PHYA507 Integration Week
β cells (pancreatic β cells in the islets of Langerhans produce insulin, which is low or absent in type 1 diabetes)
A 14-year-old girl is brought to the doctor by her mother because she has had increased urination and thirst. She also has been losing weight, despite an increased appetite. Her urine dipstick is positive for glucose. Which cells in her pancreas are most likely to have been destroyed?
inhaled corticosteroid therapy for persistent asthma (Inhaled corticosteroids cause a local immunosuppression that can lead to an overgrowth of normal oral flora like C albicans)
A 14-year-old patient presents with "white stuff all over" his mouth. You diagnose him with oral candidiasis. Which of the following most likely led to this infection?
leukocyte esterase and nitrites (Acute cystitis is caused by the retrograde transmission of bacteria, usually Escherichia coli, into the bladder. These bacteria release nitrites as a metabolite of anaerobic respiration. In addition, white blood cells involved in the inflammatory process will release leukocyte esterase as they lyse)
A 16-year-old girl with a medical history of childhood asthma presents with urinary discomfort of 1-week duration. The patient reports a burning sensation on urination as well as some discomfort in her lower abdomen. Patient has noticed her urine looks cloudy but reports no blood or odor. Patient reports she has recently become sexually active with her first boyfriend and used condoms during sexual activity. On physical examination, her temperature is 99.3F (37.4C), blood pressure 105/68 mm Hg, heart rate 66/min, and respiratory rate 14/min. There is mild discomfort with palpation of the suprapubic area. There is no costovertebral tenderness, and a pelvic exam is benign. Blood tests are within normal ranges, and a urine β human chorionic gonadotropin (βhCG) test result is negative. Which of the following will most likely be positive on urine dipstick analysis?
Neck
A 17-year old girl with no significant medical history presents to your clinic with a fever, sore throat, runny nose, and productive cough. She has a positive rapid strep test. On a physical exam, in which region of the body would lymphadenopathy likely be present?
Ovarian teratoma (anti-NMDA receptor encephalitis (ANRE))
A 20-year-old woman is brought to the emergency department by her roommate. The roommate says the patient has been acting bizarre lately, and she is afraid her friend might be taking psychedelic drugs. She also mentions that over the last few days, the patient had what she thought was the flu. The patient is admitted to the hospital, and a week later her blood pressure becomes unstable, she spikes a fever, and she becomes obtunded. Assuming this constellation of symptoms is all attributable to one underlying cancer, what malignancy would you be most concerned for?
Von Willebrand Disease (von Willebrand disease typically presents with easy bruisability or mucosal bleeding, such as the symptoms in this patient. It is the most common hereditary bleeding disorder)
A 23-year-old woman presents to clinic with excessive menstrual bleeding and easy bruising. Which of the following disorders is the most likely cause of her symptoms?
para-aortic
A 31-year old man presents for his annual wellness check-up. On physical exam, he is noted to have a nontender nodule on his right testicle. Further work-up reveals that the patient has testicular cancer. Which lymph nodes are most likely to be enlarged in this patient?
granuloma (pulmonary histoplasmosis from spores inhaled during her cave exploration trip. The rash on her legs is most likely erythema nodosum)
A 35-year-old woman presents to your clinic with a 3-week history of dry cough, shortness of breath, intermittent fever, weight loss, and severe fatigue. She has been HIV positive for 3 years but has not been adherent with highly active antiretroviral therapy (HAART). She began experiencing these symptoms after exploring caves with her sister in Kentucky. On physical exam, you note a painful tender rash on the anterior surface of her tibias bilaterally. What would you expect to see on an anteroposterior chest x-ray?
increased aldosterone (emesis and insufficient oral intake= volume depleted= increase activity of renin, which will increase the concentration of angiotensin II. This will lead to proton secretion in the nephron and an increase in serum HCO3-. We would expect this patient to be chloride depleted and in a state of chloride-sensitive metabolic alkalosis)
A 4-year-old boy presents with several episodes of nonbilious, nonbloody emesis over the last several days. His parents also report he has not been able to eat or drink because of the repeated episodes of vomiting. Which of the following changes to his serum would be most expected?
captain's wheel-shaped budding (paracoccidioides)
A 40-year-old African American patient with HIV presents with a 1-week history of dry cough and fever after a vacation in Brazil. Cultures point to a fungus causing his infection. What would you expect to see on a lung biopsy?
abdominal and pelvic computerized tomography without contrast (kidney stones. A noncontrast CT scan or abdominal-pelvic ultrasound are the best tests. US would not be able to detect radiolucent stones, such as urate stones. No CT scan with IV contrast because the similar radiodensities between the contrast and crystals/stone could obscure the findings, and it increases the risk for contrast-induced kidney injury (ATN))
A 43-year-old woman presents to a primary care physician with one day of back pain. It started abruptly in her right flank and radiates down to her pelvis. The patient reports the pain is continuous and only mildly relieved with ibuprofen. She has never had pain like this before. She has not had any blood in her urine, malodorous discharge, or difficulty with urination. Her temperature is 98.8F (37.1C), blood pressure 129/78 mm Hg, heart rate 104/min, and respiratory rate 20/min. There is right costovertebral angle tenderness to palpation without any overlying skin changes. The chest and abdominal exam are normal. Urine βhCG is negative. Which of the following imaging modalities will best aid in the diagnosis of this patient?
Cross-matching
A 45-year-old man develops recurrent rectal bleeding from a colonic diverticulum. His hematocrit drops, and he becomes tachycardic and dizzy. His physicians prepare for an urgent blood transfusion. Which of the following lab tests requires the use of actual donated red blood cells?
aorta
A 45-year-old woman is diagnosed with left-sided renal carcinoma that has invaded the renal artery. This artery is a direct branch from which artery?
Hypercalcemia (thiazides stimulate calcium reabsorption at the distal convoluted tubule. Hypocalcemia is associated with loop diuretics)
A 45-year-old woman is taking hydrochlorothiazide for worsening hypertension. She asks you if there are any adverse effects from taking this medication. Which of the following is most associated with thiazide diuretics?
sodium chloride and water (normal saline) (Her history of recurrent vomiting suggests a chloride-sensitive metabolic alkalosis due to loss of HCl in the vomitus. Saline will correct her by restoring her extracellular volume, removing the stimulus for proximal tubule bicarbonate reabsorption and therefore letting bicarbonate be excreted in the urine)
A 47-year-old woman has recurrent vomiting due to chemotherapy treatment for her lung cancer. On a routine follow-up with her physician, she is found to have the following ABG: pH 7.51, pCO2 42 mm Hg, HCO3- 32 mEq/L Which of the following is the best treatment for her acid-base abnormality?
parathyroid hormone
A 52-year-old woman presents to your clinic. She reports she has not been feeling well over the past 3 days. She says she has been feeling tired as well as having cramps and some spasms. The patient has received multiple blood transfusions over the past 2 weeks for a hematologic disorder, and the citrate preservative is known to complex calcium and cause a drop in the free (ionized) calcium level. You order laboratory tests and find that she has hypocalcemia after receiving large doses of furosemide for heart failure. Assuming this change is acute, which of the following levels would you expect to be most elevated in her blood?
Torsemide (Loop diuretics stimulate renal calcium excretion and also may cause a contraction alkalosis, accounting for the patient's lab findings loop = lose calcium)
A 53-year-old woman comes to the emergency department with leg cramps. She takes an unknown medication. Her physical exam is normal, and her labs show hypocalcemia and a mild metabolic alkalosis. Which of the following medications is the most likely cause of these abnormalities?
red blood cell casts with various and misshapen red blood cells (poststreptococcal glomerulonephritis (PSGN) after his diagnosis of strep throat. Nephritic syndrome= cola-colored urine, hypertension, edema, hematuria, and mild proteinuria. Because the bleeding originates from the glomerulus, red blood cells found in the urine will be dysmorphic and also take the form of the renal tubules)
A 6-year-old boy is brought into the emergency department by his parents because of dark-colored urine of several days' duration. The parents report his urine has been very dark, almost "cola-colored," for the last 48 hours. In addition, the patient has complained of swelling of his feet and around his eyes. Two weeks ago, the patient was diagnosed with strep throat and successfully treated with oral ampicillin. The patient has had no problem eating or drinking. On physical examination, his temperature is 99.9F (37.7C), blood pressure 141/82 mm Hg, heart rate 92/min, and respiratory rate 16/min. The patient has swollen eyes and mild ankle edema bilaterally. The rest of the exam is benign. Which of the following findings is most likely with microscopic examination of the patient's urine sample?
overproduction of a metabolic acid (lactic acidosis) (The patient has likely pneumonia with hypoxia and signs of sepsis with fever and hypotension. This leads to lactic acidosis, which lowers the bicarbonate, lowers the pH, and raises the serum anion gap (here it is 27 mEq/L), a measure of "unexpected" anions (acids) in the blood. The clinical history suggests lactic acidosis, not an ingestion like methanol or ethylene glycol)
A 60-year-old man comes to the emergency department with a productive cough, dizziness, and fever. His temperature is 39.5°C, pulse 110/min, respirations 28/min, and blood pressure 80/58 mm Hg. He has crackles and percussion dullness at the left lung base. His oxygen saturation is 85% on room air. His blood pH is 7.22. Serum studies show: Na 137 mEq/L, K 3.9 mEq/L, Cl 98 mEq/L, HCO3 12 mEq/L Which of the below statements best explains his reduced blood pH?
bone
A 60-year-old man comes to your family practice and asks about taking magnesium for his constipation. He is concerned about taking too much magnesium and wonders what will happen if he takes too much. You tell him that his body is very good at maintaining homeostasis. Which of the following is responsible for the largest reservoir of stored magnesium in the body?
compression of the prostatic urethra (benign prostatic hypertrophy)
A 65-year-old man goes to his primary care physician because of trouble initiating urination, a problem that has slowly progressed over the last 6 months. A digital rectal examination reveals a uniformly large, rubbery mass. This patient's urinary problems are likely due to which of these?
colonoscopy (New IDA with insidious onset, especially in an elderly man like this patient, is highly concerning for occult bleeding due to an underlying malignancy (such as colon cancer).)
A 67-year-old man presents with progressive fatigue, shortness of breath, and intermittent lightheadedness for the past 3 months. He also reports previously able to walk a mile without difficulty but is now "busy catching my breath" after walking 4 blocks. He denies abdominal pain, diarrhea, hematemesis, or melena. Exam is notable for conjunctival pallor. CBC reveals the following: white blood cell count 5500/mm3 (reference range, 4500-11,000/mm3), hemoglobin 8.7 g/dL (13.5-17.5 g/dL), hematocrit 27% (41%-53%), platelets 250,000/mm3 (150,000-450,000/mm3), and MCV 75 fL (80-100 fL). Iron studies show a ferritin of 10 ng/mL (15-200 ng/mL). Which of the following is the most appropriate next step in the management of this patient?
pudendal nerve
A 72-year-old woman experiences leakage of urine when coughing. Damage to which nerve is most likely the cause?
replace the magnesium first before replacing calcium (Magnesium induces PTH secretion. If there is not enough magnesium in the body, replacing only calcium will not correct the hypocalcemia effectively because the PTH is a key player in calcium homeostasis. We need to replace the magnesium and correct PTH levels prior to replenishing the patient with calcium)
A 75-year-old patient on your surgical service is post-op day 3 after an uncomplicated bowel resection for colon cancer. On morning rounds, you note that your patient's labs reveal hypocalcemia and hypomagnesemia. Which of the following is the best course of action to correct these electrolyte disturbances?
chronic blood loss (iron deficiency anemia)
A 75-year-old woman presents with increasing shortness of breath on exertion for past 6 months. She denies recent travel. Findings on physical exam are significant for conjunctival pallor and koilonychia. Chest X-ray shows no abnormalities of heart or lungs. Pertinent lab finds include hematocrit 28% (35%-44.5%), hemoglobin 9 g/dL (12-15.5 g/dL), and MCV 70 fL (80-100 fL). Which of the following is the most likely cause of these findings?
Hypercalcemia (paraneoplastic)
A 75-year-old woman with metastatic breast cancer presents to the emergency department complaining of headache, fatigue, constipation, depression, and forgetfulness. Which of the following abnormalities is most likely responsible for her symptoms?
lipophilic, transcription
A hormone X diffuses through the cell membrane and binds to a nuclear receptor. The hormone is _____________; the receptor induces _______________
lung cancer (hypertrophic osteoarthropathy (HO), which is associated with all types of lung cancer)
A man with a 45-pack-year smoking history presents to the emergency department with an acute exacerbation of chronic obstructive pulmonary disease (COPD). When gathering the patient's history, you learn that he has persistent joint pain in his knees and ankles. On physical exam, you note that he has digital clubbing and bilateral swelling of his knees and ankles. In addition to treating his COPD exacerbation, considering his history and physical exam, which of the following diseases should you be concerned for?
TRH (IP3 pathway--> Thyrotropin-releasing hormone (TRH), ADH at V1 receptor, angiotensin II)
A new drug is being developed that would block phospholipase C from cleaving PIP2 into IP3 and DAG. Which of the following hormones would be most affected by this drug?
Aldosterone
A patient with liver dysfunction has a problem producing transport proteins for hormones. Which of the following hormones would be most directly affected by a deficiency in transport proteins?
5-year cancer-specific survival
After diagnosing a patient with cancer, a doctor tells her that her prognosis is good. He says that 75% of patients with her diagnosis will not die as a result of their cancer within 5 years of diagnosis. Which of the following describes the parameter the doctor is using to establish the patient's prognosis?
oral iron plus vitamin C
An 11-year-old child is brought in by his mother because he has been less active and mostly sleeping during the day for the past 2-3 weeks. She has also noticed the child has been craving ice. On further questioning, the mother admits there was one instance where she saw the child pass a worm in his stools but did not bring him to a physician until today. CBC shows a hemoglobin of 8 g/dL (12-15.5 g/dL), MCV 73 fL (80-100 fL), and eosinophil percentage 15% (1%-4%). There is occult blood on microscopic examination of stool. In addition to treating the infection, which of the following is most appropriate for this child?
pH 7.30, pCO2, 25 mm Hg, and HCO3- 12 mEq/L
An 11-year-old girl presents to the emergency department with worsening lethargy and abdominal pain of several hours. The patient localizes pain to her abdomen but has difficulty responding to verbal commands. A couple of days ago, the patient's parents note she had a cough, runny nose, and severe nasal congestion. The parents also report that several other children at school have had similar symptoms. The patient has been increasingly thirsty the last couple of days despite drinking plenty of water and has been using the bathroom more often. On physical examination, her temperature is 97.9F (36.6C), heart rate 105/min, and blood pressure 100/73 mm Hg. The patient is lethargic, taking long, deep breathe; and exhibits diffuse, generalized abdominal pain and poor capillary refill time. She is found to have a blood sugar of 314 and normal renal function, and her urine is positive for glucose and ketones. Which of the following values would you expect on an ABG?
paracellular transport in the small intestine
An 80-year-old woman arrives at your primary care clinic with questions about taking magnesium supplements. She has been using magnesium to help with regular bowel movements and is interested to know how magnesium gets absorbed into the body. Which of the following is the main process by which ingested magnesium is absorbed by her gastrointestinal system?
magnesium is reabsorbed via paracellular diffusion in the thick ascending limb of the loop of Henle
An 85-year-old man with previous history of heart attack comes to the emergency room complaining of shortness of breath, cough, and leg swelling. You diagnose him with congestive heart failure and prepare to give him diuretics to help with the volume overload. You remember learning about magnesium handling in the kidneys and realize that some diuretics may interfere with the delicate magnesium homeostasis of the body. Which of the following is correct regarding the reabsorption of magnesium in the renal tubules?
Downregulation (patients become desensitized to leptin. hormone is in excess, and the body isn't responding, which explains downregulation)
An obese patient comes to your office describing their difficulty losing weight. You take blood samples and test hormone function to discover the patient is secreting large amounts of leptin, but their body isn't responding to it. Which of the following mechanisms best describes this situation?
PTH increases magnesium absorption in the thick ascending loop of Henle
As magnesium is extremely important to our health, the body has several mechanisms for maintaining magnesium levels. In the renal tubule, this translates to fine-tuning reabsorption of this ion from the urine. Which of the following is correct regarding renal regulation of magnesium reabsorption?
conversion of factor X to Xa
At what event in the coagulation cascade do both intrinsic and extrinsic pathways combine to form the common pathway?
Simple diffusion
By what method does oxygen enter into the blood from the lung alveoli?
pancreatic cancer
CA19-9 is a marker for which type of cancer?
fibroblasts
Cortisol decreases the activity of ____________, which means patients with high cortisol will have poor wound healing and decreased collagen synthesis, leading to the striae
proximal convoluted tubule (approximately 85% of phosphate reabsorption happens because of the presence of sodium-phosphate cotransporters)
During rounds, you review a patient's chart and see that she has a low phosphate level. You investigate the possible sources of phosphate loss. Which of the following is the site of the most phosphate reabsorption?
tissue factor kicks off the extrinsic arm of the cascade, but this arm is soon shut off, and fibrin formation is completed using the intrinsic arm
How does the cascade work in the body?
secondary messenger (Secondary messengers bind to and activate secondary effectors to result in cellular changes. Primary effectors respond to extracellular ions, and primary messengers are often extracellular compounds such as neurotransmitters and hormones)
In studying muscle contraction, researchers demonstrated that intracellular calcium binds to calmodulin, which in turn causes a number of cellular changes. In relation to calmodulin, calcium acts as which of the following?
target cells
In the blood, most cases of thalassemia show a microcytic, hypochromic anemia with ______________. More severe cases also show anisocytosis and nucleated RBCs.
Tissue factor (first step in forming fibrin in vivo is the appearance of tissue factor, which initiates coagulation along the extrinsic pathway)
In the body, when a blood vessel is damaged, which of the following substances initiates the coagulation cascade?
small intestine (contains fat and protein-rich macromolecules called chylomicrons, which imbue the lymph with a white, milky appearance)
Lymph is typically clear. However, lymph draining one structure of the body is typically milky white. Which region is this?
adhesion receptor
P-selectin is stored in Weibel-Palade bodies in endothelial cells. When they are released and translocated to the cell surface, they bind to a ligand expressed on the cell membranes of leukocytes, which mediates tethering and adhesion of these leukocytes. What type of receptor is P-selectin?
squamous cell carcinoma of lung
Parathyroid hormone-related protein (PTHrP) is most commonly produced by which of the following cancers?
B negative
Patients with which blood type may have both anti-A and anti-Rh antibodies?
Allergic transfusion reaction
Several minutes after starting a transfusion of packed red blood cells, a patient becomes hypotensive and short of breath and develops hives all over her body. Which of the following types of transfusion reaction is this patient likely experiencing?
Disseminated Intravascular Coagulation (DIC) (death is coming)
Something kicks off the coagulation cascade, causing rampant, widespread clot formation. Then, as platelets and coagulation factors are depleted, bleeding becomes a problem. -dangerous problem
malignancy (most common paraneoplastic syndromes)
The most common cause of symptomatic hypercalcemia is ___________
Osmotic pressure
There are two containers (A and B) separated by a membrane that is only permeable to water. Container A contains a 300 mOsm/kg solution, and container B contains a 100 mOsm/L solution. You design an experiment to measure the force it would require to prevent the water from flowing between the containers. In this experiment, what are you actually measuring?
MUDPILES: Methanol/Metformin, Uremia, Diabetic ketoacidosis, Paraldehyde/Propylene glycol, Isoniazid, Lactic acidosis, Ethylene glycol, Salicylates
What are the causes of a high anion gap metabolic acidosis? anion gap (in mEq/L) = [Na+] - ([Cl-] + [HCO3-])
cholesterol and ACTH (Cholesterol is the precursor of the cortisol molecule, and the hormone ACTH is the main signal for its synthesis by the adrenal gland)
What are the two major factors needed for glucocorticoid production by the adrenal glands?
glucocorticoid response elements (The complex binds the GRE DNA sequences inside the nucleus to initiate gene expression)
What does the cortisol-GR dimer complex bind to?
increased production and increased excretion (Acidosis stimulates PCT ammonium production and secretion. ammonia can enter the lumen and combine with the H+ load to produce ammonium, which can then be excreted in the urine. The ammonia is eventually used to bind a secreted proton and exit in the urine as ammonium)
What is the effect of acidosis on renal handling of ammonia/ammonium?
Iron overload (use iron chelating agents)
What is the main risk of chronic transfusion therapy to treat thalassemia major?
left renal vein (right testicular (or ovary) vein, drains directly into the inferior vena cava)
What is the site of immediate drainage of the left testicular vein?
deletion of three α chain genes
What kind of genetic defect is present in HbH disease?
autocrine signaling
What type of cell signaling pathway involves the production and secretion of a ligand that binds to the cell that produced it? Ex. An activated T lymphocyte secretes a growth factor that binds to its own receptors, promoting an immune response to a specific antigen.
paracrine signaling
What type of cell signaling pathway refers to the propagation of signals to nearby cells? Ex. release of inflammatory mediators (eg, histamine) from cells that act on nearby blood vessels. The mediators cause vasodilation to increase the delivery of immune cells to the region.
endocrine signaling
What type of cell signaling pathway refers to when molecules called hormones are released into the bloodstream to induce an action on another cell at a distant location in the body? Ex. LH (gonadotropin hormone) produced and secreted by the anterior pituitary that stimulates the ovary, resulting in ovulation
kidneys (Vit D goes to the liver and is hydroxylated to form calcifediol. This must be again hydroxylated in the kidneys to form calcitriol=active)
Where is the "active form" of vitamin D created?
anti-glutamic acid decarboxylase antibodies (and anti-islet cell antibodies)
Which autoantibody is likely involved in the destruction of pancreatic β cells?
VII, IX, X, II (primarily affects extrinsic pathway)
Which coagulation factors is vitamin K dependent and incomplete synthesis will result in impaired blood coagulation and uncontrolled bleeding?
red blood cell width distribution (RDW) (The RDW is a measure of anisocytosis (variation in red cell size); the higher the RDW, the greater the range of red cell sizes present. In severe thalassemia, the RDW is elevated because although all the red cells are small, some are just a little smaller, and others are tiny.)
Which of the following RBC indices is elevated in severe thalassemia?
decrease in H+ secretion, decrease in bicarbonate reabsorption (In vomiting, HCl is lost in the vomitus, inducing a systemic alkalosis. This suppresses renal bicarbonate reabsorption throughout the nephron and suppresses the renal secretion of protons in the collecting duct. Renal ammoniagenesis would drop too, since buffers are not needed to excrete excess body acid. Protons are not directly reabsorbed by the kidney, but they are secreted)
Which of the following best describes the kidney's response to vomiting in a patient with gastroenteritis?
deep and rapid breaths (Kussmaul respirations, which are the body's way of compensating for the metabolic acidosis)
Which of the following clinical findings is most likely to be present in a patient presenting with diabetic ketoacidosis?
coronary artery disease (macrovascular complications of type 2 diabetes may actually precede the development of hyperglycemia, so they can occur any time. microvascular takes 5-10 yrs)
Which of the following complications of type 2 diabetes would be most likely to occur in the first year of disease?
poorly differentiated cells with numerous mitotic spindles and pleomorphic nuclei (Grade refers to the histologic characteristics of the tumor. Poorly differentiated cells are high grade, and well-differentiated cells are low grade)
Which of the following descriptions most specifically corresponds to a high-grade cancer?
Hemophilia A
Which of the following disorders is much more common in men than in women?
increasing age
Which of the following factors is most likely to lower levels of serum creatinine?
obesity
Which of the following features best differentiates type 2 diabetes from type 1?
metastasis (most important prognostic factor in staging)
Which of the following features of cancer most likely confers the worst prognosis?
gluconeogenesis (and lipolysis and proteolysis. They increase blood pressure, gluconeogenesis, and glucose sparing. They inhibit bone formation, immune responses and inflammation, and fibroblast function (wound healing))
Which of the following is an important metabolic effect of glucocorticoids?
ammonium buffering requires renal proton secretion to excrete acid (The main buffers are titratable acid and ammonia, and both require a secreted proton to excrete acid. Ammonia is secreted in the PCT, not the loop, and exceeds titratable acid (phosphate) buffering. Net acid excretion is titratable acid plus ammonia—free urinary bicarbonate)
Which of the following is most correct about renal buffering?
increases in volume-expanded states like ascites (Bicarbonate reabsorption increases in volume-depleted states because it is linked to sodium reabsorption in the tubules, and sodium reabsorption increases during volume depletion. Bicarbonate reabsorption occurs throughout the nephron, but most is in the PCT, using carbonic anhydrase. It is increased during systemic acidosis and raises the serum pH)
Which of the following is not correct about renal bicarbonate reabsorption?
stress (Stress stimulates CRH production in the hypothalamus, causing it to release CRH, which stimulates ACTH release by the pituitary, which stimulates the adrenal gland to make cortisol)
Which of the following is the most important stimulant of CRH release?
psoas major (flexes the hip)
Which of the following muscles plays an important role in walking?
bladder (Pathway of sperm: SEVEN UP Seminiferous tubules, Epididymis, Vas deferens, Ejaculatory ducts, (Nothing), Urethra, Penis)
Which of the following organs is least involved in producing semen?
Acanthosis nigricans (another option= sign of Leser-Trélat)
Which of the following paraneoplastic syndromes is most strongly associated with gastric adenocarcinoma?
70 y.o. man with stage 4 lung cancer (The stage of the cancer is the most important prognostic factor. The type is also important. lung cancer carries the worst prognosis of all the options and stage 4 is the highest stage)
Which of the following patients carries the worst prognosis?
children younger than 19 years
Which of the following populations has the highest incidence of new type 1 diabetes mellitus?
reduction of Ca2+ in the smooth muscle of arteries leads to penile erection
Which of the following statements is most correct about ejaculation and orgasm?
transverse colon (main retroperitoneal structures- SAD PUCKER: suprarenal glands, aorta/IVC, duodenum (second and third segments), pancreas (all portions except the tail), ureters, colon (ascending and descending), kidneys, esophagus, rectum)
Which of the following structures is not located in the retroperitoneum?
bleeding into joints (Patients with coagulation factor deficiencies like hemophilia tend to have extensive, deep bleeding into joints and soft tissue)
Which of the following symptoms is most consistent with a coagulation factor deficiency?
Insulin (Insulin promotes weight gain and has hypoglycemic risks, so it should be used only after lifestyle modifications and 1-3 oral hypoglycemic drugs are tried)
Which of the following would be least recommended for the initial management of type 2 diabetes?
C-peptide levels (It's a part of the secreted insulin molecule, and because patients with type 1 diabetes uniformly have little or no insulin, the levels will be low)
Which of the following would be most decreased in patients with type 1 diabetes compared with those with type 2?
serum ferritin (low)
Which parameter on the iron panel is most reliable for determining iron deficiency?
random blood glucose test showing a value of >200 mg/dL
Which test results would best confirm a diagnosis of type 2 diabetes in a symptomatic patient?
Allergic
Which type of transfusion reaction is most common?
Hypotonic
You determine that a patient is severely dehydrated. You open a drawer and pull out four different bags of fluid: distilled water, hypertonic saline, hypotonic saline, and isotonic saline. What intravenous saline bag would most likely cause water to flow into her cells?
hydrophilic (Peptide-Insulin, glucagon, prolactin and catecholamine)
__________ hormones can move freely in the interstitial space and the blood and there must be a receptor on the cell membrane that allows them to bind and signal downstream effects to exert an effect on the cell.
hydrophobic (steroid-Cortisol, estrogen, testosterone and thyroid amine)
__________ hormones need specific transport proteins to move about in the blood and extracellular fluids of the body. They can freely diffuse through their target cell membrane into the cell. There they bind to an intracellular target receptor in the nucleus, not requiring a second messenger to achieve their intracellular effect. -transport protein = longer half-life of hormone
Cortisol
___________ increases insulin resistance by decreasing translocation of GLUT4 transporters, thereby decreasing peripheral glucose use. This can cause a person to develop insulin-resistant diabetes
Thalassemias
_____________ are a group of inherited genetic blood disorders in which the body cannot make enough of the globin chains that form the backbone of the hemoglobin molecule. (most adult hemoglobin molecules contain two α chains and two β chains. Fetal hemoglobin= two α chains and two γ chains)
paraneoplastic syndrome
groups of signs and symptoms that happen in patients with cancer but are not directly related to the growth of the tumor itself Ex. peripheral neuropathy or delusions or kidney stones
Immune Thrombocytopenic Purpura (ITP)
patients make antibodies against their platelets for some unknown reason, marking them for destruction in the spleen. Eventually, the platelet count drops so low that patients begin to get symptoms, such as purpura or easy bruising.