UWORLD Missed Questions Flashcards
What organism can colonize lung cavities formed from TB forming a ball which results in hemoptysis
Asperillus fumigatus
In what abnormal structure do Aspergillomas (fungal balls) colonize?
Lung cavities formed from TB (also Emphysema and Sarcoidosis)
What syndrome is associated with nuchal translucency and a decreased maternal serum alpha fetoprotein
Down Syndrome
What chromosome abnormality is found in Down syndrome
47 XY, +21
Trisomy 21
What is the most common GI finding in Down Syndrome
Duodenal atresia
What is the mnemonic Drinking age = 21
D represents Down Syndrome
21 helps you remember that it is a trisomy of the chromosome 21
What is a Type 2 error
A false negative error
Stating that there is no effect of X on Y when in reality there is
How can you reduce the chance of a Type 2 error
Increase power of a test by increasing sample size
What disorder is associated with Mullerian duct agenesis leading to primary amenorrhea with normal secondary sexual characteristics
Mayer-Rokitansky-Kuster-Hauser Syndrome
MRKH Syndrome
What does the Mullerian duct (Paramesonephric duct) give rise to?
Fallopian tubes, uterus, upper vagina
What are the 4 types of hypersensitivity reactions? (What binds to the antigen in each)
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
Which hypersensitivity reactions involve antibody
Types 1, 2, and 3
What is the mnemonic to remember the SSRI’s?
FLashbacks PAralyze SEnior CItizens
Fluoxetine
Paroxetine
Sertraline
Citalopram
What is one of the main side effects of SSRI’s
Sexual dysfunction
What are the three enzymes in the path to begin glycogen synthesis? (Hint: Insulin first binds….)
Insulin binds to TYROSINE KINASE receptor on Liver and SM
Tyrosine kinase triggers PROTEIN PHOSPHATASE
Protein phosphatase activates GLYCOGEN SYNTHASE
What tissues synthesize glycogen
Liver and Skeletal Muscle
What does the CFTR protein require prior to releasing chloride ions from the cell
2 ATPs binding
What is the gene involved with CF
CFTR = Cystic Fibrosis Transmembrane Regulator protein
What anatomical structures are cut in an episiotomy (Cut made sometimes during birth to make delivery easier)
Vaginal and subvaginal mucossa, and the perineal body
What structure is located anterior to the anus on the pelvic floor and lies between the anus and the urogenital region
Perineal body
What endometrial condition involves uniform enlargement of the uterus with painful heavy bleeding
Adenomyosis
What two disorders can result from Bartonella henselae
Cat scratch disease and Bacillary angiomatosis
What disorder presents with scratch marks on the arm and regional lymphadenopathy
Cat scratch disease by Bartonella henselae
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
Phenotypic mixing
How come in phenotypic mixing, the subsequent progeny do not remain hybrids?
Because the genetic material is not exchanged or altered
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%
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
What disorder presents with formation of fibrous bands (Ladds bands) in the abdominal cavity and bilious emesis from intestinal obstruction
Midgut malrotation
What are the two primary functions of eosinophils
Type 1 Hypersensitivity and Parasitic defense
Through which immune mechanism do eosinophils protect against parasitic infxn
Antibody dependent cell mediated cytotoxicity (ADCC)
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)
What results with vomiting, tachypnea, and confusion/coma
Hyperammonemia from a Urea cycle disorder (Conversion of ammonia to urea)
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
Which disorder has the EKG findings atria and ventricles depolarizing completely separate of each other at a regular rhythm
3rd degree AV block
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
Which nerve is responsible for the sensory component of the corneal reflex?
Nasociliary nerve (branch of Ophthalmic V1)
Which nerve is responsible for medial adduction of the eye
Oculomotor (CN 3)
In what anatomical structure do both the nasociliary nerve and oculomotor nerve meet?
Superior orbital fissure
What is the most common cause of nipple discharge (bloody or serous)
Intraductal papilloma
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
What cell junction type is upregulated during labor
Gap junction
What are Gap junctions made of
Connexin proteins
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
What is the most common systemic vasculitis in children
HSP
What disorder presents with fever, myalgia, pharyngitis, , splenomegaly, and atypical lymphocytes
Mononucleosis
Wht agents are responsible for causing Mono
EBV and CMV
What is it called when only one parents gene isexpressed by an individual due to methylation of the other parents gene
Genomic imprinting
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
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
What anatomic structure is always affected in Hirschprung dz
Rectum
What is pyruvate converted to during cases of hypoxia and what enzyme catalyzes this process
Lactate
Lactate dehydrogenase
What is the role of ADP in Muscle contraction? ATP?
ADP helps bind myosin to actin
ATP helps release myosin from actin
What injury occurs when a child falls while holding their parents hand
Radial head subluxation
What structure is defective in a radial head subluxation
Annular ligament
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
What molecule used in the synthesis of a fatty acid that also inhibits beta oxidation of fatty acids from occuring
Malonyl coA
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
Which acid base compensation occurs immediately? and which one occurs over 3-5 days
Immediate - Respiratory compensation
Delayed - Metabolic compensation
What is calculated in a Case control study
Odd ratio
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
What is a possible complication of annular pancreas
Constricture of the duodenum
What are the 3 types of transplant rejection and when does each occur
Hyperacute - Minutes
Acute - Weeks to months
Chronic - Months to years
Which phase of transplant rejection is characterized by smooth muscle prliferation and interstitial fibrosis which result in lumenal narrowing
Chronic
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
What is one of the long term side effects of antipsychotics
Tardive dyskinesia
What is the sequence TTAGGG
Telomere
Which cranial nerve passes through the posterior triangle of the neck
Spinal accessory nerve
What muscles are affected in painful abduction of the arm above the horizontal and a drooping shoulder appearance
Trapezius
Which pathogen is responsible for causing spasmodic contractions and risus sardonicus
Clostridium tetani
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
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
What is the prolonged feeling that your gender doesn’t match your birth sex
Gender dysphoria
The finding of pancreatic and gastric tissue in Meckels diverticulum is due to what type of process
Ectopy
What tissue type is most commonly found in Meckel’s diverticulum and is associated with producing abdominal pain
Gastric mucosa (produces acid causing ulceration)
What major artery supplies the primary visual cortex (striate cortex) and can result in a contralateral homonomyous hemianopia with macular sparing if infarcted
PCA
Which disorder results from a lack of the paternal X chromosome
Turners syndrome
Which disorder presents with coarctation of the aorta, cystic hygromas in the neck, and lymphedema in the extremities
Turners
What disorder results in neurological defects, albinism, and immunodeficiency (recurrent infxns)
Chediak Higashi
Where is rRNA synthesized
Nucleolus
What two things are triglycerides broken down into
Glycerol and fatty acids
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
Which organism does Thayer Marin selective media isolate?
Neisseria
Which medium contains vancomycin, colistin, nystatin, and trimethoprim?
Thayer Marin selective media
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
What term describes the probability of seeing a difference when there is one
Power
What condition results from defective cytoskeletal proteins spectrin and ankyrin in RBCs
Hereditary spherocytosis
What structure connects the bladder to the yolk sac during development and gives rise to the urachus
Allantois
What condition involves discharge from the belly button in a newborn
Patent urachus
Which dataset (mean, median, mode, range, variange) is resistant to outliers
Mode
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
What muscle forms the pelvic floor
Levator ani
What three muscle components make up the levator ani
Iliococcygeus, pubococcygeus, and puborectalis
Which dissacharide forms fructose + glucose
Sucrose
Aldolase B is an important enzyme in the metabolism of what molecule
Fructose/Sucrose (Sucrose also since it breaks down into fructose)
Which hypersensitivity reactions utilize complement and may result in hypocomplementemia
Types 2 and 3
Which hypersensitivity reaction results in arthralgias
Type 3 (serum sickness)
Which type of lung pathology has increased elastic recoil and incresed radial traction
Interstitial lung diseases (This is a ype of Restrictive lung disease)
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
Which disorder most commonly results in Congenital Bilateral Absence of the Vas Deferens (CBAVD) and thus infertility
Cystic fibrosis
Which is the only pathogenic fungus with a polysaccharide capsule that makes it resistant to phagocytosis
Cryptococcus neoformans
Which pathogen has a capsule that is red on mucicarmine stain and cleear on india ink stain
Cryptococcus neoformans
In a patient centered approach, what is the most important thing to do when responding to a pt
Educate them
What organism destroys the myenteric plexus resulting in Achalasia in individuals from south america
Trypanosoma cruzi
Which disorder has the birds beak appearance on barium swallow
Achalasia
Which type of breast cancer has a irregularly shaped mass typicaly in the outer upper quadrants
Invasive breast carcinoma
Dimpling of the breast in cases of breast cancer signal involvement of which anatomical structure
Suspensory ligaments
Which disorder is characterized by the appearance of ragged red fibers on muscle biopsy
Mitochondrial myopathy
What two tissues are most affected by mitochondrial myopathy
CNS and Skeletal muscle b/c they use the most ATP
What 3 things shift the Oxygen hemoglobin disassociation curve to the left
Decreased Hydrogen ions
Decreased 2,3-BPG
Decreased Temperature
If a person A has a higher O2 affinity than person B, person A’s Oxygen-hemoglobin diassociation curve will be shifted
Left
What finding will be seen on immunofluorescnece of a glomerular or alveolar tissue biopsy with antibodies against the basement membrane
Linear deposits
Which interleukin promotes B cell growth and activates T cells, NK cells, and monocytes
IL 2
What feature of IL 2 gives it anti tumor capabilities
It’s activation of T cells and NK cells
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)
What two features in a study can help reduce observer and expectancy bias
Blinding and the use of placebo
Which artery is formed from the 3rd branchial arch
Carotid
What two ions contribute the most to the resting membrane potential of a cell at -70 mV
Sodium and potassium
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)
The metanephric mesenchyme gives rise to which structures in the adult
Glomerulus through distal convoluted tubule
Which embryonic structure gives rise to the ureter, pelvises, calyces, and collecting ducts
Ureteric buds
Which vaccine is conjugated to tetanus toxoid, diphtheria toxoid, or Neisseria outer membrane protein to help make it T-dependent and more immunogenic
Hib
What is the point of conjugating a vaccine with another pathogen
Make it T cell dependent
What pathogen is infamous for causing post infection glomerulonephritis
Strep pyogenes
What can be seen on renal biopsy in a patient with post sreptococcal glomerulonephritis
Immune complex deposition
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
What substance is responsible for directly signaling glycogen phosphorylase kinase to phosphorylate glycogen phosphorylase during contraction
Calcium
Which ligament attaches to the medial femoral condyle of the knee?
PCL
Which pathogen is bile soluble, optochin sensitive, and alpha hemolytic
Strep pneumo
What is the most commonly fractured bone
Clavicle
Which muscle is responsible for pulling the medial portion of the clavicle upward in a clavicle fracture
Sternocleidomastoid
What are the primary class of drugs for major depression
SSRI
What is the mechanism of SSRIs
Block serotonin reuptake in presynaptic nerve
Which disorder presents with skin tumors and hyperpigmented lesions
Neurofibromatosis Type 1 (Cutaneous neurofibromas and Cafe au lait spots)
What embryological tissue is responsible for the cutaneous neurofibromas found in Neurofibromatosis Type 1
Neural crest cells
Which mode of inheritance is often associated with heteroplasmy
Mitochondiral inheritance
What is it called when variable expression results due to the presence of both normal and abnormal mitochondrial genotypes within a single cell
Heteroplasmy
Which cytokine is responsible for inducing isotype switch
IL-4
Secondary lactase deficiency can occur following what infection
Giardiasis
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
In cardiac pacemaker cells, what substance can prolong phase 4
Adenosine
Which ions are responsible for the phase 4 rise in pacemaker membrane potential
Slowing of K efflux
Na and Ca influx
Which observational study compares 2 groups with different risk factors and then looks at disease incidence
Cohort study
Which pathogen can cause infection that leads to Waterhouse Friedrichsen Syndrome
Neisseria meningitidis
Which disorder is characterized by adrenal insufficiency, DIC, and shock
Waterhouse-Friderichsen Syndrome
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
Which dopaminergic pathway is responsible for inhibiting the release of prolactin from the anterior pituitary
Tuberoinfundibular
Which class of drugs can inhibit the dopaminergic pathways by inhibiting D2 receptors
Antipsychotics
Which cell types release the protease elastase
Macrophages and neutrophils
What disorder has the classic triad of conjunctivitis, arthralgia, and urethritis
Reactive arthritis (can’t see, can’t pee, can’t climb a tree)
What disorder is characterized as a seronegative spondyloarthritis and can thus cause sacroilitis in addition to its classic triad
Reactive arthritis
Which enzyme is responsible for transporting fatty acids from the cytoplasm to the mitochondira during fatty acid degradation
Carnitine
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
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
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
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
What is the equation to calculate the Standard error of mean
SEM = SD / sqrt(n)
PTH has what effect on the kidney
Increases Ca reabsorbtion and decreases Phosphorous reabsorbtion
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
An cavitary lesion with an air fluid level describes what
An abscess
What is the most common cause of a lung absces
Aspiration
What does being a true diverticulum mean
Contains all 3 intestinal wall layers: Mucosa, submucosa, and muscularis
What is the blind pouch that extends from the ileum and contains all three intestinal layers
Meckel’s Diverticulum
Which pharyngeal pouch contains the thymus and inferior parathyroid glands
3rd
Which organ is enlarged in myasthenia gravis
Thymus
What is usually the best preventive intervention especially in diabetics
Smoking cessation
What is gluten
A grain
What condition results in duodenal changes including villous atrophy, crypt hyperplasia, inflammation
Celiac disease
What disorder is characterized by annoying others, blaming others, getting annoyed easily, and not listening to authoritative figures
Oppositional defiant disorder
What are the two promoter regions
CAAT and TATA box
What is the region where RNA polymerase 2 binds for transcription
Promoter regions
Which disorder has hypogammaglobulinemia and low/absent T cells
Severe combined immunodeficiency (SCID)
What compound accumulates in Alkaptonuria resulting in bluish black tissues and black urine after it sits a while
Homogentisic acid
Homogentisic acid is a compound found in what pathway
Tyrosine metabolism
What cell type is has racquet shaped intracytoplasmic granules
Langerhans cells
What are dendritic cells in the skin known as
Langerhans cells
What is it called when the urethra opens on the ventral side of the penis proximal to the distal tip of the penis
Hypospadias
Failure of the urethral folds to close in a male results in what
Hypospadias
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)
How do you calculate the Number Needed to Treat (NNT)
NNT = 1 / Absolute Risk Reduction
What virus has a segmented genome
Influenza virus
Viruses with segmented genomes undergo genetic/antigenic shift by what mechanism
Reassortment
What physiologic process does cyanide poisoning target
Cytochrome C in ETC
What agents work to unbind Cyanide from Cytochrome C by inducing Methemoglobinemia (Fe3+), giving cyanide a new binding spot
Nitrites
What gastric tumor commonly metastasizes to the ovaries via lymphatics
Krukenberg tumor
What displays signet ring cells do to excessive mucin production displacing the nucleus
Krukenberg tumor
What disorder is characterized by physical symptoms causing severe distress but has no etiology and that is not being feigned
Somatic symptom disorder
How do you manage an individual with somatic symptom disorder
Have them follow up regularly with the same provider
Back pain with recent bacteremia should lead you to suspect what disorder
Vertebral osteomyelitis
What is the imaging method of choice for osteomyelitis
MRI
Which artery is involved in an inferior wall MI
Right coronary artery
What inhibits the release of prolactin from the anterior pituitary during pregnancy thus resulting in suppressed lactation
Progesterone
What is the virulence factor in strep pneumo
Polysaccharide capsule
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
What is the inheritance pattern of Phenylketonuria
Autosomal recessive
Which catabolic pathway when functioning normally produces acetoacetate (ketone bodies)
Beta oxidation of fatty acids
What enzyme deficiency within the mitochondrial matrix may result in hypoketonic hypoglycemia
Acyl CoA dehydrogenase
What disorder presents with maldevelopment of the third and fourth pharyngeal pouches
DiGeorge Syndrome
The 3rd and 4th pharyngeal pouches form what structures
3rd - Inferior parathyroid and Thymus
4th - Superior parathyroid
The correlation coefficient value can range from
-1 to +1
What disorder presents with a down and out appearance of the eye
Oculomotor nerve palsy
Between what vessels does the Oculomotor nerve emerge on the brain making it prone to Berry aneurysms
Superior Cerebellar and PCA
To prevent future asthma triggers, what medications should be used
Anti IgE antibodies (Omalizumab)
NOT antihistamines. That hels with urticaria and stuff
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
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
Tendons are composed of what
Type 1 collagen
What collagen form is present in wound repair and scarring
Type 1 collagen
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
A diverticula form the foregut leads to the development of what
Trachea and respiratory tract
An infant that presents with choking, drooling, and cyanosis during feeding should be suspected to have what condition
Tracheoesophageal fistula
What disorder is characterized by recurring intrusive thoughts and repetitive time consuming actions
OCD
Aside from the definitions themselves, what is the big difference between OCD and Obsessive Compulsive Personality Disorder
OCD - Ego dystonic
OCPD - Ego systonic
What is the mechanism by which Huntingtons CAG repeats cause decreased gene expression
Histone deacetylation
What is the purpose of histone acetylation, methylation, and phosphorylation
Gain access to DNA for replication/transcription
What disorder can result in a rash on the palms and soles from a small cell vasculitis
Neisseria meningitidis infection
What immune system component is necessary to fight off a Neisseria infxn
C5-C9 (MAC)
What disorder presents with fatigue, cold intolerance, myalgia, bradycardia, constipation, and a number of other things
Hypothyroidism
The thyroid secretes what hormone primarily
T4
May be deaminated to T3 in periphery
Foot drop and steppage gait indicate damage to which nerve
Common peroneal
At which point on the sarcomere does actin bind to structural proteins
Z line
What disorder is characterized by watery diarrhea, hypochlremia, and achlorhydria
Vipoma
AKA WDHA syndrome
What hormone is released from a vipoma
Vasoactive intestinal polypeptide (VIP)
Maternal CMV infection during pregnancy results in what eye condition in the neonate
Chorioretinitis
What disorder is characterized by autoimmune destruction of parietal cells
Pernicious anemia
Which layer of gastric tissue are parietal cells located in
Upper glandular layer
Down syndrome is often associated with progression to what disorder
Early onset Alzheimers Disease
What substance is elevated in Alzheimers patients
Amyloid Precursor Protein (Amyloid beta)
Which artery is located along the lesser curvature of the stomach and may be damaged by an ulcer
Left Gastric Artery
Which artery is located along the greater curvature of the stomach
Right and Left Gastroepiploic Arteries
What are the three phases of acid secretion in the stomach
Cephalic
Gastric
Intestinal
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
What disorder results in situs inverus, immotile cilia, and immotile flagella resulting in recurrent respiratory infections and infertility
Kartagener syndrome
What structure is defective in Kartagener syndrome
Dynein arms
What is the mechanism of pathogenicity for shigella
Mucosal invasion of M cells
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
How can performance of surgery on the wrong site be prevented
Verification by 2 medical professionals independently
What scan be used to diagnose Meckel’s Divertiiculum
Technetium pertechinate
What disorder presents with painless abdominal bleeding
Meckel’s diverticulum
What is the term for the ability of multiple mRNA codons to code for the same amino acid
Degeneracy
What genetic principle allows only the first two nucleotides of a codon to matter in the determination of a the amino acid placement
Wobble
What disorder resuts in elevated IgE, eosinophilia, and bronchiectasis in immunocompromised individuals
Allergic Bronchopulumonary Aspergillosis (ABPA)
What study type looks at population data rather than individual data
Ecological study
What disorder presents with oligohydramnios and bilateral kidney enlargement with diffuse small cysts
Autosomal Recessive Polycystic Kidney Disease
In the neonate, what may ARPKD progress to
Potters Sequence (limb deformity, flattened facies, pulmonary hypoplasia)
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
What disorder presents with cleft palate, facial abnormalities such as orbital hypertelorism, bifid uvula, and cardiac defects such as TOF
Velocardiofacial syndrome
What causes Velocardiofacial syndrome
Microdeletion at Chromosome 22q11
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
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
What is the mnemonic B3 = 3 ATP and what is it used for
Vitamin B3 (Niacin) makes NAD
What is Vitamin B3 (Niacin) synthesized from
Tryptophan
The killed inluenza vaccine stimulates antibody production that targets what structure
Hemagglutinin
What substance of the Influenza virus enables it to enter cells
Hemagglutinin
Hypocalcemia results in what findings
Tetany such as Chvostek’s sign and Trousseau’s sign from uninhibited neuron depolarization
Chvostek’s sign and Trousseaus sign indicate what abnormality
Hypocalcemia
What arteries run anterior and posterior to the ureter in the true pelvis
Anterior - Gonadal arteries
Posterior - Internal iliac
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
What disorder shows crescent formation on renal biopsy
Rapidly Progressive Glomerulonephritis
In Rapidly Progressive Glomerulonephritis, what are the crescent formations seen on biopsy composed of
Monocytes
Macrophages
Glomerular parietal cells
Fibrin
What cell structure forms the blood brain barrier
Tight junctions
What substance prevents the formation of the paramesonephric ducts in males
Mullerian inhibiting factor
In the absence of ADH, which portion of the nephron has the highest osmolarity
Portion between descending and ascending loops
Which portion of the nephron is impermeable to water
Thick ascending limb of the Loop of Henle
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
In erythrocyte precursors, where does heme synthesis occur
Cytoplasm and Mitochondria
Why are mature RBC’s unable to synthesize hemoglobin
They’ve lost their Mtc so they can’t synthesize heme
Which cells types are present in tuberculosis
Langhans giant cells
What cell type is described as an activated macrophage with multiple nuclei that form a horseshoe shape
Langhans giant cells
What surface marker is found on macrophages
CD14
What ankle ligament is most commonly injured in an inversion accident
Anterior talofibular ligament
What is the mechanism by which C diff becomes pathogenic
Overgrows in GI tract
What puts an individual at risk for a C diff infection
Anything that alters the NF causing loss of normal growth suppression
What protein transports vesicles and organelles from the nucleus outward along microtubules
Kinesin
What cell molecule helps move secretory vesicles along the axon to the nerve terminal
Kinesin
Transcription of the lac operon is induced by what two things
Catabolite activator protein (CAP)
Lactose binding to repressor
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
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)
What is administered at birth to prevent hemorrhagic disease of the newborn
Vitamin K
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
What is the inheritance pattern for Neurofibromatosis Types 1 and 2
Autosomal dominant
What disorder presents with sessile to pedunculated masses that appear all over the body
Neurofibromatosis Type 1 (neurofibromas. LOOK DISGUSTING!!)
What disorder presents with recurrent bacterial infections without pus, failure of umbilical cord to separate, and leukocytosis
Leukocyte adhesion deficiency type 1
What marker on phagocytes is defective in Leukocyte adhesion deficiency type 1 causing impaired chemotaxis
CD18
What is characterized by hyperactivity and or inattention
Attention deficit and hyperactivity disorder
In order to diagnose ADHD, aside from the symptoms, what is required
Symptoms present in at least 2 locations (school and home)
What is the most common site of carriage of Staph aureus
Anterior nares
What injury results from a lesion of the ACA
Contralateral lower limb motor and sensory loss
What artery supplies the medial portion of the frontal and parietal lobe
Anterior cerebral artery
In pancreas divisum, what duct drains a majority of the pancreas
Accessory duct
What does the ventral pancreatic bud give rise to
Portion of the head of the pancreas
Uncinate process of the pancreas
Main pancreatic duct
Heavy smoking is a risk factor for what condition that involves dilated air spaces
Emphysema
What cells are responsible for the damage that ensues in Emphysema due to their release of proteases (elastase, etc.)
Macrophages and Neutrophils
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
What disorder is similar to avoidant personality disorder except for the fact that the person PREFERS to be alone
Schizoid
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
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
Vaginal dryness and hot flashes are indicative of what
Menopause
What hormone is increased in menopause due to resistant ovaries
FSH
What disorder is characterized by low back pain that radiates down the leg
Sciatica
The sciatic nerve involves what levels
L3-S1
What nerve root is responsible for the ankle reflex
S1
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
The spleen is derived from what embryologic tissue type
Mesoderm
What abdominal organ is most commonly injured from blunt trauma
Spleen
What cell structure is responsible for steroid synthesis
Smooth ER
Which tissues are rich with Smooth ER
Liver, Adrenal cortex, Gonads
Which virus is located in 3rd world countries, passed through water, and is most concerning for pregnant individuals
Hepatitis E Virus
What is the morphology of Hepatitis E virus
Unenveloped RNA virus
Which cell types secrete IL-4 to promote class switching
Th2 cells
What is the mutation that results in a defective CFTR gene in Cystic Fibrosis
Deletion of F508
(Phe508)
(Phenylalanine at position 508)
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
What structural element connects osteocytes together in bone
Gap junctions
Which disorder is characterized by hypoplasia of the bones of mastication and the bones of hearing
Treacher Collins
Treacher Collins is a defect of neural crest tissue that affects what pharyngeal arches
1st and 2nd
Which direction does Carbon monoxide shift the HB-O2 binding curve
Left
What does a decreased p50 indicate
Increased affinity for oxygen
What disorders can result from a Robertsonian translocation
Down Syndrome - Trisomy 21
Patau Syndrome - Trisomy 13
What disorder presents with prominent epicanthal folds and increased skin at the nape of the neck
Down Syndrome
What disorder is characterized by hyperflexibility at joints, elastic skin, and a tendency to bleed
Ehler Danlos
What protein is defective in Ehler Danlos Syndrome
Collagen
Which cranial nerves are located below the pons
6-12
What disorder can result in hearing loss and buzzing in one ear
Acoustic neuroma (Schwann cell tumor)
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
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!)
Cocaine is classified as what type of drug
Stimulant
Depression, fatigue, sleepiness, and hyperphagia are characteristic of what withdrawal
Cocaine
What disorder is associated with unhygienic delivery and wound care
Neonatal Tetanus
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
What region of the brain is responsible for maintaining the circadian rhythm
Suprichiasmatic nucleus (Part of the hypothalamus)
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
What is the major component of lecithin in pulmonary surfactant
Dipalmitoyl phosphatidylcholine
Phosphatidylglycerol is another component but not as much
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
How does one increase the precision (reliability) of a test
Reduce random error
What pathogen is beta hemolytic, intracellular, and can be cultured at 4 degrees C
Listeria monocytogenes
What host immune response is necessary to fight off Listeria monocytogenes
CMI
Which disorder has autoantibodies target Ach receptors
Myasthenia Gravis
What disorder results in autoantibodies against the alveolar basement membrane and glomerular basement membrane
Goodpasture’s Syndrome
In a patient with motor weakness affecting the arm, leg, and lower face, what region might you expect to be at fault
Internal capsule
What cells seen on Pap smear are characteristic of HPV infection
Koilocytes
What enzyme is responsible for providing the glucose and ketones during times of starvation from adipocytes
Hormone sensitive lipase
Triglycerides break down into
Fatty acids and glycerol
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
What term is used to describe the obligation of respect physicians must place on patients decisions
Autonomy
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
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
What disorder is characterized by facial anomalies, limb deformities, and pulmonary hypoplasia
Potter sequence
What is the cause of Potter sequence
Kidney problems typically preventing urination
What vaccine comes in a conjugated and a nonconjugated form
PCV13 (conjugated) and PPSV23 (not conjugated)
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
What are the 3 stop codons on an mRNA strand
UAA, UAG, and UGA
What is the last codon to have an anticodon bind during translation
The codon just before the stop codon
What disorder is characterized by exertional dyspnea, bone pain, and abdominal pain
Sickle cell Disease
What is the mutation that results in sickle cell disease
Valine substituting a glutamic acid on the Beta chain
How does an MI affect a cardiac and vascuar function curve
Cardiac output decreases
Venous return stays the same
What pathogen is used to treat dystonias, achalasia, and muscle spasms
Clostridium botulinum TOXIN
Clostridium species can survive harsh conditions due to their ability to form what
Spores
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
What two vessels precede the Middle Meningeal Artery stem from
External carotid - Maxillary - Middle Meningeal Artery
What is the formula to calculate the Odds ratio
Odds ratio = ad/bc
What term is used to describe the likelihood that the outcome was associated with a particular exposure
Odds ratio
What is the morphology of parvovirus B19
Nonenveloped ssDNA virus
Parvovirus B19 causes an aplastic crisis in individuals with what condition
Sickle Cell
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
What substances are specifically is found in the kidneys of individuals with post streptococcal glomerulonephritis
IgG, IgM, and C3
Post streptococcal glomerulonephritis results in what specific glomerular disease
Nephritic syndrome
Down Syndrome predisposes individuals to what specific neoplasms
Acute lymphoblastic leukemia (most commonly)
Acute myelogenous leukemia
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
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
Transketolase is an enzyme found in what pathway
Pentose phosphate pathway
What biochemical processes occur in the cytosol
Glycolysis
Fatty acid synthesis
Pentose phosphate pathway
What is the most important muscle in increasing intrathoracic and intraabdominal pressure during the Valsalva maneuver
Rectus abdominus
What are examples of Type 4 hypersensitivity reactions
Contact dermatitis
TB skin test
Granulomatous inflammation in TB
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
Sertraline would be used to treat a pt with what condition
Depression
All SSRI’s carry may cause what potential side effect
Mania (since they are depression treatments)
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
How can one diagnose melanoma if it is suspected
ABCDE
Assymetry Border irregularity Color Diameter > 6mm Evolution
What pathogen is a common agent of cellulitis, pharyngitis, and impetigo
Strep pyogenes
What type of hypersensivity reaction is Post streptococcal glomerulonephritis
Type 3
When does hypothyroidism present in newborns
After maternal T4 wanes
Which disorder presents in a newborn with a large anterior fontanelle, umbilical hernia, lethargy, constipation, and hypotonia
Congenital hypothyroidism
What is the leading cause of cancer deaths in males and females
Cancer
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
Which enzyme decreases in activity in Lesch Nyhan syndrome, and which enzyme increases in activity
Decreases: Hypoxanthine guanine phosphoribosyltransferase (HGPRT)
Increases:Adenosine deaminase
What are the purine salvage disorders
Adenosine deaminase deficiency
Lesch-Nyhan Syndrome
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)
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
Which nerve is responsible for the sensory component of the pupillary reflex
Optic nerve
Which nerve is responsible for normal vision
Optic nerve
What is the virulence factor of Haemophilus Influenzae
Polyribosylribitol phosphate which makes up its polysaccharide capsule
What pathogen causes Epiglottitis
Haemophilus influenzae Type B
How does gout appear on polarized light microscopy
Needle shaped Negatively birefringent (yellow when parallel to slow ray)
Myeloproliferative disorders increase the risk of what condition occuring
Gout
What is it called when a subject being study changes their behavior once they find out they are being studied?
Hawthorne effect (Observer effect)
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
What immunity is utilized against Clostridium tetani
Humoral immunity with antibodies neutralizing the toxin
Which anatomic structure can be used to locate the appendix
Teniae coli which converge at the appendix
What protein is synthesized from lysyl oxidase cross linking together the monomers
Elastin
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
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
What should you be concerned about in a premature infant
Neonatal respiratory distress syndrome from surfactant not being produced yet
What is used to stimulate surfactant production in preterm babies
Steroids (Dexamethasone etc.)
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
Hypocapnia indicates that what is occurring
Hyperventilation
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
What is the purpose of certain bacteria possessing an IgA protease
Cleaves IgA allowing the bacteria to adhere to the mucosal surface
Which bacteria possess IgA protease virulence factors
SHiN
Strep pneumo
Haemophilus influenzae
Neisseria gonorrhea and Neisseria meningitidis
What is another word for precise, as in a very precise test
Reliable
Hemophilia A and B follow what inheritance pattern
X linked Recessive
Which disorders are characterized by hemarthroses (bleeding into joints)
Hemophilias
What are the two major causes of polyhdramnios due to poor fetal swallowing
GI obstruction
Anencephaly (failure of swallowing center to form)
Anti epileptics can cause what major side effect
Neural tube defects (anencephaly, spina bifida, etc.)
Where do amino acids bind to tRNA molecules
CCA-3’ end
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)
What lung pathology results in destruction of alveolar walls
Emphysema
What is the morphology of Haemophilus influenzae
Coccobacillus
What does Haemophilus require in media for growth
Factor X (hematin) Factor V (NAD+)
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
What anatomical structure can be used to distinguish between a direct and indirect hernia
Inferior epigastric vessels
What is the normal pressure in the RA
20/5 mmHg
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
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
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
What type of breathing battern is described as hyperpnea with periods of apnea between
Cheyne Stokes breathing
What condition resuts in Cheyne Stokes breathing
Congestive heart failure
What is the most common cause of unilateral hydronephrosis in the fetus
Failure of recanalization at the ureteropelvic junction
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
What are the top 4 cancers with the highest mortality in order in males and females
Males: Lung, Prostate, Colon
Females: Lung, Breast, Colon
Where does T cell postitive and negative selection occur
Positive - Cortex
Negative - Medulla
What are the submucosal alkaline secreting (bicarbonate) cells of the duodenum
Brunner’s glands
Increased gastric acid production will result in hypertrophy of what structures
Brunners glands in the duodenum
What enzyme is responsible for stimulating glycolysis and inhibiting gluconeogenesis
Fructose-2,6-bisphosphate
Where is serotonin synthesized
Raphe nucleus
What drugs are used to treat depression and anxiety
SSRIs
What is the inheritance pattern for sickle cell anemia
AR
What is the best way to determine whether two people may have a sickle cell child
Hb electrophoresis
Can ID carriers
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
What organism displays a tumbling motility
Listeria monocytogenes
How is Listeria monocytogenes most commonly transmitted
Contaminated food
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
What results in dry skin, hepatosplenomegaly, and papiledema
Chronic Vitamin A excess
What disorder is characterized by a negative nitroblue tetrazolium test of neutrophils
Chronic granulomataous Dz
What is an individual susceptible to if he has chronic granulomatous dz
Infxn with catalase + organisms
What is the most important muscle for hip flexion
Iliopsoas
Drugs which target which ion channel in phase 0 of pacemaker action potentials can result in a reduced heart rate
Funny Sodium channels
Which phase of pacemaker action potential can reduce heart rate without affecting contractility or resting
Phase 0
Emphysema results in elevation of what substance
Elastase
What virulence factor of staph aureus is bound to it’s peptidoglycan cell wall structure
Protein A
What is the fxn of the Protein A virulence factor produced by Staph aureus
Bind Fc portion of Antibodies preventing complement activation
The process of viral gene exchange via crossing over of 2 DNA molecules is referred to as
Recombination
Patent foramen ovale results from what
Incomplete fusion of primum and secundum
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
Which pathogens produce dextrans that allow them to bind to structures and thus cause endocarditis and dental caries
Strep Viridans
What condition results in an inability to adduct one eye while the other abducts. The abducting eye presents with nystagmus additionally
Internuclear ophthalmoplegia
What structure allows for coordinated horizontal eye movemement due to communication between CN 4 and CN 6
Medial longitudinal fasciculus
Where is the Medial longitudinal fasciculus located
Distal pons
What condition results in elevated PCO2 from increased mass, low PO2 from reduced lung volume, and a normal alveolar arterial gradient
Obesity hypoventiation syndrome
Which conditions can cause hypoxemia and a normal alveolar arterial pressure gradient (5-15mmHg)
Hypoventilation
High altitude
Where on the Ig molecule do neutrophils, macrophages, mast cells etc. attach
Fc portion near the carboxy terminal (near the end)
What attaches to the Fc portion of Ig molecules right next to the hinge region
Complement
What is one of the major causes of cor pulmonale
Pulmonary hypertension
What is the difference between Northern, Southern, Western, and Southwestern blots
Northern - mRNA
Southern - DNA
Western - Proteins
Southwestern - DNA binding proteins
What is it called when a single mRNA encodes multiple proteins
Polycistronic mRNA
What is a well known polycistronic mRNA strand
Lac Operon
Cleft lip results from what
Failure of intermaxillary segment fusing with the maxillary prominences
Cleft palate results from what
Failure of palatine shelves fusing
Cleft lip and spina bifida follow what inheritance pattern
Multifactorial
Atherosclerosis begins with what cell type
Endothelial cell dysfunction
What information is necessary in order to perform PCR
The nucleotide sequence of the flanking regions
Necessary for primer to bind
Where is the femoral vein located relative to the femoral artery and inguinal ligament
Medial to the femoral artery
Below the inguinal ligament
What are the first line medications for generalized anxiety disorder
SSRIs and Serotonin Norepinephrine Reuptake Inhibitors
What relative risk value indicates that there is no difference in risk between the exposure group and the unexposed group
1
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
What is the extrinsic pathway of apoptosis consist of
Fas ligand
What is a classic example of Fas induced apoptosis (an extrinsic pathway apoptosis)
Negative selection of T cells in the thymus
Which viral genome requires only host machinery for translation
Single stranded + sense RNA virus
What is the genome of Rhinovirus
+ssRNA virus
Failure of the processus vaginalis to close can result in what abnormalities
Hydrocele
Indirect inguinal hernia
What embryologic defect can result in a hydrocele and indirect inguinal hernia in infants
Persistent processus vaginalis
What individuals have increased bone density relative to other groups
African Americans (women especially)
What disorder is characterized by CGG repeats
Fragile X
In Fragile X, what biochemical process prevents FMR1 from being expressed properly and thus leading to neurological problems
DNA methylation of CGG repeats
What disorder is characterized by a failure of B cells to mature due to a mutated bruton tyrosine kinase gene
X linked agammaglobulinemia
In X linked Bruton Agammaglobulinemia, what lymph node structure will be missing
Germinal centers
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)
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
What disorder may present with amenorrhea, hypotension, bradycardia, cardiac complications, and osteoperosis
Anorexia nervosa
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
Asthma results in what type of resistance being increased
Air flow resistance
Not elastic resistance. Thus an asthma pt would breathe slower and deeper
Where do Stanford A and Stanford B aortic dissections start at
A - Sinotubular jxn
B - Left Subclavian
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)
A tzanck smear identifies multinucleated giant cells caused by what pathogen
Herpes virus
Tzanck heavens I do not have herpes
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
An anteriorly placed aorta on echo is characteristic of what disorder
Transposition of the Great vessels
What developmental mechanism results in Transposition of the great vessels
Failure of the aorticopulmonary septum to spiral
Which pathogen has reverse transcriptase and a partially double stranded DNA genome
HBV
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
What is the defect in Chronic granulomatous disease
Defective NADPH Oxidase
Thus cannot form reactive oxygen species to kill off pathogens in the phagolysosome
What disorder presents with sugary smelling urine
Maple syrup urine disease
What enzyme is defective in Maple syrup urine disease
Branched chain alpha ketoacid dehydrogenase
What substances accumulate in Maple syrup urine disease
Branched chain amino acids (Leucine, Isoleucine, Valine)
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
How does Tourette syndrome differ from Chronic tic disorder
Tourette - Both motor and vocal tics
Chronic Tic - Either motor or vocal tics
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
ADH increases urine osmolarity by reabsorbtion of water via aquaporin channels and what other channels
Urea transporters which passively pull water with them
Which region of the nephron does ADH act at to reabsorb water via aquaporin channels and urea transporters passively abosrbing water
Distal convoluted tubule
What term describes the situation where an individual who is aware of a disorder alters their memory of the exposure
Recall bias
Recall bias is associated with what type of study
Case Control
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
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
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
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
What cells secrete Mullerian Inhibitory Factor (MIF) to prevent female INTERNAL genitalia formation
Sertoli cells
What cells secrete androgens to promote male INTERNAL and EXTERNAL genitalia formation
Leydig cells
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
What is the most common complication of Varicella zoster infxn
Post herpetic neuralgia
Which portion of the brain is in charge of executive functioning such as planning, fulfilling tasks, and organizing things
Frontal lobe
How do lesions of the right and left frontal lobes differ
Right –> Disinhibited behavior
Left –> Apathy and depression
What sex chromosome disorder commonly results from somatic mosaicism
Turners Syndrome
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)
How does the structure of MHC 1 and MHC 2 differ
MHC 1 - Contains beta 2 microglobulin
MHC 2 - Contains alpha and beta chains
What is one of the most common regions of the digestive tract affected by Crohns
Terminal Ileum
Where are bile acids reabsorbed
Terminal ileum
Reduced bile reabsorbtion as in the case of some Crohns patients results in an increased risk for gallstone formation. Why?
Cholesterol/Gallstone ratio increases
What is another name for the pectinate line in the rectum
Dentate line
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
How do you calculate flow through a blood vessel
(P1 - P2) / Resistance
How do you calculate the resistance in a blood vessel
Resistance = (viscosity x length) / Radius^4
RAS is active when bound to what substance
GTP
What term describes the force that the left ventricle pumps against during systole
Afterload
How can you decrease the amount of regurgitant flow in an individual with mitral regurgitation
Decrease afterload
What binds to the stop codon on an mRNA sequence
Releasing factors
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
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
What enzyme acts as a glucose sensor to regulate insulin release in pancreatic beta cells
Glucokinase
Which enzyme converts glucose to glucose-6-phosphate in the first step of glycolysis
Glucokinase
What enzyme when mutated can result in maturity onset diabetes of the young (MODY)
Glucokinase
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
What is the mechanism behind a bicornuate uterus
Faillure of paramesonephric ducts to laterally fuse
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
Which nerve is responsible for wrist flexion, thumb flexion, 1st 2nd and 3rd digit palmar sensation
Median nerve
What class of medications should be used to treat bipolar disorder
Mood stabilizers
What mood stabilizer drugs are good for maintenance tx for bipolar disorder
Lithium and Valproate/Valproic acid
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)
In what lung pathologies do individuals function at hyperinflated states
Obstructive lung pathologies
What term describes the air remaining in the lungs after maximal exhalation
Residual volume
What term represents the amount of air the lungs can accomadate maximally
Total lung capacity
What structure arises from incomplete obliteration of the vitelline duct
Meckel’s Diverticulum
The vitelline duct connects what two structures
Yolk sac with Midgut lumen
In an individual with lower extremity pain and cramping during exercise, what might you suspect
Coarctation of the aorta resulting in claudication
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!!
What is targed by the killed influenza virus vaccine
Hemagglutinin
Why does ethanol cause hypoglycemia
Suppresses gluconeogenesis
Ethanol uses up NAD which is needed in steps of gluconeogenesis
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
What is the most likely reasoning for anovulatory cycles in teenage females with missed cycles and then heavy bleeds
Immature hypothalamic pituitary ovarian axis
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
Who might you suspect anovulatory cycles in
Females in the first few years folowing menarche
Females in the last few years before menopause
Scaphoid fractures may damage what other structure
Radial artery
Courses over the scaphoid on the dorsal side
Damage to the radial artery in a scaphoid fracture results in what pathology
Avascular necrosis
What enzymes are defective in Acute intermittent porphyria
ALA synthase - upregulated
Porphobilinogen deaminase - downregulated
These both lead to accumulation of Porphobilinogen and delta ALA
What is the goal of tx in Acute intermittent porphyria
Decrease ALA synthase enzyme activity
Prevents accumulation of porphobilinogen
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
What can be done to prevent recurrence of genital herpes simplex infection
Daily oral acyclovir, valacyclovir, or famciclovir
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
What midline abdominal protrusion is associated with Down Syndrome
Umbilical hernia
Umbilical hernias result from what abnormality
Defect in linea alba (fascia that closes umbilical ring)
What factors increase diffusion across a semipermeable membrane
Increased temperature
Increased surface area
Larger difference in concentration gradients
Increased solubility
What is another name for homeobox genes
Hox genes
What do Hox genes code for? (These are highly conserved genes containing typically 180 nucleotides)
Transcription factors
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.
What disorder presents with fever, hypotension, chest and back pain, and brown urine (hemoglobinuria)
Acute hemolytic transfusion reaction
What type of hypersensitivity is an acute hemolytic transfusion reaction
Type 2
What is lithium used for
Mood stabilization in bipolar disorder
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)
What enables bacteria to survive in boiling water
Spores
Which bacteria form spores and are found in soil
Bacillus anthracis and Clostridium genus
What disorder is characterized as a ventricular pre excitation syndrome with reentry circuits that may cause SVT
Wolf Parkinson White
What is the triad of EKG findings in WPW
Delta wave
Shortened PR interval
Widened QRS
What vein is found just inferolateral to the pubic tubercle and used commonly for coronary artery grafting
Great saphenous vein
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
What is the term to describe the number of new cases of a disease over a period of time
Incidence
Aldose reductase is used to trap glucose inside cells by forming what compound
Sorbitol
Sorbitol is broken down by sorbitol dehydrogenase into what compound
Fructose
What is the formula to calculate positive predictive value
Postive predictive value = a / (a+b)
What pathogen is characterized by having a spherule form that contains Endospores
Coccidioides immitis
In what geographical location is Coccidioides immitis found in
Southwestern US (California, Az, etc.)
Which nuclear material contains a poly A tail at its 3’ end
Mature mRNA
Prevents degradation in cytoplasm
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
What is another name for Sirolimus
Rapamycin
Makes sense since it inhibits Mammalian Target of Rapamycin (MTOR)
Which substances are broken down into propiony CoA
Branched chain AAs (Leucine, Isoleucine, Valine)
Methionine
Threonine
Odd chain FA’s
In an individual with elevated propionyl CoA, which enzyme is defective
Propionyl CoA carboxylase
Converts Propionyl CoA from ptn breakdown to Methylmalonyl CoA
What should be addressed in an individual typically in an outpatient setting but essentially if they become hospitalized
Advanced Directives
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
Which disorder is characterized by short stature with long bone shortening, midface hypoplasia, and macrocephaly
Achondroplasia
Which cells are affected in achondroplasia
Chondrocytes
Which anatomical structure produces NE
Locus Ceruleus
Where is the Locus ceruleus located
Near the lateral floor of the 4th ventricle in the posterior rostral pons
What do an elevated Acethylcholinesterase and Alpha feto protein indicate
Neural tube defect
Opening allows for spilling of these substances into the amniotic fluid
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)
What is the mechanism by which Neural Tube Defects arise
Failed fusion of neural plates or neuropores
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
What does Rhogam target
The D Rhesus antigen on Rh+ fetal RBC’s
What type of Ig is Rhogam
IgG
What term describes the difference in risk between the exposed group and the unexposed group? (20% - 7% = 3%)
Attributable risk
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
What does RT-PCR bind to and do
Binds to mRNA and converts it to cDNA
exons only since it is a mature mRNA
The ectoderm can be further subcategorized into what germ layers
Surface ectoderm
Neural tube
Neural crest
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
What heart sound is described as having a high frequency opening snap and a diastolic rumble heard best in the apex
Mitral stenosis
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
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!
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
What ion channels cause depolarization and repolarization in a NEURON action potential
Voltage gated Sodium influx causes depolarization
Voltage gated Potassium efflux causes repolarization
Why does HCV have many variable envelope antigens
It lacks 3 to 5’ exonuclease activity and is thus prone to mutation
What is Trisomy 18
Edwards Syndrome
Election age = 18
What disorder is charcterized by low set ears, hypertonia (clenched fists), rocker bottom feet, and overlapping fingers
Edwards Syndrome (Trisomy 18)
What vessel carries oxygenated blood from the mom to the babies circulation
Umbilical vein
What disorder is characterized by gingivitis, myalgias, hemorrhages, and impaired wound healing due to impaired formation of collagen
Scurvy
What is another name for Vitamin C
Ascorbic acid
What disorder is characterized by a deficiency in Ascorbic acid (Vit C)
Scurvy
What viruses contain segmented genomes
Orthomyxoviruses (Influenza virus) Rotairuses Reoviruses Bunyaviruses Arenaviruses
Segmented viral genomes are capable of performing what
Reassortment
Recurrent infxn and absence of all Ig types suggests what disorder
X linked Bruton Agammaglobulinemia
What cell markers are seen on the surface of B cells
CD 19
CD 20
Others also, but these are the main ones
How is copper removed from the human body
Mainly secreted in the bile/stool
Some is secreted (not filtered) by the kidney
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
What substance is responsible for male external genitalia development and prostrate development
Dihydrotestosterone (DHT)
What enzyme converts Testosterone to Dihydrotestosterone
5 alpha reductase
Where to intraparenchymal deep brain hemorrhages most commonly occur
Basal ganglia and Internal capsule
What vessels most often cause hemorrhaging into the basal gangia and internal capsule (deep brain hemorrhages)
Lenticulostriate arteries
Branch of MCA
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
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
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
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
What is the term used to describe a single gene causing multiple phenotypic effx
Pleitropy
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
What pathogen has thick walls and displays broad based budding
Blastomyces dermatidis (Agent of blastomycosis)
What is the mnemonic for Blastomyces
Blastomyces Buds Broadly
Fungus displays broad based budding
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
What thrombolytic agent is used for MI’s and Strokes
tPA
What substance can cause reperfusion arrhythmias
tPA
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
Procollagen peptidase deficiency which cleaves the C and N terminals of Procollagen will result in what disorder
Ehler Danlos Syndrome
Neurophysins are released with what hormones
Oxytocin and ADH
Neurophysins stabilize these hormones during axonal transport from the hypothalamus to the posterior pituitary
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
What signs should clue you in to drug misuse
Requesting a specific medication
Running out of medication
Pain out of proportion to exam
If you suspect drug misuse in an individual, what is the best next step
Accessing their prescription history
Hypothyroidism will show an increase in what laboratory value
Creatine Kinase
Commonly causes myopathy! Kind of odd but it does!
Myopathy is an odd finding in what disorder
Hypothyroidism
What are the most common opsonins
IgG
C3b
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
In dizygotic twins, what is the chorion amnion presentation
Dizygotic are always Dichorionic-Diamnionic
What is the fertilization that occurs to produce dizygotic twins
2 sperm fertilize 2 eggs
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
What is the normal pressure in the aorta/aortic root
120/80 mmHg
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
Where do most nosebleeds occur
Anterior nasal septum
Where is Kiesselbach’s plexus located and what arteries form it
Anterior nasal septum
Anterior ethmoidal A.
Sphenopalatine A.
Superior labial A.
What pathogen most commonly causes bacterial endocarditis in patients with prosthetic valves and septic arthritis in patients with prosthetic joints
Staph epidermiditis
How can you differentiate Staphylococci from Streptococci
Catalase test. Staph are Catalase +
How can you differentiate Staph aureus from other Staph
Coagulase test. Staph aureus is Coagulase +
What disorder is characterized by severe photosensitivity and hyperpigmentation in response to sunlight
Xeroderma pigmentosum
What is defective in Xeroderma pigmentosum
Endonuclease excision repair
This removes the Thymine-Thymine dimers that form from UV light
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
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
What pathogen forms germ tubes
Candida
What pathogen forms pseudohyphae
Candida
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
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
What is another term for the flexor retinaculum
Transverse carpal ligament
An incision of what structure can relieve carpal tunnel syndrome
Flexor retinaculum (AKA transverse carpal ligament)
What disorder is characterized by pain pain and paresthesias in the first 3 digits and thenar eminence atrophy
Carpal tunnel syndrome
What binds to the CAAT and TATA promoter sequences
RNA polymerase 2
What disorder is characterized by neurological symptoms, anemia, and occurs in impoverished families
Lead poisoning
What enzymes are defective in lead poisoning
ALA dehydratase and Ferrochelatase
Hence why you get anemia
What clears foreign particles in the respiratory bronchioles and alveolar ducts
Alveolar macrophages
What term is used to describe diseases that result from fine dust particles going down into the respiratory bronchioles and alveoli
Pneumoconioses
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
Which neurotransmitters are affected by Clostridium tetani
Glycine
Gamma aminobutyric acid (GABA)
Which neurotransmitter is affected by Costridium botulinum
Acetylcholine
A parallel serpentine cord appearance on microscopy is suggestive of what
Cord factor + Mycobacteria tuberculosis strains
Only tb strains with cord factor are virulent
Cord factor in virulent strains of Mycobacteria tuberculosis cause what to occur
Inhibit neutrophils/macrophages
Damage mtc
Release TNF
What is the term used to describe the probability of making a type 2 error
Beta
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
Which disorder causes the formation of oxalate kidney stones
Crohns dz
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
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
What is one of the main products of the HMP shunt
2 NADPH
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
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
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
What structure separates the Anterior 2/3 of the tongue from the posterior 1/3
Terminal sulcus and foramen cecum
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.
What is another term for the delta agent
Hepatitis D virus
What does the Hepatitis D virus REQUIRE in order to cause infxn
HBsAg
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
What binds to potassium channels in beta pancreatic cells causing insulin release
ATP
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
What nerve can be stimulated to improve obstructive sleep apnea
Hypoglossal
Shifts tongue forward increasing the AP diameter of the oropharynx
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!
Marfan disorder results from a defect in what
Fibrillin 1
Glycoprotein that acts as a scaffold for elastin
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
What hormone is responsible for negative feedback in the thyroid hypothalamus pituitary axis
T3 (Triiodothyronine)
What does T4 (Thyroxine) convert to
T3 - Active thyroid hormone
Reverse T3 - INACTIVE thyroid hormone
What disorder is characterized by a long face, large jaw, large ears, and large testes
Fragile X
What is the mnemonic for Fragile X
Xtra large testes, jaw, and ears
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
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
Which disorder is characterized by a barrel shaped chest
Emphysema
What are the PFT’s in a pt with Emphysema
TLC Increses
FVC Decreases
FEV1/FVC Decreases
RV Inecreases
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
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
How is antisocial personality disorder diagnosed
Must be 18
Must have history of conduct disorder before age 15
What do Nocardia and Mycobacteria contain in their cell wall making them acid fast
Mycolic acid
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
What is another term for the Acid fast stain
Carbol fuschin stain or Ziehl-Neelsen stain
What is described as an atrioventricular conduction pathway that bypasses the AV node
Wolff Parkinson White Syndrome
What is the triad of EKG findings seen in Wolff Parkinson White Syndrome
Shortened PR interval, Delta wave, Widened QRS
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
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
What disorder results from incomplete degeneration of the central fibrous tissue band connecting the walls of the vagina
Imperforate hymen
NK cells are of what origin
Lymphoid
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)
Pusatile release of GnRH causes what to occur
Release of LH and FSH
Note that it must be PULSATILE
What is pulsatile administration of GnRH commonly used for
Infertility
What condition is characterized by euvolemic hyponatremia
SIADH
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
What is the mnemonic to remember HbF and HbA components
alpha always, gamma goes
HbF = 2 alpha 2 gamma HbA = 2 alpha 2 beta
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
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
Blood levels of what virulence factor correlate with morbidity and mortality rates in pts with meningococcemia and meningococcal meningitis
Lipooligosaccharide
What are the 3 ways down syndrome may result
Nondisjunction
Translocation
Mosaicism (as a result of nondisjunction)
In an African American female with Hilar adenopathy, what might you suspect
Sarcoidosis
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
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
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
What nerve innervates the serratus anterior and when can it be injured
Long thoracic nerve
Axillary lymph node dissections
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
What are the 4 main phases of the Cardiac Pressure Volume Loops
Isovolumetric contraction
Systolic ejection
Isovolumetric relaxation
Rapid and Reduced filling
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
How would you describe a murmur heard in aortic regurgitation
High pitched blowing early diastolic decrescendo murmur
What are common causes of aortic regurg
Bicuspid aortic valve
Aortic root dilation
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
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
What is it called when a woman displays male-pattern hair growth
Hirsuitism
What drugs treat hirsuitism by inhibiting LH release thus causing reduced testosterone release
Oral contraceptives
What do sugars, honeys, cereals, fruits, and vegetables all contain
Fructose
In fructose intolerance, what enzyme is defective
Aldolase B
What are the three enzymes of fructose metabolism
Fructokinase
Aldolase B
Triokinase
Macrophages produce what cytokine to induce differentiation of TH cells into TH1 cells
IL-12
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
What disorder is characterized by the appearance of clue cells,a gray discharge, and a fishy odor
Bacterial vaginosis
What is the pathogen and morphology for the agent that causes bacterial vaginosis
Gardnerella vaginalis
Anaerobic gram variable rod
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
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
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
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
What term is used to define the point at which a given test result is determined as either positive or negative
Cutoff point
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..
What is the mineralocorticoid secreted from the adrenal cortex
Aldosterone!!
Not ADH!
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
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
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
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
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)
Which mole contains no fetal parts
Complete mole
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
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
What nerve may be damaged during an appendectomy
Iliohypogastric N. (L1)
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
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…
Voluntary breathing with diaphragmatic fatigue indicates what pathology
Myasthenia gravis, Obstructive lung dz, or Restrictive lung dz
What marker indicates immunity to Hep B virus
Anti-HBs
What immune markers indicate acute Hep B infxn and chronic Hep B infxn
Anti-HBc (IgM) - Acute
Anti-HBc (IgG) - Chronic or Prior exposure
What precautions are required in order to handle a pt with C. diff
Hand washing
Nonsterile gloves
Gown
What is one of the strongest indicators of insulin resistance or Type 2 diabettes
Increased waist circumference (Visceral obesity)
What fixes pyrimidine dimers in Nucleotide excision repair
Endonuclease
Nicks the sides allowing for removal of the defective region
Excessive sunlight can increase the risk of forming what
Pyrimidine-Pyrimidine dimers
Sunlight is UV light!
What organisms cause pelvic inflammatory disease
Neisseria gonorrhea and Chlamydia trachomatis
What is a common complication of PID
Ectopic pregnancy
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)
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
What is the fxn of 2,3-BPG in RBC’s
Decreases Hb’s affinity for O2 thus allowing for O2 unoading in tissues
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
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
How does glucose course through the kidney
Filtered by glomerulus
Completely reabsorbed in the proximal tubule with some sodium
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)
What is the problem in Cystinuria
Kidneys and Intestines cannot reabsorb Cystine, Ornithine, Lysine, and Arginine (COLA)
What is the main compication of Cystinuria
Hexagonal Cystine kidney stone forming
From decreased reabsorbtion
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
An individual with major distrust has what disorder
Paranoid perosnality disorder
What enzyme tags proteins for destruction by the proteasome enzyme
Ubiquitin ligase
Attaches ubiquitin to proteins, marking them for destruction
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
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
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)
What is the inheritance pattern of G6PD
X linked recessive
What disorder is characterized by hemolytic anemia in response to oxidant stress (sulfa drugs, antimalarials, infxn, fava beans)
G6PD
Decreased glutathione
What cytokines attenuate the immune response
TGF beta and IL-10
IL-10 aTENnuates the immune response
What are the functions of IL-10
Reduce MHC II expression
Reduce TH1 cytokines
Inhibit macrophages and dendritic cells
What disorder presents with headaches and bitemporal hemianopsia
Pituitary adenoma
Additional symptoms depend on which anterior pituitary homone is elevated
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
What are the hormones released by the anterior pituitary
ACTH TSH FSH LH Prolactin GH
What blocks the myosin binding sites on actin molecules
Tropomyosin
What does Calcium released from the SR bind to in skeletal muscle contraction
Troponin
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
What pathogens lack a cell wall
Mycoplasma
Ureaplasma
What drugs act on the cell wall
Penicillins
Cephalosporins
Carbapenems
Vancomycin
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)
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
What term is defined as the probability of being dz free if the test result is negative
Negative predictive value
t(14;18) results in what disorder
Follicular lymphoma
Translocation of heavy chain Ig (14) and BCL-2 (18) leads to Bcl-2 overexpression
What enzyme prevents Cytochrome C release during apoptosis
Bcl-2
What structures have openings in them to form the deep inguinal ring and superficial inguinal ring
Deep - Transversalis fascia
Superficial - External abdominal oblique
What population is most susceptible to gallstone formation
Fat, fertile, female, and forty
What substances lead to the increased gallstone risk in pregnancy and how
Estrogen - Increases cholesterol synthesis
Progesterone - Induces gallbladder HYPOmotility
Heroin addiction can be treated with what other opioid agonists
Methadone - Full agonist
Buprenorphine - Partial agonist
What characteristic of Methadone makes it good for treating heroin addiction
It is long acting
What is the most abundant amino acid in collagen
Glycine
What protein displays the peptide sequence Gly-X-Y in repetitive sequence
Collagen
What substance gives sputum a greenish color
Myeloperoxidase
Blue-green heme containing pigment
What enzyme converts hydrogen peroxide to hypochlorous acid during respiratory burst within neutrophils
Myeloperoxidase
White or blue gray lesions on the buccal mucosa indicate what
Koplik spots which are pathognomonic for Measles!
What are the classic findings in Measles
Cough, coryza, conjunctivitis, and then later a maculopapular rash that goes from the head down
What disorder is characterized by polyuria, polydipsia, and fruity smeling urine
DKA
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
How does HAV most typically present
Asymptomatic or Acute Self limited dz with RUQ pain and jaundice
Which Hep viruses do not have a carrier state
HAV and HEV
What disorder is characterized by fever, hypotension, flushing, and DIC
Septic shock
What substance causes the release of IL-1 and TNF alpha from macrophages leading to septic shock
Lipid A
What process occurs in the nucleolus
rRNA transcription
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
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
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
What neurotransmitter is targeted in OCD therapy
Serotonin
SSRIs are FLD
What disorder is characterized by abdominal pain, diarrhea, and a maculopapular rash
Graft vs Host dz
Follows a transplant (variable time range)
What is the immune response in Graft versus Host dz
Donor graft T cells are sensitized against Host MHC antigens
What might you suspect in a pt with dysarthria and contralateral ataxic hemiparesis
Infarct of the mid pons
What structure arises from the mid pons
Trigeminal N
What are the fast lactose fermenting bacteria
Klebsiella
E. Coli
Enterobacter
What pathogen is lactose fermenting + and indole +
E. Coli
The fact that it can form Indole from tryptophphan (Indole +) distinguishes it from Enterobacter
What term describes different rearrangements of mRNA from the same gene to produce a large number of unique proteins
Alternative splicing
If a Northern blot shows different findings for the same gene, what might you suspect
Alternative splicing
What enzyme converts Progesterone to 11-Deoxycorticosterone in adrenal steroid synthesis
21-hydroxylase
What do all the adrenal steroid synthesis disorders present with
Adrenal hyperplasia
All have low cortisol produxn, thus ACTH increases causing adrenal hyperplasia
What are the adrenal steroid synthesis disorders
17-Hydroxylase deficiency
21-Hydroxylase deficiency
11 beta-Hydroxylase deficiency
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
Where does ammonia combine with glutamate to form glutamine prior to entering the neuron
Astrocyte
What are the ways O2 can induce hypercapnea
- Causes pulmonary vasodilation, increasing physiologic dead space and thus less blood going to meaningful alveoli
- Haldane effect where presence of O2 decreases Hb’s affinity for CO2
- Reduced chemoreceptor stimulation causes decreased respiratory rate
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
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
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
What is the main regulator of cerebral blood flow
PCO2
What condition is associated with facial pain and a black eschar appearing on the face
Mucormycosis
What is the diagnostic test used to ID mucormycosis
Histologic examination of affected tissue (Biopsy)
Which pts are most at risk for Mucormycosis
DKA pts
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
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
What is the biochemical problem in beta thalassemia
DNA mutation leading to defective MRNA transcription and translation
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
What nerve is at risk of injury during thyroidectomy
External branch of superior laryngeal N.
What muscle is innervated by the superior laryngel N.
Cricothyroid
What disorder is characterized by deformities, joint pain, and sucutaneous nodules
Rheumatoid arthritis
What pathologic substance is an IgM that targets the Fc component of IgG
Rheumatoid factor
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
Amitryptiline belongs to what class of drugs
TCA’s
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
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
Which cells express GLUT-4
Adipose and Skeletal muscle
How does carotid massage affect baroreceptor firing
Increases stretch on carotid baroreceptors
–>INCREASES firing from baroceptor through CN 9
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
What term describes a disorder appearing more severe or earlier subsequent generations
Anticipation
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
What pathogen displays branching filaments and can mimic TB by causing pulmonary cavitary lesions
Nocardia
Nocardia affects what regions of the body
Lungs - Cavitary lesions like TB
Skin
Brain - Abscess
What is the formula to calculate the Number Needed to Harm
1 / Attributable risk
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
What disorder is described as having calcium deposition in the setting of normocalcemia
Dystrophic calcification
When does dystrophic calcification occur
Following injury or necrosis
In a positive skew, which direction is the tail of the curve
To the right
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
What inhibits the release of prolactin from the anterior pituitary
The actions of Dopamine on the D2 receptors on lactotrophs in the anterior pituitary
What is the ony pituitary hormone that is negatively regulated by hypothalamic secretions
Prolactin
Impaired Sertoli cell function would result in what problem
Infertility
No release of Inhibin B
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)
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
Where does the Bohr-Haldane effect occur
Haldane - Lungs
Bohr - Tissues
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
What transplant rejection causes a dense lymphocytic infiltrate
Acute CMI: Host T cells against graft MHC
What is the tx for transplant rejection
The Calcineurin inhibitors Cyclosporine and Tacrolimus
What enzyme is responsible for the conversion of androgens to estrogens
Aromatase
What disorder presents with ambiguous external genitalia in the female and virilization of the mother during pregnancy
Placental Aromatase Deficiency
What pathogen causes myonecrosis (gas gangrene)
Clostridium perfringens
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
What nerve palsy presents with tilting head away from affected side
Trochlear nerve palsy
What nerve innervates the Superior oblique muscle
Trochlear nerve
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
What disorder is characterized by medullary thyroid cancer, pheochromocytoma, mucosal neuromas, and marfanoid habitus
Multiple Endocrine Neoplasia 2B
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
What is used to monitor the relationship between left ventricular volume and left ventricular pressure during both systole and diastole
Pressure volume loops
What substances maintain normal blood glucose levels during fasting
Glucagon
Epinephrine
Growth hormone
Cortisol
Which substance promotes gluconeogenesis, proteoysis, and lipolysis during fasting by binding to a cytoplasmic receptor to encourage transcription
Cortisol
What type of transplant rejection results in mottled and cyanotic appearing tissue
Hyperacute
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
What disorder is characterized by weight loss, polyuria, polyphagia, and polydipsia
Diabetes mellitus type 1
How is diabetes diagnosed
Fasting glucose > 126
HbA1C > 6.5%
If a pt requests an abortion what should you NOT do
Encourage them to consider keeping the child. Let thm make their own decision
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
As prevalence increases, what happens to PPV and NPV
PPV increases
NPV decreases
What genetic abnormality results in Turners Syndrome
Paternal meiotic nondisjunction
What disorder presents with short stature, horseshoe kidney, streak ovaries, and a broad chest
Turners
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
How is Group B strep prevented in neonates
Intrapartum penicillin or ampicillin
What term describes a drop in systolic BP by at least 10 during inspiration
Pulsus paradoxus
What disorder presents with JVD, distant heart sounds, and pulsus paradoxus
Cardiac tamponade
This is Beck’s Triad!
When is Beck’s Triad seen
Cardiac tamponade
What structure is most commonly injured by an impact injury to the anterior aspect of the knee
Patella
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
What disorder is characterized by anemia, thrombocytopenia, neutropenia, and DIC
Acute promyelocytic leukemia
Marrow replaced by immature myeloid cells
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
What Hepatitis virus has a unique genome and what is it
Hep B
Partially double stranded DNA
What is the pattern of nuclear replication in Hep B
Double stranded DNA
- -> +RNA
- -> Double stranded DNA progeny
What are the signs of apoptosis occurring
Eosinophilia and pyknosis
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
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
What disorder presents with redness, pain, and swelling of a joint
Synovitis (includes gout, septic arthritis, etc)
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
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
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)
What nerve provides innervation to the masseter, medial and lateral pterygoids, and temporalis
Mandibular division of Trigeminal N.
Which foramen does each branch of the Trigeminal N. pass through
V1 - Superior orbital fissure
V2 - Foramen rotundum
V3 - Foramen ovale
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
What disorder presents with failure to thrive, developmental delay, megaloblastic anemia, elevated orotic acid levels in the urine, and normal ammonium levels
Orotic aciduria
What is the tx for Orotic aciduria, the disorder of Uridine monophophate (UMP) synthase resulting in defective pyrimidine synthesis
Uridine
UVA exposure causes wrinkles and loss of Rete ridges via what mechanism
Decreased collagen fibril production
Increased degradation of collagen and elastin
What class of drugs are FLD for Schizophrenia
Antipsychotics
What drug is used for treatment resistant Schizophrenia and what is its side effect
Clozapine
Agranulocytosis
Mnemonic: Watch marrow clozely for Clozapine
What is the darkest region of the sarcomere
Z line
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
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
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
What nerve is most frequently damaged by a shoulder injury (anterior dislocation, humeral fracture)
Axillary
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
When would you use a chi square test
In a study that is not assessing means but instead looks at qualitative data
If we are studying genes, what piece of nuclear material are we looking at
DNA
What type of mutation is Sickle Cell Disease
Missense mutation
During fasting, when do glycogenolysis and gluconeogensis occur
Glycogenolysis - First 12-18 hours
Gluconeogenesis - After Glycogenolysis
What are the unidirectional enzymes of glycolysis
Hexokinase
Phosphofructokinase
Pyruvate kinase
What are the enzymes unique to Gluconeogenesis
Pyruvate carboxylase
Phosphoenolpyruvate carboxykinase
Fructose-1,6-bisphophatase
Glucose-6-phosphatase
In a pt with a history of GI bleeds and Hepatitis infxn who presents with AMS and asterixis, what might you suspect
Hepatic encephalopathy
What is the problem in hepatic encephalopathy
Failure of the liver to metabolize ammonia
What should you watch for in a patient who presents with hypotension, and cardiac tamponade following an MI
Free wall reupture
How long after an MI does free wall rupture occur
3-14 days ish
What puts one at risk for bacillus anthracis infxn
Occupational exposure to animals
Which organism is a Gram positive rod that produces a black eschar
Bacillus anthracis
What substance activates vWF to bin to GpIb on platelets
Ristocetin
What disorders present with abnormal platelet aggregation with Ristocetin
vWF and Bernard Soulier syndrome
What disorder has xray findings that include cephalization of the pulmonary vessels, perihilar alveolar edema, and pleural effusions
Acute Decompensated Heart Failure
What is another name for diastolic heart failure
Heart failure with preserved ejection fraction
What can lead to Diastolic heart failure
Transthyretin deposition
What fungi form nonseptate hyphae that branch at right angles
Mucor, Rhizopus, and Absidia
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
What substance is used to caclulate renal blood flow
para-aminohippuric acid (PAH)
What is the formula to calculate renal blood flow
[(Urine PAH x Urine flow rate) / Plasma PAH) / (1 - HCT)]
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
What conditions have low Alpha feto protein? high?
Low: Down syndrome
High: Neural tube defects. Abdominal wall defects (Gastroschisis and Omphalocele)
In a pt that was vaccinated against Hep B, what serologic profile would you expect
Anti HBs +
Anti HBc IgM -
Anti HBc IgG -
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
What portion of a gene affects the rate at which it is transcribed bybinding special activator or repressor proteins
Enhancers and Silencers
Where are enhancer and silencer regions of a gene found
Anywhere, super far or close, upstream or downstream, sometimes in the gene itself
What are the findings in Wiskott Aldrich
WATER
Wiskott Aldrich:
Thrombocytopenia (platelets unusually small too)
Eczema
Recurrent infxn
What pathogens can cause intraerythrocytic ring inclusions
Plasmodium and Babesia
What is the mode of transmission of Babesiosis
Ixodes tick
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
Why is the spleen enlarged in hemolytic anemias
Red pulp hyperplasia from so much RBC destruxn
What region of the brain is situated in the area postrema in the dorsal medulla near the floor of the 4th ventricle
CRTZ
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
What disorder is characterized by disorientation, sweating, tremors, and palpitations
Hypoglycemia
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
What should be suspected in a pt with a sudden increase in O2 saturation in the RV from the RA
VSD
What murmur is heard in a VSD and where
Holosystolic murmur at the left sternal border (tricuspid area)
What is the main problem with Tumor Lysis Syndrome
Hyperuricemia from excess purine breakdown
What drug can help treat Tumor Lysis Syndrome by converting Uric acid (the normal last product of purine catabolism) to Allantoin
Rasburicase
What are the protein groups that bind to DNA
Transcription factors
Steroid receptors (cortisol, aldosterone, etc)
Thyroid hormone receptors
Fat soluble vitamin receptors
Progesterone is what type of hormone
Steroid hormone
What is the benefit of a live vaccine
Stronger immune response elicited
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
What enzyme catalyzes the conversion of Testosterone to DHT which can cause alopecia and BPH
5 alpha reductase
What drug is used to treat BPH and alopecia by inhibiting 5 alpha reductase
Finasteride
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
What disorder is characterized by confusion, ophthalmoplegia, and ataxia
Wernicke’s Encephalopathy
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
At what time periods following an MI does
1. The myocardium stop contracting due to cessation of aerobic glycolysis and takeover of anaerobic processes
- Is tissue irreversibly lost due to depletion of adenosine (ATP->AMP->Adenosine) in attempts to vasodilate
- Within 60 seconds
2. Around 30 minutes
What muscle is located between Pec major and Latissimus dorsi at the mid axillary line
Serratus anterior
What structures are pierced during placement of a chest tube in the 5th intercostal space
Serratus anterior
Intercostal muscles
Parietal pleurae
What test is used to diagnose Cryptococcal meningitis
India ink stain of CSF
What is the tx for Cryptococcal meningitis
Amphotericin B and Flucytosine followed by long term Fluconazole
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
How do TNF alpha and other substances cause insulin resistance
Phosphorylate serine residues in the Tyrosine Kinase signaling pathway that Insulin typically triggers
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
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
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
What genes have been associated with Early and Late onset Alzheimer’s
Early: Amyloid precursor protein gene, Presenilin 1, Presenilin 2
Late: Apolipoprotein E4
What drug is used to treat both general tonic-clonic seizures and Absence seizures
Valproate
What is the fxn of Thiazide diuretics
Block Na/Cl symporter in DCT
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
What is it called when emotions are shifted from their aactual target to a neutral person or object
Displacement
How does displacement differ from transference
Transference is similar to displacement but it is toward a physician
What disorders can result from Haemophilus Influenzae Type B (These differ from the nontypable strains)
haEMOPhilus inlfuenzae type b
Epiglottitis
Meningitis
Otitis media
Pneumonia
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
How does normal saline fix Hypovolemic shock
Increases preload and hence EDV
What occurs when End diastolic volume increases
The end diastolic sarcomere length is increased
As is the case when saline is added IV
What are some of the common causes of atrophy
Disuse Denervation Loss of blood supply Loss of hormonal stimulation Poor nutrition
What occurs in isotype switching
- CD4 cell binds B cell via CD40 ligand
2. Cytokines are released from CD4 cell that induce isotype switching
Where does Isotype switching occur
Germinal center
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
What hormone receptors are inhibited by Odansetron to treat Nausea and vomiting that results from GI receptors stimulating the NTS
Serotonin
Renal cell carcinoma is often associated with what genetic abnormality
Deletion or mutation of VHL (Von Hippel-Lindau) gene on Chromosome 3
What disorders often result from Chromosome 3 problems
Renal cell Carcinoma
Von Hippel-Lindau
Both are 3 words and are on Chrome 3
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
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
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
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
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
What hormone is responsible for producing dilated coiled endometrial glands and vascularized edematous stroma
Progesterone
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
What is the abnormality that results in Duchenne muscular dystrophy
Frameshift or nonsense mutation resulting in a truncated dystrophin protein
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
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
What disorder might you suspect in someone with a rapidly progressing fever, drooling, sore throat, and airway obstruction
Acute epiglottitis
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
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)
What immune cells are responsible for initially fighting off TB infxn
TH1 and Macrophages
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
What are the best drugs for hypertriglyceridemia
Fibrates:
Gemfibrozil
Bezafibrate
Fenofibrate
What is the tx of choice for an individual diagnosed with specific phobia
Behavioral therapy
What term is used to describe the situation where individuals are systematically confronted with their feared object or situation
Behavioral therapy
What is the most common cause of alopecia in men and women
Androgenetic alopecia
What factors predispose to androgenetic alopecia
The name gives it away…
Androgens and Genetics (multiple genes actually; it is polygenic)
Ibuprofen and other NSAIDS prevent formation of what substance
Prostaglandins
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
What disorder is characterized by symmetric proximal muscle weakness with numerous MHC 1 molecules and CD8 cells seen on biopsy
Polymyositis
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
Defects in what system can lead to Parkinsons or Alzheiemers
Ubiquitin proteasome
What is the FLD for Narcolepsy
Modafanil
What is the appropriate next step for close contacts of a pt with Neisseria meningitidis
Administer prophylactic Rifampin (main one), Ciprofloxacin, or Ceftriaxone
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
What disorder shows an elevated CD4/CD8 ratio in broncheolar lavage fluid
Sarcoidosis
What disorder is characterized by failure to thrive, jaundice, vomiting, hepatomegaly, within days of birth along with infantile cataracts
Classic Galactosemia
What is the inheritance pattern of Classic Galactosemia
AR
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
What are the myeloproliferative disorders
Polycythemia vera
Essential thrombocythemia
Myelofibrosis
CML (kinda?) not sure about this one..
What drugs are used to treat C. dif and which is best for recurrent infxns
Metronidazole
Vancomycin
Fidaxomicin (best for recurrent infxn)
What veins fuse to form the IVC
Right and left common iliac veins
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
During what phase of the cardiac cycle is blood flow halted
Systole
Where in the heart does blood flow hault during systole
LV b/c it contracts so much compressing the vessels
What drug inhibits viral DNA polymerase, RNA polymerase, and Reverse transciptase and does not require activation
Foscarnet
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
How do manic episodes differ from hypomanic episodes
Hypomanic are less severe, do not involve psychosis, and individuals are often more productive
What cardiac anomalies are associated with Turners
Bicuspid aortic valve
Coarctation of the aorta
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
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
What enzyme is deficient in Niemann PIck Disease
Sphingomyelinase
No man picks (Niemann Picks) his nose with his sphinger (sphingomyelinase)
What are the Lysosomal Storage Diseases
Fabry Gaucher Niemann Pick Tay Sachs Krabbe Metachromatic Leukodystrophy Hurler Syndrome Hunter Syndrome
What pathogen can cause flatulence and fatty foul smelling diarrhea in campers/hikers
Giardia lamblia
What is the tx for Giardia
Metronidazole
What disorder is characterized by mental status changes, muscle weakness, constipation, and polyuria/polydipsia
Hypercalcemia
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)
Bee stings induce what type of hypersensitivity response
Type 1
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
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
What drugs can be used to treat Lyme dz
Doxycycline or penicillin type antibiotics (Ceftriaxone)
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
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)
What causes the blurred optic disc margins in pseudotumor cerebri
Compression of CN2 by elevated ICP which results in reduced axoplasmic flow
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
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
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
Calcium sensing receptors in the parathyroid are what type of receptors
G protein coupled receptors
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
Which enzyme has a lot more work to do on the lagging strand of DNA
DNA ligase
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
What pathogen causes pseudomembranous pharyngitis with a grayish white membrane
Corynebacterium diphtheriae
How does Corynebacterium diphtheriae gain the ability to cause disease
Lysogenization in which phage gives it the ability to produce toxin
What heart defect can produce a holosystolic mumur best heard at the apex
Mitral regurgitation
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
What drugs are contraindicated during pregnancy due to their ability to stain the child’s teeth
Tetracyclines
Where are Nicotinic receptors found
NM jxn, ganglia, and Adrenal medulla
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
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
What disorder is characterized by linear intensely pruritic vesicles that often appear on the hands and legs
Poison ivy dermatitis (Form of contact dermatitis)
What type of hypersensitivity is Contact dermatitis
Type 4
What drugs are infamous for causing dilated cardiomyopathy
Anthracyclines (Doxorubicin, Daunorubicin)
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
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
What are vaginal epithelial cells covered with gram variable rods called
Clue cells
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
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
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
What prevents proper ascent of horseshoe kidney
Inferior mesenteric artery
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
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
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
Where in the LN are T cells and B cells found
T cells - Paracortex
B cells - Germinal centers and follicles in the cortex
Is UV the same as ionizing radiation?
No, Ionizing radiation is much stronger. UV is a form of NON IONIZING radiation
How does ionizing radiation cause damage to cancer cells
Causes double stranded DNA breaks and free radical formation
When determining acid base imbalances and checking for metabolic compensation, what must you always remember
Metabolic compensation occurs only after about 48 hours
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
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
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
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
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
What is one of the main ways that resistance can be achieved against Cephalosporins
Changes in transpeptidase (penicilling bindin protein) structure
What disorder is characterized by inappropriate laughter, sedation, conjunctival injection, dry mouth, increased appetite, and tachycardia
Marijuana intoxication
What is the structure most commonly injured during hysterectomy that results in unilateral flank pain but normal urination
Ureter
What disorder is characterized by a high arched palate and atrophic ovaries
Turners
What organism is a gram - rod, a non lactose fermenter, and oxidase positive
Pseudomonas aueriginosa
What are the oxidase + gram - organisms
Pseudomonas
Campylobacter jejuni
Vibrio
Helicobacter
Pseudomonas and the curved rods
What disorder is associated with tampons or nasal packing
Toxic Shock syndrome
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
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
Why does eukaryotic DNA replicate much faster than prokaryotic DNA despite being much larger and complex
Multiple origins of replication
What disorder is characterized by hypotension, DIC, hypoxia, and even death and occurs during pregnancy or delivery
Amniotic fluid embolus
What laboratory finding will be seen in a pt with an amniotic fluid emboli
Fetal squamous cells in pulmonary artery branch
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
What drugs commonly cause Anticholinergic toxidrome during overdose
Antihistamines Tricyclic antidepressants (Amitriptyline)
What is the mechanism by which fibrates (gemfibrozil, bezafibrate, fenofibrate) work
Promote LPL and reduce hepatic VLDL production
Spliceosomes which remove introns are formed from what substance
small nuclear ribonucleoproteins (snRNPs)
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.
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)
Candida albicans is often suggestive of what
HIV which is obtained through sexual intercourse
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
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
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
What drug is effective in the treatment of oral candidiasis by swishing and swallowing it
Nystatin
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
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
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
What disorder is characterized by a mosaic pattern of woven and lamellar bone
Paget disease of bone
What are the stages of Paget disease of bone
Lytic - Osteoclast activity (Initially OsteoCLASTS)
Mixed - Osteoclast and osteoblasts
Sclerotic - Osteoblasts
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
What cells are infected by EBV in Mononucleosis
B cells
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
What health insurance has low monthly premiums and low copays and deductibles
Health maintenance organization
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
What class of anti HIV drugs all end in -navir
Protease inhibitors
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
What disorder is characterized by cardiomegaly, macroglossia, and hypotonia
Pompe disease
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
Blood transfusion puts an individual at risk for what
Hypocalcemia (paresthesias will be seen)
Why can blood transfusion cause hypocalcemia
Contains lots of citrate which is a Calcium chelator
How can a woman with Turners Syndrome become pregnant
In vitro fertilization with a donated ovum
What are the 4 segments of the urethra
Prostatic
Membranous
Bulbous
Penile
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
What pathogen produces pyocyanin pigment giving it a green blue color on culture
Pseudomonas aureginosa
What is the agent of hot tub folliculitis
Pseudomonas aureginosa
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
Increased erythropoietin production is seen in what conditions
Hypoxic conditions (COPD can cause it)
What are the 4 main neutrophil chemotactic factors
Leukotriene B4
C5a
IL-8
5-HETE (Leukotriene precursor)
What disorder is characterized by EKG findings which include absent P waves, irregularly irregular rhythm, and a narrow qrs
Atrial fibrillation
What determinnes the rate of ventricular contraction in a fib
The rate at which the AV node repolarizes
What infection can commonly lead to infertility in a woman
PID following cervicitis
What are the pathogens that cause cervicitis and PID and what are their treatments
Neisseria gonorrhea - Cephalosporin
Chlamydia trachomatis - Azithromycin or Doxycycline
Homocysteine makes what AAs
Methionine
Cysteine
Homocystinuria results in a deficiency in what enzyme leading to a builldup of methionine
Cystathionine synthase
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
What set of disorders are haracterized by lack of social engagement, repetitive play, and insistence on a pattern
Autism spectrum disorders
What drug is contraindicated during pregnancy due to its ability to cause neural tube by decreasing folate levels
Valproate
Valproic acid is used to treat what
Epilepsy, bipolar disorder, and migraines
What enzyme is deficient in Severe combined immunodeficiency
Adenosine deaminase
What toxic substance accumulates in lymphocytes in individuals with SCID
Adenosine
What increases the chances of a woman getting epithelial ovarian cancer
Ovulation
What things decrease the chance of a woman getting epithelial ovarian cancer
Pregnancy, oral contraceptive use, and breastfeeding
All prevent ovulation
Which portion of the visual field nerve track is damaged if there is damage to the temporal lobe
Meyer’s loop
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
What disorder is characterized by flushed skin, dry mucosa, blurred vision, and a fast heart rate and respiratory rate
Anticholinergic toxidrome
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
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
How should older patients be addressed
By their last name unless otherwise indicated
What disorder is characterized by bleeding gums, corkscrew hairs, and perifollicular hemorrhages
Scurvy
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
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
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
What are the 4 tips to keep in mind when ID’ing spinal cord level based on cross sxn
- FC and FG are both only found above T7
- Gray matter decreases as you go up
- Cervical and Lumbar have fat ventral horn
- Thoracic and upper lumbar have lateral horn
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
What pathogen is associated with hoofed animals like sheeps wool
Bacillus anthracis
What fundoscopic findings are seen on a pt with glaucoma
Increased cupping
What drug is used to treat glaucoma
Latanoprost - A prostaglandin that increases aqueous humor outflow
What are the 4 findings in TOF
Pulmonic stenosis
Right V hypertrophy
Overriding aorta
VSD
What is the main indicator for prognosis in TOF
Degree of pulmonic stenosis
What is the bioavailability of a drug that is administered IV
1
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
What marker in Hep B indicates current infxn
HBsAg
What marker for Hep B indicates high Hep B transmissibility
HBeAg
What is the normal alveolar to arterial PO2 gradient
5-15mmHg
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
What disorder is depicted by a infant with flat facies, small ears, and a protruding tongue
Down Syndrome
What is the most common cause of Down Syndrome
Nondisjunction
What histologic change to the adrenal cortex occurs in response to ACTH
Hyperplasia! not Hypertrophy
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
What tumor often affects CN 7, 8, and 5
Acoustic Schwannoma
Where are acoustic schwannomas most commonly found
Cerebellopontine angle
What pathogen can cause Ecthyma gangrenosum in immunocompromised individuals which has necrotic cutaneous lesions
Pseudomonas aeruiginosa
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
Serotonin is a derivative of what molecule
Tryptophan
Tryptophan leads to the production of Niacin and Serotonin
What disorder is characterized by neuromuscular activation like clonus, AMS, and autonomic activation (vomiting, hyperthermia, tachycardia, etc.)
Serotonin syndrome
What drug is used to treat serotonin syndrome
Cyproheptadine
Michael Scott “silly signs prohibited!”
What is it called when a person has an immune reaction to a drug
Anaphylaxis (Type 1 hypersensitivity)
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
What causes the release of mast cell granules
Aggregation of IgE
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)
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
What is the main stimulator of respiration in healthy individuals
PCO2
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
What substance activates pyruvate carboxylase (the enzyme responsible for converting pyruvate to oxaloacetate in the first step of gluconeogenesis)
Acetyl CoA
What organism forms black colonies on cysteine-tellurite agar
Corynebacterium diphtheriae
What immune cells contain a bilobed nucleus
Eosinophils
What substance do eosinophils produce that has activity against helminths and can cause bronchial damage in asthma pts
Major basic protei
What substance is increased in response to Ace inhibitor use
Bradykinin
Angiotensin converting enzyme typically breaks down Bradykinin
What is an adverse result of bradykinin accumulation in pts on ace inhibitors
Angioedema (swelling of kips, eyelids, tongue etc.)
Bradykinin is a vasodilator
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
What substances are released from virally infected cells
Interferon alpha and beta
What effect do IFN alpha and beta have on virally infected cells
Halt protein synthesis
What cells display both CD4 and CD8 markers
Immature cortical T lymphocytes
What fungus is capable of causing sepsis via entrance with a venous catheter
Candida albicans (Candidemia)
What can cause hyperosmotic volume contraction with an increase in osmolarity and a decrease in both intracellular and extracellular fluid volume
Diabetes insipidus
What substance is filtered by the glomerulus and secreted in the proximal tubule resulting in an amount filtered < amount excreted
Para aminohippuric acid
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
What nerve can be damaged by a stretch injury during childbirth
Pudendal nerve (S2-S4)
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
What is the strongest risk factor for suicide in a pt
A previous suicide attempt
What condition results in night blindness and dry scaly skin
Vitamin A deficiency
What can lead to a Vitamin A deficiency
Bile obstruction
Exocrine pancreatic insufficiency
Crohns etc
Remember, it’s a fat soluble vitamin
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
What labs must you obtain before and after administration of an SGL2 inhibitor
Creatinine and BUN to assess renal fxn
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
What substance is responsible for allowing the activation of IL 2 in T cells and their proliferation
Calcineurin
Target of immunosupressants Cyclosporine and Tacrolimus
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
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
What is a common cause of falls in elderly nursing home patients
Medication
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
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)
Sudden onset vertigo with nausea/vomiting and difficulty walking is most commonly due to dysfunction with what
Inner ear (vestibular dysfxn)
What disorder is characterized by morning stiffness and fusion of the SI joints and a bamboo spine
Ankylosing spondylitis
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)
What drug can be used to treat glaucoma by decreasing the production of aqueous humor
Timolol
Where does Timolol act on to treat glaucoma
Ciliary body epithelium
Causes it to produce less aqueous humor
In a child complaining of bone pain in a long bone, what might you suspect
Osteomyelitis
What is the most common cause of osteomyelitis
Staph aureus infxn
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
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)
What disorder might you suspect in a child with cataracts
Galactosemia
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
What disorder is characterized by joint pain, a photosensitive rash, and fever in women or African Americans typically
Systemic lupus erythematos
What is a complication of Lupus
Antiphospholipid syndrome –> Recurrent pregnancy loss and venous/arterial thrombosis
What pathogen is viewed with dark field microscopy
Treponema pallidum
What are the FLD’s for PTSD
SSRIs
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
What condition results in bone resorption with cystic degeneration
Osteitis fibrosa cystica
A complication of Primary hyperparathyroidism
What are some of the adverse effects of nitrate use such as Isosorbide dinitrate
Hypotension, flushing, and headache (Monday Dz)
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
What causes the compensatory release of ADH, RAAS activation, and sympathetic stimulation in Heart failure patients
An initial drop in blood pressure
Deletion/mutation of what structure confers resistance to HIV by preventing its binding and entrance into cells
CCR5
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
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
For rapid reversal of warfarin what would you use
Fresh Frozen Plasma
Vitamin K is the other option, but it takes time
Failure to thrive, diarrhea, and recurrent infxns in a child suggests what disorder
SCID
Candida antigen test is what type of reaction
Type 4 hypersensitivity
Type 4 hypersensitivity reactions involve what cell types
CD4, CD8, Macrophages
What substance can cause POST transcriptional mRNA silencing by degrading mRNAs thus resulting in gene supression
MicroRNAs
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
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
what is the first line medication for trigeminal neuralgia
Carbamazepine
Sketchy: 3 gems on top of the classic car outside Ben’s diner
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
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
What bacteria can grow on alkaline media
Vibrio cholera
Sketchy: “BASE” cAMP
What is seen in the stool of pts with vibrio cholera infxn
Mucus and sloughed epithelium (No RBCs or WBCs)
Rice water stool
What is the diff between PT and aPTT
PT - Monitors extrinsic pathway (Factor 7)
aPTT - Monitors intrinsic pathway (Factor 12, 11, 9, 8)
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
What is the MOA of beta blockers
Competitively inhibits adrenergic beta receptors
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
