Uworld Q Flashcards
1
Q
Amatoxins are found In mushrooms and cause what symptoms? Complications? What is the MOA of these toxins?
A
Symptoms start within 6-24 hrs —> abdominal pain, vomiting severe (cholera like diarrhea) Complications? —> hepatic failure or renal failure Potent inhibitors of RNA polymerase 2 (halt mRNA synthesis)
2
Q
Ricin toxin MOA?
A
Inhibits protein synthesis by cleaning the r RNA component of the eukaryotic 60s subunit
3
Q
The metabolism of ethanol results in hypoglycemia, this is a result of inhibition of what metabolic process?
What is the reasoning behind this?
A
Gluconeogenesis
Ethanol metabolism by alcohol dehydrogenase & acetaaldehyde dehydrogenase reduced NAD + to NADH. Increases the NADH/NAD+ radio. This inhibits all pathways requring NAD+.
4
Q
Disease Incidence Definition:
Disease Prevalence Definition:
Which one is dependent on the other and what is the equation?
Case examples:
- Improved quality of care would result in what effect on indicidence + prevalence?
A
Incidence is the number of new cases diagnosed in a population in a given time perido
Prevalence is the total number of disease individuals in the population at a particular point.
Prevalence = (indicidence) X (duration of disease)
- Increase in just prevalence & constant incidence. Factors that prolong disease duration can increase prevalence because lower mortality in diabetics = more prevalence over time.
5
Q
Base excision repair is used to _________ induced spontaneously or by exogenous chemicals.
What are the enzymatic steps of this process?
1,2,3,4,5,
A
correct single-base DNA defects
Examples of alterations fixed by DNA repair are depurination, alkylation, oxidation and deamination,
- Glycosylase: cleaves altered base leaving AP site
- Endonuclease: cleaves 5’ end
- Lyase: completes extraction of 3’ sugar-Pi
- Polymerase: fills the single nucleotide gap
- Ligase: seals the nick
6
Q
what bacteria causes this?
A
CLOSTRIDIUM Dificile exotoxin B
- Colonic mucosa responds to toxin exposure by forming white, patch pseudomembranes, which consist of Neutrophil predominant infiltrate, fibrin, bacteria and necrotic epithelium
Pts with severe disease may develop nonobstructive toxic megacolon àleads to perforation (abdominal pain, fever, diarrhea
7
Q
Key Side effects of Anti Psychotic Drugs:
What are the 3 Extra-Pyramidal side effects? What are the differences between them?
Explain Tardive Dyskinesia
What are the main symptoms of Neuroleptic Malignant Syndrome?
A
- Acute Dystonia: Sudden onset, sustained muscle contractions of neck, mouth, tongue or eye muscles
- Akathisia: subjective restlessness with inability to sit still
- Drug-induced Parksonism: Tremor, Rigidity, Bradykinesia, masked facies
Tardive Dyskinesia: involuntary movements after chronic use (lip smacking, choreoathetoid movements)
NMS: Fever, rigidity, Mental status change, autonomic instability(sympathetic hyper actvity –> sweat, Inc HR)
8
Q
Exercise Phsyology:
Cardiac Output (Increased/Decreased)
LV-EDP (Increased/Decreased)
Pulmonary A. Systolic P (Increased/Decreased)
Systemic Systolic BP (Increased/Decreased)
Total Systemic Vascular resistance (Increased/Decreased)
A
Cardiac Output (Increased/Decreased)
LV-EDP (Increased/Decreased)
Pulmonary A. Systolic P (Increased/Decreased)
Systemic Systolic BP (Increased/Decreased)
Total Systemic Vascular resistance (Increased/Decreased)
Due to shunting of blood to the muscles
9
Q
Influenza Vaccine/Pharm:
(Inactivated/ or Live attenuated) vaccine stimulates the formation of neutralizing antibodies agaist hemagluttinin antigen –> preventing viral entry
(Inactivated/ or Live attenuated) vaccines can generate a strong cell-mediated immune response that can kill virally infected cells, in addition humoral immunity.
Oseltamivir MOA
A
Inactivated vaccine stimulates the formation of neutralizing antibodies agaist hemagluttinin antigen –> preventing viral entry
Live attenuated vaccines can generate a strong cell-mediated immune response that can kill virally infected cells, in addition humoral immunity.
Oseltamivir: sialic acid analogue that competively inhbiits influenza neuraminidase –> prevents release of viral progency (virions)
10
Q
Cavernous Carotid Syndrome
Expanding aneurysm in cavernous portion of ICA will initially cause headache + diplopia.
WHAT ARE THE NERVES THAT ARE AFFECTED BY THIS ?
A
Main one: Abducens Nerve –> Lateral rectus weakness, inward eye deviation
Oculomotor Nerve
Trochlear Nerve
V1 and V2 branches of Trigeminal nerve
11
Q
Intravenous Fluid & Clinical Indications
Volume resusciation (hypovolemia, shock, sepsis)
Severe, symptomatic Hyponatremia
Free water deficit
Maitenance Hydration
Volume replacement; treatment of SBP or HRS
A
Volume resusciation (hypovolemia, shock)–> 0.9 normal saline or Lactated Ringer solution (both isotonic)
Severe, symptomatic Hyponatremia –> 3% hypertonic saline (hypertonic)
Free water deficit: 5% Dextrose in water or half-normal saline (hypotonic)
Maitenance Hydration: 5% dextrose in half normal saline (hypotonic)
Volume replacement: Albumin (isotonic)
12
Q
______________ is a blood-loving organism that requires X (hematin) & V (NAD+) factors for growth. This can be accomplished by growing this bacteria in the presence of what? (Satellite phenomenon)
Wont grow on sheep blood’s agar because no factor 5 or 10.
A
Haemophilus influenza
Satellite Phenomenon: Presence of Beta-Hemolytic Staph aureus –> lysis RBCs –> release factor X and V –> growth of Haem infleunza.
13
Q
Median Nerve Pathway
- Arises from the __________ cords of the brachial plexus –> 2. travels in the bicipital groove (w brachial A) –>
- Now in the forearm the median nerve courses between the humeral and ulnar heads of the ____________ –>
- flexor digitorum profundus –> enter hand through carpal tunnel –> first 3.5 digits (palmar aspect)
Compression at ________ = impaired sensation to palmar aspect of first 3 digits
Compression at _______ = senstaion impaired also to the entire lateral palm + first 3 digits
A
Medial & lateral cords
pronator teres muscle
carpal tunnel
pronator teres
14
Q
__________ –> episodes of jaundice, impaired bilirubin excretion, black liver, direct bilirubin
_____ Syndrome is also Direct Bilirubine
_____ & _____syndomre = impaired bilirubin conjugation (indirect bilirubinemia)
A
Dubin-Johnson Syndrome:
- Autosomal Recessive
- Defective hepatic excretion of bilirubin glucoronides –> mutation in caclilulaur membrane transport protein
- Episodes of Jaundice (trigger = stress, illness, pregnant)
- Direct hyperbilirubinemia (because impaired excretion)
- Liver appears black (gross) due to imapred excretion of epinepherine metabolites (in lysosomes)
Other answers: Rotor; Criggler Najar & Gilbert
15
Q
____Pancreatic Bud –> Tail, body, most of head, small accesory pancreatic ducts
____pancreatic bud –> Uncinate process, portion of head, proximal portion of main pancreatic duct
________: failure of bentral and dorsal buds to fuse –> pancreatic secretions drained via to seperate duct systems (dorsal draining most)
A
Dorsal Bud
Ventral Bud
Pancreatic divisum
16
Q
___________complications (name the complication)
- Worsening of baseline symptoms + development of painful swallowing
2, Metaplastic columnar epithelium replaces normal stratified squamous –> No change is symptoms, Just dysphagia + weight loss
- develops in the setting of healing when collagen fibers contract and cause narrowing of lumen –> feeling of dysphagia + food getting stuck
A
Gastro esophageal Reflux disease (GERD) complications
- Erosive esphagitis with esophageal ulcers (odynophagia = painful swallow)
- Barret esophagus
- Esophageal stricture
17
Q
WIlson’s Disease results in cystic degneration of what structure?
Huntington disease effects what structure?
What are the other labeled structures?
A
WIlson’s Disease results in cystic degneration of Putamen (B)
Huntington disease effects caudate nucleus (D)
Internal capusle is C
Globus pallidus is D
Amygdala is E
18
Q
Name the Embryologic malformation & MOA:
- Cecum in RUQ, Presense of fibrous bands connecting cecum and right colon to retroperitoneum –> extrinsic compression of duodenum (possible compression of SMA –> necrosis); Present with billious vomiting
- Double bubble sign, Billious vomiting, associated with down syndrome
- Delayed passage of meconium, abdominal distention, bilious vomit. Mega colon
- True Diverticulum, sometimes contains ectopic gastric tissue, rule of 2s
A
- Intestinal obstruction & Midgut volvulus due to intestinal marotation
- Duodenal atresia due to failure of gut recanilization
- Hirschprung disease –> failure of NCC migration in gust –> agagnlionic sigmoid colon/rectum
- Meckel Diverticulum
19
Q
Pulsatile GnRH release from hypothalamus –> stimulate release of LH and FSH from anterior pituitary.
LH stimulates ______ –> release ________
FSH stimulate _______ –> release _______
High Local levels of _______& _______ are necessary for spermatogenesis
A
Theres is a negative feed back loop
Leydig cells –> Release Testosterone
Sertoli Cells –> release Inhibin B
High Local levels of Testosterone & FSH are necessary for spermatogenesis
20
Q
What gene/protein is defective in familial Dilated cardiomyopathy? Inheritance pattern?
What chemicals can cause Dilated cardiomyopaththy
A
Dilated cardiomyopathy
-
Pathogenesis
- Direct insult to myocardium –> decrease in contractile function with increase in ventricular cavity size
- Causes
- Viral infection
- Chemicals (Doxorubicin, alchohol, cocaine)
- Idiopathic/familial (AutoDom) = Truncated TTN gene -> defective Titin protein
- Symptoms of decompensated heart failure
- Dyspnea, fatigue, orthopnea
- Risk of sudden cardiac death due to ventricular arrythmia
21
Q
Case:3yo Recurrent sinupulmonary infections, giardia lamblia gastreoenteritis, enterovirus infections. Pan-hypoglobulinemia
What disorder is described above? what cell surface (CD) marker would be deficent?
A
X-Linked agammaglobulinemia
- Mutation in Bruton Tyrosine Kinase à failure of bone marrow pre-B cells to develop into mature B cells (a step necessary for B cells to leave the bone marrow and enter circulation)
- Recurrent sinopulmonary infections
- ·Giardia Lamblia Gastroenteritiis
- ·Failure to thrive
- ·Low Immunoglobulin levels
- ·Low or absent B cells (NO cd19,20,21)
- ·Pan-hypogammaglobulinemia
SCID would be a deficeincy of T and B cells; failure to thrive, candidiasis, severe infections (PCP) at younger age
22
Q
Atheroembolic disease
- Typically occurs after an invasive vascular procedure –> mechanical dislodgement of atherosclerotic plaque –> showering of cholestorol-rich emobli into circulation
- Needle-shaped cholestorol clefts in affected vessels are diagnost
- Commonly involved organs include
- ______________________
- ______________________
- ______________________
- ______________________
A
- Commonly involved organs include
- Kidneys (Acute Kidney Injury)
- Skin (blue Toe syndrome, livedo reticularis)
- GI tract (bleeding, infarction)
- CNS (stroke, amaurosis fugax)
23
Q
_________is TB drug that is similar in structure as B6 –> causes B6 deficiency which manifests as:
- Sensory Ataxia + decreased Pain sensation + numbness and tingling of his hands and feet
_____and _____chemo drugs that inhibit microtubule formation and directly toxic to nerves
A
Isoniazid
Vincristine and Paclitaxel
24
Q
Type 1 Diabetes Mellitus
- Hypoglycemia can be induced by:
- _______________________________
- ___________________________
- ____________________________
- Uptake of glucose by ____________ is mediated by GLUT4 Transporter, which is translocated to the cell membrane in response to _____and/or _________. Hypoglycemia can be precipitated by ______in pts with insulin treated diabetes due to persistent dosing of exogenous insulin.
A
Type 1 Diabetes Mellitus
- Hypoglycemia can be induced by:
- Inadvertent overdose of insulin
- decrease carb intake (skipped meal)
- Intensive physical exercise
- Uptake of glucose by skeletal muscle is mediated by GLUT4 Transporter, which is translocated to the cell membrane in response to insulin and/or muscle contraction. Hypoglycemia can be precipitated by exercise in pts with insulin treated diabetes due to persistent dosing of exogenous insulin.
25
Acute bacterial Prostatis is mostly caused by what organism?
Community acquired pneumonia in endemic areas (califoria, arizon) can also cause erythema nodosum/mulftiforme OR arthralgias?
E. Coli
Coccidiodes
26
Stages of change model (ex: alcohol); what are the 5 stages?
1. Precontemplation
2. Contemplation
3. Preparation
4. action
5. maintenace
27
CSF showing Lymphocytic pleocytosis + Acute onset Assymetric flaccid paralysis with concurrent parkinsonias features is highly suggestive of what disease process?
West Nile Virus (Flavivirus)
* Description
* (+) sense, ssRNA virus
* Clinical
* West Nile Fever: headache, rash (maculopapular/morbilliform)
* Neuroinvasive: meningitis, encephalitis, acute assymetric flaccid paraylysis
* Parkinsonian Sx (rigidity, bradykineasia, tremor)
* Transmission
* Female Mosquitos, summer/fall, Warm climate
* Risk factors: Older age, malignancy/organ transplant
* Diagnosis: anti-WNV Abs
28
Inability to extend wrist on PE. Midshaft fracture of the humerus is found. What structures risk of injury?
Humerus fracture associated with inability to extend wrist (**wrist drop**) indicates **radial nerve** injury. It innervates most of the forearm **extensors**(triceps) at the elbow, hand **extensors** at the wrist, brachioradialis and finger extensors. Consists of c5-T1 nerve roots
**Deep brachial A.** runs with **Radial Nerve** posterior to the midshaft of the humerus.
29
**_Disorders_**--- **_Serum Na_** -- **_Serum Osmo_**-- **_Urine Osmo_**
## Footnote
Diabetes Insipidus ??? ??? ???
Primary Polydipsia ??? ??? ???
Diabetes Mellitus ??? ??? ???
SIADH ??? ??? ???
SIADH can be caused by ectopic ADH secreting tumors like ___________________ and head and neck cancers
small cell lung carcinoma
30
Which feature applies to complete hydatidiform mole vs partial?
1. Enlarged Uterine size
2. Extremely high ß-HCG
3. Fetal/Embryonic tissue present
4. Diffuse trophoblastic proliferation + edematous chorionic villi
5. Paternal DNA only
6. p57 positive
7. Which has higher risk of gestation trophoblastic neoplasia?
31
Complications of Complete Hydatidiform mole?
* First trimester \_\_\_\_\_\_\_\_\_\_\_\_\_\_
* ______________ (vomiting due to inc ß-hCG)
* ______________ (due to ß-hCG)
* Pre-eclampsia, anemia, hyperthyroidism
* Need to monitor **ß-hCG** levels after uterine evacuation to risk of **malignant transofrmation** (\_\_\_\_\_\_ or \_\_\_\_\_\_\_\_\_\_)
* First trimester **vaginal bleeding**
* **Hyperemesis gravidarum** (vomiting due to inc ß-hCG)
* **Theca-lutein cysts** (due to ß-hCG)
* Pre-eclampsia, anemia, hyperthyroidism
* Need to monitor ß-hCG levels after uterine evacuation to risk of malignant transofrmation (**invasive mole** or **choriocarcinoma**)
32
**\_\_\_\_\_\_\_\_** is a benign, auto recessive disorder. Presents asymptomatic, but urine will test postiive for a reducing sugar (fructose) with copper reduction test. Due to defective \_\_\_\_\_\_\_enzyme.
**\_\_\_\_\_\_\_\_\_** presents as hypoglycemia & vomitting, after \_\_\_\_\_ingestion. Complications are failure to thrive, Liver and Renal failure. Due to deficiency of _______ enzyme (failure of __________ --\> toxic intermediate). Treat with \_\_\_\_\_\_\_\_\_.
\_\_\_\_\_\_\_ is an autosomal recessive disorder due to **\_\_\_\_\_\_\_\_** deficiency. Presents with neonatal jaundice, vomiting, **cataracts**, hepatomegaly, and failure to thrive. Treat by **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**.
**Essential Fructosuria** is a benign, auto recessive disorder. Presents asymptomatic, but urine will test postiive for a reducing sugar (fructose) with copper reduction test. Due to defective Fructokinase.
**Hereditary fructose intolerance** presents with hypoglycemia & vomitting, after _____ ingestion. Complications are failure to thrive, Liver and Renal failure. Due deficiency of **aldolase B** enzyme (failure of **fructose-1P metabolism** --\> toxic intermediate). Treat with **elimination of dietary fructose**.
**Galactosemia** is an autosomal recessive disorder due to **G-1P uridyl transferase deficiency**. Presents with neonatal jaundice, vomiting, cataracts, hepatomegaly, and failure to thrive. Treat by **eliminating all milk products and feed soy**.
33
**_Hep B Serologic Markers_**
* ______ --\> surface glycoprotein; detectable during acute infection; persistent more than 6 months = chronic infection
* HB**e**Ag --\> Polypeptide; detectable during acute infection; indicates \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* ___________ --\> First sign of acute infection; present during **window phase** prior to HBsAg & HBeAg
* _________ --\> Seen with cleared infection or vaccination
* confers long-term **immunity**
* Anti-HBe --\> develops in cleared infection & later in chronic infection; indicates \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
* Anti-HBc IgG --\> present in both acute & chronic infection
* (Present or not present??) after vaccination
**_Hep B Serologic Markers_**
* HB**s**Ag --\> surface glycoprotein; detectable during acute infection; persistent more than 6 months = c**hronic infection**
* HB**e**Ag --\> Polypeptide; detectable during acute infection; indicates **viral replication** & infectivity
* Anti-HBc IgM --\> **First sign** of **acute** infection; present during **window phase** prior to HBsAg & HBeAg
* Anti-HBs --\> Seen with cleared infection or **vaccination**
* confers long-term **immunity**
* Anti-HBe --\> develops in cleared infection & later in chronic infection; indicate **Dec viral replication/infectivity**
* Anti-HBc IgG --\> present in both acute & chronic infection
* **_Not_ present after vaccination**
34
Precision(\_\_\_\_\_) definition
Accuracy(\_\_\_\_) definition.
Precision(reliability) = **ability of test to reproduce identical or similar results with repeated measurements**
Accuracy(validity) = ability of a test to measure what it is suppose to measure. For a new test to be accurate it results should be equivalnt to the results obtained with a gold standard on the same individual.
35
Just compare these TWO
_Hereditary fructose intolerance._
* **Aldolase B** deficiency (Life threatening disorder)
* Patients present with fructose containing foods are introduced into the diet. (**baby weaned off breast milk onto a fructose containing product**)
* Vomiting and **hypoglycemia** 20-30 mins after fructose ingestion. Hypoglycemia is a result of intraceullar accumulation of fructose 1-phoshohate and depletion of inorganic phosphate --\> inhbiition of glycogenolysis and gluconeogenesis.
* Failure to thrive, jaundice and hepatomegaly
* Complications: **Liver failure and renal failure** --\> death
* Tx: fructose free diet
Classic Galactosemia
* Galactose-1P uridyl transferase deficiency (life threaten)
* Autosomal recessive
* Vomiting, feeding intolerance, neonatal jaundice, hepatomegaly and death if untreated
* Symptoms start **soon after breast feeding initiated** (younger age)
* Neonatal **cataracts**?
36
Tumbling motility is pathomnemonic for?
Listeria monoctyogenes (unpasteurized milk)
37
25-hydroxylase (in Liver)
1 alpha-hydroxylase in Kidney
38
Fluid movement across the capillary wall (filtration) into the interstitium is dependent on (1) hydrostatic pressure, (2) oncotic pressure and (3) capillary permeability. It is tighly balanced by lymphatic drainage (returns interstitial fluid to the vasculature. **Peripheral Edema** results when **transcapillary plasma filtration** **_exceeds_** the **resorptive capactiy of the lymphatics**
_Factors that **favor** development of **edema**_ include:
* Elevated capillary hydrostatic pressure
* Arteriolar dilation or impaired venous return
* Decreased plasma oncotic pressure
* Decreased albumin (nephrotic syndrome, cirrhosis, malnutrition)
* Sodium and water retention
* Lowers oncotic pressure & inc hydrostatic pressure
* kidney Disease and heart failure
* Lymphatic obstruction
* Filiariasis, invasive malignancies, iatrogenic (surgical LN dissection and radiation therapy)
JUST GET FAMILIAR WITH THIS SHIT
39
_Tricyclic antidepressants (TCAs) side effects_
* Inhibition of NT(NE & 5-HT) reuptake --\> Tremor & insomnia
* Blockade of cardiac fast sodium channels --\> Conduction defects, \_\_\_\_\_\_\_, \_\_\_\_\_\_\_
* Antagonism of Muscarinic Ach-R --\> \_\_\_\_\_\_\_, dry mouth, \_\_\_\_\_\_\_\_\_, hyperthermia, _____ RETENTION
* Antagonism of alpha-1 adrenergic receptors --\> \_\_\_\_\_\_
* Antagonism of H1 receptors --\> \_\_\_\_
**_SN_****_RI_**
· Selective **i**nhibits _presynaptic_ **R**e-uptake of **Serotonin** (**via SERT AND Norepinephrine (via NET)**
_Includes TCAs_
·**3****°****Amine TCA**: inhibit both 5HT & NE relatively equally
·**2****°****Amine TCA**:**inhibit NE**\> 5HT
_Normal SNRI_:
1. Desvenlafaxine
2. Duloxetine
3. Venlafaxine
4. Levomilnacipram
_TCAs_
5.**_3_****_°_****_Amine TCA_**_:_
Amitriptyline
Clomipramine
Doxepin
imipramine
6.**_2_****_°_****_Amine TCA_**
Amoxapine
Desipramine
Nortriptyline
**_SNRI’s + DA_**
Amoxapine
**_TCAs_** _also block other receptors (side effect)_
·ONLY TCA based SNRI have impact on 3 key non-efficacy related receptors
**1.Histamine (H1)**
**2.Muscarinic(cholinergic)**
**3.****a****1 adrenergic**
**_TCA system based-side effects(toxicity)_**
**1.Cardiovascular (**a**-adrenergic)**
**-**Tachycardia, orthostatic Hypotension, dysrhythmias(life-ending)
**2. Anticholinergic (muscarinic)**
-Dry mouth, urinary retention, constipation, Blurred vision, increase IOP
**3. CNS (histamine)**
**-**Sedation/fatigue & dizziness/seizures
_TCA: Toxic ingestion overdose_
**_3Cs:_**
1. Coma
2. Cardiotoxicity (conduction abnormalities) – **Quinidine-like (slows conduction and phase 0 depolarization (class1A))**
3. Convulsions
Rest of the SNRIs have similar side effects to SSRI
40
**_Acyclovir, valacyclovir, Famciclovir, Ganciclovir_**
* _______ analog
* Once it enters the host cell it is phosphorylated to acyclovir-monophosphate by a \_\_\_\_\_\_-encoded _________ (RATE LIMITING STEP) in acyclovir activation --\> then phosphorylated by _____ enzymes to active Triphosp form --\> impairs DNA polymerase mediated replication of **\_\_\_\_\_\_\_\_**
* Effective against _________ and \_\_\_\_\_\_\_\_\_\_
* ______ and \_\_\_\_\_\_do not produce the same thymidine kinase --\> less effective
**_cyclovir, valacyclovir, Famciclovir, Ganciclovir_**
* Guanosine analog
* Once it enters the host cell it is phosphorylated to acyclovir-monophosphate by a **virally**-encoded **thymidine kinase** (RATE LIMITING STEP) in acyclovir activation --\> then phosphorylated by **cellular** enzymes to active Triphosp form --\> impairs DNA polymerase mediated replication of **HSV/VZV**
* Effective against **Herpes Simplex and Varicella Zoster**
* **CMV and EBV** do not produce the same thymidine kinase --\> less effective
41
Chronic Kidney Disease leads to **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**and causes **_hypocalcemia --\> which manifests as:_**
* Chvostek (**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**)
* Trosseau (**\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**)
* \_\_\_\_\_\_\_\_\_\_\_\_\_reflexia
* QTc **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_**
* Seizures
Chronic Kidney Disease leads to **hyperphosphatemia** and causes **_hypocalcemia --\> which manifests as:_**
* Chvostek (**facial twitiching** elicited by tapping of Facial N)
* Trosseau (**carpal spasm** triggered by inflation of BP cuff around the arms)
* **HYPER**reflexia
* QTc **prolongation**
* Seizures
42
Lidocaine is a **\_\_\_\_\_\_\_\_\_\_\_\_\_** that **blocks transmission from free nerve endings**. It is mised with **epinephrine** which causes **\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_** when injected SQ. This \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_, decreases bleeding during the procedure and reduces sytemic lidocain absorption.
Lidocaine is **local anesthetic** that **blocks transmission from free nerve endings**. It is mised with **epinephrine** which causes **profound vasoconstriction** when injected SQ. This **prolongs lidocaine's duration of action**, decreases bleeding during the procedure and reduces sytemic lidocain absorption.
43
**_Antibiotics and there MOA_**
1. \_\_\_--\> prevent production of UDP-NAM by blocking MurA
2. Beta Lactams --\> prevent \_\_\_\_\_\_\_\_of peptidoglycan
3. \_\_\_\_\_\_\_--\> prevents subunit incorporation
4. \_\_\_\_\_\_\_\_\_& \_\_\_\_\_\_\_\_inhibit bacterial 50s subunit; \_\_\_\_\_\_\_\_\_\_=\>myelosuppression+aplastic anemia
5. flouroquinolones(ciprofloxacin) --\> inhibit ________ and \_\_\_\_\_\_\_\_\_\_\_\_\_
6. \_\_\_\_\_\_\_\_--\>inhibit 30s sub unit (protein synth)
**_Antibiotics and there MOA_**
1. **Fosfmyocin** --\> prevent production of UDP-NAM by blocking MurA
2. Beta Lactams --\> prevent **transpeptidation** of peptidoglycan
3. **Vancomycin** --\> prevents subunit incorporation
4. **Azithromycin** & **chloramphenicol** inhibit bacterial 50s subunit; **chloramphenicol**=\>myelosuppression+aplastic anemia
5. Flouroquinolones(ciprofloxacin) --\> inhibit D**NA topoisomerase** and **gyrase** (**DNA damage**)
6. **Doxycline** --\>inhibit 30s sub unit (protein synth)
44
_Collagen subtypes_
* Type __ --\> Basement membrane
* Alport syndrome
* Type 1 --\> \_\_\_, dermis, \_\_\_\_, \_\_\_\_\_, dentin, cornea, blood vessels & \_\_\_\_\_\_tissue
* (what disorder associated)
* Type _ --\> Skin, \_\_\_\_\_\_, intestines, \_\_\_\_\_vessels, bone marrow, \_\_\_\_\_\_\_, & \_\_\_\_\_\_\_tissue
* Ehlers-Danlos Syndrome
* Type 2 --\> \_\_\_\_\_\_\_, vitreos humor, & \_\_\_\_\_\_\_\_\_\_
* \_\_\_\_\_\_\_
_Collagen subtypes_
* Type 1 --\> Bone, dermis, tendons, ligaments, dentin, cornea, blood vessels & scar tissue
* Osteogenesis impefecta
* Type 2 --\> Cartwolage, vitreos humor, & nucleus pulposus
* Nothing
* Type 3 --\> Skin, lungs, intestines, blood vessels, bone marrow, lymphatics, & granulation tissue
* Ehlers-Danlos Syndrome (3&4)
* Type 4 --\> Basement membrane
* Alport syndrome
45
**_Time after Myocardial Infarction ---\> Light microscopy change_**
0-4 hours ---\> \_\_\_\_\_\_\_
4-12 hours--\> wavy fibers with \_\_\_\_, \_\_\_\_\_\_mycoytes
12-24 hrs--\>Myocyte hyper\_\_\_\_\_\_ w \_\_\_\_\_\_(shrunk) nuclei
1-3 days--\>\_\_\_\_\_\_\_\_\_\_\_\_(loss of nuclei/striations), predominately _______ infiltrate
3-7 days--\> Disintegration of dead ___ & myofibers; \_\_\_\_\_\_\_\_\_infiltration at border areas
7-10days--\> Robust phagocytosis of dead cells by \_\_; beginning of _________ formation at margins
10-14 days--\> well developed \_\_\_\_\_\_tissue w \_\_\_\_\_\_\_\_\_
2wks-2months--\> Progressive \_\_\_\_\_\_\_\_\_and ____ formation
**_ime after Myocardial Infarction ---\> Light microscopy change_**
0-4 hours ---\> **No change**
4-12 hours--\> wavy fibers with **narrow**, **elongated** mycoytes
12-24 hrs--\>Myocyte hyper**eosinophilia** w **pyknotic**(shrunk) **nuclei**
1-3 days--\>**Coagulation necrosis**(loss of nuclei/striations), predominately **neutrophil(Nø)** infiltrate
3-7 days--\> Disintegration of dead Nø & myofibers; **macrophage** infiltration at border areas
7-10days--\> Robust phagocytosis of dead cells by Mø; beginning of **granulation tissue** formation at margins
10-14 days--\> well developed **granulation** tissue w **neovascularization**
2wks-2months--\> Progressive **collagen deposition** and **SCAR** formation
NEED TO ADD POST MI COMPLICATIONS in here
46
**_CytoMegalo Virus (CMV)_**
* Herpes family, enveloped dsDNA virus
* Most are asymptomatic
* High risk patients for serious infection are
* Transplant pts, HIV pts, and fetuses
* Histology shows intranuclear and intracytoplasmic inclusions; often have a surrounding halo (Owl's eye)
* HIV pts complications: Esophagitis, colitis Retinitis
* Transplant patients --\> pneumonitis
**_CytoMegalo Virus (CMV)_**
* Herpes family, enveloped dsDNA virus
* Most are asymptomatic
* High risk patients for serious infection are
* Transplant pts, HIV pts, and fetuses
* Histology shows intranuclear and intracytoplasmic inclusions; often have a surrounding halo (Owl's eye)
* HIV pts complications: Esophagitis, colitis Retinitis
* Transplant patients --\> pneumonitis
47
_**\_\_\_\_\_\_\_\_\_poisoning**_
* Findings: Reddish skin discoloration, lactic acidosis, hypertension, narrowing of venous arterial PO2 gradient
* Complications quickly develop: CV collapse & seizures
* Targets cytochrome C oxidase in mitochondria
* Toxicity of \_\_\_\_\_\_\_is dependent upon its ability to bind ferric iron(Fe3+) with high affinity affinity
* Antidotes
* inhaled amyl nitride --\> what is MOA?
* Hydroxycobalamin
**_Cyanide poisoning_**
* Findings: Reddish skin discoloration, lactic acidosis, hypertension, narrowing of venous arterial PO2 gradient
* Complications quickly develop: CV collapse & seizures
* Toxicity of cyanide is dependent upon its ability to bind ferric iron(Fe3+) with high affinity affinity
* Antidotes
* inhaled amyl nitride
* Convert Fe2+ in Hemoglobin to Fe3+ --\> makes Methemoglobin (binds cyanide with high affinity) --\> sequesters cyanide and protects it from effecting Mitochondrial cytochrome C oxidase)
* Hydroxycobalamin
48
**_Eukaryotic Gene Transcription Mediators_**
Promoter sequence:
* Directly Bind Transcription Factors and RNA polymerase II \_\_\_\_\_\_\_\_from the gene locus.
* This is ____________ for initation of transcription
* Examples: \_\_\_\_(Hogness box:25 bases upstream) or \_\_\_box(70-80 bases upstream)
Enhancer/Silencer Sequence
* Bind activator proteins that facilitate ______ of DNA. Which allows activator proteins to interact with TFs and RNA poly2 @ \_\_\_\_\_\_\_\_site --\> increases rate of transcription(or decrease by binding repressors if silencer)
* Can be __________ from gene locus and can be near gene locus or very far away. Can also be within \_\_\_\_as well as on \_\_\_\_\_\_\_\_chromosomes
**_ukaryotic Gene Transcription Mediators_**
Promoter sequence:
* Directly Bind Transcription Factors and RNA polymerase II upstream from the gene locus.
* This is **necessary** for initation of transcription
* Examples: **TATA**(Hogness box:25 bases upstream) or **CAAT** box(70-80 bases upstream)
Enhancer/Silencer Sequence
* Bind activator proteins that facilitate **BENDing** of DNA. Which allows activator proteins to interact with TFs and RNA poly2 @ **promoter** site --\> i**ncreases rate of transcription**(or decrease by binding repressor if silencer)
* Can be **upstream or downstream** from gene locus and can be near gene locus or very far away. Can also be within introns as well as on **seperate** chromosomes
49
Traveler's Diarrhea is most commonly due to ETEC. This pathogen produces plasmid-encoded, **heat-labile(LT** or **cholera-like toxin**) and heat stabile toxin(ST) enterotoxins
LT activates \_\_\_\_\_\_\_cyclase --\> Inc \_\_\_\_\_
ST activates \_\_\_\_\_\_cyclase --\> inc \_\_\_\_\_\_
Both cause water, electrolyte loss and waterry diarrhea and some abdominal pain
Traveler's Diarrhea is most commonly due to ETEC. This pathogen produces plasmid-encoded, **heat-labile(LT** or **cholera-like toxin**) and heat stabile toxin(ST) enterotoxins
LT activates adenylate cyclase --\> Inc cAMP
ST activates guanylate cyclase --\> inc cGMP
Both cause water, electrolyte loss and waterry diarrhea and some abdominal pain
50
OCD first line treatment is ?
Selective Serotonin Reuptake inhibitor
51
Blood brain barrier is made of \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_which associate with actin filaaments to form a belt-like seal.
\_\_\_\_\_\_are spot like junctions that anchor adjacent cells together via keratin intermediate filaments. (site of pemphigus vulgaris Abs)
\_\_\_\_\_\_\_\_\_\_\_\_\_ permit free passage of small ions/molecules
\_\_\_\_\_\_\_bind basal layer of epithelial cells to basemment membrane (Bullous pemphigous Abs)
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ right below tight juctions
Blood brain barrier is made of T**ight Junctions (zona occludens: claudins & occludins)** which associate with actin filaaments to form a belt-like seal.
**Desmsomes** are spot like junctions that anchor adjacent cells together via keratin intermediate filaments. (site of pemphigus vulgaris Abs)
**Gap** junctions (connexins) permit free passage of small ions/molecules
**Hemidesmosomes** bind basal layer of epithelial cells to basemment membrane (Bullous pemphigous Abs)
**Intermediate junctions (zona adherens)** right below tight juctions
52
(Rotavirus or Norovirus?)
is the most common cuase of viral gastroenteritis. Outbreaks are common and symptoms include vomiting and watery diarrhea.
Norovirus
there is a rotavirus vaccine in developed coutnries so it is unlikely
53
Which cardiac tissue has the **slowest** conduction velocity?
Which cardiac tissue has the **Fastest** conduction velocity?
Think of the mnemonic
Slowest= **_AV node_**
Fastest =**_Purkinje system_**
AV node, Ventricular muscle, Atrial Muscle, Purkinje System
54
_Myotomes of the upper extremity(which spinal number?)_
* Shoulder/scapula elevation ---\> \_\_\_\_\_\_
* Finger abduction ---\> \_\_\_\_\_
* Shoulder abduction --\> \_\_\_\_\_
* Wrist Flexion & Finger Flexion --\> \_\_\_\_\_
* Elbow flexion & wrist extenion --\> \_\_\_\_\_\_
* Elbow extension & Finger extension --\> \_\_\_\_\_\_
* Shoulder/scapula elevation ---\> C4
* Finger abduction ---\> T1
* Shoulder abduction --\> C5
* Wrist Flexion & Finger Flexion --\> C8
* Elbow flexion & wrist extenion --\> C5, C6
* Elbow extension & Finger extension --\> C7
55
Reflexes of Upper extremity (What spinal level?)
* Biceps + Brachioradialis =\> \_\_\_\_\_
* Trceps =\> \_\_\_\_\_
* Biceps + Brachioradialis =\> C5, C6 (musculocutaneous N.\_
* Trceps =\> C7, C8
56
What surface marker is specific to the monocyte/Macrophage lineage?
CD14
This question came in the context of epitheliod histiocyte in caseating granuloma of TB
57
1. In acute compartment syndrome (after post-ischemic reperfusion injury), reactive oxygen species are formed due to high oxidative stress. Which enzymes can help neutralize these damaging species?
Deficiency of what enzyme leads to Chronic granulomatous disease?
1. Antioxidants: **Superoxide Dismutase**, **Glutathione Peroxidase**, **Catalase**
2, **NADPH oxidase**
58
What is the difference between the following 3 categories of microbiology mediums? What are examples of each?
Differential Media
Enrichment media
Selective Media
59
In a normal distribution (bell shaped curve) **_Median, mode_** and **_mean_** are all equal.
## Footnote
1. In a postively skewed plot in which order (highest to lowest) are these 3 found in?
2. In a Negatively skewed plot in which order (highest to lowest) are these 3 found in?
Positve: Mean(highest), median, mode
Negative: Mode(highest), median, Mean
60
Can a Turner Syndrome patient get pregant? (yes or no)
Yes: ONLY by. In Vitro Fertilization is possible in Turner Syndrome patient
Look at other
61
Which of the following is the last structure to disappear as you descend through the respiratory tract?
Cartilage
Cilia
Goblet cells
Mucous glands
Serous glands
Cilia is correct (present in respiratory bronchioles in order to serve function as mucociliary escalator. Take note that the airway epithelium cahnges for pesudostratified ciliated columnar to cilaited simple cuboidal by the level of terminal bronchioles.
Bronchololes lack glands and cartilage and levels of goblet cells decrease as you get more distal. But cilia are the last ones at the level of respitaory bronchioles
62
**\_\_\_\_\_\_\_\_\_\_\_\_** is an autosomal recessive disorder caused by mutation in the BLM gene of **\_\_\_\_\_\_**--\> chromosamal instability and breakage.
Clinical manifestation is **growth retardation**, **facial anomalies**, **photosensitive rash**, and **immunodeficiency**
**Bloom Syndrome** is an autosomal recessive disorder caused by mutation in the BLM gene of **helicase** --\> chromosamal instability and breakage.
Clinical manifestation is **growth retardation**, **facial anomalies**, **photosensitive rash**, and **immunodeficiency**
63
What structures are derived from the 3rd pharyngeal pouch?
What structures are derived from the 1st pharyngeal pouch?
Thymus and inferior parathyroids
Epithelium of middle ear and audotory tube
64
PSGN shows granular deposits of \_\_\_, \_\_\_, and ____ in the mesangium and basement membrane.
IgG, IgM and C3
65
1. What are the ultrasound findings of Down Syndrome?
2. What is the genetic cause of this condition?
3. What is GI manifestation is associated with this condition?
1. Decreased Materenal serum alpha-fetoprotein AND increased nuchal translucency
2. Mostly due to meiotic non disjunction
3. Duodenal atresia (double bubble)
66
Open neural tube and ventral wall defects are associated with what key lab finding in utero?
Holoprosencephaly is most associated with which congential trisomy?
**Markedly elevated AFP** are associated with open neural tube (spina bifida) and ventral wall defects(gastroschisis &omphalacele)
Trisomy 13 (Patau)
67
What is the function of IL-2? IL-4? TNF-alpha?
68
Incidence vs prevalence?
69
What microtubule associated protein is involved in anterograde transportion of materials and cells? What about Retrograde?
Which one does the reactivation of Herpes Simplex virus use?
HSV reactivation uses kinesin
HSV initial infection used dynein to become latent in ganglia
70
Mullerian Duct Anomalies:
1. Failure of Lateral fusion of the paramesonephric ducts results in?
2. Complete Agenesis of Paramesonephric duct results in?
3. Involution of the paramesonephric duct?
4. What other anomalies are commonly associated?
71
What is the function of IL-1, IL-5, IL-12, Interferon gamma, TNF alpha, IL-10, TGF-Beta, IL-4, IL-17, IL-12? Which ones are anti-inflammatory?
72
What is the pathophysiology of Non-typhoid salmonella vs Salmonella Typhi?
What is the difference in clinical presentation?
73
SMA syndrome is caused by what? and compresses what particular portion of the small intestine?
Presents with billious vomitting
74
Folate is tied to nucleotide synthesis via which enzyme?
In a folate deficient state, supplementing what substance can help limit the amount of cells undergoing apoptosis? In other words which substance can mask the symptoms of folate deficiency?
Thymidalate synthesis
Thymidine
75
Interscalene nerve block is used to provide anesthesia for what body parts?
What is at risk of transient paraylysis via what nerve?
Shoulder and upper arm (C5-C7)
Diaphragm (C3-5; phrenic nerve)
76
Describe the following studies:
Case-control study
Cohort study
Cross-sectional surveys
Ecologic Study
Qualitative study
Nested case control study?
Systematic Review?
77
What are the two most common alternative opioid agonists used for opioid withrawal and craving?
Which on is a full-mu-opioid receptor agonist and is known for its long-half life?
Which one is a partial agonist, less likley to cause respiratory depression?
Methadone (used with nalaxone) and buprenorphine
78
Erythrocytosis can be defined as hematocrit greater than ___ in men and ___ in women.
Measurement of _______ is needed to distinguish absolute from relative.
52% and 48&
RBC mass
normal RBC mass indicates what cause? (look up)
79
_Mitochondrial Diseases_
1. Known to have what inheritance? Do they effect boys or girls more?
2. What is the name for the variable degrees of severity season in mitochondrial disease? What is the reason behind this variability?
80
Mitochondrial syndrome:
1. (NAME) leads to bilateral vision loss
2. (NAME) myoclonic seizures and myopathy associated with exercise. Skm biopsy shows irregulary shaped muscle fibers.
3. (NAME) seizure disorder several stroke like episodes with neurologic deficits. Muscle weakness. Increased lactate and rest and post exercise)
81
Name the associated E.coli virulence factor and MOA?
1. Bacteremia and septic shock
2. Neonatal meningitis
3. Gastroenteritis (blood)
4. Gastroenteritis (watery)
5. UTI
82
**\_\_\_\_\_\_\_\_\_\_\_\_** is characterized by episodic, spontaneous (during rest and nighttime) with transient ST elevation due coronary vasospasm.
What could be some aggravating factors?
What is the Treatment for this?
**Prinzmental (variant) angina** is characterized by episodic, spontaneous (during rest and nighttime) with transient ST elevation due coronary vasospasm.
Dihydroergotamine, cigarette, cocaine/amphetamine, triptans
Vasodilators like Nitroglycerin or CCBs
83
What is the biggest Risk Factor for Renal Cell Carcinoma?
What is a familial Gene mutation associated with RCC?
Smoking
Von Hippel Lindau gene (AD also hemagioblastoma + pheochromacytoma)
84
What is the mnemonic for TB drugs?
Which one's MOA is inhibition of Arabinosyl transferase?
Which one causes red-orange body fluids and cytopenias?
Which one causes hepatotoxicity and hyperuricemia?
Which one's MOA is inhibition of mycolic acid synthesis?
Which one causes Optic Neuropathy?
Which one requires B6/pyroxidine as a supplement?
R.I.P.E.
85
Which antibiotics act on the 50s subunit?
Which act on the 30s subunit?
50S: chloramphenicol, clindamycin, linezolid, macrolides
30s: tetracycline, doxycycline, amingoglycosides
86
**_Antibiotics that inhibit cell wall synthesis._**
(NAME) prevents production of UDP-NAM via inhibition of MurA
(Two classes of drugs) are _____ that bind to and inhibit transpeptidase
(Name) binds to the D-alanine-D-alanine terminus of peptidoglycan --\> preventing cross linking
Fosfomycin
Penicillin and cephalospirin
Vancomycin (D-alanine substituion to D-lactate is method of resistance)
87
Teratogenic medications: Contraindicated in pregnancy
1. Phenytoin --\>
2. Lithium --\>
3. Valproate --\>
4. Isotretinoin --\>
5. Methotrexate --\>
6. ACE- inhbitor --\>
7. Warfarin --\>
88
Thiamine Deficiency results in which two syndromes?
Wernicke-Korsakoff and Beri Beri
89
Wernicke Korsakoff manifests as \_\_\_\_\_, \_\_\_\_\_\_, \_\_\_\_\_\_\_and \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_. Occurs Primary in _________ --\> \_\_\_\_\_\_deficiency.
Infantile Beriberi appears at age \_\_\_\_\_\_. Manifests as fuliminant \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_.
Wernicke Korsakoff manifests as confusion, ataxia, oculomotor abnormalites and permanent memory deficits. Occurs Primary in alcoholics. Thiamine deficient.
Infantile Beriberi appears at age 2-3 months. Manifests as fuliminant cardiac syndrome (cardiomegaly, tachycardia, Cyanosis, dyspnea, vomitting)
90
Adult Beriberi is associated with a deficiency in what?
How does Dry Beriberi manifest and how does it differ from Wet Beri Beri?
Dry Beriberi = symmetric peripheral neuropathy of the distal extremities with resulting sensory + motor impairment.
Wet Beriberi = the addition of CARDIAC involvement (cardiomyopathy, high output congestive HF, peripheral edema, tachycardia)
CNS involvement is mostly just Wernicke Korsakoff syndrome (alcoholics)
91
Vitamins and there primary function!
B1(thiamine) --\> \_\_\_\_\_\_\_
B2(riboflavin) --\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
B3(Niacin) --\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
B6(pyridoxine) --\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
B9(folate) --\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
B12(cobalamin) --\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Vit C (ascorbic acid) --\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Vitamins; NOW TELL ME THE ASSOCIATED deficiency!!
B1(thiamine) --\> Decarboxylation of alpha keto acids
B2(riboflavin) --\> Mitochondrial electron carrier (FMN, FAD)
B3(Niacin) --\> Electron transfer reactions (NAD/NADP)
B6(pyridoxine) --\> Transamination of Amino acids (AA synthesis)
B9(folate) --\> Hydroxymethyl/formyl carrier (purine & thymine synthesis)
B12(cobalamin) --\> isomerase & methyltransferase co factor (DNA & methionine synthesis)
Vit C (ascorbic acid) --\> Hydroxylation of proline and lysine (collagen synthesis)
92
Which cells play a role in COPD?
Which Cells play a role in asthma?
COPD --\> Neutrophils (elastase), Macrophages and CD8+ T lymphocytes
Asthma--\> CD4+ Helpers, Eosinophils. Mast cells?
93
M1 receptors are found in ?
M2 Receptors are found in ?
M3 Receptors are found in ?
M1 receptors are found in the **Brain** (Memory/cognitive function)
M2 Receptors are found in **heart**(dec HR + atrial contraction)
M3 Receptors are found in:
* **Lungs** (Bronchoconstriction),
* **Bladder** (Detrusor contraction),
* **Eyes**(Pupillary sphincter contraction--\> Miosis, ciliary muscle contraction--\> accomodation),
* **GI**(Inc peristalsis, salivary secretion and gastric secretion)
* **Skin** (increased sweat production) and
* **Peripheral vasculature** (Smooth muscle relaxation [via NO] --\> vasodilation, hypotension)
94
Explain the mechanism of activation of M3 receptors on **peripheral vasculature.**
Explain M3 receptors activation in **other locations**
M3 receptors are present on endothelial cells. Activation leads too production of Nitric Oxide --\> diffuses into vascular smooth muscle --\> activate Guanylate cyclase --\> inc cGMP --\> myosin light chain phoshphatase --\> dephosphorylates myosin and prevents interaction of myosin head with actin --\> smooth muscle relaxation and vasodilation.
GPCR--\> inc calcium --\> smooth muscle contraction
95
Primary osteoporosis lab values:
* Calcium: (Increased/Decreased/normal)
* PTH (Increased/Decreased/normal)
* Phosphorous (Increased/Decreased/normal)
Risk factors for osteoporosis
* Nonmodifiable
* ???
* Modifiable
* ????
Presentation
* \_\_\_\_fractures, \_\_\_fractures
Primary osteoporosis lab values:
* Calcium: (normal)
* PTH (normal)
* Phosphorous (normal)
Risk factors for osteoporosis
* Nonmodifiable
* Advancing age, Female, White/hispanic/asian, Fam Hx
* Modifiable
* Dec Physical activity, Low body weight, poor Ca2+/VitD, alcohol or tobacco use, Premature Menopause, Glucorticoid use
Presentation
* Vertebral fractures, Hip fractures
96
Progressive Multifocal leukoencephalopathy is caused by what Virus?
When does initial infection occur?
What cells does this virus attack?
How does this present and in what kind of state?
Brain MRI findings?
JC polyoma virus reactivation
97
EBV virus encephalitis in AIDS can cause\_\_\_\_\_\_\_\_\_\_ which presnts as a signle enhancing lesion
primary CNS lymphoma
98
1. What LN does the testis drain to?
2. Scrotum? what other structures drain to this common LN
3. Glans Penis?
4. What strucutures does the Inferion Mesenteric node drain?
2. All lymph from ubilicus to the feet, including external genitalia and anus (up to the dentate line); except testis, glans penis and cutaneous posterior calf.
4. descending and sigmoid colon and upper rectum
99
**_Right-sided brachiocephalic vein obstruction_**
Can be caused by ?
Presents as ?
What is the difference between this and SVC syndrome?
Apical Lung tumor compression or catheter
Right sided face, and arm swelling/redness. Engorgement of SubQ veins on same side of neck.
SVC syndrome is the exact same except BILATERAL
100
Male patient with Nocturnal Back pain, spinal tenderness and indurated prostate suggests what diagosis?
Leuprolide therapy is initated what would be the effect on Testosterone and DHT?
Prostate Adenocarcinoma
In Normal physiology GnRH is released in a pulsatile fashion( 90-120 mins) to stimulate LH release --\> stimulate androgen production.
In this medical orchiectomy, leuprolide (GnRH analog) is given in continous fashion instead --\> this will eventually lead to downregulation of of GnRH receptor on pituitary --\> lower LH --\> **lower Testosterone and DHT**
However **initally**, there is a **transient increase in systemuc androgens during first week of therapy**
101
What is the main function of M protein the virulence factor of Strep pyogenes ?
M protein shares strucutral homology with what?
Resist phagocytosis
Tropmyosin and myosin --\> rheumatic carditis
102
Oxygen supplementation in premature infants can lead to what eye maninfestaton? What growth factor is used? what are the complications of this?
Retinopathy of prematurity or renrolental fibroplasia
VEGF
Retinal vessel neovascularization --\> retinal detachment and blidness
103
Sharp Chest pain that radiates to left shoulder. Pain increases with inspiration and is partially releived by sitting up and leaning forward. What is the diagnosis? what would be an additional finding on PE?
Acute pericarditis and pericardial friction rub is an exam finding (scratching sound)
104
Which adregenic drugs are known to cause orthostatic hypotension?
What are the effects of B2 agonism?
alpha 1 antagonist
B2 stimulation --\> bronchodilation, vasodilation in SKM, uterine relaxation
105
The Progression of Diabetic nephropathy can be reduced by glycemic control and \_\_\_\_\_\_\_\_\_\_\_\_\_\_? By what mechanism?
**ACE inhibitors (prils)** --\> lowers glomerular pressure (**antiproteinuric** effect)
106
Which Diabetes Drug class works by activating **peroxisome proliferator activated receptor gamma**?
What are the metabolic effects of activating this receptor?
Thiazolidinediones (TZDs)
Decreases insulin resistance by upregulating GLUT4 in adipocytes and SKM & upregulating adinopectin release by fat tissues.
107
How can you test which pupil has the lesion in aniscoria?
108
1. What is the treatment for ganciclovir resistant CMV? Hint: This alternative drug causes hypocalcemia and hypomagnesia
2. Which CMV drug is associated with nephrotoxicity (proteinuria + inc Cr)?
3. What side effects does gangciclovir cause?
**1.Foscarnet** ( it can also chelate calcium and induce renal wasting of Mg)
Side note: Low Ca OR Low Mg cna both promote **seizures**
**2. Cidofuvir**
**3. Severe neutropenia**
109
Gastric Bypass leads to small intestinal bacterial overgrowth (SIBO) --\> this leads to an elevation what subtances?
**Vitamin K and Folate** (produced by enteric bacteria) --\> N/V/D + malabsoprtion of pther nutrients(B12, A, D, E) due to bypass
110
Abrupt onset of sudden severe headache indicates what
Rupture of berry saccular aneurysm --\> subarachnoid hemorrhage
111
112
Highest risk factors of abdominal aortic aneurysm?
Male + smoking and age greater than 65
AA involves **transmural inflammation**
113
What does the SADPUCKER nmenonic stand for? is SPleen one of them?
114
What does the POWER of s study indicate?
Is POWER related to type 1 or 2 error?
Define a Type 1 vs Type @ error
Ability of a study to detect a dfiference beween groups when such a difference truly exists.
Type 2 error (B) (Power = 1 -B)
Type 1 error (alpha) --\> described probablty of seeing a difference when there is no difference in reality. Alpha = probababilily that the observed difference is due to chance alone.
115
1. One or more deep, painful ulcers with ragged borders that have grey exudate, inguinal LAD. Immigrant. Gram negative rod in clumping pattern. WHat is the organism?
2. Multiple, small, grouped ulcers, shallow with erythematous base. Multinucleated giant cells + intranuclear inclusions? Painful.
3. Extensive & progressive ulcerative lesions without LAD. Deeply staining, gram-negative intracytoplasmic cysts?
4. Single, indurated, well circumscribed ulcer with clean base.
5. Small and shallow ulcers. Large, painful, coalesced inguinal LNs. Intracytoplasmic chlamydial inclusion bodies in epithelial cells and leukocytes.
1. this is a chancroid (Haempholis Ducreyi)
116
Can you explain how low body weight, frequent strenous exercise, chronic illness, eating disorders contribute to functional amenorrhea?
FHA is due to reduced circulating leptin (due to diminished adipose tissue) --\> inhbiit pulsatile gonadotropin releasing hormone from hypothalamus --\> dec LH and FSH --\> Low Estrogen --\> amenorrhea
117
What is the first line treatment for acute gouty arthritis?
If the patient has PUD or Renal failure what is the second line treatment for acute goutry arthritis? What is the MOA
NSAIDs
Colchicine --\> disrupts microtubule formation
118
Sudden upward jerking of the arm at the shoulder can injure \_\_\_\_\_\_. Leading to Difficulty performing fine finger movements.
Lower Trunk of Brachial Plexus (Median and ulnar nerves) --\> total hand claw deformity (Klumpke claw)
119
Vasectomy involves transection of the vas deferens. What should the patient be advised against and why?
unrprotected sex because viable sperm can still be present in distal vas deferns for 3 months or 20 ejeculations afterward.
120
Volar lunate dislocation can can compress/injure what nerve?
Hook of hamate fracture?
Median Nerve
Ulnar Nerve
121
What are the findings in Late teriary syphillis?
Gummas. Neurosyphillis, ascending aortic aneurysm, aortic valve insufficiency
122
An infant with poor feeding, vomiting and progressive lethargy. Diaper has Burnt sugar smell. Normal pregnancy and Delivery. Other children are healthy. Mom has exclusively breast fed. Infant has Dry Mucous membranes and generalized Hypertonia.
What is diagnosis? What Enzyme is deficient? What Should you restrict from this patients diet? what is the treatment?
Maple Syrup Urine disease
* Autosomal recessive
* Branched alpha keto acid complex deficiency
* Needed to Break down of **Leucine, Isoleucine and Valine** to go into TCA cycle
* Elevated Leucine is Neurotoxic
* Sweet Urine odor
* Tx: is dietary restriction
* DIfferential (LOOK THESE UP)
* PKU
* Homocystinuria
* Galactosemia
123
Tibial Bone pain. Lumpy protuberance over the right tibia + progressive hearing impairment for the last year. Bone biopsy shows Multinucleated cells, some containing over 100 nuclei.
What is the disease and what else can you tell me about its pathogenesis?
What is this multinucleated cell? What induces its differentiation into that cell type? what inhibits it?
Pagets DIsease of Bone (read in picture)
**Osteoclasts**
* Is a monocyte subtype; The two most important factors for osteoclastic differentiation are
* M-CSF
* Receptor for Activated Nuclear factor Kappa-B (RANK-L)
* Osteoprotegerin is a physiologic decoy recpetor that decreased RANK-L binding --\> decreased osteoclast survival
* FGF (chondrogenesis), IGF-1, TGF beta all favor bone deposition
124
125
Recurrent palpitations that start and stop abruptly. There is an abnormal conduction pathway in this patients heart beat that bypasses the AV node. What part of the ECG is most effected? What is the name for this process?
126
Young kid notices Dark Red blood on toilet paper. No Abdominal Pain. Low Hg. Tc pertechnetate scintigraphy --\> RLQ.
Meckel Diverticulum
* Ileal outgrowth results from failed obliteration of the vitelline (omphalomesenteric) duct
* Painless GI bleed,
* Can be a lead point to intussuception (currant jelly sttol)
* TC pertechnatate scan has high affinity for **parietal cells**
127
What is the Clozapine used to Treat? What is the main side effect associated with this?
Treatment Resistant Schizporeia (associated w suicidality)
Main adverse effects in order: Agranulocytosis, Seizures, Myocarditis, Metabolic Syndrome
This second generation antipsychotic requires mointoring of absolute neutrophil count
128
GO OVER PSYCH DEFENSE MECHANISMS
129
Glucagon is upregulated in the fasting state an has its primary effect on what organs?
Epinephrine has its primary affect on what organs?
Liver
Epi = SKM, adipose tissue and renal cortex
130
What is the causes the earliest morphologic change in superficial thermal burn?
Deeper burn wounds form blisters due to what MOA?
Release of preformed histmaine from mast cells
Due to fluid extravasation through gaps b/n damaged venule endothelial cells
131
3 month onset of Heavy Menstrual Bleeding. Dysmenorrhea (pain). Uniformly Enlarged Uterus. Negative Urine hCH. No bleeding problems before. No pain with sex. What is the likely diagnosis? What are other findings/diagnostic criteria?
Adenomyosis
* Endometrial glandular tissue within the myometrium
* Normal appearing endometrial tissue on biopsy
* Only diagnosed by microscopic exam of hysterectomy
* DIfferential (ruled out)
* Leiyomyoma (irregularly enlarged uterus)
* Ectopic pregnancy (- hCG)
* vWF disease (heavy menstrual bleeding had recent onset)
* Endometrial hyperplasia (irregular, not painful)
* Endometrial polyps (no uterine enlargement)
132
What does Blotchy Red muscle fibers on Gomori Trichome stain indicate? What is the inheritance pattern?
Mitochondrial myopathies
What are the 3 mitochondrial myopathies? (Look up)
* which one is characterized by myoclonic epilepsy ?
* blindess?
* Stroke like episodes and lactic acidosis?
133
LOOK UP QUESTION 5 in 5/27/20 practice test
134
Family History of unexplained death. Echocardiography findings as follow: Overal increase in LV mass, Reduced LV cavity size, Assymetric increase in LV wall thickness (marked in crease in septum size ), Normal/increase LV ejection fraction, Left Atria enlargement. What is the likely diagnosis? What is the inheritance pattern?
Hypertrophic Cardiomyopathy(HCM)
* Cause of Sudden cardiac death; often asymptomatic
* Autosomal Dominant
* Impaired diastolic function
* **Another characteristic finding is poorly developed coronary capillary network (in hypertrophied region) --\> with evidence of ischemia** (fibrosis, scarring)
* Microscopiccaly shows myocyte disarray
* Myosin heavy chain (sarcomeric protein) mutation
* Harsh systolic ejection murmur
* Differential
* Cardiac adaption in athletes
* eccentric hypertrophy with enlarged LV cavity
* Uniform LV wall thickness increase (not just septum)
*
135
1. The Locus Ceruleus is located where? What does it produce? What is the function of the Locus ceruleus? What pathology is caused by its abnormal activation?
2. The Raphe Nucleus is Located where? What does it produce?
3. What structures make dopamine? Where is it located
1. Posterior rostral pons near the lateral floor of the fourth ventricle, NorEpenephrine. Arousal(reticular activating system), sleep-wake states, cognition, mood, blood pressure control (autonomics).Anxiety Disorders
2. Medulla (serotonin)
3. Ventral tegmental area & substantia nigra pars compacta. 3 Major pathways: Mesolimbic/mesocorticol (cognition + behavior), Nigrostriatal (voluntary Movement), Tuberoinfundibular (inhbit prolactin)
136
Unresponsive patient, history of poorly controlled HTN (240/120 now), Extensor posturing + pinpoint pupils, CT scan shows acute pontine hemorrhage w mass effect. Autopsy shows disruption of all pigmented neurons in posterior rostral pons at the alteral floor of 4th ventricle.
These neurons produce what? What structure are they part of?
NE, Locus ceruleus
137
1. HMG-CoA reductase is the rate limiting step in \_\_\_\_\_\_\_\_\_\_. This enzyme is also a target of statin therapy.
2. Cholesterol 7alpha hydroxylase is rate limiting step in \_\_\_\_\_\_\_\_. This is inhibited as a side effect of what medication?
Formation of Cholestorol Gallstones
* 3 key MOAs involved in pathogenesis are
* Increased Cholestorol
* ex) Upregulation of HMG-coA reductase (Estrogen)
* Decreased Bile Acids
* ex)**_2. Bile acid synthesis, Fibrate medications_**
* Decreased phosphatidylcholine
* These will all lead to Bile becoming supersaturated with cholestorol --\> precpitates into insoluble crystals
* Risk factors
* Obesity, rapid weight loss, female sex, glucose intolerance, hypomotility of GB (pregnant, long fasts)
138
1. Patient feels as sense of heightened arousal/ tension that quickly escalates to rage and uncontrollable impulses to be verbally or physically aggressive. Outbursts present relief that is usually followed by remorse. Describes what disorder? Treat with SSRI + CBT
2. Frequent verbal or physical outbursts. Persistent irritability or anger between episodes. Child less than age 10. Described what disorder?
Intermittent explosive disorder (IED)
Disruptive mood dysregulation disorder
139
What Drug is used to treat ADHD? What are there common adverse effects?
Lamotrigine is what type of drug and what is it used for? What is the key adverse effect\>
Psychostimulants (methylphenidate and amphetamines)
**Decreased appetite, weight loss and insomnia** (less common are tics and inc HR/BP)
Anticonvulsant used to treat seizure + bipolar disorder --\> Steven Johnson Syndrome
140
Somnolence, decrease RR after ingesting 6 unknown pills. Improvement of RR w naloxone. what did he ingest?
what would be additional findings?
opiod intoxication
miosis. decrease bowel sounds, hypotension, dec tidal volume
141
What is the likely are the 3 causes of a baby that presents at birth with a flat nose, club feet and signs of respiratory distress?
1. Bilateral Renal Agenesis
2. Posterior Uretheral Valves
3. AR PKD
142
What are the well known Hypercoagulable states include?
(8 of them)
1. Post-Operative
2. Malignancy
3. Pregnancy
4. **Elevated homocysteine**
5. Nephrotic syndrome (loss of AT3)
6. **Smoking**
7. Inherited Thrombophilia (Factpr 5 Leiden, Prothromen Gene mutation, Antithrombin 3 deficient, Protein C/S deficient
6. Antiphosholipid Ab syndrome
143
Young kid with myocardial infarction, ocular lens displacement and intelectual disability.
1. These Symptoms are a result of a build up of what substances?
2. What is the Treatment?
3. What Enzyme is most likely deficient?
**_Homocystinuria_**
1. Build up **homocysteine** --\> leads to **methionine** build up
2. **Cysteine** supplementation is essential & limit methionine
3. Cy**stathionine B synthase** deficiency
Notes: Homocysteine is prothrombotic
144
Defense Mechanisms Immature:
1. Attributing one's own feelings to others
2. Transforming unacceptable feelings/impulses into the opposite
3. Reverting to earlier developmental stage
4. Avoiding conflict by expressing hostility covertly
145
Extertional Heat stroke leading to Low platelets, Increased PT & aPTT are indicative of what ?
What other key Lab findings associated with this?
**_Disseminated Intravascular Coagulation_**
Elevated D-dimer (indicated Increased Fibrinolysis)
Low Fibronogen
Elevated thrombin
KEY diff: from HUS/TTP is the pt/ptt levels (normal in HUS)
146
You have a malnourished patient come in. He is given thiamine, folic acid, multivitamins + IV dextrose. A few hours later the patient has **significant muscle weakness**. Serum phosphate is extremely low. What is the explanation for this response?
What are other causes of hypophosphatemia (differential)?
This is due to REFEEDING SYNDROME (search it up)
If you give glucose too fast then it will increase insulin --\> redistributes Pi into muscle and hepatic cells because they require ATP for glycosis --\> leads to even more decrease of Pi.
This can lead to cardiac (CHF) and respiratory failure
Key is refeed glucose back slowly so body can adjust.
147
Right Leg injury. Pain in lower leg and cant bear weight. Tibial and fibular shaft fracture on Xray. Patient undergoes surgery + immobilization. Hours later he has severe pain in right leg. PE shows increased tension within anterior compartment. Which structure is most likely compromised?
What is in the lateral compartment? Deep posterior compartment?
**_Acute compartment Syndrome_**
* Causes: long bone fracture, crush or thermal injury, bleeding disorders
* Pressure in a compartment increased --\> leads to vascular compromise --\> severe pain and tissue ischemia
* Most common locationL Anterior compartment of leg
* **Foot extensor muscle**
* **Anterior tibial Artery**
* **Deep peroneal Nerve**
* Lateral compartment
* Superficial peroneal nerve (foot drop + sensation loss over foot) + proximal deep peroneal N.
* Deep Posterior compartment
* Posterior Tibial A, Peroneal A
* Tibial N.
* Decreased senation over plantar foot
148
**_Blotting technique --\> Substance detected --\> Probe type_**
## Footnote
1. Northern Blot --\> ___________ --\> \_\_\_\_\_\_\_\_
2. Southern Blot --\> ___________ ---\> \_\_\_\_\_\_\_\_\_\_\_\_
3. Western Blot --\> ___________ -----\> \_\_\_\_\_\_\_\_\_\_\_\_
4. Southwestern Blot --\> ________ ---\> \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
ELISA vs Western blot
* ELISA = pt serum directly tested
* Western proteins are first seperated by electrophoresis
SNOW DRIP
149
Two most common enzyme mutation/defects in SCID?
150
Isotype switching of B cells occurs in what section of the Lymph node? What cell signals are required for this?
151
Look UP false negatives with sensitivity and specificiity
152
Older child with cyanotic spells that improve with squatting, harsh systolic murmur + RV impulse is indicative of what?
What is the main cause of this disease?
What factor determines the severity of this disease?
**_Tetralogy of Fallot_**
* Deviation of the infundibular septum --\> causes all 4 problems
* Severity of cyanosis/shunt is determined by degree of of subpulmonic stenosis
153
Kartagener syndrome is due to a defect in what? What is a clinical complication? What is the triad
Form of **_primary ciliary dyskinesia_**
* Due to a defect in **Dynein**
Triad:
1. Chronic sinusitis (mucocillary defect)
2. Bronchiectasis (recurrent resp infections)
3. Situs inversus (organs on wrong side: organ migration)
4. Also Infertility (flagella)
154
2 month old infant. Progressive Hypotonia. Immigrant. Lethargy. Constipation. Large fontanelle, Large tongue, Umbilical hernia. What is diagnosis?
155
When is a two sample t test used?
When is a chi-square test used?
When is a correlation coefficent used?
When is a meta analaysis used?
156
Common Cancer Immunotherapy involve targetting two receptors that allow neoplastic cells to evade cellular immunity. What are these two receptors? (Melanoma & RCC)
Another type of immunotherapy induces ischemia and tumor necrosis via what mechanism? what is the name of this drug?
Anti-**PD-1** Abs and anti-**CTLA-4** Abs
157
What is the genetic cause of Turner Syndrome? What gene winds up missing?
Most common: **Meiotic nondisjunction** during gametogenesis (45, X)
**SHOX gene**
**Side note: Uniparent disomy is Prader willi/agenlman**
158
Non-fusion of the urethral folds is NORMAL process in what gender? What does it cause in the other gender?
**_Weeks 8-15: External genitalia_**
Normal in females --\> Labia minora, vestibule of vagina
Failure of fusion in males --\> **hypospadias**
side note: epispadias is associated with extrosphy of bladder and is caused by malpositioning of genital tubercle
159
Explain the findings of the electrophoresis
1. Hemoglobin A Will Travel the furthest/fastest because of its negative charge (glutamate)
2. HbS (sickle cell) has valine (neutral AA) replace glutamate (negative) --\> wont travel as far
* Sickle cell trait has both HbS and HbA so thats why two marks
* Sickle Cell disease has mostly HbS
3. HbC has lysine(Postive AA) in the place of glutamate --\> this results in even less migration
* HbC Trait has both HbA and HbC
* HbC disease has mostly just HbC
4. Hemoglobin SC disease has HbS and HbC
160
HbC and HbS both result from what type of mutation?
Missense
161
Which Psych disorder is characterized by unstable and intense relationships. Mood reactivity, All or nothing ideation. Hard to control anger. Impulsive. Self mutliating behaivor.
162
What is the first step of muscle contraction in terms of actin/myosin?
1. Cell membrane depolarizes --\> SR releases Ca2+ via Ryanodine receptor
2. Calcium binds to troponin C on thin filaments --\> conformational change and displacement of tropomyosin --\> exposing myosn binding site on actin filament
3. ATP is bound to myosin head --\> cleaved to form ADP + pi (retained at head) --\> myosin binds actin filament --\> comfrmation change causes myosin to pull acin filament --\> muscle contraction + ADP release
4. New ATP is then bound to myosin head --\> release of actin filament
163
30 year female. bloody nipple discharge. No palpable masses or skin changes. No enlarged LNs. Otherwise healthy. What is the cause of this?
What is the histologic finding?
Intraductal papilloma
Proliferation of papilary cells in a duct or cyst wall with a fibrovascular core
164
Most common cancers (excluding skin cancers) in women by incidence are? by mortality are?
Incidence: Breast, Lung, Colon
Death: Lung, Breast, colon
165
**_Effects of Androgen Deprivation in Males:_**
Specifically decreases the ________ (not \_\_\_\_as much)
Specifically decrease prostate glandular volume (not stroma)
166
A patient has Psychotic Symptoms (delusions/paranoia), Diaphoresis, tremors, tachycardia, HTN and mydriasis. These symptoms are most consistent with what?
Cocaine Intoxication
Must distinguish for PCP intoxication (Violent behavior + nystagmus)
167
Middle age man. Hours of difficulty swallowing, dry mouth, and blurred vision. Major Depression History. Mydriasis and poorly reactive pupils. Normal nerve conduction velocity, but decrease compound muscle action potential. stimulating nerve helps. What is the like cause? and How does this condition happen?
Botulinum toxin from canned food
168
Severe Neuropsychatric delay, \>200 CGG trinucleotide repeats in chromosome X. What is the cause of this Disorder?
Fragile X syndrome
* \>200 repeats CGG trinucleotide repeats leads to **hypermethylation of FMR1 (inactivation)**
169
What type of Hormones use receptors that contain Zinc fingers in their Motif?
What is the Signifcance of Zinc-fingers?
What type of hormones use second messengers?
**Intracellular (lipid soluble) receptors** contain **Zing-fingers.** Intracellular hormones include the s**teroid hormones**(estrogen, aldosterone, cortisol), **Thyroid Hormone** and f**at soluble vitamin receptors**
**Zinc-fingers --\>** are the most common **DNA bind domain in humans (Many transcription factors** use this)**. Intracellular receptors act as TFs.**
Surface Receptors use Second messengers
170
A cutip is inserted into the meatus in close contact withthe posterior wall. Patient suddenly becomes light headed and faint. He recovers with no problem. What nerve is irritated ?
Vagus Nerve --\> Vasovagal syncope
Innervates posterior external auditory canal
171
**_Hyperacute Rejection (Type 2 HS)_**
* Onset: Minutes to hours ; Irreversible
* characterized by **preformed antibodies against graft HLA or blood group**
* Results in: **fibrinoid necrosis and thrombotic occlusions** of capillaries (**cyanotic and mottled**)
* Antibody and complement mediated vascular injury + subsequent thrombotic occlusion
**_Acute Rejection (Type 4 HS)_**
* Onset: less than 6 months; Reversible w immunsuppress
* **Cell mediated response (T cells)**
* Cell mediated: Lymphocytic intersitial infiltrate
* Humoral: C4d deposition + Neutrophils & necrotizing vasculitis
**_Chronic Rejection_**
* Months to years
* **Humoral**
* **Vascular wall thickening + luminal narrowing**
* **Intersitial fibrosis & parenchymal atrophy**
172
Sarcomere is defined as?
Where are actin(thin) filaments bound to structural proteins? How about myosin(thick) filaments?
What is the A band? Does it change length in contraction?
What is the I band? Does it change in length?
What is the H band? Does it change in Length?
1. Sarcomere = Distance between Z lines
2. Actin is bound to Z line; Myosin is bound to M line
3. A band = ALL myosin (overlapped w actin and not); DOES NOT change in lengeth
4. I band = region which actin does not overlap with myosin.
H band is region in which myosin does not overlap actin
BOTH get shorter in contraction
173
What is the best method for determining whether a gene is undergoing transcription (due to a mutation in a non-coding sequence)? (ELISA, or one of the 4 blots)
You need to analyze for the presence of **mRNA** using **NORTHERN blot. Better for assesing degree of transcription (Non coding = promoter or silencer)**
174
During the process of T cell maturation, TCRs demonstate very high affinity interaction with MHC molecules expressed on thymic medullary epithelial cells and dendritic cells. What is this process called?
What process occurs before this in the thymic cortex?
Negative selection
Positve selection
175
Infant presents with signficant drooling, choking, coughing and cyanosis with feeding? What embryologic process went wrong? What are other associations?
**_Tracheesophageal fistula with esophageal atresia_**
* Failure of lung bud to seperate from the primitive foregut
* **Polyhydramnios** may be seen prenatally.
* Inability to swallow saliva, food
* X-ray will show **stomach bubble** (air flow )
176
Look up Number needed to harm calculation
177
During Total thyroidectomy a nerve is injured while ligating an artery that enters into the superior pole of the thyroid lobe. Which Nerve is it and which muscle will be denervated as a result of this injury?
* **Superior Thyroid Artery**
* **External branch of Superior Laryngeal Nerve.**
* **Crycothyroid Muscle** (Only muscle innervated by this)
* Acts to tense the vocal cords (injury = low hoarse voice)
The remaining laryngeal muscles are innervating by r**ecurrent laryngeal nerves** (Posteriorly: inferior thyroid artery)
* Aryepiglotticus, lateral & posterior cricoarytenoid, thyroarytenoid muscles
178
**_Fasting/Starvation_**
* During the first _____ hours of fasting __________ is the main source of glucose
* What are the Key steps in this Process?
* After ______ hours, _______ is the main process used by body to maintain glucose level.
* What are the key steps and enzymes of this process?
12-18 hours. glycogenolysis, formation of glucose-1 phoshpate
**_Gluconeogenesis_**
* Glucose is formed from lactate, glycerol, glucogenic AAs
* Goal is to bypass steps of glycolysis (Hexokinase, PFKinase, Pyruvate Kinase)
* (1) Commited Step: **Pyruvate --\> Oxaloacetate**
* Via **Pyruvate Carboxylase** (requires Biotin; in mitochondria)
* Then malate shuttle and back to OAA in cytosol
* (2) **Oxaloacetate --\> PEP**
* via **PEPCK**
* Both steps bypass pyruvate kinase
* (3)**Fructose 1,6 biphosphatase** (bypass PFKinase)
* (4)**Glucose-6-phosphatase** (Bypass Hexokinase)
179
T2DM morpholohy?
T1DM morphology?
T2DM: amyloid deposition on pancreatic islet
T1DM: Pancreatic islet infilration with leukocytes (insulitis) & Abs against ilset antigens
180
Digeorge Syndrome results in impaired development of which embryonic structures?
Impaired NCC migration into **3rd and 4th pharyngeal pouch.**
181
Patient with hypothyroidism --\> what is the underlying Mechanism behind elevated LDL cholestorol in this pt? What is the Mechanism of elevated triglycerides?
**Decreased LDL receptor Gene expression** --\> decreased clearance of LDL
Hypertryglyceridemia can occur due to **decreased expression of lipoprotein lipase.**
**READ highlights**
182
Why does D-Glucose transport across plasma membrane of adipocytes and muscle tissue becomes much faster in the presence of insulin? What is this due to?
**_GLUT4_** is the insulin sensitive transporter. It is stored in cytoplasmic vesicles. Increased number of these transporters = faster glucose uptake by the process of **faciliated diffusion**
**GLUT2** facilitates export of glucose from liver, Small intestine & kidneys into the circulation
183
**_MEN1 = Diamond or 3 Ps_**
* **What is the main feature?**
* Primary HyperPTH (hyperplasia or adenoma)
* Pancreatic tumor (Gastrinoma)
**_MEN2A_** = Rectangle with star in middle
* **What is the main feature?**
* Pheochromacytoma
* Primary hyper PTH (hyperplasia)
**_MEN2B: Ms + triangle_**
* Medullary Thyroid Carcinoma
* Pheochromacytoma
* Marfanoid habitus
* Mucosal neuromas
184
A patient with HTN is being treated with a drug. He has Normal Na+, K+, BUN and Cr. Calcium is elevated and PTH is decreased. What is the cause of these lab values?
Thiazide Diuretic
185
What substrate stimulates the first enzyme involved in a fasting state of 24 hours?
Commited step in **gluconeogenesis** is **pyruvate carboxylase** and is **stimulated by acetyl coA**
**Citrate** is **+ regulator of Acetyl coA carboxylase (FA synthesis)** & **F 2,6 Bpase (gluconeogenesis)**
186
Mortality reduction: single most biggest factor is?
Smoking cessation (especially in diabetes)
187
GPCR proteins that contains alpha-helical regions composed of Valine, alanine and isoleucine perform what function in the cell?
Anchoring to Cell Membrane
188
189
The probability that a child from 2 populations with differant mutant allele carrier frequiencies will inherit an autosomal recessive disorder is 25% x CarrierFrequencyOne% x CarrierFrequencyTwo%
Example is Mom (1/30) and Father is 1/100)
1/30 X 1/100 X 1/4 = 1/12000
190
A patient with poor sleep, feeling tired all day, snores loudl during sleep and frequently gasps for breath. BMI 30 + HTN. He has a bulky tongue and crowded narrow oropharnyx. What is the diagnosis? Stimulation of which nerve would help?
Obstructive Sleep Apnea, Hypoglossal N
191
Severe shortness of breathe no tobacco use. Autopsy shows hyperinflated lungs, airway mucus plugging and cellular infiltration of the bronchial wall. What is this describing and what long treatment could have prevented this?
Uncontrolled asthma and Fluticasone
192
A 60 yo patient. SOB. Dyspnea while lying flat and sleeping up right. JVD is present. Dullness to percussion at bialteral lung bases. Chest Xray shows cardiomegaly + bilateral effsuions. Serum protein is 6, and LDH is 60. What is the description of the pleural fluid and what be considered normal values of protein, LDH, glucose and WBC in the fluid?
Patient has heart failure --\> **transudative effusion**
**_Light criteria_**
Exudative = increased capillary permeability so everything leaks out
Transudative = low pleural fluid/serum ratio
193
Which asthma med works by inhibiting the interaction of inflammatory mediators with sell surface receptors (reduce bronchoconstriction)?
Which Asthma med works by inhibiting NFkB --\> anti-inflammation. Also inhibits phospholipase A2?
Which Asthma med inhibits the enzyme 5-lipoxygenase --\> reduce production of LTs?
1. Montelukast
2. Inhaled ICS
3. Zileuton
194
What determines the total airway resistance in the Lower Respiratory Tract?
Where is airway resistance the highest?
Since the airways arrange in **parallel**, airway resistance in determined by the **total cross-sectional area** of all airways at the level. **The greater the total cross sectional area --\> the lower the airway resistance**
## Footnote
**Highest in medium sized bronchi**
195
Candida Albicans can cause lung infection?
NAAAA bitch
196
Sputum cultures on selective medium appear as parallel chains (serpentine cords). This growth indicates what organism and what is the significance?
What are other components of this organism?
TB cord factor (virulence factor) --\> prevent macrophage mediated desctruction and helps make caseating granuloma.
197
What is the pathway of fetal circulation?
Placenta --\> umbilical vein (most O2) --\> ductus venosus --\> Inferior Vena Cava (SVC not participate) --\> R. Atrium (rest of heart via foramen ovale) --\> pulmonary circulation --\> ductus arterosis --\> descending aorta --\> paired umbical arteries --\> placenta
198
What is the major stimulator of respiration in healthy individuals? What is stimulated and where?
What changes to this process are seen in COPD?
Healthy: **_Central Chemoreceptors_** locate in the medulla
* Sense high CO2
* Respond to hypercapnia (& H+) --\> Inc RR
COPD: **_Peripheral chemoreceptors_** (carotid body:CN9 and aortic body:CN10)
* Sense PaO2
* stimulated by hypoxemia --\> increase RR
* inhibited by oxygen supplementation --\> Dec RR
* **reponse to CO2 is blunted in COPD**
199
Silicosis key finding? What is a consquence of this and why?
TB infection due to impaired macrophage function
Classic finding would be egg shell calcification
200
The Work of Breathing in Restrictive lung disease is chracterized by?
The work of breathing in Obstructive lung disease is characterized by?
Restrictive = rapid shallow breathing (low tidal volume)
Obstructive = low RR, slow deep breathing; (high tidal volume)
201
Transpulmonary pressure vs Lung Volume Graph measures what?
Compliance
202
Midline mass that moves superiorly with protrusion of tongue or swallowing. Can be infected after URI. What is the Dx? what other midline mass can you rule out?
What would be the likely Differential of a lateral neck mass?
1. Thyroglossal duct cyst is the diagnosis. You can rule out dermoid cyst because those DO NOT move with swallowing
2. Carotid body tumor, Cystic hygroma, Brachial cleft cyst
203
Teenager with painless mass in right scrotum. Nodule felt on PE. Does not change in size with positioning and no transillumination. No LAD. What is diagnosis?
Painless, solid scrotal mass should be considered testicular cancer until proven otherwise.
204
What are the two main types of genetic anomalies that give you down syndrome?
Meiotic non disjunction(47 XX +21) and Unbalanced Robertsonian translocations( 46 XX, t(14;21))
205
Name the Congenital Defect:
1. Protruding tongue, excessive skin at nape of neck, upslanting palpebral fissures. VSD
2. Low set ears, webbed neck, wide spaced nipples, coarctation of aorta
3. Hypertelorism, micrognathia, cleft palate, ToF
4. Micrognathia, low set ears, clenched hands with overlapping fingers, hypertonia
5. Microopthalmia, cleft lip and palate, polydactyl. holoprosecnphaly
1. Down Syndrome
2. Turner Syndrome
3. DiGeorge
4. Edward
5. Patau
206
What Specific Defect leads to recurrent Neisseria infections?
What problem can lead to severe Neisseria infection?
Deficiency of **membrane attack complex** (factors C5b -C9)
**TOO MUCH IgA** (all it does is bind to bacteria and prevents attachment to mucosal surfaces). This will prevent IgG or IgM from binding leading to less activation of complement and clearance of bacteria
207
UWORLD look up how to calculate false positive and negative
208
What functions are the frontal lobes responsible for?
What area/lobe is responsible for language comprehension?
Lesions in what lobe would give you right-left disorientation and finger agnosia?
Lesions that result in inability to recognize a familiar face?
Personality, Language, motor functions and execute functions(abstraction, planning, inhibition, attention and working memory)
209
Peptic Ulcers(stomach or duodenal mucosa) are most commonly due to what?
H. Pylori and NSAIDs
What is the MOA of NSAIDS and its effect gastric mucosa? (dont open picture till you answer)
210
Young female, normal BMI. Gestational diabetes and fasting hyperglycemia are genetically predisposed. What enzyme is likely reduced in activity?
What is the mechanism of Insulin relase by pancreatic beta cells? What stimulates it?
Glucokinase
Stimulated by glucose + AA
Inhibited by epinephrine
211
LOOK UP INFORMED CONSENT
212
1. What is the pathogenesis behind migraines? What pharm therapy targets this?
2. What is the pathogenesis behind absence seizures?
3. What is the pathogenesis behind narcolepsy?
1. Increased cerebral excitability --\> wave of cortical spreading depression --\> release of calcitonin gene-related peptide (vasoactive) by trigenminal afferents --\> pain transmission. Triptans and Erenumab
2. Dysfunction of thalamocortical fiber Ca2+ channels
3. Orexin A and B (hypothalamus) --\> inhibit transition to REM sleep
213
What is the MOA behind Renal Changes during pregnancy? What does this due to the following:
GFR
RBF
Serum Creatinine
Cardiac Output?
214
\_\_\_\_\_\_\_\_\_\_\_ (in series) --\> group **1b** --\> sense **Tension** (not length) --\> too much force results in **sudden muscle relaxation** (prevent damage: negative feedback)
\_\_\_\_\_\_\_\_\_ (parallel) --\> Group 1a & 2--\> sensitive to change in **muscle length** --\> Mediate stretch (**myotatic reflex; DTRs**) ; contraction that resists stretch
215
What is the MOA of latanoporst in glaucoma?
What is the MOA of dorzolamide?
What is the MOA of Timolol?
What is the MOA of Brimonidine?
What is the MOA of muscarinic agonist?
216
What viral infection are patients that undergo transplant and immunosuppression susceptible to reactivate? What are the manifestations? What is first line therapy for this and associated side effects?
217
STEMI treatment. What was the TX responsible for the rapid reperfusion?
What is the drug used in Treatment + prevention of Venous thromboembolism?
What is the Treatment used to treat heparin-induced thrombocytopenia?
What two drugs are irreversible inhibitors of platelet aggregation? used in STEMI regimen?
How does Heparin work?
Alteplase
218
Teenager with 1 day of left testicular pain. Pain is worse with movement. Swelling and TTP on posterior and superior Testis. Other testis is normal. Cremasteric reflex is normal. Urinalysis has numerous leukocytes w no bacteria. What is Dx and what is the cause?
**Acute epididymitis**
219
LOOK UP VOLUME OF DISTRIBUTION FOR PHARM
220
Urine turns black overnight + Arthritis with black pigment in cartilage. What is Diagnosis? What Enzyme is deficient? What conversion process is affected?
**_Alkaptonuria_**
* Autosomal Recessive (**Tyrosine** metabolism)
* Deficiency of **homogentisic acid dioxygenase**
* Conversion of **Tyrosine** --\> **Fumarate**
* Retained homogentisic acid binds to collagen in Connective tissue, tendons and cartialge
* Symptoms:
* **Black Urine overnight** (Oxidation)
* **Onchronosis**
* Blue black pigment (ears, nose, cheeks)
* **Onchronotic arthropathy**
* Black pigment in cartialge joints
221
Gap Junctions are made of what type of protein? What is the Function?
Tight junctions?
Adherens Junctions?
Desmosomes?
Hemidesmosomes?
222
What medications can you do to approximate physiologic insulin secretion?
223
Older pt. Admitted to hospital for increasing LE edema and dyspnea. History of Pulm HTN, obesity hypoventilation syndrome and chronic LE edema. What is his likely diagnosis at this time?
5 days after admission his Hg, BUN, and Cr all go up alot. Elevated BUN/Cr ratio. Low Urine sodium. What is the likely cause for these abnormalities?
224
Patient SOB is worse with lying flat, dyspnea, bilateral basilar crackeles and S3 heart sound. Decrease Pulse Ox. High RR. What is diagnosis?
These findings suggest pulmonary edema, how does this present in terms of lung function, compliance?
225
What are the symptoms of opioid withdrawal and what other drug can precipitate withdrawl and how?
Buprenorphine (partial agonst)
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227
What is the treatment for tonic-clonic seizures mixed with absence seizure episodes?
What about absence seizure alone?
How about focal seizures?
228
Apical holosytolic murmur months after an MI. Resolves with diuretic and vasodilator Tx. What is the murmur and what is the likelt cause?
Mitral Regurgitation secondary to decompensated heart failure
229
Which Nerve is injured deep to the mucosa of the overlying piriform recess?
230
Hematuria, flank pain, 3+ blood in urine. Compression of Left Renal vein between the SMA and aorta. What is Dx and complication?
Varicocele (nutcracker syndrome) due to pressure elevation and retro grade flow
231
30 yo female with severe joint pain in hands, wrist and ankles for a week. Unable to perform daily activities. High fever and and diffuse rash during a trip to Puerto Rico 2 weeks ago. No other red flags. Periarticular swelling + tenderness of said joints. Decreased ROM. Lymphopenia. What is cause of joint pain?
Chikungunya fever, alpha virus
232
34 yo Female. Mass in breast. 2cm nodule. What is Dx?
Fibroadenoma
* Most common benign tumor of breast (young women15-35)
* Well demarcated painless mobile
* myxoid stroma that encircles epithelium-lined glandular and cystic spaces.
233
3 week old infant. Lethargy and difficult to arouse. Did not recieve any vaccinations or medications after birth. Head circumference is 99th percetile. Weight and length are 25th. Large, bulging anterior fontanel. Eyes appear driven downward and cant move up. Intracranial hemorrhage is seen on CT. What is the cause?
Vitamin K deficiency --\> impaired clotting factor carboxylation
234
What are the Risk factors for Uric acid Kidney stones? What is the treatment?
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5 day old infant. Multiple vomitting spells. Tachypnea, hypotension. Jaundice, lethargy, sunken fontanelle, dry mucous membranes, hepatomegaly. Hypoglycemia + ALT elevation. Normal ammonia. Gram negative rods. Infant placed on special formula and improves. What is the disorder and what enzyme is deficient?
237
What is the general rule for lymphatic drainage of Large intestine?
Where does Lymph drainage proximal to anal dentate line go to (what major LNs?
How about distal to the anal dentate line?
238
Sharp and pleuritic chest pain that is exacerbated by swallowing and coughing. Diffuse ST elevations. Happens 3 days post MI. What is the cause?
What if it was a week to a month out?
Pericardial inflammation over the overling necrotic segment (peri-infarction) pericarditis (follows a transmural MI)
Pericardial inflammation due to autoimmune reaction to necrotic tissue (dressler syndrome)
239
What is the difference between Postpartum blues, postpartum depression and post partum psychosis?
240
What medication impairs the cell-mediated immune response and leaves people susceptible to intracellular bacteria and granulomatous fungi?
TNF-alpha inhibitor
241
What are the steps of Insulin receptor cell signaling propogation?
What subtances inhibit or cause insulin resistance and how?
STep1: Insulin binds
Step2: Activate Tyrosine phosphorylation (autophosphyrylation)
Step 3: Binding of substrates (IRS-1/2) --\> downstream effect
Step4: PIK3 --\> GLUT4, glycogen, lipid, protein synthesis
MAPK: cell growth and DNA sytnehsis
TNFalpha, Glucagon, epinephrine, glucocorticoids (phosphorylation of threonine or serine residues on IRS)
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Lactose fermenting, indole postive gram negativ rod?
E. Coli
243
Most Rodentacides contain what? (Hint: symptoms are bloody emesis, scattered ecchymoses, blood in stool)
What is the treatment for this?
244
1. Which Drug is indicated in insanely high Triglyceride levels?
2. Which drug is used for prevention of CV disease and major use is lowing LDL cholestorol?
3. Which two drugs are used in hypercholesterolemia?
4. Which drug increased HDL, but has alot of side effects like flushing?
245
What is the MOA of antiobiotic that is used to treat enterococcus and side effect is tinnitus/hearing loss + renal issues?
Which Abx worls by creating transmembrane channels tha cause ion leakage and cell membrane depolarization? what are its side effects?
AMinoglycosides inhibit genetic code reading and protein synthesis by binding to prokaryotic 30s subunit.
246
Which metalloprotease breaks down polypeptides released for the heart that are responsible for vasodilation, diuresis and inhibition of RAAS?
Neprylisin
247
Hematogenous osteomyelitis in kids effects what bone region?
248
2 yo girl ambigous gentialia, Clitoral enlargement. High blood pressure. Hypokalemia. What enzyme deficient?
2 week old girl ambigous genitalia, hypotension, hyperkalemia, N/V. What enzyme is deficient?
2yo boy with ambigous gentialia. Hypertesion and hypokalemia. Often diagnosed at puberty?
1. 11-beta hydroxylase deficiency (HTN due to weak mineralacorticoid build up (acts like aldosterone)
249
Which drug is used as an anticonvulsant and mood stabilizer? Can effectively treat Bipolar disorder + epilepsy. What are this medications side effects?
What are other mood stabilizers used in Bipolar disorder?
Valproate
Tell me key side effects?
250
Describe MOA of acute viral hepatits and morphology of acute vs chronic
251
What is the typical stool finding in watery diarrhea? Specifically Vibrio?
What is the typical stool finding in bloody diarrhe?
How about diarrhea caused by Typhoid Fever?
252
What are the symptoms of Serotonin Syndrome? What is the most important one?
What are common medications that can cause it?
253
Some MRSA carry a cytotoxin that destorys leukocytes and causes tissue necrosis what is this called?
What is the main virulence factor of Strep Pneumo?
254
Severe Dry eyes and Dry mouth are characteristic of what disease?
What are the Serologic Markers for this?
What is the site of biopsy? What is seen on histology?
Sjogren's Syndrome
Anti-Ro (SSA) and anti-La (SSB)
Lip biopsy (**periductal lymphocytic infiltrates**)
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256
Explain the mechanism of acute kidney injury by NSAIDS. What part is effected?
Prostaglandins cause vasodilation of the afferent arteriole leading to increased GFR and RBF. NSAIDS inhbit PG production --\> block vasodilatory effects. (pre-renal azotemia)
What medication causes efferent arteriole vasodilation (lower GFR) ?
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258
Omeprazole blocks what channel?
Tedrodotoxin & Lidocaine block what channels?
Verapamil blocks what channel?
Dofeltilide blocks what channel?
259
Look up relative risk reduction
260
Look up Cutoffs
261
All patients with a major depressive episode should be screened for ___________ before Treatment. Why?
Past history of manic episode (Bipolar disorder) antidepressant monotherapy can carry a **risk of inducing mania.**
Not as important as first part: history of sexual dysfunction may be of concern to some people
262
What part of the colon is always involved in Hirshprung's disease and what is the mechanism/reasoning behind this?
Rectum
(NCC cells move caudally along vagal N; proxmal colon at 8th week and rectum by 12th week) if disruption in this process rectum will always be involved
263
Phenylketonuria can be caused by a 1. deficiency in phenylalanine hydroxylase OR 2.deficiency of __________________ which forms _______ (a cofactor used in the synthesis of \_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_. What is the treatment of this second form.
Both causes lead to excess Phenylalanine.
Dihydrobiopterin reductase, BH4 --\> Tyrosine, Serotonin and DOPA (precursor to NE, E and D)
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Acute onset constipation. Lung carcinoma. Increasing low back pain. Dry cough. weight loss. increasing difficulty with urination. Pain over the lower spine. Bilateral LE weakness. Sensation impaired in perineal region. What is Dx? What is causing the constipation?
265
What are the pulmonary changes seen with aging?
266
What is the main mechanism of copper removal in healthy human body?
Hepatic secretion into bile and excreted in stool
267
What is the finding on biopsy in a patient with lactate deficiency?
Normal Bowel mucosa
268
What are the effect of opioids(morphine) on the spinal cord neurons (2)?
1. Bind to Mu receptor(inhibitory G protein) --\> closure of voltage gated Ca2+ channels --\> reduce calcium influx --\> decrease Excitatory NT release (presynaptic terminal)
2. Bind to Mu receptor on postsynaptic terminal --\>opens K+ channels ==\> hyperpolarization (K+ efflux)
Lidocaine works by inhibiting voltage gated Na+ channels
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Teenager. Difficulty moving. Progressively worsening symptoms. Kyphoscoliosis, high plantar arch. Relative with neurologic issues + HF at age 25.
What is Diagnosis?
Can you explain the cause of his movement issues?
What gene?
270
What is the best/most sensitive test to order when assesing patient with impaired nutrient absorption (loose stools)?
Sudan 3
271
What AIDS defining illness would be seen with a CD4 count of less than 50? What are the symptoms?
272
What part of the kidney is erythropoetin released by? In respose to what?
Peritubular (interstital cells) Fibroblasts in renal cortex
In response to decreased renal oxygen delivery
273
How long does it take for vitamin B12 stores in the body to deplete? What are some known causes of B12 deficiency?
274
Explain OCD
275
In anti-epileptic drugs: blocking voltage gated Ca2+ channels. What subsequent step will not occur?
Fusion and release of NT from vesicles
276
Progressive fever with, relative bradycardia, followed by salmon colored macules on the trunk and diarrhea describe what disease?
Typhoid Fever
277
Influenza virus pt. Superinfection can happen by what 3 bacteria? What is the one that is likely to infect young, healthy patients?
Strep pneumoa, haemophlilus influenza, and Staph aureus
Staph aureus can cause it in younger previously healthy pts
278
What is the mode of inheritance?
1. CF, Hemochromatosis, Sickle cell
2. Huntington, Marfan, MEN, NF
3. Myoclonic epilepsy, MELAS & leber hereditary optic neuropathy
4. Duchenne/Becker Muscular dystrophy, hemophilia, G6PD deficiency?
5. Spina bifida, Cleft palate, HTN
1. AR
2. AD
3. Mitochondrial
4. X-linked Recessive
5. Multifactoral
279
Herpez Zoster (shingles) presents as what?
280
Chronic Transplant rejection is characterized by what findings?
Acute Transplant rejection is characerized by what?
Hyperacute?
1. Irreversible, obliterative vascular wall thickening with tubular atrophy and interstial fibrosis
2. Dense, intersitial, mononuclear(lymphoctic) infiltrate; T cell medaited
3. Vascular fibrinoid necrosis with capillar thrombotic occlusions
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282
What are all the effects of Angiotensin 2?
1. Efferent arteriole constriction --\> Raise GFR, dec RPF
2. Increased Na/H20 reabsorption
* Proximal tubule via capillary effect
* Direct proximal tubule resportion through Na/H+ exchange
3. Aldosterone release
4. Pituitary ADH secretion
5. SNS activation
283
What is CardioRenal Syndrome caused by?
What are the 3 Main Renal effects?
284
pt with tonic/clonic seizure, headache, vomitting, confusion and Fever. Papilledema. Neck Rigidity. Patient died, Biopsy is seen
Yeast with thick polysaccharide capsule (cryptoccoccus neoformans)
285
What medications are common cause of QT prolongation?
What are common causes of AV block?
286
30 year old patient. Severe palpiations and light headedness. Has had similar epeiosdes in the past. SHe is asymptomatic 30 mins after arrival. Shows Delta waves. What is the cause?
287
The same antiobiotic are given at two different dosages. One is every 6 hours(1 gram) and the other is every 12 hours(2 grams).
Which will have improved patient compliance? which will have lower average plasma drug level? Which will have lower drug toxicity?
288
How does te foramen ovale close? what is a rare complications years later if it remains patent?
289
Where is a likely sign for common fibular nerve injury?
What does the common fibular nerve branch into? What compartments do these supply? What areas of the foot? Which one does foot dorsiflexion vs eversion?
290
What are the manifesations of Carcinoid tumor? What dictates when it becomes carcinoid syndrome? What is a longterm complication?What is the treatment?
291
Pure Sensory stroke is most likely to becaused by a lesion in what location?
Pure Motor stroke would be a result of lesion where?
A lesion causing contralateral weakness and ataxia due to involvement of corticospinal and corticobulbar tract would be located where?
A lesion causing behavior issues (agitation, psychosis, abulia), speech/language issue and choreathetosis would be located where?
292
Autopsy shows 5 to 6mm cavities in deep structures of the brain filled with clear fluid? what is the cause of these findings?
293
What is clinical presentation of Infant botulism?
294
A women gives has a stillbirtth at 20 weeks. A few weeks ago she had pain in both knees, and ankles that resolved in a week. She is a third grade teacher. Autopsy of fetus shows pleural effusion, pulmonary hypoplasia and ascites. What virus is the cause? Is it an RNA/DNA virus? ss or ds? Enveloped or not?
What are some other TORCH infections?
Parvovirus B19, enveloped, ssDNA
295
What does the **TORCH** mnemonic stand for?
Which one causes **limb hypoplasia, cutaenous scarring**, cataracts, chorioretinitis?
Which one causes **hydrops fetalis**?
Which one causes chorioretinitis, **intracranial calcifications, hydrocephalus**?
Which one causes "**snuffles**", hepatomegaly, **skeletal anomalies**?
Which one causes **Sensorineural deafness, catarcts and blueberry muffin rash**, HSM, heart defects?
Which one causes **deafness, periventricular calcifications**, **jaundice**, HSM, chorioretinits?
Which one causes **Cutaneous vesicles**, lesions, scarring?
296
Why do PPIS need to be slowly tapered off?
297
What are pneumoconiosis?
298
Persistent, profuse mucoid diarrhea. Hypokalemia and microcytic anemia. 2,5 cm, cauliflower like mass in sigmoid colon. What is diagnosis?
299
25 yo male normal male pattern facial and pubic hair. SMall testes and decreased sperm count. Normal testosterone. What is Dx?
300
Which Key growth factors promote angiogenesis in neoplastic and granulation tissue?
Which cytokine are indirectly involved and can stimulate one of these growth factors?
301
Hepatitis B vs Hepatitis C
Transmission?
Acute syndrome?
Symptoms?
Chronic State?
302
What type of Immunoglobulins do blood group A or B mothers have circulating?
How about blood group AB?
How about blood group O?
303
Diabetic Mononeuropathy can can cause diplopia, down and out eye, and ptosis by which mechanism?
How is this different from the other cause of mononeuropathy?
304
Brain abscess appears as what on CT? and arise from what location in the body? what species?
What would cause a temporal lobe abscess?
305
Older patient has 6 month Hx of chest tightness when he walks uphill or climb stairs. Radiates to his throat. Last 5- 10 minutes before going away. T2DM plus Increased LDL. Father had CABG & mom had stroke. What does he likely have?
What medication does the metabolite S-nitrosothiols come from? This drug effects vascular smooth muscle in which part of the body? Tx leads to relief of Symptoms.
Stable angina pectoris.
Relieved with nitrate (nitroglycerin. isosorbide mononitrate/dinitrate) --\> metabolized to **nitric oxide and s-nitrosothiolds.**
**Predominantly effects LARGE VEINS (venodilation) --\> decrease preload (lower Myocardial O2 demand)**
306
How can you tell that a patient with mitral valve stenosis also has aortic valve involvement?
307
CMV retinitis is the most common cause of eye disease in AIDS patients with CD count below 50. What will fundsocopy show? Treatment?
Yellow, white fluffy retinal lesions, near retinal vessels also has hemorrhage
Gangciclovir.
308
Hyaline casts are made up of? Caused by?
Fatty casts are made up of? caused by?
Waxy casts are made up of? Caused by?
Granular (muddy brown) casts are made up of? caused by?
WBC casts are made up of? caused by?
RBC casts are made up of? caused by?
309
What findings is most indicative of a poor prognosis of cirrhosis?
Tests of Liver function
1. Elevated Prothrombin time
2. Low albumin
3. Elevated BR
310
Look up correlation coefficient
311
What is the mechanism of of the pictured lung condition in a 45 year smoker?
312
Treatment of metastatic prostate cancer.
What does Leuprolide inhibit?
What does Ketoconazole, spironolactone inhbiit?
What does Finasteride inhbiit?
What does flutamide, spironolactone, cyproterone inhibit\>
313
Early fall season. 43 yo. 4 weeks of cough. Initially a bad cold and the other symptoms stopped but the cough has stayed and worsened. Bursts of coughing for minutes and unable to clear mucus. So heavy he vomitted after. teacher. all vaccinations recieved, but hasnt seen doc in years, nothing on chest xray. WHat is dx?
What are its main toxins
What is a unique lab feature?
Pertactin
Pertussin Toxin
Lymphocytosis
314
Middle age women. Several "near collisions" driving at night. Generalized pruritis. Hasnt seen dr in years. Skin is diffusely course and dry. What could have caused this?
Pruritus due to Bile acid deposition
Hyperkeratosis + night due to Vit A deficiency
Cause of vit A deficiency are?
What is Dx?
315
Patient has diabetes that requires insulin therapy. Hisotry of HTN, hyperlipidemia and migraines. In the morning her blood glucose is 42. She says she feels hungry but has no symptoms of hypoglycemia. What medication can explain her lack of hypoglycemic symptoms? What is the mechanism behind this?
Non selective Beta blockers (Propranalol)
Think about the MOA behind this.
In response to hypoglycemia the body activates \_\_\_\_\_\_\_\_\_\_\_\_. This results in two distinct pathways that cause different array of symptoms. What are the different mediators of these two symptoms? What symptoms do they cause?
316
Has a puncture leg wound. Right foot is dorsiflexed and everted. The patient cannot stand on his tip toes. No fractures, and pulses are intact. What nerve is damaged? Where would sensory loss be?
317
A diabetic patient is experiencing recurrent hypoglycemic episodes (below 50 on multiple occasions). The patient has CKD from diabetic nephropathy. GFR has declined to 20. Why is he havving these symptoms?
Due to decreased insulin clearance by the kidney (exogenous insulin). Insulin clearance is dependent on GFR
NOT increased glucose excretion (this is hyperglycemia)
318
Explain the different mechanisms of contraction between SKM, cardiac and smooth muscle.
Why does verapamil have minimal effect on SKM?
319
Screening for early stage diabetic nephropathy is best accomplished by measuring urinary excretion of what?
What would be a good Tx that can reduce mortality if this subtance is increased in urine?
Albumin
ACE- inhibitors
320
Punch biopsy of normal looking epidermis shows stellar cells with intracytoplasmic granules in shape of tennis racquet. These cells have myeloid surface markers and can interact with T cells. What is this cell type?
321
322
1. Defective ApoE leads to elevated \_\_\_\_\_\_. manifests as \_\_\_\_\_\_\_, ______ and \_\_\_\_\_\_
2. Defective __________ or ApoB-100. Lead to elevated \_\_\_\_. Manifests as \_\_\_\_\_\_\_\_, _____ and \_\_\_\_
3. Defective _______ or ApoC-2. Leads to elevated \_\_\_\_\_. Maninfests as \_\_\_\_\_\_\_\_, \_\_\_\_\_\_\_\_
4. ApoA1 and LCAT deficiency --\> Low levels of ____ and increased \_\_\_\_\_
5. Familial Hypertrycleridemia will have elevated levels of \_\_\_\_?
1. VLDL and Chylomicons. Premature atherosclerosis
2. LDL receptor. Premature atherosclerosis, tendinous xanthomas.
3. Lipoprotein Lipase. Chylomicrons, Acute pancreatitis
4. Low HDL and increased free cholestorol
5. VLDL
323
Teenager. Never menstruated. Fully developed secondary sexual characteristics. Shorted vaginal canal with rudimentary uterus? What is Dx?
324
Severe respiratory distress. Patient needs intubation. Ketamine is given. What purpose does it serve for thisc scenario?
What two other medications are used and why?
Ketamine NMDA antagonist (similar to PCP); preserves respiratory drive. Also an anesthetic. Ketamine --\> stimulate catecholamine reease (sympathomimemtic) --\> bronchodilation
Propofol and Etomidate
NM blockade (succinycholine or rocuronium)
325
You need to counsel diabetic patietns taking insulin about weight gain (dont ignore because it may lead to reduced adherence)
326
Explain the mechanism behind Cystic Fibrosis. How is it caused?
327
2 yo. Recurrent infections. Always sick. Otitis media, skin infections, pneumonia, Staph aureus on skin infection. DECREASED CD18 Antigens on surface of leukocytes. What is diagnosis? What is patient at risk for? What is CD18?
328
What is persistent depressive dirosder?
329
