UWORLD Set #1

Hemochromatosis: how does it affect the heart?

DILATED Cardiomyopathy or Restrictive Cardiomyopathy Dilated Cardiomyopathy is MOST COMMON!

Roth Spots

Infective Endocarditis -Edematous & Hemorrhagic lesons of the Retina

Interferon-gamma (IFN-gamma): function?

activates MACROPHAGES increases MHC expression promotes Th1 differentation -critical in immunity against viral and intracellular bacterial infections.

Insurer pays a provider a single payment to cover all the expenses associated with an incident of care.

Global Payment Most commonly done for elective surgeries

Acute Poststreptococcal Glomerulonephritis: LM?

Glomeruli Enlarged and Hypercellular

Inner membrane of Tympanic Membrane: innervation?

Glossopharyngeal Nerve (CN IX)

Loss of general sensation at the tonsillar lining: innervation?

Glossopharyngeal Nerve (CN IX)

Sensory of Eustachian Tube: innervation?

Glossopharyngeal Nerve (CN IX)

Tonsillar Region: Innervation?

Glossopharyngeal Nerve (CN IX)

How does Glucagon treat Beta-Blocker overdose?

Glucagon increased cAMP in cardiac myocytes --> increasing the release of calcium during muscle contraction --> increases HR and cardiac contracitily

Occulomotor (CN III): Paralysis

-"Down and out gaze" -Drooping of the Eyelid -Fixed, dilated pupil (loss of accommodation) LEVATOR PALPEBRAE INFERIOR OBLIQUE Superior Rectus Inferior Rectus Medial Rectus

Bicuspid Aortic Valve: may lead to?

-AORTIC STENOSIS in 50s (MOST IMPORTANT) -Aortic Regurgitation -Aortic Dissection (still <1% and risk increases with age) -Increased risk of Infective endocarditis (risk is 2-3% and rises with age, due to increasingly turbulent blood flow across the abnormal valve)

Organophosphate Poisoning: treatment

-ATROPINE (muscarinic antagonist) and -PRALIDOXIME(reactivates acetytlcholinesterase by binding organophosphates and decoupling them from the enzyme)

Neural Crest (Ectoderm): derivatives?

-Adrenal Medulla -Melanocytes -Branchial Arches (bones & cartilage) -Endocardial Cushions (aorticopulmonary septum) -Pia & Arachnoid Mater -Schwann Cells -Ganglia (autonomic, sensory, & Celiac)

Cystic Fibrosis: Treatment?

-Albuterol -Aerosolized dornase alfa (DNAse) -Hypertonic saline (facilitates mucous clearance) -Antibiotics (for lung infections) -Azithromycin (anti-inflammatory agent) -PANCREATIC ENZYMES (PANCREATIC LIPASE)(insufficiency) -N-Acetylcysteine (not in FA) I missed this question (answer was PANCREATIC LIPASE!!)

Multiple Sclerosis: effective monotherapy for muscle spasms?

-Baclofen (GABA-b receptor agonist) -Tizanidine Both decrease the excitability of spinal reflexes

Open-Angle Glaucoma: What drugs act on Ciliary Epithelium to Decrease production of Aqueous Humor?

-Beta Blockers (Timolol, Betaxolol) -Carbon Anhydrase Inhibitors (Dorzolamide-topical, Acetazolamide-systemic)

Phenytoin: toxicity?

-CNS manifestations (Ataxia & Nystagmus) -GINGIVAL HYPERPLASIA -COARSENING of facial features -HIRSUTISM -MEGALOBLASTIC ANEMIA (interferes with the metabolism of folic acid)

Hyperosmolar Volume Contraction: causes?

-Diabetes Insipidus -Profuse Sweating

Fabry Disease: clinical features?

-EPISODIC PERIPHERAL NEUROPATHY -Angiokeratomas -Telangiectasias Late: -Renal Failure -Cardiac Disease (left ventricular hypertrophy) -Cerebrovascular Disease (TIA, stroke)

Hemolytic Uremic Syndrome: what lab findings?

-Elevated Serum BUN & Creatinine (acute kidney injury) -Elevated Serum Indirect Bilirubin -Decreased Hemoglobin, haptoglobin -Increased LDH (I choose low fibrinogen and elevated D-Dimer Level, which was wrong, in RX question it said that DIC is a characteristics of this so not sure...)

Insulin Resistance Contributing factors?

-Elevated free fatty acids -Obesity -Sedentary Lifestyle Elevated FFA contribute to INSULIN RESISTANCE by IMPAIRING INSULIN-DEPENDENT GLUCOSE UPTAKE in LIVER & MUSCLE and INCREASING HEPATIC GLUCONEOGENESIS

Contact precautions: Bordetella Pertussis

-FACEMASK -NON-STERILE GLOVES -GOWN *Droplet Precautions

Contact precautions: Influenza

-FACEMASK -NON-STERILE GLOVES -GOWN *Droplet Precautions

Tertiary Syphilis: presentation

-GUMMAS (begin as painless, indurated granulomatous lesions that progress to white-gray rubbery lesions that may ulcerate. They are most commonly cutaneous but also appear in the subcutaneous tissue, bones, liver, and other organs. -CARDIOVASCULAR (Ascending Aortic Aneurysm -> seen by calcifications on x-ray possibly. AORTIC VALVE INSUFFICIENCY-->VASA VASORUM OBLITERATION) -Neurosyphilis (may be asymptomatic or may cause subacute meningoencephalitis, tabes dorsalis, or headeaches, memory loss, etc)

Hereditary Nonpolyposis Colorectal Cancer (HNPCC): what is the most likely mechanism by which the MSH2 gene is involved in this condition? -Inactivation of DNA repair proteins -Inhibition of cell cycle regulatory proteins

-Inactivation of DNA repair proteins

Patient has sudden onset of heart palpitations. Initial BP is 110/70 and Pulse is 160. Carotid Sinus is massage and HR is now 75 and BP is 120/80. 1. What is the mechanism responsible for improvement of the patient's condition?

-Increase in Baroreceptor Firing from Carotid Sinus -Increase in Parasympathetic Output to SLOW IMPULSES TO SA NODE and CONDUCTION THROUGH AV NODE -withdrawal the sympathetic output to the heart and peripheral vasculature (DECREASE IN SYSTEMIC VASCULAR RESISTANCE) *I choose INCREASE VASCULAR RESISTANCE

Dialysis: what will increase rate of drug removal?

-Increase surface area of membrane -increased solubility of the diffusing substance -higher molecular concentration gradients

Acute Respiratory Distress Syndrome: what is ABNORMAL

-Increased CAPILLARY PERMEABILITY -Decreased LUNG COMPLIANCE -Increased WORK of breathing -Worsened VENTILATION to PERFUSION MISMATCHING -Normal Pulmonary Capillary Wedge Pressure There is ENDOTHELIAL DAMAGE -> INCREASED ALVEOLAR CAPILLARY PERMEABILITY -> PROTEIN-RICH LEAKAGE into ALVEOLI -> DIFFUSE alveoli damage and NONCARDIOGENIC PULMNOARY EDEMA

If Hepcidin is Low what does this stimulate?

-Increased Intestinal Iron Absorption -Increased Iron release by Macrophages

Hepatic Encephalopathy: what is the most likely precipitating factor?

-Increased load of NITROGENOUS SUBSTANCES ABSORBED BY THE GUT! -Drugs (sedatives, narcotics) -HYPOVOLEMIA (diarrhea, vomiting) -EXCESSIVE NITROGEN LOAD(1st falls into this) -INFECTIONS -Metabolic Disturbances (Hypokalemia, Metabolic Alkalosis)

Acetycholine (ACh) & Adenosine slow the depolarizization of Atrial pacemaker cells by?

-Increasing Potassium Conductance (prolongs phase 4) -slows conduction through the AV node by HYPERPOLARIZING the nodal pacemaker and conducting cells

Organic Acidemia: How to recognize them?

-Infant that has poor feeding and vomiting (low sugar in blood) -either METHYLMALONIC ACIDEMIA or PROPIONIC ACIDEMIA -METABOLIC ACIDOSIS -HYPOGLYCEMIA (organic acids are toxic to gluconeogenisis) -HYPERAMMONEMIA (organic acids are toxic to Urea cycle) -ELEVATED urine METHYLMALONIC ACID and PROPIOINIC ACID -URINE KETONES Propionic Acidemia -> Only Propionic Acid will be elevated (that is the only difference.

A double stranded virus (HPV) that encodes that proteins E6 & E7 has integrated into the host genome. Which of the following is the most likely mechanism by which these viral proteins are involved in this condition? -Inactivation of DNA repair proteins -Inhibition of cell cycle regulatory proteins

-Inhibition of cell cycle regulatory proteins -E6 (p53) -E7 (Rb) *both important to REGULATE CELL CYCLE

Alcohol Withdrawal Symptoms?

-Insomnia -Tremulousness -anxiety -autonomic hyperactivity -agitation **ABRUPT cesssation decreases inhibitory tone and results in CNS EXCITATION (withdrawal)

Rheumatoid Arthritis: Extraarticular manifestations?

-Interstitial Lung Disease -Anemia of Chronic Disease -Neutropenia + Splenomegaly (Felty Syndrome) -AA Amyloidosis -Sjogren Syndrome -Scleritis -Carpal Tunnel Syndrome

Taenia Solium: presentation?

-Intestinal Tapeworm or -Neurocysticercosis (seizures, MRI with cysts) **people from developing countries!!

What are the Airborne Precautions? 2. What organism?

-Isolated Room w/ NEGATIVE PRESSURE VENTILATION -RESPIRATOR MASK w/ FILTERING CAPACITY (N95 MASK) 2. Mycobacterium Tuberculosis

What organisms are resistant to Cephalosporins?

-Listeria Monocytogens -MRSA -Enterococci -Atypicals (Mycoplams, Chlamydia)

Methadone: what makes it an effective treatment program?

-Long half-life! -FULL AGONIST -mu-opioid receptor agonist Naloxone (is a partial agonist don't mixed that up!)

Ventral Pancreatic Bud: forms what?

-MAIN PANCREATIC DUCT (of Wirsung)(aka Major) -Uncinate Process -Inferior/Posterior portion of head

Pneumothorax due to emphysema or an infection: treatment?

-MECHANICAL VENTILATION with use of HIGH PRESSURES (BAROTRAUMA) **I would be careful with this one if it shows TENSION PNEUMOTHORAX then --> IMMEDIATE CHEST TUBE PLACEMENT

Atropine (homatropine, or tropicamide): use?

-Mydriasis (dilation of eye) -Cycloplegia (paralysis of the ciliary muscle)

Niacin is an essential component of?

-Nicotinamide Adenine Dinucleotide (NAD) -Nicotinamide Adenine Dinucleotide Phosphate (NADP)

Pilocarpine: uses?

-Open-angle Glaucoma -Close-angle Glaucoma -Sjogren Syndrome

C3b: function

-Opsonin -binds to C3b convertase and form C5 Convertase, ultimately triggering the Membrane Attack Complex

Candida Albicans: may cause the following

-Oral thrush -Vulvovaginal Candidiasis -Cutaneous Candidiasis -Disseminated Disease

Splenic Artery branches?

-Pancreatic Branches -Left Gastroepiploic Artery -Short Gastric Branches

If the interaction of Inositol Triphosphate with its intracellular receptor is blocked what enzymes will have decreased activity?

-Protein Kinase C -Protein Kinase C is activated by Calcium released by IP3. *I chose Phospholipase C but this is much further up in this pathway. OOPS!

contact precautions: multidrug resistant organisms (MRSA, VRE)?

-SOAP & Water (no sanitizer) -NONsterile gloves -GOWN

Social anxiety Disorder: Treatment

-SSRI/SNRI -CBT -Beta-Blocker or Benzodiazepine -> (Performance-only subtype)

Patient overdoses on Beta-Blockers what can you treat them with?

-Saline -Glucagon -Atropine

Most common causes of Meningitis in Children 6 months - 6 years?

-Streptococcus Pneumoniae (6 mos - 60 -> except teenagers) -Neisseria meningitis -Haemophilus Influenzae Type B (Hib) -Enteroviruses

Alpha-1 Blockers: names? 2. Use?

-Tamsulosin -Doxazosin -Prazosin -Terazosin 2. Hypertension & Benign Prostatic Hyperplasia (BPH) (TAMSULOSIN--> DOES NOT LOWER BP!!!)

Thrombolytic or Fibrinolytic Drugs: names?

-Tissue Plasminogen Activator (tPA) -Reteplase -Tenecteplase -Streptokinase

Alcohol Withdrawal Findings

-Tremor -Tachycardia -Diaphoresis -Seizures (possible if more severe) -Alcoholic Hallucinosis (more severe)

Medications with Anticholinergic Properties (with classes)

-Tricyclic Antidepressants (AMITRIPTYLINE!!, Imipramine) -Antihistamines (Diphenhydramine, Doxylamine) -1st-generation low potency antipsychotics (CHLORPROMAZINE) -2nd-generation antipsychotic CLOZAPINE -antiparkinsonian drugs (BENZTROPINE, TRIXYPHENIDYL) -Belladonna Alkaloids (ATROPINE)

Charcot-Bouchard Microaneurysm: important? associate with what?

-associated w/ CHRONIC HYPERTENSION -affects small vessels (eg in BASAL GANGLIA, THALAMUS) -not seen on angiogram Compare with Subarachnoid Hemorrhage due to Berry Aneurysm or Saccular Aneurysm.

Aortic Regurgitation: findings? 2. caused by?

-bounding femoral pulses ("Water-hammer" Pulses) -Carotid pulsations that are accompanied by head-bobbing (de Musset sign) 2. caused by a LARGE LEFT VENTRICULAR STROKE VOLUME (LVSV) to the head & neck (large PULSE PRESSURE)

Statins: MOA

-competitive inhibition of HMG-CoA reductase -question asked --> ENHANCED HEPATIC LDL RECEPTOR RECYCLING -INCREASED LDL clearance from the circulation

Postpartum Psychosis: characteristics? 2. biggest thing to not do?

-days to weeks -Delusions -Hallucinations -though disorganization -bizarre behavior treatment: Antipsychotics & antidepressants 2. DO NOT LEAVE INFANT ALONE WITH MOTHER!!!

Jugular Foramen Lesion?

-dysphagia -hoarseness -loss of gag reflex (ipsilateral side) -deviation of uvula toward normal side -weakened shoulder (ipsilateral side) -loss of taste to posterior 1/3 of tongue

Wilson's Disease: Where does the Copper deposit?

-eventually Copper leaks from INJURED HEPATOCYTES into circulation and is deposited in various tissues -> CORNEA (descemet membrane) and BASAL GANGLIA, KIDNEY, JOINTS

Standard Precautions that all hospitals require before and after every patient?

-handwashing before and after patient contact -proper disposal of cleaning instruments & linens -occasional use of gowns and gloves as required (CONTACT WITH BODILY FLUIDS)

Taenia Solium: transmission?

-ingestion of undercooked pork -exposure to infected stool **people from developing countries!!

Abetalipoproteinemia: serum Triglycerides, cholesterol, chylomicrons, VLDL, and apoB?

-low plasma triglyceride & cholesterol levels, -ABSENT chylomicrons, VLDLs and apoB.

Alpha-1 Blockers: MOA? 2. Side effects?

-relax smooth muscle in arterial and venous walls (decrease peripheral vascular resistance) -relaxation of smooth muscle in the bladder neck & prostate (decrease in urinary obstruction) -DO NOT AFFECT THE HEART!) 2. Hypotension & vertigo from to much vasodilation (START A SMALL DOSE AT FIRST!!)

Organophosphate Poisoning: symptoms

-salivation -lacrimation -diaphoresis (sweating) -bradycardia -bronchospasm -diarrhea -excitation of skeletal muscle -Urination -Miosis (constriction of pupil)

Postpartum Depression: characteristics?

-starts within 4 weeks -MODERATE to SEVERE depression -SUICIDAL IDEATION!!! -sleep or appetite disturbance -low energy -psychomotor changes -guilt -concentration difficulty treatment -> CBT or SSRI

Popliteal Cyst (Baker Cyst)?

-swelling of Gastrocnemius Bursa or Semimbranosus Bursa. -OSTEOARTHRITIS or Inflammatory Joint Disease

Polycystic Ovary Syndrome (PCOS): treatment

-weight loss -combination hormonal contraceptives -Metformin (if hyperglycemic)

Inhaled Anesthetic Drug: What does a blood solubility of 0.1 vs 1.0 mean?

0.1 = poor solubility but RAPID INDUCTION 1.0 = good solubility but SLOW INDUCTION

To ensure that investigators will not miss a difference between drug B and standard of care (if a difference truly exists), what do they want to maximize?

1 - Beta (Statistical Power) -this represents a study's ability to detect a difference when one exists It is the probability of rejecting the null hypothesis when it is truly false. The probablity of finding a true relationship. Power depends on sample size and the difference in outcome between the groups being tested.

Acute Stroke: microscopic changes first occur when? 2. what is the first change seen?

1. 12-48 hours since ischemic event 2. Dead Red Neurons

Heart Failure 1. Treatment with proven mortality benefit? 2. Symptomatic Treatment?

1. ACE-I, ARBs, Spironolactone, B-Blockers (except in Acute Decompensated HF) 2. Thiazide or Loop diuretics

Acute Decompensated Heart Failure: 1. Treatment with proven mortality benefit? 2. Symptomatic Treatment?

1. ACE-I, or ARBs (proven mortality benefit) 2. Thiazide or Loop diuretics (remove excess volume but no proven mortality benefit)

40 yo woman has persistent anxiety and insomnia over the past 6 months. She says. I'm really worried that something is wrong with me. I was never a particularly anxious person, but now I feel anxious all the time. Sometimes I feel panicky for no reason and I have episodes in which my heart races and I break out in a sweat. She has lost 5 lbs without trying. She has no significant medical or psychiatric history. BP is 130/90, pulse is 106/min. On PE patient is restless and has warm, moist skin, and mild hand tremor bilaterally and notable for a frightened stare. 1. Diagnosis?

1. ANXIETY due to a general MEDICAL CONDITION The new onsent of anxiety in this patient with no prior psychiatric history and prominent physical findings on examination suggest that anxiety is more likely due to a medical condition. (AXIETY IS A DIRECT PHYSIOLOGICAL EFFECT OF THE MEDICAL CONDITION) than to a primary disorder. Specifially this patient's weight loss, tachycardia, warm, moist skin, tremor, frightened stare, and restlessness are consistent with hyperthyroidism. Other conditions that may present with anxiety symptoms are HYPOGLYCEMIA, PHEOCHROMOCYTOMA, HYPERCORTISOLISM, AND CARDIAC ARRHYTMIAS.

Promoter region of a eukaryotic gene: function: 1. What is located here? 2. What binds here?** 3. A mutation here would cause?

1. AT-rich upstream sequence from ATG start codon (CAAT and TATA boxes) 2. RNA Polymerase II 3. A dramatic DECREASE in level of GENE TRANSCRIPTION INITIATION

Blood-brain Barrier: what type of substances cross slowly?

Glucose & Amino Acids by carrier mediated transport mechanisms

Farmer, confused, disoriented, BP 110/70, pulse 50. Pupils are symmetric, 2 mm, and reactive to light. Eyes are tearing considerably. Scattered wheezes bilaterally on lung auscultation. Skin is clammy and he is sweating profusely. 1. What is impaired? 2. Diagnosis? 3. Treatment?

1. Acetylcholinesterase Inhibition 2. Organophosphate Poisoning 3. Atropine (muscarinic antagonist) and Pralidoxime (reactivates acetytlcholinesterase by binding organophosphates and decoupling them from the enzyme) Organophosphates are IRREVERSIBLE CHOLINESTERASE INHIBITORS (widely used as pesticides in agriculture)

Woman with abdominal pain, nausea, and confusion, urine is reddish in color an darkens on standing for 24 hours. IV dextrose (glucose) resolves her symptoms significantly. 1. Diagnosis 2. Dextrose infusion most likely improves this patient's condition by affection what pathway?

1. Acute Intermittent Porphyria 2. Porphyrin Synthesis Treatment for Acute Intermittent Porphyria is HEME or GLUCOSE both inhibit ALA SYNTHASE which inhibit POPRHYRIN SYNTHESIS In this question stem it also said that smoking and alcohol had made her sick in the past. That is because Alcohol and smoking are CYP450 INDUCERS. and ALA SYNTHASE is upregulated by CYP450 INDUCERS like SMOKING & ALCOHOL.

Sudden onset of palpitations, he had a similar episode a year ago that resolved spontaneously. Rapid IV injections of a drug into this patient results in instantaneous resolution of the arrhythmia but is accompanied with transitory flushing, burning in the chest and shortness of breath. What was the drug? 2. What is the diagnosis?

1. Adenosine (drug of choice for PSVT) 2. Paroxysmal Supraventricular Tachycardia (PSVT) -comes on SUDDENLY -automaticy LIES ABOVE VENTRICLES -often from REENTRANT CIRCUIT Adenosine -slows conduction through the AV node by HYPERPOLARIZING the nodal pacemaker and conducting cells

Painful abdomen, tingling of the limbs, and an IV infusion of a heme preparation leads to rapid resolution of her symptoms. The improvement of her symptoms is most likely due to treatment-induced downregulation of what enzyme? 2. Diagnosis? 3. Deficient Enzyme?

1. Aminoleveulinate Synthase (ALA Synthase) 2. Acute Intermittent Porphyria 3. Porphobilinogen Deaminase

Male patient has sever neurological disease dies from overwhelming respiratory infection. Light microscopy revels a severe loss of neurons in anterior horn of spinal corn and in the hypoglossal and ambiguous cranial nerve nuclei; corticospinal tracts stain only faintly, indicating demyelinization. 1. patient most likely suffered from what?

1. Amyotrophic Lateral Sclerosis

HIV male: Viral strains isolated from blood samples drawn at this visit demonstrate a significant increase in pol gene mutations over the last year. What is this observed finding related to?

1. Antiretroviral chemotherapy

Patient with generalized weakness and fatigue for 2 weeks, significant bruising on his trunk that is spontaneous. No known medical problems and takes no known medications. Has conjunctival pallor and truncal ecchymoses. Lab studies reveal a hemoglobin of 6.8. Creatinine is normal. Bone marrow aspirate is performed. The aspirate is grossly pale and histologically appears dilute due to high lipid content. (see image for smear) 1. Diagnosis 2. What is increased?

1. Aplastic Anemia 2. Increased Erythropoietin (EPO)

Patient is not using medication correctly, including skipping doses, doubling up doses. 1. How do you approach this?

1. Assess and PROVIDE TARGETED EDUCATION

Intermittent nocturnal dyspnea, episodic cough, and family history of atopic dermatitis, normal spirometry 1. consider the diagnosis of? 2. administer what medication for a diagnostic workup?

1. Asthma 2. Methacholine

Ataxia, recurrent pulmonary infections, unsteady gait in an 8 year old male 1. Diagnosis 2. Genetic defect in child?

1. Ataxia-telangiectasia 2. Failure to REAPIR DNA DOUBLE STRAND BREAKS!

64 yo smoker has nagging right shoulder pain that radiates to the ipsilateral arm. Patient also has weakness in the right upper extremity. Symptoms started 2 months ago and have worsened progressively. On neurologic examination patient is alert, oriented and follows commands. He has partial right sided ptosis and fully intact extraocular movements. His pupils are asymmetric in dim light. Right upper extremity has 3/5 strength and absent deep tendon reflexes. 1. This patient's autonomic dysfunction is most likely a result of a lesion involving what? 2. Diagnosis

1. Autonomic Ganglia 2. Pancoast Tumor (usually non-small cell lung cancers like squamous cell carcinoma or adenocarcinoma) HORNER'S SYNDROME 1. Partial Ptosis 2. Miosis 3. Anhydrosis (impaired sweating)

Patient is started on a new antipsychotic medication. 3 weeks later, the patient comes to the ED due to generalized muscle stiffness and shaking of his right hand. 1. What is the best treatment for this patient's current symptoms?

1. BENZTROPINE, or trihexyphenidyl Patient was likely taking a Typical antipsychotic (first-generation antipsychotic) due to greater D2 blockade but can also occur with second-generation antipsychotics. If the antipsychotic cannot be reduced or discontinued, drug induced parkinsonism is best treated with a centrally acting ANTIMUSCARINIC AGENT (trihexyphenidyl, BENZTROPINE). Levodopa should not be used to treat antipsychotic-induced parkinsonism as it can precipitate psychosis.

Patient hospitalized for acute cholecystitis is being evaluated for anxiety and agitation. He underwent open cholecystectomy with no complications. 2 days after admission, the patient experiences anxiety and tremulousness, and he becomes severely agitate and verbally abusive to the nursing staff. He admits to drinking 6-8 beers daily for the last several years. What is the most appropriate pharmacotherapy for this patient? 2. MOA?

1. Benzodiazepines (DIAZEPAM or CHLORDIAZEPOXIDE) (first line therapy for PSYCHOMOTOR AGITATION associated with alcohol withdrawal an to PREVENT PROGRESSION TO SEIZURES AND DELIRIUM. 2. act by ENHANCING GABA INHIBITORY ACTION.

URI symptoms 2 days later by wheezing, cough & respiratory distress 1. Diagnosis? 2. Family of Virus 3. Most common organism?

1. Bronchiolitis 2. Paramyxovirus 3. Respiratory Syncytial Virus

Immunocompromised from Hodgkin's Lymphoma treatment. Patient experiences fever, dyspnea, and malaise. Blood cultures Germ Tubes at 37 C. 1. Organism? 2. What does this organism appear at 20 C?

1. Candida Albicans 2. Pseudohyphae and Budding Yeasts at 20 C Germ tubes at 37 C "Germ Tubes" are growing hyphae and becoming True Hyphae. In immunocompromised patients, Candida can also cause disseminated disease that may affect any organ system. Potential manifestations include PNEUMONIA, ESOPHAGITIS, RIGHT-SIDED ENDOCARDIITIS, ABSCESSES, AND CANDIDEMIA (sepsis).

Patient with a central venous catheter and receiving parenteral nutrition has Sepsis (fever and tachycardia) with blood cultures growing yeast. 1. Diagnosis 2. What are the characteristics of the culture of the yeast?

1. Candidemia (Candida in the bloodstream) 2. Pseudohyphae with Blastoconidia Patient with a central venous CATHETER who are receiving a PARENTERAL NUTRITION are at HIGH RISK FOR CANDIDEMIA. High Risk -Catheter -Parenteral Nutrition

Peroxisome-Proliferator Activated Receptor-gamma (PPAR-gamma): important genes upregulated?

Glucose transporter-4 (GLUT-4) an insulin responsive transmembrane glucose transporter expressed in adipocytes and skeletal myocytes that increases glucose uptake by target cells. Adiponectin (a cytokine secreted by fat tissue that increases the number of insulin-responsive adipocytes and stimulates fatty acid oxidation)

PAH, Inuline, Urea, Glucose, the only one that has a transport maximum?

Glucose!!

HMP Shunt (Pentose Phosphate Pathway): Oxidative Step what is the enzyme? 2. What else is necessary?

Glucose-6-P Dehydrogenase 2. NADP+

Infant born with flaccid lower extremities and absent ankle reflexes bilaterally. X-rays reveal a poorly developed lumbar spine and sacrum. Mother has a complex past medical history and blames herself for noter caring enough for her baby. 1. Diagnosis 2. What is most likely related to this condition?

1. Caudal Regression Syndrome (Anal Atresia to Sirenomelia) 2. Uncontrolled Maternal Diabetes Infants born with AGENESIS OF THE SACRUM AND OCCASIONALLY LUMBAR SPINE AND EXPERIENCE RESULTANT FLACCID PARALYSIS OF THE LEGS, dorsiflexed contractures of the feet, and URINARY INCONTINENCE. Can range from ANAL ATRESIA to SIRENOMELIA.

Inhaled Anesthetics (Isoflurane): increases what parameter during anesthesia? 2. Decreases what?

1. Cerebral Blood Flow (increased intracranial pressure) 2. Myocardial Depression (hypotension) Respiratory Depression Decreased Renal function

Severe epigastric pain that starts after a heavy meal, often related to fatty food consumption. PE reveals marked tenderness in the right subcostal area. What hormones most likely provokes the epigastric pain? 2. Explain

1. Cholecystokinin (CCK) 2. In Cholecystitis, FATTY FOODS INCREASE CCK production and pain occurs when an inflamed and or obstructed gallbladder contracts. CCK is responsible for gallbladder contraction. It is produced in I cells of duodenum and jejunum when fat-protein rich chyme enters the duodenum. It also increases pancreatic enzyme secretion (acinar cells) and decreases gastric emptying.

Postprandial epigastric pain that is does not respond to antacids, food aversion, and lost more than 10 lbs. 1. Diagnosis?

1. Chronic Mesenteric Ischemia Atherosclerosis involving the SMA & IMA. Te bowel can suffer from diminished blood supply and hypoperfusion which can be very painful, is especially pronounced within an hour after meals when blood is need for digestion of food (Like Stable angina because there is decreased oxygen supplied for digestion)

Gain of function mutation of a non-receptor tyrosine kinase protein in hematopoietic cells, leading to persistent activation of signal transducers and activators of transcription (STAT) proteins. 1. What disorders is STAT related to? 2. What mutation?

1. Chronic Myloproliferative Disorders -Polycythemia Vera -Essential Thrombocytosis - Primary Myelofibrosis 2. JAK-STAT (JAK2 is a cytoplasmic tyrosine kinase)

Painful paroxysmal involuntary muscle contractions mainly the jaw, neck and trunk. 1. Organism 2. what is the route of the causative substance?

1. Clostridium Tetani 2. spores in soil -> wound -> motor neuron axon -> spinal cord

34 yo male, recurrent headaches, pain is constant "unbearable and isolated to right side of head. Pain around right eye and nostril and lasts about 30 minutes. Right eye tearing and nasal congestion. 1. Diagnosis?

1. Cluster Headaches Onset: during sleep Male>Female Location: Behind one eye Character: excruciating, sharp, and steady Duration: 15 - 90 MINUTES!! Associated symptoms: SWEATING, FACIAL FLUSHING, NASAL CONGESTION, LACRIMATION, PUPILLARY CHANGES

22 yo has spontaneous rupture of cerebral aneurysm and died from extensive intracranial hemorrhage. 1. Patient's condition is most likely associated with?

1. Coarctation of the Aorta

Man has a good diet his whole life. Has an MI then vows to lose weight. With his new diet it has minimal variation and is entirely devoid of a certain vitamin. AFTER 4 years, symptoms of a specific vitamin deficiency develop. What vitamin is mission from his diet?

1. Cobalamin (Vitamin B12) This long of delay between cessation of dietary vitamin intake and symptom development can only occur with cobalamin (Vitamin B12). PREVIOUSLY WELL-NOURISHED INDIVIDUALS HAVE HEPATIC VITAMIN B12 RESERVES SUFFICIENT TO LAST FOR UP TO SEVERAL YEARS OF COMPLETE DIETARY DEPRIVATION.

Diabetic Ketoacidosis: what enzyme is contributing this patient's abnormal blood glucose finding? (Acetyl CoA carboxylase, Acyl CoA synthetase, Glycerol Kinase, Glucose-6-phosphate dehydrogenase)

Glycerol Kinase -see next slide

2 month NOT BORN IN US. has progressive worsening floppiness and poor feeding. Stools have decreased to every other day and are small and pellet-like. PE shows hypotonic infant with a LARGE ANTERIOR FONTANELLE, LARGE TONGUE, and REDUCIBLE UMBILICAL HERNIA, low tone and unable to hold his head erect on his own. 1. Diagnosis?

1. Congenital Hypothyroidism -ASYMPTOMATIC AT BIRTH (often due to mothers T4 if this is due to Thyroid Dysgenesis which is most common) -REDUCIBLE UMBILICAL HERNIA! (means you can push it back in) -LARGE FONTANELLE! -LARGE TONGUE (often protruding) -CONSTIPATION -LETHARGY -HYPOTONIA -all other signs of hypothyroidism! IMPORTANT** -> infant not born in the US because in the US this is on the universal newborn screening.

6 mo girl with hepatomegaly, height and weight below 10th percentile. Hypoglycemia, and ketoacidosis. Liver biopsy shows Heptaic fibrosis without fat accumulation. Abundant quantities of multi branched polysaccharide with abnormally short outer chains within the cytosol of the hepatocytes. 1. Diagnosis 2. What enzyme is deficient?

1. Cori Disease 2. Debranching Enzyme Deficieny -ABNORMALLY SHORT OUTER CHAINS!! -Hypoglycemia -Hepatomegaly -Ketoacidosis -Muscle Weakness -Hypotonia

Steady-state creatinine levels are a result of the balance between what?

1. Creatinine synthesis in muscle 2. Excretion via glomerular Filtration & Proximal Tubule Secretion *mostly these 2 remain relatively constant

Zenker Diverticulum:What mechanism is the most likely cause? 2. symptoms 3. False or True Diverticulum?

1. Cricopharyngeal motor dysfunction (Esophageal dysmotility causes herniation of mucosal tissue at Killian Triangle between the thyropharneal and circopharygneal parts of the the inferior pharyngeal constrictor) 2. dyshpagia, obstruciton, gurgling, aspiration, FOUL BREATH, neck mass, eldery male 3. False Diverticulum

A patient brought to ER with 1 week history of headaches and progressive confusion. He was hospitalized months ago with viral esophagitis and two months ago with Pneumocystic pneumonia. Lumbar puncture is performed and shows moderate increase in CSF concentration and CSF pleocytosis. Latex Agglutination test is positive for soluble Polysaccharide Antigen. 1. Organism? 2. Light Microscopy will show?

1. Cryptococcus Neoformans 2. Round or Oval encapsulated cells with narrow Budding Yeast recent Viral Esophagitis and Pneumocystis Pneumonia are virtually diagnostic for HIV Headache and confusion, and inflammatory CSF changes are typical symptoms of meningitis. Capsule is a THICK POLYSACCHARIDE capsule Often causes MENINGOENCEPHALITIS in AIDS patients. -India Ink Stain of CSF -Latex Agglutination of CSF

Profuse, water, diarrhea in AIDs patient with CD4 count of 50 cells. Endoscopy shows inflammation but no ulcers. Biopsy shows basophilic clusters on surface of intestinal mucosal cells.

1. Cryptosporidium

Malignant Hyperthermia: 1.Treatment? 2.MOA OF TREATMENT?

1. Dantrolene 2. INHIBIT RELEASE of CALCIUM from SARCOPLASMIC RETICULUM by binding to RYANODINE RECEPTORS

Somatostatin: function? 2. secretion site?

1. Decrease secretion of most GI hormones 2. D cells (pancreatic islets, gut mucosa)

Hepatic Encephalopathy due to Cirrhosis: 1. Which metabolic intermediates are deficient? 2. Which metabolic intermediate accumulates? 3. What is the result?

1. Deficient (ATEs) -Alpha-ketoglutarate -Glutamate (excitatory neurotransmitter) 2. Accumulation -Glutamine 3. Astrocyte swelling and dysfunction. Hyperammonemia is the initial cause!!

A 72 yo old man while at a tri-weekly hemodialysis appointment accuses homodialysis staff of violating his rights, says he has to get to work, and then appears to be falling asleep. Fifteen minutes later, the patient becomes violent and requires restraints. His past meidcal history is significant for HTN, type 2 DM, hyperlipidemia, peripheral vascular disease, and BPH. The patient was also diagnosied with major depression that has been in remission for 15 years. His wife says that he was acting normally the previous night but the he has experienced mild memory and word finding difficulties over the last year. His T is 101 F ,BP is 112/63. pulse is is 93. respirations are 18/min. The patient has aleft carotid bruit, and a right internal jugular dialysis catheter is present. Bronchial breath sounds are heard at the right lung base. During neurologic evaluation, he is confused but cooperative with no focal findings. 1. Diagnosis?

1. Delirium -Acute Onset -Impaire Consciousness -Fluctuating Course -Reversible Prognosis -Global Impairment The ACUTE ONSENT OF MENTAL STATUS CHANGE is most suggestive of DELIRIUM.

Man can't sleep. He claims he must remain alert to protect himself from workers at a nearby chemical plant. He savers that for the past 10 years they have tried to poison him by secretly dumping toxic waste in his backyard at night. All soil toxicity tests have been negative. He has no psychiatric treatment history. What is the most likely diagnosis?

1. Delusional Disorder -FIXED, PERSISTENT, FALSE BELIEF!! >1 delusion for at least 1 month -other psychotic symptoms absent -FUNCTION NORMAL Don't confuse with Paranoid -> Pervasive Distrust, and Suspiciousness

1 week old boy has poor feeding, lethargy and unusual muscle movements involving the left thumb and hand over the last 2 days. The infants vital signs are normal but unusual flexion of the left wrist and thumb and extension of the fingers are observed with cuff blood pressure measurment. PE reveals a hypoplastic mandible, low-set ears, a bifid uvula, and a cleft palate. A chest x-ray shows no thymic shadow. 1. Diagnosis?

1. DiGeorge Syndrome 2. 3rd & 4th Pharyngeal Pouch (Branchial Pouch) HYPOCALCEMIA (affected development of parathyroid from 3rd) -absent thymic shadow NEURAL CREST FAILS TO MIGRATE into 3rd and 4th pouches

Infant with orbital hypertelorism, submucous cleft palat, bifid uvula and Tetralogy of Fallot 1. Diagnosis 2. Pathogenesis?

1. DiGeorge Syndrome 2. Chromosome Microdeletion (22q11) -defective neural crest migration Fluorescence in Situ Hybridization (FISH) is used to find Microdeletions

Polyuria, Polydipsia, volume depletion, hyperglycemia, high anion gap, decreased sodium levels, low bicarbonate. 1. signs of?

1. Diabetic Ketoacidosis (DKA)

How to we obtain Niacin?

1. Dietary Intake 2. Synthesized endogenously from TRYPTOPHAN (only if we are Niacin deficient -PELLAGRA))

Patient is started on Lisonopril and blood pressure drops to102/66 the very next day and its 80/45 when she is standing. What is the most likely factor?

1. Diuretic Therapy -> First-Dose Hypotension in patients with volume depletion or heart failure. ACE-Inhibitors (ACE-I) should be INITIATED AT LOW DOSAGES to reduce risk of first-dose hypotension. I choose that Unilateral Renal Artery Stenosis was the cause. (ACE-I can worsen renal impairments in patients with bilateral renal artery stenosis but usually not in those with UNILATERAL renal artery stenosis.

Alcoholic with current ACUTE PANCREATITIS and with blood alcohol level of 245 mg/dL (0.245% blood alcohol content): doesn't want to be hospitalized. Wife wants him hospitalized. What do you do?

1. Do not allow the patient to leave the ED and reassess when sober. -While patient is intoxicated, surrogate decision makers (close family members) should make health care decisions. When sober if the patient can understand his condition and the risks of refusing treatment and still refuses, it WOULD NOT BE APPROPRIATE TO DISCHARGE HIM AGAINST MEDICAL ADVICE -patients WITH DECISION-MAKING CAPACITY have the RIGIHT TO REFUSE TREATMENT, even if the decision seems unwise. >100 (10%) result in intoxication, slurred speech and impaired decision-making >200 (20%) motor impairment, loss of consciousness, and memory blackouts

External Beam Radiotherapy: what is the effect of this therapy (2 methods)

1. Double-strand DNA breaks 2. Free Radical Formation (ionization of water; oxygen free radicals are then able to cause cellular and DNA damage) -must be DOUBLE-STRAND because single strand breaks are readily repaired by polymerases

Acute Pancreatitis causes by hypertriglyceridemia (>1000 mg/dL): treatment?

1. EXERCISE and calorie-restricted diet 2. Reduced alcohol intake 3. FIBRATES (Fenofibrate, Gemfibrozil, Bezafi brate) -obviously nobody will do the first 2, american is to fat and lazy. So give them their drugs. -Fibrates -> ACTIVATE PEROXISOME PROLIFERATOR-ACTIIVATED RECEPTOR ALPHA (PPAR-alpha) -> this increases lipoprotein lipase activity -rapidly lower TRIGLYCERIDES by >25-50%!

18 month is getting his Haemophilus Influenzae Serotype B (Hib) conjugate vaccine. Mother asks "Why is 'Tetanus Toxoid conjugate' listed on the package insert?" My son has already received the DTaP vaccine which has the diphtheria-tetanus-acceullar pertussis vaccine. 1. What is the reason for the purpose of Hib vaccine conjugation?

1. Elicits T cell-dependent immune response which INCREASES IMMUNOGENIC MEMORY Bacteria with POLYSACCHARIDE CAPSULES (streptococcus pneumoniae, neisseria meningitidis, Hib) provoke an ANTIBODY-MEDIATED (B CELL) IMMUNE RESPONSE. However, vaccines containing the polysaccharide antigen alone are INEFFECTIVE IN CHILDREN AGE <2 YEARS due to their IMMATURE HUMORAL IMMUNITY. Therefore, the polysaccharide is CONJUGATE with a CARRIER PROTEIN to amplify teh patient's humoral response against the polysaccharide through T cell recruitment. IMMUNOGENICITY IS INCREASED as a result of T CELL-DEPENDENT STIMULATION OF BE LYMPHOCYTES and the PRODUCTION OF MEMORY B LYMPHOCYTES.

Atherosclerosis Steps?

1. Endothelial cell dysfunction 2. Macrophage and LDL accumulation 3. Foam Cell Formation 4. Fatty Streaks 5. Smooth Muscle Cell Migration (involves PDGF & FGF) 6. Proliferation & Extracellular Matrix Deposition 7. Fibrous Plaque --> Complex Atheroma

High serum level of antibodies against Polyribitol Ribose Phosphate (PRP). These antibodies are most likely protective against what disease? 2. Organism

1. Epiglottiitis 2. Haemophilus Influenzae Type B The capsule of H. Influenzae if immunogenic and is composed of a linear polymer composed of RIBOSE, RIBITOL, AND PHOSPHATE.

Mycobacterium Tuberculosis patient is started on combination therapy with RIPE drugs. One month later he returns to office reporting blurry vision. Examination shows bilateral central scotomas. What drug is most likely responsible?

1. Ethambutol "EYEthambutol" Causes Optic Neuropathy Clinically manifests as DECREASED VISUAL ACUITY, CENTRAL SCOTOMAS, or COLOR BLINDESS. May be REVERSIBLE with discontinuation of drug.

45 yo woman has multiple scratches, small sores, and abscesses on her left arm. She is worried because the sores have been present for the past month and have not healed. The patient has no idea how the sores develope and is concerned that they will spread. She is a nurse who is well known to the staff from a similar presentation 2 years ago. At that time she had similar skin lesions, many of which were severely infected and did not respond to usual treatment. Fecal bacteria were found in one of the sores. On another occasion, the patient had a spreading infection and cellulitis that required prolonged hospitalization and IV antibioitics. She has no other medical problems. What is the most likely cause of this patients condition?

1. Factitious Disorder Deliberate induction of infection in the ABSENCE of obvious external rewards. Patients DECEPTIVELY PRODUCE SIGNS AND SYMPTOMS OF A MEDICAL OR PSYCHIATRIC ILLNESS OR INDUCE INJURY TO OBTAIN ATTENTION. Intentional falsification or inducement of symptoms with goal to assume sick role.

Patient has long bone fracture shortness of breath confusion, petechial rash to his chest. 1.Diagnosis

1. Fat Embolism Syndrome -multiple FAT GLOBULES may get TRAPPED in Pulmonary micro vessels causing respiratory distress -Petechial Rash (Thrombocytopenia) *FAT GLOBULES dislodge from bone marrow enter the marrow vascular and occlude pulmonary micro vessels, impairing gas exchange, occlude the cerebral white matter, brain stem, and spinal cord (causing neurologic manifestations)

Patient with preexisting gallbladder disease and high triglycerides and LDL cholesterol. What medication should be avoided?

1. Fibrates (Gemfibrozil)

Physical examination shows moderate thinning of hair at the anterior scalp, temporal region and vertex on a male. What drug can be used to treat this patient? 2. MOA of drug?

1. Finasteride 2. 5-alpha-reductase inhibitors These drugs decrease the conversion of testosterone to dihydrotestosterone (DHT) which seems to be the primary pathogenic factor of hair loss.

Patient is 39 yo male has facial puffiness has HIV, Protein urine is > 3.5 g/day. Renal biopsy shows glomerular epithelial cell enlargement and vacuolization, aw well as varying degrees of glomerular capillary wall collapse. Diagnosis?

1. Focal Segmental Glomerulosclerosis (FSGS) LM: shows Segmental Sclerosis and Hyalinosis

HEMOLYTIC ANEMIA patient has a Macrocytic Anemia with a low reticulocyte index. What is the most likely cause of this patient's macrocytosis?

1. Folic Acid Deficiency -any patients with Sickle Cell Disease (SCD) or other Hemolytic Anemias are predisposed to develop Folic acid deficiency due to INCREASED ERYTHROCYTE TURNOVER. LOW FOLIC ACID levels impair DNA synthesis leading to a LOW RETICULOCYTE INDEX.

several hours of difficulty swallowing, dry mouth, and blurred vision, mydriasis, and poorly reactive pupils with a history of major depression. Normal nerve conduction velocity but decreased compound muscle action potential (CMAP). Repetitive nerve stimulation leads to facilitation of CMAP. 1. Diagnosis?

1. Food poisoning with Clostridium Botulinum Toxin Dysphagia Diplopa Dysphonia - difficulty speaking (watch for the 3 Ds)

Male patient has large amounts of fructose in his urine, no symptoms. He has a hereditary defect in his fructose metabolism. 1. What enzyme is defective. 2. This patient most likely remains able to metabolize fructose due to the compensatory activity of what enzyme?

1. Fructokinase (defective) 2. Hexokinase this is called Essential Fructosuria a benign disorder of fructos metabolism caused by FRUCTOKINASE DEFICIENCY. The dietary fructose load is converted by HECOKINASE to FRUCTOSE-6-PHOSPHAGE, which can then enter glycolysis, this pathway is not significant in normal individuals. Normally Fructokinase takes fructose and makes Fructose 1-Phosphate thane Aldolase B makes DHAP and Glyceraldehyde.

A medication is selected that decreases the heart rate but has no effect on myocardial contractility or relaxation is added to a patient's regimen. What ion transporters does this medication most likely inhibit? 2. What is name of the drug?

1. Funny sodium channels during phase 4 2. Ivabradine -prolongs PHASE 4 -slows SA node firing -no effect on cardiac contractility (inotropy)

A 6 yo boy has fatigue and abdominal distension. He bruises easily and appears pale. Physical examination reveals subconjunctival pallor and several ecchymoses on the boy's extremities. His abdomen is distended with nontender massive splenomegaly and moderate hepatomegaly. Lab studies show that his Hemoglobin level is 8, leukocyte count is 3,800 and platelet count is 90,000. Bone marrow biopsy results. (see image) 1. Diagnosis? 2. Deficient enzyme? 3. Accumulation of?

1. Gaucher Disease 2. Beta-glucocerebrosidase Deficiency 3. Glucocerebroside The LIPID-LADEN MACROPHAGES (or GAUCHER CELLS) are classically described as "wrinkled tissue paper" "wrinkled silk" or "crumpled newspaper" in a bone marrow aspirated. The cells may be found throught the body in sites such as the liver, bone marrow and lymphatic tissue (spleen, lymph nodes, tonsils) Pain pain due to bone marrow invasion/inflammation. ANEMIA, and THROMBOCYTOPENIA, are more common than LEUKOPENIA but all 3 can be present.

5 yo boy with generalized edema following mild upper respiratory infection. UA shows massive proteinuria with no hematuria. Patients urine protein consists principally of albumin. 1. What is causing the massive proteinuria? 2. Diagnosis

1. Glomerular Podocyte Damage 2. Minimal Change Disease

Ethanol can inhibit what? 2. what symptom results?

1. Gluconeogenesis 2. Hypoglycemia -once Hepatic Glycogen stores are depleted -> HYPOGLYCEMIA sets in

28 yo AFrican American man given prophylactic medications and vaccinations before a business trip to Africa. 5 days later, he comes to ED with jaundice and dark Urine. He shows Anemia and elevated Bilirubin. Has low Haptoglobin. His peripheral smear shows RBC with dark inclusions when stained with supravital stain. 1. Diagnosis. 2. Disease has what inheritance pattern?

1. Glucose-6-Phosphate Dehydrogenase (G6PD) Deficiency 2. X-linked Recessive Inheritance Low Haptoglobin due to removal of free hemoglobin-haptoglbin complexes Heinz Bodies -> dark intracellular inclusion that stain with Supravital stain Bite Cells

mTor pathway?

1. Growth Factor Ligand (Insulin binding) 2. Tyrosine Autophosphorylation 3. Activation of Phosphoinositide-3 Kinase Pathway 5. Activation of Protein Kinase B (AKT) 6. Activation of mTor 7. Gene Transcription

List all the steps in the Ras/Map Kinase pathway?

1. Growth Factor Ligand (Insulin binding) 2. Tyrosine Autophosphorylation 3. Interaction with SOS Protein 4. Activation of RAS binding to GTP *** 5. Activation of RAF Kinase 6. Activation of MAP Kinase 7. Gene Transcription

Central Vein Catheters: CDC recommendations to reduce CVC infections?

1. HAND hygiene!! 2. BARRIER Protection 3. prep site with CHLORHEXIDINE ANTISEPTIC 4. use SUBCLAVIAN or INTERNAL JUGULAR insertion site (Femoral vein has HIGH risk of infection) 5. Prompt removal of catheter when it is no longer needed)

Patient has a hypoplastic great toe and thumbs. She also has a longitudinal vaginal septum and duplication of the cervix. MRI reveals Uterus Didelphys. Patient's mother also has shortened first digits and a history of miscarriages. What gene is responsible for this? 2. What is the syndrome called? 3. Inheritance

1. HOXA13 2. Hand-Foot-Genitals Syndrome 3. Dominantly inherited -hypoplastic FIRST DIGITS -GENITOURINARY MALFORMATIONS

3 yo boy immigrant. Brought to ED with fever, malaise, and swollen right knee. Hypotensive, tachycardic. recent episode of otitis media. several vaccinations are not up to date. Cloudy synovial fluid of right knee. Gram stain shows pleomorphic, gram-negative coccobacilli. Cultures performed on a blood agar plate supplemented with a disk containing hematin an nicotinamide adenine dinucleotide (NAD+) grow colonies only near the disk. 1. Organism 2. Virulence Factor?

1. Haemophilus Influenzae Type B 2. Capsule Requires booth X FACTOR (HEMATIN) & V FACTOR (NAD+) to grow.

Abdominal pain, Anemia, low platelets, elevated total bilirubin, high lactate dehydrogenase, low haptoglobin, Magnetic resonance angiography reveals mesenteric vein thrombosis. Flow Cytometry reveals abscence of CD55 on RBC. What is the most likely pathologic renal finding in this patient? 2. Diagnosis?

1. Hemosiderosis 2. Paroxysmal Nocturnal Hemoglobinuria (PNH) -THROMBOSIS at atypical sites (possibly due to release of prothrombotic factors from lysed RBC. Chronic hemolysis with breakdown of iron-containing erythrocytes can also lead to IRON DEPOSITION in the kidney (HEMOSIDEROSIS)

Iron homeostasis is maintained by multiple types of cells in the body. What cell secretes a substance that controls iron storage and release by other cells involved in iron homeostasis? 2. What do they release?

1. Hepatic Parenchymal Cells 2. Hepcidin

Patient has several months of fatigue and weight loss. Patient with a history of illicit IV drug use, sex with girlfriend. Liver biopsy shows finely granular, homogenous, pale pink cytoplasm. 1. Diagnosis?

1. Hepatitis B Infection (Acute Hepatitis) -one of the MOST COMMON CAUSES OF HEPATIC INJURY in the US

Nausea, vomiting, diarrhea, abdominal cramping, muscle aches, and arthralgia. Normal vital signs. Dilated Pupils, prominent, and hyperactive bowel sounds. Prominent Lacrimation and patient is yawns frequently. 1. Most likely diagnosis of drug intoxication/withdrawal?

1. Heroin/Opioid Withdrawal -DILATED PUPILS -HYPERACTIVE BOWEL SOUNDS -LACRIMATION -YAWNING -PILOERECTION -Diarrhea -Nausea/vomiting -Abdominal Cramping -Muscle Aches

4 yo with 3 days of fever, irritability, oral lesions. He won't eat or drink and lack of urination. PE with painful ulcers on tongue and gingiva, swollen gums and cervical lymphadenopathy. Microscopic examination of an oral ulcer base scraping is shown in image (see image, but not necessary for diagnosis) 1. Diagnosis 2. Organism 3. Primary Infection, or virus reactivation?

1. Herpetic Gingivostomatitis 2. Herpes Simplex Virus-1 (HSV-1) 3. Primary Infection Reaction -> latent herpes infection in the TRIGEMINAL GANGLIA generally results in mild perioral vesicles

48 yo woman has a change in body habitus. Legs are like sticks and her belly is getting bigger. There is loss of adipose tissue from the extremities and face, with a noticeable increase in abdominal girth. 1. What medication may be responsible for these symptoms?

1. Highly-active Antiretroviral Therapy (HAART) Medication-induced fat redistribution (LIPODYSTROPHY or LIPOATROPHY) -common adverse effect -wasting of fat from face -wasting of fat from extremities -deposition of fat in the trunk and viscera

2 day old infant with dark green emesis plain films show air fluid levels and small bowel dilation. Forceful expulsion of stool, after rectal exam? 1. Diagnosis?

1. Hirschsprung Disease *SQUIRT SIGN!!

Bee sting causes an erythematous plaque with evanescent borders and mild central pallor. What is immune mediators are directly responsible for the above finding? 2. What is this lesion called?

1. Histamine (MAST CELL degranulation) 2. Wheal Plaque is ELEVATED skin lesion > 1 cm TYPE I Hypersensitivity Reaction

5 yo boy with development delay has trouble seeing the board at school. Boy is tall, thin habitus with elongated limbs. Funduscopy shows bilateral lens subluxation. 4 years later boy dies of massive cerebrovascular accident. Autopsy shows cerebral artery thrombosis and old renal infarcts. 1. Diagnosis 2. What supplementation would have been important for this patient?

1. Homocystinuria 2. Pyridoxine The deficient enzyme Cystathionine beta-synthase requires Pyridoxine (Vitamin B6). About 50% of patients respond to high doses.

Artery Biopsy: homogenous acellular thickening of arteriolar walls? 1. what is this called? 2. What causes this?

1. Hyaline Arteriolosclerosis 2. Essential Hypertension or diabetes Mellitus vs Severe Hypertension which causes Hyperplastic Arteriolosclerosis"Onion skinning"

Loss of appetite, constipation, muscle weakness, and increased thirst & urination. Patient has been taken large doses of vitamin and mineral supplements. 1. What Vitamin is most likely increased? 2. What condition could result in a similar presentation?

1. Hypercalcemia (muscle weakness, constipation, polydipsis/polyuria and mental status changes. Possibly associated bone pain) 2. Granulomatous Disease (Sarcoidosis & Tuberculosis) -> due to expression of 1-alpha-hydroxylase in activated macrophages leads to increased intestinal calcium absorption with subsequent hypercalcemia and hypercacliuria.

Methylation of DNA: what is this called? 2. Methylating attached to what residue of the DNA molecule? 3. May result in what syndromes?

1. Imprinting 2. Cytosine 3. Prader-willi Syndrome (P for PATERNAL is deleted/mutated) or angelMan Syndrome (M is deleted/mutated)

Motilin: function? 2. Secretion site?

1. Increase GI motility 2. M Cells (small intestine)

Gastrin: function? 2. secretion site?

1. Increase Gastric Acid Secretion 2. G Cells (Gastric Antrum, duodenum)

GIP: function? 2. Secretion site?

1. Increase INSULIN release Decrease Gastric H+ secretion 2. K cells (small intestine

Secretin: function? 2. Secretion site?

1. Increase Pancreatic Bicarbonate (HCO3-) secretion Decrease H+ secretion 2. S Cells

2 day old infant born at 33 weeks to mother w/o prenatal care DIED! At autopsy analysis of several large, cuboidal alveolar cells under electron microscopy reveals DECREASED numbers of GRANULES CONTAINING PARALLEL STACKS OF MEMBRANE LAMELLAE. What was the pathological process that killed the infant?

1. Increased alveolar tendency to collapse (decreased SURFACTANT production) -SURFACTANT IS STORED AND TRANSPORTED TO THE CELL SURFACE BY LAMELLAR BODIES --> GRANULES CONTAINING PARALLEL STACKS OF MEMBRANE LAMELLAE (Type II pneumocytes)

47 yo woman had red rash on chest for 2 months that is itch and skin is rough. She had breast implants 10 years ago. Induration and swelling over right breast. Right axillary lymphadenopathy without breast masses. Left breast normal. 1. Diagnosis 2. Cause of patient's skin changes?

1. Inflammatory Breast Cancer (INVASIVE!!) 2. Lymphatic Obstruction *this is CLASSIC Peau d'orange with ITCHY, FIRM, COARSE RASH *Breast EDEMA are characteristic presentation of INFLAMMATORY BREAST CANCER (misnomer because its NOT INFECTION but CANCEROUS CELLS. -often mistaken for Mastitis (however, Mastitis has should present with FEVER)

Patient has 3 episodes of DVT in a six year period. Has a history of pulmonary embolism as well. Patient's partial thromboplastin Time (PTT) is normal and remains unchanged when activated protein C is added to her plasma. 1. Is this a Immune or Inherited problem? 2. Diagnosis?

1. Inherited 2. Factor V Leiden Mutation in Factor V gene, renders factor Va resistant to INACTIVATION by ACTIVATED PROTEIN C. Most common cause of inherited hyper coagulability in Caucasians.

A child has a febrile seizure because his temperature is 105 F. You administer Antipyretics (Acetaminophen, Ibuprofen). What is the mechanism these work?

1. Inhibiting prostaglandin synthesis. Decreased levels of prostaglandin E2 reduces the THERMOREGULATORY SET POINT in the Hypothalamus. Lower Body Temperature.

60 yo man confused at home. Daughter found him with an empty bottle of Amitriptyline. He is delirious and sees small animals running around in the corner of the room. He appears flushed. He has a brief seizure and becomes unconscious. Temperature is 99F. BP is 70/44. Pulse 120. Both pupils are dilated and equally reactive to light and mucous membranes are dry. ECG shows QRS widening and QTc prolongation. He dies despite resuscitation attempts. 1. Patient's death is most likely related to what mechanism of Amitriptyline and TCAs?

1. Inhibition of Sodium Channels (cardiac fast sodium channels) -> slowing down myocardial depolarization and leading to CARDIAC ARRHYTHMIAS, the most common CAUSE OF DEATH in patients with TCA overdose. Refractory hypotension resulting from cardiac contractility and and direct peripheral vasodilation (from peripheral alpha-1 adrenergic receptor antagonism) is also a major cause of mortality in these patients.

47 yo man brought to the ED from a high speed motor vehicle collision. He was a restrained driver and rear-ended a slow moving car on the highway. He complains of chest pain, abdominal pain, and difficulty breathing. The patient has a past medical history of HTN, asthma, and Type 2 DM. On arrival his blood pressure is 98/54 and pulse is 121/min. 30 minutes later, he becomes unresponsive and his pulse is no longer detectable. ECG demonstrates tachycardia. Despite extensive resuscitation efforts, the patient dies. 1. An autopsy would most likely show an injury involving what part of the Aorta? 2. What caused his death?

1. Injury most often at the AORTIC ISTHMUS, which is tethered by the LIGAMENTUM ARTERIOSUM and is relatively fixed and immobile compared to the adjacent descending aorta. 2. Blunt Aortic Injury (traumatic aortic rupture) -> which is most commonly caused by MOTOR VEHICLE COLLISIONS. Often involves a SUDDEN DECELERATION. The majority (>80%) of patients die from aortic rupture before even reaching the hospital. Those who survive the initial injury have nonspecific findings such as CHEST PAIN, BACK PAIN, or SHORTNESS OF BREATH. A WIDENED MEDIASTINUM may also be seen on chest x-ray.

How do platelets bind to other platelets?

GpIIb/IIIa

64 yo patient has difficulty walking and has muscle cramps after walking one block on level ground. Cramps subside quickly with res. He has also noticed decreased sexual activity. PMH is significant for Myocardial Infarction and Carotid Endarterectomy. 1. Diagnosis 2. What would a Biopsy of the artery show?

1. Intermittent Claudication (muscle pain with exercise that remits with rest) 2. Lipid-filled Intimal Plaques Claudication is almost always the result of ATHEROSCLEROSIS OF LARGER NAMED ARTERIES. (Lipid-filled Intimal Plaques)

1. Generalized Seizure? 2. What are the 3 Generalized types of seizures?

1. Involves both hemispheres at onset 2. Tonic-Clonic Seizure Myoclonic Seizure Absence Seizure

Excess Hemolysis what will likely deposit in the kidney? 2. What is this called?

1. Iron 2. Hemosiderosis Chronic hemolysis with breakdown of iron-containing erythrocytes can also lead to IRON DEPOSITION in the kidney (HEMOSIDEROSIS) This was from a Paroxysmal Nocturnal Hemoglobinuria question but I don't see why it doesn't apply to any Hemolytic Anemia question.

Two graphs: one that shows Cardiac Contractility increasing as time increases. The second shows vascular resistance decreased as time increases. 1. what medications could have been given?

1. Isoproterenol (answer) Epinephrine (also would have been right but was not an answer choice) NOT Norepinephrine which would INCREASE CONTRACTILITY (Beta-1) and INCREASE VASCULAR RESISTANCE (alpha-1)

Patient has hoarseness and difficulty swallowing, no disturbances in vision or hearing. Loss of gag reflex on left side, when they say "ah" uvula deviates to the right side. Should is drooped and strength is reduced during left shoulder shrug testing. Where is the lesion? 2. What nerves are affected?

1. Jugular Foramen Sydrome (Vernet Syndrome) 2. CN IX (Glossopharyngeal) CN X (Vagus) CN XI (Spinal Accessory) -dysphagia -hoarseness -loss of gag reflex (ipsilateral side) -deviation of uvula toward normal side -weakened shoulder (ipsilateral side) -loss of taste to posterior 1/3 of tongue

AIDs patient with CD4 count of 50 cells. Has intermittent, bloody diarrhea and abdominal pain for past month. Colonoscopy reveals multiple hemorrhagic polypoidal lesions. Biopsy reveals spindle cells with surrounding blood vessel proliferation. 1. Diagnosis

1. Kasposi's Sarcoma Colonoscopy ->Reddish/Violet, flat maculopapular lesions or hemorrhagic nodules Biopsy -> Spindle-shaped tumor cells with small-vessel proliferation *HHV-8 *Kaposi's Sarcoma usually involve's SKIN & GI tract and is common in HIV patients NOT on Antiretroviral therapy.

45 yo woman with unintentional loss of 15 lbs over 6 months. She used to enjoy dining with friends, but has become concerned about lower abdominal pressure and feeling full very quickly. She has epigastric pain, no dysphagia, regurgitation, vomiting, or diarrhea. PE shows bilateral adnexal fullness. Ultrasound shows bilateral complex ovarian masses with solid and cystic components. 1. Diagnosis 2. What is seen histologically?

1. Krukenberg's tumors (Gastric Carcinoma with metastasis to the OVARIES) 2. Mucin-secreting SIGNET cells

23 yo woman suffers from an acute attack of optic neuritis. She has a history of relapsing-remitting multiple sclerosis. An MRI of her brain shows an area of demyelinizaton involving her left optic nerve. 1. Explain what happens with "Light in Right Eye" and "Light in Left Eye"

1. Light in the Right Eye -> Both pupils CONSTRICT Light in the Left Eye -> No Change in Both Pupils The AFFERENT Limb of the light reflex pathway is the OPTIC NERVE. The EFFERENT LIMB is the parasympathetic fibers of the OCULOMOTER NERVE. When an optic nerve is damage, light in that eye will cause neither pupil to constrict (the nerve can't sense the light). However, the light in the contralateral eye will cause both pupils to constrict.

Kid climbs a tree, falls and grabs onto a branch. PE reveals difficulty performing fine finger moments with the right hand. What structures are likely injured? 2. What is this called? 3. if sensory loss also occurred where would it have been?

1. Lower Trunk of Brachial Plexus (C8-T1) -> Median & Ulnar 2. Klumpke's Palsy (Total claw hand deformity) 3. sensory loss also may occur over the medial aspect of the hand/forearm -together these nerves innervate all of the intrinsic muscles of the hand. -involvement of the T1 nerve root proximal to the sympathetic trunk may cause concomitant Horner's Syndrome (ipsilateral ptosis, miosis, anhidrosis)

55 yo woman has fever, cough, and night sweat for past 2 weeks. Chest imaging shows a nonspecific pulmonary lesions. Transthoracic needle aspiration is performed. The specimen is cultured and grows several bacterial species including, Peptostreptococcus and Fusobacterium. 1. What is the lesion in the lung? 2. What are predisposing factors to these bacteria?

1. Lung Abscess 2. Oropharyngeal Aspiration is most common cause of Lung Abscess (these abscesses often contain mixed aerobic and anaerobic oral flora) Risk Factors -LOSS OF CONSCIOUSNESS -DYSPHAGIA (difficulty swallowing) things that may lead to these are Alcoholism, Drug overdose, Seizure Disorders, Prolonged Anesthesia, and Severe Neurologic Diseases. Anaerobic Oral Flora include -> Peptostreptococcus, Prevotella, Bacteroides, and Fusobacterium

Vasopression (ADH) act at V2 receptor at kidney to do what (2 things)?

1. MAXIMALLY CONCENTRATES THE URINE 2. INCREASES WATER REABSORPTION Insert AQUAPORIN H2O channel which increases H2O reabsorption and INCREASES UREA REABSORPTION. (this Urea re-circulates from inner medullary collecting duct into the medullary interstitium & thin loop of Henle, greatly contributing to the osmotic gradient.

Patient has thyroid nodule, mucosal neuromas of the lips and tongue. Arm span is noted to exceed his height and he has long fingers. Serum Calcitonin is elevated. 1. Diagnosis 2. What else is likely to develop in this patient?

1. MEN 2B (Multiple endocrine Neoplasia 2B) 2. Pheochromocytoma -Medullary Thyroid Cancer (Calcitonin) -Pheochromocytoma -Mucosal Neuromas/Marfonoid Habitus

Differential (Indicator) Media: what are 2 examples? 2. Grows what organisms (4)?

1. MacConkey Agar (organisms appear pink if ferment lactose) -Eosin Methylene Blue (EMB) agars (organisms appear black if ferment lactose) 2. Klebsiella E. Coli Enterobacter Serratia (weak fermenter)

Woman is diagnosed with gestational diabetes mellitus during her first pregnancy. Her glycemic status improves markedly after delivery, however her fasting glucose levels remain modestly elevated. Her past medical history is unremarkable, but her mother and younger sister had "high blood sugars" during pregnancy. 1. Diagnosis 2. Decreased activity of what enzyme?

1. Maturity-onset Diabetes of the Young (MODY) 2. Glucokinase (Liver & Beta-cells of Pancreas) A mutation in Glucokinase will decrease the amount of Glucose metabolized -> decreased ATP formation and DIMINISHED INSULIN secretion.

2 day old infant with dark green emesis plain films show air fluid levels and small bowel dilation. Emergency laparotomy shows an inspissate, green fecal mass obstructing distal ileum. 1. Diagnosis

1. Meconium Ileus -intraoperative finding of a gree INSPISSATED MASS (DEHYDRATED MECONIUM) in DISTAL ILEUM points to the diagnosis of MECONIUM ILEUS as source obstruction.

Individuals who demonstrate increased activity of a specific intracellular enzyme are more susceptible to developing benz(o)pyrene-induced lung cancer. What enzyme is most likely overactive in these patients?

1. Microsomal Monoxygenase Procarcinogens are metabolized by CYTOCHROME P450 MONOOXYGENASE, an anzyme system present in hepatic microsomes and the endoplasmic reticula of varied other tissues. CYTOCHROME P450 MONOOXYGENASE metabolizes steroids, alcohol, toxins, and other foreign substances by rendering them soluble and easier to excrete. Unfortunately, this metabolic processing also CONVERTS PROCARCINOGENS INTO CARCINOGENS CAPABLE OF CAUSING MUTATIONS IN HUMAN DNA.

patient has adenocarcinoma of sigmoid colon. Serum carcinoembryonic antigen assay is ordered. The results of this assay would be most useful for what aspects of this patient's care?

1. Monitoring for Tumor Recurrence Carcinoembryonic Antigen (CEA) CEA -> cannot be used to diagnose colon cancer, but it is helpful for detectint residual desease and recurrence.

Immunocompromised patient, had severe right sided headaches, right behind his eye, with nasal stuffiness. PE reveals right-sided proptosis, and periorbital tenderness. Biopsoy of maxillary sinus mucosa reveals a nonseptate hyphae that branches at wide (90 degree angle). 1. Diagnosis 2. Species (3 possible)?

1. Mucormycosis 2. Mucor, Rhizopus, Absidia -associated with Diabetic Ketoacidosis, immunosuppression. -facial and pariorbital pain, headache, and purulent nasal discharge. -BLACK ESCHAR (may be seen on palate or nasal turbinates) -fungi proliferate in walls of blood vessels and cause necrosis of the corresponding tissue.

15 yo girl with fully developed secondary sexual characteristics. Pelvic ultrasound shows a shortened vaginal canal with a rudimentary uterus. 1. Diagnosis?

1. Mullerian Aplasia (Mullerian Agenesis)(Mayer-Rokitansky-Kuster-Hauser Syndrome) These patient have NORMAL OVARIES which secrete Estrogen Normally and enable REGULAR DEVELOPMENT OF SECONDARY SEXUAL CHARACTERISTICS (BREAST, PUBIC HAIR) NOT Androgen Insensitivity Syndrome (have minimal axillary or pubic hair due to androgen resistance. Also have cryptorchid testes and no uterus or ovaries)

Low back pain, fatigue, hemoglobin is 8.5 mg/dL, serum creatinine is 2.2. and serum calcium is 10.6 (slightly elevated). 1. Diagnosis?

1. Multiple Myeloma CRAB hyperCalcemia Renal involvement (AMYLOIDOSIS) Anemia Bone lytic lesions/Back pain

Explain the steps of Insulin secretion?

1. N-terminal signal peptide directs translocation of PREPROINSULIN to ROUGH ER 2. Signal peptide is cleaved, converting PREPROINSULIN to PROINSULIN 3. PROINSULIN is cleaved to INSULIN & C-PEPTIDE in SECRETORY GRANULES 4. INSULIN & C-PEPTIDE are secreted from cell into blood stream

Patient has Atrial Fibrillation, given medication and sent home, now his ECG shows second-degree atrioventricular block and severe constipation. What drugs could have caused this?

1. Nondihydropyridine Caclium-Channel Blockers -Diltiazem -Verapamil adverse effects: CONSTIPATION, Bradycardia, AV BLOCK!!, worsening of heart failure Beta Blockers and Cardiac Glycosides also cause AV Block

12 yo girl with poor grades, stubborn, irritable and overly emotional. She gets angry for no reason, doesn't listen, and deliberately annoys and fights with her siblings. She won't do chores or homework, or go to bed on time. Girl talks back to teachers and skips classes. Girl says school is boring and blames her behavior on stupid rules and unreasonable demands. 1. Diagnosis?

1. Oppositional Defiant Disorder Pattern of ANGRY/IRRITABLE MOOD, ARGUMENTATIVE/DEFIANT BEHAVIOR > 6 MONTHS -argues with adults, defies authority figures -REFUSES TO FOLLOW RULES -deliberately annoys others -blames others for own mistakes or misbehaviors -easily annoyed, angered, resentful or vindictive -NOT DUE TO ANOTHER MENTAL DISORDER

Imprinting: hyperphagia, obesity, intellectual disability, hypogonadism, hypotonia. 1. Diagnosis? 2. Whose genes are being expressed? 3. Whose genes are silent?

1. Prader-willi 2. PATERNAL (DADS!) 3. Moms are SILENT FROM IMPRINTING but probably normal Prader-willi Syndrome (P for PATERNAL is deleted/mutated)

Patient has dizziness, headaches, and pruritus after showering. He has smoked half a pack of cigarettes daily for the past 15 years and drinks socially. PE shows a ruddy complexion and mild splenomegaly. Lab results so Hemoglobin 19. Hematocrit 59%. Erythrocytes 7.5 mil. Platelets 550,000. Leukocytes 15,6000. 1. Diagnosis 2. Erythropoietin level? 3. Mutation

1. Primary Polycythemia Vera 2. Decreased Erythropoietin (EPO) 3. V617F JAK2 Gene (mutation replaces a Valine with a Phenylalanine at the 617 position) This mutation renders HEMATOPOIETIC CELLS MORE SENSITIVE TO GROWTH FACTORS SUCH AS ERYTHROPOIETIN AND THROMBOPOIETIN. (PRIMARY POLYCYTHEMIA VERA) INCREASED RBC MASS INCREASED PLASMA VOLUME LOW EPO levels Additional manifestations may include: -ELEVATED PLATELETS -ELEVATED WBC COUNT -THROMBOTIC EVENTS (from blood hyperviscosity) -PEPTIC ULCERATION (histamine release from basophils) -PRURITIS (histamine release from basophils) -GOUTY ARTHRITIS (increased cell turnover) -RUDDY FACE -SPLENOMEGALY Diagnosis -> by confirming LOW SERUM EPO & bone marrow aspiration cytogenetic studies showing a JAK2 MUTATION Treatment: SERIAL PHLEBOTOMY to keep HEMATOCRIT < 45%

Episodic and transient chest paint accompanied by transient ST-segment elevations (typically occurring during the night): Diagnosis? 2. This chest pain could be provoked by?

1. Prinzmetal Angina (Variant Angina) 2. Ergonovine (tobacco, cocaine, and triptans could trigger too) Transient attacks of CORONARY VASOSPASM -typically occurring at REST and DURING THE MIDNIGHT-TO-EARLY morning hours. -TRANSMURAL STEMI

During pregnancy Prolactin levels steadily increase in the circulation as the pregnancy progresses. What prevents lactation in during a pregnancy?

1. Progesterone *after delivery the precipitous (steep) drop in progesterone allows prolactin to stimulate lactation

Colonic Polyps: What is the Adenoma to Carcinoma Sequence? 1. first step and gene mutated 2. 2nd step and gene mutated 3. 3rd step and gene mutated?

1. Progression from normal mucosa to SMALL POLYP (Early Adenoma) -APC Gene 2. Increase in the size of the polyps - K-RAS (KRAS) 3. Malignant Transformation (adenoma to carcinoma) -p53 -DCC

Warfarin therapy is started, two days later the patient has severe skin and subcutaneous fat necrosis. 1. Drug effects on what process is most likely responsible for this patient's skin findings?

1. Protein C or Protein S activity WARFARIN-INDUCED SKIN NECROSIS Thrombosis and CLOTTING can interrupt blood flow to the skin and lead to SKIN NECROSIS. due to a TRANSIENT HYPERCOAGULABLE STATE that occurs during the FIRST FEW DAYS of Warfarin Therapy. Protein C has a SHORT HALF-LIFE so its anticoagulant activity is reduced quickly when Warfarin therapy is initiated by about 50% within the first day. During this time Factors II, IX, X continue to have a procoagulant effect because they have a LONGER half live. (Factor VII has a short half-life similar to protein C)

patient recently underwent surgery, present with acute-onset dyspnea and chest pain. 1. diagnosis? 2. what could prevent this?

1. Pulmonary Embolism 2. Low-dose Heparin (acts by binding to ANTITHROMBIN III) -Enoxaparin -Dalteparin

Transbronchial biopsy of a mass demonstrates malignant cells with large nuclei that contain prominent, round, BASOPHILIC BODIES. What enzyme is most likely to function predominantly within this BASOPHILIC REGION of the nucleus? 2. What does it make?

1. RNA POLYMERASE I 2. rRNA (ribosomal RNA)

32 yo male present to ER with fever, malaise and a maculopapular rash that includes his palms and soles. When patient's serum is added to a mixture of cardiolipin, lecithin, and cholesterol, extensive flocculation is observed. 1. What is this test? 2. The next step in management of his condition would require evaluation for?

1. Rapid Plasma Reagin (RPR) test (patietns serum mixed with CARDIOLIPIN, cholesterol, and lecithin. Aggregation, or flocculation demonstrates CARDIOLIPIN in patient's serum. This test DOES NOT DETECT TREPONEMAL ORGANISMS OR ANTIBODIES DIRECTED AGAINST TREPONEMAL ORGANISMS. Instead it detects ANTIBODIES TO HUMAN CELLULAR LIPIDS released into the bloodstream after cell destruction by T. Pallidum. Could be positive in cases of Syphilis, Yaws, Pint, or Bejel which are all subspecies of T. Pallidum. Because the nontreponemal RPR and VDRL tests are easy and inexpensive they are typically performed FIRST in patients with suspected infection. If test is positive, confirmation is established with a TREPONEMAL TEST LIKE FTA-ABS 2. Spirochetal Antibodies in a FTA-ABS (A positive FTA-ABS confirms infection with T. Pallidum)

A nonpathogenic influenza strain is cultured together with a pathogenic influenza strain. Following viral replication, some of the nonpathogenic viral particles are found to have the wild-type hemagglutinin and therefore become capable of infecting respiratory epithelium. Subsequent progeny of these altered viruses continue to have the same characteristics. What is the mechanism?

1. Reassortment (IMPORTANT THAT THESE ARE SEGMENTED) NOT Recombination -> is a rare event and refers to the gene exchange that occurs through the crossing over of 2 double-stranded DNA molecules. The resulting progeny can have recombined genomes WITH GENES NOT PRESENT SIMULTANEOUSLY IN EITHER PARENT VIRUS

Beta Blockers: MOA to lower BP in hypertensive patients via what 2 mechanisms?

1. Reducing myocardial contractility and heart rate 2. DECREASING RENIN Release by Kidney

A new cholesterol measuring device determines a patients blood cholesterol level to be 200 mg/dL on 3 measurements of the same blood sample. Using the gold standard measurement method, the same sample is found to have a cholesterol level of 260. 1. The new measuring device is?

1. Reliable (Precise) but not accurate

21 yo man comes in with 2 days of gross hematuria. No other symptoms. Has a younger sister with sickle cell disease. 1. diagnosis?

1. Renal Papillary Necrosis He probably has Sickle Cell Trait so it is presenting later. -MICROHEMATURIA (medullary infarcts) -Decreased Oxygen in papilla

13 month girl no longer able to sit on her own and doesn't babble anymore like she used to. She now twists her hands together and mother can't get her to stop. Her skin is getting red, dry and painful. Weight & height are in 60th %. However head growth, had decreased from 50th% to 40th% in 3 months. On exam child is globally hypotonic and unable to sit upright, child does not make eye contact, child makes no sound apart from an occasional grunt. Child wrings her hands repeatedly. 1. What best explains this patient's condition? 2. Defect?

1. Rett Syndrome 2. de novo mutations in X-Linked MECP2 gene X-Linked Dominant

Where does the RIGH LUNG STOP? 1. Midclavicular Line? 2. Midaxillary Line? 3. Paravertebral Line?

1. Rib 6 2. Rib 8 3. Rib 10

8 year old middle eastern immigrant had low-grade fever and skin rash. Rash started on face and spread rapidly down his body. Boy recently returned from Yemen. Boy has generlized, fine, pinkish maculopapular rash and tender lymphadenopathy bilaterally behind hears. 1. Diagnosis 2. Family of Virus

1. Rubella (German Measles) 2. Togavirus -Single-Stranded-Linear Positive RNA -Icosahedral Immigrants may not have completed vaccination regimen. Both Measles (Rubeola) and German Measles (Rubella) are characterized by a Maculopapular rash that begins on the face and spreads to the trunk and extremities. Rubella -> Rash typically spreads FASTER and DOES NOT DARKEN OR COALESCE. POSTAURICULAR AND OCCIPITAL LYMPHADENOPATHY is particular common in RUBELLA!

One study has a relative risk (RR) of MI to be 1.30 (p=0.07) and researchers conclude that there is no statistically significant. Subsequently, the results of a meta-analysis determine an overall (RR)=1.32 (p=0.03). 1. what is the most likely problem in the first study? 2. what type of error is this?

1. Sample Size 2. Type II (beta) error -> falsely concluded there is NO DIFFERENCE The probable reason behind this is the LARGER meta-analysis reflects the true-status (increased risk) whereas, the first study results represented a Type II (beta) error.

Continuous or recurring seizures (defined as > 5 min) 1. Diagnosis? 2. Treatment? 3. MOA?

1. Status Epilepticus 2. Benzodiazepines (Lorazepam or Diazepam) 3. Enhance the effect of the inhibitory neurotransmitter GABA-A receptor which causes increased INFLUX of chloride ions when GABA binds. (INCREASES FREQUENCY OF CHLORIDE CHANNEL OPENING!!!)

Patient had 2 week history of nasal congestion. He has used a topical decongestant every few hours since his symptoms began. He experience relief for almost 1 week, then his nasal congestion returned. 1. What is the appropriate next step?

1. Stop the decongestant! 2. Tachyplaxis (rapidly declining effect) after a few days of use. -It occurs because of decreased production of endogenous norepinephrine and release from nerve endings, which diminishes their effect

Woman brought in with a sudden and severe headache. Her blood pressure is 160/90 and pulse is 90. Pupils are symmetric and reactive to light and she can move all four extremities without weakness. CT of her head is shown below. (see image) 1. Diagnosis

1. Subarachnoid Hemorrhage (SAH) more specifically SACCULAR (BERRY) ANEURYSMS Fever and nuchal rigidity may also be present with "WORST HEADACHE OF MY LIFE!" Focal neurological deficits are usually not present. Saccular or Berry Aneurysms are the most common cause of SAH. They usually occur at the circle of Willis, with the Anterior Communicating Artery being the most common site. Berry Aneurysms are associated with Ehlers-Danlos and Autosomal Dominant Polycystic Kidney Disease (ADPKD). Arteriovenous malformations also predispose certain individuals to SAH. CT without contrast -> is diagnostic. Lumbar puncture -> reveals gross blood or Xanthochromia (yellow discoloration of CSF

During a man's fasting his liver begins to synthesize large quantities of glucose from source molecules such as ALANINE, LACTATE, and GLYCEROL. As part of this process, PHOSPHOENOLPYRUVATE is formed from OXALOACETATE in a reaction that requires a SPECIFIC NUCLEOSIDE TRIPHOSPHATE as a cofactor. What reaction from the The Citric Acid Cycle produces this?

1. Succinyl CoA ---> Succinate That ATP is actually GTP!!!!

A total thyroidectomy is planned, during the surgery a nearby nerve is injured, while ligating an artery entering the superior pole of the thyroid lobe. 1. What artery? 2. What nerve? 3. What muscle is denervated? 4. action of muscle?

1. Superior Thyroid Artery 2. External Branch of the Superior Laryngeal Nerve 3. Cricothyroid Muscle 4. movement of vocal cords REMAINING LARYNGEL MUSCLES -> innvervating by RECURRENT LARYNGEAL NERVES

Mechanic has weakness on EXTENSION OF FINGERS AND THUMB IN THE RIGHT HAND. Sensation of hand is all preserved. Where is the injury most likely?

1. Supinator Canal -CUTANEOUS SENSORY BRANCHES are similarly preserved! -often from frequent screwdriver use, direct trauma or dislocation of the radius

After exposure to mutagens, several strains of enveloped RNA viruses isolated from the nasal exudate of experimental animals acquire the ability to infect human epithelial cells. What viral-encoded protein is most likely to have mutated in this circumstance?

1. Surface Glycoprotein -in the case of an enveloped virus, whether or not the virus can attach to a specific host cell generally depends on the GLYCOPROTEIN!! (I choose Capsid Protein -> Capsid protein just surround the viral genome and are not directly involved in viral attachment)

Patient is being switched from Phenelzine to Sertraline. Patient needs to wait at least 2 weeks during this washout interval to allow Sertraline therapy to be initiated safetly? What process is taking place? 2. What type of drugs are these?

1. Synthesis of Monoamine Oxidase 2. Phenelzine is MAO-Inhibitor SERTRALINE --> Selective Serotonin Reuptake Inhibitor (SSRI) Monoamine Oxidase is an enzyme located in presynaptic nerve terminals that is responsible for the breakdown of monoamine neurotransmitters (serotonin, norepinephrine, dopamine)

Candida: 1. Local defense against Candida is prevented by what immune cells? 2. Systemic infection is prevented by what immune cells?

1. T Cells 2. Neutrophils For this reason localized candidiasis is common in patients who have HIV. Neutropenic individuals are more likely to have the systemic form of the Candidiasis.

Patient has a skin rash on his leg, he had recently worked in a unmaintained, wooded area. He is constantly scratching his leg. What type of cell is most likely responsible for causing the tissue damage seen in this patient?

1. T Lymphocytes (CD8+ T cells) POISON IVY DERMATITIS a form of CONTACT DERMATITIS. TYPE IV Hypersensitivity (delayed-type)

8 month girl that is irritable and has regression of motor skills. She can no longer sit or roll over. She startles easily with loud noises. Head circumference measurement is consistent with macrocephaly. Bilateral fundoscopic evaluation shows a bright red fovea centralis that is surrounded by a contrasting white macula. Peripheral vision is decreased. Abdominal examination is normal. 1. Diagnosis 2. Deficient Enzyme 3. What is accumulated?

1. Tay-Sachs Disease 2. Hexominidase A 3. GM2 GAnglioside NO ABDOMINAL involvement Niemann-Pick Disease is SIMILAR (with cherry red macula but has hepatosplenomegaly)

A child with turning blue episodes that assumes squatting position as it makes him "feel better" 1. Diagnosis? 2. What embryological events is the most likely mechanism that caused this condition?

1. Tetralogy of Fallot 2. caused by Anteriorsuperior displacement (deviation) of the infundibular Septum -Cyanotic spells -Squatting to improve spells -prominent right ventricular impulse -Systolic murmur 1. Ventricular Septal Defect (VSD) 2. Overriding Aorta over the right and left ventricles 3. Right ventricular outflow tract (RVOT) obstruction (Pulmonary Stenosis) (Pulmonary Infundibular Stenosis: Pulmonary Stenosis) -> MOST important for determinant for PROGNOSIS) 4. Right Ventricular Hypertrophy

Selective Media: what is an example? 2. grows what organism?

1. Thayer-Martin VCN Selective Medium (contains Vancomycin, Colistin, Nystatin) 2. Neisseria Gonorrhoeae

Patient has a vasectomy: What should the patient be advised to expect during the first month following the procedure?

1. There is Viable sperm left in the ejaculate (up to 3 months or 20 ejaculations!!) USE ANOTHER BIRTH CONTROL METHOD FOR 3 MONTHS AFTER VASECTOMY!! Vasectomy blocks new sperm from epididymis but has no effect on sperm distal to the ligation. Sexual intercourse can typically be resumed within a week following the procedure, but pregnancy is still possible as viable sperm may be present in the ejaculate.

Patient had an STEMI and medical management was initiated. After initial treatment the pain decreased in intensity, but a reperfusion complex ventricular arrhythmia emerged. The arrhythmia was asymptomatic and resolved spontaneously. Which of the following drugs was most likely responsible for rapid reperfusion in this patient?

1. Thrombolytic or Fibrinolytic Drugs -Tissue Plasminogen Activator (tPA) -Reteplase -Tenecteplase -Streptokinase

1. T Cell Positive Selection: where? 2. T Cell Negative Selection: where?

1. Thymic CORTEX 2. Thymic MEDULLA

Patient has weakness, fatigue, and conjunctival pallor. Low Hemoglobin, but platelets, and leukocytes normal. Reticulocytes are Low. Iron studies and serum B12, and Folic acid levels are all normal. 1. Further workup would most likely show what? 2. Diagnosis

1. Thymic Tumor (Thymoma) 2. Pure Red Cell Aplasia *Anemia with LOW RETICULOCYTES (normal is 0.5% - 1.5%) *patient had 0.1%

Patient is learning how is father was never available to him while growing up. During a recent confrontation, the patient told the father, "I am angry that you were never there for me." The following week, the psychiatrist unexpectedly cancels a session to attend to an emergency. At the next appointment, the patient says, "I feel as if you are not interested in listening to me, like I am not your priority." 1. What is the likely explanation of this?

1. Transference 2. SHIFTING of EMOTION or desires associate with a PERSON FROM THE PAST to another PERSON IN THE PRESENT

Bacteria resistant to ampicillin and Bacteria resistant mixed on plate with both Abx and bacteria growth is noted. Same experiment is repeated with addition of DNAase to the plate and NO BACTERIA growth. is the mechanism of bacterial survival in the 1st experiment?

1. Transformation Deoxyribonuclease (DNAase will DEGRADE NAKED DNA in medium --> NO TRANSFORMATION seen)

Serum fluorescent treponemal antibody absorption testing is positive and a descrescendo-type diastolic murmur over the right sternal border. Mediastinal widening on chest x-ray. 1. What pathologic process is responsible for these symptoms?

1. Vasa Vasorum Obliteration (begins with ENDARTERITIS and OBLITERATION resulting in inflammation, ischemia and weakening of the adventitia, aneurysmal dilation of the thoracic aorta results and can extend to involve the aortic valve ring.) The murmur is characteristic of Aortic Regurgitation. -Mediastinal widening, suggests an aortic aneurysm that has dilated the aortic annulus -Postive serology (FTA-ABS)

Girl's skin becomes red and scaling with only minimal sun exposure. Mother noticed this when girl was 7 months old. Now girls skin is thin and hyperpigmented. Patient has a few nevi on her hands that have been rapidly enlarging. 1. Diagnosis 2. defective gene is responsible for?

1. Xeroderma Pigmentosum (literally means pigmented dry skin) 2. DNA excision Repair (Nucleotide excision repair of PYRIMIDINE DIMERS) Skin is normal at birth. Disease manifests during 1st year of life with erythema, scaling, and hyperpigmentation and lentigo formation on light-exposed areas (especially face). Later, skin of affected areas shows atrophy, telangiectasias, and intermingling areas of hypo & hyperpigmentations. Develop skin malignancies as early as 5-6 years of life (squamous cell carcinoma, basal cell carcinoma, and malignant melanoma)

Ectopy (HETEROTOPY): what? 2. example?

1. functionally normal cells/tissues found in an abnormal location due to embryonic maldevelopment 2. MECKEL DIVERTICULUM GASTRIC, PANCREATIC, and other types of MUCOSA found in MECKEL DIVERTICULUM are examples of ECTOPY (aka HETEROTOPY)

A double stranded RNA molecule consisting of 21 base pairs is created that is complementary to a region of mRNA encoding c-Myc. Introduction of this molecule into tumor cells results in a significant reduction in cell growth. 1. what process is interrupted? 2. Types of silencing RNA?

1. mRNA translation (posttranscriptional gene silencing by base-pairing with complementary sequences within target mRNA molecules.) 2. Small interfering RNA (siRNA) and microRNA (miRNA)

39 yo woman with pelvic pressure and constipation. She can defecate easier while pushing the vaginal canal with her fingers to get the stool out. Menses occur every 28 days without heavy flow or severe pain. Examination shows an irregularly enlarged uterus and normal rectal tone. 1. Diagnosis?

11. Posterior Subserosal Uterine Leiomyoma Fibroids can put pressure on adjacent organs like rectum (constipation) or obstructive urinary symptoms such as urgency or incomplete emptying.

Right & Left Gastroepiploic Arteries: function?

Greater Curvature of Stomach

Antifungal: Preventing mitosis by binding tubulin?

Griseofulvin

Acute Stroke: Histologic Features Timing from start to finish?

12-48 hours -> Dead Red Neurons 24-72 hours -> Necrosis + NEUTROPHILS 3-5 days -> Macrophages (MICROGLIA) 1-2 weeks -> ASTROCYTES (Reactive Gliosis + Vascular Proliferation) > 2 week -> Glial Scar As neurons disintegrate, their fragments begin to be phagocytized by MICROGLIA. This appears as an abundance of LIPIDS IN CYTOPLASM OF MICROGLIA (myelin breakdown products). NEUTROPHILS will not phagocytize myelin remnants and therefore do not stain for lipids.

Grows in Bile and 6.5% NaCl?

Group D (Enterococcus) -Enterococcus Faecium -Enterococcus Faecalis (Gamma Hemolysis)

Hypoglycemic patient passes out at Walgreens, they hand you the first aid kit. Her blood glucose level is 34 mg/dL. 1. What do you give her?

1st Intramuscular Glucagon 2nd Buccal or Sublingual glucose or sucrose (glucose paste, cake frosting, sugar packets)

Salicylate (Aspirin) overdose: explain the metabolic consequence?

1st Respiratory Alkalosis: The Salicylates directly STIMULATE the medullary respiratory center. INCREASING VENTILATION which leads to a DECREASE in CO2. 2. Anion Gap Metabolic Acidosis begins to develop shortly after as high concentrations of salicylates increase lipolysis, uncouple oxidative phosphorylation, and inhibit the citric acid cycle. This results in the accumulation of organic acids in the blood (ketoacids, lactate, & pyruvate)

Stab wound at the left fifth intercostal space at the midclavicular line: injure what?

1st penetrate the Left Lung 2nd penetrate the Left Ventricle (only if wound is deep enough)

In order for Hepatitis D to penetrate the hepatocyte what must happen first?

HDV must be coated by the external coat of Hepatitis B surface antigen (HBsAg) of HBV to penetrate the hepatocyte.

A man is started on an ACE-I which lowers his BP however in 3 weeks his serum creatinine has increased from 1.1 to 2 mg/dL. What has caused this increase in serum creatinine?

ACE-I lower angiotensin II levels, causing SYSTEMIC VASODILATION and reduced blood pressure. However, they also cause EFFERENT ARTERIOLAR DILATION and lower intraglomerular pressure, which lower GFR. Many patients experience an increase in Serum creatinine within 2-5 days of starting ACE-I. Patients with bilateral Renal Artery Stenosis and depend on angiotensin II to maintain GFR can experience a precipitous fall in GFR and develop ACUTE RENAL FAILURE.

Serum levels are decreased of complement C4 and C1 esterase inhibitor levels. What drug is contraindicated in this patient?

ACE-Inhibitors (ACE-I) Low serum levels of C1 esterase inhibitor are diagnostic of HEREDITARY ANGIOEDEMA, an inherited AUTOSOMAL DOMINANT condition that causes episodes of painless, non-pitting, well-circumscribed edema. The face, neck lips, and tongue are most commonly affected, but internal organs may also be involved. Angioedema affecting the tracheobronchial tree can cause respiratory obstruction and is potentially fatal Angioedema of the GI tract manifests with abdominal pain, vomiting, and diarrhea.

Diabetic Ketoacidosis (DKA): Metabolic disturbance? what are the values of pH, Bicarbonate, and PaCO2?

HIGH ANION GAP METABOLIC ACIDOSIS (Typically accompanied by a COMPENSATORY RESPIRATORY ALKALOSIS) LOW pH LOW serum BICARBONATE LOW PaCO2 pH in dKA is less than 7.30 typically (some may be less than 6.90 Serum Bicarbonate levels DECREASE becausee of Lactic Acid buildup Typically accompanied by a COMPENSATORY RESPIRATORY ALKALOSIS -> this yields a LOW PaCO2

What best explains the recurrence of Neisseria Gonorrhoeae infection in a patient that has been seen several times before with similar symptoms.

HIGH VARIABILITY OF MICROBIAL ANTIGENIC STRUCTURE An infection with N. Gonorrhoea does not result in lasting immunity because of the ability of these bacteria to modify the outer membrane proteins by the process of antigenic variation. ANTIBODIES GENERATED DURING ONE INFECTION WILL ONLY BE SPECIFIC FOR THAT SINGLE ANTIGENIC EPITOPE.

Platelet Dense granules contain?

ADP Calcium

Clopidogrel: MOA?

ADP receptor inhibitors

Esophageal Cancer: Squamous Cell Carcinoma Risk Factors?

ALCOHOL TOBACCO N-nitroso containing foods (BETEL NUTS)(ASIAN countries)

Huntington Disease: What is the mechanism responsible for the decreased gene expression.

HISTONE DEACETYLATION CAG Trinucleotide repeats Increased -> these code for HUNTINGTON PROTEIN -> this is a GAIN-OF-FUNCTION that leads to pathological interaction with other proteins, including various transcription factors. Acetylation of DNA -> weakens the DNA-histone bond which enhances gene transcription. In Huntington Disease, INCREASED HUNTINGTON PROTEIN causes INCREASED HISTONE DEACETYLATION which silences the genes necessary for neuronal survival.

Chronic Smoker, moderately overweight. Vessels most likely to show atherosclerotic involvement?

Abdominal Aorta > Coronary Arteries > Poplitieal Arteries > Internal Carotid > Circle of Willis

Infant with bulky greasy stools and an Acanthocyte seen on blood smear?

Abetalipoproteinemia

Arteriovenous (AV) shunt or AV fistula: what is it? 2. what might be seen on physical exam if someone has an AV fistula?

Abnormal communication between an artery and a vein that bypasses the arterioles, the major source of resistance in the vascular system. AV SHUNTS ALLOW BLOOD UNDER ARTERIAL PRESSURE TO DIRECTLY ENTER THE VENOUS SYSTEM. 2. Pulsatile mass, with a thrill on palpation, auscultation reveals a constant bruit over the site.

Lumbosacral Radiculopathy of S1: Sensory? Weakness?

All these actions move the leg posterior & SENSORY OVER LATERAL FOOT & POSTERIOR THIGH & CALF Buttocks Posterior Thigh Posterior Calf LATERAL FOOT Hip extension (Gluteus Maximus) Knee Flexion (Hamstring) Foot Plantarflexion (Gastrocnemius) Achilles Reflex (Ankle Reflex)

Different mutations in the same locus produce the same phenotype.

Allelic heterogeneity

Antihistamines: use?

Allergic Rhinitis careful to watch out for REBOUND RHINORRHEA caused by TOPICAL DECONGESTANTS

Telomerase: function? Prokaryotes or Eukaryotes?

An RNA-dependent DNA polymerase that adds DNA to 3' ends of chromosomes to avoid loss of genetic material with every duplication Eukaryotes

Rheumatoid Arthritis: high specificity antibodies react with?

Anti-cyclic Citrullinated Peptide Antibody (Fc portion of human IgG -> Rheumatoid Factor: these are not as specific and occur in 10% of healthy individuals, 30% of patients with SLE, and nearly ALL patients with CRYOBLOBULINEMIA.

Cultures performed on a blood agar plate supplemented with a disk containing hematin an nicotinamide adenine dinucleotide (NAD+) grow colonies only near the disk. 1. Organism?

Haemophilus Influenzae Type B Requires booth X FACTOR (HEMATIN) & V FACTOR (NAD+) to grow.

Harsh ejection type systolic murmur heard best at the base of the heart at the second right intercostal space with radiation to the carotid arteries. Second heart sound is diminished in intensity.

Aortic Stenosis Second heart sound is diminished in intensity due to reduced mobility of the aortic leaflets probably from extensive valve calcification if the patient is elderly.

Aplastic Crisis vs Aplastic Anemia?

Aplastic Crisis -Sickle Cell Patients -Parvovirus B19 -only low RBCs (ANEMIA) Aplastic Anemia -PANCYTOPENIA -BONE MARROW FAILURE!

Neonate 46xx with ambiguous genitalia and clitoromegaly. Elevated testosterone and androstenedione. Ultrasound shows normal-size Uterus. Mother experience facial hair growth and voice deepening during pregnancy. What is deficient in the newborn?

Aromatase *Fetal-placental aromatase deficiency *only difference between this and 21-hydroxylase is that mom is virillized during pregnancy (AROMATASE) and in 21-hydroxlase the infant will be a salt-waster.

Cerebral circulation: hypoxemia causes?

Arteriolar dilation

What is the most common cause of Lung Abscesses?

Aspiration of Oropharyngeal Contents -ANAEROBIC bacteria normally found in the ORAL cavity ->Fusobacterium, Peptostreptococcus, Bacteroides (I choose Aspiration of stomach contents, the question said the sputum was foul-smelling and it made me think ANAEROBIC, which I was correct in thinking that but ORAL bacteria are ANAEROBIC.

Reye Syndrome: mechanism?

Aspirin metabolites DECREASE BETA-OXIDATION by reversible INHIBITION OF MITOCHONDRIAL ENZYMES

Human T Lymphotropic Virus: disease?

Associated predominately with ADULT T-CELL LEUKEMIA-LYMPHOMA (not B-Lymphocyte proliferation)

Essential Fructosuria: symptoms?

Asymptomatic condition *however -> Fructose appears in Blood & Urine *Fructose is not trapped in cells!

Aortic Stenosis Pressure Tracings Where will the peak murmur intensity be found on this graph?

At the peak of Left Ventricular Systole SYSTOLIC EJECTION-TYPE, CRESCENDO-DECRESCENDO MURMUR.

Atopic Dermatitis vs Contact Dermatitis: Hypersensitivity?

Atopic Dermatitis: Type I Hypersensitivity Contact Dermatitis: Type IV Hypersensitivity

Amyloid Deposition confined to Cardiac Atria?

Atrial Natriuertic peptide This is a precursor protein or peptide responsible for localize amyloidosis (confined to single, specific organ)

Acute Intermittent Porphyria: inheritance?

Autosomal Dominant

Aldolase B deficiency: inheritance?

Autosomal Recessive

Cystic Fibrosis: inheritance

Autosomal Recessive

Jervell and Lange-Nielsen syndrome: inheritance?

Autosomal Recessive

PKU: inheritability?

Autosomal Recessive

What can help reduce the incidence of medication errors?

Avoiding use of UNSAFE ABBREVIATIONS and TRAILING ZEROS

Prophylaxis treatment that would have prevented Mycobacterium Avium Complex?

Azithromycin or Clarithromycin Start this at CD4+ < 50 Cells

AIDS: prophylaxis CD4 < 50?

Azithromycin or Clarithromycin -Mycobacterium Avium Complex

Give a Selective Beta-1 Adrenergic Antagonist what cellular changes would occur as a direct effect of this medication (Cardiomyocyte-cAMP, Juxtaglomerular cell-cAMP, vascular smooth muscle- cAMP)?

B-1 receptors are found in CARDIAC tissue and on RENAL JUXTAGLOMERULAR cells, but not vascular smooth muscle. Cardiomyocyte-cAMP: Decreased Juxtaglomerular cell-cAMP: Decreased vascular smooth muscle- cAMP: No significant change

D-Glutamate Capsule?

Bacillus Anthracis only medically relevant bacteria with a PROTEIN CAPSULE!!

Goat wool processor with fever, chest pain hemoptysis.. diagnosis?

Bacillus Anthracis (Pulmonary Anthrax) "woolsorters" disease

Esophageal Cancer: Adenocarcinoma Risk Factors?

Barrett's Esophagus GERD (Gastroesophageal Reflux Disease) Obesity Tobacco Use

Acetycholine is synthesized where?

Basal Nucleus of Meynert

Allelic heterogeneity: example?

Beta-Thalassemia * Different mutations in the same locus produce the same phenotype.

Hb A Absent Hb A2 Significantly Increased Hb F Significantly Increased

Beta-Thalassemia Major

Laboratory analysis shows a hemoglobin A2 level of 7.5% (normal 1.5%-3.5%). What is the most likely explanation for this patient's abnormal laboratory finding?

Beta-Thalassemia Trait

Turner Syndrome: heart defects?

Bicuspid Aortic Valve Aortic Coarctation Bicuspid Aortic Valve -> EARLY SYSTOLIC, HIGH-FREQUENCY CLICK

Colesevelam: MOA?

Bile Acid Sequestrant -binds bile salts in the intestine, decreasing their reabsorption. Subsequent depletion of the bile acid pool causes upregulation of cholesterol 7-alpha-hydroxylase, which converts cholesterol into bile acids -Colestipol -Cholestyramine

MOA: increasing fecal loss of cholesterol derivatives

Bile Acid-binding resins (eg, CHOLESTYRAMINE)

Fat, Fertile, Female has Cholecystokinin stimulation test that shows incomplete gallbladder emptying. What is the pathologic finding?

Biliary Sludge (propensity to form future stones) -Mucin -Cholesterol Crystals -Calcium Bilirubinate -other Calcium salts Normally the gallbladder functions to actively absorb water from bile. Conditions that cause BILIARY STASIS result in bile concentration. This promotes bile precipiation of particulate material listed above (biliary sludge-> precursor to stone formation.

Amphotericin B: MOA?

Binds ERGOSTEROL of fungal cell membranes, leading to fungal cell lysis (similar to Cholesterol)

Sirolimus (Rapamycin): MOA?

Binds FK-506 binding protein (FKBP) that INHIBITS mTOR this leads to INTERRUPTION OF INTERLEUKIN-2 (IL-2) SIGNAL TRANSDUCTION (preventing response to IL-2) INTERRUPTION OF IL-2 SIGNAL TRANSDUCTION!! Sirolimus ultimately prevents G1 to S phase progress and lymphocyte proliferation.

Nystatin: MOA?

Binds to Ergosterol Molecules in fungal cell membrane --> causes pores and leakage of fungal cell contents *same mechanism as AMPHOTERICIN B

Thiazolidinediones/Glitazones: MOA?

Binds to Peroxisome-Proliferator Activated Receptor-gamma (PPAR-gamma) transcription regulator increases production of GLUT-4 and Adiponectin

Doxycycline: MOA?

Binds to the 30S ribosomal subunit of bacteria

Gentamycin: MOA?

Binds to the 30S ribosomal subunit of bacteria

Streptomycin: MOA?

Binds to the 30S ribosomal subunit of bacteria

Azithromycin: MOA?

Binds to the 50S ribosomal subunit of bacteria

Chloramphenicol: MOA?

Binds to the 50S ribosomal subunit of bacteria

Clindamycin: MOA?

Binds to the 50S ribosomal subunit of bacteria

Erythromycin: MOA?

Binds to the 50S ribosomal subunit of bacteria

Linezolid: MOA?

Binds to the 50S ribosomal subunit of bacteria

Calculate what the most appropriate dosing interval for this First Order Elimination Kinetics drug is. -Volume of distribution is 10 L -Rate of Drug Clearance is 7 L/hr -Repeat the second dose when 75% of drug is eliminated

Half-life of a drug can be calculate from its volume of distribution (Vd) and clearance rate (CL) t (1/2) = (0.7 x Vd) / CL t (1/2) = (0.7 x 10) / (7) = 1 HOUR (half life) 0 Half Lives = 0% eliminated 1 Half Lives = 50% eliminated 2 Half Lives = 75% Eliminated 3 Half Lives = 87.5% Eliminated NOW YOU NEED 2 HALF LIFES BECAUSE IT SAID TO REPEAT THE SECOND DOSE WHEN 75% OF DRUG IS ELIMINATED ANSWER IS 2 HOURS!!!

vitamin deficiency related to egg whites?

Biotin (Vitamin B7)

A poorly Soluble Gas: explain gas partition coefficient and brain saturation? 2. Example

Blood Saturates QUICKLY!! INCREASED Pressure leads to DECREASED ONSET TIME!! (FASTER!!) Nitrous Oxide

A HIGHLY Soluble Gas: explain gas partition coefficient and brain saturation?

Blood Saturates SLOWER!! DECREASED pressure leads to INCREASED ONSET TIME (SLOWER!!)

SGLT2 Inhibitors: what do you want to monitor?

Blood urea nitrogen and creatinine *I choose Thyroid Function Test --> these are only routinely performed before Lithium and amIODarone. NOT REQUIRED BEFORE any DIABETIC MEDICATION!!

Labile Cells (Stem Cells)?

Bone Marrow Gut Epithelium Skin Hair Follicles Germ Cells -most affected by chemotherapy

Splitting commonly seen in what personality disorder?

Borderline Personality Disorder

Toxin mechanism name the organism: disinhibits adenylate cyclase via Gi ADP ribosylation?

Bordetella Pertussis -DISINHIBITS ADENYLATE CYCLASE via Gi ADP ribosylation, INCREASING cAMP production in the host cell; -causes increased histamine sensitivity & phagocyte dysfunction

Retinoblastoma (Rb) "two hit" hypothesis?

Both copies of the gene must be knocked out in order to promote malignancy

Mullerian Aplasia vs Androgen Insensitivity Syndrome

Both have a rudimentary Uterus Mullerian Aplasia -Hormones should be NORMAL -46 XX -NORMAL SECONDARY SEXUAL CHARACTERISTICS -OVARIES present (secrete Estrogen normally and enable regular development of secondary sexual characteristics) Androgen Insensitivity Sydnrome -46 XY -Minimal pubic Hair -Elevated testosterone, Estrogen, LH -Cryptorchid Testes (secretes TESTOSTERONE)

Right sided face and arm swelling and engorgement of subcutaneous veins on right side of neck. What vein is most likely obstructed?

Brachiocephalic Vein

A new drug dilates Arterioles and Veins, and promotes diuresis. This drug is most likely an analog of what endogenous substance?

Brain Natriuretic Peptide Atrial Natriuretic Peptide

Maple Syrup Urine Disease: deficient enzyme? 2. What 5 cofactors do these enzymes require?

Branched-chain alpha-ketoacid dehydrogenase, pyruvate dehydrogenase, and alpha-ketoglutarate dehyrogenase. 2. THIAMINE Pyrophosphate Lipoate Coenzyme A FAD NAD (Tender Loving Care For Nancy) Some MSUD improve with high-dose Thiamine treatment)

Aldolase B: function?

Breaks downs Fructose-1-P

Presbyopia: what is it?

Hardened lens is UNABLE TO THICKEN -> WHEN CILIARY MUSCLE CONTRACTS *NORMAL AGE CHANGE (starting at around 40-50) --> cause individuals an INABILITY TO FOCUS ON NEAR OBJECTS

Smoker with depression what medication?

Buproprion!!

EBV (Ebstein-Barr Virus) is associated with what cancers?

Burkett Lymphoma HODGKIN Lymphoma NASOPHARYNGEAL Carcinoma Primary CNS Lymphoma (in immunocompromised patients

Triceps Reflex?

C7, C8

Postpartum Depression: treatment

CBT or SSRI

Macrophage: surface Marker?

CD14

Rituximab: targets what?

CD20 antigen

What T Cells fight Bacteria?

CD4+ T lymphocytes

Student is contaminated with a Mycobacterium Tuberculosis Infection and chest radiograph shows a small calcified lesion in the right lung field. Which cells contributed most to the containment of the infection? (CD4+ TH1 Lymphocytes and Macrophages OR CD8+ T Lymphocytes and Macrophages)

CD4+ TH1 Lymphocytes and Macrophages

Isotype switching: What receptor is necessary?

CD40L/CD40 CD40L (Th cell CD4+) CD40 B-Cell

Alemtuzumab: targets what?

CD52 antigen

Neuroendocrine Markers?

CHROMOGRANIN Synaptophysin Neuron-Specific Enolase

Heteroplasmy?

CLINICAL VARIABILITY of MITOCHONDRIAL DISEASE! Variability occurs because during mitosis, mitochondria are randomly distributed between daughter cells. Some cells contain mitochondria with mostly damaged mtDNA, while some contain mostly normal mitochondrial genomes. This mixture of two types of genetic material is called HETEROPLASMY! (this is responsiblve for clinical variability of diseases)

Jugular Foramen: what exits?

CN IX (Glossopharyngeal) CN X (Vagus) CN XI (Spinal Accessory)

Foramen Rotundum: what exits?

CN V 2 (Trigeminal Branch 2)

Hypoglossal Canal: what exits?

CN XII (Hypoglossal)

DEPRESSION, fatigue, hypersomnia, hyperphagia, and vivid dreams: characteristic of what type of withdrawal?

COCAINE WITHDRAWAL Following a binge, patients may experience a period of acute, intense symptoms including SEVERE DEPRESSION with SUICIDAL IDEATION, Hyperphagia = increased appetitie (also seen in Nicotine withdrawal as a major symptoms!) In contrast to withdrawal from opiates, alcohol, and benzodiazepines, withdrawal from cocaine and other stimulants usually results in minor physical symptoms.

Uterus Didelphys: Defect?

COMPLETE FAILURE of Fusion of MULLERIAN DUCTS

Tuning fork placed on her left mastoid process until the sound is no longer audible. The tines are then quickly placed near the patient's left auditory meatus, and she reports hearing no sound. Vibrating tuning fork on the middle of forehead, and patient hears vibration more strongly in the affected ear. 1. what type of hearing loss?

CONDUCTIVE HEARING LOSS Conductive hearing loss causes lateralization to the affected ear as the conduction deficit masks the ambient noise in the room, allowing the vibration to be better heard.

Tuning fork placed on her left mastoid process until the sound is no longer audible. The tines are then quickly placed near the patient's left auditory meatus, and she reports hearing no sound. 1. What type of hearing loss?

CONDUCTIVE HEARING LOSS Rinne Test (MASTOID sticks out like a Rhino)

DiGeorge Syndrome: Heart Defects?

CONOTRUNCAL (Outflow Tract) DEFECTS -Truncus Arteriosus -Tetralogy of Fallot -VSD

DiGeorge Syndrome: heart defects?

CONOTRUNCAL CARDIAC DEFECTS -Tetralogy of Fallot -TRUNCUS ARTERIOSUS (no wall between pulmonary trunk and aorta -> blood from RV goes into Aorta too) -Aortic Arch anomalies

Zero-order Elimination

CONSTANT AMOUNT

First-order Elimination

CONSTANT FRACTION or PERCENTAGE 0 Half Lives = 0% eliminated 1 Half Lives = 50% eliminated 2 Half Lives = 75% Eliminated 3 Half Lives = 87.5% Eliminated t (1/2) = (0.7 x Vd) / CL

Patient has recurrences of genital herpes: treatment?

CONTINUOUS DAILY ----> VALACYCLOVIR, ACYCLOVIR, or FAMCICLOVIR Weeklong: won't work against recurrence

30 you old male with ADPKD presents to ED with sudden onset of severe headache and confusion. He has no meningeal sign or focal neurological deficits. CT showns blood in subarachnoid space. On 5th day after admission, patient begins to complain of weakness in his right arm and leg. What drug could most likely prevent this patient's neurological sequelae?

Calcium Channel Blocker Vasospasm leading to clinical symptoms occurs in about 20-30% of patients with subarachnoid hemorrhage (SAH) caused by ruptured intracerebral aneurysm. Symptoms of a cerebral vasospasm include an altered mental status as well as focal neurologic deficits Substances generated by the degradation of subarachnoid blood clots are believed to the etiologic agents. Symtoms manifest no earlier than 3 days after the hemorrhage and most frequently occur 7-8 days following SAH.

5 Layers of Epidermis?

Cali's Like Girls in String Bikini's -Stratum Corneum (Keratin) (Calluses, Psoriasis) -Straum Lucidum -Stratum Granulosum (Lichen Planus) -Stratum Spinosum (DESMOSOMES) -Stratum Basale (stem cell site)

Pseudohyphae and Budding Yeasts at 20 C and Germ Tubes at 37 C

Candida Albicans "Germ Tubes" are growing hyphae and becoming True Hyphae.

Employer would like to negotiate a contract in which the medical group would provide care to all the company's employees in exchange for a set monthly fee. What is the name for this?

Capitation --> arrangment in which a payer (individual, employer, or government entity) pays a FIXED, PREDETERMINED FEE to cover all the medical services required by a patient. this is the payment structure underlying Health Maintenance Organization Provider Networks. there is an incentive for the provider and patient to reduce expenses, usually by restricting patients to a limited panel of providers within the plan, requiring referrals from a primary care provider prior to specialist consultations, and denying payment for services that do not meet established evidence-bsed guidelines.

Clostridium Perfringens uses what for energy?

Carbohydrates -its rapid metabolism of muscle tissue carbohydrates produces significant amounts of gas, which can be demonstrated by gas in the tissue on x-ray or CT!! (beware this isn't the MECHANISM for the toxin though)

Biotin required fro what reactions?

Carboxylase reactions (page 85 first aid) -Pyruvate -> Oxaloacetate -Acetyl-CoA -> Malonyl-CoA -Propionyl-CoA -> Methylmalonyl-CoA This is exactly how it was asked (with a list of these type of choices)

Beta-1 receptors major locations?

Cardiac Tissue Renal Juxtaglomerular Cells

Long-chain Fatty Acid (LCFA) degradation requires what for transport in the mitochondrial matrix?

Carntine shuttle CARnitine =CARnage of fatty acids

What study compares a group of people with disease to a group of people without disease to look for a PRIOR? exposure or risk factor?

Case-Control Study asks "What Happened?"

Dehydrogenase: function?

Catalyzes oxidation-reduction reactions

What substances increase the depolarization of Atrial pacemaker cells?

Catecholamines Increase depolarization and Increase Heart Rate

Which NSAID agent does not impair platelet aggregation and thus can safely be given to a patient with pain, fever, and hematuria?

Celecoxib -these DO NOT IMPAIR PLATELET FUNCTION because PLATELETS predominantly express COX 1 SELECTIVE COX 2 INHIBITOR doesn't have the side effects of bleeding and GI ulceration with non-selective COX inhibitors.

Patient has pain, fever, and hematuria, what NSAID is appropriate?

Celecoxib SELECTIVE COX 2 INHIBITOR doesn't have the side effects of bleeding and GI ulceration with non-selective COX inhibitors.

Splenic Artery branches off what artery?

Celiac Trunk

Small Cell Carcinoma: is usually located?

Centrally may say "large mediastinal mass causing tracheal deviation" etc.

DNA Polymerase I: function? 2. What is unique?

Chiefly to replace the RNA primers with DNA segments 2. Has 5' --> 3' Exonuclease activity (unique that DNA Polymerase III doesn't have.)

Case-Control Study: an example of a control group... This Case-Control Study is designed to evaluate the hospital officials' claim that exposure to chemical waste increases the risk for developing AML in childhood.

Children who do not have AML, REGARDLESS of exposure status to chemical waste

Rituximab: MOA?

Chimeric antibody directed against the CD20 antigen (specific to B lymphocytes). It depletes B cells (and abnormal antibody production) through multiple pathways, including complement-mediated lysis, antibody-dependent cytotoxicity (via NK cells) and induction of lymphocyte apoptosis.

Malaria: treatment?

Chloroquine (sensitive areas) Mefloquine (Chloroquine-resistant) -MOST AREAS ARE RESISTANT SO USE MEFLOQUINE!! Image shows Trophozoites.

Patient is given Chlorthalidone Monotherapy what is likely to increase out of these three (Cholesterol, Glucose, Creatinine)?

Cholesterol & Glucose -Cholesterol and Glucose increases as a result of DECREASE INSULIN SECRETION & INCREASED INSULIN RESISTANCE! -Chlorthalidone (Thiazide diuretic) Creatinine could increase but not as likely as Cholesterol (Creatinine will only increase in the case of Acute Interstitial Nephritis (Tubulointerstitial Nephritis) which is major bad.

Rate-limiting step of bile acid synthesis?

Cholesterol 7-alpha-hydroxylase

Chronic Graft Nephropathy: Seen in what type of Rejection?

Chronic Transplant Rejection

Obliterative Vascular Fibrosis: Seen in what type of Rejection?

Chronic Transplant Rejection

Vanishing Bile Duct Syndrome: Seen in what type of Rejection?

Chronic Transplant Rejection

Host CD4+ T Cells Activated recipient APCs: what TYPE of Transplant rejection? Timing?

Chronic Transplant Rejection (Months to Years)

Pleural Effusion with milky appearance from trauma or malignancy?

Chylothorax (Lymphatic) -> THORACIC DUCT injury

As airways continue distally, the epithelium changes. What feature is last to disappear? (Cilia, Goblet Cells, Mucous Glans, Serous Glands, Cartilage)

Cilia -Important because cilia function to propel MUCUS TOWARD THE PHARYNX.

Infant with failure to thrive jaundice, vomiting, hepatomegaly, intellectual disability, and lethargy in the first few days of life (possible infantile cataracts). 1. Diagnosis 2. Defect?

Classic Galactosemia 2. Absent Galacts-1-phosphate Uridyltransferase

Patient with Stable Angina is started on low-dose aspirin but has shortness of breath and wheezing. What is the best alternate?

Clopidogrel

Gram Positive Bacilli (Rods)? 2. Which ones are Anaerobic?

Clostridium Listeria Corynebacterium Bacillus 2. Clostridium

Toxin mechanism name the organism: Presynaptic Acetylcholine release?

Clostridium Botulinum -Blocks the presynaptic release of acetylcholine at the neuromuscular junction resulting in flaccid paralysis

White/yellow plaques on the colonic mucosa and biopsy shows that the plaques are composed of fibrin: 1. Diagnosis 2. Toxins?

Clostridium Difficile Colitis (Psudomembranous Colitis) Enterotoxin A (watery diarrhea) Cytotoxin B (colonic epithelial cell necrosis & fibrin deposition)

2nd-Generation Antipsychotic (SGA): which carry the greatest risk of metabolic adverse effects (eg, weight gain, dyslpidemia, hyperglycemia)?

Clozapine Olanzapine *check GLUCOSE & LIPID PANEL

Blood groups A, B, AB are a genetic example of what?

Codominance

alpha-1-antitrypsin deficiency is a genetic example of what?

Codominance

Relative Risk used in what studies?

Cohort Studies

Afferent Arterioles (Renal):

Coming TOWARDS Glomerulus

Tzanck Smear?

Common HSV-1, HSV-2, and VZV infection. Not Specific

In a study you knock on neighbors doors and interview a group consisting of the patients' neighbors who are of similar age and race. This design technique best helps address what potential problems with a study?

Confounding Bias (Matching) Used in Case-Control studies to eliminate potential confounders of the study (match age, race)

Progesterone: describe what is making this hormone during pregnancy and when?

Corpus Luteum (1st Trimester) Placenta (2nd & 3rd Trimesters)

S3 in a healthy child or an adult <40?

Could be a normal finding

Patient with exposure to farm animal waste, who develops a nonspecific illness (myalgias, fatigue, retroorbital headache fever [>10 days]), normal leukocyte count, thrombocytopenia, and increased Liver enzymes. 1. Diagnosis?

Coxiella Burnetii (Q FEVER)

to study a gene whose deletion causes embryonic death: what is this called?

Cre-Lox System

Inflammatory Bowel Disease: which one more commonly presents with STRICTURES and FISTULAS? 2. why?

Crohn's Disease 2. Transmural Inflammation The involvement of all layers of the intestinal wall. Transmural Inflammation -> causes edema and fibrosis -> which could cause a STRICTURE (or narrowing) or if it caused an ulcer that penetrating the entire wall you would have a FISTULA!

Latex Agglutination Test positive for soluble polysaccharide Antigen: organism?

Cryptococcus Neoformans Specific!!

Aspirin IRREVERSIBLY inhibits what enzymes?

Cyclooxygenase-1 (COX-1) Cyclooxygenase-2 (COX-2)

Low dose aspirin will reduce the risk of cardiovascular events by inhibiting platelet aggregation through what enzyme?

Cyclooxygenase-1 (COX-1) which prevents the synthesis of THROMBOXANE A2 (TXA2)

Meconium Ileus: associated disorder?

Cystic Fibrosis -Meconium Ileus is a very specific finding for Cystic Fibrosis

Nasal Polyps and recurrent respiratory infections, steatorrhea. Diagnosis?

Cystic Fibrosis Nasal Polyps (Sinusitis) related to Cystic Fibrosis

Marfan Syndrome: heart defects

Cystic Medial Necrosis of the Aorta

How does increased levels of Angiotensin-II affect Renal Plasma Flow and Filtration Fraction?

DECREASED Renal Plasma Flow INCREASED Filtration Fraction *Angiotensin-II constrict Efferent Arteriole

Patient has a lower leg injury. Has closed reduction. several hours later increasingly severe pain in his right leg. PE shows increased tension within the anterior compartment. What nerve and vessels could be compressed?

DEEP PERONEAL Nerve Anterior Tibial Artery & Vein

If the eye is denervated and you give a drug that constricts the pupil size. What drug could it be?

DIRECT CHOLINOMIMETIC AGENTS -PIlOCARPINE (answer) -Carbachol (also constricts pupil) NOT (Physostigmine) -> Anticholinesterase which means it needs to work through activating the nerve receptor

Which Polymerase has the function of "removal of RNA primer nucleotides"?

DNA Polymerase I Has 5' --> 3' Exonuclease activity (unique that DNA Polymerase III doesn't have.) WHICH ALLOWS IT TO REMOVE RNA PRIMER!

Wilson's Disease: Lab Values?

Decrease Ceruloplasmin Increased Urine Copper The mutation in Wilson's disease hinders copper metabolism by reducing the formation and secretion of ceruloplasmin and decreasing hepatic secretion of copper into biliary system.

Digoxin: what is the initial event triggering a response to the medication? (Decreased Sodium efflux or Increased Calcium Influx)

Decreased Sodium Efflux (Decrease in sodium efflux decreases the transmembrane sodium gradient and reduces the activity of the sodium calcium exchanger, causing a DECREASE IN CALCIUM EFFLUX!! --> causing myocyte contraction from calcium binding to Troponin C and subsequent binding of actin-myosin cross-bridge formation.

Bicornuate Uterus: fertility and pregnancy?

Decreased fertility INCREASED RISK OF COMPLICATED PREGNANCY

Muscular Atrophy what would be seen microscopically?

Decreased protein synthesis & loss of myofibrils

Nerve: does foot dorsiflexion and toe extension? 2. Sensory?

Deep Peroneal Nerve Sensory: between big toe and 2nd toe

Leukocyte Adhesion Deficiency: defect?

Defect in LFA-1 integrin (CD18)

Defect: Endocardial Cushion Defect

Defects of atrioventricular Septum and valves -typically ASD or VSD

Waxing and waning level of consciousness with acute onset of mental status change: diagnosis?

Delirium

The acute onset of mental status change is most suggestive of?

Delirium -Acute Onset -Impaire Consciousness -CONFUSED STATE -Fluctuating Course -Reversible Prognosis -Global Impairment Most commonly seen in elderly patient with MEDICAL ILLNESS and is often associated with anxiety, agitation, delusions, and/or hallucinations. Patients of advanced age and with neurologic conditions such as Parkinson disease, dementia, and prior stroke are more likely to develop delirium due to reduced cognitive reserve.

The acute onset of mental status change is most suggestive of?

Delirium -Acute Onset -Impaire Consciousness -Fluctuating Course -Reversible Prognosis -Global Impairment

Primary (first) infection can be asymptomatic or cause self-limited disease in most adults. Secondary infection is due to infection with a different viral serotype and usually causes more severe illness?

Dengue Viruses -Endemic areas (like Mexico) -Aedes Mosquito) -FLAVIVIRUS (RNA Virus) -Primary infection -> may be asymptomatic or cause a self-limited disease in most adults (high grade fever, headache, retro-orbital pain, bleeding, epistaxis, petchiae/purpura, diffuse macular rash, musclea nd joint pain, break-bone fever, leukopenia, thrombocytopenia, and elevated liver enzymes (LIFELONG IMMUNITY against SAME SEROTYPE) -SECONDARY INFECTION (DIFFERENT VIRAL SEROTYPE) -->DENGUE HEMORRHAGIC FEVER -THROMBOCYTOPENIA, -PROLONGED FEVER, -RESPIRATORY/CIRCULATORY FAILURE, -SHOCK!!! -PETECHIAE -SPONTANEOUS BLEEDING

MAB targets RANKL?

Denosumab

DNAase aka?

Deoxyribonuclease

Metastatic Calcification: definition? 2. this is caused by?

Deposition of Calcium in NORMAL TISSUE 2. due to HYPERCALCIEMIA

Celiac Disease: what skin finding?

Dermatitis Herpetiformis

Gastric Adenocarcinoma: Diffuse type vs Intestinal Type?

Diffuse Type -Infiltrative Growth within the STOMACH WALL -SIGNET RING -grossly thickened and leathery (linitis plastica) Intestinal Type -Rapid INTRALUMINAL Expansion -associate with H. PYLORI -looks like Ulcer with raised margins

mu opiate receptor agonist that slows diarrhea by decreasing motility?

Diphenoxylate Loperamide -DECREASES MOTILITY (question) -MU OPIOID Receptor agonist in GI TRACT

Mutation of a transcription factor in its allosteric site. Nonfunctioning mutant can still bind DNA, preventing wild-type transcription factor from binding: what is this called?

Dominant negative mutation

Chronic inflammatory interstitial pneumonitis. Compared with a healthy man, analysis of this patient's biopsy specimen is most likely to show which of the following patterns of changes in the cell populations of alveoli? Type I Pneumocytes ,Type II Pneumocytes, Fibroblasts (A) ↑ ↑ ↑ (B) ↑ ↑ ↓ (C) ↑ ↓ ↑ (D) ↑ ↓ ↓ (E) ↓ ↑ ↑ (F) ↓ ↑ ↓ (G) ↓ ↓ ↑ (H) ↓ ↓ ↓

E DECREASED Type I Pneumocytes INCREASED Type II Pneumocytes INCREASED Fibroblasts

Invasive Carcinoma: cell to cell contact is lost by INACTIVATION of what?

E-Cadherin

HPV: E7 viral protein function?

E7 inhibits the Retinoblastoma gene product (Rb)

Escherichia Coli (E. Coli) strain that does not ferment sorbitol and does not produce a glucuronidase?

EHEC O157:H7 w/ Shiga-like toxin that inactivates ribosomal subunits causing bloody diarrhea and Hemolytic Uremic Syndrome

Papule

ELEVATED skin lesion < 1 cm

Plaque

ELEVATED skin lesion > 1 cm

Amyloid Precursor Protein) gene on chromosome 21: associate with?

Early-onset Familial Alzheimer Disease (onset <60)

Presenilin 1 Gene on chromosome 14: associated with?

Early-onset Familial Alzheimer Disease (onset <60)

Presenilin 2 Gene on chromsome 1: associated with?

Early-onset Familial Alzheimer Disease (onset <60)

Collagen Disorder: Failure of Cleavage of Procollagen C & N Terminals

Ehlers-Danlos Syndrome

Collagen Disorder: failure of lysyl oxidase to create covalent crosslinks between collagen fibrils (tropocollagen) (does not properly crosslink) 1. What disorder?

Ehlers-Danlos Syndrome

Hypothyroidism: CK levels?

Elevated Hypothyroidism should be excluded with measurement of TSH levels in all patients with UNEXPLAINED CK ELEVATION

Indicator of Impaired LIVER transport and metabolic capacity?

Elevated Bilirubin

Simultaneous development of Stroke, intestinal or foot ischemia, and renal infarction should raise suspicion for?

Embolic Phenomena -Atrial Fibrillation -Ventricular Clots -Valvular Vegetations *patient had stroke, elevated LDH (cell necrosis), renal infarction, hematuria.

Down Syndrome: heart defects?

Endocardial Cushion Defects -Ostium Primum ASD (ASD in lower part) -Regurgitant AV valves (Mitral/Tricuspid)

First step in atherosclerosis (coronary disease) involves what cell type? 2. what is exposed?

Endothelial Cell 2. Subendothelial Collagen (promotes platelet adhesion)

Benzodiazepines: MOA?

Enhance the effect of the inhibitory neurotransmitter GABA-A receptor which causes increased INFLUX of chloride ions when GABA binds. (INCREASES FREQUENCY OF CHLORIDE CHANNEL OPENING!!!)

Low-Molecular-Weight Heparins (LMWH)?

Enoxaparin Dalteparin

Acyclovir Famiciclovir Valacyclovir: Explain how these drugs are activated?

Enter the virus and are Phosphorylated by HSV/VZV THYMIDINE KINASE (this is the first and rate limiting step) These drugs are more effective against HSV and VZV than cytomegalovirus and Epstein-Barr Virus.

Hepatic Abscesses: Causes linked with organism

Enteric Bacteria (E. Coli, Klebsiella, and Enterococci) -ascending cholangitis -portal vein pyemia -direct invasion from an adjacent area (cholecystitis) Staphylococcus Aureus -> via Hematogenous Seeding of the Liver

Scotch tape to anus test?

Enterobius Vermicularis (Pinworm) *Perianal Egg Deposition

Perianal Egg Deposition

Enterobius Vermicularis (Pinworm) -Pinworms migrate out of the anus at night to deposit eggs on the surrounding perianal folds

CD19 positive cells are isolated, purified and exposed to monoclonal antibodies against cell surface complement receptor CD21. The cells are subsequently incubated with several viruses being studied. Initial exposure to monoclonal antibodies against CD21 is most likely to prevent cell infection with what virus?

Epstein Barr Virus Basically the CD19 cells were exposed to MAB of CD21 so CD21 MAB will bind to that receptor and block them. So this question is asking what Virus needs the CD21 to infect the cell. EVB envelop glycoprotein gp350 binds to CD21 (also known as CR2) the cellular receptor for the C3d complement component. CD21 is normally present on the surface of B cells (CD19-positive cells) and nasopharyngeal epithelial cells). Therefore EXPOSURE TO ANTI-CD21 ANTIBODY COULD INTERFERE WITH EBV ATTACHMENT TO B CELLS.

AIDS patient: they are at the greatest risk of developing a malignant B-lymphocyte proliferation associated with which virus?

Epstein-Barr Virus Latent EBV infection is present in up to 90% of normal individuals. Patients with AIDS have INCREASED INCIDENCE OF EBV-associated LYMPHOMAS, including BURKITT LYMPHOMA and AIDS-related primary central nervous system lymphoma.

Diabetic Ketoacidosis what process leads to HYPERGLYCEMIA (usually they are extremely high!)

Excess fat breakdown and Increased Ketogenesis

Superficial Inguinal Ring is a physiological opening in what layer?

External oblique muscle aponeurosis

Undescended testis palpated superior to the scrotum, medial to the right mid-inguinal point. During Orchiopexy the testis will most likely be pulled through a physiologic opening in what structure?

External oblique muscle aponeurosis

Diabetic Ketoacidosis (DKA): potassium levels extracellular and intracellular and total body?

Extracellular -> Increased/Normal Intracellular -> Decreased Total Body -> Decreased Extracellular is INCREASED/NORMAL the body is trying to keep it normal so that organs are not affected. When Insulin is given to treat DKA this will cause a shift of Potassium into the cells, careful!!

Only a Increased Prothrombin Time (PT) indicates a defect in what pathway? 2. What factor?

Extrinsic Pathway 2. Factor VII

Pleural Effusion from Collagen Vascular Disease: Type of fluid?

Exudate (Increased Protein)

Riboflavin a component of what?

FAD and FMN (Flavins)

Filtration Fraction calculation

FF = GFR/RPF

Antifungal: Inhibits cell wall synthesis?

FUNGIN!! Echinocandins -Anidulafungin -Caspofungin -Micafungin Inhibit cell wall synthesis by inhibiting synthesis of Beta-D-Glucan.

Reduced salivary secretion from the submandibular gland: innervation?

Facial Nerve (CN VII) Chorda Tympani Branch & Lingual Nerves

Pancreas Divisum: what is the cause of this?

Failure of the ventral and dorsal pancreatic buds to fuse *usually asymptomatic but may cause chronic abdominal pain or PANCREATITIS

Olanzapine: at a 3-month checkup after this is started what studies should be obtained?

Fasting glucose and lipid panel 2nd-Generation Antipsychotic (SGA) -associated with METABOLIC ADVERSE EFFECTS -WEIGHT GAIN, -DYSLIPIDEMIA -HYPERGLYCEMIA -INCREASED RISK of DIABETES

Hepatitis A (HAV): transmission? 2. Common ways to get it?

Fecal-Oral 2. SHELLFISH (commonly tested) Travelers Day-Care

Mullerian Duct becomes?

Female Internal Genitalia aka PARAmesonephric Duct -Fallopian Tubes -Uterus -Vagina (upper portion)

Provides sensation to upper thigh and inner leg and innervates muscles that extend the knee: what nerve?

Femoral Nerve (L2-L4)

What binds iron in enterocytes before the iron enters circulation?

Ferritin (its low in iron deficiency)

When Hepcidin binds to Ferroportin what happens?

Ferroportin is degraded Ferroportin functions to move Iron from intracellularly into circulation. Also moves cells from Macrophages into the circulation.

Phenytoin: what happens if taken in pregnancy?

Fetal Hydantoin Syndrome

Has a dental cleaning last week. Mitral Valve Prolaps, patient has fever, bacteria grows dextrans. What does the bacteria adhere to on the valve?

Fibrin-Platelet Aggregates -these are deposited at sites of endothelial trauma providing a site for bacterial adherence and colonization during bacteremia. *Staphyloccous Aureus is more aggressive and can adhere to INTACT VALVES

14 yo boy not taking his insulin at lunch time in school: how can you increase his adherence?

Find peers who take insulin consistently at school

Part of Maxillary Artery: derivative?

First Aortic Arch (1st Aortic Arch) 1111st arch is MAXimal

Enzyme that "Unwinds the 2 strands of template DNA?"

Helicase

High lipid content of bone marrow aspirate, suggestive of?

Hematopoietic Cell Aplasia or Hypoplasia

Antifungal: Inhibition of fungal protein synthesis?

Flucytosine Inhibits DNA and RNA biosynthesis by conversion to 5-fluorouracil by cytosine deaminase.

Benzodiazepine or Nonbenzodiazepine hypnotics: overdose treatment?

Flumazenil

Gold standard for finding a Microdeletion?

Fluorescence in Situ Hybridization (FISH)

Integrins part of?

Hemidesmosomes *bind to collagen and laminin in basement membrane

Integrins: associated with what?

Hemidesmosomes (cellular anchor to basement membrane) Bullous Pemphigoid (BELOW)

Liver with Prussian Blue Staining?

Hemochromatosis

Liver Biopsy: golden-yellow granules in hepatocytes?

Hemochromatosis -deposition of iron -Cirrhosis & portal hypertension result if condition left untreated

What is the best test to determine if a parent has the Sickle Cell Trait?

Hemoglobin Electrophoresis

Sickle Cell Anemia: a patient's hemoglobin would most likely aggregate (sickling) in what conditions?

Hemoglobin S (HbS) aggregates in the deoxygenated state. Low oxygen levesl, increased acidity, or low blood volume -Acid condition (low pH values) -OXYGEN UNLOADING (low oxygen levels) -Dehydration (low blood volume) -High levels of 2,3-biphsophglycerate (causes oxygen release at the tissue level which will cause low levels of oxygen)

Glitazone/Thiazolidindiones: what are these patients at risk of and what tests are important before beginning treatment and during treatment?

Hepatoxicity and Heart Failure (HF) -assess for signs & risks of HF and do Liver Function Tests (LFTs) occassionally

Histone Methylation?

Histone METHYLATION mostly makes DNA MUTE Usually reversibly represses DNA transcription, but can activate it it in some cases depending on methylation location.

AIDS: prophylaxis with Itraconazole? What does this cover?

Histoplasma Capuslatum -CD4 < 150 -endemic area (Ohio and Mississippi River valleys

Mu receptors (Opioid Receptor for Morphine): what type of receptor?

G PROTEIN-LINKED RECEPTORS One pathway involves increased potassium efflux. Binding of MORPHINE to MU RECEPTORS results in G protein-coupled activation of potassium conductance. Increased potassium efflux out of cells and causes hyperpolarization of postsynatpic neurons effectively blocking pain transmission.

k-RAS: what kind of protein and what is general function?

G-protein and participates in cellular signaling

Endoderm: derivatives?

GI tract Liver Pancreas Lung Thymus Parathyroids Thyroid Follicular Cells MIDDLE EAR Bladder Urethra

Metanephric mesoderm: derivatives?

GLOMERULUS through DISTAL CONVOLUTED TUBULE (DCT) -glomerulus -bowman's space -proximal convoluted tubule (PCT) -loop of henle -distal convoluted tubule (DCT)

Pancreatic Beta Cell Function?

GLUCOSE IS THE MAJOR STIMULANT OF INSULIN SECRETION. Glucose enters through GLUT-2. GLUCOKINASE metabolizes to GLUCOSE-6-PHOSPHATE -> further metabolized by glycolysis and the krebs cycle to produce ATP. a HIGH ATP to ADP ratio within the beta cell results in the closure of ATP-sensitive potassium (Katp) channels). Depolarization of beta cells results in OPENING OF VOLTAGE-DEPENDENT CALCIUM CHANNELS. HIGH INTRACELLULAR CALCIUM CAUSES INSULIN RELEASE.

Binding of growth factor ligand -> Autophosphorylation of Tyrosine residues -> Interaction with SOS protein -> Activation of "X" protein -> Activation of RAF Kinase -> Activation of MAP Kinase -> Gene Transcription Protein X becomes activated when it binds which of the following? 2. what is protein X?

GTP 2. RAS

Osteocytes remain connected to each other by?

Gap Junctions

Clostridium Perfringens: causes what two disease?

Gas Gangrene -Lecithinase (alpha toxin)(aka Phospholipase C) Food Poisoning (WATERY DIARRHEA) -spores survive in undercooked food -heat-labile enterotoxin

Hypochromic microcytic anemia, poor appetitie and weight loss, thin and has a shiny tongue, pale conjuctivae, hyperpigmented velvety plaques on the skin noted in the axillae and neck. 1. Diagnosis

Gastric Adenocarcinoma Acanthosis Nigricans: hyperpigmented velvety plaques on the skin and axillae and neck. NOT Adrenal Insufficiency (patient can be thin and fatigued, BUT HYPERPIGMENTATION IS usually diffuse) NOT Peutz-Jeghers (patient has HYPERPIGMENTATION more typically of MOUTH, FEET, HANDS, GENITALS and also have GI POLYS -> will usually present in child)

Personal friend or family member WITH DEPRESSION wants to avoid seeing her own physician as it is difficult to get an appointment and her own schedule is very busy. What is the appropriate response?

"I would like to help, but I am uncomfortable prescribing for someone I am not treating." ethics guidelines consistently recommend that TREATMENT OF FRIENDS should be LIMITED to EMERGENCY SITUATIONS when NO OTHER PHYSICIAN IS AVAILABLE.

Cross Sectional Study?

"Snapshot Study" -Exposure and outcome are measured simultaneously at a PARTICULAR POINT IN TIME!! -In other study designs, a certain time period separates the exposure from the outcome.

HPV 6, HPV 11?

Genital Warts (Conylomata Acuminatum)

Decreased sensation to the Upper Anterior thigh and Decreased function of the Cremasteric reflex in men or Mons Pubis in women: what nerve?

Genitofemoral Nerve (L1-L2)

Imperforate Anus: what additional defects are associated?

Genitourinary Tract Malformations -Renal Agenesis -Hypospadias -Epispadias -Bladder Extrophy

Male infant fails to pass meconium during first 24 hours after his birth. PE->"a dimple is found instead of an anal opening in the perineum." What additional defects are most likely to be found in this patient?

Genitourinary Tract Malformations -Renal Agenesis -Hypospadias -Epispadias -Bladder Extrophy -most often associated with URORECTAL, UROVESICAL, UROVAGINAL FISTULAS -if a FISTULA is present the meconium may discharge from the urethra or the vagina Upper Anal Canal (above Pectinate Line) -> formed from hindgut Lower Anal Canal (below the Pectinate Line) -> INVAGINATION OF SURFACE ECTODERM

Persistent headache and pain in the jaw when chewing food?

Giant Cell Arteritis (Temporal Arteritis)

Mild jaundice after fasting Total Bilirubin 2.8 Direct Bilirubin 0.2

Gilbert Syndrome

Gestational Diabetes: What hormone is most likely contributing? 2. explain?

Human Placental Lactogen (hPL) 2. hPL stimulates pancreatic beta cell insulin production. Gestational DM results when pancreatic function is not sufficient to overcome the pregnancy-related increase in insulin resistance.

Thiazide Diuretic

Hydrochlorothiazide Chlorthalidone Metolazone

Does the heart under go hypertrophy or hyperplasia?

Hypertrophy

Narcolepsy caused by decreased secretion of what? 2. from where

Hypocretin (orexin) 2. Hypothalamus

Deviation of the protruded tongue toward the left side: innervation?

Hypoglossal Nerve (CN XII)

Reye Syndrome: glucose level?

Hypoglycemia

Where is the Thermoregulatory Set Point?

Hypothalamus

6-Mercaptopurine: activated by what enzyme? 2. Inactivated by what enzyme?

Hypoxanthine-Guanine Phosphoribosyl Transferase (HGPRT) 2. Xanthine Oxidase When 6-Mercaptopurine or Azathiopurine which is its prodrug are given the oncologists expects XO to inactivate a certain percentage and HGPRT to activate a certain percentage. What this means is that if Allopurinol is given at the same time which is an XANTHINE OXIDASE INHIBITOR then more 6-Mercaptopurine will be ACTIVATED than expected!!

Aldesleukin: what is it? 2. Use?

IL-2 2. metastatic melanoma and Renal Cell Carcinoma

Giant Cell Arteritis (Temporal Arteritis): What mediator is associated?

IL-6 (Interleukin-6) The inflammatory infiltrate in affected vessels is composed of lymphocytes (predominantly CD4-positive T cells) and macrophages) and frequently contains MULTINUCLEATED GIANT CELLS. The production of cytokines in particularl INTERLEUKIN-6 appears to closely correlate with the severity of the disease. A monoclonal antibody against IL-6 (Tocilizumab) is effective in treating Temporal Arteritis.

Estrogen medications like (Estrogen replacement therapy or Oral contraceptives): How will this affect Cholesterol secretion?

INCREASE biosynthesis of Cholesterol -potentially lead to formation of gallstones.

Vasopressin-1 (V-1) receptor location and action?

INCREASE vascular smooth muscle contraction

Lactase Deficiency: confirmatory testing for this condition will show an increase in what?

INCREASED Breath Hydrogen Content *increased ACID in breath (lactose hydrogen breath test)

How does Ethanol inhibit Gluconeogenesis?

INCREASED NADH DECREASE NAD- FA pg 83 metabolism of ethanol reduces NAD+ to NADH (INCREASED NADH/NAD+ ratio) -----> this INHIBITS all other pathways requiring NAD+ including reactions required for GLUCONEOGENESIS!!

Exercise: what happens to Left Ventricular End-diastolic pressure?

INCREASES Both LV end-diastolic VOLUME and PRESSURE ELEVATE during maximal exercise due to an increase in LV filling (INCREASED VENOUS RETURN)

Does the cephalic phase affect gastric acid secretion by increasing or decreasing gastric acid secretiong?

INCREASES gastric acid secretion

Does the gastric phase affect gastric acid secretion by increasing or decreasing gastric acid secretiong?

INCREASES gastric acid secretion

Clostridium Botulinum: mechanism of the toxin?

INHIBITS ACETYLCHOLINE RELEASE TOXIN is a protease that cleaves SNARE proteins for neurotransmitters.

A patient has been on chronic glucocorticoid therapy with prednisone: where does this effect the hypothalamic pituitary adrenal axis?

INHIBITS Corticotropin-Releasing Hormone (CRH) -> decreased ACTH -> decreased Cortisol

Erythropoietin: production is increased increased by what cells? 2. in response to what?

INTERSTITIAL CORTICAL Cells in PERITUBULAR CAPILLARY BED of the Kidney (Renal Cortex, the outer part of the Kidney) 2. Hypoxia (COPD)

Alpha-1 Antitrypsin (AAT) Deficiency: what is seen on a liver biopsy?

INTRAHEPATOCYTE ACCUMULATION OF POLYMERIZED AAT MOLECULES -> this can lead to Cirrhoses the 2nd most common cause of death in this population These stain reddish-pink with the periodic acid-Schiff reaction and resist digestion by diastase ( an enzyme that breaks down glycogen)

Malignant cells Involve the ENTIRE THICKNESS OF EPITHELIUM AND PENETRATES the BASEMENT MEMBRANE?

INVASIVE CARCINOMA *IRREVERSIBLE (All all stages are Reversible)

What CHANGE IS ONLY SEE IN CARCINOMA?

IRREVERSIBLE CHANGES

Omalizumab: targets what?

IgE for Allergic Asthma; prevents IgE binding to Fc;RI

Type A & B blood mothers the circulating antibodies are of what class?

IgM

Poststreptoccal Glomerulonephritis (PSGN): What immune component is most likely responsible for the damage caused to the kidneys?

Immune Complex Type III Hypersensitivity

Primary Systemic Amyloidosis: what type of polypeptide fragments?

Immune Globulin Light Chain

Cholesterol 7-alpha-hydroxylase: function?

Important to make BILE SALT from CHOLESTEROL.

An enzyme is found to catalyze the methylation of cytosine residues in DNA using S-adenosyl-methionine (SAM) as the methyl donor. This enzyme most likely plays a crucial role in what genetic process? (Aneuploidy, Epistasis, Imprinting, Meiotic nondijunction, Pleitropy)

Imprinting -caused by DNA Methylation; an epigenetic process in which genes can be silenced by attaching methyl groups to cytosine residues in the DNA molecule.

The incidence of a disease has been stable at 3 cases per 1,000. However the prevalence of this disease increased progressively over the same period. What explains this?

Improved quality of care (such a trend can be attributed to factors that prolong the duration of the disease; e.g. improved quality of care) Prevalence = Incidence X Time Incidence = measure of appearance of NEW cases Prevalence = measure of those with the disease in the population at a PARTICULAR POINT IN TIME

Chloythorax Pleural Effusion (Lymphatic Pleural Effusion): What is increased?

Increased TRIGLYCERIDES

Exudate Pleural Effusion: pathophysiology?

Increased VASCULAR PERMEABILITY --> Increased Protein Conten *CLOUDY

Type II DM: Serum Triglycerides are elevated and the HDL level is low, which of the following additional findings would be most suggestive of increased insulin resistance in this patient? (Decreased hepatic glucose production, elevated LDL level, increased waist circumference)

Increased Waist Circumference -VISCERAL FAT correlates much more strongly with INSULIN RESISTANCE than does subcutaneous fat. WAIST CIRCUMFERENCE or WAIST-TO-HIP RATIO will measure VISCERAL FAT. *INCREASED HEPATIC GLUCOSE PRODUCTION -> (in insulin resistance, gluconeogenesis is uninhibited)

Osler Nodes

Infective Endocarditis -PAINFUL, violacious nodules see on fingertips and toes

Janeway Lesions

Infective Endocarditis -caused by MICROEMBOLI to skin vessels -NONTENDER lesions on palms and soles

What landmark will best aid the surgeon in distinguishing a indirect from a direct inguinal hernia? (Inferior Epigastric Vessels, Transversalis Fascia, Cooper's Ligament, Femoral Vein)

Inferior Epigastric Vessels

Thymus shares is origin with? 2. what pharyngeal Pouch

Inferior Parathyroid Glands 2. 3rd Pharyngeal Pouch

Filter for deep venous thrombosis and pulmonary Embolism is planned where is this placed?

Inferior Vena Cava -IVC filters are designed to prevent the propagation of DVT from legs to the lung vasculature

Purulent abrasion on the right lateral foot?

Inguinal Nodes

What is the physiologic inhibitor of FSH secretion 2. How is LH concentration controlled?

Inhibin B (produced by Sertoli Cells) 2. Testosterone feedback (Leydig Cells)

Selegiline: MOA? 2. what other drug is similar?

Inhibition of Monoamine Oxidase-B (MAO-B) -resulting in DECREASED CENTRAL DOPAMINE DEGRADATION 2. Rasagiline

Rasagiline: MOA?

Inhibition of Monoamine Oxidase-B (MAO-B) -resulting in DECREASED CENTRAL DOPAMINE DEGRADATION 2. Selegiline

Isoniazid (INH): MOA?

Inhibition of Mycolic Acid Synthesis

Class IA Antiarrhythmics: characteristics 2. Names

Inhibition of phase 0 depolarization -> INTERMEDIATE Effect on Length of Action Potential -> PROLONGED 2. Quinidine Procainamide Disopyramide

Integrase Inhibitors: MOA? 2. use? 3. names?

Inhibits ability of double-stranded HIV DNA to INTEGRATE into the host cell's chromosomes, thereby preventing host cellular machinery from TRANSCRIBING VIRAL mRNA!! 2. HIV 3. Raltegravir Dolutegravir Elvitegravir

AZOLES: MOA?

Inhibits the CYTOCHROME P-450 (P450) enzyme that converts lanosterol to ergosterol) (INHIBITS FUNGAL STEROL(ERGOSTEROL) SYNTHESIS)) -Clotrimazole -Fluconazole -Itraconazole -Ketoconazole -Miconazole -Voriconazole

Anatomy: Putamen Globus Pallidus Caudate Nucleus Internal Capsule Thalamus

Internal Capsule -> Between Globus Pallidus and Subthalamic Nucleus (which is right underneath the THALAMUS) if it were labeled) Wilson's Disease can cause Cystic Degeneration of the Putamen as well as other Basal Ganglia structures. (Wilson's is the most likely to be emphasized on USMLE)

During the first week after an ACUTE STROKE: CT imaging studies reveal what?

Ischemic area to be HYPODENSE and poorly delineated from the surrounding tissue. Edema and loss of distinction of the gray-white matter junction are also seen.

Galactocerbroside accumulates?

Krabbe Disease -Optic Atrophy -Peripheral Neuropathy -Development Delay -Globoid Cells

Glactocerebrosidase enzyme deficiency?

Krabbe Disease -Optic Atrophy -Peripheral Neuropathy -Development Delay -Globoid Cells

Spinal Foraminal Stenosis of L5-S1 affects what nerve root?

L5 verse if it was a Disc Herniation of L5-S1 it would have affected S1.

Normal Cardiac Pressures?

LA <5 LV 25/5 PA 25/10 PCWP 4 - 12 RA 4 - 12 RV 130/10 Aorta 130/90

Large Pleural Effusion vs Obstructive Atelectasis on x-ray?

Large Pleural Effusion -Complete Hemithorax Opacification -Tracheal deviation AWAY FROM AFFECTED LUNG Obstructive Atelectasis -Complete Hemithorax Opacification -Tracheal deviation TOWARDS AFFECTED LUNG

Patient has left dominant circulation with a normal left main coronary artery. A small thrombus detaches and moves forward, causing obstruction of the artery supplying the Atrioventricular Node. What artery supplies the AV Node?

Left Circumflex Artery (LEFT DOMINANT 10%) Right Coronary Artery (RIGHT DOMINANT 70%) Both (codominant 20%)

Left anterior descending artery (LAD artery) CT Scan Right Coronary Artery CT Scan

Left anterior descending artery (LAD artery) branches off --> LEFT MAIN CORONARY ARTERY If seen in the image the LEFT CIRCUMFLEX ARTERY arises from the LEFT MAIN ARTERY and runs in the left AV groove between the LEFT ATRIUM and LEFT VENTRICLE.

Foregut Derivatives?

Liver Pancreas Gallbladder

Arsenic exposure: what cancers?

Liver Angiosarcoma (Hepatic Angiosarcoma) Lung Cancer Squamous Cell Carcinoma (Skin)

Postherpetic Neuralgia (PHN)

Localized dermatomal pain that persists for several months following a zoster eruption

Norepinephrine is synthesized where?

Locus Ceruleus

Mutations at different loci can produce a similar phenotype.

Locus Heterogeneity

Panic Disorder: treatment?

Long Term: SSRI/SNRI, Venlafaxine & Cognitive Behavioral Therapy (all 1ST LINE) Immediate: Benzodiazepines

Monitor Serum Potassium with what drugs?

Loop Diuretics Spironolactone ACE-I (ACE Inhibitors) Angiotensin II receptor Blockers (ARBs)

A tubular fluid sample with osmolarity of 1200 mOsm/L is obtained from where?

Loop of Henle (1200)

When a PULMONARY EMBOLISM occurs why does a LUNG INFARCTION RARELY OCCUR?

Lung is supplied by DUAL CIRCULATION -Pulmonary System -Bronchial System COLLATERAL CIRCULATION

Cryptococcus Neoformans: most likely primary focus of the infection?

Lungs -fungus infects humans via the RESPIRATORY TRACT and enters the LUNGS *usually ASYMPTOMATIC in lungs and from the lungs it may disseminate to other organs *has a predilection to CNS

Hypoxic brain injury due to embolic activity: (hemmorrhage into necrotic area OR Lysosomal digestion of the tissue)

Lysosomal digestion of the tissue *(Liquefactive Necrosis)

Acute Rheumatic Fever: antibodies directed against specific GAS antigens?

M protein (attack myosin) & N-acetyl-beta-D-glucosamine (attack lysoganglioside-a neuronal cell surface protein)

The Peroxisome-Proliferator Activated Receptor (PPAR) family play a significant role in the pathogenesis of what?

METABOLIC SYNDROME (obesity, hypertension, dyslipidemia, and insulin resistance)

A patient's urine pregnancy test is positive, the oocyte was most likely arrest in which of the following stages of meiosis immediately prior to fertilization?

METAPHASE of Meiosis II Meiosis II completed when it is FERTILIZED!

Asthma: what may be used to elicit asthma symptoms to confirm the diagnosis?

METHACHOLINE HISTAMINE administration Exercise Cold air inhalation

Small Intestine bacterial overgrowth: what nutritional substances are likely to be DECREASE?

MOST VITAMINS (DECREASED ABSORPTION) Vitamin A Vitamin D Vitamin E Vitamin B12 IRON *remember INCREASED PRODUCTION of FOLIC ACID & VITAMIN K (you should be set!!)

Typical Antipsychotic: TREATMENT OF EXTRAPYRAMIDAL SYSTEM side effects?

MUSCARINIC ANTAGONIST (Antimuscarinic agent) -BENZTROPINE, Trihexyphenidyl Don't confuse with DANTROLENE (used for Neuroleptic malignant syndrome)(skeletal muscle relaxant)

Hydrocephalus in a infant will lead to what?

Macrocephaly Poor Feeding Muscle Hypertonicty (UMN injury) Shunt to bypass the obstruction

Thiamine (Vitamin B1): mainly affects who?

Malnutrition & Alcoholics -Peripheral Neuropathy -Dilated Cardiomyopathy -Wernicke-Korsakoff Syndrome (confusion, ophthalmoplegia, ataxia, confabulation, personality change, memory loss)

Bloody Diarrhea what is expected in stool findings? 2. Organisms?

Many Leukocytes with Neutrophils (polymorphonuclear leukocytes) 2. -Shigella Species Salmonella Species Campylobacter Jejuni Enteroinvasive E. Coli Yersinia Entercolitica Clostrdium Difficile Entamoeba Histolytica

P-Selectin mutation will affect what neutrophil function?

Margination & Crawling

CD34 mutation will affect what neutrophil function?

Margination & Rolling

E-Selectin mutation will affect what neutrophil function?

Margination & Rolling

GlyCAM-1 mutation will affect what neutrophil function?

Margination & Rolling

L-Selectin mutation will affect what neutrophil function?

Margination & Rolling

Mac-1 mutation will affect what neutrophil function?

Margination & Rolling

Sialyl-Lewis mutation will affect what neutrophil function?

Margination & Rolling

Cerebroside Sulfate accumulates?

Metachromatic leukdystrophy -Peripheral Neuropathy -Progressive neurodegeneration -dementia

Invasive Carcinoma: cells have invaded basement membrane by using what:

Metalloproteinases -Collagenases -Hydrolases

Kinesin: proteins functionally associated with what cell structure?

Microtubules

Reye Syndrome: light microscopy of his liver will reveal?

Microvesicular Steatosis (Fatty Liver)

Foramen Spinosum: what exits?

Middle Meningeal Artery

Superior Mesenteric Artery supplies blood to?

Midgut -3rd part of Duodenum to Proximal 2/3 of Transverse Colon

Beta Blockers are useful for treating Hypertension in people with what comorbid conditions?

Migraine ESSENTIAL TREMOR Angina ATRIAL FIBRILLATION

Both Melanocytes and Germ Cells undergo? (Apoptosis, migration, metaplasia, hypertrophy)

Migration

Maturity-onset Diabetes of the Young (MODY): characteristic features?

Mild, nonprogressive hyperglycemia that often worsens with pregnancy-induced insulin resistance. Often seen in families.

The concentration of the anesthethetic in the alveoli that renders 50% of patients unresponsive to painful stimuli (ED50): What is that?

Minimal Alveolar Concentration (MAC)

Potency of a gas anesthetic is measured by

Minimal Alveolar Concentration (NOT POTENCY!!) CAREFUL!!

Base substitution that result in the placement of an incorrect amino acid in a protein sequence. (UUU to UCU)?

Missense Mutation

Long-chain Fatty Acid (LCFA) are degraded where?

Mitochondrial Matrix

Delirium Tremens?

Most severe ALCOHOL WITHDRAWL manifestation appears 48-96 hours after last drink CONFUSION, AGITATION, FEVER, TACHYCARDIA, DIAPHORESIS

Dystrophic Calcification: definition? 2. Grossly and H & E?

NORMAL CALCIUM LEVEL IN BLOOD -Calcium deposits in ABNORMAL TISSUES -SECONDARY to INJURY or NECROSIS 2. Grossly -> calcium deposits seen as fine, gritty white granules or clumps H & E stain -> dark-purple, sharp-edged aggregates

Acute Gouty Arthritis: Preferred Treatment? 2. MOA? 3. Who should these be avoided in? 4. 2nd-line

NSAID (Naproxen & Indomethacin) 2. Cyclooxygenase Inhibitor (decrease prostaglandin synthesis and exerta broad anti-inflammatory effect that includes INHIBITION OF NEUTROPHILS) 3. Renal & hepatic dysfunction, high risk for peptic ulcer 4. Colchicine

UV light damages DNA causes THYMINE DIMERS (PYRIMIDINE DIMERS): explain repair process?

NUCLEOTIDE EXCISION REPAIR 1. Endonuclease detects abnormalities in DNA 2. Endonuclease complex NICKS the damaged strand on both sides of the PYRIMIDINE DIMER 3. defective region is excised 4. DNA polymerase synthesizes new DNA in place of damaged DNA 5. DNA LIGASE seals the final remaining nick XERODERMA PIGMENTOSUM -> mutation in the Nucleotide excision repair

Modafinil: use?

Narcolepsy

Patient has uncontrollable nose bleed. Cautery is performed where?

Nasal Septum (Anterior) -Kiesselbach's Plexus

MAB Targets alpha4-integrin?

Natalizumab

T cell receptors of many lymphocytes demonstrate a very high-affinity interaction with MHC molecules expressed on thymic medullary epithelial and dendritic cells. What process do these lymphocytes undergo at this time?

Negative Selection Thymic MEDULLA!

#1 cause of meningitis in teenagers?

Neisseria meningitis

Anaplastic Tumor (Anaplastic Cells) demonstrate? 2. What are the features?

Neoplastic cells that demonstrate a COMPLETE LACK OF DIFFERENTIATION and LACK ANY FEATURES OF THE ORIGINAL TISSUE. Brain tumor cells forming giant cells (example from question)(most characteristic of an anaplastic tumor!) 1. Loss of Cell Polarity 2. Cellular pleomorphism and Nuclear Pleomorphism 3. Large nuclei or Large Nucleoli 4. Numerous, often abnormal mitotic figures 5. Giant, multinucleated tumor cells

Amphotericin B: most dangerous adverse effect? 2. What specifics effects happen as a result?

Nephrotoxicity -Anemia (decreased erythropoietin (EPO)) -HYPOKALEMIA -HYPOMAGNESIUM Hypokalemia & Hypomagnesium are caused by an increase in the MEMBRANE PERMEABILITY (due to binding of cell membrane cholesterol) of the DISTAL TUBULE Normally Amphotericin B bind Ergosterol of Fungal Cell Membraned however it can bind to Cholesterol in Human Cell membranes to some degree which explain a number of its adverse effects.

Bilateral Acoustic Schwannoma (Bilateral Schwannoma): associated with?

Neurofibromatosis Type II

Bilateral Acoustic Schwannoma what else might be seen on physical exam?

Neurofibromatosis Type II -Juvenile Cataracts -Meningioma -Ependyoma *all seem to be in HEAD AREA

MOA: reducing hepatic VLDL production?

Niacin Fibrates Fish Oil

What 2 disease have the bright red fovea centralis that is surrounded by a contrasting white macula?

Niemann-Pick Disease (Hepatosplenomegaly) Tay-Sachs Disease (no abdominal involvement)

Sildenafil: the intracellular signaling of this drug is most similar to what substances?

Nitric Oxide Brain Natriuretic Peptide Atrial Natriuretic Peptide All work through the same cGMP second messenger system to VASODILATE

Verapamil: function?

Non-dihydropyridine Calcium Channel Blocker (CCB) that slows depolarization of cardiac slow-response tissue (SA and AV nodes) by DECREASING CALCIUM ION INFLUX that occurs during phase 0 and the latter part of phase 4. Verapamil also DECREASES THE AMOUNT OF INTRACELLULAR CALCIUM AVAILABLE WITHIN CARDIOMYOCYTES (fast response tissue), which can REDUCE MYOCARDIAL CONTRACTILITY.

What is the relationship between Serum Creatine and GFR?

Nonlinear -serum creatinine can be essentially normal even after a 50% loss of kidney function. -serum creatinine levels being to RISE as the GFR declines to <60 mL/min

Introduce a stop codon within a gene sequence, that results in the formation of truncated proteins? (UCA to UAA)

Nonsense Mutation UAA is a Stop Codon baby!!!

A chronic cigarrete smoker will see what changes in the bronchi? 2. what is this called?

Normal bronchi: Pseudostratified Columnar Ciliated Epithelium Smoker: Stratified Squamous Epithelial Cells METAPLASIA! I missed this on UWORLD and USMLE-RX! A smoker causes METAPLASIA OF TRACHEA OR BRONCHIAL CELLS FROM COLUMNAR TO SQUAMOUS!!

Normal cells of Trachea? 2. Trachea or Bronchial Cells of a Chronic Cigarette Smoker?

Normal bronchi: Pseudostratified Columnar Ciliated Epithelium Smoker: Stratified Squamous Epithelial Cells METAPLASIA! I missed this on UWORLD and USMLE-RX! A smoker causes METAPLASIA OF TRACHEA OR BRONCHIAL CELLS FROM COLUMNAR TO SQUAMOUS!!

Fructokinase: function?

Normally Fructokinase takes fructose and makes Fructose 1-Phosphate thane Aldolase B makes DHAP and Glyceraldehyde.

Vas Deferens: Function?

Not only as a transport duct from the epididymis to the ejaculatory duct, but also serves to STORE and PROTECT SPERM following spermatogenesis IMPORTANT IN VASECTOMY

Acanthosis Nigricans: associated with?

Obesity (most commonly) Insulin Resistance (most commonly) *GASTRIC ADENOCARCINOMA & other visceral malignancies

Neither patients nor physicians are aware who takes the drug or placebo. The study setup described above is most effective in preventing: what kind of bias?

Observer Bias -> a researcher's belief in a positive outcome in treated patients can potentially result in observer bias.

-Decreased breath sounds over Right lung -completely opacified right lung on x-ray -Trachea is deviated to the right 1. Diagnosis?

Obstructive Atelectasis (Right Mainstem Bronchus Lesion)

Best approach in a drug seeking individual?

Obtain confirmation of the patient't prescription history

Chronic, Progressive loss of peripheral vision with elevated intraoccular pressure: Diagnosis?

Open-Angle Glaucoma -may show INCREASED cup-to-disc ratio (due to loss of ganglion cell axons) due to increased production or decreased outflow of aqueous humor (aqueous humor is produce by the EPITHELIAL CELLS of the Ciliary Body. It is secreted into the posterior eye chamber and transferred through the pupil into the anterior eye chamber. The Anterior chamber angle (iridocorneal angle) contains a trabecular meshwork through which the aqueous humor diffuses into Schlemm's canal)(scleral venous sinus)

Superior Orbital Fissure: what exits?

Opthalmic Artery CN III (Oculomotor) CN IV (Trochlear) CN VI (Abducens) ****CN V 1 (Trigeminal Branch 1)

Complete Visual Loss in one eye: what nerve?

Optic Nerve (CN II)

Pupillary Light Reflex: What nerve is responsible for the Afferent limb?

Optic Nerve (CN II)

Sputum cultures grow budding yeast that form germ tubes at 37 C. The most likely site of this organism before entering the sputum is from where?

Oral Cavity *presence of Candida Albicans in sputum does NOT indicate disease -normal inhabitant of the GI tract (including oral cavity) in up to 40% of the population

Phosphoenolpyruvate Carboxykinase

Oxaloacetate ----> Phosphoenolpyruvate (using GTP made in the TCA cycle from Succinyl CoA ---> Succinate)

Beta Blockers (Esmolol): What part of the ECG will be most affect by the medication?

P wave -SLOW THE AV NODAL CONDUCTION P wave represent atrial depolarization Beta Blockers (Class II) (except Sotalol, which also has Class III properties) do not have any specific effects on QRS or QT interval durations.

Husband is infertile, using a donor insemination. Have one son with Pompe Disease (autosomal Recessive). In general population disease affects 1 in 40,000. Genetic testing confirms patient is a carrier for disease. What is the probabiliyt of the patient having a second affected child with a different sperm donor?

P(affected child given carrier parents) X P(carrier mother) X P(carrier father) = PROBABILITY!! 1/4 X 1 X 1/100 = 1/400 P(affected child given carrier parents) = 1/4 P(carrier mother) = 1 (mother is a carrier we know that) P(carrier father)(use hardy-weinberg) p + q = 1 p^2 + 2pq + q^2 = 1 (p^2) = Normal frequency 2pq = Carrier frequency q^2 = Disease frequency ESTIMATE!!! ------>>>>>> P(carrier) = 2q Probably give you you 1 in 40,000 of general population have the autosomal recessive disease. (this is q^2)(this makes q = 1/200) P = 2(1/200) = (1/100)

Which of the following signs, if present on physical examination, would be the most specific indicator of pulmonary arterial hypertension in this patient? (A) Increased jugular venous pressure (B) P2 louder than A2 (C) Peripheral edema (D) Presence of an S3 (E) Pulmonary crackles

P2 Louder than A2

ultrafiltrate concentration ratios

PAH & CREATINE similar to INULIN Urea is also similar to Chloride Potassium similar to Sodium Amino Acids similar to Glucose

von Willebrand Factor: lab values (PC, BT, PT, PTT)

PC: Normal BT: INCREASED PT: NORMAL PTT: INCREASED vWF acts to carry/protect FACTOR VIII so this INCREASES PTT if it is vWF is deficient

CD31 associated with what?

PECAM-1 (CD31) Diapedesis-WBC travels between endothelial cells and exits blood vessel -LIVER ANGIOSARCOMA is CD31+

Lateral, irregular mole on the right great toe: what lymph nodes will be swollen?

POPLITEAL Nodes Inguinal Nodes Popliteal Nodes are not enlarged in Medial tracks

Neural Tube (Ectoderm): derivatives?

POSTERIOR PITUITARY RETINA Pineal Gland Brain Spinal Cord

Electrophysiologic properties of human muscle cells: Under normal physiologic conditions, what ions will most likely flow OUT of the cell after opening of their respective ion channels?

POTASSIUM ONLY!

Studying Calcium Stones in solution: Saturation of the solution with Citrate?

PREVENT'S STONE FORMATION! A high urine citrate concentration has a stone-preventing effect as well, as citrate binds to free (ionized) calcium, preventing its precipitation and facilitating its excretion. Potassium Citrate is often prescribe to prevent recurrent CALCIUM stones in adults when dietary modifications are unsuccessful

Small Fibrotic focus in the lower lobe of the right lung and calcified lymph node in the right lung hilus? (primary or secondary Mycobaterium Tuberculosis?)

PRIMARY Mycobaterium Tuberculosis -Ghon Complex -> Lower Lobe Lung lesion (Ghon Focus) accompanied by ipsilateral hilar adenopathy is described as a Ghon complex. Occurs during INITIAL infection.

Analysis of a partially replicated DNA fragment shows the presence of uracil. This finding is most likely mediated by what enzyme?

PRIMASE (RNA Polymerase) URACIL is found ONLY IN RNA. So the question essentially asks which enzyme involved in DNA synthesis catalyzes the formation of RNA strands. Primase is responsible for synthesizing a short RNA primer using the separated strands of DNA at the replication fork as templates. DNA replication then proceeds with DNA polymerase using the 3' hydroxyl group of the RNA primer as a starting point for synthesis.

A girls oocytes are arrested in what stage of development from childhood to puberty?

PROPHASE of Meiosis I Primary oocytes are completely developed in female embryos by the 5th month of gestation, at which point they are arrested in PROPHASE OF MEIOSIS I.

Myasthenia Gravis: treatment? 2. Next, the patient develops abdominal cramping, nausea, sweating, and diarrhea probably from the medication. What could you give her to treat these symptoms?

PYRIDOSTIGMINE (Cholinesterase Inhibitor) 2. Scopolamine or Hyoscyamine Pyridostigmine may cause excessive cholinergic stimulation of the gut!! Scopolamine is a selective muscarininc acetylcholine receptor antagonist that will reduce the effects of cholinesterase inhibitors in sites where acetylocholine action is mediated by muscarinic receptors (such as the gut!). It will do this without affect the action of the cholinesterase inhibitor on Skeletal muscle (which uses nicotinic receptors)

Winter's Formula?

PaCO2=(1.5 * HCO3-) + 8 +or- 2 CALCULATE for METABOLIC ACIDOSIS If you calculate the PaCO2 using Winter's Formula and it doesn't fall within this range than there is a RESPIRATORY ALKALOSIS happening too.

Acute Intermittent Porphyria: 5 P's?

Painful Abdomen Port Wine Urine Polyneuropathy Psychological Disturbances Precipitated by drugs (P-450 inducers) Alcohol, and starvation

Shoulder pain radiating toward the axilla and scapula in a smoker of 40 years?

Pancoast Tumor -most common presenting symptom

Antidiuretic Hormone is made where?

Paraventricular Nuclei & Supraoptic Nuclei of the Hypothalamus

Herpes Zoster: what will a patient suffer from within the next 6 months?

Persistent local pain (Postherpetic Neuralgia (PHN)) The skin rash is not likely to recur in immunocompetent individuals.

Antecubital vein being used for infusion of Norepinephrine blanches and the tissues surrounding the IV site become cold, hard, and pale. Local injection of the affected tissues with what agent is likely to be of the greatest benefit?

Phentolamine Induration and pallor of the tissues surrounding the IV site are signs of NE extravasation (let out of the vessel). The NE leak causes INTENSE alpha1-receptor mediated vasoconstriction which can lead to local tissue necrosis. Such necrosis can be prevented by infiltration of PHENTOLAMINE (alpha-receptor blocker). This antidote must be given within 12 hours of extravasation to be effective. Remember that Phentolamine and other alpha-receptor blockers lead to vasodilation, thus counteracting the alpha1-receptor mediated vasoconstriction of NE.

Gingival Hyperplasia: what drug most likely caused this?

Phenytoin (common side effect) Ca2+ channel blockers Cyclosporine

Hemochromatosis: Treatment?

Phlebotomy (blood donation) is the preferred method to slow the progression.

Sildenafil: MOA?

Phosphodiesterase-5 Inhibitor -> leads to a rise in intracellular cGMP

Sildenafil: MOA?

Phosphodiesterase-5 Inhibitor -> leads to a rise in intracellular cGMP and vasodilation of the arteries supplying the corpus cavernosum

Clostridium Perfringens: mechanism of action of toxin? 2. Name of Toxin?

Phospholipid Splitting -catalyzes the SPLITTING OF PHOSPHOLIPID MOLECULES -hydrolyzes lecithin-containing lipoprotein complexes in cell membranes, causing cell lysis (including erythrocyte hemolysis), tissue necrosis, and edema 2. Lecithinase (alpha toxin)(Phospholipase C)

Glucokinase & Hexokinase: function? 2. Location

Phosphorylation of glucose to yield Glucose-6-Phosphate Hexokinase -> Most tissues except liver & Beta-cells of pancreas Glucokinase -> Liver or Beta-cells of pancreas

1st committed step of glycolysis? 2. Enzyme

Phosphorylation of glucose to yield Glucose-6-Phosphate (Glycolysis or Glycogen Synthesis) 2. Hexokinase (most tissues) or Glucokinase (Liver or Beta-cells of pancreas)

Atropine: toxicity treatment? 2. symptoms

Physostigmine -> INHIBITS ACETYLCHOLINESTERASE both peripherally and centrally and is capable of crossing blood-brain barrier. The INCREASED ACETYLCHOLINE counteracts atropine's blockade of muscarinic cholinergic receptors Restless, disoriented, combative, DILATED PUPILS, TACHYCARDIA, dry flushed skin, hyperthermia (atropine fever) mydriasis and cycloplegia, bronchodilation, constipation, and urinary retention Atropine -> BLOCK'S MUCCARINIC CHOLINERGIC RECEPTORS

Thrombotic Thrombocytopenic Purpura: treatment?

Plasmapheresis (plasma exchange) -> life saving

Malaria without Liver hypnozoites 2. Treatment?

Plasmodium Falciparum 2. Chloroquine (sensitive areas) Mefloquine (Chloroquine-resistant)

Malaria: which organisms can establish a latent hepatic infection?

Plasmodium Vivax Plasmodium Ovale

Malaria with liver hypnozoites? 2. Treatment?

Plasmodium Vivax Plasmodium Ovale 2. Primaquine

Phenytoin causes increased expression of what?

Platelet-derived growth factor (PDGF) When gingival macrophages are exposed to increased amounts of PDGF, they stimulate proliferation of gingival cells and alveolar bone -> causing GINGIVAL HYPERPLASIA

One gene contributes to multiple phenotypic effects.

Pleiotropy

Pneumothorax vs Obstructive Atelectasis on x-ray?

Pneumothorax shows increases LUCENCY Obstructive Atelectasis shows OPACIFICATION

Plans that allow patients to see providers outside the network, albeit usually at higher out-of pocket costs (copays and deductibles).

Point-of-service plans

The difference in disease prevalence is most likely to affect what statistical parameters? 2. How?

Positive Predictive Value Negative Predictive Value 2. INCREASED Prevalence of Disease INCREASES PPV DECREASED Prevalence of Disease INCREASES NPV

T cell receptors of many lymphocytes demonstrate interaction and capability to bind with self-MHC on cortical epithelial cells. What process do these lymphocytes undergo at this time?

Positive Selection Thymic CORTEX!!

Leukocyte Extravasation predominantly occurs where?

Postcapillary Venules

Left homonymous hemianopia with macular sparing, decreased sensation over left side of her body, if patient had a stroke what artery?

Poster Cerebral Artery

STEMI in V7 - V9: occlusion of what artery?

Posterior Descending Artery (PDA) *Posterior Wall *may also see ST depression in V1-V3 with tall R waves

Taenia Solium: treatment?

Praziquantel

Alpha-1 Blockers: Which drug can be used for PTSD?

Prazosin

Not yet acknowledging that there is a problem

Precontemplation *NOT ACKNOWLEDGING

Rheumatoid Arthritis: what drug would provide the most rapid relief of symptoms?

Prednisone

Getting ready to change behavior: what stage of change model?

Preparatoin/Determination

How does Presbyopia affect someone who already has Myopia?

Presbyopia may COMPENSATE for MYOPIA by DISPLACING THE IMAGE BACKWARD so that it FOCUSES on the RETINA

Holosystolic murmur best heard at the apex of the heart that radiates to the axilla. What is the best indicator of the severity of this patient's problem?

Presence of AUDIBLE S3 In cases of severe MT, the left ventricular S3 gallop reflects an increased rate of left ventricular filling due to a large volume of regurgitant flow re-entering the ventricle during mid diastole. The intensity of the holosystolic murmur does not correlate well with regurgitant volume as larger regurgitant orifices often present with SOFTER MURMERS!!!

Heparin Bridge with Warfarin: why is it used?

Prevent WARFARIN-INDUCED SKIN NECROSIS Thrombosis and CLOTTING can interrupt blood flow to the skin and lead to SKIN NECROSIS. Protein C has a SHORT HALF-LIFE so its anticoagulant activity is reduced quickly when Warfarin therapy is initiated by about 50% within the first day. During this time Factors II, IX, X continue to have a procoagulant effect because they have a LONGER half live. (Factor VII has a short half-life similar to protein C)

Brain Histology: Cytoplasmic Inclusions in Oligodendrocytes?

Progressive Multifocal Leukoencephalopathy (PML)

Amyloid Deposition confined to Pituitary Gland?

Prolactin This is a precursor protein or peptide responsible for localize amyloidosis (confined to single, specific organ)

Progesterone suppresses what during pregnancy?

Prolactin LH (action on anterior pituitary) FSH (action on anterior pituitary)

Studying Calcium Stones in solution: What does Increasing the ionized phosphate concentration in the solution do?

Promote supersaturation of the solution and INCREASE STONE FORMATION

What drug inhibits both Thyroid peroxidase and 5'-deiodinase?

Propylthiouracil

What drug inhibits oxidation of I2, organifcation of I2, and peripheral conversion of T4 to T3?

Propylthiouracil

Patent Ductus Arteriosus (PDA): production of what is causing this infant's condition?

Prostaglandin

What inhibits Gastric Acid secretion from Parietal Cells?

Prostaglandins

Resisted simultaneous extension of the leg and thigh, particularly at the hip: what does this mean?

Psoas Sign Most likely a Psoas Abscess Can occur as the result of a hematogenous or lymphatic seeding from a distant site or by spread from an adjacent site. Fever, back or flank pain, inguinal mass, and difficutly walking. Psoas Muscle originates (T12 - L5)

Epoprostenol or iloprost: use?

Pulmonary Artery Hypertension

Acute Respiratory Distress Syndrome: what parameter is NORMAL?

Pulmonary Capillary Wedge Pressure There is ENDOTHELIAL DAMAGE -> INCREASED ALVEOLAR CAPILLARY PERMEABILITY -> PROTEIN-RICH LEAKAGE into ALVEOLI -> DIFFUSE alveoli damage and NONCARDIOGENIC PULMNOARY EDEMA

34 yo female with progressive shortness of breath. An echocardiographic study suggests coronary sinus dilation. What best explains this finding?

Pulmonary Hypertension The Coronary Sinus communicates freely with the RIGHT ATRIUM, it will BECOME DILATED by any FACTOR THAT CAUSES DILATION OF THE RIGHT ATRIUM! Most common cause of CORONARY SINUS DILATION EVIDENT ON EHOCARDIOGRAPHY IS ELEVATED RIGHT-SIDED HEART PRESSURE SECONDARY TO PULMONARY ARTERY HYPERTENSION.

Homocystinuria: supplementation?

Pyridoxine (Vitamin B6) Restriction of Methionine The deficient enzyme Cystathionine beta-synthase requires Pyridoxine (Vitamin B6). About 50% of patients respond to high doses.

Metformin (Biguanides): prior to initiated therapy what should be assessed? 2. Why?

RENAL FUNCTION by measuring SERUM CREATININE Measurement 2. Increased risk of LACTIC ACIDOSIS (Metformin inhibits mitochondrial enzymes which reduces hepatic metabolism of lactic acid due to decreased gluconeogenesis. This increases the risk of LACTIC ACIDOSIS, particularly in older patients and those with significant HEPATIC OR RENAL DYSFUNCTION.

P-450 Inducer Drugs?

RIFAMPIN PHENYTOIN Chronic alcohol use St. John's wort Phenobarbital Nevirapine Griseofulvin Carbamazepine

What gives rise to the POSTERIOR DESCENDING ARTERY in the majority of patients?

RIGHT CORONARY ARTERY (In about 70% of patients) Arises anteriorly from the right coronary cusp and courses through the right AV groove between the RIGHT ATRIUM & RIGHT VENTRICLE.

Exercise: what happens to Pulmonary artery systolic pressure?

RISES The PRESSURE INCREASE and the BLOOD FLOW INCREASES. The pulmonary vascular resistance DECREASES!!!

dsRNA separates and promotes degradation of target mRNA, "knocking down" gene expression.

RNA interference

Obstructive Lung disease: what is greater RV/TLC ratio or TLC/RV ratio?

RV/TLC ratio

Uncomfortable feelings are transformed into their opposites...? What is this?

Reaction Formation patient expresses deep appreciation for the psychiatrist's care, rather than acknowledging his anger and disappointment toward the psychiatrist

Young man with acute lower extremity arthritis, sterile joint effusion, following a GI infection? 2. Commonly associated with what other findings?

Reactive Arthritis 2. Conjunctivitis Urethritis Keratoderma Blennorhagicum Post-GI (Shigella,Salmonella,Yersinia, Campylobacter)or Chlamydia infections. CHLAMYDIA most common. -HLA-B27

A geneticist finds that a section of the tRNA contains dihydrouridine residues: what are these necessary for?

Recognition by the correct aminoacyl tRNA synthetase

A virologist is researching Acyclovir-resistant Herpes Simplex Virus (HSV). In an experiment a resistant HSV type 2 strain containing a mutation is cultured in a cell line, and the cell culture is coinfected with a nonresistant HSV type 1 strain. It is found that some of the type 1 virions acquire resistance to acyclovir, and subsequent progeny continue to be resistant. Which of the following mechanisms best explains the observe findings.

Recombination The exchange of gene between 2 chromosomes via crossing over within homologous regions. The resulting progeny can have recombine genomes with traits not present simultaneously in either parent virus.

Panic Disorder: characteristics?

Recurrent & unexpected panic attacks with 4 > (or equal) of the following: -chest pain, palipitation, Shortness of breath -trembling, sweating, nausea -dizziness, paresthesias -derealization, dpersonalization -fear of losing control, dying Worry about additional attack, avoidance of behavior

RBF from PAH Urine (100 mg/ml) Serum (0.2 mg/ml) Hematocrit 50%?

Renal Blood Flow = (PAH Clearance) / (1- Hematocrit) PAH Clearance = (100 * 1)/0.2 = 500 Answer = 1000 ml/min

Histology: Nests of epithelial cells with abundant clear cystoplasm?

Renal Cell Carcinoma Causes -> Flank pain, hematuria, and palpable abdominal mass. Clear-cell type is the most common type and appears as nests of epithelial cells with abundant clear cytoplasm separated by branching vascular tissue. Tumor often spreads to the lungs and bone by invasion of the IVC.

Thrombolytic or Fibrinolytic Drugs may cause what effect on arterial re-opening after an Acute STEMI?

Reperfusion Arrhythmia

Listeria Monocytogenes mechanism of resistant to Cephalosprins?

Resistant Penicillin-Binding Proteins

Atrioventricular Node: What artery supplies the AV Node?

Right Coronary Artery (RIGHT DOMINANT 70%) Left Circumflex Artery (LEFT DOMINANT 10%) Both (codominant 20%)

Arteries that run along the lesser curvature of the stomach?

Right Gastric Artery Left Gastric Artery

Arteries that run along the Greater curvature of the stomach?

Right Gastroepiploic Artery Left Gastroepiploic Artery

Diagnostic Thoracentesis needle is inserted along the UPPER BORDER OF THE 10TH RIB AT THE RIGHT MIDAXILLARY LINE. What structure is most at risk of injury?

Right Hepatic Lobe

Oxygen-Hemoglobin Dissociation Curve: Increased Temperature?

Right Shift

Oxygen-Hemoglobin Dissociation Curve: Increased 2,3-DPG?

Right Shift *2,3-diphosphoglycerate (2,3-DPG) is PRODUCED when oxygen availability is reduced, as occurs in CHRONIC LUNG DISEASE, HEART FAILURE, CHRONIC EXPOSURE TO HIGH ALTITUDES --> Allows release of more O2 in the peripheral tissues

Oxygen-Hemoglobin Dissociation Curve: Increased Acid?

Right Shift *Increased Acid (Decreased pH)

STEMI in leads II, III, and aVF: occlusion of what artery?

Right coronary artery *Inferior wall of the Left Ventricle

Ristocetin Test: How does it work? 2. What two diseases fail the Ristocetin test?

Ristocetin activates vWF to bind GpIb. Failure of agglutination indicates deficiency. 2. Von Willebrand Disease Bernard Soulier Syndrome (decreased GpIb)

Non-Hodgkin's Lymphoma, the tumor cells stain strongly for the CD20 marker. What biologic agent can be added to the patient's chemotherapy regimen to help improve the treatment response?

Rituximab Rituximab is a monoclonal antibody directed against the CD20 antigen.

Child with a family history of long QT interval prolongation and NO Neurosensory deafness

Romano-Ward syndrome

Ventral Wall Defects? What happens in each of these? (Rostral, Later, Caudal)

Rostral Fold Closure -Sternal Defects Lateral Fold Closure -Omphalocele -Gastroschisis Caudal Fold Closure -Bladder Extrophy

Reassortment: Only what type of viruses can use this method?

SEGMENTED VIRUSES All are RNA viruses: BOAR Bunyaviruses (Hantavirus) Orthomyxoviruses (Influenza) Arenaviruses Reoviruses (Rotavirus, Coltavirus) The other Bunyaviruses and Arenaviruses are the crazy Fever viruses with long names! INFLUENZA AND ROTAVIRUS are the ones I have been asked to so far!

Two spheres with elastic properties similar to alveoli are connected one larger than the other with a clamp in the middle to prevent airflow. Surface tension is identical and neither one is lined with a surfactant. What will happen when the clamp is opened?

SMALLER sphere will COLLAPSE! Smaller spheres collapse before larger ones. Alveoli have INCREASED tendency to collapse on expiration as radius DECREASES (law of Laplace).

Acute Respiratory Distress Syndrome: Causes?

SPPARTAS Sepsis Pancreatitis (Acute) Pneumonia Aspiration uRemia Trauma Amniotic fluid embolism Shock

Bulimia Nervosa: treatment?

SSRIs (Fluoxetine)

What drug is recommended in all patient with known cardiovascular disease; regardless of baseline lipid levels?

STATINS

What cells have the Longest Teloemeres?

STEM CELLS!! Bone Marrow Gut Epithelium Skin Hair Follicles Germ Cells

HPV 6 & 11 affects what areas?

STRATIFIED SQUAMOUS EPITHELIUM Anal Canal Vagina Cervix TRUE VOCAL CORDS

True Vocal Cords: what cell type?

STRATIFIED SQUAMOUS EPITHELIUM undergo near-constant friction and abrasion to produce speech. The cells are protective, as deeper cells can replace surface cells that are damaged.

Restrictive Cardiomyopathy: Causes?

Sarcoidoses Amyloidosis Postradiation Fibrosis Loffler Syndrome (endomycoardial fibrosis with a prominent eosinophilic infiltrate)

23 yo African American has fatigue and nodular rash on bilateral lower extremities. X-ray shows lung nodules and hilar fullness. Biopsy shows large epithelioid cells, occasional giant cells and no areas of necrosis. 1. Diagnosis?

Sarcoidosis -typically AA -Transbronchial biopsy showing non-caseating granulomas is necessary for DIAGNOSIS!!

Atenolol: what type of drug?

Selective Beta-1 Adrenergic Antagonist B1 > B2 Acetubulol (partial agonist) ATENOLOL Betaxolol Carvedilol Esmolol METOPROLOL

Celecoxib: MOA?

Selective Cox-2 inhibitor (inhibits prostaglandin synthesis) -> HELPS MAINTAIN GASTRIC MUCOSA!

Lumbosacral Radiculopathy of L4: sensory? Weakness?

Sensory (Start at the hip and move lateral to medial) Motor (PATELLAR REFLEX, Hip adduction, knee extension- L3 does both of these too) Lower Anterior LATERAL Thigh, Knee MEDIAL Calf & Foot Hip Adduction Knee Extension (QUADRICEPS) PATELLAR REFLEX

Single vagina, single cervix, single uterus with a septate in the middle.

Septate Uterus *Careful with the image vs Bicornuate Uterus

Hypothyroidism or Hyperthyroidism: most sensitive marker for diagnosis?

Serum TSH Most patients with hypothyroidism have primary hypothyroidism, which is caused by dysfunction within the thyroid gland itself.

Pancoast Tumor: most common presenting symptom?

Shoulder pain radiating toward the axilla and scapula

Hb A Absent Hb A2 ~2.5% Hb S Significantly Increased Hb F Significantly Increased

Sickle Cell Disease

Hb A 90% Hb A2 ~2.5% Hb S 7%

Sickle Cell Trait

Epithelium of Bronchiole -> Terminal Bronchioles?

Simple Ciliated Columnar Epithelium

Somatic Symptom Disorder vs Conversion Disorder?

Somatic Symptom Disorder -Excessive ANXIETY and preoccupation with 1 or more unexplained symptoms Conversion Disorder -NEUROLOGIC symptom incompatible with any known neurologic disease; often acute onset associated with stress

Caseating Granuloma(see image) and patient is positive for acid fast bacilli: The caseating granuloma resulted from which of the following (Activation of CD8+ T lymphocytes, B lymphocyte transformation, or Stimulation by CD4+ T lymphocytes)

Stimulation by CD4+ T lymphocytes Don't get confused (I choose CD8+ originally because I was thinking TH1 but TH1 can be either CD4 or CD8) REMEMBER THAT CD4+ are for BACTERIAL and CD8-> VIRAL! 1. Mycobacterium Tuberculosis immune response begins with MACROPHAGE phagocytosis and antigen presentation to T LYMPHOCYTES. 2. Specific T LYMPHOCYTES are then activated, with CD4+ TH1 CELLS playing a pivotal role in the cell-mediated immune response to tuberculosis. 3. CD4+ TH1 cells stimulate MACROPHAGES which endow them the ability to kill intracellular M. Tuberculosis organisms.

Beta Hemolytic and Pyrrolidonyl Arylamidase (PYR) negative?

Streptococcus Agalactiae (GBS)

Quellung Reaction?

Streptococcus Pneumoniae

Optochin Sensitive, Bile Soluble?

Streptococcus Pneumoniae THE ONLY ONE!! (Alpha-Hemolytic)

Optochin Sensitive?

Streptococcus Pneumoniae THE ONLY ONE!! (Alpha-Hemolytic)

Beta Hemolytic and Bacitracin sensitive?

Streptococcus Pyogenes (GAS)

Pyrrolidonyl Arylamidase Positivity?

Streptococcus Pyogenes (GAS)

Toxin mechanism name the organism: Plasminogen Activation?

Streptococcus Pyogenes (GAS)

Beta Hemolytic and Pyrrolidonyl Arylamidase (PYR) positive?

Streptococcus Pyogenes (GAS) also BACITRACIN SUSCEPTIBLE -> not very specific for S. Pyogenes, so it has been replaced in many laboratories by the PYR test.

Beta Hemolytic bacteria?

Streptococcus Pyogenes (GAS) Streptococcus Agalactiae (GBS) don't forget---> STAPHYLOCOCCUS AUREUS!!!

Glossopharyngeal Nerve (CN IX): function?

Stylopharyngeus Muscle (elevates LARYNX) Parotid Gland Secretion Posterior 1/3 of Tongue (Taste & Sensory) Sensory -Tympanic Membrane -Inner membrane -Eustachian Tube -Tonsillar Region -Upper Pharynx (AFFERENT of GAG REFLEX) -CAROTID BODY -CAROTID SINUS

Leser-Trelat Sign: what is it?

Sudden onset of multiple seborrheic Keratoses

Left Renal Vein may get compressed posteriorly behind what structure?

Superior Mesenteric Artery This may cause VARICOCELE (LEFT GONADAL VEIN comes off the LEFT RENAL VEIN)

Facial Swelling, blanching of the skin after fingertip pressure, prominent neck veins are distended, upper extremity edema bilaterally. What vein is most likely obstructed?

Superior Vena Cava Syndrome

Cocaine Withdrawal: treatment?

Supportive only -> no medication has proven effective in treating cocaine withdrawal.

in the case of an enveloped virus, whether or not the virus can attach to a specific host cell generally depends on...?

Surface Glycoprotein

Dimpling in breast cancer is caused by malignant infiltration into what?

Suspensory ligaments (Cooper Ligaments)

Clopidogrel with aspirin working together is an example of what drug interaction?

Syndergistic

Leuprolide: MOA Use?

Synthetic analog of gonadotropin-releasing hormone (GnRH) Continuous administration suppresses release of LH & FSH. Management of Prostatic Cancer, Precocious Puberty, and Endometriosis.

T3 or T4: which one is the main active thyroid hormone?

T3 T4 is converted to T3 in peripheral tissues

What do you want to test for before starting an Anti-TNF-alpha drug?

TB (Mycobacterium Tuberculosis) -These drugs can cause Granulomatous breakdown which can disseminate the disease.

Integrase Inhibitors: Names?

TEGRA Raltegravir Dolutegravir Elvitegravir Used for Antiviral Therapy (HIV Therapy)

CD18 mutation will affect what neutrophil function?

TIGHT BINDING and CRAWLING

ICAM-1 (Intercellular Adhesion Molecule-1) mutation will affect what neutrophil function?

TIGHT BINDING and CRAWLING

VCAM-1 (Intercellular Adhesion Molecule-1) mutation will affect what neutrophil function?

TIGHT BINDING and CRAWLING

Patient with parkinson disease is given an infusion of IV dopamine. The IV dopamine does not improve this patient's Parkinson symptoms. Which of the following cell structures accounts for this lack of responsiveness? (fenestrae, gap junctions, hemidesmosomes, intermediated junctions, tight junctions)

TIGHT JUNCTIONS Dopamine is UNABLE to CROSS THE BLOOD BRAIN BARRIER.

AIDS: prophylaxis CD4 < 100?

TMP-SMX -Pneumocysitis Pneumonia -Toxoplasmosis

What released from macrophages maintains granuloma formation?

TNF-alpha

Nystatin uses?

TOPICAL USE ONLY!! Oral Candidiasis Diaper Candidiasis (Diaper Rash) Vaginal Candidiasis

CD31 mutation will affect what neutrophil function?

TRANSMIGRATION (aka DIAPEDESIS)

PECAM-1 (Platelet endothelial cell adhesion molecule 1) mutation will affect what neutrophil function?

TRANSMIGRATION (aka DIAPEDESIS)

Alcohol Withdrawal Initial finding?

TREMOR or "shakes"

Wheal observed after an insect sting: what type of hypersensitivity? 2. What happens on initial exposure 3. on subsequent exposures?

TYPE I Hypersensitivity Reaction 2. Antibodies class switch to IgE 3. Degranulation of MAST CELLS and BASOPHILS with release of HISTAMINE & HEPARIN (& other vasoactive mediators) (this degranulation can cause a response as MILD AS AN URTICARIAL WHEAL, or as SEVERE AS ANAPHYLAXIS)

HER-2 (cerbB2) is what kind of receptor?

TYROSINE KINASE RECEPTOR

Sensory Ataxia & Argyll Robertson Pupils?

Tabes Dorsalis a late form of neurosyphilis (Tertiary Syphilis)

Acute decrease in response to a drug after initial/repeated administration: what is the name of this drug interaction?

Tachyphylactic

MDMA and LSD are examples of what type of drug interactions?

Tachyphylactic

Neurocysticercosis: caused by?

Taenia Solium

Clostridium Tetani: pathogenesis of toxin? 2. Neurotransmitters impaired?

Tetanospasmin (exotoxin) is a protease that cleaves SNARE proteins for neurotransmitters. Blocks release of INHIBITORY NEUROTRANSMITTERS (GABA & GLYCINE) from RENSHAW CELLS. 2. GLYCINE & GABA Clostridium Botulinum (Botulinum Toxin) is a protease that cleaves SNARE proteins too!

Blood pressure medication: side effect Hyponatremia & Hypokalemia?

Thiazide Diuretics

31 yo had itchy rash on chest. Has annular and scaling plaque 5 cm in diameter with central clearing on chest. KOH prep of skin scrapings shows BRANCHING SEPTATE HYPHAE. 1. Diagnosis? 2. treatment?

Tinea Corporis (Dermatophytes)(RINGWORM 2. Terbinafine (used for treatment of Dermatophytosis) -Annular scaling plaque with well-demarcate, RAISED ERYTHEMATOUS BORDERS and CENTRAL CLEARING

Hypercoaguable States?

Trauma Cancer Pregnancy Chronic Disease (several) all these could trigger Pulmonary Embolism

What nerve exits at the lateral aspect of the mid-pons at the level of the middle cerebellar peduncles?

Trigeminal Nerve (CN V)

means of 2 groups?

Two-sample t test TEA is MEANt for 2

21 year old Polyuria, polydipsia, polyphagia accompanied by fatigue and weight loss?

Type 1 DM (test with Fasting blood glucose level) I thought this was SIADH.

HBsAb Positive HBcAg Negative

Vaccinated Patient has antibodies to the hepatitis B (HBV) surface antigen. I think if HBsAb Positive and HBcAg Positive than they are infected with Hepatitis B.

Hoarseness due to left vocal cord dysfunction: innervation?

Vagus Nerve (CN X) Recurrent Laryngeal Nerve

What is the only 2 maneuvers that Decreases the intensity of most murmurs? 2. How do they do this? 3. List the change in murmurs

Valsalva (phase II) Standing up 2. Decreasing Preload 3. -DECREASES intensity of most murmurs -INCREASES intensity of Hypertrophic Cardiomyopathy murmur -MVP: has earlier onset of click/murmer

Nicotinic ACh receptor partial agonist. Used for smoking cessation.

Varenicline

2 patients with neurofibromatosis type 1 (NFl) may have varying disease severity: what is this?

Variable Expressivity

Reye Syndrome: associated with what viruses?

Varicella Zoster Virus (VZV) & Influenza B

Pulmonary Arterial Hypertension: genetic cause what is the pathogenesis? 2. What is the mutation?

Vascular smooth muscle proliferation 2. BMPR2 MUTATION --> Normally BMPR2 gene inhibits vascular smooth muscle proliferation.

Patient with Heart Failure with crackles in lungs: what is the cause of their pulmonary hypertension?

Vasoconstriction due to pulmonary Venous Congestion I choose (Hypoxia-induced pulmonary vasoconstriction) --> this is the cause in diseases like COPD.

Most frequent mechanism of Sudden Cardiac Death in first 48 hours after Acute Myocardial Infarction?

Ventricular Fibrillation

Occulomotor Nerve (CN III) Palsy: causes what?

Vertical & Horisontal Diplopia, Ptosis, and ENLARGED & NONREACTIVE Pupil

Toxin mechanism name the organism: activates adenylate cyclase via Gs ADP ribosylation?

Vibrio Cholerae -ACTIVATES ADENYLATE CYCLASE via Gs ADP ribosylation, INCREASING cAMP PRODUCTION in the host cell; -SECRETORY DIARRHEA -DEHYDRATION -ELECTROLYTE IMBALANCES

Methacholine Challenge?

a DECREASE in FEV1 after Methacholine challenge indicates bronchial ASTHMA Used as a BRONCHOPROVOCATION TECHNIQUES to elicit asthma symptoms and confirm the diagnosis of ASTHMA Methacholine is a muscarinic cholinergic agonist that causes bronchoconstriction and increased airway secretions.

gamma-interferon (gamma-IFN): function?

activates MACROPHAGES and (may also stimulate CD8+ cytotoxic T-cells) secreted by helper T-cells

Mother notices an odor of burnt sugar in infants diapers: what is the defective enzyme?

alpha-keto acid dehydrogenase

Atopic Dermatitis: pathogenesis is mediated by what immune response?

defects in Innate immunity and a TH2 skewed immune response

Patient wants to give you a card an 4 courtside playoff basketball tickets. What do you say?

"I appreciate your thoughtfulness an will treasure the card you have made for me. However it would not be right for me to accept the tickets." Expensive gifts may influence or appear to influence the physicians PROFESSIONAL JUDGEMENT. UNETHICAL TO ACCEPT GIFTS OF SIGNIFICANT MONETARY VALUE.

Patient is failing medications, "wants to give up work, go on disability" response"?

"I can see that your lack of improvement has been very frustrating" Build the physician-patient relationship BY EMPATHIZING WITH THE PATIENT'S FRUSTRATION ADN DISAPPOINTMENT WITH PAST TREATMENT FAILURES. I chose "Although previous medications have not worked, consultation with a pain specialist may be helpful."

AID patient with CDF cell count of 38. Has fever, abdominal pain and explosive diarrhea. Has right sided tenderness to palpitation. Colonoscopy reveals areas of erosions and ulceration; pathology demonstrates cells with viral intranuclear and intracytoplasmic inclusions. 1. Diagnosis? 2. Treatment?

1. Cytomegalovirus Colitis (CMV) -usually when CD4 < 100 CMV can cause Retinitis, Esophagitis, Colitis, Pneumonitis, Encephalitis in AIDS patients with CD4 cell count < 100. 2. Ganciclovir (1st), Foscarnet (2nd if resistant to Ganciclovr)

Ectopic Pregnancy, and a uterine curettage is performed. What is expected to see?

1. DECIDUALIZED ENDOMETRIUM --> Dilated, COILED ENDOMETRIAL GLANDS AND VASCULARIZED EDEMATOUS STROMA These changes also occur in the LUTEAL PHASE of the menstrual cycle -> under the influence of PROGESTERONE (as the endometrium prepares for implantation) questions stem said there was a thickened endometrial stripe -> I think this means that the endometrium has thickened is all.

Medicare covers?

-65 and older with a work history -younger individuals w/ DISABILITIES -END-STAGE RENAL DISEASE

What 2 exposures are linked to PDA in an infant?

-Alcohol exposure in utero (Fetal Alcohol Syndrome) -Congenital Rubella Syndrome

ANTIPHOSPHOLIPID SYNDROME all antibodies associated?

-Anticardiolipin antibodies -Lupus Anticoagulant -Anti-Beta2 Glycoprotein Antibodies

Adenosine: adverse effects?

-CUTANEOUS FLUSHING -Chest burning (due to bronchospasm -Hypotension -high grade AV block

Neurofibromatosis Type 1: BIG points

-Cafe-aulait spots -cutaneous Neurofibromatosis -Lisch Nodules (pigmented hamartomas; asymptomatic) -Bony abnormalities (pseudoarthrosis, scoliosis) -Tumors (astrocytomas, gliomas, Pheochromocytomas) (patient may have headache, etc)

Dystrophic Calcification: Examples when they occur?

-Calcific Aortic stenosis (cell necrosis) -TB (lung & pericardium) -PSAMMOMA BODIES -LIQUEFACTIVE NECROSIS of CHRONIC ABSCESSES -FAT NECROSIS -INFARCTS -THROMBI -SHISTOSOMIASIS -MONCKEBERG ARTERIOLOSCLEROSIS -CONGENITAL CMV + TOXOPLASMOSIS

STEMI, with hypotension, distended jugular veins, and CRACKLES on auscultation: what is the cardiac output, pulmonary capillary wedge pressure, central venous pressure?

-Cardiac Output: Decreased -Pulmonary Capillary Wedge Pressure: INCREASED -Central Venous Pressure: Increased PCWP if you hear crackles than that means the PCWP has INCREASED!!

STEMI, with hypotension, distended jugular veins, and CLEAR LUNGS on auscultation: what is the cardiac output, pulmonary capillary wedge pressure, central venous pressure?

-Cardiac Output: Decreased -Pulmonary Capillary Wedge Pressure: NORMAL/DECREASED -Central Venous Pressure: Increased PCWP if you DON'T hear crackles than that means the PCWP is NORMAL/DECREASED

Listeria Monocytogenes is resistant to what treatments?

-Cephalosporins (CEFTRIAXONE or CEFOTAXIME) -VANCOMYCIN

Ehlers-Danlos Syndrome: caused by a defect in what two processes?

-Cleavage of Procollagen C & N Terminals or -failure of lysyl oxidase to create covalent crosslinks between collagen fibrils (tropocollagen) (does not properly crosslink)

Immunohistochemical analysis indicates that the malignant cells have decreased INTEGRIN expression. These cells are most likely to exhibit poor adhesion to what components of the EXTRACELLULAR MATRIX?

-Collagen -FIBRONECTIN -Laminin INTEGRINS are a family of transmembrane protein receptors that interact with the extracellular matrix by binding to SPECIFIC PROTEINS, including the ones above. Other adhesion molecules besides Integrins are Cadherins, Selectins, and Ig Superfamily members

Poster Cerebral Artery: symptoms?

-Contralateral Hemianopia often with macular sparing (due to collateral circulation from the middle cerebral artery) -Contralateral Paresthesias and numbness (face, trunk, and limbs) (from affected Thalamus)

Wilson's Disease: treatment?

-Copper Chelation with PENICILLAMINE or TRIENTINE -ORAL ZINC

Obstructive Atelectasis: Important facts?

-DECREASED BREATH SOUNDS over Right lung -Opacifications on the Right -DEVIATION OF TRACHEA TOWARD RIGHT All suggest a Collapsed lung due to BRONCHIAL OBSTRUCTION -> usually due to an obstruction of a MAINSTEM BRONCHUS (like a central lung tumor in a chronic smoker) The air trapped in the lung gradually GETS ABSORBED into the blood, there is loss of lung volume due to ALVEOLAR COLLAPSE (Atelectasis), which causes the trachea to deviate toward the affected side.

Metformin (Biguanides): Mechanism?

-DECREASED HEPATIC GLUCONEOGENESIS -INCREASES PERIPHERAL GLUCOSE UTILIZATION INHIBITS MITOCHONDRIAL ENZYMES ( glycerophosphate dehydrogenase and complex 1 (first electron transport chain enzyme)). THE RESULTING DECREASE IN ENERGY stimulates AMPK ACTIVATION leading to DECREASED HEPATIC GLUCONEOGENESIS. It also INCREASES PERIPHERAL GLUCOSE UTILIZATION. It does not increased endogenous insulin secretion and does not cause hypoglycemia when used as monotherapy.

Dialysis: what will decrease rate of drug removal?

-Decrease surface area of membrane -decreased pore size -increased membrane thickness -higher molecular weights -lower temperatures

Brain Natriuretic Peptide (B-type) Atrial Natriuretic Peptide FUNCTION?

-Dilates ARTERIOLES & VEINS -PROMOTES DIURESIS (constricting the Efferent Arteriole and Dilating the Afferent arteriole)

Suprapatella Bursa?

-Distal Femur & Quadriceps -Direct Blow or REPETITIVE QUADRICEPS ACTIVITY (RUNNING)

Azoles: Adverse Effects?

-Drug interactions -> Inhibits Human Cytochrome P-450 (P450) -Testosterone synthesis inhibition (GYNECOMASTIA: especially with KETOCONAZOLE)

Circumstances when MINORS DO NOT require parents consent?

-Emergency care -STI -Substance Abuse (most states) -Prenatal Care (most states) -Emancipated Minors

Contact precautions: Mycoplasma Pneumoniae

-FACEMASK -NON-STERILE GLOVES -GOWN *Droplet Precautions

Contact precautions: Neisseria Meningitides

-FACEMASK -NON-STERILE GLOVES -GOWN *Droplet Precautions

Contact precautions: Respiratory Syncytial Virus

-FACEMASK -NON-STERILE GLOVES -GOWN *Droplet Precautions

Anticholinergic Toxicity: clinical features?

-Fever (hot as a hare) -Flushing (red as a beet) -Dry skin & mucous membranes (dry as a bone) -nonreactive mydriasis (blind as a bat) -Delirium (mad as a hatter) -Urinary Retention (full as a flask) -Decreased Bowel Sounds -Tachycardia

Abetalipoproteinemia: presentation

-First year of life -symptoms of malabsorption (abdominal distention, foul-smelling stool. -deficiency of fat-soluble vitamins (poor lipid absorption and essential fatty acids -NEUROLOGIC ABNORMALITIES (progressive ataxia, retinitis pigmentosa)

6 month baby with Hypoglycemia, jaundice, cirrhosis, vomiting, and decreased Aldolase B: treatment?

-Fructose -Sucrose (Glucose + Fructose) *deficiency of Aldolase B

Type III Collagen:

-GRANULATION TISSUE -Skin -Lungs -Intestines -Blood Vessels (also Type I) -Bone Marrow -Lymphatics *associated disease -> Ehlers-Danlos Syndrome (Type 3 & 4)

Pseudohyphae Budding Yeast Germ Tubes True Hyphae

-Germ Tube (Candida Albicans) -Budding Yeast

Celiac Disease: markers?

-HLA-DQ2 -HLA-DQ8 Celiac Sprue (gluten intolerance) I ate (8) too (2) much GLUTEN at DQ!

If an Ureter was ligated during surgery, would would be the presenting symptoms post surgery?

-HYDRONEPHROSIS -Flank Pain (distension of the ureter and renal pelvis) -Creatine & Urine output are normal because contralateral kidney still functioning.

Friedreich Ataxia: characteristics?

-HYPERTROPHIC CARDIOMYOPATHY -DIABETES MELLITUS -KYPOHOSCOLIOSIS -PES CAVUS (high arch) -MUSCLE WEAKNESS -LOSS of DTRs, VIBRATORY SENSE, PROPRIOCEPTION (degeneration of spinocerebellar tracts)

DiGeorge Syndrome: major defects to look for?

-HYPOCALCEMIA -ABSENT THYMIC SHADOW

Emancipated minors: in what situations?

-Homeless -Parent -Married -Military -Financially Independent -High School Graduate

What decreases Hepcidin production?

-Hypoxia -increased Erythropoiesis

IL-2 used as immunotherapy for metastatic melanoma and Renal Cell Carcinoma: what are the Effects of IL-2?

-IL-2 is produced by helper T cells The increased activity of T CELLS and NATURAL KILLER CELLS is thought to be RESPONSIBLE for IL-2's ANTI-CANCER EFFECT. 1. stimulates growth of CD4+ & CD8+ T cells and B cells. 2. Activates NATURAL KILLER Cells 3. Activates MONOCYTES 4. T-Cell growth and INF-gamm secretion

Isoproterenol: effects on heart, vascular resistance and heart rate?

-INCREASED Contractility (beta-1) -DECREASED Vascular Resistance (beta-2 which cause vasodilation) -REFLEX TACHYCARDIA -Diastolic Blood Pressure (DBP) DECREASES -Systolic Blood Pressure (SBP) INCREASES

Epinephrine: effects on heart, vascular resistance and heart rate?

-INCREASED Contractility (beta-1) -DECREASED Vascular Resistance (beta-2 which cause vasodilation) -REFLEX TACHYCARDIA -Diastolic Blood Pressure (DBP) DECREASES -Systolic Blood Pressure (SBP) INCREASES SAME as Isoproterenol but not as much vasodilation (which means MAP INCREASES instead of DECREASES)

Norepinephrine: effects on heart, vascular resistance and heart rate?

-INCREASED Contractility (beta-1) -INCREASED Vascular Resistance (alpha-1) -REFLEX BRADYCARDIA

Crohns Disease is associated with mutation in NOD2 gene which is important for what?

-INNATE immunity. It encodes an intracellular microbial receptor that recognizes bacterial lipopolysaccharides and subsequently activates the NF-kB pathway. -Crohn's Disease this NOD2 gene mutation causes DECREASE NF-kB which IMPAIRS the INNATE IMMUNE RESPONSE that results in CHRONIC GI INFLAMMATION.

Cephalosporins: MOA?

-Inhibit Bacterial CELL WALL SYNTHESIS -inhibits bacterial transpeptidase

Watery Diarrhea: What is expected in stool findings?

-MUCUS and some SLOUGHED EPITHELIAL cells -NO FECAL LEUKOCYTES!! -Vibrio Cholerae -Enterotoxigenic Escherichia Coli (E. Coli) -Bacillus Cereus -Staphylococcus Aureus -Giardia Lamblia -Cryptosporidium Specieis -Cyclospora Species -Microsporidia

Succinylcholine: adverse effects?

-Malignant Hyperthermia -Severe Hyperkalemia (life-threatening arrhythmias) -Hypercalcemia Hyperkalemia (patients at high are those with BURNS, MYOPATHIES, CRUSH injuries, DENERVATING INJURIES, question with a quadriplegic)

Anserine Bursitis?

-Medial Knee -Obesity -overuse in athletes

Rheumatoid Arthritis: Disease-Modifying Antirheumatic Drugs (DMARDs)

-Methotrexate (1st line) -Sulfasalazine -Hydroxychloroquine -Minocycline -TNF-alpha Inhibitors

Atypical Major Depression characteristics?

-Mood reactivity -Leaden paralysis (arms and legs feel extremely heavy) -Rejection sensitivity (overly sensitive to slight criticism) -increased sleep and appetite

Neonatal Abstinence Syndrome (NAS): who is at risk?

-Mothers with poor mental health -No prenatal care -Hepatitis C Infection

Giant Cell Arteritis (Temporal Arteritis): biopsy?

-Multinuclear Giant cells -Intimal Thickening -Elastic Lamina Fragmentation

What are changes seen in both Dysplasia and Carcinoma?

-Pleomorphism -Nuclear Abnormalities -Abundant Mitoses -Disordered Maturation -Changes in Cell Polarity

Scabies: treatment?

-Premethrin Cream -washing/drying al clothing/bedding -also TREAT CLOSE CONTACTS

Sildenafil: use?

-Pulmonary Artery Hypertension -Erectile Dysfunction

Salmonella Typhi vs other species?

-Rose Colored spots (Salmonella Typhi) -Carrier State (Salmonella Typhi)

Type I Collagen:

-SCAR TISSUE (after MI!!) -Dermis -Bone -Tendons -Ligaments -Dentin -Cornea -Blood Vessels *associated disease -> Osteogenesis Imperfecta

contact precautions for Clostridium Difficile?

-SOAP & Water (no sanitizer) -NONsterile gloves -GOWN

contact precautions: Scabies

-SOAP & Water (no sanitizer) -NONsterile gloves -GOWN

Parasite Eggs in the Stool

-Schistosoma Mansoni -Schistosoma Japonicum

Diphendyramine, Dimenhydrinate, Chlorpheniramine: what adverse effects?

-Sedation -Antimuscarinic (block Acetylcholine)(blurry eyes) -Anti-alpha-adrenergic

Theophylline Intoxication major concerns? 2. major cause of death?

-Seizures (Major Cause of death!) -Tachyarrhythmias

Renal Papillary Necrosis associated with? 2. characteristic symptoms?

-Sickle Cell Disease or Trait -Analgesic Nephropathy -Diabetes Mellitus -Pyelonephritis 2. ABRUPT-onset GROSS Micro Hematuria.

Hemochromatosis: what is affected? 2. where does Iron accumulate?

-Skin Pigmentation (bronze diabetes) -Diabetes Mellitus (impaired glucose homeostasis) -DILATED CARDIOMYOPATHY (reversible) -Atypical arthritis (calcium pyrophosphate deposition) -Hypogonadism -Cirrhosis (iron accumulates in liver) -Hepatocellular Carcinoma (common cause of death) Iron accumulates in liver, pancreas, skin, heart, pituitary, joints.

Synthesis of Exotoxinsf: what bacteria are well known for this mechanism?

-Staphylocococcus Aureus (food poisoning) -Botulinum Toxin -Diptheria Toxin -Tetanus Toxin -Pertussis Toxin

Most common causes of Meningitis in Children 6 years - 60 years?

-Streptococcus Pneumoniae (6 mos - 60 -> except teenagers) -Neisseria meningitis -Enteroviruses -HSV Same list just pull out (Haemophilus Influenzae Type B (Hib))

Surfactant: function?

-Surfactant counteracts alveolar collapse by DECREASING SURFACE TENSION as the ALVEOLAR RADIUS DECREASES -prevents SMALLER ALVEOLAR from COLLAPSE when the RADIUS DECREASES -Alveoli have INCREASED tendency to collapse on expiration as radius DECREASES (law of Laplace).

Neonatal Abstinence Syndrome (NAS): clinical manifestations

-TACHYPNEA -IRRITABILITY -DIARRHEA -Tremors -Crying -Sneezing -Jittery movements

Monoamine Oxidase Inhibitors (MAOIs): when are they good to use?

-TREAMENT-RESISTANT DEPRESSION -ATYPICAL MAJOR DEPRESSION not 1st or 2nd line because of their risk of severe adverse effects such as hypertensive crisis and serotonin syndrome

Fibrates: must knows?

-Use for HIGH TRIGLYCERIDES -MYOPATHY -inhibits Cholesterol 7-alpha-hydroxylase -INCREASED RISK of CHOLESTEROL GALLSTONES -Upregulate LPL to INCREASE TRIGLYCERIDE CLEARANCE -Activates PPAR-alpha to induce HDL synthesis

Celiac Disease: what will the Biopsy display?

-Villous Atrophy or Blunting -Crypt Hyperplasia (double arrows) -intraepithelial lymphocytosis

Small Intestine bacterial overgrowth: what nutritional substances are likely to be INCREASED?

-Vitamin K -Folate *Enteric Bacteria can PRODUCE VITAMINS K & FOLATE

Colchicine: MOA? (stated in several different ways) 2. What specific structure does it bind and stabilize? 3. What specific structure does it inhibit? 4. What immune cell does it impair?

-affects the Cytoskeleton -binds and stabilizes TUBULIN to INHIBIT MICROTUBULE POLYMERIZATION -IMPAIRS NEUTROPHIL CHEMOTAXIS and DEGRANULATION 2. Tubulin 3. Microtubule 4. Neutrophil

Tension Pneumothorax: cause?

-could be from any of the subtypes but it causes AIR enters PLEURAL SPACE BUT CANNOT EXIT -TRACHEA DEVIATES AWAY FROM AFFECTED LUNG

Attention and Concentration test?

-count down from 100 by intervals -recite months of year in reverse -spell world backwards

Superior Vena Cava Syndrome: symptoms?

-dizziness -headache -facial swelling -swelling of upper extremities

Eating dinner with a colleague. A Patient comes up and talks to the colleague and then nods briefly in your direction and you as the physician acknowledge the gesture with a smile. Afterward, the physician's colleague asks, "How do you know her? She is a family friend who was recently diagnosed with breast cancer and I have been worried about her. Can I assume she is a patient of yours and ask how she is doing? 1. Appropriate Response?

1. "No, I cannot say whether she is my patient," DO NOT SHARE INFORMATION WITH PHYSICIAN COLLEAGUES WHO ARE NOT SERVING AS HEALTH CARE PROVIDERS FOR THE PATIENT.

Carcinoembryonic Antigen what is it good for?

1. -> rising CEA levels are a SENSITIVE INDICATOR OF COLORECTAL CANCER RECURRENCE. ->Low Sensitivity and Low Sensitivity --> used for monitoring tumor recurrence. Elevated initial CEA levels are associated with a WORSE PROGNOSIS in COLON CANCER.

Osteoclasts: 1. urine markers? 2. serum marker? 3. most reliable?

1. -Urinary Deoxypyridinoline (most reliable overall) -Urinary Hydroxyproline 2. Tartrate-resistant acid phosphatase (not used widely) 3. Urinary Deoxypyridinoline

Migration of Neural Crest Cells: 1. When does it start and end? 2. What direction

1. 8th week and completed by 12th week 2. Migration moves Caudally and ends in the Rectum --> this is why Hirschsprung affects the RECTUM!! -move CAUDALLY give rise to Submucosal (Meissner) & Myenteric (Auerbach) plexi of the bowel wall. Both are Parasympathetic.

Negative Likelihood Ratio: what? 2. What do the numbers mean?

1. A ratio representing the likelihood of having the disease given a negative result. 2. Ratio > 1 indicate that the respective test result is associated with the presence of disease; likelihood ratios <1 mean that the test result is associated with the absence of the disease.

Mitral Stenosis: Which is the most useful measure for assessing the degree?

1. A2-to-opening snap (OS) time interval Severe - EARLY OS time Mild - LATE OS time The OS occurs due to abrupt tensing of the valve leaflets as the mitral valve reaches its maximum diameter during forceful opening. AS MITRAL STENOSIS WORSENS, LEFT ATRIAL PRESSURES INCREASE, due to impaired movement of blood into the LV. HIGHER PRESSURE CAUSES THE VALVE TO OPEN MORE FORCEFULLY AND EARLIER!!

72 yo has progressive memory loss over last 2 years. Now she needs help with her daily activities, such as shopping and housekeeping. MRI reveals diffuse cortical and hippocampal atrophy. 1. Diagnosis 2. Biochemical abnormalities?

1. Alzheimer Disease 2. Decreased Acetylcholine levels in the HIPPOCAMPUS and NUCLEUS BASALIS OF MEYNERT

What Amino Acid is a precursor to Nitric Oxide?

1. Arginine

Acetylcholine infusion during a coronary angiography results in dilation of epicardial coronary vessels. A reaction involving what amino acids is most likely responsible for the observed dilation? 2. This AA is a precursor to what?

1. Arginine 2. Nitric Oxide

Goat wool processor with fever, chest pain hemoptysis, chest x-ray shows widened mediastinum, sputum and blood cultures reveal large gram-positive rods that form medusa head colonies on standard media. 1. Diagnosis

1. Bacillus Anthracis (Pulmonary Anthrax) -caused by IHALED SPORES -Hemorrhagic Mediastinitis (widened mediastinum on x-ray) -bloody pleural effusions -leads to SEPTIC SHOCK, DEATH!

18 yo man with severe right groin pain and difficulty bearing weight on his right extremity, hospitalized 6 months ago for a similar episode. Has nontender hepatomegaly. X-ray shows marked Osteopenia with cortical collapse. 1. What enzyme deficiency would be the cause of his problems? 2. Diagnosis?

1. Beta-glucocerbrosidase 2. Gaucher

Human fetus with a 46, XY genotype has testes with normally functioning Leydig cells but total absence of Sertoli Cells. Which will the phenotype be?

1. Both female and male internal genitalia and male external genitalia (pg 571 FA)

An RNA molecule is extracted from S. Aureus and is purified for further analysis. It is found to contain high amounts of chemically modified bases such as dihydrouridine, pseudouridine, and ribothymidine, and its secondary structure arises from base pairing within the chain. What is the most likely composition of the 3' end of this molecule?

1. CCA 2. tRNA The CCA tail is a posttranscriptional modification in eukaryotes and most prokaryotes. Several enzymes (proteins) utilize this tail to help recognize tRNA molecules tRNA contains chemically modified bases (DIHYDROURIDINE, RIBOTHYMIDINE, PSEUDOURIDINE)

HIV binds to what cells? 2. using what?

1. CD4 2. gp120

Nondihydropyridine Caclium-Channel Blockers -Diltiazem -Verapamil 1. Common side effects? 2. one probably tested?

1. CONSTIPATION, Bradycardia, AV BLOCK!!, worsening of heart failure 2. AV BLOCK!

Acetylcholine Bradykinin Serotonin Substance P Shear Force These stimuli activate specific membrane receptors present on vascular endothelial cells leading to an increase in what? 2. This increased substance causes activation of what?

1. Calcium 2. eNOS (endothelial nitric oxide synthase)

College student living in a dormitory, headache, purpuric rash, myalgia, headache, nuchal rigidity? 1. A vaccine could have prevented this meningitis what does this vaccine contain? 2. Organism

1. Capusular Polysaccharide 2. Neisseria meningitis

Unable to dorsiflex, or evert the right ankle, or extend the toes. Ankle inversion is intact. Sensation is decreased over the dorsum of the right foot. Deep tendon reflexes are normal. 1. injury to what nerve?

1. Common Peroneal Nerve Dorsiflex, Extend Toes -> Deep Peroneal Nerve Evert Right Ankle -> Superficial Peroneal Nerve Sensation of Dorsum of Foot -> Superficial Peroneal Ankle Inversion, Plantar Sensation -> Tibial Nerve

Bacterial pneumoia, patient is given ceftriaxone and azithromycin for treatment. soon after patient complains of difficulty breathing, abdominal cramps, and lightheadedness. His current BP is 70/55 and HR 120/min. PE reveals maculopapular rash. What drug should be administered NOW?

1. Epinephrine All these signs soon after administration of Beta-lactam antibiotics are suggestive of anaphylactic shock! EPINEPHRINE is drug of choice for treatment of anaphylactic shock due to ability to reverse the mechanism of anaphylaxis. Resevere vasodilation by increasing VASOCONSTRICTION (ALPHA-1) BLOOD PRESSURE, INCREASES CARDIAC CONTRACITLITY (BETA-1) & it STIMULATES BETA-2 causing BRONCHODILATION which makes it a popular choice for treatment of SEVERE ASTHMATIC REACTIONS.

1. Focal Seizure? 2. What are the 2 types?

1. Involves 1 Cerebral hemisphere at onset 2. Simple Seizure Complex Seizure

Patient with parkinson disease is given an infusion of IV dopamine. The IV dopamine does not improve this patient's Parkinson symptoms. 1. What should the patient have been given instead of IV dopamine?

1. L-DOPA (dopamine precursor) -> has low lipid solubility just like dopamine but it has a high affinity for a transporter that will take it across the blood-brain barrier.

18 month child with fever, runny nose, sore throat, doctor sends them home with fluids. Two days later infant has persistent fever, brassy cough, and difficult breathing. PE reveals Stridor. 1. Diagnosis? 2. Family of Virus 3. Most common organism?

1. Laryngotracheitis (CROUP) 2. Paryamyxovirus 3. (most commonly caused by PARAINFLUENZA VIRUS) -BRASSY COUGH (BARKING COUGH) -dyspnea -recent history of URI

White plaque on tongue that cannot be easily scraped off?

1. Leukoplakia 2. Associated with Tobacco use

Buproprion: 1. Use? 2.side effect that is a concern?

1. Major Depression (often preferred by patients because it does not cause weight gain or sexual side effects) -also used for SMOKING! 2. Seizures

Painful muscle cramps during exercise, urine discoloration after periods of intense training Diagnosis? 2. deficient enzyme?

1. McArdle Disease (Type V Glycogen Storage Disease) 2. Myophosphorylase (Skeletal muscle glycogen phosphorylase) -Increased Glycogen in Muscle -Red Urine (myoglobinuria) w/ strenuous exercise -arrhythmia from electrolyte abnormalities

Urethritis in a young man 1. Organism 2. Treatment

1. Neisseria Gonorrhoeae or Chlamydia Trachomatis 2. Ceftriaxone (N. Gonorrhoeae) and Doxycycline or Azithromycin (C. Trachomatis)

Purpuric cutaneous lesions, damage to adrenals, disseminated intravascular coagulation (DIC), and shock 1. Organism? 2. Diagnosis?

1. Neisseria Meningitidis 2. Waterhouse-Friderichsen Syndrome

2 day old infant has crying, tremors, tachypnea, sneezing and diarrhea. Infant has increased tone in all extremities. Mother was 1. Diagnosis 2. Treatment?

1. Neonatal Abstinence Syndrome (NAS) due to withdrawal from OPIATES 2. Methadone or Morphine

What happens if Cholesterol 7-alpha-hydroxylase is inhibited?

1. Not very much Bile Salt is made 2. Increased Cholesterol Excretion 3. INCREASED RISK of CHOLESTEROL GALLSTONES

Man who worked in a factory where he was around loud noises for a long time is losing his hearing. An audiogram is shown his High-Frequency decreased. 1. What is most likely abnormal in this patient?

1. ORGAN OF CORTI (Stereociliated hair cells) HIGH-FREQUENCY hearing is lost first from LOUD NOISES

Prolonged exposure to loud noises causes damage to what? What type of hearing is lost first?

1. ORGAN OF CORTI (Stereociliated hair cells) 2. HIGH-FREQUENCY hearing is lost first from LOUD NOISES

White plaques on tongue that can be scraped off? 1. Diagnosis 2. Risk Factors?

1. Oral Thrush (Candida Albicans) 2. Sexual practices, denture wearers, diabetics, immunosuppressed patients, patients receiving steroids, antibiotics, or chemotherapy Oral Thrush CAN BE SCRAPED OFF!

Urea Cycle KILL IT!

1. Orinthine 2. + Carbamoyl Phosphate ----> Citrulline 3. +Aspartate (ATP) ---> Argininosuccinate 4. (Fumarate is MADE) ----> Arginine 5. UREA Ordinarly Careless Crappers Are Also Frivolous About Urination

2 yo boy with fever vomiting and sleepiness. Increased blood ammonia levels and increased orotic acid excretion in urine. 1. What is deficient?

1. Ornithine Transcarbamylase Ornithine Transcarbamylase (OTC) deficiency, the MOST COMMON UREA CYCLE disorder stimulates PYRIMIDINE SYNTHESIS which results in excess CARBAMOYL PHOSPHATE. OROTIC ACID is an INTERMEDIATE in this pathway so it accumulates and results in an INCREASED URINARY OROTIC ACID. -Interferes with the body's ability to eliminate AMMONIA

1. What is a normal PAO2 2. What is a normal PaO2?

1. PAO2 about 100 mm Hg 2. PaO2 > 92 mm Hg

PAOP aka? 2. most likely corresponds to what?

1. PCWP: Pulmonary Artery Occlusion Pressure 2. Left Atrial Pressure

Woman has bleeding from right nipple, no fever or breast pain. no medications, no palpable masses or skin changes. no enlarged lymph nodes. 1. What is the most likely histopathologic finding in this patient's breast? 2. Diagnosis?

1. Papillary cells with fibrovascular core 2. INTRADUCTAL PAPILLOMA Affected individuals usually have no associated mass or skin changes. Caused by a proliferation of PAPILLARY CELLS in a DUCT OR CYST WALL WITH FIBROVASCULAR CORE and may contain foci of atypia or ductal carcinoma in situ. Bloody discharge results from twisting of the vascular stalk of the papilloma in the duct.

Hepatic Abscesses: common cause in underdeveloped countries? 2. common cause in developed countries?

1. Parasitic Infections (Entamoeba Histolytica, Echinococcal) 2. Bacterial Infection (however hepatic abscesses are uncommon in developed countries)

Sickle Cell Patient with dyspnea, weakness, hematocrit of 16%, conjunctival pallor. 1. What virus may have infected them? 2. Virology

1. Parvovirus B19 2. Nonenveloped, Single-Stranded DNA virus APLASTIC CRISIS in Sickle Patient's is usually due to Parvovirus infection of erythroid precursor cells in the bone marrow. This is NOT APLASTIC ANEMIA (which manifests as PANCYTOPENIA) not just ANEMIA (Aplastic Crisis)

4 yo, failure to thrive, bounding peripheral pulses, palpable thrill over left upper sternal border, and continuous murmur over same region. 1. Diagnosis 2. Surgery is planned, the surgeon should intervene on a derivative of which of the following embryologic structures?

1. Patent Ductus Arteriosis (PDA) 2. Sixth Aortic Arch (6th)

Combination of progressive fatigue, lower-extreminity paresthesias, and megaloblastic RBC (macrocytic anemia) 1. Diagnosis?

1. Pernicious Anemia (Vitamin B12 Deficiency) Caused by antibody-mediated destruction of PARIETAL CELLS in the gastric body and fundus. PARIETAL CELLS are found predominantly in the UPPER GLANDULAR LAYER that secrete gastric acid and INTRINSIC FACTOR (IF) Because IF is required for the absorption of Vitamin B12 (cobalmin) in the Ileum. Its ABSENCE LEADS TO VITAMIN B12 DEFICIENCY.

3 yo old severe intellectual disability with pallor of the substantia nigra, locus ceruleus, and vagal nucleus dorsalis. Patient dies from refractory seizures resulting in respiratory failure. 1. Diagnosis? 2. The underlying condition is most likely caused by a deficiency of what enzyme?

1. Phenylketonuria 2. Phenylalanine Hydroxylase or Tetrahydrobiopterin Cofactor HYPOPIGMENTATION of SKIN HAIR EYES & CATHECHOLAMINERGIC BRAIN NUCLEI is frequently seen!

Boy has an infection on his leg that shows a gram-positive cocci in clusters, and sensitivity demonstrates little response to nafcillin, but good response to vancomycin. 1. What is the most likely explanation for nafcillin failing in this patient?

1. Poor interaction with binding proteins (MRSA -> has altered penicillin-binding protein target site)

Gardner has knee pain. Sharp localized pain on palpation of knee, passive range of motion is normal in all joints, but patient has severe pain when walking around room or climbing onto table. Which bursae is affect?

1. Prepatellar Bursae causes anterior knee pain and usually due to REPETITIVE OR PROLONGED KNEELING

A Malaria patient is prescribed both chloroquine and primaquine: why?

1. Prevent Disease Relapse -CHLOROQUINE -> eradicates chloroquine-sensitive plasmodia from the bloodstream, but NO activity against the LATENT HEPATIC INFECITON established by P VIVAX and P OVALE -PRIMAQUINE-is added to COMPLETELY ERADICATE THE HYPNOZOITES 1. Anopheles mosquito first inoculate the human 2. Organism then travels to the Liver and infects hepatocytes and replicates here. 3. Lysis of Hepatocyes release MEROZOITES into the bloodstream. 4. MEROZOITES go on to infect erythrocytes 5. Erythrocytes lysis causes the RELAPSING FEVERS and SWEATING 6. Plasmodium Vivax, Plasmodium Ovale are unique because they establish a latent hepatic infection in the form of HYPNOZOITES --> responsible for RELAPSES

Hypertension, hypokalemia, Decreased Renin, Increased, Aldosterone 1. Diagnosis 2. Possible Causes?

1. Primary Hyperaldosteronism (Conn syndrome) 2. -Adrenal Adenoma -Bilateral Adrenal Hyperplasia -Aldosterone-producing Tumor

Aortic Regurgitation Pressure Tracings 1. The patient's murmur would most likely be loudest at which of the following time points in the graph?

1. Right after Aortic Valve closes which is the line that separates from the peak . Murmur is best heard along the LEFT STERNAL BORDER at 3RD & $TH INTERCOSTAL SPACES while patient is SITTING UP and LEANING FORWARD with the BREATH HELD IN END EXPIRATION

46 yo missionary just returned from Latin America and comes to clinic with fever, headache, abdominal pain, and 1 week history of watery diarrhea that has recently become bloody. His temperature is 102F. PE shows hepatosplenomegaly and several faint, erythematous maculopapular lesions on the chest and abdomen. Blodd cultures are pending. 1. Most likely organism?

1. Salmonella Typhi Week 1 (rising fever, bacteremia, relative bradycardia) Week 2 (abdominal pain, rose spots on trunk & abdomen) Week 3 (Hepatosplenomegaly, Intestinal bleeding and perforation)

Athralgias, hepatomegaly, x-ray with enlarged hilar lymph nodes and tender dep nodules on her legs, elevated angiotensin converting enzyme (ACE) level. 1. Diagnosis 2. liver biopsy will demonstrate?

1. Sarcoidosis 2. Scattered Granulomas chest x-ray and elevated serum ACE level suggest Sarcoidosis!

Diffuse itching rash on hands spread to wrist, arms and axillae. Exam shows erythematous papules on palms with excoriations, scattered vesicles, and pustules on finger webs, palms, wrist, and axillary skin folds bilaterally. Remainder of skin normal. 1. diagnosis 2. What will be the most likely finding on skin sampling of the lesion?

1. Scabies 2. Sarcoptes Scabiei Mite and Eggs -Flexor Surfaces of wrist, lateral surfaces of fingers, and finger webs -DELAYED TYPE IV HYPERSENSITIVITY to mite, mite feces, and mite eggs -may also be seen on elbows, axillary folds, nipples, and women's areola, or scrotum, and penis, less commonly back and head.

Man has dysuria and blood in his urine at end of urination. He came back to the US after touring Africa. He went spelunking, bathed in beaches, lakes, and ate local street food. Ultrasound reveals mild bilateral hydronephrosis and bladder wall thickening. 1. Organism 2. animal that was the source of infection

1. Schistosoma Haematobium (Schistosomiasis) 2. FRESHWATER SNAILS (not in US) May cause SQUAMOUS CELL CARCINOMA of the bladder Clinical manifestations of Schistosomiasis result from a TH2-mediated granulomatous response directed against the eggs. This ultimately leads to Ulceration and scarring of the bowel or bladder/ureters.

Hypertension, hypokalemia, Increased Renin, Increased, Aldosterone 1. Diagnosis 2. Possible Causes?

1. Secondary Hyperaldosteronism 2. -Juxtaglomerular Cell Tumor (renin-secreting tumor) -renovascular disease (hypertension) -malignant hypertension -renin-secreting tumors)

Patient has weakness and headaches for 2 months. Decreased serum potassium. Elevated Renin. Elevated Aldosterone. Hypertension. Increased potassium excretion. 1. Diagnosis 2. What are the possible causes?

1. Secondary Hyperaldosteronism 2. -Juxtaglomerular Cell Tumor (renin-secreting tumor) -renovascular disease (hypertension) -malignant hypertension -renin-secreting tumors) In secondary hyperaldosteronism, OVERPRODUCTION OF ALDOSTERONISM occurs SECONDARY to INCREASED RENIN SYNTHESIS resulting in elevate renin and aldosterone.

19 year old girl with recurrent otitis media. She was in a motor vehicle accident. At the ED her BP drops to 80/60 Blood transfusion with O negative packed RBC is begun and patient develops diffuse itching, skin rash and bronchospasm and dies 30 minutes later. 1. Diagnosis?

1. Selective IgA deficiency (Selective Immunoglobulin Deficiency Patients with this often form IgG antibodies directed against IgA. When transfused with blood or blood products containing small amounts of IgA these patients may develop potentially fatal anaphylactic reactions.

Emergency Cricothyrotomy: what will the incision pass through?

1. Skin 2. SUPERFICIAL CERVICAL FASCIA (subcutaneous fat & PLATYSMA muscle) 3. INVESTING & PRETRACHEAL layers of the DEEP CERVICAL FASCIA 4. CRICOTHYROID MEMBRANE NOT -Thyroid Isthmus -Cricoid Cartilage -Buccopharyngeal Fascia (extends from carotid sheath to invest the pharyngeal constrictor muscles) -Prevertebral Fascia DEEP CERVICAL FASCIA (has 3 layers, Investing, Pretracheal, and Prevertebral. The Prevertebral layer is the only layer NOT penetrated.

Histopathology of a lymph node after biopsy reveals clusters of small, ovoid cels with scant cytoplasm and high mitotic count. Immunohistochemical staining is positive for chromogranin. 1. Diagnosis?

1. Small Cell Carcinoma

patient compliment her surgeon and says she is "a brilliant doctor who save my life" then several days later when the surgeon is delayed due to an emergency the patient responds angrily saying the surgeon is "terrible and only in it for the money." 1. key defense mechanism?

1. Splitting -> Seeing others as ALL BAD OR ALL GOOD commonly seen in BORDERLINE PERSONALITY DISORDER

Child recently had a ventriculoperitoneal shunt placement for congenital hydrocephalus. Child has high fever, irritability, and photophobia. Temperature is 101. Has signs of Meningitis. Blood cultures show coagulase negative Staphylococcus. 1. Organism? 2. most important virulence mechanism?

1. Staphylococcus Epidermidis 2. Synthesis of extracellular Polysaccharide Matrix (BIOFILMS)

Patient underwent mitral valve replacement. Gram positive cocci in clusters that are catalase-positive and coagulase-negative. 1. most likely organism? 2. Empiric Antibiotic Treatment?

1. Staphylococcus Epidermidis 2. Vancomycin (initial empiric treatment) Nafcillin or Oxacillin (if susceptible to Methicillin) Most strains are Methicillin-Resistant so we must assume this until proven otherwise. VANCOMYCIN should be a component of initial therapy. Additional antimicrobial agents (eg. Gentamicin and/or rifampin, which kills bacteria on foreign material) are administered in some cases of deep-seated methicillin-resistant infection. If susceptibility results show methicillin-susceptible isolate (switch Vancomycin to a semi-synthetic Beta-lactamase-resistant penicillin) such as NAFCILLIN or OXACILLIN

24 yo female has burning urination, urgency, and frequency. She is sexually active. Urine cultures show CATALASE-POSITIVE, GRAM-POSITIVE COCCI. 1. What organism? 2. Novobiocin sensitive or novobiocin resistant?

1. Staphylococcus Saprophyticus Common cause of UTI, almost HALF of all UTIs in sexually active young women. 2. RESISTANT to NOVOBIOCIN!! (R to SEX)

Patient comes to you for a follow up after Acute MI. His total serum cholesterol level is 155. HDL level is 27. and Triglyceride level is 92. What lipid lowering agent should be prescribed? 2. why?

1. Statin!! 2. patient has LOW HDL (<40 men <50 women) are at INCREASED RISK FOR CARDIOVASCULAR DISEASE. However, -----> use of medication to raise HDL levels DOES NOT IMPROVE CARDIOVASCULAR OUTCOMES!!! -->EXERCISE, WEIGHT LOSS, & SMOKING CESSATION help to RAISE HDL LEVELS & have significant CARDIAC BENEFIT

Patient has pain playing basketball. Pain is reproduced when the patient straightens out the right knee. Evaluation reveals avulsion of the secondary ossification center of the Tibia due to repetitive muscle contraction and traction on the bone. What is the insertion site of the muscle tendon causing this injury? 2. Diagnosis

1. Tibial Tuberosity (insertion point of the patellar ligament) 2. Osgood-Schlatter Disease overuse injury of the SECONDARY OSSIFICATION CENTER (apophysis) of the TIBIAL TUBERCLE Patellar Ligament connects to the Quadriceps!! (Rectus Femoris, Vastus Intermedius, Vastus Medialis, Vastus Lateralis) --> PAIN in LEG EXTENSION!!

A barbiturate-like IV anesthetic agent is used in a patient undergoing a minor surgical procedure. 30 minutes after the initial administration of the drug, the patient seems alert and responds to verbal commands adequately. Which of the following is the most likely mechanism that explains the recovery from anesthesia in this patient?

1. Tissue Redistribution of the drug THROUGHOUT THE BODY!! (lean tissue)

Breast cancer expresses Estrogen receptor (+), Progesterone receptor (+), and Human Epidermal Growth Factor Receptor 2 (+). Adjuvant Therapy with a monoclonal antibody is started. 1. What is the drug? 2. What type of receptor is targeted?

1. Trastuzumab (Herceptin) 2. Tyrosine Kinase Receptor

patient sees double vision when he walks downstairs or reads his newspaper looking down. Normal vision walking up stairs. 1. what nerve is affected 2. nerve innervates?

1. Trochlear Nerve (CN IV) 2. Superior Oblique Eye DEVIATED UPWARD Vertical Diplopia: patients with Trochlear Nerve palsy typically present with vertical diplopa which is most noticeable when the affected eye looks down and toward the nose. (UP-CLOSE READING, WALKING DOWN STAIRS)

Newborn with posterior neck mass, an bilateral nonpitting edema of hands and feet. Femoral pulses are diminished. Neck ultrasound reveals mass composed of cystic spaces separated by connective tissue: diagnosis?

1. Turner Syndrome (45 XO) *Loss of Paternal X Chromosome

Homocysteine level in one group is determined to be 11.1 with a standard deviation of 1. 2. In a separate group of patients it is 9.5 with a standard deviation of 1.3. What statistical model should be used to compare the mean homocysteine levels of these 2 groups of patients?

1. Two-sample t test (TEA is MEANt for 2) use this to determine if the means of 2 populations are equal. You need.. -2 mean values -standard deviations (sample variances) -sample sizes

Painless Penis ulcer, what is most useful in diagnosing Treponema Pallidum infection in this patient at this stage? 2. How does it appear?

1. Ulcer Exudate Microscopy with DARK-FIELD ILLUMNATION 2. MOTILE HELICAL organism FTA-ABS could have been used as well (this is the most specific test)(this was not an answer choice)

35 yo man brought to ED with confusion and lethargy. T is 98 F. BP 86/48. Pulse is 120 and respirations are 12/min. Arterial blood gas shows pH 7.59, pCO2 49 mm Hg, and pO2 85 mm Hg. What lab studies would be the most useful for diagnosing the cause of this patient's acid-base abnormality. 2. Diagnosis

1. Urine Chloride 2. Metabolic Alkalosis (pH>7.45 and pCO2>40mm Hg)

6 months of persistent diarrhea (watery stools) Her gastric contents shows a lack of gastric acid secretion. Somatostatin Treatment promptly relieves the symptoms. 1. If she has an excess of a pancreatic hormone which one is it? 2. What electrolyte is a concern?

1. Vasoactive Intestinal Peptide (VIP) -probably a VIPoma 2. Potassium (HYPOKALEMIA) WDHA Syndrome Watery Diarrhea Hypokalemia Achlorhydria

Man dies 30 minutes after onset of severe chest pain while driving to the ED. Autopsy performed and his mid right coronary artery shows thrombotic occlusion of the RCA. 1. Most likely cause of death?

1. Ventricular Fibrillation (Sudden Cardiac Death) -Most frequent mechanism of Sudden Cardiac Death in first 48 hours after Acute Myocardial Infarction *I chose Atrial Fibrillation (simply because I didn't see Ventricular Fibrillation-answers said that A-Fib would not lead to SCD in such patients.)

Tetralogy of Fallot: 4 parts?

1. Ventricular Septal Defect (VSD) 2. Overriding Aorta over the right and left ventricles 3. Right ventricular outflow tract (RVOT) obstruction (Pulmonary Stenosis) (Pulmonary Infundibular Stenosis: Pulmonary Stenosis) -> MOST important for determinant for PROGNOSIS) 4. Right Ventricular Hypertrophy

Long-standing severe Rheumatoid Arthritis patient had an urgent endotracheal intubation. Several hours later she developed areflexic paralysis of all extremeties. What is the most likely cause of the neurological deficits in this patient?

1. Vertebral Subluxation Severe CHRONIC RHEUMATOID ARTHRITIS can involve the CERVICAL SPINE and cause joint destruction with VERTEBRAL MALIGNMENT (SUBLUXATION) The ATLANTOAXIAL JOINT is often involved and more prone to SUBLUXATION as the atlas (C1) has ahigh degree of mobility relative to the axis (C2 odontoid and body) with limited intrinsic bony stability.

Infant is seen with prominent oral thrush, interstitial pneumonia, and sever lymphopenia during the 1st year of life. 1. Diagnosis of infant. 2. What could have prevented this infant's condition?

1. Vertical transmission of HIV-1 (mother to child) 2. Antiretroviral Therapy during pregnancy (reduces risk of perinatal transmission to 1%-2%)(REVERSE TRANSCRIPTASE INHIBITORS: aka ENZME INHIBITOR DRUGS)(PROTEASE INHIBITOR is also given) ALL PREGNANT WOMEN WITH HIV SHOULD TAKE ART, regardless of their CD4 cell count or viral load. ART SHOULD BE CONTINUED AS LONG AS WOMEN ARE BREASTFEEDING.

Patient presents with cough night sweats and occasional hemoptysis. Sputum culture shows mycobacteria observed to grow in parallel chains ("serpentine cords"). This observed bacterial growth pattern most strongly correlates with what? 2. what is this called? 3. What is this responsible for?

1. Virulence 2. CORD FACTOR 3. Cord Factor is responsible for INACTIVATING NEUTROPHILS, DAMAGINNG MITOCHONDRIA, and INDUCING RELEASE OF TUMOR NECROSIS FACTOR. Growth of thick, ropelike cords of Mycobacterial organisms in a twisted, "serpentine" pattern is consistent with the presence of CORD FACTOR. Cord Factor is a Mycoside, meanint it is composed of two mycolic acid molecules bound to the discaccharide trehalose.

Incidental abdominal cyst is discovered and removed. Cyst is is connected by a fibrous band to the ileum and the umbilicus. 1. What is this? 2. What other condition is also caused by the same embryologic defect responsible for the abdominal cyst?

1. Vitelline Duct Abnormality 2. Meckel Diverticulum -Vitelline Sinus -Vitelline Duct Cyst Basically anything that has Vitelline in it! normally this obliterates during the 7th week of EMBRYONIC DEVELOPMENT!!!

Woman with lower extremity weakness, 3 days of malaise headache and myalgias. One day ago she started experiencing bilateral leg weakness and difficulty walking. She has never been outside the US. Fever of 101. BP 130/70. Pulse 96. Patient is confused and has a morbilliofrm rash on her trunk and arms. She has a coarse hand tremor and flaccid paralysis of bilateral lower extremities. Lumbar punture and CSF PCR yields viral RNA. 1. Diagnosis 2. What is the mode of of transmission?

1. West Nile Virus 2. Insect Bite -Febrile Viral Illness -RASH -NEUROLOGIC MANIFESTATIONS -ENCEPHALITIS (confusion) -FLACCID PARALYSIS -positive-sense, single-strand RNA FLAVIVIRUS -CULEX Mosquitos

Aortic Stenosis: 1. Age related calcifications start at what age? 2. Calcifications due to Bicuspid Aortic valve start at what age?

1. age 60 (these are the most common type, aka Senile Calcific Aortic Stenosis in patients with normal aortic valves) 2. around age 50

Fabry Disease: defective enzyme? 2. what accumulates?

1. alpha-galactosidase A (C in picture) 2. Ceramide Trihexoside (globotriaosylceramide)

Imprinting: Laughter ("happy puppet"), seizures, ataxia, and severe intellectual disability 1. Diagnosis? 2. Whose genes are being expressed? 3. Whose genes are silent?

1. angelMAN Syndrome 2. Maternal (MOMS!!) 3. DADS are SILENT FROM IMPRINTING but probably normal angelMan Syndrome (M is deleted/mutated)

Patient with tonic-clonic seizures has a low phenytoin level. She states that she has been compliant with her medication. What drugs could be responsible for this condition?

1. any P-450 inducer (RIFAMPIN) RIFAMPIN PHENYTOIN Chronic alcohol use St. John's wort Phenobarbital Nevirapine Griseofulvin Carbamazepine (I choose oral contraceptives which is wrong. Oral Contraceptives are a Substrate. So if you take Oral Contraceptives with an Inducer! UH OH you might get pregnant if you have sex! But OCP will not effect Phenytoin. However, Phenytoin will affect OCPs!)

Pernicious anemia: pathophysiology?

1. due to autoimmune destruction of parietal cells 2. leads to decreased production of Gastric Acid and INTRINSIC FACTOR 3. these causes a COMPENSATORY INCREASES IN GASTRIN!! 4. CHRONIC GASTRITIS and PERNICIOUS ANEMIA

Hemochromatosis: what gene mutation? 2. on what chromosome?

1. mutation in HFE gene (C282Y > H63D) 2. Chromosome 6 (only one on 6 we need to know)

Histologic analysis of a cerebellar lesion shows neurons with eosinophilic cytoplasm and loss of Nissl substance: when did the insult most likely occur?

12-24 hours ago -Eosinophilic Cytoplasm -LOSS of NISSL SUBSTANCE -PYKNOTIC NUCLEI

Schizotypal vs Paranoid vs Schizoid?

ALL -> Odd, eccentric, have difficulty developing meaningful social relationships. Genetic associations with SCHIZOPHRENIA! Paranoid -> must display a PERVASIVE DISTRUST AND SUSPICION Schizoid -> "loners" socially detached voluntarily Schizotypal-> Magical thinking, eccentric appearance The question I had the patient only took the medicine when her body told her too, and believed she had a "sixth sense" that indicates if someone is bad and cannot be trusted. --> MAGICAL THINKING

Medications with Anticholinergic Properties (only drug names)

AMITRIPTYLINE!!!! Imipramine Diphenhydramine Doxylamine CHLORPROMAZINE CLOZAPINE BENZTROPINE TRIXYPHENIDYL ATROPINE

Amyloid Deposition confined to Pancreatic Islets?

AMYLIN (Islet Amyloid Protein) This is a precursor protein or peptide responsible for localize amyloidosis (confined to single, specific organ)

What type of bacteria are Fusobacterium, Peptostreptococcus, Bacteroides?

ANAEROBIC bacteria normally found in the ORAL cavity Commonly cause LUNG ABSCESSES

means of 3 or more groups

ANOVA (ANalysis Of VAriance) 3 words for 3 means or more!

78 yo male has BP of 180/70. PE is normal You explain to the patient that his hypertension is most likely caused by age-related?

AORTIC STIFFENING (Isolated Systolic Hypertension) caused by age-related DECREASES IN THE COMPLIANCE OF THE AORTA Isolated Systolic Hypertension becomes quite common after age 50. SBP greater than 160 and DBP below 90 is found in about 20-30% of people 80 and older.

ARBs: what is the level of (Renin, Angiotensin I, Angiotensin II, Aldosterone, & Bradykinin)?

ARBs = Angiotensin II Receptor Blocker Renin: INCREASED Angiotensin I: INCREASED Angiotensin II: INCREASED Aldosterone: DECREASED Bradykinin: No Change

Diphenoxylate & Loperamide are given with what to discourage abuse?

ATROPINE -adverse symptoms (dry mouth, blurry vision, nausea) if taken in high doses.

New antifungal agent is found to inhibit liver cytochrome P450-dependent metabolism of several drugs. Based on this data, the new antifungal agent is most similar to what other antifungal medications?

AZOLES

AID patient: Testing for HLA-B*57:01 is performed and results positive. This is most relevant if the patient is considered for what medication

Abacavir Abacavir hypersensitivity reaction develops in 2 - 8% of patients and strongly associated with this allele. Fever, malais, GI symptoms and delayed rash.

MAB Targets Platelet glycoproteins IIb/IIIa?

Abciximab

What drug bind to GPIIb/IIIa and inhibits binding of this receptor to FIBRINOGEN?

Abciximab

Preeclampsia: pathophysiology?

Abnormal PLACENTAL VACULATURE

Most often a child with a blank stare, but does not lose consciousness. 2. Treatment?

Absence Seizure 2. Ethosuximide

Abetalipoproteinemia: blood smear?

Acanthocytes ("spur cell")

A geneticist finds that aminoacyl tRNA synthetase in a fibroblasts "loads" lysine residues onto tRNA molecules containing the anticodon UUU. The residue most likely attaches to tRNA at what part?

Acceptor Stem: the 5'-CCA-3' is the amino acid acceptor site

What substances slow the depolarization of Atrial pacemaker cells?

Acetycholine (ACh) Adenosine Decrease depolarization and Decrease Heart Rate

Acetyl-CoA carboxylase: function?

Acetyl-CoA (2C) ---> Malonyl-CoA (3C)

Patient is taking Chlorpheniramine and starts having blurred vision in both eyes for 2 days: This patient's visual symptoms are likely due to blockade of what mediator?

Acetylcholine *side affect is anticholinergic (anti-muscarinic) of first-generation antihistamines (Diphendyramine, Dimenhydrinate, Chlorpheniramine) *caused pupillary dilation - (mydriasis)

Vascular Endothelium plays an important role in vasodilation mediated by what 5 things?

Acetylcholine Bradykinin Serotonin Substance P Shear Force

Carbolfuchsin?

Acid-Fast Stain -> stains organisms (Red/Pink) -stains MYCOLIC ACID!

Changing behaviors: what stage of change model?

Action/Willpower

Aldosterone: function?

Acts @ Collecting Tubules (Principal & Intercalated Cells) -Resorption of SODIUM & H2O -Loss of POTASSIUM & HYDROGEN IONS Antagonists of Aldosterone Receptor (Spironolactone & Eplerenone)

Acute Lymphoblastic Leukemia vs Gaucher Cell?

Acute Lymphoblastic Leukemia -can have PANCYTOPENIA -HEPATOSPLENOMEGALY -bone marrow will show BLASTS Gaucher Disease -can have PANCYTOPENIA -HEPATOSPLENOMEGALY -bone marrow will have GAUCHER CELLS -maybe EASY BRUISING

DIC and t(15;17)?

Acute Promyelocytic Leukemia (APL) (M3 type of AML) -abnormal RETINOIC ACID RECEPTOR

Dense mononuclear Interstitial Infiltration: Seen in what type of Rejection?

Acute Transplant Rejection

Host CD8+ T Cells Activated against Donor MHCs: what TYPE of Transplant rejection? Timing?

Acute Transplant Rejection (Weeks to months)

Herpes Simplex Virus (HSV-1 & HSV-2) & Varicella Zoster Virus (VZV): What drug is effective?

Acyclovir Famiciclovir Valacyclovir

Acknowledging that there is a problem but not yet ready or willing to make a change: what stage of change model?

Contemplation **ACKNOWLEDGING **BUT NOT WILLING TO CHANGE

Loss of sensory or motor function often following an acute stressor?

Conversion disorder (functional neurologic symptom disorder)

Aromatase: function?

Converts Androgens to Estrogens

CXCR4 receptor? 2. important for what infection?

Coreceptor on T CELLS that enables the HIV virus to enter cells 2. HIV virus

Intrahepatocyte accumulations seen on Periodic Acid-Schiff reaction (PAS): disease?

Alpha-1 Antitrypsin (AAT) Deficiency vs (Hemochromastosis which uses the Prussian Blue Staining.

Patient has high blood pressure and is straining during urinate, hesitancy and intermittent urinary flow. What medication could you prescribe to take care of both problems?

Alpha-1 Blockers -Doxazosin -Prazosin -Terazosin (TAMSULOSIN--> DOES NOT LOWER BP!!!) -relax smooth muscle in arterial and venous walls (decrease peripheral vascular resistance) -relaxation of smooth muscle in the bladder neck & prostate (decrease in urinary obstruction) -DO NOT AFFECT THE HEART!)

Epinephrine administration is found to cause a decrease in insulin levels. However, after pretreatment with Drug A, epinephrine injection causes a paradoxical increase in insulin concentration. Which of the following receptors does Drug A most likely block?

Alpha-2 Adrenergic Receptors

What receptors INHIBIT Insulin secretion?

Alpha-2 Adrenergic Receptors Somatostatin 2

2 Drug Classes that Bind to the 30S Ribosomal subunit of Bacteria

Aminoglycosides -Gentamicin -Neomycin -Amikacin -Tobramycin -Streptomycin Tetracyclines -Tetraclycine -Doxycycline -Minocycline

Pulmonary Arterial Hypertension: other causes?

Amphetamines Cocaine Connective Tissue Disease HIV Portal Hypertension Congenital Heart Disease Schistosomiasis

Listeria Monocytogenes: what should you treat with?

Ampicillin

Most common site for both MRSA and Methicillin-sensitive Staphylococcus Aureus?

Anterior Nares 25-30% of individuals have nasal colonization at any given time.

Biotin deficiency caused by?

Antibiotic use or excessive ingestion f egg whites RARE

Whipple Disease: Treatment?

Antibiotics -caused by GRAM-POSITIVE actinomycete Tropheryma Whippelii

70% of an adult population in the community remains uninfected by Influenza A. A strain that is similar to the one circulated in the preceding year. What is the most important host facto in preventing influenza infection in these subjects?

Antibodies against Hemagglutinin (primarily blocking its binding to the host cells) Antibodies to Neuraminadase are not the main source or protection against reinfection although they have some protective effect. (decrease extent of viral invasion and shedding).

Myasthenia Gravis: what does reduced motor end-plate potential mean?

Antibodies are binding to the postsynaptic nicotinic acetylcholine receptors. This means there are less receptors to try to reach the Threshold. So when Acetylcholine is released, the Threshold potential is not reached, and the muscle cells do not depolarize -> REDUCED MOTOR END-PLATE POTENTIAL!!

Dalteparin: what does this drug bind to?

Antithrombin III Low-Molecular-Weight Heparin (LMWH)

Enoxaparin: what does this drug bind to?

Antithrombin III Low-Molecular-Weight Heparin (LMWH)

Surfaces of the heart?

Apex (bottom tip) is formed by the LEFT VENTRICLE. Anterior surface is formed chiefly by the RIGHT VENTRICLE. Diaphragmatic (inferior surface) is formed by LEFT & RIGHT VENTRICLES. Posterior Surface is mainly LEFT ATRIUM (BASE of heart)

Rebound Rhinorrhea?

Associated with the use of TOPICAL DECONGESTANTS for > 3 days the use of ADRENERGIC AGONISTS should be stopped to allow the restoration of NORMAL NOREPINEPHRINE FEEDBACK PATHWAYS

Hb A 91% Hb A2 8% Hb F <1%

Beta-Thalassemia Minor

Diaphragm: innervated what what nerve roots?

C3, 4, 5 keeps the diaphragm ALIVE

Radial Nerve: receives fibers from what nerve roots?

C5-T1

Optic Canal: what exits?

CN II (Optic)

Study: asks "What is happening?

CROSS-SECTIONAL STUDY What study collects data from a group of people to asses frequency of diseases (and related risk factors) at a PARTICULAR POINT IN TIME? Measures -> Disease PREVALENCE

What study collects data from a group of people to asses frequency of diseases (and related risk factors) at a PARTICULAR POINT IN TIME?

CROSS-SECTIONAL STUDY asks "What is happening?" Measures -> Disease PREVALENCE

Subarachnoid Hemorrhage (SAH): diagnose? 2. What is Xanthochromia?

CT without contrast -> is diagnostic. Lumbar puncture -> reveals gross blood or 2. Xanthochromia (yellow discoloration of CSF

West Nile Virus: transmitted by?

CULEX Mosquitos

Chi-square?

Checks DIFFERENCES between 2 or more PERCENTAGES or PROPORTIONS of CATEGORICAL OUTCOMES

IgA Nephropathy (Henoch-Schonlein Purpura): what mechanism is the most likely underlying cause of this patient's condition?

Circulating Immune Complexes! IgA immune complex-mediated vasculitis (Type III Hypersensitivity)

Aspartate is necessary for what step in the Urea Cycle? 2. What else is necessary for this step?

Citrulline ----> Argininosuccinate 2. 1 ATP

Glomerular Filtration Rate calculation?

Clearance (Creatine or Inulin) = (Urine concentration)/(Serum Concentration)

Renal Plasma Flow (RFP) calculation?

Clearance (PAH) = (Urine concentration)/(Serum Concentration)

Toxin mechanism name the organism: actin depolymerization?

Clostridium Difficile -DAMAGES CYTOSKELETON INTEGRITY -induces ACTIN DEPOLYMERIZATION leading to MUCOSAL CELL DEATH, NECROSIS of COLONIC MUCOSAL SURFACES and pseudomembrane formation

Diphenoxylate & Loperamide: side affects?

Constipation mild sedation DO NOT use in diarrhea due to TOXIN-producing or INVASIVE organisms or CLOSTRIDIUM infections

Insurer pays a provider for each individual service provided at a pre-arranged, discounted rate?

Discounted fee-for service

What has decreased platelet count, increased prothrombin time (PT), Increased partial thromboplastin time (PTT), decreased fibrinogen?

Disseminated Intravascular Coagulation DIC should be suspected in any SICK PATIENT with an ELEVATED PT & PTT. ESPECIALLY IF FIBRINOGEN LEVELS ARE DECREASED!! FIBRIN DEGRADATION PRODUCTS (FDP) will be INCREASED, particularly D-DIMER!! (indicating lyses of cross-linked fibrin)

A tubular fluid sample with osmolarity of 110 mOsm/L is obtained from where?

Distal Convoluted Tubule -LOWEST osmolarity occurs in DCT

Carbidopa: MOA?

Dopa Decarboxylase Inhibitors DECREASES THE BREAKDOWN OF LEVODOPA IN PERIPHERAL TISSUES and INCREASES THE AMOUNT OF LEVODOPA available to cross the blood-brain barrier.

Hirschsprung Disease: associated disorder?

Down Syndrome

Mild jaundice after fasting Total Bilirubin 2.8 Direct Bilirubin 2.2

Dubin-Johnson Syndrome

Defective hepatocellular excretion of bilirubin glucuronides: diagnosis?

Dubin-Johnson Syndrome BLACK LIVER (impaired excretion of epinephrine metabolites, which histologically appear as dense pigments within lysosomes)

Loss of what... promotes Metastasis?

E-Cadherin

Nasopharyngeal Carcinoma associated with?

EBV (Ebstein-Barr Virus)

Cetuximab: targets what?

EGFR

MOA: Blocking intestinal cholesterol absorption?

Ezetimibe

Macule

FLAT skin lesion < 1 cm

Deletion or insertion of a number of bases that is NOT DIVISIBLE by 3 results in?

FRAMESHIFT Mutation -DELETION of a SINGLE NUCLEOTIDE -DELETION or INSERTION of any number of nucleotides that are NOT MULTIPLES OF 3

Antifungal: Blocking Beta-D-Glucan Synthesis

FUNGIN!! Echinocandins -Anidulafungin -Caspofungin -Micafungin

Black Stained reaction in Lung and Long bone Fractures?

Fat Embolism Syndrome

Paresthesias and numbness at the dorsum of the right foot and weakness of dorsiflexion at the right ankle. Where is the site of compression?

Fibular Neck (Common Peroneal Nerve ->BOTH SUPERFICIAL & DEEP are affected!) Common Peroneal branches off the Sciatic nerve just before the popliteal fossa. Then it COURSES AROUND THE NECK OF THE FIBULA. Deep Peroneal Nerve -Dorsiflexors of the foot and toes -sensation between 1st and 2nd digits Superficial Peroneal Nerve -Muscles of Lateral Comparment (EVERSION) -Sensation of DORSUM of foot and lateral shin

Antiviral therapy used to treat colitis in aids patients that does not require intracellular activation and is known to bind in vitro with viral-encoded enzymes such as DNA polymerase, RNA polymerase, and reverse transcriptase. 1. What drug?

Foscarnet (2nd line behind Ganciclovir) The Colitis is Cytomegalovirus Colitis (CMV) -usually when CD4 < 100

Small intestinal bacterial overgrowth is a result of what procedure often?

Gastric Bypass

Zollinger-Ellison Syndrome: secretes what?

Gastrin

What increases gastric acid secretion from Parietal Cells?

Gastrin Acetylcholine Histamine

Chronic Atrophic Gastritis: what hormone will be secreted in excess?

Gastrin (Atrophic Gastritis causes LESS ACID to be released so a COMPENSATORY INCREASE IN GASTRIN!!)

Duodenal Bulb ulcer penetrating an artery through the posterior? what artery?

Gastroduodenal

Gaucher Disease: bone marrow biopsy will reveal?

Gaucher Cell The LIPID-LADEN MACROPHAGES (or GAUCHER CELLS) are classically described as "wrinkled tissue paper" "wrinkled silk" or "crumpled newspaper" in a bone marrow aspirated. The cells may be found throught the body in sites such as the liver, bone marrow and lymphatic tissue (spleen, lymph nodes, tonsils)

Afferent of GAG REFLEX: innervation?

Glossopharyngeal Nerve (CN IX)

Carotid Sinus & Body: innervation?

Glossopharyngeal Nerve (CN IX)

Platelets bind to vWF via what?

GpIb Then platelets undergo conformational change (release ADP and Calcium necessary for coagulation cascade) ADP helps platelets adhere to endothelium

What part of the sarcomere only contains thick filaments? 2. Thin filaments only?

H band 2. I Band Careful because the A BAND includes a small portion of the THIN FILAMENTS TOO. THIS WAS SUPER TRICKY on the question.

Vasopressin-2 (V-2) receptor location and action?

H2O permeability and reabsorption in MEDULLARY collecting tubules of kidney (V2 is found in the 2 kidneys)

Focal Segmental Glomerulosclerosis (FSGS) associated with what 3 conditions?

HIV Sickle Cell Disease Heroin abuse

Brain Histology: Microglial Nodules & Multinucleated Giant Cells?

HIV-associated Encephalopathy

Abducens Nerve (CN VI) Palsy: causes what?

HORIZONTAL DIPLOPIA Eye: INWARD DEVIATION

Polycystic Ovary Syndrome (PCOS): sugar level? 2. what can they develop?

HYPERglycemia 2. Type II DM -careful I choose Type I DM (there hyperglycemia is caused from INSULIN RESISTANCE which is TYPE II DM!!)

Diabetes Insipidus: Hypothalamus vs Posterior Pituitary Injury?

HYPOTHALAMUS injury will lead to PERMANENT Diabetes Insipidus Posterior Pituitary Injury or Infundibulum can cause TRANSIENT Diabetes Insipidus. If the hypothalamic nuclei are intact, axonal regeneration and hypertrophy may allow adequate ADH release into the circulation

Patient has excessive thirst and frequent urination after a motorcycle accident several years ago. He was started on therapy and symptoms resolved. However 1 week ago he ran out of medication and symptoms returned. Water Deprivation test after 2 hours is 250 mOsm/L and it increases to 700 mOsm/L after antidiuretic hormone (ADH). Is the injury in the HYPOTHALAMUS or the POSTERIOR PITUITARY?

HYPOTHALAMUS injury will lead to PERMANENT Diabetes Insipidus Posterior Pituitary Injury or Infundibulum can cause TRANSIENT Diabetes Insipidus. If the hypothalamic nuclei are intact, axonal regeneration and hypertrophy may allow adequate ADH release into the circulation

Cirrhosis with a flapping tremor: Name? 2. What is elevated in the Serum?

Hepatic Encephalopathy 2. Elevated Ammonia (NOT BUN!!)

Liver Biopsy: accumulation of large and small vesicles of fat within hepatocytes

Hepatic Steatosis -caused by -excessive alcohol ingestion (ALCOHOL STEATOHEPATITIS) -NONALCOHOLIC STEATOHEPATITIS

What viruses are responsible for Hepatocellular Carcinoma?

Hepatitis B Hepatitis C

Enveloped virus containing partially double-stranded circular DNA. An enzyme packed in its virion has RNA-dependent DNA-polymerase activity. 1. What virus?

Hepatitis B Virus (HBV) Not a retrovirus but has reverse transcriptase Human Immunodeficiency Virus (HIV) is an RNA virus with reverse transcriptase

Liver Biopsy: Lymphoid aggregates within portal tracts and focal areas of macrovesicular steatosis.

Hepatitis C

What are indicators of Liver Injury?

Hepatocyte Injury -AST & ALT Cholestasis -Elevated Alkaline Phosphatase -Elevated Gamma-Glutamyl Transpeptidase These do not indicate PROGNOSIS OF A PATIENT!!

High iron levels and inflammatory conditions increases the synthesis of what what? 2. What makes this?

Hepcidin 2. Hepatic Parenchymal Cells

Acanthosis Nigricans: what is it?

Hyperpigmented velvety plagues in axilla and neck

Friedreich's Ataxia: heart defects?

Hypertrophic Cardiomyopathy

What may occur if a lingual thyroid gland is removed? 2. symptoms?

Hypothyroidism 2. Lethargy, feeding problems, constipation, macroglossia, umbilical hernia, large fontanels, dry skin, hypothermia, and prolonged jaundiced

Unexplained CK Elevation: whats on the differential?

Hypothyroidism (Serum TSH to rule out) Muscular Dystrophies Inflammatory Muscular Diseases Medications (HMG-CoA reductase inhibitors)

Anti-TNF-alpha drugs: use?

IBD (Crohn's) Rheumatoid Arthritis Ankylosing Spondylitis Psoriasis

Patient highly suggestive of asthma with sputum microscopy showing many granule containing cells and crystalloid masses. Sputum findings suggest the role of which of the following substances in the patient's condition?

IL-5 Chronic eosinophilic bronchitis in asthmatic involved bronchial wall infiltration by numerous activated eosinophils, largely in response to IL-5. Crystalloid Bodies -> Charcot-Leyden Crystals (contain eosinophil membrane protein)

Which of the following molecules is most likely involved in mediating the accumulation of pus? (C3a, IL-3, IL-8, IL-10, Leukotriene C4)

IL-8 (major chemotaxis for neutrophils!!) see next slide for more!

Pneuomthorax of unknown cause in a 22 yo female with asthma on right side (heart is deviated to the left side, trachea still fairly midline): treatment?

IMMEDIATE needle decompression and CHEST TUBE PLACEMENT

Celiac Disease: antobodies?

IgA Anti-tissue Transglutaminase (MOST SPECIFIC!!) Anti-Endomysial Anti-Deamidated Gliadin Peptide

Type O blood mothers the circulating anti-A and anti-B antibodies are of what class?

IgG

What are the original antibodies?

IgM and IgD

Neutrophil Chemotaxis?

Il-8 C5a LTB4 (Leukotriene B4) Kallikrein Bacterial Products

Decreased sensation to the suprapubic and gluteal regions and Decreased motor funciton to the anterolateral abdominal wall muscles: what nerve?

Iliohypogastric Nerve (L1)

What are the most important OPSONINS (coating proteins)?

Immunoglobulin G (IgG) Complement C3b

Warfarin: increases PT, PTT, or both?

Increases PT

Morphine (Opioid): MOA

Increases potassium efflux out of cells and causes hyperpolarization of postsynatpic neurons effectively blocking pain transmission.

Which hernia will be felt in the scrotum?

Indirect Inguinal Hernia

Prostaglandin inhibitors to close the Patent Ductus Arteriosus (PDA)?

Indomethacin or ibuprofen ENDomethacin

Oseltamivir, Zanamivir: MOA?

Inhibit influenza NEURAMINIDASE

Class IC Antiarrhythmics: characteristics 2. Names

Inhibition of phase 0 depolarization -> STRONG Effect on Length of Action Potential -> NO CHANGE 2. Flecainide Propfenone

Class IB Antiarrhythmics: characteristics 2. Names

Inhibition of phase 0 depolarization -> WEAK Effect on Length of Action Potential -> SHORTENED 2. Lidocain Mexiletine

Diabetes Mellitus Type II: What treatment option will most likely increase this patient's serum C-peptide level?

Insulin and C-peptide will increase in 1. INSULINOMA 2. SULFONYLUREA use -chlorpropamide (1st) -tolbutamide (1st) -glimepiride (2nd) -glipizide (2nd) -GLYBURIDE (2nd) (answer) MEGLITINIDES -Nateglinide -Rapaglinide

Deficiency of IL-12 receptors: What could you supplement with to improve this patient's condition?

Interferon-gamma (IFN-gamma)

If you think IL-12 what should you think of?

Interferon-gamma (IFN-gamma)

Patient has sudden-onset loss in vision in left eye for one hour. Exam shows cherry-red spot in the macula with surrounding retinal whitening. CN exam is otherwise unremarkable. Left-sided neck bruit on cardiovascular examination. 1. Trace the path of the Embolus from Internal Carotid up!

Internal Carotid Artery -> Ophthalmic Artery -> Retinal Artery RETINAL ARTERY OCCLUSION is a cause of ACUTE, PAINLESS, MONOCULAR VISION LOSS!

Proglottids in the Stool: organism?

Intestinal Tapeworm -Taenia Solium -Diphyllobothrium Latum -Taenia Saginata Proglottids = segments that make up the Intestinal Tapeworm

Corynebacterium Diphtheriae: mechanism of action of the exotoxin?

Intracellular protein RIBOSYLATION AB exotoxin that inhibits protein synthesis by ADP-ribosylation of EF-2

Only an Increased Activated Partial Thromboplastin Time (PTT) indicates a defect in what pathway? 2. What factors?

Intrinsic Pathway 2. VIII, IX, XI, XII

Nitrites: what effect do these have on blood? 2. Diagnosis, symptoms, treatment?

Iron in Hemoglobin is normally Fe2+ (reduced form) and Nitrites change it to Fe3+ (oxidized form) 2. Causes Cyanosis and chocolate-colored blood (METHEMOGLOBINEMIA) Treatment: Methylene Blue & Vitamin C (patient will not respond to supplement oxygen because the partial pressure of oxygen is NORMAL!)

Brain biopsy: Shrunken nuclei, no detectable Nissl substance, and intensely eosinophilic cytoplasm. The findings described most likely indicate (reversible or irreversible cell injury?)

Irreversible Cell Injury

Gyrase: function?

Is a type II topoisomerase that helps to relieve the resultant supercoiling when Helicase unwinds the DNA

Giant Cell Arteritis (Temporal Arteritis): prompt institution of therapy (Glucocorticoids->Steroids) most likely reduces the risk of what complication?

Ischemic Optic Neuropathy

Mother notices an odor of burnt sugar in infants diapers: what amino acids should be restricted in this infants diet?

Isoleucine Leucine Valine

Cobalamin (Vitamin B12): Primary Function?

Isomerase & methyltransferase cofactor (DNA & methionine synthesis)

Primase: function?

DNA-dependent RNA polymerase that incorporates short RNA primers into replicating DNA. Primase is responsible for synthesizing a short RNA primer using the separated strands of DNA at the replication fork as templates. DNA replication then proceeds with DNA polymerase using the 3' hydroxyl group of the RNA primer as a starting point for synthesis.

Adding Deoxyribonuclease to a plate of bacteria. What would happen?

DNAase will DEGRADE NAKED DNA in medium --> NO TRANSORMATION seen

Pelvic Surgery such as a salpingo-oophorectomy: what is a potential complication?

Damage to the Ureter (UNINTIONAL URETERAL LIGATION)

Clostridium Difficile Colitis: Toxin mechanism?

Damages CYTOSKELETON INTEGRITY -cause disruption of intercellular tight junctions leading to cell rounding/retraction as well as increased paracellular intestinal fluid secretion.

Open-Angle Glaucoma: treatment?

Decrease Aqueous Humor Secretion -Beta Blockers (Timolol, Betaxolol) -Carbon Anhydrase Inhibitors (Dorzolamide-topical, Acetazolamide-systemic) ALL of the ABOVE act on CILIARY EPITHELIUM to decrease production of aqueous humor Increase Outflow Aqueous Humor Secretion -Prostaglandins F2alpha (Latanaprost, Travoprost) -Cholinergic Agonists (Pilocarpine, Carbachol) Increase Outflow & Decrease Production -Alpha Agonist (Brimonidine)

SGLT2 Inhibitors: MOA?

Decrease proximal tubular reabsoprtion of glucose, thereby promoting urinary glucose loss

Acute Poststreptococcal Glomerulonephritis: what serum values are decreased?

Decreased Serum C3 level Decreased Serum total complement levels

Mycobacterial resistance to Isoniazid (INH): mechanism?

Decreased activity of bacterial catalase-peroxidase

Why is long term treatment of Parkinson's Disease with Levodopa unpredictable?

Patients have good mobility during "on periods" and increased bradykinesia/rigidity during "off periods" --. "ON-OFF PHENOMENON" -As PD progresses, the THERAPEUTIC WINDOW for LEVODOPA narrows, possibly due to NIGROSTRIATAL DEGENERATION. --> as a result small changes in serum drug levels can result in motor fluctuations

Placebo Effect?

Patients' expectations affecting an outcome

An infection site is treated with antibiotics and then bacteria isolated from the injection site several days later assume a spherical configuration when placed in an isotonic solution and disintegrate rapidly when placed in a hypotonic solution. What type of antibiotics was most likely used in this experiment?

Penicillins Cephalosporins Vancomycin These drugs disrupt the peptidoglycan Cell wall of Gram-positive & Gram-negative organisms

What part of bacteria allows them the ability to survive osmotic stress?

Peptidoglycan Cell wall of Gram-positive & Gram-negative organisms

Midline Episiotomy: what is involved in this incision?

Perineal Body (tendinous center point of the perineum which separates the urogenital and anal triangles.

Cortisol increases glucose release by the liver in response to Glucagon: what is this called?

Permissiveness

Cortisol increases vascular and bronchial smooth muscle reactivity to catecholamines: what is this called?

Permissiveness

Lower Leg Deep Posterior Compartment: nerves & vessels compresses?

Peroneal Artery & Veins Tibial Nerve Posterior Tibial Artery & Veins

Proximal muscle weakness and muscle biopsy reveals major histocompatibility complex class I over expression on the sarcolemma with CD8+ lymphocyte infilatration: Diagnosis?

Polymyositis dont forget --> ENDOMYSIAL MONONUCLEATE INFILTRATE Dermatomyositis --> PERIMYSISAL, CD4+ Increased expression of MCH antigens on sarcolemmas has been demonstrated and likely leads to presentation of autoantigens to CD8+ cytotoxic cells that subsequently initiate myocyte destruction!

Histidyl-tRNA synthetase Antibodies?

Polymyositis or Dermatomyositis aka Anti-Jo-1

Why is MRSA resistant to Nafcillin (Methicillin), Oxacillin, & Dicloxacillin?

Poor interaction with binding proteins (MRSA -> has ALTERED PENICILLIN-BINDING PROTEIN which is where Nafcillin binds!)

Telomerase Function?

Prevents Chromosomal shortening by add DNA to 3' ends -RNA-dependent DNA polymerase

Bronchiectasis without eosinophilia in Cystic Fibrosis: organism?

Pseudomonas Aeruginosa (gram-negative rod)

Warfarin: what is the best test to monitor the anticoagulation effect of warfarin?

Ptrothrombin TIme (PT) particulary FACTOR VII is most important

Pulmonary Artery in relation to the Bronchus: Right Lung?

Pulmonary Artery --> ANTERIOR Right Anterior; Left Superior

Pulmonary Artery in relation to the Bronchus: Left Lung?

Pulmonary Artery --> SUPERIOR Right Anterior; Left Superior

Bosentan: use?

Pulmonary Artery Hypertension

Does the instestinal phase affect gastric acid secretion by increasing or decreasing gastric acid secretiong?

REDUCES gastric acid secretion

Anterolateral Humeral Fracture: what nerve is a concern?

Radial Nerve

Insulin with amino acid substitution at the C terminal end of the Beta chain?

Rapid Insulin (Mealtime) Lispro Aspart Glulisine

Linear appearance of IgG deposition on glomerular and alveolar basement membranes

Rapidly Progressive Glomerulonephritis (Goodpasture syndrome)

Prolonged PTT, False-positive VDRL/RPR, glomerulonephritis, and photosensitive skin rash: this patient is at greatest risk for what complications? 2. diagnosis?

Recurrent Miscarriages 2. ANTIPHOSPHOLIPID SYNDROME

Thallium stress test shows hypoperfusion of the cardiac muscle forming the diaphragmatic surface of the heart. What coronary artery is most likely occluded in this patient?

Right Coronary Artery The inferior wall of the left ventricle forms most of the diaphragmatic surface of the heart. Right Ventricle does form part of this surface. The POSTERIOR DESCENDING ARTERY supplies this area. In 85-90% of individuals this artery derives from the RIGHT CORONARY ARTERY!!

Oxygen-Hemoglobin Dissociation Curve: Chronic high-altitude adaptatoin?

Right Shift (Decreased Hemoglobin O2 affinity) *2,3-diphosphoglycerate (2,3-DPG) is PRODUCED when oxygen availability is reduced, as occurs in CHRONIC LUNG DISEASE, HEART FAILURE, CHRONIC EXPOSURE TO HIGH ALTITUDES --> Allows release of more O2 in the peripheral tissues

Oxygen-Hemoglobin Dissociation Curve: severe anemia?

Right Shift (Decreased Hemoglobin O2 affinity) *Anemia severe enough to cause LACTIC ACIDOSIS will DECREASE pH

Oxygen-Hemoglobin Dissociation Curve: Hypoventilation?

Right Shift (Decreased Hemoglobin O2 affinity) *Increased tissue CO2 levels --> DECREASED pH

Oxygen-Hemoglobin Dissociation Curve: Strenous exercise?

Right Shift (Decreased Hemoglobin O2 affinity) *Increased tissue CO2 levels --> DECREASED pH

Ligase: function?

Joins Okazaki fragments Catalyzes the formation of a phosphodiester bond within a strand of dsDNA

What organ is more likely than others to suffer embolic infarctions?

KIDNEY *they are PERFUSED at a HIGHER RATE!!

C1 Esterase Inhibitor inactivates what?

Kallikrein -> which catalyzes the conversion of kininogen to bradykinin In Hereditary Angioedema, active Kallikrein and Bradykinin levels are increased because C1 Esterase Inhibitor is decreased which leads to INCREASED KALLIKREIN & INCREASED BRADYKININ Don't give these patients ACE-I.

When is it safe to treat a fever with aspirin?

Kawasaki Disease

Patella Reflex?

L3, L4

Disc Herniation of L4-L5 will affect which nerve root?

L5

Efferent Arterioles (Renal):

LEEEEEEEEEEEAVING Glomerulus

Occulomotor (CN III): innervates?

LEVATOR PALPEBRAE INFERIOR OBLIQUE Superior Rectus Inferior Rectus Medial Rectus

Diastolic Heart Failure: LVEDP, LVEDV, LV Ejection Fraction?

LVEDP -> INCREASED LVEDV -> Normal LV EF -> Normal Diastolic heart failure is caused by decreased ventricular compliance and is characterized by normal left ventricular ejection fraction, normal LV end-diastolic volume, and elevated LV filling pressures.

POORLY DIFFERENTIATED (high-grade) tumors contain cells that?

Lack most of the characteristic features of the original tissue

A new drug is given for at least 5 years and relative risk of stroke is 0.75 (p<0.01). In contrast the same drug is given for less than 5 years and the relative risk of stroke is found to be 0.95 (p=0.45). What factor best explains why the relative risk of stroke is lower with longer use of the drug?

Latent Period *In this case, at least 5 years of continuous exposure to the drug were required to reveal the protective effect of the drug on the outcome (stroke)

Clostridium Perfingens: name of toxin?(3 different names?)

Lecithinase (alpha toxin) (or Phospholipoase)

STEMI in V3-V4: occlusion of what artery?

Left Anterior Descending Artery *Anteroapical Wall of Left Ventricle (distal LAD)

STEMI in V1-V2: occlusion of what artery?

Left Anterior Descending Artery *Anteroseptal Wall of Left Ventricle

Pulmonary Capillary Wedge Pressure (PCWP) good approximation of what? 2. What should this be? 3. Where is it measured?

Left Atrial pressure 2. 4 - 12 3. Pulmonary Artery Catheter

Cardiomegaly and complains of Dysphagia what part of the heart is causing this?

Left Atrium

STEMI in I and aVL: occlusion of what artery?

Left Circumflex Artery *Lateral Wall of Left Ventricle

STEMI in V5, V6: occlusion of what artery?

Left Circumflex Artery or Left Anterior Descending Artery *Anterolateral Wall of Left Ventricle

Oxygen-Hemoglobin Dissociation Curve: Decreased 2,3-DPG?

Left Shift *2,3-diphosphoglycerate (2,3-DPG) is PRODUCED when oxygen availability is reduced, as occurs in CHRONIC LUNG DISEASE, HEART FAILURE, CHRONIC EXPOSURE TO HIGH ALTITUDES --> Allows release of more O2 in the peripheral tissues

Myocardial Infarction: most common cause of death within 5-14 days after MI?

Left Ventricular Free Wall Rupture -sudden onset of CHEST PAIN -Profound Shock -rapid progression to death -CARDIAC TAMPONADE

What is given to patients that are taking Methotrexate and have Myelosuppression?

Leucovorin (FOLINIC ACID)

Which 2nd-Generation Antipsychotic has the highest risk of causing amenorrhea, galactorrhea, gynecomastia? 2. Why?

Risperidone (other drugs in this class have risk of causing this too) 2. HYPERPROLACTINEMIA!! *prolactin levels are not routinely monitored

MAB Targets CD20?

Rituximab

In a female what is a vestige of the gubernaculum?

Round Ligament

Secretin: produced by what cells? 2. function?

S cells of duodenum 2. Increase Pancreatic HCO3- secretion Decrease Gastric H+ secretion

Primary Polycythemia Vera: Treatment?

SERIAL PHLEBOTOMY to keep HEMATOCRIT < 45%

Subarachnoid Hemorrhage (SAH): most common cause?

Saccular or Berry Aneurysms -are the most common cause of SAH. They usually occur at the circle of Willis, with the Anterior Communicating Artery being the most common site.

Hilar lymph nodes and elevated ACE levels?

Sarcoidosis

Depression medication: that causes sexual dysfuction? 2. What does it cause?

Selective Serotonin Reuptake Inhibitors (SSRIs) 2. -DECREASED LIBIDO (ANORGASMIA)

Vibrating tuning fork on the middle of forehead, and lateralization is to the unaffected ear. 1. what type of hearing loss?

Sensorineural Hearing Loss Because the unaffected ear can BETTER SENSE the vibration.

Lumbosacral Radiculopathy of L5: sensory? Weakness?

Sensory (DORSAL FOOT & ANTERIOR LATERAL LEG, POSTERIOR LATERAL LEG) Motor (unusual foot motions and forward foot motions) Buttocks POSTERIOR LATERAL Thigh ANTERIOR LATERAL LEG DORSAL FOOT Foot DORSIFLEXION & INVERSION (Tibialis Anterior) Foot EVERSION (Peroneus) Toe EXTENSION (Extensor Digitorum)

Corneal Reflex?

Sensory Limb mediated by the nasociliary branch of the first division of the trigeminal nerve (CN V1). The motor component of the Corneal Reflex is carried primarily by the temporal branch of the Facial Nerve (CN VII) The Nasociliary Nerve enters the orbit through the Superior Orbital Fissure. A lesion here would knock out the Corneal Reflex)

Septate Uterus: Treatment?

Septoplasty

Chest tube is placed at 5th intercostal space in midaxillary line. What muscle is dissected during the process? (Latissimu Dorsi or Serratus Anterior?)

Serratus Anterior

Latissimus Dorsi vs Serratus Anterior

Serratus Anterior will be pierced in a chest tube on the midaxillary line!

Inhibin B is produced by what cells?

Sertoli Cells

Males: what cells converts Testosterone and androstenedione to Estrogens via aromatase?

Sertoli Cells

Males: what is responsible for involution of Paramesonphric Ducts? 2. What is secreted?

Sertoli Cells 2. Mullerian Inhibiting Factor

Celiac Disease leads to vitamin abnormality with diffuse bone pain and weakness. What is the serum Calcium, phosphorous, PTH?

Serum PTH: INCREASED Serum Phosphorus: DECREASED Serum Calcium: DECREASED FA pg 427

No loss of consciousness, no postictal tate, motor, sensory autonomic, or psychic symptoms? 2. Treatment?

Simple Seizure 2. (these are all Narrow Spectrum) Carbamazepine Gabapentin Phenobarbital Phenytoin

Anesthetic agent is administered at a constant partial pressure while arterial and venous concentrations are monitored. The study results show that the anesthetic has a very large arteriovenous concentration shortly after beginning inhalation. Describe the onset of action (fast or slow)?

Slow Onset of Action This describes a very soluble Inhaled Anesthetic. HIGHER BLOOD SOLUBILITY means that MORE ANESTHETIC must be absorbed by the blood before it can be effectively TRANSFERRED TO OTHER TISSUES LIKE THE BRAIN!!

Where do Goblet cells end in airways?

Smallest Bronchi

Multiple Sclerosis: how will this affect the Length Constant, Space Constant, and Conduction Velocity?

Space Constant & Length Constant are the same: DECREASED Conduction Velocity: DECREASED

Myelin: how does this affect the space constant, conduction velocity and length constant?

Space Constant & Length Constant are the same: INCREASED Conduction Velocity: INCREASES

evaulation reveals a mutation of a protein involved in the assembly of small nuclear ribonucleoproteins (snRNPs) in motor neurons. This patient most likely has imparied function of what cellular element?

Spliceosomes 1. Primary transcript combines with Small Nucelar Ribonucleoproteins (snRNPs) and other proteins to form a SPLICEOSOME 2. Lariat shape looped intermediate is generated 3. Lariat is released to precisely remove intron and join 2 exons

Protein A is found on what bacteria?

Staphylococcus Aureus -it binds to the Fc region of immunoglobulins -S. Aureus uses Protein A to inhibit opsonization and phagocytic engulfment

Congenital Hypothyroidism: treatment?

Levothyroxine by 2 WEEKS!!! can normalize cognitive and physical development

Males: testosterone is secreted in presence of LH by what cells?

Leydig Cells

What is responsible for the development of male external genitalia?

Leydig Cells -> Testosterone -> DHT -> Genital Tubercle & Urogenital Sinus -> Genital Tubercle becomes Penis and Urogenital Sinus becomes Prostate

To reach the IVC and right atrium a venous catheter is passed into the Umbilical Vein. The catheter will pass through what structure to reach the IVC?

Ligamentum Venosum

Defective Migration disorders?

Lingual Thyroid Cryptorchidism Hirschsprung Disease (failure of Neural Crest cell migration) Kallmann's Syndrome (Failure of GnRH-secreting neurons to migrate from olfactory lobes to the hypothalamus)

Tendency for certain alleles at 2 linked loci to occur together more or less often than expected by chance. Measured in a population, not in a family, and often varies in different populations.

Linkage Disequilibrium

Nafcillin (Methicillin), Oxacillin, & Dicloxacillin: Use?

Staphylococcus Aureus (except MRSA) Poor interaction with binding proteins (MRSA -> has ALTERED PENICILLIN-BINDING PROTEIN which is where Nafcillin binds!) -Use NAF (naficillin) for STAPH

What Beta-Hemolytic Bacteria is unique and doesn't fall under the Streptococcus Hemolysis tree?

Staphylococcus Aureus!!!! OH YA AUREUS BABY!!

Coagulase Negative Staphylococcus? 2. Which one is Novobiocin Resistant?

Staphylococcus Epidermidis Staphylococcus Saprophyticus 2. Staphylococcus Saprophyticus

2nd most common UTI in sexually active women?

Staphylococcus Saprophyticus

Lung abscess associated with prior penetrating trauma: organism (2)?

Staphylococcus and Streptococcus species

Postpartum Blues: when do they start when should they resolve?

Start: 2-3 days Resolve: Within 10 DAYS -MILD depression, tearfullness, irritability appropriate to say "Postpartum mood changes are common; please call if you do not improve in a few days."

MOA: Decreasing hepatic cholesterol synthesis?

Statins inhibit HMG-CoA reductase

1 - Beta?

Statistical Power -this represents a study's ability to detect a difference when one exists It is the probability of rejecting the null hypothesis when it is truly false. The probablity of finding a true relationship.

TSH is under negative feedback by what?

T3

AIDS: prophylaxis CD4 < 200?

TMP-SMX -Pneumocysitis Pneumonia

Herpes Simplex Virus-1 (HSV-1): where does the latent virus hang out?

TRIGEMINAL GANGLIA

Rocker bottom feet, hypertonia, clenched hands, overlapping fingers, Cardiac anomalies (VSD, patent ductus arteriosus), horseshoe kidney

TRISOMY 18 (Edwards Syndrome) due to Meiotic NONDISJUNCTION -FETAL GROWTH RETARDATION -HYPERTONIA (clenched hands with overlapping fingers -ROCKER BOTTOM FEET -CARDIAC/GI/RENAL DEFECTS

Hypothyroidism: administering T3 to this patient would result in what hormone levels of the following? (TSH, T3, reverse T3, T4)

TSH: DECREASED T3: INCREASED reverse T3: DECREASED T4: DECREASED

Non-caseating granuloma: what 3 immune mediators are responsible for this finding?

Th1 IL-2 IFN-gamma (interferon-gamma) (my answer was Th2, IL-3, IFN-gamma ->TH2 stimulate class switching and antibody production by B-cells as part of humoral immunity. IFN-gammy is NOT produced by TH2 cells

Primary Polycythemia Vera: Cause?

The JAK2 mutation renders HEMATOPOIETIC CELLS MORE SENSITIVE TO GROWTH FACTORS SUCH AS ERYTHROPOIETIN AND THROMBOPOIETIN. (PRIMARY POLYCYTHEMIA VERA)

53 man had difficulty breathing and increasing fatigue. 2 months ago he had an MI that was not revascularized due to delay in treatment. On cardiac ausculatation, a diastolic heart sound is heard when he lies in left lateral decubitus position. What would accentuate this finding?

Listening at END EXPIRATION (decreases lung volume and brings the HEART CLOSER to the CHEST WALL S3 & recent MI is consistent with decompensated Heart Failure due to LV systolic dysfunction. S3 is caused by a sudden limitation of ventricular movement during rapid passive ventricular filling. Best heard with the bell of the stethoscope over the cardiac apex with the patient in the left lateral decubitus position at END EXPIRATION.

Abdominal pain vascular tumor associated with THOROTRAST (former radioactive contrast medium) exposure?

Liver Angiosarcoma (Hepatic Angiosarcoma)

Abdominal pain and exposed to vinyl chloride and arsenic?

Liver Angiosarcoma (Hepatic Angiosarcoma) -also associated with THOROTRAST (former radioactive contrast medium)

What organs would you most likely see a "Hemorrhage into necrotic area"?

Lungs (dual blood supply from pulmonary and bronchial arteries)

Muscarinic Receptors (M1): Function?

M1 = Memory formation/cognitive functioning (Brain)

Muscarinic Receptors (M3): Function?

M3 = -PERIPHERAL VASODILATION, smooth muscle relaxation, hypotension (peripheral vasculature) -Bronchoconstriction (lung) -Detrusor Contraction (bladder) -miosis, accommodation, (eyes) -Increased peristalsis, increased salivary and gastric secretions (GI) -Increased sweat production (GI)

Where are Ketones produced? (be specific)

MITOCHONDRIA of Liver

Interferon-gamma (IFN-gamma) activates what?

Macrophages

Maintaining the behavior changes

Maintenance

Mitral Stenosis: standard for diagnosis and determination of MS?

Measurement of mean transvalvular pressure gradients via 2-D Doppler Echocardiography.

The ONLY TRUE DIVERTICULUM?

Meckel Diverticulum

Foot: Inguinal Nodes enlarged where is lesion?

Medial Foot

Anteromedial Humeral Fracture: what nerve and artery is a concern?

Median Nerve Brachial Artery

Malaria: what drug is used to treat drug resistant strains?

Mefloquine

Dystrophic Calcification: occurs secondary to?

NECROSIS or INJURY NORMAL CALCIUM LEVEL IN BLOOD -Calcium deposits in ABNORMAL TISSUES

Isosorbide Dinitrate vs Nitroglycerin

NItroglycerin -absorbed directly from oral mucosa into the VENOUS CIRCULATION and has a HIGHER BIOAVAILABILITY -> SMALLER DOSES can be given compared to Isosorbide Dinitrate. Isosorbide Dinitrate -LOW BIOAVAILABILITY due to extension 1st-PASS HEPATIC METABOLISM prior to release in circulation.

Crohn Disease is associate with mutations in what gene?

NOD2 gene

Most Down syndrome cases are caused by?

NONDISJUNCTION: 1st -> Maternal Meiosis I (homologous chromosomes fail to separate) 2nd -> Maternal Meiosis II (failure of sister chromatids to separate)

Gamma Hemolysis bacteria?

Nonenterococcus Streptococcus Bovis Group D (Enterococcus) -Enterococcus Faecium -Enterococcus Faecalis

Hb A 95% Hb A2 ~2.5% Hb F <1%

Normal

Round, dense, basophilic (dark-staining) within nuclei: what is this? 2. What is likely to predominantly function here? 3. What does it make?

Nucleolus 2. RNA POLYMERASE I 3. rRNA (ribosomal RNA)

Immunocompromised patient with Oral Candidiasis: treatment?

Nystatin --> oral agent ("swish and swallow")

P-450 Substrate Drugs?

ORAL CONTRACEPTIVE PILLS WARFARIN Anti-epileptics Theophylline Ketoconazole

Marked Elevation of CA-125 with US of an ovarian mass: what would have reduced the risk of this condition?

OVARIAN CANCER DECREASE FREQUENCY OF OVULATION!! -Oral Contraceptives -Multiparity -Tubal Ligation, or salpingo-oophorectomy

Marked Elevation of CA-125 with US of an ovarian mass: what increases the risk of this condition?

OVARIAN CANCER INCREASE THE FREQUENCY OF OVULATION -Infertility (increased estrogen) -Endometriosis - Genetics (BRCA1 or BRCA2, LYNCH syndrome) -Postmenopausal Age

Penicillinase-resistant penicillins: names?

OXACILLIN NAFCILLIN (Methicillin) Dicloxacillin

Superior Orbital Fissure: what important structures enter?

Occulomotor (CN III) Trochlear (CN IV) Abducens (CN VI) Superior Opthalmic Vein

Oppositional Defiant Disorder vs Conduct Disorder?

Oppositional Defiant Disorder -> the problem behaviors are MORE SEVERE and AGGRESSIVE Conduct Disorder -> physical aggression or cruelty TOWARD PEOPLE or ANIMALS, DESTRUCTION OF PROPERTY, or the typical pattern of STEALING or DECEIT. ODD may precede the development of conduct disorder and increases the risk of adult antisocial behavior, impulse-control problems, substance abuse, anxiety, and depression.

Hypoglycemic (anxiety, tremor, & sweating) patient is still alert: treatment?

Oral Intake of 15-30 g of fast-acting carbohydrates (glucose tablets, sweetened fruit juices, hard candy) When the hypoglycemia becomes severe enought to induce unconsciousness, PARENTERAL TREATMENT (INTRAMUSCULAR GLUCAGON) is required.

What steps of the Urea Cycle are in the Mitochondria?

Ornithine ----> Citrulline and everything in between!

Increased Orotic Acid excretion in urine and Hyperammonemia (vomiting and confusion/coma)?

Ornithine Transcarbamylase (OTC) deficiency Both Ornithine Transcarbamylase (OTC) deficiency & Orotic Aciduria have Increased Orotic Acid exretion. Ornithine Transcarbamylase (OTC) deficiency --> Hyperammonemia Orotic Aciduria --> Megaloblastic Anemia

Increased Orotic Acid excretion in urine and megaloblastic anemia?

Orotic Aciduria Both Ornithine Transcarbamylase (OTC) deficiency & Orotic Aciduria have Increased Orotic Acid exretion. Ornithine Transcarbamylase (OTC) deficiency --> Hyperammonemia Orotic Aciduria --> Megaloblastic Anemia

overuse injury of the SECONDARY OSSIFICATION CENTER (apophysis) of the TIBIAL TUBERCLE

Osgood-Schlatter Disease

Collagen Disorder: impaired triple helix formation?

Osteogenesis Imperfecta

Deficient GPI protein attached to RBC

Paroxysmal Nocturnal Hemoglobinuria (PNH) -GPI protein anchors CD55 (Decay-Accelerating Factor) and CD59 (MAC inhibitory protein) proteins to RBC membrane which prevents Complement-mediated intravascular RBC lysis

absence of CD55/CD59 on surface of RBC (obtained by flow cytometry)

Paroxysmal Nocturnal Hemoglobinuria (PNH) CD55 = Decay-Accelerating Factor -CD55 Prevents Complement-mediated intravascular RBC lysis

Medicare: part C

Parts (A+B) delivered by approved private CCCCompanies (optional CCCCCapitated plan w/additional benifits VVVVision, DDDDental)

nonenveloped, single-stranded DNA virus?

Parvovirus B19

Hydrops Fetalis: What virus may cause this? 2. Virology?

Parvovirus B19 2. Nonenveloped, single-stranded DNA virus Parvovirus can lead to INTERRUPTION OF ERYTHROPOIESIS causing PROFOUND ANEMIA and congestive heart failure

Hydrops Fetalis: causes?

Parvovirus B19 alpha-Thalassemia (4 allele deletion) Hydrops Fetalis (collection of fluid in 2 more compartments) -subcutanesous tissue - abdomen -pericardium -pleura

Metolazone: what type of drug? 2. risk?

Thiazide Diuretic Hyper GLUC Hypokalemia Metabolic Alkalosis HyperGLYCEMIA HyperLIPIDEMIA HyperURICEMIA HyperCALCEMIA SULFA Allergy

Blood pressure medication: side effect Acute kidney injury?

Thiazide Diuretics

Blood pressure medication: side effect ELEVATED GLUCOSE?

Thiazide Diuretics

Blood pressure medication: side effect Elevated CHOLESTEROL?

Thiazide Diuretics

Blood pressure medication: side effect Hyperuricemia and Gout?

Thiazide Diuretics

T Cell Positive Selection: Where & What?

Thymic Cortex T-cells expressing TCRs capable of binding self-MHC on cortical epithelial cells survive.

T Cell Negative Selection: Where & What?

Thymic Medulla T cells expressing TCRs with high affinity for self antigens undergo apoptosis. Tissue-restricted self-antigens are expressed in the thymus due to the action of autoimmune regulator (AIRE).

UV light causes what type of damage to DNA?

Thymine Dimers (or cytosine residues) -may also be called PYRIMIDINE DIMERS

Insertion point of the patellar ligament? 2. Patellar Ligament connects to what muscles?

Tibial Tuberosity 2. Quadriceps (Rectus Femoris, Vastus Intermedius, Vastus Medialis, Vastus Lateralis)

CD11 mutation mutation will affect what neutrophil function?

Tight Binding & Crawling

LFA-1 mutation will affect what neutrophil function?

Tight Binding & Crawling

VLA-4 Integrin will affect what neutrophil function?

Tight Binding & Crawling

CD54 mutation will affect what neutrophil function?

Tight Binding and Crawling

Claudins: associated with what?

Tight Junction (paracellular barrier)

Occludin: associated with what?

Tight Junction (paracellular barrier)

What prevents paracellular passage of fluid and solutes between nonfenestrated capillary endothelial cells?

Tight Junctions (Zonula Occludens)

When is Clozapine the drug of choice?

Treatment-resistant Schizophrenia

Apoptosis Disorder?

Type 1 DM (Beta cells undergo apoptosis, even though they are still needed)

Falsely conclude there is a difference: what type of error?

Type I (alpha) error

Cornea: What type of Collagen?

Type I Collagen

Dermis: What type of Collagen?

Type I Collagen

Ligament: What type of Collagen?

Type I Collagen

Osteogenesis Imperfecta defect in what type of Collagen?

Type I Collagen

Scar Tissue (Myocardial Infarction: What type of Collagen?

Type I Collagen

Tendon: What type of Collagen?

Type I Collagen

Blood Vessels: What type of Collagen?

Type I Collagen & Type III Collagen

Stating that there is an effect or difference when none exists?

Type I Error (alpha) this is also saying that you have INCORRECTLY REJECTED THE NULL HYPOTHESIS IN FAVOR OF THE ALTERNATE HYPOTHESIS. NULL HYPOTHESIS IS ACTUALLY CORRECT!

Chronic Transplant Rejection: Type of Hypersensitivity?

Type II & Type IV Hypersensitivity Reactions

falsely concluded there is NO DIFFERENCE: what type of error?

Type II (beta) error

Hyaline Cartilage: What type of Collagen?

Type II Collagen

Nucleus Pulposus: What type of Collagen?

Type II Collagen

Vitreous Humor: What type of Collagen?

Type II Collagen

Stating that there is not an effect or difference when one exists?

Type II Error (Beta) this is also saying that the NULL HYPOTHESIS IS NOT REJECTED!!!

Bone Marrow: What type of Collagen?

Type III Collagen

Acute Transplant Rejection: Type of Hypersensitivity?

Type IV Hypersensitivity Reactions

Stop Codons?

UAG UAA UGA if questions ask for the last amino acid go to the one RIGHT BEFORE THE STOP CODON-> LOOK AT THE ENTIRE SEQUENCE FOR THE FIRST STOP CODON!

Which one is more effective Low-Molecular-Weight Heparins (LMWH) or Unfractionated Heparin?

Unfractionated Heparin -> has more molecules than LMWH, allowing it to bind FACTOR Xa and THROMBIN more effective in INACTIVATING THROMBIN!!

Poison ivy, poison oak and poison sumac all produc?

Urushiol a small allergenic substance that causes an inmmune resopnse when attache to proteins (ie, a hapten)

Methanamine Silver Stain: use for?

Used to identify Fungal elements in histologic sections of tissue.

How can you prevent the "Red Man" Syndrome?

Using Slower Rate of Infusion *results from widespread HISTAMINE RELEASE (mast cell degranulation) when VANCOMYCIN is INFUSED TOO RAPIDLY

Double Uterus, vagina, cervix? 2. Pregnancy possible? 3. Defect?

Uterus Didelphys 2. YES! 3. COMPLETE of FUSION of MULLERIAN DUCTS

Bevacizumab: targets what?

VEGF

Myocardial Infarction: most common cause of death within 48-72 hours after MI?

Ventricular Arrhythmias

Optochin Resistance and Bile-insoluble?

Viridans Streptococci (Alpha-Hemolytic)

Alpha Hemolytic bacteria?

Viridans Streptococci Streptococcus Pneumoniae

Bacteria that makes Dextrans ONLY ONE!

Viridans Streptococci (Streptococcus SANGUINIS)

Once introduced into a human cell, a purified RNA molecule is able to induce Viral protein synthesis and viral genome replication: What does this mean?

Virus must be: -SINGLE-STRANDED (SS) & -POSITIVE (+) SENSE

Tuberculosis patient receiving treatment has Neurotoxicity, what should you give them?

Vitamin B6 (Pyridoxine)

Warfarin: MOA?

Vitamin K antagonist (Vitamin K Epoxide Reductase Inhibitor) -Factors II, VII, IX, and X, Protein C & S (vitamin K-dependent clotting factors)

All patients with Major Depression should be screen for what?

past history of MANIC episodes

Inferior Vena Cava FILTERS (IVC filters): indicated in what patients?

patients who have CONTRAINDICATIONS TO ANTICOAGULATION

Patch

FLAT skin lesion > 1 cm

Medicare: part D

prescription DDDDDrugs

Foramen Ovale: what exists?

CN V 3 (Trigeminal Branch 3)

Internal Auditory Meatus: what exits?

CN VII (Facial) CN VIII (Vestibulocochlear)

Indicator of Impaired Liver Function?

Elevated Prothrombin Time Hypoalbuminemia

SGLT2 Inhibitors?

FLOZIN Canaliflozin Dapagliflozin Empagliflozin

Decreased sensation to the suprapubic region: what nerve?

Iliohypogastric Nerve (L1)

Impaired taste sensation from the anterior 2/3 of tongue: innervation?

Facial Nerve (CN VII) Chorda Tympani Branch

N-acetylglutamate is necessary for what step in the Urea Cycle? 2. What else is necessary for this step?

CO2 + NH3 ----> Carbomyl Phosphate 2. 2 ATP

What steps of the Urea Cycle is ATP necessary?

CO2 + NH3 ----> Carbomyl Phosphate Citrulline ----> Argininosuccinate

Granulation Tissue: What type of Collagen?

Type III Collagen

Decreased sensation to the upper & medial thigh & parts of the external genitalia: what nerve?

Ilioinguinal Nerve (L1)

Excessive preoccupation with acquiring or having a serious illness

Illness Anxiety Disorder

Skin: What type of Collagen?

Type III Collagen

Woman who ingest Rat poison on purpose to create physical or psychological symptoms.. What is this called?

Factitious Disorder

Vitamin K dependent Factors?

Factor II Factor VII Factor IX Factor X Protein C Protein S

Pro-T cell: define?

"double negative" cells - cells that lack both CD4 and CD8 antigens These are the cells that leave the bone marrow and arrive at the Thymus.

delayed separation of the umbilical cord (> 1 month) and leukocytosis

Leukocyte Adhesion Deficiency *absence of neutrophil migration

Prevalance?

# of existing cases PrevALLence looks at ALL current cases # of existing cases/(total # of people in a population)

Incidence?

# of new cases of a disease Incidence looks at new cases (INCIDENTS!) (# of new cases)/(# of PEOPLE AT RISK)

Contralateral homonymous Hemianopia without macular sparing

#3 Optic Tract

BPH: what would the kidney show?

Atrophic and scarred due to reflux of urine and damage or renal tissue (parenchymal pressure atrophy)

Holosystolic Murmurs?

Tricuspid Regurgitation Mitral Regurgitation Ventricular Septal Defect

Lactase Deficiency: confirmatory testing for this condition will show a decrease what?

DECREASED Stool pH *causes ACID in stool!

Parvovirus B19 binds to host cells via what?

Erythrocyte P Antigen

What tissues cannot use Ketones for energy? 2. Why?

Erythrocytes 2. RBCs do not have Mitochondria which are essential for metabolism of KETONES

Activated Protein C resistance?

Factor V Leidein (hereditary thrombosis syndrome) Mutation in Factor V gene, renders factor Va resistant to INACTIVATION by ACTIVATED PROTEIN C.

What converts Prothrombin to Thrombin?

Factor Xa

Ehlers-Danlos defect in what type of Collagen?

Type III Collagen (Ehlers-Danlos Types 3 & 4)

Alport Syndrome is a defect in what type of Collagen?

Type IV Collagen

Decreased Alveolar Surface tension: what would this do?

IMPROVES COMPLIANCE and allows stretching of the alveoli during inhalation. SURFACTANT DECREASES SURFACE TENSION

Bicornuate Uterus: defect?

INCOMPLETE FUSION of MULLERIAN DUCTS

Basement Membrane: What type of Collagen?

Type IV Collagen

Amantadine: MOA?

INCREASE Dopamine Release DECREASES Dopamine reuptake Enhances the effect of endogenous dopamine

Collagen Disorder: impaired glycosylation of hydroxylysine residues?

Osteogensis Imperfecta

Eukaryotic can be Polycistronic: T or False?

FALSE! one mRNA codes for several proteins like LAC OPERON (one mRNA codings for 2 enzymes) The example I have seen of Polycistronic is LAC OPERON!

What is the mechanism that the following are able to resist Cephalosporins? -Listeria Monocytogens -MRSA -Enterococci

Resistant Penicillin-binding proteins

Lesser Curvature of the Stomach?

Right & Left Gastric Arteries

56 yo has sudden onset of headache and partial loss of vision. She has a 3 year history of atrial fibrillation. The occlusion is most likely in what artery? Contralateral homonymous Hemianopia with Macular Sparing

#7 POSTERIOR Cerebral Artery PCA supplies the occipital lobe which contains the primary visual cortex of each hemisphere and receives information about the contralateral visual field from the ipsilateral lateral geniculate nucleus via the optic radiation. Contralateral homonymous Hemianopia

Solitary mass in the Right Temporal Lobe: what visual field defects are seen? 2. this caused an injury to what?

(F in image) Left Hemonymous Superior Quadrantanopia 2. Meyer's Loop

Chronic Transplant Rejection: Features

*Dominated by ARTERIOSCLEROSIS -Vascular Smooth Muscle PROLIFERATION -Parenchymal Atrophy -Interstitial Fibrosis

Leser-Trelat Sign: associated with?

*GASTRIC ADENOCARCINOMA & other visceral malignancies

Atherosclerosis: What cell is directly responsible for the Fibrous Cap with dense deposition of extracellular matrix and collagen?

*Smooth Muscle Cells 1. Endothelial cell dysfunction 2. Macrophage and LDL accumulation 3. Foam Cell Formation 4. Fatty Streaks 5. Smooth Muscle Cell Migration (involves endothelin-1, interleukin-1, PDGF -> platelet-derived growth factor & FGF -> Fibroblast growth factor) 6. Proliferation & Extracellular Matrix Deposition 7. Fibrous Plaque --> Complex Atheroma

Great Saphenous Vein path?

*answer (Just inferolateral to the pubic tubercle)

Preventable Adverse Event?

*involve harm to the patient by an act of commission or omission rather than from the underlying disease *result from FAILURE TO FOLLOW evidence-based BEST PRACTICE GUIDELINES

Picornaviruses: Virology 2. Virus names?

+ssRNA Naked PERCH Poliovirus Echovirus Rhinovirus Coxsackievirus Hepatitis A

Superior Vena Cava Syndrome: causes?

-Malignancy (PANCOAST tumor) -THROMBOSIS (from indwelling catheters)

Celiac Disease: increased risk of?

-Malignancy (T-cell Lymphoma)(moderately)

Obstructive Sleep Apnea: can lead to?

-Systemic HTN -Pulmonary HTN which can lead to RIGHT HEART FAILURE -Arrhythmias -Sudden Cardiac Death

Patient has Hyperthyroidism: what findings would be most suggestive of a specific underlying cause of this patient's hyperthyroidism?

-lower leg skin thickening & induration (pretibial myxedema) -exophthalmos -periorbital edema -eye movement limitations all these indicate INFILTRATIVE DERMOPATHY and are seen primarily in GRAVES DISEASE (autoimmune response against the TSH receptor)

Vertebral Subluxaton: signs?

-neck pain -stiffness -neurological findings (radicular pain) -PARALYSIS with decreased or ABSENT REFLEXES below the level of compression (spinal shock) -Hypotension (from loss of sympathetic tone) -possible sudden death

Rett Syndrome: important?

-occurs mainly in GIRLS -usually starts 5 mos - 18 mos -development of STEREOTYPIC HAND MOVEMENTS -DECELERATION OF HEAD GROWTH -INTELLECTUAL DISABILITY -loss of motor & language skills -development of seizures -autistic features -breathing abnormalities -most cases -> de novo mutations in X-Linked MECP2 gene

Gallbladder Hypomotility: risk factors?

-pregnancy -total parenteral nutrition -Octreotide -high spinal cord injuries

Decreased Lung Compliance: what conditions cause this?

-presence of fluid in lungs (Heart Failure - HF)(crackles heard in lungs) - Pulmonary Fibrosis -Insufficient Surfactant (Increased Surface Tension)

Drug seeking behaviors: red flags?

-requesting specific medication by name -running out of medication -pain out of proportion -reporting lost or stolen medication -obtaining multiple opioid prescriptions from different providers

Succinylcholine: MOA? 2. use

-strong ACh receptor agonist which produces SUSTAINED depolarization and prevents muscle contraction 2. Muscle paralysis in surgery or mechanical ventilation

A nerve is injured in the deep to the mucosa overlying the piriform recess? What is most likely impaired in this patient? 2. What nerve?

1. Cough Reflex 2. INTERNAL LARYNGEAL NERVE (Internal Branch of the Superior Laryngeal Nerve) It carries SENSATION FROM THE MUCOSA SUPERIOR TO THE VOCAL CORDS.

Streptococcus Pneumoniae: bacteriology 2. What type of capsule? 3. Primary Virulence factor?

1. Gram-positive diplococci -(small alpha-hemolytic colonies grow in a blood agar plate) 2. Polysaccharide Capsule (Quellung Reaction) 3. Polysaccharide Capsule also has IgA Protease (inactivates secretory IgA), Adhesins (necessary for adhesion to epithelial cells) and Pneumolysin (cytotoxin that causes pores in cell membrane and cell lysis)

Recent-onsent mild headaches, left leg weakness, Cafe-au-lait spots, neurofibromas. 1. Diagnosis 2. Inheritance Pattern

1. Neurofibromatosis Type 1 2. Autosomal Dominant Headache probably from an associated brain tumor! -Cafe-aulait spots -cutaneous Neurofibromatosis -Lisch Nodules (pigmented hamartomas; asymptomatic) -Bony abnormalities (pseudoarthrosis, scoliosis) -Tumors (astrocytomas, gliomas, Pheochromocytomas) (patient may have headache, etc)

Amiodarone: before initiating long-term therapy to prevent future arrhythmic episodes. What should be tested?

1. Serum TSH AmIODarone is 40% iodine by weight. It can cause HYPOTHYROIDISM due to decreased production of thyroid hormone. Or it can also cause HYPERTHYROIDISM due to increased thyroid hormone synthesis or destructive thyroiditis with release of preformed thyroid hormone.

Carboxylase function? 2. what is required?

1. add 1 carbon 2. Biotin

Patient takes Isosorbide Dinatrate early in morning and again in afternoon, but NO EVENING dose. Why is it given this way?

1. to prevent TOLERANCE DEVELOPMENT around-the-clock nitrate administration (IN ANY FORM) rapidly results in development of tolerance to nitrates. A NITRATE-FREE INTERVAL must be provided every day in patients.

Epstein Barr Virus (EBV) binds to what on B cells? 2. via what

1.CD21 (B cells) 2. via gp350 (EBV)

Patient has headaches and blurred vision for 4 months. Abdominal CT shows 2 cm adrenal mass on left side. Adrenalectomy is performed. Gross exam shows well-defined yellowish tumor within the Cortex. Cells are functionally similar with cells of the outermost layer of the adrenal cortex. 1. Diagnosis? 2. What other symptoms may be present?

1.Primary Hyperaldosteronism (CONN SYNDROME) 2. headaches from HTN, decreased or normal Potassium, and Metabolic Alkalosis (answer said PARESTHESIAS & MUSCLE WEAKNESS -> this must have been due to electrolyte abnormalities) -This is an Adrenocortical Adenoma which is appearing as a well-defined yellowish tumor of the adrenal cortex. -outermost layer is secreting ALDOSTERONE -reminder -> HIGH ALDOSTERONE, LOW RENIN

What forms the Blood-Brain Barrier (3 structures)?

1.TIGHT JUNCTIONS (Zonula Occludens) between nonfenestrated capillary endothelial cells that prevent the paracelular passage of fluid and solutes. 2. Basement Membrane 3. Astrocyte Foot Processes

Ischemic Brain Injury (stroke): when does the Dead Red Neuron appear?

12 hours - 48 hours

How many days after fertilization does the the Morula enter the Uterus?

3-4 days

Inhaled Anesthetic Drug: MAC (minimal alveolar concentration) of 2.0 vs 7.0?

2.0 = HIGHER POTENCY 7.0 = LOWER POTENCY

What is Filtration Fraction normally in healthy individuals?

20%

Relative Risk calculate (if 21% of smokers develop lung cancer vs 1% of nonsmokers)?

21/1 = 21 is the risk of an outcome (lung cancer) in the exposed group diveded by the risk of that outcome in the unexposed group (individuals who did not smoke) If RR > 1.0 then the exposure is associated with INCREASED RISK OF DISEASE RR < 1.0 means that the exposure is associated with DECREASED RISK of DISEASE

Palatine tonsils what pharyngeal pouch?

2nd pharyngeal pouch

What position is the Wobble position? 2. What does the wobble position mean?

3 Nucleotide position 2. Means that the 3rd codon may differ in the 3rd 'wobble' position but may code for the same tRNA/amino acid

Embryonic kidney Development?

3 sets of nephric systems (PRONEPHROS (week4) MESONEPHROS (1st trimester), METANEPHROS (permanent).

Viral genetic instability is most likely due to the lack of which of the following features during the viral replication process?

3' --> 5' exonuclease activity the virion-encoded RNA polymerase has no proofreading 3' --> 5' ability.

Person advised to have intake of 3,000 calories with 30% from protein. How much protein per day will this patient consume on the new dietary plan?

3000 * 30% = 900 Calories 900 Calories / 4 calories/1 gram of protein = 225 GRAMS OF PROTEIN!! 4 calories from 1 gram of protein 9 calories from 1 gram of fat

How many calories come from 1 gram of protein?

4 calories from 1 gram of protein

Larynx: what pharyngeal pouch?

4th & 6th pharyngeal ARCHES!!

Superior Parathyroid Glands are what pharyngeal pouch?

4th Pharyngeal Pouch

What enzyme converts T4 to T3? 2. What drug inhibits this?

5'-deiodinase 2. Propylthiouracil

Normal A-a gradient?

5-15 mm Hg If this is low then hypoxemia due: -Ventilation-Perfusion mismatch (V/Q mismatch) -O2 diffusion Impairment

How many days until IMPLANTATION after fertilization?

6 days (basically the same amount time until beta-hCG starts being made! -once implanted the the outer cell mass (trophoblast) differentiates into the CYTOTROPHOBLAST and SYNCTIOTROPHOBLAST

After fertilization Beta-hCG begins being produced by the syncytiotrophoblasts when? 2. when is beta-hCG detected in SERUM? 3. when is beta-hCG detected in URINE?

6-7 days after fertilization (at the earliest) 2. serum 8 DAYS!! 3. urine 14 DAYS!!

4,000,000 population 20,000 have disease A 7,000 new cases of the disease 1,000 deaths 40,000 deaths per year What is the incidence?

7000 / 3,980,000 The number of NEW CASES OF A DISEASE PER YEAR DIVIDED BY THE TOTAL POPULATION AT RISK.

when does the Vitelline Duct obliterate normally?

7th week!

Platelet lifespan?

8-10 days

How many calories from 1 gram of fat?

9 calories from 1 gram of fat

Potential of adenomatous Polyps: size? 2. Histologic Appearance?

< 1cm: unlikely to undergo malignant transformation > 4 cm: 40% risk of malignancy 2. Villous Adenomas are more prone to be MALIGNANT (than Tubular Adenomas) Villous Adenoma in the picture (VILLIAN!!!)

Does HYPERTROPHY of the heart represent 1. a high rate of mitotic activity or 2. a high rate of myosin mRNA synthesis?

A high rate of myosin mRNA synthesis because INCREASED PROTEIN SYNTHESIS is what occurs in HYPERTROPHY and mRNA makes protein. HYPERTROPHIC STATE is through INCREASES in RATE OF PROTEIN SYNTHESIS!! -the QUANTITY OF SARCOMERES AND MITOCHONDRIA INCREASE within each myocyte.

Positive Likelihood Ratio: what? 2. What do the numbers mean?

A ratio representing the likelihood of having the disease given a positive result. 2. Ratio > 1 indicate that the respective test result is associated with the presence of disease; likelihood ratios <1 mean that the test result is associated with the absence of the disease.

Suffice: Cept?

A receptor Molecule Etanercept (Soluble Receptor Decoy Protein)

Why do adolescents sometimes miss menstrual periods and have heavy bleeding?

ANOVULATION common in the first several years after menarche and the last few years before menopause. -Ovarian Follicle does not degenerate and become a CORPUS LUTEUM which means NO PROGESTERONE IS PRODUCED and ESTROGEN LEVELS REMAIN persistently ELEVATED --> CAUSING ENDOMETRIUM TO REMAIN IN PROLIFERATIVE PHASE!!

Morula

A solid ball of cells that makes up an embryo; in humans, this stage occurs within three days of fertilization. (2-3 days)

Annular Pancreas: what is the cause of this condition?

Abnormal migration of the ventral pancreatic bud *normally the Ventral pancreatic bud ROTATES BEHIND the duodenum

S3 in an adult >40?

Abnormal-->suggests VENTRICULAR ENLARGMENT!! -chronic severe MITRAL REGURGITATION -chronic AORTIC REGURGITATION -HEART FAILURE (dilated or ischemic cardiomyopathy)

Maxillary sinus

A: Frontal Sinus B: Ethmoid Sinus (Ethmoid Air Cells) C: Sphenoid Sinus D: Maxillary Sinus MEDIAL to orbit: ETHMOID SINUS INFERIOR TO ORBIT: Maxiillary

Blood pressure medication: side effect Hyperkalemia?

ACE-I

Surface Ectoderm: what comes from it?

ANTERIOR PITUITARY (Rathke's Pouch) LENS & CORNEA INNER EAR SENSORY ORGANS Olfactory Epithelium Nasal and Oral Epithelial Linings Epidermis Glands (Sweat, Mammary, Salivary)

Anti-Beta2 Glycoprotein Antibodies?

ANTIPHOSPHOLIPID SYNDROME

Anticardiolipin antibodies and lupus anticoagulant can cause what?

ANTIPHOSPHOLIPID SYNDROME -False-positive VDRL/RPR & -Prolonged PTT

Miliary Mycobaterium Tuberculosis: describe the lesion?

ANY of the following -Disseminated lesions in Lungs -Meninges -Axillary Lymph nodes (or others) -Disseminated lesions in LIVER -Disseminated lesions in SPLEEN -Disseminated lesions in ADRENAL -JOINTS & LONG BONES -VERTEBRAE (POTT DISEASE)

Aspirin and acetaminophen working together is an example of what drug interaction?

Additive

Effect of substance A and B together is equal to the sum of their individual effects: what is the name of this drug interaction?

Additive

Hydroxylase: function?

Adds HYDROXYL group (-OH) onto substrate

Chromaffin Cells

Adrenal Medulla Cells (POSTganglionic sympathetic neurons) derived from Neural Crest Stimulated by Acetylcholine

Clostridium Botulinum: adults vs babies?

Adults -> ingestion of PREFORMED TOXIN (canned food) Babies -> ingestion of SPORES (honey)

Alcohol explain how chronic use affects the brain?

Alcohol is a CNS depressant that BINDS to the GABA-A receptor complex, ENHANCING the INHIBITORY action of GABA (the MAJOR INHIBITORY NEUROTRANSMITTER) in the brain) **Chronic Alcohol consumption leads to decreased GABA sensitivity and alcohol tolerance develops. **ABRUPT cesssation decreases inhibitory tone and results in CNS EXCITATION (withdrawal)

Nonpolar, hydrophobic Amino Acids 2. Why are these ones important?

Alanine Valine Leucine Isoleucine Phenylalanine Tryptophan Methionine Proline Glycine 2. Make up Transmembrane Domain (these AA are arranged in alpha-helical fashion and project their hydrophobic R groups outward, anchoring the transmembrane region of the protein to the hydrophobic core of the phospholipid bilayer.

Locus Hetorgeneity: example?

Albinism *Mutations at different loci can produce a similar phenotype.

Early-stage Diabetic Nephropathy screening is best achieved through measuring urinary concentration of which of the following substances?

Albumin

Initial Symptoms: -agitation -tremors -tachycardia -hypertension (12-24 hours) Some patients progress to: -Seizures -Delirium Tremens

Alcohol Withdrawal

MAB Targets CD52?

Alemtuzumab

Which DNA polymerases can removed mismatched nucleotides?

All 3 prokaryotic DNA Polymerases via their 3' to 5' exonuclease ("proofreading") activity. Only DNA Polymerase I has 5' to 3' exonuclease activity, which is used to remove the RNA primer synthesized by RNA primase

Hypothesis of SOME difference or relationship

Alternative Hypothesis (H1) -there is SOME association between the disease and the risk factor in the population

A-a gradient?

Alveolar-arterial oxygen gradient PAO2 - PaO2

Asymptomatic male is found to be homozygous for the apolipoprotein E-4 allele. In the future this patient is most likely to suffer from what?

Alzheimer Dementia

ApoE2: Decreased risk of what?

Alzheimer Disease

ApoE4: Increased risk of what?

Alzheimer Disease

Brain Histology: Neurofibrillary tangles and neocortical plaques?

Alzheimer's Disease

Alpha-helices regions of a protein: importance?

Anchoring the protein to the Cell Membrane

Fatigue, weakness, conjunctival pallor, and decreased hemoglobin, suggestive of?

Anemia

Screening: DECREASED Maternal Serum alpha-fetoprotein (AFP)?

Aneuplodies

Both chromosome 15s are from Father?

AngelMan Syndrome

Inappropriate laughter, seizures, ataxia, and severe intellectual disability in a 3 yo with normal 46 XY.

AngelMan Syndrome

Microdeletions involving the Maternal 15?

AngelMan Syndrome

ARBs: MOA?

Angiotensin II Receptor Blocker Block the receptors of Angiotensin II and inhibit the effect of angiotensin II -> DECREASES ALDOSTERONE

Urge Incontinence or Overactive Bladder Syndrome: Treatment? (general, and specific drug names)

Antagonism of Muscarinic Cholinergic Receptor (Anticholinergic Drugs) -OXYBUTYNIN -Solifenacin -Tolterodine -sudden sensation of urgency, with involuntary leakage or urine before reaching the toilet.

Spirnonolactone & Eplerenone: MOA

Antagonists of Aldosterone Receptor Normals function of Aldosterone: -->Acts @ Collecting Tubules (Principal & Intercalated Cells) -Resorption of SODIUM & H2O -Loss of POTASSIUM & HYDROGEN IONS

What blood vessels anastomase at Kiesselbach's plexus?

Anterior Ethmoidal Sphenoplatatine Superior Labial Arteries

Anticardiolipin antibodies?

Antiphospholipid syndrome

Mycobacteria that do no produce Cord Factor?

Are NOT able to cause disease! -CORD FACTOR IS VIRULENCE FACTOR

What step of the Urea Cycle is UREA produced? 2. What is needed for this step?

Arginine ----> Ornithine 2. H20

Pupils that do not react to light but do constrict with accommodation.

Argyll Robertson Pupils (Tertiary Syphilis)

Colon Adenocarcinoma: Stool shows guaic-positive brown stool and cause iron deficiency anemia: where is the lesion?

Ascending Colon (Right-sided lesion) -tend to grow large, bulky masses that protrude into colonic lumen due to the large caliber of the ascending colon. -more likely to cause iron deficiency anemia -bleeding is usually occult (guaic-positive brown stool) (both right-sided and left-sided colon adenocarcinoma)

Broom-like appearance on Methanamine Silver Stain?

Aspergillus Fumigatus

Bronchiectasis and eosinophilia in Asthma patient: organism?

Aspergillus Fumigatus *Allergic Bronchopulmonary Aspergillosis (ABPA)

Bronchiectasis and eosinophilia in Cystic Fibrosis: organism?

Aspergillus Fumigatus *Allergic Bronchopulmonary Aspergillosis (ABPA)

Celiac Disease: pathophysiology?

Autoimmune-mediated intolerance of gliadin (gluten protein found in wheat) -> causes malabsoroption and seatorrhea

Entacapone & Tolcapone: MOA?

DECREASES THE BREAKDOWN OF LEVODOPA IN PERIPHERAL TISSUES and INCREASES THE AMOUNT OF LEVODOPA available to cross the blood-brain barrier. Catechol-O-Methyltransferase (COMT) inhibitors

Lower Leg Anterior Compartment: nerves & vessels compresses?

DEEP PERONEAL Nerve Anterior Tibial Artery & Vein

Perimysial Infiltrates?

Dermatomyositis (DM)

Naive T-cell Activation: what receptors are necessary? (which cell are they on?)

B7 (CD80/86) -> APC CD28 -> Naive T Cell

Alzheimer Disease: the decline in Acetylocholine levels is most notable where?

BASAL NUCLEUS of MEYNERT HIPPOCAMPUS this area participates in memory and cognition.

Multiple Sclerosis: what is the cause of urinary incontinence?

BLADDER HYPERTONIA (SPASTIC BLADDER) -> due to presence of an UPPER MOTOR NEURON LESION in the spinal cord Bladder will not DISTEND/RELAX properly due to loss of descending inhibitory control from the upper motor neuron

Medusa head colonies on standard media

Bacillus Anthracis

Type IV Collagen:

Basement Membranes *associated disease -> Alport Syndrome

Medicare: part B

Basic medical BBBBBills (OUTPATIENT SERVICES-->doctor's fees, diagnostic testing, medical devices)

Specific Phobia: treatment?

Behavioral Therapy

Enterobius Vermicularis (Pinworm): treatment

Bendazole becauses worms are BENDY!!

Status Epilepticus: Drug of choice? (Be specific)

Benzodiazepines (Lorazepam or Diazepam) (Give IV)

Deficiency of GpIb? what disorder?

Bernard Soulier Syndrome

Blood pressure medication: side effect SEXUAL DYSFUNCTION?

Beta Blockers

Secondary structure of Proteins?

Beta Sheets Alpha Helixes Hydrogen Bonds make up secondary structure.

What receptors STIMULATE Insulin secretion?

Beta-2 Adrenergic Receptors Glucagon-like peptide-1 Glucagon Muscarinic M3

Amyloid Deposition confined to Cerebrum or cerebral blood vessels?

Beta-Amyloid Protein This is a precursor protein or peptide responsible for localize amyloidosis (confined to single, specific organ)

Acoustic Schwannoma: where is it located?

Between the cerebellum and lateral pons (Cerebellopontine angle)

Double Uterus, one vagina, one cervix?

Bicornuate Uterus *Careful with the image vs Septate Uterus

BPH: what would the bladder and ureters show?

Bladder: HYPERTROPHY to increase it contractile force Ureters, Renal Pelvis, Calyces -> Dilate and deform from HYDRONEPHROSIS!

Acute Lymphoblastic Leukemia: bone marrow or peripheral blood will reveal?

Blasts

Rifampin: MOA?

Block RNA synthesis by inhibiting DNA-dependent RNA polymerase

Diphendyramine, Dimenhydrinate, Chlorpheniramine: MOA?

Blocks Histamine (H1) Receptors

Phenytoin: MOA?

Blocks Na+ channels

What is the only way to removed large amounts of iron from the body?

Blood loss

Multiple Myleoma: Treatment? 2. How does this work?

Bortezomib 2. PROTEASOME INHIBITION which causes increased apoptotic factors that leads to APOPTOSIS of the MALIGNANT PLASMA CELLS. Proteasomes usually regulate proteins, breaking down misfolded, damaged and cytotoxic proteins. Proteasome inhibition results in the accumulation of toxic intracellular proteins. In addition proteasomes regulate the balance or pro- and antiapoptotic proteins. Inhibition of Proteasomes leads to excess of proapoptotic proteins. Both of these effects induce APOPTOSIS OF THE MALIGNANT PLASMA CELLS!

Pulmonary Hypertension Drugs?

Bosentan Sildenafil Epoprostenol Iloprost

Foramen Magnum: What exits?

Brainstem

Dopamine Agonists?

Bromocriptine (ergot) PRAMIPEXOLE (non-ergot) ROPINIROLE (non-ergot)

recurrent episodes of binge eating, followed by compensatory behaviors to prevent weight gain. 1. Diagnosis? 2. Treatment?

Bulimia Nervosa 2. SSRIs (Fluoxetine)

What T Cells fight Viruses?

CD8+ T lymphocytes

Biceps Reflex?

C5, C6

vWF binds to exposed?

COLLAGEN (missed this) Then PLATELETS bind vWF via fpIb

Ureteric Bud: derivatives?

COLLECTING SYSTEM! Collecting Ducts Major Calyces Minor Calyces Renal Pelvis Ureters

Potassium Sparing Diuretics: where do they act?

COLLECTING TUBULE

Amyloid Deposition confined to Thyroid Gland?

Calcitonin This is a precursor protein or peptide responsible for localize amyloidosis (confined to single, specific organ)

Prinzmetal Angina (Variant Angina): treatment?

Calcium Channel Blockers (CCB), Nitrates and smoking cessation

Blood pressure medication: side effect Dizziness or lightheadeness?

Calcium Channel Blockers (Dihydropyridine CCB) -Amlodipine -Nifedipine

Blood pressure medication: side effect PERIPHERAL EDEDMA?

Calcium Channel Blockers (Dihydropyridine CCB) -Amlodipine -Nifedipine

Inflammatory Breast Cancer: pathogenesis?

Cancerous Cells OBSTRUCT LYMPHATIC DRAINAGE AFTER SPREAD TO THE DERMAL LYMPHATIC spaces

Arrangment in which a payer (individual, employer, or government entity) pays a FIXED, PREDETERMINED FEE to cover all the medical services required by a patient?

Capitation this is the payment structure underlying Health Maintenance Organization Provider Networks. there is an incentive for the provider and patient to reduce expenses, usually by restricting patients to a limited panel of providers within the plan, requiring referrals from a primary care provider prior to specialist consultations, and denying payment for services that do not meet established evidence-bsed guidelines.

Capsid Protein?

Capsid protein just surround the viral genome and are not directly involved in viral attachment

N-acetylglutamate is necessary for what enzyme in the Urea Cycle?

Carbamoyl Phosphate Synthetase I

Pain and tingling affecting the first three digits of BOTH hands, no problems with her legs. Patient has chronic renal failure due to uncontrolled HTN, and she is on hemodialysis. She has bilaterally diminished sensation over the thumb, first two fingers, and the radial half of her third finger. 1. Diagnosis?

Carpal Tunnel Syndrome *often occurs BILATERALLY *I chose Endoneural arteriole hyalinization (this occurs in Diabetes Mellitus and usually starts in the feet) --> this patient didn't even have diabetes?????? Say what?

Type II Collagen:

Cartilage (including Hyaline Cartilage) Vitreous Humor Nucleus Pulposus

Study: asks "What Happened?

Case-Control Study What study compares a group of people with disease to a group of people without disease to look for a PRIOR? exposure or risk factor?

Anti-TNF-alpha drugs?

Certolizumab Infliximab Adalimumab Etanercept (decoy TNF-alpha receptor) used for IBD, Rheumatoid Arthritis, Ankylosing Spondylitis, Psoriasis

MAB Targets EGFR?

Cetuximab

Accelearted Atherosclerosis: Seen in what type of Rejection?

Chronic Transplant Rejection

Bronchiolitis Obliterans: Seen in what type of Rejection?

Chronic Transplant Rejection

Gram +,spore-forming, obligate anaerobic rods?

Clostridium

Vitamin Deficiency: Megaloblastic Anemia with Neurologic Deficits

Cobalamin (Vitamin B12)

Megaloblastic Anemia, neurologic symptoms, subacute combine degeneration of dorsal and lateral spinal columns

Cobalamin (Vitamin B12) Deficiency

Bosentan: MOA?

Competitive ANTAGONIST of ENDOTHELIN RECEPTORS -decreases pulmonary resistance bosENtan =ENdothelin

A bacteria penetrating beyond the surface epithelium are immediately coated with preformed IgG antibodies. Which of the following substances acts in the most similar manner to IgG antibodies to facilitate phagocytosis? (Complement C3b, Complement C5a, or Immunoglobulin M?)

Complement C3b The most important OPSONINS (coating proteins are -Immunoglobulin G (IgG) -Complement C3b These act as a handle for receptors on phagocytes (Fc receptors and C3b receptors) to grasp. Allowing phagocytes to easily engulf the foreign cell.

patient is positive for HBSAg. you should inform the patient that the most likely outcome for his infection is?

Complete Resolution (>95%)

Loss of consciousness & postictal state, and may have automatisms (lip smacking. 2. Treatment?

Complex Seizure 2. (these are all Narrow Spectrum) Carbamazepine Gabapentin Phenobarbital Phenytoin

False association of an exposure with a disease?

Confounding Bias

Congenital Infection that causes PDA?

Congenital Rubella

NEUROLOGIC symptom incompatible with any known neurologic disease; often acute onset associated with stress

Conversion Disorder

Wilson's Disease: how does it damage liver?

Copper is a pro-oxidant and causes damage to hepatic tissue through GENERATION OF FREE RADICALS. -eventually it leaks from INJURED HEPATOCYTES into circulation and is deposited in various tissues -> CORNEA (descemet membrane) and BASAL GANGLIA, KIDNEY, JOINTS

Chemokine receptor CCR5? 2. What would deletion of BOTH CCR5 gene? One Allele?

Coreceptor on MACROPHAGES that enables the HIV virus to enter cells 2. Deletion of BOTH of the genes that code for this receptor results in resistance to HIV infection. ONE ALLELE -> delayed manifestations.

Larynx: How to remember it all?

Cricothyroid Muscle -> External Branch of Superior Laryngeal Nerve (Thyroidectomy) Sensation above Vocal Cords -> Internal Branch of Superior Laryngeal Nerve (injured -> SWALLOWING & GAG REFLEX) All other Laryngeal Muscles & SENSATION BELOW VOCAL CORDS -> Recurrent Laryngeal Nerve (injured -> INABILITY TO SPEAK, HOARSENESS)

Epithelium of Respiratory Bronchioles?

Cuboidal Ciliated Cells -> Squamous Cell

Intravascular Hemolysis vs Extravascular Hemolysis: main finding?

DARK URINE -> Intravascular Hemolysis -Hemoglobinuria/hemosiderinuria

Septate Uterus: fertility?

DECREASED FERTILITY

DNA methylation?

DNA methylation at CpG islands represses transcription CpG METHYLATION makes DNA MUTE

Thiamine (Vitamin B1): Primary Function?

Decarboxylation of alpha-keto acids (carbohydrate metabolism)

Congestive Heart Failures: Walk through the physiology?

Decreased Cardiac Output (both RHF & LHF) -> leads to decreased perfusion of peripheral tissues -> induces compensatory mechanisms in 2 ways 1. Renin-angiotensi-aldosterone system (RAAS): INCREASED RENIN is produce now, eventually ANGIOTENSIN II is made (potent VASOCONSTRICTOR). By causing vasoconstirction, angiotensin II increases arterial resistance and AFTERLOAD INCREASES. Which decreases tissue perfusion more and Increases Renin more and creates a vicious circle 2. INCREASED SYMPATHETIC OUTPUT is stimulated by baroreceptors. Epinephrine and Norepinephrine increase HR & contractility. But these also increase Peripheral Arterial Resistance which INCREASES AFTERLOAD.

Prolactinoma: increased or decreased estrogen? 2. What effect will this have on bone mass?

Decreased Estrogen 2. Estrogen maintains bone. Loss of bone mass. Osteoporosis.

Abrupt Standing: physiologic effect?

Decreased Preload

Nitroglycerin administration: physiologic effect?

Decreased Preload

Valsalva (straining phase): physiologic effect?

Decreased Preload

Metformin (Biguanides): Should be avoided in what patients?

Decreased Renal Function Congestive Heart Failure Alcoholism Due to INCREASED RISK of LACTIC ACIDOSIS in these populations

Colon Adenocarcinoma: altered bowel habits, constipation, abdominal distention, nausea and vomiting. Where is the lesion?

Descending Colon or Rectosigmoid Colon -smaller lesions (than right-sided lesions) -often infiltrate the wall of the colon, encircling it and narrowing the lumen (causing obstruction) -altered bowel habits, abdominal distension, and nausea and vomiting -liver and lungs are common sites of metastasis (both right-sided and left-sided colon adenocarcinoma)

Polydipsia, polyuria, and fruity odor to breath and/or urine?

Diabetic Ketoacidosis (DKA)

What is the leading cause of end-stage renal disease in the US?

Diabetic Nephropathy

Obstetric ultrasound reveals twins. A Male and a Female. What is the twin placentation presentation like?

Dichorionic/Diamnionic ALWAYS!!

MAB targets Digoxin?

Digoxin immune FAB

Restrictive Cardiomyopathy vs Dilated Cardiomyopathy

Dilated Cardiomyopathy (1) Restrictive Cardiomyopathy (2)

Exerts a dominant effect. A heterozygote produces a nonfunctional altered protein that also prevents the normal gene product from functioning.

Dominant negative mutation

A Reversible process that does not necessarily proceed to cancer?

Dysplasia

Laparotomy of 4 yo with abdominal pain reveals a blind pouch connected to the ileum. The pouch is removed, it demonstrates pancreatic acini. The latter finding would be best described as which of the following. (Hypoplasia, Metaplasia, Ectopy)

Ectopy (HETEROTOPY) GASTRIC, PANCREATIC, and other types of MUCOSA found in MECKEL DIVERTICULUM are examples of ECTOPY (aka HETEROTOPY)

MAB Targets Complement protein C5?

Eculizumab

Paroxysmal Nocturnal Hemoglobinuria (PNH): treatment? MOA?

Eculizumab -terminal complement inhibitor ( Complement protein C5)

Subarachnoid Hemorrhage (SAH) -> Saccular or Berry Aneurysms: associated with?

Ehlers-Danlos Autosomal Dominant Polycystic Kidney Disease (ADPKD) Arteriovenous malformations also predispose certain individuals to SAH.

Man with morning erections and psychogenic impotence: cause of erectile dysfunction?

Emotional Stress

Cells found in an experiment had a high amount of a particular protein in comparison to other cell types. This protein has REVERSE TRANSCRIPTASE activity hat functions to add TTAGGG repeats to the 3' end of chromosomes. Which of the following cell types was most likely studied in this experiment? (epidermal basal cells, RBC, Myocardial cells, Neurons, Pancreatic Beta Cells)

Epidermal Basal Cells Reverse Transcriptase --> TELOMERASE

Pterion Fracture will cause what? 2. What artery?

Epidural Hematoma 2. Maxillary Artery (MIDDLE MENINGEAL ARTERY a branch of Maxillary) -Fracture at the junction of the frontal, parietal, temporal, and sphenoid bones,

Severe Asthmatic Reactions: treatment?

Epinheprine (read bottom line) EPINEPHRINE is drug of choice for treatment of anaphylactic shock due to ability to reverse the mechanism of anaphylaxis. Resevere vasodilation by increasing VASOCONSTRICTION (ALPHA-1) BLOOD PRESSURE, INCREASES CARDIAC CONTRACITLITY (BETA-1) & it STIMULATES BETA-2 causing BRONCHODILATION which makes it a popular choice for treatment of SEVERE ASTHMATIC REACTIONS.

What effect to sex steroids have on bone growth?

Estrogen & Testosterone initially INCREASE LINEAR growth, but they also encourage closure of EPIPHYSEAL GROWTH PLATES.

If a child has precocious puberty: what effect will this have on their growth?

Estrogen & Testosterone initially INCREASE LINEAR growth, but they also encourage closure of EPIPHYSEAL GROWTH PLATES. The child will be taller than their peers early, but ULTIMATELY THE CHILD MAY NOT MEET THEIR FULL GROWTH POTENTIAL -> due to early closure of EPIPHYSEAL GROWTH PLATES.

Sinus Medial to orbit?

Ethmoid Sinus (Ethmoid Air Cells)

Graves: What symptoms will not respond to Beta-Blocker Therapy (Propranolol)?

Exophthalmos Pretibial Myxedema Caused by lymphocytic infiltration, enlargement of the extraocular muscles from myositis, fibroblast proliferation, and overproduction of mucopolysaccharides in response to anti-thyroid antibodies.

Patient is using an internet supplement possibly with caffeine and several herbs that promote weight loss. How should the physician respond?

Explain that weight loss supplements are poorly regulated and have potential risks

Immature T-Lymphocytes: define?

Express both CD4 & CD8 antigens and are in the thymus.

Increased level of acetylcholinesterase in the amniotic fluid suggests what?

Failed Fusion If the neuropore does not fuse, an opening exists between the neural tube and the amniotic cavity and leakage of fetal cerebrospinal fluid in the amniotic fluid.

Pancreatic Divisum: what went wrong? 2. What drains the majority of the pancreas?

Failure of Ventral & Dorsal pancreatic buds to fuse. In this condition the ductal systems remain separate, with the accessory duct draining the majority of the pancreas.

PRIMARY Mycobaterium Tuberculosis: Where is the lesion?

Fibrocaseous cavitary Lesion (usually UPPER LUNG LOBES)

Carpal Tunnel: what is incised during surgery?

Flexor Retinaculum or TRANSVERSE CARPAL LIGAMENT!

Celiac Trunk supplies blood to?

Foregut -Stomach -up to 2nd part of the duodenum -Liver, Pancreas, Gallbladder

a pyrophosphate analog used to treat CMV?

Foscarnet FOScarnet = pyroFOSphate analog

Part of Aortic Arch: derivative?

Fourth Aortic Arch (4th Aortic Arch)

Right Subclavian Artery: derivative?

Fourth Aortic Arch (4th Aortic Arch)

Type II DM: Elevated serum levels of which of the following substances are most likely contributing to this insulin resistance?

Free Fatty Acids -Insulin resistance in adipose cells hinders the antilipolytic effects of insulin, leading to lipolysis and release of free fatty acids. In turn, CHRONICALLY ELEVATED FREE FATTY ACID LEVELS contribute to INSULIN RESISTANCE by impairing insulin-dependent glucose uptake in liver and muscle and increasing hepatic gluconeogenesis.

Frataxin Protein defect?

Friedreich Ataxia -Iron binding protein -> leads to IMPAIRMENT IN MITOCHONDRIAL FUNCTIONING -trinucleotide repeat (GAA) -autosomal recessive -Chromosome 9 (FRATAXIN)

Ataxia GAAit?

Friedreich Ataxia -trinucleotide repeat (GAA) -autosomal recessive -Chromosome 9 (FRATAXIN)

Essential Fructosuria: deficient enzyme? 2. What enzyme can compensate for this deficient enzyme?

Fructokinase 2. Hexokinase

Lung Volumes & Capacities

Functional Residual Capacity (point where Pulmonary Vascular Resistance is LOWEST!)

Colchicine: side effects?

GI side effects (nausea & vomiting) MYOPATHY

Connexin: associated with what?

Gap Junction (intercellular communication)

Deficiency of GpIIb/IIIa? what disorder?

Glanzmann THrombasthenia

Defect in GpIIb/IIIa: what disease?

Glanzmann Thrombasthenia

Which Type 2 DM carries that greatest risk of Hypoglycemia (Glipizide, Glimepiride, or Glyburide)

Glyburide & Glimepiride *both are 2nd generation Sulfonylureas -> which have the GREATEST POTENTIAL of all ORAL DIABETES MEDICATIONS *both are LONG-acting and have HIGHER incidence of HYPOGLYCEMIA *Glipizide -> SHORT-acting and has a lower incidence of hypoglycemia

Glycerol Kinase: function?

Glycerol --> Glycerol 3-phosphate *Triglyceride Metabolism (breakdown)

Collagen is 1/3 what amino acid?

Glycine

FSH stimulates what cells in a woman to produce Estradiol

Granulosa Cells (Estradiol is made from the Androgens)

TGF-Beta: function?

Growth factor involved in TISSUE REGENERATION & REPAIR

Protein from brain tissue is mainly beta-pleated sheets. Medication is applied to the protein and the structure changes to alpha-helical structure. This conformational change is the result of reorganization of which bonds?

HYDROGEN BONDS -> make up the secondary structure of proteins

Brown Adipose Tissue: main function?

Heat Production -contain several intracytoplasmic fat droplets and many more mitochondria than white adipose cells -produce heat by Uncoupling Oxidative Phosphorylation with the protein Thermogenin

A viral particle surface is highly similar to that of the cell nuclear membrane. The patient is most likely infected with what family of virus?

Herpesvirus (this includes HSV-1, HSV-2, VZV, EBV, CMV-Cytomegalovirus, HHV-7, HH8) Most enveloped nucelocapsid viruses acquire lipid bilayer enveloped by budding through the PLAMA membrane of the host cell. However Herpesviruses bud through acquire the lipid bilayer envelop from the NUCLEAR membrane.

Mitochondrial Inheritance: what is the word that describes the variability of clinical manifestations int he affected family members?

Heteroplasmy

Presence of both normal and mutated mtDNA, resulting in variable expression in mitochondrially inherited disease.

Heteroplasmy

Mitochondrial disease can be inherited different (in the question a brother and sister both had the same disorder but she had very few symptoms and he had a lot of symptoms). 1. What explains the variability in clinical presentation in mitochondrial diseases?

Heteroplasmy Variability occurs because during mitosis, mitochondria are randomly distributed between daughter cells. Some cells contain mitochondria with mostly damaged mtDNA, while some contain mostly normal mitochondrial genomes. This mixture of two types of genetic material is called HETEROPLASMY! (this is responsiblve for clinical variability of diseases)

High LDL levels and premature atherosclerosis: diagnosis? 2. Inheritance? 3. Defect?

Heterozygous Familial Hypercholesterolemia 2. Autosomal Dominant 3. Defective LDL receptor

Pancreatic secretions: Low flow?

High Cl-

Malignant cells Involve the ENTIRE THICKNESS of EPITHELIUM but does NOT penetrate the basement membrane?

High-Grade Dysplasia or Carcinoma In Situ *REVERSIBLE

What Collagen Synthesis Step requires Vitamin C?

Hydroxylation of Proline and Lysine Residues

Recipient Antibodies react to donor antigen: what TYPE of Transplant rejection? Timing?

Hyperacute Transplant Rejection (WITHIN MINUTES!!)

Woman came to ED with chest tightness and dyspnea. Chest CT shows a SaddlePulmonary Embolus. Patient's medical problems include Type II DM, hypertension, hyperlipidemia, and ovarian cancer. She has smoked a pack of cigarettes a day for 30 years and stopped smoking 10 years ago. 1.Which factor most likely contributed to this patient's current condition. (Atherosclerosis or Hypercoagulability)

Hypercoagulability *due to her OVARIAN CANCER which causes Hypercoagulation

Primary Polycythemia Vera: presentation?

INCREASED RBC MASS INCREASED PLASMA VOLUME LOW EPO levels Additional manifestations may include: -ELEVATED PLATELETS -ELEVATED WBC COUNT -THROMBOTIC EVENTS (from blood hyperviscosity) -PEPTIC ULCERATION (histamine release from basophils) -PRURITIS (histamine release from basophils) -GOUTY ARTHRITIS (increased cell turnover) -RUDDY FACE -SPLENOMEGALY

BRCAl gene mutations do not always result in breast or ovarian cancer: what is this?

Incomplete Penetrance

Septate Uterus: Defect?

Incomplete RESORPTION OF SEPTUM

Thrombolytic or Fibrinolytic Drugs: MOA? 2. Use?

Increase formation of PLASMIN from Plasminogen 2. Treatment of ACUTE MYOCARDIAL INFARCTION (most effective within 6 hours of onset of STEMI) Use of fibrinolytic drugs in properly selected patients of Acute STEMI decreases mortality significantly

Sustained hand grip: physiologic effect?

Increased Afterload

Arteriovenous (AV) shunt or AV fistula: how would this affect a left ventricular pressure-volume loop?

Increased Cardiac Preload Decreased Cardiac Afterload The pressure volume loop's height is decreased and it is widened.

Anemia of Chronic Disease: Hepcidin level?

Increased Hepcidin -Decreased Intestinal Iron Absorption -Decreased Iron release by Macrophages

Passive leg raise: physiologic effect?

Increased Preload

Squatting (from a standing position): physiologic effect?

Increased Preload Increased Afterload

Patient comes to the ED after several episodes of coffee ground emesis. BP is 90/60. His skin is cool and clammy. Pulse is 120. He feels dizzy on standing. What is molecule is likely increased in his vascular smooth muscle? (cAMP, cGMP, inositol triphosphate?)

Inositol Triphosphate (IP3)

When will C-peptide increase?

Insulin and C-peptide will increase in 1. INSULINOMA 2. SULFONYLUREA use -chlorpropamide (1st) -tolbutamide (1st) -glimepiride (2nd) -glipizide (2nd) -GLYBURIDE (2nd) MEGLITINIDES -Nateglinide -Rapaglinide

Adhesion Molecules?

Integrins Cadherins Selectins Ig Superfamily Members

Drug for asthma works by reversing irritant-induced bronchoconstriction it has no bronchodilatory effects. What is this most similar to?

Ipratropium or Tiotropium (long-acting) -asthma or COPD

Hemochromatosis: what is protective in women? 2. When does it typically present in men and women?

Iron loss through menstruation slows progression in women. 2. Men after age 40. Women significantly later -> secondary to protective effects of blood (iron) loss during menstruation.

A mutation has resulted in a decreased transcription of factor VIII causing Hemophilia A (an X-linked recessive disorder). The geneticist suspects that the patient has a deletion mutation in the ENHANCER SEQUENCE OF THE FACTOR VIII GENE. Where on the gene could this mutation be location?

It can be located upstream, downstream, or within introns of the gene. -Enhancers and silencers may be located upstream, downstream, or within a transcribed gene -these gene sequence function to INCREASE & DECREASE the rate of transcription

Child with a family history of long QT interval prolongation and Neurosensory deafness: name?

Jervell and Lange-Nielsen syndrome

Oxygen-Hemoglobin Dissociation Curve: Increased pH?

Left Shift *Increased pH (decreased Acid)

Oxygen-Hemoglobin Dissociation Curve: Hyopthermia?

Left Shift (Increased Hemoglobin O2 affinity) *Decreased Temperature helps stabilize the bonds between oxygen and hemoglobin.

DNA synthesis in gram-negative bacteria: What process will differ the most between 2 daughter strands during their synthesis?

Joining of DNA fragments by ligase -Lagging strand requires the repetitive action of DNA PRIMASE and DNA ligase

Suffix: Nib?

Kinase Inhibitor

Dysplastic squamous cervical cells with "raisinoid" nuclei and hyperchromasia

Koilocyte Characteristic sign of Human papillomavirus (HPV) -> which could present as Condylomata Acuminata (Genital warts) or (Intraepithelial neoplasia) HPV 6 & HPV 11 (Condylomata Acuminata - Genital Warts) HPV 16 & HPV 18 (Intraepithelial neoplasia)

Time elapsed from initial exposure to clinically apparent disease?

Latent Period

Foot: Popliteal Nodes & Inguinal Nodes enlarged: wheres is lesion?

Lateral Foot

A test diagnoses or detects the disease at an earlier stage than another test does without impacting the natural history of the disease?

Lead-time Bias

Absent CD18 antigen on the surface of leukocytes: what diagnosis? 2. Increased Neutrophils or Decreased Neutrophils?

Leukocyte adhesion Deficiency (type 1) 2. INCREASED Neutrophils PERSISTENT NEUTROPHILS (LEUKOCYTES) is a very common finding because leukocytes are not being able to MIGRATE OUT OF THE BLOOD VESSELS. -CD18 antigen is necessary for the formation of integrins. Integrins are essential for leukocyte adhesion to endothelial surfaces and migration to peripheral tissues in response to infection or inflammation.

Stress Urinary Incontinence: exercise what muscle?

Levator Ani -> Kegel Exercises

Thyroid function tests are necessary with what drugs?

Lithium AmIODarone

Bipolar Disorder: treatment?

Lithium Valproic Acid Carbamazepime Atypical Antipsychotics PINE & DONE & Aripiprazole (Atypical Antipsychotics) Aripiprazole Asenapine CLOZAPINE Iloperidone lurasidone olanzapine Paliperidone Quetiapine RISPERIDONE ZIPRASIDONE

What type of vaccine may prevent a PDA?

Live Attenuated Vaccine *given BEFORE PREGNANCY though

Where does Fructose Metabolism occur?

Liver

Malignant cells that Do NOT involve the ENTIRE thickness of epithelium?

Low-Grade Dysplasia *REVERSIBLE

Lumbosacral Radiculopathy of L3: sensory? Weakness?

Lower anterior medial thigh Hip Flexion (Iliopsoas) Hip Adduction Knee Extension (QUADRICEPS)

Hypoxemia causes vasoconstriction in what what organ?

Lung

Metastatic Calcification: where are common places the deposition occurs?

Lung Kidney Gastric Mucosa These tissue lose Acid quickly (increased pH) -> this favors deposition

Colon Adenocarcinoma: common sites of metastasis?

Lung Liver

Stimulation of Muscarinic Receptors:

M1 = Memory formation/cognitive functioning (Brain) M2 = Decreased HR & Atrial Contraction (Heart) M3 = -PERIPHERAL VASODILATION, smooth muscle relaxation, hypotension (peripheral vasculature) -Bronchoconstriction (lung) -Detrusor Contraction (bladder) -miosis, accommodation, (eyes) -Increased peristalsis, increased salivary and gastric secretions (GI) -Increased sweat production (GI)

Muscarinic Receptors (M2): Function?

M2 = Decreased HR & Atrial Contraction (Heart)

What is given with Cyclophosphamide or Ifosfamide to prevent Hemorrhagic Cystitis?

MESNA

Dorsal Pancreatic Bud: forms what?

Majority of pancreatic tissue -Body -Tail -Superior Aspect of the Head -Accessory Pancreatic Duct

Wolffian Duct becomes?

Male Internal Genitalia (except prostate) aka MESONEPHRIC DUCT -Seminal Vesicles -Epididymis -Ejaculatory Duct -Ductus Deferens (SEED)

Dermatomyositis: has increased risk of what?

Malignancy -Ovarian -Lung -Colorectal -non-Hodgkins Lymphoma Specifics aren't to important but remember that DERMATOMYOSITIS MAY OCCUR ALONE OR AS A PARANEOPLASTIC SYNDROME OF AN UNDERLYING MALIGNANCY!!

Histology: Sebaceous glands and keratinaceous debris?

Mature Cystic Teratomas of the ovaries Usually Asymptomatic or can cause torsion (acute pelvic pain) if very large. Sebaceous gland and keratinaceous debris indicate the presence of skin and hair follicles and are hallmarks of this benign tumor

Fracture at the junction of the frontal, parietal, temporal, and sphenoid bones, causes injury to what arteries? 2. what is this point called? 3. What will this cause?

Maxillary Artery (MIDDLE MENINGEAL ARTERY a branch of Maxillary) 2. Pterion 3. Epidural Hematoma

Sinus INFERIOR to orbit?

Maxillary Sinus

Acute Respiratory Distress Syndrome: treatment?

Mechanical Ventilation LOW TIDAL volumes

Spleen is derived from what tissue? 2. What is unique about the blood supply though

Mesodermal (mesentery of stomach) 2. Spleen has FOREGUT blood supply from CELIAC TRUNK --> Splenic Artery

Cytokeratin + and Calretinin +

Mesothelioma

Chest CT shows right-sided pleural effusion and diffuse nodular thickening of the pleura.

Mesothelioma -HEMORRHAGIC pleural effusions are frequently present -NODULAR or SMOOTH PLEURAL THICKENING is the main finding on radiographic studies and macroscopic examination

Pleural Biopsy shows proliferation of epitheloid -type cells that are joined by desmosomes, contain abundant tonofilaments, and are studded with very long microvilli. Diagnosis?

Mesothelioma Histopathology will show tumor cells with numerous, LONG SLENDER MICROVILLI and ABUNDANT TONOFILAMENTS -Immunohistochemical markers (PANCYTOKERATIN) are useful in diagnosis

Arysulfatase A enzyme deficiency

Metachromatic leukdystrophy -Peripheral Neuropathy -Progressive neurodegeneration -dementia

Opioid or Heroin Addiction: treatment?

Methadone

What is another name for Nafcillin?

Methicillin

What drug only inhibits Thyroid Peroxidase?

Methimazole

What is a product of Vitamin B12 dependent metabolism of homocysteine?

Methione or S-Adenosyl Homocysteine (SAM) * I answered Methylmalonyl-CoA (B12 deficiency results in INCREASED METHYLMALONYL-COA)

Trimethoprim what drug has the same intracellular target? 2. Target?

Methotrexate & Pyrimethamine 2. Inhibits bacterial dihydrofolate reductase (inhibition of folate synthesis)

Dynein: proteins functionally associated with what cell structure?

Microtubules

Gomori trichrome stain of a muscle biopsy specimen shows muscle fibers with a blotchy red appearance?

Mitochondrial Myopathies -Myoclonic Epilepsy with ragged red fibers (MERRF) -Leber Optic Neuropathy (blindness) -Mitochondrial Encephalopathy) with stroke-like episodes and lactic acidosis (MELAS) "red ragged fiber" diseases ONLY MATERNAL MITOCHONDRIA ARE TRANSMITTED TO THE FETUS!

Red Ragged Fiber

Mitochondrial Myopathies -Myoclonic Epilepsy with ragged red fibers (MERRF) -Leber Optic Neuropathy (blindness) -Mitochondrial Encephalopathy) with stroke-like episodes and lactic acidosis (MELAS) Gomori trichrome stain of a muscle biopsy specimen shows muscle fibers with a blotchy red appearance ONLY MATERNAL MITOCHONDRIA ARE TRANSMITTED TO THE FETUS!

Holosystolic murmur best heard at the apex of the heart that radiates to the axilla?

Mitral Regurgitation

Myxomatous degeneration of the mitral valve leaflets: what does this refer to?

Mitral Valve Prolapse Murmur -> non-ejection click and mid-to late systolic murmur of mitral regurgitation

Diastolic murmur best heard at the apex of the heart has an opening snap?

Mitral stenosis

Narcolepsy: treatment?

Modafinil (1st line!) Amphetamines nightime Sodium Oxybate (GHB)

Medial band-like Calcification of Artery? 2. symptoms?

Monckeberg Sclerosis 2. Clinically asymptomatic because they DO NOT NARROW the vessel lumen

Trastuzumab: MOA?

Monoclonal Antibody against HER-2 (cerbB2) a TYROSINE KINASE RECEPTOR

Patient with a refractory peptic ulcer should be queried for a family history of what disorder?

Multiple Endocrine Neoplasia Type I (MEN I)

Brain Histology: Patches of white matter destruction?

Multiple Sclerosis

Mesoderm: derivatives?

Muscles BONES & CARTILAGE Connective Tissue Serosa linings (peritoneum) Cardiovascular System Blood Lymphatic System Spleen Internal Genitalia Kidney & Ureters ADRENAL CORTEX

Hemochromatosis: pathogenesis?

Mutation causes abnormal iron sensing and INCREASED INTESTINAL ABSORPTION.

Bacteria isolated from lung tissue fails to decolorize with hydrochloric acid and alcohol after staining carbolfuchsin. What cell wall component is responsible for this staining phenomen? 2. What type of stain? 3. What organisms?

Mycolic Acid 2. Acid-Fast Stain 3. Mycobacterium and Nocardia Carbolfuchsin (Red/Pink)

Sudden-onset jerking movement in both arms. Never loses consciousness. 2. Treatment?

Myoclonic Seizure 2. (these are all BROAD SPECTRUM) Lamotrigine Levetiracetam Topiramate Valproic Acid

If measured, the oxygen dissociation curve of the dissolved beta subunits will resemble what line on an Oxygen-Dissociation curve?

Myoglobin Curve Myoglobin has a single heme group and so does not experience heme-heme interactions; therefore its oxygen-dissociation curve is hyperbolic. In contrast to hemoglobin, Myoglobin is a MONOMERIC protein and the primary oxygen-storing protein in skeletal and cardiac muscle tissue; it is only found in the bloodstream after injury. The partial pressure of oxygen at whith 50% of myoglobin molecules are oxygen saturate (P50) is only 1 mm HG, which is much lower than the P50 of hemoglobin (26 mm Hg)

Inhibition of lactate dehydrogenase in strenuously exercising skeletal muscles would eventually lead to an inhibition of glycolysis due to intracellular depletion what substance?

NAD+ NAD+ is required to convert glyceraldehyde-3phosphate to 1-3biphosphoglycerate in GLYCOLYSIS. Under anaerobic conditions, NADH transfers protons to pyruvate to form lactate and to regenerate NAD+

HPV 16, HPV 18

NEOPLASIA -cervical -vaginal -vulvar

Myopia? 2. Where does the image focus?

Near-sightedness (increased eye axial length) -Image focuses IN FRONT OF THE RETINA!!

Encapsulated Bacteria

Neisseria Meningitidis Streptococcus Pneumoniae Haemophilus Influenze Type B

Child with a family history of long QT interval prolongation. This might be accompanied with?

Neurosensory Deafness

Liquefactive Necrosis: explain pathophysiology

Neutrophils release lysosomal enzymes that digest tissue

Vitamin B3 AKA?

Niacin

What is the mechanism that the following are able to resist Cephalosporins? -Atypicals (Mycoplams, Chlamydia)

No Cell Wall

Gram Positive Branching Filaments? 2. Which one are Anaerobic? 3. Which one are Acid Fast? 4. Which one is Aerobic?

Nocardia 2. Actinomyces 3. Nocardia 4. Nocardia

Grows in Bile and NOT IN 6.5% NaCl?

Nonenterococcus Streptococcus Bovis (Gamma Hemolysis)

Blood-brain Barrier: what type of substances cross rapidly?

Nonpolar/lipid soluble

GABA is synthesized where?

Nucleus Accumbens

Notochord becomes?

Nucleus Pulposus of intervertebral discs

Hypothesis of NO difference or relationship

Null Hypothesis (H0) -there is NO association between the disease and the risk factor in the population

What antifungal has the same MOA as Amphotericin B? 2. Use of this antifungal?

Nystatin 2. Topical Use only (Amphotericin B: serious, systemic Mycoses)

Pupillary Light Reflex: What nerve is responsible for the Efferent limb?

Oculomotor (CN III)

MAB targets IgE?

Omalizumab

Hyperacute Transplant Rejection: Type of Hypersensitivity?

Type II Hypersensitivity Reaction

Pleiotropy definition? 2. example?

One gene contributes to multiple phenotypic effects 2. Untreated phenylketonuria (PKU) manifests with light skin, intellectual disability an musty body odor)

Screening: INCREASED Maternal Serum alpha-fetoprotein (AFP)?

Open Neural Tube Defects Ventral Wall Defects Omphalocele Gastroschisis Multiple Gestation

Patient has a right-sided white pupillary reflex. His father was diagnosed with a retinal neoplasm during childhood. What does this child have the greatest risk of developing?

Osteosarcoma -Retinoblastom is MOST COMMON ocular tumor of childhood -White pupillary Reflex (leukocoria) in children <5 yo think Retinoblastoma -sporadic retinoblastoma are NOT at risk for malignancies but patients with FAMILIAL RETINOBLASTOMA often develop SARCOMAS later in life. (OSTEOSARCOMAS most often)

Abdominal cramps, nausea, vomiting, yawning, muscle aches, piloerection, lacrmination, and dilated pupils

Opioid Withdrawal Although withdrawal is uncomfortable it is generally not life-threatening.

Majority of overdose deaths in the United States are related to?

Opioids including both PRESCRIPTION pain medication and HEROIN

CA-125?

Ovarian Cancer (usually markedly ELEVATED in cancerous ovarian cells compared to normal cells) Nothing more specific than that!

P wave QRS T wave

P wave represent atrial depolarization QRS represents Ventricular Deplarization.

Paroxysmal Nocturnal Hemoglobinuria (PNH): usual mutation?

PIGA gene (phosphatidylinositol glycan class A gene) -> GPI anchor protein) -GPI protein anchors CD55 (Decay-Accelerating Factor) and CD59 (MAC inhibitory protein) proteins to RBC membrane which prevents Complement-mediated intravascular RBC lysis

MAB targets RSV F protein?

Palivizumab

Croup: name the virus?

Parainfluenza Virus

Croup:name the family of virus

Paramyxovirus

Dermatitis, diarrhea, and dementia? 2. Deficiency (name 2)

Pellagra - Niacin deficiency (or deficiency in Tryptophan)

Pecnicillinase-sensitive penicillins: names?

Penicillin G, V Ampicillin Amoxicillin

Antibiotics that disrupt the Peptidoglycan cell wall of Gram-positive and Gram-Negative bacteria?

Penicillins Cephalosporins Vancomycin

Primary Structure of Proteins?

Peptide Ponds link Amino Acids

Presence of substance A is required for the full effects of substance B: what is the name of this drug interaction?

Permissive

Cortisol exerts an effect on many hormones to help improve the response to a variety of stressors: what is this called?

Permissiveness

Harmtomatous GI polyps, hyperpigmentation of mouth, feet.

Peutz-Jeghers Syndrome

What are the Antipseudomonal Penicillins? 2. Why?

Piperacillin Ticarcillin 2. Same mechanism as Penicillin, Extended Spectrum (Pseudomonas species and gram negative rods; susceptible to penicillinase; *use with BETA-LACTAMASE INHIBITORS (CLAVULANIC ACID, SULBACTAM, TAZOBACTAM)

Sudden hemorrhage of pituitary gland,

Pituitary Apoplexy often in the presence of an existing pituitary adenoma -sudden onset SEVERE HEADACHE -visual impairment (eg, bitemporal hemianopia, diplopia due to CN III palsy) -FEATURES OF HYPOPITUITARISM

Endomysial Infiltrates?

Polymyositis

anti-Jo-1

Polymyositis Dermatomyositis

anti-Mi-2

Polymyositis Dermatomyositis

anti-SRP

Polymyositis Dermatomyositis

Resting potential of the neuronal membrane is close to the equilibrium potential of what?

Potassium Because the resting membrane is most permeable to potassium

Patient has arrhythmias and a decreased serum TSH level. The arrhythmias is treated appropriately and he is scheduled for radioactive iodine therapy. Pretreatment with which of the following agents would decrease the effects of radiotherapy through competitive inhibition of iodine transportation?

Potassium Perchlorate or Pertechnetate This is basically only asking what drug competitively bind to the Na-I symporter of the Thyroid Follucular epithelial cell.

How is potency related to Minimal Alveolar Concentration?

Potency is inversely proportional to the Minimal Alveolar Concentration (MAC); the lower the MAC, the more potent the anesthetic.

Both Chromosome 15s are from Mother?

Prader-Willi Syndrome

Hyperphagia, obesity, intellectual disability, and hypogonadism with normal 46XY 3 yo. 1. Diagnosis?

Prader-Willi Syndrome

Microdeletions involving the Paternal 15?

Prader-Willi Syndrome

Primary Polycythemia Vera vs Secondary Polycythemia Vera?

Primary -MULTIPLE ELEVATED CELL LINES (ELEVATED THROMBOCYTES, ELEVATED WBCS, with the ELEVATED RBC) -SPLENOMEGALY is more common -HEMATOPOIETIC CELLS MORE SENSITIVE TO GROWTH FACTORS SUCH AS ERYTHROPOIETIN AND THROMBOPOIETIN -LOW ERYTHROPOIETIN Secondary -most likely due to a tumor (Renal cell carcinoma or hepatoceullular carcinoma -INCREASED ERYTHROPOIETIN -only INCREASED RBC (other cell lines not increased)

Syphilis Lesions Names

Primary -> Chancre Secondary -> Condylomata LATA Tertiary -> Gumma

DNA Polymerase III: function?

Primary enzyme responsible for the synthesis of daughter DNA strands.

Ergonovine is used to aid in the diagnosis of what?

Prinzmetal Angina (Variant Angina) this drug PROVOKES CORONARY VASOSPASM and aids in diagnosis.

Brain Histology: Spongiform Transformation of gray matter?

Prion Disease -Creutzfeldt-Jakob Disease -Bovine Spongiform Encephalopathy

Langerhans Cells: function?

Profession Antigen Presenting Cells (APC) -dendritic cells found in the skin -racquet-shaped INTRACYTOPLASMIC granules known as BIRBECK GRANULES

Glucagon binds to a transmembrane receptor in hepatocytes. What mediators are responsible for Glucagon's effects?

Protein Kinase A Adenylate Cyclase cAMP Gs

precursor of Thrombin?

Prothrombin

Indicators of LIVER FUNCTION?

Prothrombin Time Albumin Bilirubin

Nondelusional belief of being pregnant?

Pseudocyesis

Diphteriae Toxin: what bacteria produces a toxin with a mechanism of action most similar?

Pseudomonas Aeruginosa -BOTH inactivate EF-2 via RIBOSYLATION --> thus inhibiting host CELL PROTEIN SYNTHESIS

Indwelling catheter with UTI. it is a non-lactose fermenting gram-negative rod? What is it?

Pseudomonas Aeruginosa (also could have Proteus Mirabilis) also OXIDASE POSITIVE

Type of epithelium in Bronchi & Trachea?

Pseudostratified Ciliate Columnar Epithelium

Cardiac Tissue Conduction Velocity: fastest to slowest?

Purkinje System Atrial Muscle Ventricular Muscle AV Node "Park AT VENTure AVenue"

Denosumab: targets what?

RANKL

Phosphatase: function?

REMOVES PHOSHPATE group from substrate

Insomnia in elderly: treatment? 2. MOA?

Ramelteon 2. Melatonin Receptor Agonist in the Suprachiasmatic Nucleus one of the few medications with demonstrated safety and efficacy in OLDER ADULTS

MAB targets VEGF

Ranibizumab Bevacizumab Ranibizumab (only for Neovascular age-related MACULAR DEGENERATION) Bevacizumab for above and Colerectal cancer, & Renal Cell Carcinoma)

Serotonin is synthesized where?

Raphe Nucleus

Returning to old behaviors

Relapse

Multiple Myeloma: major complications?

Renal Involvement (AMYLOIDOSIS) ANEMIA HYPERCALCEMIA increased SUSCEPTIBILITY TO INFECTION BONE RESORPTION (bone pain)

Blue RBC on Wright-Giemsa Stain: what is this?

Reticulocyte *this is a RETICULOCYTE (immature RBC) that is slightly larger and BLUER than a mature RBC. *lacks a cell nucleus but retains a BASOPHILIC, RETICULAR (mesh-like) network of residual ribosomal RNA.

White pupillary Reflex in a young child?

Retinoblastoma

MECP2 gene?

Rett Syndrome

Mycophenolate: MOA?

Reversibly inhibits a critical step in de novo purine nucleotide synthesis (inosine monophosphate dehydrogenase), which is require for proliferation of activated lymphocytes. It selectively targets lymphocytes, reducing B cell and T cell proliferation and antibody production while promoting T cell apoptosis.

Woman wants a tubal ligation, what is the most appropriate response?

Review the risks and benefits of tubal ligation and alternate birth control methods Every individual has AUTONOMY. CONSENT IS ONLY NEEDED FROM PATIENT.

Children with febrile illness treated with "some over-the-counter pills" and it helped his fever. However boy lapses into a fever. What is the syndrome called. What was he given?

Reye Syndrome *Salicylates (Aspirin)

Cheilosis (inflammation of lips, scaling and fissures at the corners of the mouth), Corneal vascularization. 1. what vitamin deficiency? 2. Necessary for what enzyme?

Riboflavin (Vitamin B2) 2. Succinate Dehyrdrogenase -Complex II (Electron Transport Chain) -FAD and FMN (Flavins)

Red blood cells that appear blue on wright-giemsa stain: the bluish color of the RBC is best explained by the presence of what in the RBC?

Ribosomal RNA *ribosomal RNA appears blue microscopicaly after the application of the Wright-Giemsa stain

What cells would increased bicarbonate concentration in the duodenum? 2. action?

S cells (Small Intestine) -> secrete SECRETIN 2. Increase Pancreatic HCO3- secretion Decrease Gastric H+ secretion Cholecystokinin (CCK) also INCREASES HCO3- secretion.

Achilles Reflex?

S1, S2

Pudendal: what nerve roots?

S2-S4

Scabies: organism?

Sarcoptes Scabiei

Somatic Symptom Disorder: management?

Schedule regular outpatient office visits

Freshwater Snails: organism?

Schistosoma Haematobium (Schistosomiasis)

Collagen Disorder: impaired hydroxylation of proline and lysine residues

Scurvy -this step requires Vitamin C

Stapedial Artery & Hyoid Artery: derivative?

Second Aortic Arch (2nd Aortic Arch) SSSecond =SStapedial

4000 subjects enroll in study to assess daily alcohol consumption and breast cancer incidence. 800 subjects dropped out of study mainly whom were moderate to heavy alcohol consumers. What type of bias does this represent?

Selection Bias (Attrition Bias) Attrition Bias does not occur when the losses happen randomly between the exposed and unexposed groups, as this simply leads to a smaller study population. However in this example 800 were lost that were MODERATE TO HEAVY ALCOHOL CONSUMERS.

Berkson's Bias?

Selection bias that can be created by selecting hospitalized patients as the control group

Young infant with ver low gamma globulin levels, absent thymic shadow, an oral candidiasis infection, chronic loose stools, and multiple infections since birth.

Severe Combined Immunodeficiency *CHRONIC DIARRHEA *CANDIDIASIS *absent THYMIC SHADOW *absent GERMINAL CENTERS

No lactation postpartum, absent menstruation, cold intolerance?

Sheehan Syndrome (HYPOPITUITARISM) -ISCHEMIC INFARCTION (often signs of anemia; low hemoglobin, anemia) -PANHYPOPITUITARISM (failure to lactate from low Prolactin, Hypothyroidism, adrenal insufficiency) -during pregnancy pituitary enlarges due to estrogen-induce hyperplasia of LACTOTROPHS --> however BLOOD SUPPLY DOES NOT INCREASE PORPORTIONALLY. ->ischemia occurs often due to systemic hypotension from PERIPARTUM HEMORRHAGE.

Proximal greater curvature of stomach above the splenic artery: what artery supplies this part of the stomach?

Short Gastric Arteries

Which artery is most affected by compression of the splenic artery (Pancreatic Branches, Left Gastroepiploic Artery, Short Gastric Branches)

Short Gastric Branches *Not Left Gastroepiploic Artery because it Anastomoses with the Right Gastroepiploic Artery

Essential Tremor: Treatment?

Short-term -> Alcohol Long-term -> Beta-Blockers (Propanolol) Primidone

A medication is taken that inhibits lymphocyte proliferation by blocking interleukin-2 (IL-2) signal transduction. The medication used by this patient is most similar to what drug?

Sirolimus Binds FK-506 binding protein (FKBP) that INHIBITS mTOR this leads to INTERRUPTION OF INTERLEUKIN-2 (IL-2) SIGNAL TRANSDUCTION (preventing RESPONSE to IL-2) INTERRUPTION OF IL-2 SIGNAL TRANSDUCTION!!

Ductus Arteriosus: derivative?

Sixth Aortic Arch (6th Aortic Arch)

Proximal part of Pulmonary Arteries: derivative?

Sixth Aortic Arch (6th Aortic Arch)

HPV strains 1-4?

Skin wars (Verruca Vulgaris)

Where does Cartilage end in the airways?

Smalles Bronchi

Etanercept: MOA?

Soluble Receptor Decoy Protein -tumor necrosis factor-alpha (TNF-alpha) INHIBITOR added to METHOTREXATE to treat RHEUMATOID ARTHRITIS (usually if patients have failed MTX alone). -Etanercept reduces the biological activity of TNF-alpha by acting as a decoy receptor.

Excessive ANXIETY and preoccupation with 1 or more unexplained symptoms

Somatic Symptom Disorder

Variety of bodily complaints like pain and fatigue lasting for months to years. Often will say that non-prescription analgesics are working. Overuse of hospital

Somatic Symptom Disorder *may co-occur with medical illness

1/3 of platelet pool stored where?

Spleen

Short Gastric Arteries come off what main artery?

Splenic Artery

Toxin mechanism name the organism: T cell hyperstimulation?

Staphylcoccus Aureus -TSS Toxin (SUPERANTIGEN) -stimulates T-cells leading to WIDESPREAD CYTOKINE RELEASE AND SHOCK!

Callus (Tyloma): is a thickening of what skin layer?

Stratum Corneum (Epidermis)

Gram Positive Cocci?

Streptococcus Staphylococcus

Beta Hemolytic and Bacitracin resistant?

Streptococcus Agalactiae (GBS)

Rhabditiform Larvae in the Stool: organism?

Strongyloides Stercoralis (Threadworm) Nematode (roundworm)

Mycobacterial resistance to Rifampin: mechanism?

Structural alteration of enzymes involved in RNA synthesis (DNA-dependent RNA polymerase)

Riboflavin is low, what is impaired?

Succinate Dehyrdrogenase Electron Transport Chain (acceptance of electrons)

Lower Leg Lateral Compartment: nerves & vessels compresses?

Superficial Peroneal Nerve

Ultrsound-guided midline suprapubic Cystotomy: what structures are penetrated?

Superficial to Deep -Anterior abdominal Aponeurosis -Superficial Fascia (Camper Fascia, Scarpa Fascia, Investing Fascia) -Transversalis Fascia -Extraperitoneal Fat *Bladder is EXTRAPERITONEAL --> Peritoneum is not entered (NOT Visceral or Parietal peritoneum)

Anterior Pituitary is derived from?

Surface Ectoderm (Rathke's Pouch)

Most common cause of Renal Infarction?

Systemic Thromboembolism (from the left atrium or ventricle) *Atrial Fibrillation

Candida extract skin reaction and a firm nodule forms: What cell type is responsible?

T-Lymphocyte (TH1-lymphocytes) Delayed-type hypersensitivity reactions (DTH) (Type IV hypersensitivity)

A geneticist finds that the aminoacyl tRNA section has ribothymidine pseudouridine, cytidine. What is this section important for and where is it located?

T-arm: necessary for tRNA-ribosome binding

TRH is under negative feedback by what?

T3

Alpha-1 Blockers: Which drug does not lower BP?

Tamsulosin

Taenia Solium: what type of organism?

Tapeworm (Cestodes)(parasite)

Inhibition of Squalene Epoxidase

Terbinafine: MOA INHIBITS SYNTHESIS ------>ERGOSTEROL!!

Defect: anterosuperior displacement of the infundibular septum?

Tetralogy of Fallot

What is a STUDY'S POWER? 2. what increases a study's power?

The ability of a study to detect a difference when a difference truly exists. 2. The larger the sample size, the greater the ability of a study to detect a difference if one truly exists. (Meta-Analysis usually have a large sample population)

Obstructive Atelectasis: pathogenesis behind collapsed lung?

The air trapped in the lung gradually GETS ABSORBED into the blood, there is loss of lung volume due to ALVEOLAR COLLAPSE (Atelectasis), which causes the trachea to deviate toward the affected side.

Informed Consent: who should give? 2. What if attending asks you to give it and you don't know the procedure?

The basic elements of INFORMED CONSENT are ACCURATE DESCRIPTION of the intervention and ALTERNATIVE TREATMENTS and discussion of RISKS AND BENEFITS, followed by an assessment of the PATIENTS UNDERSTANDING AND PREFERENCE. Get the Supervising Resident to assist you if you don't know the procedure well enough to explain these things.

A pure alpha-adrenergeic agonist increases systolic and diastolic blood pressure by stimulating alpha1 adrenoreceptors in the vascular walls causing vasoconstrictors. What is the reflex result?

The elevated SBP causes a reflexive increase in VAGAL tone, resulting in DECREASED HR and SLOWED atrioventricular node conduction.

Histologic examination of injured lung tissues a month later shows partial recovery of the alveolar epithelial lining. What cell is responsible for regenerating this tissue?

Type II Pneumocytes

Pulmonary Vascular Resistance is lowest at what point?

The functional residual capacity. Increased lung volumes increase PVR due to the longitudinal stretching of alveolar capillaries by the expanding alveoli. Decreased lung volumes also increases PVR due to decreased radial traction from adjacent tissues on the large extra alveolar vessels.

In order to perform PCR: what must be known about the source DNA template?

The nucleotide sequence of the REGIONS FLANKING the target exons. The exact nucleotide sequence of the targe region does not need to be known.

Incidence?

The number of NEW CASES OF A DISEASE PER YEAR DIVIDED BY THE TOTAL POPULATION AT RISK.

LH stimulates what cells in a woman to produce Androgens?

Theca Interna

Drug for asthma works by reversing irritant-induced bronchoconstriction by causing bronchodilation.

Theophylline

What is a Methylxanthines?

Theophylline

Theophylline vs Ipratropium or Tiotropium?

Theophylline -> causes BRONCHODILATION by inhibiting phosphodiesterase Ipratropium or Tiotropium -> INHIBITS BRONCHOCONSTRICTION via MUSCARINIC ANTAGONIST OF M-3.

Vitamin Deficiency: Peripheral Neuropathy with Heart Failure?

Thiamine (Vitamin B1) -Peripheral Neuropathy -Dilated Cardiomyopathy -Wernicke-Korsakoff Syndrome (confusion, ophthalmoplegia, ataxia, confabulation, personality change, memory loss)

What cofactor is often needed for the enzyme deficiency in Maple Syrup Urine Disease (MSUD)?

Thiamine?

Chlorthalidone: what type of drug? 2. risk?

Thiazide Diuretic 2. Hyper GLUC Hypokalemia Metabolic Alkalosis HyperGLYCEMIA HyperLIPIDEMIA HyperURICEMIA HyperCALCEMIA SULFA Allergy

What hypertension medication, has a beneficial effect on calcium homeostasis and could reduce a patient's fracture risk?

Thiazide Diuretics (Hydrochlorothiazide, Chlorthalidone) INCREASE CALCIUM REABSORPTION in the DISTAL CONVOLUTED TUBULE! Inhibit Na-Cl cotransporter in the DCT leading to decreased sodium reabsorption. Thiazides also cause peripheral vasodilation, resulting in reduced peripheral vascular resistance. Studies have show that use of thiazides is associated with higher bone mineral density and reduced fracture risk.

Common Carotid Artery: derivative?

Third Aortic Arch (3rd Aortic Arch) CC is 33rd letter of alphabet

Proximal Part of Internal Carotid Artery: derivative?

Third Aortic Arch (3rd Aortic Arch) CC is 33rd letter of alphabet

Deficiency of IL-12 receptors: what does this cause?

This would make helper T-cells UNABLE TO DIFFERENTIATE into the TH1 subpopulation. Without TH1 cells the synthesis of IFN-gamma required for ACTIVATION OF MACROPHAGES DOES NOT OCCURE. IL-12 secretion induces the T helper cells to differentiation into the TH1 subtype. Mature TH1 cells then produce INTERFERON-GAMMA (IFN-gamma, IFN-y) which activates macrophages, improving their ability to kill

Exudate Pleural Effusion: treatment?

Thoracentesis -> MUST BE DRAINED -> due to risk of infection

Bruising not associated with trauma, suggestive of?

Thrombocytopenia

CD106 mutation will affect what neutrophil function?

Tight Binding & Crawling

Insect Bite Viruses?

Togaviruses -Eastern -Western -Venezuelan Equine Bunyavirus -California Encephalitis (Aseptic Meningitis Most common in SUMMER & FALL

Diffuse muscle contraction of limbs followed by rhythmic jerking. Loss of consciousness and postictal state. 2. Treatment?

Tonic-Clonic Seizure 2. (these are all BROAD SPECTRUM) Lamotrigine Levetiracetam Topiramate Valproic Acid

What transports iron in blood?

Transferrin TIBC (is HIGH is high in iron deficiency)

Carboxylase: function?

Transfers CO2 groups with the help of BIOTIN

Holosystolic Murmur that increases on inspiration?

Tricuspid Regurgitation -during inspiration, intrathroacic pressure drops, allowing MORE BLOOD to return to the RIGHT HEART

Crohn's Disease: what is the most likely explanation of fistula formation in these patients?

Transmural Inflammation

Pleural Effusion from Cirrhosis: type of fluid?

Transudate (Decreased Protein)

Pleural Effusion from Nephrotic Syndrome: type fluid?

Transudate (Decreased Protein)

Pleural Effusion from increased hydrostatic pressure: type of fluid?

Transudate (Decreased Protein)

Deep Inguinal Ring is a physiological opening in what layer?

Transversalis Fascia

Mediolateral Episiotomy: what muscle is cut?

Transverse Perineal Muscle

Some human cells are unable to generate NADPH from glucose metabolism but are able to synthesize ribose from fructose-6-phosphate. What enzymes are essential for the latter finding? 2. What enzyme is required as a cofactor?

Trasketolase Transaldolase 2. Thiamine ALL CELLS can synthesize RIBOSE from the blycolysis intermediate Fructose 6-phosphate and glyceraldehyde 3-phosphate with the help of TRANSKETOLASE & TRANSALDOLASE even if the OXIDATIVE REACTIONS of the HMP Pathway are not active in those cells.

MAB Targets HER2/neu?

Trastuzumab

Low maternal serum alpha-fetoprotein (AFP) Low Estriol Increased Beta-hCG Increased Inhibin A

Trisomy 21 (Down Syndrome) Low AFP and low Estriol, possibly due to suboptimal fetal tissue function. Increased Beta-hCG and Increased Inhibin A possibly due to compensatory placental hyperfunction.

A patient has genital warts and has oral sex, what part of the oral and larynx could this affect? 2. Which virus is she affected with? (be specific)

True Vocal Cords 2. HPV 6 & 11 HPV 6 & 11 -> has predilection for STRATIFIED SQUAMOUS EPITHELIUM True Vocal Cords -> in the respiratory tract are the only area with STRATIFIED SQUAMOUS EPITHELIUM.

Digeorge Syndrome: Disturbed development of which cardiac structure most likely occurred in Utero? (Truncus Arteriosus or Primitive Ventricle?)

Truncus Arteriosus *I choose VSD and the answer said the Primitive Ventricles are not DIRECTLY AFFECTED although VSDs can occur... Lame!

Acute Necrotizing Pancreatitis: inappropriate activation of what enzyme initiates this condition?

Trypsinogen

Niacin can be synthesized endogenously from?

Tryptophan IMPORTANT FOR NIACIN DEFICIENCY (PELLAGRA)

Rasburicase: use?

Tumor Lysis Syndrome

Which of the following anticoagulants is most effect in inactivating thrombin? (Enoxaparin, Fondaparinux, Unfractionated Heparin)

Unfractionated Heparin

Which type of Heparin is able to bind to both antithrombin and thrombin?

Unfractionated Heparin

Tuberous Sclerosis: heart defects?

Valvular obstruction due to cardiac rhabdomyomas

Estrogens: how do they affect synthesis of Cholesterol?

Up regulated HMG-CoA reductase activity -potentially lead to formation of gallstones.

Lumbosacral Radiculopathy of L2: sensory? Weakness??

Upper anterior medial thigh Hip flexion (iliopsoas)

1. Describe the airway resistance curve on a graph from trachea to terminal bronchioles? 2. Resistance to airflow is greatest in what region of the respiratory system?

Upper respiratory tract (nasal passages, mouth, pharynx, larynx) accounts for about HALF of the total airway resistance. resistance INCREASES in the MEDIUM-SIZED BRONCHI because of HIGHLY TURBULENT AIRFLOW.

Mitral Regurgitation Pressure Tracings

Upslope on the left atrium is called a V WAVE

Oxybutynin, solifenacin, tolterodine: Use?

Urge Incontinence or Overactive Bladder -sudden sensation of urgency, with involuntary leakage or urine before reaching the toilet.

Dopamine is synthesized where?

Ventral Tegmentum SNpc

Papilledema, dry skin and hepatosplenomegaly: what vitamin is being used wrong?

Vitamin A OVERUSE Acute Toxicity -> a single high dose of Vitamin A includes NAUSEA, VOMITING, VERTIGO, and BLURRED VISION Chronic Toxicity -> ALOPECIA, DRY SKIN, HYPERLIPIDEMIA, HEPATOTOXICITY, HEPATOSPLENOMEGALY, AND VISUAL DIFFICULTIES. PAPILLEDEMA, when present is suggestive CEREBRAL EDEMA in the setting of BENING INTRACRANIAL HYPERTENSION (PSEUDOTUMOR CEREBRI). Teratogenic Effects of excessive Vitamin A ingestion -> Microcephaly, cardiac anomalies, and fetal death (especially first trimester of pregnancy)

Riboflavin aka?

Vitamin B2

Niacin AKA?

Vitamin B3

Biotin aka?

Vitamin B7

Patient's platelets do not aggregate appropriately in response to Ristocetin. 1. Patient is deficient in?

Von Willebrand Factor *I chose Hagemen Factor (Factor XII) would cause marked PTT prolongation without bleeding diathesis. Instead patients may have a tendency for a Thromboembolic complication.

Parents are concerned that sending their child with Cystic Fibrosis to school will cause her to get infected with chronic infections. The child misses seeing her friends. Which of the following is the most likely cause of this patient's excessive school absences?

Vulnerable Child Syndrome Parents perceive the child as especially susceptible to illness or injury. Usually follows a serious illness or life-threatening event. Can result in missed school or overuse of medical services.

Mechanical Heart valves: what drug should you give them? 2. MOA?

Warfarin 2. Vitamin K Epoxide Reductase Inhibitor

HypoKalemia: what can it cause?

Weakness Arrhythmias -T wave flattening -ST-segment depression -prominent U waves -prematures atrial and ventricular contractions Profound hypokalemia can cause VENTRICULAR TACHYCARDIA or FIBRILLATION

Salmonella Typhi: progression

Week 1 (rising fever, bacteremia, relative bradycardia) Week 2 (abdominal pain, rose spots on trunk & abdomen) Week 3 (Hepatosplenomegaly, Intestinal bleeding and perforation)

Erythroblastosis Fetalis?

When Type O mother have IgG antibodies that cross the placenta and cause hemolysis in the fetus.

Kayser-Fleischer Ring: Diagnosis? 2. What other associated conditions?

Wilson's Disease 2. Basal Ganglia Atrophy -Liver Disease (causes chronic hepatitis) -Neurologic Disease (dysarthria, dystonia, tremor, parkinsonism) -Psychiatric Disease -Hemolytic Anemia -Renal Disease (eg, Fanconi Syndome

Low Serum Ceruloplasmin

Wilson's Disease The ONLY DISEASE for this!! The mutation in Wilson's disease hinders copper metabolism by reducing the formation and secretion of ceruloplasmin and decreasing hepatic secretion of copper into biliary system.

What ethnicities have a greater risk for osteoporotic fracture?

White Hispanic Asian (African American Ethnicity have a GREATER BONE DENSITY!!)

18 month male, eczematous skin rash, several bouts of severe respirator infections, increased bleeding time, WBC count of 9,000. Platelets of 40,000. Platelets are abnormally small and deformed on peripheral blood smear. 1. Diagnosis?

Wiskott-Aldrich Syndrome -X-linked Recessive

Lesch-Nyhan Syndrome:

X-linked Recessive

DNA excision Repair (Nucleotide excision repair): what diseases associated with this?

XERODERMA PIGMENTOSUM Fanconi Anemia Bloom Syndrome

Recurrent Ulcers in duodenum and jejunum?

Zollinger-Ellison Syndrome

Sleep problems and non pharmacologic measures aren't working, patient wants something that won't make them addicted: treatment?

Zolpidem Zaleplon EsZopiclone "all ZZZ's put you to sleep"

Tight Junctions aka?

Zonula Occludens

When Ciliary Muscles relax: what happens to the lens?

Zonular Fibers TIGHTEN -> FLATTEN LENS

Ciliary Muscle CONTRACTS: what happens to the lens?

Zonular fibers Relax --> THICKEN LENS

Adiponectin: function?

a cytokine secreted by fat tissue that increases the number of insulin-responsive adipocytes and stimulates fatty acid oxidation

Minimal Alveolar Concentration?

a measure of potency of an inhaled anesthetic

Interferon-gamma (IFN-gamma) is produced primarily by? (be specific)

activated T LYMPHOCYTES (Th1) & Natural Killer Cells

Cadherins: associated with what?

a part of CADHERINS (protein) in the cell junction of DESMOSOMES Pemphigus Vulgaris

Desmogleins: associated with what?

a part of CADHERINS (protein) in the cell junction of DESMOSOMES Pemphigus Vulgaris

Desmoplakin(protein): associated with what?

a part of CADHERINS (protein) in the cell junction of DESMOSOMES Pemphigus Vulgaris

Protein Kinase A (PKA): how is it activated? 2. How does it activate its target?

activated by cAMP formed by adenylate cyclase. PKA regulated the activity of its target proteins by phosphorylating threonine and serine residues

Phenylephrine: MOA?

a sympathomimetic drug with PURE ALPHA ADRENERGIC AGONIST activity. Infusion of this drug causes VASOCONSTRICTION with an INCREASE in SYSTEMIC VASCULAR RESISTANCE.

Phosphorylase: function?

add INORGANIC PHOSPHATE onto substrate without using ATP

Permanent Cells?

aka Terminally Differentiated adult somatic cells Neurons Skeletal Muscle Cardiac Muscle RBCs

Foregut structures?

all structures from MOUT to 2nd part of the duodenum

Hemolysis: alpha, Beta, Gamma? 2. What bacteria?

alpha Hemolysis: partial Beta Hemolysis: Complete Gamma Hemolysis: NO hemolysis (grows in BILE) 2. STREPTOCOCCUS

Decongestants: MOA?

alpha-adrenergic agonists -VASOCONSTRICTION OF THE NASAL MUCOSA VESSELS

Neural Tube Defects: what will be elevated in the CSF?

alpha-fetoprotein (AFP) Acetylcholinesterase

Polymyositis & Dermatomyositis may occur independently or as a manifestation of what?

an underlying malignancy (especially ADENOCARCINOMA)

West Nile Virus: diagnosed by?

anti-WNV antibodies

Remote Memory test?

ask patient about details of significant life events (birth, graduation, marriage dates)

Comprehension test?

ask patient to follow multistep commands

Why are Berry Aneurysms particularly prone to rupture when associated with coarctation of the aorta?

because of HYPERTENSION in branches of the aortic arch PROXIMAL TO THE COARCT.

Atrial Natriuretic Peptide & Brain Natriuretic Peptide (ANP & BNP): MOA?

bind ANP receptors, these transmembrane receptors are linked to guanylyl cyclase that converts guanosine 5'-triphosphate to cyclic guanosine 3' , 5'-monophosphate (cGMP). cGMP then activates a downstream protein kinase that leads to RELAZATION OF VASCULAR SMOOTH MUSCLE AND SUBSEQUENT VASODILATION

Phenytoin: MOA? Therapeutic Index?

blocking voltage-gated sodium channels in neurons has a NARROW-therapeutic index (with a number of potential adverse effects)

Metyrapone: function?

blocks conversion of 11-deoxycortisol to cortisol USED TO TEST FOR ADRENAL INSUFFIENCY

Osteoblasts: serum marker?

bone-specific Alkaline Phosphatase

Gastroschisis vs Omphalocele

both are HERNIATION OF abdominal contents Gastroschisis -> NOT covered by peritoneum Omphalocele -> COVERED by periotneum

Primary Polycythemia Vera: Diagnosis?

by confirming LOW SERUM EPO & bone marrow aspiration cytogenetic studies showing a JAK2 MUTATION

Kinase: function?

catalyze transfer of PHOSPHATE group from a high-energy molecule (usually ATP) to a substrate

Pernicious Anemia: What does a loss of Gastric Acid and Intrinsic Factor cause?

causes a COMPENSATORY INCREASES IN GASTRIN!!

Drug: Agonist plug noncompetitive antagonist 2. what does this change?

decreases EFFICACY

Drug: Partial Agonist (alone) 2. what does this change?

decreases EFFICACY

Drug: Reversible Competitive Antagonist 2. What does this change?

decreases POTENCY (ED50)

Ezetimibe: MOA

decreases intestinal absorption of cholesterol

Carnitine Deficiency: what would this cause 2. What substance has deficient synthesis in this patient's disease?

defect in transport of Long-chain Fatty Acid (LCFA) into the mitochondria -> TOXIC ACCUMULATION OF LCFA. -WEAKNESS -HYPOTONIA -HYPOKETOTIC HYPOGLYCEMIA (OVERUSE OF GLUCOSE) -CARDIOMYOPATHY 2. KETONE BODIES (ACETOACETATE) because Beta-oxidation of fatty acids into Acetyl-Coa is prevented so in times of fasting there is impaired ketone body production. Medium-chain Acyl-CoA Dehydrogenase Deficiency (MCAD) is similar presentation just not a deficiency in Carnitine

Rasburicase: MOA?

converts Uric acid to more soluble Metabolites (Catalyzes metabolism of URIC ACID to ALLANTOIN)

cholesterol 7-alpha-hydroxylase: function?

converts cholesterol into bile acids

HPV: E6 viral protein function?

degrades p53 (tumor suppressor protein regulating the cell cycle)

Fondaparinux, Apixaban, and Rivaroxab: MOA?

direct FACTOR Xa inhibitor

club cell

dome-shaped cells with short microvilli, found in the small airways (bronchioles) of the lungs; One of the main functions of club cells is to protect the bronchiolar epithelium; also responsible for detoxifying harmful substances inhaled into the lungs

Hepatitis B Virus: replication sequence?

double-stranded DNA -> +RNA template -> double-stranded DNA progeny Although it is a DNA virus, HBV replicates via Reverse Transcriptase.

Glucocorticoids: MOA?

inhibit PHOSPHOLIPASE A2, which decreases PROSTAGLANDIN and LEUKOTRIENE synthesis

What is the best estimate of Renal Plasma Flow?

estimated using para-aminohippuric acid (PAH) clearance because between filtration and secretion there is nearly 100% excretion of all PAH that enters the kidney.

Myoedema

focal mounding of muscle following percussion

Hippocampus: function?

formation of new memories

Brain preferentially uses what for energy? 2. Brain will utilize what for most of its energy needs during PROLONGED STARVATION?

glucose 2. Ketones

Pulmonary Hypertension value?

greater than or equal to 25 mm Hg (normal 10-14)

Pancreatic secretions: High flow?

high HCO3-

Medicare: part A

hospitAAAL insurance (inpatient hospital visits)

Why do asthmatics sometimes get oral candidiasis?

if they take oral or inhaled steroids they are increased risk

Metyrapone Stimulation Test

inhibits 11-Beta-Hydroxylage which converts 11-deoxycortisol to cortisol Decreased Cortisol production INHIBITS CORTISOL SECRETION -> causes an ACTH SURGE SERUM 11-deoxycortisol and URINARY 17-hydroxycorticosteroid levels will NORMALLY RISE in response to METYRAPONE STIMULATION TEST indicating an INTACT HPA 11-deoxycortisol is metabolized by the liver to 17-hydroxycorticosteroids that accumulate in the URINE.

Disseminated Intravascular Coagulation: what are the levels for ?platelet count, prothrombin time (PT), partial thromboplastin time (PTT), fibrinogen, fibrin degradation products (FDP), d-dimer?

increased prothrombin time (PT), Increased partial thromboplastin time (PTT), decreased fibrinogen INCREASED FDP INCREASED D-DIMER

Recombination

is a rare event and refers to the gene exchange that occurs through the crossing over of 2 double-stranded DNA molecules. The resulting progeny can have recombined genomes WITH GENES NOT PRESENT SIMULTANEOUSLY IN EITHER PARENT VIRUS

Stable Cells?

meaning they can enter G1 from G0 when stimulated Hepatocytes Lymphocytes

Length Constant (Space Constant): what is it?

measure of how far along an axon an electrical impulse can propagate

Bosentan: what do you need to monitor during treatment?

monitor Liver Function Tests (LFTs) *Hepatotoxic

Well differentiated (low-grade) tumors contain cells that are? 2. examples?

morphologically and architecturally similar to normal cells in the tissue of origin -skin tumor cells producing keratin pearls -bronchial epithelial cells producing keratin pearls (this one is tricky -> first the cells undergo a phenotypic switch from columnar epithelium to squamous epithelium. The process of switching from one differentiated cell type to another is known as metaplasia and often occurs in response to irritants (tobacco smoke or gastric acid)

Prokaryotic mRNA can be Polycistronic: what does that mean?

one mRNA codes for several proteins like LAC OPERON (one mRNA codings for 2 enzymes)

discharge from an umbilical cord and the umbilical cord has fallen off less than 1 month

persistence of allantois remnant

What happens when Pro-T cells arrive at the thymus?

originally they lack both CD4 and CD8 antigens "double negative" cells. Next, the process of TCR gene rearrangement begins first with rearrangement of the b chain genes. This leads to expression of both CD4 and CD8 antigens. Now these are "double positive" T cells = IMMATURE T-LYMPHOCYTES

Hardy-Weinberg Analysis

p + q = 1 p^2 + 2pq + q^2 = 1 (p^2) = Normal frequency 2pq = Carrier frequency q^2 = Disease frequency ESTIMATE!!! ------>>>>>> P(carrier) = 2q Probably give you you 1 in 40,000 of general population have the autosomal recessive disease. (this is q^2)(this makes q = 1/200) P = 2(1/200) = (1/100)

Investigators report a 5-year relative risk of 1.4 fore people who consume alcohol daily compared to those who do not. The 95% confident interval is 1.02 - 1.85. Which of the following p-values is most consistent with the results described?

p-value <0.05 When the 95% Confidence Interval DOES NOT include the null value, this give s a corresponding P-Value < 0.05 and the association between exposure and outcome is considered statistically significant. 95% confidence interval and p-value are 2 measures of statistical significance that can help strengthen the findings of a study using RR.

Salicylate (Aspirin) overdose about 4-5 hours ago. Predict the pH, PaCO2 and Plasma HCO3-?

pH 7.38 PaCO2 20 mm Hg Plasma HCO3- 12 mEq/L PaCO2 is low because the medullary respiratory center was stimulated by the salicylates. Then the Anion Gap Metabolic Acidosis began to set by increased organic acids which lowered the HCO3- in the blood. These combine to balance out the pH which make it in the NORMAL RANGE.

Renal Plasma Flow: what is it?

plasma entering and then leaving the kidney per unit time

Thromboxane A2: function

potent stimulator of PLATELET AGGREGATION & VASOCONSTRICTION

Mutase: function?

relocates a functional group within a molecule.

NF-kB pathway: function

proinflammatory transcription factor that INCREASES CYTOKINE PRODUCTION

Angiosarcoma: generally what type of tissue does it affect?

rare blood vessel malignancy

Nesiritide?

recombinant form of Brain Natriuretic Peptide

what the heck is REVERSE T3?

reverse T3 (inactive form) -all UWORLD says.

Internal Branch of the Superior Laryngeal Nerve: function?

sensory innervation to the laryngeal mucosa ABOVE THE VOCAL FOLDS

During normal Embryonic development: Melanocytes start where and end up where? (called MIGRATION!)

start in NEURAL CREST and end in EPIDERMIS -this is considered MIGRATION

During normal Embryonic development: Germ cells start where and end up where? (called MIGRATION!!)

start in the YOLK SAC and end move to the GONADAL RIDGE -this is called MIGRATION!

West Nile Virus: management?

supportive

After implantation what cells secrete Beta-hCG?

syncytiotrophoblasts

eNOS: function

synthesizes Nitric Oxide from Arginine, NADPH, and O2

Pancreas is derived from?

the Duodenal portion of the FOREGUT!! The pancreas grows like twigs off the duodenum.

Very high levels of hCG can over-stimulate what?

thyroid gland, causing paraneoplastic hyperthryroidism. This can occur in TESTICULAR MALIGNANCY or GESTATIONAL TROPHOBLASTIC DISEASE. TSH receptors can be stimulated and cause HYPERTHYROIDISM.

Heparin: main goal?

to INACTIVATE THROMBIN -> this is done by binding ANTITHROMBIN II (AT III). Once activated, AT II binds to FACTOR XA and stops FACTOR XA from converting PROTHROMBIN to THROMBIN (which means less THROMBIN IS PRODUCED!!) -> less coagulation (anticoagulation)

N-myc or C-myc: general function?

transcription factor, by definition they are capable of binding DNA Because of its DNA-binding ability the MYC proteins can be detected by DNA probes

Helicase: function?

unwinds the DNA at the replication fork which causes supercoiling.

Platelet Dense alpha contain?

vWF (von-Willebrand Factor) Fibrinogen Fibronectin

How do Osteocytes send signals and exchange nutrients and waste products with the osteocytes within neighboring lamellae?

via Gap Junctions

Histone Acetylation?

weakens the DNA-histone bond Histone ACETYLATION makes DNA ACTIVE

Normal Distribution (Gaussian): 95% of of data falls within how many standard deviations of the mean?

within 2 standard deviation from the mean. 68% = 1 standard deviation 95% = 2 standard deviation 99.7% = 3 standard deviation 65/95/99

Pleural Effusion from malignancy: type of fluid?

Exudate (Increased Protein)

Pleural Effusion from pneumonia: type of fluid?

Exudate (Increased Protein)

Pleural Effusion from trauma: type of fluid?

Exudate (Increased Protein)

RSV: name the family of virus

Paramyxovirus

Croup & RSV come from the same family: what is it? 2. What other viruses are in this family?

Paramyxovirus 2. Measles & Mumps

Red urine in the morning, fragile RBCs

Paroxysmal Nocturnal Hemoglobinuria (PNH)

Effect of substance A and B together is greater than the sum of their individual effects: what is the name of this drug interaction?

Synergistic

Artery Biopsy: Onion-like concentric thickening of arteriolar walls 1. what is this called? 2. What causes this?

1. Hyperplastic Arteriolosclerosis "Onion skinning" 2. Severe Hypertension

Elevated levels of CK, weight gain, and chronic fatigue 1. Diagnosis 2. What test should be done?

1. Hypothyroidism 2. Serum TSH levels

Enhancers: function? 2. location?

1. INCREASE & DECREASE the rate of transcription 2. upstream, downstream, or within a transcribed gene

Cholecystokinin (CCK): function? 2. Secretion site?

1. Increase Pancreatic Enzyme Secretion (Trypsinogen) Increase Bicarbonate (HCO3-) secretion GALLBLADDER CONTRACTION 2. I Cells (small intestine)

Promoters: function? 2. location 3. types?

1. Initiate Transcription 2. 25 or 75 bases upstream from associated genes 3. TATA (Hogness) Box or CAAT box

Thoracentesis on RIGHT: where should it be performed? 1. Midclavicular Line? 2. Midaxillary Line? 3. Paravertebral Line?

1. Rib 6-8 2. Rib 8-10 3. Rib 10-12 Risk of Injury to LIVER if you are below these levels on the RIGHT side

All patients with Systolic Heart Failure should receive what medication that will REDUCE MORTALITY?

ACE-I (ACE-Inhibitor) or ARB (Angiotensin II Receptor Blockers)

Hypertension & Diabetes: what medication?

ACE-I or ARBs Diabetes causes impaired autoregulation of glomerular blood flow, leading to significant elevations of intraglomerular pressures and chronic glomerular injury. Patients with diabetes and hypertension are at especially high long-term risk for CHRONIC KIDNEY DISEASE. Both of these will cause preferential DILATION of the glomerular EFFERENT arteriole, lowering intraglomerular pressures and reducing the risk of chronic glomerular injury.

Measles (Rubeola) vs German Measles (Rubella)

BOTH are characterized by a Maculopapular rash that begins on the face and spreads to the trunk and extremities. Measles (Rubeola) -Paramyxovirus -NOT associated with postauricular lymphadenopathy and tenderness German Measles (Rubella) -Togavirus -ASSOCIATED with postauricular lymphadenopathy and tenderness

Weak urinary stream, straining on micturition, nocturia, with oliguria, and polyuria.

BPH

Zolpidem Zaleplon EsZopiclone : MOA?

BZ1 subtype of the GABA receptor

Blood smear shows normocytic, normochormic anemia with cross-shaped intrerythrocytic inclusions: Diagnosis? 2. The vector responsible for this condition can also transmit what other organism? 3. Vector? 4. Treatment?

Babesiosis (Babesia)(Protozoa) -also has ring form -causes fever & hemolytic anemia -northeastern US -asplenia increased risk of severe disease 2. Borrelia Burgdorferi Anaplasma spp 3. Ixodes Deer Tick 4. Atovaquone + Azithromycin

Atrophy: explain the size, and number of cells?

DECREASE IN SIZE and/or DECREASE in NUMBER OF CELLS

Most important biochemical abnormality in Alzheimer disease?

DECREASE in ACETYLCHOLINE LEVEL This usually occurs due to the deficiency of CHOLINE ACETYLTRANSFERASE.

Excess Cortisol is characterized by what (CRH, ACTH, cortisol levels)? Decreased Cortisol?

DECREASED CRH, ACTH, and cortisol INCREASED CRH, ACTH, and cortisol

Polycystic Ovary Syndrome (PCOS): what is the level of progesterone? 2. why does this matter?

DECREASED Progesterone 2. risk of ENDOMETRIAL HYPERPLASIA (ADENOCARCINOMA)

Phenylketonuria: what is deficient? 2. what is elevated?

DECREASED Serotonin & Dopamine (DOPA) 2. ELEVATED Phenylalanine

Exercise: what happens to Systemic Vascular Resistance?

DECREASES

Thiazolidinediones/Glitazones: exert their glucose-lowering effect by?

DECREASING INSULIN RESISTANCE (aka INCREASING INSULIN SENSITIVITY in peripheral tissue -> skeletal muscle and fat)

Beta Hemolytic and CAMP-positive?

Streptococcus Agalactiae (GBS)