0
Q
1, 2, and 3 standard deviations from the mean = ______, _______, _______ % of the data
A
- 68
- 95
- 99.7
1
Q
aromatase converts ________ to estrone and ________ to estradiol. Placental aromatase deficiency causes __________ in the mother and ______ in the neonate.
A
- Androstenedione
- Testosterone
- virilization in mom
- ambiguous external genitalia in female infants (normal internal genitalia)
2
Q
What are cholinergic agonists’ effect on vasculature?
A
-bind to muscarinic receptors on endothelial cells –> promote release of NO —> activation of Guanalyl cyclase –> decr endoth calcium conc, —> Vasodilation
3
Q
________ co-occurs in more than half of patients with temporal arteritis……What are the Sx of this?
A
- Polymyalgia rheumatica
- neck, torso, shoulder, pelvic girdle pain and morning stiffness….possibly also fever, fatigue, and weight loss
4
Q
What is the initial treatment for staph epidermidis infection?
A
- Vancomycin
- possibly add rifampin or gentamicin
*frequently methicillin resistant
5
Q
Through which foramen do cranial nerve 9, 10, and 11 leave?
A
- Jugular foramen
* part of 11 also leaves through foramen magnum
6
Q
Where is somatostatin released from? WHat does it do?
A
- Pancreatic delta cells
- suppresses release of secretin, CCK, glucagon, insulin, and gastrin
7
Q
CO poisoning causes a _______ shift in the O2-Hgb dissociation curve
A
-Left shift
8
Q
Accumulation of lipids WITHIN muscle fibers is seen in what diseases? Example?
A
- Lipid myopathies
- Carnitine palmitoyltransferase deficiency
9
Q
Pregnant lady with HIV who hasnt taken antiretrovirals…..whatdo you do?
A
- Start Zidovudine at 14 weeks!
- continue throughout pregnancy, IV administration during labor
- **Oral ZDV to the infant for 6 weeks post-partum
10
Q
What areas of the brain are selectively more vulnerable to ischemic irreversible damage?
A
- HIPPOCAMPUS is first area damaged during global cerebral ischemia, damage to pyramidal cells
- Neocortex
- Purkinje cells of the cerebellum
11
Q
CN3 exits the midbrain and courses between the _________ and ________ arteries.
A
- Posterior cerebral
- superior cerebellar
12
Q
Aneurysm of the AICA can compress ________
A
- CN7
- CN8
13
Q
What is Bethanechol used for? mech of action?
A
- Muscarinic agonist
- used to improve bladder emptying in patients with post-surgery urinary retention
- normal post-void resid. volume is < 50 cc
14
Q
What is the most common benign lung tumor? What is it made out of? How is it found?
A
- Hamartoma
- disorganized cartilage, fat, fibrous tissue
- Usually found incidentally on CXR in 50-60 yr olds. Coin lesion with “popcorn” calcification
15
Q
WHat are the 4 types of non-neoplastic colonic polyps?
A
- Hyperplastic = well diff, form glands and crypts
- Hamartomatous = mucosal glands, SM, conn. tissue (peutz jeghers, Juvenille polyposis)
- Inflammatory = UC and crohns (regenerating intestinal mucosa)
- Lymphoid = kids …mucosa infiltrated with lymphocytes
16
Q
Which type of polyp is pre-malignant? what 3 things determine potential for malignant transformation?
A
- Adenomatous
1. Degree of dysplasia
2. Histologic pattern –> villous more likelly to transform than tbular
3. Size —> >4cm have 40% chance of transformation
17
Q
What condition causes you to see hemosiderin-containing macrophages in the alveoli?
A
- aka “siderophages” , aka “heart failure cells”
- Chronic left heart failure!
- repeated episodes of pulm edema –> RBC extravasate into alveoli due to incr pulm vascular pressures –> hemosiderin dep in macrophages who eat it
18
Q
What are some 1st-generation anti-histamines and what are their side effects?
A
- Chlorpheniramine, diphenhydramine, promethazine, hydroxyzine
- Anti-muscarinic, serotonergic (appetite stim) , alpha adrenergic (dizziness, orthostatic HoTN)
19
Q
In scleroderma, deposition of collagen in tissues happens bc monoclonal ________ cells secrete _________ , increasing the production of collagen and ECM proteins by fibroblasts
A
- Monoclonal T-cells
- various cytokines, especially TGF-BETA
20
Q
What are the 3 phases and characteristics of ATN from ischemia to kidney?
A
- Initiation:
- original insult
- start of damage, GFR starts to fall, UOP decreases - Maintenance (oliguric phase)
- renal tubule injury established
- GFR stabilizes at well below normal
- lasts for 1-2 weeks
- microscopy = granular casts in tubular lumina, tubular epith. necrosis - Recovery phase:
- re-epithelization of tubules
- polyuria and gradual normalization of GFR
21
Q
IL-4 is responsible for ______, while IL-5 is responsible for ______
A
- B-cell growth and isotype switching, IgE secretion, diff. of naive T cells
- B-cell differentiation, IgA production, eosinophil activity
22
Q
What protein is secreted by Eosinophils, causing Bronchial epithelial damage in pts with allergic asthma? What else does it do?
A
- Major basic protein
- kills helminths!
23
Q
What is seen in the urine of patients with cystinuria? How is presence of cysteine tested?
A
- Hexagonal cystine crystals
- Sodium Cyanide nitroprusside test: detects cystine’s sulfydryl groups
*Cyanide converts cystine to cysteine, nitroprusside then binds to cysteine –> turns purple
24
Dofelitide is a class _____, ______- blocking agent used for arrhythmia. It affects phase ______ of the cardiac myocte AP
- class 3
- K+ blocking
- phase 3
25
Describe Osler-Weber-Rendu syndrome:
- Autosomal dominant
| - telangiectasias of the skin and mucous membranes (lips, oronasopharynx, resp tract, Gi tract, urinary tract)
26
Function of BRCA genes?
DNA repair
27
Why do people get neuro sx during panic attacks?
- Decr CO2 --> Vasoconstriction of cerebral vessels
| * CO2 is normally a very potent vasodilator in the brain .......PO2 has much less of an effect
28
How can you differentiate between sarcoidosis and hypersensitivity pneumonitis?
- CD4/CD8 ratio = high in sarcoid, low in others
| * sarcoid also can have hypercalcemia and hilar adenopathy
29
What receptors does carvedilol antagonize? What is it particularly useful for?
- Beta 1 and 2
- Alpha 1
-CHF!
30
What enzyme induces class switching in B cells?
- DNA recombinase
| * remember the order.... Ig M, D, G, E, A
31
Mechanism of pulsus paradoxus?
-Incr venous return with inspiration ---> poor compliance of pericardium causes RV to bulge into LV space ---> decr LV filling and subsequent SV ---> decr BP with inspiration
32
How is digoxin cleared?
Renally
- half life 1.5 days
- older patients get lower dose bc of declining renal function
33
What arteries supply the ureters?
- Upper 1/3 = branches of renal artery
| - Lower 2/3 = branches from aorta, iliac, gonadal, vesical
34
______ is a polypeptide precursor of beta-endorphins, ACTH, and MSH?
-POMC (propiomelanocortin)
35
What is the most common clinical manifestation of botulism in adults?
- 3 D's
1. Diplopia
2. Dysphagia
3. Dysphonia
36
What drugs can cause hepatic granulomatosus? (hint: MHQ)
- Methyldopa
- Hydralazine
- Quinidine
37
Which cancers of the thyroid are associated with the RET proto-oncogene?
- Medullary thyroid cancer
| * associated with MEN 2A and 2B
38
What does medullary thyroid cancer look like on histology?
-Spindle-shaped cells in an amorphous background
39
In males, incomplete fusion of the ________ causes hypospadias
-Urogenital folds
40
What do you need to periodically monitor in patients taking Lithium?
- blood lithium levels
- TSH
- renal function
41
What is the most common renal malignancy and what does it look like on histology?
- Clear cell carcinoma
| - Rounded or polygonal cells with abundant clear cytoplasm (packed with glycogen and and lipids)
42
What is the formula for half-life?
half life = 0.7 x Vd / CL
43
After blunt trauma to the eye.....If the inferior orbit is broken, blood would leak into the _______, and if the Medial orbital wall is damaged, blood would leak into the _________.
- Maxillary sinus
| - Ethmoid air cells
44
What drugs are used to treat Cholinergic toxicity (organophosphates)?
- Atropine (does not prevent muscle paralysis however, bc it doesn't work on Nicotinic receptors)
- Pralidoxime reverses both nicotinic and muscarinic by "restoring" cholinesterase
45
Describe the pathophys of a serum sickness type of reaction:
- Type 3 hypersensitivity (immune complex deposition)
- Fever, pruritic rash, arthralgias 7-14 days after exposure to antigen
- small vessel vasculitis with fibrinoid necrosis and neutrophil infiltration
- Low complement!!!*** bc consumed locally in affected tissues
- neutropenia
*reaction to non-human proteins.....including the "mab" monoclonal Ab drugs
46
Dobutamine is mainly _________ - selective, and used for ________
- Beta-1
| - Heart failure for chronotropy and inotropy....also for stress tests (chemical)
47
SIADH can be caused by paraneoplastic syndrome of what lung cancer?
- Small cell carcinoma
| * Clinically normal body fluid volume!!
48
What virulence factor allows E. Coli to survive in the bloodstream and establish meningeal infection?
- K1 capsule
| - prevents recognition, complement deposition, and subsequent phagocytosis
49
When do myoclonic seizures normally occur in a patient with myoclonic syndrome?
Treatment?
- in the morning, typically induced by lack of sleep or stress
- Valproic acid
50
What is the function of the 16S rRNA in prokaryotic ribosomes?
- Found in the 30S subunit
- Contains a sequence complementary to the shine-dalgarno sequence on mRNA
- **necessary to bind mRNA for initiation of protein translation**
51
What are some aggravating factors, including meds, of restless-leg syndrome?
- alcohol
- nicotine
- caffeine
- glucocorticoids
- SSRIs
- Lithium
52
What is the most crrucial gene regulated by PPAR-gamma?
-Adiponectin (cytokine secreted by fat tissue....low in diabetics)
53
Male infants with 21-hydroxylase have _______ genitalia.
Normal !
| -females have ambiguous (virilization)
54
How do you calculate renal plasma flow from renal blood flow?
(1 - hematocrit) x renal blood flow
55
What do xanthelasmas look like on histology?
-benign-appearing macrophages with abundant, finely vacuolated (foamy) cytoplasm containing cholesterol (free and esterified), phospholipids, and TGs
56
Blood type A or B moms have ____ immunoglobulins, whereas O moms have _______.
- IgM (cant cross the placenta)
| - IgG
57
What lab value is abnormal in both hemophilia A and B?
-PTT
58
The 3rd pharyngeal arch is associated with the _______ aortic arch and the _______ nerve, and gives rise to _________
- 3rd aortic arch
- glossopharyngeal nerve
- parts of hyoid bone, stylopharyngeus muscle, common and proximal internal carotid arteries
59
Pt with a lung mass (or breast, ovarian, uterine) has progressively worsening dizziness, limb and truncal ataxia, dysarthria, visual disturbances..........brain tissue shows extensive cerebellar purkinje cell degeneration.
-What is the diagnosis and what is the underlying patholog. process?
- Paraneoplastic cerebellar degeneration
- immune response against tumor cells that cross-reacts with with purkinje neuron antigens ----> acute onset rapid degeneration of the cerebellum
- Anti-Yo, anti-P/Q, and anti-Hu
60
PsychoPharm: _________ is associated with retinitis pigmentosa, while _______ is associated with corneal deposits
- Thioridazine
| - chlorpromazine
61
Which beta-blocker also has class 3 anti-arrhythmic properties? How does it work and what are some side effects?
- Sotalol
- blocks K+ channels, slows repolarization
- Side eff = QT prolongation, PR interval prolongation
62
Decreased heme concentration leads to increase in ___________ activity, which can cause porphyria
What things can precipitate acute attacks of intermittent hepatic porphyria?
-ALA synthase
- Phenobarb, griseofulvin, phenytoin
- alcohol and low calorie diet too
63
How does morphine exert its effects via Mu receptors?
- G-protein coupled -->activation of K+ channels --> increased efflux of potassium --> hyperpolarization of post-synaptic neurons --> decr pain
- Can also inhibit adenalyl cyclase --> decr calcium conductance --> decr transmitter release
64
What does alpha-1-antitrypsin look like in the liver?
-reddish-pink, PAS + granules of un-secreted polymerized A1AT in the periportal hepatocytes
65
Triad of cerebellar ataxia, incr risk of pulmonary infxns, and telangiectasia.....diagnosis?
-underlying pathophys and inheritance?
- Ataxia telengiectasia
- Autosomal recessive
- mutates ATM gene --> responsible for DNA break repair. Pts hypersensitive to X-rays and UV rays
- IgA deficiency --> airway infections
- incr risk of hematologic malignancies
66
In liver disease, when synthetic function declines, the first factor depleted is factor ________, which causes prolongation of the _______ first.
- Factor 7
| - PT
67
WHat type of cancer is never treated with surgery, even if localized?
-Small cell carcinoma
68
C3a of the complement system recruits and activates _______ and _____.
- Eosinophils
| - Basophils
69
Tumors in ovaries that are poorly differentiated and heavily loaded with mucous.....most likely came from where?
-Stomach (adenocarcinoma)
70
Where is the thrombus in budd chiari? and what is seen on Liver pathology?
- Hepatic vein
| - Centrilobular congestion and fibrosis
71
What are the 3 signs of pre-eclampsia?
- HTN
- Proteinuria
- Edema
*sometimes TCP
72
WHat is HELLP syndrome?
- Hemolytic anemia
- Elevated liver enzymes
- Low platelets
Pre-eclampsia may progress to this!
73
What is a glomangioma and what cells does it arise from?
-Bluish neoplasm found underneath the nail bed
Glomus bodies:
-Neurovascular organs found in the dermis of nail bed, pads of fingers and toes, and ears
-function = shunt blood away from skin in cold temps and vice versa
74
Celecoxib is a _________ inhibitor, and causes fewer side effects, such as ________
- Selective COX-2
| - GI ulcers/bleeding
75
When does ventricular free wall rupture normally occur, and why?
- 3-7 days after onset of total ischemia
- Coagulative necrosis, neutrophil infiltration, enzymatic lysis of connective tissue ---> weakens the infarcted myocardium
76
T or F......amyloid is not seen in the brains of patients with Vascular dementia
-True
77
Renal embryology:
- The ureteric bud ultimately gives rise to the ________
- The metanephric blastema gives rise to the _________
- collecting tubules and ducts, major and minor calices, renal pelvis, ureters
- Glomeruli, bowman's space, proximal tubules, loop of henle, DCT
78
What kind of drug is Raltegravir?
- Integrase inhibitor
| - prevents viral ds-DNA integration into host genome, therefor decreasing mRNA transcription
79
What are contraindications to metformin?
- Renal failure (Cr > 1.5 males or 1.4 females)
- hepatic dysfunction
- hypersensitivity to metformin
- severe CHF and alcoholics --> due to incr risk of lactic acidosis
80
Pathophys of Pompe disease and clinical presentation?
- Glycogen storage disease type 2
- Deficiency of alpha-1,4-glucosidase in lysosomes ---> accumulation of abnormal glycogen in lysosomes
- Clinically: NO Hypoglycemia, HEPATOMEGALY, incr risk of cirrhosis, HYPOTONIA, FEEDING difficulty, cardiomegaly
81
What organism, usually acquired after travel to 3rd world, manifests with Hepatosplenomegaly, low fever, rose-colored spots on abdomen, Diarrhea OR constipation
-Salmonella typhi or paratyphi
* can lead to sepsis, bloody diarrhea, peritonitis, carrier state
* fecal-oral route
82
What fungus can infect immunocompetent people, causing flu-like illness, cough with sputum production, possible hemoptysis, dyspnea, pleuritic cp?
Diagnosis?
Treatment?
- Blastomyces dermatitidis
- Sputum stain with KOH --> round yeast with doubly refractive walls, each yeast with a single, broad-based bud.
- Tx = Itraconazole
83
What is the clinical presentation of reactive arthritis?
- non-gonococcal urethritis, conjunctivitis, arthritis ----> weeks after a primary infection
- Can have skin findings as well, including vesicular rash on the palms and soles
- HLA-B27
84
What is seen histologically is aortic aneurysms?
- myxomatous changes in the media of large arteries
| - aka "cystic medial degeneration"
85
How do you calculate the net renal excretion rate of a substance?
total filtration rate - total tubular reabsorption rate
total filtration rate = GFR x conc. of substance in plasma
86
Overactivity of what enzyme has been implicated in the development of colon cancer?
COX-2
87
What is an "axonal reaction" in neurons and when can it be seen?
- Reaction in cell body seen when axon is severed
- swelling of acute reversible damage is seen....first visible 24-48 hours after injury
- reflect incr synthesis of protein to restore axon
88
What does vitamin D deficiency look like in the bone, histologically?
- Osteoid matrix (unmineralized) around trabeculae
| - widening between osteoid seams
89
Only _________ heparin can bind to both anti-thrombin and thrombin, making it the most effective at unactivating thrombin
-Unfractionated heparin
90
What 2 vascular disorders can show granulomas in the media?
- Giant cell (temporal) arteritis
- Takayasu arteritis
* takayasu - aortic arch, females < 40, lower BP in upper extremities, cold or numb fingers
91
WHich skull foramen does the middle meningeal artery go thru?
-Foramen spinosum
92
What aspect of the myocyte Action potential does myasthenia gravis change?
- Reduces the motor end-plate potential
| * partly bc of damae to motor endplate from complement fixation
93
What are P bodies and where are they located?
- Distinct foci in eukaryotic cells that are involved in mRNA regulation and turnover
- control mRNA expression repression, degradation, silencing, store them for later, etc
- happens in the CYTOPLASM
94
What is the clinical presentation and histo features of Lymphogranuloma venereum?
- caused by Chlamydia trachomatis
- initial painless small ulcer on genital mucosa ---> weeks later swollen, painful inguinal nodes that coalesce, ulcerate, and rupture. ---> stellate abcesses may develop and coalesce into large, necrotic, draining foci
-Histo: mixed granulomatous and neutrophilic inflammation, chlamydial inclusion bodies in the epith. and inflamm. cells
95
Colchicine for gout should not be used in who??
- elderly
| - renal dysfunction
96
Name the target and use of each of the following drugs:
- Infliximab
- Rituximab
- Interleuken-2
- Imatinib
- Abciximab
- Infliximab = vs TNF-alpha --> RA, ankylosing spond, fistulizing crohns
- Rituximab = vs CD20 ---> ??
- IL2 = activates and helps differentiate T cells ---> RCC, melanoma
- Imatinib = inhibits BCR/Abl tyrosine kinase ----> CML
- Abciximab = vs GP2b/3a ---> PCI
97
Why would someone with a testicular/ovarian mass also have hyperthyroidism?
- Certain tumors like teratomas (usually found in gonads) produce B-HcG
- B-HcG is structurally similar to TSH, LH and FSH ----> binds to thyroid receptors and causes hyperthyroidism
98
What is the histological feature of hodgkins?
- Reed-Sternberg cells
- Bi-lobed or double nuclei, ample cytoplasm, inclusion-like eosinophilic nucleoli, background of lymphocytes, histiocytes, eosinophils
99
What are the differences in immunophenotyping in immature B-cell vs T-cell ALL?
B-cell:
- TdT positive
- CD10
- CD19
T-cell:
- TdT positive
- CD1a maybe
- CD2, 3, 4, 5, 7, 8
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