UWorld Journal

Question 1

copper reduction test

Answer 1

nonspecifically detects presence of reducing sugar such as fructose, glucose, and galactose

Question 2

essential fructosuria

Answer 2

benign, autosomal recessive disorder causes some of dietary fructose load to be secreted in urine unchanged due to defective metabolism by fructokinase (so deficient in Aldolase B)

Question 3

hypocalcemia symptoms

Answer 3

paresthesias (lips, mouth, hands, and feet), muscle twitching or cramps

worsening–> trismus or tetany with changes in mental status and generalized seizures

Question 4

insulin types

Answer 4

basal long acting: glargine (once daily) and NPH (twice daily)

short acting: lispro (peak 2-3 hrs), aspart (peak 2-3 hours), regular (peal 30-90min, best for postmeal)

Question 5

Calcitriol

Answer 5

active form of vitamin D

chosen over calcidiol because the conversion of calicidiol to calcitriol is dependent on parathyroid hormone

Question 6

what are thiazolidinediones?

Answer 6

lower glucose by reducing insulin resistance by upregulating genes

takes several days to weeks to observe significant reduction in glucose

Question 7

genes upregulated by thiazolidinediones

Answer 7

• glucose transporter-4 (GLUT4)= insulin-responsive transmembrane glucose transporter expressed in adipocytes and skeletal myocytes
• adiponectin= cytokine secreted by fat tissue that increases the # of insulin-responsive adipocytes and regulates fatty acid oxidation

Question 8

metformin functions by

Answer 8

acting as a noncompetitive inhibitor of mitochondrial glycerol-3-phosphate dehydrogenase–> significant reduction in hepatic glucose production

Question 9

risk of radioactive iodine-131

Answer 9

significant tissue damage to throid gland–> radiation induced hypothyroidism and thyroid carcainoma

treat with potassium iodide

Question 10

Wolff-Chaikoff effect

Answer 10

large increases in serum iodide levels inhibit iodine organification –> reduce thyroid hormone release

Question 11

medullary thyroid cancer

Answer 11

enlarged thyroid nodule with elevated calcitonin level

calcitonin from the parafollicular C cells

Question 12

multiple endocrine neoplasia 2B (MEN2B) diseases

Answer 12

mucosal neuromas, marfanoid habitus (arm span>height, long fingers, joint laxity) medullary thyroid cancer, pheochromocytomas

Question 13

Pheochromocytomas symptoms

Answer 13

paroxysmal hypertension, flushing, diaphoresis, and headaches due to episodic secretion of catecholamines

5 P’s: Pressure (hypertension), pain (headache), perspiration, palpitations, and pallor (alpha1 vasoconstriction)

Question 14

Cushing disease

Answer 14

ACTH-secreting pituitary adenoma

Cushing syndrome is just increased cortisol due to different things

Question 15

characteristics of papillary carcinoma cells

Answer 15

large wtih overlaping nuclei containing finely dispersed chromatin (ground glass appearance aka Orphan Annie eye)

lots of intranuclear inclusion bodies and grooves

psammoma bodies (laminated calcium deposits)

Question 16

biopsy of subacute granulomatous thyroiditis (de Quervain thyroiditis)

Answer 16

early- neutrophilic infiltrate with microabscess formation

then- lymphocytic infiltrate with macrophages and multinucleated gian cells

Question 17

Conn syndrome

Answer 17

aldosterone-producing adrenal adenoma leading to primary hyperaldosteronism

Question 18

aldosterone escape phenomenon

Answer 18

high aldosterone levels–> increased intravascular volume–> increased renal blood flow and augmented release of atrial natriuretic peptide.–> increased sodium excretion by the renal tubues–> limits net sodium retention and prevents the development of overt volume overload and significant hypernatremia

Question 19

histopathological characteristic of gynecomastia

Answer 19

ductal epithelial hyperplasia surrounded by dense stromal fibrosis

Question 20

common pathologic causes of gynecomastia

Answer 20

• obesity (increased aromatase conversion of testosterone to estrogen)
• hyperthyroidism (increased LH secretion and estrogen production)
• cirrhosis (increased aromatse activity, decreased clearance of estrogens)
• chronic kidney disease (decreased testosterone production)

Question 21

tamoxifen

Answer 21

*selective estrogen receptor modulator
inhibits effects of estrogen on breast tissue
*efficient for preventing and treating gynecomastia in patients on androgen-deprivation therapy
*increase risk for endometrial hyperplasia and cancer

Question 22

Spironolactone

Answer 22

K+ sparing diuretics

potent antiandrogen that decreases testosterone production and inhibits the testosteone receptor

commonly used to treat heart failure

side effect- gynecomastia, decreased libido, and impotence

Question 23

deficiency of dihydrobiopterin reductase

Answer 23

• the enzyme necessary to convert phenylalnine to tyrosine and from tryosine to DOPA
• hyperphenylalanemia and elevated prolactin
• impaired phenylalanine hydroxylase activity and low dopamine levels from impaired tyrosine hydroxylase activity

Question 24

tyrosinase deficiency

Answer 24

causes albinism

melanin is synthesized in melanocytes from tyrosine by tyrosinase

Question 25

proximal tubules reabsorb ____ % of water filtered by the glomeruli

Answer 25

>60%

Question 26

ADH acts on which part of the kidney

Answer 26

collecting ducts to change how much more water it needs to reabsorb (additional water reabsorption to the reabsorption that happens in the proximal tubules)

Question 27

Goodpasture syndrome

Answer 27

combined presentation of renal failure and pulmonary hemmorhage in patients with anti-glomerular basement membrane *autoantibodies against alpha 3 chain of type IV collagen

Question 28

anti-glomerular basement membrane (anti-GBM) disease

Answer 28

nephritic deposits composed of IgG and C3 anti-GBM antibodies target collagen type IV, a component of the glomerular basement membrane--> subsequent complement deposition--> rapidly progressive (crescentic) glomerulonephritis

Question 29

Glomerular cresents composed of

Answer 29

proliferating parietal cells with an infiltration of monocytes and macrophages are seen on ligh microscopy

Question 30

Erythropoiesis-stimulating agents

Answer 30

- treat anemia of chronic kidney disease - increased risk for thromboembolic events due to increased blood viscosity - hypertension

Question 31

Vasopressin effects on urea

Answer 31

vasopressin activates urea transporters in the medullary collecting duct--> increaseing urea reabsorption and decreasing renal urea clearance (allows for the production of maximally concentrated urine)

Question 32

most comomon pathologic cause of unilateral fetal hydronephrosis

Answer 32

narrowing or kinking of the proximal ureter at the ureteropelvic junction

Question 33

chronic renal allograft rejection results in

Answer 33

obliterative intimal thickening, tubular atrophy, and interstitial fibrosis

Question 34

hyperacute transplant rejection due to

Answer 34

preformed antiboies against graft see gross mottling and cyanosis, arterial fibrinoid necrosis and capillary thombotic occlusion

Question 35

acute transplant rejection due to

Answer 35

exposure to donor antigens induces humoral/cellular activation of naive immune cells - humoral:C4d deposition, neutrophilic infilitate, necrotizing vasculitis - cellular: lymphocytic interstitial infiltrate and endotheliitis

Question 36

chronic transplant rejection due to

Answer 36

low-grade immune response refractory to immunosuppressants - vascular wall thickening and luminal narrowing - interstitial fibrosis and parenchyma atrophy

Question 37

Graft vs host disease

Answer 37

- commonly seen with bone marrow transplantation - when competent donor T-cells transplanted into an immunocompromised patient and subsequently attack the recipient's organs

Question 38

acidosis stimulates what in the kidneys

Answer 38

-renal ammoniagenesis (process where renal tubular epithelial cells metabolize glutamine to glutamate, generating ammonium that is excreted in urine and bicarb that is absorbed into blood)

Question 39

multiple schlerosis develop _________ a few weeks after developing an acute lesion of the spinal cord

Answer 39

spastic bladder (due to presence of upper motor neuron lesion in spinal cord) increased urinary frequency and urge incontinence

Question 40

ACE inhibitors (-pril) block ACE and cause

Answer 40

- decrease the conversion of angiotensin I to angiiotensin II - increase bradykinin levels

Question 41

ACE inhibitors effects on creatinine

Answer 41

acute rise in serum creatinine by blocking angiotensin mediated efferent arteriold vasoconstriction --> reduction in renal filtration fraction--> can lead to renal failure if patients are dependent on efferent arteriole constriction

Question 42

how can humans acquire schistosomiasis?

Answer 42

-contact with freshwater sources that contain snails infected with Schistosoma larvae - S japonicum and S mansoni cause intestinal and hepatic schistosomiasis - S haematobium cuases urinary schistosomiasis

Question 43

virus carried by bats

Answer 43

rabies

Question 44

filtration fraction (FF)

Answer 44

fraction of plasma flowing through glomeruli filtered across the glomerular capillaries into Bowman's space FF=GFR/RPF (renal plasma flow=RPF) RPF= RBF*(1-Hematocrit)

Question 45

most of the K+ filtered by the glomeruli is resorbed where

Answer 45

proximal tubule and loop of Henle late distant and cortical collecting tubules are the primary sites for regulation of K+ concentration in the urine

Question 46

aldosterone - where does it act in the kidney

Answer 46

acts on the principal and intercalated cells of the renal collecting tubules to cause resorption of soidum and water and loss of potassium and hydrogen ions

Question 47

aldosterone receptor antagonists

Answer 47

sprionolactone and eplerenone important side effect: gynecomastia

Question 48

signs of hyperaldosteronism

Answer 48

hyertension, hypokalemia, metabolic alkalosis and decreased plasma renin activity

Question 49

detrusor overactivity

Answer 49

cause urge incontinence--> frequent urge to urinate

Question 50

renal cell carcinoma- findings

Answer 50

hematuria, renal mass of proximal tubules, malignant cells on histopathology

Question 51

genetic component of renal cell carcinoma

Answer 51

most are sporatic some are associated with von Hippel-Lindau (VHL) disease (autosomal dominant disorder due to deletion or mutation of the VHL tumor suppressor gene on chromosome 3p)

Question 52

Somatic pain from appendicitis

Answer 52

inflammed appendix irritates the parietal peritoneum and abdominal wall to cause more severe somatic pain that shifts from umbilical region to McBurney point (2/3 of distance from umbilicus to anterior superior iliac spine)

Question 53

3 types of groin hernias

Answer 53

direct inguinal, indirect inguinal, and femoral direct and indirect inguinal occurs above the inguinal ligament femoral occurs below inguinal ligament

Question 54

femoral hernias location

Answer 54

lateral to pubic tubercle and lacunar ligament medical to femoral artery and vein more common in women and tend to occur on the right side

Question 55

VIPoma

Answer 55

vasoactive intestinal peptide --> watery diarrhea, hypokalemia, and achlorhydria syndrome(absence of HCl in gastric secretions) (pancreatic cholera) VIP stimulates pancreatic bicarb and chloride secretion, and its binding to intestinal epithelial cells leads to adenylate cyclase activation and increased cyclic AMP production, causing sodium, chloride, and water secretion into the bowel

Question 56

somatostatin

Answer 56

aka octreotide | decreases production of many GI hormones

Question 57

Cholecystokinin

Answer 57

causes increased secretion of pancreatic enzymes and bicarb, gallbladder contraction, and inhibition of gastric emptying produced by I cells of the proximal small bowel mucosa in response to fatty acids and amino acids

Question 58

Hepatitis A virus

Answer 58

most commonly silent or subclinical in young children can present as acute, self-limited illness characterized by jaundice, malaise, fatigue, anorexia, nausea, vomiting, RUQ pain, or aversion to smoking

Question 59

what kills cells with decreased or absent MHC class I proteins on their surfaces?

Answer 59

Natural killer cells

Question 60

Natural killers cells activated by

Answer 60

interferon-gamma and IL-12

Question 61

Small intestinal bacterial overgrowth (SIBO)

Answer 61

- characterized by overproduction of vitamin K and folate--> nausea, bloating, ab discomfort, and malabsorption - caused by gastric bypass

Question 62

test for Meckel diverticulum

Answer 62

99mTc-pertechnetate scan increased uptake of 99mTc-pertechnetate in the periumbilical/RLQ

Question 63

cause of Meckel diverticulum

Answer 63

ileal outgrowth due to failed obliteration of the vitelline (omphalomesenteric) duct

Question 64

why do fructose have a faster metabolism compared to other carbohydrates?

Answer 64

it bypasses a major regulatory step in glycolysis (phosphofructokinase)

Question 65

number of cells needed for Shigella to cause disease

Answer 65

as few as 10-500 cells Shigella is able to invade tissues and is highly adapted to surviving the acidity of stomach and bacteriostatic action of bile

Question 66

most prominent organisms isolated from intraabdominal infections

Answer 66

Bacteroides fragilis and E. coli

Question 67

Vibrio cholerae (description of cells and where they are found)

Answer 67

- oxidase-positive, gram-negative, comma shaped organism - found in contaminated food or water ingestion - treat with fluid replacement

Question 68

Vibrio cholerae- what does the cholera toxin do?

Answer 68

activates adenylate cyclase in intestinal epithelial cells--> increased cyclic adenosine monophosphate, enhanced chloride efflux and decreased dosium reabsorption induces mucin ejection by goblet cells--> causes massive, water diarrhea with mucus and sloughed epithelial cells

Question 69

how does lactase deficiency lead to watery diarrhea?

Answer 69

undigested lactose accumulate in small intestine--> increase in secretion of water and electrolytes in intestinal lumen

Question 70

how can carcinoembryonic antigen (CEA) be used to help monitor colon cancer recurrence?

Answer 70

a glycoprotein involved in cell adhesion elevated initial CEA levels associated with worse prognosis higher in smokers

Question 71

cause of annular pancreas

Answer 71

- abnormal migration of the ventral pancreatic bud - second part of the duodenum surrounded by ring of pancreatic tissue - the annular pancreas can compress the duodenal lumen or obstructed pancreatic drainage (acute or chronic pancreatitis)

Question 72

Aspergillus flavus and Aspergillus parasiticus

Answer 72

produce aflatoxins and grow on food--> consumption strongly associated with hepatocellular carcinoma p53 mutations G:C-->T:A transversaion in codon 249

Question 73

Lactase deficiency and pH

Answer 73

- fermentation of undigested lactose --> production of short-chain fatty acids that acidify the stool (decrease stool pH) - produce hydrogen gase (increased breath hydrogen content)

Question 74

anterior vs posterior duodenal ulcers

Answer 74

anterior wall of the duodenal bulb prone to perforation posterior wall pront to hemorrhage duodenal ulcers more common than gastric ulcers

Question 75

artery associated with posterior duodenal wall

Answer 75

gastroguodenal artery artery located behind the posterior duodenal wall so can when eroded by duodenal ulcers, cause upper gastrointestinal bleeding

Question 76

vitamin E deficiency

Answer 76

vitamin E protect fatty acids from oxidation so deficiency cause oxidative injury, especially neurons with long axons and erythrocytes -->neuromuscular dz and hemolytic anemia

Question 77

production of intrinsic factor

Answer 77

parietal cells int he body and fundus of stomach binds to vitamin B12 to form complex that is absorbed in terminal ileum

Question 78

long-term hyperglycemia most likely contributed to cataract formation by causing

Answer 78

oversaturation of polyol pathway polyol pathway: (first step is to convert glucose into sorbital by aldose reductase, which gets converted slowly to fructose with sorbitol dehydroenase) too much glucose --> too much sorbital that can't be converted to fructose fast enough

Question 79

How does sorbitol accumulatioin due to hyperglycemia leads to diabetic retinopathy, neuropathy, and nephropathy?

Answer 79

increases cellular osmotic and oxidative stress

Question 80

insulin suppresses ________ by directly actin on the alpha cells

Answer 80

glucagon

Question 81

gene mutation assoicated with DiGeaorge syndrome

Answer 81

22q11.2 microdeletion

Question 82

impaired development of which embryonic structures associated with DiGeorge Syndrome

Answer 82

Third pharyngeal pouch--affects inferior parathyroid and thymus Fourth pharyngeal pouch- affects superior parathyroid leads to hypocalcemia and T cell deficiency

Question 83

DiGeorge Syndrome-hypocalcemia increased ________ excitability - ->tapping on facial nerve elicits twiching of nose and lips (_______ sign) - -> inflation of blood pressure cuff leads to carpal spasm (_________sign)

Answer 83

neuromuscular, Chvostek, Trousseau

Question 84

low bone density and vaginal dryness are common sequelae of decreased _________

Answer 84

estrogen

Question 85

if hyperprolactinemia is not treated, prolonged hypogonadism (low estrogen) causes:

Answer 85

accelerated bone loss--> fragility fractures

Question 86

what is maple syrup urine disease? (genes)

Answer 86

autosomal recessive disorder characterized by the defective breakdown of branched-chain amino acids (leucine, isoleucine, and valine)

Question 87

maple syrup urine disease: mutations in branched-chain alpha-ketoacid dehydrogenase complex result in accumulation of ______________ in ___ and _________tissues

Answer 87

branched chain amino acids; serum; peripheral --> neurotoxicity that includes seizures, irritability, lethargy, and poor feeding

Question 88

the sweet odor of the urine in maple syrup urine disease due to:

Answer 88

metabolite of isoleucine

Question 89

Branched-chain alpha-ketoacid dehydrogenase (in addition to pyruvate dyhydrogenase and alpha-ketoglutarate dehydrogenase)requires 5 cofactors:

Answer 89

Thiamin, Lipoate, Coenzyme A, FAD, NAD (mnemonic: Tender Loving Care for Nancy) some patients with maple syrup urine disease improve with high dose thiamine treatement wtih lifelong dietary restrictions

Question 90

why would long term glucocorticoid use decrease cortisol?

Answer 90

--> atrophy of hypothalamic CRH- releasing neurons, pituitary corticotrphic cells, and adrenal zona reticularis and zona fasciulata ==> acute adrenal insufficiency (adreanl crisis) have low CRH, ACTH, and cortisol

Question 91

Why does T3 levels remain normal in hypothyroidism?

Answer 91

T3 has short half-life and conversion of T4 to T3 in peripheral tissues can be variable, T3 levels fluctuate serum T3 levels often remain normal until relatively late-stage hypothyroidism

Question 92

what is maturity-onset diabetes of the young and what is the enzyme that is mutated?

Answer 92

mild-nonprogressive hyperglycemia that often worsens iwth pregnancy-induced insuline resistance. mutation with glucokinase

Question 93

Becuase the symptoms of pheochromocytoma result form increase catecholamine secretion, the symptoms are ____________ due to fluctuations in catecholamine synthesis by tumor

Answer 93

episodie symptoms: headache, tachycardia/palpitations, sweating, hypertension

Question 94

three components of craniopharyngioma

Answer 94

solid, comprised of actual tumor cells cyctic, filled with "machinery oil" liquid calcified component tumor arising from remnants of Rathke's pouch

Question 95

how does craniopharyngioma leads to hyperprolactinemia

Answer 95

compression of pituitary stalk--> loss of dopaminergic inhibition so hyperprolactinemia also cause hypopituitarism

Question 96

risk of pancreatitis rises with increasing _____________

Answer 96

triglyceride pancreatic lipase metabolize triglycerdies to free fatty acids, which have toxic and inflammatory effects on pancreas

Question 97

_________ are the most effective agents for treatment of hypertriglyceridemia

Answer 97

fibrates (eg. fenofibrate)

Question 98

____________ is characterized by a mixed cellular infiltrate with occasional multinuclear giant cells

Answer 98

Subacute (de Quervain, granulomatous) thyroiditis

Question 99

_________________ is characterized with mononuclear infiltrate consisting of lymphocytes and plasma cells, often with germinal centers, residual follicles surrounded by Hurthle cells (large oxyphilic cells filled with granular cytoplasm)

Answer 99

Hashimoto thyroiditis

Question 100

methimazole and propylthiouracil inhibit ___________________, enzyme responsible for both iodine organification and coupling of idotyrosines

Answer 100

thyroid peroxidase

Question 101

thyroid peroxidase is the enzyme responsible for both

Answer 101

iodine organification and coupling of idotyrosines

Question 102

mealtime insulin analogs (eg. lispro, aspart, glulisine) with amino acide substitution at __ terminal end of the ____

Answer 102

C, B

Question 103

____________ an oxidase-positive, non-lactose-fermenting, Gram-negative oranism (common cause of UTI with indwelling bladder catheters)

Answer 103

Pseudomonas aeruginosa

Question 104

acute renal allograft rejection is associated with diffuse ________ infiltration of the renal _________, _______, and _______

Answer 104

lymphocytic; vasculature (endotheliitis), tubules, and interstitium

Question 105

why is inulin clearance commonly used to calculate the GFR?

Answer 105

freely filtered at the glomerulus | neither reabsorbed nor secreted by renal tubules

Question 106

how is acyclovir nephrotoxic?

Answer 106

excreted in urine via glomerular filtration and tubular secretion when concentration exceeds its solubility, crystallization, crystalluria, and renal tubular damage may result if no adequate hydration

Question 107

_________ binds to immunophilin FK-506 binding protein (FKBP) in cytoplasm to form complex that binds and inhibits mTOR--> blocks interleukin-2 signal tranduction and prevents cell cycle rogression and lymphocyte proliferation

Answer 107

Sirolimus

Question 108

__________________ IgA immune complex-mediated vasculitis that generally follows upper respiratory or other minor infection

Answer 108

Henoch-Schonlein purpura type III hypersensitivity reaction self-limited and resolves after circulating immune complexes clear

Question 109

clinical manifestations of Henoch-Schonlein purpura

Answer 109

- palpable purpura - arthralgias - abdominal pain, intussusceptions - renal disease similar to IgA nephropathy (hematuria) most common systemic vasculitis in children

Question 110

left 12 rib overlies the parietal pleura ____________ and the kidney___________

Answer 110

medially; laterally

Question 111

CRAB mneumonic for multiple myeloma's symptoms

Answer 111

HyperCalcemia Renal involvment Anemia Bone lytic lesions/ Back pain osteolysis -->hypercalcemia-->negative feedback on PTH--> urinary loss of Ca2+ renal failure--> decreased 1,25-dihydroxyvitamin D--> decreased Ca2+ reabsorption Monoclonal M protein spikes

Question 112

symptoms of renal cell carcinoma

Answer 112

hematuria, flank pain, abdominal mass (proximal tubules), ppolycythemia (increased erythropoietin production by tumor), fever, weight loss

Question 113

Which of the following nephron segments responds to vasopressin by increasing absorption of a specific solute that is important for generating a high medullary concentration gradient?

Answer 113

medullary segment of the collecting duct medullary interstitium is the region of highest osmolarity in the kidney

Question 114

__________________ of the kidney contain the most dilute urine while the _______________ will contain the most concentrated urine.

Answer 114

distal tubule; collecting ducts

Question 115

tubular fluid osmolarity in presence of high ADH

Answer 115

1) proximal tubule= water reabsorbed with electrolytes so isotonic with plasma (300 mOsm/L) 2) descending limb of loop of Henle= free water drawn out of tubules so hypertonic (>300mOsm/L) 3) thin ascending limb of loop of Henle= electrolytes, not water, reabosrbed, so hypotonic (<300 mOsm/L) 4) distal convoluted tubule= impermeable to water so hypotonic, continue to reabsorb solutes (100mOsm/L) 5) collecting duct= water leaves, hypertonic urine (up to 1200 mOsm/L)

Question 116

most dangerous adverse effect of amphotericin B

Answer 116

nephrotoxicity--> hypokalemia, anemia, hypomagnesemia drug of choice to treat many systemic mycoses

Question 117

___________ is a DNA-dependent RNA polymerase that incorporates short RNA primers into replicating DNA

Answer 117

Primase crucial enzyme for bacterial replication as DNA polymerase cannot initiate DNA synthesis without shor nuclei acid sequence primer

Question 118

Deposition of ______ within Bowman's space is pathologic step in crescent formation in rapidly progressive glomerulonephritis

Answer 118

Fibrin leakage of fibrin into Bowman's space--> proliferation of parietal cells, monocytes, and macrophages

Question 119

What is found in immunofluorence and light microscopy of Acute poststreptococcal glomerulonephritis?

Answer 119

IM: granular ("starry sky") ("lumpy-bumpy") due to IgG, IgM, and C3 deposition along GBM and mesangium LM: enlarged glomeruli and hypercellular

Question 120

what (3) things in urine will promote salt cyrstallization leading to renal calculi (kidney stones)?

Answer 120

increased calcium (hypercalciuria), oxalate (hyperoxaluria), and uric acid (hyperuricosuria)

Question 121

what are two things that can help prevent renal calculi formation (kidney stones)?

Answer 121

increased urinary citrate concentration and high fluid intake

Question 122

what medications can help reduce risk of progession of worsening diabetic nephropathy?

Answer 122

ACE inhibitos or angiotensin II receptor blockers along with glycemic and blood pressure control

Question 123

how to calculate for the total filtration rate

Answer 123

total filtration rate of substance A= GFR * plasma concentration of substance A GFR= inulin clearance Total Filtration Rate of Substance A= (inuline clearance)(plasma concentration of Substance A) net excretion rate of substance A=(inulin clearance)(plasma concentration of Substance A)- (tubular reabsorption of substance A)

Question 124

treatment for 21-hydroxylase deficiency

Answer 124

adrenocorticotropic hormone (ACTH) decrease in cortisol--> increase ACTH--.increase androgen overproduction

Question 125

In Niemann-Pick disease, _______________ deficiency causes accumulation of lipid ____________

Answer 125

sphingomyelinase; sphingomyelin clinical features: hepatospenomegaly, neurologic regression, and cherry-red macular spot in infancy

Question 126

Growth hormone binds to cell surface receptors, leading to intracellular activation of ______________ pathway

Answer 126

JAK-STAT nonreceptor tyrosine kinase STAT induced IGF-1 gene transcription same pathway used with prolactin, immunomodulators (cytokines, IL-2, IL-6,etc), G-CSF, erythropoietin, thrombopoietin

Question 127

inflammation and accumulation of ____________ increases the volume of the retro-orbital tissues to cause proptosis/ exophthalmos

Answer 127

glycosaminoglycans treat with high-dose glucocorticoids- their anti-inflammatory effects most helpful antityroid drugs don't improve ophthalmopathy

Question 128

_________________ reduce synthesis of estrogen from androgens, suppressing estrogen levels in postmenopausal women and slowing progression of estrogen-receptor positive tumors

Answer 128

Aromatase inhibitors (eg. anastrozole, letrozole, exemestane) aromatase needed to aromatize androgens to make estrogens (part of the P450 superfamily)

Question 129

Multiple endocrine neoplasia type 1 characterized by tumors of __________, ___________, and __________

Answer 129

parathyroid gland, pituitary, and pancreas ("3P's") primary hyperparathyroidism --> hypecalcemia or renal stones pituitary (prolactinomas)--> bitemporal hemianopia and headache from mass effect pancreas--> gastrinoma (Zollinger-Ellison syndrome), insulinoma and non-function tumors

Question 130

Debranching enzyme deficiency (Cori disease)--> accumulation of ___________ wiht abnormally _______ (short or long) outer chains (limit dextrins) due to inability to degrade _______________ branch points

Answer 130

glycogen; short; alpha-1,6-glycosidic present with hypoglycemia, ketoacidosis, heptomegaly, and muscle weakness and hypotonia

Question 131

signs of androgenic steroid abuse (cardio, derm, genito, psych, breast, other)

Answer 131

cardio: increased hematocrit, increased LDL, decreased HDL Derm: acne, hirsutism, male-pattern hair loss genito: clitoromegaly, oligomenorrhea, testicular atrophy, decreased spermatogenesis psych: depression, hypomania (female), aggressiveness, mood disorders (males) breast: atrophy for female, gynecomastia for males other: deepen voice, premature epiphyseal closure (kids)

Question 132

21-hydroxylase help convert progesterone or 17-OH progesterone into ____________ and _____________, respectively.

Answer 132

11-Deoxcorticosterone (weak mineralocorticoid); 11-Deoxycortisol

Question 133

skeletal findings in hyperparathyroidism most commonly involve the ________ bone in the __________ skeleton

Answer 133

cortical (compact); appendicular (pectoral girdle, pelvic girdle, and limbs) subperiosteal thinning that appears radiologically as subperiosteal erosions in phalanges of hand, granular "salt-and-pepper" skull, and osteolytic cysts in long bones (osteitis fibrosa cystica)

Question 134

glycogen storage disease type II (__________) caused by deficiency of _______________, an enzyme responsible for breaking down glycogen within acidic environment of lysosomes

Answer 134

Pompe disease; acid alpha-glucosidase (acid maltase)

Question 135

Findings of Pompe disease (glycogen storage disease type II)

Answer 135

cardiomegaly, hypertrophic cardiomyopathy, hypotonia macroglossia hepatomegaly, exercise intolerance normal blood glucose levels muscle biopsy show accumulation of glycogen in lysosomes

Question 136

why is insulin levels higher with oral glucose compared to IV glucose?

Answer 136

incretins=gastrointestinal hormones produced by gut mucosa that stimulate pancreatic insulin secretion due to sugar-containing meals in IV glucose adminstration, incretin is absent so less insulin secretion incretin= such as glucagon-like peptide-1 and glucose-dependent insulinotropic polypeptide (GIP)

Question 137

hereditary orotic aciduria occurs due to a defect in what enzyme?

Answer 137

uridine 5'-monophosphate (UMP) synthase

Question 138

tumor necrosis factor alpha (TNF-alpha) effects on insulin

Answer 138

TNF-alpha is a proinflammatory cytokine that induces insulin resistance through activation of serine kinases, which then phosphorylate serine residues on the beta subunits of insuline receptor (IR) and insuline receptor substrate 1 (IRS-1)--> inhibits tyrosince phosphorylation of IRS-1 by IR and hinders downstream signaling so resistance to normal actions of insulin beta subunits of insulin receptors have tyrosine kinases that are activated when insulin attaches to the alpha subunits of the receptor to induce signaling

Question 139

Testosterone purpose in sexual development

Answer 139

development of internal male genitalia, spermatogenesis, male sexual differentiation at puberty (muscle mass, libido)

Question 140

estrogen purpose in sexual development

Answer 140

endometrial proliferation, development of ovarian granulosa cells, breast development

Question 141

5alpha-reductase (what does it do? and describe the 2 types)

Answer 141

converts testosterone to DHT -2 types: type 1 in postpubescent skin, type 2 in genitals male fetus with defect in this enzyme--> external genitalia do not develop properly--> male pseudohermaphroditism

Question 142

Thyroid peroxidase- what does it do?

Answer 142

catalyze oxidation of iodide, iodination of thyroglobulin, and coupling reaction between 2 iodinzed tyrosine residues to make MIT and DIT

Question 143

symptoms of hereditary orotic aciduria

Answer 143

physical and mental retardation, megaloblastic anemia (elevated mena corpuscular volume, low reticulocyte count), elevated urinary orotic acid patients have failure to thrive and hyperammonemic encephalopphy due to impaired urea synthesis

Question 144

diabetes and cholesterol relationship

Answer 144

insulin resistance promote increased VLDL production diabetics may develop a secondary Type IV or V hyperlipidemia (increased VLDL, chylomicrons) and/or secondary diabetic dyslipidemia with elevated LDL and low HDL

Question 145

Dihydrotestosteron (DHT) purpose in sexual development

Answer 145

development of external male genitalia, growth of prostate, male-pattern hair growth -also increases testosterone effects due to high affinity for testosterone receptor

Question 146

what is hereditary orotic aciduria

Answer 146

rare autosomal recessive disorder of de novo pyrimidine synthesis

Question 147

xanthelasma

Answer 147

xanthoma found on medial eyelids xanthoma often associated with hypercholesterolemia

Question 148

metabolic abnormalities associated with both highly-active antiretroviral therapy (HAART like for HIV) and Cushing's

Answer 148

insulin resistance, hypertriglyceridedema, and reduced HDL cholesterol level

Question 149

thiazide diuretics can cause (side effects)

Answer 149

hyperglycemia and hypertriglyceridemia, may have small effect on fat distribution (loop diuretics do not have these effects)

Question 150

gestational diabetes effect on babies

Answer 150

1) beta cell hyperplasia and hyperinsulinism | 2) after delivery, hypoglycemia due to excess insulin without the same amount of glucose as before

Question 151

common adverse side effect of highly-active antiretroviral therapy (HAART) (for HIV)

Answer 151

medication-induced fat distribution (similar to Cushing's)- lipoatrophy/lipodistrophy (loss of fat from face, butt, and extremities) and central fat deposition

Question 152

Proton pump inhibitors side effects:

Answer 152

hypomagnesemia and increased risk of osteoporosis

Question 153

Sheehan syndrome

Answer 153

ischemic necrosis of pituitary gland

Question 154

pituitary apoplexy

Answer 154

hemorrage of the pituitary gland, different from Sheehan since that is ischemic necrosis

Question 155

most prostate cancer are ________________ dependent

Answer 155

*androgen require androgen deprivation therapy to slow progression and relieve bone pain from bone metastases

Question 156

dihydrotestosterone (DHT)

Answer 156

converted from testosterone by 5-alpha reductase. so when testosterone drops, so does DHT

Question 157

subcutaneous lipoatrophy associated with what enzymes (2)

Answer 157

nucleoside reverse transcriptase inhibitors (especially stavudine and zidoudine) and protease inhibitors

Question 158

chromaffin cells' roles (in adrenal medulla):

Answer 158

1) modified post-ganglionic sympathetic neurons derived from neural crest 2) stimulated by acetylcholine (released from the pre-ganglionic neurons) 3) secrete catecholamines (80% epinephrine and 20% norepinephrine)

Question 159

effects of beta-blockers on glucose level

Answer 159

non-selective beta-blockers (e.g. propranolol, timolol, nadolol) inhibit norepinephrine/epinephrine-mediated compensatory reactions to hypoglycemia (cholinergic symptoms are unaffected such as sweating, hunger and paresthesias) blockade of beta2-adrenergic receptors inhibits hepatic gluconeogenesis and peripheral glycogenolysis and lypolysis use beta-blockers with caution in diabetic patients due to increased risk of hypoglycemia

Question 160

epinephrine effects on glucose use

Answer 160

limits glucose use, also stimulates hepatic glycogenolysis and gluconeogenesis

Question 161

what is leuprolide? how does leuprolide treat prostate cancer

Answer 161

- gonadotrophin-releasing hormone analog - when deliverd in pulsatile fashion, can cause transient rise in LH and tesosterone production (agonist properties) - continuous GnR stimulation--> supresses pituitary LH release and leads to reduced production of testosterone by Leydig cells (antagonist properties)

Question 162

amiodarone- what and its side effects

Answer 162

class II anti-arrythmic agent used to suppress life-threatening rhythm disturbances 40% iodine by weight so can alter thyroid function --> cause hypothyroidism

Question 163

signs of phenylketonuria (PKU)

Answer 163

intellectual disability, gait or posture abnormality, eczema, and musty body odor hypopigmentation of skin, hair, eyes, and catecholaminergic brain nuclei (autosomal recessive)

Question 164

MEN type 2 is associated with germ line mutations in the RET proto-oncogenes and is characterized by what disorders

Answer 164

- pheochromocytomas - medullarythyroid cancer (malignancy of parafollicular C cells) - either parathyroid hyperplasia (MEN 2A) or mucosal neuromas and marfanoid habitus (MEN 2B)

Question 165

T3 vs. T4 in negative feedback on TSH

Answer 165

T3 is the mainly one to have negative feedback

Question 166

absorption of Ca and phosphate in vitamin D deficiency

Answer 166

Ca and phosphate both decreased--> increaed PTH

Question 167

Meningoccocal septicemia can cause bilateral hemorrhagic infarction of the:

Answer 167

adrenal gland--> acute adrenal crisis (Waterhouse-Friderichsen syndrome)

Question 168

structures arising from neural crest cells: MOTEL PASS

Answer 168

Melanocytes, Odontoblasts, Tracheal cartilage, Enterochromaffin cells, Laryngeal cartilage, Parafollicular cells of the thyroid, Adrenal medulla and all ganglia, Schwann cells and Spiral membrane

Question 169

ions/electrolytes imbalances caused by primary hyperaldosteronism

Answer 169

increased aldosterone--> decreased K+ and H+, increased Na+ (Na+ does not increase above normal range) H+ decrease--> metabolic alkalosis (bicarb will increase to compensate)

Question 170

impaired metabolism of 11-deoxycorticosterone (leading to congenital adrenal hyperplasia)- clinical findings

Answer 170

increased production of adrenal androgens so have females with ambiguous genitalia weak mineralocorticoid accumulate--> development of low-renin hypertension and hypokalemia even when aldosteron synthesis is impaired different form 21-hydroxylase deficiency since you don't have hypertension at all

Question 171

5alpha-reductase deficiency effects

Answer 171

needed for conversion of testosterone to dihydrotestosterone so if deficient, will cause ambiguous genitalia in males not females

Question 172

What injury will lead to permanent and transient central diabetes insipidus, respectively?

Answer 172

- can be permenant if injury to hypothalamic nuclei | - transient if injury to posterior pituitary/ infundibular

Question 173

Where does ADH production occur? (2 locations)

Answer 173

occurs in the paraventricular and supranuclei of the hypothalamus

Question 174

exophthalmos of Graves' disease caused by

Answer 174

lymphocytic infilitration, enlargment of the extraocular muscles from myositis, fibroblast proliferation, and overproduction of mucupolysaccharides in response to anti-thyroid antibodies not adrenergic so don't respond to beta blocker

Question 175

FSH and what does it do/produce | for male

Answer 175

stimulates the release of inhibin B from the Sertoli cells in the seminiferous tubules of the testicles produce androgen-binding protein locally, within the seminiferous tubules (responsible for high local testosterone concentration)

Question 176

what is needed for spermatogenesis?

Answer 176

high local levels of testosterone and FSH -defective FSH receptors will prevent spermatogenesis and cause low inhibin B levels

Question 177

SIADH and relationship with Na+

Answer 177

hyponatremia (so no overload) increased ADH--> excessive water reabsorption--> hypervolemia --> supresses renin-aldosterone axis--> stimulates production of natriuretic peptides--> excretion of Na+ in urine (natriuresis) --> patients have normal extracellular fluid volue and low pasma osmolaliy (euvolemic hyponatremia)

Question 178

SIADH is associated to which cancer?

Answer 178

SIADH caused by small cell carcinoma of the lung

Question 179

Hormone-sensitive lipase (HSL)

Answer 179

- enzyme found in adipose tissue that catalyzes athe mobilization of stored triglyercides into free fatty acids (lead to ketone bodies) and glycerol (lead to glucose) - activated by stress hormones (catecholamines, glucagon, ACTH) - inhibited by insulin

Question 180

enzyme used to convert T4 to T3

Answer 180

iodothyronine deiodinase aka 5'-deiodinase

Question 181

Pheochromocytomas

Answer 181

catecholamine-secreting tumors arising from the chromaffin cells of the adrenal medulla or extra-adrenal sympathetic chain

Question 182

symptoms of Meckel diverticulum

Answer 182

spontaneous but painless lower GI bleeding potential lead point for intussusceptioin--> collicky ab pain and "currant jelly" (strawberry jam appearance) stools

Question 183

hyperthyroidism and beta-adrenergic receptors

Answer 183

hyperthyroidism is associated with increased expression of beta-adrenergic receptors --> hypertension, tachycardia, heat involerance, weight loss, and hyperreflexia

Question 184

nerve at risk of injury during thyroidectomy

Answer 184

external branch of superior laryngeal nerve---> innervate cricothyroid muscle (tense vocal cords, so damage leads to low, hoarse voice with limited pitch range)

Question 185

what is Reverse T3

Answer 185

inactive, formed mostly from the conversion of T4 in the periphery

Question 186

what does fructose 2,6-bisphosphate do?

Answer 186

- balance between gluconeogenesis and glycolysis - activates phosphofructokinase-1 (PFK-1) to convert fructose 6-phosphate to fructose 1,6-bisphosphate - inhibit gluconeogenesis, leading to decreased conversion of alanine and other gluconeogeneic substrates to glucose`

Question 187

how does chronically elevated free fatty acid levels contribute to insulin resistance?

Answer 187

impairing insulin-dependent glucose uptake and increasing hepatic gluconeogenesis

Question 188

bile acid-binding resins- what do they do and side effect?

Answer 188

inhibit enterohepatic circulation of bile acids--> synthesis of new bile acids and increase uptake of cholesterol to reduce LDL side effect: hypertriglyceridemia

Question 189

anterograde axonal transport ( away from nucleus, down axon, toward nerve terminal) mediated by what protein?

Answer 189

kinesin retrograde axonal transport mediated by dynein

Question 190

tetrodotoxin poisoning-source and how?

Answer 190

from pufferfish | toxin binds to voltage-gated Na channels in nerve/cardiac tissue--> prevent Na influx and depolarization

Question 191

symptoms of tetrodotoxin poisoning

Answer 191

dizziness, weakness, loss of reflexes, paresthesias of face and extremities, nausea, vomiting, diarrhea, hypotension, respiratory failure treat with gut lavage and charcoal

Question 192

solubility of drug in the peripheral tissues

Answer 192

if tissue solubility is high: large amount of drug taken up from arterial blood, so low venous concentration--> saturation of blood needs more of the drug to become saturated so take longer for the onset of actions (want blood to be saturated for drug to work)

Question 193

deficiency of ______________ results in recurrent infections by Neisseria species

Answer 193

complement factors that form the membrane attack complex (ie., C5b-C9)

Question 194

general sensory innervation of the tongue: 1) anterior 2/3 2) posterior 2/3 3) posterior area of the tongue root

Answer 194

1) mandibular branch of trigeminal nerve 2) glossopharyngeal nerve 3) vagus nerve

Question 195

gustatory innervation (taste buds) of tongue 1) anterior 2/3 2) posterior 2/3 3) posterior area of tongue root and taste buds of larynx an upper esophagus

Answer 195

1) chorda tympani branch of facial nerve 2) glossopharyngeal 3) vagus

Question 196

clinical features of fragile X syndrome

Answer 196

long, narrow face, prominent forehead and chin, large testes, hyperlaxity of hang joints, developmental delay

Question 197

how does muscarinic3 receptors promoting synthesis of nitric oxide lead to vasodilation?

Answer 197

NO diffuses to vascular smooth muscle cells to activate guanylate cyclase and increase intracellular cGMP to activate myosin light chain

Question 198

functions of peroxisomes

Answer 198

- oxidation of very long and branched-chain fatty acids | - hydrogen peroxide degradation

Question 199

3 D's of pellagra for niacin deficiency

Answer 199

dementia, dermatitis, diarrhea

Question 200

symptoms of Vitamin A toxicity: - acute - chronic - tertogenic

Answer 200

- acute: nausea, vomiting, vertigo, blurred vision - chronic: alopecia, dry skin, hyperlipidemia, hepatotoxicity, hepatosplenomegaly, visual difficulties - tertogenic: microcephaly, cardiac anomalies, and fetal death

Question 201

myasthenia gravis- mechanism of action does compound muscle action improve with stimulation?

Answer 201

autoimmune attack against postsynaptic nicotinic receptors compound muscle action does not improve with stimulation

Question 202

Lambert-Eaton myasthenia syndrome- mechanism of action does compound muscle action improve with stimulation?

Answer 202

autoantibodies against presynaptic voltage-gated calcium channels compound muscle action does improve with stimulation

Question 203

Clostridium botulinum toxin- mechanism of action

Answer 203

inhibits acetylcholine release from presynaptic nerve terminals at NMJ with decreased compound muscle action potential, but increase with repetitive nerve stimulation

Question 204

minimal alveolar concentration- what is it used to measure and what affects it?

Answer 204

=intrinsic property of anesthetics, percentage of anesthetic in the inspired gas mixture that renders 50% of patients unresponsive does not depend on type of surgery, duration of anesthesia, or sex, height, and weight depend on body temp and decreases with increasing age

Question 205

cryptococcus neoformans- histology, from what, who does it affect, and how is it transmitted?

Answer 205

spherical yeast forms with peripheral clearing and thick capsules; from soil and bird droppings immunocompromised; respiratory tract

Question 206

essential tremor- classic signs

Answer 206

- familial tremor - tremor worsens while maintaining a particular posture - usually report that symptoms improve with alcohol consumption

Question 207

treatment for essential tremor

Answer 207

propranolol- nonselective beta-adrenergic antagonist

Question 208

what is the mechanism of action of triptans?

Answer 208

serotonin 5-HT1B/5-HT1D agonist- inhibit release of vasoactive peptides, promoting vasoconstriction, and blocking pain pathways in the brainstem for migraines prophylaxis

Question 209

key features of somatic symptom disorder

Answer 209

excessive anxiety and preoccupation with >/= 1 unexplained symptoms

Question 210

key features of conversion disorder (functional neurologic symptom disorder)

Answer 210

neurologic symptom incompatible with any known neurologic disease; often acute onset associated with stress

Question 211

what is neurofibromatosis type I (von Recklinghause disease)

Answer 211

autosomal dominant neurocutaneous disorder due to mutations in NF1 tumor suppressor gene hyperpigmented macules (cafe-au-lait spots_ over trunk after birth and increased risk of developing CNS neoplasms --> elevated intracranial pressure and headache

Question 212

mneumonic for eye muscle innervation

Answer 212

LR6-SO4-R3

Question 213

Oculomotoer nerve (CNIII) palsy- clinical features

Answer 213

-"down and out" due to unopposed action of the superior oblique and lateral rectus -ptosis -impaired pupillary constriction and accomodation diagonal diplopia

Question 214

principal site for norepinephrine synthesis in brain what does it control?

Answer 214

locus ceruleus (paired pigmented brainstem nucleus located in the posterior rostral pons near the lateral floor of the fourth ventricle) control of mood, arousal, sleep-wake states, cognition, and autonomic function (ie blood pressure)

Question 215

4-drug combination to treat pulmonary tuberculosis

Answer 215

RIPE therapy | rifamycin (eg, rifampin, rifabutin), isoniazid, pyrazinamide, and ethambutol

Question 216

side effect of rifamycin

Answer 216

GI side effects, hepatotoxicity, minor drug reaction (increase in cytochrome P450), harmless red-orange discoloration of body fluids mechanism of action: inhibit DNA-dependent RNA polymerase- prevent transcription and lead to deficiency of proteins necessary for mycobacterial survival

Question 217

mechanism of action of rifamycin

Answer 217

inhibit DNA-dependent RNA polymerase to prevent transcription and lead to deficiency of proteins necessary for mycobacterial survival structural alteration of this DNA-dependent RNA polymerase induces bacterial resistance

Question 218

mechanism of bacterial resistance to penicillin

Answer 218

upregulation of beta-lactamase synthesis resistance to beta-lactam drugs like penicillin, aminopenicillin, cephalosporins, and monobactams

Question 219

what type of food can cause Hepatitis A

Answer 219

contaminated water or food, with raw or steamed shellfish being the typical transmission through fecal-oral route

Question 220

what chemokine receptor allows HIV virus to enter cells

Answer 220

CCR5- act as as a coreceptor to CD4 proteins since HIV virus uses CD4 as the primary receptor. HIV binds to both to enter cell if cells don't have CCR5 protein on membrane, then the virus binds to CD4 but cannot enter cell

Question 221

1) in what cell types are cholesterol converted to androgens in females? 2) where are androgens converted to estrogen?

Answer 221

1) theca interna (synthesis of androgens) (need LH input) | 2) granulosa cells (contain aromatase) (need FSH input)

Question 222

what do interleukin-8 do?

Answer 222

chemokine produced by macrophages that induces chemotaxis and phagocytosis in neutrophils-->becomes pus calls in the neutrophil to site of infection and then kills then after they arrived and di dtheir jobs

Question 223

clinical presentationof bacterial vaginosis

Answer 223

grayish-white, "fishy-smelling", and mildly pruritic vaginal discharge clue cells (epithelial cells covered with gram-variable rods) caused by imbalance of vaginal bacterial flors--> overgrowth of Gardnerella vaginalis

Question 224

what landmarks will help distinguish between direct and indirect inguinal hernias?

Answer 224

inferior epigastric vessels inguinal hernias different from femoral hernia since they are located above the inguinal ligament

Question 225

superior mesenteric vessels lie _____________ to the third part of the dudenum

Answer 225

anterior

Question 226

presence of ca central vascular catheter and receipt of parenteral nutrition are risk factors for

Answer 226

candidemia (Candida in the bloodstream) Candida display a morphology of branching pseudohyphae with blastoconidia

Question 227

antigen attaches to ______________ on immunoglobin G1

Answer 227

Fab

Question 228

phagocytic cells attaches to ______________ on immunoglobin G1

Answer 228

Fc Receptor

Question 229

histology of cavernous hemangioma

Answer 229

carvernous, blood-filled vascular sapces of variable size lined by a single epithelial layer biopsy not advisable since it can cause fatal hemorrhage cavernous hemangioma= most common benign liver tumor

Question 230

effect of fibrates on gallbladder

Answer 230

reduce cholesterol solubility and promote gallstone formation by reducing bile acid synthesis

Question 231

effects of pernicious anemia with loss of parietal cell mass

Answer 231

- decreased HCl secretion--> elevated intraluminal pH that leads to upregulation of gastrin secretion - decreased intrinsic factor secretion so develop vitamin B12 deficiency

Question 232

4 main classes of antifungal medications and their mechanism of action

Answer 232

1) polyenes (amphotericin B, nystatin): bind to ergosterol molecules in fungal cell membranes to create pores for cell lysis 2) triazoles (ketoconazole, fluconazole, etc): inhibit synthesis of ergosterol 3) echinocandins (caspofungin, micafungin): inhibit synthesis of glucan, a component of fungal cell wall 4) pyrimidines: flucytosine, only agent in this class, is converted to 5-fluorouracil within the cell and interferes with fungal RNA and protein synthesis

Question 233

____________ virus is a replication-defective RNA virus that is only capable of causing infection when encapsulated with HBsAg

Answer 233

Hepatitis D...aka delta agent or hepatitis delta virus

Question 234

intestinal atresias of the midgut (eg, jejunum, ileum, proximal colon) are the result of ____________ in utero

Answer 234

vascular occlusion

Question 235

clinical features of herpes simplex virus type 1 encephalitis

Answer 235

edema and hemorrhagic necrosis of the temporal lobe | headache, fever, mental status changes, cranial nerve deficits, seizures

Question 236

mechanism of action of isoniazid

Answer 236

antimicrobial agent active only against mycobacteria inhibition of mycolic acid synthesis, so mycobacteria lose their acid-fastness and become unable to synthesize new cell walls or multiply

Question 237

in what gastric layers do parietal cells reside?

Answer 237

upper glandular layer they secrete gastric acid and intrinsic factor

Question 238

laboratory/imagining studies findings of rheumatoid arthritis

Answer 238

- positive rheumatoid factor and anti-cyclic citrullinated peptide (anti-CCP) antibodies - C-reactive protein and ESR correlate with disease activity - X-ray: soft tissue swelling, joint space narrowing, bony erosions

Question 239

Meckel's diverticulum is a true diverticulum and consists all parts of the intestinal wall, which include:

Answer 239

mucosa, submucosa, and muscularis false diverticula only have mucosa and submucosa

Question 240

what are maternal serum alpha-fetoprotein (MSAFP) screening used for?

Answer 240

identify pregnancies at high risk of congenital defects - open neural tube defects - ventral wall defects - multiple gestation - aneuploidies (when have decreased MSAFP, the others are increased MSAFP)

Question 241

features of mitochondrial myopathy

Answer 241

mitochondria not functioning properly so can't make enough ATP--> myopathy, lactic acidosis, nervous system dysfunction muscle biopsy shows ragged red fibers inheritance: materal mitochondrial DNA

Question 242

Staphylococcus virulence mechanism by which it causes disease?

Answer 242

synthesis of an extracellular polysaccharide matrix that encases the bacteria. this biofilm acts as a barrier to antibiotic penetration

Question 243

mechanism of action for Class III antiarrhythmic drugs (eg, amiodarone, sotalol, dofetilide)

Answer 243

block potassium channels and inhigibt outward potassium currents during phase 3 of cardiac action potential --> prolong repolarization and total action potential duration

Question 244

___________ has been the leading cause of cancer mortality in both women and men in the United States since the 1980s

Answer 244

lung cancer

Question 245

how does the metyrapone stimulation test work? what is it testing for?

Answer 245

sensitive indicator of hypothalamic-pituitary-adrenal axis integrity blocks cortisol synthesis by inhibiting 11-beta-hydroxylase so no negative feedback from cortisol on pituitary--> increase in ACTH

Question 246

what is primary and secondary hyperaldosteronism

Answer 246

primary: increased aldosterone, decreased renin- due to aldosterone-producing tumor or bilateral adrenal hyperplasia secondary: increased both renin and aldosterone- due to renovascular hypertension, renin-secreting tumor, and edema

Question 247

clinical features of arginase deficiency

Answer 247

- an enzyme in urea cycle that produces urea and ornithine - diagnosed based on elevated arginine levels - spastic diplegia (stiffness of lower extremities) - abnormal movments - growth delay - treat with low-protein diet devoid of arginine

Question 248

clinical features of Lesch-Nyhan syndrome

Answer 248

X-linked recessive | dystonia, choreoathetosis, self-mutilation, and hyperuricemia

Question 249

cause of Lesch-Nyhan syndrome

Answer 249

deficiency of hypoxanthine-guanine phosphoribosytransferase (HGPRT)- enzyme for purine salvage pathway deficiency--> increased degradation of guanine and hypoxanthine bases into uric acid and increased demand for de novo purine synthesis

Question 250

individuals with Down syndrome have a 10- to 20-fold increased risk of developing ________ and __________ (cancer)

Answer 250

Acute lymphoblastic leukemia and acute myelogenous leukemia

Question 251

which part of the nephron do potassium sparing diuretics act on?

Answer 251

collecting duct | spironolactone and amiloride

Question 252

which part of the nephron do carbonic anhydrase act on

Answer 252

proximal tubule (acetazolamide)

Question 253

osmotic diuretics act on this part of the nephron

Answer 253

descending limb of Henle's loop and proximal tubule (mannitol)

Question 254

loop diuretics act on this part of the nephron

Answer 254

thick ascending limb of Henle's loop | furosemide

Question 255

thiazide diuretics act on which part of the nephron

Answer 255

distal convoluted tubules | hydrochlorothiazide

Question 256

Guillain-Barre syndrome can be caused by _______________ infection

Answer 256

Campylobacter jejuni

Question 257

what is hereditary angioedema?

Answer 257

inherited autosomal dominant condition that causes episodes of painless, non-pitting, well-circumscribed edema. If it affects the tracheobronchial tree, then cause respiratory obstruction indicated by low serum levels of C1 esterase inhibitor

Question 258

lab findings of hereditary angioedema

Answer 258

low serum levels of C1 esterase inhibitor, increased level of active kallikrein and bradykinin contraindicated for ACE inhibitors since ACE inhibitors can increase bradykinin even more

Question 259

how does lithium induce nephrogenic diabetes insipidus?

Answer 259

reduce ability of the kidney to concentrate urine primarily by antagonizing the action of vasopressin (antidiuretic hormone) i the collecting tubules and ducts

Question 260

what is X-linked agammoglobulinemia (XLA)?

Answer 260

mutation in the Bruton tyrosine kinase gene causes failure of bone marrow pre-B cells (CD19+, CD20+) to develop into mature, circulating B lymphocytes (CD19+, CD20+, CD21+) have low or absent B cells in peripheral blood and pan-hypogammaglobulinemia ( low immunoglobulin)

Question 261

embryologic derivatives: mesoderm

Answer 261

muscles (skeletal, cardiac and smooth), connective tissue, bone, cartilage, serosa linings (eg peritoneum), cardio system, blood, lymphatic system, spleen, internal genitalia, kidney and ureters, adrenal cortex

Question 262

embryologic derivatives: endoderm

Answer 262

GI tract, liver, pancreas, lungs, thymus, parathyroids, thyroid follicular cells, middle ear, bladder and uretra

Question 263

embryologic derivatives: ectoderm- surface ectoderm

Answer 263

Rathke pouch (anterior pituitary, lengs and cornea, inter ear sensory organs, olfactory epithelium, nasal and oral epithelial linings, epidermis; salivary, sweat and mammary glands

Question 264

embryologic derivatives: ectoderm-neural tube

Answer 264

brain and spinal cord, posterior pituitary, pineal gland, retina

Question 265

embryologic derivatives: ectoderm- neural crest

Answer 265

autonomic, sensory and celiac ganglia; Schwann cells; pia and arachnoid mater; aorticopulmonary septum and endocardial cushions; branchial arches (bones and cartilage); skull bones, melanocytes; adrenal medualla

Question 266

risk of asbestos exposure

Answer 266

asbestosis, pleural plagues, bronchogenic carcinoma, and malignant mesothelioma Bronchogenic carcinoma is the most common malignancy then mesothelioma

Question 267

clinical features of DiGeorge syndrome

Answer 267

- conotruncal cardiact defects (tetrology of Fallot, truncus arteriosus, interrupted aortic arch) - abnormal facies - thymic hypoplasia/aplasia (T-cell deficiency) - craniofacial deformities (cleft palate) - hypocalcemia/hypoparathyroidism

Question 268

4 criteria of tetrology of Fallot

Answer 268

1) pulmonary infundibular stenosis (most important determinant for prognosis) 2) right ventricular hypertrophy 3) overriding aorta 4) ventricular septal defect

Question 269

graft-versus-host disease- cause

Answer 269

for those who are immunocompromised, immunocompetent donor T cells from the graft survive and migrate into host tissues--> recognize host MHC antigens as foreign and become sensitized donor CD4+ and CD8+ T cells (not B cells) participate in host cell destruction\ GVDH occur after transplantation of organs rich in lymphocytes (eg, liver)

Question 270

carbonic anhydrase inhibitor diuretic- mechanism of action

Answer 270

block bicarb reabsorption so enhanced bicarb and water excretion--> increase urinary pH and potential metabolic acidosis also used to help with intraocular pressures in open-angle and angle-closure glaucoma

Question 271

lesion of the _________________ can produce contralateral homonymous hemianopia with macular sparing

Answer 271

occipital cortex (eg, posterior cerebral artery occlusion)

Question 272

best an most reliable auscultatory indicator of the degree of mitral stenois is the __________ interval

Answer 272

A2-OS (A2-aortic valve closure) (opening snap due to abrupt tensing of the value leaflets as the mitral valve reaches its maximum diameter during forceful opening) shorter interval= more severe stenosis can also hear diastolic rumbling murmur with presystolic accentuation due to left-atrial contraction

Question 273

dengue hemorrhagic fever- symptoms

Answer 273

high-grade fever, diffuse macular rash, muscle and join pain, leukopenia, hrombocytopenia, elevated liver enzymes, headache, retro-orbital pain, bleeding

Question 274

primary vs secondary infection of Dengue virus

Answer 274

primary- can be asymptomatic or self-limited disease in most adults secondary- infection with a different viral serotype and usually causes more severe illness

Question 275

O2 and CO2 content of arterial vs. venous blood during exercise

Answer 275

homeostatic mechanism maintain arterial O2 and CO2 contents and pH near normal resting values venous blood O2 and CO2 and pH changes- O2 decreased and CO2 increased, pH decreased

Question 276

what is case-control stdy

Answer 276

selecting patients with particular diseases (cases) and without that disease (controls) and determining their previous exposure status

Question 277

cross-sectional study aka __________

Answer 277

prevalence study= simultaneous measurement of exposure and outcome

Question 278

surface marker of monocyte-macrophage cell lineage

Answer 278

CD14

Question 279

histology signs of secondary tuberculosis

Answer 279

caseating granulomas with central necrosis and Langhans giant cells

Question 280

posteromedial papillary muscle is supplied solely by the _______________ artery

Answer 280

posterior descending

Question 281

anteroateral papillary muscle has dual blood supply from the _______________ and ____________ arteries

Answer 281

left anterior descending (LAD) ; left circumflex

Question 282

clinical features of coarctation of the aorta

Answer 282

systolic hypertension of upper extremities along with characteristic diminished and /or delayed femoral pulses (brachial-femoral delay) (femoral

Question 283

clinical presentation of aortic regurgitation

Answer 283

increase in LV end-diastolic volume and wall stress, hypertrophy of LV, diastolic decresendo murmur at left sternal border in 3rd and 4th intercostal space, wide pulse pressure (bounding femoral and carotid pulses), head bobbing

Question 284

frothy, foamy urine may be caused by _____________ or __________ in the urine

Answer 284

proteinuria; bile salts can lead to regional or generalized interstitial edema because the decrease in serum albumin and total protein lowers the plasma oncotic pressure and increases net plasma filtration in capillary beds (associated with nephrotic syndrome)

Question 285

_______________ is the only prokaryotic polymerase that also has 5' to 3' exonuclease activity

Answer 285

DNA polymerase I functions to remove the RNA primer created by RNA primase to be replaced with DNA and repair damaged DNA sequences

Question 286

function of topoisomerase II aka DNA gyrase in prokaryotes

Answer 286

relieve tension created during DNA strand unwinding by adding or removing supercoils into the circular DNA antibiotics that work by inhibiting DNA gyrase: fluoroquinolones

Question 287

what does DNA polymerase III do?

Answer 287

Prokaryotes only. Elongates leading strand by adding deoxynucleotides to the 3′ end. Elongates lagging strand until it reaches primer of preceding fragment. 3′ -->5′ exonuclease activity “proofreads” each added nucleotide. DNA polymerase III has 5′ 3′ synthesis and proofreads with 3′ 5′ exonuclease.

Question 288

What cell types are directly responsible for synthesizing fibrous cap of atheromas in atherosclerosis

Answer 288

vascular smooth muscle cells

Question 289

homeobox or hox gene code for ______________ that bind to regulatory regions on DNA, altering the expression of genes involved int eh segmental organization of the embryo

Answer 289

transcription factors homeobox gene mutations--> abnormalities such as skeletal malformation and improperly positioned limbs and appendages

Question 290

locations to auscultate for holosystolic murmurs 1) mitral regurgitation 2) tricuspid regurgitation 3) ventricular septal defect

Answer 290

best heard at: 1) apex 2) left 2nd and 3rd intercostal spaces 3) left 3rd and 4th intercostal spaces

Question 291

S1 heart sounds

Answer 291

mitral and tricuspid valve closure. Loudest | at mitral area.

Question 292

S2 heart sounds

Answer 292

aortic and pulmonary valve closure. | Loudest at left upper sternal border.

Question 293

S3 heart sounds

Answer 293

in early diastole during rapid ventricular filling phase. Associated with increased filling pressures (eg, mitral regurgitation, HF) and more common in dilated ventricles (but can be normal in children and young adults).

Question 294

S4 heart sounds

Answer 294

in late diastole (“atrial kick”). Best heard at apex with patient in left lateral decubitus position. High atrial pressure. Associated with ventricular noncompliance (eg, hypertrophy). Left atrium must push against stiff LV wall. Consider abnormal, regardless of patient age.

Question 295

characteristics of Pseudomonas aeruginosa

Answer 295

motile gram-negative rod that is oxidase-positive, produces green pigment during culture (aerugula is green)

Question 296

"hot tub folliculitis" is due to _________________ infection of the hair follicles following exposure to a pool or spa not maintained appropriately

Answer 296

Pseudomonas aeruginosa

Question 297

first line agent to treat narcolepsy because it is effective, well tolerated, and drug abuse is rare (non-amphetamine stimulant)

Answer 297

Modafinil--enhance dopaminergic signaling

Question 298

why is COX 2 inhibitors preferred over COX1 inhibitors when deciding NSAIDs?

Answer 298

COX2 inhibitors have less risk of bleeding and gastrointestinal ulceration

Question 299

Function of type II pneumocytes

Answer 299

source of pulmonary surfactant and have the ability to proliferate in response to injury act as progenitor cells for type I pneumocytes, which cannot regenerate on their own

Question 300

structure of MHC class I that present antigen to CD8+ cytotoxic T-cells

Answer 300

heavy chain and beta2-microglobulin

Question 301

structure of MHC class I that present antigen to CD4+ T-helper lymphocytes

Answer 301

alpha and beta polypeptide chains

Question 302

_________ is a cause of rapidly progressive (crescentic) glomerulonephritis type 3 (pauci-immune)

Answer 302

Granulomatosis with polyangiitis (Wegener's)

Question 303

Granulomatosis with polyangiitis (Wegener's): characteristic findings:

Answer 303

1) lowr respiratory tract- pulmonary symptoms (cough and/or hemoptysis) 2) involvement of the upper respiratory tract (i.e., ear , nose, sinuses, throat) 3) renal disease in the form of rapidly progressive (crescentic) glomerulonephritis

Question 304

embryonic development of the urachus

Answer 304

In the 3rd week the yolk sac forms the allantois, which extends into urogenital sinus. Allantois becomes the urachus, a duct between fetal bladder and umbilicus.

Question 305

patent urachus that connects the umbilicus and bladder to due to:

Answer 305

complete failure of obliteration of the urachus... aka persistence of allantois remnant patients present with straw-colored urine discharge from the umbilicus

Question 306

what is Gerstmann syndrome?

Answer 306

neurologic disorder characterized by: 1) agraphia 2) acalculia (can't carry out math problems) 3) finger gnosia (can't identify individual fingers) 4) left-right disorientation due to damage to the angular gyrus of the dominant parietal lobe

Question 307

Hemoglobin C is caused by a _____________ mutation that results in a ______________ residue being substituted by ______ in the beta globin chain

Answer 307

missense; glutamate; lysine

Question 308

most common eye-related complication of congenital cytomegalovirus infection

Answer 308

chorioretinitis

Question 309

earliest lesions of atherosclerosis and can be seen as early as the second decade of life

Answer 309

fatty streaks appear as a collection of lipid-laden macrophages (foam cells) in the intima that can eventurally progress to atherosclerotic plaques

Question 310

personality disorder- schizoid

Answer 310

prefers to be a loner, detached, unemotional cluster A- weird

Question 311

personality disorder-schizotypal

Answer 311

eccentric; odd thoughts, perceptions and behavior =magical thinking cluster A-weird

Question 312

personalitydisorder: histrionic

Answer 312

dramatic, superficial, attention-seeking, sexually provocative cluster B-wild

Question 313

influenze epidemics and pandemics are typically caused by reassortment of the ____ segments coding for ________________ or __________ proteins (major antigenic shifts)

Answer 313

RNA; hemagglutinin; neuraminidase

Question 314

________ is a cause of acute, painless, monocular vision loss--> caused by thromboembolic complications of atherosclerosis from the _______________ artery and through the ______ artery

Answer 314

Retinal arter occlusion; internal carotid; ophthalmic

Question 315

blood flow is ______ proportional to the vessel radius raised to the _____ power

Answer 315

directly ; fourth *resistance to blood flow is inversely proportional to the vessel radius raised to the fourth power

Question 316

test used for diagnosis of Cryptococcus neoformans meningoencephalitis in HIV (+) poatients

Answer 316

latex agglutination test detects the polysaccharide capsule antigen india ink staining of theCSF shows round or oval budding yeast

Question 317

_________ is the major amino acid responsible for transferring nitrogen to the liver for disposal

Answer 317

alanine

Question 318

how does alanine and glutamine play a role in transporting nitrogen throughout the body

Answer 318

catabolism of proteins--> release of alanine and its amino groups transferred to alpha-ketoglutarate to form glutamate--> glutamate processed in liver to form urea to be disposed

Question 319

characteristics of amiodarone (how it works)

Answer 319

``` -class III antiarrhythmic drug for management of a variety of supraventricular and ventricular arrhythmias block K+ channels and inhibit outward K+ currents during phase 3 to prolong repolarization and total action potential duration -QT prolongation -very little risk of inducing torsades de pointes ```

Question 320

local cutaneous adverse effects of chronic topical corticosteroid administration

Answer 320

atrophy/thinning of the dermis that is associated with loss of dermal collagen, drying, cracking, and/or tightening of the skin, telangiectasias (spider veins), and ecchymoses (discoloration of skin resulting from bleeding underneath, typically caused by bruising)

Question 321

niacin as treatment of _______________

Answer 321

hyperlipidemia - increases HDL - decreases LDL and tryglycerides - causes cutaneous flushing mediated by prostaglandins

Question 322

ECG findings of atrial fibrillation

Answer 322

absence of P waves and irregularly irregular rhythm with varying R-R intervals some have irregular, low-amplitude, fine fibrillatory waves (f waves) between QRS complexes for the chaotic atrial activation

Question 323

measure urinary concentration of _____________ can screen for early-stage diabetic nephropathy

Answer 323

albumin

Question 324

which diuretics are used to treat patients with heart failure exacerbation and significant fluid overload (eg, pulmonary and/or peripheral edema)? WHY?

Answer 324

loop diuretics (IV) most potent type of diuretics and provide maximum amount of diuresis in the shortest period of time

Question 325

when to use carbonic anhydrase inhibitors (acetazolamide)? and WHY?

Answer 325

weak diretics so used to treat glaucoma and acute mountain sickness

Question 326

mechanism of loop diuretics (furosemide, torsemide, bumetanide) and where in the nephron?

Answer 326

inhibit Na-K-2Cl symporter in thick ascending limb of loop of Henle blocks Na+ and Cl- reabsorption so increase excretion of Na+, Cl- and water

Question 327

can Enterococcus convert nitrates to nitrites

Answer 327

no- so would find negative result on urinalysis nitrite

Question 328

immfluorescent microscopy findings for Pauci-immune rapidly proliferative glomerulonephritis

Answer 328

no immunoglobulin or complement deposits on the basement membrane

Question 329

what is a key finding with Pauci-immune rapidly proliferative glomerulonephritis

Answer 329

antineutrophil cytoplasmic antibodies (ANCA) in their serum condition associted with granulomatosis with polyangiitis (Wegener) or microscopic polyangiitis but can be idiopathic

Question 330

what stimulate eosinophils for parasitic defense?

Answer 330

IL-5 produced by TH2 and mast cells

Question 331

eosinophils, macrophages, neutrophils, and natural killer cells mechanism of action

Answer 331

antibody-dependent cell-mediated cytotoxiity

Question 332

cause of stress incontinence (leakage with coughing, lifting, sneezing

Answer 332

decrease urethral sphincter tone and urethral hypermobility

Question 333

bladder emptying is mainly due to ______________, while continence is maintained by the _______________

Answer 333

detrusor muscle contraction; urethral sphincters

Question 334

what is overflow incontinence? what is it caused by?

Answer 334

incomplete emptying and persistent involuntary dribbling impaired detrusor contractility; bladder outlet obstruction

Question 335

relationship between H2PO4- and NH4+ with diabetic ketoacidosis

Answer 335

these two are acid buffers for the urine--> they take up H+ to get rid of H+ without lowering urinary pH both increased with DKA

Question 336

characteristics of Fabry disease (not the symptoms)

Answer 336

* X-linked recessive lipid storage disorder | * alpha-galactosidase A deficiency-->can't break down globotriaosylceramide (Gb3), sphingolipid

Question 337

symptoms of Fabry

Answer 337

* neuropathic pain and hypohidrosis (decreased sweating) * distal extremity pain and burning and distal loss of hot/cold temp sensation * worse with exercise, stress, and fatigue * angiokeratomas (dark red, non-blanching macules and papules around but, groin, and umbilicus) * telangietasias (spider veins) * cerebrovascular, cardiac, and glomerular complications

Question 338

principal site of uric acid precipitation and why

Answer 338

collecting ducts due to low urine pH

Question 339

how to differentiate between metabolic and respiratory alkalosis

Answer 339

pCO2 high--> metabolic low--> respiratory

Question 340

features of thiazide or loop diuretic induced metabolic alkalosis

Answer 340

* high arterial blood pH, HCO3-, pCO2, Na+ * decrease K+ and H+ and Cl- * can be correct by volume and NaCL repletion with isotonic saline (saline-responsive)

Question 341

features of mineralocorticoid excess state induced metabolic alkalosis

Answer 341

* increase Na+, HCO3-, CL- * decrease K+ and H+ * cannot be corrected by isotonic saline due to persistent mineralocorticoid activity (saline-unresponsive)

Question 342

electrolyte abnormalities associated with loop diuretic

Answer 342

hypokalemia, metabolic alkalosis, hypocalcemia (in serum) (thick ascending limb of loop of Henle)

Question 343

electrolyte abnormalities associated with thiazide diuretics

Answer 343

``` hyponatremia hypokalemia metabolic alkalosis hypercalcemia (in serum) ``` (distal convoluted tubule)

Question 344

electrolyte abnormalities associated with carbonic anhydrase

Answer 344

hypokalemia metabolic acidosis (in serum) (proximal tubule)

Question 345

electrolyte abnormalities associated wtih sodium channel blockers and mineralocorticoid receptor antagonists (diuretics)

Answer 345

hyperkalemia metabolic acidosis (in serum) (cortical collecting duct; cortical collecting tubules)

Question 346

diuretics used to help decrease risk for calcium kidney stone

Answer 346

thiazides--> decrease urine Ca2+ excretion

Question 347

loop diuretics stimulate _____________ release to increase renal blood flow to increase GFR

Answer 347

prostaglandin

Question 348

what glomerular disease has glomerular basement membrane disruptions and fibrin deposition on electron microscopy

Answer 348

Goodpasture GBM breaks are due to fibrinoid necrosis of the glomeruli crescent formation contributed by fibrin escape into Bowman's space

Question 349

blood supply to the proximal ureter comes from branches of the _______ artery; distal ureter is supplied by ____________

Answer 349

renal artery; superior vesical artery

Question 350

highest osmolarity occurs at the ________________ of the nephron

Answer 350

loop of Henle

Question 351

severe toxicities of aggressive osmotic diuretics such as mannitol

Answer 351

pulmonary edema and dehydration

Question 352

increased Ca2+ will _______ PTH, but decreased Ca2+ will _______________ PTH

Answer 352

suppress; increase

Question 353

relationship between chronic kidney disease and serum calcium level

Answer 353

chronic kidney dz--> hyperphosphatemia (binds serum Ca2+) and low 1,25-dihydroxyvitamin D (decrease intestinal Ca2+ absorption and Ca2+ release from bone)--> hypocalcemia--> increase PTH--> secondary hyperparathyroidism

Question 354

low oncotic pressure in nephrotic syndrome such as minimal change disease can lead to

Answer 354

increased lipoprotein production in the liver

Question 355

what would you see with the electron microscopy for diabetic nephropathy?

Answer 355

hyaline, acellular deposits composed of plasma proteins, can be seen in Kimmelstiel Wilson nodules

Question 356

every time GFR ________, creatinine levels ________

Answer 356

halves; doubles

Question 357

RPF is calculated using the clearance of __________________

Answer 357

para-aminohippuric acid (PAH) RPF= PAH clearance= (urine [PAH] X urine flow rate/ plasma [PAH] RBF=(PAH clearance)/ (1-hematocrit)

Question 358

what type of renal complications happen in multiple myeloma

Answer 358

myeloma case nephropathy due to excess excretion of free light chains (Bence Jones proteins)--> form cases that cause tubular obstructiona nd epithelial injury (glassy casts stain intensely eosinophilic)

Question 359

suspect multiple myeloma when an elderly patient present with these 5 things

Answer 359

1) fatigability (due to anemia) 2) constipation (due to hypercalcemia) 3) bone pain, most commonly in the back and ribs (bone lysis due to production of osteoclast-activating factor by myeloma cells) 4) elevated serum protein (monoclonal proteins) 5) renal failure think CRAB

Question 360

during the recovery phase (polyuric phase) of acute tubular necrosis, patients can become dehydrated and can develop severe_____________

Answer 360

hypokalemia -due to high volume, hypotonic urine

Question 361

common side-effects of ACE-inhibitors

Answer 361

decreased GFR, hyperkalemia, and cough angioedema=rate, but life-threatening

Question 362

ureters pass ______________ to the ovarian (gonadal) vessels with the retropreritoneum and ______ to the common/external iliac arteries to reach the true pelvis

Answer 362

posterior (water under the bride) anterior

Question 363

equation for net filtration pressure

Answer 363

=(hydrostatic pressure in capillaries- hydrostatic presure in interstitium) - (oncotic pressure of capillaries- oncotic pressure of interstitium)

Question 364

characteristics of Foscarnet (antiviral agent)

Answer 364

an analog of pyrophosphate that can chelate calcium and promote nephrotoxic renal magnesium wasting hypocalcemia and hypomagnesemia--> seizure

Question 365

most common and second most common places for metastasis of advanced stage renal cell carcinoma

Answer 365

lung and bone

Question 366

significant renal hypoperfusion--> hyperplasia of __________ cells

Answer 366

JG cells of the afferent arteriole (modified smooth muscle cells with renin-containing zymogen granules)

Question 367

humoral hypercalcemia of malignancy is caused by secretion of ________________

Answer 367

parathyroid hormone-related protein (PTHrP) -->increased bone resorption and decreased renal excretion of calcium

Question 368

grapefruit juice______________ CYP450 3A

Answer 368

inhibit--> increase nephrotoxicity of durgs

Question 369

diabetic autonomic neuropathy can cause __________ incontinence

Answer 369

overflow--> due to inability to sense a full bladder and incomplete emptying

Question 370

Beta blockers's mechanism of action on the RAA system

Answer 370

- decrease RBF - sympathetic stimulation - prevent increase of renin to decrease BP

Question 371

does beta blockers affect bradykinin levels?

Answer 371

no- since they don't have an effect on ACE activity

Question 372

host T-lymphocyte sensitization against graft (foreign) MHC antigens mediates ____________ rejection

Answer 372

acute cellular transplant rejection

Question 373

treatment for acute transplant rejection

Answer 373

* calcineurin inhibitors such as cyclosporin or tacrolimus | * corticosteroids

Question 374

para-aminohippuric acid has the lowest concentration in the ____________

Answer 374

Bowman's space (not reabsorbed by any portion of the nephron) highest in proximal tubules due to its active secretionandreabsorptionof waterand solutes

Question 375

metanephric diverticulum (ureteric bud) of the kidney give rise to

Answer 375

collecting system of the kidney: such as the collecting tubules and ducts, major and minor calyces, renal pelvis, and the ureters

Question 376

metanephric mesoderm (blastema) of the kidney gives rise to

Answer 376

glomeruli, Bowman's space, proximal tubules, loop of Henle, and distal convoluted tubules

Question 377

recovery phase of acute tubular necrosis

Answer 377

re-epithelization of tubules

Question 378

presentation of renal artery stenosis

Answer 378

unilateral kidney atrophy, elderlys due to atherosclerotic changes, women of childbearing age due to fibromuscular dysplaia have hypertension and abdominal bruit

Question 379

transitional cell carcinoma of bladder (risk factors)

Answer 379

smokers, individuals with occupational exposure to rubber, plastics, aromatic amine-containing dyes, textiles, or leather, men> women

Question 380

biochemical risk factors for ____________________ include: low urinary pH and low urine volume with high uric acid concentration, which may occur i setting of chronic diarrhea

Answer 380

uric acid nephrolithiasis (kidney stones) *diarrhea-->metabolic acidosis--> kidnesy compensate with excreting more H+ and reabsorbing more bicarb--> insoluble uric acid

Question 381

acute tubular necrosis- histology characteristics

Answer 381

proximal tubular cell ballooning and vacuolar degeneration

Question 382

presence of oxalate crystals in tubular lumen is highly suggestive of _______________

Answer 382

ethylene glycol poisoning---> lead to calcium oxalate crystals

Question 383

second most common cause of UTI in sexually active women is

Answer 383

Staphylococcus saprophyticus

Question 384

characteristic of IgA nephropathy (Berger disease)

Answer 384

*most common cause of glomerulonephritis * older children and young adults painless hematuria within 5-7 days of upper respiratory tract infection

Question 385

characteristics of clear cell carcinoma in histology

Answer 385

rounded/polygonal cells with abundant clear cytoplasm (in proximal tubules) - contain lots of inracellular glycogen and lipids - from the proximal tubular epithelial cells most common form of clear cell carcinoma= renal cell carcinoma

Question 386

hemolytic uremic syndrome- characterized by a triad of:

Answer 386

microangiopathic hemolytic anemia, thrombocytopenia, and acute kidney injury

Question 387

NSAID-associated chronic renal injury is morphologically characterized by

Answer 387

chronic interstitial nephritis papillary necrosis

Question 388

cystinuria- genetics and cause

Answer 388

autosomal recessive defective transportation of dibasic amino acids (cystine, ornithine, arginine, and lysine) across intestinal and renal tubular epithelium --> cystine crystals (hexagonal-shaped)

Question 389

which diuretics can cause ototoxicity

Answer 389

loop diuretics inhibiting Na/K/2Cl symporters in ascending limb of the loop of Henle--> may inhibit similar symporters in the inner ear

Question 390

poor prognostic factor for post-streptococcal glomerulonephritis

Answer 390

increased age, pre-existing kidney disease for children 5-12yo--> >95% recover

Question 391

drug induced acute interstitial nephritis- symptoms and signs

Answer 391

fever, maculopapular rash, and symptoms of acute renal failure 1-3 weeks after beginning a beta-lactam antibiotic, peripheral eosinophilia and eosinophiluria symptoms go away afte cessation of medication

Question 392

clearance of digoxin

Answer 392

by the kidney digoxin=cardiac glycoside

Question 393

digoxin- mechanism of action

Answer 393

cardiac glycoside Direct inhibition of Na+/K+ ATPase --> indirect inhibition of Na+/Ca2+ exchanger. increase [Ca2+]i --> positive inotropy. Stimulates vagus nerve --> decreased HR.

Question 394

idiopathic membranous nephropathy is associated with circulating ___ antibodies to the _______________ receptor

Answer 394

IgG4; phospholipase A2

Question 395

endometrial cells undergo ______________ to have menstrual bleeding

Answer 395

apoptosis

Question 396

pelvic floor strengthening (Kegel exercises) targets the _____________ (muscle) to improve support around the urethra and bladder (helps with stress urinary incontinence)

Answer 396

levator ani

Question 397

human chorionic gonadotropic (hCG) is structurally similar to _____

Answer 397

LH therefore simulates LH surge by inducing ovulation LH and hCG has similar alpha subunit (structurally similar)

Question 398

live mass associated with an increased alpha-fetoprotein level is typical presentation of

Answer 398

hepatocellular carcinoma -hepatocellular carcinoma is strongly associated with HBV infection and is often precded by HBV-induced cirrhosis

Question 399

breast carcinoma: malignant infiltration of ____________ of the breast causes dimpling of the overlying skin

Answer 399

suspensory ligaments

Question 400

what structure is the most vulnerable to injury during a hysterectomy?

Answer 400

ureter

Question 401

protective factors against epithelial ovarian cancer

Answer 401

oral contraceptives, multiparity, and breastfeeding since they decrease the frequency of ovulation risk factors: BRCA mutation, nulliparity, and infertility

Question 402

histology of metastatic tumor cells of the ovary from Krukenberg tumor from the stomach

Answer 402

have large amounts of mucin with apically displaced nuclei--> signet ring appearance

Question 403

characteristic of ductal carcinoma in situ

Answer 403

breast cancer ducts distended by pleomorphic cells with prominent central necrosis that do not penetrate the basement membrane * precursor to invasive ductal carcinoma, most common type of breast cancer * can also lead to Paget disease

Question 404

mechanism of action for misoprostaol- for terminating pregnancy

Answer 404

misoprostol- prostaglandin E1 agonist==> cervical softening and uterine contractions to expel pregnancy

Question 405

mechanism of action for mifepristone-> terminate pregnancy

Answer 405

progesterone antagonist and glucocorticoid antagonist

Question 406

mechanism of action of methotrexate

Answer 406

folic acid antagonist--> decrease DNA synthesis | help with abortion, cancer, rheumatoid arthritis, psoriasis , IBD, vasculitis

Question 407

characteristic of turner syndrome

Answer 407

narrow, high-arched palate; low hairline; webbed neck' widely spaced nipples; cubitus valgus; aortic coarctation; bicuspid aortic valve; horseshoe kidney; streak ovaries; amenorrhea; infertility; short stature

Question 408

in females, ______________________ fuse to form the fallopian tubes, uterus, cervix, and upper vagina

Answer 408

paramesonephric ducts *incomplete lateral fusion of the ducts--> bicornuate uterus (indentation in the center of the fundus)

Question 409

detection of ____ and ____ is used for prenatal screening of neural tube defects

Answer 409

alpha-fetoprotein (AFT); acetylcholinesterase

Question 410

selegiline-mechaism of action

Answer 410

inhibitor of MAO, type B (inhibit breakdown of dopamine) clinically used to delay progression of Parkinson disease

Question 411

drug of choice for treating trigeminal neuralgia (pain in the distribution of CN V)

Answer 411

carbamazepine * make sure to check CBC for aplastic anemia * a P450 inducer

Question 412

three important mitochondiral syndromes

Answer 412

1) leber hereditary optic neuropathy--> bilateral vision loss 2) myoclonic epilepsy with ragged-red fibers: myoclonic seizures and myopathy with exercise 3) mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes (MELAS)

Question 413

mitochondiral diseases affect males and females with _____ frequencey

Answer 413

equal (100%) heteroplasmy

Question 414

demyelination of 1 optic nerve: pupillary reflex?

Answer 414

if light on the side affected: no constriction of either eye. Constriction when light is on the side that is not affected

Question 415

amino acid precursor for serotonin

Answer 415

tryptophan

Question 416

amino acid precursor for thyroxine, dopamine, epinephrine, norephinephrine, and melanin

Answer 416

tyrosine

Question 417

treatment or serotonin syndrome

Answer 417

cyproheptadine (serotonin receptor antagonist)

Question 418

most common finding with posterior cerebral artery stroke

Answer 418

contralateral homonymous hemaniopsia, often with macular sparing

Question 419

symptoms of temporal lobe lesion

Answer 419

* disrupt Meyer's loop and produce contralateral superior quadrantanopia * aphasia, memory deficits, seizures, and hallucinations

Question 420

what cause syringomyelia

Answer 420

central cystic dilation in cervical spinal cord (syrinx) that enlarges and damage ventral white commissure and anterior horns

Question 421

symptoms of syringomyelia

Answer 421

bilateral loss of pain and temp sensation loss of UE pain and temp, UE weakness and hyporeflexia, LE weakness and hyperreflexia and kyphoscoliosis

Question 422

facial effect of parotid gland tumor

Answer 422

tumor can compress and disrupt ipsilateral facial nerve and branches --> facial droop

Question 423

blood discharge from nipples commonly caused by

Answer 423

intraductal papilloma - due to proliferation of papillary cells in a duct or cyst wall with fibrovascular core and may contain foci of atypia or ductal carinoma in situ - blood from twisting of the vascular stalk of the papilloma in the duct

Question 424

what part of the body gets cut in a midline episiotomy

Answer 424

perineal body (fibromuscular tissue between urogenital and anal triangle)

Question 425

epithelia type of ovary

Answer 425

simple cuboidal -rapidly proliferate to repair ovulatory surface defects

Question 426

insulin resistance during pregnancy is due to this hormone

Answer 426

human placental lactogen (hPL) (pepetide hormone secreted by syncytiotrophoblast)

Question 427

cause of turner syndrome

Answer 427

45, X karyotype due to loss of paternal chromosome X

Question 428

hypospadia

Answer 428

abnormal opening of penile urethra on ventral surface of penis due to failure of the urethral folds to fuse (urethral folds in females don't fuse and form the labia minora)

Question 429

clinical features of polycystic ovary syndrome

Answer 429

* androgen excess--> hirsutism, acne, androgenic alopecia * ovarian dysfunction: menstrual irregularity, polycystic ovaries * insulin resistance * obesity * elevated LH

Question 430

treatment for polycystic ovary syndrome

Answer 430

* weight loss * combination of hormonal contraceptives * metformin (for hyperglycemia/diabetes)

Question 431

mechanism of action of clomiphene

Answer 431

antagonist of estrogen receptors in hypothalamus --> prevents negative feedback inhibition on the hypothalamus and pituitary by circulating estrogen--> increased FSH and LH--> ovulation (help people with PCOS get pregnant)

Question 432

cause of ovarian torsion

Answer 432

twisting of the infundibulopelvic ligament due to weight of a large adnexal mass

Question 433

why use both chloroquine and primaquine for treating malaria?

Answer 433

chloroquine- treatment of choice fo uncomplicated malaria primaquine` added with infection with P vivax and P ovale to eradicate the intrahepatic stages , which are responsible for relapses of malari

Question 434

what cause congenital torticollis

Answer 434

malposition of the head in utero or birth trauma child prefers to hold the head tilted to one side revolve with conservative therapy and stretching

Question 435

what is a complete mole pregnancy?

Answer 435

when an empty ovum is fertilized by a haploid sperm. The chromosomes from the sperm duplicate to form 46, XX that only has paternal DNA

Question 436

what is endometriosis

Answer 436

aka ectopic endometrium * presence of endometrial tissue outside the uterus * inflammation after menstruation--> distorts organ structure and function--> infertility

Question 437

risk factors of endometriosis

Answer 437

nulliparity, early menarche, and prolonged menses

Question 438

bilateral ligation of ___________ artery can decrease uterine blood flow and control postpartum hemorrhage

Answer 438

internal iliac

Question 439

dysmorphic features of Down syndrome

Answer 439

epicanthal folds, upslanting palpebral fissures, protruding tongue, excessive skin at the nape of the neck, birthweight and length often below average, hypotonia and weak startle (Moro) reflex *cardiac defects

Question 440

_________ due to hypogonadotrophic hypogonadism can be treated by pulsatile administration of GnRH

Answer 440

Anovulation (to treat infertility)

Question 441

most likely location of the urethra to be associated with pelvic fractures

Answer 441

posterior urethra at the bulbomembranous junction

Question 442

_______ is needed for normal renal deveopment

Answer 442

Angiotensin II *so moms can't take ACE inhibitor during pregnancy--> oligohydraminos and potter sequence

Question 443

what hormone is elevated in menopausal women?

Answer 443

FSH *due to lack of inhibition from estrogen

Question 444

what is neonatal abstinence syndrome (NAS)? symptoms?

Answer 444

NAS= newborns with mothers who used drug such as opiate during pregancy crying, tremors, hypertonia, jittery movments, sweating, pupillary dilation, tachypnea, sneezing, irritability, and diarrhea

Question 445

neuroimagining of a patient iwth herpes simplex virus (HSV) encephalitis

Answer 445

abnormal MRI signal in the bilateral temporal lobes

Question 446

lymphatic drainage of scrotum occurs via the_________________ lumph nodes

Answer 446

superficial inguinal *drain nearly all cutaneous lymph from umbilicus to the feet, including external genitalia and anus

Question 447

lymphatic drainage of the testes, ovaries, kidneys, and uterus drains directly into the __________ lymph nodes

Answer 447

para-aortic (retroperitoneal)

Question 448

what produces beta-hCG and when?

Answer 448

syncytiotrophoblast secrete it 6-7 days after fertilization * can be detected in maternal serum about 8 days after fertilization * can be detected in urine 14 days after fertilization

Question 449

how come rotavirus can have reassortment (genetic shift)?

Answer 449

because they have segmented genomes capable of genetic shifts through reassortment

Question 450

most common subtype of germ cell tumor

Answer 450

teratomas= have hair follicles, skin, teeth, bones, and other tissues if mature (cell lines of > 1 germ layer)

Question 451

what is primary ciliary dyskinesia (PCD)

Answer 451

autosomal recessive *disfunction of flagella and cilia - ->situs inversus (reversed right and Left organs) - -> bronchiectasis (permanent airway enlargement) - -> infertility - ->chronic sinusitis

Question 452

gestational choriocarcinoma

Answer 452

malignant tumor from trophoblast * hematogenous spread * lungs= most common site of metastasis * abnormal proliferation of mononuclear cytotrophoblasts and multinuclear syncytiotrophoblasts * no villi

Question 453

clinical finding of gestational choriocarcinoma

Answer 453

* preceded by pregnancy * causes abnormal vaginal bleeding, uterine enlargement, and increased beta-hCG * metastasis to lung

Question 454

second-trimester quad screen test results for Down syndrome

Answer 454

low maternal serum alpha-fetoprotein and unconjugated estriol high beta-hCG and inhibin A

Question 455

which cell type produce anti-Mullerian hormone

Answer 455

sertoli cells

Question 456

which cell type stimulates Wolffian ducts to develop into internal male reproductive organs?

Answer 456

Leydig cells--secrete testosterone

Question 457

what is an imperforate hymen

Answer 457

obstructive lesion caused by incomplete degeneration of the central portion of the fibrous tissue band connecting the walls of the vagina *present with primary amenorrhea with cyclic ab pain due to accumulation of menstrual blood in vagina and uterus

Question 458

histological findings of fibroadenoma

Answer 458

(most common benign tumor of breast) | cellular or myxoid stroma that encircles and sometimes compresses epithelium-lined glandular and cystic spaces

Question 459

methylmalonic acidemia: what is it? and lab findings?

Answer 459

organic acidemia due to complete or partial deficiency of methylmalonyl-CoA mutase. hyperammonemia, ketotic hypoglycemia, and metabolic acidosis, elevated urine methylmalonic acid and propionic acid

Question 460

what is cerebral amyloid angiopathy?

Answer 460

beta-amyloid deposition in the walls of cerebral arteries --> vessel wall weakening -->rupture *common cause of spontaneous lobar hemorrhage (recurrent; involves the occipital and parietal lobes)

Question 461

mechanism of action of tricyclic antidepressants (TCAs)

Answer 461

inhibit reuptake of NE and 5-HT inhibit fast Na+ channel conduction, slowing down myocardial depolarization --> cardiac arrhythmias and refractory hypotension (common causes of death in overdose)

Question 462

cerebellar hemispheres are responsible for motor planning and coordination of the _______ extremities

Answer 462

ipsilateral

Question 463

hyperactivity of the ______ pathway is associated with positive symptoms of schizophrenia, whereas low activity of the ________ pathway is associated with negative symtoms

Answer 463

mesolimbic; mesocortical

Question 464

thymoma is associated with __________

Answer 464

myasthenia gravis *benign neoplasm of thymus

Question 465

anesthetics with higher blood solubility have ______ blood/gas partition coefficients

Answer 465

larger larger partition coefficients/ higher solubility--> needs larger amounts to be absorbed before the blood becomes saturated so slower onset of action

Question 466

function of the glossopharyngeal never

Answer 466

gag reflex; general sensation of the upper pharynx, posterior tongue, tonsils, and middle ear cavity; loss of taste sensation on the posterior third of the tongue

Question 467

how can buprenorphine precipitate withdrawal in opioid-tolerant patients?

Answer 467

* it's a partial opioid agonist that has low intrinsic activity (efficacy) for opioid mu-receptors * binds w/ high affinity (potency)and prevent binding of other opioid medications (act as opioid receptor antagonist)

Question 468

phrenic nerve irritation cause

Answer 468

dyspnea, hiccups (diaphragmatic irritation), and referred pain tot he shoulder (area innervated by supraclavicular nerve originating from C3 and C4

Question 469

"red ragged" muscle fibers are seen in _____________ myopathies

Answer 469

mitochondrial have this appearance because abnormal mitochondria accumulate under the sarcolemma

Question 470

Klinefelter syndrome

Answer 470

47, XXY or more X | tall stature; small, firm testes; azoospermia; gynecomastia; mild intellectual disability

Question 471

Marfan syndrome-caused by

Answer 471

inherited defect of the extracellular matrix protein fibrillin

Question 472

marfan syndrome- clinical findings

Answer 472

tall with long extremities; pectus carinatum or pectus excavatum; hypermobile joints; long, tapering fingers and toes (arachnodactyly); cystic medial necrosis of aorta; aortic incompetence and dissecting aortic aneurysms; floppy mitral valve. dislocation of lenses, typically upward and temporally

Question 473

pregnant mom with rubella infection-->

Answer 473

women with polyarthritis and poly arthralgia infant with sensorineural deafness, cataracts, and cardiac malformations (PDA)

Question 474

mechanism of action of flutamide

Answer 474

nonsteroid agent that acts as competitive testosterone receptor inhibitor

Question 475

PCOS is associated with

Answer 475

* oligomenorrhea, hirsutism, and polycystic ovaries | * increased risk for endometrial hyperplasia/carcinoma and type 2 diabetes

Question 476

Risk factors for cervical cncer

Answer 476

*infection w/ high-risk HPV strains (16, 18) (strongest risk) *history of STD *early onset of sexual activity multiple or high-risk sexual partners *immunosuppression *oral contraceptive use *low SES *tabacco use

Question 477

granulosa cell tumors

Answer 477

sex-cord stromal tumors of the ovary that secrete estrogen and can cause endometrial hyperplasia

Question 478

inhibin

Answer 478

secreted by sertoli cells to inhibit FSH--> stop sertoli cells from making sperm

Question 479

LH

Answer 479

produce testosterone/ estrogen

Question 480

somatic vs germline mosaicism

Answer 480

somatic: affects cells forming the body, cause disease manifestations to develop in affected individuals (milder form of turner syndrome) germline: affect cells that give rise to gametes so affect the offspring

Question 481

prostatectomy or injury to the prostatic plexus can cause

Answer 481

erectile dysfunction

Question 482

estrogen stimulates upregulation of ______________________ between individual myometrial smooth muscle cells

Answer 482

gap junctions | gap junctions consist of aggregated connexin proteins

Question 483

what is primary amenorrhea

Answer 483

absence of menses by age 145 in someone who has normal growth and secondary sexual characteristics or absence of menses by age 13 in girls without secondary sex characteristics

Question 484

cystic fibrosis-clinical findings

Answer 484

recurrent pneumonia, digital clubbing, azoospermia (due to absence of vas deferens), nasal polyps, pancreatic insufficiency

Question 485

incomplete obliteration of the processus vaginalis leads to ______ and_____

Answer 485

communicating hydrocele (fluid in scrotum); indirect inguinal hernia

Question 486

gonadal arteries on both sides arises form the

Answer 486

abdominal aorta *only the left gonadal vein and left suprarenal vein comes from the renal vein

Question 487

gonadal arteries on both sides arises form the

Answer 487

abdominal aorta *only the left gonadal vein and left suprarenal vein comes from the renal vein

Question 488

FSH roles in females

Answer 488

stimulates ovary to recruit 1 primary follicle on the onset of menstruation (day 1) stimulates granulosa cells inside the follicle to produce estrogen

Question 489

_______ (hormone) increases the most in concentration after ovulation

Answer 489

progesterone---> to sustain the corpus luteum

Question 490

cancers of the pelvis, including prostate, spread to lumbosacral spine via ______

Answer 490

vertebral venous plexus (communicates with lots of venous networks like prostatic venous plexus)

Question 491

placenta accreta

Answer 491

a placenta that is morbidly adherent to the myometrium scar from prior surgery lead to absent decidual layer so placenta can have direct myometrial attachment by the villous tissue

Question 492

epithelial ovarian cancer- increased levels of _________

Answer 492

cancer antigen 125 (CA-125) most common subtype of ovarian cancer (out of epithelial, germ cell, and sex cord stroma)

Question 493

what is synaptophysin

Answer 493

transmembrane glycoprotein found in the presynaptic vesicles of neurons, neuroectodermal and neuroendocrine cells

Question 494

neoplasms of glial origin (astrocytomas, ependymomas, and oligodendrogliomas)

Answer 494

glial fibrillary acidic protein (GFAP)

Question 495

meningiomas

Answer 495

benign tumor cells of the arachnoid villi

Question 496

neurofibromatosis type 1

Answer 496

autosomal dominant *cafe-au-lait spots, neurofibromas (lumps all over body), lisch nodules (pigmented, asymptomatic hamartomas of the iris), pseudoarthorsis, scoliosis, other associated tumors (meningiomas, astrocytomas, gliomas, pheochromocytomas)

Question 497

thiamine (vitamin B1) is a cofactor for:

Answer 497

1) pyruvate dehydrogenase to convert pyruvate into acetyl-CoA 2) alpha-ketoglutarate dehydrogenase, an enzyme of the citric acid cycle 3) branched-chain alpha-ketoacid dehydrogenase to break down BCAA 4) transketolase- enzyme of pentase phosphate pathway that helps convert ribulose 5-P to glycolysis intermediates

Question 498

thiamine deficiency leads to decreased ______ utilization

Answer 498

glucose

Question 499

mechanism of action for beta-blockers

Answer 499

inhibiting the neurotransmitter-receptor interaction in adrenergic synapses

Question 500

naltrexone mechanism of action

Answer 500

blocks the mu-opioid receptor blocks the rewarding and reinforcing effects of alcohol

Question 501

restless leg syndrome

Answer 501

uncomfortable urge to move the legs with : - unpleasant sensations in the legs - onset with inactivity or at night - relief with movement treat with dopamine agonist

Question 502

what hormones are stimulant medication using to treat ADHD?

Answer 502

they increase availability of norepinephrine and dopamine in prefrontal cortex

Question 503

standard deviation--> % of data/ confidence interval

Answer 503

SD 1/2/3--> 68/95/99%

Question 504

neurological syndrome associated with B12 deficiency occurs due to abnormal myelin synthesis--> degeneration of these

Answer 504

1) doral columns 2) lateral corticospinal tracts--> upper motor neuron signs 3) axonal degeneration of peripheral nerves--> numbness or paresthesias

Question 505

symptoms of Von Hippel-Lindau disease

Answer 505

capillary hemangioblastomas in retina and/or cerebellum, congenital cysts and/or neoplasms in the kidney, liver, and pancreas increased risk for renal cell carcinoma (bilateral) rare, autosomal dominant

Question 506

initial drug of choice for status epilepticus

Answer 506

IV benzodiazepines--> work by enhancing effect of GABA at GABA-A receptor, leading to increased chloride influx and suppression of action potential firing

Question 507

lateral medullary (Wallenberg) syndrome

Answer 507

caused by posterior inferior cerebellar artery occlusion vertigo/nystagmus, ipsilateral cerebellar signs, loss of pain/temperature sensation in the ipsilateral face and contralateral body, bulbar weakness, and ipsilateral Horner syndrome

Question 508

nigrostriatal degeneration in Parkinson --> excessive excitations of the _________________________ by the _________--> excessive inhibition of the_________

Answer 508

globus pallidus internus; subthalamic nucleus; thalamus

Question 509

Cystic fibrosis- has mutation in FTR gene--> what is the most common kind of CFTR gene mutation

Answer 509

3-base pair deletion of phenylalanine at aa position 508. mutation--> impaired post-translational processing (improper folding and glycosylation ) of CFTR

Question 510

rubber-like properties of elastin are due to ________ between elastin monmers, which is facilitated by _____________

Answer 510

cross-linking; lysyl oxidase

Question 511

medication to help patients with cessation of tobacco by reducing withdrawal cravings and attenuating the rewarding effects of nicotine

Answer 511

varenicline= partial agonist of nicotinic acetylcholine receptors

Question 512

mechanism of action for combined hormonal contraceptives

Answer 512

supress GnRH in the hypothalamus--> decrease gonadotropins FSH and LH in the anterior pituitary--> prevent the LH spike needed for ovulation

Question 513

turner syndrome is due to what mutation

Answer 513

meiotic nondisjunction during gametogenesis *loss of one X chromosone

Question 514

meconium ileus-what is it and what disorder is it associated to?

Answer 514

distal small bowel (ileum) obstruction due to abnormally dehydrated meconium in a patient with cystic fibrosis (CF)

Question 515

Ebstein's anomaly- characteristics and what causes it?

Answer 515

apical displacement of the tricuspid valve leaflets, decreased volume of the right ventricle, and atrialization of the right ventricle caused by exposure to lithium for treating bipolar disorder

Question 516

primary oocytes are arrested in ______ of meiosis ___ until ovulation

Answer 516

prophase; I

Question 517

secondary oocytes are arrested in ______ of meiosis ____ prior to fertilization

Answer 517

metaphase; II

Question 518

valproate is teratogenic and causes _____

Answer 518

neural tube defects valproate decreases folic acid level