Za Uwarudo review cards

Question 1

<p>In addition to upregulating lipoprotein lipase, what other enzyme do fibrates inhibit? </p>

Answer 1

<p>Cholesterol 7 alpha-hydroxylase (rate limiting step in bile formation, which can potentially decrease bile secretion leading to cholesterol gallstones). </p>

Question 2

<p>What affect do estrogens have on cholesterol synthesis? </p>

Answer 2

<p>They up-regulate HMG-CoA reductase, increasing cholesterol synthesis. </p>

Question 3

<p>In the urea cycle, conversion of arginiosuccinate to arginine releases what?</p>

Answer 3

<p>Fumarate (tying the TCA cycle to the urea cycle)</p>

Question 4

<p>What functions are folate derivatives crucial for? </p>

Answer 4

<p>Nucleic acid synthesis (particularly thymidine), conversion of homocysteine into methionine, and generation of S-adenosyl-methionine (SAM, for methylation reactions). </p>

Question 5

<p>What amino acids are necessary for nucleic acid synthesis? </p>

Answer 5

<p>Glutamine, Aspartate, and Glycine (GAG)</p>

Question 6

<p>What infection is associated with Classical Galactosemia? </p>

Answer 6

<p>E. coli sepsis. </p>

Question 7

<p>When would Classical Galactosemia likely appear?</p>

Answer 7

<p>In the first few days of life (milk has lactose which contains galactose). Hereditary fructose intolerance would appear later when fructose containing foods are introduced. </p>

Question 8

<p>What accounts for the splenomegaly seen in hemolytic anemia syndromes (Sickle cell, pyruvate kinase, spherocytosis, ect)?</p>

Answer 8

<p>Red pulp hyperplasia (increased activity of reticuloendothelial macrophages). </p>

Question 9

<p>What process does acidosis stimulate in renal tubular cells? </p>

Answer 9

<p>Renal ammoniagenesis (glutamine in converted into glutamate, which is then converted into alpha-ketoglutarate, releasing NH3 into the urine to bind H+ making NH4+). </p>

Question 10

<p>What is the major mechanism of renal acid secretion in chronic acidosis? </p>

Answer 10

<p>Renal ammoniagenesis. </p>

Question 11

<p>A deficiency of what enzyme would present similarly to G6PD deficiency? </p>

Answer 11

<p>Glutathione reductase </p>

Question 12

<p>What is the role of hormone sensitive lipase? </p>

Answer 12

<p>Initiates lipolysis in adipocytes in response to stress hormones (glucagon, catecholamines, ect) leading to release of free fatty acids and glycerol. Provides substrates for gluconeogenesis and ketogenesis in times of starvation. </p>

Question 13

<p>What is Zellweger syndrome? </p>

Answer 13

<p>An inborn error of metabolism cause dby an absence of peroxisomes, leading to an inability to beta-oxidize very long chain fatty acids (VLCFA's). </p>

Question 14

<p>Where can gene enhancers or silencers be located?</p>

Answer 14

<p>Anywhere upstream, downstream, or within introns of the transcribed gene. Bind activators/repressors that directly bind RNA polymerase II/transcription factors (which are directly bound to promotor) to enhance or silence transcription. </p>

Question 15

<p>What is the probability that the sister of a male with an x-linked disease and normal parents is a carrier? </p>

Answer 15

<p>If the parents are normal then the mother is a carrier and the father has a normal X, which makes the probability of her being a carrier 50%. She then conversely has a 50% chance of passing on the affected X chromosome. </p>

Question 16

<p>What is the inheritance pattern of mitochondrial disorders? </p>

Answer 16

<p>Mitochondrial disorders are exclusively inherited from one's mother (maternal inheritance). </p>

Question 17

<p>What accounts for the variable expressiveness of mitochondrial disorders? </p>

Answer 17

<p>Heteroplasmy (mitochondria are randomly distributed among daughter cells after mitosis with some having more or less damaged mitochondrial DNA). </p>

Question 18

<p>Do mitochondrial disorders preferentially affect males or females? </p>

Answer 18

<p>Mitochondrial disorders equally affect males and females. </p>

Question 19

<p>What is the inheritance pattern of androgenic alopecia? </p>

Answer 19

<p>Polygeneic (i.e. multiple genes result in phenotype. Hypertension is another example). </p>

Question 20

<p>What are some dysmorphic features of Down's?</p>

Answer 20

<p>Epicanthal folds, upslanting palpebral fissures, a protruding tongue, and excessive skin at the nape of the neck. </p>

Question 21

<p>What is the sound ausculated with with a VSD (such as that found with Down's)?</p>

Answer 21

<p>A holosystolic murmur heard at the sternal border. </p>

Question 22

<p>Does Down's present with hypotonia or hypertonia at birth? </p>

Answer 22

<p>Hypotonia and a weak startle/Moro's reflex (Edwards would have hypertonia). </p>

Question 23

<p>How can the infertility of cystic fibrosis be differentiated from that of primary ciliary dyskinesia? </p>

Answer 23

<p>Cystic fibrosis has infertility due to an absence of the vas deferens (azoospermia) whole primary ciliary dyskinesia has infertility due to immobile sperm (the vas deferens are still patent). </p>

Question 24

<p>What is the probability that an unaffected child (with unaffected parents) and a sibling with an autosomal recessive disease is a carrier for that disease? </p>

Answer 24

<p>2/3</p>

Question 25

<p>What is the name for a study where one group starts with a placebo, the other with the treatment, and then after a period of time the placebo and treatments are switched? </p>

Answer 25

<p>A crossover study. </p>

Question 26

<p>What is a case series study?</p>

Answer 26

<p>A descriptive study that tracks patients with a known condition (e.g. exposure, risk factor, or disease) to document the natural history or response to treatment. </p>

Question 27

<p>Would blood pressures being measured over one week count as a time-frame? </p>

Answer 27

<p>No, it simply means that it took a week to get a single measurement/data point. Bring this up because of a question asking about a cross-sectional study (i.e. a snapshot taken in the present to assess prevalence) and confused measuring BP over a week as a time-frame (which made me pick case control as an answer). It would only be a time frame if multiple measurements/data points were taken over time, and if there was a control and experimental group (this question only mentioned a randomized study population). </p>

Question 28

<p>What is a cross-sectional study?</p>

Answer 28

<p>A study that looks at the frequency of a disease (prevalence) at a particular point in time (snapshot). Would not have a control and experimental group like a case control or cohort study would. </p>

Question 29

<p>What statistical value is the most sensitive to an outlier? </p>

Answer 29

<p>The mean (i.e. a large outlier would change the mean. The mode is the most resistant since it is the most common value and thus would not be changed by an outlier). </p>

Question 30

<p>What is the embryological defect in tetralogy of fallot?</p>

Answer 30

<p>Displacement of the infundibular septum due to abnormal neural crest cell migration. While the endocardial cushions (defects seen with Down's) are also neural crest abnormality of them would result in ostium primum ASD and AV valve malformations. </p>

Question 31

<p>What is the issue with total anomalous pulmonary venous return (TAPVR)? </p>

Answer 31

<p>TAPVR is when the pulmonary vein drains into the SVC, resulting in both oxygenated and deoxygenated blood entering the right atrium. </p>

Question 32

<p>What type of collagen is found in granulation tissue? </p>

Answer 32

<p>Type II collagen (reticular). </p>

Question 33

<p>What type of collagen would be found in scarred myocardium months after an MI? </p>

Answer 33

<p>Type I collagen (also found in tendons, dermis, ect). </p>

Question 34

<p>What course does the left lead of a biventricular pacemaker take? </p>

Answer 34

<p>It passes through the coronary sinus, which resides in the atrioventricular groove on the posterior aspect of the heart. </p>

Question 35

<p>If a question asks to calculate the number of false negatives of a test, what value should be used? </p>

Answer 35

<p>The sensitivity is the measurement that deals with true positive (TP) and false negatives (FN). I.e. if the sensitivity was 75% (75% of people with disease test positive) and 200 patients out of 600 had a disease then the number of FN would be 25% of 200 (50). </p>

Question 36

<p>If a question asks to calculate the number of false positives, what value should be used? </p>

Answer 36

<p>The specificity is the measurement that deals with true negatives (TN) and false positives (FP). I.e. if the specificity of a test was 80% (80% of people who don't have the disease test negative) and 200 out of 600 people had a disease, the number of false positives would be 20% of 400 (80). </p>

Question 37

<p>What cardiac abnormality is Freidreich Ataxia associated with? </p>

Answer 37

<p>Hypertrophic cardiomyopathy. </p>

Question 38

<p>What cardiac abnormality is tuberous sclerosis associated with? </p>

Answer 38

<p>Valvular obstruction from cardiac rhabdomyomas. </p>

Question 39

<p>What is Pulsus Paradoxus (sharp decrease in BP upon inspiration) associated with? </p>

Answer 39

<p>Cardiac tamponade, asthma, and COPD. </p>

Question 40

<p>What is Kussmaul's sign (elevated JVP upon inspiration) associated with?</p>

Answer 40

<p>Constrictive pericarditis and restrictive pericarditis. </p>

Question 41

<p>What is loratadine? </p>

Answer 41

<p>A 2nd generation H1 antagonist (less anti-muscarinic effects and less sedation). Don't be confused by the suffix ("dine" is usually associated with H2 blockers). </p>

Question 42

<p>The presence of what interval in the CI of a cohort or case control study would render the results statistically insignificant?</p>

Answer 42

<p>1 </p>

Question 43

<p>The presence of what interval in the CI for a mean difference between two variables would render the results statistically insignificant? </p>

Answer 43

<p>0</p>

Question 44

<p>What disorders can present with pheochromocytoma? </p>

Answer 44

<p>MEN2A, MEN2B, Neurofibromatosis-1, Von-hippel lindau .</p>

Question 45

<p>What will giving iodine (or iodine containing substance like amiodarone) to someone with a baseline hyperthyroid state (Grave's, toxic multinodular goiter) result in? </p>

Answer 45

<p>Jod-Basedow phenomenon (hyperthyroidism in the presence of increased iodine).</p>

Question 46

<p>What will giving iodine (or a iodine containing substance like amiodarone) to someone with normal thyroid function result in? </p>

Answer 46

<p>Wollf-Chiakoff effect (hypothyroidism in the presence of increased iodine). </p>

Question 47

<p>What is the typical progression of a thyroiditis? </p>

Answer 47

<p>Initially hyperthyroid (damaged follicles release thyroid hormone) but progresses to hypothyroidism (damaged follicles cannot synthesize more). </p>

Question 48

<p>What is the only painful/tender thyroiditis? </p>

Answer 48

<p>Subacute/de Quervain/granulomatous thyroiditis. </p>

Question 49

<p>What endocrine abnormality can result in atrial fibrillation? </p>

Answer 49

<p>Hyperthyroidism (check TSH levels in an afib patient). </p>

Question 50

<p>What would be an example of a wide QRS complex SVT (SVT usually narrow complex, has to be distinguished from vtach)? </p>

Answer 50

<p>Afib in a WPW patient. Can be distinguished from Vtach by being irregularly irregular. Important because the usual afib drugs (b-blockers, Ca2+ blockers, adenosine, digoxin) cannot be used. Use procainamide or ibutilide instead. </p>

Question 51

<p>What kinase inhibitor is used for melanoma? </p>

Answer 51

<p>Vemurafenib (inhibits BRAF kinase)</p>

Question 52

<p>What is a potential consequence of Kawasaki's disease? </p>

Answer 52

<p>Coronary artery aneurysm (which can lead to myocardial ischemia). </p>

Question 53

What type of cells are the adrenal medullary chromaffin cells, and what are they activated by?

Answer 53

The chromaffin cells are post-ganglionic sympathetic neurons and are stimulated by acetylcholine secreted by pre-ganglionic sympathetic neurons.

Question 54

What is calcipotriene?

Answer 54

A vitamin D analog used in the treatment of psoriasis. Binds to the vitamin D receptor (a nuclear transcription factor) resulting in inhibition of keratinocyte proliferation.

Question 55

What is ustekinumab?

Answer 55

An anti IL-12 and IL-23 antibody used in the treatment of psoriasis.

Question 56

What is one of the most effective preventative measures a patient can take to reduce mortality?

Answer 56

Smoking cessation. (question presented a hypertensive diabetic. I was thinking smoking cessation but put exercise just to see, but smoking cessation was the correct answer after all).

Question 57

Where are posterior pituitary hormones synthesized?

Answer 57

The hypothalamus (supraoptic and paraventricular nuclei). Damage to the hypothalamus can thus result in permanent DI (while damage to the posterior pituitary results in central DI it would not persist for years as the patient in the question did).

Question 58

What can cause transient central DI?

Answer 58

Damage to the posterior pituitary (if the hypothalamic nuclei are intact then axonal regeneration can occur). Only damage to the hypothalamus will result in permanent central DI.

Question 59

What is the most common complication of herpes zoster?

Answer 59

Persistent local pain (postherpetic neuralgia). Initially put recurrent skin rash but VZV does not cause recurrent rashes in immunocompromised hosts, only HSV does that.

Question 60

What happens to c-peptide after it is cleaved from proinsulin?

Answer 60

It is stored together with the insulin in secretory vesicles. Both are released upon beta cell stimulation.

Question 61

Elevated serum levels of what substance contributes to the insulin resistance of type II DM?

Answer 61

Free fatty acids. Chronically elevated FFA impairs insulin dependent glucose uptake by cells and also stimulates hepatic gluconeogenesis. (initially put c-peptide but that does not cause insulin resistance).

Question 62

What is a large tongue and an umbilical hernia indicative of in an infant with failure to thrive?

Answer 62

Congenital hypothyroidism/Cretenism. Most commonly due to an absence of the thyroid peroxidase enzyme (dyshormonogenesis). Remember that it is asymptomatic at first due to persistence of maternal T4.

Question 63

What is PPAR-gamma?

Answer 63

Peroxisome-proliferator-activated-receptor-gamma. An intracellular nuclear receptor that binds to the retinoic acid receptor upon activation to then transcribe genes. PPAR-alpha is similar but is the target of fibrates.

Question 64

What drugs target PPAR-gamma?

Answer 64

The diabetic medications thiozolidinediones (all have the suffix “glitazone”, like pioglitazone and rosaglitazone).

Question 65

What is one of the most important products upregulated by PPAR-gamma activation?

Answer 65

Adiponectin, a cytokine secreted by adipose tissue that increases insulin sensitivity and fatty acid oxidation.

Question 66

What are the cancers associated with Psammoma bodies?

Answer 66

Papillary thyroid carcinoma, Serous cystadenoma/cystadenocarcinoma (ovarian tumor), Mesothelioma, and Meningioma (mneumonic: PSMM, i.e. psammoma with the vowels removed).

Question 67

What can cause secondary lactase deficiency?

Answer 67

Processes that damage the microvilli, like celiac’s or infection (like giardia, question was 2 year old with giardiasis who then had similar diarrhea after treatment for the giardia).

Question 68

Where are the parietal cells located in the gastric glands?

Answer 68

In the upper glandular layer (in the body and fundus). Arrow was pointing to the top of the glands below the gastric mucosa.

Question 69

What is the appropriate response to a patient taking an herbal weight loss supplement?

Answer 69

Explain the risks of unregulated supplements to the patient.

Question 70

What is the treatment for arsenic poisoning?

Answer 70

Dimercaprol, a chelating agent that increases excretion of heavy metals. Also used for lead poisoning.

Question 71

What is essential to making the diagnosis of thrombotic thrombocytopenic purpura (TTP)?

Answer 71

Hemolytic anemia and thrombocytopenia (renal failure, fever, and CNS dysfunction are far less important diagnostic features).

Question 72

Where does negative selection of T-cells occur?

Answer 72

In the thymic medulla (question mentioned medullary dendritic cells). Positive selection occurs in the thymic cortex.

Question 73

What two B-cell malignancies are CD5+?

Answer 73

CLL/SLL and Mantle cell (11:14 translocation, cyclin D1).

Question 74

What electrolyte abnormality does amphotericin B nephrotoxicity result?

Answer 74

Hypokalemia (due to increased membrane permeability of distal tubule cells, i.e. type I RTA). Hypokalemia leads to weakness and cardiac arrhythmias (PVCs, ect).

Question 75

What is the most common presenting symptom of a pancoast tumor?

Answer 75

Shoulder pain due to involvement of the lower brachial plexus (specifically the inferior trunk causing C8/T1 dysfunction).

Question 76

What is one manifestation of pulsus paradoxus?

Answer 76

Systolic Kortakoff sounds only heard during inspiration (drop in BP upon inspiration renders then inaudible at the time).

Question 77

What is the MOA of prostaglandins (like latanoprost) in the treatment of glaucoma?

Answer 77

They increase uveoscleral outflow of aqueous humor.

Question 78

What additional symptom could be seen in a patient with atherosclerotic renal artery stenosis?

Answer 78

Post-prandial pain due to intestinal ischemia also caused by atherosclerosis (don’t forget that atherosclerosis is an example of a disease process that can affect multiple organ systems concomitantly).

Question 79

What is globus sensation?

Answer 79

An abnormal sensation of a foreign object in the throat that is worse after swallowing saliva. It is associated with anxiety disorders.

Question 80

What is DNA laddering?

Answer 80

The appearance of DNA fragments in multiples of 180 base pairs that appear on gel electrophoresis of apoptotic cells. An absence of such fragments indicates a cell that is resistant to apoptosis.

Question 81

Can a 15:17 translocation AML occur in adults?

Answer 81

Yes. (I chose 9:22 because I thought 15:17 AML was exclusively in children, but apparently it can occur in adults. Histology even showed the appearance of auer rods)>

Question 82

What is a common risk factor for postpartum endometritis (occurs in the uterus)?

Answer 82

Cesarean section (introduction of cervicovaginal flora into the uterus).

Question 83

Can shingles occur in a 4 year old child?

Answer 83

Yes, especially if they had a primary (chickenpox) infection in the first year of life (cold with generalized rash).

Question 84

What is reflection?

Answer 84

A facilitating interview technique where a physician repeats what a patient said either exactly or paraphrased (ex. “So you have been drinking more in response to your divorce?”). Shows the patient that you have been listening and strengthens the patient-physician relationship.

Question 85

What happens to GFR immediately after and then long-term following a single nephrectomy?

Answer 85

Immediately after GFR is reduced to 50% compared to pre-surgery, with the remaining kidney eventually adapting to 80% of pre-surgery GFR.

Question 86

Where are N-terminal transport signals translated?

Answer 86

In the cytosol, where they direct transport to the ER. If a preprohormone did not have a signal peptide then it would be stuck in the cytosol, not the ER.

Question 87

What maintains the high concentrations of testosterone in the semineferous tubules?

Answer 87

Androgen binding protein (ABP) which is synthesized by the sertoli cells.

Question 88

What arterial blood gas changes occur with a pulmonary embolism?

Answer 88

V/Q mismatch leads to hypoxemia, triggering ventilation reflexes (tachypnea). This decreases PaCO2 levels (respiratory alkalosis) but can’t fully account for PaO2 (i.e. decreased PaCO2 and PaO2).

Question 89

What is the pathogenesis of idiopathic pulmonary hypertension?

Answer 89

Pulmonary arterial endothelial dysfunction followed by an increase in the tunica media (SM).

Question 90

What effect would adding more enzyme have on the reaction kinetics?

Answer 90

Increases Vmax (be careful though as this would translate to a smaller y intercept on the lineweaver-burke plot since the y-intercept is 1/Vmax).

Question 91

What allows for apoptotic protein translation during apoptosis (elongation factors are degraded so an alternative method is used)?

Answer 91

Internal ribosomal entry sites (IRES). I thought IRES was only found in picornaviruses but eukaryotes also have IRES which allows pro-apoptotic proteins to continue to be translated even though caspases have degraded translation elongation factors.

Question 92

What is the cause of peripheral artery disease (intermittent claudication)?

Answer 92

Atherosclerotic plaques (put DVT because I thought that could cause it, and the diabetic patient had foot ulcers which I thought was venous insufficiency, but that is a separate issue from the claudication).

Question 93

What kind of nerve fibers are post-ganglionic autonomic nerves?

Answer 93

Unmyelinated nerve fibers (others include afferent fibers for heat sensation and slow burning pain, i.e. C fibers).

Question 94

What can iron deficiency anemia present with?

Answer 94

Loss of taste sensation, glossal pain (burning sensation in mouth) and chelitis.

Question 95

Would a testicular varicocele reduce when lying down?

Answer 95

Yes, due to increased venous drainage. Was unsure if a varicocele would reduce like that which is why I put testicular cancer.

Question 96

Would a testicular varicocele illuminate under pen light?

Answer 96

No.

Question 97

What serological effects does vitamin D supplementation have?

Answer 97

Increased calcium, increased phosphate, and decreased PTH.

Question 98

What happens during the cooling step of PCR?

Answer 98

Binding of the primer to single stranded DNA.

Question 99

What is the presentation of primary HSV-1 infection in a child?

Answer 99

Gingivostomastitis (vesces on the lips and hard palate with fever and cervical lymphadenopathy).

Question 100

How can Hand Foot and Mouth disease be differentiated from gingivostomastitis (primary HSV-1 infection)?

Answer 100

Hand foot and mouth disease presents with vesicles on the buccal mucosa, tongue, and soft. Primary HSV-1 infection meanwhile will present with vesicles on the lips and hard palate

Question 101

Is griseofulvin a cytochrome P450 inhibitor or inducer?

Answer 101

Griseofulvin is a P450 inducer (it is the azole antifungals that are inhibitors, but griseofulvin is an inducer).

Question 102

Are macrolides cytochrome P450 inhibitors or inducers?

Answer 102

Macrolides (erythromycin, ect). are P450 inhibitors.

Question 103

What statin is not metabolized by CYP P450 enzymes?

Answer 103

Pravastatin.

Question 104

What prokaryotic DNA polymerase has 5’-3’ exonuclease activity?

Answer 104

DNA polymerase I

Question 105

What is the MOA of C. difficile toxins A and B?

Answer 105

They inactivate rho regulatory proteins leading to disruption of the enterocyte actin cytoskeleton.

Question 106

Does niacin reduce the risk of cardiovascular events?

Answer 106

Even though niacin is the most effective at raising HDL, it does not reduce the risk of cardiovascular events. Only statins actually reduce risk, and are indicated regardless of baseline lipid levels.

Question 107

Can IgA nephropathy present with anemia or thrombocytopenia?

Answer 107

No. If a child has bloody diarrhea and then presents a few days later with anemia, thrombocytopenia, and renal failure then it is Hemolytic Uremic Syndrome (HUS - microangiopathic anemia due to microthrombi), not IgA nephropathy.

Question 108

What is gallstone ileus?

Answer 108

When a large gallstone causes a fistula between the gallbladder and GI tract (usually duodenum).

Question 109

Where does a gallstone lodge in the GI tract following gallstone ileus?

Answer 109

The gallstone tends to lodge in the ileum (narrowest portion of the small bowel).

Question 110

What are two systemic sequelae of diphtheria toxin?

Answer 110

Neurologic toxicity and myocarditis/heart failure.

Question 111

What do viridans Streptococci adhere to in the setting of endocarditis?

Answer 111

Fibrin-platelet aggregates.

Question 112

What does binding of ATP to the myosin head in skeletal muscle do?

Answer 112

Myosin head detachment from the actin filament (the need of ATP to release the myosin head from actin is what accounts for rigor mortis after death).

Question 113

Is zero order kinetics a constant amount metabolized or a constant proportion metabolized?

Answer 113

Zero order kinetics is a constant amount metabolized (ex will always metabolize 10 mg ethanol no matter how much is ingested) while first order kinetics is a constant proportion (amount metabolized will increase with drug amount but the proportion is constant).

Question 114

What happens to the kinetics of a first order drug as it reaches saturation/maximum amount that the body can metabolize?

Answer 114

It switches over to zero order kinetics (constant amount metabolized). (ex if 500 mg is the maximum amount that the liver can metabolize of drug x then once the concentration of drug x reaches that then any increase in the concentration will still result in 500 mg being metabolized).

Question 115

What are the toxicities of aminoglycosides?

Answer 115

Nephrotoxicity and ototoxicity.

Question 116

What should severe comedomal acne in a young athlete raise suspicion of?

Answer 116

Anabolic steroid abuse.

Question 117

What does elevated acetylcholinesterase levels in amniotic fluid suggest?

Answer 117

A neural tube defect (failure of the neural plate edges to fuse).

Question 118

What is the MOA of shiga toxin?

Answer 118

Halts protein synthesis via inactivating the 60S ribosomal subunit.

Question 119

What should be done if a patient comes into the ER seeking pain medication?

Answer 119

Obtain the patient’s prescription history.

Question 120

Can hexokinase act on fructose?

Answer 120

Yes, Hexokinase converting fructose to fructose-6-phosphate is how patients with essential fructosuria (fructokinase deficiency) are still able to metabolize fructose.

Question 121

What will a chronic arteriovenous fistula do to the cardiac output - venous return curve?

Answer 121

While an acute AV fistula will only affect TPR initially (no change to mean systemic pressure), chronically an AV fistula will both increase CO as well as venous return (increased mean systemic pressure).

Question 122

What is the best course of action to ensure medicine compliance in a patient who requires supervision and who’s family has been unable to do so?

Answer 122

Involve a social worker in the discharge planning.

Question 123

What is the leading cause of cancer mortality in men and women?

Answer 123

Lung cancer (followed by breast/prostate 2nd and then colon 3rd).

Question 124

What is a general rule of thumb for the relationship between GFR and serum creatinine?

Answer 124

Every time GFR is halved, serum creatinine doubles.

Question 125

What accounts for the short duration of action of propofol?

Answer 125

Tissue redistribution of the drug (lipophilic drugs rapidly distribute to organs with high blood flow like the brain and then subsequently redistribute to organs with less blood flow).

Question 126

What is key to the diagnosis of aplastic anemia?

Answer 126

The absence of splenomegaly

Question 127

What accounts for intestinal atresias of the midgut (jejunum, ileum, proximal colon)?

Answer 127

Vascular occlusion in utero.

Question 128

What can improper rotation of the gut result in?

Answer 128

Malrotation of the gut and risk of volvulus (coffee bean sign).

Question 129

What are the features of glucocorticoid induced myopathy?

Answer 129

Proximal muscle weakness without pain and with normal CK levels (hypothyroid and other myopathies have elevated CK levels).

Question 130

When eliciting the knee reflex, a brisk contraction of the quadriceps with delayed relaxation is suggestive of what condition?

Answer 130

Delayed DTRs which is a sign of hypothyroidism. Hypothyroidism can also present with brittle nails.

Question 131

What antibiotic used in the treatment of C. difficile inhibits RNA polymerase?

Answer 131

Fidaxomicin.

Question 132

What are the oral options for treatment of C. difficile?

Answer 132

Vancomycin and fidaxomicin (metronidazole is given IV in C. diff patients).

Question 133

What are the symptom of legionella?

Answer 133

Pneumonia, diarrhea, and hyponatremia (confusion).

Question 134

What medications should be avoided in HOCM patients?

Answer 134

Vasodilators and diuretics (both decrease pre-load which worsens the LVOT obstruction).

Question 135

What is holoprosencephaly (fused cerebral hemispheres) an example of?

Answer 135

A developmental field defect (initially put agenesis but that would be a complete absence of neural tissue).

Question 136

What is the clinical course of a follicular lymphoma?

Answer 136

A long, waxing and waning clinical course (i.e. LN that fluctuates in size over the course of a year, ect).

Question 137

What is the major virulence factor of H. influenzae?

Answer 137

Polyribosylribitol phosphate (PRP) which comprises its polysaccharide capsule (prevents complement activation).

Question 138

What do the CGG repeats in fragile X syndrome lead to?

Answer 138

DNA methylation of the FMR1 gene (gene silencing).

Question 139

What is the extra heart sound heard in mitral stenosis?

Answer 139

An opening snap (i.e. when the mitral valve is opening at the beginning of systole).

Question 140

hat kind of visual field defect would result from retinal lesions in the macula?

Answer 140

Central scotoma.

Question 141

What effect does aldosterone have on the salivary glands?

Answer 141

It promotes K+ secretion (saliva contains HCO3- and K+, could theoretically become hypokalemic from excessive salivation).

Question 142

What accumulates within astrocytes in hyperammonemia?

Answer 142

Glutamine (combines ammonia with glutamate to make glutamine, disrupting excitatory neurotransmission).

Question 143

What is projection?

Answer 143

Defense mechanism of misattributing one’s own unconscious/undesired thoughts/feelings onto another person who does not have them (ex. child of a divorced couple who thinks his parents are mad at them).

Question 144

What is identification?

Answer 144

Defense mechanism of modeling one’s behavior after someone else. (ex child of a child abuser becoming an abuser).

Question 145

What is the negative predictive value (NPV)?

Answer 145

The probability that a negative test result is actually negative (ex. patient who was told they do not have cancer asking what the chances are that they actually do not have it). Initially put specificity but that is an intrinsic, unchanging aspect of a test.

Question 146

Is S. pneumoniae bile soluble?

Answer 146

Yes (Strep viridans are bile insoluble).

Question 147

What defines akathesia?

Answer 147

Subjective restlessness and an inability to sit still that presents days to weeks after starting anti-psychotic therapy.

Question 148

What is the preparation stage of change?

Answer 148

Planning a behavior change (ex an alcoholic planning to call a rehab center).

Question 149

What does noise induced hearing loss result from?

Answer 149

Trauma to the stereociliated hair cells of the organ of corti.

Question 150

What does 3’-5’ exonuclease activity allow DNA polymerase to do?

Answer 150

Removal of mismatched base pairs during DNA replication (proof reading activity).

Question 151

What test is most specific for diagnosing acute cholecystitis?

Answer 151

Failed gallbladder visualization on radionuclide biliary scan (gallstone blocks uptake of contrast dye).

Question 152

What is isoproterenol?

Answer 152

A non-specific beta agonist (causes increased contractility through beta-1 activation and vasodilation through beta-2 activation).

Question 153

What serum abnormality (aside from hyperbilirubinemia) can be seen in primary biliary cirrhiosis?

Answer 153

PBC is an ecample of a hyperlipidemic state and thus can present with xanthelemas (lipid filled macrophage filled skin lesions).

Question 154

What does an anterolateral supracondylar humerus fracture damage?

Answer 154

The radial nerve.

Question 155

What does an anteromedial supracondylar humerus fracture damage?

Answer 155

The median nerve and brachial artery.

Question 156

What is an ecological study?

Answer 156

When the frequencies of a given characteristic and a given outcome are studied using population data.

Question 157

Is there a serum assay for tetanus toxin?

Answer 157

No. Diagnosis of tetanus requires a thorough examination and history.

Question 158

What will puncture of the common femoral artery (continuation of the external iliac) superior to the inguinal ligament result in?

Answer 158

Retro-peritoneal hemorrhage (runs beneath the peritoneum so would not result in pelvic hemorrhage).

Question 159

Where can the great saphenous vein be accessed?

Answer 159

Just inferolateral to the pubic tubercle (right before it crosses the cribiform fascia to join the femoral vein).

Question 160

Can Gaucher’s present with pancytopenia?

Answer 160

Yes (would see Gaucher cells [enlarged macrophages with a “crinkled” appearance] on bone marrow biopsy).

Question 161

What is one of the arrythmias that can result from digoxin toxicity?

Answer 161

Bradycardia with junctional escape beats (combined with color vision issues and hyperkalemia suggests digoxin toxicity).

Question 162

If a person with a history of cognitive decline over a year suddenly has a change of mental status in the hospital, what is the most likely diagnosis?

Answer 162

Delirium. Even if there was a prior history of cognitive decline, the acute and sudden onset of acute mental status change is most likely delirium and due to an underlying medical condition like pneumonia, ect.

Question 163

What does it mean if it takes a dose an inhaled anesthetic longer to reach it’s partial pressure in the blood?

Answer 163

It means that it’s more soluble in the blood (high blood/gas partitioning coefficient i.e. slower onset of action).

Question 164

What enzymes in the TCA cycle are dependent on NAD+?

Answer 164

PDH, isocitrate dehydrogenase, alpha-ketoglutarate dehydrogenase, and malate dehydrogenase. (initially put succinate dehydrogenase but that is FAD+ dependent).

Question 165

What would be seen 6 months after an ischemic stroke? (Wallerian degeneration process in the CNS)

Answer 165

Persistent myelin debris (unlike the PNS, clearance of myelin debris is sowed due to the BBB impairing microglia migration as well as oligodendrocyte apoptosis). Can lead to a glial scar.

Question 166

What does Wallerian degeneration refer to?

Answer 166

The process of axonal degeneration and breakdown of the myelin sheath that occurs distal to the site of injury.

Question 167

What is the most appropriate response when a patient brings up a history of sexual abuse?

Answer 167

Acknowledge the sexual abuse while gently asking if they would like to further discuss it. (ex that sounds like an awful experience, are you comfortable talking about it?”

Question 168

What is the target of kegel exercises?

Answer 168

The levator ani (pelvic floor). Strengthening the levator ani/pelvic floor results in increased urethral support, decreasing stress incontinence.

Question 169

What would be seen grossly upon inspection of a lacunar infarct?

Answer 169

A small fluid filled cyst. The initial insult in a lacunar stroke is lipohyalinosis/microatheroma resultin in small vessel occlusion.

Question 170

What antibiotic used in the treatment of MRSA can cause myopathy?

Answer 170

Daptomycin (creates transmembrane channels resulting in loss of membrane potential).

Question 171

Is daptomycin effective in pneumonia?

Answer 171

No, because it is inactivated by surfactant

Question 172

What is permissiveness in pharmacologic terms?

Answer 172

When one compound allows an other to exert its maximal effect (ex cortisol has no vasoconstrictive effects on it’s own, but allows maximal effect of NE through alpha-1 upregulation).

Question 173

What receptors are responsible to the decrease in respiration seen in COPD patients put on 100% O2?

Answer 173

The peripheral chemoreceptors (aortic arch and carotid bodies).

Question 174

What is clinically relevant about CO2 being a perfusion limited gas?

Answer 174

The PCO2 will be normal in states of diffusion impairment (normal PAO2, low PaO2, normal PaCO2). It is also the reason why tachypnea in PE will blow off CO2 (respiratory alkalosis) but not correct the hypoxemia.

Question 175

What nerve innervates the posterior portion of the external auditory canal?

Answer 175

The auricular branch of the vagus (stimulation can lead to vasovagal syncope).

Question 176

Is malpractice a medical error category?

Answer 176

No, it is a legal term. If a physician for example missed an obvious test result (TSH levels, ect) and did not address it, the medical error category would be preventable adverse event.

Question 177

Where is the location of Kiesselbach’s plexus?

Answer 177

The nasal septum.

Question 178

Where does the assembly of the procollagen alpha triple helix occur?

Answer 178

In the endoplasmic reticulum.

Question 179

Where does the N and C terminal propeptide removal step of collagen synthesis occur?

Answer 179

In the extracellular space.

Question 180

A lesion in what structure would cause a homonymous hemianopsia with marcus gunn pupils (impaired afferents)?

Answer 180

Optic tract. A LGB/LGN lesion would also cause contralateral homonymous hemianopsia but would not affect the pupillary reflex.

Question 181

What pancreatic bud gives rise to the main pancreatic duct?

Answer 181

The ventral pancreatic bud

Question 182

What pancreatic bud gives rise to the accessory pancreatic duct?

Answer 182

The dorsal pancreatic duct (as wells as most of the pancreas i.e. most of head, body, tail)

Question 183

What is most similar between the systemic and pulmonary circulations during both exercise and rest?

Answer 183

Blood flow per minute (RV output must match LV output).

Question 184

Over-expression of what marker is associated with more aggressive breast cancer?

Answer 184

HER2

Question 185

What is the time frame for a true ventricular aneurysm?

Answer 185

1 months (due to the presence of scar tissue defining a true aneurysm).

Question 186

What is the most likely cause of death 5 days after a massive anterior MI?

Answer 186

Ventricular free wall rupture, which would present as profound hypotension, cardiac tamponade, ect).

Question 187

If a patient has dysphagia and the PMH only mentions GERD, what structure on imaging should be pointed to?

Answer 187

GERD can cause dysphagia on its own, so the involved structure would be the esophagus itself (between the trachea and spine) and not an exogenous structure compressing it (led me to look for the LA even though the MRI was at the level of the aortic arch).

Question 188

What is the MOA of the Bacillus anthraxis edema toxin?

Answer 188

It is a calmodulin dependent adenylate cyclase that increases cAMP, leading to edema and neutrophil/macrophage function.

• Similar to the pertussis toxin

Question 189

What happens to LH/FSH with continuous Leuprolide administration?

Answer 189

There is a transient increase before suppression happens.

Question 190

What is the morphology of Candida?

Answer 190

Pseudohyphae with blastoconida

Question 191

In addition to baclofen, what agent can be used for spasticity in multiple sclerosis/brain and or spinal disease?

Answer 191

Tizanidine (alpha-2 agonist).

Question 192

What should you do if you suspect illiteracy in a patient?

Answer 192

Use visual aids.

Question 193

What property of an anesthetic is indicated by the arteriovenous concentration gradient?

Answer 193

The peripheral tissue solubility. (A high concentration gradient between the arteries and veins suggests more is uptaken by the periphery and thus it will take longer for the brain to be saturated/slow onset of action. The reverse is also true).

Question 194

What would damage to the radial nerve at the axilla (crutch palsy) result in?

Answer 194

Weakness of hand, wrist and forearm (triceps) extension with sensory loss.

Question 195

What would damage to the radial nerve at the midshaft humerus result in?

Answer 195

Weakness of hand/wrist extension with sparing of the triceps and sensory loss over the posterior hand.

Question 196

What would damage to the radial nerve at the supinator canal result in?

Answer 196

Weakness of hand extension with sparing of the triceps and preserves sensation.

Question 197

What is lead time bias?

Answer 197

When there is an apparent increase in survival time among patients undergoing screening when they actually have an unchanged prognosis. (detected earlier but still die at the same time. Overall mortality rates, not survival time, should be used in assessing the efficacy of early screening).

Question 198

What is length time bias?

Answer 198

When subjects with a rapidly progressive form of disease are less likely to be detected by screening compared to those with slowly progressive disease.

Question 199

What electrolyte abnormalities can cause nephrogenic DI?

Answer 199

Hypercalcemia and hypokalemia.

Question 200

What are the signs of stimulant (cocaine, amphetamine) withdrawal?

Answer 200

Depression, fatigue, hypersomnia, hyperphagia, and vivid dreams.

Question 201

In addition to non-caseating granulomas what is seen histologically with Crohn’s?

Answer 201

Thickening of the muscularis mucosae.

Question 202

What QT prolonging drug has the least risk of torsades de pointes?

Answer 202

Amiodarone (initially put verapamil but that has no effect on the OT interval).

Question 203

What does early antibiotic treatment of GAS pharyngitis lead to?

Answer 203

Decreased incidence of rheumatic fever (PSGN incidence is not affected).

Question 204

What does pre-T ALL present with?

Answer 204

An anterior mediastinal mass, which can compress surrounding structures (dyspnea, dysphagia, SVC syndrome, ect).

Question 205

What accounts for the dyspnea seen in left heart failure?

Answer 205

Decreased lung compliance (due to fluid accumulation in the lung interstitium).

Question 206

What is the major determinant of whether an atherosclerotic plaque will cause ischemic myocardial injury?

Answer 206

The rate of growth (slow growing plaques allow the formation of collateral circulation).

Question 207

What is the MOA of isoniazid resistance?

Answer 207

Decreased activity of bacterial catalase-peroxidase

Question 208

What artery does the AV nodal artery come off of?

Answer 208

Whatever is the dominant artery (RCA in right dominant, left circumflex in left dominant).

Question 209

What lab finding would be seen in perinatal HBV infection?

Answer 209

High viral load and HBeAg.

Question 210

What is the major adverse effect of gancyclovir?

Answer 210

Neutropenia (especially if combined with TMP-SMX or zidovudine).

Question 211

What is found at the 3’ end of tRNA?

Answer 211

A CCA sequence that is used as a recognition site for proteins and whose 3’ hydroxyl group serves as the amino acid binding site.

Question 212

In addition to increased methylmalonic acid, what lab findings are found with methylmalonic acidemia?

Answer 212

Increased propionic acid, hypoglycemia, increased ketones, and hyperammonemia.

Question 213

What should be done if a physician suspects child abuse?

Answer 213

Interview the child alone and do a physical. After that can Child Protective Services be contacted.

Question 214

What are the signs of neonatal abstinence syndrome (NAS)? (i.e. neonatal opioid withdrawal)

Answer 214

Hypertonia, diarrhea, sneezing, mydriasis, tachypnea, irritability, ect. Treatment is methadone.

Question 215

What is the treatment for TCA toxicity?

Answer 215

Sodium bicarbonate.

Question 216

The serum marker is elevated in parotitis? (enlarged, tender parotid gland, i.e. from preauricular area to angle of mandible).

Answer 216

Elevated amylase in the absence of pancreatitis is diagnostic of parotitis.

Question 217

What should be suspected in an intubated patient who develops preauricular swelling/pain that extends to the mandible?

Answer 217

Acute parotitis (usually due to S. aureus or anaerobes) (other risk factors include decreased salivary flow, such as xerostomia from anti-cholinergics, ect).

Question 218

What precautions are needed for C. difficile?

Answer 218

Non-sterile gloves and gown (contact precautions).

Question 219

If a meta-analysis comparing SBP between cocoa eaters and control groups found a difference of -2.2 with a 95% CI of [-2.7 to -1.3], what does that mean?

Answer 219

There was a statistically significant reduction in SBP. Remember, if the CI does not contain the null value (0 if comparing means and 1 for an odds ratio) then the results are statistically significant.

Question 220

What are the pressures in the right ventricle?

Answer 220

25/10.

Question 221

What are the pressures for the pulmonary artery?

Answer 221

25/12 (slightly higher diastolic compared to the right ventricle).

Question 222

Loss of the anal wink reflex and saddle anesthesia correspond to loss of what segments?

Answer 222

S2-S4 (commonly cauda equina syndrome).

Question 223

When does the blastocyst implant and begin hCG secretion (development of syncytiotrophic tissue)?

Answer 223

Days 6-7

Question 224

What is effect modification?

Answer 224

When the effect of an exposure on an outcome is modified by another variable.

Question 225

How can effect modification be identified?

Answer 225

Stratified analysis (analyzing the cohort as different subgroups, such as smokers and non-smokers, ect.).

Question 226

How can effect modification be differentiated from a confounding bias?

Answer 226

Stratified analysis will show that different strata will have different measures of association with effect modification (ex. smokers have a different outcome compared to non-smokers). Meanwhile, stratified analysis will show no significant association between the strata (ex. shoe size in children may initially seem associated with intelligence, but when stratified by age the association disappears).

Question 227

What serum findings can be found in primary hyperparathyroidism?

Answer 227

Hypercalcemia, hypophosphatemia, and hypercalciuria (despite increased resorption).

Question 228

How many calories per gram are carbohydrates and protein?

Answer 228

4 calories per gram.

Question 229

What would a laterally directed stab wound in the left 5th ICS at the midclavicular line damage?

Answer 229

The left lung (initially put the right ventricle but that would be the sternocostal border, i.e. more medial). If the stab wound was medially directed then the left ventricle would have been damaged (apex of the heart at the left 5th ICS in the midclavicular line).

Question 230

What trisomy can present with cleft lip/palate, cutis aplasia, and omphacele?

Answer 230

Trisomy 13 (Patau).

Question 231

What drug can cause congenital cutis aplasia?

Answer 231

Methimazole.

Question 232

If a patient has parotid hypertrophy, lanugo hair, low BMI, and amenorrhea, what is the most likely diagnosis?

Answer 232

Anorexia nervosa (specifically the binge eating type. Looks like bulimia but remember that bulimia has normal body weight, ect).

Question 233

What is the greatest risk of a cavernous hemangioma?

Answer 233

Intracerebral hemorrhage.

Question 234

What is a cavernous hemangioma?

Answer 234

A vascular malformation that most commonly occurs in the brain parenchyma. Have a risk of seizures and intracerebral hemorrhage.

Question 235

What would suggest mullerian agenesis?

Answer 235

A short vagina (absence of upper vagina) and a rudimentary uterus in a patient with normal secondary sex characteristics and primary amenorrhea.

Question 236

What cytokine is associated with giant cell arteritis?

Answer 236

IL-6

Question 237

What is tazobactam?

Answer 237

A beta-lactamase inhibitor

Question 238

What is the most modifiable risk factor for falls in the elderly?

Answer 238

Medications (an elderly patient with falls should have a medication review for high risk drugs such as anti-depressants, benzos, ect).

Question 239

Can malignancy present in a lung cavitary lesion?

Answer 239

Typically no. Hemoptysis and the presence of a mass from a prior TB cavity in a patient who has had to weight loss is much more likely to be an aspergilloma.

Question 240

What procedures can result in enteroccocus endocarditis? (remember that enterococcus is catalase negative, gamma hemolytic, and bile/salt tolerant).

Answer 240

Cystoscopy, colonoscopy, and obstetric procedures.

Question 241

Are beta-1 selective beta blockers (metoprolol) safe in COPD?

Answer 241

Yes (If a patient with stable COPD has an MI then metoprolol is safe for use).

Question 242

What should be considered in a patient with obstructive jaundice and weight loss?

Answer 242

Pancreatic adenocarcinoma (smoking is a major risk factor).

Question 243

What kind of bladder dysfunction can multiple sclerosis patients develop?

Answer 243

Spastic/hypertonic bladder (UMN lesion).

Question 244

What is the pathogenesis of gallstones in Crohn’s disease?

Answer 244

Increased bile acid wasting/decreased bile acid reabsorption

Question 245

What can occur in the setting of cervical spine trauma resulting in vertebral artery dissection?

Answer 245

Lateral medullary syndrome (PICA comes off the vertebral, the AICA comes off the basilar).

Question 246

How can lateral medullary syndrome be distinguished from lateral pons?

Answer 246

Both involve the vestibular nuclei (vertigo/nystagmus), spinothalamic and spinal V tracts, ipsilateral cerebellar signs, and ipsilateral horner’s. Facial droop/weakness is what localizes to the pons, while dysphagia and hoarseness (nucleus ambiguus) localizes to the medulla.

Question 247

What could be responsible for a significant increase in pol mutations in an HIV patient on HAART?

Answer 247

Anti-retroviral resistance (for pol specifically it indicates protease that is resistant to protease inhibitors).

Question 248

What are the signs of Dengue fever?

Answer 248

Flu-like febrile illness with myalgias and joint pain (bone break fever), maculopapular rash, and retro-orbital pain

Question 249

What are the signs of Dengue hemorrhagic fever?

Answer 249

Dengue fever plus thrombocytopenia (petechiae in addition to maculopapular rash) and spontaneous bleeding.

Question 250

What serological values would be seen in long-term steroid use?

Answer 250

Decreased CRH, ACTH, and cortisol. (not only are the adrenals atrophied but the corresponding pituitary and hypothalamic cells as well)

Question 251

What hormone are spider angiomatas associated with?

Answer 251

Estrogen (gynecomastia and spider angiomatas in cirrhosis share the same underlying pathophys)

Question 252

What is pure red cell aplasia?

Answer 252

A selective decrease in erythroid precursors (isolated anemia). Associated with thymomas (like myasthenia gravis).

Question 253

What is the appearance of the “ground glass” hepatocytes in chronic HBV infection?

Answer 253

Hepatocytes with finely granular, pale pink cytoplasm.

Question 254

What is the histopathological finding of Reye’s syndrome?

Answer 254

Microvesicular steatosis w/o inflammation.

Question 255

What drugs can provide rapid relief of rheumatoid arthritis?

Answer 255

NSAIDs and corticosteroids (DMARDs like sulfasalazine take weeks).

Question 256

What statistical test would be used to estimate the association between simvastatin use and high fibrinogen levels?

Answer 256

Chi-square test (assesses categorical/qualitative variables) (ANOVA and t-test are for comparing means, i,e, quantitative variables).

Question 257

Where will lipophilic drugs (like propofol) eventually accumulate?

Answer 257

In tissues with that are poorly vascularized (skeletal muscle, fat, bone).

Question 258

What is the intrapleural pressure at FRC?

Answer 258

-5 cm H2O

Question 259

What antibiotic can cause aplastic anemia?

Answer 259

Chloramphenicol

Question 260

What causes superior displacement of the medial portion of a fractured clavicle?

Answer 260

The sternocleidomastoid.

Question 261

What causes inferior displacement of the lateral portion of a fractured clavicle?

Answer 261

The pectoralis major and the weight of the arm.

Question 262

What cardiac hemodynamics are found in acute mitral regurgitation?

Answer 262

Decreased afterload, increased preload, and increased ejection fraction.

Question 263

What is seen with long term use of levodopa in Parkinson’s patients?

Answer 263

Periodic fluctuations in motor function (days of good motion and days of bradykinesia). In advanced PD occurs independently of drug dose and is unpredictable.

Question 264

What muscle groups are used when sitting up from a supine position?

Answer 264

The external obliques, the rectus abdominus, and the hip flexors (psoas major).

Question 265

What kind of heart dysfunction can result from viral myocarditis?

Answer 265

Dilated cardiomyopathy (suspect this in a young patient who develops heart failure following a viral prodrome).

Question 266

What determines the prognosis of colon cancer, the grade (# mitotic figures, tumor cell differentiation, ect) or the stage (tumor penetration into intestinal wall, ect)?

Answer 266

The stage is the biggest determinant of cancer prognosis, not grade.

Question 267

What does weight gain, constipation, hair loss, and dry skin in a patient with bipolar disorder suggest?

Answer 267

Lithium induced hypothyroidism.

Question 268

What kind of inguinal hernia does a patent processus vaginalis predispose to?

Answer 268

An indirect inguinal hernia.

Question 269

What is the histology of a granulosa cell tumor?

Answer 269

Cuboidal cells in sheets that form follicle/rosette like structures with a central pink/eosinophilic center.

Question 270

In a 3rd degree heart block, what cells act as the pacemaker?

Answer 270

The AV node (defect is in the His-Purkinje but the AV node is still acting as the pacemaker).

Question 271

What is the most likely identity of a hyperpigmented, raised bump under the breast that responds to the menstrual cycle?

Answer 271

An accessory nipple (failure of involution of the mammary ridge). Don’t confuse it for a congenital nevus.

Question 272

How many half lives corresponds to 75% elimination of a drug?

Answer 272

2 half lives.

Question 273

In addition to constrictive pericarditis, what else can cause a rapid y descent?

Answer 273

Restrictive cardiomyopathy (secondary to amyloid in the question).

Question 274

What is the goal of stimulus control therapy for insomnia?

Answer 274

To dissociate the bedroom from any stimulating activities or fear of not sleeping (ex leave the bedroom if can’t sleep after 20 minutes).

Question 275

If a question gives you the frequency of affected individuals of an autosomal recessive disease when asking for the chances of passing it on to a child, what is the next step?

Answer 275

Use the Hard-Weinberg equation to find the carrier frequency. Specifically use square root of disease frequency (q^2) to find mutant allele frequency (q) and then use that to find carrier frequency (2q).

Question 276

What is a man angry at his wife over a divorce lashing out at his daughter an example of?

Answer 276

Displacement.

Question 277

In addition to RAAS, what else is activated in CHF that contributes to the symptoms (edema, ect)?

Answer 277

Sympathetic nervous system (vasoconstriction to maintain blood pressure).

Question 278

What should new onset odontophagia (pain with swallowing) in a GERD patient raise suspicion of?

Answer 278

Erosive esophagitis with ulceration.

Question 279

What nerve can a mass/hematoma overlying the psoas damage?

Answer 279

The femoral (loss of sensation over the anterior thigh and weakness of the quadriceps).

Question 280

What has the highest oxygen content in the fetal circulation?

Answer 280

The umbilical vein (then enters the IVC via the ductus venosus). Blood leaves by the umbilical arteries (lowest oxygen content).

Question 281

What immunodeficiency predisposes to disseminated Candida infection (candidemia, endocarditis)?

Answer 281

Neutropenia is important for preventing disseminated Candida (CD4+ T cells are important for preventing cutaneous Candida infections).

Question 282

What is the most common cause of aminoglycoside resistance?

Answer 282

Antibiotic modifying enzymes (acetylation, ect).

Question 283

What is the MOA of foscarnet?

Answer 283

It directly inhibits herpesviridae DNA polymerase/RNA polymerase as well as HIV reverse transcriptase. Unlike the other anti herpesviridae drugs it does not requires intracellular phosphorylation.

Question 284

What two vitamins is breast milk typically deficient in?

Answer 284

Vitamin K (given parenterally at birth) and vitamin D (vitamin D supplementation should be considered in exclusively breastfed infants).

Question 285

What is the only non-glucose monosaccharide that bypasses PFK-1?

Answer 285

Fructose (hence why fructose-1-phosphate has the fastest rate of metabolism of the monosaccharides).

Question 286

What should empiric treatment of coagulase-negative Staph include?

Answer 286

Vancomycin, due to widespread methcillin resistance (assume resistance to penicillins and cephalosporins).

Question 287

What is the role of dystrophin?

Answer 287

It links the sarcolemma to the cytoskeleton.

Question 288

What type of receptor is the calcium sensing receptor (CaSR)?

Answer 288

G-protein coupled receptor.

Question 289

What is the most likely site of thrombus formation in atrial fibrillation?

Answer 289

The left atrial appendage.

Question 290

What is actinic elastosis/solar elastosis?

Answer 290

An accumulation of abnormal elastin in the dermis due to photoaging/sun exposure. Presents as erythematous, scaling, wrinkling patches and can causesbruising/ecchymoses. Don’t confuse with actinic keratosis.

Question 291

What part of the vertebra is the best place to access the neural canal

Answer 291

The lamina (portion between the transverse and horizontal processes.

Question 292

What is the venous drainage of the cecum?

Answer 292

The ileocolic vein to the superior mesenteric vein to the portal vein.

Question 293

What does increased alpha-fetoprotein in the amniotic fluid suggest?

Answer 293

Spina bifida (thought it was Down’s but that has deceased alpha-fetoprotein).

Question 294

What is the best way to test for C. diff diarrhea?

Answer 294

Test the stool for the C. diff toxin.

Question 295

What is responsible for the rash in scarlet fever?

Answer 295

Erythrogenic toxin.

Question 296

What kind of atelectasis can occur following radiation therapy?

Answer 296

Contraction atelectasis (radiation induced fibrotic changes).

Question 297

What muscle is responsible for flexion of the DIP?

Answer 297

The flexor digitorum profundus (the flexor digitorum superficialis does the PIP).

Question 298

If a patient is fired from his job after being prescribed benzodiazepines and his wife calls letting you know of this, what is the next best step?

Answer 298

Contact the patient (put the answer that you can’t accept the wife’s claims because of HIPAA but that is wrong).

Question 299

What receptor does dopamine activate at high doses?

Answer 299

Alpha-1 (vasoconstriction).

Question 300

What is the most likely diagnosis in a child with epistaxis/bruising following a viral illness who has normal coagulation studies, an isolated thrombocytopenia, and increased megakaryocytes on BM biopsy?

Answer 300

Idiopathic/Immune thrombocytopenia (ITP) (antibodies against GpIIb/IIIa).

Question 301

What vitamin D derivative accumulates during hypercalcemia induced feedback inhibition of 1-alpha hyfroxylase?

Answer 301

24,25-dihydroxycholecaliferol (25-hydroxycholecalciferol is shunted over to this in the absence of 1-alpha hydroxylase).

Question 302

Meiotic non-dysjunction is most likely to occur in what cell in spermatogenesis?

Answer 302

Primary spermatocyte (undergo meiosis I to become secondary spermatocytes).

Question 303

What is the best way to ensure compliance to a plan of behavioral modifications such as exercise and dietary changes?

Answer 303

Provide follow-up appointments to assess the patient’s progress in attaining their goals.

Question 304

What should a physician do if their patient confides they have sexual thoughts about them?

Answer 304

Have a chaperone join for the remainder of the examination.

Question 305

How do you calculate relative risk reduction (RRR)?

Answer 305

RRR = 1 - RR (Relative risk = incidence in experimental group/incidence in control)

Question 306

Aside from oxytocin, what contributes to uterine contractions in labor?

Answer 306

Release of prostaglandins from the decidua (initially put oxytocin from the fetus but the fetus doesn’t make oxytocin).

Question 307

How do you tell trigeminal neuralgia from TMJ dysfunction?

Answer 307

While both can cause sharp unilateral facial pain, TMD would have additional symptoms like clicking/locking of the jaw, jaw muscle spasms, and ear involvement. If it’s just shooting pain brought on by chewing or brushing teeth then it is more likely to be trigeminal neuralgia than TMD.

Question 308

What is the most likely diagnosis of unilateral breast enlargement in a male undergoing normal puberty with a family history of breast cancer?

Answer 308

Gynecomastia (a normal finding in puberty and not breast cancer).

Question 309

What is an inflamed (neutrophils on arthocentesis) unilateral knee in a 65 year old with a slight fever most likely?

Answer 309

It is most likely gout as opposed to N. gonorrhea.

Question 310

If a person last minute changes their mind about surgery before receiving anesthesia, what is the most appropriate response?

Answer 310

Ask them about their concerns and why they want to cancel the operation.

Question 311

If a physician who receives a call requesting emergency contraception but they don’t prescribe that out of moral reasons, what is the most appropriate response?

Answer 311

Tell them that you will have a colleague call back with them to discuss their concerns (put call the local Women’s health clinic put that was wrong).

Question 312

What would be expected in the urine of someone with calcium oxalate nephrolithiasis?

Answer 312

Low urinary citrate levels (citrate binds calcium in the urine and promotes excretion).

Question 313

What does a serum pH of 7.25, PaCO2 of 70, and HCO3- of 25 suggest?

Answer 313

Acute respiratory acidosis (such as heroin overdose, ect). This is due to the HCO3- being normal (25). If it was chronic respiratory acidosis (such as chronic bronchitis) then the HCO3- would be elevated due to renal compensation.

Question 314

What are cytoplasmic P bodies?

Answer 314

Distinct foci in eukaryotic cells that are involved in mRNA regulation and turnover. Have a fundamental role in translation repression and mRNA decay.

Question 315

What is important in the management of somatic symptom disorder?

Answer 315

Scheduling regular outpatient visits with the same provider.

Question 316

What would be the most appropriate therapy for a beta-lactamase producing Bacteroides infection?

Answer 316

Piperacillin-Tazobactam (broad coverage against a large number of gram positive, gram negative, and anaerobes [Bacteroides]).

Question 317

At what lung volume is pulmonary vascular resistance the lowest?

Answer 317

FRC

Question 318

When does myocardial contractility cease in ischemic insult?

Answer 318

Mycocardial contractility stops about about 60 seconds/1 minute into an ischemic event.

Question 319

If a patient is started on empiric antibiotics and then has their condition deteriorate several days after because the sputum results were not checked, how could this medical error have been prevented?

Answer 319

Use of standardized patient hand-offs (Had been transferred from the admitting physician by that point and thus the hand-off sheet was the source).

Question 320

What occurs in the respiratory mucosa in cystic fibrosis aside from decreased Cl- excretion?

Answer 320

Increased Na+ absorption (more negative trans-epithelial membrane potential test) (CFTR increases Cl- excretion and inhibits Na+ re-absorption so that more NaCl is in the lumen, resulting in increased hydration).

Question 321

What is the pathogenesis of diverticulitis?

Answer 321

Pulsion (increased intraluminal pressure during strained bowel movements).

Question 322

What is chlordiazepoxide?

Answer 322

A long-acting benzodiazepine.

Question 323

What are patients with a history of irregular menses at risk for in regards to pregnancy screening?

Answer 323

They are at risk for inaccurate pregnancy dating, which is important to know for screening tests such as alpha-fetoprotein (need to know the true gestational age to know whether alpha-FP levels are abnormal).

Question 324

Where is the primary site of ribosomal assembly?

Answer 324

The nucleoulus (round, dense basophilic body within the nucleus). Is the primary site of RNA polymerase I activity (rRNA).

Question 325

What would sudden onset jerking movements in both arms in a teenage with no other medical conditions most probably be?

Answer 325

Myoclonic seizures (generalized due to the involvement of both arms). Would be best treated with valproic acid.

Question 326

Do generalized myoclonic seizures have mental status changes or a post-ictal state?

Answer 326

No.

Question 327

What type of lymphoid (either B or T cell) proliferation is highly suggestive of malignancy?

Answer 327

Monoclonal

Question 328

Does a VSD necessarily have to present with eisenmenger syndrome in an 11 year old?

Answer 328

No, a small VSD could have no pulmonary involvement if caught early enough. A holosystolic murmur heard at the left sternal border that worsens with handgrip is a VSD (thought a VSD would have pulmonary involvement in an 11 year so I put HCM, but that would improve with handgrip).

Question 329

What is seen immediately following a myocardial infarction?

Answer 329

Normal myocardium (coagulative necrosis does not happen until after 4 hours).

Question 330

What comprises most of the right side of the cardiac silhouette on CXR?

Answer 330

The right atrium (with the SVC superior and IVC inferior).

Question 331

What nerve can be damaged during an appendectomy?

Answer 331

The iliohypogastric nerve (loss of sensation over the suprapubic area).

Question 332

What agents can be used for Neisseria meningitis prophylaxis?

Answer 332

Rifampin, ciprofloxacin, and ceftriaxone.

Question 333

What type of ion channel is the CFTR?

Answer 333

An ATP-gated chloride channel (even though it is modulated by cAMP it is not directly bound by cAMP).

Question 334

What is leukoclastic vasculitis?

Answer 334

A vasculitis the only affects the skin (palpable purpura) and typically arises due to drug or pathogen exposure (HBV/HCV, penicillins, cephalosporins, sulfonamides, phenytoin, allopurinol).

Question 335

What hormone causes upregulation of PMNT (epinephrine production) in the adrenal medulla?

Answer 335

Cortisol.

Question 336

What bias does matching (i.e. matching subjects based on having similar characteristics) protect against?

Answer 336

Confounding.

Question 337

What histopathological changes occur in idiopathic pulmonary fibrosis?

Answer 337

Loss of type I pneumocytes and hyperplasia of type II pneumocytes.

Question 338

If a self-proclaimed family member shows up to the ER asking about the status of an unconscious patient, what is the best response?

Answer 338

Inform them that the patient is stable (basic information) but that they will have to wait for the patient to give permission for details to be shared (confidentiality/HIPAA).

Question 339

What can happen in cystic fibrosis infants who are exclusively breast fed?

Answer 339

They may develop hyponatremia (vomiting, lethargy) due to excessive salt loss in the sweat.

Question 340

What is the gross appearance of a glioblastoma?

Answer 340

Poorly defined with areas of necrosis and hemorrhage.

Question 341

Where is the best place to do a femoral nerve block?

Answer 341

At the inguinal crease (lateral border of the femoral artery).

Question 342

What lab value should be measured for the assessment of metabolic alkalosis?

Answer 342

The urine chloride (low urine chloride represents saline responsive alkalosis like volume contraction, while high urine chloride represents saline unresponsive like aldosterone excess).

Question 343

What is acalculous cholecystitis?

Answer 343

Acute inflammation of the gallbladder in the absence of gallstones. Commonly occurs in critically ill patients (sepsis, burns, trauma, ect).

Question 344

In what portion of the nephron does ADH help to reabsorb urea to create the medullary concentration gradient?

Answer 344

The medullary portion of the collecting duct (is then secreted into the thin ascending limb of the loop of henle, resulting in urea recycling).

Question 345

What is the most appropriate initial phrase for starting an interview?

Answer 345

“What can you tell me about your pain?”. Ect. Always start with an open ended phrase that let’s the patient talk, no matter what circumstances may be present.

Question 346

What neonatal meningitis pathogen is resistant to 3rd generation cephalosporins (ceftriaxone and cefotaxime)?

Answer 346

Listeria monocytogenes (treat with ampicillin instead).

Question 347

What anti-retroviral can’t be given to those with HLA-B*57:01?

Answer 347

Abacavir (results in a severe hypersensitivity reaction).

Question 348

Can Klinefelter’s present with mild intellectual disability?

Answer 348

Yes. Always remember that intellectual disability can be a part of Klinefelter’s.

Question 349

What should be suspected in a patient who presents with fever, jaundice, and a recent history of surgery?

Answer 349

Anesthesia induced hepatotoxicity (halothane most likely). Severe disease can cause a shrunken liver on autopsy.

Question 350

What would show up first in liver failure, an elevated PT or hypoalbuminemia?

Answer 350

Elevated PT, since factor VII has a relatively short half-life while albumin has a long half life.

Question 351

In addition to reflex tachycardia, what else can arteriole specific vasodilators (hydralazine, minoxidil) result in?

Answer 351

Sympathetic RAAS activation (retained sodium and fluid).

Question 352

What cells can perform glycolysis to yield pyruvate and yet yield no ATP?

Answer 352

RBCs (sacrifice the ATP generated to produce 2,3-BPG ).

Question 353

What basal ganglia nuclei can be inhibited by deep brain stimulation in the treatment of medically intractable Parkinson’s?

Answer 353

The globus pallidus internus and subthalamic nucleus (both serve to inhibit the thalamus, thus inhibition results in disinhibition of the thalamus, resulting in improved movement).

Question 354

If the Pringle maneuver (pinching of the hepatoduodenal ligament) was performed but there was still bleeding from the liver, what vessel is most likely involved?

Answer 354

The IVC (or hepatic veins).

Question 355

What space does CN XI travel through in the neck?

Answer 355

The posterior triangle of the neck (injury here would result in trapezius dysfunction - shoulder droop and difficulty in arm abduction).

Question 356

What 2nd generation sulfonylurea has a shorter half-life and thus decreased risk of hypoglycemia?

Answer 356

Glipizide (conversely glyburide and glimepiride have longer half lives and an increased risk of hypoglycemia).

Question 357

How does HDV depend on HBV for replication?

Answer 357

HDV particles must be coated with HBsAg in order to be viable.

Question 358

What is seen histologically in VZV lesions?

Answer 358

Multi-nucleated cells with intranuclear inclusions.

Question 359

In addition to statins and blood pressure control, what additional medication should be given following a TIA (transient ischemic attack) secondary to an atherosclerotic artery?

Answer 359

Low dose aspirin (risk of upper GI bleed).

Question 360

What happens to pulmonary function due to normal aging?

Answer 360

Increased RV, decreased FVC, and an unchanged TLC.

Question 361

What kind of melanocytic nevus is common in adults?

Answer 361

Compound melanocytic nevus (junctional nevus is common in children).

Question 362

What is Cheyne-Stokes breathing?

Answer 362

A cyclic breathing pattern in which apnea is followed by gradually increasing then gradually decreasing tidal volumes until the next apnic period. Seen in CHF patients.

Question 363

What can a stab wound above the clavicle and in between the midclavicular line and lateral sternal line damage?

Answer 363

The apex of the lung.

Question 364

When does the aortic valve open?

Answer 364

When left ventricular pressure exceeds that of the aortic pressure (i.e. not at the point on a cardiac cycle graph when the LV pressure is just starting to rise).

Question 365

What is the role of Rifaximin in the treatment of hepatic encephalopathy?

Answer 365

Causes decreased intraluminal ammonia production (kills ammonia producing bacteria). Increasing conversion of ammonia to ammonium is the MOA of lactulose (fermented by GI bacteria into acidic by products).

Question 366

What are the most common agents of septic abortion (retained products of conception)?

Answer 366

Gram negative bacilli and Staph aureus.

Question 367

What is one of the ways O2 supplementation can lead to hypercapnia in COPD patients aside from decreased peripheral chemoreceptor stimulation?

Answer 367

O2 supplementation leads to pulmonary vasodilation (decreased PVR), which diverts blood flow away from well ventilated regions, leading to increased physiologic dead space (V/Q mistmatch).

Question 368

What is the deep inguinal canal an opening in?

Answer 368

The transversalis fascia

Question 369

What is the superficial inguinal canal an opening in?

Answer 369

The external oblique aponeurosis (an un-descended testis in the inguinal canal must be reduced through this).

Question 370

What is antral gastritis most likely?

Answer 370

H. pylori (can cause duodenal ulcers and iron deficiency anemia).

Question 371

What renal finding can be seen in the kidneys of someone with chronic hemolytic anemia?

Answer 371

Hemosiderosis (iron deposition due to hemoglobinuria).

Question 372

What amino acids can be converted into propionyl-CoA?

Answer 372

Valine, isoleucine, methionine, threonine.

Question 373

What occurs in the first few weeks following TB exposure?

Answer 373

Intracellular replication of the bacteria (cord factor inhibits phagolysosome fusion) (granuloma formation happens after a couple of weeks).

Question 374

What is necessary for the development of acute pyelonephritis?

Answer 374

Vesicoureteral reflux (either anatomic or functional i.e. due to repeated bouts of cystitis).

Question 375

What regenerates NAD+ in anaerobic glycolysis?

Answer 375

Lactate dehydrogenase (a LDH deficiency would shut down anaerobic glycolysis due to a depletion of NAD+).

Question 376

What would decrease regurgitant flow in mitral valve regurgitation?

Answer 376

Decreasing systemic vascular resistance/aortic pressure (diverts flow away from the LA into the aorta).

Question 377

What is the histology of a liposarcoma?

Answer 377

Lipoblasts with scalloped nuclei and multiple mitotic figures (compare this with lipoma which is mature fat cells with no scalloped nuclei and little mitotic figures).

Question 378

What point corresponds with S2 (closure of the AV valves) on Wigger’s diagram?

Answer 378

Where the dicrotic notch appears.

Question 379

A special stain on a kidney biopsy that shows staining in a region in between a glomerulus and a tubule is likely staining for what?

Answer 379

Renin (JG apparatus in between the DCT and the afferent arteriole of the glomerulus).

Question 380

What is a calcified mass on MRI that is in between the kidneys and just anterior to the IVC/Aorta in a patient with epigastric pain most likely?

Answer 380

A pancreatic pseudocyst

Question 381

What strand do the primers anneal to during PCR?

Answer 381

The 3’ strand (allows for 5’-3’ DNA synthesis).

Question 382

Why is heparin safe in pregnancy?

Answer 382

It is highly water soluble (does not cross the placenta).

Question 383

What is acitretin?

Answer 383

A retinoid (teratogenic) used in the treatment of psoriasis.

Question 384

What is an agglutination inhibition test?

Answer 384

When a serum/urine sample is added to a solution containing antibodies to the substance of interest. Latex particles coated with the substance are then added. If no agglutination occurs it’s a positive result (serum/urine substance bound the Ab), and if agglutination occurs it’s a negative result (Ab free to bind to latex).

Question 385

What is the sodium status in DKA?

Answer 385

Hyponatremic (hyperosmotic hyponatremia due to hyperglycemia).

Question 386

What structure do Kayser-Fleisher rings involve?

Answer 386

The cornea.

Question 387

How can a fibroadenoma be distinguished from fat necrosis? (i.e. just because trauma was in the question stem doesn’t mean it’s fat necrosis)

Answer 387

Fibroadenoma is round/regular while fat necrosis is irregular and may have overlying ecchymosis. Plus a fibroadenoma will respond to estrogen (change in size).

Question 388

How is CO2 incorporated into DNA?

Answer 388

Is combined with glutamine by carbamoyl phosphate synthase II in the cytoplasm.

Question 389

What kind of cerebral edema can a neoplasm cause?

Answer 389

Vasogenic edema (Imaging showing a brain mass = vasogenic edema).

Question 390

What triad of symptoms may be seen in disseminated N. gonorrheae infection?

Answer 390

Polyarthritis, vesiculopustular rash, and tenosynovitis.

Question 391

What type of necrosis is characteristic of CNS hypoxia?

Answer 391

Liquefactive necrosis.

Question 392

Age related changes to what can increase the risk of digoxin toxicity?

Answer 392

Renal clearance (decreases with age).

Question 393

What receptor causes uterine relaxation?

Answer 393

Beta-2

Question 394

What is the best approach to febrile seizure?

Answer 394

Supportive care only.

Question 395

Can IgA nephropathy be recurrent?

Answer 395

Yes (i.e. initial hematuria 3-4 days after a mucosal infection with recurrent episodes every couple of months).

Question 396

What vessel is most likely to show atherosclerotic changes?

Answer 396

The abdominal aorta.

Question 397

What is the first line treatment for pinworm/Enterobius?

Answer 397

Albendazole.

Question 398

What is the differential diagnosis for a blue neoplasm underneath a nail?

Answer 398

Either a subungal melanoma or a benign glomangioma ( neoplasm of glomus bodies which are responsible for skin thermoregulation).

Question 399

What cell type forms the fibrous cap of an atheroma?

Answer 399

Vascular smooth muscle cells.

Question 400

When during an action potential is the membrane most permeable to K+?

Answer 400

Repolarization (the down-shoot).

Question 401

What is the most common genotype of a complete hydatidiform mole?

Answer 401

46 XX (duplication of paternal X w/i an empty ovum).

Question 402

Where do most anal fissures occur?

Answer 402

In the posterior midline distal to the dentate line (decreased blood supply here).

Question 403

What ligament is thickened in neurogenic claudication?

Answer 403

The ligamentum flavum.

Question 404

What cephalosporins are effective against Pseudomonas?

Answer 404

Cefepime and ceftazidime.

Question 405

In addition to VEGF, what substance helps drive angiogenesis?

Answer 405

Fibroblast growth factor (FGF).

Question 406

When is the murmur of aortic stenosis loudest?

Answer 406

At the peak of left ventricular pressure (middle of the LV peak on Wigger’s diagram).

Question 407

What cholinergic toxicity (i.e organophosphate) sign can’t be reversed with atropine?

Answer 407

Muscle weakness (nicotinic mediated, not muscarinc).

Question 408

Why are viral RNA polymerases unstable (i.e. high mutation rate)?

Answer 408

They lack 3’-5’ exonuclease proofreading activity.

Question 409

What comprises a cholesteatoma (pearly mass behind the tympanic membrane)?

Answer 409

Squamous cell debris.

Question 410

What agent used in hypertensive emergency/crisis increases renal perfusion and natriuresis?

Answer 410

Fenoldopam (a D1 agonist).

Question 411

What does an AV fistula do to the PV loop?

Answer 411

Increases preload/EDV (more blood entering the venous system from the arteries) as well as decreased afterload.

Question 412

What drugs are given for Grave’s ophthalmopathy?

Answer 412

Glucocorticoids (decrease inflammatory infiltrate).

Question 413

What is the accumulation effect?

Answer 413

When the duration of exposure is necessary for a statistically relevant effect (ex people who took antioxidants for less than 5 years had no reduction in stroke incipience [p=0.4] while those who took it longer did [p=0.05]).

Question 414

What are central dopamine effects that can be seen in L-Dopa/carbidopa therapy?

Answer 414

Anxiety and agitation.

Question 415

Where does blunt aortic trauma commonly occur?

Answer 415

The aortic isthmus (attachment of the ligamentum arteriosum next to the left subclavian).

Question 416

What can be given to prevent post-operative hypocalcemia due to parathyroid removal/damage?

Answer 416

Oral calcium and vitamin D (calcitriol).

Question 417

What is a potential cause of direct/conjugated hyperbilirubinemia in a neonate with mild hepatomegaly?

Answer 417

Biliary atresia (extrahepatic obstruction).

Question 418

What is the role of menotropin and hCG in the treatment of anovulation infertility?

Answer 418

Menotropin (FSH analog) is given to develop the follicle. Subsequently hCG 9same alpha unit as LH) is given to simulate the LH surge (induce ovulation).

Question 419

What causes a dilated coronary sinus?

Answer 419

Increased right heart pressure (such as that seen in pulmonary hypertension).

Question 420

What is the sequence of genome replication for HBV?

Answer 420

dsDNA to (+) RNA to dsDNA progeny (reverse transcriptase).

Question 421

If a question asks why excretion or reabsorption does not increase with increased plasma concentrations past a certain point, what is the answer?

Answer 421

Carrier transport is saturated (can’t be “max excretion/reabsorption is reached” because filtration is not enzyme or protein mediated so it doesn’t have a maximal value).

Question 422

What is the main virulence factor for salmonella osteomyelitis?

Answer 422

Capsule leading to resistance to opsonization/phagocytosis.

Question 423

How can you tell if elevated ALP is due to biliary or bone causes?

Answer 423

Check the gamma-glutamyl transpeptidase levels (elevated if biliary and normal if bone).

Question 424

What kind of mitral regurgitation can occur in decompensated heart failure?

Answer 424

Secondary MR (enlarged LV stretches the mitral annulus causing a functional MR. Treating the heart failure should make the holosystolic murmur go away).

Question 425

What are the adverse side-effects of EPO/EPO-analogs?

Answer 425

Thromboembolic events and hypertension.

Question 426

What is post-prandial epigastric pain associated with weight loss/food aversion in the setting of generalized atherosclerosis suggestive of?

Answer 426

Chronic mesenteric ischemia.

Question 427

What is the role of sodium thiosulfate in cyanide poisoning?

Answer 427

Serves as a sulfur donor (used to metabolize cyanide).

Question 428

What is the underlying cause of an abdominal aortic aneurysm?

Answer 428

Chronic transmural inflammation.

Question 429

How does TNF-alpha induce insulin resistance?

same mechanism as catecholamines, glucagon, and cortisol

Answer 429

Phosphorylates serine residues on the insulin receptor and IRS-1.

Question 430

What eye condition can congenital CMV cause?

Answer 430

Chorioretinitis (like toxoplasmosis).

Question 431

What happens to RPF, GFR, and the FF in severe hypotension?

Answer 431

Both RPF and GFR drop, but RPF drops more the GFR, resulting in an increased FF.

Question 432

What lipid laden cells would be seen 1 week after a CNS infarct?

Answer 432

Microglia (phagocytose myelin)

Question 433

What can a child with a learning disability (difficulties in reading, writing, or math) present with?

Answer 433

Anxiety, inattention, and hyperactivity (embarrassed/being teased by peers. Don’t confuse this for ADHD).

Question 434

Is binge eating followed by fasting binge eating disorder or bulimia nervosa?

Answer 434

Bulimia (not just vomiting, is defined by binge eating followed by a compensatory behavior to prevent weight loss).

Question 435

What suppresses lactation/prolactin during pregnancy?

Answer 435

Progesterone (precipitous drop after delivery allows lactation to occur).

Question 436

Prophylaxis with what antibiotic prevents Mycobacterium avium complex (MAC) infection in AIDS patients?

Answer 436

Azithromycin.

Question 437

What is the most important determinant of prognosis in PSGN?

Answer 437

Age (adults have a worse prognosis).

Question 438

What vitamin can help improve maple syrup urine disease?

Answer 438

Thiamine.

Question 439

What is the treatment for multiple myeloma?

Answer 439

Bortezomib, a proteasome inhibitor that leads to apoptosis.

Question 440

How do non-dihydropyridine Ca2+ blockers (verapamil, diltiazem) affect nodal cells?

Answer 440

They slow the phase 4/spontaneous depolarization (L-type Ca2+ channels contribute to both phase 4 and the phase 0 up-shoot).

Question 441

A patient with signs of lung cancer and edema/congestion on one side of the upper extremities and face is indicative of what?

Answer 441

Brachiocephalic vein compression (unlike SVC compression which affects the entire face and upper extremities brachiocephalic vein compression results in unilateral venous congestion).

Question 442

Are CYP enzymes found in the gut wall?

Answer 442

Yes (would be inhibited by grapefruit juice, ect).

Question 443

What does bilateral wedge-shaped cerebral infarcts suggest?

Answer 443

Hypoxic-ischemic encephalopathy (the wedge shapes are the watershed zones b/t the ACA/MCA/PCA which are more affected by ischemia).

Question 444

Sickle cells sickle in the presence of what process?

Answer 444

Oxygen unloading (remember that HbS sickles in hypoxic, acidic environments, i.e. peripheral tissues where O2 unloading occurs).

Question 445

What is the most appropriate test for Down’s at 12 weeks gestation?

Answer 445

Chorionic villi sampling.

Question 446

What happens to respiratory rate, tidal volume, and airway resistance in the setting of rib fractures?

Answer 446

Increased RR, decreased TV, and no change in airway resistance.

Question 447

Where does the aminoacyl-tRNA enter the ribosome during elongation?

Answer 447

The A site (“A” for aminoacyl-tRNA)

Question 448

What happens to the cross-sectional area of the pulmonary microcirculation during exercise?

Answer 448

It increases due to extension and recruitment of microvessels.

Question 449

If a newborn has HIV antibodies, what can be inferred about the mother’s and the newborn’s HIV status?

Answer 449

The mother has HIV but the newborn’s status can’t be determined from AB alone (has HIV ab due to placental transfer of IgG).

Question 450

What does absent tactile fremitus, hyperresonance on percussion, and an absence of breath sounds at the left lung base imply?

Answer 450

A left pneumothorax.

Question 451

How do oral fluids help in cholera?

Answer 451

They stimulate the Na/glucose symporter (increased Na+ reabsorption limits Cl- secretion).

Question 452

What is the histology of a syphilis chancre?

Answer 452

Obliterative endarteritis with lymphocytes and plasma cells.

Question 453

What TCA cycle enzymes would be inhibited in a patient with Wernicke’s encephalopathy?

Answer 453

PDH, alpha-ketoglutarae dehydrogenase (require both NAD+ and thiamine, both of which are affected n chronic alcohol abuse.

Question 454

What does demyelination do to the length and time constants of a neuron?

Answer 454

Decreases the length constant and increases the time constant.

Question 455

What vitamins are seen in excess in small intestinal bacterial overgrowth?

Answer 455

Folate and vitamin K (remember that enteric bacteria produce these).

Question 456

Where is the AV node located?

Answer 456

In the interatrial septum near the opening of the coronary sinus and the septal leaflet of the tricuspid valve.

Question 457

What should an itchy erythematous rash over the breast raise suspicion of?

Answer 457

Inflammatory breast cancer (rash is peau d’orange from dermal lymphatic obstruction).

Question 458

What is responsible for the thrombocytopenia seen in ITP?

Answer 458

Immune destruction of platelets.

Question 459

What SERM can be used for osteoporosis while also decreasing the risk of breast cancer?

Answer 459

Raloxifene.

Question 460

What sympathetic receptors are on pancreatic beta cells?

Answer 460

Alpha-2 (decrease insulin release) and beta-2 (increase insulin release).

Question 461

What is viral phenotypic mixing?

Answer 461

When a virus co-infecting a cell receives capsid proteins from another virus but still retains the original genome (i.e. new particles can infect new cell type but the progeny can’t).

Question 462

A child with clubbing/cyanosis in the lower extremities but not the upper is suggestive of what?

Answer 462

A patent ductus arteriosus (PDA).

Question 463

What population is at risk for drug induced lupus?

Answer 463

Slow acetylators.

Question 464

What characterizes breast ductal carcinoma in situ?

Answer 464

Ducts distended by pleomorphic cells with prominent central necrosis. Often detected as microcalcifications on mammography with a normal breast exam.

Question 465

What is one presentation of acute HBV infection?

Answer 465

A serum sickness like reaction with arthralgias and a urticarial rash (in addition to elevated liver enzymes, ect).

Question 466

What characterizes acute contact dermatitis?

Answer 466

Spongiosis (edema in the epidermis).

Question 467

What can be protective against ovarian cancer?

Answer 467

OCP use (others include multiparity and breast feeding).

Question 468

What is pituitary apoplexy?

Answer 468

An intra-pituitary hemorrhage that occurs in the setting of a pre-existing adenoma (i.e. signs like headache and bitemporal hemianopsia will present before the hemorrhage). The acute bleeding will then result in a sudden, severe headache and signs of hypopituitarism.

Question 469

What are penicilins structuraly similar to?

Answer 469

D-alanine-D-alanine (vancomycin meanwhile binds to D-ala-D-ala).

Question 470

What structures does the facial nerve transmit parasympathetic fibers to?

Answer 470

The lacrimal glands as well as the submandibular and sublingual salivary glands.

Question 471

How can a lacunar stroke (hypertensive arteriolar sclerosis) be differentiated from a Charcot-Bouchard aneurysm?

Answer 471

While both are associated with hypertension and affect the same brain areas, a lacunar stroke will have an initially normal head CT (rules out intraparenchymal hemorrhage, i.e. Charcot-Bouchard aneurysm).

Question 472

What is the underlying mechanism behind acyclovir nephrotoxicity?

Answer 472

Crystallization within the tubules (can be prevented with adequate hydration).

Question 473

What is systemic mastocytosis?

Answer 473

Diffuse clonal expansion of mast cells due to a KIT tyrosine kinase mutation, resulting in widespread histamine release (hypotension, pruritis, urticaria/maculopapular rash, and increased gastric acid due to histamine’s effects on parietal cells).