

A

anserine bursa (+pain in medial knee)

414
Q

likely bursa from osteoarthritis or inflammatory joint dz

A

popliteal (Baker) cyst

415
Q

tx for alcoholism to reduce cravings

A

naltrexone

416
Q

naltrexone mechanism

A

blocks mu-opioid receptor

blocks rewarding/reinforcing effects

417
Q

Treacher-Collins syndrome

A

abnormal development of 1st and 2nd arch

418
Q

CYP450 inducers

A 
carbamazepine
phenobarbital
phenytoin
rifampin
griseofulvin
St. johns wort
modafinil
cyclophosphamide
419
Q

CYP450 inhibitors

A 
amiodarone 
cimetidine
fluoroquinolones 
erythromycin/clarithromycin
azoles
isoniazid 
ritonavir
grapefruit juice
420
Q

physostigmine vs neostigmine

A

phsyo penetrates CNS, neo doesn’t

421
Q

neuropathic pain NT affected by capsaicin

A

substance P (decreased)

422
Q

for what pathway is G6PD the rate limiting enzyme

A

pentose phosphate pathway (main source of NADPH)

423
Q

what do you need NADPH for

A 
reducing glutathione (prevent oxidative damage)
making cholesterol, fatty acids and steroids
424
Q

glucagonoma sx

A

DM
necrolytic migratory erythema
GI sx
anemia

425
Q

necrolytic migratory erythema

A

erythematous papules/plaques on face/perineum/extremities

lesions getting bigger/coalesce, leaving a bronze, central indurated area w/ peripheral blistering/scaling

426
Q

surfactant levels in 3rd trimester

A

lecithin (phosphatidylcholine) goes up after 30 wks
phosphatidylglycerol goes up after 36 wks
sphingomyelin stays relatively constant
L/S > 2 shows adequate surfactant production

427
Q

organ susceptibility to infarction

A

most to least

CNS, heart, kidney, spleen, liver

428
Q

glucagon signaling

A 
Gs receptor
adenylate cyclase 
up cAMP
activates protein kinase A
(same as epinephrine, but epi uses beta receptors)
429
Q

lithium ADEs

A

diabetes insipidus
hypothyroidism
tremor
ebstein anomaly

430
Q

how long after vasectomy do you have viable sperm

A

3 months/20 ejaculations

431
Q

what does c-Myc do

A

make protein that is a transcription activator

432
Q

lymphoma genes

A

follicular: BCL2 (inhibit apoptosis)
Burkitt: c-Myc (transcription activator controls prolif/apop)
CML: BCR-ABL (inhibits apop, increase tyrosine kinase activity)

433
Q

where does complement bind to an Ab

A

Fc region of heavy chain near hinge point

434
Q

indirect hernia pathophys

A

patent processus vaginalis
lateral to inf epigastric vessels, thru deep inguinal ring
most common hernia

435
Q

direct hernia pathophys

A

weakness of transversalis fascia
medial to epigastric vessels, thru hesselbach’s triangle
more common in elderly

436
Q

femoral hernia pathophys

A

weakness of proximal femoral canal

inferior to inguinal lig, thru femoral ring

437
Q

Hesselbach’s triangle

A

inguinal ligament
inferior epigastric vessels
rectus abdominus
most common hernia in women

438
Q

pearly mass in middle ear

A

cholesteatomas (NOT made of cholesterol)

made of squamous cell debris

439
Q

why shouldn’t Kieran get Dengue fever again

A

once you get it you have lifetime immunity to that serotype
but if you get a secondary infection with a diff serotype your immune system goes batshit (Ab enhancement, more immune complex formation, increased T-cell response)

440
Q

how does hyperglycemia → retinopathy

A

glucose → sorbitol (by aldose reductase) → fructose
sorbitol and fructose increase osmotic pressure
more water → osmotic cellular injury
(lens: more water → bursts fiber cells → lens becomes opaque)

441
Q

stage of eggs until ovulation

A

prophase of meiosis I

442
Q

stage of eggs just before fertilization

A

metaphase of meiosis II

443
Q

what do you give to pts with methotrexate to avoid myelosuppression?

A

leucovorin (folinic acid - reduced form of folic acid that doesn’t need DHF-reductase)

444
Q

wtf are neurophysins

A

carrier proteins for oxytocin and vasopressin (ADH)

445
Q

what tests to run if you think they have type I DM

A 
fasting blood glucose (>126)
Hb A1c (>6.5)
446
Q

when do you do glucose tolerance tests

A

gestational DM
CF-related DM
equivocal other testing

447
Q

risk when you give gancyclovir with SMX/TMP

A

myelosuppression

448
Q

ADEs a/w erythropoiesis -stimulating agents

A

risk of thromboembolic events

HTN

449
Q

breast: ducts distended by pleiomorphic cells w/ prominent central necrosis that do not penetrate BM

A

ductal carcinoma in situ

450
Q

breast: palpable masses with orderly rows of cells organized in a single file

A

lobar carcinoma

451
Q

breast: disorderly, hypercellular CT w/ leaf-like projections

A

phyllodes tumor (from breast stroma)

452
Q

signs of selective IgA def

A

recurrent sinopulm infections,
recurrent GI infections
autoimmune d/os (celiacs)

453
Q

what happens when you give O blood to someone IgA def

A

anaphylaxis

454
Q

ovarian venous drainage

A

L into L renal vein

R into IVC

455
Q

uterine venous drainage

A

uterine veins into internal iliacs

456
Q

sx of hyperthyroidism NOT due to increased metabolic rate

A

pretibial myxedema
exophthalmos
periorbital edema
all due to autoimmune response against TSH receptor

457
Q

sx of Friedrich ataxia

A

spinocerebellar tract degeneration → gait ataxia
lateral CST degeneration → muscle weakness
kyphoscoliosis
foot abnormalities (pes cavus)
hypertrophic CM, CHF
DM

458
Q

gyn: when do you do nucleic acid amplification testing

A

neisseria

chlamydia

459
Q

how do you tell what kind of mutation it was by length?

A

non-sense: the difference in base pairs is divisible by 3

missense: same length
frameshift: not divisible by 3

460
Q

what does dextrans do (viridans)

A

lets the bacteria bind to fibrin

461
Q

main immune against neisseria

A

MAC (C5b-C9)

462
Q

immune response to poison ivy

A

urushiol is substance
delayed type IV hypersensitivity
CD8 cells, mainly

463
Q

phenylalanine catabolism

A

phenylalanine → tyrosine (if not = PKU) → fumarate → TCA

464
Q

leucine catabolism

A

leucine → acetyl CoA → TCA

465
Q

valine catabolism

A

valine → propionyl CoA → methymalonyl CoA (need biotin) → succinyl CoA (need B12) → TCA

466
Q

isoleucine catabolism

A

isoleucine → propionyl CoA → methymalonyl CoA (need biotin) → succinyl CoA (need B12) → TCA

467
Q

threonine catabolism

A

threonine → propionyl CoA → methymalonyl CoA (need biotin) → succinyl CoA (need B12) → TCA

468
Q

methionine catabolism

A

methionine → propionyl CoA → methymalonyl CoA (need biotin) → succinyl CoA (need B12) → TCA

469
Q

how do L and R frontal lobe lesions differ in Sx?

A

right: disinhibited
left: apathy

470
Q

hypersensitivity to tobacco shows

A

Buerger dz

471
Q

path of buerger dz

A

segmental vasculitis

472
Q

bone pain, anemia, kidney dz, hypercalcemia shows

A

multiple myeloma

473
Q

dantrolene mechanism

A

antagonize ryanodine receptors
inhibit Ca release from SR
relax muscles

474
Q

how do you hurt the long thoracic nerve (→ winged scapula)

A

chest tube

dissection of axillary lymph node (mastectomy)

475
Q

deep peroneal nerve injury →

A

motor: dorsiflexion, toe extension
sensory: flip flop toe crease

476
Q

superficial peroneal nerve injury →

A

motor: eversion
sensory: dorsal foot/lateral malleolus/lateral shin

477
Q

tibial nerve injury →

A

motor: plantarflexion, inversion, toe flexion
sensory: sole

478
Q

sciatic nerve injury →

A

tibial + common peroneal (deep + superficial)

ALSO can’t flex knee

479
Q

femoral nerve →

A

motor: hip flex, knee extend
sensory: medial thigh/leg + knee

480
Q

primary HSV in children Sx

A

gingivostomatitis: vesicular lesions on lips and hard palate

481
Q

mechanism of viral infection → CHF

A

viral myocarditis → dilated CM (eccentric hypertrophy, systolic dysfunction)

482
Q

hawthorne effect

A

change behavior because you know youre being studied

483
Q

berkson’s bias

A

selection bias in choosing hospitalized pts as control group

484
Q

IF in membranous glomerulonephropathy

A

granular deposits

485
Q

IF in membranoproliferative glomerulonephritis

A

granular deposits

486
Q

IF in anti-BM glomerulonephritis

A

linear

487
Q

what kind of drug is chlordiazepoxide

A

benzo

488
Q

where are brunner glands? what do they do? when would you see them get bigger?

A

duodenum
secrete alkaline stuff (when acid comes in → secretin released → alkaline released)
excess acid or H pylori → hyperplasia

489
Q

what kind of hydrocephalus causes symmetrical enlargement?

A

communicating hydrocephalus

490
Q

normal CSF flow

A

lateral ventricles → interventricular foramen on Monro → 3rd ventricle → cerebral aqueduct → 4th ventricle → foramina of Luschka and Magendie → subarachnoid space (arachnoid granulations absorb it) → venous sinuses

491
Q

mechanism of communicating hydrocephalus

A

no obstruction
dysfunction or obliteration of subarachnoid villi
problem w/ arachnoid granulations

492
Q

mechanism of thymic aplasia in DiGeorge

A

maldevelopment of 3rd and 4th pharyngeal pouch derivatives

493
Q

T cells kill

A

viral
fungal
protozoan
intracellular bacteria

494
Q

where in the lymph nodes are T cells?

A

paracortex (btwn follicles and medulla)

495
Q

what are transmembrane domains?

A

part of integral membrane proteins

made of alpha helices and hydrophobic amino acid residues

496
Q

what part of DNA synthesis requires folate?

A 
making dTMP (deoxythymidine monophosphate)
can give thymidine to compensate a smidge
497
Q

why does hereditary spherocytosis cause jaundice?

A

hemolysis → increased bilirubin production

498
Q

what is a multi-compartment model of distribution?

A

model for highly lipophilic drugs (eg propofol)
drug is administered (central compartment - plasma)
quickly goes to well-vascularized peripheral compartment (brain, liver, kidney, lungs)
long time → poorly vascularized peripheral compartment (muscle, fat, bone)

499
Q

what does RANKL stand for

A

receptor activator of nuclear factor kappa-B ligand (part of osteoclast differentiation)

500
Q

what to give in panic disorder if not benzos (due to abuse or whatever)

A

SSRIs +/- CBT

501
Q

hyperparakeratosis and reduced or absent stratum granulosum →

A

psoriasis

502
Q

where will you see neutrophils in psoriasis

A

they form clusters in parakeretonic stratum (called Munro microabscesses)

503
Q

signs of hemolytic anemia

A

jaundice
increased LDH
decreased haptoglobin

504
Q

hemolytic anemia + thrombocytopenia

A

TTP

505
Q

germ tubes

A

candida albicans

506
Q

spherules

A

coccidioides immitis

507
Q

nonseptate hyphae @ wide angles

A

mucor

rhizopus

508
Q

budding yeast

A

cryptococcus neoformans

509
Q

latex agglutination test (+) for soluble polysaccharide ag

A

cryptococcus neoformans

510
Q

virus that gets their envelope from host nuclear membrane

A

herpesviruses (other enveloped viruses get it from the plasma membrane)

511
Q

nerve at risk during thyroidectomy

A

superior laryngeal nerve (external branch)

512
Q

what does the external branch of the superior laryngeal nerve innervate

A

cricothyroid muscle (tenses vocal cords)

513
Q

what happens if you injure the external branch of the superior laryngeal nerve

A

you get a low hoarse voice with limited pitch range

514
Q

rash in measles

A

maculopapular
starts after fever
face then trunk, coalesces

515
Q

hypercalcemia, hypercalciuria, hypophosphatemia

A

primary PTHism

516
Q

skeletal manifestation of hyperparathyroidism

A

usually involves cortical (compact) bone in appendicular skeleton
subperiosteal thinning/erosions
salt and pepper skull
osteolytic cysts in the long bones (osteitis fibrosa cystica)

517
Q

what are you trying to access when placing central lines/.

A

SVC

518
Q

phosphorylation of serine and threonine residues of insulin receptor/substrate →

A

increased insulin resistance

see w/ TNF-alpha, catecholamines, glucagon, glucocorticoids

519
Q

neoplasm with rosenthal fibers and granular eosinophilic bodies

A

pilocytic astrocytomas

520
Q

MC CNS tumor in AIDS pts

A

primary CNS lymphoma (usually a/w EBV)

521
Q

collagen post MI

A

7 days post MI: granulation tissue (type III)

from 2 wks - 2 mo: fibrosis (type I) → scar

522
Q

pee coming out of umbilicus

A

patent urachus (persistent allantois remnant)

523
Q

orphan annie eyes (description)

A

overlapping cells w/ large nuc containing sparse, finely dispersed chromatin. + intranuclear inclusion bodies and grooves

524
Q

areas most likely affected in graft v host

A

skin (maculopapular or desquamating)
liver
GI

525
Q

complications post subarachnoid hemorrhage

A

vasospasm: 4-12 days after, no significant change on CT
hydrocephalus: CT shows increased CSF P and ventricular dilation
rebleed: most dangerous, can see on CT

526
Q

tx to prevent vasospasm post subarachnoid hemorrhage

A

nimodipine

527
Q

pathophys of CF resp glands

A

CFTR misfolding
non functional CFTR Cl channel → impaired Cl absorption and activation of ENaC
increased ENaC activity → increased Na absorption
water follows
→ thick mucus outside cells

528
Q

pathophys of CF sweat glands

A

CFTR misfolding
non functional CFTR Cl channel → impaired Cl absorption and inhibition of ENaC
decreased ENaC activity → decreased Na absorption
→ very salty sweat

529
Q

muscle pain with exercise that gets better with rest

A

claudication (usually from stenotic lesions from atheromas)

530
Q

tx for cyanide poisoning

A

amyl nitrates

531
Q

asthma med affecting parasympathetics

A

ipratroprium (anti-Ach)

532
Q

psammoma bodies

A

papillary thyroid carcinoma
mesothelioma
papillary serous carcinoma of the ovary
meningioma

533
Q

lamellar wet keratin

A

craniopharyngiomas

534
Q

perivascular rosettes

A

ependymomas

535
Q

pseudo-palisading brain tumor

A

glioblastomas

536
Q

homer-wright rosettes

A

medulloblastomas

537
Q

palisading nuclei around verocay bodies

A

schwannomas

538
Q

hemolytic anemia, hypercoagulability and pancytopenia

A

paroxysmal nocturnal hemoglobinuria

539
Q

Abs against citrullinated peptides/proteins

A

RA

540
Q

rheumatoid factors

A

autoantibodies targeting Fc portion of human IgG

541
Q

effect of long term topical corticosteroids on skin

A

skin atrophy, dryness, telangiectasias, ecchymoses

542
Q

what does it mean if someone tests positive for varicella IgG Abs?

A

they have had it before (prob protected against chicken pox but not shingles)

543
Q

acute repeated knee episodes

A

gout

544
Q

tx for gallstones (non-surgical)

A

hydrophilic bile acids

545
Q

where do you see cytokeratins?

A

epithelial cells

546
Q

what takes out introns and assembles snRNPs?

A

spliceosome

547
Q

what is deficient in narcolepsy

A

hypocretin-1 (CSF)

hypocretin-2

548
Q

S-100 positive

A

melanoma

schwannoma

549
Q

highly cellular areas mixed with myxoid regions of low cellularity

A

schwannomas

550
Q

dopamine actions by dose

A

low: D1 → renal/mesenteric vasodilation
high: beta 1 → cardiac contractility
very high: alpha 1 → general vasoconstriction

551
Q

mechanism: being treated for leukemia → oligouria

A

tumor lysis syndrome
obstructive uropathy (crystals)
acute renal failure

552
Q

tx to avoid tumor lysis syndrome

A

alkalinize the urine + hydration

553
Q

MCC bacterial meningitis in adults

A

strep pneumo

554
Q

back pain w/ recent endocarditis or bacteremia

A

vertebral osteomyelitis

555
Q

proximal muscle weakness, CN involvement, autonomic sx

A

lambert eaton syndrome

556
Q

intron start/stop

A

GU @ 5’

AG @ 3’

557
Q

alpha-1-antitrypsin liver path

A

intrahepatocyte accumulation of polymerized AAT molecules → cirrhosis and hepatocellular carcinoma
granules stain reddish-pink with PAS and resist diastase digestion

558
Q

what to give to people exposed to radioactive iodine

A

potassium iodide

559
Q

possible complications from orbital floor fractures

A

enophthalmos
entrapment of inferior rectus → impaired superior gaze
injured infraorbital nerve → numbness/paresthesis of upper cheek, upper lip, and upper gingiva

560
Q

propranolol in hyperthyroid

A

decrease symp effects on heart (excess thyroid hormone upregulates catecholamine receptors)
inhibit iodothyronine deiodinase (decrease conversion of T4 to T3)

561
Q

coronary blood flow (R vs L)

A

L: only during diastole (P too high in systole)
R: constant (P not so crazy)

562
Q

cheilosis, glossitis, dermatitis and peripheral neuropathy

A

B6 def

563
Q

vitamin C other name

A

ascorbic acid

564
Q

black urine when exposed to air

A

alkaptonuria

565
Q

features of alkaptonuria

A

black urine
blue-black face pigmentation
ochronotic arthropathy

566
Q

portal hypertension affects which other veins

A

left gastric vein → esophageal or gastric varices

splenic vein → fundal gastric varices

567
Q

pathophys of peau d’orange

A

cancerous cells obstruct lymphatic drainage due to spread to the dermal lymphatic spaces

568
Q

OR equation

A

PrEvent/(1 - PrEvent)

569
Q

tx for narcolepsy

A

modafinil

570
Q

movement proteins in a neuron

A

kinesin (anterograde - move along axon)

dynein (retrograde - toward cell body)

571
Q

bicuspid aortic arch → which heart murmur

A

aortis stenosis

572
Q

marfan cardiac problems

A

aortic root dz: aneurysms, regurg or dissection

573
Q

effects of increased estrogen on thyroid

A

increased levels of thyroxine-binding globulin

increase in total thyroid hormone levels, but normal free thyroid hormone

574
Q

what is bosentan

A

competitive endothelin receptor antagonist

use to treat pulmonary arterial HTN

575
Q

pathophys of hyperacusis

A

injury to facial nerve (VII) affects stapedius nerve → stapedius muscle is paralyzed → stapes oscillates more wildly → hyperacusis

576
Q

what is NF-kappaB

A

proinflammatory transcription factor that increases cytokine production

577
Q

what do neisseria pili do?

A

prevent attachment to epithelial surfaces

578
Q

what are the non-medical options for parkinsons?

A

high frequency brain stim of globus pallidus internus or subthalamic nucleus (promotes thalamo-cortical disinhibition)

579
Q

what do you call the genital ulcer in syphilis?

A

primary: chancre
secondary: condyloma lata (maybe w/ maculopapular rash)
tertiary: gumma (maybe w/ aortic problems, tabes dorsalis, etc)

580
Q

pathophys of renal osteodystrophy

A

decrease GFR → decrease Ca/P → PTH kicks in → osteitis fibrosa cystica

581
Q

diffuse erythema, skin comes off easily with pressure

A

staphylococcal scalded skin syndrome (exotoxin mediated)

582
Q

posterior column degeneration

A

tertiary syphilis

B12 deficiency

583
Q

ataxia, repeated sinopulm infections, oculocutaneous telangiectasia (late)

A

ataxia-telangiectasia (inefficient DNA repair)

584
Q

barr body description

A

heavily methylated DNA and deacetylated histones

585
Q

renal blood flow equation

A

(renal artery P - renal vein P) / renal vascular resistance
RBF = PAH clearance / (1 - hematocrit)
PAH clearance = PAHurine x urine flow / PAHserum

586
Q

hepatosplenomegaly, neuro regression, cherry red macular spot

A

Niemann-Pick

587
Q

insulin analogs w/ AA substitution @ the C terminal end of the B chain

A

lispro
aspart
glulisine

588
Q

which aortic arch makes the carotids?

A

3rd

589
Q

normal heart pressures

A

RA: 1-6
RV: 1-15/30
PA: 6/12 - 15/30
PCWP: 6-12

590
Q

immune defense against giardia

A

CD4 and secretory IgA production (impairs adherence)

591
Q

lobar pneumonia stages

A

congestion
red hepatization
gray hepatization
resolution

592
Q

what makes Ras active or inactive?

A

bound to GTP = active

593
Q

single broad based bud

A

blastomyces dermatidis

594
Q

bowel appearance in primary lactase deficiency

A

normal

595
Q

rat poison = ?

A

warfarin

596
Q

lung dz description in morbid obesity

A

extrinsic restrictive lung disease

597
Q

PFTs in morbid obesity

A

down: ERV, FRC, FEV-1, FVC, TLC

normal residual volume

598
Q

ribavirin mech

A

nucleoside antimetabolite

interferes with viral genetic duplication

599
Q

medullary thyroid cancer: what part of thyroid

A

parafollicular, calcitonin secreting C cells

600
Q

what mitochondrial change is indicative of irreversible cell damage?

A

vacuolization

601
Q

severe bilateral radicular pain, saddle anesthesia, hyporeflexia, bowel/bladder incontinence (late)

A

cauda equina syndrome

602
Q

how does the pudendal nerve get damaged during labor

A

stress placed on pelvic floor (it’s close to the ischial spine)

603
Q

pudendal nerve injury →

A

weakness of perineal musculature → fecal/urinary incontinence, perineal pain and sexual dysfunction

604
Q

SER fxn

A

make steroids/phospholipids
detox
sarcoplasmic reticulum

605
Q

statistical power eq

A

1 - beta

beta = probability of a type II error

606
Q

type I error

A

reject the null, but its true

607
Q

type II error

A

don’t reject the null but should have

608
Q

strep pneumo vaccine

A

unconjugated polysaccharide vaccine → T cell independent response
conjugated polysaccharide + protein Ag → robust T cell response

609
Q

where does isotype switching take place?

A

germinal centers of lymph nodes

610
Q

diseased modifying antirheumatic drugs

A 
methotrexate
sulfasalazine
hydroxychloroquine
minocycline
TNF alpha inhibitors
611
Q

zenker diverticulum pathophys

A

diminished relaxation of cricopharyngeal muscles → increased intraluminal P in oropharynx → mucosa herniates

612
Q

lung cells that regenerate

A

type II pneumocytes

613
Q

signs of constrictive pericarditis

A

JVD
Kussmaul
pulsus paradoxus
pericardial knock

614
Q

enterobacter cloacae description

A

lactose fermenting gram negative rod

615
Q

acute hemolytic transfusion rxn sx

A

fever/chills
chest/back pain
hemoglobinuria
w/in minutes to hours of transfusion

616
Q

acute hemolytic transfusion rxn mechanism

A

type II (Ab mediated) HS

617
Q

papillary muscle dysfxn → which murmur

A

mitral regurg

618
Q

histo of choriocarcinoma

A

proliferation of cytotrophoblasts (mono-nuc) and syncytiotrophoblasts (multi-nuc)

619
Q

pouch → thymus

A

3rd

620
Q

wrist/thumb extension when blood pressure cuff is inflated

A

carpal spasm (Trousseau sign)

621
Q

why do you see Trousseau sign and Chvostek sign in DiGeorge pts?

A

parathyroid hypoplasia (3rd/4th pouch) → hypocalcemia

622
Q

blood supply cut off in inferior MI

A

posterior descending artery (usually from right coronary artery)

623
Q

parts of kidney susceptible to hypoxia (and why)

A

PCT thick LoH

active transport of ions needs ATP (and O2)

624
Q

H pylori effects on gastric/duodenal mucosa

A

bacteria destroy mucosal layer (urease) → gastric ulcers
bacteria destroy delta cells → less somatostatin → increased gastrin → increased H+ secretion → duodenum can’t compensate → duodenal ulcers

625
Q

blood supply to Wernicke’s area

A

MCA (inferior division)

626
Q

blood supply to Broca’s area

A

MCA (superior division)

627
Q

tumor classification that determines prognosis

A

stage (extent of expansion)

628
Q

postprandial epigastric pain w/ generalized atherosclerosis

A

chronic mesenteric ischemia

629
Q

when do you see red neurons?

A

12-24 hrs post ischemic stroke

630
Q

what starts DIC in Ob complications

A

release of tissue factor from placenta into maternal circulation

631
Q

tx for bacteroides fragilis (beta lactam producer)

A

piperacillin-tazobactam

works for pseudomonas too

632
Q

acute graft rejection histo

A

dense interstitial lymphocytic infiltrate (T cell mediated)

633
Q

what do you treat with all-trans-retinoic acid

A

APL

634
Q

when in pulmonary vascular resistance lowest?

A

functional residual capacity

635
Q

MCC of sudden cardiac death in first 48 hrs post acute MI

A

ventricular tachycardia

636
Q

path of cirrhosis

A

diffuse hepatic fibrosis

replace normal tissue w/ parenchymal nodules

637
Q

MCC neonatal intraventricular hemorrhage

A

low birth weight → fragile germinal matrix (lines ventricles)

638
Q

first area damaged in global ischemia

A

hippocampus

639
Q

most abundant AA in collagen

A

glycine

640
Q

DKA pts are susceptible to what?

A

mucor infection

641
Q

black necrotic eschar in nasal cavity

A

mucormycosis

642
Q

long term complication of ASD

A

Eisenmenger syndrome

pulmonary vascular sclerosis → chronic pulmonary HTN

643
Q

levels that increase risk of gallstones

A

increased cholesterol
decreased bile salts
decreased phosphatidylcholine

644
Q

renal problems + eosinophilia

A

acute interstitial nephritis

645
Q

mechanism of ataxia telangiectasia

A

AutoRec
ATM gene
impaired DNA break repair → IgA deficiency → airway infections

646
Q

human recombinant insulins w/o any AA modification

A 
regular insulin (duh)
NPH
647
Q

eq to use for 95% confident

A

Mean +/- 1.96 x SD/sqrt n (95)

Mean +/- 2.58 x SD/sqrt n (99)

648
Q

MCC bloody nipple discharge

A

intraductal papilloma

proliferation of papillary cells in a cyst wall or duct that may contain focal atypia

649
Q

movement of PAH into/out of the tubules

A

freely filtered by glomerulus but majority is secreted by PCT
not reabsorbed anywhere

650
Q

melanocyte embryology derivative

A

neural crest cells

651
Q

turner syndrome mechanism of genetic loss

A

paternal meiotic nondisjunction

652
Q

hereditary pulmonary arterial HTN genetics

A

2 hit mechanism starts with an abnormal BMPR2

653
Q

pulmonary arterial HTN pathophys

A 
dysfunctional endothelial and smooth muscle proliferation
increased endothelin (vasoconstrictor)
decreased NO and prostacyclin
654
Q

what do you grow on a Bordet-Gengou medium

A

bordetella pertussis

655
Q

cough lasting > 2 wks a/w post-tussive emesis

A

pertussis (adults lose immunity w/o boosters)

656
Q

ADEs of methotrexate

A 
oral/GI ulcers
alopecia
pancytopenia
hepatotoxicity
pulmonary fibrosis
657
Q

how does iodine kill things?

A

halogenation of proteins and nucleic acids

kills spores too

658
Q

what happens with septic emboli

A

tricuspid valve endocarditis → pulmonary emboli → wedge shaped hemorrhagic lesions

659
Q

blood supply to ureters

A

proximal: renal artery
distal: superior vesical artery

660
Q

causes of acute serum sickness

A

exposure to an antigen
antigenic heterologous proteins (like monoclonal Abs)
nonhuman immunoglobulins (like venoms)
non protein drugs (penicillin, cefaclor, TMP-SMX)

661
Q

fever, pruritic skin rash, arthralgias

A

acute serum sickness

662
Q

clasp knife spasticity

A

initial resistance to passive extension followed by a sudden release of resistance

663
Q

pure motor weakness affecting contra arm, leg, lower face

A

internal capsule stroke

664
Q

Hashimoto histo

A 
intense lymphocytic infiltrate, often with germinal centers
Hurthle cells (large oxyphilic cells filled with granular cytoplasm)
665
Q

pyruvate kinase deficiency splenomegaly pathophys

A

deformed RBCs are destroyed in red pulp by reticuloendothelial cells → hyperplasia → splenomegaly

666
Q

why do you check phospholipid levels in amniocentesis?

A

check lung development

667
Q

what is the difference btwn CML and leukemoid rxn

A

both have elevated WBC and increased precursors (bans/myelocytes)
CML also has decreased leukocyte (neut) alkaline phosphatase (normal in leukemoid)

668
Q

pronephros →

A

regresses

669
Q

mesonephros →

A

wolffian duct in males

vestigial Gartner’s duct in females

670
Q

metanephric diverticulum (ureteric bud) →

A

collecting system: collecting tubules, ducts, calyces, renal pelvis, ureters

671
Q

metanephric mesoderm (blastema) →

A

glomeruli, Bowman’s space, proximal tubules, LoH, DCTs

672
Q

tx for lymphoma w/ CD20 marker

A

rituximab

673
Q

tx for CML

A

imatinib

674
Q

what cancers do you treat w/ IL-2

A

renal cell carcinoma

melanoma

675
Q

how does imatinib work

A

inhibits tyrosine kinase (made by BCR/ABL)

inhibits cell proliferation but doesn’t induce apoptosis

676
Q

buildup in B12 def

A 
methylmalonic acid (MMA) and homocysteine
→ neuro symptoms
677
Q

signs of cocaine withdrawl

A

increased appetite
hypersomnia
psychomotor retardation
severe depression (crash)

678
Q

signs of opiate withdrawl

A

dilated pupils
yawning
n/v/d
lacrimation

679
Q

Ca action in muscle cells

A

bind to troponin C, displace tropomyosin, expose myosin binding sites on actin filaments

680
Q

MC pediatric malignancy

A

ALL

681
Q

how to tell diff btwn B-cell and T-cell ALL

A

B-cell more common
B cell lineages: TdT, CD10, CD 19, CD20
T cell lineages: CD2, CD3, CD4, CD5, CD7, CD8
T-cell often presents w/ mediastinal mass → respiratory sx, dysphagia, SVC syndrome

682
Q

when to give group strep B prophylaxis

A

intrapartum

check GBS @ 35-37 wks

683
Q

MS cell type changes

A

depletion of oligodendrocytes
proliferation of astrocytes
lipid laden macs

684
Q

CSF in MS

A

increased IgG (oligoclonal bland on protein electrophoresis)

685
Q

when do you see oligodendrocyte depletion

A

MS

progressive multifocal leukoencephalopathy

686
Q

what do mitochondria do in apoptosis

A

release cytochrome c → activates caspases → intrinsic pathway apoptosis

687
Q

when do you see superficial hemangiomas

A

aka infantile, capillary or strawberry

first weeks of life, initially grow fast, regress spontaneously by late childhood

688
Q

kind of injury to urethra (men)

A

posterior: pelvic fractures
anterior: straddle injuries

689
Q

signs of urethral injury (men)

A

can’t void but feel the need
high riding, boggy prostate
blood @ urethral meatus

690
Q

vitamin given in measles

A

vitamin A: prevent ocular comps, reduce risk of pneumonia, encephalitis

691
Q

pneumoconioses by lobe

A

asbestos: lower

silica/coal: upper

692
Q

pneumoconiosis w/ hilar calcifications

A

silicosis (eggshell calcifications)

693
Q

charcot-bouchard aneurysms bleed where?

A

MC: basal ganglia, cerebellar nucs, thalamus, pons

694
Q

basal ganglia blood supply

A

lenticulostriate arteries (from MCA)

695
Q

pathophys of pulmonary abscesses

A

macs/neuts release lysosomal enzymes

696
Q

short vagina, small uterus, normal secondary sex characteristics

A

Mullerian aplasia (Mayer-Rokitansky-Kuster-Hauser syndrome)

697
Q

adrenal insufficiency → what electrolyte levels

A

adrenal insufficiency → less aldosterone
less Na
more K
more H (→ low HCO3 from non-anion gap acidosis → Cl retention to maintain electrical neutrality)

698
Q

how to tx cyanide poisoning

A 
hydroxocobalamin (binds CN ions)
sodium nitrate (induce methemoglobinemia)
sodium thiosulfate (add sulfur molecule → thiocyanate)
699
Q

vitamin A toxicity (acute)

A

nausea, vomiting, vertigo, blurred vision

700
Q

vitamin A toxicity (chronic)

A 
alopecia
dry skin
hyperlipidemia
hepatotox
hepatosplenomegaly
visual problems
papilledema (from pseudotumor cerebri)
701
Q

vitamin A toxicity (teratogen)

A

microcephaly
cardio anomalies
fetal death
(all worse in first trimester)

702
Q

where does parvovirus like to replicate

A

bone marrow (tropism for erythrocytes)

703
Q

MCC aortic stenosis in developed nations

A

calcific degeneration of trileaflet aortic valve

704
Q

MCC aortic stenosis in developing nations

A

rheumatic valve dz (usually involves mitral too)

705
Q

high cortisol levels that don’t suppress with low dose dexamethasone but do with high dose

A

cushing syndrome (pituitary tumor)

706
Q

high cortisol levels don’t suppress with even high dose dexamethasone

A

ectopic (paraneoplastic) ACTH

707
Q

how to manage somatic symptom disorder

A

schedule regular visits with the same provider

708
Q

what cells promote migration/proliferation in atherosclerotic plaques

A

platelets, macs, dysfunctional endothelial cells

→ platelet-derived growth factor released

709
Q

newborn with jaundice, anemia, positive coombs test

A

hemolytic disease of the newborn (erythroblastosis fetalis)

710
Q

epinephrine effects on diastolic BP

A

low dose: beta 2 > alpha 1

high dose: alpha 1 > beta 2

711
Q

most important muscle in valsalva

A

rectus abdominis

712
Q

what do anti-smith Abs actually affect

A

snRNPs (takes out introns)

713
Q

pneumatosis intestinalis present in what condition

A

necrotizing enterocolitis

714
Q

acute allergic contact dermatitis histo

A

spongiosis

715
Q 
severe fasting hypoglycemia
high blood lactate
gout
hepatomegaly
enlarged kidneys
A

Von Gierke

716
Q

cardiomegaly
hypertrophic CM
exercise intolerance

A

Pompe disease

717
Q

hepatomegaly
hypoglycemia
hyperlipidemia
normal lactate levels

A

Cori dz

718
Q

muscle cramps
myoglobinuria
arrhythmia

A

McArdle dz

719
Q

episodic peripheral neuropathy
angiokeratomas
hypohidrosis

A

Fabry

720
Q

hepatosplenomegaly
pancytopenia
osteoporosis
aseptic necrosis of femur

A

Gaucher dz

721
Q

progressive neurodegeneration
hepatosplenomegaly
foam cells
cherry red spot on macula

A

Niemann-Pick

722
Q

progressive neurodegeneration
developmental delay
lysosomes with onion skin
cherry red spot on macula

A

Tay-Sachs

723
Q

peripheral neuropathy
developmental delay
optic atrophy
globoid cells

A

Krabbe dz

724
Q

central and peripheral demyelination

ataxia and dementia

A

metachromatic leukodystrophy

725
Q 
developmental delay
gargoylism
airway obstruction
corneal clouding
hepatosplenomegaly
A

hurler synd

726
Q

milder Hurler w/ aggressive behavior and no corneal clouding

A

Hunter synd

727
Q

failure of processus vaginalis to obliterate →

A

indirect inguinal hernia

communicating hydrocele

728
Q

reye syndrome histo

A

microvesicular steatosis

729
Q

tx for arsenic poisoning

A

dimercaprol

DMSA

730
Q

vitamin given to pts with homocystinuria

A

vit B6

731
Q

how much lumin has to be blocked to cause angina

A

at least 75%

732
Q

most important action in preventing renal stones

A

increase hydration

733
Q

actions of angiotensin II

A

systemic vasoconstriction
constriction of EFFerent glomerular arteriole
increased aldosterone

734
Q

pathophys of diverticulosis

A

pulsion (increased luminal pressure) → mucosa and submucosa outpouch thru muscularis

735
Q

what cells cant use ketones

A

RBCs

736
Q

fibrosis and cysts in lungs show

A

idiopathic pulmonary fibrosis (honeycombing)

737
Q

autodom polycystic kidney dz vs autoRec (timing)

A

autodom usually shows up around 40-50

autorec in first year of life

738
Q

sustained muscle contraction, weakness, cataracts, frontal balding, gonadal atrophy

A

myotonic dystrophy

739
Q

what is the main regulator of iron homeostasis?

A

hepcidin made by the liver

it inhibits iron absorption and release from macs

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