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Random Learning > Uworld Part 2 > Flashcards

Uworld Part 2 Flashcards

1
Q

What bacterial factor of E coli causes Septic Shock?

A

Lipid A

(part of LPS, heat-stable ENDOTOTOXIN.

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2
Q

SSRI work on which part of the brainstem?

A

Raphe Nucleus

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3
Q

Where do SNRI’s work in brain?

The question asks that where can we find serotinin and NE-releasing neurons in the brain?

A

Raphe Nucleus in whole of the brainstem (i.e Midbrain, Pons and Medulla)

NE releasing neurons are found in the LOCUS CERULEUS of dorsal Pons.

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4
Q

Apixaban is a Factor Xa inhibitor, so which of the following will it directly affect when given as therapy?

1) Conversion of factor X to Xa
2) Conversion of prothrombin to thrombin

A

The correct answer is it affects the conversion of prothrombin to thrombin.

It is a DIRECT factor Xa inhibitor, it doesn’t inhibit the conversion of factor X to factor Xa. It binds to factor Xa to inhibit it.

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5
Q

Story of Retinoblastoma, the security guard of G1/S transition?

A

Retinoblastoma is just like a security guard. He is always active and dephosphorylated binding tightly to its gun(E2F)

But when Cyclin Kinases come to rob the building, they PHOSPHORYLATE Rb i.e. shoot him. Shooting is phosphorylation because ammunition contains phosphorous. And it gets down, releases E2F from it hand and the thieves progress i.e cell cycle continues.

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6
Q

Typical age for Schizophrenia is?

A

In men, early 20’s. And women, late 20’s.

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7
Q

Another name for septic shock is?

A

Fluid refractory hypotension because of sepsis

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8
Q

ACA stroke causes?

A

C/L leg and foot weakness, urinary incontinence.

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9
Q

MCA stroke causes?

A

C/L Face and upper limb paralysis and sensory loss.
Haath kay kaam nahyin ker sakay ga jaisay gripping, aur mu kay bhee jaisay whistling and swallowing.

Aphasia agar dominant lobe ho jaata hai damage, aur agar non dominant lobe damage ho tou hemineglect ho jaata hai.

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10
Q

Spinal muscular atrophy in a child, SMN1 gene affected. What protein is defective?

A

snRNPs in lower motor neurons.

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11
Q

When snRNPs are defective, which cellular element doesn’t work?

A

Spliceosomes

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12
Q

Diseases caused by splice site mutation and what does a splice site mutation cause?

A

Gaucher, B thalassemia and Marfans are a result of splice site mutation.

In a splice site mutation, intron retained in the mRNA when it should have been cleaved.

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13
Q

Splice sites of introns have what specifications?

A

GU———————AG

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14
Q

Defective SnRNPs and antibodies against snRNPs are seen in which diseases respectively?

A

Defective snRNPs are seen in Spinal Muscular Atrophy.

Antibodies against snRNPS are seen SLE. The anti-smith Antibodies are actually against snRNPs.

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15
Q

Amazing fact about snRNPs?

A

Have lots of Uridine in them so are also called U-RNA.

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16
Q

Treatement of Nesserio Gonorrhea?

A

Macrolide (Azithromycin) and a third generation cephalosporin (Ceftriaxone)

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17
Q

Why does acute salicylate intoxication cause primary anion gap metabolism?

A

Increases lipolysis
Uncouple oxidative phosphorylation
Inhibits citric acid cycle.

So there’s accumulation of lactate, ketoacids.

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18
Q

You have told the patient that she has pancreatic cancer. She begins to cry while holding her head in her hands. Which of the following is the most appropriate response?
A) “I know this isn’t the news you wanted to hear, let’s talk about the results in a bit more detail”
B) “I wish I had better news to share with you. I imagine this is very upsetting to hear”

A

B) “I wish I had better news to share with you. I imagine this is very upsetting to hear”

Not A, because we need to give the patient time to process this news and express her emotions. Instead physician should let the patient take the lead and answer the questions that the patient asks.

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19
Q

Actinic Keratosis progresses to?

A

Squamous Cell Carcinoma

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20
Q

Characteristics of Actinic Keratosis?

A

Has a sandpaper texture, occurs on sun-exposed areas.
Hyperkeratosis
Parakeratosis (Retention of nuclei in Stratum Corneum)

DO NOT INVADE DERMIS.

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21
Q

Liver Biopsy reveals dilated Bile Canalculi with green-brown plugs and yellowish green accumulations of pigment with the hepatic parenchyma.

What is it?

A

Cholestasis.

Has a lot of reasons, there’s a table for it in your camera roll. PLEASE GO LOOK.

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22
Q

NPH can occur due to decreased absorption of cerebrospinal fluid by _____________________.

A

Arachnoid Granulations.

Arachnoid Granulations don’t absorb CSF adequately when fibrosed from previous cerebral inflammation or bleeding.

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23
Q

Cause of urinary incontinence in NPH?

A

Lateral Ventricles expand——-> Stretch cortical descending fibres———-> lack of cortical inhibition———> Detrusor Muscle Hyperactivity (Urge Incontinence)

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24
Q

What bacterial virulence factor of Staph aureus causes necrotising pneumonia?

A

Leukocidin is a cytotoxin responsible for tissue necrosis.

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25
Q

In BPH treatement, which drug acts on the epithelial components and which drug works on smooth muscle components?

A

Finasteride (5 alpha reductase inhibitor) works on the epithelial component)

Alpha-1 blockers work on smooth muscles.

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26
Q

Patient has pheochromocytoma. CT Scan abdomen reveals a mass in right adrenal gland.
Which of the following cells have the same embryological origin as the tissue responsible for this patient’s current condition?

A) Capillary Endothelial Cells
B) Cardiac Myocytes
C) Interstitial fibroblasts
D) Melanin-producing cells
E) Thyroid Follilcular cells.
A

D) Melanin-producing cells.
(Pheo Schwann’s PNS is dark)

Neural Crest derivatives:
Neural ganglia, adrenal medulla
Schwann cells; pia & arachnoid mater
Aorticopulmonary septum & endocardial cushions
Branchial arches (bones & cartilage)
Skull bones
Melanocytes
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27
Q

1 SD and 2 SD of the normal distribution curve is how much of the total population in percentage.

A

1 SD is 68%

2 SD is 95%

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28
Q

What’s peculiar about mesothelioma?

A

Pleural effusions are BLOODY/HEMORRHAGIC/ EXUDATIVE

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29
Q

Histo of Mesothelioma?

A

Proliferation of epitheloid type cells that are joined by desmosomes,

Contain abundant TONOFILAMENTS.

Studded with very long MICROVILLI.

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30
Q

3 symptoms/signs of SIADH?

A

Hypotonic Hyponatremia (Serum sodium and serum osmolality are decreased)

Concentrated Urine (Increased Urine Osmolality, Increased Urina Na)

CLINICAL EUVOLEMIA.

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31
Q 
Which of the following drugs can cause SIADH?
A) Canagliflozin
B)Carbamazepine
C) Furesemide
D)Lithium
E) Spironolactone
A

Carbamazepine.

There’s also a table for SIADH, that you SHOULD revise.

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32
Q 
22 year old comes to you with erectile dysfunction, lack of sexual desire, Bilateral Gynecomastia, small firm testis.
What should be given for treatment?
A) Aromatase inhibitor
B) Gonadotropin
C) PDE5 inhibitor
D) Selective Estrogen receptor Modulator
E) Testosterone
A

E) Testosterone.

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33
Q

What will be the levels of following in Klinefelter’s Syndrome?

Serum LH
Testosterone
Serum FSH
Inhibin B
Sperm count
A 
Serum LH- INCREASED
Testosterone- DECREASED
Serum FSH- Increased
Inhibin B- Decreased
Sperm count- ABSENT.
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34
Q

In a patient of Klinefelter’s syndrome. 47 XXY——> what is the main pathology?

A

Dysgenesis of seminiferous tubules

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35
Q

Disturbances that increase alveolar-arterial O2 gradient include _________, ____________ and ______________________.

A

V/Q mismatching ( eg Pulmonary Embolism)

Diffusion Limitation

Right-to-left shunting (Eg Eisenmenger Syndrome)

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36
Q

What causes syncope in a panic attack?

A

Hyperventilation causes DECREASED ARTERIAL PARTIAL PRESSURE OF CO2—-> the hypocapnia reduces Cerebral blood flow and leads to lightheadedness/ dizziness.

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37
Q

Endurance training will result in increase of?

A) Anaerobic Glycolytic Enzymes
B) Mitochondrial Content
C) Proportion of type 2( fast twitch fibres)

A

Increased Mitochondrial content.

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38
Q

What happens to skeletal muscle fibres in Endurance training?

A

It promotes characteristics of Type 1 fibres—-> increased size and increased mitochondrial content, increase in aerobic oxidative enzymes.
Increases capillary density
Anaerobic glycolytic enzymes will decrease

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39
Q

What happens to skeletal muscles during resistance training?

A

Enhances characteristics of Type 2 muscle fibres.

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40
Q

No matter what kind of exercise you do, what characteristic of skeletal muscles remains unchanged?

A

Number of muscle fibres within a motor unit

Or

Endplates per fiber

DO NOT CHANGE.

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41
Q

21 year old woman comes to office with facial flushing, headache, nausea, vomiting and abdominal cramps after drinking alchohol ar a party. What is she being treated for?

A

She is taking Metronidazole for treatement of trichomonas vaginitis or Bacterial vaginosis—-> disulfiram reaction occured and accumulation of acetaldehyde dehydrogenase is causing all of these symptoms.

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42
Q

Mechanism of action of Clostridium difficile toxins on colon?

A

The toxins affect the colonic mucosa. These toxins disrupt the cellular cytoskeletons and intercellular TIGHT junctions leading to COLONOCYTE APOPTOSIS.

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43
Q

What will you see on histo of colon when infected by clostidium difficile?

A

There’s going to be DENUDED colonic epithelium/Necrotic epithelium.—-> That’s why there’s formation of white/gray pseudomembranes seen grossly.

There’s also going to be inflammatory infiltrate over this which includes FIBRIN AND NEUTROPHILS.

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44
Q

Reactive lymphocytes are seen in?

A

Intracellular infections like HIV, CMV, Toxoplasmosis and infectious mononucleosis caused by EBV

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45
Q

Reactive Lymphocytes are large, ____________ and have abundant cytoplasm.

A

SCALLOPED.

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46
Q

Reactive lymphocytes are effector cells that contain __________

(You did this wronggg)

A

Perforins and granzymes.

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47
Q

Cytotoxic granules in reactive lymphocytes are released in response to foreign antigens on the surface of (MHC Class I receptors/ MHC class II receptors.)

A

MHC Class I receptors

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48
Q

Which of the following steps involving the processing and handling of pre-mRNA/HnRNA occur only in the cytoplasm of cells?

A) Interation with snRNP
B) Methylation of 5’terminal guanine
C) Multiple Adenine nucleotide attachment to the 3’ end.
D) interaction with P bodies

A

interaction with P bodies

P bodies interact with mRNA once it is out of the nucleus after being all finalized with the Poly A tail and splicing done in the NUCLEUS. P bodies are responsible for fundamental role in translational repression and mRNA decay.

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49
Q

What is acute retroviral syndrome? You

A

When HIV infected people develop mononucleosis like symptoms (Sore throat, headache, diffuse lymphadenopathy, OROPHARYNGEAL ULCERS AND DIFFUSE MACULOPAPULAR RASH)

This period is after 2-4 weeks of inoculation. The labs will show NEGATIVE SEROLOGY i.e ‘o antibodies.

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50
Q

Person with megaloblastic anemia, has low Vitamin B12 levels but normal folate levels. What’s the diagnosis?
And what will be the levels of the following?

Gastrin (Elevated, Reduced, Normal)
Gastric PH (High, Low, Normal)
Parietal Cell Mass ( Increased, Decreased, Normal)

A

This means intrinsic factor problem. And that indicates autoimmune gastritis/Pernicious anemia.

CD4+ T cells attacking parietal cell, cause a DECREASED parietal cell mass. Resulting in decreased gastric acid (caused HIGH gastric PH), and decreased production of intrinsic factor (causing low vitamin B12 and hence megaloblastic anemia)

The high PH, stimulates more gastrin to be released, so ELEVATED GASTRIN.

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51
Q

What is the effect on GFR and FF if efferent arteriole constricts?

A

Efferent arteriole constricts so because of back pressure or in short increased capillary hydrostatic pressure and causes INCREASED GFR.

However, efferent arteriolar constriction causes DECREASED RPF.

So this causes, INCREASED FF.

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52
Q

Which gonadal cells are responsible formation of internal reproductive organs in a male?

A

Sertoli cells.

In lack sertoli cell function, the kid will have BOTH male and female internal reproductive organs.

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53
Q

What is needed for the following to happen in a male fetus for the development of reproductive gonads?

1) Involution of paramesonephric ducts——>
2) wolfian duct/mesonephric duct into male internal reproductive organs—->
3) Development of external male reproductive organs——->

A

1) Involution of paramesonephric ducts——> MIF from Sertoli cells needed
2) wolfian duct/mesonephric duct into male internal reproductive organs—-> Testosterone from Leydig cells.
3) Development of external male reproductive organs——-> DHEAT.

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54
Q

Due to increase in which clotting factors during pregnancy and pierperium there is risk of thrombosis?

A

Factor 7,8 and 10

vWF and Fibrinogen are also increased.

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55
Q

Ovarian vein drain into what on each side?

A

Right ovarian vein drains into IVC

Left ovarian vein drains into left renal vein.

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56
Q

Which intracellular signalling pathway is stimulated with the medication used to treat Turner’s syndrome in a 6 year old girl?

A

JAK-STAT pathway activated by growth hormone.

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57
Q

Growth hormone induced the production of _____________ by __________.

A

IGF-1 (Insulin Like growth factor) by hepatocytes.

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58
Q

What is another name for JAK-STAT pathway?

A

Non-receptor tyrosine Kinase

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59
Q

Which hormones use JAK-STAT pathway?

A

Prolactin, Growth Hormone, Erythropoietin, Cytokines like IL-6, IL-2, IFN.

Also G-CSF.

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60
Q

IP3-calcium-calmodulin pathway and DAG- Protein Kinase C are the same pathways. They start from?

A

Gq receptors that activate Phospholipase C

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61
Q

Hormones that work via IP3 pathway?

A

Mnemonic is GOAT HAG.

GnRh, Oxytocin, ADH (V1 receptor), TRH, Histamine, Angiotensin 2, Gastrin.

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62
Q

3 diseases in which pulse-temperature dissociation is seen?

A

Typhoid, Tularemia, Yellow Fever.

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63
Q

Antibodies seen in SLE?

A

Positive ANA,
Anti-dsDNA,
Anti-smith ( that are actually antibodies against snRNPs)

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64
Q

Lab abnormalities seen in SLE:

A

Mnemonic is SAB KAM HOTA HAI.

Anemia, leukopenia, thrombocytopenia, low complement levels.

But INCREASED LEVELS OF IMMUNE COMPLEXES.

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65
Q

Anti-cyclic cittrulinated peptide antibodies are seen in?

A

Rheumatoid Arthritis.

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66
Q

Anti-mitochondrial antibodies are seen in?

A

Primary Biliary Cirrhosis.

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67
Q

60 year old man comes with enlarged vertebral bodies with cortical thickening, what is the diagnosis and how will you diagnose the patient?

A

Paget’s disease, diagnosed by presence of ELEVATED ALK PHOS LEVELS.

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68
Q

On gross examination of a signet ring carcinoma, characteristirized by diffuse involvement of the stomach wall due to loss of _____________.

A

Cell Adhesion protein E-cadherin.

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69
Q

2 types of acute pancreatitis and their pathology?

A

Acute interstitial pancreatitis——-> Fat cell destruction and calcium deposition
(because of duct obstruction—-> Stasis of Pancreatic secretions leads to digestion of adipose cells by lipase and causes precipitation of insoluble calcium salts)

Acute necrotic Pancreatitis ——> autodigestion of pancreatic tissue due to Trypsin activating all the proteolytic enzymes. Destruction of blood vessels causes areas of Hemorrhage. Macroscopically, it is seen an AREAS OF WHITE CHALKY FAT NECROSIS AND BLACK AREAS OF HEMORRHAGE.

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70
Q

Reddish Urine that darkens on exposure, which disease is it?

A

Acute intermittent porphyria.

Deficiency of prophonilinogen deaminase deficiency.

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71
Q

What is patiromer?

A

Nonabsorbable cation exchanger that binds phosphate and gives up its calcium in the intestine.

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72
Q

_____________ prevent the hematogenous spread of candida.

A

Neutrophils

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73
Q

Disseminated candidiasis presents as?

A

Candidemia, endocarditis.

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74
Q

The (Sympathetic/Parasympathetic) Nervous System is responsible for physiological adaptations of vessels in hypothermia

A

Sympathetic

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75
Q

The medication works by inhibiting metalloprotease to prolong the action of endogenous polypeptides. These polypeptides are most likely secreted by which cells?

A

Cardiomyocytes releasing ANP, BNP.

The medication is neprilysin inhibitor (sacubitril)

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76
Q

Cause of hypercalcemia in Multiple Myeloma?

A

IL-1 and TNF-alpha liberating calcium from bones leads to lytic lesions of bones and hypercalcemia.

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77
Q 
There are four major diseases with hypercalcemia:
Multiple Myeloma
Primary Hyperparathyroidism
Tertiary Hyperparathyroidism
Familial hypocalciuric hypercalcemia.

What the mnemonic/story for their differences?

A

In Multiple Myeloma, increase in calcium occurs sab sey pehlayyy. So PTH is decreased and then 1,25 OH-Vit D is also decreased.

In Primary Hyperparathyroidism, pehlay PTH increases and then it causes an increase Calcium. So there will also be HYPERCALCIURIA.

In familial Hypocalciuric hypercalcemia——> same as Primary hyperparathyroidism, normal to increased PTH, INCREASED CALCIUM, but HYPOCALCIURIA.

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78
Q

Why is the real problem in instussusception is compromised blood supply?

A

Impaired venous return from the invaginated segment of the bowel.

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79
Q

Pseudodiverticula had which particular layer missing?

A

Muscularis propria

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80
Q

___________________ is the essential pathogenic mechanism for Shigella infection.

A

Mucosal invasion

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81
Q

Pathogen most commonly associated with cat and dog bite infection?

A

Pasteurella Multicoda.

It is indole positive so the infection produces a mouse like odour.

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82
Q

What causes lymphangitis in immunocompetent hosts?

A

Bartonella henselae via cat bite

(Lymphogranuloma Venereum caused by Chlamydia L1-L3 occurs in immunocompetent hosts—> Mixed granulomatous and neutrophilic infilteration with epithelial cells and inflammatory cells having chlamydial intracellular inclusion bodies.
The painless ulcers—-> Buboes (painful lymphadenopathy)–> causes STELLATE ABSCESS.

Stellate shaped granuloma/abscesses–> are also called suppurative granulomas because they are granulomas and abscesses too.—> Occur in Bartonella. Lymphogranuloma venerum, and tularemia.

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83
Q

3 types of pathogens responsible for skin infection after human bite?

A

Anaerobes
Strep
Eikenella corrodens

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84
Q

Entameba histolytica histopathology will show?

A

Flask-shaped colonic ulcers with FOAMY trophozoites that resemble macrophages.

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85
Q

How is the word actin related to Shigella and Clostridium?

A

Shigella induces apoptosis of host cells and spread to adjacent cells via protrusions created through host cell actin polymerization.

Clostiridium difficile toxin INACTIVATE RHO-REGULATORY PROTEINS, involved in signal transduction and actin cytoskeletal structure maintenance. Thus, there’s disruption of intercellular TIGHT junctions.

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86
Q

Ribosomal protein synthesis is inhibited by

A

Shiga and Shiga-like toxin( EHEC).

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87
Q

What is the pathogenic mechanism of cholera exotoxin?

A

Apical ion transport affected——-> increased transport of Na and Cl out of the gut mucosa cells leading to watery diarrhoea.

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88
Q

Roseola infantum caused by HHV-6,7

Jo meeru ko hua tha, what are its signs/symptoms?

A

Pehlay buhat taez bukhaar hota hai————> phir rash hota hai, aur rash starts on the TRUNK.
(Rosy-Ola)—> Rosy later!

(Rash appearing after fever has subsided also occurs in Parvovirus)

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89
Q

Erythema infectiosum is caused by which pathogen and what are its signs and symptoms?

A

It is caused by Parvovirus B19.

Pehlay flu hota hai, phirrr slapped cheek rash aur reticular truncal rash (cheeky smile—> because the kid feels better)

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90
Q

Axonal reaction?

A

Neuronal body becomes round, swollen and the nucleus is displaced to periphery.

Nissl substances become fine, granular, and dispersed throughout the cytoplasm. This is called CENTRAL CHROMATOLYSIS.

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91
Q

6 year old boy is brought to the ER due to confusion and intractable vomiting after taking Aspirin.

This is Reye’s syndrome. What will we see in the light microscopy of his liver specimen?

A

Microvesicular steatosis.

(presence of small fat vacuoles in the cytoplasm of hepatocytes.

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92
Q

Labs in Reye Syndrome?

A

Increased LFTs,
Increased ammonia,
Increased bilirubin,
Prolonged PT and PTT

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93
Q

Chest Tube placement to drain left sided pleural effusion.

Incision is at the 5th intercostal space in the mid axillary line. Which muscle will mostly likely by dissected?

A

Serratus Anterior

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94
Q

What do leprosy skin lesions demonstrate?

A

Increased IL-2 and interferon-gamma in skin lesions.

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95
Q

The cavitary lesion in TB, is formed due to which of the following mechanism?

A) Aggregation of activated leukocytes
B) Intraelveolar bacterial overgrowth

A

Aggregation of activated leukocytes

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96
Q

Culture on sabouraud agar can be done for detection of which pathogen?

A

Cryptococcus Neoformans.

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97
Q

Embryological cause of omphalocele or gastroschisis?

A

Failure of extraembryonic gut to return to the abdominal cavity.

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98
Q

Embryological Cause of congenital umbilical hernia associated with Down’s Syndrome?

A

Incomplete closure of the umbilical ring

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99
Q

Fate of umbilical hernia?

A

Spontaneous closure. Elective surgery around age 5.

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100
Q

Gross appearance of the following:

Umbilical Hernia—->
Gastroschisis———>
Omphalocele——>

A

Umbilical Hernia—-> Large midline abdominal protrusion, covered by skin that is more pronounced when he cries. The umbilical stump is at the center of protrusion.
Gastroschisis———> Eviscerated bowel with no covering membrane, beside umbilical cord.
Omphalocele——> Sac containing multiple organs. Umbilical cord at apex.

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101
Q

What is the pathway of heart failure because of systemic hypertension?

A

Systemic Hypertension——-> causes concentric LV Hypertrophy, ie. uniformly thickened left ventricular walls and a small LV cavity——-> leads to IMPAIRED DIASTOLIC FILLING AND HEART FAILURE WITH PRESERVED EJECTION FRACTION———> Elevated diastolic filling pressures are transmitted back to LA and cause left atrial dilatations predisposing it to Atrial fibirillation.

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102
Q

________________ can lead to dramatic reduction in left ventricular filling in patients of Diastolic HF and can precipitate ACUTE DECOMPENSATION.

(Pathological mechanism of acute decompensation in diastolic HF due to HTN)

A

Loss of Atrial contraction.

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103
Q

Cardiac amyloidosis and Concentric hypertrophy due to HTN————> Both cause impaired diastolic function, but what’s the difference?

A

In cardiac amyloidosis, the diastolic filling is impaired because of VENTRICULAR WALL STIFFENING.

In concentric hypertrophy, the diastolic filling is impaired because of VENTRICULAR WALL THICKENING.

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104
Q

Receptor X upon activation, cause immediate change in transmembrane Calcium, Sodium and Potassium flow secondary to opening of the channel. Receptor X is most likely which type of receptor?

A

Nicotinic cholinergic receptors found at motor end plate. These receptors are ION channels. One receptor has 2 Ach binding sites and will only open if both the sites are bound bu Ach. Then the ion channel opens, and causes:

Sodium and Calcium INFLUX
Potassium EFFLUX.

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105
Q

Which monosaccharide has the fastest rate of metabolism in the glycolytic pathway? And why?

A

FRUCTOSE-1-PHOSPHATE, because it bypasses phosphofructokinase enzyme which is an important regulatory enzyme of glycolysis.

Hence, fructose is metabolized by the liver fastest and is rapidy cleared from bloodstream following dietary absorption.

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106
Q

The prostatic plexus lies within the fascia of the prostate. It is made up for which nerves?

A

Inferior hypogastric plexus, with additional input from pelvic and sacral splanchnic nerve.

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107
Q

Injury to prostatic plexus results in?

A

Erectile dysfunction because the cavernous nerves coming from this plexus carry post-ganglionic Parasympathetic fibres that facilitate Penile erection.

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108
Q

68 year old woman is visiting her kids in Texas when she comes to ED due to confusion and flaccid paralysis of the left lower extremity with preserved sensation. What is the causative organism and what is its mode of transmission?

A

West Nile Virus causing meningitis/encephalitis and acute ASYMMETRIC flaccid paralysis.

Positive sense, single stranded RNA transmitted by mosquito CULEX SPP.

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109
Q

18 year old boy is brought to you in clinic, due to increasingly BIZARRE behaviour since the past 2 months. Doesn’t attend classes, doesn’t socialize, believes cafetaria food is poisoned. What is the diagnosis out of the following?

A) Brief Psychotic Disorder
B) Schizophreniform disorder
C) Schizophrenia
D) Delusional disorder.

A

A) Brief Psychotic Disorder- symptoms of schizophrenia for less than 1 month.
B) Schizophreniform disorder- CORRECT (symptoms have been there for more than a month, bur less than 6 months)
C) Schizophrenia- Symptoms should be for more than 6 months.
D) Delusional disorder.- The patient won’t act bizarre, just has a delusion.

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110
Q

Most likely mechanism of low serum phosphate in a patient of primary HyperPTH.

A

Decreased Phosphate reabsorption in proximal tubules.

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111
Q

Cause of clinical variability of mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes?

A

Heteroplasmy, the mixture of two types of genetic materials is the cause of clinical variability of mitochondrial diseases.

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112
Q

What is low-expression variability?

A

Variability in severity of autosomal dominant disorders, such as seen in Marfan Syndrome.

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113
Q

What down-regulates gastric acid secretion after a meal?

A

The third phase of stomach acid secretion called intestinal phase. Because of intestinal influences, the food upon reaching the ileum and colon releases PEPTIDE YY.
Peptide YY binds to ECLS which inhibit gastrin-stimulated histamine release from ECLs.

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114
Q

3 factors that reduce gastric acid secretion after a meal?

A

Intestinal influences, Somatostatin, Prostaglandins

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115
Q

Vitamin C deficiency clinical manifestation?

A

Normocytic normochromic anemia.

Normal PT, aPTT while bleeding gums and loose teeth are seen. Skin ecchymosis and hemarthrosis are also seen.

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116
Q

There is presence of Noncaseating granulomas on intestinal biopsy. What your choice for an effective treatment?

A

TNF-alpha inhibitors like infliximab, adalimumab are used as first-line therapy in the T/M of Crohn’s disease.

Becaused TNF-alpha production by macrophages plays a central role in the pathogenesis of CD.

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117
Q

On physical examination, the right pupil is 3 mm and the left pupil is 5 mm.
Anisocoria increases in dimmed room.

What is the most like location of the lesion?

A

Right oculosympathetic pathway.

If anisocoria increases in dim light, that means sympathetic pathway is affected. Sympathetic is needed to dilate, so smaller pupil is the one with defect.

Hence, right sided oculosympathetic pathway is damaged.

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118
Q

Chest x-ray shows pulmonary infiltrates and area of cavitation in upper lobe. Sputum microscopy shows acid fast bacilli. What’s the most accurate statement concerning the patient’s pulmonary infection?

A) First exposure to bacilli occurred recently.
B) Healing of lung lesion would result in Ghon Complex formation.
C) It originated from reactivation of an old infection.

A

A) First exposure to bacilli occurred recently- Primary TB mein focal lesion banti hai mid-to-lower lungs mein jissay kehtay hein Ghon Focus.
B) Healing of lung lesion would result in Ghon Complex formation- Ghon Complex formation primary TB infection meim hoti hai jabb Ghon focus bn jaata hai hai and with that there’s also hilar lymphadenopathy.
C) It originated from reactivation of an old infection- CORRECT. Cavitation means reactivated of TB.

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119
Q

The levels of which antibody will differ the most in two patients who are give Salk and Sabin separately and not both?

A

Duedenal Luminal IgA response is only seen in Sabin ( the oral polio vaccine).
As it is oral, it generates a much more robust and oropharyngeal and intestinal mucosal IgA response than the inactivated Salk poliovirus vaccine.

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120
Q

Lab Studies reveal AAT deficiency. What will be the patterns of the following pulmonary function parameters?

FEV1/FVC
Total Lung Capacity
DLCO

A

FEV1/FVC- obstructive so DECREASED.
Total Lung Capacity- EMPHYSEMA of all any sort causes INCREASED TLC because of hyperinflation of lungs.
DLCO- DECREASED.

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121
Q

Affect of Beta-blockers, other than on B-receptors when given for hyperthyroidism?

A

Inhibits peripheral conversion of T4 to T3

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122
Q

On autopsy, increased pigmentation is noted around the nipple areola and anal and vaginal mucous membranes. Which of the following additional findings are most likely to be seen on autopsy?

A

A) Atrophy of both adrenal

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123
Q

Gomori Trichrome stain for?

A

Muscle biopsy showing blotchy red muscle fibres are characteristic of mitrochondrial myopathies.

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124
Q

EM of mitochondrial myopathy will show?

A

INCREASED number of enlarged abnormally shaped mitochondria

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125
Q

Person with membranous nephropathy comes to you with complains of flank pain, hematuria and left vericocele likely has?

A

Renal Vein Thrombosis as a result of Nephrotic Syndrome.

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126
Q

Why is renal vein thrombosis a complication of nephrotic syndrome?

A

Due to loss of Anti-thrombin 3—-> hypercoagulable state.

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127
Q

Patient comes to you with 10-day history of abdominal pain and loss of appetite. Has a family history of colon cancer. Abdominal examination is significant for tenderness on deep palpation of the LLQ along with an appreciable mass. What is the cause of the abdominal pain?

A) Acute Diverticulitis
B) Colon Cancer
C) Ischemic Colitis

A

A) Acute Diverticulitis- CORRECT———> Leukocytosis and tenderness with or without palpable mass.
B) Colon Cancer- Tumour large enough to be palpated with manifest with more chronic symptoms like weight loss.
C) Ischemic Colitis——> common cause of abdominal pain in older patients. So it was a close call, but it presents as hematochezia and post-prandial pain.
(You stop the blood supply of organs and they start giving out blood—-> renal infarction presents with hematuria, Ischemia colitis presents with hematochezia sometimes when it is being experienced due to low blood supply)

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128
Q

45 year old woman with sores and abscesses on her arm, fecal bacteria was found in one of the sores. What’s the most likely cause of patient’s condition?

A) Factitious disorder
B) Conversion Disorder
C) Malingering.

A

A) Factitious disorder- CORRECT. Coming with facts, real chotein per khud ko lagaayi hon.
B) Conversion Disorder- Exxagerate kerna, per patient jhoot nahyin bol raha hota. Dimaghi masla hota hai.
C) Malingering- Jhoot bolna, exaggerate kerna symptoms ko.

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129
Q

Patient’s cyanosis that does not improve with supplemental oxygen has ____________________.

A

Acquired Methemglobinemia

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130
Q

Acquired methemoglobinemia’s 3 causes?

A
  1. Dapsone. (Cannot be given in G6PD, used for treatment of Dermitis herpetiformis.)
  2. Topical/Local Anesthetic——> Benzocaine.
    (MOA is??–> Inhibition of Na channels/ Na influx)
  3. Nitrates/Nitrites (Found in drinking ground water)
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131
Q

What do you see on calf biopsy of a patient of Duchenne Muscular Dystrophy?

A) Fibrofatty muscle replacement
B) Multiple lipid droplets within the muscle fibre

A

A) Fibrofatty muscle replacement- CORRECT. There’s myonecrosis in this condition, regenerating fibres with variation in shape and size are seen along with INCREASED amounts of Connective Tissue on LM.
B) Multiple lipid droplets within the muscle fibre—-> Tricky, but seen in carnitine palmitoyltransferase deficiency.

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132
Q

Patient with a cavitary lesion with an air-fluid level on chest x-ray, raising strong suspicion for _________________.

A

Lung Abscess

So, remember: Air fluid level in chest means Lung Abscess, Air fluid level in intestines/abdominal x-ray means—> intestinal obstruction.

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133
Q

What is the etiology of Subacute cerebellar degeneration?

Common in small cell carcinoma/oat cell—> so will present with mass in the lung

A

Autoimmune——-> Anti Yo, Anti Hu antibodies. Anti P/Q antibodies.

Paraneoplastic cerebellar degeneration is due to an immune response against tumor cells that cross-reacts with Purkinje neuron antigens, leading to acute-onset rapid degeneration of the cerebellum.

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134
Q

Paraneoplastic cerebellar degneration has what signs and symptoms?

A

Progressively worsening dizziness, limb and truncal ataxia, dysarthria and visual disturbances ( diplopia, oscillopsia)

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135
Q

Medication induced esophagitis can be due to which drugs?

A

Tetracyclines
Aspirin, NSAIDS.
BISPHOSPHONATES PLISS REMEMBER THISSSS.

Potassium Chloride, Iron.

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136
Q

Bisphosphonates are C/I in?

A

Conditions that impair esophageal motility such as stricture, achalasia.

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137
Q

What’s a peculiar side effect of bisphosphonates?

A

Osteonecrosis of jaw and atypical fractures of subtronchanteric zone and femoral shaft.

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138
Q

The cause of LVOT in HOCM?

A) Ascending aorta and interventricular Septum

B) Mitral Valve leaflet and interventricular Septum

C) Aortic Valve Cusp and Interventricular septum.

A

B) Mitral Valve leaflet and interventricular Septum- CORRECT.

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139
Q

Which one out of the following will lead to cancer because of an activating mutation?

A) APC
B) BRCA1
C) KRAS
D) RB
E) TP53
A

KRAS because it is a proto-oncogene.

An activating mutation causes cancer.

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140
Q

A lesion in Jugular foramen will cause?

A

Vernet/Jugular foramen Syndrome characterized by 9, 10, 11 dysfunction.

Lose of taste from posterior 1/3rd of tongue (CN 9)
Loss of Gag reflex and Dysphagia (CN 9,10)
Hoarseness, uvula deviating towards the normal side (CN10)

Sternocleidomastoid and Trapezius muscle paresis (CN11)—-> question will tell that shoulder is drooper on the affected side, and strength is reduced during shoulder shrug test

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141
Q

Hemotympanum in the right ear. The patient is greatest risk for injury involving which cranial nerve?

A

Hemotympanum can occur in temporal bone fracture and temporal bone also contains the FACIAL NERVE (CN 7)

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142
Q

Which tissue cannot utilize ketone bodies for energy?

A

Erythrocytes ONLY.

Even brain starts using ketone bodies in prolonged starvation

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143
Q

Patient comes to you with hypotension, tachycardia and jugular venous distension. Also, pulsus paradoxus after a recent upper respiratory viral infection.

A) Cardiac Temponade
B) Constrictive Pericarditis

A

A) Cardiac Temponade- CORRECT.
B) Constrictive Pericarditis- Pulsus paradoxus can occur in this too, but this condition takes several weeks to months to develop. Ans kussmaul sign is a MUST mention for us to diagnosse this.

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144
Q

28 year old man, comes with muscle weakness and headaches (Hypokalemka and Hypertension). His BP is 190/120. His plasma renin and aldosterone are elevated. What’s the most likely cause?

A) Adrenal Cortical Tumour
B) Juxtaglomerular cell Tumour

A

A) Adrenal Cortical Tumour (Conn’s Syndrome) - will cause primary Hyperaldosteronism- Increased Aldo will inhibit Renin production, and Renin will be drecreased.
B) Juxtaglomerular cell Tumour- CORRECT——> Renin and Aldosterone both increased.

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145
Q

A person with traumatic brain injury during a motor vehicle collision comes to ED. One day later, a repeat head CT scan reveals diffuse cerebral edema. The ventilator respiratory rate is adjusted to achieve a PaCO2 of 26-30 mm Hg. What will be the effect of this ventilation?

A

Diffuse cerebral edema will cause an INCREASED ICP.

Lowering PaCO2 to reduce ICP in mechanically ventilated patients with cerebral edema is a trick/intervention in the ICU because this would cause cerebral vasoconstriction and hence, reduced cerebral blood flow leading to reduced ICP.

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146
Q

Mechanism of action of Triamterene?

A

Blocking renal tubular epithelial Sodium Channels.

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147
Q

Cytosine Deamination is repaired by what?

A

Base Excision repair.

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148
Q

Tell the enzymatic sequence of Base Excision Repair?

A

Glycosylase—->endonuclease——->lyase——-> DNA polymerase——-> Ligase

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149
Q

Foot drop is due to which nerve?

A

Common fibular/peroneal nerve——-> question stem will say weakness in foot dorsiflexion and eversion.

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150
Q

How can common peroneal nerve be damaged?

A

Trauma to knee and tightly applied plaster casts due to its superficial location at the neck of the fibula.

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151
Q

Patient who is on sulfonylurea and ACE inhibitor, starts taking a weight loss supplement which she believes is completely herbal and contains caffeine. What do you do?

A

Offer to review the ingredients with the patient and discuss potential risks of the supplements.

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152
Q

What is defective in Androgen insensitivity syndrome?

A

In AIS, there’s loss of feedback inhibition of GnRH, FSH, LH due to destruction of Androgen receptors in hypothalamus and pituatary.

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153
Q

Labs in androgen receptor dysfunction?

A

Oligosepermia, FSH normal aur baaki Sabb increased ( Testosteron, LH)

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154
Q

Delayed Typer HSR in candida is due to which cells?

A

CD 8+

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155
Q

Greatest risk of cavernous hemangioma is the development of?

A) Intracerebral Hemorrhage
B) Subarachinoid Hemorrhage
C) Subdural Hematoma

A

A) Intracerebral Hemorrhage- CORRECT, as they are so thin-walled they have the tendency to bleed into brain paranchyma.
B) Subarachinoid Haemorrhage- caused by ruptured saccular aneurysms.
C) Subdural Hematoma- most commonly by head trauma when bridging veins in subdural space are ruptured.

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156
Q

Exclusively breastfed childen need the supplementation of which vitamin?

A

Vitamin D

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157
Q

What changes will you see in arteriovenous fistula formation?

A

Low resistance fistula pathway REDUCES SYSTEMIC VASCULAR RESISTANCE——-> Reduced afterload.

Blood passes through quickly in reduced peripheral resistance——-> Increased preload.

INCREASED STROKE VOLUME due to reduced afterload and increased preload, helps maintain blood pressure.

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158
Q

Arteriovenous malformations cause high-output heart failure, why?

A

The left ventricle is unable to keep up with the increased venous return despite a sustained increased in cardiac output/Stroke volume.

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159
Q

Arteriovenous malformations are found in which conditions?

A

Osler-Weber-Rendu Syndrome/Heriditary Hemorrhagic telengectasia- Arteriovenous malformations in brain that have a tendency to rupture and cause Subarachnoid Hemorrhage.
(These people present with Telengectasia of skin, GI bleeding or Epistaxis, and is AUTOSOMMAL DOMINANT.)

Osteitis deformans/Paget’s disease of Bone.

Acquired after a traumatic injury.

Surgical placement for hemodialysis.

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160
Q

If marginal artery from IMA is ligated in a surgery, which artery’s collaterals prevent ischemia of the descending colon?

A

SMA

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161
Q

In a pregnant women, the INCREASE in insulin resistance is primarily due to the action of _____________________ a peptide hormone, secreted by the _________________.

A

Human placental Lactogen

Syncytiotrophoblast.

162
Q

Strep pyogenes causing Glomerulonephritis after cellulitis/Erysiplas——-> The organism responsible for patient’s symptoms would demonstrate which of the following?

A) Bile Solubility
B) Catalase Positivity
C) Growth in hypertonic saline
D) Optochin Sensitive
E) PYR positive
A 
A) Bile Solubility
B) Catalase Positivity
C) Growth in hypertonic saline- Only enterococci, which causes IE after GU procedures.
D) Optochin Sensitive
E) PYR positive- CORRECT ANSWER.
163
Q

Patient injured his leg while operating a motorized watercraft on the ocean near Florida 2 days ago. Dorsum of foot shows a small laceration, surrounding with hemorrhagic Bulla. Wound Culture yields curved gram-negative rods. What is the greatest risk factor for this patient’s infection?

A

The patient has gotten cellulitis due to Vibrio fulnicus. Vibrio fulnicus lives in salty water and is a curved gram negative rod. Causes wound infection with necrotising fasciitis and HEMORRHAGIC BULLAE.

Patients with IRON OVERLOAD are are greatest risk of getting infected, because iron acts as a growth catalyst for this bacteria.

164
Q

The joint destruction in RA is characterised by _____________ and ____________.

A

Synovial hyperplasia and inflammatory infilteraretes (often containing lymphoid follicles)

165
Q

Early onset Alzheimer’s disease in Down’s syndrome people due to am extra 21 chromosome is due to which gene?

A

The APP GENE

Amyloid precursor protein

166
Q

H pylori lives in which specific part of the Stomach?

A

Gastric antrum

167
Q

Mechanism of ulcer formation in H pylori infection?

A

Colonization of the gastric antrum is associated with DECREASED SOMATOSTATIN———> Causing increased acid production by parietal cells.

168
Q

After 15 minutes, the skin at the site with peanut extract is erythamatous with a raised, itchy bump that improves by the time the family leaves the office. 4 hours later, the parents notice a HARD, RED SWELLING at the puncture site. What is most likely involved in this secondary reaction?

A

Epithelial damage by major basic protein.

Th2 xells release IL-5 to activate eosinophils——-> eosinophils release major basic protein, eosinophil peroxidase

169
Q

65 year old man is evaluated for HYPOTENSION,SHORTNESS OF BREATH, TACHYCARDIA AND TRACHEAL DEVIATION shortly after placement of subclavian central venous catheter.

What is the diagnosis? And the cause of hypotension?

A

The diagnosis TENSION PNEUMOTHORAX, because of close proximity to the apex of lung, there is risk of lung puncture during the procedure.

170
Q

Which particular pressure changes in tension pneumothorax but stays the same in simple pneumothorax?

A

In simple, pneuomothorax as air rushes into the pleural space, it leads to LOSS OF INTRAPLEURAL NEGATIVE PRESSURE and pressure equalisation——> i.e. intrapleural pressure is almost equivalent to lung pressures and doesn’t change progressively.

In Tension pneumothorax, intrapleural pressure keeps on increasing progressively with each breath.

171
Q

Clinical triad of Fat Embolism syndrome?

A
  1. Confusion/ acute onset neurological abnormalities
  2. Hypoxemia (Will present has SOB)
  3. Petechial Rash
172
Q

Cause of petechial rash in fat embolism?

A

Fat emboli-associated microvascular occlusion in dermal capillaries——> extravasation of erythrocytes————> petechial rash

173
Q

Elevated Postassium and Cardiac Arrythmia is a presentation of __________________ in a patient being treated for Atrial Fibrillation and Congestive Heart Failure.

A

Digoxin toxicity.

Digoxin toxicity causes hyperkalemia due to inhibition of Na-K-ATPase pump and that results in increased extracellular potassium.

174
Q

Mother doesn’t agree to som get erythromycin antibiotic as she says she doesn’t have STD.
What do you say to her?

A

Giving Medication to a healthy baby may seem unusual and unnecessary; let’s talk about why this treatment is recommended for all newborns.

175
Q

What do you see on a gross specimen of lung of a CF patient?

A

Bronchiectasis——> thickened and dilated bronchioles.

Mucus plugging.

176
Q

Fatal Hemoptysis in CF, what is the cause?

A

Rupture of hypertrophied Bronchial arteries.

177
Q

Hemorrhage from a highly vascular endobronchial tree tumour. presents with hemoptysis commonly.

A

Carcinoid tumour

178
Q

The antigenic target of anti-thyroid peroxidase antibodies is involved in which process?

A

Thyroglobulin iodination

179
Q

In a mid-clavicular fracture, why is the lateral clavicle pulled downwards?

A

Deltoid

180
Q

In a mid-clavicular fracture, why is the medial clavicle segment pulled upwards?

A

Trapezius

181
Q

What changes will Mannitol administration bring to the following:

A) Serum Na Conc
B) Renal Tubular flow
C) Glomerular filterate osmolality

A

A) Serum Na Conc- DECREASED. The cause is dilutional hyponatremia as warer moves from intracellular space into the plasma.
B) Renal Tubular flow- INCREASE as plasma volume expansion occirs.
C) Glomerular filterate osmolality- INCREASED.
As Mannitol filters freely through the glomerulus, so the glomerular filterate will now by hyperosmolar

182
Q

Pathogenesis of cerebral edema after an ischemic stroke?

A

Failure of ATP-dependant ion transporters.

( Accumulation of intracellular Na and water in neural and glial cells, along with release of excitatory AA such as glutamate———> causes cerebral edema)

183
Q

The great Saphenous vein should be accessed at which site?

A

Just inferolateral to the pubic tubercle.

184
Q

Risk of statin-associated myopathy is maximum with which of the following drug combinations?

A) Atorvastatin and ezetimibe
B) Atorvastatin and gemfibrozil
C) Niacin and Ezetimibe

A

A) Atorvastatin and ezetimibe
B) Atorvastatin and gemfibrozil- CORRECT, maximum risk with THIS combination because gemfibrozil impairs hepatic clearance of statins
C) Niacin and Ezetimibe

185
Q

DIC labs?

A

Elevated D-Dimer, prolonged PT, aPTT.

Low plasma fibrinogen.

186
Q

Which leukemia is associated with DIC and what is the translocation and abnormal gene involved?

A

APML/ M3 variant of AML
(Acute Promyelocytic Leukemia)
T (15; 17)

Codes for abnormal Retinoic acid receptor which then inhibits myeloblast differentiation.

187
Q

Tumour cells invade the Basement membrane via enhanced secretion of ________________ and ______________.

A

Metalloproteinases and Cathepsin D protease.

188
Q

Tumour cells ADHERE to Basement Membrane, that is facilitated by INCREASED expression of ____________.

A

Laminin.

189
Q

Tobacco smoke is the MOST important risk factor for which 3 cancers?

A

Pancreas, Renal and Bladder cancer.

190
Q

Bacterial vaginosis treatement?

Tell both drugs and they are bacteriostatic or bacteriocidal?

A

Clindamycim (Bacteriostatic) and Metronidazole (Bactericidal as damages the DNA of facultative anaerobes)

191
Q

Sorbitol by sorbitol dehydrogenase is converted into?

A

FRUCTOSE.

YOU DID THIS WRONGGG. WHYYYY

192
Q

Autopsy reveals B/L hemorrhagic necrosis of the inferior and medial TEMPORAL LOBES.
What is the most likely cause of the infection?

A

HSV.

Behan, yeh sketchy mein hai phir bhee ghalat kiya tha tumnay

193
Q

Anti-parkinson drugs have caused a person to have abrupt onset IMPULSE CONTROL DISORDER
(Such as gambling, compulsive buying, compulsive sexual behaviour) WHYY?

A

Stimulating dopamine activity by central dopamine receptors.

(Stimulating dopamine activity in ventral striatum, which includes nucleus accumbens which is involved in motivation and reward pathways) and substantia nigra

194
Q

Initiation of allopurinol with which immunosuppressant drug causes increased risk of cellular toxicity?

A

Azathioprine. (Inhibits conversion of prpp into imp)

195
Q

Commom Side effects associated with drugs prescribed to a kid of ADHD, that parents should he educated about?

A

Decreased appetite, weight loss and INSOMNIAAAA.

196
Q

Which pathogen is the most common cause of bacterial meningitis in adults of all ages?

A

Strep pneumoniae

197
Q

Cause of DIC in obstetrics?

A

In pregnancy, DIC is mediated by release of tissue factor/thromboplastin into maternal circulation.

Tissue factor is round in high concentration in placental trophoblast.

198
Q

Which TCA cycle reaction will be defective in an alcoholic?

A

Alcoholics have thiamine deficiency.

And conversion of alpha-ketoglutarate to Succinyl CoA is a thiamine dependant reaction in TCA cycle.

199
Q

Neurological symptoms of __________ closely mimic _________, because there’s loss of dorsal columns, spinocerebellar tracts and loss of deep tendon reflexes due to peripheral nerve degeneration.

A

Vitamin E deficiency closely mimics Friedreich Ataxia.

200
Q

Wernicke-korsakoff Syndrome, which part of brain is damaged?

A

Mamillary bodies( with medial temporal lobe), dorsomedial thalamus.

201
Q

What is the dysfunction in wernicke-korsakoff Syndrome that is immediately reversible upon thiamine infusions?

A

Oculomotor dysfuntion.

202
Q

How does the oculomotor dysfuntion manifest in wernicke-korsakoff syndrome?

A

Horizontal nystagmus, and B/L abducens palsy.

In the vignette, it is described as horizontal nystagmus evoked on lateral gaze with B/L weakness of lateral rectus muscles.
(CN 3 and 6 are affected)

203
Q

PDA is associated with a __________ murmur best heard at _______________ with maximal intensity at ____________.

A

Coninuous machine like murmuer, best heard at left infraclavicular region with the maximal intensity at S2

204
Q

Patient says “Antibiotics always seem to help me feel better fast”
What do you say?

A

Feeling sick can be unpleasant; let’s talk about why antibiotics are not recommended and what treatments can help you feel better.

205
Q

Pheobe’s personality type is?

you did this wrong thrice

A

Schizotypal personality disorder.

206
Q

Thiazide diuretics cause (Hypercalcemia/Hypocalcemia) and (Hypercalciuria/Hypocalciuria)

A

Thiazide diuretics increase renal Ca reabsorption leading to Hypercalcemia and Hypocalciuria.

(Anjum auntie takes a Thiazide diuretic and she has the strongest bones!!)

207
Q

Cardiogenic shock,

What happens to the following?

A) Cardiac contractility
B) SVR
C) Pulmonary artery systolic pressure/ PCWP

A

A) Cardiac contractility- Decreased.
B) SVR- INCREASED- extremities are cold and clammy.
C) Pulmonary artery systolic pressure/ PCWP- INCREASEDDDD.

208
Q

Campylobactor jejuni can be caused due to undercooked poultry, but due to one more thing?

A

Direct contact with domesticated animals, such as puppies from kennels.

209
Q

__________________ withdrawal is characterized by rebound anxiety, tremor, insomnia and sympathetic hyperactivity (diaphoresis, palpitations). In severe cases, it results in hallucinations, delusions and seizures.

A

Benzodiazepines (eg. Lorazepam)

210
Q

EM of pheochromocytoma?

A

Shows dense membrane-bound granules containing catecholamines.

211
Q

Multiple myelome patient is at a greatest risk of?

A

Amyloidosis

212
Q

What is the cause of perinuclear clearing/perinuclear paleness in plasma cells seen in the BM of a multiple myeloma patient?

A

Well-developed golgi apparatus.

213
Q

What will the brain autopsy of PKU patient show?

A

Pallor of substantia nigra, locus ceruleus, and vagal nucleus dorsalis.

214
Q

Gastrointestinal adenocarcinoma is associated with which 3 dermal conditions?

A

Leser-Trélat sign- Sudden onset of multiple seborrheic keratosis ( Due to INCREASED IGF-1 and, FGF)

Acanthosis nigricans

Dermatomyositis.

215
Q

Two dermal conditions in which the lesions are always on extensor surfaces?

A

Dermitis herpetiforimis (IgA deposition on the tips of–> dermal papillae—->associated with celiac disease)–>treated with dapsone

and psoriasis–> Treated with methotrexate (asked in NBME 16)

216
Q

In which two dermal lesions, NUMBER OF MELANOSOMES is increased?

A

Freckles, and Café-au-lait spots.

217
Q

Café-au-lait spots are seen in which diseases?

A

McCune Albright Syndrome (Activating Mutation in Gs protein)- U/L café-au-lait spots seen.

NF1

Fanconi anemia (genetic loss of DNA crosslink repair)

(Fanconi and BRCA1 mutations are basically mutations in Homologous recombination)

218
Q

Earliest finding of Rheumatoid Arthritis?

A

Synovial neovascularization!!

219
Q

Story for Acute leukemia.

Uworld table is there.

A

Acute leukemia is characterized by Bone marrow blasts.
Now blasts can be of two types, MYELOBLASTS OR LYMPHOBLASTS.

Myeloblasts are MPO+/Auer rods seen.
(Milo aurrr peenay ko dil chaahta hai)

Lymphoblasts are TdT+ in nucleus( DNA polymerase). Lymphoblasts per agar CD number chota hai tou that’s T-cell type, agar barra hai tou that’s B-cell type.

220
Q

Hairy Cell leukemia manifests as?

A

Massive Splenomegaly in 54 year old.

Dry tap on BM aspiration.

TRAP+

Treatment is ADA inhibitor CLADRIBINE

221
Q

Bcl-2 and bcl-xl are proapoptotic or antiapoptotic?

A

Buckles rok kay rakhtay hein bhaee tummy ko.

So ANTI-APOPTOTIC.

222
Q

Bcl-2 overexpression is seen in?

A

Follicular lymphoma (T 14:18) and Diffuse Large B cell Lymphoma.

(Both are neoplasms of mature B cells)

223
Q

Mantle Cell Lymphoma’s translocation and problem?

A

Overexpression of Cyclin D1

Translocation (11:14)

Mazay ki baat, common in Adult males so MAN.

CD5+

224
Q

Cardiac temponade on echo?

A

Right Ventricular Collapse in early diastole is seen.

This is when intracardiac pressure is the lowest.

225
Q

What will be the following echocardiographic findings in a person with amyloid cardiomyopathy?

A) Left Atrial Cavity Size
B) Left Ventricular Cavity Size
C) Left Ventricular wall thickening
D) Left ventricular relaxation

A

A) Left Atrial Cavity Size- DILATED.
B) Left Ventricular Cavity Size- NOT DILATED, this is the one with the problem!
C) Left Ventricular wall thickening- INCREASED. I knoww weird, stiffening and thickening BOTH.
D) Left ventricular relaxation- Impaired.

226
Q

Intense endurance training in an athlete’s heart, will bring about what changes in the following as compared to normal heart:

Left Atrium Cavity Size
Left Ventricular Cavity Size
Left Ventricular Wall Thickness
Left Ventricular relaxation
Ejection Fraction
Maximal Cardiac Output
A

Left Atrium Cavity Size- Normal/Not dilated.
Left Ventricular Cavity Size- DILATED.
Left Ventricular Wall Thickness- INCREASED.
Left Ventricular relaxation- Normal
Ejection Fraction- Unchanged
Maximal Cardiac Output- Increased

227
Q

What changes will you see in the following in Mitral Stenosis?

Left Atrium Cavity Size
Left Ventricular Cavity Size
Left Ventricular Wall Thickness
Left Ventricular relaxation

A

Left Atrium Cavity Size- DILATED
Left Ventricular Cavity Size- NORMAL
Left Ventricular Wall Thickness- NORMAL
Left Ventricular relaxation- NORMAL

228
Q

What changes will you see in the following in dilated cardiomyopathy?

Left Atrium Cavity Size
Left Ventricular Cavity Size
Left Ventricular Wall Thickness
Left Ventricular relaxation

A

Dilated cardiomyopathy causes CONTRACTILE DYSFUNCTION.
So, wall thickness and relaxation will be normal.

Left Atrium Cavity Size- INCREASED
Left Ventricular Cavity Size- INCREASED.
Left Ventricular Wall Thickness-NORMAL
Left Ventricular relaxation-NORMAL

229
Q

The best method for determining whether a gene is undergoing transcription is to analyze the presence of it ________ using a ___________ blot.

A

mRNA, Northern Blot.

230
Q

One month old baby comes with a history of PERSISTENT JAUNDICE, with MUSCLE RIGIDITY AND SEIZURES. What is the disease and the defect?

A

The disease is Crigler-Najjar.
Presents early in life (The baby is so smollllll)

There’s unconjugated bilirubin being thrown into blood because of LACK OF UDP-Glucuronosyltransferase.

231
Q

Conjugated hyperbilirubinemia seen in a baby, which two diseases can be the cause?

A

Dubin-Johnson or Rotor Syndrome.

232
Q

Dubin-Johnson and Rotor Syndrome are due to defective liver excretion of conjugated Bilirubin. And how is that written in uworld?

A

1) Defective hepatocellular excretion of bilirubin glucoronides due to a mutation in canalicular membrane transport protein.
2) impaired canalicular bile transit

233
Q

Drug of abuse that presents with RAPID IMPROVEMENT OF THE INITIAL SYMPTOMS and perinasal as well as perioral rash?

A

Inhalants.

The dermatitis/ rash is known as Glue Sniffer’s rash.

234
Q

Kid eats Mushroom that has a poision which stimulates muscarinic receptors.
Which of the following is a direct effect of this poision?

A) NO synthesis
B) Pupillary Dilation
C) Reduced Salivation.

A

NO synthesis- CORRECT. M3 stimulation causes Parasympathetic activity and NO synthesis leads to vasodilation!

235
Q

Person gets very mild dengue fever when goes to Mexico 5 years ago. But presents to you with very severe symptoms of Dengue when comes back from Mexico now. What is the mechanism of patient’s current severe illness?

A

Secondary Infection with a different viral serotype causes more sever illness because of ANTIBODY DEPENDANT ENHANCEMENT OF INFECTION, ENHANCED IMMUNE COMPLEX FORMATION, and ACCELERATED T LYMPHOCYTE RESPONSE.

236
Q

Pathway of embolus causing cherry-red spot in the macula with surrounding retinal whitening?

A

That means, central retinal artery occlusion.

Internal Carotid Artery——-> Ophthalmic artery——> Retinal artery.

237
Q

The patient’s serum fails to agglutinate horse erythrocytes. The agglutination test is repeated a week later and, again, no agglutination is noted. What does this mean?

A

This means NEGATIVE MONOSPOT test. Infectious Mononucleosis like syndrome due to CMV in characteristic of a negative monospot test.

238
Q

The difference between infectious mononucleosis caused by EBV vs CMV

A

Infectious Mononucleosis caused by EBV will atleast have ONE POSITIVE MONOSPOT TEST. In the beginnning, sometimes the Monospot test doesn’t come positive in EBV. Sore throat and Lymphadenopathy MUST.

Infectious Mononucleosis caused by CMV will never have a positive monospot test. Lack of Sore throat and Lymphadenopathy. Can be caused by blood-transfusion because CMV affects leukocytes of granulocyte-macrophage lineage.

239
Q

causes of heterophile antibody-negative mononucleosis-like syndromes include:

A

CMV, human herpesvirus-6, HIV, and toxoplasmosis.

240
Q

Dependant segments of lung while lying down? Right Lung is more more to aspiration or left lung?

A

Posterior segment of upper lobe, superior segment of lower lobe.

Right Lung is more prone to Aspiration.

241
Q

Erythema Nodosum?

A

Tender Subcutaneous Nodules on Lower extremities.

242
Q

In which conditions is Erythema Nodosum seen?

A

Coccidioidomycosis, sarcoidosis, Ulcerative Colitis, Crohn’s and BEHCET’S SYNDROME.

243
Q

What is the likely mechanism triggered in Anaphylaxis?

A) Anibody dependant Cell-mediated Cytotoxicity
B) CD8+ T lymphocytes- mediated Hypersenstivity
C) Cell surface-bound antibody bridging by Antigen

A

A) Anibody dependant Cell-mediated Cytotoxicity- Happens in Type 2 HSR
B) CD8+ T lymphocytes- mediated Hypersenstivity- Happens in Type 4 HSR.
C) Cell surface-bound antibody bridging by Antigen- CORRECT

244
Q

_________________ the most common type of cardiac defect in patients with Down syndrome

A

complete atrioventricular (AV) canal defect, the most common type of cardiac defect in patients with Down syndrome

245
Q

Features of complete AV Canal defect?

A

Failure of endocardial cushion fusion, results in:

1—> Ostium Primium ASD
2—-> VSD
3—–> Single AV valve/Common AV Valve.

246
Q

Auscultatory findings of Complete AV Canal defect?

A

There is AV Valve regurgitation—> So, that will present as holosystolic murmur at apex (The vignette said hyperdynamic precordium)

and INCREASED Pulmonary Venous Return——> Presents as Mid diastolic rumble at LSB

247
Q

patients with severe emphysema are expected to have ___________?
(You need to stop doing this wronggg)

How is their mizaaj when they are talking? (Hint)

A

Patients with severe emphysema are expected to have chronic respiratory acidosis with metabolic compensation

248
Q

What effects the absorption of levothyroxine?

A

Soy products
Iron
Calcium
antacids

249
Q

Labs in congenital Hypothyroidism?

A

INCREASED TSH, but DECREASED free thyroxine/T4

250
Q

Most common benign vascular tumour in children vs most common benign vascular tumour in adults?

A

In children, it is strawberry (capillary) hemangioma.

In adults, it is cherry hemangioma.

251
Q

Histology of a Cherry Hemangioma?

A

Dilated capillaries and post-capillary venules are seen in the papillary dermis.

252
Q

Most common cause of sudden cardiac death?

A

Ventricular fibrillation causing acute MI leads to SCD.

You did, embolic stroke. Embolic stroke doesn’t typically lead to SCD.

253
Q

2 brain tumours in children that occur in cerebellum, and how do they appear differently on MRI?

A

Pilocytic Astrocytoma and Medulloblastoma both occur in cerebellum.
Pilocytic Astrocytoma is more of CYSTIC AND SOLID, so will appear BLACK AND WHITE on MRI.

Medulloblastoma is a SOLID tumor, it appear white on MRI.

254
Q

Dihydrorhodamine flow cytometry testing reveals an absence of the green fluorescence produced by normal neutrophils. This patient’s condition is most likely due to impaired activity of which of enzyme?

A

NADPH Oxidase.

255
Q

Physical examination shows a laterally directed anterior chest wall stab wound at the fifth intercostal space along the left midclavicular line. Which of the following structures is most likely to have been injured in this patient

A

Left lung

256
Q

Global ischemia of the brain for 3 minutes only will damage what in the brain sabb sey pehlay?And how will the patient present?

A

CA1 pyramidal neurons of the hippocampus, which can be damaged by ischemia in as little as 3 minutes.

Inability to make new memories (anterograde amnesia), disoriented to time and place.

257
Q

How does a HepB vaccinated person, fight off future HepB infection upon needle-stick exposure?
(What’s the mechanism of immunity provided upon a vaccinated person when he gets exposed to needle stick prick of HepB blood?)

A

Vaccination is upon HBsAG, HepB surface antigen is the glycoprotein on the surface of the virus, that mediates virus attachment and entry into hepatocytes.

So, the antibodies produced against new exposure in an already vaccinated person prevent/impair virion entry into Hepatocytes.

258
Q

In patients exposed to HBV, the resolution of acute infection is mediated primarily by a vigorous, polyclonal ______________________ response that destroys infected hepatocytes.

A

Cytotoxic T-cell response.

259
Q

Procedure of acid-fast staining of Mycobacteria?

A

Acid-fast staining means that the pathogen holds onto the dye/stead-fast even upon being treated with an acid and alcohol.

Mycobacteria and Nocardia once takes up aniline dye (carbolfuschin), doesn’t decolorize even when it is treated with Hcl and Alcohol.

260
Q

Truncating mutations (usually nonsense mutations) affecting the _____________ are the most common cause of familial DCM.

A

TTN gene, which encodes for the sarcomere protein titin. Titin is an elastic protein, which anchors beta-myosin heavy chains to Z-disks. Titin is the cause of passive myocardial tension.

261
Q

Oral thrush is treated by?

A

Nystatin

262
Q

Bite cells are found in which disease, and how are they formed?

A

Bite cells are found in G6PD deficiency as well as Glutathione reductase deficiency.

Bite cells are formed when splenic macrophages remove Heinz bodies from erythrocytes.

263
Q

What are Hein bodies?

A

Heinz bodies are intraerythrocytic inclusions of OXIDIZED HB CONGLOMERATES.

264
Q

Patient says: “Doctor, please don’t tell me if the tests say cancer.”
What would you say to the patient?

A

Tell me more about your concerns, so I can better understand why you feel this way.

265
Q

Jetlag is due to the release of substannces by which hypothalamic nucleus?

A

Circadian rhythms are maintained by the suprachiasmatic nucleus (SCN).

It releases cortisol (stress-hormone) and melatonin (sleep-inducing hormone).

266
Q

GFR with the help creatinine clearance is measured of two people. The serum creatinine of each one of them is 1.1 mg/dl. GFR estimated via an equation reveals one has a GFR of 118 ml/min and the other has 70 ml/min. What is the cause of this difference in GFR?

A

Skeletal Muscle mass–> Creatinine is a waste product of muscle breakdown.
Therefore, patients with lower muscle mass or reduced dietary meat intake may have significantly lower GFRs for any given creatinine level. Because they have to get less creatinine out the body, so when the equation is used it shows less GFR.

267
Q

Person, has high aldosterone and low rennin. What will be the levels of the following?
Serum Potassium
Serum Sodium
Serum bicarbonate

A

This scenario is of hypokalemic alkalosis.
Serum Potassium- low
Serum Sodium- Normal
Serum bicarbonate- high

268
Q

A 4-year-old boy is brought to the office with 3 days of fever, irritability, and oral lesions. His parents are concerned due to his refusal to eat or drink and lack of urination today. Physical examination demonstrates painful ulcers on the tongue and gingiva, swollen gums, and cervical lymphadenopathy.Which of the following is the cause of patient’s condition?

A) Latent Infection
B) Primary infection
C) Virus Reactivation

A

A) Latent Infection- shows no clinical symptoms
B) Primary infection- CORRECT.—> HSV causing gingivostomatitis.
C) Virus Reactivation- HSV reactivation causes herpes labialis. In herpes labialis the lesions are mild, unilateral and only on lips.

269
Q

14 year old boy presents with Flesh coloured nodules seen on lips and tongue. Marfanoid Habitus. Had a thyroidectomy 5 years ago.

A

Men 2B

Medullary thyroid cancer (calcitonin)
Pheochromocytoma
Mucosal neuromas/marfanoid habitus

270
Q

Patient of BPH comes with gross hematuria, what must be the cause?

A

Microscopic/Gross Hematuria can result in patients of BPH due to formation of new friable blood vessels formed in area of prostatic hyperplasia.

271
Q

Cytoscopy done in a patient of BPH shows

A

Increased detrusor wall trabeculations due to detrusor muscle hypertrophy.

272
Q

How does interstitial cystitis present as?

What will the cytoscopy show?

A

More common in females.
No hematuria
SUPRAPUBIC PAIN, specially when the bladder is full. Pain gets better upon voiding.

Cytoscopy shows patchy erythema and petechiae.

273
Q

Pacemaker action potential, depolarization is due to?

A

Large increase in Calcium Influx.

274
Q

Most common gene mutation associated with Polycythemia Vera and what does it cause?

A

The mutation is V617F involving the JAK2 gene, which is involved in signal transduction. The mutation makes HEMATOPOEITIC CELLS MORE SENSITIVE TO GROWTH FACTORS LIKE ERYTHROPOEITIN AND THROMBOPOEITIN.

275
Q

Classic labs of primary Polycythemia Vera?

A

Increased red cell mass, with decreased erythropoetin.

276
Q

18 year old suddenly collapses on the ground while playing Soccer. He has been experiencing fatigue, and exertional dyspnea since the past weeks. Which of the following will be seen on cardiac autopsy?

a) Dilatation of all cardiac chambers with flabby ventricular walls
b) Myocardial Hypertrophy with patchy interstitial fibrosis

A

a) Dilatation of all cardiac chambers with flabby ventricular walls- This is also close, and points towards DCM. But a patient of familial DCM also present with orthopnea, leg swelling and they won’t be able to participate in strenuous activities like soccer!!!
b) Myocardial Hypertrophy with patchy interstitial fibrosis- CORRECT. The person has HCM because it is the most common cause of SCD in young people.

277
Q

Which pathogens produce toxins that increase cyclic cGMP?

A

Heat stable toxin of ETEC and Yersenia enterolitica.

278
Q

What do Shiga and Shiga like toxin of EHEC do?

A

Halt protein synthesis by binding to 60S ribosomal units of infected cells.

279
Q

What is the difference between appendicitis causing vague midline pain and appendicitis causing severe pain at a point 2/3 between umbulicus and ASIS?

A

The vague midline pain in appendicitis is due to visceral pain. Visceral pain is carried by ANS. Because there’s activation of ANS, this pain is accompanied by nause, vomiting and sweating.

As appendix becomes for inflammed it irritates parital peritoneum and that results in severe pain with rebound tenderness.

280
Q

2 causes of appendicitis presenting as pain with hip extension?

A

Inflammed appendix lies against right psoas muscle

Retrocecal orientation of appendix.

281
Q

In temporomandibular joint, which nerve causes the jaw joint referred pain to ear?

A

Mandibular Branch of Trigerminal Nerve.

Why do you always do this wrong?

282
Q

In addition to having endometrial glands with hemosiderin pigment, one of the biopsies contains simple cuboidal epithelial cells. Which of the following is the most likely site of the biopsy?

A

This is endometriosis. Ectopic endometrial tissue found in ovary.
As ovaries have simple cuboidal epithelium.

283
Q

Patient has increasing neck and lower back pain, most severe in the morning. Her pain improves as the day passes. There’s tenderness over lumbosacral area and at the insertion site of the Achilles Tendon. What will be raised in serum?

A

Pain that improves with exercise and not rest, and tenderness of insertion sites of tendons (enthesitis) is characteristic of Ankylosing Spondylitis.
There’s upregulation of IL-17, TNF-alpha.

284
Q

Which enzyme degrades heme into green colour substances that causes the bruise to turn green in colour?

A

Heme Oxygenase converts Heme into Biliverdin which is green in colour.

285
Q

Which enzyme and substance is the cause of yellow colour of a bruise?

A

Biliverdin Reductase converts Biliverdin into Yellow Pigment Bilirubin.

286
Q

Fever, maculopapular rash, and acute renal failure (eg, elevated creatinine, oliguria) occurring within a few weeks of starting a beta-lactam antibiotic are highly suggestive of _____________________.

A

Drug Induced Acute Interstitial Nephritis.

287
Q

What will be the lab findings of urine in Acute Interstitial Nephritis?

A

WBCS AND WBC CASTS IN URINE, RBCS IN URINE.

EOSINOPHILURIA!

288
Q

In which conditions the Renal Papillary Necrosis occurs?

A

It is common in severe acute pyelonephritis.

Sickle Cell Disease, Diabetes Mellitus, or analgesic Nephropathy.

289
Q

Local vs invasive manifestation of Hib?

A

Local is—> acute otitis media, sinusitis by unencapsulated strains of H. Influenza or encapsulated Type B causing infection in unvaccinated children.

Invasive is—–> Septic arthritis, Meningitis, Bacteremia. The cause of invasive disease is its anti-phagocytic capsule.

290
Q

What is the cause of vaccination failure in an old person?

A

Decrease in Naive B and CD4+ T lymphocytes.

291
Q

What is the only type of cells that are increased in immunosenescence?

A

Increased CD8+ memory T cells.

292
Q

What is the etiology of hypothyroid myopathy?

A

The impaired use of muscle glycogen and triglyceride and increased oxidative stress causes myocyte injury. Will present as elevated creatinine kinase and proximal muscle weakness?

293
Q

What is myoedema?

A

Occurs in hypothyroidism. It is focal muscle contraction at the site of percussion.

294
Q

What is the cause of myoedema and delayed tendon reflexes seen in the hypothyroidism?

A

These characteristic findings are caused by impaired reuptake of Calcium by Sarcoplasmic Reticulum

295
Q

What are the changes seen in the following values, in Diabetes Insipidus?

Osmolarity:
ICF
ECF

A

Osmolarity: INCREASED
ICF: DECREASED
ECF: DECREASED

DI, Dehydration and profuse sweating cause HYPEROSMOTIC CONTRACTION.

296
Q

What are the changes seen in the following values, in Acute GI Bleeding?

Osmolarity:
ICF
ECF

A

Osmolarity: No change
ICF: No change
ECF: Decreased

This is called iso-osmotic volume contraction, as the osmolarity doesn’t change and there’s only loss of ECF. This occurs in Diarrhea and GI Hemorrhage.

297
Q

In which two conditions. the figure of osmolarity, ECF and ICF are opposite to one another?

A

Adrenal insufficiency, pulls it down from upper right corner.

Hypertonic Saline infusion, pulls it upwards from upper right corner.

298
Q

What are the changes seen in the following values, in Adrenal insufficiency?

Osmolarity:
ICF
ECF

A

Osmolarity: decreased
ICF: Increased
ECF: decreased

299
Q

What are the type of receptors that Cinacalcet works on?

A

Ca-Sensing receptors that are Gq coupled/ Membrane bound receptors coupled with a G protein.

Cinacalcet increases Ca-sensing receptors’ sensitivity—> and that reduces PTH.

300
Q

Name 4 Opsonins for body?

A

IgG,
Complement C3b,
Mannose Binding Lectin,
C-reactive protein.

301
Q

Maximum flow occurring during diastole and minimal flow occurring during ventricular systole. This pattern is unique for the _________________.

A

Left Ventricular Myocardium.

There’s constant Blood flow to the right ventricular myocardium because of low pressures even in systole

302
Q

What are the levels of the following in a person with one testicle in scrotum:

FSH
LH
Inhibin

A

In these patients, the testicle that is not in the scrotum has DAMAGED SERTOLI CELLS IN SEMENIFEROUS TUBULES.
Now, LH causes release of testosterone by Leydig cells. and FSH causes release of Inhibin B by sertoli cells in normal people. However, FSH will be elevated as there’s not enough Inhibin produced by damaged sertoli cells.

FSH- INCREASED
LH-Normal
Inhibin B- DECREASED.

303
Q

Patient comes to you with symptoms of hyperthryroidism, when she has been taking levothyroxine after thyroidectomy. What will be the levels in the following?

Serum TSH
T4
T3
Serum Thyroglobulin
Radioiodine uptake
A 
Case of exogenous thyrotoxicosis.
Serum TSH- Low
T4- HIGH
T3- HIGH (T4 is deiodinated into T3 in the periphery. And if a T3 supplement like liothyronine is used then only T3 will be elevated and not T4)
Serum Thyroglobulin- LOW
Radioiodine uptake- Low
304
Q

What is the first ever step in the pathogenesis of atheroma formation in blood vessels?

A

Endothelial Cell Injury

305
Q

What is the second step in the pathogenesis of atheroma formation?

A

Endothelial Cell dysfunction results in monocyte adhesion and migration to intima, while exposure of subendothelial collagen promotes platelets adhesion.

306
Q

Which cells are important for the formation of fatty streaks in vessels?

A

Macrophages.

307
Q

How does subclavian steal syndrome represent as?

A

It is mostly asymptomic, but when symptoms occurs they can be:

Exercise induced pain, fatigue and parasthesias in the affected extremity.
Vertebrobasilar insufficiency causes drop attacks, dizziness, vertigo.

308
Q

How does a vestibular schwannoma manifest as?

A

Vestibular Schwannoma occurs in cerebellopontin angle, and compresses the following nerves:

CN 7: Will cause ipsilateral facial paralysis–> e.g. asymmetric smile.
CN 8: will causes sensineural hearing loss, and ringing of ear.
CN 5: Ipsilateral facial sensation and loss of afferent limb of corneal reflex.

309
Q

Location of a vestibular schwannoma?

A

Between lateral pons and cerebellum.

310
Q

What is the CNS manifestation of nocardia and how is treated?

A

Brain abscess, treated by surgical drainage of the abscess and TMP-SMX.

311
Q

45y old woman comes to you with fracture of the wrist. Dexa scan shows osteoperosis and labs show elevated PTH, mild hypercalcemia. What is the major contributor to bone loss seen in this patient?

A

This is a vignette of Hyperparathyroidism. Elevated PTH causes increased RANK-L expression, and decreased OPG. This results in LOW opg: rankl ratio——-. INCREASED osteoclast formation and activity.

The bone loss is due to Increased Bone resorption due to paracrine stimulation of osteoclasts.

312
Q

How does Biliary atresia present as?

A

In biliary atresia, the infant is normal at birth as the biliary tree is normal at that time.
However, an infant of LESS THAN 2 MONTHS OF AGE, will present as:

Jaundiced skin
Increased total, and direct bilirubin
Dark urine
Clay colored stools

313
Q

What the pathology in Biliary Atresia and how can it be diagnosed?

A

The pathology is obstruction of extra-hepatic bile ducts.

Diagnosis can be confirmed on a liver biopsy which shows proliferation of intrahepatic bile ducts, potral tract edema and fibrosis.

314
Q

Which step in Hep B virus cycle is important for the infection?

A

Reverse transcription of template RNA into Viral DNA.

315
Q

Which step in Hep B virus cycle is important for hepatocarcinogenesis?

A

Integration of viral genome into host cells.

316
Q

What kind of immune response is responsible for clearing of HepB infection

A

A robust, polyclonal Cytotoxic T cell response is needed to completely get rid of HepB.

People who develop a latent infection of HepB basically have a narrow cytotoxic T cell response.

317
Q

What causes Hepatocyte damage in HepB?

A

Hepatocyte damage occurs majorly when Cytotoxic T cells recognize HBV antigens on infected cells.

318
Q

What is the major risk factor for developing Barret’s esophagus:

Alcohol
Obesity

A

Obesity——–> Barret’s esophagus——> Adenocarcinoma.
( GERD, )

Alcohol is the risk factor for esophageal squamous cell carcinoma.
(Thermal injuries, preservative foods, )

319
Q

What are the shortest acting Benzodiazepines?

A

Triazolam, Midazolam

320
Q

Which Benzodiazepine will you give to a 911 emergency dispatch operator who has trouble sleeping at night but is supposed to be clear-headed in the morning?

A

Intermediate acting Benzodiazepine————> Oxazepam, Lorazepam, alprazolam.

321
Q

Hypoattenuation of an area in Brain CT Scan means?

A

Hypoattenuation in CT scan means BLACK——–. ischemic infarct

322
Q

What is the cause of splenomegaly in pyruvate kinase deficiency?

A

Splenomegaly is because of RED PULP HYPERPLASIA, as reticuloendothelial cells in the red pulp are responsible for removing damaged RBCS.

323
Q

Manifestation of pyruvate kinase deficiency?

A

Often presents as hemolytic anemia of the newborn.

Because of decreased pyruvate kinase—–> decreased ATP——-> leading to water and potassium loss—–> rigid RBCs——-> extravascular hemolysis——> increased 2.3 BPG——–> Decreased affinity of hemoglobin for O2.

324
Q

Which intraerythrocytic inclusions are found in pyruvate kinase deficiency?

A

Burr cells/ Echinocytes.

325
Q

How is trichomoniasis diagnosed?

A

Wet mount microscopy shows flagellated, motile protozoans.

NAAT is the the gold standard.

326
Q

Which vaginal infection gives positive test with KOH?

A

KOH when added to Bacterial Vaginosis (Causes by Gardnerella Vaginalis) gives off a charasteritc odour. Also called positive whiff test.

327
Q

For which vaginal infection, the partner has to be treated as well?

A

For Trichomoniasis, the patient and partner have to be treated with metronidazole.

328
Q

Stop codons?

A

UAA, UAG, UGA

329
Q

Biopsy findings in CMV pneumonitis?

A

Intranuclear and intracytoplasmic inclusions that resemble owl’s eyes.

Because inclusions surrounded by a halo, so looks like owl’s eyes.

330
Q

Universal prophylaxis with ______________ is done to prevent CMV pneumonitis in Lung transplant patients.

A

Valganciclovir

331
Q

What is the prodrug of ganciciclovir? and what is its benfit?

A

Ganciciclovir’s prodrug is valganciclovir and it has better bioavailability.

332
Q

ECG shows diffuse ST elevation. Diagnosis?

A

Acute pericarditis.

333
Q

Colchicine’s mechanism of action?

A

Colchicin binds to intracellular protein tubulin, inhibits microtubular polymerization. Disrupt cytoskeleton dependant functions like phagocytosis and chemotaxis.

334
Q

A kid who cannot get Hib vaccine, is prone to which infection the most?

A

Meningitis.
The kid without antibodies produced by B-lymphocytes after being vaccinated is prone to INVASIVE diseases caused by Hib. Such as Meningitis, Bacteremia, Pneumonia and Epiglottitis.

335
Q

Antidote for SSRI overdose?

A

Cyprheptadine

336
Q

Mutation in which gene causes Bare lymphocyte Syndrome?

A 
In Bare lymphocyte Syndrome, there's a deficiency of MHC CLASS 2-PEPTIDE COMPLEX formation, which is necessary for activation of B and T lymphocytes. 
So, a mutation in HLA-DR,DP,DQ causes problems in MHC class 2.
337
Q

What will the flow cytometry show for Bare Lymphocyte Syndrome?

A

Normal levels of CD3+ (Reflects normal levels of circulating T-cells)
Normal levels of CD19+ (Reflects normal levels of circulating B cells)
Absence of HLA-DR+ cells.

338
Q

What will the flow cytometry show for DiGeorge Syndrome?

A

Absence/Reduction of CD3+ cells. As the failure of development of thymus, results in deficiency of circulating T cells.

339
Q

CD40L is expressed on _____________.

A

Activated T-helper cells.

340
Q

A deficiency in CD40L will cause ____________.

A

Hyperimmunoglobulin IgM Syndrome.

341
Q

A mutation in which gene will show a reduction of CD19+ cells on Flow Cytometry?

A

BTK gene causes X-linked agammaglobulinemia, because there’s problem in signal transduction by Bruton Tyrosine Kinases for maturation of B-cells.

Manifests after 3 months of age, when maternal IgG are depleted.

342
Q

Nonbililous Vomiting in the setting of Pyloric Stenosis causes which Acid-base disorder in an infant?

A

Primary Metabolic Alkalosis with respiratory compensation.

343
Q

Phosphorylation of mannose residues on lysosome-bound proteins, allowing them to _____________ and ultimately be transported to the lysosome, where they serve as catalysts for degradation of cellular components.

A

Golgi Network.

Impaired in I-cell disease.

344
Q

What will mass spectometry analysis show in I-cell disease?

A

Performed on cultured fibroblasts and reveals deficient phosphorylation of mannose residues on certain glycoproteins in the Golgi apparatus.

345
Q

Which 2 enzymatic deficiencies cause orotic aciduria?

A 
Uridine monophosphate synthetase (UMPS)( Nohyperammonemia, patient has megaloblastic anemia)
Ornithine transcarbamylase (OTC) deficiency, the most common urea cycle disorder.(OTC deficiency results in excess carbamoyl phosphate, and hyperammonemia)
346
Q

Increased insulin sensitivity during exercise can be attributed to?

A

Translocation of GLUT4 to cell surface membrane.

347
Q

V/Q mismatch vs Alveolar Hypoventilation, because both cause HYPOXEMIA.

A

Alveolar Hypoventilation cause by opioids, sedatives, hypoventilation syndrome———> RESPIRATORY ACIDOSIS, Normal A-a gradient with hypoxemia.

V/Q Mismatch caused by PE——–> RESPIRATORY ALKALOSIS, INCREASED A-a gradient with hypoxemia.

348
Q

ARDS is typically characterized by 2 things?

A

1-Progressive hypoxemia refractory to oxygen therapy

2-diffuse interstitial edema in the absence of cardiogenic causes.

349
Q

Alveolar Hyaline Membrane formation results because of a transudative/exudative process.

A

Exudative.

Pulmonary edema due to cardiogenic causes is a transudative cause.

350
Q

Which 2 pulmonary function testing values increase with aging?

A

Residual Volume and FRC.

351
Q

What remains unchanged in PFT in aging?

A

TLC

352
Q

Drugs used for spasticity act on which receptors?

A

Drugs that treat spasticity are GABA agonists, because GABA is an inhibitory neurotransmitter.

GABA A is ion-gate chloride channels. Benzodiazepines used for muscle relaxation are GABA A agonists.

GABA B is G-protein coupled receptors that opens K+ channels. Baclofen is a GABA B agonist.

353
Q

Antagonists of acetylcholine muscarinic receptors are used to treat spasticity in which specific condition?

A

Benztropine and Trihexyphenidine is used to treate acute dystonia, tremors and rigidity in Parkinson’s and Drug-induced Parkinson’s. Not used to treat any other spasticity.

354
Q

Acute Viral Hepatitis histology?

A

Presence of “spotty necrosis” with ballooning degeneration (hepatocyte swelling with wispy/clear cytoplasm), Councilman bodies (eosinophilic apoptotic hepatocytes), and mononuclear cell infiltrates.

355
Q

The major cause of oxygen-induced hypercapnia in COPD is due to?

A

INCREASED ventilation-perfusion mismatch.

356
Q

Cytokines that are present in high quantities in granulomatous diseases like TB, sarcoidosis?

A

IL-2 and interferon Gamma.

357
Q

IL-1 and TNF-alpha are important cytokines in which 2 diseases?

A

Bone loss in Multiple Myeloma, Bony erosions in RA.

Hence, RA treatment include TNF-alpha blockers ( adalimumab, etanercept) and IL-1 inhibitors (anakinra)

358
Q

Smudge cells are seen in?

A

CLL.

359
Q

How does TNF-Alpha induce insulin resistance?

Qid 1326

A

TNF-alpha activates Serine Kinases—-> Serine Kinases phosphorylate serine residues on B-subunit of Insulin Receptor and IRS-1—-> this obviously hinders IR causing tyrosine phosphorylation of IRS-1——> resulting in resistance to normal actions of insulin.

360
Q

What is found on histopathology of IPF?

A

Loss of Type 1 pneumocytes, and hyperplasia of Type 2 pneumocytes.

361
Q

Meningeal irritation can be seen in _____________ as well.

Not meningitis

A

Subarachinoid Hemorrhage.

362
Q

What does the brain imaging show in SAH?

A

Blood layering cerebral sulci

363
Q

Advanced Alzheimer’s disease is associated with diffuse brain atrophy. Atrophy is most pronounced in the ______________ and _____________.

A

Temporoparietal lobes and Hippocampus.

364
Q

Normal aPTT indicates an intact ____________.

A

Intrinsic coagulation system.

365
Q

Prolonged PT indicates ____________, and can be due to the deficiency of _______.

A

defective extrinsic pathway, can be due to deficiency of Factor 7

366
Q

3 characteristics of late-stage radiation dermatitis

A

Fibrosis, characterized histologically by homogenization of dermal collagen, due to fibroblast activation by transforming growth factor-beta from damaged tissue and responding immune cells

Vascular damage, resulting in chronic hypoxia and ulceration

Abnormal, dilated microvasculature (ie, telangiectasias

367
Q

Histology of Steven Johnson Syndrome/Toxic epidermal necrolysis widespread blistering?

A

1) Full thickness epidermal necrosis

2) Subepidermal bullae

368
Q

What is found histologically in pseudomembranes formed in clostridium difficile infection?

A

They are basically, white yellow plaques fibrin, inflammatory cells, and cellular debris.

369
Q

Treatment with a medication that alters glucose metabolism within the liver by increasing the concentration of fructose 2,6-bisphosphate within hepatocytes. Which of the following conversions will be inhibited by high intracellular concentrations of this metabolite?

A

Alanine—–>Glucose.

Because increased Fructose 2,6 BPG inhibits gluconeogenesis

370
Q

Ischemic brain injury results in _________ necrosis.

A

Liquefactive

371
Q

In irreversible brain injury, necrotic neuronal remnants are then phagocytized by ______, and _______ proliferate at the site of the injury to form a glial scar.

A

Microglia phagocytose.

Astrocytes make glial scar.

372
Q

Neuronal cells with foamy appearance due to accumulated undigested macromolecules is seen in?

A

Lysosomal Storage disease like Neimann-Pick, Tay-Sachs

373
Q

Neurons with shrunken nuclei and eosinophilic cytoplasm lacking Nissl bodies. Which of the following is the most likely cause of these findings?

A) Irreversible Ischemic Injury
B) Transection injury of the nerve fibre

A

A) Irreversible Ischemic Injury- CORRECT.

B) Transection injury of the nerve fiber- This causes axonal reaction, not red neurons.

374
Q

Treatment of narcolepsy?

A

Modafinil, it is a nonamphetamine psychostimulant that promotes wakefulness.
It enhances dopaminergic signalling.

or Nighttime sodium oxybate.

375
Q

5 month old baby boy comes with complete loss of extremity muscle tone. Patient receives formula as a sole source of nutrition except fruits and honey occasionally. Which of the following test will confirm the diagnosis in the patient?

a) Blood Test for Liver enzymes
b) Stool test for bacterial toxin
c) Urine testing for amino acids

A

a) Blood Test for Liver enzymes- Heriditary fructose intolerance causing hepatocyte damage can be diagnosed in this situation but the symptoms would include hypglycemia, vomiting, hepatomegaly.
b) Stool test for bacterial toxin- CORRECT. Patient has infant botulism because of honey, classic symptom is hypotonia.
c) Urine testing for amino acids- MSUD can be diagnosed with this, also presents with vomiting and poor feeding but will present in a neonate.

376
Q

Inactivated versions of the influenza vaccine stimulate the formation of neutralizing antibodies against the ___________ of included strains.

A

Heamagglutinin antigen, which is important for attaching to sialic acid receptor of host epithelial cells for VIRAL ENTRY.

377
Q

Catheter area ablation for atrial flutter is done in which area?

A

Cavotricuspid isthmucs—-> The area between tricuspid valve and IVC in RA.

378
Q

Emergency laprotomy done in a 2 day old boy shows inspissated, green fecal mass obstructing distal ileum. what is going to be the most likely cause of mortality in this patient?

A

PNEUMONIA

The intraoperative finding of a green inspissated mass (dehydrated meconium) in the distal ileum points to the diagnosis of meconium ileus as the source of obstruction. Meconium ileus is a very specific finding for cystic fibrosis (CF).

379
Q

Which drugs cause inhibition of androgen synthesis?

A 
Ketoconazole
Spironolactone ( Also impairs androgen-receptor binding interactions.)
380
Q

A deep laceration is present at the proximal aspect of the right cubital fossa, just lateral to the medial epicondyle. Examination reveals absent sensation in the lateral palm and the palmar surfaces of the first 3½ fingers, inability to flex the proximal interphalangeal joints, and inability to pronate the forearm. Which structure is responsible for patient’s bleeding?

A

Median Nerve Injury and Brachial artery damaged.

381
Q

Most common metastasis sights of colon cancer are?

A

Liver and Lungs

382
Q

Mechanism of action of finasteride?

A

inhibits conversion of androgens into DHT in peripheral tissues.

383
Q

Mechanism of action of sitagliptin?

A

It is a DPP4 Inhibitor. It works by increasing GLP-1 and GIP levels.

384
Q

Peculiar S/E of saxaliptin?

A

Nasopharyngitis

385
Q

Metyrapone blocks cortisol synthesis by inhibiting __________________, which converts 11-deoxycortisol to cortisol in the zona __________.

A

11-β-hydroxylase,

Zona Fasiculata

386
Q

Why does Metyrapone stimulation test in a normal person shows increase 17-OH Progesterone?

A

Due to ACTH surge.

387
Q

Metyrapone Stimulation test results? Discuss.

A

In a normal person, cortisol DECREASED, so ACTH and 11-deoxycortisol INCREASE.
In primary Adrenal insufficiency, ACTH INCREASES, but 11-deoxycortisol DECREASES.
In secondary/tertiary Adrenal Insufficiency, ACTH might increase or decrease, but 11-deoxycortisol DECREASES GREATLY.

388
Q

Acne vulgaris is the problem of _______________.

A

pilosabeceous follicles.

389
Q

A 72-year-old woman comes to the office due to persistent headaches, fatigue, and diffuse muscular pain. She has a history of hypertension and osteoarthritis. She is given prednisone and her symptoms improve considerably. What is the pathology seen?

A

This is Giant Cell Arteritis, patient may have headache, jaw claudication, polymyalgia rheumatic–> achy pain in shoulder and hip girdle.
Pathology is: GRANULOMATOUS INFLAMMATION OF THE MEDIA.

390
Q

Explain vessel histopathology of polyarteretis Nodosa in 2 different ways?

A

1) Transmural inflammation of the vessel wall with fibrinoid necrosis.
2) Fibrinoid degeneration of the vessel wall with luminal narrowing.

391
Q

The bacteria and fungi responsible for infections in CGD are?

A

The bacteria and fungi responsible for infections in CGD are catalase-positive organisms that can destroy their own hydrogen peroxide.
Staphylococcus aureus, Burkholderia cepacia, Serratia marcescens, Nocardia, and Aspergillus.

392
Q

Which vasculitis causes mononeuritis multiplex?

A

Churg strauss—> But obviously, why would they let you get through by just remembering that? They want you to remember it as EOSINOPHILIC GRANULOMATOSIS WITH POLYANGITIS.

(Late onset-Asthma,sinusitis, mononeuritis multiplex aka assymetic multifocal neuropathy aka wrist drop,foot drop due to involvment of epineural vessels.)

393
Q

Which vasculitis causes mononeuritis multiplex?

A

Churg strauss—> But obviously, why would they let you get through by just remembering that? They want you to remember it as EOSINOPHILIC GRANULOMATOSIS WITH POLYANGITIS.

(Late onset-Asthma,sinusitis, mononeuritis multiplex aka assymetic multifocal neuropathy aka wrist drop,foot drop due to involvment of epineural vessels.)

394
Q

Which vasculitis causes mononeuritis multiplex?

A

Churg strauss—> But obviously, why would they let you get through by just remembering that? They want you to remember it as EOSINOPHILIC GRANULOMATOSIS WITH POLYANGITIS.

(Late onset-Asthma,sinusitis, mononeuritis multiplex aka assymetic multifocal neuropathy aka wrist drop,foot drop due to involvement of epineural vessels.)

395
Q

The __________ is the nerve most commonly injured by anterior shoulder dislocations.

A

Axillary nerve, It innervates the deltoid and teres minor muscles and provides sensory innervation to the skin overlying the lateral shoulder.

396
Q

Examples of disease that are Type 3 HSR?

A

SLE, Polyarteretis Nodosa, PSGN

397
Q

Clinical Presentation of Jarvell Lange-Neilsen Syndrome?

A

An autosomal recessive disorder characterized by profound bilateral sensorineural hearing loss and congenital long QT syndrome, which predisposes individuals to syncope and sudden cardiac death.

This syndrome occurs secondary to mutations in genes (eg, KCNQ1, KCNE1) that encode the alpha and beta subunits of voltage-gated potassium channels.(Asked in uworld specifically)

398
Q

What is a possible manifestation of folate overdose?

A

Folate antagonizes phenytoin. So, someone on phenytoin might have seizures because folate is not letting phenytoin do its work.

399
Q

Actinic Keratosis vs Seborrheic Keratosis.

They are unrelated, but both have hyperkeratosis—>thickening of stratum corneum

A

Actinic Keratosis, appears on sun-exposed areas and it non-pigmented.

Seborrhein Keratosis, often point towards GI adenocarcinoma. Have Hyperkeratosis as well as keratin cysts. Flat macules with greasy appearance and well-demarcated borders.

400
Q

In Plasmodium falciparum infection, red blood cells have _______________________________________.

A

In Plasmodium falciparum infection, red blood cells have multiple small rings representing developing trophozoites (arrows) and banana-shaped gametocytes (not shown).

401
Q

What is the treatment of choice for Plasmodium Falciparum, in a chloroquine-resistance area?

A

Atovaquone and Proguanil.

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