0
Q
A patient with wernicke’s has trouble utilizing glucose for energy, name 3 enzymes that are impaired:
A
- Pyruvate dehydrogenase
- alpha-ketoglutarate DH
- Transketolase (HMP shunt…. pentoses –> Glyceraldehyde-3-P)
1
Q
What type of bacteria can typically survive very high temperatures (past 100 deg C)?
A
- Spore-forming ones
e. g. Bacillus and Clostridium
2
Q
TZD diabetes drugs like Pioglitazone’s most common side effect is _________. Because of this, you dont wanna give it to patients who have ________.
A
- EDEMA and weight gain (2/2 edema)
- patients with HF
3
Q
WHat are some clues to tell you a patient with SLE has anti-phospholipid antibodies?
A
- prolonged aPTT (in vivo though, they are actually Hyper-coagulable)
- False positive non-treponemal tests
- recurrent miscarriages
4
Q
The __________ nerve runs right above the superior thyroid artery. injury causes loss of innervation to the _________ muscle.
A
- Superior laryngeal nerve
- Cricothyroid muscle (external branch)
- internal branch —> sensory innervation of Larynx above vocal cords
*All other laryngeal muscles done by RECURRENT Laryngeal nerve
5
Q
How does the killed influenza virus prevent infection?
A
- increases host circulating antibodies against Hemaglutinin
- The antibodies interfere with the binding of Hemaglutinin to the sialic acid on host cell plasma membranes —> prevents viral entry into host cells via rec.-mediated endocytosis.
*In general, killed vaccines generate a humoral response instead of a strong cell-mediated response
6
Q
The presence of hemosiderin-laden macrophages is detectable by _______ staining. Their presence in pulmonary alveoli indicates _________.
A
- Prussian blue staining
- chronic elevation of capillary hydrostatic pressures. (usually L sided HF)
7
Q
How do PPI’s work?
A
-Inhibit active transport of H+ out of gastric cells by inhibiting H+/K+ ATPase
8
Q
How does McArdle’s disease typically present and what enzyme is deficient?
A
- Decr exercise tolerance
- myoglobinuria
- Muscle pain with physical activity
-Glycogen phosphorylase (myophosphorylase in muscle)
9
Q
What is a common side effect of colchicine?
A
- GI distress
* affects microtubules, including those of GI mucosal cells –> diarrhea, N/V, abd pain
10
Q
___________ forms precursor mRNA from the DNA template
A
-RNA polymerase 2
11
Q
Pro-carcinogens are converted to carcinogens by ________, the same enzymes responsible for metabolizing steroids, alcohol, toxins, etc?
A
-P450 monooxygenase
12
Q
What is Mifepristone used for? How does it work? Side effects?
A
- Medical abortion
- Progesterone antagonist
- Side effects related to its stimulation of Prostaglandin release: Abd cramps, nausea, vaginal bleeding
13
Q
What are Homeobox genes?
A
- Highly conserved DNA sequences
- code for DNA-binding transcription factors…which alter expression of genes involved in morphogenesis
14
Q
Acutely, corticosteroids cause an increase in _________ (cells), and a decrease in _________ (cells)
A
- Neutrophils
- Lymphocyte, monocyte, basophil, eosinophil
15
Q
What is the treatment for Acetomeniphen toxicity?
A
- Sulfhydryl group supplementation (N-acetyl cysteine aka NAC)
- Also acts as a glutathione substitute and binds to the toxic metabolite
16
Q
What is the effect on TSH, Reverse T3, and T4 ….from supplementation of exogenous T3?
A
-All decrease
17
Q
Communicating hydrocephalus usually occurs 2/2 dysfunction or obliteration of ________
A
-Subarachnoid villi (granulations)
18
Q
Where should thoracoscentesis be performed?
A
- Midclavicular –> above rib 7
- Midaxillary –> above rib 9
- posterior scapular –> above rib 11
19
Q
Burkitt’s lymphoma is associated with what translocation?
A
- C-MYC gene
- usually onto the Ig heavy chain region of chromosome 14 ( t(8;14) )
20
Q
High levels of aflatoxin from aspergillus is associated with a __________ transversion in the _______ codon of the p53 gene. This greatly increases the risk of ________.
A
- G:C —> T:A
- 249 codon
- Hepatocellular carcinoma
*most common is aflatoxin B1
21
Q
Describe Estrogen’s effects on Thyroid hormones:
A
- Estrogen increases TBG
- This leads to increased TOTAL T3 and T4, but Free T3 and T4 remain unchanged, as does TSH
22
Q
Sulfonylurea or meglitinide abuse shows increases in ________.
The same is true for what tumor?
A
- Insulin, pro-insulin, c-peptide
- Insulinoma
*Insulin abuse would show low c-peptide
23
Q
What is the mechanism of action for chloramphenicol? What are some notable side effects?
A
-binds the 50s ribosomal subunit and inhibits peptidyl transferase enzyme —> inhibition of protein synthesis
- Dose-related Anemia, Leukopenia, and/or TCP (reversible with med withdraw)
- Dose-independent Aplastic anemia (usually severe and fatal without marrow tpx)
24
What is the mechanism of action of etanercept and what is it used for? Patients should first be screened for _______.
- TNF-alpha inhibitor
- Tx of mod-severe RA, particularly in pts who failed methotrexate.
- TB
*also incr risk of infxn with fungi, and other mycobacteria
25
A child with ulcerative gingivitis, fever, and cervical LAD may have ________. Sample from one of the ulcers shows multinucleated giant cells with some intranuclear inclusions.
- HSV-1 primary infection
| * Q 1499
26
What viruses are the most common causers of aseptic meningitis?
Enteroviruses:
- coxsackie
- Echovirus
- polio
- enterovirus
27
Which bacteria is Gram positive rod in clusters, non-motile, and has polar granules that stain deeply with aniline dyes?
How does its toxin work?
- Corynebacterium diphtheriae
- AB toxin
* B toxin --> endocytosis of toxin and affinity for cardiac and neuronal cells
* A toxin ---> Inhibits EF-2 by ADP-ribosylation --> inhib prot synthesis
28
Inhaled anesthetics with high A-v O2 gradients have _______ tissue solubility, and _______ onsets of action.
- High
- Slower
* slower bc tissues extract a lot of drug, meaning it takes longer to get a good concentration in the brain
29
In a Methacholine challenge, decrease in FEV1 by more than ______ from baseline indicates diagnosis of bronchial asthma
-20%
30
Pathway for pupillary light reflex:
-Afferent on CN2 --> Pretectal nucleus in the superior colliculus ---> fibers project to ipsilateral and contralateral Edinger westphal nuclei ---> efferent fibers of CN3 leave EW nuclei travel within CN3 to the ciliary ganglion -----> synapse in ciliary ganglion with post-synaptic parasympathetics ---> ciliary muscles ---> constriction
31
What is the clinical presentation involved with cyanide poisoning?
What are 2 treatment options and how do they work?
Symptoms (rapidly developing):
- cutaneous flushing
- tachypnea
- headache
- tachycardia
- N/V
- confusion
- weakness
Tx options:
1. Nitrites: induce formation of metheboglobin by oxidizing Iron --> strongly binds Cyanide and doesnt let it interact with O2 utilizing cells
2. Sodium Thiosulfates = combine with cyanide to form less-toxic thiocyanate --> urinary excretion
32
What is the Sudan III stool stain used for?
-Detection of the presence of fat in the stool. Diagnosis of malabsorption
33
The R brachiocephalic vein is formed by the union of the R _______ and the R ________.
*compression leads to _______
- R subclavian
- R internal jugular
*compression --> R sided face, neck and arm swelling
34
What is the most common site of staph aureus colonization (including MRSA) ?
-Anterior nares
35
Describe the underlying pathophys of CML and what drug targets it specifically?
- t(9;22) --> ABL oncogene translocated to chromosome 22, where it is placed next to the BCR proto-oncogene
- New BCR-ABL gene codes for a protein with tyrosine kinase activity
- Tyrosine kinase stimulates proliferation of granulocytic precursors -----> CML
-Gleevec = tyrosine kinase inhibitor, specific for BCR-ABL protein. Competitively binds the ATP binding site of the ABL portion
36
WHat facilitates auscultation of an Aortic regurgitation murmur?
-Patient leaning forward and fully exhaling
37
in What area is H. Pylori most typically found in greatest concentration?
-Pre-pyloric area of the antrum of the stomach
38
Buerger's disease is also known as _________.
- It is common in what population?
- what is seen histologically?
- Thromboangiitis obliterans
- Smokers before age 35 (either direct endothelial cell toxicity or hypersensitivity to tobacco products)
- segmental vasculitis extending into contiguous veins and nerves
39
What do kaposi's sarcoma lesions of the GI tract typically look like? both grossly and histologically
- Gross: vary from reddish/violet flat maculopapular lesions to raised hemorrhagic nodules or POLYPOID masses.
- Histo: SPINDLE CELLS with cytologic atypia, blood vessel proliferation, extravasated RBCs with hemosiderin deposition
40
What is the clinical presentation of polyarteritis nodosa?
- histology of vessels?
- associated with what infection?
Clinical:
-fever, abd pain, periph neuropathy, weakness, weight loss, diffuse muscular aches and pains.
Histo:
- transmural inflammation of the arteries with fibrinoid necrosis
- fibrous wall thickening
Association:
-Hep B infection (10-30% of cases )
41
Saddle anesthesia and impaired anal sphincter tone are symptoms of ________, which is associated with damage to the ________ nerve roots
- Cauda equina syndrome
| - S2 - S4
42
what are some ligands/receptors that use the phosphoinositol messenger system?
- Alpha adrenergic receptors, M1 and M3 cholinergic, V1 vasopressin, Histamine, Oxytocin, Angiotensin 2, TRH, GnRH
43
Which 2 organisms causing non-gonococcal urethritis are not succeptible to penicillins or cephalosporins, and why?
- Chlamydia trachomatis --> lacks peptidoglycan in its cell wall
- Ureaplasma urealyticum lacks a cell wall entirely
44
Von-Hippel-lindau lesions include _________. Inheritance is_______
- cerebellar or retinal hemangioblastoma
- cysts and/or neoplasms in the kidneys, liver, and/or pancreas
- Incr risk of RCC, sometime b/l
-Inheritance is AD
45
what histologic feature is seen in meningioma?
What type of cell does a meningioma arise from?
what other cancer has this characteristic histology?
- Psammoma bodies (Q 1151)....round, dense pink hyalinized things
- Arachnoid villi
- papillary thyroid cancer and serous papillary ovarian cancer
46
Primary oocytes arrest in _________ and remain there until puberty. FSH stmulates some oocytes to complete __________, forming secondary oocytes and polar bodies. LH then stimulates release of this oocyte at day 14 of cycle, but his secondary oocyte is stuck in _______ until fertilization occurs.
- prophase of Meiosis 1
- Meiosis 1
- Metaphase of meiosis 2
47
WHat heart manifestation is seen in fragile X?
-Mitral valve prolapse
48
In a hydrocele, fluid is confined to what layer?
-Tunica vaginalis
49
Bcl-2 gene overexpression is normally seen in what cancer? What is the translocation and what does Bcl-2 do?
- Follicular lymphoma (clinically = lymphadenopathy)
- translocation of the bcl-2 oncogene from chrom. 18 to the Ig heavy chain locus on chrom 14
- Bcl-2 --> inhibits apoptosis --> tumor growth
50
What is the clinical presentation of inhaled anesthetic hepatotoxicity? Gross and histo appearance? Labs?
- fever, anorexia, nausea, myalgias, arthralgias, rash, death
- extensive hepatocellular damage --> atrophy --> shrunken appearance
- histo = centrilobular necrosis and inflamm of portal tracts and parenchyma
- Markedly elevated transaminases and prolonged PT
* since its acute...albumin is fine bc of half life, no portal hypertension signs
51
What mutations result in a LONGER, nonfunctional protein, but with retained immunoreactivity?
-Splice site mutation
52
In a CNS infarct, after macrophages come and clear debri etc, which cells form a wall around the resorbed cystic cavity?
-Astrocytes (gliosis)
53
What are common findings on vaginal exam in pts with endometriosis?
- Nodularity of the uterosacral ligaments
| - Fixed retroversion of the uterus
54
What factors can predispose someone to first-dose HoTN phenomenon of ACEi's?
- Hyponatremia
- Hypovolemia 2/2 diuretic use (thiazide or loop)
- low baseline BP
- high renin or aldo
- renal impairment
- HF
55
What Dx should you expect in an elderly pt with: Easy fatigue, constipation, bone pain (usually back/ribs), and renal failure?
What is seen in the kidneys?
- Multiple myeloma
| - atrophic tubules with large obstructing eosinophillic casts
56
WHat are the main anti-fungal classes and how do they work?
Polyenes: (amphotericin and nystatin)
-bind ergosterol and create membrane pores
Triazoles: (azoles)
-inhibit ergosterol synthesis
Echinocandins: (fungins)
-inhibit glucan synthesis
Pyrimidines: (flucytosine)
-interferes with RNA and prot synthesis
57
Bradykinin vs ANP/BNP actions on arterioles and veins?
- ANP/BNP dilates both
| - Bradykinin constricts veins and dilates arterioles
58
What is seen histologically in acute viral hepatitis?
- Ballooning degeneration
- mononuclear cell infiltrates
- councilman bodies (eosinophillic apoptotic hepatocytes)
59
What is the histological appearance of renal tissue in acute pyelonephritis?
- massive infiltration of interstitium with Neutrophils
- neutrophil infiltration of tubular lamina as well
- possible microabcesses
- WBC casts
60
How do phosphodiesterase inhibitors work for HF? example of one? Another effect?
- incr cAMP --> incr intracellular Calcium --> incr contractility
- Milrinone
- vasodilation (careful in hypotensive pts)
61
Diff between cervical and thoracic spinal cord segment cross section?
-Thoracic = lateral horns
62
Blood from an infected patient clots in a tube with EDTA while in ice water....but rapidly un-coagulates when tube is warmed in hand. What causes this? Which organism is likely responsible?
- Cold Aglutinins (IgM)
* Antibodies produced in response to Mycoplasma directed against surface antigens --> homologous to antigens on RBC membranes
-Mycoplasma (also EBV)
63
What disease is caused by deficient or defective glycoprotein 2b/3a on platelets?
What drug is a blocker of the GP 2b/3a receptor, inhibiting its interaction with fibrinogen?
- Glanzman thrombasthenia
- abciximab (ReoPro)
others: eptifibatide , tirofiban
64
WHat blood vessel is most at risk of damage with femoral neck fractures?
-Medial circumflex artery
65
What type of cells secrete catecholamines, and from where? In response to what stimulus?
*What are these cells' origin?
- Chromaffin cells in the adrenal medulla
- AcH
*They are modified post-ganglionic sympathetic neurons derived from neural crest.
66
What hormone dramatically increases the secretion of pancreatic bicarbonate?
Where is it released from?
What stimulates it's release?
- Secretin
- S endocrine cells in the duodenum
- Release of HCl into the duodenum
67
What type of drug is phentolamine?
- alpha receptor blocker
| - good for reversing vasoconstriction caused by certain drugs like Noreipinephrine
68
Cleft Lip results when one of the ________ fails to properly fuse with the _______.
- Maxillary prominences
| - Intermaxillary segment
69
The liver uses ________ transport to get indirect billi from the blood. It uses ________ transport to secrete Direct billi into the biliary system.
- Passive (facilitated)
| - Active
70
Dendritic cells arise from what cell line?
Myeloid
71
What is the pathophys of psoriasis?
| What is the histology?
-CD4 cells activating CD8 cells in the epidermis after interacting with APCs ---> cytokine production and keratinocyte growth factor production --> proliferation, inflammation
- Histo:
- hyperkeratosis, acanthosis
- reduced or absent stratum granulosum
- epidermal cell layer above the dermal papillae = thinned with dilated blood vessels
72
What determines whether someone with a carcinoid tumor has carcinoid syndrome (symptoms)?
- If the tumor metastasizes
| * normally, when confined to intestine, the secretory products are metabolized by the liver, so no symptoms
73
If a patient has an increased PT, but normal PTT and bleeding time, then there is impairment in the ________ pathway, meaning factor ______ is deficient:
- Extrinsic pathway
| - 7 (any others???)
74
What are some anaerobic bacteria that cause lung abcess following aspiration?
- Peptostreptococcus
- Prevotella
- Bacterioides
- Fusobacterium
75
What does it mean if someone's PTT remains unchanged after addition of activated Protein C?
- Possible Factor 5 Lieden mutation
| - mutated factor 5a is resistant to inactivation by protein C
76
What are the 4 main thalamic nuclei and their function?
VPL: ---> primary somatosensory cortex
- Spinothalamic tract - pain and T
- Medial lemniscus - position and proprioception
VPM: ---> primary sensory cortex
- trigeminal pathway
- gustatory pathway
Lateral geniculate body:
-relay nucleus for vision
Medial geniculate body:
- auditory pathway
- receives impulses from superior olivary nucleus and the inferior colliculus of the pons ----> projects to auditory cortex
77
The ________ artery runs with the radial nerve, and is succeptible to damage in humeral shaft fractures
-Deep brachial
78
What 2 features of a drug result in preferential processing in the liver rather than the kidneys?
-High Lipophilicity
-High volume of distribution
(low volume of dist. would mean it gets confined to bloodstream and tends not to diffuse into hepatocytes as easily)
79
Atenolol is a selective/non-selective? Beta-blocker. It works by _______ cAMP in associated receptor(s)' tissue.
Which tissues would it affect?
- Selective Beta-1 antagonist at low doses
- Decreases cAMP
- Beta-1 found on heart and in JG cells of kidney, none in periph vessels
80
How is acyclovir activated in the cell to terminate viral DNA ?
- converted to acyclovir mono-phosphate via THYMIDINE KINASE
* rate limiting
-Then cellular enzymes phosphorylate it to active tri-phosphate form --> impairs viral DNA polymerase
81
What are adaptive immune mechanisms that prevent infection with Influenza virus?
- Anti-hemaglutinin IgG serum antibodies
| - Anti-hemaglutinin IgA mucosal antibodies
82
What is the underlying pathophys in fragile X?
- mutation in FMR-1 gene on long arm of chromosome X
- Hypermethylation of gene ---> subsequent deactivation
- <200 repeats = usually phenotypically normal
83
What nerve can be damaged from objects stuck in the piriform recess? What reflex is therefore lost?
- Internal laryngeal nerve
- Cough reflex
*common for food items to get stuck there
84
What are some factors that precipitate isolated episodes of A-fib?
- Binge alcohol consumption
- incr sympathetic tone
- pericarditis
85
What makes Automaticity of cardiac pacemaker cells possible?
- slow, inward sodium current that occurs during phase 4
| - this brings membrane potential closer to threshhold --> phase 0 calcium influx
86
The _______ duct connects the midgut lumen with the yolk sac cavity in embryonic life.
It normally obliterates during the _____ week of development.
If obliteration is incomplete, the following 4 things can occur: ______
- Omphalomesenteric (Vitelline) duct
- 7th week
- Persistent duct, Meckel diverticulum, Vitelline sinus, Vitelline duct cyst
87
PCR requires primers that are complementary to _______
What are the other requirements?
- regions of DNA flanking the segment of interest
| - DNA template, DNA polymerase, Deoxynucleotide triphosphates
88
What 2 tissues cannot use ketone bodies for energy?
- RBC (lack mitochondria...cant use acetyl CoA)
| - Liver (lack enzyme: succinyl CoA-Acetoacetate CoA transferase)
89
Which organisms are facultatively intracellular?
- salmonella
- Neisseria
- Brucella
- Mycobacteria
- Listeria
- Francisella
- legionella
- Yersinia
90
What drug is used for tx of tinea corporis? how does it work?
- Terbinafine ...or other Allylamines
| - Suppresses Squalene oxidase --> decr ergosterol synthesis
91
What is the tx for someone who ingested rat poison?
- FFP and vitamin K
| * Syrup of ipecac is an emetic that is effective if taken immediately following the ingestion
92
What is Muromonab-CD3 (OKT3) and how does it work?
- Drug used to reduce acute rejection in pts with kidney, heart, liver Tpx
- Monoclonal antibody vs CD3
93
Methotrexate can cause what lung complication?
-Interstitial pneumonitis and fibrosis
94
Cytokeratin staining identifies ________ - derived cells
-Epithelial
95
the ________ oncogene encodes for a 185-kD transmembrane glycoprotein that has intracellular tyrosine kinase activity.
What does it do?
Overexpression is seen in 30% of invasive breast cancers, and is also associated with _________.
Her2/neu
- controls epithelial growth and differentiation. too much --> too much growth
- Ovarian, gastric, and endometrial carcinomas as well
96
Use of concentrated O2 therapy for neonatal respiratory distress is associated with what complication?
- Retinopathy of prematurity
| - Retinal neovascularization, possible retinal detachment, possible blindness
97
Inheritance of G6PD deficiency?
X-linked recessive
98
What is the adjunct test used for CF diagnosis when sweat chloride test is negative?
What does it normally show if positive?
- Measurement of nasal transepithelial potential difference
| - Significantly more negative nasoepithelial surface due to Na+ absorption
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