1
Q
mesosalpinix vs mesovarium, vs mesometrium
A
all part of board ligament
- between uterine tube and ovary
- covers ovary
- below ovary
2
Q
define: suspensory ligament aka round ligament ovarian ligament transverse cervical ligament aka what vessels and structures are in each?
A
- infundibulopelvic ligament, connects ovaries to lateral pelvic wall, contains ovarian vessels, ligate during ooporectomy to avoid bleeding, avoid ligating ureter nearby
- uterine wall fundus to labia majoria, courses through round inguinal canal, above artery of Sampson
- connects medial pole of ovary to lateral uterus, has no blood vessels
- cardinal ligament, from cervix to side wall of pelvis, contains uterine artery, ligate during hysterectomy to avoid bleeding.
3
Q
treatment for pin worm aka
A
enterbius vermicularis
albendazole and mebendazole in school age children
pyrantel pamoate in pregnant pts.
4
Q
triad for lupus- sex, false test? and PTT level change. why? complications (2)-due to elevated levels of
A
glomerulonephritis, photosensitive rash, arthralgias in young female.
- lupus anticoagulant (causes prolonged PTT and false positive VDRL)
- elevated levels of antiphospholipid antibody causes thromboembolism formation and repeated miscarriages.
5
Q
pt with loss of upper extremity pain and temp sensation, upper extremity lower motor signs, and lower extremity upper motor signs in setting of scoliosis is? not ALS because? not Guillain-Barr because?
A
syringomyelia-central cystic lesion (C8-T1) that affects ventral white commissure (2nd order lateral spinothalamic tract) and anterior horns (lower motor neuron cell bodies for upper extremity), further extension causes damage to lateral corticospinal (UMN in lower exterminities)
- ALS-affects only upper and motor neurons no sensory loss
- Guillain-Barr- peripheral autoimmune demyelinating disease causing LMN deficts in symmetric ascending pattern
6
Q
presentation of Turner’s syndrome (4), genotype, ovary presentation, FSH and LH labs levels? possibility of pregnancy?
A
short, thick neck, square chest, and widely spaced nipples
-(45 X,O)
-missing X leads to streak gonads aka ovaries
elevated levels of LH and FSH
-can get pregnant (normal uterus) need donor eggs
7
Q
easy calculation for True Negatives and False Positives
A
TN=(Spec)*(# of pts without disease)
FP= (1-Spec)* (# of pts without the disease)
8
Q
reasons for intestinal obstruction below second part of duodenum vs above this point.
examples of each
A
vascular accidents in utero vs congenital or migration abnormalities (i.e Hirspsrung’s)
below-jeunal, ileal, and colonic artresia
above-duodenum atresia
9
Q
occlusion of which artery in utero leads to “apple peel” or “Christamas tree” artresia
A
- superior mesenteric artery occlusion leads to ischemia of jejunum and ileum
- leads to formation of jejunal pouch and ileum that assumes a spiral configuration around an ileocolic vessel
10
Q
presentation of annular pancreas vs pancreas divisum
A
- dudenal atresia
- usually asymptomatic
11
Q
description of renal clear cell carcinoma
triad
most common site for metastatis
A
histology-large rounded or polygonal cells with clear cytoplasm.
grossly-yellow (lipids and steroid)
triad of hematuria, flank pain, and palpable mass
lung is most common site for metastasis
12
Q
mech of acyclovir
A
nucleoside analogue
-incorporates into newly made viral DNA and terminate DNA chain synthesis
13
Q
viral drugs mech/ give examples
- prevent attachment to target cells
- inhibit viral protease activity
- prevent virion release
- increase interferon release
A
- enfuvirtide
- indinavir
- neuramindase inhibitors
- interleukins
14
Q
symptoms of turner syndrome (4)
A
primary amenorrhea, high arched palate, widely spaced nipples, ovarian dysgenesis with streak gonads
15
Q
thermogenin
A
protein found in brown fat. uncouples oxidative phosphorylation to generated heat
16
Q
location of prostate on CT
A
between pubic symphysis and anal canal. does not cover top of pubic bone (if so that’s the distal end of the bladder)
17
Q
causes of HIV-assocaited esophagitis and difference between them (endoscop and histo)
A
candida-patches of grey/white pseudomembranes on erythematous mucosa. histo-yeast cells invading muscosal cells
HSV-1-small vesicls that evole into “punched out” ulcers. histo- eosinophilic intranuclear inclusions (Cowdry type A) in multinuclear squamous cells at margin of ulcers
CMV-linear ulceration. histo-both intranuclear and cytoplasmic inclusions
18
Q
what drains to superficial inguinal lymph nodes? exception?
A
all skin from umbilicus down, including anus (up to dentate/pectinate line) (i.e. distal vag, vulva, scrtoum) but excluding posterior calfs (popliteal lymph nodes)
19
Q
lymph drainage of
- testes/ovaries
- prostate
- superior portion of bladder
- inferior portion of bladder
- sigmoid colon
- proximal vag/uterus
A
- para-aortic lymph nodes
- internal iliac nodes
- external iliac nodes
- internal iliac nodes
- inferior mesenteric lymph nodes
- obturator, external iliac, and hypogastric nodes
20
Q
location of femoral hernias, serious complications (2)
A
inferior to inguinal ligament, lateral to pubic tubercle and medial to femoral vein.
incarceration-bowel is present in hernia sac can cause bowel obstruction (nausea, vomiting, abdominal pain, distention)
-strangulation-bowel in hernia sac undergoes ischemia and necrosis (fever)
21
Q
kidney stones causes
- normocalcemia and hypercalciuria
- normocalcemia and hyperoxaluria
- normocalcemia and hyeruricosuria
A
- idiopathic, calcium kidney stones
- high dies in oxalate (chocolate, nuts, spinach). low Ca2+ diet (calcium bind oxalate in gut) in Crohn’s disease and intestinal malabsorption
- high protein diets, protein becomes uric acid. forms calcium calculi formation
22
Q
these findings seen in which conditions
- straight short endometrial glands and compact stroma
- decidualized endometrium
- decidualized endometrium, with chorionic villi
- endometrial inflammatory inflitration
- atypical endometrial cells, disorganized glands, and multiple mitoses
A
- early proliferative phase of the menstrual cycle
- ectopic pregnancy
- intrauterine pregancy
- endometriosis
- endometrial adenocarcinoma
23
Q
partial mole vs complete mole (karyotype, symptoms, macroscopic appearance, complication risk)
A
- partial will have triploid vs normal karyotype
- crampy abdominal pain vs enlarged uterus, pre-eclampsia, HyperTSH, hyperemesis
- fetal parts, some enlarged vili vs trophoblasts only “bunch of grapes”
- low risk of malignancy vs 15-20% malignant trophoblastic disease
24
Q
symptoms of missed abortion (def, bleeding, os, uterus size, fetal heart, hCG levels)
A
embryonic death in utero
-vaginal bleeding with closed cervical os, small uterus, absence of fetal heart sounds, and low hCG levels
25
mech of resistance to
- penicillin (2)
- vancomycin
- tetracyclines
- ciprofloxacin
- aminoglycoside
- production of beta-lactamase and production of low-affinity PBP
- Dala-Dala cell wall precusors to Dala-Dlactate
- synthesis of binding protein (ribosome) and decreasing intracellular concentration
- mutations in DNA gyrase or topoisomerase
- modifying enzymes add different chemical groups (actyle, adenyl, or phosphate)
26
renal infarct, stroke, intestinal or foot ischemia should make you think what?
- embolic phenomena
| - left arterial clots or ventricular clots (a or v fib), valvular vegetations, or aortic atherosclerotic plaques
27
lactase test results in pts with lactase deficiency?
-increased stool osmotic gap (undigested lactase in Gi tract), increased breath hydrogen content and decreased stool pH (increased bacteria fermentation of lactose produces short chain fatty acids and increased hydrogen)
28
pick's diseases affects which lobes
-frontotemporal lobes
29
relationship of ureters to
- common/external iliac vessels
- gonadal vessels
- internal iliac vessels
- over
- under and medial (as it enters true pelvis)
- lateral (as it enters true pelvis)
30
mech of ethambutol, not inhibiting mycolic acid synthesis b/c? main toxicity.
inhibits carbohydrate polymerization preventing peptioglycan cell wall synthesis
- optic neuritis with decreased visual acuity and color blindness
- isoniazid is only TB drug to work this way
31
which anticonvulsant causes elevated phenobarbital levels and causes lethargy? meatbolized to what other substance? mech of metabolite products?
- primidone
- metabolized to phenobarbital and phenylethylmalonamide (PEMA)
- all of these are anti-convulsants
32
resevoir for schistomaiasis
snails
33
location of schiotomiasis and symptoms
- S.haematobium
- S.mansoni
- S.Japonicum
- North africa, sub-Saharn Africa, Middle East. urinary schistosomaiasis.
- sub-saharn Africa, Middle East, South America and Caribbean. intestinal schistosomiasis (can cause iron deficiency anemia)
- Asia, (China), philippines and Japan. hepatic schistosomiasis
34
causes of impetigo
staph aureus or strep pyogenes
35
how is posterior urethra damaged?
anterior urethra?
signs of urethral injury?
contraindications?
- pelvic fractures
- straddle injuries
- inability to void, high riding boggy prostate, blood in urethral meatus
- Foley catheter
36
mech of fatty liver in due to alcohol
- decrease in fatty acid oxidation use to excess NADH production by alcohol metabolize enzymes
- alcohol dehydrogenase and aldehyde dehydrogenase
37
which bacteria grows well in cold temps
listeria monocytogens
38
which has an increased risk for hepatocellular carcinoma? HBV or HCV why?
HBV because it's DNA integrates into host genome
39
gross and microscopic presentation of cirrohsis
micro-diffuse hepatic fibrosis
| macro-fibrous lined parencymal nodules
40
dilation of sinusoid and perivascular hemorrhage
acute venous outflow obstruction
41
substance accumlation within hepatocytes
Dubin-Johnson syndrome
| -course pigmented granules cause liver to look black
42
intrahepatic cysts with surrounding fibrosis
echinococcus infection
43
granulomatous destruction of bile ducts
primary biliary cirrohsis
44
what is important allosteric activator of pyruvate carboxylase. role of enzyme?
-Acetyl -Coa
| pyruvate to oxalotacetate in gluconeogeneis
45
elevated AFP vs low AFP
multiple gestation, neural tube defects (also look for increased acetylcholinesterase) and abdominal wall defects
-low AFP is associated with Downs
46
psychogenic impotence vs other causes
- sudden onset and presence of morning erections
| - no morning erections in vascular, or neurologic causes
47
drugs that cause impotence
SSRs and sympathetic antagonists (clonidine, methyldopa, beta blockers)
48
role of mifepristone vs misoprostol in abortion
anti-progestin (causes decidual necrosis and increased release of PGs to cause uterine contration
-analogue of PGE1 that causes contraction of uterus
49
blood supply to distal ureter vs proximal ureter
- superior vesicial art from internal iliac art
| - renal art (allows for this portion of ureter to be salvages in kidney transplant)
50
eosinophils action against parasites is considered what type of hypersensitivity? not type I b/c?
- antibody-dependent cytotoxicity. (stimulated by IgE bound to parasitic cells)
- type 1 hps is mediated by basophils and mast cell. eosinophils regulate this rxn by releasing histaminases (to degrade histamine and reduce severity of symp)
51
antibodies in SLE
- sensitive but not spec
- spec and prognostic
- spec but not prognostiv
- ANA
- dsDNA
- anti-smith (anti-snRNPs)
52
recurrent kidney stones in young pt
- cystinuria
- hexagonal cystine crystals
- sodium nitroprusside test detects cystine's sulfhydryl group (red-purple when added to urine after sodium cyanide)
53
vascular fibrinoid necrosis and neutrophil infiltration vs obliterative vascular fibrosis
-hyperacute rejection vs chronic rejection
54
PCOS increases risk for (2)
Type II DM (not type I)
| endometrial adenocarcinoma
55
name three mech of OCPs. which is main one?
- decreasing gonadotropin levels, increasing cervical mucus, and progestin effects (prevents growth of endometrium)
- main effect is inhibition of gonadotrophins (no LH surge no ovulation)
56
name mc pt pop and anatomy of
- indirect inguinal
- direct inguinal
- femoral hernia
- male infants; enters inguinal ring lateral to inferior epigastric vessels. caused by permanent process vaginalis and failure of internal inguinal ring to close); covered by all three layers
- older men; bulges through Hesselbach's triangle, medial to iev, to reach external inguinal ring. caused by weakness of transversalis fascia; covered by external spermatic fascia
- women; protrudes through femoral ring, medial to femoral vessels and inferior to inguinal ligament
57
gummas vs chancres
- painless, indurated necrotizing granulomas occurring in skin, mucosa, subcutaneous tissue, bones, and other organs. seen in 3rd syphilis
- painless ulceration with raised borders 1 syphilis
58
condylomata lata vs condylomata acuminata
- large gray wart like growths. 2nd syphilis
| - warts caused by HPV 6 and 11
59
describe site of protrusion, lower border, medial border, and lateral border of
direct vs indirect hernia
- direct: hesselbach triangle, inguinal ligament, rectus abdominis, inferior epigastric
- indirect: deep inguinal ring, inguinal ligament, inferior epigastric vessels
60
what is posterior to femoral ligament
Cooper's (pectineal) ligament
61
which drug can cause disulfiram like effects when combined with alcohol
- oral metronidazole
| - used to treat giardiasis
62
absolute contraindication of OCPs
- prior history of thromoboembolic event or stroke
- history of estrogen dependent tumor
- women over age 35 who smoke heavily
- hypertriglyceridemia
- decompensated or active lier disease (would impair steroid metabolism)
- pregnancy
63
what is used to treat syphillis? what is it an analog of?
penicillin
D-Ala-D-Ala
bind to transpeptidase which recognizes this a.a sequence on peptidoglycan precursor molecules
64
how to tell difference b/t lesions (causative agent, pain, features)
- chancroid
- genital herpes
- granuloma inguinale (donovanosis)
- syphilis
- lymphogranuloma venerum
- Haemophilus ducreyi; painful, organisms clump in long parallel strands "schools of fish"
- HSV-1 andHSV-2; painful, multiple* small grouped ulcers, multi nucleated giant cells
- klebsiella inguinale;non painful, no lymphadenopathy* gram stain negative
- treponema pallidum; not painful,clean base, darfield microscopy
- chlamydia trachomatis; small, not painful, lympadenopathy* intracytoplasmic inclusion bodies
65
how to know that it's acute pyelonephritis on histology?
look for massive interstitial infiltration with neutrophils in tubular lumina*
66
major effects of ILs from macs
- IL-1-neutrophil and macrophage migration, acute phase reactance, fever, and shock
- lL-6 increase T and B cell growth, osteoclast activity, acute phase reactants and fever
- IL-8,neutrophil activation and chemotaxis
- IL-12, increase TH1 cell differentiation, increase NK and CD8+ T cell activity
67
major effects of ILs from Th2 cells
- IL-4- increase TH2 cell differentiation, B cell growth, isotype IgE switching
- IL-5 increase differentiation of eosinophils, isotype switching to IgA
- IL-10- decrease TH1 cell differentiation, decrease cell mediated immunity and APC activity, increase B cell function
68
major effects of IL released from all T cell types
- IL-2 increase T cell activation and proliferation, NK cell and mac activity, B cell growth
- IL-3, increase hematopoiesis
- IL-8 increase neutrophil activation and chemotaxis
69
E. Coli virulence factor mechanism
- P fimbriae
- heat-stable/heat liable enterotoxins
- lipopolysaccharide
- K1 capsule polysaccharide
- verotoxin (shiga-like toxin)
- permit adhesion of E coli to uroepithelium (UTIs)
- promote fluid and electrolyte secretion from intestinal epithelium (gastroenteritis, watery)
- macrophage activation causes release of IL-1, IL-6, and TNF alpha (bacteriemia leading to shock)
- prevents phagocytosis and complement mediated lysis (neonatal meningitis)
- inactivate 60S component halting ribosomal protein synthesis and causing cell death (gasteroenteritis, bloody)
70
which drugs inhibit dihydrofolate reductase
- trimethoprim (anti bacteria)
- methotrexate (anti tumor)
- pyrimethamine (antifungal)
71
gross image of ADPKD vs hydronephrosis
-lumpy bumpy surface cysts vs smooth enlargement and distortion
72
adding a competitive antagonist changes what and shift curve how? adding non-competitive antagonist?
- change ED50 shift curve right
| - change Emax shift curve down
73
likely cause of toe gangrene or livedo reticularis following a invasive vascular procedure? look for what on histology of kidney?
- atheroembolic renal disease
| - cholesterol emobli obstructing renal arterioles
74
how to differentiate upper (acute pyleonephritis) vs lower (cystitis, and urethritis) UTIs
- both have pyuria and bacteriuria
| - WBC casts are only in upper UTIs
75
how to tell acute pyelonephritis vs acute interstitial nephritis?
both have WBC casts
- pyelonephritis have fever and painful urination
- interstitial has low grade fever and no pain on urination
76
what causes symptoms seen in endometriosis
dysmenorrhea (shedding of ectopic tissue)
dyspareunia (retroversion of uterus and endometrial implants on uterosacral ligaments)
-dyschezia (due to pelvic adhesions)
-infertility (growth can cause adhesions on ovaries or fallopian tubes ectopic tissue secrete prostaglandins that interfere with ovulation and tubal functions)
77
how laboratory test differentiate between cystitis, urethritis, and pyelonephritis? what bacteria should you think of?
urethritis UA will show sterile pyuria (N.gonorrheae or C. trachomatis)
- cystitis: UA and Micro will show +leukocyte esterase, +nitrates, +Bac, +WBCS, +RBC (think e. coli, s. saprophyticus, p mirabilis, klebiella, and enterococci)
- pyelonephritis: UA and Micro will show same as cystitis except with WBC cast, CBC will show elevated WBC (think same organisms as cystitis)
78
name 4 types of kidney stones and how to tell them apart
- calcium oxalate or calcium phosphate (most common, colorless octahedron,square crossed by diagonal line in 2-d view, acidic or neutral)
- struvite (Magnesium ammonum sulfate or triple phosphate) (rectangular prism, basic and urease forming organisms (proteus))
- uric acid (only one that radiolucent, rhombus shape, acidic)
- cystine (flat and hexagonal, acidic)
79
of the inborn errors of amino acid metabolism does not present with mental retardation
- cystinuria (kidney stone instead)
| - PKU, homocystinuria, and maple syrup disease have MR
80
histology of fibroadenoma vs sclerosing adenosis
cellular, myxoid stroma that encircles and sometimes compresses* epithelium-lined glandular and cystic spaces
-central acinar compression and distortion and peripheral ductal dilation*
81
common causes of nongononcoccal urethritis?
ureaplasma and chlamydia
82
what is necessary for acute pyelonephritits caused but UTIs
anatomic of functional vesicoureteral reflex without this ascend of pathogens into kidney impossible
83
latent period bias
exposure only has effect after some years
| -look for comparison of two relative risks in groups with exposure over different time periods
84
name two commonly enzymes can be defected in urea cycle and how to tell them apart?
all the enzymes are
1. Carbamoyl phosphate synthetase (CPS)*
2. Ornithine transcarbamoylase (OTC)*
3. Arginiosuccinic acid synthetase (AS)
4. Argininiosuccine acid lyase (AL)
5. Arginase (AG)
6. N-Acetyleglutamate synthetase (NAGS)*
- with OTC look for high levels of ammonium+orotic acid (accumulated carbamoyl phosphate is converted to orotic acid)
- with CPS and NAGS (need to activate CPS) look for low levels of carbamoyl phosphate and no elevation of orotic acid just high ammonium
85
BH4 is a cofactor for synthesis
tyrosine, dopa, serotonin, NO
86
presentation of ischemic tubular necrosis vs papillary necrosis
both caused by ischemia
- ITN-oligouria and muddy brown casts
- PN-gross hematuria and passage of tissue fragments in urine
87
what is azithromycin used to treat?
macrolide
| treats chalmydia, mycoplasma, H. influ, and Moraxella catarrhalis
88
what is used to treat gram negative enteric anaerobes?
piperacillin-tazobactam (pseudomonas and bacteroides)
89
manifestation of hypoK
muscle cramping and muscle weakness
90
neurofibromin vs merlin
protein mutated in NF1 vs NF2
91
PID is strongly associated with what pregnancy complication?
ectopic preg
92
cytarabine vs gemcitabine
both pyrimidine analogs:
- cytarabine is specific to S phase
- gemcitabine is not S phase specific and can inhibit ribonucleotide reductase
93
major virulence factor for S. pyogenes targeted by humonal immunity? not hyaluraonate b/c? not streptolysin O b/c?
- protein M
- is protective but not immunogenic
- is immunogenic but not protective (note this is protein detected in ASO titer)
94
does N. meningitis have to include meningitis?
no
95
treatment of gout (1st, 2nd, 3rd choice. acute vs chronic)
1st-NSAIDs
2nd- colchicine is second line b/c of side effects (nausea and diarrhea)
3rd-glucocorticoids are indicated in pts with renal or hepatic failure
-don't use uricosuric agents and allopurinol are contraindicated during acute attacks (they can make symps worse) instead use them for prophylactic treatment
96
wrist drop with sensory loss
| vs wrist drop without sensory loss
- both are radial head injuries
- with sensory loss damage at armpit
- without sensory loss damage is at radial head (sensory nerve is spared) "look for kid whose arm was pulled up"
97
```
level of where nerves arise
CN V
CN VII
CN IX
CN III
CN IV
```
- middle cerebellar peduncle at lateral aspect of mid pons
- pontomedullary junction (below middle cerebellar peduncles)
- rostral medulla
- superior colliculus and red nucleus (midbrain)
- inferior colliculus below red nucleus (midbrain)
98
which CN is the only one to decussate before reaching destination?
CN IV
| -superior oblique muscle
99
hydrocele results from fluid in
tunica vaginalis
100
mutation of Rb vs p53
- Rb- leads to retinoblastomas vs osteosarcomas
| - p53 leads to Li-Fraumeni, autosomal dominant, sarcomas, breast, brain, adrenal cortex tumors
101
which short-acting barb is used for induction of anesthesia? why is there rapid recovery as well?
- thiopental
- b/c it's rapidly distributes into skeletal muscles and adipose tissue
- is NOT metabolism by kidney or liver but redistribution that causes this. HY know this!
102
best treatment for drug induced parkinsonism? not levodopa or dopamine agonist b/c?
- centrally acting anti-muscarinic agent (benztropine, trihexyphenindyl) or amantadine
- these can exacerbate psychosis
103
does vasectomy always result in complete azoospermia?
-no 20% of pts have viable sperm in their ejactulate after 3months and at least 20 ejactulations
104
aromatase deficiency vs 21-hydroxylase vs 17-hydroxylase in females
- all present with masculinization
- normotensive vs hypotension vs hypertensive
- aromatase def can also have maternal virilization during pregnancy b/c of increased androgens from fetus
105
females vs males with aromatase def
- males tall and osteoperosis b/c estrogen is necessary for fusion of epiphyses
- females also tall with primary amenorrhea, and virilization
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