QLOG STEP 1

MI - switch to anaerobic glycolysis (occurs in seconds, metabolites produces) + ↓ in ATP = *loss of contractility within 60 seconds* of total MI. < 30 min is reversible, > 30 is irreversible.

Animal experiment - artery ligated at time 0 and changes in ATP levels were recorded. At what time point would the affected portion of myocardium stop contracting?

Decreased first pass/ decreased delivery to liver

Administering drug rectally will cause what change in bioavailability?

*Adenosine and dipyridamole* are selective vasodilators of coronary vessels that can cause *coronary steal*, a phenomenon in which blood flow in ischemic areas is reduced due to arteriolar vasodilation in nonischemic areas. Coronary steal leads to hypoperfusion and worsening ischemia.

Administration of certain medictions can cause redistribution of blood flow away from ischemic areas, *exacerbating existing myocardial ischemia*. A drug that causes these effects would be associated with what type of phenomenon?

Anaphylaxis Selective IgA deficiency

Adverse effect of blood transfusion in patient with... recurrent sinopulmonary infections, autoimmune disorder, and GI infection?

Anticholinergic (antimuscarininc) effects, blurring vision

Adverse effect of first-generation antihistamines (chlorpheniramine, diphenhydramine)?

Disulfuram-like reaction (blocked Acetyladehyde dehydrogenase) Metronidazole

Adverse effect of medication for treating Trichomonas vaginitis?

Osmotic demyelination > Central Pontine Myelinolysis

Adverse effect of rapid correction of chronic hyponatremia?

↑neutrophil (demarginate, recruitment less effective). ↓LMBE (rest of cells)

Affects on corticosteroids on WBC (neutrophil, lymphocyte, monocyte, basophil, eosinophil)?

CN IX Carotid Sinus Hypersensitivity

Afferent limb causing lightheadness while buttoning colar?

Rabies. Bats main source

Animal source that is causing agitation/dysphagia/ spasms that lead to coma?

*******************Hepatit D virus

Another name for the hepatitis D virus, which is dep on Hep B for infectivity?

NT defects, anencephaly

Anti-eleptic therapy (valproate, carbamazepine, phenytoin) tertatogenic effects?

Na channel blockers, 1C > 1A > 1B.

Antiarrythmic drugs binding strength?

Aminoglycosides (gentamicin) Prevents 16S binding

Antibiotic-modifying enzymes that *add chemical groups to drugs* are most effective against which class ?

Nucleoside reverse transcriptase inhibitors (MC: nevirapine, efavirnz)

Antiretroviral Therapy that doesn't require activation via intracellular phosphorylation?

Binds type 1 interferon reeptors on infected cells to transcribe enzymes that halt protein synthesis

Antiviral actions of 𝜶 and 𝝱 interferon?

*Acute Interstitial Pancreatitis* progressing to necrotizing (hemorrhagic) pancreatitis

Appearance of chalky white lesions in the mesentery with fat cell destruction & Ca2+ deposition indicates what disease process?

Microvascular statosis w/o inflammation, cerebral edema

Appearance of liver in patient w Reye syndrome to salicylate acid?

1. AV node (0.05), 2. Ventricular muscle (0.3) 3. Atrial muscle (1.1) 4. Purkinje system (2.2)

Arrange Ventricular muscle, Atrial muscle, AV node, and Purkinje system in order of increasing conduction speed (time/sec).

Chronic respiratory alkalosis with renal compensation***

Arterial blood gas volumes after 2 days at high altitude?

****Hyperventilation > ↓PaCo2 (29) > ↑pH > HCO3 stabilizes pH in 48hr (7.46). O2 (57)

Arterial blood gases (pH, pCO2, pO2) changes in high-altitude?

Left Cicumflex artery

Artery affected by pathology in leads I and aVL (lateral heart)?

Contralateral Subclavian Atery Stenosis

Artery occlusion causing vertebral artery retrograde (caudal) flow?

Celiac artery

Artery proximal to the common hepatic artery?

Communicates choice, Understands Info, Appreciates Consequences, Rationalizes decision

Assessment of decision-making capacity?

Roseola infantum caused by *HHV-6*. Usually starts on the trunk. MC cause of febrile seizures.

Age < 2 years with 3-5 days of high fever, generalized seizure, followed by blanching maculopapular rash. Pathogen?

Celecoxib

Agent that deceases inflammation, but has no effect on COX-1, minimizing gastroduodenal toxicity?

Hexokinase shunts to Fructose-6-P

Alternative pathway for fructose metabolism in patients with essential fructosuria?

Cholinesterase inhibitors (Doneprezil), antioxidants (Vit A) and NMDA receptor antagonists (memantine)

Alzhemiers Dementia-specific therapies?

***Exclusive Ketogenic AA (lysine and Leucine) > precursor for acetyl-CoA

Amino Acid in patient w *pyruvate dehydrogenase deficiency* that will not cause a build up of lactic acid?

CCA tail on 3'-OH is the amino acid binding site

Amino acid binding site on tRNA?

Arginine

Amino acid precursor to nitric oxide?

Peptostreptococcus, Bacteroides, Prevotella, Fusobacterium

Anaerobic bacteria often involved in aspiration pneumonia?

*Cyproheptadine* - histamine antagonist w nonspeciifc 5-HT1 and 5-HT2 receptor antagonistic properties. Also supportive care (airway maintenacne, hydration, and temperture maintenance).

Anecdote for Serotonin Syndrome?

VEGF Fibroblast Growth Factor

Angiogensis is predominantly driven by which 2 substances?

HBV-induced hepatocellular carcinoma

Associated cause of increased liver mass with an increased alpha fetoprotein?

Nondihydropyridine CCB (Diltiazem & Verapamil)

Atrial fibrillation medication responsible for constipation, new-onset 2nd degree AV block, & syncope?

Acute myeloid leukemia

Auer rods are associated with what disease process?

*Citrullinated peptides*

Autoantibodies against which component is most specific for a pt w RA?

Oligodendrocytes and CNS myelin

Autoimmune response w T cells/Ab target what structre in MS?

Malignant cause (prostate, breast, kidney, thryoid, lung)

Back pain that occurs at night, not relieved by analgesics in an elederly pt indicates what?

GERD due to gastroesophageal unction incompetence

Basal zone hyperplasia, elongation of the lamina propia papilla, scatter neutrophils w nocturnal cough w/o heartburn?

A2-opening snap time interval (Short,worse)

Best ausculatory indicator of degree of mitral stenosis?

Acknowledging its difficult to take medication daily for silent illness

Best initial approach for building a therapeutic alliance with patient?

Clarify the patient's mediation hx to determine drug hx

Best next step for pain mgmt in drug-seeking behaior?

Pyridoxine (Vit B6) Homocystinuria

Best treatment for *cystathionine synthase deficiency*?

Dopamine agonists (Pramipexole)

Best treatment for restless leg syndrome?

Observer bias, blind the study

Bias that occurs when investigator's evaluation is affected by preconceived expectations or prior knowledge; how to reduce?

Intimal thickening, Tubular atrophy, Interstitial fibrosis

Biopsy findings of *chronic renal allograft rejection*?

Mesangial deposition of of IgA in IgA nephropathy (Berger disease)

Biopsy for recurrent , self-limited painless hematura within 5 days after URI?

*RNA polymerase I*: transcribes 45S pre-rRNA gene, codes for *ribosomal RNA components* (18S, 5.8S, and 28S rRNAs). Nucleolus is site of ribosomal subunit maturation and assembly.

Biopsy of large nuclei with prominent, round, basophilic bodies. What *enzyme only functions in the basophilic region of the nucleus*?

Mixed inflammatory infiltrate with macrophages/multinucucleated giant cells Subacute granulomatous thyroiditis

Biopsy of painful thyroid enlargement after viral illness?

Duodenal (↑levels of giladin) for Celiac disease

Biopsy to dx autoantibodies (IgA) to tissue transglutaminase?

Activated CD8+ cytotoxic T lymphocytes

Blood smear in pt w infectious mononucleosis?

Posterior Descending Artery (85-90% RCA)

Blood supply and origin of artery that supplies inferior surface of heart?

Proximal: Renal Artery vs. Distal: Superior vesical Artery

Blood supply to the proximal ureter vs. distal ureter?

Residual Ribosomal RNA

Bluish cytoplasm in immature RBCs?

Conductive vs. Sensorineaural hearing loss

Bone C > Air C, W lateralizes to affected VS. Air C > Bone C, W lateralizes to unaffected ear?

Bone pain, subperiosteal erosions affecting phalanges of hands, 'salt/pepper' skull, brown tumor bone cysts

Bone appearance in Osteitis fibrosa cystica due to primary hyperparathyroidism?

Prostate Cancer

Bony pain in an olderman w osteoblastic lesion is suspicious for what?

Ectoderm -surface ectoderm -neural tube -neural crest

Brain derivative for structure causes bitemporal hemianopsia, and amenorrhea?

Angular gyrus of dominant parietal lobe

Brain injury causing agraphia, acalculia, finger agnosia, L/R disorient?

Jugular foramen

Brain location of lesion causing dysphagia, hoarseness, and ipsilateral loss of gag reflex?

Cortical spinal tracts. Description of UMN lesion, "clasp-knife" spasticity.

Brain structure is responsible for initial resistance followed by sudden release of tension?

Heat production essential for neonates

Brown Adipose Tissue Function?

Peroxisomal disorders (Zellweger Syndrome)

Buildup of... very long chain and branched-chain FA due to *impaired oxidation* is hallmark of what disease ?

Fidaxomicin

C diff treatment that inhibits RNA polymerase?

*Hereditary Angioedema*

C1 Esterase Inhibitor Deficiency?

Pneumocystitis jiroveci pneumonia

CD4 count <200 indicates antimicrobial prophylaxis of TMP/SMX for what pathogen?

↓ FEV1/FVC, ↑ TLC

COPD PFTs?

*It is formed by the union of the common iliac veins*. IVC-L renal vein on top. Below R renal A - Aorta - L renal A

CT axial image at level of pancreas/full kidney. Structure that is anterior to the right renal artery is described as?

Cortical bridging veins causing Subdural Hematoma

CT shows crescent-shaped mass. Which vessels are injured?

Efferent vasoconstriction > ↑FF; ↓↓RPF ? ↓GFR

Cahnges in RPF, GFR, and FF in the presence of hypovolemia?

FF = GFR/RPF. RPF = RBF*(1-Hct); FF =.1*.5=.2

Calculation for filtration fraction if given RBF (1), GFR (0.1), Hct (0.5)?

Maintenance (mg/min) = Cp(ss) X Clearance/ [Bioavailability fraction]

Calculation for maintenance dose?

Femoral Triangle (lateral - medial). Nerve, Artery, Vein, deep inguinal nodes/lymphatic vessels. Cannulation: 1 cm below inguinal ligament, medial to fem artery pulsation.

Cannulation site within femoral vein in realtion to the femoral triangle?

Arrrangement in which a payor pays a fixed, predetermined fee to provide all services required by a patient.

Capitation defintion?

Carrier-Mediated: dependent on a protein carrier (potential for saturation)

Carrier-Mediated definition?

Vertebral sublaxation, RA in mobile cervical spine

Cause for areflexic, flaccid paralysis in RA patient *after endotracheal intubation*?

Vitamin B12 deficiency

Cause for degeneration of ascending (dorsal columns/Gait issues), descending (corticospinal tract)/UMN signs, and axonal degernation of peripheral nerves (numb/peresthesias)?

↑endolymph volume (inner ear) Meniere disease

Cause for episodic tinnitus, vertigo, and sensorineural hearing loss?

Chornic kidney disease

Cause for hyperphosphatemia and ↓1,25 Vit D, eventually causing secondar hyperparathyroidism?

Renal anomly (Oligohydraminos)

Cause for infant with pulmonary hypoplasia, flattened face, and limb abnormalities (Potter Sequence)?

Patent processus vaginalis

Cause for painless scrotal swell that transilluminates (communicating hydrocele)?

Halogenated inhaled anesthetics (halo/en/iso/sevo/desflurane), which are metabolized by cytochrome P450 enzyme

Cause for patient presenting w acute hepatits days after medication exposure?

IgE-independent mast cell degranulation

Cause for pt given IV morphine sulfate, 15 min later, diffuse itching in arms, legs, back?

Sternocleidomastoid muscle

Cause for superior displacement of medial clavicle fragement during injury?

Gastrinoma causing Zollinger-Ellison Syndrome

Cause for symptoms of peptic ulcers, heartburn, and diarrhea?

Diabetes insipidous

Cause of *hyperosmotic volume contraction* (↑Osm, ↓ICF, ↓ECF)?

Malposition in utero/trauma Cong torticollis

Cause of 3 wk old child with head titled to side?

Cervical sympathetic ganglia (autonomic)/brachial plexus in pancoast tumor

Cause of Horner's syndrome (ipsilateral partial ptosis, miosis, anhydrosis) with unilateral arm pain?

Carecholamine-secreting tumor > Episodic ha, tachycardia, htn, diaphoresis

Cause of Pheochromocytoma?

↑Bradykinin, ↑vascular permeabolity

Cause of angioedema in the presence of an ACE ihibitor?

Weakness of transversalis fascia

Cause of direct inguinal hernia?

Macrophage-activated formation of 1,25 dihydroxyvitamin D (PTH-independent)

Cause of elevated calcium in sarcoidosis patient?

Mitral stenosis

Cause of enlarged LA causing hoarseness via recurrent laryngeal n.?

Pheochromocytoma in MEN 2B

Cause of episodic headache along with... medullary thyroid cancer, mucosal neuromas marfanoid habitus?

Candida vaginitis grows post-antibiotic use, *↓gram+ bacteria in the vagina*

Cause of erythematous vulva & thick white discharge that adheres to vaginal wall?

Cytomegalovirus

Cause of esophageal hyperemia and linear ulcerations in HIV patient with previous *Pneumocystis jirovecii* infection?

Atrophy of fibrous replacement

Cause of esophogeal dismotility in CREST (Calcinosis, Raynaud, Esoph dysmotile, sclerodactyll, and telanglectasia)?

Hypertension

Cause of flame-shaped hemorrhage on fundoscopic exam?

↑androstenedione production > ↓free testosterone/estrogen ratio

Cause of gynecomastia, testicular atrophy, decreased body hair, and spider angiomata in setting of liver cirrhosis?

Gi bleed causing increased nitrogen delivery to the gut

Cause of increased inhibitory neurotransmission and impaired excitatory release in hepatic encephalopathy?

High O2 > Poorly ventilated lung areas have higher O2 levels. > revereses pulm vasoconstriction > ↑physiologic dead space + ↓alveolar ventilation.

Cause of lethargic & confusion after COPD pt recieves high-flow O2?

Folic acid (↓↓thymidine bases) or B12 def in alcoholic

Cause of macrocytic anemia in presence of chronic pancreatitis and hepatomegaly?

Lipid A from E. coli

Cause of macrophage activation leading to release of IL-1, TNF𝜶 leading to gram-negative sepsis?

Cryptococus Neoformans

Cause of meningoencephalitis in untreated AID dx w polysaccharide capsule in CSF?

*Lipid-filled intimal plaque*. Intermitten claudication, due to atherosclerosis

Cause of muscle cramps in right thigh that subside quickly with rest w med Hx of MI?

Weakened junction > *vescourteral reflux*

Cause of patient being more susceptible to pylelonephritis after having multiple UTIs?

Cancer cells obstructing lymphatic drainage

Cause of peau d-orange rash in inflammatory breast cancer?

Releative Erythrocytosis

Cause of polycythemia if RBC mass is normal and there is plasma volume contraction?

Damage to parathyroid glands > ↓PTH

Cause of post-thyroidectomy muscle cramps and twitching?

Large change in alveolar or intrapleural pressure > break in visceral pleura (*ruptured superficial bled*)

Cause of primary spontaneous pneumothorax?

Heme oxygenase (converts heme → biliverdin)

Cause of the green pigment that develops in bruises several days after injury?

↓CNS destrusor cont > atonic/dilated bladder

Cause of urinary incontenence in Multiple Sclerosis?

Protein C or S deficiency

Cause of warfarin-induced skin necrosis?

Chronic Arteriovenous shunt

Cause of ↑sympathetic stimulation, ↓TPR, ↑venous return leading to ↑CO?

Bradykinin, C1NH blocks kallikrein-induced conversion of kininogen to bradykinin

Cause og angioedema in C1 inhibitor deficiency patient?

Nocardia asteroides

Cavitary pneumonia w branching gram+ organisms seen on sputum examination in immunocompromised patient?

Structual changes in PBPs that prevent ceftriaxone from binding

Ceftriaxone Antibiotic resistance?

TdT+, CD10+, CD19+

Cell expression of lymphoblasts in precursor B-ALL?

I: humoral immune response (inhibits viral entry into cells), L: strong cell-mediated immune response in addition to humoral

Cell response by inactivated viral vaccins vs. live-attenuated viral vaccines?

Simple cuboidal epithelial cells Ovary

Cell type for the structure that, if endometriosis develops upon, will cause infertility?

Erythrocytes

Cell type that lacks mitochondria and is unable to use ketones for energy?

Microglia

Cell type that moves to area of brain ischemic infarct 3-5 days after ischemia obset?

Smooth Muscle Cells of JG apparatus

Cell type that will undergo hyperplasia in setting of renal hypo-perfusion?

T cells (IL-2) Macrophages (IL-2/TNF-alpha)

Cells responsible for *↑IL-2 and IL-1/TNF𝜶* during toxic shock syndrome?

Proteinases released from neutrophils and macrophages

Cells responsible for destruction in smoking-induced centriacinar emphysema?

Neutrophils and macrophages

Cells responsible for the proteaes in alveolar fluid?

𝛼1 vasoconstrict skin/viscera, 𝝱1 heart ↑cAMP in cardiac m., 𝜶2 ↓cAMP in GI > ↓insulin/motility.

Cellular changes in direct response to norepinephrine?

Small Cell Carcinoma composed of round or oval cells with scant cytoplasm and large hyperchromatic nuclei.

Centrally located tumor associated w smoking. Positive for neuroendocrine markers (neuron-specific enolase, *chromogranin*, synaptophysin). Histo & Dx?

Penicillin binding proteins (eg transpeptidases), different species generate different PBPs

Cephalosporins MOA?

2/3 chance

Chance of individual being a carrier if sibling is affected with AR condition?

There is an *additional factor affecting the duration of the condition*, a factor that prolongs disease duration (improved quality of care) will increase disease prevalence, as affected patients survive longer.

Change in prevalence in a steady-state population with a constant incidence rate indicates what?

1. parallel *shift to the right* in a log-dose response curve, illustrating ↑ED50. 2. *no change in the maximum efect (Emax)*. Competitive = change ED50 = shift right. Noncompetitive = Emax will shift down.

Changes in the log dose-response curved for a reversible competitive antagonist.

Demyelinating > ↓length, ↑time. Velocity = length/time.

Changes in velocity in presence of MS?

↑intraepithelial lymphocytes Celiac Disease

Characteristics of associated disease to bilateral/symmetric extensor surface erythematous *pruritic papules*, vesicles and bullae?

High MW, High plasma protein binding, high charge, hydrophillicity

Characteristics of drug that trap it within the plasma compartment?

Portosystemic collateral veins within the *lower end of the esophagus, anterior abdomen and lower cecum*. Dilation of theses collateral vessels is responsible for the esophageal varices, caput madusae, and anorectal varices commonly seen in patients w cirrhosis.

Cirrhosis w portal HTN arises from increased resistance to portal flow in the hepatic sinusoids. Results in increased pressure in which veins?

Lidocaine

Class IB antiarrhythmic drug that binds inactivated Na channels and rapidly dissociates → suppressing ventricular tachyarrhythmias?

Block K+ channels, inhibit outward potassium currents during phase 3 of cardio AP

Class III antiarrhythmic (amiodarone, sotalol, dofetilide) MOA?

Handwashing w soap, gown, nonsterile gloves changed after contact

Clostridium difficile infection prevention?

Tender Loving Care For Nancy: Thiamine, Lipoate, Coenzyme A, DFD, NAD

Coenzymes required in the Branched-chain 𝜶-ketoacid dehydrogenase complex (deficient in Maple Syrup Urine Disease)?

Concentration: Reciting months of the year backwards; Comprehension: Following multistep command

Cognitive testing, differentiate concentration from comprehension.

Gly-X-Y > 𝜶-chain > 3 for triple helix

Collagen Structure?

Cholesteatomas

Collections of squamous cell debris behind tympanic membrane that can cause hearing loss?

*Midbrain*: upper portion contains neural structure (optic n, pretechtal n, Ewnucleus, oculomotor) direct to get direct & consensual light reflex.

Comatose w fixed & dilated pupils. No direct or consensual pupillary response to light. Which areas of the brain responsible for pupillary findings?

Injury to parathyroid glands during thyroid surgery

Common cause of primary hypoparathyroidism and hypocalcemia?

Psoriatic arthritis, nail pitting, uveitis

Common complications of psoriasis?

Pancreas injury (head or body)

Common source of traumatic retroperitoneal bleeding?

Cytokeratin (cytoskeleton of epithelial cells)

Commonly used marker for epithelial-derived tumors?

R < L; Pulmonary vasculature resistance < systemic resistance

Compare R vs. L heart pressures and pulmonary vascular resistance vs. systemic vascular resistance?

Two antigens share no epitopes

Compare epitope similarities if there is no change in radioactivity w increasing antigens?

******Both have hyperbolic oxygen-dossociation curve (pO2(p50) = 1), Hgb = sigmoid curve (pO2(p50) = 26)

Comparison of % saturation in ... monomeric Hgb subunits vs myoglobin vs Hgb?

↑ lymphatic drainage

Compensatory mechanism in chronic heart failure that prevents edema?

Triggers sympathetic activation > RAAS > *Na/Fluid retention*

Compensatory side effects of arteriolar vasodilators?

Down Syndrome

Complete AV canal defect (atrial and ventricular septal defects and common AV valve) is associated w what disease state?

Renal osteodystrophy (2nd hyperparathyroidism due to hyperphosphatemia and hypocalcemia)

Complication in patients w chronic kidne disease?

Coronary artery aneurysms in Kawasaki disease

Complication of ≥5 day fever, bilateral conjunctivitis, cervical LAD, and mucocitis 'strawberry tongue'?

Reapsorption (& ↓urinary) bicarbonate, glucose, and aa

Components reabsorped in Proximal Tube Fluid?

Hemosiderin

Composition of yellow/brown Kupffer cell granules after multiple transfusions?

****Cholestatic (primary biilary cirrhosis)

Conditions that can cause xanthelasma in associated w 1/2 hyperlipidemia?

Ab bind to Treponema pallidum

Confirmatory test for diffuse rash & LAD seen in Syphillus?

Mutation that impairs binding of repressor protein

Constituitive expression of structual genes of lac operon indicates what?

*Delayed-type hypersensitivity reactions*

Contact dermatitis, granulomatous inflammation, TB skin test, and Candida extract skin reactions are all examples of what?

IVC

Continuous bleeding site after Pringle maneuver comes from what structure?

Patent Ductus Arteriosus

Continuous murmur along with *inspiratory splitting of S2 indicates*?

extracelllar Ca2+ influx through L-type channels

Contraction of cardiac and smooth muscle cells is dependent on what?

1/2/3 SDs

Correlation between 68/95/99 and SDs?

Allergic bronchopulmonary aspergillosis due to *Aspergillus fumigatus*. High serum IgE levels along with eosinophilia, hypersensitivity in asthmatics and cystic fibrosis.

Corticosteroid-dependent asthmatic with eosinophilia and bronchiectasis. What is the likely pathogen?

Interferon-𝛾, IL-12, and TNF-𝜶

Critical cytokines for the formation and maintenance of granulomas?

Lung cancer

Current cancer that has leading cause of mortality?

*Ecchymosis*. Petechia ( <5mm) & Purpura (5mm - 1 cm) - cutan or subcutan extravasted blood due to cap fragility, areas of increased venous pressure.

Cutaneous or subcutaneous collection of extravasated blood ≥ 1 cm. Deep hemorrhage (hematoma). Do not blanch under pressure. Classification?

Cheyne-stroke in congestive heart failure

Cyclic breathing in which apnea is following by gradually increasing/decreasing tidal volumes disease assoc?

Symp > 1yr, assess severity, persistence, and degree of social/academic impairment

Cyclothymic disorder def?

Pilocystic Astrocytoma

Cystic tumor in cerebellum of child is most likely?

Meitoni Nondis (95%), Unbalanced translocations (2-3%), Mosaicism, nondis during mitosis (<2%)

Cytogenic abnormalities that can lead to Down Syndrome?

IL-10

Cytokine that *reduces pro-inflammatory* Th1 cytokines (IL-2, INF𝛾)?

*IL-6*, Correlates w severity

Cytokine that drives cell-mediated immunity in giant cell arteritis with polymyalgia rheumatica (↑ESR)?

TNF-𝜶

Cytokine that mediates paraneoplastic cachexia?

*Bcl-2 over-expression* Follicular Lymphoma t(14;18)

Cytology of *lymphoproliferative disorder* with packed follicles and obscured normal lymph node architecture?

F26-B activates phosphofructokinase-1 (increasing glycolysis) and inhibits fructose 1,6-bisphosphatase (decreasing gluconeogenesis). *F26-B is increased by phosphofructokinase- 2 in response to insulin* and decreased by fructose 26 bisphosphatase in response to glucagon.

DM Tx that alters glucose metabolism within liver by *increasing concentration of fructose 2,6-bisphosphonate within hepatocytes*. What conversion will be inhibited by high intracellular concentrations of this metabolite?

DNA Polymerase I

DNA Polymerase removes short fragments in lagging strand in prokaryotic replication?

Primase

DNA-depedent RNA polymerase that incorporates short RNA primers into replicating DNA?

pt > designated health care proxy > next of kin. If married, this is spouse.

DNR: Chain of Command?

Common presentation in SCD in young children, considered vasoocclusive manifestation of SCD. Sickling episodes > hemoylsis > increased indirect bilirubin and lactate dehydrogenase, *decreased levels of haptoglobin*

Dactylitis (painful swelling of hands and feet) in young AA boy. What is most likely to be abnormal in patient?

Visual info of the left geniculate nucleus

Damage to left temporal hemiretina disrupts which structure?

Subthalamic nucleus, reduces inhibition of thalamus

Damage to what brain structure can result in contralateral hemiballism?

Finding in CF, pneumonia, bronchiectasis, and cor pulmonarle

Death associated w distal small bowel obstructure due to abnormally dehydrated meconium (green inspissated mass)?

renal hypoxia > Increased erythropoietin synthesis and compensatory erythrocytosis

Decreased P50 at which 50% hemoglobin is saturated will result in what physiologic response?

Pyridoxine's active form is cofactor for *𝝳-aminoevulinate synthase*

Decreased production of which enzyme in the setting of isonizaid therapy can lead to sideroblastic anemia?

Stapes. Treacher-Collins Syndrome

Defect in 1st/2nd pharyngeal arches. Structure affected?

Damaged cell membrane

Defect in reperfusion injury that allows creatinine kinase leakage?

*Nucleotide excision repair* defect

Defect in xeroderma pigmentation?

Autoimmune due to *extrinsic pathway apoptosis*

Defective Fas gene production could lead to what type of disease process?

Ornithine transcarbamylase > MC disorder of urea cycle

Defective enzyme ... hyperammonemia & elevated urinary otic acid w urea cycle defects?

Defect in Adenosine deaminase > ↑adenosine toxic to lymphocytes > SCID

Defective gene causing infant chronic diarrhea and failure to thrive, ↓ T lymphocyte count & ↓↓ serum IgG level?

Mutations that affect transciption, processing, and tranlation of 𝝱-globin mRNA

Deficiency in 𝝱-thalassemia?

↑NADH, ↓thiamine, no gluconeogenesis via CAC (Pyruvate ⇢Acetyle CoA)

Deficiency of what in setting of alcohol binge cause hypoglycemia?

Antithrombin III

Deficiency of what is responsible for the thrombotic and thromboembolic complications of nephrotic syndrome?

Folic Acid deficiency → Megaloblastic Anemia

Deficiency that causes hypersegmented neutrophil nuclei in alcoholics?

Arginase (Arginine → Urea and Ornithine) Absence of Hyperammonemia

Deficient enzyme causing ... *g*rowth delay and *a*bnormal movements *s*pastic diplegia in 3 yo?

Ketone bodies (acetoacetate) due to Primary Carnitine Deficiency

Deficits in pt w myopathy, cardiomyopathy, and hypokinetic hypoglycemia w ↓muscle carnitine content?

*PPV* = TP/(TP + FP) *NPV* = TN/(TN +FN) The sensitivity and specificity of a diagnostic test are not affected by disease prevalence.

Define PPV & NPV.

Sensitivity (rule out, SNOUT) vs. Specificity (rule in SPIN)

Define and distinguish between TP/(TP +FN) vs. TN (TN+FP)?

Recombinaton

Define mechanism involved in exchange of genes between chromosomes, *progeny have genomes from both parents*?

probability of rejecting a null hypothesis when it is truly false (set at 80%)

Define power (1-𝝱)?

Total # of cases (old & new) at *particular point in time*

Define prevalence.

Case: w Disease, Controls: w/o disease. Exposure frequency to variables is not part of selection

Define the case and control in a case-control study.

Drug-induced liver injury Halothane

Diagnosis for... recent surgery in Mexico, ↑serum aminotransferase levels, prolonged prothrombin time, liver inflammation/shrinking?

von Willibrand disease

Diagnosis for... Prolonged bleeding time Prolonged partial thomboplastin time?

Tuberous sclerosis

Diagnosis for... cardiac rhabdomyomas, facial angiofibromas, leaf-shaped patches of skin lacking pigement, and renal angiomyolipoma?

Schizo*typal* personality disorder

Diagnosis for... eccentric behaviors, odd beliefs, perceptual distortion, and social anxiety despite familiarity.

Mesothelioma

Diagnosis for... hemorrhage pleural effusion, pleural thickening, and *histology of numerous, long slender microvilli and abundant tonofilaments*?

von Williebrand disease

Diagnosis for... normal platelets, lifelong history of mucosal bleeding, and prolonged bleeding time?

Reaction Formation (Immature) vs. Suppression (Mature)

Diagnosis of... responding in manner opposite to actual feels vs. putting unwanted feelings aside to cope with reality?

*↓Erythrocyte transketolase activity* Thiamine (B1) deficiency Wernicke encephalopathy

Diagnostic lab value for alocholic with hemorrhage and necrosis in mammilary bodies?

Saline microscopy (wet mount) Trichomonas vaginalis

Diagnostic test for *yellow-green frothy vaginal discharge and dysuria*?

Heterophile Antibody (IgM) Test

Diagnostic test for EBV?

Primary (chancre, Treponema pallidum infection site, 3-6 wks). Secondary (palm/soles rash, conduloma lata, 5-10 wks). Late (gummas, ascending aortic aneurysms, aortic valve insufficiency). Neurosyphyllus can develop at any stage.

Diastolic murmur and calcifications of ascending aorta. Positive VDRL test. How to describe the patient's vulvar lesion?

BCAA (leucine, isoleucine, valine). Maple Syrup Urine Disease

Diet restriction for days old infant w irritability, dystonia, poor feeing, burnt sugar urine?

Candida albicans have pseudohyphae "germ tube"

Difference between Candida albicans & Cryptococcus neoforms?

MEN1: AD, parathyroid adenomas w hyperparathyroidism, anterior pituitary gland tumors, and pancreatic endocrine tumors (3 P's). MEN2B: meduallary carinoma of thryroid, pheochromocytoma, marfanoid habitus, and oral and intestinal mucosal neuromas.

Difference between MEN1 and MEN2B?

First: a constant fraction (or proportion) of drug is metabolized per unit of time, so the amount metabolised *changes based on the serum concentration*. Zero: a constant amount of drug is metabolized per unit of time, *independent of serum levels.*

Difference between first and zero order kinetics.

Low ( extend <1/3 ) and High (extend beyond) epithelium

Difference between low & high grade squamous cervical intraepithelial lesions?

Proto-oncogenes - stimulate cell proliferation, activating mutation increases neoplastic growth (*KRAS*). Anti-oncogenes - tumor suppressors that inhibit cellular proliferation. Inactivation loss-of-function contibutes to tumor development (APC, BRCA1, RB, TP53).

Differentiate and name examples of proto-oncogenes and anti-oncogens.

*Amiodarone*Class III antiarrhythmic drug

Drug that prolongs QT interval w ↓ chance of tosade de pointes compared to others?

Gemfibrozil

Drug that reduces cholesterol solubility and promotes gallstone formation by reducing bile synthesis?

Thioamides (methimazole); Propylthiouracil also ↓peripheral conversion

Drug that ↓thyroid hormones via *inhibition of thyroid peroxidase*, (iodine organification of coupling of iodotyrosines)?

Methadone

Drug to tx opioid opuse, potent, longacting opioid agonist?

5-HT3 (GI); Antihistamine (vestibular); Dopamine (migraine)

Drug type for tx of visceral nausea due to GI insults vs. vestibular nausea vs. migraine nausea?

Long-term use of 𝝱-blockers (cervedilol, metoprolol)

Drug used after stabilization to *improve survival in decompensated systolic heart failure*?

Sodium bicarbonate

Drug used for tricyclic antidepressant overdose?

Spironolactone, an aldosterone antagonist. Eplerenone is a more selective aldosterone antagonist with fewer side effects .

Drug used in heart failure that has anti-androgenergic effects and can cause gynecomastia, decreased libido, and impotence?

Acyclovir

Drug w antiviral activity agaisnt HSV 1, HSV 2, and VZV; considered a guanisine analog ( impairs viral DNA)?

AntiHTN meds (ACEi or ARBs), No Angiotensin I metabolism

Drugs during pregnancy that cause fetal anuria, oligohydraminos, pulmonary hypoplasia, limb contractures and calvarium defects?

Thiazides

Drugs that block Na-Cl symporters in DCT > enhanced Na, Cl, H2O excretion, and can cause Hypercalcemia?

Digoxin Toxicity

Drugs that causes arrhythmias, N/V, confusion/weakness, visual disturbances & ↑K due to inhibition of Na-K-ATPase pumps?

Chlorpheniramine (causes sedation)

Drugs that shouldn't be administered in patient taking diazepam?

Alpha1-blockers (Doxazosin, Prazosin, and Terazosin)

Drugs used to treat both benign prostatic hyperplasia and HTN?

Cephalosporins (cefepime and ceftazidime)

Drugs w good anti-pseudomonal coverage in burn patients?

Adenomyosis: endometrial glandular tissue in myometrium.

Dx 42 yo, G4P4. Heavy menstrual bleeding, dysmenorrhea. Uniformly enlarged uterus?

Henoch-Schonlein purpura. MC vasculitis that follows URI.

Dx child w abdominal pain, arthralgias, palpable purpura, hematuria & URI last wk?

Idiopathic Intracranial HTN (pseudotumor cerebri). Compression impairs axoplasmic flow > papilledema

Dx daily HA, transient visual disturbance, BMI 32.4. Reason for PE of bilateral symmetric papilledema?

↑LVEDP (Normal LVEDV & LVEF)

Dx findings (LVEDP, LVEDV, LVEF) in *isolated diastolic heart failure*?

Dandy-Walker malformation

Dx for hypoplasia/absence of cerebellar vermis, cystic dilation of 4th ventricle, and skull/posterior fossa enlargement?

Neuroblastoma

Dx for opsoclonus-myoclonus syndrome, abdominal mass, ↑catecholamine metabolites (neural crest cells of adrenal medulla)?

*Avoidant* personability disorder

Dx for social inhibition, feelings of inadequacy, fear of embarrassment and rejection?

Optic tract lesion

Dx for *contralateral homonymous hemianopia* & ↓pupils constrict in swinging light test?

Pheochromocytoma

Dx for *excess cortisol* > phenylethanolamine-N-methyltransferase > increased norepinerphrine to epinephrine conversion in adrenal medulla?

*Hepatic Encephalopathy*: hyperammonemia in liver failure, cirrhotic liver can't metabolize nitrogenous waste products. Ammonia crosses the BBB, ecess glutamine to accumulate within astrocytes. ↓glutamate in neurons → disruption of excitatory neurotransmission.

Dx for 54 yo, hx of cirrhosis second to Hep C. Agitated, confused, bright red blood vomit. Recent GI bleed causing corresponding increase in nitrogen absorption by the gut. PE: abd distension, ↓liver span, testicular atrophy. Jerky, irregular flexion-extention tremor seen with wrist extension?

Aplastic Anemia due to apoptosis of pluripotent stem cells.

Dx for 7 yo w pancytopenia + bone marrow hypocellularity?

Biliary atresia. Obstruct extrahepatic bile duct > conjugated hyperbilirubinemia

Dx for <2 mo old w jaundice, dark urine (renal excretion of bilirubin), alcoholic/pale stools?

Cushing Syndrome

Dx for ACTH-secreting pituitary adenoma > hyperplasia of zona fasciculata (&reticularis) of cortex?

Poststreptococcal Glomerulonephritis Pathophys

Dx for Immune complexes (IgG, IgM, C3) form electron dense deposits on GBM (subepithelial humps)?

Gullian Barre Syndrome

Dx for URI viral illness > molecular mimicy > demyelination + endoneural inflammatory infiltrate and ↓ reflexes?

Crohn disease, transmural inflammation

Dx for abdominal pain w diarrhea, low-grade fevers, and fatigue, with symptoms that worsen during periods of stress?

Calcium Pyrophosphate deposition disease - rhomboid-shaped *calcium pyrophosphate crystals*

Dx for acute articular arthritis (MC in knee), ↑WBC (neutrophils), pseudogout?

Turner Syndrome

Dx for aortic coarctation, LE claudication, BP discrepency between UE & LE?

Reactive arthritis

Dx for assymetric oligoarthritis due to depostiion of immune complex that follows infection?

Pemphigus vulgaris (painful flaccid bullae)

Dx for autoimmune bullous disease w autoantibodies against desmoglein?

Acute Decompensated Heart Failure due to LV dysfunction

Dx for cephalization (vessels more prominent due to pulmonary venous hypertension), perihilar alveolar edema, and blunting of costophrenic angles?

von Hippel-Lindau disease

Dx for cerebellar hemangioblastoma w congenital cysts of kidneys, liver, and/or pancrease?

Inflammatory Bowel Disease

Dx for chronic inflammation > ^proinflam cytokine (IL-1, IL-6, TNFalpha) > liver release acute-phase reactants (CRP, fibrinogen) > ↑erythrocyte sedimentation rate?

Cholecystitis

Dx for colicky pain and absent gallbladder on US?

Diastolic heart failure

Dx for decreased ventricular compliance with normal LV EF, normal LV EDV, and elevated LV filling pressure?

Acute transplant rejection (weeks). Cell-mediated process.

Dx for dense mononuclear lymphocytic infiltrate w *myocyte damage post-heart transplant*?

Schizophrenia

Dx for disorganized speech, grossly disorganized behaviors, and functional decline?

Poststreptococcal Glomerulonephritis

Dx for granular depostis of IgG, IgM, and C3 along with subepithelial humps?

Transitional cell carcinoma of bladder

Dx for gross hematuria in elderly man w hx of smoking/occupational exposure to rubber, plastics, etc.?

G6PD (G6P → 6PG) deficiency

Dx for hemolytic anemia during ↑ oxidative stress?

Hereditary Spherocytosis

Dx for hemolytic anemia, jaundice, splenomegaly, and ↑Mean corpuscular Hgb concentration?

Pulmonary *Anthrax* (inhaled spors in goat hair)

Dx for hemorrhagic mediastinitis (widened mediastinum) > medusa head/serpentine > Capsule w D-glutamate?

Sarcoidosis

Dx for hiilar adenopathy, pulmonary disease, and non-caseating granulomas?

Esophageal squamous cell carcinoma

Dx for histo of solid nests of neoplastic squamous cells w abundant eosinophillic cytoplasma, keratinization, and intercellular bridges?

Hydrocephalus ex-vacuo

Dx for hydrocephalus post-cortical atrophy in AIDS dementia patient?

Trisomy 18/Edwards Syndrome

Dx for hypertonia (clenched hangs), rocker bottom feet, and cardia/Gi/renal defecits?

Abnormal migration of ventral pancreatic bud. Annular Pancreas.

Dx for infant w clear emesis that becomes bilious w panc tissue constricting duodenum?

Severe combined immunodeficiency virus

Dx for infant w recurrent bacterial, viral, fungal, and opportunistic infections and chronic diarrhea?

Severe Combined Immune Deficiency

Dx for infant with... severe bacterial/viral infections, mucocutaneous candidiasis, diarrhea. Absent CD3+ T cells, hypogammaglobulinemia, thymic hypoplasia?

Sertoli-Leydig cell tumor

Dx for large adnexal mass, amenorrhea and virulization (hirsutism, clitoromegaly, deep voice)?

Chronic *Hepatitis B* - accumulation of HBVsAg in infected hepatocytes

Dx for liver biopsy - large hepatocytes w finely granular, homogenous, pale pink cytoplasm?

Burkitt Lymphoma via Epstein-Barr Virus

Dx for mass w *diffuse-medium lymphocytes* & ↑proliferation index (↑↑K-57)?

Senile systemic amyloidosis

Dx for myocardium w amorphous/acellular pink material infiltratas in setting of restrictive cardiomyopathy?

Granulomatosis w polyangitis (Wegner's) , C-ANCA target neutrophil proteinase 3

Dx for necrotizing vasculitis of upper/lower resp tract and rapidly progressive glomerulonephritis?

Fragile X Syndrome

Dx for neuropsychiatric features, long, narrow face, prominent mandible, large testes, hyperlaxity of hand joints?

Chronic granulomatous disease, def of NADPH oxidase

Dx for neutrophils unable to form oxidative burst to kill within their phagolysosomes (absence of blue/green pigment on nitroblue tetrazolium/dihydrorhodamine test)?

Invasive Pulmonary Aspergillosis (↑susceptible to viral/fungal)

Dx for prolonged/profound neutropenia, consolidation, and septate narrow hyphae w 45 degree angle branch?

Borderline Personality Disorder.

Dx for pt hospitalized for depression, suicidal, alcohol abuse, and intense relationships?

Aldolase B deficiency > Hereditary fructose intolerance

Dx for pt w ↑Fructose 1 P, vomitting, hypoglycemia?

Bullimia nervosa

Dx for recurrent binge eating and restrictive or purging compensatory behaviors?

Clear cel carcinoma (kidney)

Dx for rounded and polygonal cells w abundant clear cytoplasm?

Actinic Keratoses

Dx for sun exposed areas of erythematous papules & sandpaper-like texture, considered premalignant?

Acute Epiglottitis

Dx for swollen, cherry-red epiglottitis, febrile, ↑ WBC; caused by H. influenzae, prevented via vaccintion?

Wiskott-Aldrich Syndrome

Dx for triad of eczema, thrombocytopenia, and combine B-lymphocyte and T-lymphocyte deficiency?

McCune-Albright Syndrome

Dx for triad of fibrouse dysplasia of bone, endocrine abnormalities, and café-au-lait spots?

Abetaliproproteinemia, can't synthesize apolipoprotein B

Dx for unabsorbed lipids accumulate in intestinal epithelium > results in enterocytes with clear/foamy cytoplasm?

COPD

Dx for when given supplemental PaO2 > ↓ peripheral chemoreceptor stim (carotid bodies) > ↓RR ?

Atypical depression

Dx for ↑appetite/sleep, paralysis, rejection sensitivity, and mood reactivity?

Huntington Disease

Dx for ↑triucleotide repeats in Chr 4 > ↓GABA-containing neurons > dementia & choreiform movement disorder?

Plain abdominal X-ray

Dx imaging study for toxic megacolin due to ulcerative colitis?

Serum TSH for Hypothyroidism

Dx test for ↑CK, fatigue, brittle nails, and weight gain?

Toxoplasmosis. In-utero infection (cat feces)

Dx triad of hydrocephalus, intracranial calcifications, chorioretinitis (white/yellow retina)?

*Epinephrine*, likely anaphylactic shock. Collapse of peripheral vascular resistance, increase permability, leakage of fluid. Epinephrine reverses pathology of anaphylaxis (𝛼1, 𝝱1, 𝝱2)

Dyspnea, hypotension, and tachycardia soon after 𝝱-lactam antibiotics. Suggestive of.. ? What drug should be administed?

Lower ED50, indicating greater potency

ED50 in a drug that binds receptors w higher affinity?

Moderately increased albuminuria (<300)

Earliest manifestation of diabetic nephropathy (GBM thickening)?

Acute Rheumatic Fever Group A Strep

Early *penicillin after bacterial pharyngitis* prevents what?

Effect of the main exposure on the outcome is modified by the *presence of another variable*. Not a bias.

Effect modification defintion?

↑ in mixed venous blood bc ↑O2 consump

Effect of CO2 production during aerobic exercise?

Precipitates mania

Effect of antidepressant monotherapy given to bipolar patient?

C: ↑ to normal, N: no change

Effect of desmopressin on urine osmolarlity during water deprivation test in central DI (ADH def) vs. nephrogenic DI (unresponseive kidney)?

Envelope dissolution

Effect of ether on enveloped viruses?

suppresses hypothalamus-pituitary adrenal axis > adrenal insufficiency/crisis

Effect of glucocorticoid in Hypopituitarism?

Increased Bile acid production

Effect of interruption of bile acid sequestrants (Cholestyramine)?

Rapid emergence of *antibiotic resistance* in M. tuberculosis

Effect of isoniazid monotherapy in the setting of *active tuberculosis*?

Promotes hydrophobic interactions among Hb molecules → polymerization/sickling

Effect of valine subs for glutamic acid in HbS?

Blunt adrenergic manifestastion of hyperthryroidism. Lipid-soluble also reduce conversion of T4→T3

Effect of 𝝱 blockers in hyperthyroidism?

↑Preload, ↓Afterload

Effects of AV sunts on the ventricular pressure-volume loop?

Impaired post-translational processing (goes to proteosome)

Effects of CFTR mutation in MC cystic fibrosis?

↑Aldosterone > resorption of Na/H2O + wasting of K/H >> ↓renin

Effects of hyperaldosteronism on Renin?

↑Ca2+, ↓Phosphate (excreted in urine)

Effects of serum Ca2+ and serum phosphate during PTH stimulation?

Vasodilation/tachycardia will not be affected, only 𝜶 vasoconstriction will remain

Effects on propranolol on epinehrine effect?

Diverticula - true vs false, traction v pulsion. *Pulsion* ↑intraluminal pressure during strained bowel movements (chronic constipation) → sub-mucosa herniate through focal areas in muscalris (false). Diverticula in fetal development w 3 layers (Meckel's, true). Traction: inflammation and scarring of gut wall. Inflammed: diverticulitis.

Eldery pt w hematochezia and abnormal outpouchings from the colonic lumen. *Pouches composed of mucosal and submucosal layers covered by serosa*. Patient's diverticula best described by which of the following terms?

Detoxifying sulfur donors (sodium thiosulfate)

Element that can reverse nitroprusside induced cyanide toxicity?

*Bipolar I disorder with psychotic features*: patient meets criteria for manic episode. Pt with 1= manic episode have this dx. Distinguish from Brief psychotic disorder: 1+ psychotic symtoms lasting 1+ days, but less than 1 mo, will complete resolution.

Elevated/irritable mood, hyperactivity, *decreased need for sleep, pressured speech, and grandiosity*. Most likely dx?

Mesoderm

Embryologic derivative for the spleen?

Everyone, always provide life-saving tx to minor

Emergent situation w Jehovah's witness of all ages, who gets treatment?

↓Oxidative phosphorylation

End-organ hypo-perfusion in septic shock causes what to lead to buildup of NADH and shunting of pyruvate to lactate following glycolysis?

Coccidioides immitis in *Southwesern US* (Arizona)

Endemic location that causes acute pneumonia w spherules packed with endospores?

Propiomelanocortic (POMC) precursor that goes through enzymatic cleavage and modification to produce *beta-endorphins, ACTH, MSH*. Same precursor, similar physiologic effect

Endogenous compounds that share similar structure in being able to bind to delta and mu-receptors?

Bos*en*tan

Endothelin receptor antagonist used for idiopathic pulmonary hypertension?

Cytomegalovirus (owl's eye)

Enveloped dsDNA virus that is common cause of pneumonitis in patients with lung transplants?

Protein kinase C activation

Enzyme affected by blocking inositol triphosphate?

Pyruvate, Isocitrate, Malate, and 𝜶KG dehydrogenase

Enzyme decreased when there is a Niacin deficiency?

Galactokinase deficiency (↑galactitol in lense)

Enzyme deficiency causing cataracts w normal PE?

Aromatase (accumulation of androgens)

Enzyme deficiency causing... maternal hirsutism in pregnancy and infant ambiguous genitals with clitoromegaly.

Fructokinase Essential Fructosuria

Enzyme deficiency in asymptomatic patient with *positive copper reduction test (detects reducing sugars)*?

PBG deaminase deficiency with ALA synthase inhibition

Enzyme down-regulated in acute intermittent porphyria (accumulation of ALA and PBG)?

Ferrochelatase Delta-ALA dehyrodrogatase Lead Poisoning

Enzyme inhibition that leads to anemia and neurotoxicity (language regression, tantrums)?

Glycosylase, endonuclease, lyase, polymerase, ligase. Base Excision Repair

Enzymes that repair nitrate demaniation of cystein, adenine, and guanine?

Nasal septum cautery to cover Kiesselbach plexus (ant ethmoidal, sphenopalatine, sup labial arteries anastomses)

Epistaxis Tx?

NER (mg/min) = (Inulin clearance*Plasma concentration of Substance A) - Tubular Reabsorption of Substance A

Equation for net excretion rate (NER) of a substance that is freely filtered and reabsorbed into renal tubules?

1/TPR = 1/2 + 1/2 + 1/2 etc. .

Equation to calculate systems in parallel?

Nucleosomes DNA wrapped around a core (H2A, H2B, H3, H4)2.*H1 histone* is located outside of this histone core and help package nucleosomes into more compact structures by binding and *linking* the DNA between adjacent nucleosomes. Histones w positive change.

Eukaryotic cells during interphase show a "beads on a string" appearance. Treated w an endonuclease that cleaves the string portions of the chromatin. Beads are DNA wrapped around core proteions. *Which histone portion is most likely found outside of this core* and helps promote chromatic compaction?

Lac operon is polycsitronic, one mRNA codes several proteins (z, 𝝱-galactosidase, hydrolysis ; 𝛾-permease, permability, a, 𝝱-GT, transfers acetyl groups, not needed). Regulated by regulatory, promoter, and operator genes.

Example of mRNA sequence that codes for multiple proteins? How is it regulated?

BNP: diuretic, natriuretic, and vasodilatory. Neprilysin: cleaves/inactivates BNP

Explain the role of BNP and neprilysin inhibitors in the tx of heart failture?

CCl4 > oxidized by P450 oxidase in liver > *free radial injury w CCl3* which reacts w lipids > lipid degradation and H2O2 formation. This is lipid peroxidation > rapid development that swells ER, destroys mitochondria, and increases membrane permeability.

Exposure to *carbon tetrachloride* causes rapid and extensive liver damage. Liver shows fatty change and hepatocyte necrosis. Explain why.

E: ↑ I: ↓

Extracellular and Intracellular K level in Diabetic Ketoacidosis?

PAH (paraaminohippuric acid) is freely FILTERED from the blood into the glomerular capillaries to the tubular fluid in Bowman's capsule. PAH is also SECRETED from blood via a carrier protein-mediated process in proximal tubule cells. Extraction ratio = (artery PAH-venous PAH)/artery PAH90% when PAH < 20 mg/dL. Above this value the ratio decreases due to the *carrier transport being saturated.*

Extraction ratio of PAH at < 20 mg/dL is 90%. PAH concentrations below 20 mg/dL causes the extraction ratio to decrease. Why is this?

*MHC Class II bound to foreign antigen* and subsequet lack of interaction between *APCs and T-cells*. MHC Class II function by presenting antigen to APC. Antigen is taken into the APC by phagocytosis or endocytosis, leaded onto MHC Class II within acidified endosomes, and the MHC Class II protein-antigen complex is then expressed on the cell surface for subsequent interaciton.

Failure to acidify lysosomes would lead to deficient expression of what?

Lunate

Fall on outstretched hang, ↓sensation on palmer aspect of multiple fingers. Bone injury?

Chylomicron remnant uptake by liver cells

Familial dysbetalipoproteinemia patients have defect in ApoE3 and ApoE4 which impairs what process?

Asymmetric (septal) LV hypertrophy that can result in suffent cardiac death. AD mutations affecting the cardiac sarcomere genes (cardiac *Beta-myosin heavy chane gene* and mysoin-binding protein C gene) are responsible for the majority of cases.

Family w history of hypertrophic cardiomyopathy (sudden deaths at young ages.). What *protein was most likely mutated in this syndrome*?

Progesterone withdrawl causes *apoptosis* of endometrial cells > menstrual bleeding.

Hormone that is respsonsible for stimulating the endometrium. When withdrawn what will happen to endometrial cells?

Leuprolide

GRH agonist that causes transient ↑in pituitary LG > ↑testosterone; continuous use ↓LH, ↓testosterone?

Biliary sludge > Biliary Colic

Gallbladder hypomotility due to excessive dehydration leads to?

H+ Secretion. Cephalic Phase: though, smell, taste. Gastric: food, distention triggers histamine. *Intestinal*: protein triggers, but peptide YY binds ECLs to counteract cephalic and gastric.

Gastric function during and after a meal shows an initial rise, peak, and then decline. *What helps down-regulate gastrin after a meal?*

Iron deficiency anemia

Gastrojejunostomy to treat Peptic Ulcer Disease will result in what?

TP53, Li-Fraumeni Syndrome

Gene mutation causing sarcomas, breast cancer, brain tumors, adrenocortical carcinoma, and leukemia?

NF-2 on Chr 22 vs. NF1 on Chr 17

Genetic associated with bilateral acoustic neuromas vs. café-au-lait spots and lisch nodules?

X-lined recessive vs. AD

Genetic association of glucose-6-phosphate dehydrogenase deficiency vs. Hereditar spherocytosis?

UAA, UAG, UGA

Genetic code Stop Codons that terminate translation?

t(15;17) Acute promyelocytic leukemia

Genetic translocation for ... leukemia with intracytoplasmic Auer rods, bleeding in the setting of DIC (RAR𝜶:PML)?

Germiline: Parent unaffected, pass to offspring; Somatic: cells of the body, milder form

Germline mosaicism vs. Somatic mosaicism?

Preeclampsia

Gestational HTN, proteinuria or end-organ damage is a sign of?

Complete Mole. 46, XX

Gestational trophoblastic disease: Grapes (chorionic villi) /Snowstorm (cysts)?

*Phosphodiesterase* Hormones that use this system: TSH, glucagon, PTH. PKA is respsonsible for the intracellular effects of the Gprotein mediated adenylate cyclase second messenger system

Glucagon binds transmembrane receptor in hepatocytes >promotes binding of intracellular GTP >decrease in intracellular glycogen stores and release of glucose into the blood. What is the mediator that is responsible for these effects?

Glycerol as a part of triglycerides in adipose tissue

Gluconeogenic precursor synthesized in adipose tissues to synthesize gluconeogenesis when insulin is low?

Enteroccocus

Gram+ cocci in pairs and chains, gamma-hemolytic cause of UTI after cystoscopy for hematuria evaluation?

Clostridia botulinum

Gram+ spore-forming anaerobic rods with.. subterminal spore formation ability used as local injection to treat focal dystonias, achalasia, and spasms?

Streptococcus pyogenes (Group A)

Gram+, Coag-, Cat-, PYR+, cocci cause of Necrotizing fasciitis?

Th1 and macrophage acitvaiton

Granulmoa formation involves chronic activation of what in response to difficult-to-eradicate antigen?

Grow in proportion to child, then ultimately regresses

Growth process of strawberry-type capillary hemanigiomas?

Chronic HBV w high infectivity

HBeAg (viral rep) persists for months & low anti-HBeAg indicates what?

Lopinavir (protease inhibitor)

HIV drug that can lead to ... lipodystrophy, hyperglycemia, and P450 inhibition?

*Kaposia sarcoma*: involves skin, GI. Common not on therapy. CMV: multiple ulcers, cells w inclusion bodies

HIV patient w bloody diarrhea. Noncompliant meds, CD4: 50. Colonoscopy: multiple hemorrhagic polyploidal lesions + spindle cells. Pathogen?

Anal squamous cell carcinoma (most anal cancers are ulcerative). These have been linked to *human papillomavirus infection* (also linked to cervical cancer, type 16, 18)

HIV patient w pain, itching, and rectal bleeding. PE: superficial ulceration. What pathogen is likely responsible for this anal pathology?

Vasoconstriction > Intimal thickening & medial hypertrophy

HTN > ↑Diastolic filling pressure > ↑LA pressure > Pulmonary venous congestion > ↑ Pulmonary arterial pressure > ?

Dilation of *Efferent arteriole*

HTN agent, remipril, affects which part of kidney?

Nephritic Syndrome. Anti-GBM disease. Deposits are IgG and C3 targeting *Collagen Type IV*. Leads to rapidly progressive (crescentic) glomerulonephritis. Can also cross react in lungs.

HTN, hematuria, moderate proteinura. Biopsy shows linear deposits of IgG along glomerular basement membrane.

Slit lamp examination of Kayser-Fleischer rings

Helpful diagnostic test in confirming Wilson disease?

1. Severe stenosis impairs LV output, 2. Higher systolic pressures cause LV hypertrophy 3. Atrial contraction necessary for filling of stiffened LV. Acute atrial fibrillation can lead to sudden-onset heart failure. In patients w chronic aortic stenosis and concentric LV hyper, atrial contraction contributes significantly to LV filling. Afib > loss of A contraction > ↓ LV preload + CO > systemic hypotension.

Hemodynamics of severe aortic stenosis?

MC in circle of Willis, Subarachnoid Hemorrhage "thunderclap"

Hemorrhage presentation of ADPKD after berry aneurysm rupture?

Anti-HBsAg IgG

Hepatitis B marker after vaccination or clearance?

No 3'→5' exonuclease → hypervariable genomic regions in envelope

Hepatitis C virus feature that causes antigeneic variety and slows the mounting of an effective immune response?

HBVsAg must coat HDVAg before it can infect hepatocytes and multiply

Hepatitis D requirements prior to infection?

Femoral hernia

Hernia type inferior to inguinal ligament, lateral to pubic tubercle, and medial to femoral vein?

*Aminoaciduria* (Nitroprusside test) Cystinuria disorder

Hexagonal-shaped crystals and recurrent nephrolithiasis in young patients indicates what?

Multiple Myeloma: ↓PTH > ↑urine calcium + light chain cast nephropahty > renal failure (↓1,25-dihydroxyvitamin D synthesis)

Hgb↓, Creatinine ↑, Calcium ↑, Total protein ↑. Dx & describe trends in PTH, Urinary Calcium, 1,25-dihydroxyvitamin D?

Hepatocellular Carcinoma

High levels of dietary aflatoxin associated with G:C → T:A transversion in p53 gene, a mutation that increases risk of what?

Bacterial joint infection, tx w antibiotics

High synovial fluid leukocyte count (>100k) and absent crustals suggest?

Abnormal migration of neural crest cells. Rectum is always affected

Hirschsprung's disease Pathophys?

Transudate (filtered plasma water/electrolytes)

Histo presentation of cardiogenic acute pulmonary edema?

Thiazide diuretics

History of Hypertension, presents w hypercalciuria and low PTH. What drug is responsible?

Pituitary Hemorrhage due to Pituitary Adenoma

History of headache/decreased libido, what is pathophysiology if presenting with *severe* headache?

Tricuspid Regurgitation

Holosystolic murmur that increases intensity on inspiration?

Cholecystokinin (CCK)

Hormone responsible for gallbladder contraction, made in d/j in response to FA/AA?

Progesterone

Hormone that inhibits lactation in pregnancy?

Amniotic fluid embolism - Fetal squamous cells

Hypoxia, hypotensive shock, and DIC > death. Appearance of feal squamous cells?

Fenol*dopan* (Dopamine 1 receptor agonist)

IV drug given in hypertensive emergency that dilates arterioles, ↑ renal perfusion, and promotes diuresis and natriuresis?

Lactulose Rifaximin

Identify drugs for treatment of hepatic encephalopathy that ... ↑conversion of ammonia to ammonium & ↓intraluminal ammonia production?

D1, 𝝱1, 𝜶1

Identify the receptors responsible for vasodilation/↑blood flow in renal/mesentery → ↑CO → ↑systemic vascular resistance in ↑ [dopamine] infusion?

Thymoma

IgG and cytotoxic T lymps inhibiting erythropoietic precursors in pure red cell aplasia is associated with what other PE finding?

Vit K/Fresh Frozen Plasma ****LA hydrocy coumarin derivative

Immediate treatment for *rodenticide poisoning* in bleeding patient?

*Dexamethosone* (Glucose supplementation) Chronic Primary Adrenal Insufficiency

Immediate treatment for history of hypothyroidism, presents with ... hyperpigmentation, severe hypotension, weight loss, abdominal pain, vomiting and weakness?

Diphtheria antitoxin (*passive immunization*)

Immunization type of most important tx of diptheria infection?

Histoplasma capsulatum

Immunocompromised patients - fever, weight loss, painful oral ulcer, LAD, HSM. Pathogen replicates within macrophages?

Calcineurin is an essential protein in the activation of IL-2, which promotes the growth and diffferentiation of T cells. *Cyclosporine* and *Tacrolimus* work by inhibiting Calcineurin.

Immunosuppressive therapy when desire is to reduce the proliferation and differentiation of T lymphocytes?

Tyrosine, dopamine, serotonin (PKU)

Impaired tetrahydrobiopterin will cause what deficiency?

Food poisoning (C botulinum toxin)

Impairment of muscarinic and nicotinic neurotransmission indicates what?

*TNF𝛼* produced by activated macrophages in septic shock

Important mediator in tetrad of hypotension, tachycardia, tachypnea, and ↑↓body temp?

↑afterload, excess fluid retention

In heart failure, activation of RAAS and SNS leads to what?

Amino group transferred to *𝜶-ketoglutarate* to form glutamate. *Glutamate > GDH > free amonia + 𝜶-keto*. Free ammonia excreted into urine to regulate acid-base status. Skeletal muscle releases alanine as part of glucose-alanine cycle to remove excess nitrogen.

In liver, alanine is transaminated by alanine aminotransferase to pyruvate. Which molecule will take on the *transferred amino group*?

Proeasome inhibition > accum of toxic metabolites > apoptosis

In multiple myeloma, plasma cells become susceptible to what?

↓compliance

In the setting of left ventricle failure, fluid accumulation in the lung insterstitium leads to what?

*Pulmonary vasular bed* is unique in that tissue hypoxia results in a vasconstrictive response. Occurs in the samll muscular pulmonary arteries to divert blood flow away from the underventilated regions toward better ventilated ones.

In what organ would you be likely to see hypoxic vasoconstriction?

t (15; 17) Acute Promyelocytic Leukemia.

In what syndrome do you see Auer Rods?

Paramesonephric (Mullerian) ducts

Incomplete lateral fusion of which ducts leads to bicornate uterus?

↑ SV (Ventricular P-V loop)

Increased contractility with a larger volume of blood ejected indicates what?

*Acid maltase (𝜶-glucosidase) deficiency* presents in early infancy w aforementioned features. *Pompe disease*. Enzyme normallly breaks down glycogen within the acidic environment of lysosomes.

Infant w cardiomegaly, macroglossia, and profound muscular hypotenion. Muscle biopsy shows *enlarged lysosomes containing periodic acid-Schiff (PAS)-positive material*. What enzyme is lkely deficient in this patient?

*46, XX t(14;21)* Translocation down syndrome, LC, Unbalanced Robertsonian translocation. Down Syndrome (meiotic disjunction, 3 copies of 21)

Infant with epicanthal folds, upslanting palpebral fissues, a protuding tongue, and excessive skin at nape of neck. Low birth weight and length. Hypotonia & weak startle Cardiac defects in 50%. Which karyotype is likely to be found?

3 (Inferior parathyroid/thymus) & 4 (Superor parathyroid) DiGeorge Syndrome

Infant with hypocalcemia & T cell deficiency likely has maldevelopment of which pharyngeal arch?

DiGeorge syndrome - *maldevelopment of the 3/4 pharyngeal pouch derivatives*. Thymic aplasia, deficiency in mature T lymphocytes. T cells process in thymus. *Paracortex* is region of lymph node poulated primarily by T lymphocytes (between follicles and medulla). Area enlarged during infection.

Infant. *Facial dysmorphia and cleft palate. R-L shunt and absence of thymic shadow on x-ray*. Recurrent sinopulmonary infections. Examination of the patient's lymph nodes is most likely to show poor development of what structure?

SRY (on Y Chr) codes for testes-determining factors (differentiates primitive gonads into testes). Sertoli cells produce anti-Mullerian hormone > causes regression of *Mullerian ducts and suppresses female internal productive organ development*. Leydig cells produce testosterone, differentiating Wolffian ducts into internal male reproductive organs. DHT is required for differentiation of the external male genitalia.

Infant. Karyotype is 46, XY. Gonadal tissue shows *lack of Sertoli cells* but normally functioning Leydig cells. What *phenotype* is likely to be present?

Epstein-Barr

Infectious Mononucleosis MC cause?

Tricuspid valve Tricuspid regurgitation

Infectious carditis location in IV drug user w S. aureus infection?

Single-gene AD Neurofibromatosis Type 1 gene

Inheritance pattern for ... café-au-lait spots, neurofibromas, and lisch nodules?

AR, enzyme deficiency

Inheritance pattern for MC and severe galactosemic disorder, Classical galactosemia?

Maternal Ineritance. Mitochondrial Disease

Inheritance pattern for blotchy red muscle fibers on Gomori trichrome stain?

Austosomal Dominant

Inheritance pattern of achondroplasia?

*Postcentral gyrus* : processes all somatic sensory modalities (touch, temperature/pain, vibration/propioception) of the contralateral body. Partial (focal seizure) can result in contralateral sensory disturbance.

Initial right arm numbness/paresthesias. HTN, paroxysymal atrial fibrillation, and ischemic stroke. *Parethesias spreads to entire body and he develops right-sided convulsions followed by tonic-clonic seizures.* What structure is most likely the *origin of the seizure*?

Amphotericin B Flucystosine

Initial treatment for *Cryptococcal Neoforms meningitis*?

*Chlamydia trichomatis*. Intracytoplasmic chlamydial inclusion bodies in epithelial cells & leukocytes.

Initially painless ulcer w later progression to painful inguinal LAD ("buboes") and ulceration. Pathogen?

Tibial N. injury, popliteal fossa (common site)

Injury causing dorsiflexed & everted foot w sensory loss over sole?

Lesions in dorsal pons > disrupt ipsilateral MLF

Injury if pt unable to adduct while contralateral eye abducts w nystagmus?

Transient: Posterior Pituitary Permanent: Hypothalamic Nucleus

Injury responsible for transient central DI vs permanent central DI?

Absent Cough Reflex Internal Laryngeal Nerve Injury

Injury to piriform recess can lead to what deficit?

Iliohypogastric N.

Injury to what nerve after appendectomy would cause decreased sensation to suprapubic region?

Lower brachial trunch (C8 & T1)

Injury to what structre would cause finger clumsiness w total claw hand deformity?

Spinothalamic + Dorsal Columns > VPL. Trigeminal Pathway > VPM. Damgage to VPM/VPL > contralateral sensory loss

Injury to what structure during ischemic stroke causes contralateral sensory loss?

*Chron disease* presentation. Prone to developing fistulas/abscesses as the lesion affects the entire thickness of the bowel wall. Perianal diseases are also common.

Insidious onset of abdominal pain, diarrhea, and constituional symptoms (weight loss, fevers). What is this patient at risk for developing?

Cortisol

Insulin-promoting hormone that binds to DNA elements to promote gluconeogenesis during fast?

*10*. >240 mg/dL is 2 SDs, 2.5% will be in this range. 2.5 x 400 = 10. 68% of all values within 1 SD, 95% within 2, 99.7% within 3 SD.

Intern collecting data. 600 patient population. Serum cholesterol mean among population was 230mg/dL w 10mg/dL standard deviation. How many patients expected to have cholesterol >240 mg/dL?

*Schwannomas* PNS tumors with high cell area (Antoni A) and nuclear -free zones (Verocay bodies) and low cell myoxid regions (Antoni B). MC site: Cerebellopontine angle (acoustic neuromas) at CN 8 - tinnitus, vertigo, and sensorineural hearing loss.

Intracranial mass, 33 yo, biphasic pattern of cellularity (Antoni A and B, regular, oval nuclei) and S-100 positivity. What is the most likely diagnosis in this patient?

Fragile germinal matrix leading to long-term neurodevelopment impairment

Intraventicular hemorrhage common complication in premature infants in what structure?

Cerebellar hemisphere

Ipsilateral dysdiadochokinesia, limb dysmetria, and intention tremor indicate a lesion on what brain strucutre?

Clopidogrel

Irreversible *blocker of P2Y12 portion of ADP receptors* that prevents platelet aggregation as well as Aspirin?

Lysosomal enzymes (Liquefactive Necrosis)

Ischemic neurons produce what to degrade the tissue?

Ischemic Acute Tubular Necrosis

Kidney injury during hemorrhage?

Increased FSH. Klinefelt Syndrome [XXY]

Lab finding in ♂ bilateral painful breast enlargement, special Ed, small/firm testes?

↓ C3, C4

Lab findings in SLE?

↑serum indirect bilirubin, Hemolytic Uremic Syndrome

Lab findings in pt w acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia?

Serum TSH

Lab tests to be performed before long-term amIODarone?

Alkaline phosphatase. 1. ↑osteoclastic activity 2. ↑osteoblast activity

Lab value and cell activity elevated in Pagets disease of bone?

Normal PT, aPTT, and Platelet count, ↑ bleeding time due to accumulation of uremic toxins that impair aggregation

Lab values (PT, PT, platelet count, bleeding time) for prolonged bleeding patient w end-stage renal disease?

Hyperammonemia Ketotic hypoglycemia Metabolic acidosis HKM

Laboratory findings in methylmalonyl-CoA mutase deficiency (Methylmalonic acidemia)?

Inferior epigatric vessels. Indirect (lateral), Direct (medial)

Landmark that distinguishes indirect from direct inguinal hernia?

Biventricular pacemaker (requires 2-3 leads). 2 in RA/RV. 1 in LV (courses through coronary sinus).

Left ventricular leads in a biventricular pacemaker course where?

ICA, impinge on optic chiasm, uncrossed optic nerve from temporal portion of retina is affected

Lesion location for ipsilateral nasal hemianopia?

Coagulative (CNS-liquefactive)

Lethal tissue ischemia causes what type of necrosis (in most tissues)?

Propionic acidemia. Congenital deficiency of propionyl-CoA carboxylase (propionyl CoA → methylmalonyl-CoA). Excess propionic acid accumulates → severe metabolic acidosis. Tx w low protein diet w minimal amounts of *valine, isoleucine, methionine, and threonine*.

Lethargy, poor feeding, vomiting, and hypotonia 1-2 wks after birth. *Elevated propionic acid level*. Dx and Tx?

↓Hgb, normal SaO2, PaO2

Levels of SaO2, PaO2, and Hgb in setting of Anemia?

Ligamentum flavum hypertrophy Lumbar Spinal Stenosis

Ligament affected in posture-dependent LE pain, numbness/paresthesia, weakness?

Cricothryroid. Superior thyroid A & External branch of Sup Laryngeal N (Crico).

Ligating artery entering superior pole of thyroid lobe, n. injury, which muscle affected?

Obstructed lumen with needle-shaped cholesterol clefts

Light microscopy after invasive vascular procedure is complicated w atheroembolic renal disease (blue tow, livedo retucularis)?

Mitochondrive VS. cytosol

Location of Beta-oxidation of FA, TCA cycle, and gluconeogenesis VS. Glycolysis, FA synthesis, and PPP?

Promotor: 25-75 bp upstream Enhancer: upstream, downstream, or within transcribed gene

Location of ... promotor regions vs enhancers on gene?

Posterior to Trachea (radiolucency of the air).

Location of Esophagus

Endocardial surface of right atrium, near the insertion of the *septal leaflet of the tricuspid valve and the orrifice of the coronary sinus*. Near blood return to the heart on the path of the electical pulse from SA → AV.

Location of atrioventricular node?

Bladder is extraperitoneal

Location of bladder to peritoneum?

Hepcidin (Ferroportin-1) within *Hepatic parenchymal cells*

Location of central regulator for iron hemostasis?

Area postrema, dorsal medulla, near 4th ventricle

Location of chemoreceptor trigger zone?

Fc portion, close to hinge site

Location of complement binding site on IgG and IgM?

D: gastric antrum; G: gastric corpus

Location of duodenal vs gastric ulcers caused by Helicobacter pylori?

Dental enamel Travels to heart valves Viridans streptococci

Location of invasion for pathogen that *synthesizes dextrans from sucrose*?

Posterior to bladder, Anterior to Anal canal

Location of prostate in axial image?

Initial step is conversion of cholesterol to pregenolone in mitochondria. Steroidogenesis occurs in smooth ER. Steriod-producing cells contain *well-development smooth ER* (ecample - male pattern hair growth and virilization)

Location of steroid hormone synthesis in cell?

Illeum, Cholecystenteric fistula

Location of stone if xray reveals gas within gallbladder and biliary tree?

Cardiac tissue Renal juxtaglomerular cells (Gs)

Location of 𝝱1 adrenergic receptors antagonized by atenolol?

Supeficial Inguinal Lymph Nodes

Location where cutaneous lymph nodes below umbilicus drain?

Protein M > inhibits phagocytosis/complement activation

MOA of *strep pyogenes* major virulence factor causing *pharyngitis*?

Predominantly *block K+ channels* and inhibt the outward K+ current during phase 3 of the cardiac action potential, thereby *prolonging repolarization* and total AP duration.

MOA of Class III antiarrhythmic drugs (amiodarone, sotalol, dofetilide)?

Block the serontonin receptor

MOA of SSRIs?

Nitrates > methemoglobinemia (Fe3+), which has ↑ cyanide binding affinity

MOA of amyl nitrate given to pt w cyanide poisoning (tachypneic, red skin)?

Inhibits Topoisomeras II/ability to seal the strand breaks Top II induces.

MOA of etoposide & podophyllin used against cancer cells?

Capillaries are dilated, thin-walled w/o much nerve tissue Effects are seizures & hemorrhage

MRI diagnosis of cavernous hemangioma. Describe capillaries and adverse effects.

Headache Cutaneous flush Lightheaded HypoTN *All due to systemic vasodilation*

Main adverse effects of nitrate therapy (isosorbide dinitrate)?

Seizures

Major cause of morbidity/mortality in theophylline intoxication?

limit access to lethal methods, decrease stress and provide support

Major interventions to reduce suicide risk?

*Lipo-oligosaccharide* Neisseria meningitidis

Major virulence factor for rapid-onset sepsis and circulatory collapse in healthy young?

5𝜶 reductase deficiency. Testosterone →(5𝜶 reducase)→ Dihydrotestosterone > development of external male genitalia.

Male neonate. Feminized external genitalia. Small phallus & hypospadias. Defect?

*Adrenal cortical hyperplasia* due to non-salt-wasting 21-hydroxylase deficiency. Females with classic 21-hydroxylase deficiency (with or without salt-wasing) present with ambiguous genitalia at birth.

Male, 2-4 yo w early virilization, increased linear growth, and elevated levels of 17-hydroxyprogesterone and androgens. What is most likely present in the patient?

Lung, colorectal, and ovarian

Malignancies strongly associaed with dematomyositis?

Strawberry Hemangiomas, Capillary hemangioma variant

Most common thin-walled blood vessels with narrow lumens filled with blood and separated by connective tissue in children?

C: junction between descending and ascending; D: Collecting ducts

Most concentrated and most dilute areas of the nephron tubule in absence of ADH?

Med Review: Psychotropic Ca2+ block NSAIDS ...have increased risk

Most effective strategy in managing nursing home patient's risk of fall?

Ventricular fibrillation due to electrical instability in the ischemic myocardium.

Most frequent mechanism of sudden cardiac death in the first 48 hours after acute MI?

Smoking

Most important *environmental risk factor* for Pancreatic Cancer?

MAC (inverse relationship)

Most important indicator of anesthetic potency?

Nitric Oxide

Most important mediator of coronary vascular dilation?

IgG C3b

Most important opsonins (2, coating proteins)?

D: HTN, A: HTN, smoking, DM, hypercholesterolemia

Most important risk factor for the development of intimal tears leading to aortic dissection vs. aneurysm?

P fimbrae (binds uroepithelial)

Most important virulence factor expressed by *uropathogenic E coli*?

Stan A: sinotubular junction; Stan B: L subclavian A.

Most likely aorta dissection locations in the presence of severe HTN?

Herpes simplex virus type 1 encephalitis

Most likely pathogen causing fatality post-headache, fever, altered mental, seizure with temporal lobe hemorrhage?

Prenatal care, diagnosis or tx of STD, contraception, and drug/alcohol rehabilitation.

Most minors can consent to what medical assistance without emancipation or parental consent or notification?

In vitro fertilization

Most promising way to achieve pregnancy in Turner Syndrome patient?

TSH for Primary Hypothyroidism

Most sensitive marker for most patients with hypothyroidism?

Stool Sudan III stain (fat)

Most sensitive strategy for screening malabsorptive disorders?

Watershed area: splenic flexure & rectosigmoid junction

Most susceptible areas for GI ischemia?

Antimuscarinic + Antihistamines > prevent motion sickness

Motion Sickness tx?

Beta-2 promote secretion, Alpha-2 inhibits release (overriding effect)

Overall effects of epinephrine (sympathetic stimulation) on insulin secretion?

Lead Poisoning

PBS with basophilic stippling indicates what?

*Anaphylaxis*. Echinococcus granulosus tapeworm mc cause of hydatid cysts

PE: Hepatomegaly. US: large liver mass with cystic lesions/eggshell calcification. When resecting the mass, patient dies. Cause of death?

PPV = TP/(TP+FP); NPV=TN/(TN+FN)

PPV vs. NPV?

AV-SA conduction is impaired (3Dblock). Atria/Vent depolarize independent. Narrow QRS since normal AV firing.

Pacemaker Potential Definition?

Ventral (main duct + body,tail,>head) & dorsal (access duct) pancreatic buds fail to fuse

Pancreas divisium causing recurrent pancreatitis def. ?

1: HLA II, 2: Pancreatic islet amyloid deposition

Pancreative Amyloid deposition vs. HLA class II gene DM type?

Kussmaul sign

Paradoxical rise in JVP during inspiration in the setting of constrictive pericarditis?

H → hypersecretion of gastric acid

Parietal cell side effect of systemic mastocytosis (proliferation of mast cells and ↑histamine release)

*Buprenorphine* low acitivty , but high affinity! Prevents binding of other opioid medications. Long-term activation of mu-opioid receptors associated w increased pain sensitivity.

Partial opioid receptor agonist that binds with high affinity, but has low intrinsic activity. Can precipitate withdrawal in patients on long-term opioid therapy.

*Erythrocytes* (bone marrow). Erythema infectiosum (5th disease)

Parvovirus B19 replicates in progenitor of which cell line?

Chikungunya, Aedes aegypti

Pathogen and vector cause for flulike symptoms, prominent polyarthralgia, and diffuse macular rash?

Toxoplasmosis in HIV patient

Pathogen for oral thrush, cervical and inguinal LAD, and brain lesions?

Pneumocystis pneumonia

Pathogen for hypoxia, bilateral intersitial infiltrates and positive silver stain in patient w impaired cell-mediated immunity?

Actinomyces israelli causing Cervicofacial Actinomycosis

Pathogen for slow growing, firm abscess in face/neck that forms cutaneous sinus tracts after oral trauma?

*Togavirus* Rubella

Pathogen responsible for febrile maculopapular rash (*face→trunk/extremities*) and post-auricular/occipital LAD?

Listeria monocytogenes (altered PBP, treat with Ampicillin)

Pathogen responsible for *cefotaxime-resistant meningitis* in young or immunocompromised patients?

Salmonella Typhi, Typhoid Fever

Pathogen responsible for escalating fever then abd pain, rose spots, and hemorrhagic enteritis?

Staphylococcus aureus

Pathogen that causes fever, abdominal pain, uterine tenderness, foul-smell discharge after pregnancy termination (Septic abortion)?

Staphylococcus aureus

Pathogen that causes hepatic abscesses via hematogenous seeding of the liver?

Klebsiella pneumoniae

Pathogen that causes... tissue necrosis, early abscess w prod of thick, mucoid, *blood-tinged sputum pneumonia*?

Enteroccus faecalis, Cystoscopy of GU tract

Pathogen that grows in hypertonic saline and boil route to cause endocarditis?

Staphylococi epidermidis

Pathogen that grows on foreign bodies due to ability to form *biofilm*?

Neurofibrillary tangles and amyloid-beta plaques. Down syndrome have 3 copies of amyloid precursor protein gene. At high risk of developing disease.

Pathogeneiss of Alzheimer disease and its relation to trisomy 21?

Disruption of normal endocardial surface (area of max blood flow, atrium side of AV valves, venttricular side of Semilunar valves). Next, *fibrin deposition* with fibrin and platelets. Strep infects cardiac valves w preecisting lesions. Staph aureus adheres to damaged and normal endothelial cells.

Pathogenesis of infective endocarditis?

Inflammation of *microglial cells*/macrophages fuse to form multinucleated giants/necrosis in HIV-associated dementia

Pathogenesis of memory loss in non-compliant HIV person?

Asbestos

Pathogenic cause of pleural plaque/thickening with calcification of the mid-lung/diaphragm?

GI mucosa Shigella

Pathogenic mechanism for glucose w/o gas, no H2S, and unable to replicate at refrigeration temperatures?

Aspergillus colonization

Pathogenic mechanism that causes fungus ball formation within preexisting lung cavity?

↓MSAFP (Aneuploidies). ↑MSAFP (NT, Ventral wall defect, multiple gestation)

Pathology for ↓ vs. ↑ *maternal serum quadruple screen* (MSAFP)?

Segmental thrombosing vasculitis in Thromboangitis obliterans (Buerger's dis)

Pathology of hypersensitivty to intradermal tobacco injections in heavy cig smokers?

Main bronchus obstruction → atelectasis

Pathology responsible for unilateral pulmonary opacification and mediastinum deviation toward opacified lung?

Homogentisic acid dioxygenase deficiency > ineffective tyrosine metabolism. Alkaptonuria

Pathophys for CT blue-black deposits and osteoarthropahy spine/joints?

Mutation in bacterial ribosomal proteins

Pathophys for Streptomycin (blocks 30S) Antibiotic Resistance?

Degeneration of spinocerebellar tracts seen in Friedreich ataxia

Pathophys for hyphoscoliosis high plantar arch, and difficulty moving?

Diffusion impairment

Pathophys for large alveolar (104 mm Hg) to pulmonary venous blood (70 mm Hg) w normal pulmonary PCO2 (40 mm Hg)?

↑ radial traction on airway walls (outward pulling) > ↑ expiratory flow rates.

Pathophys of Pulmonary Fibrosis?

Deffective heptacellular excretion of bilirubin glucuronides. Dubin-Johnson Syndrome

Pathophys of jaundice pt w black liver containing dense pigements and lysosomes?

Intimal thickening of Pulmonary arterioles (Pulmonary Hypertension) from systemic sclerosis (↑collagen)

Pathophysiology for sclerodactyly, Raynaud phenomenon, accentuated second heart sound?

Microthrombi in small blood vessels. Shiga Toxin Hemolytic Uremic Syndrome

Pathophysiology of.. microangiopathic hemolytic anemia, thrombocytopenia, acute kidney injury *following diarrheal* illness?

JAK-STAT pathway

Pathway activated by the binding of growth hormone to stimulate IGF-1 in the liver?

PPP

Pathway that is the main source for NADPH?

Cord factor forms cylindrical micelles that surround the organism and *prevent macrophage-mediated destruction within the phagolysosome*. Also forms highly toxic crystalling monolayer of hydrophobic sufaces

Patient infected with mycobacteria that appear as *parallel chains (serpentine cords) under microscopy*. This type of growth pattern strongly correlates with what feature of the bacteria?

Advanced malignancy /chronic inflammation /sepsis

Platelet-rich thrombi on mitral valve in setting of nonbacterial thrombotic endocarditis indicates what?

*Cryptococcus neoformans* (red on micicarmine)

Pleuritic chest pain, cough. Infiltrate LL of R lung. Mucicarmine stain bronchoalveolar fluid. Pathogen?

Late distal convoluted tubules Cortical collecting tubules

Primary sites for *regulation of K+ concentration* in the urine?

Primary: ↑Aldosterone, ↓Renin, Secondary: ↑Aldosterone and ↑Renin (Renin is the stimulant)

Primary vs. Secondary Hyperaldosteronism?

Nonmaleficience (first, do no harm)

Principle that prescription medications that do more than good should be avoided?

Drug induced lupus erythematosus

Procainamide, hydralazine, and isoniazid are linked to N-acetylation in the liver and can cause?

****Carrier-mediated transport

Process of glucose (primarily D-glucose) occurs via what process?

Serum albumin, bilirubin levels, and PT time

Prognostic factors for patients w cirrhosis?

Fragility fracture and vaginal dryness/atrophy

Prolactinoma →↓GnRH →↓LH, the resulting estrogen deficiency will cause what deficits?

Azithromycin/Clarithromycin w Rifabutin/Ethambutol "ACER"

Prophylactic treatment for Mycobacterium avium complex in HIV+ patient w CD4+ counts <50 cells/μL?

Oral contraceptives (↓ovulation freq)

Protective factor for CA-125+ epithelial ovarian cancer?

*Phenylephrine*: selective 𝛼1 adrenergic receptor (IV vasoconstriction) → ↑ systemic vascular resistance & BP and ↓pulse pressure and heart rate

Pt given IV infusion of agent that ↑ peripheral vascular resistance, ↑SBP, ↓pulse pressure, ↓ heart rate. What agent is being described?

*Valsartin*. An ARB (block Angiotensin 2) that will eliminate the cough while still providing the same long-term renovascular benefits.

Pt has HTN and DM. Currently on *ACE inhibitor* to reduce risk of chronic kidney disease. Experiencing AE of *dry, nagging cough*. What is the *best Tx* for the patient's HTN?

Isoniazid inhibits synthesis of mycolic acids/cell wall, myobacteria lose acid-fastness

Pt presents with TB. Drug that causes culture to become less resistant to discoloration?

*Increased frequency of chloride channel opening* in benzodiazepines. Barbituates increase the duration of channel opening.

Pt w insomnia. Prescribe a *hypnotic agent aka anixolytic*, muscle relaxant, and anticonvulsant. What is MOA of drug?

Membranous Glomerulonephropathy

Renal disease with GBM thickness, *"spike and dome"* appearance on methenamine silver stain, and *granular IF deposits*?

Glutamine via Renal Ammoniagenesis

Renal metabolism of which AA is most important for maximizing acid excretion in patient w acute ischemic colitis?

Phosphorylastion of specific mannose residues to ensure proper transit through Golgi apparatus. Defect in I-cell disease

Requirement for proteins destind for the lysosome?

(2) ATP-gated

Requirements for chloride channel involved in CFTR protein?

Folic acid

Requirements for patient with chronic hemolytic anemia that have increased erythrocyte turnover?

W: FFP, VitK. H: Protamine

Rescue treatments for Warfarin vs. Heparin?

*Phosphodiesterase-3 inhibitors* (milrinon and inamrinone) > ↑ [ intracellular cyclic adenosine monophosphate ] > systemic vasodilation, limits use in hypotensive patients + promotes intracellular Ca2+ influx + ↑ cardiac contrality.

Response after Milrinone?

Decline as it is ethically problematic

Response to patient attempting to give expensive gift?

Loss of gag reflec (afferent limb) and taste sensation on the posterior 1/3 of tongue.

Result of lesions of the glossopharyngeal nerve?

Neg. feedback that ↓NE synthesis/release & diminishes effect (tachyphylaxis)

Result of overuse of topical 𝜶-adrenergic agonists?

*Messenger RNA transcript containing BCR and ABL exons*. RT-PCR used to detect and quantify levels of mRNA in a sample. Uses RT to create complimentary CAN (?) that is amplified using standard PCR.

Reverese transcription polymerase chain reaction use to dx *chronic myelogenous leukemia* in the patient. What will most likely be detected by this test?

FAD in TCA/ETC (electron acceptor for succinate dehydrogenase (sucinate→fumarate)

Riboflavin (precursor for coenzymes FMN and FAD) deficiency will cause what effects?

Internal Iliac A.

Right ureter is anterior to what structure?

Chronic lymphedema > Angiosarcoma

Risk after axillary lymph node dissection?

Lack of barrier contraception leading to HPV 16,18, 31

Risk for cervical intraepithelial neoplasia III?

MEN2 Pheochromocytoma > *Anesthesia-induced catecholamine surge*

Risk for patients with medullary thyroid cancer (calcitonin) and RET mutation during surgery?

Hypertension Thromboembolic events

Risks (2) associated with erythropoiesis-stimulating agents?

Infundibulopelvic ligament

Rotation around which ligament causes ovarian torsion (mass weight causes sudden-onset unilateral pelvic pain)?

Supraspinatus (shoulder abduction) Infraspinatus (External Rotation) Teres minor (helps w adduction and external rotation) Subscapularis (helps w adduction and internal rotation)

Rotator cuff muscles actions?

*Lungs* infected with ... Cryptococcus neoformans

Route of *opportunistic yeast infection in HIV* patient w headache & fever?

Infected stool (uncooked pork) Neurocysticercosis

Route of infection for immunocompetent Central/South American patient with... seizures and cystic lesions?

S4 is a low frequency sound heard at the end of diastole just before S1. It's due to *decreased left ventricular compliance* is often associated with restrive cardiomyopathy and left ventricular hypertrophy

S4 heart sound definition?

Plasmodium falciparum

SCT patients have protection from what?

*Initiation of transcription*. Highly conserved sequence that promotes transcritpion in euk. TATA is a second promoter region. CAAT + TATA boxes promote initiation of transcription by acting as binding sites for transcirption factors and RNA polymerase II.

Schematic representation of the gene and transcribed RNA shown. Arrow pointing to CAAT. What is the function of this base sequence?

Simple partial

Seizure w/o loss of consciousness or postictal state and contains motor, sensory, autonomic, or psychic symptoms?

Dopamine Agonist: Bromocriptine (ergot), Pramipexole & Ropinirole (nonergot).

Tx for Parkinson's w long 1/2 life and delays need for levodopa?

D-penicillamine

Tx for Wilson disease (hepatolenticular generation)?

Benzodiazepines

Tx for alcohol withdrawal?

Lack peptidoglycan cell walls. Tx Antiribosomal (tetracyclines, macrolides)

Tx for bacteria resistant to drug that inhibits bacterial glycosyltransferase enzyme?

Antibiotics for Whipple disease

Tx for disease that involves small intestine, joints, and CNS?

Central antimuscarinic agents (trihexyphenidyl, benztropine)

Tx for drug-induced parkinsonism?

Nonspecific 𝝱-adrenergic antagonist, propranolol

Tx for essential tremor?

Clindamycin coveres anerobic & aerobic infections

Tx for lung abscesses in alcoholics?

Thiazide (hydrochlorothiazide) diuretics > ↑Ca reabsorption

Tx for patient w hypercalciuria causing nephrolithiasis?

Restricted H2O intake Primary (psychogenic) polydipsia

Tx for patient with hyponatremia and low urine osmolality?

Cephalosporin (3rd Gen) + Azithromycin or Doxycycline

Tx for pelvic inflammatory disease (C trachomatis/N gonorrheae)?

Inhaled corticosteroids (Fluticasone)

Tx for persistent chronic asthma that can reduce # and severity of acute asthma exacerbations?

Nimodipine, selective Ca2+ channel blocker, for vasospasm (major cause of morbidity and mortality)

Tx for possible AE 4-12 days after subsrachnoid hemorrhage?

Muscarinin agonist (bethanechol) or 𝜶1 blocker

Tx for postoperative urinary retention (incomplete bladder emptying)?

Topical Vitamin D analog (calcipotriene, calcitriol, and tacalcitol) bind to the Vit D receptor and inhibit keratinocyte proliferation and *stimulate keratinocyte differentiation*

Tx for psoriasis that acitvates a nuclear transcription factor. What drug is likely prescribed?

Short-acting (triazolam) or immediate-acting (lorazepan) benzodiazepines (minimize daytime AE)

Tx for significant increase in insomnia/anxiety during initiation period of SSRI?

Behavioral therapy, possible short-acting benzos

Tx for specific phobia?

Broad-Spectrum Ab (LLTV)

Tx for tonic-clonic and myoclonic seizures?

2nd Gen antihistamines (loratadine, cetirizine)

Tx for urticaria in elderly patient?

𝝱2-adrenergic agonists > ↑ intracellular [ cAMP ]

Tx in pt w acute obstructive pulmonary exacerbations?

Clindamycin or Metronidazole

Tx of Gardnerella vaginalis causing Bacterial vaginosis?

Later time in private. No violation patient privacy (not even acknowledging patient had procedure in public)

Where should conversations regarding patients be conducted?

*Trimethopim, methotrexate, and pyrimethamine*. Trimethoprime resticts bacterial growth, works well in conjunction w sulfonamide, structual analog of *PABA* (an enzyme needed for dihydrofolic acid synthesis, intermediate step in formation of THF).

Which 3 dugs will *inhibit dihydrofolate reductase*? Which particularly restricts bacterial growth through this process?

Third aortic arch (CN IX)

Which arch forms the common and proximal carotid arteries?

Sirolimus.

Which drug blocks interleukin-2 signal transduction?

*Cromolyn and nedocromil*: mast cell stabilizers. Less effective than inhaled glucocorticoids and are considered 2nd line treatment of allergic rhinitis and broncial asthma.

Which drugs inhibit mast cell degranulation independent of the triggering stimulus?

Transaldolase Transketolase

Which enzymes convert fructose-6-P to ribose-5-P?

Hepatitis A

Which hepatitis virus is transmitted fecal-oral via food (shellfish)?

Posture Skeletal Muscles (Soleus & Paraspinal m.)

Which muscles contain Type I slow twitch, red muscle fibers that get ATP from oxidative (aerobic) metabolism?

Kidneys

Which organ will increase hematocrit via erythropoeitin in setting of hypoxia?

Eccrine sweat glands and adrenal medullae, inn by cholinergic neurons like PNS

Which organs are exceptions from the SNS using cholinergic preganglionic and adrenal postganglionic neurons?

Large veins most susceptible

Which vessels are most suceptible to nitrates (venodilators)?

Malabroption of fat-soluble Vit K

Why are cystic fibrosis infants at ↑risk of severe bleeding?

CNS recruits phagocytes more slowly, myeline debris persists for years, which suppresses axonal growth (PNS clears quickly)

Why does Wallerian degeneration not occur in the CNS?

Adenosine

*PSVT treatment* that can cause flushing/hypotension, bronchospasm, High-grade AV block?

14: 103024612

14: 103024613

49: 5/29, 105807914

49: 5/29, 105807915

4: 100813337

4: 100813338

Varenicline

Drug that partially stimulates the 𝜶4𝝱2 nicotinic Ach receptor reducing nicotine withdrawl?

Ipratropium

Drug that prevents bronchoconstriction via blocked Ach and muscarinic receptors?

*Antagonize muscarinic* receptors (M3) on smooth muscle cells in bladder

MOA for tx of urinary incontience?

Pseudomonas Aeruginosa

Most common cause of malignant Otitis Externa?

Minimal Change Disease (Nephrotic)

Most common childhood nephrotic syndrome (edema, hyperlipidemia)?

↓ERV, ↓FRC Restrictive disease

Most common indicator of obesity-related lung disease?

Hyponatremia, gram stain shows manh neutrophils but few/0 organisms (intracellular bacillus)

Most common laboratory abnormality seen with Legionella pneumonia?

Subarachnoid Villi *****(from Mening inf causing Comm. Hydrocephalus)

Most common location of dysfunction/obliteration that leads to symmetrical enlargement of ventriculi?

*Meningo*encephalitis Cryptococcus neoformans

Most common presentation of budding yeast with thick capsules?

Mandibular CN V Temperomandibular disorder

Nerve that supplies pain sensation from TMJ?

Caudate Nucleus Putamen

Neuronal loss location w progressive dementia and choreiform movements (Huntington Disease)?

SA: ≥75% of lumen obstructed A: <75%

Plaques associated w stable angina vs. asymptomatic?

RET

Sporadic and familial medullary thyroid cancers are associated w mustations in what proto-oncogene?

Colitis: Younger, Flat (nonpolyploid) lesion, Proximal > distal, *Multifocal*, Mucinous, early p53. Sporadic: Older, polyploid, distal > proximal, singular, rarely mucinous (well diff), early APC.

Sporadic colorectal carcinoa vs Colitis-associated colorectal cancer.

Denial, Anger, Bargaining, Depression, Acceptance

Stages of grief (DABDA)?

Analysis of variance (ANOVA) compares difference between means of 2+ groups

Statistical method to compare lab values between groups for specific variable?

degrade excess & detoxify dietary tyramine

Step of monoamine neurotransmission affected by MOAi?

No erythrocytes/leukocytes

Stool microscopy in setting of Vibrio cholerae toxin-mediated watery diarrhea?

Myotonic dystrophy (T1 most affected)

Striated muscle contraction (myotonia) along with weakness and atrophy, inability to release doorknob, and *cataracts* dx?

HBeAg

Strongest risk factor for infant infection and most likely HBV lab result in neonate?

*Nucleolus* is a dense intranuclear body function as the primary site of ribosome synthesis and assembly. *All ribosomal RNA except 5S rRNA is transcribed here.*

Structual *RNA for non-coding RNA molecules* are primarily synthesized in what intracellular site?

Lung pleura > Tension Pneumothorax

Structure injured in stab wound between midclavicular and lateral sternal lines above clavicle?

Descending thoracic aorta

Structure posterior to the esophagus?

Proximal: mucociliated cuboidal/club Distal: alveolar macrophage

Structure that clears particles proximal bronchioles vs. distal terminal bronchioles?

Left Kidney

Structure that lie immediately deep to the tip of the 12th rib?

Population: Ecology study vs. Individuals: Case-control, Cohort, Cross-sectional

Study description in which unit of analysis is populations vs. individuals?

Cross-sectional "snapshot" study

Study type in which exposure and outcome are measured simultaneously at a particular point in time?

DNA-binding proteins (*c-Jun*) Southwestern blotting

Substance detected using blotting technique and dsDNA probe?

NAD+

Substance produced via *lactate dehydrogenase* that is necessary for anaerobic glycolysis in skeletal muscles?

Ca2+

Substance that *activates phosphorylase kinase*, stimulating glycogen phosphorylase to ↑glycogenolysis during active skeletal muscle contraction?

ATP closes K channels > depolarization

Substance that binds directly to K channels on Pancreatic Beta cells to alter activity?

Cytochrome P450 monooxygenase

Substance that metabolizes pro-carcinogens (benz(o)pyrene) into carcinogens?

Vancomycin

Substitution of D-lactate in place of D-alanine during peptidoglycan cell was synthesis prevents what drug from binding?

LV free wall rupture (slit-like tear)

Sudden onset of chest pain/shock 5-14 days after MI ?

*Adenovirus* Year-round outbreaks in crowded areas (day care, dorms, military)

Summer camp, erythematous oropharynx w bilateral conjuntival injection and serous discharge, causal organism?

Superficial: Extra abdominal oblique aponeurosis, *************T: deep inguinal rings

Superficial and deep inguinal rings are openings of what structures?

Cancer, esp adenocarcinomas of pancreas, colon, or lung (hypercoagulability due to production of thrombo-plastin like substance)

Superficial venous thromboses appearing/disappearing at different sites (migratory thrombophlebitis) should raise suspicion for what?

CN 3, CN V1 (sens, corneal reflex), CN 4, CN 6, superior opthalmic vein

Superior Orbital Fissue Contents

Uridine for Orotic aciduria

Supplementation for child w physical and mental retardation, megaloblastic anemia, and large amounts of urinary orotic acid?

L cirucmflex Artery vs. R coronary Artery

Suppliers of the AV node in L vs. R dominant heart?

Multiple Endocrine Neoplasia Type 1

Tumors of the pituitary, parathyroid gland and pancreas is indicative of what syndrome?

Sulfonylurea meds Insuilinoma

Two causes of elevated endogenous insulin?

Shiga-like in Shigella dysenteriae and E. coli

Two orgnaisms that produce toxin that inhibits the 60S subunit, preventing tRNA bind/protein synthesis?

Late distal tubule Cortical collecting duct

Two sites of action for K+ sparing diuretics?

Giardia lamblia, tx w Metronidazole

Tx MC enteric parasite in US/Canada, cause of diarrhea in campers/hikers?

Cholinomimetics.

Tx class indicated in (non-obstructive) *urinary retention*, paralytic ileus, glaucoma?

SSRI (fluoxetine)

Tx for Bulimia nervosa?

Ondansetron (inhibit serotonin receptors)

Tx for N/V following chemotherapy?

Testes: Para-aortic lymph nodes. Scrotum: superficial inguinal lymph nodes

Where does lymph from the testes drain?

*Sixth aortic arch*. Patent Ductus Arteriosis

"Machinery-like" murmur and palpable thrill over the left infraclavicular region, what is the derivature of the structue causing pathology?

*Oxaloacetate → phosphoenolpyruvate*. After 12-18 hrs of fast, *gluconeogenesis is prime source*. Must bypass hexokinase, PFK, and pyruvate kinase (all are unidirectional). Initial steps *Pyruvate→(pyruvate carboxylase)→oxaloacetate→(PEP carboxykinase)→PEP*

*30 hr fast*. Glucose is 78 mg/dL. Which *biochemical rxm* is most likely responsible for *maintaining blood glucose levels*?

Baclofen

*Agonist at the GABA-B receptor* used for spasticity-related complications due to MS?

*Echinocandins (Capsofungin, micafungin).* Mitosis: Griseofulvin. DNA/RNA synthesis: Flucytosine.

*Antifungal* medications that *inhibit synthesis of polysaccharide glucan*?

Hemosiderosis Paroxysmal Nocturnal Hemoglobinura

*Chronic* effects of hemoglobinuria, pancytopenia, multi-site thrombosis?

*Tryptophan* is precursor for serotonin. Any drug that increases serotonin levels, including combinations of SSRIs and MAO inhibitors and high doses of SSRIs, can precipitate Serotonin Syndrome.

*Confusion, agitation, tremor, tachycardia, HTN, clonus, hyperreflexia, hyperthermia, and diaphoresis*. Patient was extremely sad and was found with an *empty bottle for pills*. ↑ CNS activity caused by what type of *amino acid derivative* was likely respsonsible for this patient's condition?

*Pancreatic insufficiency* due to pancreative duct obstruction and distension due to the viscous mucus and subsequent inflammation > eventually leads to fibrosis. Inability to absorb fats and fat-soluble vitamins > *steatorrhea and failture to thrive*. PI patients require pancreative enzyme supplementation.

*Cystic fibrosis* patient. (thick, dehydrated, and viscous mucus), recurrent sinopulmnoary infections and congenital absence of the vas deferens. What is the *MC GI manifestation*?

Ribosylation of EF-2 > *halts protein synthesis*

*Diptheria's toxin* causes what biochemical action?

*Multiple Myeloma*. Myeloma cast nephropathy due to excess excretion of free light chains (Bench Jones proteins). Tubular obstruction and epithelial injury.

*Easy faitgability, constipation, back pain, elevated serum protein*, and azotemia in an elderly patient. Renal biopsy shows atrophic tubules, many w large, obstructing, intensely eosinophillic casts. What is likely dx?

Glucokinase (heterozygous) > ↓𝝱 glucose metabolism > ↓ATP > ↓insulin secretion

*Enzyme disfunction* causing maturity-onset diabetes of the young that worsens with pregnancy-induced insulin resistance?

Exits: stylomastoid foramen. Travels through: parotid gland

*Facial Nerve pathway* exits from where and travels through what?

*Cefuroxime*. Penicillins, cephalosporins, vancomycin - *disrupt the peptidoglycan cell wall of Gram+/-* organisms and can *survive osmotic stress*. This ability is lost after treatement w antibiotic agents.

*Gram+ bacteria* isolated assume a spherical configuration when in isotonic solution and *disintegrate rapidly when placed in hypotonic solution*. Which antibiotic was likely used in the experiment?

*Pyrimethamine and sulfadizine* for *Toxoplasma gondii.* Cat is definitive host, ingestion of *food or water w cat feces or undercooked meat*. Second dx based on symptoms - CNS lymphoma.

*HIV patient. Multiple ring-enhancing lesions with mass effect*. Presents w *new-onset tonic-clinic seizures*. Not taking meds. Sleepy, weak, loss of appetite for 2 wks. *Treatment*?

*B lymphocytes*. Lack of improvement after starting therapy for Toxo means further evaluation is needed. T-lymphocytes are malignant cells in AIDS associated T-cell lymphoma.

*HIV* patient, noncompliant w meds, has *ring-enhancing lesions in frontal lobe. Not responding to tx with pyrimethamine and sulfadizine*. Serology and PCR neg for Toxo. *Epstein-Barr virus is positive*. Tissue biopsy from the frontal lobe lesions would show *abnormal population of what type of cells*?

Dihydropyridine Ca2+ block (amlodipine, nifedipine)

*HTN treatment* that can cause peripheral edema HA flushing and dizziness?

Raltegravir

*Integrase inhibitor* > disrupts HIV genome integration > prevents synthesis of vial RNA?

*Campylobacter jejuni* transmitted domestic animals ato humans. Inflammatory diarrhea (intially watery, later bloody). Abdominal cramping, tenesmus and leukocytes in stool. Mimics *appendicitis*. Associated w GBS.

*MC cause of acute gastroenteritis in child and adults* in industrilized countries. Transmitted via *fecal-oral route*. Pet puppy had diarrhea a week ago. What *organism* is likely the cause of his symptoms?

*Malassezia globosa* forms spores and hyphae, producing a 'spaghetti and meatballs' on KOH.

*Pityriasis versicolor (tinea versicolor)* causes erythematous, hyper- or hypopigmented macules and patches. It is associated with what *pathogen*?

*Phase 0* Class 1C Blocks fast Na+ channels

*Portion of action potential* affected by drug that causes QRS prolongation ↑QT interval duration?

Na/K ATPas, the H/K ATPase, and the Ca ATPase

*Primary active transport*, the carrier molecules are enzymes that hydrolyze ATP (ATPases) and use the energy released to transport ions and molecules against their concentration gradients. *What are some examples*?

Splenomegaly, RBC hemolysis

*Pyruvate kinase deficiency* would cause what PE findings?

N meningitidis. Antibodies against the *polysaccharide capsule* confer immunity. Quadrivalent conjugate vaccine: capsular polysaccharide antigens (from major serotypes - A, C, Y, W). Serogroup B vaccine: use recombinant proteins.

*Rapid onset HA, fever, altered mental status, nuchal rigidity, and purpuric rash*. 22 yo exchanged student. Leucocyte count is elevated, and lumber puncture is performed. Gram stain establishes diagnosis. What is a component of the vaccine that could have prevneted this patient's current condition?

Protein A > binds Fc portion of IgG > impaired opsonization and phagocytosis.

*S. aureus* virulence factor that causes *skin and soft tissue infection*?

Due to accessory pathways that bypasses the AV node and directly connects the atria and ventricles. *Wolf-Parkinson-White*. *Triad: Short PR interval, Widened QRS interval, slurred & broad upstroke of QRS (delta waves)*

*Short PR* interval, slurred initial upstroke of the QRS complex (*delta wave*), and *widering of the QRS complex*. What is dx/pathophys?

ototoxicity (hearing loss, tinnitus) nephrotoxicity

*Side effects of aminoglycoside* used to treat enterococcal endocarditis?

Annular ligament in Radial head subluxaton

*Structure injured* with sudden traction on the outstretched and pronated arm of child?

*Bilateral nodular hyperplasia* of Zona Glomerulosa causing Primary Hyperaldosteronism

*Structure* that has overactivity with presenting symptoms of... Hypertension ↓plasma renin activity, hypokalemia, metabolic alkalosis?

Oxidation (iodide) Iodination (thyroglobulin) Coupling reaction

*Thyroid peroxidase* catalyzes what reactions?

Panic disorder

*Unexpected* anxiety attacks w abrupt surge of fear accomplanied by physical and cognitive symptoms dx?

Opsonization resistance Salmonella

*Virulence* for Non-lactose fermenting, Oxidase(-), motile Gram(-) cause of *osteolmyelitis in SCD*?

*Secretory IgA production. Giardia lamblia*: intestinal flagellate that induces a mucossal inflammatory response . Major immune response is *CD4+ T helper cells and secretory IgA* - binds trophozoites and impair adherence to upper small-bowel mucosa.

*Watery diarrhea, n/v. Ab failed to improve* diarrhea. 15 lb weight loss. Stool microscopy for *ova and parasites show: pear-shaped organisms w 2 nuclei*. Impairment of which *defense mechanisms would predispose* the patient this condition?

*Interstitial myocardial granulomas* (Aschoff bodies) found on Histo. Present in carditis due to *acute rheumatic fever*, develops after an *untreated group A streptococcal pharyngeal infection*.

10 yo boy, tachypnea, tachycardia, hypotension. New holosystolic murmur. What preceded this patient's current condition?

*Increased release of IGF-1 from the liver*

10 yo boy, tall for age and sweats a lot (Giganticism), causal agent?

10: 101286128

10: 101286129

11: 102925567

11: 102925568

Defect in *cystathionine synthase* → inability to form cystein from homocystiein → (HOMOCYSTINURIA). *Cysteine* essential in pt due to homocystein buildup → ↑↑methionine. Homocystein is prothrombic reuslting in premature thromboembolic events.

12 yo boy w intermittent substernal chest pain. P 132 R 24, Tropinin is elevated, STEMI, increased serum concentration of methionine. *Which AA is most likely essential in this patient?*

*Pancarditis. Acute Rheumatic Fever*: 1-4 wks after Group A streptococcal pharygytisi. Clin: migratory artritis, fever, +Anti-strep titer. Mol mem: anti-strep Ab attack cardio and neural antigens. Prevent via promp tx of strep pharyngitis w penicillin.

12 yo w swelling & pain of elbows, knees. Febrile, P 110. New *holosystolic murmur, Antistreptolysin O* titers higher than normal. During hospitalization, she is at *greatest risk of dying from what*?

Description of pulsus paradoxus. ↓in SBP > 10mmHg with inspiration.

120mmHg - Korotkoff sounds in exp only. 100mmHg-K sounds throughout respiratory cycle.

12: 102954091

12: 102954092

Thyroid gland is formed from invagination of the *pharyngeal epithelium* and descends to the lower neck. *Due to failure of migration*, the thyroid can reside anywhere along the thyroglossal duct's usual path, incluing the tongue (lingual thyroid).

13 yo boy w progressive *difficulty breathing*, hoarseness, and dysphagia Symptoms began insidiously. Oropharyngeal exam shows large, red lingual mass. Patient undergoes excision and the *recovered tissue is thyroid tisue*. Failure of what *embryologic proces is most responsible for this patient's lesion*?

13: 102996857

13: 102996858

Cystic Fibrosis, causes steatorrhea and failure to thrive due to malabsorption secondary to pancreatic insufficiency, which can be corrected by pancreatic enzyme supplementation (*Pancreatic lipase*).

14 yo boy chronic diarrhea and failure to gain weight. Hx of recurrent infections (one of which was Pseudomonas aeruginosa). What agent will improve this patient's condition long term?

*Absece of GnRH secretory neurons in hypothalamus*. *Kallmann*: due to defective migration of GnRH-secreting neurons from the olfactory placode (outside CNS).

14 yo w central hypogonadism and anosmia, also delayed puberty (secondary sexual characteristics). What pathway is defective in this patient?

Glycogen is source of glucose during fasting & can be mobilized during muscle use. *Myophosphorylase deficiency* (McArdle disease/glycogen storage disease V) causes muscle glycogenolysis to fail > myoglobinuria, muscle pain, craming, decreased tolerance.

15 yo boy with poor exercise tolerance. Severe muscle cramping and urine discololration after intense training. His tolerance improves with oral glucose. Patient is most likely deficient in which enzyme?

15: 103061827

15: 103061828

16: 103086713

16: 103086714

*Bicupsid Aortic Valve-Turner Syndrome*: streak ovaries, amenorrhea, and infertility. Short stature, webbed neck, shield chest, and low posterior hairline. Bicupsid is MC cardiac anomaly.

17 yo girl autopsy. Ovaries small and underdeveloped, *ovaries composed of CT w/o follicles*. What additional *abnormality* is likely to be found on *postmortem examination*?

17: 103157352

17: 103157353

UV exposure creates thymine dimers > *Endonuclear recognizes deformed helix and nicks the damaged DNA strand* on both sides of the pyrimidine dimer > Damaged DNA is discarded > synthesis of replacement segment (DNA polymerase) > Remaining gap is sealed (DNA ligase)

18 yo w painful erythema affecting his extremities, trunk, and face. Recent vacation in Florida. What is most likely to happen within the patient's skin cells as a result of his exposure?

*Fabry disease, 𝜶-galactosidase A deficiency causes accumulation of sphingolipid globotriaosylceramide.* Early presentation aformentioned. Glomerular (proteinura, *renal failure*), cardiac (LVH), and cerebrovascular (transient ischemic attach, stroke) complications develop in adulthood.

18 yo. Skin rash. *Neuropathic pain* (burning sensation in palms and soles exacerbated by stress and fatigue) and *angiokeratomas* (non-blanching red papules in gluteal, inguinal and umbilical areas). *Undetectable levels of 𝜶-galactosidase A*. What condition would this patient be at risk for developing?

18: 103207005

18: 103207006

*D-alanine-D-alanine* Chancre due to primary syphilis caused by spirochete, Treponema pallidum. Spirochetes sens to penicillin bc *Gram-w pep wall. Pencillins inhibit transpeptidase (cross-liks ala-ala)*. Weakned wall - osmotic lysis. *Vancomysin: directly binds* D-alanine-D-alanine.

19 yo w *indurated and painless glans penis ulcer*. No erythema or inguinal LAD. Noticed 3 days ago. *Frist-line tx has structual similarties to what*?

*Wrist extension*. Lateral epicondulitis (tennis elbow) due to overuse of the extensor *carpi radialis brevis*. Results in angiofibroblastic tendontiis at its origin on lateral epicondyle.

19 yo w tendon injury and left elbow pain. Picture pointing to *lateral epicondyle* as site for glucocorticoid injection. What are actions of affected muscles?

19: 103261033

19: 103261034

1: 100693074

1: 100693075

*DNA virus, double-stranded, enveloped*. Primary *HSV-1* infection in children causes gingivostomatitis (vesicular lesions on the lips and hard palage). All herpes viruses have the bolded criteria. Multinucleated giant cells visible on Tzank smear.

2 yo, swollen gums & vesciular, inflamed lesion on hard palate & lips. Enlarged/tender cervical lymph nodes. What is most likely responsible for the patient's condition?

20: 103475284

20: 103475285

21: 103509574

21: 103509575

*Mother- Polyarthralgia, Infant - deafness*. Maternal rubella infection, no vaccination to MMR (lowgrade fever, maculopapular rash w cephalocaudal progression & post auricular or suboccipital LAD. Adult: polyarthralgia & polyarthritis as sequalae. Congenital rubella syndrome (sensorineural deadness, cataracts, and PDA)

22 yo Middle E immigrant. Low-grade fever & *maculopapular rash that spreads (face, chest, trunk)* over 48 hrs. Postauricular LAD. What are mother and fetus at risk of developing?

*Porphyria cutanea tarda (PCT)* MC disorder of porphyrin (heme) synthesis. *Uroporphyrinogen decarboxylase deficiency*. Photosensitivity presents as vesicle and blister formation on sun-exposed areas. Early step defects → abd pain + neuropsychaitric probs W/O photosensitivity. Late step defects → photosensitiviy, due to accumulation of porphyrinogens. (P. 9)

22 yo w *recurrent blistering on his hands and forearms for several years. Heal w hyperpigmentation after rupturing*. Drinks 2-3 cans of beer daily. PE: vesicles and erosions on dorsum of hands.. What *enzyme is deficienct* in this patient?

*Fibrin platelet aggregates*. Viridans streptocci- normal inhabitants of the oral cavity, common infection after dental work. In patients w pre-existing valvular lesions, viridans streptoccoi can adhere to fibrin-platelet aggregates and establish infection that leads to endocarditis.

22 yo, routine dental celaning last wk. Hx of mitral valve prelapse. Temp 100.8. Non-ejection, mid-systolic click followed by a late systolic murmur heard at cardiac apex. Blood cultures are gram+ that synthesize *dextrans from sucrosis*. What is the most likely *adherance site for these bacteria*?

22: 103701929

22: 103701930

*Bone and dura matter*. Middle meningeal artery. *Subdural biconvex hematoma*. Subdural gradual onset of HA and confusion. Subarachnoid hemorrhage will cause severe HA, worst of life, fever, nuchal rigidity.

23 yo in MVA. *Lucid interval following by a loss of consciousness*. Patient's symptoms mean blood most likely accumulated between which two layers?

HbeAg (soluble proteinmarker of viral replication & increased infectivity). HBsAg (first marker detected after inoculation, entire symptomatic phase of acute). Immunize child at birth w HBIG, followed by HBV vaccine.

23 yo pregnanct female w chronic viral hepatitis B on liver biopsy. Which serologic marker most increases the liklihood of vertical transmission of virus to fetus?

Hypertrophic Cardiomyopathy avoid: *Vasodilators* (dihydropyridine Ca2+ channel block, nitroglycerin, ACE inhbits) > ↓ systemic vascular resistance > ↓ afterload and lower LV volumes. *Diuretics* > ↓ LV venous filling (preload) > ↑outflow obstruction. *Goal is to reduce LVOT obstruction*.

23 yo w hx of sudden death in uncle. Chest discomfort, crescendo-decrescendo systolic murmur at apex and L sternal border while supine that is pronounced when he stands. What medication should be avoided while treating this patient's condition?

Phenytoin metabolism depends on hepatic P450 oxidases. Drugs that inhibit hepatic microsomal enzymes (*phenobarbital, carbamazapine and rifampin*) enahnce metabolism and decrease [serum].

23 yo w tonic-clonic seizure. Hx of seizures that she takes phenytoin for. Plasma phenytoin levels are low. What drug may be responsible for the patient's condition if administered w phenytoin?

23: 103731431

23: 103731432

*Enoxaparin: Low Molecular Weight Heparin*. Pt has DVT assoc w ↑venous stasis, endothelial injury, and hypercoagulability assoc w pregnancy. Good Bioavailability, simple mode of adm.

24 yo , *14 wks gestation*. 1+ edema L LE w mild erythema. US shows *L popliteal & femoral vein thrombosis*. Cr 0.7 mg/dL. *Best tx* for patient?

*Respiratory distress*. AR polycystic kidney disease. Most severe if detected prenatally. Potter sequence: falt face,limb deformities, pulmonary hypoplasia.

24 yo at routine US. US reveals bilaterally enlarged fetal kidneys with diffuse small cysts with low amniotic fluid. No other anomalies are seen. What is most likely to be present in the newborn?

*Enlarged ovaries. Polycystic ovary syndrome*: ↑LH levels, excess androgen production, insulin resistance. Clinic: obesity, menstrual irregulatiries, enlarged ovaries (Ovarian dysfxn), hirsuitsm (Androgen excess), ↑risk of DM (Insulin resistance) & endometrial hyperplasia. Tx: weight loss, hormonal contraceptive, metformin.

24 yo infertile female. Irregular menstrual cycles. *BMI 33*. PE: *facial acne and excessive hair growth* on upper lip and chin. What is a likely *pathologic finding on the patient*?

*Sudden standing* in the presence of hypertrophic cardiomyopthy increases preload/afterload. He has dynamic left ventricular outflow obstruction which will vary depending on the LV end-diastolic volume. Mechanisms that ↓ preoload or ↑ afterload reduce the LV sie.

24 yo w harsh systolic ejection murmur. Dies suddently Gross autopsy shows increased thickness of myocardium. What would most likely have increased the intesity of the murmur?

24: 103791181

24: 103791182

*Parvovirus* *Nonenveloped, single-standed DNA virus* increased incidence in child/teachers. Acute, symmetric arthralgia/arthritis involving hands, wrists, kness, and/or fee, with or without rash. Fetal infection can interrupt erythropoiesis > profound anemia > heart failure (pleural effusions, pericardial effusions, and ascites).

25 yo w stillbirth. During pregnancy, had pains in both knees and feet. Fetal autopsy shows pleural effusion, pulmonary hypoplasia, and ascites. Infection with what organism was likley the etiology of the stillbirth?

25: 103820606

25: 103820607

26: 103887833

26: 103887834

27: 103958294

27: 103958295

Endometriosis (or *ectopic endometrium*). Nulliparity, early menarch, and prolonged menses are risk factors. Blood undergoes hemolysis and induces inflammation > adhesions > distorts organ fxn. Adhesions responsible for symtoms.

28 yo nulliparous woman presents w *dysmenorrhea, dyspareunia, and/or infertility*. What does this patient's condition *most likely to involve*?

*Hodgkin lymphoma*. Nontender LAD, systemic B syptoms: fevers, night sweats, weight loss). Cells are *Reed-Sternberg*

28 yo previously healthy. Episodic fevers, night sweats, and weight loss. From kenya. Cervical LAD. Biopsy: Cells with abundant cytoplasm, *bilobed* and inclusion-like eosinophil nuceloli. Dx?

*Seronegative spondyloarthropathies* including ankylosing spondylitis, reactive arthritis, psoritatic arthritis, and arthritis associaed with inflammatory bowel disease. Individuals expression *HLA B27* at increased risk for seronegative spondyloarhropathies. *A specific human leukocyte antigen class I serotype*

28 yo w dull low back pain, morning stiffness. Normal vitals. *Limited anterior flexion of the spine*. No swelling or warmth of peripheral joints. Xray shows *narrowing of the sacroiliac joints*. What is *strongly associated* with this patient's disease?

Dx of panic disorder, key feat is *worrying about additional attacks*, avoidance behavior. Immediate: Benzodiasepines (risk for abuse), Long-term: *SSRI/SNRI* and/or CBT.

28 yo w frequent anxiety attacks. Feels faint, starts to shake and sweat, heart is racing. Most appropiate pharmacotherapy?

28: 103996903

28: 103996904

*Bipolar II* (hypomanic episode, ≥1 major depressive episode). Cyclothymic (≥2 yr fluctuating, mild hypomanic & depressive symptoms). Hypomanic - less severe, no psychosis involvement, lesser degree of functional impairment. Bipolar I (manic episode, depressive common).

29 yo w depression (1 mo), previous similar episodes. Previous weeks when she was confident and optimistic (juggling multiple jobs and getting 3-4 hrs of sleep t night). No excessive drug use. What is dx?

*Human chorionic gonadotropin* is similar to TSH. Testicular germ cell tumors or *gestational trophoblastic disease* can develop high levels, this stimulates TSH receptors and cause a paraneoplastic hyperthyroidism

29 yo w ↑ sweating, heat intolerance, insomnia, unintientional weight loss over 4 wks. P 108. Thyroid is mildly enlarged. *Enlarged, nontender R testicle. ↑thyroxine and triiodothyronine levels*. Hypoechoic mass of R testicle. Elevated levels* of which of the following would explain symptoms?

29: 5/14, 104128248

29: 5/14, 104128249

2: 100748666

2: 100748667

11𝝱-hydroxylase. Converts 11-Docycortisol→Cortisol.

2yo ambiguous genitalia, HTN, hypokalemia. Which enzyme is deficienct?

*GTP* is synthesized by *succinyl-CoA synthetase (succinul-CoA →succinate)*. During gluconeogenesis, PEP carboxy kinase uses GTP (oxaloacete → PEP)

3 day fast, liver synthesizes glucose from alanine, lactate, and glycerol. *PEP forms from oxaloacetate* (requires nucleoside triphosphate as cofactor). Image of citric acid cycle and asked at *which of the reactions was the cofactor* synthesized?

*Ventromedial nucleus (VMN)* is center for satiety. Hypothalamus is key region responsible for homeostasis. Lesions here can cause hyperphagia and obesity.

5 yo boy with persistent food-seeking behavior. Location of brain lesion?

Intestinal atresias: duodenal (failure of recanalization), jejunum/ileum (*vascular injury/occlusion*), colonic (unkonwn). Billous emesis - obstruction below 2nd part of duodenum. Duodenal , spondal configuration known as "apple-peel*.

3 do girl, presents with greenish yellow color of emesis without blood. Normal appearing jejunum and ileum, remainder of the distal ileum winding around a think vascular stalk. What intrauterine process is most likely responsible for this patient's condition?

*Familial retinoblastoma* occurs as a result of mutation of each of the two Rb genes ("two hits"). Patients have an increased risk of secondary tumors, especially *osteosarcomas*.

3 mo w right-sided white pupillary reflex. Father has retinal neoplasm. Child is at greatest risk for developing what type of neoplasm?

Intracranial, GI, cutaneous, umbilical, and surgical bleeding is sign of Neonatal Vit K deficiency. Thus, *impaired clotting factor carboxylation*

3 wk old w/o vaccinations. Large head circumference, bulging anterior fontanel and eyes that are directed downward. Intracranial hemorrhage. Cause?

Septic arthritis due to H influenza, requires both X factor (hematin) and V factor (NAD+) to frow (both found in erythrocytes). *Capsule is virulence that prevents phagocytosis, invades blood vessels and spreads hematogenously*. Ab to type b capsule provide immunity by promoting fixation and opsonization.

3 yo boy, immigrant, hypertensive, tachycardic. Cultures - pleomorphic, gram-negative coccobacilli. In culture with hematin and nicotinamide adenine dinucleotide (NAD+), only grows near disk. Organism responsible has what type of virulence factor?

Nontypeable strains of H influenzae are part of the normal URT flora and common cause of acute otitis media, sinusitis, and bronchitis. *Nontypeable strains do not form a polysaccharide capsule so immunity is not conferred by vaccination.*

3 yo w *acute otitis media, H. influenza positive* culture of otoscopic exudate. Immunizations are up to date. What explains the patient's *suceptibility* to the pathogen causing the current infection?

Fragile X Syndrome: mutation in FMR1 in long arm of X Chr. FMR1 normal: 55 CG trinucleotide repeats. Full mutation >200 CGG trinucleotide repeats, which causes *FMR1 hypermethylation* measured via Southern blot.

3 yo w intellectual diability. Lab shows 226 CGG trinucleotide repeats in gene located on X chromosome. What is the most likely cause of this patient's disease and is the most common inherited cause of diability?

Diabetic ketoacidosis is presenting symptoms. ↑ in ketone production aids the development of Rhizopus bc of its ketone reducatase activity → succeptibility to *mucorpycosis (caused by Mucor or Rhizopus species)*. Presents as rhinocerebral. *Dx w muscle biopsy & characteristic necrotic eschar in the nasal cavity*. Dx mucurmycosis (broad ribbon-like nonseptate hyphae w R-angle branch) from Aspergillus (septate narrow hyphae w sharp-angle branching).

30 yo found unconscious. In ICU. pH 7.1, +serume ketones. Dry mucus membranes. Tx initiated, but then develops fever, HA, and eye pain. PE: *black necrotic eschar adherent to inferior turbinate*. Which procedure would reveal the pathogen responsible for his later symptoms?

*Cavernous hemangiomas*, mulberry-like appearance due to purple vascularture. Recurrent hemorrhages. Neuro deficits/seizures when compress structures → surgical resesction.

30 yo w recurrent generalized tonic-clonic serizure. Lesion has engorged purplish clusters, dilated capillaries and endothelial lining seperatd by thin layer of fibrous CT. Dx?

30: 5/14, 104162311

30: 5/14, 104162312

31: 5/15, 104243502

31: 5/15, 104243503

*Gastrin*: Parietal cells (fundus/body-eosin cytoplasm), secrete HCL & intrinsic factor. Influenced by *histamine, Ach, and gastrin* to ↑gastric acid secretion. Patient has Zollinger-Ellison syndrome w gastrin hypersecretion → PUD & Pchyperplasia.

32 yo f/u on PUD. PPI for months w/o improvement. H. pylori is negative. Parietal cell hyperplasia, causing visible enlargement of gastric folds. What stimuli is most likely cause of the parital cell changes?

*Decreased serum C3 level* Serum sickness is a type III hypersensitivity rxn to nonhuman proteins characterized by vasculitits results from tissue deposition of circulating immune complexes. Clinical findings: fever, pruritic skin rash, arthralgias, and low serum C3/C4.

32 yo man on infliximab for Chron disease. Days later, he has joint pain and pruritic skin rash. Skin biopsy shows fibrinoid necrosis and neutrophill infilration. What additional finding is likely to be found in this patient's condition?

US doppler will demonstrate *continuous blood flow from the higher-pressure aortic root to the lower-pressure right ventricle (L-R cardiac shunt)*. Central aortic pressure is higher than RV pressure during systole and diastole.

32 yo man w IV drug use hx. P 105. Aortic valve endocarditis w intracardiac abscess and *small fistula formation between aortic root and right ventricle*. US of the fistula would reveal *what blood flow pattern*?

Pericardial effusion w cardiac tamponade (**Beck triad**). Pulsus parodoxus - exaggerated drop in systolic blood presssure (>10 mm Hg ) during inspiration. Fluid in pericardum > limits RV expansion (exacerbated during inspiration by ↑venous return > interventricular septum bows > ↓ LV EDV and SV > *↓ systolic pulse pressure during inspiration*.

32 yo w (**HypoTN, ↑ jugular venous pressure, and muffled heart sounds**). Echocardiography shows pericardial fluid accumulation w late diastolic collapse of the right atrium (due to displacement of pericardial fluid w ventricular expansion). What PE will be seen in this pt?

Hepatitis B virus does not have cytotoxic effect itself; however, the presence of viral HBsAg and HBcAg on the cell surface *stimulate the host's cytotoxic CD8 T lymphocytes* to destroy infected hepatocytes. Considered the proliferative phase.

32 yo w anorexia and fatigue has persistently elevated ALT and AST. Also positive for *HBsAg*. What describes the *mechanism of liver injury in this patient*?

32: 5/15, 104267235

32: 5/15, 104267236

*Fusion inhibitors* selectively bind to the HIV envelope transmembrane glycoprotein gp41 prevent the conformational changes necessary for the viral membrane to fuse with the target cellular membrane. En*fu*viritide.

33 yo w HIV started on antiretroviral regimen that includes agent that binds to HIV gp41 protein. The drug directly inhibits what viral process?

33: 5/16, 104346095

33: 5/16, 104346096

*Sacroiliitis*. Reactive arthritis triad: urethritis, conjunctivitis, and mono- or oligoarticular arthritis. Assoc w HLA-B27. Keratoderma blennorrhagicum (vesicles on pals/soles) & cicinate balanitis (annular dermatitis of the glans penis). Sacrolitiis is part of axial involvement.

34 yo man w *urethritis or enteritis*. Treated and symptoms resolve. *2 weeks later conjunctivitis, mono- or oligoarticular arthritis*, and vesicular rash on palms and soles. Condition is most closely *associated with what disease process*?

*LH surge*. *Menotropin* (human menopausal gonadotropin) tx that acts like FSH and triggers formation of dominant ovarian follicle. Ovulation is then induced with hCG which mimics LH surge.

34 yo w PCOS presents w infertility. Has chronic anovulation. Fails to conceive w clomiphene. Given short course of *menotropins w single injection of hCG*. Use of hCG mimics what phys event?

*Papillary cells with fibrovascular core*. Intraductal papilloma: proliferation of papillary cells in a duct or cyst. Blood is from twisting of the vascular stalk of the papilloma in the duct. MC reason for blood discharge.

34 yo w bleeding from right nipple. No palpable masses, skin changes, or enlarged lymph nodes. What is the most likely histopathologic finding on the patient's breast?

*Drooping of the left eyelid (CN III)*. CN II is respsonsible for the afferent limb of the pupillary reflex, and CN III is responsible for the efferent limb. R CN II and R CN III are functional. L CN II is also functional bc of sensensual response. Constriction of the left pupil is not seein in either circumstance.

34 yo w double vision that progressed to frank diplopia. Shining R eye, constricts R, but not left. *Shining in L eye, constricts R, but not L*. What is an *additional physical exam finding* that will likely be seen?

*Bartonella henselae* causes cat-scratch disease, *bacillary angiomatosis* and culture-negative endocarditis. Cat-scratch disease - low fever, LAD, and self-limited course.

34 yo w enlarged, tender axillary lymph node. Scratch marks. Veterinarian. Organism responsible for LAD is associated with which condition?

MC cause of coronary sinus dilation evident on ECG is ↑ R-sided heart pressure secondary to *pulmonary HTN*.

34 yo w fatigue and progressive exertional dyspnea. Normal lung asucultation, *enlarged coronary sinus*. What is an observed finding in this patient?

Mallory-Weiss tear near the gastreoesophageal junction. Results in forceful vomitting, which can cause *metabolic alkalosis*.

34 yo w upper GI bleed. Hx of alcoholism. *Linear mucosal tear at gastroesophageal junciton*. Process directly respsonsible for the patient's mucosal tear will result in what type of *acid-base disturbance*?

34: 5/17, 104468804

34: 5/17, 104468805

B12 def in preexisting autoimmune disease: Pernicious Anemia. CD4+ cell-mediated immune response against parietal cells in body/fundus. *Loss of parietal cell mass*, ↓intrinsic factor, *↓HCl > ↑intraluminal pH > ↑ gastrin secretion by G cells*.

35 yo w malaise/weakness. T1DM and hypothyroidism. *Conjunctival Pallor. MCV 118. Hgb 10. HCT 30. ↓↓B12 level and normal folate*. What will be the set of *physiologic alterations in this patient*?

35: 5/17, 104512610

35: 5/17, 104512611

*Crescent glomerulonephritis*. Granulomatosis with polyangitis (Wedner's) is a cause of rapidly progressive (crescentic) glomerulonephritis (RPGN) type 3 (pauci-immune). Symptoms - signs of upper and lower respiratory tract involvement. Crescents on light microscopy, absence of deposits of IF, and elevated serum c-ANCA are diagnostic.

36 yo hospitalized with hemoptysis, HTN, and hematuria. Alcohol-fixed neutrophils of the patient's serum show indirect immunofluorescence with absence of deposits. What is the most likely dx?

36: 5/18, 104590836

36: 5/18, 104590837

37: 5/14, 104608425

37: 5/14, 104608426

Acute pancreatitis due to a toxic or ischemic injury to the acinar cells > *Premature activation cleavage of trypsinogen to trypsin* inside the pancreatic acini. Trypsin activates other proteolytic enzymes and starts a sef-sustaining cycle of pancreative inflammation and autodigestion with release of enzyme. Severe cases - necrotizing pancreatitis.

38 yo w severe abdominal pain and vomitting. *Pain radiates to the back and improves by bending forward*. Diffuse *pancreative enlargement w areas of necrosis*. Inappropiate activation of what molecule is what most likely initiated this patient's condition?

*Systemic Lupus Erythematosis*. Cardio: accelerated atherosclerosis w ↑MI risk. Verrucous (Libman-Sacks) endocarditis, thickened valve leaflets with small vegetations. Renal: DPG, lesions w cresenct formatio.

38 yo woman collapse w severe chest pain, dies en rought. Autopsy rupture plaque of LAD. *Thickened mitral valve w multiple small vegetations on both valve surfaces* and fibrinoid necrosis of arterioles. Glomerular basement thickening with *wire-loop changes*. Dx?

38: 5/19, 104679799

38: 5/19, 104679800

39: 5/21, 104845377

39: 5/21, 104845378

3: 100793476

3: 100793477

40: 5/21, 104915231

40: 5/21, 104915232

Complete mole class findings: vaginal blebs, hyperemesis gravidarum from ↑↑𝝱-HCG levels. Stimulates overgrowth of thca-letein cysts. Check *𝝱-HCG levels as there is significant risk for malignant transformation* (invasic mole or choriocarcinoma).

41 w positive home urine pregnancy test. Dilation and curettage shows *edematous hydropic villi, appears as "bunch of grapes" as a result of trophoblast proliferation*. Smowstorm pattern. P57 negative. What should be *closely monitored* in this patient after the procedure?

*Acute Myeloid Leukemia*: t(15;17), gene for retinoic acid recepter transferred from Chr17 to Chr 15, where it fused with PML gene. New gene is PML/RAR𝛼. Tx w all-trans-retinoic acid, a Vit A derivative, overcomes and stimulates differentiation of myeloblasts into mature granulocytes.

41 yo epistaxis & gum bleed. Mucosal pallor, cloncal proliferation of WBC w abnormal protein. WBC that *grow in the midst of Vitamin A*. What condition does she have?

41: 5/22, 104973451

41: 5/22, 104973452

56: 6/3, 106322779

56: 6/3, 106322780

*Schistosomiasis* via contact w freshwater sources, contains *snails* infected with Schistosoma larve. S japonicum & S mansoni cause intestinal/hepatic schistosomiasis. S haematobium cause urinary schistosomiasis. Th2 mediated granulomatous response - ulceration/scarring, periportal fibrosis.

42 yo dysuria and hematuria. 2 wks in Africa. US mild bilateral hydronephrosis and bladder wall thickening. What animal caused this infection?

42: 5/23, 105086178

42: 5/23, 105086179

Tx Cytomegalovirus-induced retinitis w *Ganciclovir* (guanine nucleoside analogue, >activity against CMV). Dx: inflammatory vascular sheathing (white portions) + associated hemorrhage (red blobs), MC in AIDs w <50 CD4. Acyclovir for herpes simplex infections.

43 yo HIV+ w progressive visual impairment. CD4 + count: 47cell/𝛍L. Ophthalmoscopic examination in Picture. What is best initial therapy?

*Foscarnet*. Chelates Ca2+, induces renal wasting of magnesium > hypomagnesemia + ↑PTH. Hypocalcemia + Hypomagnesium promots seizures. Foscarnet is analog of *pyrophosphate*. Lamivudine is a nucleoside reverse transcriptase inhibitor, minimal AE.

43 yo woman, lung transplant for cystic fibrosis. 2 episodes of CMV in past few mo treated w ganciclovir. PCR shows elevated CMV levels indicating *ganciclovir-resistant CMV*. She is started on *alternate agent*, but develops *hypocalcemia and hypomagnesemia*. What agent is responsible?

*Fever, anorexia, and dark-colored urine*. Acute hepatitis A infection. Illness is self-limitied.

43 yo. Recent travel to S America. *Liver biopsy shows spotty hepatocyte necrosis and inflammatory cell infiltration* What will be the initial clinical presentaiton of patient?

43: 5/23, 105157210

43: 5/23, 105157211

Chronic alcohlics, frequent deficiency in thiamine: cofactor for pyruvate dehydrogenase, 𝜶-ketoglutarate dehydrogenase, and transketolase. Glucose given to thiamine def patient, depletes thiamine resulting in injury in high metabolic brain regions (*Wernicke encephalopathy*). EtOh met by EtOH & aldehyde dehydrogenase consumes NAD+. *𝜶-Ketoglutarate→(𝜶-Ketoglutarate dehydrogenase complex, thuamine dependent)→Succinyl-CoA*

44 yo homeless, agitation and confused. Tx w *IV dextrose*. Bilateral horizontal nystagmus & ↓ lateral eye movments, unstedy gait. EOM were previously intact. Med Hx shows previous admittance w *alcoholic intoxication*. Which rxn within the citric acid cycle is most likely to be impaired?

Chronic aortic regurgitation, persistent LV volume overload trigger eccentric hypertrophy, causes compensatory increase in SV to maintain CO. Compensatory mechanism allows for a relative long asymptomatic period in most patients; however, LV dysfunction eventually occurs, leading to heart failure. *Increase in LV SV*

44 yo w IV drug use hx. Blood culture + for S. aureus & dx w infective endocarditis. Descescendo diastolic murmur over 3rd L IC space. *Aortic regurgitation* as infection sequalae. Which *change is most responsible for maintaining CO in the setting of the valvular abnormality*?

44: 5/25, 105318820

44: 5/25, 105318821

*Extensive lymphyoyte infilatration and granulomatous destruction of interlobular bile ducts.* Primary Biliary cirrhosis: chronic autoimmune liver disease. Presents insidiously w pruritus and fatigue in middle-aged women. Clinical signs of cholestasis (jaundice, pale stool, dark urine) and hypercholesterolemia (xanthelasma).

45 yo woman with a long history of pruritis and fatigue who has *pale stools and xanthelasma*. Biopsy?

*Ceftriaxone*. Early Lyme: flu-lke symptoms and erythema chronicum migrans. Second Lyme: atrioventricular block & facial palsy. Late Lyme: chronic asymmetric large joint arthritis and encephalopathy. Easily tx w doxycycline or penicillin-type ab.

45 yo. 2 days of left knee swelling and pain. Facial palsy 3 mo ago. 6 mo ago went hiking. Left knee joint swelling w/o erythema. Which of the following might have prevented this patient's knee condition?

45: 5/26, 105400550

45: 5/26, 105400551

QRS complex is normally slightly reduced during exercise in response to ↑ in cardiac conduction velocity. His reponse suggest the drug lengthens the QRS in a rate-dependent manners. *Flecainide- Class 1C antiarrhytmic, bind fast Na channels, prolongs QRS in use-dependent* manner, Na blocks intesifies as HR increases due to less time for meds to dissociate from receptor.

46 yo man w *normal QRS at rest, but prolonged QRS at near-maximal heart rate*. On meds for paroxysmal atrial fibrillation. Based on results, which of the following medications is likely being used to *treat his atrial fibrillation*?

*Aortic regurgitaton*: inability of aortic valve leaflets to effectively close during diastole → regurgitation of blood into LV w ↑ in LV EDV & wall stress. Increase in total SV w abrupt distention & rapid falloff of peripheral arterial pulses, wide pulse pressure. "Blowing" diastolic descrescendo murmor.

46 yo man. Mild dyspnea, heart murmor. Bounding peripheral pulses and head bobbing with each hearteat. Dx?

Subcutaneous nodules are consistent with sporotrichosis, a subcutanous mycosis caused by *Sporothrix schenckii* ( a dimorphic fungus in the natural environment (mold). Enters the body through break in the skin (*thorn prick*). Bipsy shows granuloma.

46 yo w nonpainful skin lesions. No fever, allergies, etc. *Lesions spread along lympatics and are determined to be of fungal etiology*. What scenario most likely lead to this patient's symptoms?

Tricyclic antidepressants (especailly *amitriptyline*) have strong anticholinergic effects.

46 yo woman presenting with *anticholinergic AE* (fever, cutaneous flushing, dry oral mucosa; dilated, poorly reactive pupils and confusion). Has long *psychiatric hx w overdose* in the past. What drug would most likely cause this clinical presentation?

46: 5/26, 105459585

46: 5/26, 105459586

47: 5/29, 105792531

47: 5/29, 105792532

Exercise is assoc w several hemodynamic and vasoregulatory adjustments. Symp discharge contracts arterioles in tissues of muscles, ↑CO & vasoconstriction, only modest increase in mean bp due to vasodilation within skeletal muscle. *Rise in mean arterial pressure is lower due to a decrease in systemic vascular resistance.*

48 yo w T2DM. Retrosternal chest pain. Treadmill stress testing - stops after 7 min due to fatigue. What *parameter was most likely decreased during peak stress compared to the resting state of the patient*?

48: 5/29, 105802009

48: 5/29, 105802010

*Normal behavior* hallucintion of recently deceased relatives in children are part of a normal grief reaction and may not be indicative of major psychiatric illness.

5 yo lost gma 2 months ago. Cried for the first few weeks and asked when she would return. Now talks to an empty chain in her room and says it is her grandmother she is speaking to. What is the dx?

*Tetralogy of Fallot*. Ventricular septal defect, Overriding aorta over the right and left ventricles, *right ventricular outflow tract obstruction (harsh, systolic ejection murmur over mid-left upper sternal border)*, right ventricular hypertrophy. Squatting increases peripheral system vascular resistance.

5 yo w *cyanotic spells that improve with squatting*, prominnent right ventricular impuse, systolic murmur. *Harsh systolic murmur*. What *embryological event caused this condition*?

5/6, 106705427

5/6, 106705428

Insulin resistance in adipose cells hinders the antilipolytic effects of insulin leading to liplysis and release of FFA. *Elevated FFA* contributes to insulin resistance by impairing insulin-dependent glucose uptake and increasing hepatic gluconeogenesis. Acanthosis Nigricans.

50 yo woman w weight gain, hyperpigmentation in skinfolds is noted on the neck. Lab shows elevated fasting blood glucse and A1C of 8%. Fam Hx of T2Dm. Elevated serum levels of which of the following substances is most likely contributing to this patient's disease process?

50: 5/30, 105896551

50: 5/30, 105896552

*Intense lymphoplasmacytic infiltrate with active germinal centers.* Chronic Lymphocytic (Hashimoto) thyroiditis. Symptoms of hypothyroidism w diffuse goider. Female (46-65). *↑Antithyroid peroxidase Ab* levels confirm dx.

51 yo w *fatigue, weight gain, constipation 6 mo.* BP 110/80, P 55. PE: mild, *diffuse enalrgement of the thyroid gland*. *Biopsy* of the thyroid will show what?

51: 5/30, 105914937

51: 5/30, 105914938

52: 5/31, 106058917

52: 5/31, 106058918

*Metastatic liver disease. MC* malignant hepatic leasion is a metastasis from another primary site. Heptocellular carcinoma is diffuse infiltrate (MC in older, hx of cirrhosis, hep B/C, 20x LC than metastasis)

53 yo, worsening *anorexia & abd discomfor*t. 31 lb loss since symptom onset 4 mo ago. PE: *nontender hepatomegaly*. *↑serum alkaline phophastase level*, marginally ↑alanine aminotransferase level. Showed contrast of CT scan (multiple *nodules*). What is most likely dx?

53: 5/31, 106058917

53: 5/31, 106058918

*Colchicine* inhibits tubulin ( a part of the *cytoskeleton*) polymerization into microtubules and used for acute tx and prophylaxis of gout. AE: nausa, abdominal pain, and diarrhea.

54 yo w *gouty arthritis*. Started on a new medication that provides significant relief of his symptoms, but he returns a *wk later w diarrhea and persistent nausea*. The drug used in this patient most likely affects which of the following *cell strucutres*?

Vitamin B12 deficiency includes subacute combined *degeneration of the dorsal colums* (loss of position and vibration sensation, positive Romberg sign) and *lateral corticospinal tracts* (spastic paresis).

54 yo w easy fatigability. Gastrectomy. Shiny tongue and pale palmar creases. Mild symmetrical loss of strength affectiing proximal LE muscles. Hgb 7.2 WBC 3,600. Describe location of lesions present in patient.

*Cell-mediated immunity* (T-cells, macrophages, cytokines) *Listeria monocytogenes*: faculative, intracellular, Gram+ rod w very narrow zone of beta hemolysis. Tumbling motility at room temp and grows in refrig. Patient has imparied cell immunity and is susceptible.

54 yo w fever, chills, and malaise. Dx for Hodkin disease. 103 F, P 114. Blood cultures grow *gram-positive rods* and produce a very narrow zone of beta hemolysis on blood agar. *Bacteria grow well at refrigerated temperature*. What *process is most important for eliminating this type of bacteria from the body*?

54: 6/1, 106137601

54: 6/1, 106137602

Acute Transmural MI due to severe chest pain w lack of relief w drugs. 1. Peaked T waves, 2. Stemi within minutes to hours, 3. Q-waces in hours to days. Most commonly caused by Acute plaque changes (ruputre) which produces a superimposed thrombus that occludes the involved coronary artery. *Rupture atherosclerotic plaque with partically obstructive thrombus*.

55 yo male w severe substernal chest pain, sweating, mild dyspnea, that *does not respond to aspirin or NO*. Hx of HTN, DM, Hyperlipid. ECG: Stemi w deep Q-wave development over hours. Cardiac cathetriztion would show which of the following?

*TNF𝜶 inhibitors impair cell-mediated immunity*, needed for sequestration of mycobacteria within granulomas. Patients should be *evaluated for latent TB*. Etanercept: decoy receptor for TNF𝜶.

55 yo w RA is being considered for *etanercept* treatment. What test should be performed beginning treatment?

Pancreatitis is major risk factor for ARDS. Results in cytokines and pancreatic enzymes in circulation > infiltration of pulmonary interstitium and alveolar spaces > edema, inflamation, and fibrin > waxy *hyaline membranes* on autopsy.

55 yo w severe abdominal pain, n/v. Marked elevation of amylase and lipase, heavy EtOH use. Develops *severe respiratory distress and dies due to progressive respiratory failure*. What is likely to be seen on *autopsy*?

55: 6/1, 106175863

55: 6/1, 106175864

UTI complicated by fever & hemodynamic instablity (sepsis). Rapid-onset respiratory failure is likely Acute Respiratory Distress Syndrome, bilateral pulmonary infiltrates and hypoxemia in absence of heart failure. 3 Phases. 1 - Exudative (*leakage of protein-rich fluid into the alveolar space*). 2 - Proliferative (1-2 wwks form scars, edema resorbed ) 3. Fibrotic (potential fibrosis + Pulm HTN)

56 yo AA woman w hx of HTN w 3 days of dysuria and back pain. T 102. 6, P 120, BP 70/40 R 28. Confused suprapubic + CVAT. Leukocytosis w ↑ neutrophils. 7 hrs later, patient is hypoxic & requires mechanical ventilation. Patient's respiratory symptoms are due to which pathology?

Celiac Artery > Splenic Artery > pancreatic, *short gastric*, and left gastroepiploic a. > spleen. Poor anastomoses > short gastric a supply is vulnerable to ischemic injury following splenic a block.

56 yo w large irregular mass extending posteriorly from the greater curvature of the stomach, impinging on the splenic a/v. *Tissues suplied by which artery will be affected by this compression?*

Hyperacute rejection (Onset: Min - Hr, Preformed Ab aginst graft) *Anti-body mediated hypersensitivity (eg. anti-ABO and anti-HLA)*. Acute (Onset: <6 mo, Exposure to donor antigens induce humoral/cellular activaiton of naïve immune cells). Chronic (Onset: Mo-Yrs, Chornic, lowgrade response refractory to immunosuppressants.

57 yo w AD Polycystic kidney disease > end-stage kindey failure. *Renal allograft transplantation, during operation* the graft becomes *cyanotic and mottled* soon after vessels are connected to the recipient. What *immunologic mechanism* best explain these findings?

*Decreased androgen aromatization*. Aromatase inhibitors (anastrozole, letrozole, exemestane) ↓ synthesis of estrogen from androgens, suppressing estrogen levels and slowing progression of ER+ tumors.

57 yo w breast adenocarcinoma. Estrogen+, HER-2-. Started on *Anastrozole*. What is best explanation of the therapeutic effect of the agent?

*Erythromycin*. Most statins metabolized by cytochrome P-450 3A4, except for pravastatin. Concominant administration of drugs that inhibit statin metabolism (macrolide) is associaed with increased incidence of statin-induced myopathy and rhabdomyolysis. Acute renal failure is sequela of rhabdomyolysis.

57 yo w muscle pain, fatigue and dark urine. Stable angina. Metoprolol, atorvastatin, and aspirin. Lab shows acute renal failure. Addition of what medication likely precipitated the patient's condition?

*Intraalveolar wall destruction*. COPD pic: narrowing of bronchi + ↓lung elasticity from destruction of walls. Ex: Chronic bronchitis and/or emphysema.

57 yo w progressive dyspnea. Respiratory flow-volume curve shows: marked reduction in expiratory flow rates, ↑total lung volume & residual volume. What is most likely to be present in patient?

*Lacunar infarcts* - small ischemic infarcts involving deep brain structure and subcortical white matter. Inolves small penetrating arterioles. Due to chornic HTN which promotes lipohyalinosis, microatheroma formation, and hardening/thickening of vessel wall (*hypertensive arteriolar sclerosis*)

58 yo R-sided weakness. HTN. Decreased strength (3/5) on R side. CT shows no abnormalities. *4 weeks leater, CT shows 9-mm, fluid-filled cavitary lesion in the left internal capsule*. Patient's condition is most likely caused by what?

5: 1008844503

5: 1008844504

*Hyperimmunoglobulin M syndrome (hyper-IgM)*. MC Pathphys: *Defect in CD40 ligand -CD40 interaction* → Unable to splice out DNA coding for heavy chain constant region. X-linked recessive.

6 yo boy w *recurrent sinopulmonary and GI infections* and failure to thrive. Large tonsils, palpable lymph nodes, and HSM. *Defective signaling between activated CD4+ T cells and B lymphocytes. Which immunoglobulin has highest [serum]*?

*Osteoid production by osteoblasts*. Osteogenesis imperfect, *impaired synthesis of type 1 collagen* by osteoblasts. T1Collagen-major collagen in osteoid, allows bone to be flexible while maintaining strength. AD.

6 yo boy, 5 bone *fractures*, 3 after minimal trauma. Small malformed teeth. Image of *blue sclera*. Patient's condition is associated with *impairment of what process*?

*Enterovirus*. Symptoms are indicative of aseptic meningitis. Enterovirus is MC cause. Aseptic is less severe and seizures/altered mental stats is absent. Neg. gram stain & sterile culture confirms aspectic meningitis.

6 yo fever, meningeal signs (eg HA, neck stiffness), CSF w lymphocytic pleocytosis, elevated protein, and normal glucose. Pathogen?

Familial Chylomicronemia Syndrome - AR that is caused by LPL deficiency. Marked triglyceridemia, recurrent *acute pancreatitis*, lipemia retinalis (milk-appearing retinal vasculature), and eruptive xanthomas (extensor surfaces). Tendon xanthomas w HyperCHOLesterolemia.

6 yo, routine blood draw shows milk plasma w creamy-appearing supernatant upon standing. *Lower than normal lipoprotein lipase activity after heparin administration*. If condition is untreated, what *features is he likely to develop*?

6/12, 107494006

6/12, 107494007

6/13, 107609183

6/13, 107609184

6/16, 1078

6/16, 1079

6/16, 107911565

6/16, 107911566

6/16, 107933072

6/16, 107933073

6/16, 107940345

6/16, 107940346

6/3, 106336360

6/3, 106336361

6/3, 106350558 (24)

6/3, 106350558 (24)

6/3, 106376438

6/3, 106376439

6/4, 106479612

6/4, 106479613

6/5, 106616116 (23)

6/5, 106616116 (23)

6/5, 106625363 (23)

6/5, 106625363 (23)

ARB block Angiotensin II typ 1 receptors, inhibiting Angiotensin II. Results in arterial vasodilation and decreased aldosterone secretion. Results in fall in bp that *increases renin, angiotensin, and angiotensin II levels*. ARBs don't affect activity of ACE, and will not affect bradykinin degradation or cause cough.

60 yo man w HTN. Started on lisinopril, had a dry cough. Drug stopped, *losartan* was prescribed. Compared to no treatment at all, what effect will the current therapy have on the *patient's Renin, Angiotensin I, Angiotensin II, Aldosterone, and Bradykinin*?

*Invasive breast carcinoma* typically present as an irregularly shaped adherent breast mass, most commonly in the upper outer quadrant. Malignant infiltration of *suspensory ligaments* of the breast causes dimpling of the overlying skin.

61 yo w skin dimpling on the right breast. Findings are due to malignant infiltration of what structure?

*Papillary thyroid cancer*: most common type . This is typical Histopath. *Glass appearance is the Orphan Annie eye*. Also has psammoma bodies. Anaplastic thyroid cancer is more aggressive, markedly pleomorphic cells, w biphasic spindles

61 yo, neck lump. *Nontender, firm nodule w normal TSH*. Histopath: *large cells w nuclei containing finely dispersed chromatin, resulting in empty or ground-glass appearance, and intranuclear inclusions or grroves*. Most likely dx?

*Joints*. Gout.

Activating mutation involving *phosphoribosyl pyrophosphate synthetase*. What organ is likely to develop a pathology?

*Nifedipine*. Dihydropyridine (nife + amlodipine) affect peripheral arteries cause vasodilation. Nondihydropyridines (verapamil, dilitiazem) affect the myocardium, cause bradycardia & slowed AV conduction. CCB inhibit L-type Ca channel on vascular SM and cardiac cells.

62 yo man - f/u for HTN. Dx 10 years ago, many meds w AE. Currently on remipril & chlorthalidone. ECG: bradychardia w PR interval prolongation (280 sec). What medication would be most effective in lowering BP w/o worsening ECG abnormalities?

Adenocarcinoma in situ: *a malignant neoplasm* . Adenocarcinoma is MC type of lung cancer. Arises from the alveolar epithelium and located at periphery of lung *(charac by growth along intract alveolar septa)*. Tendency to undergo aerogenous spread and can progres to invasive disease if not resected.

62 yo w cough/dyspnea. Pale tan-colored fluid. Histo: *columnar mucin-secreting cells that line alveolar spaces* w/o invading stroma or vessels. Patient's condition is best categorized as what?

Prostatic plexus lies within the fascia of the prostate and innervates the *corpus cavernosa* of penis, which facilities *penile erection*.

62 yo w elevated PSA. Hard *prostate* nodules, biopsy confirms adenocarcinoma. During surgery, *nerves within facia surrounding the gland are injured*. What will be the *consequence of this nerve injury*?

*Atropine* is indicated for bradycardia tx - decreased vagal influence on SA and AV nodes. *Side effect: increased intraocular pressure*. Precipitates acute closed-angle glaucoma in susceptible individuals.

62 yo woman w acute chest pain. *STEMI in inferior leads*. Therapy initiatied, vitals return to normal. Now complains of *severe right-sided eye pain*. What is the most likely cause for the eye pain?

Decreased CO2 reduces renal perfusion, stimulating renin secretion. Renin > A I > *Angiotensin II* in the small pulmonary vessels by endothelial -bound ACE. *Levels of AII will be highter in vein (vasoconstricture) causing a rise in BP.*

63 yo man with CHF. Level of what substance will be higher in the pulmonary vein compared to the pulmonary artery?

****Hypokalemia. Thiazide > ↑aldosterone > ↑excretion of K+/H+ ions

63 yo with muscle cramping and taking *chlorthalidone*, cause of symptoms?

Combined use of *non-dihydropyridine calcium channel blockers (Verapamil, dilitizem) and Beta-adrener blockers ( atenolol)* can have additive negative chronotropic effects yielding severe bradycardia and hypotension.

64 yo w *stable angina* w atenolol and aspirin. Worsened symptoms, another medication is added. Presents to ED w *severe dizziness, bradycardia and hypotension*. What *medication* was likely administered?

*Acute left basal ganglia (putaminal) hemorrhage*. MC affected location is the basal ganglia (putamen), which is supplied by the *lenticulostriate arteries* Normally involves the adjacent internal capsule (*contralateral hemiparesis and hemianesthesia* due to disruption of corticospinal and somatosensory fibers). Hypertensive vasculopathy involving small branches of cerebral arteries is MC cause of *spontaneous deep intracerebral hemorrhage*.

65 yo R side weakness, slurred speech, n/HA. Hx of poorly controlled HTN. R flaccid hemiplegia and lower facial weakness, R hemisensory loss, and dysarthia. *Cerebral blood vessel* affected?

Digoxin toxicity with Gi, Neuro (confusion, weakness), and Cardiac (*life-threatening arrhythmias*)

65 yo man upset stomch, disturbed color perception, anorexia, n/v, and dierrhea. His CHF has been controlled w multiple medication. If symptoms aren't treated, what complication is he most likely to develop?

Dx of Schizo means tx w antiphysycotic meds for many years. Long-term tx w dopamine antagonist mediations → *tardive dyskinesia*. Extrapyramidal syndromes from exposure to dopamine antagonists : acute dystonia, akathisia, and drug-induced parkinsoniasm

65 yo w *facial grimacing, lip smacking*, and twisting movements of her fingers that are worse after emotional stress and fatigue. Prev dx of schizophrenia. She is socially isolated. What is likely dx?

*Pernicious anemia* (LE paresthesias, macrocytic RBCs, and gastric/fundal atrophy, indicating oxynitic gland involvement). Autimmune disorder caused by destruction of *parietal cells* in a histology image highlighting the upper glandular area.

65 yo w *fatigue and LE paresthesias. MCV = 112 fL*. Atrophic mucosa in gastric body and fundus, normal antrum. Destruction of what cell layer is responsible for the patient's symptoms?

*Superior mesenteric artery* and Inf are the 2 main vessels supplying the small and large intestinges. Contain multiple anastomoses.

65 yo with AAA undergoing surgery. In procedure inferior mesenteric artery ligated, collateral circulation via which vessels prevents the descending colon from developing ischemia?

*𝜶1-adrenergic*. Orthostatic (postural) hypotension. Drop in >20 SBP and/or >10 DBP). Standing causes polling of blood in veins below the heart. 𝛼1-adrenergic antagonists used in benign prostatic hyperplasia and often associated.

66 yo mean with episodes of lightheaded ness. BP 120/70 P 70 while supine. BP 90/60 P 97 when standing. Blockade of which receptor is most likely contributing to the patient's current condition?

Clin Pres: Subacute cerebellar degeneration. Small cell lung cancer; breast, ovarian & uterine. Etiology Anti-Yo, AntiP/q & ati-Hu Ab. Paraneoplastic cerebellar degeneration due to an *immune response against tumor cells that cross-reacts w Purkinje neuro antigens* (see etio).

66 yo w *dizziness, dysarthria, and bilateral limb ataxia*. Worsenes over 2 wks. 50 pack yr. *Mass* in R lung. Autopsy shows *extensive cerebellar Purkinje cell degeneration*. What is the etiology of the neurologic condition?

Age-realted macular degeneration - leading cause of blindness (↑age + smoking). *Wet*: (acute, meta, fundo results). Tx w *VEGF inhibitors (ranibizumab, bevacizumab)*. Dry: gradual, drusen deposits (yellow spots). Both stop smoking.

67 yo smoker. Acute vision loss (days to weeks) with *metamorphopsia* (distortion of straight lines). Fundoscopy: *grayish-green subretinal discoloration with adjacent fluid/hemorrhage*. What is specifically targeted in this tx regimen?

*KRAS protein*

Activation mutation in which in what molecule would make anti-EGFR drug therapy inefficient in patient w adenocarcinoma?

PCP (phencyclidine)

Acute drug intoxication w nystagmus and violent behaviors?

Omalizumab (Anti-IgE)

Add-on therapy to ↓ steroid dependency in severe allergic asthmatics?

Chronic Myeloproliferative disorders: Overproduction of myeloid cells. Harbor JAK2 mutation. *Primary Myelofibrosis*: Atypical megakeryocytic hyperplasia > fibroblast proliferation > bone marrow replaced with collagen. CS: pancytopenia, heptao-spleno-megaly due to *extramedullary hematopoiesis*. PBS would show teardrop-shaped RBCs.

67 yo w severe fatigue, weight loss, mucosal pallor, hematomegaly, and massive splenomegaly. *Gain of function mutation* of a non-receptor tyrosine kinase protein in *hematopoietic cells*, persistent activation of signal transducers and activators of STAT proteins. Patient is suffering from what disorder?

Porcelain gallbladder (firm, palpable and lots of calcification) - thickened gallbladder with rim of calcification. Chronic cholecystiasis causes porcelain. Porcelain assoc w ↑ risk of adenocarcinoma of the gallbladder.

68 yo w 8 lb wellness visit. Weight loss, no abd pain, jaundice, stool changes. Past med hx HTN and hypercholesterolemia. Firm mass palpated in RUQ. X-ray showed calcified mass behind liver. Should be evaluated for what condition?

6: 100861131

6: 100861132

Epithelial ovarian cancer is MC ovarian malignancy. Produce *CA-125*, which can be used as a serum marker. Histo is described as the aforementioned.

73 yo w ↑ abdominal girth, right adnexal fullness. Microscope of anaplasia of epithelial cells w invasion into the stroma and multiple papillary formations w cellular atypica. What *marker is most likely to be elevated within this patient*?

Abnormal spasm or diminised relaxation of the cricopharyngeal muscles (*cricopharyngeal motor dysfunction*) is underlying mechanism in *Zenker diverticulum* formation. Increased oropharyngeal intraluminal pressure results in herniation of the pharyngeal mucosa through a zone of muscle weakness (false diverticulum)

74 yo w choking spells, dysphagia, and cough. Recurrent pneumonia. HTN, foul smelling breath. Barium swallow test shows *luminal narrowing caused by extrinsic esophageal compression*. What mechanism is most likely the cause of his symptoms?

*Thiazide diuretics (hydrochlorothiazide, chlorthalidone) increase calcium absorption in DCT*, associated increased bone mineral density and recommend for Tx of HTEN (?) in patients at risk for osteoporosis. Loop diuretics increase urinary calcium loss.

74 yo w left hip pain (shorter and extrenally rotated). Many comorbities, one of which is HTN. Bone density consistent w *osteoporosis*. What *drugs would have had a beneficial effect on calclium homeostasis and reduced this patient's fracture risk*?

*Left gastric* and right gastric arteries run along lesser curvature, likely to be penetrated, cause gastric bleed. Most gatric ulcers on *lesser curve at transitional zone between gastric corpus (body) and antrum*. Ulcers in posterior duodenal bulb erode into the gastroduodenal artery (coming from common hepatic).

75 yo man w *deep peptic ulcer localized on lesser curvature of the stomach*. Acute-onset profuse vomiting of large amounts of bright red blood that leads to death. *Ulcer most likely penetrated* which of the following *arteries*?

*Virion particle release*. *Oseltamivir - neuraminidase inhbitor*, can tx Influenza A & B. *Neuraminidase required for release of virus from infected cells & its spread to resp tract*. Can shorten complications if taken within 48 hrs of symptom onset. Also impairs viral penetration of mucous secretions that overlie the respiratory epithelium.

78 yo : fever, HA, sore through, cough, severe myalgias for 24 hrs. Nasal specimen is positive for *influenza*. Started on *Oseltamivir*. What is most likely *impaired in this patient's infected cells as a result of tx*?

7: 100969489

7: 100969490

*GM(2) ganglioside. Tay-Sachs disease*. Ashkenazi Jews. 𝝱-hexosaminidase A deficiency is responsible for the accumulation. Center fovea *lacks ganglion cells, so choroid transmits red color*. Usually die in 2-5 yrs. Distinguish from Niemann-Pick disease (sphingomyeline accum), will have heptosplenomegaly (Tay Sachs will not)

8 mo girl. Progressive *neurodegeneration, bright red fovea centralis surrounded by white macula*. Startles easily w loud noise, macrocephaly. Irritable, regression of motor skills. Accumulation of what metabolite is present in the tissues?

8: 101044538

8: 101044539

9: 101230750

9: 101230751

Right Ventricle

A penetrating injury at the left sternal border in the 4th IC would puncture what structure?

*Alpha-fetoprotein* is often moderately elevated in patients w chronic viral hepatisis. However, it is strikingly elevated in hepatoceullar carcinoma. Sudden risk could indicate cancer.

A striking elevation in what molecule in the presence of chronic liver disease would indicate the risk for hepatocellular carcinoma?

In life, ADULTS are DOMINANT, BABIES are NOT (recessive)

AD vs. AR polycystic kidney disease?

QT prolong > Torsades de pointes de pointes, bradycardia via Sotalol

AE for 𝝱 block + Class III (K+ channel-block) for tx of atrial fibrillation?

Doxycycline causing teeth staining

AE from first-line therapy of Lyme disease?

Bronchoconstriction

AE of noncardioselective 𝝱-adrenergic receptor blockers?

Slective estrogen receptor modulator. Antagonist estrogenic effect in breast & Agonist effect in endometrium. Risk for endometrial hyperplasia/cancer.

AE of tamoxifen used in estrogen/progesterone +, HER2- breast cancer?

Chronic pulmonary hypertension

ASD can cause what as a result of L→R intracardiac shunting?

Type IV Collagen 𝜶3chain Goodpasture Syndrome

Ab in RPGN (nephritic) and alveolar hemorrhage (dyspnea, hemoptysis)?

Anti-centromere

Ab sepcific for CREST (Calcinosis, Raynaud, Esophageal dysmotility, Sclerodactulu and Telangiectasias)?

Isoniazid structurely similar to pyridoxine (B6)

Ab that causes pyridoxine deficiency leading to defective GABA synthesis?

C5, C6: *Biceps & Brachioredialis.* C7, C8: Triceps reflex. Absent or decreased indicates LMN.

Absent biceps reflex indicates which spinal segments are affected?

I: Thin Filaments bound to Z: Structural Proteins. A: Thick Filaments (length of myosin, does not change w muscle contraction) bound to M: structural protein line. H band is where myosin does not overlap with actin

Define the following segments of sarcomere (H, M, I, Z, A)?

Tabes dorsal due to Neurosyphillus

Degeneration of dorsal columns/roots > loss of prop/vib, lancinating pains, and sensory ataxia along w Argyll Robertson pupils?

Alzheimer's dementia

Dementia associated with 𝝱-amyloid deposits in the brain parenchyma and walls of cerebral vessels (MI risk)?

Amyloidosis, assoc w multiple myeloma

Derived from monoclonal Ig light chains and can form deposits in organs?

Early mature neutrophil precursors and granules in neutrophils

Describe blood smear in patient w benign leukocytosis (>50k) recurring in response to severe infection/hemorrhage, solid tumors, or acute hemolysis?

Margination (vasc leak), rolling (L, E, P, selectin) , activation (integrins), tight adhesion & crawling CD18-ICAM-1), transmigration (PECAM-1)

Describe inflammation in terms of steps MRATT.

Anal fissure, Posterior midline, Distal to dentate line

Describe location for most common site of anal tear due to chronic constipation?

Reduced amplitude below threshold

Describe motor end plate potential in the setting of *myasthenia gravis*?

Lower L sternal border Holosystolic murmur

Describe murmur for small Ventricular Septal Defect?

Bile salts and phosphtidylcholine ↑chol solubility and ↓risk of gallstones

Describe role of bile salts and phosphatidulcholine and the risk of gallstones?

High: Glom/PT/Desc limb. Non: Thick/thin ascend-early DCT. Vary: late DCT - CD.

Describe the permability of different parts of the nephron to water.

↓renal blood flow > tubular epithelial necrosis & acute renal failure

Describe the process of acute Tubular Necrosis?

↑breath urea H+, ↓pH, elevated osmolality

Describe the stool in a lactose intolerant patient?

Parvovirus, Nonenv ssDNA

Description of MC cause of *aplastic crisis in SCD*?

Trabecular thinning with fewer interconnects

Description of osteoportic bone?

Fibrous and granulation tissue

Description of pancreatic pseudocysts caused by complication of pancreatitis?

Right Ventricular Outflow Tract obstruction

Determinant for degree of L-R shunting in Tetralogy of Fallot?

Viral surface proteins that can bind complementary host cell plasma receptors

Determinant of viral tropism depends on what portion of the virus?

Age 3 Fine Motor

Developmental milestone age for circle copying and utensil use?

Cardiac tamponade

Diagnose triad of Hypotension w pulsus paradoxis ↑jugular venous pressure muffled heart sounds (Beck's triad)??

Dihydrobiopterin reductase deficiency

Diagnosis for *hyperphenylalanemia elevated prolactin*?

Portal Vein Thrombosis

Diagnosis for esophageal varices, splenic enlargement, normal liver biopsy?

Gaucer disease

Diagnosis for *𝝱-glucerebrosidase deficiency* with pancytopenia and HSM; histology shows macrophages w "wrinkled tissue paper"?

Large Patent Ductus Arteriosis complicated w Eisenmenger Syndrome

Diagnosis for 10 yo with ... congenital heart disease, presents w heart failure, cyanosis/clubbing of lower extremity with 2+/=/B lower extremity pulses?

Leukocyte adhesion deficiency

Diagnosis for absent CD18 antigens on surface of leukocytes?

Hair cell leukemia (indolent B-cell neoplasm)

Diagnosis for bone marrow failure 'dry tap', massive splenomegaly, lymphocytes and cytoplasmic projections?

Post-streptococcal glomerulonephritis (Subepithelial deposits)

Diagnosis for child with... gross hematuria (tea/cola), hypertension, periorbital edema if urinalysis shows RBC casts and mild proteinuria?

Chediak-Hidashi Syndrome

Diagnosis for disorder of neutrophil phagosome lysosome fusion → neurologic abnormalities, partial albinism, immunodeficiency (↓neutrophil)?

Generalized Anxiety Disorder

Diagnosis for excessive chronic worry over multiple issues lasting ≥ 6 months?

Medulloblastoma

Diagnosis for gait instability, midline posterior fossa mass, biopsy shows primitive cells with many mitotic figures?

Necrotizing enterocolitis

Diagnosis for infant w abdominal distention, blood stools, and air in bowel wall (thin curvilinear areas of lucency)?

Fragile X Syndrome

Diagnosis for large ears, long face, macroorchisism?

PTSD *Prazosin* for nightmares

Diagnosis for nightmares, avoidance and emotional detachment for ≥1 month? How to treat nightmares?

Depersonalization/derealization disorder

Diagnosis for recurrent episodes of feeling detached from body/reality?

Epstein-Barr Virus mononucleosis

Diagnosis for saliva-spread fever, pharyngitis, LAD, splenomegaly, and atypical lymphocytes?

Niemann-Pick disease

Diagnosis for sphingomyelinase deficiency that causes HSM, neuro regression, and cherry-red mac spot in infancy?

Major depressive or bipolar disorder with psychotic features vs. Schizoaffective disorder

Diagnosis for symptoms .... only occurring during mood episodes vs. psychosis in absence of mood episodes, but mood symptoms present for most of illness?

Displacement: transferring feelings to a more acceptable object. Projection: attributing one's own feelings to others (w/o internal conflict in self-expression). Reaction formation: responding in a manner opposite to one's actual feelings. Regression: reverting to an earlier developmental stage (sleeping in bed w parents)

Differentiate between diplacement, projection, reaction formation, and regression.

Coccidioidomycosis

Dimorphic fungus that causes lung disease & appears as thick-walled spherules containg endospores?

Blastomyces dermatitidis

Dimorphic fungus that is a large yeast cell with a single broad-based bud, culture (25C) forms branching hyphae?

Spongiosis in Acute allergic contact dermatitis (T4HS)

Disease associated w accumulation of edema fluid in intercellular spaces of epidermis (define term)?

Meningitis due to Neiseeria meningitidis

Disease association with organism that grows on Thayer-Martin medium?

Cirrhosis

Disease characterized with diffuse hepatic fibrosis w fibrous-lined parenchymal nodules?

Sickle cell anemia

Disease leading to splenic sequestration?

Anaphylaxis

Disease process that consists of IgE receptor on basophils > binds Fc of IgE > cross-links IgE > aggregates > degranulation + release of preformed mediators?

Primary Biliary Cholangitis > Vit A deficiency

Disease responsible for pruritis, night blindness, and hyperkeratosis?

Granulomatous disease ↑VitD →↑Ca2+ Express 1𝜶hydroxylase, PTH unregulated > Ca2+ release

Disease that mimics.. Vitamin-induced weakness, constipation, mental status change, polyuria/polydypsia?

Vit E def, Friedreich ataxia, and B12 def

Diseases w degeneration of spinocerebellar tracts (ataxia), dorsal colums, and DTR loss?

Syringomyelia, CSF cavity (syrinx).

Disproportionate loss of pain and temperature sensation involving arms and hands?

*Attrition bias*, a form of selective bias. Due to the unknown of whether lost subjects would difer in their risk of developing the outcome compared to the remaining subjects. Lead-time bias: increased time from diagnosis to death, dx is earlier than usual.

Disproptionate *loss to f/u* between the exposed and unexposed groups creates the potential for what type of bias?

Myoclonus: shock-like, brief. Dystonia: sustained involuntary contraction

Distinguish myoclonus from dystonia.

****Above (Decorticate) Flexors; Below (Decerebrate) Extensors

Distinguish physical exam findings if injury above red nucleus vs. below red nucleus?

Pyrrolidonyl arylamidase (PYR)+ Streptoccous pyogenes

Distinguishing clinical feature of causal organism for *post-impetigo glomerulonephritis*?

Inferior mesenteric and internal iliac lymph nodes

Drainage location of lymph proximal to the anal dentate line?

*Inhibits DNA Polymerase* Acyclovir Herpes Simplex Virus Encephalitis

Drug Mechanism of action for CSF with... hemorrhagic lymphocytic pleocytosis, ↑protein, norm glucose, MRI signal in bilateral temporal lobes?

Clavulanic acid (𝝱-lactamase inhibitor)

Drug added to amoxicillin therapy to target resistant strains w 𝝱-lactamase activity?

Abacavir

Drug associated with hypersensitivity reaction in patients with *HLA-B*57:01 allele*?

Reducing Na channels ability to recover from inactivation Carbamazepine (SIADH)

Drug mechanism of action for first-line treatment for trigeminal neuralgias that can cause bone marrow suppression?

*Blocks Na+ channels*, ↑recover time, Phenytoin

Drug mechanism of action to present seizure occurrence in status epilepticus?

****Disruption of transmembrane channels

Drug mechanism of action used treat MRSA that can cause ↑CPK levels in patient concurrently taking a statin?

Clozapine

Drug of choice for treatment-resistant schizophrenia?

Rasburicase vs. Allopurinol

Drug that converts/*degrades uric acid* to allantoin (more soluble) vs. drug that *inhibits uric acid formation* during cell lysis in tumor lysis syndrome?

Fibrates (gemfibrozil, fenofibrate)

Drug that activates PPAR-𝜶 > ↓hepatic VLDL production and ↑Lipoprotein lipase activity?

Nitrates

Drug that activates guan cyclase > ↑cGMP > myosin light-chain dephosphorlyation > vascular SM relaxation?

Enoxaprin (LMWH)

Drug that bings to antithrombin II , which binds/inactivates factor Xa?

Proton pump inhibitors (omeprazole, lansoprazole)

Drug that blocks gastric acid secretion from parietal cells (stim. By Ach, histamine, and gastrin)?

Dihydroergotamine

Drug that can induce vasospastic angina in the setting of Prinzmetal angina?

Nimodipine (Ca2+ channel block)

Drug that can prevent cerebral vascular spasm following Subarachnoid Hemorrhage?

Succinylcholine

Drug that causes severe hyperkalemia in at risk patients (burns, myopathies, denervating injuries)?

Enalapril

Drug that causes systemic vasoconstriction, constriction of efferent, ↑adrenal aldosterone?

5-𝜶-reductase inhibitors (Finasteride)

Drug that decrease conversion of testosterone to DHT in the setting of adrogenetic alopecia (male-pattern hair loss)?

Tamoxifen

Drug that inhibits estrogen on breast tissue and reduces gynecomastia in patient on therapy for prostate cancer?

𝝱 blockers (metoprolol) inhibit 𝝱1 receptors

Drug that inhibits renin release from renal juxtoglomerular cells?

(Aortic/Mitral regurgitation, Ischemic heart disease, Dilated cardiomyopathy) Volume Overload > LV cavity enlargement via eccentric (sarcomeres added in parallel) > overhwelming wall stress > *decreased ventricular contractility* w decompensated heart failture (fatigue, dyspnea, orthopnea, peripheral edema.

Fatigue and exertional dyspnea. Dies suddenly. Autopsy shows cardiac eccentric hypertrophy. Symptoms were caused by what mechanism?

Symptoms of hypothyroidism. ↓T4 + ↑TSH + ATPA = *Primary hypothyroidism from Chronic autoimmune (Hashimoto) thyroiditis*. Compensatory *↑ in hypothalamic thyrotropin-release hormone (TRH) → TSH*.

Fatigue, *weight gain, goiter, thinning of outer eyebrow edges*. ↓T4 (thyroxine) ↑TSH + antithyroid peroxidase Ab + prolactin. *Amenorrhea with whitish nipple discharge*. What *mechanism is causing this patien't elevated prolactin level*?

Novobiocin resistant S saprophyticus

Feature of Catalase(+), Gram(+) cocci cause of UTI in sex active ♀?

Partial pressure of O2 (amount dissolved in the blood)

Feature of blood the remains unchanged in the presence of nitrate poisoning?

"germ tubes"

Feature of mucocutaneous candidiasis (oppurtunistic infection, normal GI tract inhabit)?

Beta cell hyperplasia

Fetal affects of excessive transplacental glucose from mom's poor glucose control?

*IVC*. Most thrombosis is right-sided in this case and can extend to IVC. Venous stasis and hypercoagulability from pregnancy + endothelial damage in delivery >> ovarian vein thrombosis in the puerperium (?).

Fever and localized abdominal pain one week after delivery. CT reveals *right ovarian vein thrombosis*. If the patient remains untreated, she is at risk for *extension of the thrombus into which vein*?

*Maculopapular rash*: starts on face and spreads downwards. Koplik spts (white/blue/grey on buccal mucosa) are characteristic. Live, attenuated vaccine is safe. Serious side effects are rare.

Fever, cough, rhinorrhea, and conjunctivitis followed by maculopapular rash. Recent visit to Mexicoo. Bilateral conjunctival injection & severeal small white or blue-gray lesions on buccal mucosa. Natural approach to health. Over next several days, what is likely to develop?

Flu-like symptoms indicate Infective Endocarditis. *Circulating immune complex deposition* > diffuse, proliferative glomerulonephritis > can complicate IE and result in Acute Renal Insufficiency (nephritic syndrome).

Fever, fatigue with new-onset cardiac murmur. Elevated Cr, proteinuria, and microscopic hematuria. Pathogenesis of this patient's renal findings?

Actinomyces causing Actinomycosis

Filamentous, branching, gram-positive bacteria and sulfur granules causing pulmonary symptoms in alcoholic patient?

Multiple Myeloma

Finding of a high-peak gamma-globulin indicates what?

Pyuria/bacteria vs. WBC casts

Findings in upper/lower UTIs vs pyelonephritis?

Course *erythrocyte basophilic stippling* and microcytic hypochromic anemia on PBC. High risk for kids eating paint chips and industrial workers inhaling particulate lead. Blue "lead lines". Presents w weakness, abdominal pain, and constipation. Severe can have neurologic manigestations (HA, cog impair, peripheral neuropathy)

Findings in lead poisoning?

Mutation of APC tumor suppressor gene

First step in classic adenoma-to-carcinoma sequence?

Vertical transmission of HIV-1

First year of life oral thrush, interstitial pneumonia, ad severe lymphopenia indicate what?

*Ethosuximide*is first line. *Blocks T-type Ca2+ channels* that trigger and sustain rhythmical burst discharges in thalamic neurons. Valproic Acid is second-line treatment (broad-spectum antiseizure that inhibits voltage-dep Na channels and increases [GABA].

First-line treatment for absence seizures: Drug & MOA?

NSAID (broad anti-inflammatory, including neutrophils)

First-line treatment for gouty arthritis?

Methylphenidate Amphetamines

First-line treatments (2) for ADHD in school-aged children?

Transtentorial (uncal) herniation

Fixed and dilated pupil ipsilateral to lesion indicates what?

Bile acid malabsoprtion (illeum often involved)

Frequenct complication of Crohn disease?

5' to 3' DNA synthesis 3' to 5' exonuclease (proofreading) activity

Function of *Prokaryotic DNA polymerase III*?

Abduction

Function of Supraspinatous?

Anchor GPCR to cell membrane via hydrophobic, nonpolar aa

Function of TSH target protein w 𝜶-helixes containing valine, alanine, isoleucine?

Activates trypsin

Function of enteropeptidase?

c-Myc - transcription activator

Function of oncogene involved in Burkitt lymphoma?

tuberoinfundibular pathway (inhibits prolactin secretion) mesolimbic/mesocortical (cog behaviors) nigrostriatal (move)

Function of the D2 pathways?

Accelerates cell proliferation Resists apoptosis (HER2 oncogene)

Function of transmembrane glycoprotein with *intrinsic tyrosine kinase activity*?

*Aspergillus fumigatus*. Risk in immunocompromised patients, can cause invasive aspergillosis, aspergillomas, and allergic pulmonary aspergillosis.

Fungus that produces thick, septate hyphae with acute V-shaped branching?

Gastric acid is neutralized by bicarbonate from the submucosal glands of the duodenum (Brunner glands) and from pancreatic duct secretions. Chronic overproduction of gastric acid can lead to hyperplasia of the submucosal glands.

GI endoscopy reveals hyperplasia of branched, tubular submucosal glands containing alkaline secretions. Where is the likely site of the biopsy?

Incretin

GI hormone that stimulates pancreatic insulin secretions after oral consumption of glucose?

*Interview pharmacy, nursing, and medical staff on the units where this occurred*. Root cause analysis is QI measure the identifies what, how and why a preventable AE occurred. First step is collecting data.

Hospital staff not being notified when medications expire is putting patients at risk. What is the most appropiate next step to address problem?

Bind bile acids in the GI tract, inhibiting enterohepatic circulation. Causes increase uptake of LDL from circulation. Side effects: GI upset, impaired absorption, since ↑ production of triglycerides ? ↑VLDL release → *hypertriglyceridemia*.

How do Bile acid-binding resins function and what are potential side effects?

Volume output matched, continuous circuit

How do systemic and pulmonary circulation compare?

Antigenic variation of pilus protein

How does Gonocci avoid host defenses?

Phosphorylation of *serine and threonine* on insulin receptor

How does TNF-𝜶 causes insulin resistance?

Inhibiting SA node, slowing AV node, proloing AV refractory period

How does carotid sinus massage terminate paroxysmal supraventricular tachycardia?

↑parasympathetic vagal tone → ↓AV node

How does digoxin lower the heart rate?

Median N compression through deposition of 𝝱2-microgloblin

How does hemodialysis lead to carpal tunnel syndrome?

𝜶-toxin degrades phospholipid membranes

How does lecithinase from Clostridium perfringens cause necrosis/hemolysis?

*Cytosolic acetyl-CoA carboxylase* converts acetyl-CoA to malonyl-CoA during the rate-limiting step of de novo fatty acid synthesis. *Malonyl-CoA also inhibits the action of mitochondrial carnitine acyltransferase* (inhibiting beta-oxidation in newly formed FA).

How is beta-oxidation of newly formed fatty acids inhibited?

Balance between *active (GTP-bound)* and *inactive (GDP-bound)* Ras proteins. RAS gene mutations, result in constitutively active Ras, implicated in the development of malignant tumors.

How is the Ras-MAPK signal transduction pathways regulated?

As few as 10-500

How many Shigella organisms are necessary to cause disease?

CI of mean = mean +/- 1.96 x (SD/√n)

How to calciulate confidence interval?

# fatal cases for disease or condition / total # of people w disease or condition

How to calculate case-fatality rate?

Renal plasma flow / (1-hematocrit) RPF = PAH clearance = (urine [PAH] x UFR)/plasma [PAH]

How to calculate renal blood flow?

ARP(exposed) = 100 x [(risk in exposed - risk in unexposed)/risk in exposed)]

How to calculate the absolute risk percent in the exposed population?

Clearance of inulin (filtered = excretion)

How to calculate the value of GFR?

***Rate of O2 consumption/ arteriovenous O2 content difference

How to determine CO using the Fick principle?

F = (AUC oral x dose IV) / (AUC IV x dose oral)

How to determine bioavailability of a non-IV given drug?

P affect chid = 1/4 x P ♀carrier x P ♂carrier

How to determine probability that child from populations with different carrier frequencies will inherit Autosomal Recessive disease?

Normal pulmonary capillary wedge pressure (6-12 mm Hg) Ex. Pancreatitis-induced ARDS

How to distinguish if progressive shortness of breath, hypoxemia and bilateral pulmonary infiltrates is *non-cardiogenic*?

Elecated glucagon levels

How to dx someone with hyperglycemia and necrolytic migratory erythema (blistering erythematous plaques w central clearing0?

Hardy-Weinberg equation

How to estimate disease frequency if ♀ is carrier and ♂ status unknown?

Open-ended phrase so pt can explain w/o being lead or directed

How to initiate patient visit?

Degree of chest expansion Ankylosing spondylitis

How to monitor disease with stiffness and fusion of axial joints and inflammation at insertion of tendons into bone?

IgG against exotoxin B subunit to prevent Myocarditis/heart failure from Diptheria

How to prevent consequence of pseudomembrane + Cervical LAD?

Universal vaccination to HBV

How to prevent hepatocellular carcinoma?

Engage in nonjudgemental, collaborative discussion

How to react to suspected prescription Opioid Abuse

Atropine (block muscarinic activity), Pralidoxime (block nicotinic activity)

How to treat side effects of *organophosphate poisoning* from pestides?

Broad spectrum anticonvulsant (Valproic Acid)

How to tx Tonic-clonic and myoclonic generalized seizures

PTHrP

Humoral hypercalcemia of malignancy is caused by secretion of what?

Sodium normal (ANP > limits Na+ retention > ald escape). Hypokalemia (Na reabsorp > neg charge lumen > K excretion). High bicarbonate (metabolic alkalosis, increase H+ excretion by alpha-intercalated cells)

Hyperaldosterone lab values (Sodium, Potassium, Bicarb)?

Ab-mediated Type II HS (Complement activation)

Hypersentsitivty type in acute hemolytic transfusion reaction?

*Niacin*. Blocks FFA release from adipocytes, must use FFAs from plasma > raises HDL, lowers LDL. AE due to their release of *prostaglandins* via binding to GPCR. . Side effects reduced > aspirin co-adminiatration or with meal.

Hypertriglyceride patient that hasn't had success with previous medications. Drug prescribed AE: skin flushing and warmth. What's the drug?

Alveolar Hyperventilation

Hypocapnia is associated with what changes in RR?

Cauda Equina Syndrome - bowel and bladder dysfunction (S3-S5 roots), *lesion involving S2 - S4* will cause symptoms described, indicating impairment of the pudendal n that innervates the peritoneum.

Low back pain radiating to one or both legs, saddle anesthesia, *loss of anocutaneous reflex, bowel and bladder dysfunction*, and loss of ankle-jerk reflex w plantar flexion weakness of the feet. What nerve roots are likely to be involved in this patient's condition?

*Chron disease* presents w prolonged diarrhea and abdominal pain. Transmural inflammation of the bowel wall may results in the formation of *fistulas* (enteroenteric, enterocutanous), abscesses, and fibrotic structures.

Low grade fever, fatigue, malabsorption, and weight loss. No improvement with antibiotics. *Bowel contents appear to be drainging to the surface of the skin in the RLQ*. Patient most likely suffers from which of the following conditions?

Reduced Ventricular Compliance (S4)

Low-frequency late diastolic sound on cardiac auscultation that immediately preceds S1 indicates?

*Ventricular septal defect*, small are usually asymptomatic and produces a louder murmur due to higher interventricular pressure gradient.

Low-picted holosystolic murmur heard at L sternal border. Accenuates during maneuvers that ↑ overload (handgrip). 11 yo boy. What condition is most likely to be present in the patient?

Primary TB

Lower lobe of lung Ipsilateral lymph nodes indicate what type of TB?

[-5 cm H2O]. Pressure-volume curve. Center of airway pressure-volume curve is functional residual capacity. Identifies resting state (airway pressure = 0). At FRC, intrapleural pressure is negative.

Lung and chest wall compliance curves for healthy individual. At 0 airways pressure between chest and lung compliance, what is the best estimate of intrapleural pressure.

Testes: para-aortic lymph nodes Scrotum: superficial inguinal lymph nodes

Lymph drainage from the tests vs. scrotum?

Turner Syndrome

Lymphedema and cystic hygramas along w short stature and bicuspid aorta?

*Calcific* degeneration of aortic valve > restricted leaflet mobility

MC cause of Aortic Stenosis?

Bicuspid aortic valve

MC cause of aortic stenosis in the US?

Streptoccous pneumoniae

MC cause of community aquired pneunomonia in all populations?

Cardiac arrhythmia (or arrest)

MC cause of death in pt w post-storm fern-leaf erythematous cutaneous marks?

Charcot-Bouchard aneurysm repture due to hypertensive vasculpathy of small arteries

MC cause of deep intraparenchymal hemorrhage?

Follicular lymphoma (MC NHL)

MC cause of fluctuating lymphadenopathy?

Cerebral amyloid angiopathy (Beta-amyloid)

MC cause of spontaneous lobar hemorrhage in elderly?

Rupture of saccular (berry) aneurysms

MC cause of subarachnoid hemorrhage?

Norovirus

MC cause of viral gastroenteritis outbreaks including vomitting and watery diarrhea?

Acetyl-CoA dehydrogenase (first step in pathway)

MC deficienct enzyme in impaired 𝝱-oxidation of FA that causes hypoglycemia after prolonged fasting as well as low levels of ketone bodies?

Chorioretinitis

MC eye-related complication of congenital cytomegalovirus infection?

Spongiform transformation of gray matter in Bovine Spongiform Encephalopathy in Creutzfeldt-Jakob disease

MC histo of normal 𝜶-helical 2nd structure changes to 𝝱-pleated isoform, making it resistant to proteases and leading to intracellular accumulation?

Streptococcus pneumonia (encapsulated organism)

MC organism causing bacteriemia in SCD patients?

Teratoma, cell lines of >1 germ layer

MC ovarian germ cell tumor?

Viral laryngotraceitis (croup) due to parainfluenza virus

MC pathogen causing brassy, barking cough, dyspnea and hx of URI?

Glioblastoma

MC primary cerebral neoplasm of adults located in cerebral hemisphere and can cross midline?

*Aortic isthmus*, tethered by the limanetum arteriosum and is relatively fixed and immoble compared the adjacent descending aorta. Right after the branching for the 3 vessels exiting the top.

MC site of injury during traumatic aortic ruptues? Caused by the rapid deceleration in MVAs.

Tx fibrinolytic drugs

MI Tx <6hrs?

mu-opioid receptor blockage Naltrexone

MOA for 1st line tx of *severe alcohol use disorder*?

Bind to PPAR-𝛾, a transcriptional regulator of genes involved in glucose and lipid metabolism

MOA for Thiazolidinediones?

Decrease insulin resistance by activation PPAR𝛾, alters genes in glucose/lipid metabolism

MOA for Thiazolidinediones?

Triptans, postsynaptic serotonin receptor stimulation

MOA for abortive therapy for migraine HA?

Bacterial protein synthesis inhibitor for walking pneumonia due to M./C. pneumonia

MOA for drug to treat low-grade fever, sore throat, persistent cough, and chest xray w pathcy infiltrate?

Disrupting actin cytoskeletal structure and intracellular signaling

MOA for for clindamycin causing C difficile colitis?

N-methryl-D-aspartate (NMDA) receptor antagonist

MOA for phencyclidine (PCP) intoxication?

↑ circulating level of factor VIII. Desmopressin

MOA for treatment of mild hemophilia A?

Finasteride, 5𝜶 reductase inhibitor (suppresses peripheral testosterone → dihydrotestosterone)

MOA for tx of benign prostatic hyperplasia and androgenetic alopecia?

*Vit C* (ascorbic acid) deficiency (scurvy) functions in hydroxylastion of proline & lysine (collagen synthesis). Vit B12 needed for methionin synthesis from homocysteine (megaoblastic anemia + spinal cord degeneration).

Malnourished individual w easy bruising, periodeontal disease, poor wound healing, and hyperkeratotic follices. What mechanism accounts for the symptoms?

Premature ejaculation, often seen with anxiety

Man with unwanted episodes of early ejaculation accompanied by a sense of lack of control?

HER 2 (tyrosine kinase activity that increases cell proliferation)

Marker asociated with poorly differentiated, rapidly growing breast tumors?

CD 31

Marker expressed by tumor cells in hepatic angiosarcoma?

Superior Mesenteric Artery

Mass in the 3rd part of duodenum can injur what blood vessel?

Accum. Of virus in neurrons & oligodendrocytes > Subactue Sclerosing Panencephalitis*

Measles Chronic Conditions?

Lechithin (phosphatidylcholine): Sphingomyelin (35 wks, 2:1)

Measurement of fetal lung maturity?

Urine chloride (& volume status)

Measurement to differentiate causes for metabolic alkalosis?

Mu opoid analgesics contrict of SMC in sphincter of Oddi > spasm

Mechanical cause of RUQ pain following opioid analgesic tx?

Increased hydrogen ion excretion in the kidney

Mechanism causing release of rhomboid crystal uric acid stones on urinalysis?

*Hypo-acetylation of histones* by mutant huntingtin → tight binding to DNA

Mechanism responsible for prevention of transcription of genes that code for neutrophic factors (stimulate cell death) in Huntington disease?

TCAs (i.e. emitriptyline) Strong anticholinergic properties. Elderly more susceptible.

Med cause for new-onset confusion, lack of urine output & insomnia hx in elderly?

Fibrinolytic (tenecteplase, alterplase). Most common AE is hemorrhage.

Med cause of pt w MI becoming comatose w asymmetric pupils & irregular breath hrs later?

Calcium, inward flux

Mediation for phase 0 in cardiac pacemaker cells?

First Generation Antihistamines (Diphenhydramine) Anticholinergic effects

Medication responsible for confusion, hallucination, dry mouth, and constipation in elderly on multi-drug therapy?

Unpredictable fluctuations in motor function (therapeutic window decreases w time)

Medication side effect of long-term treatment of Parkinson disease w levodopa?

Non-selective 𝝱-blockers (propranolol)

Medication that can exacerbate hypoglycemia and inhibits patient from experiencing adrenergic symptoms?

Selegiline

Medication that inhibits MAO, type B and can prevent MPTP-induced damage of dopaminergic neurons (parkinson-like)?

Class IA antiarrhythmics (Disopyramide)

Medication with intermediate *inhibition of phase 0 depolarization* and prolonged ventricular action potential?

Azoles (Itraconazole)

Medications that *inhibit demyelination of lanosterol into ergosterol* and inhibit activity of human P450 cytochrome oxidase?

Mineral corticoid receptor antagonists (spironolactone, eplerenone)

Meds to improve survival in CHF and reduced LV ejection fraction patients?

CI does not include the null value so result is statistically significant. Null value = 0 because parameter of interest is difference. Null value = 1 for odds ratio or relative risk.

Meta-analysis shows change in mean SBP of -2.2 mm Hg in case vs control group. 95% CI was -2.7 to -1.3. What does this indicate?

1. Resp Alk (Stimulates medullary resp center, ↑ventilation and loss of CO2 in expired air) 2. Anion gab metabolic acidosis 12 hrs later (salicylates ↑ kuoiktsusm uncouple oxidative phosphorylatio, and inhibit CAC)

Metabolic results from aspirin intoxicaiton?

Inhibits DHFR > ↓ DNA synthesis

Methotrexate MOA?

Folic acid DHF polyglutamate

Methotrexate causes what to accumulate in cells?

Cyst with astrocyte process (glial scar) surrounding

Microscpic appearance months-years after ischemic stroke?

*Cytochrome C* a caspase-activating substance. Intrinsic (mitochondrial) pathway, anti-apoptotic proteins (Bcl-2 and Bcl-x) are replaced with pro-apoptotic proteins (Bak, Bax, Bim). Pro-apoptotic proteins increase permeability of mitochondria which results in Cyt C release.

Mitochondrial enzyme that activates caspases and indirectly brings about cell death through intrinsic pathaway apoptosis?

*Thromboplastin* Released from injured placenta (placental abruption)

Molecule & location of release that causes DIC in pregnancy?

DNA Polymerase I has 5'-3' exonuclease ativity (only ONE in prokaryotes)

Molecule w exonuclease activity that removes RNA primers & repairs damanged DNA in Prokaryotes?

Cytoplasmic P bodies

Molecule with important role in mRNA translation regulation & degradation?

Cytomegalovirus causing Heterophile antibody-negative mononucleosis-like syndrome. MC cause is EBV.

Mononucleosis clinical presentation that fails to agglutinate horse erythrocytes twice?

Valproic Acid

Mood-stabilizing agent in bipolar disorder used also for seizure prophylaxis?

Respiratory Syncytial Virus Leads to bronchiolitis

Most common cause of ... initial rhinorrhea/congestion followed by... tachypnea, retractions diffuse wheezes and crackles in infant?

Staphylococcus aureus

Most common cause of bacterial endocarditis in IV drug users?

CFTR gene mutations

Most common cause of bilateral absence of vas deferens/azospermia?

*Primary herpes simplex virus* can be dx w *PCR*, direct fluorsence Ab, viral culture or Tzank smear. Gonorrhea: urethritis, cervicity, and PID. Gram- diplococci in chain.

Multiple *painful genital ulcers (erythematous base), dysuria (irritation of ulcers), tender LAD*, and systemic symptoms (fever, HA). What is *best dx test* for the patient's condition?

Developmental field defect

Multiple malformations seconday to embryonic disturbance in adjoining group of cells is known as?

*Oligodendrocyte depletion* due to autoimmue destruction of CNS seen in Multiple Sclerosis. Dx is mostly clinical, supported by T2 lesions on MRI or oligoclonal bands (sensitive, but not specific)

Multiple waxing and waning neurologic deficits that cannot be explained by a single lesion. What pathologic finding is likely present in this patient's brain?

Aortic regurgitation.

Murmur L sternal border (3/4 IC), high-pitch decrescendo, best heard leaning forward hold end expiration?

Mitral valve stenosis

Murmur dx for opening snap w diastolic rumbling best heard over apex?

Scalene Muscles Thoracic Outlet Syndrome

Muscle injury causing upper extremity numbness, tingling, and weakness after repetitive overhead arm moves?

Trapezius, Spinal Accessory N.

Muscle injury result from injury to nerve in the posterior triangle of the neck?

Levator Ani, ****Prolapse of ant vag wall > SUI

Muscle targeted in exercises to treat cystocele?

Rectus Abdominis

Muscle used in *valsalva maneuver* for Paroxysmal SV Tachycardia?

"Antifungal groups: 1. polyenes (Amphotericin B, *Nystatin*) 2. azoles (inhibit erg synthesis), 3. echinocandins (inhibit glucan synthesis) 4. pyrimidines (converts to 5FU and interferes with fungal RNA and protein synthesis). Polyenes bind to ergosterol molecules in the fungal membranes, creating pores and causing cell lysis"

Mutant form of Candida exhibited enhance growth in the presence of drug X via decreasing the amount of ergosterol. What type of drug is this?

Frameshift mutation

Mutation caused by deletion or addition of bases not divisible by 3? Will appear as diff. bp # on DNA migration)

Marfan: fibrillin-1 (microfibrils) Ehlers-Danlos: Collagen

Mutation in Marfan Syndrome vs Ehlers-Danlos Syndrome?

DNA Mismatch Repair (MSH2, MLH1) in Lynch Syndrome

Mutation in Syndrome that causes colorectal, endometrial, and ovarian cancers?

*JAK2,* non-receptor (cytoplasmic) tyrosine kinase

Mutation in patients with myeloproliferative disorder with uncontrolled erythrocyte production (Polycythemia Vera)?

*ATMutation → DNA break repair* Ataxia Telangiectasia

Mutation responsible for... cerebellar ataxia, telangiectasia, ↑sinopulmonary infection risk?

HFE mutation > increased DMT1

Mutation that leads to reduced iron uptake and causes enteroccytes/hepatocytes to sense falsely low iron levels in Jereditary hemochromatosis?

S1 involved with Sciatica

N root causing low back pain and pain/sensory loss down posterior thigh and calf to lateral aspect of foot?

Common Peroneal N. Near fibula head

N. injury causing "foot drop" and "steppage gait"?

IgA protease (IgA normally prevents adhesion)

N. meningitidis enzyme causing mucosal adherance of bacteria?

CN V Max branch in cavernous sinus

N. respnsible for loss of upper facial sensation and afferent limb of the corneal reflex?

*Chronic interstitial nephritis and papillary necrosis*.

NSAID-associated chronic renal injury is characterized as what?

Case-control study design. People w disease (cases) and ppl w/o (controls) asked about previous exposure. *Odds ratio* = (odds of exposure in cases) / (odds of exposure in controls). *Incidence measures* (eg, relative risk or relative rate) can't be directly measured in CC studies bc cases already have disease. Calculated in prospective and retrospective cohort studies, where risk factor assessment occurs first and then exposure and unexposed group are following over time and assessed for disease development.

NT defects. Random group A- women who delivered child w NTD, group B - women w healthy babies. 2 groups were asked if they used acetaminophen during pregnancy. What measure is likely to be included in the report?

Azonal Reaction (↑protein synthesis to facilitate repair)

Name for changes in neuron body (enlarged, rounded cells w peripheral nuclei and dispersed Nissl substance) post-axon severage?

Kozak sequence

Name for eukaryotic translation initiation site (gcc)gccRccAUGG?

1. Zona glomeruloa (mineralcorticoid, e.g. aldosterone) 2. Zona fasciculate (glucorcorticoid, cortisol) 3. Zona reticularis (androgens) 4. Adrenal medulla (chromaffincells, postganglionic sympathetic neurons that release catecholamines in response to Ach release in pregnanglionic sympathetic neurons.

Name four layers of adrenal cortex (from exterior to interior) and what they are primarily composed of.

Koilocyte HPV

Name of squamous cell with dense, irregular cytoplasm & *perinuclear halo-like* clearing on pap smear?

Scheduled daytime napes and psychostimulants (*modafinil*) for daytime sleepiness

Narcolepsy tx?

Probability of not having disease w Neg. test result.

Negative Predictive Value Definition

Immunized mom provide passive immunity via transplacental IgG

Neonatal protection from tetanus?

Radial Nerve injury

Nerve injured in supracondylar fracture with anterolateral displacement?

Hypoglossal Nerve Oropharyngeal disfunction

Nerve stimulation for loud snoring and gasping respirations during sleep?

Incremental (weakness ↓ with exercise)

Nerve stimulation response in Lambert-Eaton syndrome?

*Irreversible cell injury* known as "red neuron". Cytoplasm stains deeply eosinophllic & there is pyknosis of the nucleus w loss of Nssl. Changes occur 12-24 hrs after injruy.

Neurons w shrunken nuclei, no detectable Nssl substance and intensely eosinophilic cytoplasm. This description likely indicates what?

Norepinephrine from Posterior Rostral pons (Lateral Floor 4th Ventricle)

Neurotransmitter affected in *bilateral pontine hemorrhage* disrupting the reticular activating system leading to extensor posturing pinpoint pupils?

*67*. Number needed to treat (NNT) - # of pt treated w med to avoid an additional negative outcome. *NNT = 1/Absolute Risk Reduction*. ARR: diControl event Rate (15/1000) - Experimental Event Rate (10/1000). Lower NNT means more beneficial.

New Drug. Num of pt tx w Superstatin (MI:10/No MI:990). Num of pt tx w control meds. (MI: 25/No MI: 975). How many patients need to be treated with superstatin to prevent 1 additional MI?

Arteriovenous concentration reflects overall tissue solubility. Anesthetics w high tissue solubility have large arterivenous concentration gradients and *slower onsets of action*

New inhaled *anesthetic*, when administered at constant partial pressure, results that it has a *very large arteriovenous concentration gradient* shortly after beginning inhalation. Which of the following best describes the properties of the new anesthetic?

*0.95^8* Probability of 1 event turning out differently = 1-P (all events being the same). P=0.95. If *events are indpendent*, probability that all events will turn out the same = *product of the separate probabilities for each event*.

New medical procedure. *Test result is negative in 95% of patients who don't have disease.* If new assay is used on 8 blood samples taken from patients w/o prostate cancer, what is *probability that all 8 test results come back negative*?

"HIPPPE" Hydralazine INH Procainamide Phenytoin Penicillamine Ethosuximide

New onset lupus symptoms, which drugs could be responsible?

Erosive esophagitis and esophagitis ulcers

New-onset odynophagia in setting of chronic GERD indicates?

Urine 𝝱-HCG. Isoreinoin is tertogenic (spon abortions, fetal malformations)

Next step if considering isotretinoin treatment in pt?

Court injunction

Next step if parents rejecting tx & child at risk for serious harm & death?

Ligand-gated Ion channels that open after binding of Ach.

Nicotinic receptors are what type of receptors?

Epithelioid macrophages with pale pink granular cytoplasma and surface *CD14* at the periphery. CD14 is a surface marker of the *monocyte-macrophage cell lineage.*

Night sweats, weight loss, and cough together with apical pulmonary granulomas. Surrounding necrotic areas are large cells w abundant pale cytoplasma. What surface marker is specific for these cells?

Linezolid

Non-antidepressant drug used to treat cellulitis w MAOi that can lead to serotonin syndrome if combined w SSRI/SNRI?

Pseudomonas aeruginosa

Non-lactose-fermenting, Gram-negative rod cause of UTI in patients w indwelling bladder catheters?

Buspirone

Nonbenzo tx of generalized anziety disorder w slow onset of action, lacks muscle relaxant or anticonvulsant properties?

Flutamide

Nonsteroid anti-androgen competitive inhibitor of testosterone receptors used in prostate cancer?

Bile acids (↑Cholesterol solubility > dissolution)

Nonsurgical tx for cholesterol gallstones?

Renal Toxicity leading to Hypokalemia/Hypomagnesium

Notorious toxicity associated w Amphotericin B?

*Zidovudine* - does not have a 3'OH group, making *3'-5' phosphodiester bond formation impossible*. Thymidine analog that stops the replicating of DNA.

Nucleoside reverse transcriptase inhibitor that competitively binds to reverse transcriptase and is incorporated into the viral genome as thymidine analog. Drug and what bond is not possible in its presence?

*Phenotypic mixing*: No change in underlying viral genomes, subsequent progency will revert.

Occurs when a host cell is *coinfected with 2 viral stains and progeny cirons contain unchanged parental genomes from one strain & nucleocapside/envelope proteins from other strain.

Vascular smooth muscle cells

Only cells within atherosclorotic plaque capable of synthesizing collagen isoforms?

Obturator N.

Only major n that exits pelvis via obturator foramen?

Cidofovir

Only nucleoside analog that requires *cellular kinases*, and not viral phosphorylating enzymes to convert to active nucleoside triphosphate form?

Diphenoxylate (combine w atropine to discourage abuse)

Opioid antidiarrheal drug, binds mu opiate receptors in gut to slow motility?

Nystatin

Oral agent "swish and swallow" for oropharyngeal cadidiasis?

Histoplasmosis capsulatum

Organism endemic in OH/MS, bird/bats, exists as ovoid/round yeast within macrophages?

Trypanosoma cruzi (Chagas disease)

Organism responsible for achalasia due to destruction of submucosal & myenteric plexi?

Streptococcus gallolyticus

Organism responsible for endocarditis that is associated w Colon Cancer?

Hepatitis B

Organism that replicates w action of reverse transcriptase on an RNA template?

Bacillus antracis Bordetella pertussis

Organisms that cause *massive ↑ in intracellular cAMP* > neutrophil and macrophage dysfunciton and tissue edema?

Neuroendocrine

Origin of small cell carcinoma of the lung?

Neuroendocrine cells in the GI tract

Origin of the cellular structure responsible for appendiceal carcinods?

polyehtylene glycol

Osmotic laxatives have a similar effect as what?

In absence of an advance directive and designated health care proxy, fam member should be contacted. In emergency, can treat w/o obtaining consent. *Attempt to contact the patient's sister for consent to intubate*

Patient is somnolent. Recently told friend he would want to "go naturally". Knows of a sister, but not sure when they last spoke. Patient may need ventilation, most appropiate course of action?

Fem Nerve injury causing... *weak quadriceps* no patellar reflex no sensory ant/med thigh/leg Spontaneous Retroperitoneal Hematoma

Patient knee is buckling, fluid is displacing Right kidney and us taking warfarin. What is the *muscle deficit*?

ACE inhbitors block the conversion of Angiotensin I to angiotensin II, thus reducing vasoconstriction and aldosterone secretion. ↓ Aldosterone > ↑ K+ retention. Hyperkalmia due to ACEi is MC in patients w renal insufficiency and in patients taking *K+ sparing diureteics (amiloride, triamterene, and spironolacton)* or K+ supplements.

Patient presents with hyperkalemia in setting of stable angina and long-standing HTN. What drug when combined w lisinopril is most likely to account for the hyperkalemia?

*St Johns wort* induces a cytochrome P450 hepatic microsomal enzyme. As a result, a wide variety of drugs that are metabolized by these enymes, such as warfarin, will have lower plasma concentration and decreased efficacy.

Patient taking *warfarin for paroxysmal atrial fibrillation*. Started taking a *new drug recently*. Presents w R hemiplegia, hemisensory loss, excessive aphasia, and homonoymous hemianopia. Echo reveals *small thrombis in the L atrium*. Which drug did the patient recently start taking?

Methimazole, Propylthiouracil > agranulocytsos

Patient taking antithyroid drugs suddenly develops sudden fever/sore throat Why?

Release of prolactin is under inhibitor control by domapine secretion from the hypothalamus. Disruption of domainergic pathways or blockage of D2 recepters can cause *hyperprolactinemia*

Patient w *active sarcoidosis* w hypercalcemia (excess calcitrol) and mass effect symptoms (headahce, visual field defects). What *pituitary hormone is likely to be elevated* in the patient?

SLE is assoicated with anti-Smith antibodies (highly specific). Smith protein normally complexes with small nuclear RNA (snRNA) in the cytoplasm, forming small nuclear robinucleoproteins (snRNPs). Synthesized by Poly II, serve as component of splicesome, which remove introns from premRNA to mRNA.

Patient w SLE symptoms has autoantibodies against proteins complexed with small nuclear ribonucleic acid. The protein-ribonuclei acid complexes are most likely involved in what cellular function?

beta blockers reduce heart rate, CO, and myocardial oxygen demane. Non-cardioselevtive beta blockers can trigger bronchospasm in patient w underlying asthma/COPD. *Cardioselevtive beta blockers w predominant action on beta 1 receptrs are preferred in such patients (metoprolol, atenolol, bisoprolol, nebivolol).*

Patient w acute MI and underlying asthma (or COPD). What agent should be used to tx?

Narcolepsy. Frequent overwhelming urges to sleep. Due to depletion of hypocretin-secreting neurons in the lateral hypthalamus involved in maintaining wakefulness. Confirm dx w *low CSF levels of hypocretin-1 or shorted REM sleep latency.*

Patient w excessive daytime sleepiness, cataplexy (brief loss of muscle tone precipiated by strong emotion - laugh/excitement), and REM-related phenomenon (hallucinations and sleep paralysis). Dx/lab test?

Influenza causes lack of cillia, more free sugar in resp tract > secondary bacterial infections/pneumonia. MC causes: *S. aureus*, H. influenza, and S pneumonia

Patient with influenza has improved symptoms and then develops worsening fever and lower respiratory tract manifestations (cough, pleuritic chest pain, dyspnea). Pulmonary consolidation. What's the likely pathogen?

Low HDL patients have increased risk for cardiovascular disease. Meds that raise HDL do not improve outcomes. *HMG-CoA reductase inhibitors (statins)* lower total cholesterol and LDL levels. Statins are most effective lipid-lowering drugs for prim/sec prevention of cardiovascular events.

Patient with low HDL levels and normal range cholesterol and triglyceride levels. What lipid-loweing agent would be most effective for preventing future cardiovascular events in this patient?

*Delusional Disorder* ≥ delusion for ≥ 1 month. Tx: Antipsychotic or CBT. *Brief Psychotic disorder*: ≥ 1 positive psychotic symptoms lasting > 1 day but < 1 month. Sudden onset with full return to premorbid level of functioning.

Patient with persistent belief he is being poisoned. No hallucinations or disorganizations. *Apart from behavior related to poison, patient's actions are not bizarre or odd. Diagnosis*?

Graves opthalmopathy due to stimulation of orbital fibroblasts by the thyrotropic receptor Ab and cytokines released by activated T cells. Excess deposition of extracellular glycosaminoglycans and inflammatory infiltration lead to expansion of extraocular muscles and retro-orbital tissues. *Glucocorticoids* improve Graves opthalmopathy by *decreasing the severity of inflammation* and reducing the excess extraocular volume.

Patients w weight loss, palpitations, tachycardia and significant opthalmopathy (proptosis, diplopia). Began on appropiate therapy. 4 wks later there is *decrease in proptosis* w no redness. *Drug that improved her ocular symptoms most likely did so by affecting what*?

*Acute lymphoblastic leukemia and acute myelogenous leukemia*. Mental retardation, epicanthal folds, flat facial profile, cleft palate, nuchal fold thickening, endocardial cushion defects, duodeal & jejunal atresia, hypotonia.

Patients with Down Syndrome are at an increased risk of developing what?

*Thrombitic microangiopathies*: thrombocytopenic thrombotic purpura. Platelet activation and diffuse microvascular thrombosis (kidney, brain, heart). TMA: hemolytic anemia w schistocytes, thrombocytopenia, and organ injury. *Platelet-rich thrombi in glomeruli and arterioles*. normal PT and aPTT (will be increased in DIC).

Pentad of fever, neurologic symptoms, renal failure, anemia, and thrombocytopenia w GI illness. What will be seen on renal biopsy?

C. diphtheriae (Diptheria Toxin) and P. aeruginosa (Exotoxin A)

Pharyngitis with exudates and cervical LAD w unknown vaccination status. Two bacteria, and their associated toxin, that *inactivate EF-2 via ribosylation*, thus inhibiting host cell protein synthesis?

Visceral fat, measured with ... waist circumference waist-to-hip ratio

Physical exam finding that correlates with ↑insulin resistance?

*Kaposi sarcoma* blue-violet or brownish skin plaques on extremeties and mucous membranes of HIV+ patients. Tumors arises from primitive mesenchymal cells and is strongly asociated w **HHV-8**.

Pneumocystic pneumonia and painful oral ulcers in illicit drug user. Blue-violet or brownish dermal plaques. What is the causal pathogen?

Carbon monozise

Poisoning that increases [carboxyhemoglobin] but does n't affect pO2?

anti-histidyl-tRNA synthetase (anti-Jo-1)

Polymyositis and Dermatomyositis Serum Marker?

Thiazolidinediones > bind to PPAR-𝛾 (gene alteration, destrution in TNF-𝜶) > ↓ insulin resistance > glucose-lowering effect. *AE: fluid retention, weight gian, can exacerbate underlying CHF*.

Poorly managed diabetes, tx w *pioglitazone*. What side effects are expected?

>65 yo younger w disabilities, ESRD, ALS

Population provided by medicare?

Sorbital → Fructose via sorbital dehydrogenase

Portion of *polyol pathway* that can be overwhelmed in chronic hyperglycemia which can cause cataracts?

Straight part of *proximal tubule* & *thick ascending limb of Hemle's loop*

Portion of the renal tubule system most susceptible to injury during acute tubular necrosis?

Synaptophysin

Positive stain for CNS tumors of neuronal cell origin?

*3'→5' exonuclease activity. Hypervariable due to no proofreading 3'→5' exonuclease*. Many errors made during replication. Envelope glycoprotein sequences also contain a hypervariable region prone to frequent genetic mutation.

Post infection with *Hepatitis C virus*, later extracted RNA squences reveal *significant variance*. *Lack of which viral resplication process is responsible for this genetic instability*?

Poly-A tail

Post-transcription modification near 3' of mRNA, downstream of consensus sequence?

Hypochromic, microcytic anemia is MC due to iron deficiency. Blood loss, especially *occult loss* from GI tract must be ruled out from the GI tract.

Postmenopausal female patient that is hypochromic, w microcytic anemia (pale). Hgb 8.5 g/dL. What is the most likely underlying cause of the patient's lab findings?

*Adult onset*. Most children will recover completely but adult patients have poor prognosis and high risk of chronic HTN and renal insufficiency.

Poststreptoccocal glomerulinephritis presenting w edema, HTN, and hematuria after a streptoccocal infection. What characteristic will indidcate a poor long-term prognosis?

Independent risk factor for thrombotic events

Potential complications of HyperHomocysteinemia?

Unpaired 𝛼 > membrane damage > bad erythropoiesis. Thalassemia

Potential consequence for ↓ 𝝱 globin chain synthesis > hypochromic, microcytic anemia?

DVT > *pulmonary thromboembolism* Prothrombin →(V)→ thrombin

Potential side effects for Factor V Leiden mutations?

Sudden death + ventricular arrythmias (palpitations, syncope)

Potential side effects of mutation in K+ channel protein that ↓outward K+ current and prolongs QT AP?

Cell necrosis

Preceding event for senile dystrophic calcification w normal Ca2+ levels?

Antibiotics leading to Clostridium difficile

Preceding event that lead to the devlopment of pathogen causing profuse diarrhea post-MX trip?

Gastritis associated with NSAID use, Nephrotoxicity due to aminoglycosides. Unpredictable Idiosyncratic drug rxns are due to genetic differences.

Predictable adverse drug reactions examples (NSAIDS and Aminoglycosides)?

Large elastic arteris (Abd A) > coronary a. > Internal carotid > COW

Preferential location for atherosclerotic plaques?

ACEi A II receptor blockers

Preferred anti-HTN med to prevent diabetic nephropathy?

Neural tube defects most often occur when the *fusion of the edges of the neural plate* fail to fuse in anterior or posterior neuropores. Persistent communication between spinal canal and amniotic cavity allows leakage of AFP & AChE.

Pregnant women with elevated levels of AFP and AChE. This amniocentesis suggests failure in which type of process?

*Oxidant-induced damage* from G6PD deficiency causing hemolytic anemia

Presence of "bite cells" and Heinz bodies are indicative of what?

Chronic ↑ Pulm Cap Hydrostatic pressure (due to L side Heart failure)

Presence of hemosiderin-laden macrophages indicates what?

Hyperphosphatemia, secondary hyperparathyroididsm, and decreased calcitriol levels. Patients can be asymptomatic or develop weakness, bone pain, and fractures.

Presentation of chronic kidney disease with mineral bone disease?

T-cell Acute lymphblastic leukemia

Presentation of large anterior medistinal mass causing dysphagia/dyspnea in the setting of blast cells indicated?

Atrophic follics due to lack of TSH stimulation

Presentation of thyroid follicles w exogenous hyperthyroidism (↑T4, ↓TSH, ↓thyroglobulin)?

Low urinary citrate. ↑ [urinary citrate] + high fluid prevent calculi formation.

Presenting symptom in patients who get renal calculi?

Most common benign liver tumor Cavernous hemangioma

Prevalence of cavernous, blood-filled vascular spaces lined by single epithelial layer?

Intrapartum Ampicillin for Strep B(?) within 4 wks of birth

Prevention for 𝝱hemolytic Gram+ in chains, bacitracin-resis causing resp distress infant?

Venodilation > ↓LVEDV > ↓myocardial O2 demand

Primary anti-ischemic effect of nitrates?

Raphe Nuclei

Primary location of serotoninin-releasing neurons in CNS?

Secreted into bile Excreted in stool

Primary route of copper removal in body?

*Granulation tissue w neovasculatization*. Likely due to a *ventricular arrythmia* in the infarcted myocardium. This is found in the second wk after mi.

Pt wi *MI 12 days later suddenly dies.* Light microscopy shows what type of changes to the myocardium wall?

Fized dilated pupil ( ipsilateral 3 CN )

Pupil appearance in transtentorial herniation of the uncus?

Primaquine eradicates intra-hepatic stages of malaria, which can cause relapse

Purpose of primaquine in addition to chloroquine?

Foscarnet

Pyrophosphate analog, inhibits DNA Polymerase (HSV) & Reverse Transcription (HIV), *does not require intracellular activation* by viral or cellular kinases Drug?

*Deep peroneal nerve*. MC site for Anterior Compartment Syndrome

R leg tibial and fibular shaft fracures. Closed reduction, severe pain hrs later, tension in ant compartment, what n. is compromised?

Rotavirus via segmented genomes

RNA virus that allows rapid genetic shifts through reassortment?

*Methotrexate*: preferred disease-modifying tx for Rheumatoid Arthritis. Folate antimetabolite, haults purine and pyrimdine synthesis via competitive inhibition of dihydrofolate reductase. Sig AE: stomatitis, bone marrow suppression, and *liver abnormalities*.

Ra patient, after starting tx, develops *painful mouth ulcers and nausea. LFTs: ↑AST, ALT*. What *med* is responsible for AE?

Benzodiazepine

Rapid relief for young, healthy adult with recurrent, unexpected chest pain, tachycardia, dyspnea, diaphoresis?

Glucocorticoids (prednisone)

Rapid relief of Rheumatoid Arthritis symptoms?

*Creutzfeldt-Jakob disease* - spongiform encephalopathy, pathogenesis is linked to abnormal protein.

Rapidly progressive dementia and myoclonic jerks. Micro: multiple vaculoles. Patient most likely is suffering from?

Epstein-Barr virus

Reactivation of what pathogen causes *lymphoproliferative disorder in HIV* patients?

Iron loss via menstruation/pregnancy delays hemochromatosis

Reason a defect in GI Fe2+ absorption shows later in ♀?

Serum HCO3 buffers ketoacids (𝝱-hydroxybutyrate and acetoacetate)

Reason behind low bicarbonate levels in Diabetic Ketoacidosis?

Cytochorome oxidase inhibition (due to *ciprofloxacin* or illness)

Reason for *theophylline* toxicity following infection?

Pancytopenia (↓erythrocytes, leukocytes, and platelets) common in SLE. Occurs due to formation of *autoantibodies against blood cells* (Type II hypersensivity). Lupus nephritis is caused by immune complex deposition within the glomerulus (Type III hypersensitivity).

Reason for Pancytopenia in the setting of systemic lupus erythematous?

Preg > 20 wks. Supine IVC compress > ↓venous return > ↓preload > ↓CO > hypotension + syncope

Reason for supine HypoTN during pregnancy

Oligosaccharide on resp epithelium is same as eythrocytes

Reason for transient hemolytic anemia in the setting of Mycoplasma pneumoniae?

Extensive first-pass hepatic metabolism (use sublingual)

Reason isosorbide nitrate has low bioavailability?

Bacterial endototxins > Gram-sepsis > DIC

Reason meningococcal meningitis pt w PBS Shistocytes bleeding from venous access sites?

Preserved intestinal microbiome, no recent antibiotic use.

Reason only some persons exposed to C diff will get infected?

Above the inguinal ligament will risk for retreoperitoneal hemorrhage

Reason to cannulate below the inguinal ligament?

*Listeriosis is MC transmitted through food ingestions* and can cause meningitis in immunocompromised adults. Listeria ia gram-positive rod with tumbling motility. Grows well in cold temperatures and can contaminate refrigerated food.

Recent kidney transplantation. Symptoms of HA, neck stiffness and protein in CSF. Gram+ rods with tumbling motilits at room temp seen on CSF. How was this *patient's infection most likely transmitted*?

Norepinephrine: 𝛼1 agonist > vasoconst. Phenoxybenzamine: irreversible 𝛼1 & 𝛼2 antagonist

Receptor effects of phenoxybenzamine vs. norepinephrine?

Leukotrienes (LTC4, LTD4, LTE4)

Receptors targeted in asthma tx?

5-HT3 and neurokinine 1 (NK1) receptor antagonist.

Receptors targeted in tx of cancer induced vommiting?

Microangiopathic hemolytic anemia or mechanical RBC destruction (seen w prosthetic valves)

Red blood cell fragments, burr cells, and helmet cells are associated with what?

↑vagal tone > ↓hr & slowed AV node conduction

Reflexive reasion after elevated systemic blood pressure due to 𝜶-adrenergic agonists?

Small airways Bronchiolitis obliterans

Region of lung injured in chronic lung transplant rejection?

*Skeletal muscle cells and adipocytes express GLUT-4*, an insulin-sensitive glucose transporter that is sequesterd in the absence of insulin, but as insulin concentrations rise, the receptors translocation to the plasma membrane, facilitating glucose transport into the cell. GLUT-1 (erythrocytes/BBB) ,GLUT-2 (hepatocytes, pan B cells, baso renal rub) ,GLUT-3 (placental/neuronal glucose) ,GLUT-5 are always present (fructose transporter in spermatocytes + GI). .

Relationship between glucose transporters and insulin concentration in various cells and tissues. Graph that shows number of glucose transporters found on the surface of 2 types of cells compared to insulin concentration. What cell type increases glucose transporter expression as insulin concentrations rise? Which is not affected by changes in insulin concentrations?

↑Blood/Gas Partition Coefficient > ↑blood solubility > long onset for anesthetic

Relationship of *blood/gas partition coefficient* and anesthetic onset time?

Hyaline arteriolosclerosis & Nodular glomerulosclerosis (KW nodules)

Renal biopsy in patient with diabetic nephropathy?

*Celecoxib* - selective COX 2 inhibitor. Nonselective: Diclogenac, Genoprofen, Ibuprofen, Indomethacin, Ketorolac, Piroxicam > NSAIDS that reversibly inhbit COX 1 & COX 2. COX 1 > inhibition of platelet aggregation. Aspirin does it irreversibly.

Selective NSAID w anti-inflammatory effects w/o side effects of bleeding and GI ulceration?

FN = (1 - Sensitivity) X Number of patients w disease = (1-0.75) X 20 = *50*. Sensitivity of a test determines the proportion of patients that are correctly classified.

Sensitivity: 75%, Specific: 80%. Enrolls 600 aptients, with 200 confirmed cases of disease. How to calculate false negatives?

Neisseria gonorrhoeae. Gram-negative intracellular diplococci.

Septic arthritis, vesiculopapular rash, and renosynovitis in a young sexually active adult should raise suspicion for an organize w what phenotype?

Short non-coding RNA (micro, small interfering)

Sequence that induces postranscription gene silence via base-pairing with complement sequences in target mRNA molecules?

Myopathy Hepatitis

Serious side effects of statins?

Former are raised, latter are lowered

Serum effects of thiazide diuretics (Ca, Uric Acid, Glu, Triglyceride & Na, K, Mg)?

Antineutrophil cytoplasmic Ab

Serum finding in patient w Pauci-immune RPGN (w/o Ab/Comp IF)?

*Amylase* for Suppurative Parotitis

Serum marker to diagnose... trismus, pre-auricular swelling, fever/jaw pain in dehydrated patient?

Free wall rupture

Severe *hypotension 5-14 days* after anterior wall MI?

Pulmonary Edema

Severe adverse effect of *Mannitol*?

273 norm for autoclave machines. Lower allows spore-forming bacteria to form. Found in soil, water, and are resistant until 243. *Bacillus (Bacillus anthracis) and Clostridium (eg Clostridium perfinges, C botulinum) MC spore-forming pathogenic bacteria.*

Severe postoperative infections due to inadequate sterilizing of equipment (limited temp to 212 F). Infection most likely developed from which bacteria?

Aortic intimal tearing

Severe retrosternal pain that radiates to the back is triggered by what?

Inferior parathyroid. Both from 3rd pharyngeal arch.

Shares an embryologic origin with the thymus (name arch)?

Meglitinides (Repaglinide)

Short-acting glucose-lowering med that closes ATP-dependent K+ channel > depolarization > insulin release?

*Zolpidem* binds to GABA(a) receptor.

Short-term pharmacologic tx for insomnia?

Phrenic Nerve splenic laceration

Shoulder pain and hiccups post trauma indicate what nerve damage?

*Isoproterenol* is a 𝝱-1 and 𝝱-2 adrenergic receptor agonist that increases myocardial contractility and decreases systemic vascular resistance. Neglihible effects on 𝜶-1 adrenergic receptors.

Showed graph where drug *increased cardiac contractility* by acting on 𝝱1 and *decreased vascular resistance* due to 𝝱-2 stimulation of vasodilation/relaxation. What med is likely administered?

Hemorrhagic infarcation of adren glands → crisis (Waterhouse-Friderichsen syndrome)

Side effect of meningococcal septicemia?

Pulmonary Hypertension Right heart failure

Side effects (2) of prolonged, untreated obstructive sleep apnea?

𝝱 adrenergic agonists (mainly 𝝱1) > ↑HR > ↑Myocardial O2 consumption

Side effects of *Dobutamine*?

ACE inhibitors (named "-pril") , prevent conversion of A I to AII. Prevents efferent arteriole from constricting more than the afferent. ↓GFR, hyperkalemia, and cough. *Angioedema* is the rare event.

Side effects of ACE-inhibitors and the rare, but life-threatening defect?

Contralateral Superior Quadrantanopia

Side effects of injury to *Meyer's loop* in temporal lobe?

Compensatory Respiratory Alkalosis

Side offects of Hyperventilation?

↓LV cavity size, sigmoid ventricular septum, myocardial atrophy w ↑collagen

Signs of normal aging changes in the heart?

Tobacco smoking

Single most preventable cause of death and disease in the US, especially in diabetes pt?

Chronic Myelogenous leukemia (CML) or leukomoid rxn (both ↑WBC + ↑precursor form). *Leukocyte (neutrophil) alkaline phosphatas level*: ↓CML, normal/↑ Leukomoid Rxn). T(9:22)Philly or BCR-ABL needed to dx CML.

Sinusitis w markedly elevated WBC & ↑myeloid precursor forms on PBS. ↓ Leukocyte Alkaline Phosphatase score.

Long bone metaphysis

Site of *hematogenous osteomyelitis* in children?

Vitiligo

Skin condition is characterized by the *loss of melanocytes* in the skin?

*Constrictive pericarditis*: calcification and thickening of the pericardium. Rapid y-descent that becomes deeper and steeper during inspirationg w jugular vp tracinging. Causes - radiation to chest, surgery, TB.

Slowly progressive dyspnea, peripheral edema, and ascites. CT shown that shows heart in close proximity to surrounding pericardium. What is dx?

***Ixodes tick Vector for Babesia

Source of infection for flu-like illness in NE US w intraerythrocytic organisms on PBS?

Upper Motor Neuron lesion (above anterior horn)

Spastic paralysis, clasp-knick, hyperreflexia, Babinksi are signs of?

Pretibial myxedema Opthalmopathy

Specific features of Graves disease caused by ↑glycosaminoglycans?

5' GU 3' AG guag

Splicesomes remove introns with what nucleotides at 5' & 3'?

Experiencing self or others as "all bad or all good" can't integrate +/- qualities.

Splitting Definiton

*have the nurse and surgeon verify the surgical site indepdently* known as *dual identifiers* to independently confirm the correct patient, site, and procedure. Checks must be truly independent to ensure patient safety.

Surgeon operates on wrong arm. What procedure would be most effective in preventing a similar error?

Cat+: Staphylococcus aurerus, Burkholderia cepacia, Serratia marcescens, Nocardia, and Aspergillus

Susceptible pathogens for patient w chronic granulomatous disease (genetic defect in NADPH oxidase)?

↑Aldosterone (↑Na, ↓K/H)

Symptom of adrenal mass affecting the *outer adrenal cortex*?

Exophthalmos (adipose displacing eye)

Symptom of hyperthyroidism not relieved w 𝝱-blockers?

Brachiocephalic vein obstruction

Symptoms of SVC syndrome (face/arm swelling and vein engorgement), but only on one side of body?

Inhibits presynaptic uptake of monoamines

Synaptic cleft effects of cocaine?

Diabetic patients - 2 insulins. 1. Basal LONG-acting 2. Postprandial-SHORT acting insulin. Long - *glargina and detemir* (shot 1xday) - *NPH* (18hrs, 2x). SHORT - lispro, *aspart*, and glulisin (given 3x w meals and peaks coincide w postprandial hyperglycemia).

T2DM treated w long-acting subcutaneous insulin injection once a day. Postprandial levels are too high, what type of insuilin would be most appropiate to administer before each meal?

Glucose-6-phosphae dehydrogenase defieicny

TMP/SMX induced hemolysis (hemoglobinemia, hemoglobinuria, jaundice) indicates?

Osler-Weber-rendu syndrome (Herediatory hemorrhage telangiectasia)

Telangiectasias in skin, lips, nose, resp, GI, and urinary mucosa, recurrent nosebloods, dx?

Hawthorne effect (observer effect)

Tendency of study subject to change their behavior as a result of their awareness that they're being studied?

Pneumonia: optochin-sensitive, bile-soluble (Viridans is opposite)

Test to differentiate Streptococcus pneumonia from Viridans streptococci?

Wenicke Korsakoff Syndrome

Thiamine (B1) deficiency syndrome w confusion, ataxia, and memory issues?

Thiazide: hyponatremia & hypercalcemia Loop: hypocalcemia

Thiazide and loop diuretics cause volume depletion/RAAS activation, hypokalema & metabolic alkalosis. How to differentiate between two?

Major DD: ≥ 2 wks. Persistent: ≥2 yrs. Criteria ≥5: SIG E CAPS

Time span/criteria for... Major Depressive Disorder vs. Persistent Depressive Disorder?

Selective muscarinic antagonists, *glycopyrrolate* *hyoscyamine* *propantheline* Nicotinic unaffected

Treatment for *muscarinic side effects* in cholinergic toxicity?

Cilostazol (Phosphodiesterase inhibitor)

Treatment for Peripheral Artery Disease that dilates arteries and inhibits platelet aggregation?

Ethosuximide for Absence seizures

Treatment for brief staring spells and momentary loss of awareness followed by abrupt return to full consciousness?

Supportive care

Treatment for febrile seizure?

Niacin Hartnup disease

Treatment for impaired transport of neutral amino acids in small intestine and proximal tubule of kidney?

low-dose aspirin (GI bleed risk)

Treatment for transient ischemic attack includes optimal bp control, statin therapy, and what additional regimen?

ESBL-E. coli inactivate penicillins and cephalosporins (including 3rd/4th gen) and monobactams. Genes are located in plasmids and can be transferred between organisms. *Carbapenems (eg, imipenem)* is tx of choice.

Treatment of choice Extended spectrum beta lactamase-poducing E. coli?

*Estrogen receptor modulation*. Tx can be w *clomiphene (estrogen receptor modulator that ↓negative feedback inhibition on the hypothalamus by ciculatin estrogen)* > ↑gonadotropin production (FSH & LH) and ovulation. Advised for weight loss, Oral contraceptive or Progestin-only to help w endometrial hyperplasia if don't want to become pregnant.

Treatment options for patient w *polycystic ovarian syndrome seeking treatment for infertility*.

Niacin ↓ renal uric acid secretion

Treatment responsible for acute *gouty arthritis* in *hyperlipidemic patient*?

↓CO, ↓PCVP ↑Central Venous Pressure

Trend in CO, PCWP, CVP in RV infarction w diminished filling pressures?

R, AT I, Bradykinin: ↑ AT II, Aldosterone: ↓

Trend of Renin, AT I, AT II, Aldosertone, and Bradykinin w ACE inhibitors?

Paroxysmal Nocturnal Hemoglobinuria (PNH) due to mutation in PIGA gene (glycosylphosphatidulinositol anchor) > Lose the ability to inactivate complement/prevent MAC formation > CD55/CD59 deficiency and complement-mediated hemolysis. Splenic sequestion is complication of SCD. *Complement activation*

Triad of hemolytic anemia, hypercoagulability, and pancytopenia. What is cause of patient's anemia?

Normal-pressure hydrocephalus (↓CSF resorption by arachnoid granulations)

Triad of progresive gait difficulties, cognitive disturbances, and urinary inconteninence?

Ethambutol

Tuberculosis treatment that can cause optic neuropathy?

*ATP-dependent transporter*. Human multidrug resistance *(MDR1) gene*. Similar to p-glycoprotein (reduces influx of drugs into cytosol and *increases efflux* of drugs out of the cytosol).

Tumor cell lines able to become *resistant after exposure to anticancer agents*. Resistant cells *express a specific cell surface glycoprotein*. What is the *fxn of this protein*?

Medullary thyroid cancer (neurendocrine)

Tumor of thyroid C cells appearing as nests or sheets of cells w extracellular amyloid deposits derived from calcitonin?

p53

Tumor suppressor gene that controls cell division and apoptosis and is inactivated in many tumors?

IV normal saline and insulin. Insulin allows cells to use glucose as energy source, decreasing lipolysis and production of ketone bodies (principal acid) > inc bicarb. Intracellular shift in K+ to decrease serum K+.

Tx of choice for diabetic ketoacidosis that causes increase in serum bicarb and Ma levels, decrease in serum osmolaitiy, and drop in K level?

Direct thrombin inhibitors (hirudin, lepirudin, argatroban)

Tx of heparin-induced thrombocyteopenia?

Acetazolamide

Tx to relieve intraocular pressure in open-angle and angle-closure glaucoma that causes alkaline urine?

Type 1 Collagen

Type of collagen located in bone?

Regular Insulin

Type of insulin that works within 30 min, peaks in 2-4hrs, and lasts 5-8 hrs?

Holocrine (Sebaceous glands)

Type of secretion release for glands involved in inflammatory acne?

*Mucin-secreting signet cells*. Krikenberg tumor: gastric tumor metastasizes to ovary. Met cells have large amounts of mucin & displaced nuclei (signet ring appearance). Ovary are common sites of metastasizes from GI tumor.

Uintentional weight loss, epigastric pain, and adnexal masses. Pelvic US: bilateral complex *ovarian masses (solid & cystic). Stomach CT: stomach wall thickening & ovarian masses.* What is likely to be seen on histo?

Carcinoma of the cervix as a result of HPV. HPV is small ds DNA. Oncogenic ability to integrate into genome and produce viral proteisn E6 and E7, which interact with p53 an Rb, respecitively. *Inhibition of cell cycle regulatory proteins*.

Ulcerative lesion at external cervical os. Squamous cells invading the underlying stroma. Ds-DNA virus which encodes several proteins (E6 and E7) integrated into the host genome. What is the *most likely mechanism by which these viral proteins are involved in this patient's condition*?

Inhibition of fast Na channels in cardiac myocytes

Underlying cellular event for cardiac arrhythmia in the setting of *tricyclic overdose*?

*Renal artery stenosis* due to atherosclerotic changes in the arterial intima

Unilateral kidney atrophy is suggestive of what?

Rifampin Phenobarbital Phenytoin

Universal enhancers of the cytochrome P-450 pathway that ↓warfarin effects?

Porphobilinogen deaminase deficiency, tx inhibits ALA synthase

Urine is reddish in color and darkens on standing 24 hrs. Pathway affected by Dextrose tx??

Bladder hypertonia

Urodynamic studies of MS patient w increased urinary frequency and urge incontinence?

*Psoas muscle* originate from anterior surface of the transverse processes and lateral surface of the vertebral bodies at T12 - L5. Acts to flex the hip + lateral rotation and abduction of the thigh.

Vague back pain, in HIV patient IV drug use. Bacterial infection is likely affecting the muscle (seen on CT) that parallels the spinal cord on each side. What is the structure?

Impaired GnRH will cause all to be low

Values of LH, FSH, and estrogen in an anorexic patient?

Aortic valve

Valve that opens when LV pressure > central aortic pressure at end of isovolumetric contaction?

Chronic venous insufficiency

Varicose superficial veins, chronic ↑luminal pressure (standing), edema, ulceractions, and poor wound heal indicate?

Takayasu Arteritis. Granulomatous inflammation of media

Vasculitis with similar pathology of Giant Cell Arteritis?

Splenic Vein

Vein responsible for *gastric varices* in the setting of *chronic pancreatitis*?

Endothelial injury, venous stasis, and hypercoaguble state

Venous thromboembolism arises due to Virchow triad, which included?

S3: ↑ventricular pressures ↑volume (aortic/mitral regurg & cardiomyopathy).

Ventricular gallop sound (after S2) in 70 yo man w LE edema & distended neck veins?

Posterior Inferior cerebellar artery. Lateral medullary (Wallenberg) syndrome. Cervical spine trauma w dissection of vertebral a.

Vertigo/nystagmus, ipsi-cerebellar signs, loss pain/temp, Horner syndrome. Vessel injured?

Legionella pneumonia. Labs show hyponatremeia. Gram-negative rod - not detected on Gram stain.

Very high fever in a smoker accompanied by diarrhea, confusion and cough that may be initially productive is the classic presentation. Pathogen?

HIV gp120, Epstein-Barr virus go350, parvovirus B19

Virsus bind to normal host cell plasma membrane receptors to enter host cells. Name assoc virus for CD4, CD21, erythrocyte P antigen?

A: ADP-ribosylation of EF2, inhibits protein synthesis. Corynebacterium diphteriae.

Virulence factor causing mild tonsillar erythema w exudates lumps of Gram+polar granules, stains aniline dyes in immigrant?

K1 capsular antigen E. Coli

Virulence factor for MC cause of neonatal meningitis that allows bacteria to survive in bloodstream?

VZV, HSV, CMV

Viruses associated with ... intranuclear inclusions +Tzanck smear?

Vit A (virus depletes stores)

Vitamine useful in measle tx that reduces comorbidities, recovery time, and length of stay?

Vasoactive Intestinal Peptide VIPoma

Watery diarrhea, hypokalemia, chlorhydria (WDHA). Symptoms improve with Somatostatin. What hormone is in excess?

25-hydroxyvitamin D to 1,25 dihidroxyvitamin D

What Vitamin D synthesis step is impaired in Chronic Kidney Disease?

Th2 cells secrete IL-4 and IL-13, which together promote B-lymphocyte class switching for IgE synthesis. They secrete IL-5 in order to activate eosinophils and promote IgA synthesis.

What allergens are produced by Th2 cells to promote B-lymphocye class-switching to synthesize IgE?

According to professional judgement that is in best interest of patient

When to share basic info about incapacitated patient?

PCOS due to increased activity of 17𝜶hydroxylase; 17,20 lyase; and 3𝝱-hydroxysteroid dehydrogenase → elevated androgen levels →anovulatory cycles → ↓progesterone →↓growth-inhibitory effects on endometrium ... could lead to *endometrial hyperplasia and adenocarcinoma*

What are PCOS patients at greatest risk for?

Berry aneurysms of Circle of Willis (Spontaneous Intracranial HemorrhageCH) Aortic arch Hypertension

What are adult-type coarctation of the aorta patients at risk for?

Transcription factors (myc, Creb), steroid receptors (cortisol, aldoserone, and progesterone), THR, fat-soluble vitamin receptors.

What are some DNA bnding proteins?

Inhibits peripheral conversion of Dopa

What are the effects of Carbidopa?

Posterior decending branch of RCA (SA node)

What artery supplies leads *II, III, and aVF* in 90% of patients?

Prolonged loud noise > *damaged stereociliated hair cells* of organ of Corti

What causes hearing loss?

*Natural Killer Cells*. Don't express CD4, CD8, or CD3. Don't require thymus maturation, have no anti-specific activities, *activated by interferon 𝛾 and IL-12. Kill via apoptosis.*

What cell is responsible for destruction of cells with decreased (such as virus-infected or tumor) or *absent MHC Class I proteins on surface*?

Gout

What disease features recurrent acute mono-arthritis and history of myeloproliferative disorder?

Chronic Alcohol Consumption

What disease is associated with macrocytosis (poor nutrition) AST: ALT > 2?

Mild hemophilia A and Type 1 von Willibrand disease

What disease states will increase Factor VIII & endothelial secretion of vWF to stop bleeding after desmopressin (DDAVP) therapy?

conserved DNA sequence code for transcription factors

What do homeobox genes code for?

Neutrophil recruitment and activation > cytotoxic granules that kill bacteria > liquifying necrosis

What drives abscess formation?

Fibrates (gemfibrozil), Impair hepatic clearance

What drug *increases myopathy risk* in patients on statins?

↑TBG

What effect will increased estrogen levels have on thyroxine-binding globulin?

Obliteration of omphalomesenteric (vitelline) duct.

What embryologic process failed in patient w 99m Tc-pertechnetate scintigraphy shows focal radiotracer accumulation in RLQ?

Xanthine oxidase caution with Allopurinol (XO inhibitor)

What enzyme invactivates 6-mercaptopurine (used in ALL tx)?

Heteroplasmy, severity of mitochondrial dis related to [abnormal mitochondria].

What explains variability of disease states child (severe), mom (mod), uncle (mild) states?

Kidney is primary elimination site. *Liver is site for biotransformation, most lipophilic (good CNS penetration) are preferentially processed by the liver into more polar compounds*. Liver disease can limit or enhance the clearance of drugs metabolized by the liver.

What features would a drug need to have to have preferential elimination in the liver vs in the kidneys?

Pulmonary capillary wedge pressure (Pulm A (Swan-Ganz) catheter, inflated balloon obstructs vessels, pressure at tip = LA pressure & LVEDP). *Mitral stenosis* - leads to ↑ in the LA pressure reflected as ↑PCWP during Pulm A catheterization.

What heart condition would cause a PCWP greater than the LVEDP?

*Intercain cross-links involving lysine*

What is a property of elastin responsible for emphysema?

Neutropenia

What is a significant AE of ganciclovir therapy that is increased with co-administration of zidovudine or TMP-SMX?

Using bed only for sleep & sex; leave bed if not falling asleep

What is an example of a stimulus control therapy for pt w insomnia?

*Brain tumor cells forming giant cells* Undifferentiated (anaplastic) tumor bear no resemblance to the tissue of origin. Composed of pleumorphic cells with large, hyperchromatic nuclei that grow in a disorganized fashion. Anaplastic tumors may also contain numerous, abnormal mitoses and giant tumor cells.

What is an example of an anaplastic tumor?

Basal ganglia

What is atrohpied w Keyser-Fleischer ring in Wilson's disease pt?

Presynaptic exocytosis of Ach vesicles

What is blocked with the ingestion of botulinum neurotoxin?

Proinsulin cleavage > insulin and C-peptide, stored in granules

What is c-peptide?

*Prostaglandin E2* Patent Ductus Arteriosus. NSAIDs can inhibit PE2 > close PDA.

What is causing continuous murmur w systolic accentuation heard at left heart border?

ACE levels

What is elevated in the serum of sarcoidosis patient?

Amatoxins *halt mRNA synthesis* via binding DNA-depependent-RNA-Polymerase II

What is halted after poisonous mushroom ingestion?

Sleep deprivation > physician fatigue

What is in a dose-dependent relationship w physician cognitive performance and risk of medical errors?

Erythropoiten

What is increased in the setting of aplastic anemia & normal renal function?

Nucleotide sequence of regions flanking target exon.

What is needed for amplification part of PCR test?

FL: t(14; 18), Bcl2. t(8;14,2,22?), C-myc

What is overexpressed in Follicular lymphoma (NHL) vs. Burkitt lymphoma?

Pyeloperoxidase

What is stained in positive stain for auer rods in cytoplasm of myeoblasts in AML?

stratified squamous epithelium w friction/abrasion (true vocal cords)

Where does HPV infect?

HPV infection, especially strains 16 and 18, is the strongest risk factor for the development of cervical dysplasia and invasive cervical carcinoma. HIV coinfection allows HPV infection to persist and enhaces expression of HPV oncogenes, increasing the risk for cervical dysplasia/cancer.

What is strongest risk factor for cervical dysplasia?

*Prothrombin time*

What is the best test to monitor the anticoagulation effect of warfarin?

*Phenytoin* > ↑expression of PDGF. Gingival macrophages exposed to ↑PDGF stimulate proliferation of gingival cells and alveolar bond. Phenytoin toxicity mainly affects the cerebellum and vestibular system, causing ataxia and nystagmus.

What is the cause of gingival hyperplasia?

Nucleus translocation > survival, anti-apoptosis, and angiogenesis

What is the efect of mTOR activated by Akt in the PI3K/Akt/mTOR pathway?

Meg Anemia is 2nd to folate/B12(cobalamin) deficiency.

What is the initial pathology in megaloblastic anemia?

Metabolic parameters (weight, glucose, lipid)

What lab studies are need when taking Second Generation Antihistamines (olanzapine and clozapine)?

Long-acting Sulfonylureas (glyburide, glimedpride)

What long-acting drug class ↑ pancreatic 𝝱cell secretion of insulin, which can cause cause hypoglycemia (esp in elderly)?

Cyclooxygenase-2

What medication could reduce a patient with polyps from developing recurrent adenoma?

Diaphram, phrenic n. roots pass through interscalene sheath

What muscle will be paralyzed by interscalene nerve block to provide anesthesia for shoulder and upper arm?

Helicobactor pylori w Antibiotics

What must be eradicated to ↓duodenal peptic ulcer disease recurring?

Vagus N. via its small auricular branch. Sensation to the rest of the canal is from mandibule dividsion of the trigeminal n.

What nerve provides sensation to the *poterior external auditory canal*? Where does the surronding sensation come from?

Repolarization, closure of Na+ channels and opening of voltage-gated K+ channels

What part of AP is the membrane most permeable to K+ ions?

Proximal Tubule

What part of the nephron primarily secretes PAH?

Proximal Tubule

What portion of the glomerulus *absorbs the majority of water*?

Thick ascending Loop of Henle Distal Convoluted Duct

What portions of the nephron contain the most dilute urine?

Neutrophils Candida

What prevents *systemic spread* of pseudohyphae-producing yeast?

Left frontal lobe

What region of head trauma would result in apathy and depression?

Aldosterone receptor antagonist > *reduces K/H secretion* by collecting duct

What renal functions will be decreased after starting *spironolactone*?

*Viable sperm in the ejaculate*, will be present distal to the ligation. Can be present for 3 months and at least 20 ejaculations.

What should a patient be advised to expect during the first month following a vasectomy?

Benzodiazepines, antihistamines, and sedating antidepressants.

What should be avoided when treating the elderly for insomnia?

𝛾-glutamyl transpptidase (GGTP) in hepatocytes

What should follow a moderately elevated alkaline phophatase to determine if hepatic or bony origin?

Leukotriene B4

What stimulates neutrophil migration to sites of inflammation?

phosphatidylinositol-3-kinase activates protein phosphatase

What stimulates the metabolic functions (GLUT-4) of insulin?

ligand binding - Gq protein > activation of PLC > *hydrolyzes phosphatidyl inositol bisphosphate and forms diacylglyceral and IP3*. IP3 > ↑ intracellular Ca2+ > activates protein kinase C .

What substance increases immediately after activation of GPCR-dependent phospholipase C?

Inhibin B. FSH→(Sertoli cells)→inhibin B.

What substance is likely to be decreased in pt w inactive FSH receptors?

Prostacyclin

What substance opposes the effects of thromboxane A2?

*********𝝱2,⇢uterine contraction 𝜶1, pupillary dilator contract

What type of receptor stimulation causes tocolysis & mydriasis?

Widened pulse pressure Aortic Regurgitation

What will be the physical exam findings of patient with... pulsatile head bobbing and palpitations?

Protein restriction reduces aa turnover

What will improve a urea cycle defect causing neuro damage?

Increased O2 affinity due to ↑pH, ↓ 2,3-bisphosphoglyverate, ↓ temperature. Left shift means that O2 is less available to the tissues.

What would cause a left shift of the hemoglobin oxygen dissociation cutve?

double-stranded DNA → +RNA template → double-standed DNA progeny. Although it is DNA virus, replicates via reverse transcription.

Whats the replication sequence of HBV?

Post-metastasis from liver (no longer can be metabolised)

When does one develop carcinoid syndrome from a carcinoid tumor?

Functional Residual capacity

When is pulmonary vascular resistance the lowest?

*Sensitive*. Ability to correctly identify those with the disease. This is because identification of every person w the disease is important. Will allow for fewer cases of the disease to be missed. SnNout (sensitivy, a negative test will help rule out)

When screening for life-threatening diseases, is a more specific or more sensitive test preferred?

Physicians ethically obliged to disclose medical errors regardless of harm. ↓sue if physician is forthcoming

When should you disclose medical errors?

Digoxin is a *cardiac glycoside that is cleared by kidneys*. Elderly patients typically exhibit end-stage renal insufficiency even in the presence of normal creatinine levels.

Why must digoxin use in elderly patients be reduced?

Injury to mammary body can precipitate Wernicke Encephalopathy

Why should alcoholic/malnourished patients receive IV thiamine before IV dextrose?

Anaphylaxis

Widespread *mast cell/basophill degranulation* + release of preformed inflam mediatrs (histamine & tryptase). Tryptase is specific for mast cells. What's going on ?

Cocaine "crash"

Withdrawal from what drug → severe depression, fatigue, vivid dreams, hypersomnia?

*Pudendal Nerve Block*

Woman has second-degree laceration during delivery. Prior to repair, palpation to medial to ischial spine, through the sacrospinous ligament. *What is the target nerve to provide anesthesia to most of perineum*?

*Neurodegeneration and hepatosplenomegaly*. Niemann-Pick disease: lipid storage disorder caused by sphingomyelinase deficiency. Accumulation of lipid-laden cells leads to aformenetioned defects. Infants will miss milestones. Retinal accumulation: cherry-red macular spot.

Young Ashkenazi Jew couple interested in conceiving. Have AR disorder of *sphingomyelinase deficiency*. What are the clinical features associtated with an affected child?

Muscarinic agonist (in place of Ach) > ↑ in parasympathetic nervous system acitivty. M receptors on endothelial suface > promote NO synthesis > Guan, cGMP, myosin light > *peripheral vasodilation*

Young boy who ate mushrooms and began vomitting. Main poison stimulates muscarinic receptors. What is the most likely direct effect of this poison?

Viral myocarditis causing dilated cardiomyopahty

Young patient w decompensated heart failure after a symptomatic viral prodome?

𝝱 thalassemia causing ↑RBC turnower

↑HbA2 in setting of falsely low HbA1c indicates?