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UWORLD Missed Questions Flashcards

1
Q

What organism can colonize lung cavities formed from TB forming a ball which results in hemoptysis

A

Asperillus fumigatus

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2
Q

In what abnormal structure do Aspergillomas (fungal balls) colonize?

A

Lung cavities formed from TB (also Emphysema and Sarcoidosis)

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3
Q

What syndrome is associated with nuchal translucency and a decreased maternal serum alpha fetoprotein

A

Down Syndrome

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4
Q

What chromosome abnormality is found in Down syndrome

A

47 XY, +21

Trisomy 21

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5
Q

What is the most common GI finding in Down Syndrome

A

Duodenal atresia

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6
Q

What is the mnemonic Drinking age = 21

A

D represents Down Syndrome

21 helps you remember that it is a trisomy of the chromosome 21

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7
Q

What is a Type 2 error

A

A false negative error

Stating that there is no effect of X on Y when in reality there is

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8
Q

How can you reduce the chance of a Type 2 error

A

Increase power of a test by increasing sample size

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9
Q

What disorder is associated with Mullerian duct agenesis leading to primary amenorrhea with normal secondary sexual characteristics

A

Mayer-Rokitansky-Kuster-Hauser Syndrome

MRKH Syndrome

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10
Q

What does the Mullerian duct (Paramesonephric duct) give rise to?

A

Fallopian tubes, uterus, upper vagina

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11
Q

What are the 4 types of hypersensitivity reactions? (What binds to the antigen in each)

A

Type 1 - IgE binding to antigen and causing mast cell degranulation
Type 2 - Fab portion of antibody binding to antigen leading to its destruction
Type 3 - Fab portion of antibody binding to antigen forming an immune complex
Type 4 - Th cells encountering antigen and releasing cytokines

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12
Q

Which hypersensitivity reactions involve antibody

A

Types 1, 2, and 3

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13
Q

What is the mnemonic to remember the SSRI’s?

A

FLashbacks PAralyze SEnior CItizens

Fluoxetine
Paroxetine
Sertraline
Citalopram

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14
Q

What is one of the main side effects of SSRI’s

A

Sexual dysfunction

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15
Q

What are the three enzymes in the path to begin glycogen synthesis? (Hint: Insulin first binds….)

A

Insulin binds to TYROSINE KINASE receptor on Liver and SM

Tyrosine kinase triggers PROTEIN PHOSPHATASE

Protein phosphatase activates GLYCOGEN SYNTHASE

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16
Q

What tissues synthesize glycogen

A

Liver and Skeletal Muscle

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17
Q

What does the CFTR protein require prior to releasing chloride ions from the cell

A

2 ATPs binding

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18
Q

What is the gene involved with CF

A

CFTR = Cystic Fibrosis Transmembrane Regulator protein

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19
Q

What anatomical structures are cut in an episiotomy (Cut made sometimes during birth to make delivery easier)

A

Vaginal and subvaginal mucossa, and the perineal body

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20
Q

What structure is located anterior to the anus on the pelvic floor and lies between the anus and the urogenital region

A

Perineal body

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21
Q

What endometrial condition involves uniform enlargement of the uterus with painful heavy bleeding

A

Adenomyosis

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22
Q

What two disorders can result from Bartonella henselae

A

Cat scratch disease and Bacillary angiomatosis

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23
Q

What disorder presents with scratch marks on the arm and regional lymphadenopathy

A

Cat scratch disease by Bartonella henselae

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24
Q

What is it called when 2 different viruses form a hybrid virus that is able to infect a host it previously could not, but then the subsequent progeny revert to normal

A

Phenotypic mixing

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25
How come in phenotypic mixing, the subsequent progeny do not remain hybrids?
Because the genetic material is not exchanged or altered
26
What are the percentages within: 1 standard deviation above and below 2 standard deviations above and below 3 standard deviations above and below
68% 95% 99.7%
27
What condition results when the midgut does not rotate the full 270 degrees counterclockwise (90 + 180) around the Superior mesenteric artery during the 10th week of gestation
Midgut malrotation
28
What disorder presents with formation of fibrous bands (Ladds bands) in the abdominal cavity and bilious emesis from intestinal obstruction
Midgut malrotation
29
What are the two primary functions of eosinophils
Type 1 Hypersensitivity and Parasitic defense
30
Through which immune mechanism do eosinophils protect against parasitic infxn
Antibody dependent cell mediated cytotoxicity (ADCC)
31
In patients with anxiety, what must you rule out before diagnosing them with an anxiety disorder such as panic attacks or generalized anxiety disorder
A legit medical condition or substance abuse (Anxiety could be secondary to this)
32
What results with vomiting, tachypnea, and confusion/coma
Hyperammonemia from a Urea cycle disorder (Conversion of ammonia to urea)
33
What is the most common disorder of the Uric Acid cycle and how will it present
Ornithine Transcarbamylase deficiency Hyperammonemia and elevated urinary Orotic Acid
34
Which disorder has the EKG findings atria and ventricles depolarizing completely separate of each other at a regular rhythm
3rd degree AV block
35
Which cells in the hearts conduction system possess pacemaker ability
All 4 of them: SA node, AV node, Bundle of HIS, and Purkinje Its just that the SA node is fastest so it stifles impulse generation from the others and is the primary pacemaker
36
Which nerve is responsible for the sensory component of the corneal reflex?
Nasociliary nerve (branch of Ophthalmic V1)
37
Which nerve is responsible for medial adduction of the eye
Oculomotor (CN 3)
38
In what anatomical structure do both the nasociliary nerve and oculomotor nerve meet?
Superior orbital fissure
39
What is the most common cause of nipple discharge (bloody or serous)
Intraductal papilloma
40
What breast findings can be seen on exam in a person with intraductal papilloma
Nothing really. Just serous discharge or blood from twisting vessels. No palpable masses
41
What cell junction type is upregulated during labor
Gap junction
42
What are Gap junctions made of
Connexin proteins
43
Which disease has IgA immune complex deposition in small vessels and kidney causing a red rash on the butt and legs, joint pain, abdominal pain, and nephropathy
HSP
44
What is the most common systemic vasculitis in children
HSP
45
What disorder presents with fever, myalgia, pharyngitis, , splenomegaly, and atypical lymphocytes
Mononucleosis
46
Wht agents are responsible for causing Mono
EBV and CMV
47
What is it called when only one parents gene isexpressed by an individual due to methylation of the other parents gene
Genomic imprinting
48
What are the 3 differences between Delirium and Dementia
Delirium is acute. Dementia is gradual Delirium has impaired consciousness. Dementia has intact consciousness Delirium is reversible. Dementia is irreversible
49
What disorder is characterized by a failure of neural crest tissue to migrate fully down the vagus nerve resulting in failure to form Auerbach and Meissner plexuses. Presents with abdominal dilation and a failure to pass meconium within 48 hours
Hirschprung disease
50
What anatomic structure is always affected in Hirschprung dz
Rectum
51
What is pyruvate converted to during cases of hypoxia and what enzyme catalyzes this process
Lactate Lactate dehydrogenase
52
What is the role of ADP in Muscle contraction? ATP?
ADP helps bind myosin to actin ATP helps release myosin from actin
53
What injury occurs when a child falls while holding their parents hand
Radial head subluxation
54
What structure is defective in a radial head subluxation
Annular ligament
55
What is the difference between primary, secondary, and tertiary prevention?
Primary - Preventing a disease from occuring Secondary - Preventing symptoms from occuring in someone who got the disease Tertiary - Preventing complications from occuring in someone who has the disease and is symptomatic
56
What molecule used in the synthesis of a fatty acid that also inhibits beta oxidation of fatty acids from occuring
Malonyl coA
57
During acid base imbalances, if you have respiratory acidosis with an elevated CO2 but a normal bicarb, what does this signify?
It is an acute condition
58
Which acid base compensation occurs immediately? and which one occurs over 3-5 days
Immediate - Respiratory compensation Delayed - Metabolic compensation
59
What is calculated in a Case control study
Odd ratio
60
What is it called when the dorsal and ventral pancreatic buds fail to fuse properly during development and the ventral bud encirclest he duodenum
Annular pancreas
61
What is a possible complication of annular pancreas
Constricture of the duodenum
62
What are the 3 types of transplant rejection and when does each occur
Hyperacute - Minutes Acute - Weeks to months Chronic - Months to years
63
Which phase of transplant rejection is characterized by smooth muscle prliferation and interstitial fibrosis which result in lumenal narrowing
Chronic
64
As you move further down the respiratory tract, which feature goes the furthest? Goblet cells, mucous glands, cartialge, or cilia and why
Cilia. Push mucus up. If goblet cells were lower the mucus would backflow These all end by the terminal bronchi. From here phagocytes clear remaining particles that go lower
65
What is one of the long term side effects of antipsychotics
Tardive dyskinesia
66
What is the sequence TTAGGG
Telomere
67
Which cranial nerve passes through the posterior triangle of the neck
Spinal accessory nerve
68
What muscles are affected in painful abduction of the arm above the horizontal and a drooping shoulder appearance
Trapezius
69
Which pathogen is responsible for causing spasmodic contractions and risus sardonicus
Clostridium tetani
70
Which pathogen has the toxin travel from the wound site to the spinal cord via retrograde axoplasmic flow along motor neuron axons and inhibits inhibitory neurons
Clostridium tetani
71
Up to what age is it completely normal for children to play with dolls and toys associated with the opposite sex as they form a gender identity?
Up to 3 to 4 years
72
What is the prolonged feeling that your gender doesn't match your birth sex
Gender dysphoria
73
The finding of pancreatic and gastric tissue in Meckels diverticulum is due to what type of process
Ectopy
74
What tissue type is most commonly found in Meckel's diverticulum and is associated with producing abdominal pain
Gastric mucosa (produces acid causing ulceration)
75
What major artery supplies the primary visual cortex (striate cortex) and can result in a contralateral homonomyous hemianopia with macular sparing if infarcted
PCA
76
Which disorder results from a lack of the paternal X chromosome
Turners syndrome
77
Which disorder presents with coarctation of the aorta, cystic hygromas in the neck, and lymphedema in the extremities
Turners
78
What disorder results in neurological defects, albinism, and immunodeficiency (recurrent infxns)
Chediak Higashi
79
Where is rRNA synthesized
Nucleolus
80
What two things are triglycerides broken down into
Glycerol and fatty acids
81
What is a odd function of M3 cholinergic receptors that differs from its normal contraction of the bladder, GI, and pupil
It causes NO release from peripheral endothelial cells and thus relaxation resulting in vasodilation
82
Which organism does Thayer Marin selective media isolate?
Neisseria
83
Which medium contains vancomycin, colistin, nystatin, and trimethoprim?
Thayer Marin selective media
84
What is the mnemonic Very Typically Cultures Neisseria and what is it used for
It is used to identify the components of the Thayer martin culture media Vancomycin Trimethoprim Colistin Nystatin
85
What term describes the probability of seeing a difference when there is one
Power
86
What condition results from defective cytoskeletal proteins spectrin and ankyrin in RBCs
Hereditary spherocytosis
87
What structure connects the bladder to the yolk sac during development and gives rise to the urachus
Allantois
88
What condition involves discharge from the belly button in a newborn
Patent urachus
89
Which dataset (mean, median, mode, range, variange) is resistant to outliers
Mode
90
Which dataset term is defined as the most frequently observed data point in a trial? For example, 37 of 50 students scored a 100 on the test. In this case, the score of 100, which is the score with the majority of students would be considered the....
Mode
91
What muscle forms the pelvic floor
Levator ani
92
What three muscle components make up the levator ani
Iliococcygeus, pubococcygeus, and puborectalis
93
Which dissacharide forms fructose + glucose
Sucrose
94
Aldolase B is an important enzyme in the metabolism of what molecule
Fructose/Sucrose (Sucrose also since it breaks down into fructose)
95
Which hypersensitivity reactions utilize complement and may result in hypocomplementemia
Types 2 and 3
96
Which hypersensitivity reaction results in arthralgias
Type 3 (serum sickness)
97
Which type of lung pathology has increased elastic recoil and incresed radial traction
Interstitial lung diseases (This is a ype of Restrictive lung disease)
98
Which psychiatric disorder is characterized by one or more manic episodes involving elevated irritability and hyperactivity and may occur with psychotic features
Bipolar 1 disorder
99
Which disorder most commonly results in Congenital Bilateral Absence of the Vas Deferens (CBAVD) and thus infertility
Cystic fibrosis
100
Which is the only pathogenic fungus with a polysaccharide capsule that makes it resistant to phagocytosis
Cryptococcus neoformans
101
Which pathogen has a capsule that is red on mucicarmine stain and cleear on india ink stain
Cryptococcus neoformans
102
In a patient centered approach, what is the most important thing to do when responding to a pt
Educate them
103
What organism destroys the myenteric plexus resulting in Achalasia in individuals from south america
Trypanosoma cruzi
104
Which disorder has the birds beak appearance on barium swallow
Achalasia
105
Which type of breast cancer has a irregularly shaped mass typicaly in the outer upper quadrants
Invasive breast carcinoma
106
Dimpling of the breast in cases of breast cancer signal involvement of which anatomical structure
Suspensory ligaments
107
Which disorder is characterized by the appearance of ragged red fibers on muscle biopsy
Mitochondrial myopathy
108
What two tissues are most affected by mitochondrial myopathy
CNS and Skeletal muscle b/c they use the most ATP
109
What 3 things shift the Oxygen hemoglobin disassociation curve to the left
Decreased Hydrogen ions Decreased 2,3-BPG Decreased Temperature
110
If a person A has a higher O2 affinity than person B, person A's Oxygen-hemoglobin diassociation curve will be shifted
Left
111
What finding will be seen on immunofluorescnece of a glomerular or alveolar tissue biopsy with antibodies against the basement membrane
Linear deposits
112
Which interleukin promotes B cell growth and activates T cells, NK cells, and monocytes
IL 2
113
What feature of IL 2 gives it anti tumor capabilities
It's activation of T cells and NK cells
114
Why does the oxygen partial pressure of blood drop once it reaches the LA
Mixes with deoxygenated blood (the deoxygenated blood from the lung and heart circulation empty here)
115
What two features in a study can help reduce observer and expectancy bias
Blinding and the use of placebo
116
Which artery is formed from the 3rd branchial arch
Carotid
117
What two ions contribute the most to the resting membrane potential of a cell at -70 mV
Sodium and potassium
118
Which ion has the greatest effect on the membrane potential of a cell due to it having the greatest permeability
Potassium (-80 mV equilibrium potential)
119
The metanephric mesenchyme gives rise to which structures in the adult
Glomerulus through distal convoluted tubule
120
Which embryonic structure gives rise to the ureter, pelvises, calyces, and collecting ducts
Ureteric buds
121
Which vaccine is conjugated to tetanus toxoid, diphtheria toxoid, or Neisseria outer membrane protein to help make it T-dependent and more immunogenic
Hib
122
What is the point of conjugating a vaccine with another pathogen
Make it T cell dependent
123
What pathogen is infamous for causing post infection glomerulonephritis
Strep pyogenes
124
What can be seen on renal biopsy in a patient with post sreptococcal glomerulonephritis
Immune complex deposition
125
In intoxicated individuals who refuse medical help due to impaired decision making capacity, what should you do
Keep them in the ER until they sober up and then reassess
126
What substance is responsible for directly signaling glycogen phosphorylase kinase to phosphorylate glycogen phosphorylase during contraction
Calcium
127
Which ligament attaches to the medial femoral condyle of the knee?
PCL
128
Which pathogen is bile soluble, optochin sensitive, and alpha hemolytic
Strep pneumo
129
What is the most commonly fractured bone
Clavicle
130
Which muscle is responsible for pulling the medial portion of the clavicle upward in a clavicle fracture
Sternocleidomastoid
131
What are the primary class of drugs for major depression
SSRI
132
What is the mechanism of SSRIs
Block serotonin reuptake in presynaptic nerve
133
Which disorder presents with skin tumors and hyperpigmented lesions
Neurofibromatosis Type 1 (Cutaneous neurofibromas and Cafe au lait spots)
134
What embryological tissue is responsible for the cutaneous neurofibromas found in Neurofibromatosis Type 1
Neural crest cells
135
Which mode of inheritance is often associated with heteroplasmy
Mitochondiral inheritance
136
What is it called when variable expression results due to the presence of both normal and abnormal mitochondrial genotypes within a single cell
Heteroplasmy
137
Which cytokine is responsible for inducing isotype switch
IL-4
138
Secondary lactase deficiency can occur following what infection
Giardiasis
139
What intrauterine findings are seen during an ectopic pregnancy due to progesterone release (in spite of the absent embryo)
Dilated coiled endometrial glands and vascularized edematous stroma
140
In cardiac pacemaker cells, what substance can prolong phase 4
Adenosine
141
Which ions are responsible for the phase 4 rise in pacemaker membrane potential
Slowing of K efflux | Na and Ca influx
142
Which observational study compares 2 groups with different risk factors and then looks at disease incidence
Cohort study
143
Which pathogen can cause infection that leads to Waterhouse Friedrichsen Syndrome
Neisseria meningitidis
144
Which disorder is characterized by adrenal insufficiency, DIC, and shock
Waterhouse-Friderichsen Syndrome
145
What type of defense mechanism involves an individual replacing unacceptable feelings with the exact opposite such as a someone with sexual feelings going to a monastery
Reaction formation
146
Which dopaminergic pathway is responsible for inhibiting the release of prolactin from the anterior pituitary
Tuberoinfundibular
147
Which class of drugs can inhibit the dopaminergic pathways by inhibiting D2 receptors
Antipsychotics
148
Which cell types release the protease elastase
Macrophages and neutrophils
149
What disorder has the classic triad of conjunctivitis, arthralgia, and urethritis
Reactive arthritis (can't see, can't pee, can't climb a tree)
150
What disorder is characterized as a seronegative spondyloarthritis and can thus cause sacroilitis in addition to its classic triad
Reactive arthritis
151
Which enzyme is responsible for transporting fatty acids from the cytoplasm to the mitochondira during fatty acid degradation
Carnitine
152
What is the mnemonic CARNitine = CARNage used for and what does it stand for
Carnitine is responsible for fatty acid degradation and carnage means killing a bunch of people
153
Acetyl CoA can either enter the TCA cycle or the Ketone body synthesis pathway. Which substance is it converted to in the ketone path
Acetoacetate
154
What term is used to describe the estimate of variability that exists between the sample mean and the true mean of a population
Standard error of mean
155
What is the equation to calculate a confidence interval?
CI = mean +/- Z(SEM) Z = Z score Z score for 95% is 1.96 Z score for 99% is 2.58
156
What is the equation to calculate the Standard error of mean
SEM = SD / sqrt(n)
157
PTH has what effect on the kidney
Increases Ca reabsorbtion and decreases Phosphorous reabsorbtion
158
Which cells contain PTH receptors that allow them to produce RANKL resulting in increased bone resorption activity
Osteoblasts NOT OSTEOCLASTS PTH increases osteoclast activity INDIRECTLY by acting on osteoblasts which produce RANKL receptors that activate osteoclasts
159
An cavitary lesion with an air fluid level describes what
An abscess
160
What is the most common cause of a lung absces
Aspiration
161
What does being a true diverticulum mean
Contains all 3 intestinal wall layers: Mucosa, submucosa, and muscularis
162
What is the blind pouch that extends from the ileum and contains all three intestinal layers
Meckel's Diverticulum
163
Which pharyngeal pouch contains the thymus and inferior parathyroid glands
3rd
164
Which organ is enlarged in myasthenia gravis
Thymus
165
What is usually the best preventive intervention especially in diabetics
Smoking cessation
166
What is gluten
A grain
167
What condition results in duodenal changes including villous atrophy, crypt hyperplasia, inflammation
Celiac disease
168
What disorder is characterized by annoying others, blaming others, getting annoyed easily, and not listening to authoritative figures
Oppositional defiant disorder
169
What are the two promoter regions
CAAT and TATA box
170
What is the region where RNA polymerase 2 binds for transcription
Promoter regions
171
Which disorder has hypogammaglobulinemia and low/absent T cells
Severe combined immunodeficiency (SCID)
172
What compound accumulates in Alkaptonuria resulting in bluish black tissues and black urine after it sits a while
Homogentisic acid
173
Homogentisic acid is a compound found in what pathway
Tyrosine metabolism
174
What cell type is has racquet shaped intracytoplasmic granules
Langerhans cells
175
What are dendritic cells in the skin known as
Langerhans cells
176
What is it called when the urethra opens on the ventral side of the penis proximal to the distal tip of the penis
Hypospadias
177
Failure of the urethral folds to close in a male results in what
Hypospadias
178
What is the term used to describe the number of patients needed to treat in order to avoid a negative outcome in one patient
Number Needed to Treat (NNT)
179
How do you calculate the Number Needed to Treat (NNT)
NNT = 1 / Absolute Risk Reduction
180
What virus has a segmented genome
Influenza virus
181
Viruses with segmented genomes undergo genetic/antigenic shift by what mechanism
Reassortment
182
What physiologic process does cyanide poisoning target
Cytochrome C in ETC
183
What agents work to unbind Cyanide from Cytochrome C by inducing Methemoglobinemia (Fe3+), giving cyanide a new binding spot
Nitrites
184
What gastric tumor commonly metastasizes to the ovaries via lymphatics
Krukenberg tumor
185
What displays signet ring cells do to excessive mucin production displacing the nucleus
Krukenberg tumor
186
What disorder is characterized by physical symptoms causing severe distress but has no etiology and that is not being feigned
Somatic symptom disorder
187
How do you manage an individual with somatic symptom disorder
Have them follow up regularly with the same provider
188
Back pain with recent bacteremia should lead you to suspect what disorder
Vertebral osteomyelitis
189
What is the imaging method of choice for osteomyelitis
MRI
190
Which artery is involved in an inferior wall MI
Right coronary artery
191
What inhibits the release of prolactin from the anterior pituitary during pregnancy thus resulting in suppressed lactation
Progesterone
192
What is the virulence factor in strep pneumo
Polysaccharide capsule
193
What disorder presents with an eczematous rash and a musty body odor
Phenylketonuria | phenylalanine builds up and the phenyl group is AROMAtic and gives the smell
194
What is the inheritance pattern of Phenylketonuria
Autosomal recessive
195
Which catabolic pathway when functioning normally produces acetoacetate (ketone bodies)
Beta oxidation of fatty acids
196
What enzyme deficiency within the mitochondrial matrix may result in hypoketonic hypoglycemia
Acyl CoA dehydrogenase
197
What disorder presents with maldevelopment of the third and fourth pharyngeal pouches
DiGeorge Syndrome
198
The 3rd and 4th pharyngeal pouches form what structures
3rd - Inferior parathyroid and Thymus | 4th - Superior parathyroid
199
The correlation coefficient value can range from
-1 to +1
200
What disorder presents with a down and out appearance of the eye
Oculomotor nerve palsy
201
Between what vessels does the Oculomotor nerve emerge on the brain making it prone to Berry aneurysms
Superior Cerebellar and PCA
202
To prevent future asthma triggers, what medications should be used
Anti IgE antibodies (Omalizumab) NOT antihistamines. That hels with urticaria and stuff
203
If you suspect a patient is illiterate and you need to explain something to them, what may be beneficial
Using another sensory approach like a visual approach
204
In males, what is the fxn of FSH and LH
FSH - Acts on Sertoli cells to secrete inhibin B LH - Acts on Interstitial cells of Leydig to secrete Testosterone Hint: F[S]H acts on [S]ertoli cells
205
Tendons are composed of what
Type 1 collagen
206
What collagen form is present in wound repair and scarring
Type 1 collagen
207
What is the acronym to remember the collagens and what does it stand for
Be So Totally Cool Read Books Type 1: Bones, skin, tendon Type 2: Cartilage Type 3: Reticulin (vessels) Type 4: Basement membrane
208
A diverticula form the foregut leads to the development of what
Trachea and respiratory tract
209
An infant that presents with choking, drooling, and cyanosis during feeding should be suspected to have what condition
Tracheoesophageal fistula
210
What disorder is characterized by recurring intrusive thoughts and repetitive time consuming actions
OCD
211
Aside from the definitions themselves, what is the big difference between OCD and Obsessive Compulsive Personality Disorder
OCD - Ego dystonic | OCPD - Ego systonic
212
What is the mechanism by which Huntingtons CAG repeats cause decreased gene expression
Histone deacetylation
213
What is the purpose of histone acetylation, methylation, and phosphorylation
Gain access to DNA for replication/transcription
214
What disorder can result in a rash on the palms and soles from a small cell vasculitis
Neisseria meningitidis infection
215
What immune system component is necessary to fight off a Neisseria infxn
C5-C9 (MAC)
216
What disorder presents with fatigue, cold intolerance, myalgia, bradycardia, constipation, and a number of other things
Hypothyroidism
217
The thyroid secretes what hormone primarily
T4 May be deaminated to T3 in periphery
218
Foot drop and steppage gait indicate damage to which nerve
Common peroneal
219
At which point on the sarcomere does actin bind to structural proteins
Z line
220
What disorder is characterized by watery diarrhea, hypochlremia, and achlorhydria
Vipoma AKA WDHA syndrome
221
What hormone is released from a vipoma
Vasoactive intestinal polypeptide (VIP)
222
Maternal CMV infection during pregnancy results in what eye condition in the neonate
Chorioretinitis
223
What disorder is characterized by autoimmune destruction of parietal cells
Pernicious anemia
224
Which layer of gastric tissue are parietal cells located in
Upper glandular layer
225
Down syndrome is often associated with progression to what disorder
Early onset Alzheimers Disease
226
What substance is elevated in Alzheimers patients
Amyloid Precursor Protein (Amyloid beta)
227
Which artery is located along the lesser curvature of the stomach and may be damaged by an ulcer
Left Gastric Artery
228
Which artery is located along the greater curvature of the stomach
Right and Left Gastroepiploic Arteries
229
What are the three phases of acid secretion in the stomach
Cephalic Gastric Intestinal
230
What phase of gastric acid secretion is responsible for the release of peptide YY from the ileum and colon resulting in ECL cell inhibition and thus ultimately reduced secretion of acid
Intestinal phase
231
What disorder results in situs inverus, immotile cilia, and immotile flagella resulting in recurrent respiratory infections and infertility
Kartagener syndrome
232
What structure is defective in Kartagener syndrome
Dynein arms
233
What is the mechanism of pathogenicity for shigella
Mucosal invasion of M cells
234
Which pathogen is characterized as Gram negative, does not ferment lactose, is oxidase negative, and does not produce hydrogen sufide on triple sugar agar
Shigella
235
How can performance of surgery on the wrong site be prevented
Verification by 2 medical professionals independently
236
What scan be used to diagnose Meckel's Divertiiculum
Technetium pertechinate
237
What disorder presents with painless abdominal bleeding
Meckel's diverticulum
238
What is the term for the ability of multiple mRNA codons to code for the same amino acid
Degeneracy
239
What genetic principle allows only the first two nucleotides of a codon to matter in the determination of a the amino acid placement
Wobble
240
What disorder resuts in elevated IgE, eosinophilia, and bronchiectasis in immunocompromised individuals
Allergic Bronchopulumonary Aspergillosis (ABPA)
241
What study type looks at population data rather than individual data
Ecological study
242
What disorder presents with oligohydramnios and bilateral kidney enlargement with diffuse small cysts
Autosomal Recessive Polycystic Kidney Disease
243
In the neonate, what may ARPKD progress to
Potters Sequence (limb deformity, flattened facies, pulmonary hypoplasia)
244
What is the mnemonic for 22q11 deletion syndromes
CATCH 22 ``` Cleft palate Abnormal facies Thymic aplasia Cardiac defects Hypocalcemia ``` are results of chromosome 22q11 deletions
245
What disorder presents with cleft palate, facial abnormalities such as orbital hypertelorism, bifid uvula, and cardiac defects such as TOF
Velocardiofacial syndrome
246
What causes Velocardiofacial syndrome
Microdeletion at Chromosome 22q11
247
The following is a requirement of what disorder: The psychosis must occur in the absence of major mood episodes; however, mood symptoms must be present for most of the illness
Schizoaffective disorder
248
What is the mnemonic The 3 D's for B3 and what is it used for
The symptoms of Pellagra caused by Vitamin B3 (niacin deficiency) Dermatitis Diarrhea Dementia
249
What is the mnemonic B3 = 3 ATP and what is it used for
Vitamin B3 (Niacin) makes NAD
250
What is Vitamin B3 (Niacin) synthesized from
Tryptophan
251
The killed inluenza vaccine stimulates antibody production that targets what structure
Hemagglutinin
252
What substance of the Influenza virus enables it to enter cells
Hemagglutinin
253
Hypocalcemia results in what findings
Tetany such as Chvostek's sign and Trousseau's sign from uninhibited neuron depolarization
254
Chvostek's sign and Trousseaus sign indicate what abnormality
Hypocalcemia
255
What arteries run anterior and posterior to the ureter in the true pelvis
Anterior - Gonadal arteries | Posterior - Internal iliac
256
What does the phrase water under the bridge mean
The ureter (water) passes under the bridge (vas deferens in males; uterine artery in females) in its connection to the bladder
257
What disorder shows crescent formation on renal biopsy
Rapidly Progressive Glomerulonephritis
258
In Rapidly Progressive Glomerulonephritis, what are the crescent formations seen on biopsy composed of
Monocytes Macrophages Glomerular parietal cells Fibrin
259
What cell structure forms the blood brain barrier
Tight junctions
260
What substance prevents the formation of the paramesonephric ducts in males
Mullerian inhibiting factor
261
In the absence of ADH, which portion of the nephron has the highest osmolarity
Portion between descending and ascending loops
262
Which portion of the nephron is impermeable to water
Thick ascending limb of the Loop of Henle
263
What is the probability of an unaffected individual being a carrier for an autosomal recessive disease if both parents are carriers
2/3 We already know she is unaffected therefore she cannot be autosomal recessive (aa), and one option is eliminated
264
In erythrocyte precursors, where does heme synthesis occur
Cytoplasm and Mitochondria
265
Why are mature RBC's unable to synthesize hemoglobin
They've lost their Mtc so they can't synthesize heme
266
Which cells types are present in tuberculosis
Langhans giant cells
267
What cell type is described as an activated macrophage with multiple nuclei that form a horseshoe shape
Langhans giant cells
268
What surface marker is found on macrophages
CD14
269
What ankle ligament is most commonly injured in an inversion accident
Anterior talofibular ligament
270
What is the mechanism by which C diff becomes pathogenic
Overgrows in GI tract
271
What puts an individual at risk for a C diff infection
Anything that alters the NF causing loss of normal growth suppression
272
What protein transports vesicles and organelles from the nucleus outward along microtubules
Kinesin
273
What cell molecule helps move secretory vesicles along the axon to the nerve terminal
Kinesin
274
Transcription of the lac operon is induced by what two things
Catabolite activator protein (CAP) | Lactose binding to repressor
275
What do the LacI, LacZ, and LacY genes code for
LacI - Repressor that binds to operator LacZ - Beta Galactosidase that metabolizes Lactose LacY - Permease that allows Lactose entrance
276
How does risk differ from relative risk
Relative risk uses the risk of each group to determine the difference. It is the risk of the exposed group divided by the risk of the unexposed Risk of developing cancer in smokers = 80% Risk of developing cancer in nonsmokers = 20% Relative risk = 80/20 = 4 (4x more of a risk in smokers)
277
What is administered at birth to prevent hemorrhagic disease of the newborn
Vitamin K
278
Why are neonates deficient in Vitamin K at birth and thus predisposed for hemorrhaging
Not passed transplacentally or in breast milk | Intestinal flora not established enough to synthesize it yet
279
What is the inheritance pattern for Neurofibromatosis Types 1 and 2
Autosomal dominant
280
What disorder presents with sessile to pedunculated masses that appear all over the body
Neurofibromatosis Type 1 (neurofibromas. LOOK DISGUSTING!!)
281
What disorder presents with recurrent bacterial infections without pus, failure of umbilical cord to separate, and leukocytosis
Leukocyte adhesion deficiency type 1
282
What marker on phagocytes is defective in Leukocyte adhesion deficiency type 1 causing impaired chemotaxis
CD18
283
What is characterized by hyperactivity and or inattention
Attention deficit and hyperactivity disorder
284
In order to diagnose ADHD, aside from the symptoms, what is required
Symptoms present in at least 2 locations (school and home)
285
What is the most common site of carriage of Staph aureus
Anterior nares
286
What injury results from a lesion of the ACA
Contralateral lower limb motor and sensory loss
287
What artery supplies the medial portion of the frontal and parietal lobe
Anterior cerebral artery
288
In pancreas divisum, what duct drains a majority of the pancreas
Accessory duct
289
What does the ventral pancreatic bud give rise to
Portion of the head of the pancreas Uncinate process of the pancreas Main pancreatic duct
290
Heavy smoking is a risk factor for what condition that involves dilated air spaces
Emphysema
291
What cells are responsible for the damage that ensues in Emphysema due to their release of proteases (elastase, etc.)
Macrophages and Neutrophils
292
A person who does not socialize with others due to fear of being judged, embarassed, or rejected yet fantasizes about being married one day would be classified under what disorder
Avoidant Personality Disorder
293
What disorder is similar to avoidant personality disorder except for the fact that the person PREFERS to be alone
Schizoid
294
What bias/study error is characterized by a falsely interpreted increase in survival simply due to the fact that the case was detected earlier
Lead-time bias
295
A new test ID's lung cancer 2 years before conventional methods, thus scientists determine that these individuals live 2 years longer on average when in reality they don't live any longer, it's just being diagnosed 2 years earlier... What is this an example of?
Lead-time bias
296
Vaginal dryness and hot flashes are indicative of what
Menopause
297
What hormone is increased in menopause due to resistant ovaries
FSH
298
What disorder is characterized by low back pain that radiates down the leg
Sciatica
299
The sciatic nerve involves what levels
L3-S1
300
What nerve root is responsible for the ankle reflex
S1
301
What organ receives its blood supply from the celiac artery oddly even though it is not derived from the foregut like all the other supplied structures
The spleen
302
The spleen is derived from what embryologic tissue type
Mesoderm
303
What abdominal organ is most commonly injured from blunt trauma
Spleen
304
What cell structure is responsible for steroid synthesis
Smooth ER
305
Which tissues are rich with Smooth ER
Liver, Adrenal cortex, Gonads
306
Which virus is located in 3rd world countries, passed through water, and is most concerning for pregnant individuals
Hepatitis E Virus
307
What is the morphology of Hepatitis E virus
Unenveloped RNA virus
308
Which cell types secrete IL-4 to promote class switching
Th2 cells
309
What is the mutation that results in a defective CFTR gene in Cystic Fibrosis
Deletion of F508 (Phe508) (Phenylalanine at position 508)
310
In Cystic fibrosis, the deletion of F508 results in a mutant CFTR gene that does not leave the RER. Why not?
The protein is misfolded
311
What structural element connects osteocytes together in bone
Gap junctions
312
Which disorder is characterized by hypoplasia of the bones of mastication and the bones of hearing
Treacher Collins
313
Treacher Collins is a defect of neural crest tissue that affects what pharyngeal arches
1st and 2nd
314
Which direction does Carbon monoxide shift the HB-O2 binding curve
Left
315
What does a decreased p50 indicate
Increased affinity for oxygen
316
What disorders can result from a Robertsonian translocation
Down Syndrome - Trisomy 21 | Patau Syndrome - Trisomy 13
317
What disorder presents with prominent epicanthal folds and increased skin at the nape of the neck
Down Syndrome
318
What disorder is characterized by hyperflexibility at joints, elastic skin, and a tendency to bleed
Ehler Danlos
319
What protein is defective in Ehler Danlos Syndrome
Collagen
320
Which cranial nerves are located below the pons
6-12
321
What disorder can result in hearing loss and buzzing in one ear
Acoustic neuroma (Schwann cell tumor)
322
What type of antibodies do moms with Type A, B, and O blood have against the other blood types
Type A mom - IgM against B antigen Type B mom - IgM against A antigen Type O mom - IgG!!!! against A and B antigens
323
ABO erythroblastosis fetalis only occur if the mom is what blood type
Type O (Only one that makes IgG! Type A and B moms making IgM!)
324
Cocaine is classified as what type of drug
Stimulant
325
Depression, fatigue, sleepiness, and hyperphagia are characteristic of what withdrawal
Cocaine
326
What disorder is associated with unhygienic delivery and wound care
Neonatal Tetanus
327
What is the best way to prevent neonatal tetanus
Vaccinate the mom with tetanus toxoid. This allows her to form IgG that she can pass on to the baby for temporary protection until he is old enough to get the dTaP and form his own immunity
328
What region of the brain is responsible for maintaining the circadian rhythm
Suprichiasmatic nucleus (Part of the hypothalamus)
329
What is the major component of pulmonary surfactant that is tested for in amniotic fluid
Lecithin (a phospholipid) When the Lecithin to Sphingomyelin ratio is greater than 2, the lungs are mature
330
What is the major component of lecithin in pulmonary surfactant
Dipalmitoyl phosphatidylcholine Phosphatidylglycerol is another component but not as much
331
What term is used to describe the ability of a test to consistently get similar results even if they are not close to the true result
Reliability AKA Precision
332
How does one increase the precision (reliability) of a test
Reduce random error
333
What pathogen is beta hemolytic, intracellular, and can be cultured at 4 degrees C
Listeria monocytogenes
334
What host immune response is necessary to fight off Listeria monocytogenes
CMI
335
Which disorder has autoantibodies target Ach receptors
Myasthenia Gravis
336
What disorder results in autoantibodies against the alveolar basement membrane and glomerular basement membrane
Goodpasture's Syndrome
337
In a patient with motor weakness affecting the arm, leg, and lower face, what region might you expect to be at fault
Internal capsule
338
What cells seen on Pap smear are characteristic of HPV infection
Koilocytes
339
What enzyme is responsible for providing the glucose and ketones during times of starvation from adipocytes
Hormone sensitive lipase
340
Triglycerides break down into
Fatty acids and glycerol
341
In the event of a vegetative state, who determines the decisions for the patient
Next of kin, usually spouse, but may be children equally with spouse in some states
342
What term is used to describe the obligation of respect physicians must place on patients decisions
Autonomy
343
What is the MOST COMMON (BUT NOT THE ONLY) biochemical result of the mutated CFTR gene in Cystic fibrosis resulting from a deletion of F508
Misfolded Protein that is destroyed and doesn't reach membrane
344
A Chloride transporter that reaches the membrane but does not bind ATP or transmit Chlorine properly would result in
Cystic Fibrosis Typically cystic fibrosis results from F508 deletion with misfolded protein that doesn't even reach the membrane, but these mutant forms exist also
345
What disorder is characterized by facial anomalies, limb deformities, and pulmonary hypoplasia
Potter sequence
346
What is the cause of Potter sequence
Kidney problems typically preventing urination
347
What vaccine comes in a conjugated and a nonconjugated form
PCV13 (conjugated) and PPSV23 (not conjugated)
348
What term is used to describe a variable (smoking per se) that is related to both the exposure (alcohol) and the outcome (cancer) thus skewing the actual results
Confounding bias
349
What are the 3 stop codons on an mRNA strand
UAA, UAG, and UGA
350
What is the last codon to have an anticodon bind during translation
The codon just before the stop codon
351
What disorder is characterized by exertional dyspnea, bone pain, and abdominal pain
Sickle cell Disease
352
What is the mutation that results in sickle cell disease
Valine substituting a glutamic acid on the Beta chain
353
How does an MI affect a cardiac and vascuar function curve
Cardiac output decreases | Venous return stays the same
354
What pathogen is used to treat dystonias, achalasia, and muscle spasms
Clostridium botulinum TOXIN
355
Clostridium species can survive harsh conditions due to their ability to form what
Spores
356
What vessel is at greatest risk of being lacerated in the event of a pterion fracture (location where frontal, parietal, temporal, and sphenoid meet)
Middle meningeal artery
357
What two vessels precede the Middle Meningeal Artery stem from
External carotid - Maxillary - Middle Meningeal Artery
358
What is the formula to calculate the Odds ratio
Odds ratio = ad/bc
359
What term is used to describe the likelihood that the outcome was associated with a particular exposure
Odds ratio
360
What is the morphology of parvovirus B19
Nonenveloped ssDNA virus
361
Parvovirus B19 causes an aplastic crisis in individuals with what condition
Sickle Cell
362
How does the membrane potential of a cell change as it becomes permeable to a specific ion
It increases if it is a Cation | It decreases if it is an Anion
363
What substances are specifically is found in the kidneys of individuals with post streptococcal glomerulonephritis
IgG, IgM, and C3
364
Post streptococcal glomerulonephritis results in what specific glomerular disease
Nephritic syndrome
365
Down Syndrome predisposes individuals to what specific neoplasms
Acute lymphoblastic leukemia (most commonly) | Acute myelogenous leukemia
366
Pregnancy tests look for what substance and in what bodily fluid
Beta HCG (some just say HCG, but alpha HCG is found in a lot of other things) Blood and urine
367
How does a blood pregnancy test differ from a urine pregnancy test
The blood tests can recognize a smaller amount of HCG and thus will ID pregnancy sooner Thus preganancy can be detected within 1 week if blood testing is used or within 2 weeks if home pregnancy test is used
368
Transketolase is an enzyme found in what pathway
Pentose phosphate pathway
369
What biochemical processes occur in the cytosol
Glycolysis Fatty acid synthesis Pentose phosphate pathway
370
What is the most important muscle in increasing intrathoracic and intraabdominal pressure during the Valsalva maneuver
Rectus abdominus
371
What are examples of Type 4 hypersensitivity reactions
Contact dermatitis TB skin test Granulomatous inflammation in TB
372
What process is described below: Th1 cells encounter an antigen and release IFN gamma that signals macrophages to come to the area
Type 4 hypersensitivity reaction
373
Sertraline would be used to treat a pt with what condition
Depression
374
All SSRI's carry may cause what potential side effect
Mania (since they are depression treatments)
375
What is the acronym to remember the neural crest derived tissue
MOTEL PASS ``` Melanocytes Odontoblasts Tracheal cartilge Enterochromaffin cells Laryngeal cartilage ``` Parafollicular cells Adrenal medulla Schwann cells Spinal membrane
376
How can one diagnose melanoma if it is suspected
ABCDE ``` Assymetry Border irregularity Color Diameter > 6mm Evolution ```
377
What pathogen is a common agent of cellulitis, pharyngitis, and impetigo
Strep pyogenes
378
What type of hypersensivity reaction is Post streptococcal glomerulonephritis
Type 3
379
When does hypothyroidism present in newborns
After maternal T4 wanes
380
Which disorder presents in a newborn with a large anterior fontanelle, umbilical hernia, lethargy, constipation, and hypotonia
Congenital hypothyroidism
381
What is the leading cause of cancer deaths in males and females
Cancer
382
If you suspect abuse in an adult while interviewing the patient with their son/daughter, who is serving as their caregiver, present, what should you do next
Ask the son/daughter to leave and ask the patient questions 1 on 1
383
Which enzyme decreases in activity in Lesch Nyhan syndrome, and which enzyme increases in activity
Decreases: Hypoxanthine guanine phosphoribosyltransferase (HGPRT) Increases:Adenosine deaminase
384
What are the purine salvage disorders
Adenosine deaminase deficiency | Lesch-Nyhan Syndrome
385
What is the mnnemonic for Lesch-Nyhan syndrome and what is it used for
HGPRT (The enzyme abbreviation) Also useful for remembering the symptoms ``` Hyperuricemia Gout Pissed off attitude Retardation dysTonia (repetitive uncontrolled movements) ```
386
How does the minute ventilation volume calculation differ from the alveolar ventilation volume
Minute ventilation volume includes the physiologic dead space volume and will thus be a bigger number
387
Which nerve is responsible for the sensory component of the pupillary reflex
Optic nerve
388
Which nerve is responsible for normal vision
Optic nerve
389
What is the virulence factor of Haemophilus Influenzae
Polyribosylribitol phosphate which makes up its polysaccharide capsule
390
What pathogen causes Epiglottitis
Haemophilus influenzae Type B
391
How does gout appear on polarized light microscopy
``` Needle shaped Negatively birefringent (yellow when parallel to slow ray) ```
392
Myeloproliferative disorders increase the risk of what condition occuring
Gout
393
What is it called when a subject being study changes their behavior once they find out they are being studied?
Hawthorne effect (Observer effect)
394
What is the difference between a frameshift mutation and an in frame deletion
in frame deletion is a deletion of bases that is a multiple of 3 and thus only affects that one codon
395
What immunity is utilized against Clostridium tetani
Humoral immunity with antibodies neutralizing the toxin
396
Which anatomic structure can be used to locate the appendix
Teniae coli which converge at the appendix
397
What protein is synthesized from lysyl oxidase cross linking together the monomers
Elastin
398
If you are unsure about whether a patient can take their medications due to cognitive impairment, what should you do
Involve a social worker in discharge planning
399
What is the formula to calculate total peripheral resistance of different vessels in parallel? Such as renal coronary, cerebral?
1/RT = 1/R1 + 1/R2 + 1/R3 + ....... Think of the the different vessels as in parallel with different resistances
400
What should you be concerned about in a premature infant
Neonatal respiratory distress syndrome from surfactant not being produced yet
401
What is used to stimulate surfactant production in preterm babies
Steroids (Dexamethasone etc.)
402
What immunogenic substance does the Haemophilus influenzae vaccine contain
Type B capsular polysaccharide Thus only effective against HIB! Not effective against non typeable or other types
403
Hypocapnia indicates that what is occurring
Hyperventilation
404
A V/Q mismatch from a pulmonary embolism would result in what blood gas findings
Low PaO2 and Low PaCO2 PaO2 drops because PE is blocking arteries resulting in gas not being exchanged even though lungs are getting ventilated. Results in low PaO2. Leads to hyperventilation. Leads to low PaCO2 without O2 improvement b/c PE is still blocking blood flow so more O2 isn't comin in, just CO2 leaving
405
What is the purpose of certain bacteria possessing an IgA protease
Cleaves IgA allowing the bacteria to adhere to the mucosal surface
406
Which bacteria possess IgA protease virulence factors
SHiN Strep pneumo Haemophilus influenzae Neisseria gonorrhea and Neisseria meningitidis
407
What is another word for precise, as in a very precise test
Reliable
408
Hemophilia A and B follow what inheritance pattern
X linked Recessive
409
Which disorders are characterized by hemarthroses (bleeding into joints)
Hemophilias
410
What are the two major causes of polyhdramnios due to poor fetal swallowing
GI obstruction | Anencephaly (failure of swallowing center to form)
411
Anti epileptics can cause what major side effect
Neural tube defects (anencephaly, spina bifida, etc.)
412
Where do amino acids bind to tRNA molecules
CCA-3' end
413
Left and right shifts in the flow volume loop graph is suggestive of what lung pathologies
Left - Obstructive lung dz (More volume from air trapping) | Right - Restrictive lung dz (Reduced air volume from reduced lung expansion)
414
What lung pathology results in destruction of alveolar walls
Emphysema
415
What is the morphology of Haemophilus influenzae
Coccobacillus
416
What does Haemophilus require in media for growth
``` Factor X (hematin) Factor V (NAD+) ```
417
Why does Haemophilus only grow on blood agar with staph aureus
Staph lyses RBC's to provide Factor V (NAD+) which is required for their growth
418
What anatomical structure can be used to distinguish between a direct and indirect hernia
Inferior epigastric vessels
419
What is the normal pressure in the RA
20/5 mmHg
420
What is the difference in pressures between the RV and Pulmonary artery
RV - 25/5 PA - 25/10 Diastolic increases a little in PA b/c of arterial resistance and LA pressures
421
A patient has been abandoned by their father in the past. As you are leaving the patient room, they say to you, "You are leaving me too." What is this an example of?
Negative transference
422
A patient has a great upbringing from their parents and loves them very much. Because of such upbringing, they place a lot of trust on you as their doc. This is an example of
Positive transference
423
What type of breathing battern is described as hyperpnea with periods of apnea between
Cheyne Stokes breathing
424
What condition resuts in Cheyne Stokes breathing
Congestive heart failure
425
What is the most common cause of unilateral hydronephrosis in the fetus
Failure of recanalization at the ureteropelvic junction
426
What are the top 4 most common cancers (highest incidence) in order in males and females
Males: Skin, Prostate, Lung, Colon Females: Skin, Breast, Lung, Colon
427
What are the top 4 cancers with the highest mortality in order in males and females
Males: Lung, Prostate, Colon Females: Lung, Breast, Colon
428
Where does T cell postitive and negative selection occur
Positive - Cortex | Negative - Medulla
429
What are the submucosal alkaline secreting (bicarbonate) cells of the duodenum
Brunner's glands
430
Increased gastric acid production will result in hypertrophy of what structures
Brunners glands in the duodenum
431
What enzyme is responsible for stimulating glycolysis and inhibiting gluconeogenesis
Fructose-2,6-bisphosphate
432
Where is serotonin synthesized
Raphe nucleus
433
What drugs are used to treat depression and anxiety
SSRIs
434
What is the inheritance pattern for sickle cell anemia
AR
435
What is the best way to determine whether two people may have a sickle cell child
Hb electrophoresis Can ID carriers
436
Which nerve is responsible for afferent signals from carotid baroreceptors and may result in syncope during putting on a tie
Glossopharyngeal - Afferent for carotid baroreceptors Vagus - Afferent for aortic baroreceptors Vagus is efferent pathway to heart if baroreceptors signal too high pressure and parasymp response is needed
437
What organism displays a tumbling motility
Listeria monocytogenes
438
How is Listeria monocytogenes most commonly transmitted
Contaminated food
439
How do you calculate the absolute risk reduction of Heart attacks with Drug B versus the original Drug A
Simple subtraction ARR = % with heart attacks on Drug A - % with heart attacks on group B ARR = 30% - 27% = 3% reduction in heart attacks with Drug B
440
What results in dry skin, hepatosplenomegaly, and papiledema
Chronic Vitamin A excess
441
What disorder is characterized by a negative nitroblue tetrazolium test of neutrophils
Chronic granulomataous Dz
442
What is an individual susceptible to if he has chronic granulomatous dz
Infxn with catalase + organisms
443
What is the most important muscle for hip flexion
Iliopsoas
444
Drugs which target which ion channel in phase 0 of pacemaker action potentials can result in a reduced heart rate
Funny Sodium channels
445
Which phase of pacemaker action potential can reduce heart rate without affecting contractility or resting
Phase 0
446
Emphysema results in elevation of what substance
Elastase
447
What virulence factor of staph aureus is bound to it's peptidoglycan cell wall structure
Protein A
448
What is the fxn of the Protein A virulence factor produced by Staph aureus
Bind Fc portion of Antibodies preventing complement activation
449
The process of viral gene exchange via crossing over of 2 DNA molecules is referred to as
Recombination
450
Patent foramen ovale results from what
Incomplete fusion of primum and secundum
451
How does a patent foramen ovale differ from an ASD
ASD - Failure of septum to develop | Patent foramen ovale - Failure of fully developed septa to fuse
452
Which pathogens produce dextrans that allow them to bind to structures and thus cause endocarditis and dental caries
Strep Viridans
453
What condition results in an inability to adduct one eye while the other abducts. The abducting eye presents with nystagmus additionally
Internuclear ophthalmoplegia
454
What structure allows for coordinated horizontal eye movemement due to communication between CN 4 and CN 6
Medial longitudinal fasciculus
455
Where is the Medial longitudinal fasciculus located
Distal pons
456
What condition results in elevated PCO2 from increased mass, low PO2 from reduced lung volume, and a normal alveolar arterial gradient
Obesity hypoventiation syndrome
457
Which conditions can cause hypoxemia and a normal alveolar arterial pressure gradient (5-15mmHg)
Hypoventilation | High altitude
458
Where on the Ig molecule do neutrophils, macrophages, mast cells etc. attach
Fc portion near the carboxy terminal (near the end)
459
What attaches to the Fc portion of Ig molecules right next to the hinge region
Complement
460
What is one of the major causes of cor pulmonale
Pulmonary hypertension
461
What is the difference between Northern, Southern, Western, and Southwestern blots
Northern - mRNA Southern - DNA Western - Proteins Southwestern - DNA binding proteins
462
What is it called when a single mRNA encodes multiple proteins
Polycistronic mRNA
463
What is a well known polycistronic mRNA strand
Lac Operon
464
Cleft lip results from what
Failure of intermaxillary segment fusing with the maxillary prominences
465
Cleft palate results from what
Failure of palatine shelves fusing
466
Cleft lip and spina bifida follow what inheritance pattern
Multifactorial
467
Atherosclerosis begins with what cell type
Endothelial cell dysfunction
468
What information is necessary in order to perform PCR
The nucleotide sequence of the flanking regions Necessary for primer to bind
469
Where is the femoral vein located relative to the femoral artery and inguinal ligament
Medial to the femoral artery | Below the inguinal ligament
470
What are the first line medications for generalized anxiety disorder
SSRIs and Serotonin Norepinephrine Reuptake Inhibitors
471
What relative risk value indicates that there is no difference in risk between the exposure group and the unexposed group
1
472
If a 95% CI interval does not contain the null value in it, what p value would you expect to see
Any p < 0.05
473
What is the extrinsic pathway of apoptosis consist of
Fas ligand
474
What is a classic example of Fas induced apoptosis (an extrinsic pathway apoptosis)
Negative selection of T cells in the thymus
475
Which viral genome requires only host machinery for translation
Single stranded + sense RNA virus
476
What is the genome of Rhinovirus
+ssRNA virus
477
Failure of the processus vaginalis to close can result in what abnormalities
Hydrocele | Indirect inguinal hernia
478
What embryologic defect can result in a hydrocele and indirect inguinal hernia in infants
Persistent processus vaginalis
479
What individuals have increased bone density relative to other groups
African Americans (women especially)
480
What disorder is characterized by CGG repeats
Fragile X
481
In Fragile X, what biochemical process prevents FMR1 from being expressed properly and thus leading to neurological problems
DNA methylation of CGG repeats
482
What disorder is characterized by a failure of B cells to mature due to a mutated bruton tyrosine kinase gene
X linked agammaglobulinemia
483
In X linked Bruton Agammaglobulinemia, what lymph node structure will be missing
Germinal centers
484
What enzymes does Vitamin B12 serve as a cofactor for and what is the reaction/buildup products
Methylmalonic acid ---> Succinyl CoA (Methylmalonyl CoA Mutase) Homocysteine ---> Methionine (Methionine Synthase)
485
What substance in B12 deficiency anemia causes subacute combined degeneration of the dorsal columns of the spinal cord and other neurologic problems
Methylmalonic acid buildup
486
What disorder may present with amenorrhea, hypotension, bradycardia, cardiac complications, and osteoperosis
Anorexia nervosa
487
How do people with increased elastic resistance and increased air flow resistance each maintain the same minute ventilation as a normal person
Increased elastic resistance - Faster shallow breathing | Increased air flow resistance - Slower deep breathing
488
Asthma results in what type of resistance being increased
Air flow resistance Not elastic resistance. Thus an asthma pt would breathe slower and deeper
489
Where do Stanford A and Stanford B aortic dissections start at
A - Sinotubular jxn | B - Left Subclavian
490
How does a primary HSV1 infxn differ from a recurrent HSV1 infxn
Primary - Herpetic gingivostomatitis (on gingiva, tongue, palate, pharynx, systemic signs of fever etc.) Recurrent - Herpes labialis (just around the lips)
491
A tzanck smear identifies multinucleated giant cells caused by what pathogen
Herpes virus Tzanck heavens I do not have herpes
492
How do you calculate incidence
of new cases / # of people at risk Denominator is not the TOTAL population. Usually it is the TOTAL population - the people who already are diseased b/c they are not at risk
493
An anteriorly placed aorta on echo is characteristic of what disorder
Transposition of the Great vessels
494
What developmental mechanism results in Transposition of the great vessels
Failure of the aorticopulmonary septum to spiral
495
Which pathogen has reverse transcriptase and a partially double stranded DNA genome
HBV
496
What disorder is characterized by decreased green fluorescence seen on Dihydrorhodamine flow cytometry and noblue precipitate seen in cells on Nitroblue tetrazolium dye testing
Chronic granulomatous disease
497
What is the defect in Chronic granulomatous disease
Defective NADPH Oxidase Thus cannot form reactive oxygen species to kill off pathogens in the phagolysosome
498
What disorder presents with sugary smelling urine
Maple syrup urine disease
499
What enzyme is defective in Maple syrup urine disease
Branched chain alpha ketoacid dehydrogenase
500
What substances accumulate in Maple syrup urine disease
Branched chain amino acids (Leucine, Isoleucine, Valine)
501
What is the mnemonic for Maple syrup urine disease
I Love Vermont MAPLE SYRUP from maple tree BRANCHES Accumulation of: Isoleucine Leucine Valine Maple Syrup Urine Dz Branched chain dehydrogenase enzyme defective
502
How does Tourette syndrome differ from Chronic tic disorder
Tourette - Both motor and vocal tics Chronic Tic - Either motor or vocal tics
503
What disorder is described by a child who constantly clears his throat and shrugs his shoulder in class
Tourettes syndrome Both vocal (clearing throat) and motor (shrugging shoulders) tics are present
504
ADH increases urine osmolarity by reabsorbtion of water via aquaporin channels and what other channels
Urea transporters which passively pull water with them
505
Which region of the nephron does ADH act at to reabsorb water via aquaporin channels and urea transporters passively abosrbing water
Distal convoluted tubule
506
What term describes the situation where an individual who is aware of a disorder alters their memory of the exposure
Recall bias
507
Recall bias is associated with what type of study
Case Control
508
What is the mnemonic for pheochromocytom and what is it used for
5 Ps are for the 5 symptoms ``` Pain (Headache) Pressure (BP elevated) Perspiration (sweating) Palpitations (Tachycardic) Pallor ```
509
How does hyperthyroidism from a thyroiditis differ in clinical presentation from a pheochromocytoma
Quite similar, but a pheochromocytoma occurs in spells (relapses and remits) Hyperthyroid occurs continuously
510
What regions of the orbit are very thin and thus most commonly fractured in a blowout fracture (blunt trauma to the eye)
Medial and inferior walls
511
What sinuses are most commonly filled with fluid or blood in a blowout fracture to the eye
Maxillary and Ethmoid These two most commonly because the inferior and medial walls fracture the easiest
512
What cells secrete Mullerian Inhibitory Factor (MIF) to prevent female INTERNAL genitalia formation
Sertoli cells
513
What cells secrete androgens to promote male INTERNAL and EXTERNAL genitalia formation
Leydig cells
514
What term is used to describe the situation where the use of an exposure helps delay the course of clinical signs appearing since the time of exposure (Ex. something delaying plaque buildup eventually causing an MI)
Latency
515
What is the most common complication of Varicella zoster infxn
Post herpetic neuralgia
516
Which portion of the brain is in charge of executive functioning such as planning, fulfilling tasks, and organizing things
Frontal lobe
517
How do lesions of the right and left frontal lobes differ
Right --> Disinhibited behavior | Left --> Apathy and depression
518
What sex chromosome disorder commonly results from somatic mosaicism
Turners Syndrome
519
How do Somatic and Germline Mosaicism differ
Somatic - Occurs after fertilization and affects only that individual Germline - Occurs in either egg or sperm. Parent with germline mutation unaffected, but their offspring are all affected in every cell of the body (offspring not mosaic)
520
How does the structure of MHC 1 and MHC 2 differ
MHC 1 - Contains beta 2 microglobulin MHC 2 - Contains alpha and beta chains
521
What is one of the most common regions of the digestive tract affected by Crohns
Terminal Ileum
522
Where are bile acids reabsorbed
Terminal ileum
523
Reduced bile reabsorbtion as in the case of some Crohns patients results in an increased risk for gallstone formation. Why?
Cholesterol/Gallstone ratio increases
524
What is another name for the pectinate line in the rectum
Dentate line
525
What is the venous drainage above and below the pectinate line
Above - Superior rectal vein to Inferior mesenteric | Below - Middle/Inferior rectal vein to Internal iliac
526
How do you calculate flow through a blood vessel
(P1 - P2) / Resistance
527
How do you calculate the resistance in a blood vessel
Resistance = (viscosity x length) / Radius^4
528
RAS is active when bound to what substance
GTP
529
What term describes the force that the left ventricle pumps against during systole
Afterload
530
How can you decrease the amount of regurgitant flow in an individual with mitral regurgitation
Decrease afterload
531
What binds to the stop codon on an mRNA sequence
Releasing factors
532
What type of study is described as having individuals in Group A taking tramadol for 4 weeks, then taking a 1 week break, then taking a placebo for 4 weeks
Crossover study
533
What immune mechanism is necessary to prevent Giardia infxns
Secretory IgA Stops its adherence to the bowel of the small intestine reducing its secretioins and filfammation results
534
What enzyme acts as a glucose sensor to regulate insulin release in pancreatic beta cells
Glucokinase
535
Which enzyme converts glucose to glucose-6-phosphate in the first step of glycolysis
Glucokinase
536
What enzyme when mutated can result in maturity onset diabetes of the young (MODY)
Glucokinase
537
What are the three uterine anomalies and how do they differ
Septate - Septum extends through part of uterus Bicornuate - Septum extends through uterus and cervix Didelphys - Septum extends down into vagina
538
What is the mechanism behind a bicornuate uterus
Faillure of paramesonephric ducts to laterally fuse
539
What nerve courses under the humeral and ulnar head of the pronator teres muscles and then between the flexor digitorum superficialis and flexor digitorum profundus muscles
Median nerve
540
Which nerve is responsible for wrist flexion, thumb flexion, 1st 2nd and 3rd digit palmar sensation
Median nerve
541
What class of medications should be used to treat bipolar disorder
Mood stabilizers
542
What mood stabilizer drugs are good for maintenance tx for bipolar disorder
Lithium and Valproate/Valproic acid
543
What three agents cause esophagitis in HIV pts and how does each appear
Candida - White pseudomembrane CMV - Linear ulcers HSV - Punched out lesions Note that it is Herpes SIMPLEX! NOT OTHERS LIKE ZOSTER OR OTHER HERPES VIRUSES)
544
In what lung pathologies do individuals function at hyperinflated states
Obstructive lung pathologies
545
What term describes the air remaining in the lungs after maximal exhalation
Residual volume
546
What term represents the amount of air the lungs can accomadate maximally
Total lung capacity
547
What structure arises from incomplete obliteration of the vitelline duct
Meckel's Diverticulum
548
The vitelline duct connects what two structures
Yolk sac with Midgut lumen
549
In an individual with lower extremity pain and cramping during exercise, what might you suspect
Coarctation of the aorta resulting in claudication
550
In a Case Control Study, how does the Case group differ from the Control group
Case group - Dz + and Exposure + Control - Dz - The control group is not exposure negative, but just randomly selected nondiseased individuals!!
551
What is targed by the killed influenza virus vaccine
Hemagglutinin
552
Why does ethanol cause hypoglycemia
Suppresses gluconeogenesis Ethanol uses up NAD which is needed in steps of gluconeogenesis
553
Ethanol inhibits which step of gluconeogenesis due to its consumption of NAD resulting in hypoglycemia once glycogen stores run out
Oxaloacetate --> Malate This step requires NAD but ethanol metabolism used up the NAD
554
What is the most likely reasoning for anovulatory cycles in teenage females with missed cycles and then heavy bleeds
Immature hypothalamic pituitary ovarian axis
555
Why does an immature hypothalamic pituitary ovarian axis result in heavy bleeding every few months rather than regular bleeding every month
Anovulatory cycles occur Causes follicle to persist and continue secreting estrogen but no progesterone so endometrium grows until BV cannot support it
556
Who might you suspect anovulatory cycles in
Females in the first few years folowing menarche Females in the last few years before menopause
557
Scaphoid fractures may damage what other structure
Radial artery Courses over the scaphoid on the dorsal side
558
Damage to the radial artery in a scaphoid fracture results in what pathology
Avascular necrosis
559
What enzymes are defective in Acute intermittent porphyria
ALA synthase - upregulated Porphobilinogen deaminase - downregulated These both lead to accumulation of Porphobilinogen and delta ALA
560
What is the goal of tx in Acute intermittent porphyria
Decrease ALA synthase enzyme activity Prevents accumulation of porphobilinogen
561
What is the mnemonic for Acute intermittent porphyria and what is it used for
5 P's used to remember the 5 symptoms of Acute intermittent porphyria ``` Pain in abodmen Port wine colored urine Polyneuropathy Psych disturbances Precipitated by drugs ```
562
What can be done to prevent recurrence of genital herpes simplex infection
Daily oral acyclovir, valacyclovir, or famciclovir
563
What most likely explains a teenager that is displaying self consciousness, emotional outbursts, and a desire for privacy yet has friends and is doing fine in school
Normal adolescence
564
What midline abdominal protrusion is associated with Down Syndrome
Umbilical hernia
565
Umbilical hernias result from what abnormality
Defect in linea alba (fascia that closes umbilical ring)
566
What factors increase diffusion across a semipermeable membrane
Increased temperature Increased surface area Larger difference in concentration gradients Increased solubility
567
What is another name for homeobox genes
Hox genes
568
What do Hox genes code for? (These are highly conserved genes containing typically 180 nucleotides)
Transcription factors
569
Homeobox genes have what important function in embryogenesis
Segmental oranization of embryo Problems in Hox genes may cause Skeletal malformations and appendages in wrong locations etc.
570
What disorder presents with fever, hypotension, chest and back pain, and brown urine (hemoglobinuria)
Acute hemolytic transfusion reaction
571
What type of hypersensitivity is an acute hemolytic transfusion reaction
Type 2
572
What is lithium used for
Mood stabilization in bipolar disorder
573
What is the mnemonic for Lithium use and what is it used for
LMNOP for the Lithium side effets: Movement (tremor) Nephrogenic hypOthyroidism Pregnancy problems (Teratogen/Ebstein's anomaly)
574
What enables bacteria to survive in boiling water
Spores
575
Which bacteria form spores and are found in soil
Bacillus anthracis and Clostridium genus
576
What disorder is characterized as a ventricular pre excitation syndrome with reentry circuits that may cause SVT
Wolf Parkinson White
577
What is the triad of EKG findings in WPW
Delta wave Shortened PR interval Widened QRS
578
What vein is found just inferolateral to the pubic tubercle and used commonly for coronary artery grafting
Great saphenous vein
579
What vessel runs from the medial portion of the foot up anterior to the medial malleolus, and up the anterior medial portion of the leg and thigh before joining the femoral vein to form the External iliac vein
Great saphenous vein
580
What is the term to describe the number of new cases of a disease over a period of time
Incidence
581
Aldose reductase is used to trap glucose inside cells by forming what compound
Sorbitol
582
Sorbitol is broken down by sorbitol dehydrogenase into what compound
Fructose
583
What is the formula to calculate positive predictive value
Postive predictive value = a / (a+b)
584
What pathogen is characterized by having a spherule form that contains Endospores
Coccidioides immitis
585
In what geographical location is Coccidioides immitis found in
Southwestern US (California, Az, etc.)
586
Which nuclear material contains a poly A tail at its 3' end
Mature mRNA Prevents degradation in cytoplasm
587
Which drug inhibits lymphocyte proliferation by binding with FK 506 to inhibit MTOR (mammalian target of rapamycin) ultimately blocking IL-2 signaling, preventing G1 to S phase transition and lymphocyte proliferation
Sirolimus
588
What is another name for Sirolimus
Rapamycin Makes sense since it inhibits Mammalian Target of Rapamycin (MTOR)
589
Which substances are broken down into propiony CoA
Branched chain AAs (Leucine, Isoleucine, Valine) Methionine Threonine Odd chain FA's
590
In an individual with elevated propionyl CoA, which enzyme is defective
Propionyl CoA carboxylase Converts Propionyl CoA from ptn breakdown to Methylmalonyl CoA
591
What should be addressed in an individual typically in an outpatient setting but essentially if they become hospitalized
Advanced Directives
592
What is advanced directives
Contains 2 components: Living will - Specifies their end of life wishes (intubation, CPR, enteral feeding, etc.) Health care proxy - Who will make decisions for them should the need arise
593
Which disorder is characterized by short stature with long bone shortening, midface hypoplasia, and macrocephaly
Achondroplasia
594
Which cells are affected in achondroplasia
Chondrocytes
595
Which anatomical structure produces NE
Locus Ceruleus
596
Where is the Locus ceruleus located
Near the lateral floor of the 4th ventricle in the posterior rostral pons
597
What do an elevated Acethylcholinesterase and Alpha feto protein indicate
Neural tube defect Opening allows for spilling of these substances into the amniotic fluid
598
What are the two types of neural tube defects that arise from failed fusion of the neural plates
Rostral failed fusion - Anencephaly Caudal failed fusion - Spina bifida (spina bifida occulta, meningocele, myelomeningocele, and myeloschisis)
599
What is the mechanism by which Neural Tube Defects arise
Failed fusion of neural plates or neuropores
600
How do V, Q, and V/Q change from the apex of the lung to the base
V - Increases slightly b/c lungs expand more at base Q - Increases a lot b/c less uphill push against gravity for heart V/Q - DECREASED b/c Q increases by a lot relative to V
601
What does Rhogam target
The D Rhesus antigen on Rh+ fetal RBC's
602
What type of Ig is Rhogam
IgG
603
What term describes the difference in risk between the exposed group and the unexposed group? (20% - 7% = 3%)
Attributable risk
604
How do you calculate attributable risk
Risk of adverse event in exposed (%) - Risk of adverse event in unexposed (%) Careful with these questions, they are tricky! I think it's pretty much like positive predictive value - negative predictive value
605
What does RT-PCR bind to and do
Binds to mRNA and converts it to cDNA | exons only since it is a mature mRNA
606
The ectoderm can be further subcategorized into what germ layers
Surface ectoderm Neural tube Neural crest
607
What embryonic germ layer does a Prolactinoma (type of pituitary adenoma) originate from
Surface ectoderm This is a subclassification of Ectoderm along with Neural tube, and neural crest tissues
608
What heart sound is described as having a high frequency opening snap and a diastolic rumble heard best in the apex
Mitral stenosis
609
What is one of the most effective ways doctors can reduce medication errors
Don't use trailing 0's Someone might mistake 2.0 mg for 20 mg
610
In patients who cannot be put on anticoagulants and are at risk for a PE, what should be used
IVC filter Goes in inferior vena cava, hence the name!
611
Where is the inferior vena cava located relative to the vertebral bodies and duodenum
Anterior to the vertebral body on the right and medial to the duodenum
612
What ion channels cause depolarization and repolarization in a NEURON action potential
Voltage gated Sodium influx causes depolarization | Voltage gated Potassium efflux causes repolarization
613
Why does HCV have many variable envelope antigens
It lacks 3 to 5' exonuclease activity and is thus prone to mutation
614
What is Trisomy 18
Edwards Syndrome Election age = 18
615
What disorder is charcterized by low set ears, hypertonia (clenched fists), rocker bottom feet, and overlapping fingers
Edwards Syndrome (Trisomy 18)
616
What vessel carries oxygenated blood from the mom to the babies circulation
Umbilical vein
617
What disorder is characterized by gingivitis, myalgias, hemorrhages, and impaired wound healing due to impaired formation of collagen
Scurvy
618
What is another name for Vitamin C
Ascorbic acid
619
What disorder is characterized by a deficiency in Ascorbic acid (Vit C)
Scurvy
620
What viruses contain segmented genomes
``` Orthomyxoviruses (Influenza virus) Rotairuses Reoviruses Bunyaviruses Arenaviruses ```
621
Segmented viral genomes are capable of performing what
Reassortment
622
Recurrent infxn and absence of all Ig types suggests what disorder
X linked Bruton Agammaglobulinemia
623
What cell markers are seen on the surface of B cells
CD 19 CD 20 Others also, but these are the main ones
624
How is copper removed from the human body
Mainly secreted in the bile/stool Some is secreted (not filtered) by the kidney
625
What is it called when prior knowledge of an exposure affects the interpretation of a result
Observer bias Example: Docs who knew a pt had diabetes were more likely to report that they saw diabetic nephropathy on microscopy
626
What substance is responsible for male external genitalia development and prostrate development
Dihydrotestosterone (DHT)
627
What enzyme converts Testosterone to Dihydrotestosterone
5 alpha reductase
628
Where to intraparenchymal deep brain hemorrhages most commonly occur
Basal ganglia and Internal capsule
629
What vessels most often cause hemorrhaging into the basal gangia and internal capsule (deep brain hemorrhages)
Lenticulostriate arteries Branch of MCA
630
What disorder is characterized by impaired bacterial and fungal killing (Parasites and viruses unaffected!) due to a deficiency in NADPH oxidase
Chronic granulomatous Dz Individuals susceptible to catalase + organisms
631
Which organisms are catalase + and thus are a threat to individuals with Chronic Granulomatous Dz
CATs need PLACESS to Belch their Hairballs CATalase + include: ``` Pseudomonas cepacia Listeria Aspergillus Candida E. Coli Staphylococci Serratia marascens ``` Burkholderia cepacia H. pylori
632
In TB, what cytokines are responsible for granuloma formation
IL-12, IFN gamma, TNF alpha Macrophage with TB inside of it releases IL-12 - Converts T helper to TH1 cells TH1 cells secrete IFN gamma - Activates macrophages TH1 also secretes TNF alpha - Attracts more macrophages resulting in walling off/granuloma formation
633
What testing parameters are affected by prevalence
Positive and Negative predictive value Makes sense if you think about it, if way more people have a dz in a population (higher prevalence), the ppv is likely to be higher as well. This is when we say that it correlates with pretest probability
634
What is the term used to describe a single gene causing multiple phenotypic effx
Pleitropy
635
What ratio increases in amniotic fluid closer to delivery in a pregnant female
L/S ratio - Lecithin to Sphingomyelin Lecithin is in pulm surfactant so it will go up Sphingomyelin is a normal phospholipid in cell membranes so it stays the same
636
What pathogen has thick walls and displays broad based budding
Blastomyces dermatidis (Agent of blastomycosis)
637
What is the mnemonic for Blastomyces
Blastomyces Buds Broadly Fungus displays broad based budding
638
If a pt refuses to know their diagnosis and is fully conscious and cognitively intact, what should the physician do
Withhold the information Pts don't have to know their diagnosis if they don't want to. This is normal in many cultures
639
What thrombolytic agent is used for MI's and Strokes
tPA
640
What substance can cause reperfusion arrhythmias
tPA
641
Which nodes does lymph drainage go to above the pectinate line and below
Above - Drains to inferior mesentric nodes or internal iliac nodes Below - Drains to superficial inguinal nodes
642
Procollagen peptidase deficiency which cleaves the C and N terminals of Procollagen will result in what disorder
Ehler Danlos Syndrome
643
Neurophysins are released with what hormones
Oxytocin and ADH Neurophysins stabilize these hormones during axonal transport from the hypothalamus to the posterior pituitary
644
Where are Oxytocin and ADH released into the circulation from
Posterior Pituitary They are synthesized in NEURONS in the hypothalamus and move via axon transport to the Posterior pituitary where they are released into circulation
645
What signs should clue you in to drug misuse
Requesting a specific medication Running out of medication Pain out of proportion to exam
646
If you suspect drug misuse in an individual, what is the best next step
Accessing their prescription history
647
Hypothyroidism will show an increase in what laboratory value
Creatine Kinase Commonly causes myopathy! Kind of odd but it does!
648
Myopathy is an odd finding in what disorder
Hypothyroidism
649
What are the most common opsonins
IgG | C3b
650
How many calories do 1 gram each of Carbohydrates, Proteins, Fat, and Ethanol provide
1 gram Carbs = 4 calories 1 gram Proteins = 4 calories 1 gram Ethanol = 7 calories 1 gram Fat = 9 calories
651
In dizygotic twins, what is the chorion amnion presentation
Dizygotic are always Dichorionic-Diamnionic
652
What is the fertilization that occurs to produce dizygotic twins
2 sperm fertilize 2 eggs
653
What are the different monozygotic twin pregnancy types and when does each occur
Days 0-4 split results in Dichorionic-Diamnionic Days 4-8 split results in Monochorionic-Diamnionic Days 8-12 split results in Monochorionic-Monoamnionic Days 13+ split results in Monochorionic-Monoamnionic conjoined
654
What is the normal pressure in the aorta/aortic root
120/80 mmHg
655
In a pt with an aortocavitary fistula from the aortic root to the RV, which way does blood flow and when
Continuous flow from aorta to RV during both systole and diastole Aortic pressures are 120/80 RV pressures are 20/5 Thus since RV pressure is lower in both systole and diastole, blood will always flow to the region of lower pressure
656
Where do most nosebleeds occur
Anterior nasal septum
657
Where is Kiesselbach's plexus located and what arteries form it
Anterior nasal septum Anterior ethmoidal A. Sphenopalatine A. Superior labial A.
658
What pathogen most commonly causes bacterial endocarditis in patients with prosthetic valves and septic arthritis in patients with prosthetic joints
Staph epidermiditis
659
How can you differentiate Staphylococci from Streptococci
Catalase test. Staph are Catalase +
660
How can you differentiate Staph aureus from other Staph
Coagulase test. Staph aureus is Coagulase +
661
What disorder is characterized by severe photosensitivity and hyperpigmentation in response to sunlight
Xeroderma pigmentosum
662
What is defective in Xeroderma pigmentosum
Endonuclease excision repair This removes the Thymine-Thymine dimers that form from UV light
663
How do you calculate the case fatality rate for a particular disorder (say for example colon cancer)
of people who died from colon canacer / # of people with colon cancer Pretty easy.. just think about it
664
What are the 5 main components in the formation of an atherosclerotic plaque
``` Endothelial cell - where injury begins Platelets - bind to exposed collagen and released PDGF Macrophges - accumulate LDL - accumulate Smooth m - Comes because of PDGF ``` Foam cells are a mix of LDL and Smooth M
665
What pathogen forms germ tubes
Candida
666
What pathogen forms pseudohyphae
Candida
667
What immunity is necessary to prevent Candidal infxn
T lymphocytes - Prevent LOCAL infxn (esophageal/vaginal candidiasis) Neutrophils - Prevent SYSTEMIC infxn (disseminated candidiasis/candidemia). Probably done by phagocytosing them
668
What are the borders of the carpal tunnel and what does it contain
Borders: Flexor retinaculum on the palmar side (AKA transverse carpal ligament). Specificall connects to hamate, pisiform, scaphoid, and trapezium Carpal bones on dorsal side ``` Contains: Flexor digitorum profundus tendons Flexor digitorum superficialis tendons Flexor pollicis longus Median nerve ```
669
What is another term for the flexor retinaculum
Transverse carpal ligament
670
An incision of what structure can relieve carpal tunnel syndrome
Flexor retinaculum (AKA transverse carpal ligament)
671
What disorder is characterized by pain pain and paresthesias in the first 3 digits and thenar eminence atrophy
Carpal tunnel syndrome
672
What binds to the CAAT and TATA promoter sequences
RNA polymerase 2
673
What disorder is characterized by neurological symptoms, anemia, and occurs in impoverished families
Lead poisoning
674
What enzymes are defective in lead poisoning
ALA dehydratase and Ferrochelatase Hence why you get anemia
675
What clears foreign particles in the respiratory bronchioles and alveolar ducts
Alveolar macrophages
676
What term is used to describe diseases that result from fine dust particles going down into the respiratory bronchioles and alveoli
Pneumoconioses
677
What portion of the bronchiole passes lower than the terminal bronchiole where cilia and mucus end
Respiratory bronchiole Here alveolar macrophages take over the job of clearing foreign debris
678
Which neurotransmitters are affected by Clostridium tetani
Glycine | Gamma aminobutyric acid (GABA)
679
Which neurotransmitter is affected by Costridium botulinum
Acetylcholine
680
A parallel serpentine cord appearance on microscopy is suggestive of what
Cord factor + Mycobacteria tuberculosis strains Only tb strains with cord factor are virulent
681
Cord factor in virulent strains of Mycobacteria tuberculosis cause what to occur
Inhibit neutrophils/macrophages Damage mtc Release TNF
682
What is the term used to describe the probability of making a type 2 error
Beta
683
How do you calculate power
Power = 1 - beta Rearranged this is: Beta + Power = 1 Thus, as beta decreases (your chance of making a type 2 error), your power goes up and vice versa
684
Which disorder causes the formation of oxalate kidney stones
Crohns dz
685
In Crohns, calcium in the lumen binds to ___ instead of ___ causing formation of kidney stones
Lipids Oxalate Terminal ileum doesnt reabsorb bile acids - -> Lipids aren't absorbed (fat malabsorbtion) - -> Calcium in the lumen binds to these lipids instead of oxalate - -> Oxalate without calcium is absorbed by the gut. Typically not absorbed if Ca is bound - -> Kidney stones
686
What enzymes are the main enzymes for the Oxidative and Nonoxidative pathways of the HMP shunt/Pentose phosphate pathway
Oxidative - Glucose 6 Phosphate Dehydrogenase Nonoxidative - Transketolase
687
What is one of the main products of the HMP shunt
2 NADPH
688
What is the most common cause of acute hypocalcemia
Injury to PTH during Thyroid surgery Pt will present with signs of hypocalcemia like muscle spasms and Chvosteks sign and Trousseaus sign
689
In a pt with muscle cramps, seizures, qt prolongation, and perioral paresthesias among other things, what might you suspect
Hypocalcemia Other 2 big signs are Chvostek and Trousseaus sign
690
What must schizoaffective disorders be carefully distinguished from
Mood disorders with psychotic features Ex. Major depressive disorder with psychotic features In schizoaffective, psychosis is the driver that is always present and mood is the passenger that jumps in and out but is not always present In MDD with psychotic features, MDD is the driver that is always present and psychosis is the passenger that jumps in and out but is not always present
691
What structure separates the Anterior 2/3 of the tongue from the posterior 1/3
Terminal sulcus and foramen cecum
692
What is the innervation for the tongue? (Sensory, Taste, and Motor)
From anterior 2/3 to posterior Sensory: CN V3, 9, 10 Taste: CN 7, 9, 10 Motor: CN 12 for everything except palatoglossus which is CN 10 CN 10 acts at the back of the tongue in all 3 components.
693
What is another term for the delta agent
Hepatitis D virus
694
What does the Hepatitis D virus REQUIRE in order to cause infxn
HBsAg
695
What is seen in each stage of transplant rejection
Hyperacute - Thrombosis with cessation of blood flow due to PREFORMED Ab against donor Ag Acute - Dense lymphocytic infiltrate. Mostly T cells Chronic - Fibrosis with few inflammatory cells seen
696
What binds to potassium channels in beta pancreatic cells causing insulin release
ATP
697
What stimulates insulin release from beta pancreatic cells
Glucose! Glucose enters beta pancreatic cell via Glut 2. Undergoes glycolysis and TCA cycle. ATP from those cycles acts on K channels closing them. This leads to depolarization and Ca entry. This causes Insulin release
698
What nerve can be stimulated to improve obstructive sleep apnea
Hypoglossal Shifts tongue forward increasing the AP diameter of the oropharynx
699
How do you calculate the attack rate
who got dz / # exposed 27 people of the 100 people who ate potato salad at the picnic got diarrhea so the attack rate for the potato salad was 27% Careful. They may include more people at the picnic, but it's only the people EXPOSED that we care about!
700
Marfan disorder results from a defect in what
Fibrillin 1 Glycoprotein that acts as a scaffold for elastin
701
What type of non pharmacolicagal tx for insomnia involves going to the bedroom/bed only when sleepy and not performing other wakeful tasks in bed
Stimulus control therapy
702
What hormone is responsible for negative feedback in the thyroid hypothalamus pituitary axis
T3 (Triiodothyronine)
703
What does T4 (Thyroxine) convert to
T3 - Active thyroid hormone | Reverse T3 - INACTIVE thyroid hormone
704
What disorder is characterized by a long face, large jaw, large ears, and large testes
Fragile X
705
What is the mnemonic for Fragile X
Xtra large testes, jaw, and ears
706
MHC 1 and 2 pair with what CD4 cells, are found on what cell types, and are endogenous or exogenous
MHC 1 - CD8. All nucleated cells. Endogenous stimuli MHC 2 - CD4. Antigen presenting cells. Exogenous stimuli
707
What disorder presents with small crusted red papules that are intensely pruritic usually on the hands, wrists, and finger webs and may even appear on the palms and soles
Scabies
708
Which disorder is characterized by a barrel shaped chest
Emphysema
709
What are the PFT's in a pt with Emphysema
TLC Increses FVC Decreases FEV1/FVC Decreases RV Inecreases
710
What is the main difference seen on PFT in a pt with COPD vs Restrictive Lung Dz
COPD - Decreased FEV1/FVC | Restrictive - Increased FEV 1/FVC
711
What type of bias typicall occurs in a case control study where individuals are matched with other similar individuals to create a comparison study
Confounding bias Matching is done to compare certain variables which is pretty much intentionally finding confounding variables
712
How is antisocial personality disorder diagnosed
Must be 18 | Must have history of conduct disorder before age 15
713
What do Nocardia and Mycobacteria contain in their cell wall making them acid fast
Mycolic acid
714
What are the components of the acid fast stain and what does each do
Carbolfuschin - Turns everything red and binds to mycolic acid Alchol/Acid - Decolarizes all the red except that bound to mycolic acid Methylene blue - Turns everything else blue
715
What is another term for the Acid fast stain
Carbol fuschin stain or Ziehl-Neelsen stain
716
What is described as an atrioventricular conduction pathway that bypasses the AV node
Wolff Parkinson White Syndrome
717
What is the triad of EKG findings seen in Wolff Parkinson White Syndrome
Shortened PR interval, Delta wave, Widened QRS
718
What stages of Meiosis are primary oocytes and secondary oocytes stuck in
Primary oocytes (46 sister chromatids) are stuck in Prophase 1 until just before ovulation Secondary oocytes (23 sister chromatids) are stuck in Metaphase 2 until fertilized by a sperm (23 single chromosomes) which induces the completion of meosis 2 in eggs to 23 single chromosomes
719
What disorder presents with pain each month, amenorrhea, and a mass anterior to the rectum palpated on exam
Imperforate hymen Accumulation of blood causes pain and a mass
720
What disorder results from incomplete degeneration of the central fibrous tissue band connecting the walls of the vagina
Imperforate hymen
721
NK cells are of what origin
Lymphoid
722
Which cells are targeted to die by NK cells (remember: NK cells cause APOPTOSIS via perforin and granzymes)
Those with reduced MHC 1 expression Typically virally infected cells and tumor cells (Thus will see in cancers)
723
Pusatile release of GnRH causes what to occur
Release of LH and FSH Note that it must be PULSATILE
724
What is pulsatile administration of GnRH commonly used for
Infertility
725
What condition is characterized by euvolemic hyponatremia
SIADH
726
How does SIADH cause euvolemic hyponatremia
RAAS stops so more Na is lost and with it some water. --> hyponatremia and euvolemia Also BUN is increased to try and restore water also Think about it like this: The body is so focused on restoring the volume back to normal by excreting sodium that it solves the water problem, but you lose too much sodium
727
What is the mnemonic to remember HbF and HbA components
alpha always, gamma goes ``` HbF = 2 alpha 2 gamma HbA = 2 alpha 2 beta ```
728
When does beta thalassemia present
Early in postnatal life This is when gamma globin stops being produced and is replaced by the defective beta globin which will lead to symptoms
729
What is the main virulence factor behind meningococcemia and meningococcal meningitis
Lipooligosaccharide Polysaccharide capsule is also a virulence factor, but does not lead to SIRS or sepsis like LOS does . It pretty much just prevents phagocytosis
730
Blood levels of what virulence factor correlate with morbidity and mortality rates in pts with meningococcemia and meningococcal meningitis
Lipooligosaccharide
731
What are the 3 ways down syndrome may result
Nondisjunction Translocation Mosaicism (as a result of nondisjunction)
732
In an African American female with Hilar adenopathy, what might you suspect
Sarcoidosis
733
What cell type leads to granuloma formation and what does it produce to do so
TH1 cells release IL 2 - Acts on TH1 cells in an autocrine fashion to stimulate proliferation IFN gamma - Activates macrophages promoting granuloma formation
734
What are two things that can greatly increase risk for gallstones
Total parenteral nutrition - No intestinal stimulation and release of CCK --> stasis --> gallstones Resection of the ileum: Reduced bile acid reabsorption which is necessary to maintain cholesterol/bile acid ratio
735
Which muscle is paralyzed in a pt who is characterized by having winging of the scapula when a pt pushes against a wall and an inability to abduct the arms above the horizontal
Serratus Anterior
736
What nerve innervates the serratus anterior and when can it be injured
Long thoracic nerve Axillary lymph node dissections
737
What effect do arteriovenous shunts have on preload and afterload
Preload - Increased Afterload - Decreased Think of afterload as the pressure which the LV must pump against AV shunts bypass arterioles which are the main source of pressure in the circulatory system; thus, afterload decreases
738
What are the 4 main phases of the Cardiac Pressure Volume Loops
Isovolumetric contraction Systolic ejection Isovolumetric relaxation Rapid and Reduced filling
739
What 3 things can shift the cardiac pressure volume loops
Increased Preload - Shifts graph right due to more blood coming in and thus more filling Increased Afterload - Shifts graph upward and makes it more narrow due to more pressure to pump against and less blood being pumped Increased Contractility - Shifts graph left due to more blood being ejected
740
How would you describe a murmur heard in aortic regurgitation
High pitched blowing early diastolic decrescendo murmur
741
What are common causes of aortic regurg
Bicuspid aortic valve | Aortic root dilation
742
What are the time ranges to diagnose Brief psychotic disorder, Schizophreniform, and Schizophrenia
Brief Psychotic - Less than 1 month Schizophreniform - 1-6 months Schizophrenia - 6+ months
743
What is the G protein pathway
G protein activates Phospholipase C Phospholipase C converts PIP2 to DAG and IP3 DAG acts on Protein Kinase C directly IP3 acts on Protein Kinase C indirecty by releasing Ca from endoplasmic reticulum
744
What is it called when a woman displays male-pattern hair growth
Hirsuitism
745
What drugs treat hirsuitism by inhibiting LH release thus causing reduced testosterone release
Oral contraceptives
746
What do sugars, honeys, cereals, fruits, and vegetables all contain
Fructose
747
In fructose intolerance, what enzyme is defective
Aldolase B
748
What are the three enzymes of fructose metabolism
Fructokinase Aldolase B Triokinase
749
Macrophages produce what cytokine to induce differentiation of TH cells into TH1 cells
IL-12
750
TH1 cells produce what cytokine in response to their activation by IL-12 from macrophages
IFN gamma Induces macrophage phagocytosis Kind of a weird buddy system. Macrophage secretes IL-12 to differentiate into TH1 which then secretes IFN gamma to activate macrophage
751
What disorder is characterized by the appearance of clue cells,a gray discharge, and a fishy odor
Bacterial vaginosis
752
What is the pathogen and morphology for the agent that causes bacterial vaginosis
Gardnerella vaginalis Anaerobic gram variable rod
753
How should all medical interviews be started
With unbiased open ended questions Closed ended questions are not ONLY yes or no questions but anything where they only have a few choices Ex of 2 closed ended questions: Have you evere had pain like this before? No Is it a sharp pain or a dull a pain? Dull
754
Given carrier frequencies for two healthy parents, how can you determine the odds that there child will have the dz? Ex. Asian mom has 1/30 chance for carrying cystic fibrosis while Caucasian dad has 1/100 chance for carrying cystic fibrosis. What is the odd that the kid will have CF
1/30 x 1/100 = 1/3000. This is the odds that both parents are carriers 1/3000 x 1/4 = 1/12000. This is the odds that they also have a kid that is autosomal recessive Probability that mom is a carrier AND dad is a carrier AND child is autosomal recessive
755
What nerve exits the styomastoid foramen, enters the parotid gland, and then splits into 5 branches to provide motor innervation to the face
Facial N
756
A tumor of the parotid gland can often present with what finding
Facial droop Compresses Facial N. which provides motor innervation to the muscles of the face. Usually these are malignant tumors
757
What term is used to define the point at which a given test result is determined as either positive or negative
Cutoff point
758
What values are affected by altering the cutoff point
Sensitivity and Negative Predictive value (these go together) and Specificity and Positive Predictive value (these go together) If you shift left normally, FN goes down which means both Sensitivity and Negative Predictive value will go up If you shift right normally, FP goes down which means both Specificity and Positive predictive value will go up Dont always think left shift or right shift! Diseased may not always be on the right! I think..
759
What is the mineralocorticoid secreted from the adrenal cortex
Aldosterone!! Not ADH!
760
What electrolyte abnormalities are expected in a pt with Addisons Dz
Decreased Sodium Increased Potassium Increased Hydrogen Aldosterone is messed up. This usually brings in sodium, releases K, and releases H. Thus, you would expect the opposite if it is defective
761
What finding is commonly seen in Addisons disease in addition to the electrolyte abnormalities
Hyperpigmentation from Melanocyte Stimulating Hormone A byproduct of ACTH. No negative feedback from Cortisol since adrenals are messed up so ACtH and MSH are high
762
What can improve the Tet spells that occur in Tetralogy of Fallot
Squatting Increases SVR which means more flow will go through the stenotic pulmonic valve instead of shunting to the left side
763
If the Confidence interval contains the null value what does this indicate
There is no statistically significant difference between the exposure group and the control group
764
If a result is statistically significant, what would the confidence interval indicate
The confidence interval would not include the null value (The number that indicates that there is no difference between the control group and the exposure group)
765
Which mole contains no fetal parts
Complete mole
766
What are the genotypes of a complete and partial mole
Complete: 46 XX or 46XY Empty ovum so sperm duplicates genome (46YY not documented) or 2 sperm fertilize single empty egg Partial: 69XXX or 69 XXY or 69 XYY
767
If a parent keeps talking for their child without lettig them speak, what should you do
Ask them to step out politely so you can talk to the pt alone
768
What nerve may be damaged during an appendectomy
Iliohypogastric N. (L1)
769
Damage to the iliohypogastric N presents with what findings
Decreased sensation over the suprapubic region and gluteal region Decreased motor fxn in the anterolateral abdominnal wall
770
How does carbon monoxide disrupt Oxygen Hb binding
Competitively inhibits it Uworld says something about this causing increased oxygen binding at the other 3 heme sites and thus decreased unloading of O2 into tissues. FA says there is decreased O2 binding... IDK...
771
Voluntary breathing with diaphragmatic fatigue indicates what pathology
Myasthenia gravis, Obstructive lung dz, or Restrictive lung dz
772
What marker indicates immunity to Hep B virus
Anti-HBs
773
What immune markers indicate acute Hep B infxn and chronic Hep B infxn
Anti-HBc (IgM) - Acute Anti-HBc (IgG) - Chronic or Prior exposure
774
What precautions are required in order to handle a pt with C. diff
Hand washing Nonsterile gloves Gown
775
What is one of the strongest indicators of insulin resistance or Type 2 diabettes
Increased waist circumference (Visceral obesity)
776
What fixes pyrimidine dimers in Nucleotide excision repair
Endonuclease Nicks the sides allowing for removal of the defective region
777
Excessive sunlight can increase the risk of forming what
Pyrimidine-Pyrimidine dimers Sunlight is UV light!
778
What organisms cause pelvic inflammatory disease
Neisseria gonorrhea and Chlamydia trachomatis
779
What is a common complication of PID
Ectopic pregnancy
780
What test is used to identify if there is any significant difference between the means of two groups? What about 3 or more?
2 groups: T test (Tea is meant for 2) 3 or more: Analysis of Variance (ANOVA)
781
What cells can undergo glycolysis without producing ATP
Erythrocytes Extra step to convert 1,3-BPG to 2,3-BPG which bypasses the ATP producing step. 2,3-BPG is important for them to produce so... WORTH
782
What is the fxn of 2,3-BPG in RBC's
Decreases Hb's affinity for O2 thus allowing for O2 unoading in tissues
783
Patients who have undergone gastrectomy must receive adminsitration of what for the rest of their lives
Vitamin B12 Parietal cells are gone so no intrinsic factor which binds to B12 in the intestine and allows for its absorbtion. All other stomach functions can be performed by the pancreas/intestines or can be fixed with diet
784
What substance is used to calculate the GFR because it is filtered in the glomerulus but neither secreted or reabsorbed
Inulin Creatinine is a close approximation. It is moderately secreted so it's not as good as inulin
785
How does glucose course through the kidney
Filtered by glomerulus | Completely reabsorbed in the proximal tubule with some sodium
786
What nerves provide innervation above and below the pectinate line
Above - Autonomic innervation from inferior hypogastric plexus Below - Somatic innervation (painful) from the inferior rectal nerve (branch of the pudendal nerve)
787
What is the problem in Cystinuria
Kidneys and Intestines cannot reabsorb Cystine, Ornithine, Lysine, and Arginine (COLA)
788
What is the main compication of Cystinuria
Hexagonal Cystine kidney stone forming From decreased reabsorbtion
789
A man who questions whether his surgery was necessary and says that it was only to use his good insurance and says he works alone because his bosses were trying to set him up for failure has what disorder
Paranoid personality disorder
790
An individual with major distrust has what disorder
Paranoid perosnality disorder
791
What enzyme tags proteins for destruction by the proteasome enzyme
Ubiquitin ligase Attaches ubiquitin to proteins, marking them for destruction
792
What enzyme destroys viral proteins allowing them to be attached to MHC 1 and thus plays an important role in the antigen presenting portion of the immune response
Ubiquitin ligase Attaches ubiquitin to viral proteins just like it does to normal intracelular proteins, marking it for destruction by the proteasome
793
What CN's are responsbile for the pupillary light reflex and what is the exact nerve course of the reflex
CN 2 afferent CN 3 efferent Light shines in right eye Optic nerve (CN 2) sends sensory to right pretectal nucleus Sends sensory to BILATERAL Edinger Westphal Oculumotor nerve (CN 3) sends signal to ciliary ganglia Short ciliary nerves travel to pupillary sphincter muscle
794
What are the functions of CN 3
Somatic: Innervate Superior, Middle, and Inferior Rectus, Inferior oblique, and Levator palpebrae (raises eyelid) Autonomic: Parasympthetic to iris and ciliary sphincter muscles (pupillary constriction)
795
What is the inheritance pattern of G6PD
X linked recessive
796
What disorder is characterized by hemolytic anemia in response to oxidant stress (sulfa drugs, antimalarials, infxn, fava beans)
G6PD Decreased glutathione
797
What cytokines attenuate the immune response
TGF beta and IL-10 IL-10 aTENnuates the immune response
798
What are the functions of IL-10
Reduce MHC II expression Reduce TH1 cytokines Inhibit macrophages and dendritic cells
799
What disorder presents with headaches and bitemporal hemianopsia
Pituitary adenoma Additional symptoms depend on which anterior pituitary homone is elevated
800
Pituitary adenomas most commonly lead to an increase in which hormone
Prolactin (prolactinoma) May result in galactorrhea and amenorrhea in women and infertility in men due to its inhibition of GnRH in the hypothalamus. Additionally there will also be bitemporal heminaopsia and headaches b/c it is a tumor
801
What are the hormones released by the anterior pituitary
``` ACTH TSH FSH LH Prolactin GH ```
802
What blocks the myosin binding sites on actin molecules
Tropomyosin
803
What does Calcium released from the SR bind to in skeletal muscle contraction
Troponin
804
If a pt asks you to pray for them before their surgery and you don't agree with their beliefs, what should you do
Let them know you will keep them in your thoughts/prayers Overriding goal is to "do no harm". Don't impose religious beliefs on them or say you don't agree
805
What pathogens lack a cell wall
Mycoplasma | Ureaplasma
806
What drugs act on the cell wall
Penicillins Cephalosporins Carbapenems Vancomycin
807
What DNA polymerases are used in bacterial DNA replication
DNA polymerase 3 - Replicates DNA DNA polymerase 1 - Removes RNA primers via 5' to 3' exonuclease activity (only bacterial polymerase with 5' to 3' exonuclease)
808
If a pt who gets a negative test result then asks, "What are the chances that I really don't have cancer?" What value would you look at before responding
Negative predictive value
809
What term is defined as the probability of being dz free if the test result is negative
Negative predictive value
810
t(14;18) results in what disorder
Follicular lymphoma Translocation of heavy chain Ig (14) and BCL-2 (18) leads to Bcl-2 overexpression
811
What enzyme prevents Cytochrome C release during apoptosis
Bcl-2
812
What structures have openings in them to form the deep inguinal ring and superficial inguinal ring
Deep - Transversalis fascia | Superficial - External abdominal oblique
813
What population is most susceptible to gallstone formation
Fat, fertile, female, and forty
814
What substances lead to the increased gallstone risk in pregnancy and how
Estrogen - Increases cholesterol synthesis | Progesterone - Induces gallbladder HYPOmotility
815
Heroin addiction can be treated with what other opioid agonists
Methadone - Full agonist | Buprenorphine - Partial agonist
816
What characteristic of Methadone makes it good for treating heroin addiction
It is long acting
817
What is the most abundant amino acid in collagen
Glycine
818
What protein displays the peptide sequence Gly-X-Y in repetitive sequence
Collagen
819
What substance gives sputum a greenish color
Myeloperoxidase Blue-green heme containing pigment
820
What enzyme converts hydrogen peroxide to hypochlorous acid during respiratory burst within neutrophils
Myeloperoxidase
821
White or blue gray lesions on the buccal mucosa indicate what
Koplik spots which are pathognomonic for Measles!
822
What are the classic findings in Measles
Cough, coryza, conjunctivitis, and then later a maculopapular rash that goes from the head down
823
What disorder is characterized by polyuria, polydipsia, and fruity smeling urine
DKA
824
What are the acid base findings in DKA
pH is low Bicarb is low - Used up to buffer ketoacids CO2 is low - Compensatory respiratory response
825
How does HAV most typically present
Asymptomatic or Acute Self limited dz with RUQ pain and jaundice
826
Which Hep viruses do not have a carrier state
HAV and HEV
827
What disorder is characterized by fever, hypotension, flushing, and DIC
Septic shock
828
What substance causes the release of IL-1 and TNF alpha from macrophages leading to septic shock
Lipid A
829
What process occurs in the nucleolus
rRNA transcription
830
What does each of the RNA polymerases transcribe
RNA polymerase 1 - rRNA RNA polymerase 2 - mRNA RNA polymerase 3 - tRNA and 5s rRNA Easy way to remember is that this this is the order they appear in translation
831
What substance provides autoregulation to the heart by maintaining coronary blood flow
Nitric oxide Other things like Adenosine as well but that's the main one
832
What is the median in this number set? 5, 8, 10, 18, 90, 108
14! Since there is an even number of data points, the median would be halfway between 10 and 18
833
What neurotransmitter is targeted in OCD therapy
Serotonin SSRIs are FLD
834
What disorder is characterized by abdominal pain, diarrhea, and a maculopapular rash
Graft vs Host dz Follows a transplant (variable time range)
835
What is the immune response in Graft versus Host dz
Donor graft T cells are sensitized against Host MHC antigens
836
What might you suspect in a pt with dysarthria and contralateral ataxic hemiparesis
Infarct of the mid pons
837
What structure arises from the mid pons
Trigeminal N
838
What are the fast lactose fermenting bacteria
Klebsiella E. Coli Enterobacter
839
What pathogen is lactose fermenting + and indole +
E. Coli The fact that it can form Indole from tryptophphan (Indole +) distinguishes it from Enterobacter
840
What term describes different rearrangements of mRNA from the same gene to produce a large number of unique proteins
Alternative splicing
841
If a Northern blot shows different findings for the same gene, what might you suspect
Alternative splicing
842
What enzyme converts Progesterone to 11-Deoxycorticosterone in adrenal steroid synthesis
21-hydroxylase
843
What do all the adrenal steroid synthesis disorders present with
Adrenal hyperplasia All have low cortisol produxn, thus ACTH increases causing adrenal hyperplasia
844
What are the adrenal steroid synthesis disorders
17-Hydroxylase deficiency 21-Hydroxylase deficiency 11 beta-Hydroxylase deficiency
845
What is the role of ammonia on neuronal excitation in cases of hyperammonemia
Combine with NT glutamate to form glutamine before it reenters neuron Accumulation of glutamine without release into synapse as glutamate causes inhibition of excitation and symptoms
846
Where does ammonia combine with glutamate to form glutamine prior to entering the neuron
Astrocyte
847
What are the ways O2 can induce hypercapnea
1. Causes pulmonary vasodilation, increasing physiologic dead space and thus less blood going to meaningful alveoli 2. Haldane effect where presence of O2 decreases Hb's affinity for CO2 3. Reduced chemoreceptor stimulation causes decreased respiratory rate
848
What cytokine is essential for immunity against mycobacterial infxns and other granulomatous diseases
IFN gamma Defects in this path require individuals to have lifelong therapy
849
If you interview a child who you suspect is being abused what should you do next
Ask the parents to leave and interview the child alone This precedes calling CPS which would be the next step after your interview
850
Why does an individual undergoing a panic attack undergo dizziness and possibly fainting
They hyperventilate - -> CO2 goes down - -> Arteries to brain vasoconstrict - -> Reduced cerebral blood flow
851
What is the main regulator of cerebral blood flow
PCO2
852
What condition is associated with facial pain and a black eschar appearing on the face
Mucormycosis
853
What is the diagnostic test used to ID mucormycosis
Histologic examination of affected tissue (Biopsy)
854
Which pts are most at risk for Mucormycosis
DKA pts
855
What artery is affected in a pt presenting with both motor and sensory loss in the left face and left upper limb
Right MCA Left MCA would present with aphasia also
856
What disorder is characterized by hypochromic target cell shaped RBC's and elevated HbA2
Beta thalassemia Hb A2 contains 2 alpha and 2 delta chains
857
What is the biochemical problem in beta thalassemia
DNA mutation leading to defective MRNA transcription and translation
858
What is the genotype of an individual with Achondroplasia
Aa - Achondroplasia AA - Lethal! It is Autosomal Dominant so they must have at least one dominant allele, but in achondroplasia, homozygosity of the dominant allele is LETHAL. Thus all pts with achondroplasia must be Aa... otherrwise they would be dead
859
What nerve is at risk of injury during thyroidectomy
External branch of superior laryngeal N.
860
What muscle is innervated by the superior laryngel N.
Cricothyroid
861
What disorder is characterized by deformities, joint pain, and sucutaneous nodules
Rheumatoid arthritis
862
What pathologic substance is an IgM that targets the Fc component of IgG
Rheumatoid factor
863
What is the most common lab findings on an individual with kidney stones
Normocalcemia Hypercalciuria No reason to believe blood Ca is high unless they show signs
864
Amitryptiline belongs to what class of drugs
TCA's
865
One of the main adverse effects of TCA overdose is cardiotoxicity due to what mechanism
Sodium channel inhibition Slows dow myocardial depolarization and leads to arrhythmias and death
866
Which Glucose transporter is not always found at the plasma membrane and is dependent on the amount of insulin available
GLUT-4 All the others are expressed on the surface 24/7 and do not change with an increase in insulin conc
867
Which cells express GLUT-4
Adipose and Skeletal muscle
868
How does carotid massage affect baroreceptor firing
Increases stretch on carotid baroreceptors | -->INCREASES firing from baroceptor through CN 9
869
What effect does the Vagus nerve have on the heart during carotid massage to treat SVT
It prolongs the refractory period thus slowing the conduction Vagus pretty much only acts at SA and AV node in the heart I believe
870
What term describes a disorder appearing more severe or earlier subsequent generations
Anticipation
871
What disorders display anticipation
Trinucleotide Repeat disorders X-Girlfriends First Aid Helped Ace My Test Fragile X - cGg Friedreich Ataxia - cAa Huntingtons - cAg Myotonic dystrophy - cTg
872
What pathogen displays branching filaments and can mimic TB by causing pulmonary cavitary lesions
Nocardia
873
Nocardia affects what regions of the body
Lungs - Cavitary lesions like TB Skin Brain - Abscess
874
What is the formula to calculate the Number Needed to Harm
1 / Attributable risk
875
What does a Number Needed to Harm = 4 indicate
Example interpretation: | For every 4 patients treated with Drug X, 1 will experience an adverse outcome
876
What disorder is described as having calcium deposition in the setting of normocalcemia
Dystrophic calcification
877
When does dystrophic calcification occur
Following injury or necrosis
878
In a positive skew, which direction is the tail of the curve
To the right
879
How does the mean, median, and mode shift in skewed graphs
The mean shifts the most towards the tail, then the median, then the mode Hence why median is a better assessment of the middle than mean in skewed graphs
880
What inhibits the release of prolactin from the anterior pituitary
The actions of Dopamine on the D2 receptors on lactotrophs in the anterior pituitary
881
What is the ony pituitary hormone that is negatively regulated by hypothalamic secretions
Prolactin
882
Impaired Sertoli cell function would result in what problem
Infertility | No release of Inhibin B
883
What do Inhibin B and Testosterone provide negative feedback to
Inhibin B only provides negative feedback to the pituitary (FSH) Testosterone provides negative feedback to the hypothalamus (GnRH) and the pituitary (LH)
884
What is the Bohr-Haldane effect
Haldane - O2 and Bicarb come in. CO2 and H go out Bohr - CO2 and H come in. O2 and Bicarb go out
885
Where does the Bohr-Haldane effect occur
Haldane - Lungs Bohr - Tissues
886
In a DNR pt who is going into V fib, what should you do
Attend to the pt and make sure he's comfortable Don't remove all the comfort care like supplemental O2 and pain meds
887
What transplant rejection causes a dense lymphocytic infiltrate
Acute CMI: Host T cells against graft MHC
888
What is the tx for transplant rejection
The Calcineurin inhibitors Cyclosporine and Tacrolimus
889
What enzyme is responsible for the conversion of androgens to estrogens
Aromatase
890
What disorder presents with ambiguous external genitalia in the female and virilization of the mother during pregnancy
Placental Aromatase Deficiency
891
What pathogen causes myonecrosis (gas gangrene)
Clostridium perfringens
892
In addition to myonecrosis (gas gangrene), what other condition can Clostridium perfringens cause
Food poisoining. Causes a late onset watery diarrhea following ingestion of spores and release of toxin
893
What nerve palsy presents with tilting head away from affected side
Trochlear nerve palsy
894
What nerve innervates the Superior oblique muscle
Trochlear nerve
895
What disorder presents with vertical diplopia when walking downstairs or reading the newspper
Trochlear nerve palsy Both those movements require adducted and dpressed eye movement
896
What disorder is characterized by medullary thyroid cancer, pheochromocytoma, mucosal neuromas, and marfanoid habitus
Multiple Endocrine Neoplasia 2B
897
What is the mnemonic for the Multiple Endocrine Neoplasia and what is it used for
Used to distinguish the symptoms of each type MEN1 has 1 P: Pituitary, Pancreas, Parathyroid MEN2A has 2 P's: Parathyroid, Pheochromocytoma MEN2B has 3 P's: Pheochromocytoma
898
What is used to monitor the relationship between left ventricular volume and left ventricular pressure during both systole and diastole
Pressure volume loops
899
What substances maintain normal blood glucose levels during fasting
Glucagon Epinephrine Growth hormone Cortisol
900
Which substance promotes gluconeogenesis, proteoysis, and lipolysis during fasting by binding to a cytoplasmic receptor to encourage transcription
Cortisol
901
What type of transplant rejection results in mottled and cyanotic appearing tissue
Hyperacute
902
What type of hypersensitivity response are each of the transplant rejections
Hyperacute - Type 2 Acute - Type 4 Chronic - Type 2 and 4 Graft Vs. Host - Type 4
903
What disorder is characterized by weight loss, polyuria, polyphagia, and polydipsia
Diabetes mellitus type 1
904
How is diabetes diagnosed
Fasting glucose > 126 | HbA1C > 6.5%
905
If a pt requests an abortion what should you NOT do
Encourage them to consider keeping the child. Let thm make their own decision
906
If a pt asks you to perform a procedure for which you are trained but have conflicting morals about, what should you do
Refer them to someone else. You aren't required to do something you don't agree with
907
As prevalence increases, what happens to PPV and NPV
PPV increases | NPV decreases
908
What genetic abnormality results in Turners Syndrome
Paternal meiotic nondisjunction
909
What disorder presents with short stature, horseshoe kidney, streak ovaries, and a broad chest
Turners
910
What pathogen is characterized as a bacitracin resistant, beta hemolytic Gram + cocci in chains
Streptococcus agalactiae (GBS) Staphlocci are in clusters so it must be strep Strep pneumo is alpha hemolytic Strep pyogenes (GAS) is not bacitracin resistant
911
How is Group B strep prevented in neonates
Intrapartum penicillin or ampicillin
912
What term describes a drop in systolic BP by at least 10 during inspiration
Pulsus paradoxus
913
What disorder presents with JVD, distant heart sounds, and pulsus paradoxus
Cardiac tamponade This is Beck's Triad!
914
When is Beck's Triad seen
Cardiac tamponade
915
What structure is most commonly injured by an impact injury to the anterior aspect of the knee
Patella
916
Patellar fracture presents with what finding
Inability to extend the knee Quadriceps tendon inserts on it and wraps around it going to the tibial tuberosity
917
What disorder is characterized by anemia, thrombocytopenia, neutropenia, and DIC
Acute promyelocytic leukemia Marrow replaced by immature myeloid cells
918
What genetic abnormality results in Acute promyelocytic leukemia
t(15;17) 15 - Promyelocytic gene 17 - Retinoic acid receptor alpha gene Fusion gene that inhibits differentiation of myeloblasts results
919
What Hepatitis virus has a unique genome and what is it
Hep B Partially double stranded DNA
920
What is the pattern of nuclear replication in Hep B
Double stranded DNA - -> +RNA - -> Double stranded DNA progeny
921
What are the signs of apoptosis occurring
Eosinophilia and pyknosis
922
What are the substances involved in the intrinsic and extrinsic pathways of apoptosis
Intrinsic - Cytochrome C | Extrinsic - Fas, TNF, or Perforin and granzymes from CD8 cells
923
Shifting the Sensitivity Specificity graphs each outward results in what changes
Increased sensitivity and specificity Smaller area of overlap which correlates with the false positive and negative region
924
What disorder presents with redness, pain, and swelling of a joint
Synovitis (includes gout, septic arthritis, etc)
925
What is the best next step in a pt with synovitis
Synovial fluid analysis Want to rule out Septic arthritis as it is serious and could lead to loss of the joint or be fatal
926
What is the mnemonic for DKA and what is it for
DKA is Deadly Represents the signs and symptoms seen ``` Delirium Kussmaul respirations (rapid/deep breathing) Abdominal pain (N/V/D) ``` Deydration Not part of the mnemonic, but fruity breath odor as well from ketones
927
What are the compensatory changes done by the kidney in DKA
Increased bicarb reabsorbtion in the kidney Increased H secretion in the kidney Increased NH4 and H2PO4 secretion (buffers that allow additional H loss)
928
What nerve provides innervation to the masseter, medial and lateral pterygoids, and temporalis
Mandibular division of Trigeminal N.
929
Which foramen does each branch of the Trigeminal N. pass through
V1 - Superior orbital fissure V2 - Foramen rotundum V3 - Foramen ovale
930
Jaw deviating to the left indicates a problem in what muscle
Left pterygoid Results in unopposed action of the right pterygoids which pull the jaw to the opposite side
931
What disorder presents with failure to thrive, developmental delay, megaloblastic anemia, elevated orotic acid levels in the urine, and normal ammonium levels
Orotic aciduria
932
What is the tx for Orotic aciduria, the disorder of Uridine monophophate (UMP) synthase resulting in defective pyrimidine synthesis
Uridine
933
UVA exposure causes wrinkles and loss of Rete ridges via what mechanism
Decreased collagen fibril production | Increased degradation of collagen and elastin
934
What class of drugs are FLD for Schizophrenia
Antipsychotics
935
What drug is used for treatment resistant Schizophrenia and what is its side effect
Clozapine Agranulocytosis Mnemonic: Watch marrow clozely for Clozapine
936
What is the darkest region of the sarcomere
Z line
937
What are all the portions of the sarcomere
Z line - Darkest region M line - Center of H band/A band A band- H band + overlapping actin H band - Portion of the A band with only thick I band - Contains actin portions of two sarcomeres. Z line is at the center
938
What is the difference between direct and indirect Coombs Tests
Direct - Add Anti IgG to patients RBCs to see if there is any Ab bound to it. + indicates antibodies against patients OWN RBC's are present. Careful, the Ab could be from mom as in the case of emolytic dz of the newborn. Not necessarily autoimmune Indirect - Add RBC's and Anti IgG to patients antibodies to see if if the patients Ab will bind to this foreign RBC. + indicates antibodies against DONORS RBC's are present
939
What disorder in a newborn may present with severe anemia and extramedullary hematopoiesis with a positive Direct Coombs Test
Erythroblastosis fetalis (Hemolytic Dz of the Newborn) Direct Coombs means there is antibody bound to the RBC's
940
What nerve is most frequently damaged by a shoulder injury (anterior dislocation, humeral fracture)
Axillary
941
In a pt presenting with loss of arm abduction, flattened deltoid, and loss of sensation over the lateral portion of the arm, what nerve might you expect is damaged
Axillary
942
When would you use a chi square test
In a study that is not assessing means but instead looks at qualitative data
943
If we are studying genes, what piece of nuclear material are we looking at
DNA
944
What type of mutation is Sickle Cell Disease
Missense mutation
945
During fasting, when do glycogenolysis and gluconeogensis occur
Glycogenolysis - First 12-18 hours | Gluconeogenesis - After Glycogenolysis
946
What are the unidirectional enzymes of glycolysis
Hexokinase Phosphofructokinase Pyruvate kinase
947
What are the enzymes unique to Gluconeogenesis
Pyruvate carboxylase Phosphoenolpyruvate carboxykinase Fructose-1,6-bisphophatase Glucose-6-phosphatase
948
In a pt with a history of GI bleeds and Hepatitis infxn who presents with AMS and asterixis, what might you suspect
Hepatic encephalopathy
949
What is the problem in hepatic encephalopathy
Failure of the liver to metabolize ammonia
950
What should you watch for in a patient who presents with hypotension, and cardiac tamponade following an MI
Free wall reupture
951
How long after an MI does free wall rupture occur
3-14 days ish
952
What puts one at risk for bacillus anthracis infxn
Occupational exposure to animals
953
Which organism is a Gram positive rod that produces a black eschar
Bacillus anthracis
954
What substance activates vWF to bin to GpIb on platelets
Ristocetin
955
What disorders present with abnormal platelet aggregation with Ristocetin
vWF and Bernard Soulier syndrome
956
What disorder has xray findings that include cephalization of the pulmonary vessels, perihilar alveolar edema, and pleural effusions
Acute Decompensated Heart Failure
957
What is another name for diastolic heart failure
Heart failure with preserved ejection fraction
958
What can lead to Diastolic heart failure
Transthyretin deposition
959
What fungi form nonseptate hyphae that branch at right angles
Mucor, Rhizopus, and Absidia
960
Differentiate Depersonalization/Derealization, Dissociative amnesia, and Dissociative identity disorder
Depersonalization/Derealization - Feelings of detachment from ones own body or ones environment Dissociative amnesia - Inability to recall important personal information Dissociative identity disorder - Multiple personality disorder
961
What substance is used to caclulate renal blood flow
para-aminohippuric acid (PAH)
962
What is the formula to calculate renal blood flow
[(Urine PAH x Urine flow rate) / Plasma PAH) / (1 - HCT)]
963
What disorder has a quadruple screen and what does it show
Down Syndrome Low Alpha feto protein Low Estriol High Beta HCG High Inhibin Ae
964
What conditions have low Alpha feto protein? high?
Low: Down syndrome High: Neural tube defects. Abdominal wall defects (Gastroschisis and Omphalocele)
965
In a pt that was vaccinated against Hep B, what serologic profile would you expect
Anti HBs + Anti HBc IgM - Anti HBc IgG -
966
What serologic profile would you expect in a pt with active Hep B
HBsAg + Acute and chronic have this. Chronic just means it's been there for 6 months
967
What portion of a gene affects the rate at which it is transcribed bybinding special activator or repressor proteins
Enhancers and Silencers
968
Where are enhancer and silencer regions of a gene found
Anywhere, super far or close, upstream or downstream, sometimes in the gene itself
969
What are the findings in Wiskott Aldrich
WATER Wiskott Aldrich: Thrombocytopenia (platelets unusually small too) Eczema Recurrent infxn
970
What pathogens can cause intraerythrocytic ring inclusions
Plasmodium and Babesia
971
What is the mode of transmission of Babesiosis
Ixodes tick
972
Pyruvate kinase deficiency results in what
Hemolytic anemia Can't make pyruvate and thus no lactate either in RBCs. Also that step produces ATP typically so insufificient ATP
973
Why is the spleen enlarged in hemolytic anemias
Red pulp hyperplasia from so much RBC destruxn
974
What region of the brain is situated in the area postrema in the dorsal medulla near the floor of the 4th ventricle
CRTZ
975
If a healthcare proxy names a friend to be the chief decision maker but the spouse disagrees with the end of life wishes, who should the doc listen to
The friend
976
What disorder is characterized by disorientation, sweating, tremors, and palpitations
Hypoglycemia
977
What are the main causes of hypoglycemia in pts with Type 1 DM
Too much insulin intake Exercise Inadequate food intake Exercise mechanism: Exercise causes Glut-4 transporters to increase on SM just like insulin does. This is an insulin-independent form of glucose transport. --> Hypoglycemia. In normal people this will cause downregulation of insulin release, but DM 1 pts taking insulin have too much of a drop since insulin can't be downregulated
978
What should be suspected in a pt with a sudden increase in O2 saturation in the RV from the RA
VSD
979
What murmur is heard in a VSD and where
Holosystolic murmur at the left sternal border (tricuspid area)
980
What is the main problem with Tumor Lysis Syndrome
Hyperuricemia from excess purine breakdown
981
What drug can help treat Tumor Lysis Syndrome by converting Uric acid (the normal last product of purine catabolism) to Allantoin
Rasburicase
982
What are the protein groups that bind to DNA
Transcription factors Steroid receptors (cortisol, aldosterone, etc) Thyroid hormone receptors Fat soluble vitamin receptors
983
Progesterone is what type of hormone
Steroid hormone
984
What is the benefit of a live vaccine
Stronger immune response elicited
985
How does an oral vaccination differ from a regular intramuscular at 2 months
Results in better Duodenal luminal IgA production Oral stimulates B cells in peyers patches which release IgA in lumen
986
What enzyme catalyzes the conversion of Testosterone to DHT which can cause alopecia and BPH
5 alpha reductase
987
What drug is used to treat BPH and alopecia by inhibiting 5 alpha reductase
Finasteride
988
Chronic alcoholism leads to a decline in what substances
NADH - Inhibits pretty much all of glucose metabolism Vitamin B1 (Thiamine) - Further inhibits certain steps of glulcose metabolism Can lead to Wernicke's Encephalopathy
989
What disorder is characterized by confusion, ophthalmoplegia, and ataxia
Wernicke's Encephalopathy
990
What steps of glucose metabolism require thiamine and thus can cause Wernicke's Encephalopathy if glucose is given with alcohol (alcohol uses up thiamine also)
Pyruvate dehydrogenase Alpha ketoglutarate dehydrogenase Transketolase uses also but that's not glucose metabolism
991
At what time periods following an MI does 1. The myocardium stop contracting due to cessation of aerobic glycolysis and takeover of anaerobic processes 2. Is tissue irreversibly lost due to depletion of adenosine (ATP->AMP->Adenosine) in attempts to vasodilate
1. Within 60 seconds | 2. Around 30 minutes
992
What muscle is located between Pec major and Latissimus dorsi at the mid axillary line
Serratus anterior
993
What structures are pierced during placement of a chest tube in the 5th intercostal space
Serratus anterior Intercostal muscles Parietal pleurae
994
What test is used to diagnose Cryptococcal meningitis
India ink stain of CSF
995
What is the tx for Cryptococcal meningitis
Amphotericin B and Flucytosine followed by long term Fluconazole
996
What substances can induce insulin resistance via serine residue phosphoryation resulting in inhibition of the steps following Insulin binding to Tyrosine Kinase
TNF alpha Catecholamines Glucocorticoids Glucagon
997
How do TNF alpha and other substances cause insulin resistance
Phosphorylate serine residues in the Tyrosine Kinase signaling pathway that Insulin typically triggers
998
How can you increase the filtration fraction of the kidney? Hint: What is the formula
Increase GFR or Decrease Renal plasma flow FF = GFR / RPF
999
What is one way to increase filtration fraction of the kidney and decrease renal plasma flow
Constrict efferent arteriole Causes an increase in Capillary hydrostatic pressure
1000
How should you inquire about one's sexual history appropriately?
Ask if they have had sex with men, women, or both. Don't assume one or the other. Don't ask about relationships b/c we only care about sex. Don't ask if they are heterosexual, bisexual, etc and force them to identify
1001
What genes have been associated with Early and Late onset Alzheimer's
Early: Amyloid precursor protein gene, Presenilin 1, Presenilin 2 Late: Apolipoprotein E4
1002
What drug is used to treat both general tonic-clonic seizures and Absence seizures
Valproate
1003
What is the fxn of Thiazide diuretics
Block Na/Cl symporter in DCT
1004
What is an odd electrolyte finding of Thiazide diuretic use
HYPERcalcemia It blocks Na/Cl symport into DCT so you would expect more Calcium to be excreted
1005
What is it called when emotions are shifted from their aactual target to a neutral person or object
Displacement
1006
How does displacement differ from transference
Transference is similar to displacement but it is toward a physician
1007
What disorders can result from Haemophilus Influenzae Type B (These differ from the nontypable strains)
haEMOPhilus inlfuenzae type b Epiglottitis Meningitis Otitis media Pneumonia
1008
What are the types of pain experienced during appendicitis
Initially - Visceral pain in the periumbilial region due to appendix stretching Later - Somatic pain at McBurneys point due to irritation of the Parietal peritoneum
1009
How does normal saline fix Hypovolemic shock
Increases preload and hence EDV
1010
What occurs when End diastolic volume increases
The end diastolic sarcomere length is increased As is the case when saline is added IV
1011
What are some of the common causes of atrophy
``` Disuse Denervation Loss of blood supply Loss of hormonal stimulation Poor nutrition ```
1012
What occurs in isotype switching
1. CD4 cell binds B cell via CD40 ligand | 2. Cytokines are released from CD4 cell that induce isotype switching
1013
Where does Isotype switching occur
Germinal center
1014
What regions of the brain are responsible for vomiting and what triggers them
Nucleus tractus solitarius - Vestibular nerves come here to induce vomiting. Also GI nerves (back of mouth and stomach) come here Area postrema - Contains CRTZ where chemicals in the blood can induce vomiting. NOT via neurual stimulation like NTS
1015
What hormone receptors are inhibited by Odansetron to treat Nausea and vomiting that results from GI receptors stimulating the NTS
Serotonin
1016
Renal cell carcinoma is often associated with what genetic abnormality
Deletion or mutation of VHL (Von Hippel-Lindau) gene on Chromosome 3
1017
What disorders often result from Chromosome 3 problems
Renal cell Carcinoma Von Hippel-Lindau Both are 3 words and are on Chrome 3
1018
What receptor prevents death of tumor cells and what is it found on
Programmed Death Receptor on T cells binds binds to Programmed Death Ligand on Tumor cells preventing their death
1019
A 5 year old girl who talks to her deceased grandmother in an empty chair every night can be diagnosed with what
Normal behavior Kids don't fully understand death until around 6 so this is a normal grief reaction
1020
What antieemetic medication is used to target Serotonin receptors in the GI tract that act on Vagal afferents to induce the medulla to initiate vomiting
Odansetron
1021
What classes of drugs should be used for the different types of vomiting
Serotonin receptor antagonists - Visceral nausea due to GI irritations such as gastroenteritis, chemotherapy, and general anesthesia Antihistamines and Anticholinergics - Vestibular nausea Dopamine antagonists - Migraine nausea
1022
What phase of the cell menstrual cycle is characterized by dilated coiled endometrial glands and vascularized edematous stroma
Secretory phase (Days 15-28) Proliferative phase is Days 1-14
1023
What hormone is responsible for producing dilated coiled endometrial glands and vascularized edematous stroma
Progesterone
1024
What disorder is characterized by muscle weakness, pseudohypertrophy of the calves, and Gower maneuver
Duchenne Muscular dystrophy Gower maneuver is using the hands to stand up
1025
What is the abnormality that results in Duchenne muscular dystrophy
Frameshift or nonsense mutation resulting in a truncated dystrophin protein
1026
On a CXR, what structure forms the entire right border of the heart and borders the Right middle lobe
Right Atrium SVC and IVC's are much higher and much lower
1027
How does acute mitral regurg affect preload, afterload, and ejection fraction
Preload increases b/c RA increases from backward blood flow pushing it into ventricle Afterload decreases b/c blood can shoot into lower resistance atrium now Ejection fraction increases b/c preload increases and afterload decreases
1028
What disorder might you suspect in someone with a rapidly progressing fever, drooling, sore throat, and airway obstruction
Acute epiglottitis
1029
What are the Cytochrome P-450 inducers
Chronic alcoholics Steal Phen-Phen and Never Refuse Greasy Carbs ``` Chronic alcohol use St. John's wort Phenytoin Phenobarbital Nevirapine Rifampin Griseofulvin Carbamazepine ```
1030
How can you identify the esophagus on CT
It is between vertebral bodies and trachea and has no visible lumen (the trachea does have a visible lumen meaning you will see black air space in there)
1031
What immune cells are responsible for initially fighting off TB infxn
TH1 and Macrophages
1032
What is one of the main complications of elevated triglycerides
Pancreatitis Normal pancratic lipases that accidentally leak out may cause FA formation which damages the pancreas
1033
What are the best drugs for hypertriglyceridemia
Fibrates: Gemfibrozil Bezafibrate Fenofibrate
1034
What is the tx of choice for an individual diagnosed with specific phobia
Behavioral therapy
1035
What term is used to describe the situation where individuals are systematically confronted with their feared object or situation
Behavioral therapy
1036
What is the most common cause of alopecia in men and women
Androgenetic alopecia
1037
What factors predispose to androgenetic alopecia
The name gives it away... Androgens and Genetics (multiple genes actually; it is polygenic)
1038
Ibuprofen and other NSAIDS prevent formation of what substance
Prostaglandins
1039
What do loop diuretics do
Block Na-K-2Cl channels causing their loss Increase Prostaglandin release resulting in vasodilation and more renal plasma flow Hence why NSAIDS can decrease the effectiveness of Loop diuretics
1040
What disorder is characterized by symmetric proximal muscle weakness with numerous MHC 1 molecules and CD8 cells seen on biopsy
Polymyositis
1041
What organism is an important cause of UTIs and is labeled as gamma hemolytic meaning it does not cause hemolysis when grown on blood agar
Enterococcus
1042
Defects in what system can lead to Parkinsons or Alzheiemers
Ubiquitin proteasome
1043
What is the FLD for Narcolepsy
Modafanil
1044
What is the appropriate next step for close contacts of a pt with Neisseria meningitidis
Administer prophylactic Rifampin (main one), Ciprofloxacin, or Ceftriaxone
1045
What disorder is characterized by elevated ACE, hypercalcemia, bilateral hilar adenopathy, and non caseating granulomas
Sarcoidosis ACE and Ca are elevated b/c granuloma produces ACE and Vit D
1046
What disorder shows an elevated CD4/CD8 ratio in broncheolar lavage fluid
Sarcoidosis
1047
What disorder is characterized by failure to thrive, jaundice, vomiting, hepatomegaly, within days of birth along with infantile cataracts
Classic Galactosemia
1048
What is the inheritance pattern of Classic Galactosemia
AR
1049
Which disorders are characterized by a gain of function mutation in the cytoplasmic tyrosine kinase Jak2 STAT pathway causing it to be constantly active
Myeloproliferative disorders
1050
What are the myeloproliferative disorders
Polycythemia vera Essential thrombocythemia Myelofibrosis CML (kinda?) not sure about this one..
1051
What drugs are used to treat C. dif and which is best for recurrent infxns
Metronidazole Vancomycin Fidaxomicin (best for recurrent infxn)
1052
What veins fuse to form the IVC
Right and left common iliac veins
1053
Findings of reddish pink globules on PAS stain in hepatocytes indicates what dysfunction
Alpha 1 antitrypsin deficiency They are synthesized in the liver and can accumulate there causing cirrhosis or hepatocellular carcinoma in addition to its usual effx of emphysema
1054
During what phase of the cardiac cycle is blood flow halted
Systole
1055
Where in the heart does blood flow hault during systole
LV b/c it contracts so much compressing the vessels
1056
What drug inhibits viral DNA polymerase, RNA polymerase, and Reverse transciptase and does not require activation
Foscarnet
1057
How do Bipolar 1 and Bipolar 2 disorder differ
Bipolar 1 - At least 1 manic episode w or w/o hypomania or depression Bipolar 2 - Hypomanic AND depressive episode If an individual has mania (not hypomania), it is bipolar 1. If not, they have bipolar 2
1058
How do manic episodes differ from hypomanic episodes
Hypomanic are less severe, do not involve psychosis, and individuals are often more productive
1059
What cardiac anomalies are associated with Turners
Bicuspid aortic valve | Coarctation of the aorta
1060
What EKG leads correspond to what arteries in determining the source of an MI
V1-V4 - Left anterior descending V5-V6 - Borderline LAD or LCX 1 and AVL - LCX 2, 3, and AVF - RCA Think about this. It's not that hard
1061
What disorder presents with progressive neurodegeneration, hepatosplenomegaly, foam cells, and a cherry red spot on the macula
Niemann Pick Disease Foam cells are lipid laden macrophages
1062
What enzyme is deficient in Niemann PIck Disease
Sphingomyelinase No man picks (Niemann Picks) his nose with his sphinger (sphingomyelinase)
1063
What are the Lysosomal Storage Diseases
``` Fabry Gaucher Niemann Pick Tay Sachs Krabbe Metachromatic Leukodystrophy Hurler Syndrome Hunter Syndrome ```
1064
What pathogen can cause flatulence and fatty foul smelling diarrhea in campers/hikers
Giardia lamblia
1065
What is the tx for Giardia
Metronidazole
1066
What disorder is characterized by mental status changes, muscle weakness, constipation, and polyuria/polydipsia
Hypercalcemia
1067
Much like a Vit D overdose, what disorder can present with hypercalcemia
Sarcoidosis Contains 1 alpha hydroxylase which converts Vit D storage form to Calcitriol (active form)
1068
Bee stings induce what type of hypersensitivity response
Type 1
1069
How do initial and subsequent exposures to an allergen differ in Type 1 hypersensitivity
Initial - IgM starts switching to IgE | Subsequent - IgE crosslinks and has histamine release with wheal and flare
1070
What disorder presents with facial palsy, cardiac block, and arthritis
Lyme disease ``` Key Lyme Pie to the FACE: Facial palsy Arthritis Cardiac block Erythema migrans ```
1071
What drugs can be used to treat Lyme dz
Doxycycline or penicillin type antibiotics (Ceftriaxone)
1072
What drugs are used for treatment and prophylaxis for DVT and PE and stroke prophylaxis in patients with A fib
Coagulation factor Xa inhibitors ApiXaban and rivaroXaban
1073
What might you suspect in an individual with headaches, papilledema, and transient vision losses that occur during valsalva like bending over or lifting heavy objects
Pseudotumor cerebri (Idiopathic intracranial hypertension)
1074
What causes the blurred optic disc margins in pseudotumor cerebri
Compression of CN2 by elevated ICP which results in reduced axoplasmic flow
1075
What should you do if you are asked to obtain informed consent from a pt regarding a procedure that you have never done before
Ask the main resident or the attending to obtain the informed consent You must be able to describe the procedure from experience, answer pt questions, and inform them of the risks and benefits
1076
What disorder might you suspect in an individual with recurrent pulmonary and/or GI infxns and an anaphylacticc response on blood transfusion
Selective IgA deficiency
1077
What disorder is characterized by defective calcium sensing requiring higher than normal levels of Ca required to suppress PTH resulting in high serum Ca and low urine Ca
Familial hypocalciuric hypercalcemia
1078
Calcium sensing receptors in the parathyroid are what type of receptors
G protein coupled receptors
1079
What should you do if you make a mistake with a pt
Let them know you made an error, even if it wasn't a big deal and they didn't mind it
1080
Which enzyme has a lot more work to do on the lagging strand of DNA
DNA ligase
1081
When anesthesia is administered between the anterior and middle scalenes prior to arm surgeries in order to numb the brachial plexus and arm, what muscle is often transienty paralyzed
Diaphragm C3-C5 nerve roots are near there
1082
What pathogen causes pseudomembranous pharyngitis with a grayish white membrane
Corynebacterium diphtheriae
1083
How does Corynebacterium diphtheriae gain the ability to cause disease
Lysogenization in which phage gives it the ability to produce toxin
1084
What heart defect can produce a holosystolic mumur best heard at the apex
Mitral regurgitation
1085
What tye of mitral regurg can occur due to hemodynamic changes such as LV dilation in response to increased preload? How is it fixed
Functional mitral regurg Diuretics
1086
What drugs are contraindicated during pregnancy due to their ability to stain the child's teeth
Tetracyclines
1087
Where are Nicotinic receptors found
NM jxn, ganglia, and Adrenal medulla
1088
What are the symptoms of organophosphate poisoining
DUMBELS ``` Diarrhea/Diaphoresis Urination Miosis Bronchospasm/Bronchorrhea/Bradycardia Emesis Lacarimation Salivation ``` Organophosphates inhibit Acetylcholinesterase Sidenote: All the above are muscarinic actions of Ach which can be reversed by Atropine
1089
What drugs reverse the cholinergic toxidrome and how do they differ
Atropine - Competitively inhibits Muscarinic receptors so less Ach binds Pralidoxime - Restores AchEsterase thus more Ach is broken down
1090
What disorder is characterized by linear intensely pruritic vesicles that often appear on the hands and legs
Poison ivy dermatitis (Form of contact dermatitis)
1091
What type of hypersensitivity is Contact dermatitis
Type 4
1092
What drugs are infamous for causing dilated cardiomyopathy
Anthracyclines (Doxorubicin, Daunorubicin)
1093
What drug is classified as a depolarizing neuromuscular blocking drug with phase 1 showing equal but diminished contractions and phase 2 showing progressively fading muscle contractions
Succinylcholine
1094
What is the differential for vaginitis and the pathogens that cause each
Bacterial vaginosis caused by Gardnerella vaginalis Trichomoniasis caused by Trichomonas vaginalis Candida vaginitis caused by Candida albicans
1095
What are vaginal epithelial cells covered with gram variable rods called
Clue cells
1096
What should you do if a pt has metabolic acidosis and their Respiratory compensation doesn't seem to have occurred? (CO2 hasn't dropped)
Calculate Winters formula to see if their is a mixed acid base problem If CO2 is higher than it should be according to formula, there is respiratory acidosis going on also If lower than it should be, respiratory alkalosis going on also
1097
How do you calculate Winters formula and when is it used
PCO2 = 1.5(HCO3) + 8 +/- 2 Used in cases of metabolic acidosis to see if there is respiratory acidosis or alkalosis going on also suggesting a mixed acid base disorder
1098
Which ribosomes synthesize cytosolic proteins and which synthesize membrane/secreted proteins
Free ribosomes - Cytosolic proteins (Think about it, they are free so they like it here and will stay!) Bound ribosomes - Membrane/secreted proteins
1099
What prevents proper ascent of horseshoe kidney
Inferior mesenteric artery
1100
What is the diff between HbC and HbS
HbS has glutamic acid swapped with valine as opposed to lysine in HbC. Since lysine is polar like glutamic acid, it's NBD. Valine however is nonpolar and thus interacts with other nonpolar groups on other Hb molecules leading to polymerization and sickling
1101
What disorder presents with a photosensitive skin rash, confusion/forgetfulness, and diarrhea
Pellagra (Vit B3 deficiency) The 3D's of Vitamin B3 Dementia, Dermatitis, and Diarrhea
1102
What enzymes in the citric acid cycle require NAD and are thus affected in Pellagra (Vit B3 deficiency)
Isocitrate dehydrogenase Alpha ketoglutarate dehydrogenase Malate dehydrogenase
1103
Where in the LN are T cells and B cells found
T cells - Paracortex B cells - Germinal centers and follicles in the cortex
1104
Is UV the same as ionizing radiation?
No, Ionizing radiation is much stronger. UV is a form of NON IONIZING radiation
1105
How does ionizing radiation cause damage to cancer cells
Causes double stranded DNA breaks and free radical formation
1106
When determining acid base imbalances and checking for metabolic compensation, what must you always remember
Metabolic compensation occurs only after about 48 hours
1107
In a pt with calf swelling and dyspnea who has a PE, what would you suspect the O2 to be in the blood
Low! PE causes hypoxemia b/c lungs are not perfused properly and just return straight back to the heart without going through their normal region
1108
The external auditory canal is supplied by what nerve
Mandibular division of Trigeminal (V3) for everything except the posterior portion which is the Vagus Hence why rubbing against the back of the external auditory canal can cause vasovagal response in some during speculum exam
1109
In a pt who presents with decreased muscle strength and loss of reflexes who previously had diarrhea, what pathogen might ou suspect
Campylobacter jejuni It causes diarrhea and Guillan Barre
1110
In individuals with lactase deficiency, how does the bowel appear
Normal! Unless it is a secondary lactase deficiency due to Crohns or Celiacs or something
1111
What do Penicillins and Cephalosporins bind to in order to exert their antibiotic effects
The penicillin binding protein Transpeptidase Prevents transpeptidase from crosslinking peptidoglycans in the cell wall
1112
What is one of the main ways that resistance can be achieved against Cephalosporins
Changes in transpeptidase (penicilling bindin protein) structure
1113
What disorder is characterized by inappropriate laughter, sedation, conjunctival injection, dry mouth, increased appetite, and tachycardia
Marijuana intoxication
1114
What is the structure most commonly injured during hysterectomy that results in unilateral flank pain but normal urination
Ureter
1115
What disorder is characterized by a high arched palate and atrophic ovaries
Turners
1116
What organism is a gram - rod, a non lactose fermenter, and oxidase positive
Pseudomonas aueriginosa
1117
What are the oxidase + gram - organisms
Pseudomonas Campylobacter jejuni Vibrio Helicobacter Pseudomonas and the curved rods
1118
What disorder is associated with tampons or nasal packing
Toxic Shock syndrome
1119
What disorder is characaterized by a desquamating rash, fever, hypotension, and end organ failure resulting in elevated AST, elevated ALT, and other elevated serum lab values
Toxic Shock Syndrome
1120
Toxic shock syndrome toxin is a super antigen that does what
Binds TCR on T cells and MHC2 on APC's leading to widespread macrophage and T cell activation
1121
Why does eukaryotic DNA replicate much faster than prokaryotic DNA despite being much larger and complex
Multiple origins of replication
1122
What disorder is characterized by hypotension, DIC, hypoxia, and even death and occurs during pregnancy or delivery
Amniotic fluid embolus
1123
What laboratory finding will be seen in a pt with an amniotic fluid emboli
Fetal squamous cells in pulmonary artery branch
1124
What disorder is characterized by fever, flushing, dry oral mucosa, dilated pupils, and confusion
Anticholinergic toxidrome from drug overdose ``` Hot as a hare Mad as a hatter Red as a beet Dry as a bone Blind as a bat ```
1125
What drugs commonly cause Anticholinergic toxidrome during overdose
``` Antihistamines Tricyclic antidepressants (Amitriptyline) ```
1126
What is the mechanism by which fibrates (gemfibrozil, bezafibrate, fenofibrate) work
Promote LPL and reduce hepatic VLDL production
1127
Spliceosomes which remove introns are formed from what substance
small nuclear ribonucleoproteins (snRNPs)
1128
What nerve is damaged in an individual with an absent patellar reflex, hip flexion weakness, knee extension weakness, and loss of sensation over the anterior aspect of the thigh
Femoral N.
1129
What are the nerves of the lower extremity
``` Obturator (L2-L4) Femoral (L2-L4) Common peroneal (L4-S2) Tibial (L4-S3) Superior gluteal (L4-S1) Inferior gluteal (L5-S2) ```
1130
Candida albicans is often suggestive of what
HIV which is obtained through sexual intercourse
1131
In an emergency situation with a minor, what should you do
Always provide life saving therapy to minors. Challenge parents who diagree and possibly seek court order
1132
Should you administer blood to a mother and child who the father says are Jehovah's witnesses
Yes, unless they have their card on them that says they are Jehovahs witness and that they refuse blood
1133
What process results in X inactivation in normal females
Methylation of one X chromosome Results in heterochromatin and barr body formation of that chromosome which hangs out as a condensed body of heavily methylated DNA on the preiphery of the nuc
1134
What drug is effective in the treatment of oral candidiasis by swishing and swallowing it
Nystatin
1135
What is the MOA of Nystatin in treating non systemic candidal infxns
Bindsd ergosterol in fungal membrane causing pores to form with leakage of electrolytes
1136
What happens to majority of the potassium filtered by the glomerulus
It is reabsorbed in the proximal convoluted tubule and ascending limb of the loop of henle
1137
What cells are responsible for maintaining potassium levels
Principal cells and alpha intercalated cells in the DCT and collecting duct Principal - Secrete K during hyperkalemia Alpha intercalated - Reabsorb K during hypokalemia
1138
What disorder is characterized by a mosaic pattern of woven and lamellar bone
Paget disease of bone
1139
What are the stages of Paget disease of bone
Lytic - Osteoclast activity (Initially OsteoCLASTS) Mixed - Osteoclast and osteoblasts Sclerotic - Osteoblasts
1140
What drug blocks the main complication of vasospasm which often can occur following a subarachnoid hemorrhage? What class is it?
Nimodapine, a calcium channel blocker, prevents vasospasm (narrowing) and thus infarct
1141
What cells are infected by EBV in Mononucleosis
B cells
1142
What cells appear atypical in Mononucleosis
CD8+ Cytoxic T cells Proliferate in order to handle infected B cells. They appear bigger and their shape conforms to the borders of the surrounding cells
1143
What health insurance has low monthly premiums and low copays and deductibles
Health maintenance organization
1144
What is the downside of a Health Maintenance Organization insurance plan
Limited providers Requires referral They can deny payment for things that don't meet guidelines
1145
What class of anti HIV drugs all end in -navir
Protease inhibitors
1146
What class of drugs have side effects which include lipodystrophy (fat accumulating in back and abdomen; buffalo hump appearance), hyperglycemia, and drug-drug interactions from CytP450 inhibition
Protease inhibitors
1147
What disorder is characterized by cardiomegaly, macroglossia, and hypotonia
Pompe disease
1148
What are the gycogen storage diseases and which enzyme is defective in ech
Von Gierke - Glucose-6-phosphate Pompe Disease - Alpha-1,4-glucosidase Cori Disease - Alpha-1,6-glucosidase (Debranching enzyme) McArdle Disease - Myophosphorylaseh
1149
Blood transfusion puts an individual at risk for what
Hypocalcemia (paresthesias will be seen)
1150
Why can blood transfusion cause hypocalcemia
Contains lots of citrate which is a Calcium chelator
1151
How can a woman with Turners Syndrome become pregnant
In vitro fertilization with a donated ovum
1152
What are the 4 segments of the urethra
Prostatic Membranous Bulbous Penile
1153
What injuries put the anterior and posterior urethra at risk
Posterior - Pelvic fracture puts membranous urethra at risk | Anterior - Straddle injury puts bulbar and penile urethra at risk
1154
What pathogen produces pyocyanin pigment giving it a green blue color on culture
Pseudomonas aureginosa
1155
What is the agent of hot tub folliculitis
Pseudomonas aureginosa
1156
What drugs and class of drugs is used in diabetes pts by binding to PPAR gamma, a nuclear transcription regulator to increase insulin sensitivity
Thiazolidinediones Poglitazone Rosiglitazone
1157
Increased erythropoietin production is seen in what conditions
Hypoxic conditions (COPD can cause it)
1158
What are the 4 main neutrophil chemotactic factors
Leukotriene B4 C5a IL-8 5-HETE (Leukotriene precursor)
1159
What disorder is characterized by EKG findings which include absent P waves, irregularly irregular rhythm, and a narrow qrs
Atrial fibrillation
1160
What determinnes the rate of ventricular contraction in a fib
The rate at which the AV node repolarizes
1161
What infection can commonly lead to infertility in a woman
PID following cervicitis
1162
What are the pathogens that cause cervicitis and PID and what are their treatments
Neisseria gonorrhea - Cephalosporin | Chlamydia trachomatis - Azithromycin or Doxycycline
1163
Homocysteine makes what AAs
Methionine | Cysteine
1164
Homocystinuria results in a deficiency in what enzyme leading to a builldup of methionine
Cystathionine synthase
1165
What equation is used to find carrier frequency, disease frequency, and gene/allele frequency when one of the variables is known
Hardy Weinberg Equilibrium p + q = 1 p^2 + 2pq + q^2 = 1
1166
What set of disorders are haracterized by lack of social engagement, repetitive play, and insistence on a pattern
Autism spectrum disorders
1167
What drug is contraindicated during pregnancy due to its ability to cause neural tube by decreasing folate levels
Valproate
1168
Valproic acid is used to treat what
Epilepsy, bipolar disorder, and migraines
1169
What enzyme is deficient in Severe combined immunodeficiency
Adenosine deaminase
1170
What toxic substance accumulates in lymphocytes in individuals with SCID
Adenosine
1171
What increases the chances of a woman getting epithelial ovarian cancer
Ovulation
1172
What things decrease the chance of a woman getting epithelial ovarian cancer
Pregnancy, oral contraceptive use, and breastfeeding All prevent ovulation
1173
Which portion of the visual field nerve track is damaged if there is damage to the temporal lobe
Meyer's loop
1174
Damage to the Right temporal lobe that damages Meyer's loop results in what visual condition
Left upper homonymous quadrantanopia Upper left 1/4 of each eye's visual field missing
1175
What disorder is characterized by flushed skin, dry mucosa, blurred vision, and a fast heart rate and respiratory rate
Anticholinergic toxidrome
1176
What substance can cause a anticholinergic toxidrome to occur and what can treat it
Atropine - Causes it by being a muscarinic antagonist | Physostigmine - Treats it by being a acetylcholinesterase inhibitor
1177
What term is used to describe the tendency of 2 alleles from different loci occuring together more or less frequently than would be expected based on chance
Linkage disequilibrium
1178
How should older patients be addressed
By their last name unless otherwise indicated
1179
What disorder is characterized by bleeding gums, corkscrew hairs, and perifollicular hemorrhages
Scurvy
1180
Where in the cell does Vitamin C exert its effect
RER It is a cofactor in the hydroxylation of proline and lysine residues which occurs in the RER
1181
What are the 4 steps of Leukocyte extravasation and there associtaed cytokine things
Margination and rolling - E selectin on endothelium binds Sialyl lewis Tight binding - ICAM (Intercellular cell adhesion molecules) on endothelium binds CD18 integrins LFA1 and Mac1 Diapedesis - PECAM1 (Platelet endothelial CAM) Margination - Travels through interstitium
1182
How do GFR and serum Creatinine levels correlate
As GFR decreases, serum creatinine increases. This is not linear however!! Graph has a curved L shape with significant changes occuring once GFR drops below a certain level
1183
What are the 4 tips to keep in mind when ID'ing spinal cord level based on cross sxn
1. FC and FG are both only found above T7 2. Gray matter decreases as you go up 3. Cervical and Lumbar have fat ventral horn 4. Thoracic and upper lumbar have lateral horn
1184
Which two pathogens cause virulence by upregualating cylic AMP (that is the normal fxn of adenylate cyclase)
Bacillus anthracis - Edema factor | Bordatella pertussis - Pertussis toxin
1185
What pathogen is associated with hoofed animals like sheeps wool
Bacillus anthracis
1186
What fundoscopic findings are seen on a pt with glaucoma
Increased cupping
1187
What drug is used to treat glaucoma
Latanoprost - A prostaglandin that increases aqueous humor outflow
1188
What are the 4 findings in TOF
Pulmonic stenosis Right V hypertrophy Overriding aorta VSD
1189
What is the main indicator for prognosis in TOF
Degree of pulmonic stenosis
1190
What is the bioavailability of a drug that is administered IV
1
1191
How do you calculate the maintenance dose needed to administer for a particular drug
(Clearance x Plasma conc at steady state x dosage interval if not continuous) / Bioavailability Dosage interval would be like if the question asked how much you would give every 6 hours
1192
What marker in Hep B indicates current infxn
HBsAg
1193
What marker for Hep B indicates high Hep B transmissibility
HBeAg
1194
What is the normal alveolar to arterial PO2 gradient
5-15mmHg
1195
What would you suspect to be the cause of hypoxemia in a pt with low alveolar O2 and low arterial O2 but a normal alveolar to arterial O2 gradient
Hypoventilation
1196
What disorder is depicted by a infant with flat facies, small ears, and a protruding tongue
Down Syndrome
1197
What is the most common cause of Down Syndrome
Nondisjunction
1198
What histologic change to the adrenal cortex occurs in response to ACTH
Hyperplasia! not Hypertrophy
1199
What are the layers of the adrenal cortex and what is produced at each layer
GFR makes Salt, Sugar, and Sex Glomerulosa - Aldosterone Fasciculata - Cortisol Reticularis - Androgens
1200
What tumor often affects CN 7, 8, and 5
Acoustic Schwannoma
1201
Where are acoustic schwannomas most commonly found
Cerebellopontine angle
1202
What pathogen can cause Ecthyma gangrenosum in immunocompromised individuals which has necrotic cutaneous lesions
Pseudomonas aeruiginosa
1203
What value is unaffected by the formation of methemoglobinemia when nitrites are administered
Partial pressure of O2 This is calculated based on the amount of dissolved O2 in the blood so it stays the same
1204
Serotonin is a derivative of what molecule
Tryptophan Tryptophan leads to the production of Niacin and Serotonin
1205
What disorder is characterized by neuromuscular activation like clonus, AMS, and autonomic activation (vomiting, hyperthermia, tachycardia, etc.)
Serotonin syndrome
1206
What drug is used to treat serotonin syndrome
Cyproheptadine Michael Scott "silly signs prohibited!"
1207
What is it called when a person has an immune reaction to a drug
Anaphylaxis (Type 1 hypersensitivity)
1208
What substances do you expect to be increased in the blood in a pt with anaphylaxis
Tryptase Mast cell degranulation is what causes Anaphylaxis and Tryptase and Histamine are the main things released
1209
What causes the release of mast cell granules
Aggregation of IgE
1210
What are the retroperitoneal organs
SAD PUCKER ``` Suprarenal glands (Adrenals) Aorta and IVC Duodenum (except 1st part) ``` ``` Pancreas (head and body) Ureters and bladder Colon (ascending and descending) Kidneys Esophagus Rectum (mid-distal) ```
1211
If someone asks you whether another person (who really is your patient) is your patient or not, what should you say
I cannot confirm or deny that the individual is my patient Don't say yes, but don't lie and say no either
1212
What is the main stimulator of respiration in healthy individuals
PCO2
1213
In pts with COPD, what is the main region that regulates respiratory drive
Peripheral chemoreceptors (Carotid and aortic chemoreceptors) These chemoreceptors respond to PO2 unlike the central chemoreceptors and is important in pts with COPD that have a chronically high CO2 and thus don't respond well to that, and only respond to changes in O2
1214
What substance activates pyruvate carboxylase (the enzyme responsible for converting pyruvate to oxaloacetate in the first step of gluconeogenesis)
Acetyl CoA
1215
What organism forms black colonies on cysteine-tellurite agar
Corynebacterium diphtheriae
1216
What immune cells contain a bilobed nucleus
Eosinophils
1217
What substance do eosinophils produce that has activity against helminths and can cause bronchial damage in asthma pts
Major basic protei
1218
What substance is increased in response to Ace inhibitor use
Bradykinin Angiotensin converting enzyme typically breaks down Bradykinin
1219
What is an adverse result of bradykinin accumulation in pts on ace inhibitors
Angioedema (swelling of kips, eyelids, tongue etc.) Bradykinin is a vasodilator
1220
With the use of inhaled anesthetics, blood flow increases to what region of the body
Brain Causes decrease in vascular resistance and thus an undesirable increase in blood flow
1221
What substances are released from virally infected cells
Interferon alpha and beta
1222
What effect do IFN alpha and beta have on virally infected cells
Halt protein synthesis
1223
What cells display both CD4 and CD8 markers
Immature cortical T lymphocytes
1224
What fungus is capable of causing sepsis via entrance with a venous catheter
Candida albicans (Candidemia)
1225
What can cause hyperosmotic volume contraction with an increase in osmolarity and a decrease in both intracellular and extracellular fluid volume
Diabetes insipidus
1226
What substance is filtered by the glomerulus and secreted in the proximal tubule resulting in an amount filtered < amount excreted
Para aminohippuric acid
1227
Where is Para aminohippuric acid concentration lowest in the nephron
Bowmans capsule Additional PAH is secreted by PCT and it is not reabsorbed anywhere so lowest at the point before it is secreted
1228
What nerve can be damaged by a stretch injury during childbirth
Pudendal nerve (S2-S4)
1229
In an individual presenting with fecal incontinence, urinary incontinence, and sexual dysfunction, what might you suspect to be the suspect
Pudendal nerve (S2-S4) injury Common following labor due to a stretch injury
1230
What is the strongest risk factor for suicide in a pt
A previous suicide attempt
1231
What condition results in night blindness and dry scaly skin
Vitamin A deficiency
1232
What can lead to a Vitamin A deficiency
Bile obstruction Exocrine pancreatic insufficiency Crohns etc Remember, it's a fat soluble vitamin
1233
What is the MOA of Canagliflozin
It is an SGLT2 inhibitor (Sodium glucose cotransporter 2) This occurs in the nephron typically. Inhibition leads to glucose loss hence it is a tx for DM2
1234
What labs must you obtain before and after administration of an SGL2 inhibitor
Creatinine and BUN to assess renal fxn
1235
What structure allows tumor cells to form resistance against chemotherapeutic agents
P glycoprotein It is an efflux pump to pump toxins out of the cell
1236
What substance is responsible for allowing the activation of IL 2 in T cells and their proliferation
Calcineurin Target of immunosupressants Cyclosporine and Tacrolimus
1237
What tissue constricts in response to low oxygen and dilates in response to high oxygen
Lungs They want blood to go where the O2 is so it can pick it up. This is called hypoxic vasoconstrixn
1238
The O2 disassociation curve for a single monomer of hemoglobin (single beta unit for example of the a2b2 Hemoglobin A structure) would look like what
Hyperbolic graph like Myoglobin
1239
What is a common cause of falls in elderly nursing home patients
Medication
1240
In a pt that presents with fever, lymphadenopathy, edema,and a diffuse skin rash, what might you suspect
DRESS Syndrome Drug rxn with Eosinophilia and Systemic Symptoms
1241
What is the exact cause of DRESS Syndrome and what might you expect to find in a pt with DRESS syndrome
Phenytoin and other seizure meds (mainly phenytoin) Eosinophilia would be expected (Name gives it away: Drug rxn with Eosinophilia and Systemic Symptoms)
1242
Sudden onset vertigo with nausea/vomiting and difficulty walking is most commonly due to dysfunction with what
Inner ear (vestibular dysfxn)
1243
What disorder is characterized by morning stiffness and fusion of the SI joints and a bamboo spine
Ankylosing spondylitis
1244
What are the seronegative arthropathies and what are they associated with
PAIR Psoriatic arthritis Ankylosing spondylitis IBD Reactive arthritis Associated with HLA B27, an MHC class 1 serotype Sidenote: Their name tells you that they are negative for rheumatoid factor (IgM against IgG)
1245
What drug can be used to treat glaucoma by decreasing the production of aqueous humor
Timolol
1246
Where does Timolol act on to treat glaucoma
Ciliary body epithelium Causes it to produce less aqueous humor
1247
In a child complaining of bone pain in a long bone, what might you suspect
Osteomyelitis
1248
What is the most common cause of osteomyelitis
Staph aureus infxn
1249
What hyperbilirubinemia disorder might you suspect in a newborn with seizures, lethargy, and rigidity? What are all the hyperbilirubinemia disorders
Crigler Najjar (symptoms describe kernicterus) The 3 are: Gilbert Syndrome Crigler-Najjar Dubin Johnson
1250
What is the biochemical defect in Crigler Najjar
Absent UDP glucuronosyltransferase so bilirubin cannot be conjugated --> elevated unconjugated hyperbilirubin --> kernicterus (deposition of bilirubin in brain)
1251
What disorder might you suspect in a child with cataracts
Galactosemia
1252
In mild glactosemia that causes cataracts, what enzyme is defective
Galactokinase Remember, Lactose breaks down to Glucose and Galactose. Galactose is then broken down by Galactokinase typically
1253
What disorder is characterized by joint pain, a photosensitive rash, and fever in women or African Americans typically
Systemic lupus erythematos
1254
What is a complication of Lupus
Antiphospholipid syndrome --> Recurrent pregnancy loss and venous/arterial thrombosis
1255
What pathogen is viewed with dark field microscopy
Treponema pallidum
1256
What are the FLD's for PTSD
SSRIs
1257
What condition can result in kidney stones, bone pain, depression, and constipation
Primary hyperparathyroidism "Stones, bones, groans, and psychiatric overtones". Also will see elevated calcium and low phosphate
1258
What condition results in bone resorption with cystic degeneration
Osteitis fibrosa cystica A complication of Primary hyperparathyroidism
1259
What are some of the adverse effects of nitrate use such as Isosorbide dinitrate
Hypotension, flushing, and headache (Monday Dz)
1260
In a pt with Heart failure, what are the compensatory responses the body uses that oddly end up making things worse
ADH release RAAS activation Sympathetic stimulation
1261
What causes the compensatory release of ADH, RAAS activation, and sympathetic stimulation in Heart failure patients
An initial drop in blood pressure
1262
Deletion/mutation of what structure confers resistance to HIV by preventing its binding and entrance into cells
CCR5
1263
What nerve may be damaged during thyroidectomy due to its proximity to the inferior thyroid artery
Recurrent laryngeal nerve Remember, this nerve loops under the aortic arch on the left, and under the subclavian on the right and may lead to hoarseness or paralysis if one side or both are damaged
1264
What can be used to reverse the effects of warfarin
Vitamin K and Fresh Frozen Plasma Warfarin is used to inhibit Vitamin K typically resulting in defective factors and defective coagulation
1265
For rapid reversal of warfarin what would you use
Fresh Frozen Plasma Vitamin K is the other option, but it takes time
1266
Failure to thrive, diarrhea, and recurrent infxns in a child suggests what disorder
SCID
1267
Candida antigen test is what type of reaction
Type 4 hypersensitivity
1268
Type 4 hypersensitivity reactions involve what cell types
CD4, CD8, Macrophages
1269
What substance can cause POST transcriptional mRNA silencing by degrading mRNAs thus resulting in gene supression
MicroRNAs
1270
What is the process by which ds microRNA molecules are inserted into a cell to bind to mRNA molecules causing POST transcriptional silencing
RNA interference
1271
What is the difference between malingering, factitious disorder, somatic symptom disorder, conversion disorder, and illness anxiety disorder
Consciously faking it: Malingering - Consciously faking it for external gain (avoid work) Factitious - Consciously faking or inflicting harm for internal gain (attention from medical provider) Unconsciouly faking it: Illness anxiety disorder - No symptoms but excessive anxiety about them Somatic symptom disorder - Symptoms with excessive anxiety about them Conversion disorder - Neurological symptoms (blindness) with no known neurologic cause
1272
what is the first line medication for trigeminal neuralgia
Carbamazepine Sketchy: 3 gems on top of the classic car outside Ben's diner
1273
What is the mechanism of action of carbamazepine
Increases sodium channel inactivation Sketchy: Waitress outside of Ben's diner dropping sodium channels in front of the classic car
1274
How does the Phase 0 portion of a myocardial action potential differ from that of a pacemaker action potential
Myocardial Phase 0 - Sodium influx | Pacemaker Phase 0 - Calcium influx
1275
What bacteria can grow on alkaline media
Vibrio cholera Sketchy: "BASE" cAMP
1276
What is seen in the stool of pts with vibrio cholera infxn
Mucus and sloughed epithelium (No RBCs or WBCs) Rice water stool
1277
What is the diff between PT and aPTT
PT - Monitors extrinsic pathway (Factor 7) | aPTT - Monitors intrinsic pathway (Factor 12, 11, 9, 8)
1278
A nasal hemianopia of a single eye is likely due what lesion
Internal carotid aneurysm on that side at the optic chiasm affecting the nerve path that does not decussate
1279
What is the MOA of beta blockers
Competitively inhibits adrenergic beta receptors
1280
What is the main side effect you will see in a pt when treating their elevated HR and BP with a non selective beta blocker
Bronchoconstriction

USMLE (3 decks)

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