UWorld Questions 2 Flashcards

Question

What does mutation of the TTR gene cause? non-mutated TTR?

Answer 1

results in misfolding and extracellular deposition of transthyretin protein (prealbumin) which can cause familial amyloid polyneuropathy or familial amyloid cardiomyopathy senile cardiac amyloidosis - non-mutated transthyretin deposits in the heart

Answer 2

The HIV virus uses CD4 protein as a primary receptor and the CCR5 chemokine receptor serves as a co-receptor. Both CD4 and CCR5 are bound by the HIV viral outer envelope protein gp120. HIV virus enters by fusion with the cell membrane Tat plays a role in viral replication Nef decreases expression of MHC Class I proteins on the surfaces of infected cells

Answer 3

increased work of the splenic parenchyma which must remove the deformed erythrocytes from the circulation - red pulp hyperplasia

Answer 4

marfanoid body habitus and hypercoagulable state

Answer 5

- t(14,18) -- Bcl2 overexpression which has an antiapoptotic effect - t(9,22) - philadelphia chromosome, bcr-abl - constitutively active tyrosine kinase

Answer 6

the c-myc gene (on chr 8); can be coupled with the heavy chain promotor on chromosome 14 HER-2-neu and Erb-B2 overexpression which are both epidermal growth factor receptors

Answer 7

1. increased levels of ammonia result in depletion of alpha-keto-glutarate causing inhibition of the Krebs cycle 2. depletes glutamate an excitatory NT 3. causes an increase of glutamine which results in astrocyte swelling and dysfunction Oxindole is produced by bacteria in the gut from tryptophan and normally cleared by the liver; elevated levels have been found in patient with hepatic encephalopathy

Answer 8

Anaphylaxis is the result of widespread mast cell and basophil degranulation and the release of pre-formed inflammatory mediators including histamine and tryptase. Tryptase is relatively specific to mast cells and can be used as a marker for mast cell activation mastocytosis - abnormal proliferation of mast cells; KIT gene

Answer 9

Carcinoid syndrome (diarrhea and flushing) histo - salt and pepper chromatin

Answer 10

Type III hypersensitivity reaction to non-human proteins characterized by vasculitis resulting from tissue deposition of circulating immune complexes; fever, pruritic skin rash, arthalgias, and low complement levels; presents ~1-2weeks after exposure reaction can be to chimeric monoclonal antibodies (-iximab), venom antitoxins, and certain non-protein drugs like penicillin and TMP-SMX

Answer 11

A - 6 months in the liver (in the perisinusoidal stellate Ito cells) D - over the course of several months, stored in adipose tissue K - small amount stored in the liver that can last for 1-3 weeks, however the gut bacteria produce enough functional Vit K most water-soluble vitamins are excreted quickly

Answer 12

TERT - telomerase reverse transcriptase TERC - telomerase RNA component TERC is a built-in RNA template that is repeatedly read by the TERT subunit to add TTAGGG DNA sequence repeats to telomeres

Answer 13

superior part of lower lobe and posterior part of upper lobe; commonly seen in aspiration pneumonia

Answer 14

Acidosis stimulates renal ammoniagenesis, a process by which renal tubular epithelial cells metabolize glutamine to glutamate generating ammonia which is excreted in the urine and bicarbonate which is absorbed into the blood also increase secretion of titratable acids glutamine is the most abundant AA in the blood

Answer 15

glucose --> glucose-6-phosphate via glucokinase glucose-6-phosphate --> increase in the ATP/ADP ratio this causes closure of the ATP-sensitive potassium channels, causes depolarization of the cell, Ca floods the cell and insulin granules are released

Answer 16

S. aureus, Neisseria species, H. influenza cleaves at the hinge region rendering it ineffective

Answer 17

suppresses Ras bilateral acoustic Schwannomas retinoblastoma and osteosarcoma

Answer 18

Presents WITHOUT hyperammonemia symptoms - spastic diplegia, growth delay, abnormal movements

Answer 19

NSAIDs - inhibit COX and exert a broad anti-inflammatory event that includes inhibition of neutrophils When NSAIDs are contraindicated - used colchicine - inhibits neutrophil chemotaxis and phagocytosis by impaired microtubule formation

Answer 20

Thiazide diuretics inhibit the Na/Cl co-transporter in the distal tubule leading to increased excretion of Na, Cl, and H2O as well as K+ and H+ ions They also increase the absorption of Ca

Answer 21

C. perfringens, also known as alpha-toxin; an enzyme with phospholipase activity which increases platelet aggregation and adherence molecule expression on platelets and leukocytes resulting in vasoocclusion and ischemic disease Activates coagulation cascade, gets coated in fibrin - difficult to phagocytose

Answer 22

1. VEGF --> inhibits angiogenesis, RCC, CRectal 2. CLL, CD-52 receptor- fixes complement and has a cytotoxic effect through ADCC 3. increases expression of MHC I and II, improves antigen presentation 4. stimulates CD4, CD8, B-cells, monocytes, and NK cells - used for metastatic melanoma and renal cell carcinoma

Answer 23

1. erythrocytes - no mitochondria 2. the liver - lacks the enyzme thiophorase which converts acetoacetate into acetoacetylCoA (and ultimately into acetyl CoA)

Answer 24

FMN - flavin mononucleotide (complex I) | FAD - flavin dinucleotide (complex II of ETC = succinate dehydrogenase which is part of TCA)

Answer 25

malonyl-CoA cytosolic acetyl-CoA carboylase converts acetyl CoA to malonyl CoA which is the rate limiting step of fatty-acid synthesis; malonyl-CoA also inhibits the action of mitochondrial carnitine acyltransferase inhibiting beta-oxidation of newly formed fatty acids

Answer 26

Candida - psuedohyphae with blastoconidia associated with intertrigo - well-defined erythematous plaques or satellite vessels in warm, moist skin areas

Answer 27

Duodenal enteropeptidase activates trypsinogen to trypsin; degrades peptides and activates other proteases such as carboxypeptidase, elastase, and chymotrypsin; NOT LIPASE however - lipase is secreted in its active form; once it leaks from the damaged acini can cause fat necrosis stimulates S-cells of the duodenum to make bicarbonate (from pancreas and gallbladder) in response to low duodenal pH; also reduces gastrin secretion secretory fluid is isotonic with plasma with respect to Na and K; increased HCO3, decreased Cl

Answer 28

PNEUMONIA - lung parenchyma INFECTION, aspiration of ORAL cavity anaerobes, presents DAYS after the aspiration event, FEVER, can process to ABSCESSES (air-fluid; usually as a result of impaired consciousness or decreased ability to swallow), give antibiotics to manage PNEUMONITIS - lung parenchyma INFLAMMATION, aspiration of GASTRIC contents, present HOURS after, supportive treatment

Answer 29

D-arm has dihydrouridine residues which facilitate binding to the correct tRNA sythetase T-arm - modified bases (ribothymidine, pseudouridine, cytidine) --> binds the tRNA to the ribosome

Answer 30

III - the main polymerase with 5'--> 3' synthesis activity and 3'-->5' exonuclease activity, leading and lagging strand synthesis I - has 5' to 3' exonuclease activity - involved in removing RNA primers on the lagging strand and DNA repair

Answer 31

hypertrophic cardiomyopathy Vitamin E deficiency - increase of free radicals causes degeneration of the dorsal columns, peripheral nerves, and spinocerebellar tracts

Answer 32

glioblastoma - but usually a single, butterfly-shaped lesion; most common brain tumor in adults, presents with necrosis and hemorrhage and shift of the midline structures

Answer 33

proper hand-washing (alcohol based ones do not kill spores), gown, nonsterile gloves respirator - if pathogen is 5 microns; bordetella, Neisseria meningitis, influenza, mycoplasma pneumo, RSV

Answer 34

androgenetic alopecia (determined by circulating androgen and genetic factors), HTN, DMII, epilepsy, glaucoma, schizophrenia

Answer 35

normal flora of the upper respiratory tract - causes otitis media and sinusitis in healthy individuals; exacerbates COPD

Answer 36

Strep pyogenes 1. bacteremia - hematogenously spread 2. contiguous infection (DM or spread from recumbent ulcers) 3. direct inoculation

Answer 37

IL-12, IFN-gamma, and TNF-alpha (induces and maintains granuloma formation)

Answer 38

platelet aggregation, bronchoconstriction, vasoconstriction, increased leukocytes adhesion to the endothelium; at low concentrations causes vasodilation and increases the permeability of venules

Answer 39

cerebellar atrophy, telangiectasias, recurrent sinopulmonary infections; sensitivity to ionizing radiation Fanconi anemia is also caused by non-homologous end-joining - increased susceptibility to alkylating agents

Answer 40

Muscle weakness (myopathy, increased CK; lack of ATP from TCA), cardiomegaly, hypoketotic hypoglycemia medium (or very long chain)-chain acyl-CoA dehydrogenase deficiency

Answer 41

Risocetin activates GPIb receptors on platelets and makes them available for binding with vWF decreased aggregation if vWF def; but yes aggregation if you add normal plasma; desmopressin stimulates vWF release from endothelium decreased aggregation if GP Ib def; still negative if you add normal plasma

Answer 42

negative supercoiling to reduce the strain of unwinding which produces positive supercoiling

Answer 43

Herpes - lesions are initially painful; Cowdry bodies - intranuclear inclusions, multinucleated Giant cells Klebsiella - painless initially, deeply staining intracytoplasmic donovan bodies H. ducreyi: organisms often clump in long strands; "schools of fish"

Answer 44

helps the bacteria evade phagocytosis by preventing activation of the alternate complement pathway

Answer 45

occurs from perivascular invasion and release of skin destructive exotoxins causing vascular damage and insufficient blood flow to patches of skin that become edematous and necrotic exotoxins include - exotoxin A (protein synthesis inhibitor), phospholipase C (cell membrane disruptor), elastase (blood vessel destruction), pyocyanin (makes reactive oxygen species)

Answer 46

Should include ceftriaxone for N.gonorrhea and azithromycin and doxycylcine for Chylamydia

Answer 47

early - Alzheimer's precursor protein (21), presenilin 1 (14) and presenilin 2 (1) --> all though to promote the production of beta-amyloid late-Apolipoprotein E4 HCM: beta-myosin heavy chain

Answer 48

ADP-ribosylated the Gi protein causing increased cAMP production: 1. increased insulin 2. lymphocyte and neutrophil dysfunction 3. increased sensitivity to histamine

Answer 49

damage to the LONG THORACIC NERVE (C5-C7) that innervates the SERRATUS ANTERIOR - the SA muscle attaches the medial anterior end of the scapula against the rib cage; typically injured during axillary lymphadenopathy surgery you hit the serratus if you make an incision at the 4th/5th intercostal space at the midaxillary line; pectoralis major anterior and latissmus dorsi posterior, external oblique inferior

Answer 50

costal, mediastinal*, diaphragm*, cervical sensory innervation of the rest of the pleura is carried by the intercostal nerves and more locally referred

Answer 51

Branch of the mandibular portion of the trigeminal nerve and provides sensory innervation to the tongue

Answer 52

neuromuscular weakness - only occurs during sleep when the muscles are relaxed; the upper airway dilator muscles weaken during the transition from wake-->sleep and lead to airway narrowing and ultimately collapse when the airway is occluded, PO2 declines and PCO2 increases until the receptors in the carotid body and brainstem trigger arousal and pharyngeal tone returns - wake up often pulmonary hypertension is a complication, right heart failure, and increased risk for CV events

Answer 53

1. lie on either side of the laryngeal orifice between the thyroid cartilage; bound medially by the aryoepiglottic folds and laterally by the thyroid cartilage 2. internal laryngeal branch of the superior laryngeal nerve (sensory from the larynx and epiglottis) 3. can cause disruption of the afferent portion of the COUGH reflex

Answer 54

1. sharply increases at 30 weeks, phosphatidylGLYCEROL (another component of surfactant) increases at 36 weeks 2. decreases by 50% 3. produced in same quantities until 30 weeks; a L/S ration > 1.9 indicates mature lungs

Answer 55

inferior thyroid artery (courses behind the carotid artery and jugular vein and arises from the thyrocervical trunk) because it supplies the recurrent laryngeal nerve

Answer 56

-sternohyoid, omohyoid, sternothyroid suspect injury if penetrating wound is above cricoid cartilage the nerve block blocks the brachial plexus an also affects the DIAPHRAGM

Answer 57

at C4 below the hyoid bone

Answer 58

1. midclavicular - above 8th rib (recess is between 6-8) 2. midaxillary - above 10th rib (8-10) 3. paracentricular - above 12th rib (10-12) the rationale is that you want to get fluid from the costodiaphragmatic recess - the space between the visceral pleura and the parietal pleura (the p.pleura extends 2 ribs below the parenchyma) neurovascular bundle if you puncture below the ribs; and abdominal structures if you hit lower than these structures

Answer 59

Lies in the posterior mediastinum and drains blood from the posterior intercostals to the SVC; lies right of the midline

Answer 60

1. ligamentum teres 2. ligamentum venosus 3. fossa ovale 4. ligamentum arteriosum 5. medial umbilical ligaments 6. systemic venous circulation 7. portal vein

Answer 61

1. immobile and postoperative patients are at risk for PE; tachypnea, tachycardia, and pleuritic chest pain; the resulting ischemic injury also causes inflammation --> surfactant defiency --> atelectasis --> poorly ventilated and poorly perfused 2. causes hypoxemia by a ventilation/perfusion mismatch (impaired perfusion); the hyperventilation causes decreased CO2 and respiratory alkalosis 3. FAT EMBOLISM - triad of respiratory distress (blocks the pulmonary vasculature also release of the FFA can cause toxic injury to the endothelium), neurological symptoms, petechiae, thrombocytopenia (fat globules covered in platelets), and anemia (RBC aggregation or pulmonary hemorrhage); stains black with osmium tetroxide

Answer 62

PAO2 (104) - PaO2(100) = 4 mmHg; due to deoxygenated blood from the bronchial circulation and Thebesian veins of the heart; normal is from 5 mmHg-15 mmHg; increases as you get older due to poor diffusing capacity with age 1. HYPOVENTILATION - either due to suppressed central respiratory drive (opiate overdose) or with diseases that restrict inspiratory capacity (obesity, MG)

Answer 63

Resistance is determined by both flow (turbulent>laminar) and radius Half of the resistance is in the upper respiratory tract (nasal passages, mouth, pharynx, larynx) - resistance in the trachea and bronchus is relatively high (turbulent flow) - it increases in the medium sized airways because of increased turbulence in the airflow - greatly drops in the smaller airways because the velocity decreases because the total cross-sectional area increases; v = Q/A; flow becomes laminar

Answer 64

at the functional reserve capacity at high volume: the extra-alveolar vessels have a low resistance (radial forces pulling outward), but the alveolar vessels have a high resistance (the diameter is reduced at the vessel lengthens) at low volumes: the extra-alveolar vessels have a high resistance (they collapse inward); the alveolar vessels have a low resistance the result is a U-curve With COPD patients try to maintain the least airway resistance (that is why they are in a hyperinflated state)

Answer 65

10-15 micrometers - upper airway - coughing, sneezing 2.5-10 micrometers - mucociliary clearance pneumoconioses

Answer 66

V: increases apex to base Q: increases apex to base (to a greater extant) V/Q ratio: decreases from apex (3) to base (0.6)

Answer 67

Zone 1: PA>Pa>Pv (no blood flow) Zone 2:Pa>PA>Pv (pulsatile flow during systole) Zone 3: Pa>Pv>PA (continuous blood flow; all zones are Zone 3 when the patient is supine)

Answer 68

FVC decreased in both FEV1/FVC is DECREASED in OBSTRUCTIVE FEV1/FVC is INCREASED in RESTRICTIVE; this is because there is increased elastic recoil caused by the fibrotic interstitial tissue; this results in increased radial traction (outward pulling) leading to increased expiratory flow rates

Answer 69

hypercapnia causes vasodilation hypocapnia causes vasoconstriction hypoxia causes vasodilation, but CO2 is a more potent mediator edema = high pressure --> hyperventilate = low CO2 = vasoconstriction (increase resistance)/reduce cerebral blood flow = reduced pressure; the other way to reduce pressure is to reduce the systemic pressure

Answer 70

Hematocrit is increased in both Relative - the volume of RBCs is normal; probably due to dehydration (plasma volume contraction) Hypoxic - increased mass of RBCs; stimulated by erythropoetin (from renal peritubular cells)

Answer 71

you take a diuretic and lose a lot of volume, body increases production of aldosterone, leads to increased absorption of Na and H2O and increased EXCRETION of K and H hypokalemia - muscle weakness and parasthesias the increased blood volume increases renal blood flow which increases ANP and Na excretion

Answer 72

normal PaO2, SaO2, oxygen content venous O2 increased because oxygen is not being used by the peripheral tissues because oxidative phosphorylation is being blocked methylene blue; or amyl nitrate to make methemoglobin (binds to oxygen tightly)

Answer 73

central chemoreceptors - in the medulla and stimulated by decreased in pH (CO2) of the CSF; excess CO2 diffuses into the CSF to lower the pH carotid and aortic body - stimulated by HYPOXEMIA pulmonary stretch receptors - regulate the duration of inspiration, protect lung from hyperinflammation * in healthy people CO2 is the major stimulator of respiration; in patients with COPD, response to Co2 becomes blunted and hypoxemia becomes the major drive

Answer 74

Acute Humoral - neutrophilic infiltrate, necrotizing vasculitis Acute Cellular - lymphocytic infiltrate

Answer 75

lymphadema and cystic hygroma (abnormalities of lymphatic outflow; dilated lymphatic space lined by endothelial cells); cystic hygroma also seen in patients with Downs Syndrome

Answer 76

lack the androgen receptors - have an XY karyotype - present with amenorrhea due to the absence of the female reproductive tract and the presence of testes

Answer 77

virulence factor of TB - it is a part of the cell wall to prevent fusion with phagolysosomes

Answer 78

causes obliterative lower airway inflammation - inflammation causes granulation tissue proliferation that proceeds to obstruct small bronchioles and airways and consolidate the alveoli; typically resolves with corticosteroids

Answer 79

Nodular sclerosis - nodular growth pattern, surrounding fibrous bands, lacunar-variant Reed-Sternberg cells constitutional symptoms and enlarged lymph nodes

Answer 80

normal - hypotonic sweat; CFTR resorbs Cl- and Na+ follows; loss of free water causes hyperosmotic volume contraction CF - CFTR is defective, so the sweat has high sodium and chloride content rectal prolapse

Answer 81

1. metabolic acidosis - especially Diabetes Ketoacidosis, deep labored breathing 2. congestive heart failure - apnea is followed by gradually increasing and decreasing tidal volumes until the next apneic period; caused by increased levels for CO2 which spur the breathing and once CO2 gets below a certain threshold you have apneic breathing again 3. reductions of airflow during sleep due to airway obstruction despite adequate respiratory effort 4. hypoventilation from respiratory weakness

Answer 82

nonciliated, secretory cells found in the terminal portion of the bronchioles regenerative source of ciliated cells in the broncioles and help to detoxify tobacco smoke via a P450 mechanism

Answer 83

Respiratory/Gastric - impaired CFTR reduces luminal Cl secretion and also increases ENaC absorption (decreased Na in the lumen, more within the cell); causes dehydrated mucus and NEGATIVE transepithelial difference Sweat glands - impaired Cl- absorption and Na+ absorption by the ENaC causes hypertonic sweat with increased Cl and Na

Answer 84

galactorrhea and gynecomastia; large polygonal cells in sheets or nests, located peripherally

Answer 85

c-ANCA (neutrophils), vasculitis of small and medium sized arteries 1. upper respiratory tract - epistaxis, otitis, sinusitis 2. lungs - hemoptysis 3. kidneys - rapidly progressing glomerulonepritis p-ANCA = neutrophil myeloperoxidase; churg-strauss

Answer 86

Stage 1 - bilateral hilar lymphadenopathy 2 - bilateral hilar lymphadenopathy + pulmonary infiltrates in the upper lbes 3 - pulmonary infiltrates Stage 4 - pulmonary fibrosis also can present with uveitis and cutaneous findings including erythema nodosum non-caseating granuloma; asteroid body in macrophage

Answer 87

Prussian blue - stains blue hemotoyxlin or eosin stain - stain brown

Answer 88

- hyper-inflated lungs and a flattened diaphragm - decreased diffusing capacity in emphysema b/c the surface area of the alveolar-capillary interface is reduced due to alveolar destruction; asthma and bronchitis are normal

Answer 89

1. congestion - red, heavy boggy, vascular dilation, mostly bacteria 2. red hepatization - red, firm --> RBCs, neutrophils, fibrin 3. gray hepatization - pale, gray --> FRAGMENTED RBCs, neutrophils, fibrin 4. resolution - enzymatic degradation of the exudate

Answer 90

rheumatoid arthritis methotrexate, bleomycin, amiodarone RETICULONODULAR PATTERN

Answer 91

as cytokines circulate in response to an infection, they activate the pulmonary epithelium and provoke an inflammatory response mediated by neutrophils --> capillary damage and leakage of proteins into the alveolar space; presents within 24 hours of the inciting risk factor white-out on CXR

Answer 92

1. Hamptons Hump - wedge shaped opacity adjacent to pleura | 2. Westermark sign - area of lucency due to reduced perfusion

Answer 93

a lesion in the mainstem bronchus can prevent ventilation to the lung leading to obstructive lung collapse and complete atelactasis unilateral pulmonary opacification and deviation of the mediastinum toward the opacified side

Answer 94

-hemorrhagic pleural effusions and thickening of the pleura numerous, slender, long villi and tonofilaments

Answer 95

- anti-glomerular membrane antibody disease - vasculitis associated hemorrhage - idiopathic pulmonary hemosiderosis

Answer 96

- thymoma (increased risk of with M. Gravis), teratoma, thyroid cancer, and lymphoma

Answer 97

- groove formed by the subclavian vessels - ipsilateral Horner syndrome (miosis, anhydrosis, ptosis), shoulder pain in the C8, T1, T2 distribution, hand muscle atrophy (involvement of the brachial plexus), rib destruction

Answer 98

1. JVP (compression of the RA and decreasing venous return) 2. muffled heart sounds 3. hypotension (decreased CO from the LV) TAMPONADE normally, blood pressure is lower during inspiration than expiration - this is b/c negative intrathoracic pressure draws blood into the right side of the heart and causes the capillaries in the lung to fill with blood --> less return to the L side of the heart during tamponade, the heart chambers are smaller because of the effusion; when the RV fills up it pushes the IV septum and reduces the size of the LV --> DECREASED PRESSURE OF MORE THAN 10 MMHG

Answer 99

pleural plaques affecting the parietal pleura, ferruginous bodies on histo eggshell calcifications, birefringent silica

Answer 100

anti-leukotriene and anti-muscarinic

Answer 101

1. skin 2. pectoralis major 3. external intercostal 4. internal intercostal 5. internal thoracic artery and veins 6. transverse thoracis muscle 7. parietal pleura 8. pericardium 9. right ventricular myocardium

Answer 102

- left internal thoracic artery - great saphenous vein (located superficially in the leg and the longest vein in the body - arises inferolateral of the pubic tubercle, joins femoral vein in the saphenous opening, runs medial side of leg)

Answer 103

popliteal artery aneurysm tibial nerve

Answer 104

small saphenous vein

Answer 105

internal carotid --> ophthalmic artery --> retinal artery

Answer 106

when you are running 2 things happen: 1. you decrease the O2 content of the veins - less oxygenated blood being pumped through the systemic circulation 2. the arteries of your lower extremities are vasodilated - less resistance for the aorta to push against when you squat: 1. using less O2 2 increase resistance in the systemic vasculature and blood is diverted preferentially to the pulmonary trunk vs the aorta 3. increased return to the heart deviation of the infundibular septum

Answer 107

blood from both the pulmonary (oxygenated) and systemic (deoxygenated) flow into the right atrium; patients have obligatory right to left atrial shunting

Answer 108

in the common femoral artery BELOW in the inguinal ligament if you puncture above, increase risk of RETROPERITONEAL hemorrhage

Answer 109

space between the ascending or descending colon and the abdominal wall; blood, bile, or pus accumulates here from pathology involving the GI organs

Answer 110

- lateral - left circumflex - anterior - LAD (RUPTURE OF LV FREE WALL IS A CATASTROPHIC COMPLICATION, leads to cardiac tamponade and death) (if combined leads then left coronary) - inferior - R coronary artery

Answer 111

anterior - LA posterior - descending aorta R side - horizontally under the aortic arch and posterior to the SVC L side - superiorly over the left main bronchus

Answer 112

cephalization of the pulmonary vessels, perihilar alveolar edema (batwing), blunting of costophrenic angles due to pleural effusions, Kerley B lines (short horizontal lines representing interlobar septa) activate the RAAS and sympathetic nervous system to increase CO --> however this leads to deleterious remodeling, increased afterload, and excess fluid retention

Answer 113

right - SVC, RA, IVC inferior/anterior - RV (seen best on lateral view) left - left auricle, LV

Answer 114

decreased preload decreases intensity of aortic stenosis, pulmonary stenosis, tricuspid regurgitation increases intensity of HOCM (vasodilators and diuretics contraindicated), mitral prolapse

Answer 115

left atrial appendage

Answer 116

Middle meningeal artery (epidural hematoma) - branch of the maxillary artery and enters through the foramen spinosum the sphenopalatine is the terminal branch of the maxillary artery - supplies much of the nasal mucosa; Kiesselbach's plexus (sphenopalatine, superior labial artery, anterior ethmoidal artery) SUPERIOR MEATUS - drains posterior ethmoid and sphenoid MIDDLE MEATUS - frontal, maxillary, posterior ethmoid (nasal polyps most often found here) INFERIOR MEATUS (nasolacrimal)

Answer 117

Common iliac splits into internal and external. External splits into inferior epigastric (proximal to the inguinal ligament; runs superior and medially) and the deep circumflex iliac; the external iliac becomes the femoral artery as it crosses the inguinal ligament; the medial circumflex femoral artery branches off the deep femoral artery and supplies the femoral neck Internal iliac branches off (S to I) superior gluteal, inferior gluteal, obturator (supplies ligamentum teres, important in children because it supplies area proximal to wpiphyseal growth plate)

Answer 118

R - right coronary | L - left circumflex (branch of left coronary)

Answer 119

anemia: increased CO, slightly increased VR (decreased viscosity) anaphylaxis: increased CO to compensate for lower blood volume; decreased VR

Answer 120

senses when blood pressure is high and lowers it via action of cGMP - restricts aldosterone secretion - vasodilates - in kidney dilates afferent arterioles --> increases GFR and sodium secretion, inhibits sodium and renin secretion NEPRILYSIN INHIBITOR (normally neprilysin degrades peptide hormones; ie sacubitril)

Answer 121

age-related stiffness and reduced compliance of the aorta and the major peripheral arteries - endothelial cell dysfunction - change in ECM composition (more collagen, less elastin) can also occur due to aortic regurg (increase in stroke volume), anemia, or hyperthyroidism

Answer 122

paroxysmal supraventricular tachycardia - usually due to a recurrent impulse traveling between the slowly and rapidly conducting systems of the AV node can be relieved by Valsalva (using rectus muscles) or vagal stimulation

Answer 123

Ventricular fibrillation in the first 48 hours after an acute MI, related to electric instability in the ischemic myocardium

Answer 124

preload - increases preload because arterial blood is going into the venous system afterload - decreases afterload because blood is by passing the arterioles (major site of resistance)

Answer 125

During Phase 2, there is a calcium influx into the myocyte (due to the voltage gated L-type calcium) The calcium influx is sensed by the ryanodine receptors on the sarcoplasmic reticulum which open (calcium induced calcium release) to release more calcium calcium binds to troponin and moves tropomyosin and the cardiac muscle contraction occurs

Answer 126

beat-to-beat variation in pulse amplitude due to changes in systolic blood pressure - usually due to LV dysfunction beat to beat variation in the QRS complex - occurs with severe cardiac tamponade (heart swinging in the percardial fluid) slow-rising low amplitude, prolonged LV ejection time; seen with aortic stenosis; also with aortic stenosis S2 is diminished due to reduced mobility of the leaflets; also radiates to neck

Answer 127

RA - 1-6 mm Hg RV - systolic is between 15-30 (strength of right ventricular contraction) diastolic - lower than the RA pressure PA - systolic - around the same as the RV diastolic - due to pulmonary capillary resistance and backward transmission of left atrial pressure

Answer 128

In skeletal muscles, L-type calcium channels interact directly with the ryanodine receptors - the calcium influx does NOT cause the ryanodine receptor to open (no calcium induced calcium release)

Answer 129

affect phase 4 - activates potassium channels increasing conductance causing the membrane potential to be negative for longer; also inhibit L-type calcium channels L-Type (long-lasting) - responsible for the upstroke in Phase 0, opens when membrane potential is -40 mV T-type (transient) - opens when membrane potential is at -50 mV

Answer 130

when one hormone allows another to exert its maximal effect; cortisol on it own has no vasoactive properties, however it does upregulate the expression of alpha-1-adrenergic receptors on smooth muscle allowing NE to bind more; also increases glucose release by the liver in response to glucagon additive - sum of the effects of 2 drugs is equal synergistic - sum of the effects of 2 drugs is greater than them individually

Answer 131

occurs during early diastole and best heard with the BELL of the stethoscope in the left lateral decubitis position during EXPIRATION (decreasing lung volume and bringing heart closer to the chest wall); indicates increased left ventricular end-systolic volume not always pathologic if seen in younger patients; contrast with S4 which is pathologic in children

Answer 132

coronary sinus - the myocardium has the greatest oxygen demand

Answer 133

- antagonizes effects of thromboxane; inhibits platelet aggregation, vasodilates, increases vascular permeability - inactivates factors Va and VIIIa; vitamin K depedent - converts kininogen into bradykinin in the lung (ACE break down bradykinin; ACEI cause accumulation of bradykinin and subsequent cough); bradykinin is made in the kidneys and vasodilates the renal vasculature, implicated in angioedema - regulates mood in the CNS; secreted by gut chromaffin cells and increases peristalsis and nausea; also vasodilates and increases vascular permeability

Answer 134

- brain, myocardium, spleen, kidney, liver (dual blood supply)

Answer 135

result from the impairment of venous valves and reflux of venous blood - leads to stasis, congestion, edema, skin ulcers, and SUPERFICIAL thromboembolism; (DEEP VEIN THROMBOSIS can cause pulmonary embolism) -pain and weakness associated with exertion; most frequently due to peripheral arterial disease

Answer 136

Painful, white leg is a consequence of iliofemoral venous thrombosis occurring in peripartum women

Answer 137

Altepase can bind to fibrin and convert plasmin to plasminogen which can dissolve the clot Hemorrhage

Answer 138

Nitroprusside decreases preload and afteload Nitroglycerin just reduces preload

Answer 139

decreases when preload or afterload is increased (handgrip, passive leg raise, squatting) --> the left ventricular outflow tract is attenuated increases when preload decreases (valsalva, nitroglycerin, abrupt standing) anterior displace of the MITRAL VALVE LEAFLET and INTERVENTRICULAR SEPTUM

Answer 140

irreversibly blocks the PGY component of ADP on the platelet surface and prevents platelet aggregation

Answer 141

CNS (seizure, coma), Cardiovascular (hypotension, tachycardia, prolonged PR/QRS/QT intervals; arrythmias), anti-Cholinergic effects (hyperthermia, urinary retention, dry mouth) these symptoms are caused by blockage of cardiac fast sodium channels; treat with SODIUM BICARBONATE - it makes the serum pH higher which favors the non-ionized form of drug (less able to bind to the sodium channels); also increases the sodium concentration and helps overcomes the competitive inhibition of the fast sodium channels

Answer 142

N-acetylcysteine - reduces hepatic injury by restoring liver glutathione stores naloxone flumazenil

Answer 143

both cause unprovoked syncope in a previously asymptomatic person; mutation in the K+ channel in the cardiac action potential 1. Romano-Ward (autosomal dominant; NO deafness) 2. Jervell and Lange-Nielsen Syndrome (autosomal dominant, sensorineural deafness) - in Phase 1: transient outward potassium channel - in Phase 3 - delayed rectifier potassium channel

Answer 144

progressive fibrofatty replacement of the right ventricle

Answer 145

- Normally, JVP decreases upon inspiration - Kussmaul's sign is when JVP increases upon inspiration; found in patient's with chronic constrictive pericarditis/restrictive cardiomyopathy a brief, high-pitched sound heard in early diastole after S2 and before S3 -- in chronic (constrictive) pericarditis another sign of constrictive pericarditis is pulsus paradoxis

Answer 146

platelet-derived growth factor released by platelets, endothelial cells, and macrophages promotes the migration of smooth muscle from the media into the intima then the smooth muscle synthesizes collagen and extracellular matrix CORONARY ARTERIES and ABDOMINAL AORTA

Answer 147

transforming growth factor - angiogensis - inhibition of the cell cycle - stimulate fibroblasts to lay down ECM proteins

Answer 148

- intort when abducted; depress when adducted - vertical diplopia; unable to read or walk down stairs - compensate by tucking in chin and tilting head away from the affected side

Answer 149

caudate; but PET scan shows reduced activity in the caudate and the putamen (collectively called the striatum)

Answer 150

Anterior - separate GP/Put FROM caudate; carries thalmocortical fibers Posterior - separate GP/Put FROM thalamus; carries corticospinal motor, somatic sensory, visual and auditory fibers and the "genu" you have corticobulbar fibers CLASP KNIFE SPASTICITY, hyperreflexia, motor weakness on the contralateral side; present in newborn because of incomplete myelination

Answer 151

First Order neuron starts in the hypothalamus and descend down through the brainstem to the spinal cord where they synapse on the lateral horns in the spinal cord (T1-L2) Second Order Neurons exit the spinal cord via the ventral root and enter the sympathetic ganglia via the white communicating rami The neurons ascends and then synapses with third order neurons in the superior cervical ganglion where it follows the branches of the carotid artery to innervate its target

Answer 152

receives input from specialized photosensitive ganglion cells from the retina via the retinohypothalamic tract melatonin - high at night, low in the morning cortisol - high in the morning, low at night easier to lengthen the sleep-wake cycle (westward travel) than to shorten it (eastward travel)

Answer 153

densely packed cones, each synapses with a single bipolar cell and a single ganglion cell and then goes to a separate section of the occipital cortex that is different than peripheral vision- this is why you have macular sparing with lesions of the occipital cortex Dry - fatty deposits of drusen; gradual vision loss Wet - neovascularization as a result of hypoxia; acute vision loss and metamorphosphia; greyish-green subretinal membrane; VEGF inhibitor therapy (ranibizumab, bevacizumab) Both benefit from antioxidant therapy and smoking cessation

Answer 154

caused by a defect in the ATP7B transporter - decreased formation of ceruloplasmin (low serum ceruloplasmin is diagnostic) and decreased excretion of copper into the bile so that copper builds up in the body - hepatitis, cirrhosis - atrophy of lentiform nucleus (putamen and GP) - psychiatric symptoms - depression, personality changes - neurologic - movement disorder, disarthria - Keyser-Fleisher rings deposited in Descement membrane of the cornea

Answer 155

fusion of the right and left embryonal dorsal aorta neural crest

Answer 156

1. Klumpke's palsy - dysfunction of the intrinsic muscles of the hand (thenar, hypothenar, lumbricals, interosseus), sparing of the extensors and flexors of the hands leads to claw hand deformity 2. weakness of the deltoid (important for abduction of the arm below the horizontal plane) and teres minor, loss of sensation over the lateral shoulder 3. weak elbow flexion due to impaired biceps, coracobrachialis, loss of lateral sensation to the FOREARM 4. damages the median nerve (nerve travels through the ulnar and humeral heads of pronator teres) - lose sensation in the first 3.5 digits; impaired motor function in thumb; wrist flexion impaired (innervates flexor digitorum profundus and superficialis); impaired flexion of 2nd and 3rd digit 5. supraspinatus - impaired abduction infraspinatus - impaired lateral rotation of the arm

Answer 157

1. corticomotor/corticobulbar issues 2. Babinski 3. you also get cerebellar issues - pontinocerebellar fibers arise from the pons and then decussate and enter the contralateral cerebellum via the middle cerebellar peduncle motor portion of TRIGEMINAL NERVE arises here (lateral aspect of mid-pons)

Answer 158

Ebstein abnormality - tricuspid valves are abnormally formed; RA is large and RV is hypoplastic; right to left ASD renal and thyroid

Answer 159

normally innervates the gluteus medius and minimus (HIP ABDUCTION); when you stand on the affected foot, hip tilt to the contralateral side; when you walk lean to the ipsilateral side to maintain a level pelvis; exits through GREATER SCIATIC FORAMEN above the piriformis; risk of INJURY if injection in the SUPEROMEDIAL quadrant Innervates the gluteus maximus which helps EXTEND THE THIGH at the hip; you can't get up from a sitting position or climb stairs; exits the GREATER SCIATIC FORAMEN below the piriformis Femoral nerve helps FLEX THE HIP (illiacus and sartorius (and psoas which is innervated by the lumbar plexus)); also helps extend the knee (quads); injury results in knee buckling and loss of patellar reflex; loss of sensation on anterior and medial thigh and medial leg innervates the hamstrings; and splits into the tibial and common peroneal nerve; tibial nerve courses along the posterior calf and involved in PLANTAR FLEXION and INVERSION; the common peroneal nerve crosses the lateral head of the fibula and splits in the deep and superficial peroneal nerve; deep enters the anterior compartment and involved in DORSIFLEXION; superficial courses on the lateral side of the foot and is involved in EVERSION

Answer 160

1. RA 2. RV 3. LV accessed by left subclavian vein --> SVC --> RA/RV --> coronary sinus (atrioventricular groove) --> LV

Answer 161

a measure of how far along the axon and electrical impulse can propagate; myelination INCREASES the length constant and decreases the time constant demyelination DECREASES the length constant and increases the time constant

Answer 162

P. SANAM ``` Pia Matar Schwann cells Arachnoid Matar PNeuronS (DRG, sympathetic ganglia) Adrenal Medulla Melanocytes ``` also aorticopulmonary septum

Answer 163

muscles, bones, blood, connective tissues, kidney/ureter, dermis, *vertebrae are derived from the paraxial mesoderm, spleen thyroid follicular cells (derived from primitive tongue), thymus, parathyroids, lungs, the GI tract, middle ear, bladder, urethra

Answer 164

Binds to mu receptor (G-protein) and causes an efflux of potassium; this causes hyperpolarization effectively blocking pain transmission enkephalin, beta-endorphin is made from POMC (proopiomelanocortin) which is a peptide that undergoes enzymatic cleavage to form beta-endorphin, ACTH, and MSH

Answer 165

``` respiratory distress necrotizing enterocolitis intraventricular hemorrhage (of the GERMINAL MATRIX - a highly vascular and cellular layer under the ventricle from where neurons and glial cells migrate out during development; this area has thin-walled vessels that lack glial cells for support) PDA retinopathy of prematurity bronchopulmonary dysplasia ```

Answer 166

- Posterior cord of the brachial plexus (CRUTCH PALSY - COMPRESSION IN THE AXILLA causes impairment of everything downstream) - travels through the radial groove to innervate triceps (LESION HERE SPARES TRICEPS) - Enters the forearm anterior to the lateral epicondyle - Splits into the deep and superficial branches - Superficial branches provide sensory innervation to the back of the forearm and dorsum of the hand - Deep branch supplies the extensor compartment of the wrist - travels through the supinator canal to become the posterior interosseus nerve which innervates finger and thumb extension (INJURY DUE TO EXCESSIVE PRONATION AND SUPINATION CAN CAUSE FINGER DROP)

Answer 167

Ulnar nerve through Guyon's Canal ulnar nerve provides sensory innervation to the 4th and 5th digit; you can also have ULNAR CLAW deformity where you are unable to flex the 4th and 5th digit; also is responsible for WRIST ADDUCTION and FINGER ABDUCTION AND ADDUCTION (dorsal and palmar interossei)

Answer 168

rhomboid (retract scapula), levator scapulae (elevate scapula) latissmus dorsi (shoulder extension, ADDUCTION, internal rotation) platysma is innervated by the facial nerve

Answer 169

-loss of motor/sensory of the lower extremities, urinary incontinence, behavior changes cranial nerves III and IV and *other dorsal midbrain structures and thalamus (deep branch called the PERCHERON)*, median temporal lobe, and occipital cortex branch of the INTERNAL CAROTID - supplies posterior limb of internal capsule, optic tract, lateral geniculate body, uncus, amygdala

Answer 170

1st - trigeminal nerve; muscles of mastication; maxilla, zygomatica, mandible, malleus, incus 2nd - facial nerve; styloid process of the temporal bone, stapes, lesser part of the hyoid bone, muscles of facial expression TREACHER-COLLINS SYNDROME - hypoplasia of the mandibular and zygomatic bones; dysfunction of the 1st and 2nd arches, also have conductive hearing loss 3rd - glossopharyngeal nerve; if damaged, impaired taste perception and absent gag reflex, styloparyngeus muscle, greater horn of the hyoid 4/6th - vagus nerve, cartilaginous structures of the larynx,; dysfunction leads to laryngeal and pharyngeal dysfunction and autonomic dysfunction (impaired gastric acid secretion, esophageal motility, heart rate variability)

Answer 171

- drooping of the shoulder | - raising arm above the horizontal

Answer 172

commonly arise from direct frontal trauma to the orbit; INFRAORBITAL nerve runs here and if damaged there is impaired sensation to the upper lip, gingiva, and upper cheek; inferior rectus can also be entrapped the most susceptible parts to damage are the medial wall and floor of the orbit (ethmoid and maxillary sinuses) hematoma over the mastoid process, periorbital bruising, otorrhea are clear signs of basilar skull fracture

Answer 173

motor function to anterolateral abdominal muscles, sensation to suprapubic and gluteal regions; can be damaged during APPENDECTOMY sensation to upper anterior thigh, motor function to genitalia (cremasteric reflex) sensation to upper and medial thigh and some parts of genitalia, accompanies spermatic cord through superficial inguinal ring

Answer 174

Purkinje FIbers (2.2 m/s) atria (1.1 m/s) ventricles (0.3 m/s) AV node (0.05 m/s)

Answer 175

1. dilated pupils 2. progresses to third nerve palsy (down and out) 3. ipsilateral posterior cerebral artery compression (contralateral homonymous hemianopsia) 4. pons and midbrain (Duret hemorrhages) from basilar artery

Answer 176

loss of myocyte contractility occurs after 30 seconds after the onset of total ischemia when ischemia lasts less than 30 minutes, restoration of blood leads to reversible contractile dysfunction however, after 30 minutes injury becomes irreversible

Answer 177

-inhibits the funny sodium channels and prolongs Phase 4 and slows the SA node firing rate negative chronotropic effect with no effect on contractility

Answer 178

lymphatic drainage

Answer 179

Give dexrazoxane - iron chelating agent that decreases the formation of free radicals from -rubicins

Answer 180

Lateral spinothalamic tract (pain, temperature) Anterior spinothalamic tract (crude touch, pressure) - first order neuron body is in the DRG - synapses with second order neuron at the dorsal horn and the fibers of the lateral spinothalamic tract decussate in the VENTRAL WHITE COMMISSURE and then ascend on the contralateral side syrinx usually forms lesion in the ventral white commissure and in later stages can expand to the ventral horns causing LMN signs

Answer 181

anterior pituitary - Rathke's pouch, evagination of surface ectoderm posterior pituitary - neuroectoderm craniopharyngeoma arise from remnants of Rathke's pouch and are composed of calcified cysts containing cholesterol crystals- cystic-filled with viscous fluid that resembles machine oil; look like wet keratin under the microscope

Answer 182

unilateral, localized to frontotemporal and ocular area, progressively posteriorly and becomes diffuse; lasts from several hours to an entire day, photophobia, nausea recurrent attacks of sudden, severe, unilateral periorbital pain, ipsilateral rhinorrhea and watering of the eyes

Answer 183

consequence of beta-amyloid deposition in the walls of small to medium sized cerebral arteries; spontaneous LOBAR HEMORRHAGE most common cause of intracranial hemorrhage in children, tends to be a SINGLE lesion complication of HTN and involves DEEP BRAIN STRUCTURES PROGRESSIVE headache + nausea/vomiting + NONLOCALIZED symptoms (the non-localized nature of symptoms also common in subarachnoid hemorrhage)

Answer 184

DecerEbrate posture (Extensor) = lesion is below the red nucleus of the midbrain (disrupts signal to the flexors) and the extensor signal from the vestibulospinal tract predominates DecORticate posture (flexOR) = lesion is above the red nucleus; loss of descending inhibition from the red nucleus leads to flexor response Quadriplegia vertical gaze palsy (Parinauds)

Answer 185

- non-rhythmic conjugated eye movements - myoclonus - most common EXTRACRANIAL childhood cancer can be found in adrenal medulla

Answer 186

decreased absorption of CSF; secondary to dysfunction or obliteration of the subarachnoid villi which is a sequelae of a meningeal infection all ventricles are SYMMETRICALLY enlarged as opposed to in a non-communicating hydrocephalus you can also get this presentation if you have a choroid plexus papilloma but that is less likely

Answer 187

abdominal pain and peripheral neuropathy; can be managed with dextrose or heme infusion that blocks ALA synthase; can be exacerbated with CYP450 inducers irritability, loss of developmental milestones in infants, and learning problems in older children in adults - constipation, peripheral neuropathy, anemia, lead lines on the gum

Answer 188

in a nerve fiber, the core has the fibers that innervate the extraocular muscles; the peripheral part of the fiber has the parasympathetic fibers involved in pupil constriction Nerve compression - early sign is loss of parasympathetic function (dilated pupil) and loss of accomodation Nerve ischemia - "down and out" pupil + ptosis, pupil is reactive however and accomodation is spared

Answer 189

pain on ocular movement and decreased vision = sign of MS

Answer 190

cause truncal and gait ataxia due to impaired modulation of the medial-descending motor systems (corticospinal, reticulospinal, vestibulospinal, tectospinal) can also cause nystagmus and vertigo due to involvement of the flocculonodular node

Answer 191

stroke characterized by oculomotor nerve palsy and contralateral hemiparesis

Answer 192

presents with weakness of foot dorsiflexion due to involvement of common peroneal nerve

Answer 193

bromocriptine (ergot), pramipexole, ropinirole tolcapone (central and peripheral), entacapone (peripheral) prevent conversion of L-dopa to dopamine increase endogenous dopamine synthesis and release

Answer 194

just absence use ETHOSUXIMIDE (blocks T-type Ca channels in the thalamus), if both use VALPROATE (blocks NMDA receptors and increases GABA concentration, blocks Na receptors) phenytoin is used for generalized tonic-clonic and status epilepticus; blocks Na channels blocks Na channels; used for partial complex and partial simple seizures, trigeminal neuralgia; agranulocytosis and aplastic anemia, hepatotoxic, and SIADH blocks calcium channels in the axon terminal preventing the release of excitatory neurotransmitters

Answer 195

1. give lorezepam - benzos are first-line acute treatment because of their fast onset of action 2. give phenytoin at the same time (to prevent recurrence of seizures) 3. if still seizing give phenobarbitol 4. no improvement, give anesthetics (thiopental, midazolam, ketamine, propofol, opiates)

Answer 196

Halothane can cause Hepatotoxicity, can also cause onset of neuroleptic malignant syndrome thiopental is a short acting barbituate, high lipid solubility, rapid entry into the brain, after equilibration with the brain rapidly redistributes into adipose tissue and skeletal muscle

Answer 197

antidepressant and for smoking cessation

Answer 198

raMELTeon - a melatonin agonist with few side effects

Answer 199

abnormal ryanodine receptor releases large amounts of calcium into the muscle cytoplasm when exposed to halothane or succinylcholine; ATP-dependent mechanism to transport the calcium back into the sarcoplasmic reticulum this generates heat from using ATP loss of ATP causes muscle damage = rhabdomyolysis treat with dantrolene

Answer 200

A broad spectrum anticonvulsant like VALPROIC ACID, topiramide, lamotrigine, levetiracetam DO NOT give a more narrow spectrum anticonvulsant such as a carbamazepine, phenytoin, or phenobarbital (favored for focal onset seizures, not generalized syndromes)

Answer 201

confusion, agitation, tremor, tachycardia, hypertension, clonus, hyperreflexia, hyperclonus (abnormal mental status, autonomic hyperactivity, muscular rigidity with hyperreflexia) CYPROHEPTADINE (first gen anti-histamine with anti-serotinergic properties)

Answer 202

phenylalanine (need BH4) --> tyrosine (need BH4)--> DOPA -->NE, Epi, dopamine, thyroxine, melanin (need BH4)serotonin, NAD heme glutathione, GABA urea, NO, creatinine

Answer 203

left sided heart disease can increase the pulmonary venous pressure and cause congestion; this results in passive increase of pulmonary artery pressure which is made worse by NO depletion and increased endothelin causing vasoconstriction and pulmonary remodeling (smooth muscle proliferation + intimal thickening and fibrosis) follows a 2-hit hypothesis; mutation in BMPR2 (pro-apoptotic) gene acts as the first insult and predisposes to excessive endothelial and smooth muscle proliferation; a second insult is then thought to activate the disease process resulting in vascular remodeling and elevated pulmonary HTN; plexiform lesion treat with BOSENAN - endothelin receptor antagonist

Answer 204

- occurs commonly in children 1-4 - injury is from a sharp pull on the forearm when the forearm is pronated and the elbow is extended - the ANULAR ligament tears and is displaced - can reduce the injury by supinating forearm and flexing elbow

Answer 205

patients are born with agenesis of the sacrum and lower lumbar area and experience flaccid paralysis of the legs, dorsiflexed contractures of the feet, and urinary incontinence; associated with maternal diabetes craniofacial abnormality, posterior fossa CNS issues, auditory defects, abnormalities of the great vessels (similar to DiGeorge Syndrome) causes vasoconstriction and limits blood supply to the fetus

Answer 206

Split into the greater sciatic foramen and lesser sciatic foramen by the sacrospinous ligament; piriformis is part of the greater notch and involved in EXTERNAL HIP ROTATION part of the pelvic diaphragm (+levator ani), anterior to the sacrospinous ligament

Answer 207

originates from the anterior surface of the transverse processes and lateral surfaces of the vertebral bodies of T12-L5; acts to flex thigh at hip; psoas abcesses are a complication (presents with flank pain, inguinal mass and difficulty walking, elicits pain on PSOAS sign when the hip is extended - to minimize muscle stretching patients are in a flexed, lumbar lordosis postion) large muscle of the back that courses longitudinally along the spinous processes; bilateral contraction causes spine extension paired elastic ligaments that connect the vertebral laminae; help from the posterior wall of the spinal canal

Answer 208

overuse of the extensor muscles and characterized by angiofibroblastic tendinosis overuse of abductor pollicus longus and brevis; causes thumb and wrist pain

Answer 209

The muscle spindle is a proprioceptor. a sense organ that receives information from muscle, that senses STRETCH and the SPEED of the stretch. When you stretch and feel the message that you are at the end of your stretch the spindle is sending a reflex arc signal to your spinal column telling you not to stretch any further and CONTRACT. This sense organ protects you from overstretching. The golgi tendon organ is a proprioceptor, sense organ that receives information from the tendon, that senses TENSION. When you lift weights, the golgi tendon organ is the sense organ that tells you how much tension the muscle is exerting. If there is too much muscle tension the golgi tendon organ will inhibit the muscle from creating any force (via an inhibitory interneuron) and causing relaxation

Answer 210

Osteoblastic - bone-specific alkaline phosphatase; ALP is also made by the liver and intestine in addition to the bone; you can differentiate by this test - bone ALP is unstable in heat (bone = boil) or by monoclonal antibodies Osteoclastic - tartrate-resistant acid phosphatase and degradation products in urine including hydroxyproline and deoxypyridinoline(most reliable; pyridinoline links collagen fibers)

Answer 211

H-band contains only thick filaments (shrinks with muscle contraction) A-band (stays the same size) I-band only contains thin filaments and decreases in length during contraction

Answer 212

- race (African Americans have higher bone mass than Asians) - smoking - low BMI (low BMI --> increased risk of fractures) - early menopause (estrogen is protective - increases osteoblast activity, decrease osteoclast activity) - glucocorticoid use (prevents intestinal absorption of calcium, decreases collagen synthesis, decrease gonadotropin releasing hormone) characterized by trabecular thinning; common sites are vertebral bodies and head of the femur Hyperparathyroidism involves loss of cortical bone - characterized by subperiosteal resorption with cystic degeneration NORMAL Ca, PO4, and PTH

Answer 213

1 - epithelium of middle ear and auditory tube; pharyngeal membrane - tympanic membrane; pharyngeal groove - epithelium of external ear canal 2 - palatine tonsils 3 - inferior parathyroid, thymus 4 - superior parathyroid glands, ultimobranchial gland (calcitonin producing C-cells of the thyroid)

Answer 214

if ANTEROMEDIAL median nerve and brachial artery if ANTEROLATERAL radial nerve; basilic vein does run anteromedially, but is unlikely to be injured due to its superficial course ULNAR nerve is likely to be injured if the fall is on a hyperflexed elbow and the bone is displaced posteriorly

Answer 215

all attach at anteromedial tibia - gracilis, sartorius, semitendinosis attaches at styloid process of the fibula attaches at medial condyle of the tibia (most medial hamstring)

Answer 216

LATERAL - anterior talofibular (most commonly injured), posterior talofibular, and calcaneofibular MEDIAL - anterior tibiotalar, posterior tibiotalar, tibiocalcaneal, tibionavicular aversion of the medial malleolus gastrocnemius and soleus

Answer 217

Minor -externally rotates and adduction major - internally rotates

Answer 218

superficial lymph nodes - drain veins and subcutaneous deep - arteries and muscles medial and lateral tracts medial - drains to superficial inguinal lymph nodes, bypassing popliteal lateral - drains popliteal AND inguinal nodes

Answer 219

used in the management of peripheral arterial disease - phosphodiesterase inhibitor that inhibits platelet aggregation and acts as a direct arteriolar vasodilator increasing cAMP levels prevents platelet shape change and granule release

Answer 220

pedunculated outgrowths of normal skin seen in areas of friction dilated vascular space with thin-walled epithelial cells, can be found on skin, deep tissue, and viscera; cavernous hemangioma on brain and viscera associated with VHL; CAVERNOUS HEMANGIOMA IS THE MOST COMMON BENIGN LIVER TUMOR also known as infantile hemangioma, strawberry hemangioma small, scaly epidermal lesions; histologic findings include keratinocyte atypia, hyperkeratosis, and parakeratosis (retention of nucleus); can progress to squamous cell carcinoma benign proliferation of fibroblasts purpura are a sign of leukocytoclastic vaculitis (Type 3 hypersensitivity reaction)

Answer 221

Chronic lymphadema is caused by lymph node dissection during a masectomy Predisposes to the development of angiosarcoma (Stewart-Treves Syndrome)

Answer 222

solar lentingines = increase in melanocytes freckles = increase in melanosomes multinucleated, giant melanocytes; common finding in elderly patients; considered as "melanoma in situ"

Answer 223

- outer upper quadrant | - invasion of suspensory ligament

Answer 224

MEROCRINE - cells secrete via exocytosis; salivary glands, eccrine sweat gland, apocrine sweat gland APOCRINE - by membrane-bound vesicles; mammary glands HOLOCRINE - by cell lysis; sebaceous glands; Meibomian glands of the eyelid

Answer 225

thickening of the SPINOSUM layer - seen in psoriasis, seborrheic dermatitis (characterized by KERATIN PSEUDOCYSTS) premature keratinization of individual keratinocytes, see basophilic nuclear remnants intercellular epidermal edema that appears as an increase in width of the space between cells; eczema

Answer 226

recruit neutrophils and secrete antimicrobial peptides; improves host defense against fungi and parasites at epithelial and mucosal surfaces

Answer 227

in the BRAF gene - substitution of valine for glutamic acid; involved in the signaling pathway for melanocyte proliferation

Answer 228

opioids, vancomycin, radiocontrast agents activate protein kinase A

Answer 229

junctional - at dermo-epidermal jxn (flat macule, deeply pigemented ) compound - at jxn and in dermis intradermal - only in dermis (skin, tan color; may be pedunculated)

Answer 230

They both can have ocular involvement, but patients with LEMS also have hypo or areflexia, autonomic symptoms, and classic incremental response to stimuli with continued stimulation

Answer 231

characterized by stiffness and fusion of the axial joints and inflammation of the site of tendon insertion into bone involvement of thoracic spine, costovertebral, and costosternal junctions can limit chest wall expansion leading to hypoventilation ascending aortitis can cause AR anterior uveitis

Answer 232

somatic mosaicis mutation; due to overactivation of G-protein signaling cascade; leads to triad of - cafe au lait spots, endocrine abnormalities (precocious puberty), and osteolytic bone lesions (increased activation of fibroblasts and osteoclasts) presents in children, osteonecrosis of the hip

Answer 233

granulomatous vasculitis involving branches of the carotid, polymyalgia rheumatica, T-cell mediated inflammatory process in the media same histology as GCA; involves aortic acrches nectrotizing vasculitis involved many organs (lungs are spared); transmural inflammation with fibrinoid necrosis; beads on a string appearance

Answer 234

lymphoma and granulomatous diseases (sarcoid) increase conversion of 25-hydroxyVitamin D to 1,25-hydroxyvitamin D thyrotoxicosis causes mild hypercalcemia due to increased bone turnover

Answer 235

encourages both myofibroblast accumulation at the wound edges and scar tissue remodeling resulting in contracture, also degradation of collagen and other components of the ECM peripheral artery disease; inadequate blood supply

Answer 236

at 3 weeks of gestation, the yolk sac forms a protrusion (ALLANTOIS) that extends into the urogenital tract - the upper part of the urogenital sinus develops into the bladder, allantois becomes the urachus (a duct between the bladder and the yolk sac); normally regresses and forms medial umbilical ligament If the urachus fails to close you can get 1. patent urachus - straw-colored urine discharge from the umbilicus 2. urachal sinus (failure to close the distal portion) - periumbilical tenderness and recurrent purulent infection 3. urachal cyst - failure of central portion to obliterate viscera protrude through an abdominal wall defect next to the umbilicus abdominal content enter the chest cavity and prevent lungs from developing properly when the processes vaginalis, an outpouching of the peritoneum, fails to obliterate; leaves a path to allow bowel contents into the inguinal canal; the deep inguinal canal is made by an opening in the transverse fascia; superficial inguinal canal is made by an opening in the external abdominal oblique (if testes is stuck in the canal, has to be pulled through the opening in the external oblique)

Answer 237

Most of the K+ filtered by the kidney gets resorbed in the PCT (35% of original filtered amount) and the loop of Henle.(10% of original amount) If HYPOkalemic - H+/K+ pump in the alpha-intercalated cells increases sodium resorption (collecting duct can end up with 1%) If HYPERkalemic - increased activity of the apical K+ channels in the principal cells and secretion of potassium (can end up with 110%) the increased flow quickly flushes away secreted K+, this helps maintain a high concentration gradient allowing more intracellular K to enter the tubular fluid (more K is excreted)

Answer 238

fibrocystin - a component of epithelial cells in both the renal tubule and the bile duct abnormality of the urethral outflow, impedes flow - can cause oligohydramnois during gestation; persistent urogenital membrane; bilateral hydronephrosis non-random co-occurence of birth defects - vertebral, anal atresia, cardiac defects, tracheoesophageal fistula, esophageal atresia, renal anomalies, limb defects urteropelvic jxn (incomplete canalization)

Answer 239

kidney spleen pancreas visceral pleura of the lungs overlie posterior surface of the liver

Answer 240

proximal convoluted tubule regardless of the patient's hydration status (>60%)

Answer 241

GFR/RPF (renal plasma flow) RBF = RPF/(1-hematocrit) RPF = (1-hematocrit)*RBF

Answer 242

In the retroperitoneum ureters pass posterior to the gonadal (ovary or testicalar) vessels and anterior to the psoas muscle; at the pelvic inlet passes anterior to common iliac artery and then continues to be anterior to the internal iliac artery in the true pelvis In the true pelvis, ureter is medial to the ovarian artery and posterior to the uterine artery; testicular artery does not enter pelvic brim PROXIMAL URETER - renal artery DISTAL URETER - superior vesicular MIDDLE - anastomoses between the common, internal iliac; gonadal and uterine -diaphragm and suprarenal vessels

Answer 243

vasodilate, increase vascular permeability, pain vasodilate at arterioles, increase vascular permeability at post-capillary venules (late acting) vasoconstriction, bronchospasm, increase vascular permeability phosphodiesterase inhibitor - increased levels of cAMP cause vasodilation inhibits calcium influx into smooth muscle causing vasodilation; also stabilizes mast cells preventing degranulation

Answer 244

In the PCT - 300 mOsm/L (isosmotic to plasma) becomes concentrated as you descend; *highest at the bottom of the LoH becomes less concentrated as you ascend (permeable to electrolytes, not permeable to water); LOWEST in the DCT *highest at the end of the collecting duct where aquaporins mediate water absorption

Answer 245

At first you increase the GFR because you are in increasing the hydrostatic pressure in the glomerulus However as you continue to increase the constriction, the oncotic pressure increases and you reduce GFR FF still increases RPF goes down because of hypovolemia and because the low volume triggers vasoconstriction; GFR also goes down but less so because of constriction on the efferent arteriole --> FF increases

Answer 246

at normal GFR, decreases produce small increase in creatinine at decreased GFR, decreases produce large increase in creatinine as GFR halves, creatinine doubles PAH is secreted at the PCT

Answer 247

Stress - loss of pelvic floor support (in post-menopausal women - lack of estrogen causes laxity and weakness of the pelvic floor or damage of pudendal nerve during childbirth) and urethral sphincter incontinence; increased abdominal pressure (coughing, sneezing) greater than urethral pressure cause leakage Urge - detrusor overactivity; can be due to hand-washing, running water - loss of CNS inhibitory input to the bladder Overflow - due to impaired detrusor muscle (diabetic autonomic) or outflow obstruction (tumor); bladder is not completely emptied and involuntarily spill when pressure inside exceeds that of the sphincters

Answer 248

diastolic - decreased ventricular compliance, characterized by normal SV, ejection fraction, and LV end diastolic volume; elevated LV filling pressure systolic - reduced ejection fraction because of impaired contractility, increased LV end diastolic volume with elevated end diastolic pressure, dilated ventricles

Answer 249

Intraductal papilloma - proliferation of papillary cells around a fibrovascular core in a cyst wall or duct that may contain focal atypia; bloody discharge - twisting of the vascular stalk of the papilloma in the duct not accompanied with breast masses or skin changes

Answer 250

majority of the external ear receives sensory innervation from the mandibular division of the trigeminal nerve The POSTERIOR part of the ear is innervated by the small auricular branch of the vagus nerve; stimulation to this nerve causes increased parasympathetic output resulting in decreased heart rate and syncope

Answer 251

somatostatin is formed by the delta-cells of the pancreas ``` results in decreased secretion of: gastrin - hypochlorhydria secretin - steatorrhea (decreased bile) cholecystokinin - gall stones insulin and glucagon, but I>G --> hyperglycemia ``` somatostatin is also secreted by the hypothalmus and inhibits growth hormone production

Answer 252

1. deficiency in porphobilinogen deAminase or increased induction of ALA synthase (either via drugs - griseofulvin, phenytoin, phenobarbital; low calorie diet; progesterone); leads to an increase in ALA and porphobilinogen; treat with glucose or heme which inhibit ALA synthase; ABDOMINAL PAIN AND NEUROLOGICAL ISSUES, port wine urine 2. deficiency in uroporphyrinogen deCarboxylase; leads to increase in uroporphyrinogen; presents with tea-colored urine and blistering photosensitivity 3. inhibits ferrochelatase and ALA dehydratase; increase in ALA and protoporphyrin; microcytic anemia with basophilic stippling

Answer 253

anticonvulsants (phenytoin, carbamazepine), allopurinal, sulfasalazine, vancomycin can precipitate; develop fever, generalized LAD, facial edema, skin rash, eosinophilia, internal organ dysfunction hyperthyroid medications and hydralazine small to medium vessel vasculitis, circulating Ig-complement complexes that precipitate on refrigeration during states of chronic inflammation - hepatitis; SLE

Answer 254

hyperoxaluria - bowel resection can increase the amount of oxalate absorbed from foods which can increase the amount of oxalate excreted in urine; can TREAT WITH B6 - decreases the production of endogenous oxalate increased protein raises acid production from sulfur-containing AA; the acids are buffered with bone salts -->increased calcium excretion; the acidosis also causes increased citrate reabsorption in PCT causing HYPOCITRATURIA (citrate is protective against stone formation) less sodium is reabsorbed; calcium follows sodium so there is more calcium in the urine low calcium in the diet does not bind with all the oxalate to make excretable calcium-oxalate; the unbound oxalate ends up in the urine

Answer 255

significant artery stenosis causes renal hypoperfusion and activation of the RAAS initiated by the JGA (the smooth muscles of the afferent arteriole) renal artery stenosis on an XRay shows one atrophic kidney; patient will either be an older man with atheroschlerosis (pain after eating insinuates intestinal ischemia caused by the atheroschlerosis) or a young woman with fibrouscular dysplasia (both narrow the vessels); abdominal bruit is usually present

Answer 256

cystine - hexagonal struvite - coffin uric acid - rhomboid calcium oxalate - envelope

Answer 257

advanced liver disease with portal hypertension can cause renal failure due to vasoconstriction; kidneys are histologically normal and resume function with liver transplant toxic, acute tubular necrosis with vacuolar degeneration and ballooning of the PCT cells, increased anion gap, calcium oxalate crystals in urine common adverse side effect from cyclophosphamide; acrolein a metabolite irritates the bladder mucosa and causes hematuria

Answer 258

vomiting - lose H and Cl from gastric contents; cannot excrete HCO3 due to Cl loss and this contributes to the alkalemia; volume-depleted state that is SALINE RESPONSIVE loop diuretics and thiazides - prevent absorption of Na and Cl in the proximal parts of the tubule; the volume depletion stimulates aldosterone which increases Na absorption and wastes H and K (alkalosis); high urine chloride; SALINE-RESPONSIVE mineralocorticoid excess state - SALINE UNRESPONSIVE (hypervolemic state) high urine chloride due to pressure natriuresis

Answer 259

- easy fatigability - constipation (hypercalcemia) - back pain (bone lysis due to production of osteoclast-activating factor by the myeloma cells) - elevated serum protein - renal failure - Bence-Jones proteins - excess excretion of light chains that precipitate with Tamm Horsfall proteins - tubular obstruction and epithelial damage; GLASSY EOSINOPHILIC CASTS; can also get light chains deposited in the mesangium = AL amyloidosis

Answer 260

upper - vesicoureteral reflex lower - suppression of endogenous flora, colonization of distal urethra by pathogenic gram negative rods, attachment of those organisms to the bladder mucosa via virulence factors (fimbrae) avoiding unnecessary catheterization, sterile technique when inserting, and removing ASAP

Answer 261

atheroembolic disease which can affect the kidneys, GI tract, CNS, and skin - signs of embolism include blue toe and livedo reticularis microscopy shows partially or completely obstructed lumen with cholesterol clefts

Answer 262

dehydration, mental status changes, abdominal pain, tachypnea, increased anion gap acidosis, hyponatremia (sodium follows water), hyperkalemia, increased plasma osmolarity, ketosis INSULIN (intracellular shift of potassium because of the sodium-potassium increased glucose utilization preventing lipolysis) AND HYDRATION

Answer 263

can occur when a host cell is infected with 2 strains of a virus; the progeny contain parental genome from one strain but may contain nucelocapsid from the other strain (can acquire the ability to infect new host cells) however, as the genome is unchanged, subsequent progeny do not retain these traits

Answer 264

mesonephric ducts degenerates paramesonephric ducts fuse to form the cervix, fallopian tubes, uterus, and upper vagina; failure to fuse laterally can lead to a variety of mullerian and combined renal abnormalities transverse vaginal septum - retained menses in the uterus bicornate uterus is an example (indentation at the center of the fundus) In males: 1. SRY gene on the Y-chromosome - testes-determining factor 2. Sertoli cells make Mullerian inhibiting factor 3. Leydig cells make androgen to stimulate the mesonephric duct (aka Wolffian duct)

Answer 265

aromatase inhibitors - anastrozole, letrozole; decrease the conversion of androgen into estrogen; slows the progression of ER-positive tumors; in postmenopausal women, you have degradation of the granulosa cells so you have decreased conversion of A to E anyway but you have extraovarian aromatase in the adrenal cortex continuous-stimulation of GnRH (as opposed to pulsatile) decreases production of LH and FSH leading to decreased levels of estrogen (goserelin) tamoxifen binds to the Estrogen receptor itself If the breast cancer is HER-2 neu positive, treat with trastuzumab; inhibits MAPK signaling pathways, increases degradation of HER2, and facilitates antibody-mediated degradation of tumor cells

Answer 266

Block depolarization - parasthesias, weakness, dizziness, nausea, hypotension and respiratory distress 1. tetrodotoxin (pufferfish) 2. saxitoxin (dinoflagellates; red tide) Persistant depolarization 1. ciguatoxin (exotic fish, Moray eel) 2. batrachotoxin (South American frog)

Answer 267

Alport syndrome, Rett Syndrome, Fragile X, hypophosphatemic (vitamin D resistant) rickets AD; also has osmotic fragility

Answer 268

T-type - presents with a mediastinal mass that can cause respiratory symptoms, dysphagia, and super vena cava syndrome

Answer 269

AML 4/5 - monocyte AML 6 - erythroid precursors and affects elderly patients AML 7 - megakaryoblasts, Down syndrome in children

Answer 270

it allows for the creation of calcium-binding sites; the calcium attracts the clotting factors to the negatively charged phospholipids on platelet membranes

Answer 271

1. hemolytic anemia 2. pancytopenia (the mutation is in a stem cell) 3. hypercoagulability - release of free hemoglobin and other prothrombotic factors

Answer 272

1. RCC 2. cerebellar hemangioblastoma 3. pheochromocytoma 1. sarcoma 2. breast 3. brain 4. leukemia 1. colorectal 2. osteoma 3. fibroma 4. brain tumors 1. colorectal 2. endometrial 3. ovary

Answer 273

severe hypoplasia of erythroid elements in the bone marrow in the setting of normal granulopoesis and thrombopoiesis associated with THYMOMA and PARVOVIRUS

Answer 274

the virus has a revere transcriptase and incorporates into the host cell genome; disrupts cell cycle control by inactivating p53 tumor suppressor protein also the chronic liver cell injury causes regenerative hyperplasia increasing the number of mutations

Answer 275

abetalipoproteinemia; cholesterol accumulates in the RBCs

Answer 276

associated with repair of double-stranded DNA breaks

Answer 277

- constipation (binds to mu receptors in the gut) - causes histamine release and vasodilation and itching (should be avoided with people with hypotension) - cause contraction of smooth muscle in the Spinchter of Oddi leading to spasm and increased common bile duct pressures; also pressures in the gallbladder can increase leading to biliary colic (pain in upper right quadrant)

Answer 278

Vitamin K (given at birth intramuscularly to prevent hemorrhagic disease of the newborn) and D (exacerbated if the baby is exclusively breastfed, dark-skinned, and not exposed to sunlight) supplement with IRON if the baby is pre-term and low birth weight; althought breast milk has low iron, it is sufficient until 4 months after which time supplementation is required

Answer 279

Ribavirin is a nucleoside analog of guanosine 1. when incorporated into viral RNA, it can pair equally well with uracil and cytosine - disrupts RNA-dependent RNA replication which is lethal to RNA viruses 2. direct inactivation for viral RNA polymerase 3. inhibits the conversion of IMP to GMP (inosine monophosphate dehydrogenase); depletes intracellular GTP 4. inhibits formation of the 5' GTP cap - inefficient translation from mRNA 5. enhances Th1 immunity and suppresses Th2 cytokines

Answer 280

removing antrum of the stomach (to decrease gastrin production) and connecting it to the jejunum; blind loop is created involving the proximal jejunum and the duodenum folate, B12, calcium, iron, and vitamin D

Answer 281

arise along the lesser curvature of the stomach at the border of the acid secreting and gastrin secreting mucosa right and left gastric artery

Answer 282

1. persistent vitelline duct - meconium from the umbilicus 2. Meckel's diverticulum 3. vitelline sinus - partial closure of the vitelline duct with the patent portion open at the umbilicus 4. vitelline duct cyst - peripheral portions (those attached to the umbilicus and the ileum) are obliterated (fibrous); area in the middle remains abnormal development of anorectal structures; infants fail to pass meconium

Answer 283

caused by duct obstruction - lipase digests adipose tissue; pancreas is grossly edematous; fat necrosis; calcium deposition blood flow is disrupted to the pancreas, acinar cells are damaged and causes activation of trypsin; chalky-white areas of fat necrosis interspersed with hemorrhage due to autolysis of pancreatic tissue

Answer 284

pulsion - due to increased pressure (pseudo); diverticula in colon (mucosa and submucosa) and Zenker's traction - inflammation and scarring of the gut wall resulting in the pulling of the gut wall layers - (true); usually in midesophagus after TB or fungal infection

Answer 285

exhibits specificity for the M (microfold)-cell at the base of mucosal villi of a Peyer's patch in the terminal ileum; passes through the M-cell via endocytosis; lyses the endosome, multiplies and then spreads laterally lie at the base of the intestinal crypt - they are secretory (lysozymes and defensins) and phagocytic

Answer 286

ammonia is normally produced by the GI tract from catabolism of glutamine or bacteria catabolism of protein; in a patient with liver failure increased nitrogen from GI bleeding or increased dietary intake leads to an increase in ammonia that cannot be metabolized by the liver into urea; in liver disease DECREASED BUN impairs excitatory NT increases inhibitory NT

Answer 287

ballooning degeneration, Councilman bodies - eosinophilic apoptotic hepatocytes, and mononuclear cell infiltrates

Answer 288

most common liver neoplasm in children; associated with Beckwith-Wiedemann and FAP also, liver is the second most common organ of metastatic spread after the lymph nodes

Answer 289

290 - 2*(stool Na + stool K) plasma osmolarity - electrolytes in stool high gap - osmotic diarrhea (lactase def, Whipples) low gap - secretory diarrhea (cholera, VIPoma, laxative abuse)

Answer 290

hyperinsulinemia in the fetus (beta cell hyperplasia); the increased insulin inhibits the maturational effects of cortisol and can cause decreased surfactant production; increased insulin also contributes to increased fat deposition causing macrosomnia; after birth, at risk for HYPOGLYCEMIA decrease risk of cerebral palsy

Answer 291

1. see calcifications on mammogram with central necrosis 2. DCIS can progress to Paget's disease of the breast; erythema and ulceration of the nipple 1. tubular type - lack myoepithelial cells in a desmoplastic stroma 2. mucinous carcinoma - occurs in older women 3. medullary - inflammatory infiltrate; mimics fibroadenoma; associated with BRCA1 4. inflammatory - in dermal lymphatics; worst prognosis GALACTOCELE that can lead to breast abcess

Answer 292

kidneys not working -> increased phosphate retention -> hypocalcemia --> increased PTH secretion, can't produce 1,25-Vit D --> bone and muscle pain, decreased bone mineralization inactive form of Vit D produced by the kidneys when excess 1,25 Vit-D activity

Answer 293

round cells with basophilic cytoplasm; "fried eggs" appearance; high nuclear to cytoplasm ratio; normal finding in post-menopausal and post-partum women

Answer 294

MAIN: marginal artery (of Drummonad) and arc of Riolan (meandering mesenteric artery)

Answer 295

older, mentally slow woman of European descent; "lemon-like" - icteric and anemic; smooth, shiny tongue; shuffling gait diarrhea, abdominal bloating; false-negative stool guaiac results hemorrhagic stroke in adults; necrotizing enterocolitis in newborns

Answer 296

tacrolimus and cyclosporine inhibit calcineurin; elevated levels can cause nephrotoxicity grapefruit (furocoumarins) inhibits P450 3A and increases levels of the drug

Answer 297

hyperphagia, hypersomnia, depression, fatigue, vivid dreams 1. tremor, agitation, anxiety, tachycardia 2. seizures 3. hallucinations 4. DELIRIUM TREMENS (shaking, confusion, hallucinations, HTN), SEIZURE; treat with benzos; if liver function is impaired, treat with lorazepam, oxazepam, or temazepam (LOT) irritation, anxiety, depressed mood, insomnia, decreased appetite

Answer 298

estrogen - cholesterol hypersecretion (upregulating HMG-CoA reductase) progesterone - gallbladder hypomotility

Answer 299

conversion of fibrinogen to fibrin and conversion of V, VIII, and XIII to active forms

Answer 300

perchlorate and pertechetate propothiourahil and methimazole inhibit iodine organification and iodotyrosinase coupling

Answer 301

Follow the teniae coli (3 separate smooth muscle ribbons)

Answer 302

TRANSMURAL aortic wall inflammation, abnormal collagen remodeling and cross-linking, loss of elastin and smooth muscle cells

Answer 303

1. pre-pro-collagen transported to RER and the signal sequence is cleaved 2. hydroxylation of proline and lysine residues (need Vit C) 3. glycosylation of hydroxylysine 4. form triple helix via disulfide bonds - defective in osteogenesis imperfecta 5. exocytosis 6. proteolytic processing cleavage of N and C terminals to make insoluble tropocollagen (defective in Ehlers-Danlos) 7. Lysyl-oxidase links tropocollagen strands together; need Copper; defective in Menkes

Answer 304

FSH - menotropin (human menopausal gonadotropin) LH - hCG (alpha subunits are the same)

Answer 305

The pathogenesis of ovarian cancer is linked to the frequency of trauma and repair at the ovarian surface; oral contraceptives, breast feeding, and multiparity are protective by decreasing the frequency of ovulation risk factors - nulliparity, BRCA, infertilier

Answer 306

tricyclic antidepressants (amitryptine, nortryptiline) - decrease S and N re-uptake anticonvulsants (gabapentin) - decreased depolarization of neurons in the CNS opioids - activation of central opioid receptors capsaicin - causes release and subsequent depletion of substance P; causes build-up of intracellular calcium that leads to neuron dysfunction lidocaine - decreased depolarization of peripheral neurons

Answer 307

intensity of the murmur is proportional to the magnitude of left ventricle to aorta pressure gradient during systole

Answer 308

re-evaluate medications antipsychotics, antidepressants, and benzos have increased fall risk

Answer 309

insertion of the sartorious, gracilis, and semitendinosus

Answer 310

vancomycin - for gram positive organisms colistin - for gram negative organisms nystatin - for yeast trimethoprim - for Proteus

Answer 311

baclofen - GABA agonist | tizanidine

Answer 312

codes for P-glycoprotein; a transmembrane ATP-dependent efflux pump; decreases influx and efflux of hydrophobic compounds

Answer 313

SAD - psychosis must occur in the absence of mood symptoms for >2 weeks; but also mood disorders must be present for most of the illness with psychotic symptoms: psychotic symptoms occur exclusively during mood episodes psychosis, dissociative and anesthetic events, severe agitation leading to violent trauma, *nystagmus, ataxia, delirium, AMNESIA; NMDA-ANTAGONIST stimulant - tooth decay, tachycardia, diaphoresis, violent behavior, psychosis, NO NYSTAGMUS

Answer 314

abnormal immune response to intestinal microorganims Crohns disease shows mutations in NOD2 (encodes an intracellular microbial receptor helps to recognize bacterial LPS and contributes to innate immune response) leading to decreased activation of NF-kB --> decreased pro-inflammatory cytokines

Answer 315

clopazine - AGRANULOCYTOSIS, myocarditis, seizure, metabolic syndrome ziprasidone - prolonged QT interval risperidone - increased prolactin levels

Answer 316

atrophy/thinning of the dermis; loss of dermal collagen, drying, cracking and tightening of the skin, telangectasias, and ecchymoses

Answer 317

perineal body - fibromuscular tissue between urogenital triangle and anal triangle; damaged in MIDLINE EPISIOTOMY transverse perineal muscles - arises from ischial rami and tuberosities and inserts into perineal body; injured during MEDIOLATERAL EPISIOTOMY levator ani - part of anal triangle and supports pelvic floor; can be torn during crowning ischiocavernosus - urogenital triangle; forces blood into clitoris

Answer 318

excess collagen formation in the tunica albuginea (fibrous tissue overlying the testicles); can cause significant pain and curvature of the penis

Answer 319

Gap - conexin (upregulated during childbirth in the myometrium along with oxytocin receptors) desmosomes - intermediate filaments + cadherins (desmoglein) adherens junction - cadherin tight - claudin (affected by C. perfringens) and occludin hemidesmosomes - integrins

Answer 320

Health Maintenance Organization $; PCP referral before specialized visits, may not go outside provider network Point of service $$, can go outside provider network but with a fee, PCP referral before specialist Preferred provider organization $$$

Answer 321

long term - SSRI | immediate relief - benzos (have high abuse potential because of their rapid onset of action)

Answer 322

methotrexate - folate antagonist folinic acid; competes with MTX for DHF binding sites (leucovorin)

Answer 323

sub-periosteal erosions affected phalanges of the hand, salt and pepper skull, osteitis fibrosa cystica

Answer 324

inducers: phenytoin, carbamazepine, phenobarbital, griseofulvin, rifampin inhibitors: erythromycin, ciprofloxacin, azole, isoniazid, grapefruit juice, cimetidine, protease inhibitors, cyclosporine, amiodarone all statins are metabolized by P450 except pravastatin

Answer 325

triad: tinnitis, tachypnea, fever this is a MIXED acid-base (normal pH) vs a compensatory response (does not correct pH completely) -metabolic acidosis + respiratory alkalosis

Answer 326

Increased demargination; neutophilia catabolic - bone (decreased calcium absorption, inhibition of osteoblast activity), adipose, muscle, lymphocytes, adrenal cortex, skin anabolic - liver - increases glycogen synthesis and gluconeogenesis

Answer 327

nuclear membrane

Answer 328

- Vascular accidents in utero - apple peel atresia occurs when the superior mesenteric artery is obstructed; the result is a blind-ending proximal jejunum, a length of absent bowel and mesentery and finally a terminal ileum surrounding a distal ileocolic vessel

Answer 329

can be due to halothane which is highly hepatotoxic; cannot be distinguished histologically from viral hepatitis (centrilobular necrosis and inflammation of the portal tract); associated with high ALTs, leukocytosis, eosinophilia, increased PT

Answer 330

low estrogen leads to increased production of inflammatory cytokines and (IL-1 and TNF-alpha)

Answer 331

achalsia - reduced number of inhibitory ganglions cells; decreased amplitude in the mid-esophagus; increased tone and incomplete relaxation at the lower spinchter esophageal stricture - progressive difficulty with solid food; long history of GERD, decreased LES schleroderma - decreased LES tone, GERD, impaired motility esophageal spasm - multiple contractions in mid to low esophagus

Answer 332

chronic interstitial nephritis and papillary necrosis; nsaids collect in the medulla and are thought to cause glutathione depletion with subsequent lipid peroxidation also decrease PGE synthesis causing constriction of medullary vasa recta leading to ischemic papillary necrosis calcifications may be present

Answer 333

mucosa - most superficial upper glandular - oxyntic parietal cells that make acid and intrinsic factor lower glandular - basophilic chief cells that secrete pepsinogen muscularis mucosa submucosa

Answer 334

inhibits TNF alpha activity by competitively binding to to it and preventing its interaction with the cell surface receptor

Answer 335

``` chlamydia legionella listeria mycobacterium neisseria meningitis nocardia rickettsia salmonella typhi ``` cryptococcus neoformans histoplasma pneumocystis plasmodium toxoplasma

Answer 336

Campylobacter

Answer 337

found in adipose tissue; responsible for the synthesis of free fatty acids and glycerol; provides substrate for gluconeogenesis and ketone body formation

Answer 338

triptans and dihydroergotamine

Answer 339

1. sodium nitrate to form methemoglobin 2. hydroxycobalamin to bind to cyanide 3. sodium thiosulfate as a detoxifying sulfur donor

Answer 340

Less than 6 months to live

Answer 341

inhibits sealing activity of DNA topoisomerase II; usually the enzyme causes causes double-stranded nicks inhibits topoisomerase I which causes single-stranded nicks

Answer 342

statin therapy, myositis, HYPOTHYROIDISM, muscular dystrophies cushings, polymyalgia rheumatica

Answer 343

LV systolic dysfunction due to reduced coronary blood flow at rest that is partially or completely reversible by coronary revascularization repetitive episodes of angina prior to MI can delay cell death after complete coronary occlusion

Answer 344

round, oval budding yeast

Answer 345

the first infection can cause a self-limited disease in adults; secondary infection is from a different serotype with a more serious presentation (4 serotypes)

Answer 346

DO NOT KILL SPORES alcohol - disrupts cell membrane, protein denaturing chlorhexidine - disrupts cell membrane, cytoplasm coagulation KILLS SPORES H2O2 - free radicals that oxidize cell components iodine - halogenates things

Answer 347

infection of products of pregnancy - Staph aureus and gram negative rods

Answer 348

furosemide

Answer 349

anticonvulsants that induce Cp450 (increase vitamin D catabolism) - phenytoin, phenobarbital, carbamazepine aromatase inhibitors, medroxyprogesterone, GnRHs analogs (decrease estrogen) PPIs (decrease calcium absorption) corticosteroids, heparin (decrease bone formation)

Answer 350

inhibition of rapidly growing tissues - oral and GI mucosa (ulcers), bone marrow (pancytopenia), hepatotoxicity

Answer 351

slow ACETYLATORS

Answer 352

block IIb/IIIa receptors on platelets

Answer 353

mesna; hemorrhagic cystitis is caused by urinary excretion of the toxic metabolite acrolein; mesna binds acrolein in the urine

Answer 354

class 1B amiodarone is first choice

Answer 355

(plasma steady state * clearance)/1

Answer 356

constrictive pericarditis

Answer 357

PDA with eisenmenger

UWorld Questions 2 Flashcards

(383 cards)