1
Q
What is the antidote for severe Serotonin Syndrome?
A
Cyproheptadine: 1st gen Antihistamine with nonselective serotonin antagonist (5-HT1 and 5-HT2)
2
Q
How can you inhibit a shorter growth spurt in a child who is female who has Idiopathic precocious puberty?
A
Inhibit estrogen effects on long bone epiphyseal plate.
3
Q
Describe Strep Agalactiae (GBS)
5 points
A
- Catalase negative
- beta hemolytic
- PYR negative (Pyrrolidony Arylamidase)
- CAMP positive (Christie, Atkins and Much- Petersen test)
- Causes neonatal sepsis, meningitis, UTI
4
Q
Describe the E Coli virulence factor: P. Fimbriae
A
- allows adhesions to urothelium
- Presents as UTI
5
Q
Gram negative bacilli, cannot ferment lactose, is not oxidase-positive, and can produce H2S:
A
Proteus and Salmenella
6
Q
Gram negative bacilli, slow lactose fermenter:
A
Citrobacter and Serratia
7
Q
Describe Strep Viridans
A
- Catalase negative
- Alpha- hemolytic (partial green hemolysis)
- Optochin-resistant
- Bile insoluble
- Found in dental carries
- Responsible for subacute endocarditis
8
Q
Describe Strep Pneumoniae
A
- catalase negative
- optochin- sensitive
- bile soluble
- alpha hemolytic (partial green hemolysis)
- causes meningitis, otitis media, Pneumonia, Sinusitis
9
Q
Describe Strep Pyogenes (GAS)
A
- catalase negative
- beta hemolytic
- PYR positive (Pyrrolidonyl Arylamidase)
- Bacitracin Sensitive
- Causes Scarlet fever, Rheumatic fever, and PSGN
10
Q
Describe Enterococcus
A
- Catalase negative
- Gamma hemolytic
- Growth in Bile and 6.5% NaCl
- causes UTI, Cholecystitis, and subacute endocarditis
11
Q
Describe Strep Gallolyticus
5 points
A
- catalase negative
- gamma hemolytic
- growth in bile, not in NaCl
- PYR-Negative
- responsible for Bacteremia associated with colorectal cancer
12
Q
Describe the features of MHC II:
A
Structure: Alpha and Beta polypeptide chains
Location: APC’s (B-cells, macrophages, dendritic cells, langherans cells)
Type of Ag: Bacterial from lysosomes.
Antigen Presentation: Activates TH cells, when stimulated results in the humoral and cell-mediated immune response.
13
Q
Describe the erythematous childhood rash: German Measles (Rubella)
A
- Caused by Rubella Virus ( Enveloped, ssRNA positive sense, Togaviridae family, Rubivirus genus)
- Clinical presentation: Maculopapular rash starting on head, progressing to trunk and extremities, also occipital and post-auricular lymphadenopathy.
- Complication: Congenital Rubella Syndrome
14
Q
Dermatology Pathology:
Describe the Erythamatous rash in childhood: Roseola Infantum
A
- Caused by HHV 6 (Enveloped dsDNA, Icosahedral shape, Herpesviridae family)
- High fever for 3-5 days with rash after fever subsides. Macules and papule initially at truck that spreads to extremeties.
- Complications are self limited.
15
Q
Describe Actinomyces Israelli
A
- gram positive bacterium that grows in filaments.
- causes a cervicofacial infection that slowly evolves into multiple abscesses and draining sinus tracts with yellow “sulfur” granules.
- Histopath: chronic inflammatory granulation tissue surrounding dense fibrosis.
16
Q
Describe Statin Myopathy:
A
Myocyte Necrosis caused by increase concentration of Statin drugs, mostly due to Cyp450 inhibition. Severe cases rhabdomyolysis and AKI (elevated BUN and creatinine), dark urine.
Cyp450 inhibitors: Cyp3A4
- Non-dihydropyridine CCBs: Verapamil, diltiazem.
- Macrolides: Erythromycin, Clarithromycin.
- Protease Inhibitors: Ritonavir, Soquinavir)
- OATP inhibitors: Cyclosporine
- Corticosteroids, Fibrates, Colchicine, Ketoconazole
Statin of choice to prevent this is Pravastatin.
17
Q
Describe Lichen Planus
A
Clinical findings:
- 5 ‘p’s’: pruritic, purple/pink, polygonal, papule, plaques
- Lacy, white network (Wickman Striae)
- Locations: Skin (e.g. wrist, ankles), oral mucosa/white papule and plaques and erythema, (mucosal cetrophy ulcers), Geritalia
*Path. findings: Hyperkeratosis, Lymphocytic interface dermatitis, Eosinophilic colloid (civatte) bodies, thickened stratum granulosum, sawtooth ridges Rete
*Hx: Chronic symptoms. Form. of Lesions at sites of trauma (Köbner phenom.) Resolve 2 yr. Mucosal recur./persist.
18
Q
Describe the pathway of CSF
A
- Lateral Ventricles
- Interventricular foramina of Monro
- 3rd Ventricle
- Cerebral aqueduct of Sylvius
- 4th Ventricle
- Lateral foramina of Lusaka or midline of Magendie
- Subarachnoid space
19
Q
Describe Syringomyelia:
A
- Formation of a cavity (syrinx) in the cervical region of the spinal cord.
- The syrinx damages the ventral white commissure, leading to BL loss of pain and temperature of the affected levels (typical arms and hands), distal sensation is preserved.
- Destruction of ventral horns results in flaccid paralysis and atrophy of the intrinsic muscles of the hand.
20
Q
Describe Aplastic Anemia:
A
-Pathogenesis: Multipotent hematopoietic stem cells destroyed by cytotoxic T cells or direct cytotoxic injury –> bone marrow aplasia/hypoplasia –> lack of circulating peripheral blood cells.
*Common triggers: Autoimmune, drugs: cytotoxic chemotherapy, immunosuppresants, idiosyncratic reactions. Ionizing radiation and toxins. Viral infections (eg. viral hepatitis, HIV)
*Manifestations: anemia, thrombocytopenia, leukopenia.
21
Q
Describe pure red cell aplasia:
A
Rare form of bone failure characterized by severe anemia with reticulocytopenia and morphologically normal platelets and leukocytes. Most common with Thymoma, Lymphocytic leukemia, and parvovirus B19 infection.
22
Q
Describe IgA Vasculitis (Henoch-Schönlein purpura):
A
*Pathogenesis: Deposition of IgA immune complex in small vessels
- activates compliment.
- Neutrophillic inflame and vascular damage.
- often follows a URI
*Clinical Manifestations:
- Palpable purpura/petichiae on the lower extremities and
buttocks.
- Arthritis/arthralgia, abdominal pain, GI bleed intersusception,
renal disease (hematuria w/ w/o protein)
*Dx: Usually clinical
- Skin Bx: Leukoclastic vasculitis, IgA deposition in vessel walls
23
Q
List the anomalies associated with Trisomy 21:
A
- Neuro: Intellectual disability, Early onset Alzheimer Disease
- Cardiac: Complete AV Septal Defect, VSD, ASD
- GI: Duodenal Atresia, Hirschsprung Disease
- Endo: Hypothyroidism, T1DM, Obesity, Short Stature
- Oncologic: Acute Leukemia (ALL)
- Orthopedic: Atlantoaxial instability
24
Q
Describe Hereditary Angioedema:
A
- Recurrent episodes of cutaneous or mucosal swelling due to C1
inhibitor deficiency. - C4 levels are low due to inhibited cleavage of C4 by excess activated
C1 - Elevated bradykinin causes vasodilation and increase vascular
permeability resulting in edema.
25
Describe how chronic pancreatitis cause vitamin B12 deficiency:
What are the symptoms of chronic pancreatitis?
- Decreased production of pancreatic proteolytic enzymes (exocrine
insufficiency), needed to release vitamin B12 from the R protein.
- Symptoms: chronic epigastric pain, weight loss, and steatorrhea
26
Describe Alkaptonuria:
- Autosomal Recessive
- Deficiency in Homogentisic Acid Deoxygenase, involved in tyrosine
metabolism
- Excess homogentisic acid causes black-blue deposits in connective
tissues => sclerae and ear cartilage hyperpigmentation and
osteoarthropathy of the spine and large joints
27
What are the triggers for Reactive Arthritis?
*Preceding infection:
- GU: Chlamydia trachomatis
- GI: Salmonella, Shigella, Yersinia, Campylobacter, Clostridiodes
difficile
*MSK: Asymmetric Oligoartitis, Enthesitis, Dactylitis. Associated with HLA-B27
*Extraarticular symptoms: Ocular conjunctivitis, anterior uveitis,
genital-urethritis, cervicitis, prostatitis, dermal-keratoderma
(psoriasis-like bumps), blennorrhagicum, circinate balantis (red flat rash on penis), oral ulcers
28
Describe the Erythematous Childhood rash: Erythema Infectiosum
- Caused by Parvovirus B19 (NE ssDNA)
- Malar rash with 'slapped cheek' appearance
- Complications: aplastic crisis in sickle cell and immunocompromised
patients
29
Describe the Erythematous Childhood rash: Scarlet fever
- Agent: Strep Progenies (GAS)
- Sandpaper like rash that begins on the neck and upper trunk and
then generalizes.
- Associated with fever and sore throat
- Complications: Rheumatic fever, glomerulonephritis
30
What comprises the arterial supply of the ureters?
- Renal artery supplies the proximal ureter
- Superior vesical artery supplies distal ureter
31
Describe the Erythematous Childhood rash: Measles (Rubeola)
- Agent: Measles virus (Enveloped ssRNA negative sense,
Paramyxoviridae family)
- Macularpapular rash starting at the head, the spreads to the trunk
and extremities.
- Rash precedes by cough, coryza, conjunctivitis, and Koplic Spots.
- Complications: Bronchopneumonia, Encephalitis
32
Describe the E. coli virulence factor K1 capsular polysaccharide:
What can it cause?
- Mechanism: prevents phagocytosis and compliment-mediated lysis
- Presents as Neonatal Meningitis
33
What does an increase in acetylcholinesterase on amniocentesis suggest?
Leakage of CSF into the amniotic cavity. Suggestive of an open neural tube defect. Occurs from failed fusion of the edges of the neural plate.
34
List the antibiotics effective against Pseudomonas Aeruginosa:
- PCNs: Ticarcillin, Piperacillin
- Cephalosporins: Ceftazidine (3rd gen), Cefepime (4th gen)
- Aminoglycosides: Amikacin, Gentamicin, Tobramycin
- Fluoroquinolones: Ciproflaxicin, Levofloxacin
- Monobactams: Aztreonam
- Carbapenems: Imipenem, Meropenem
*Hint: Burn patients
35
What is the pathogenesis in Ehlers-Danlos Syndrome?
Defective collagen synthesis due to deficient procollagen peptidase. Impairs removal of N-terminal propeptide.
36
Describe Tuberous Sclerosis:
*Pathogenesis:
- Autosomal dominant
- TSC1/TSC2 tumor supressor gene mutation => Defective tubers-
hemartin complex => unrestricted cellular proliferation
Classic finding:
- Skin: Ash-leaf spots, facial angiofibromas, Shagreen Patches
- Neuro: CNS Hemartomas, Seizures, Intellectual disabilities
- Cardiac: Rhabdomyomas
- Renal: Angiomylipomas
37
What structures are derived from Endoderm?
- GIT, Liver, Pancreas
- Lungs
- Thymus, parathyroids, thyroid follicular cells
- Middle ear epithelium
- Bladder and urethra
- Parafollicular (C) cells
38
Describe Pompe Disease:
Type 2 Lysosomal Storage disease
*Deficiency in acid alpha-glucosidase
- normal glucose levels
- severe cardiomegaly
- glycogen accumulate in lysosomes
39
Describe the MOA of Azole antifungals:
Blocks fungal enzyme Lanosterol 14-alpha-demethylase (Cyp450 dependent) for Lanosterol => ergosterol conversion.
- Mutation in genes => fungal resistance
40
Describe Vitamin E deficiency:
Etiology:
- Fat malabsorption: Cystic Fibrosis, pancreatitis, cholestasis
- Genetic: abetalipoproteinemia
Clinical features:
- Hematologic: hemolytic anemia
- Neuromuscular: Spinocerebellar tract: ataxia, Dorsal columns:
Loss of vibration and proprioception, Peripheral nerves:
decreased strength and sensation hyporeflexia.
- Muscles: Myopathic weakness
*Tx: High dose Vitamin E
41
What would you expect in a patient with aortic regurgitation caused by infective endocarditis?
- Rapid loss of aortic pressure during diastole
- Eccentric hypertrophy due to increase EDV
- Increase in SV and CO
- High amplitude, rapid rise- rapid fall pulsation => widened pulse
pressure
- Corrigan sign: rapid distention and collapse of carotids
- Duroziez sign: 'to-and-fro' bruit appreciated at the Femorals.
- Aortic pressure: 160/60; LV pressure: 160/20.
-Reduced aortic diastolic pressure and elevated LVDP (diastolic back
flow). Aortic and LVSP increased from compensation.
42
Describe Turner Syndrome:
- Loss of a paternal X chromosome (45, XO)
- Physical Features: Short stature, broad chest, and webbed neck.
May have a narrow, high-arched palate, low hairline, cubits vulgarus (elbows with a weird angle).
- Cardiac: Bicuspid AV, Aortic Coarctation in which causes an increased risk of aortic dissection
- Renal: Collecting system malformation (Ureter Duplication),
Horseshoe kidney (fusion of lower poles) presented as Recurrent UTIs.
- Repro: Streak Ovaries (amenorrhea, infertility)
43
Describe the Latissimus dorsi:
- Contributes to forceful movement of the humerus
- Innervated from the thoracodorsal nerve (C6-C8)
- Extension, adduction, and internal rotation of the humerus
- injured from forceful downwards movement of the humerus,
throwing, climbing, or swinging
44
Describe Narcolepsy:
DSM 5 Criteria:
- Dx: recurrect lapses into sleep or naps (> 3/wk for 3 months)
- more than or equal to 1 of the following:
*Cataplexy: Brief loss of muscle precipitated by strong emotion
(laughter or excitement)
* Low CSF levels of hypocretin-1 (orexin-secreting hormone)
* Shortened REM latency
- Associated features: Hypnagogic/hypnopompic hallucinations, sleep
paralysis
45
Describe Pierre Robin Sequence:
*Single developmental defect causes a cascade of additional malformations
=> micrognathia, glossoptosis (small mandible displaces tongue posteriorly), U-shaped cleft palate (posterior displacement of the tongue prevents palatal fusion)
46
Describe Mucormycosis:
- Opportunistic infection caused by Rhizpus, Mucor, and Absidia
species.
- Paranasal sinus involvement in DM and Immune suppressed
patients.
- Broad nonseptate hyphae that branch at right angles
47
What are the primary cells involved in hepatic fibrosis?
- Stellate (Ito) cells
- Hepatic injury => stellate cells activated => Myofibroblasts
proliferate, promote chemotaxis, and producing lots of collagen.
- Masson trichome stain
48
What is equation for relative risk?
RR= (a/a+b)/(c/c+d)
49
Describe the effect of chronic glucocorticoid use on the HPA axis for cortisol:
Decreased Corticotropin Releasing Hormone (CRH) -> Decreased ACTH -> Decreased Cortisol
50
Describe Leishmaniasis:
-Intracellular protozoa with rod-shaped kinetoplasts causing
cutaneous lesions.
- Endemic in Middle East and Central/South America
- Transmitted through bites of infected sand flies
- Protozoa mature in macrophages
51
What virus has lifelong latent infection of the sensory ganglia, has periodic viral replication leading to cycling flares that resolve over time?
HSV- Latent infection within neuronal cell bodies.
52
Describe the antipsychotic side effect: Neuroleptic Malignant Syndrome
Fever, rigidity, mental status changes, autonomic instability
53
What structures are derived from the neural tube (ectoderm)?
Brain, spinal cord, posterior pituitary, pineal gland, retina
54
What structures are derived from the surface ectoderm? Mneumonic: A LINE
1. Anterior Pituitary (Rathke pouch)
2. Lens and Cornea
3. Inner ear sensory organs, olfactory epithelium
4. Nasal and oral epithelial lines, salivary glands
5. Epidermis, sweat and mammary glands
55
What is the key feature in congenital HSV?
vesicular/ulcerative rash
56
Describe Congenital Toxoplasmosis:
Infection acquired in utero that can present with hydrocephalus, intracranial calcification, and chorioretinitis due to CNS inflammation
57
Describe Measles Virus (Rubeola)
- Clinical Presentation: Prodrome (Cough, coryza, conjunctivitis, fever,
Koplik spots), maculopapular exanthem
- Cephalocaudal and centrifugal spread
- Spares palms and soles
- Complications:
- Primary Measles pneumonia
- Secondary bacterial infections (pneumonia and otitis media)
- Neurologic: Encephalitis (days), Subacute sclerosing
encephalomyelitis (weeks), Subacute sclerosing Panencephalitis
(years)
- Prevention: Live Attenuated Vaccine
*Increase risk with Vitamin A deficiency
58
What can a patient develop preceding Panic Disorder?
Agoraphobia: avoidance of multiple situations where they may feel trapped and helpless. Can be dx w/ for w/o panic disorder.
59
Gram negative bacilli, cannot ferment lactose, is not oxidase positive, and cannot produce H2S?
Shigella and Yersinia
60
MSK Anatomy:
What are the hip flexors?
1. Rectus femoris (also does knee extension)
2. Iliopsoas
3. Sartorius (also does knee flexion)
61
Drug(s) of choice for HIT?
Direct thrombin inhibitors: Hirudin, Lepirudin, Argatroban. Does not require ATIII.
62
Antidote for Warfarin overdose:
FFP and Vitamin K
63
Antidote for Heparin overdose:
Protamine
64
Homozygous for the apolipoprotein E4 allele. What is the most likely pathology to develop?
Late onset Familial Alzheimer's Disease
65
Describe Transudate Pleural Effusion:
- Light Criteria: Excudate criteria not met
- Pathophysiology: Change in hydrostatic or oncotic pressure.
- Common causes: Heart failure, cirrhosis (hepatic hydrothorax), nephrotic syndrome
66
What structures are derived form the mesoderm?
- Muscles
- connective tissue, bone, and cartilage
- Cardiovascular and lymphatic systems
- Spleen and hematopoietic cells
- Kidneys and ureters, internal ganglia
- Adrenal cortex
67
Prolonged exposure to loud noises causes hearing loss due to damage to what?
Stereocilliated hair cells of the organ of Corti
68
Describe the mechanism of action of patiromer?
- Exchanges calcium for potassium in the intestine. Decreases
Potassium excreted in the feces.
- AE: Diarrhea, hypokalemia, hypercalcemia, and hypomagnesemia
69
Of the respiratory tree, what is the last to disappear?
Cilia, persists up to the respiratory bronchioles.
70
Describe the Abducens Nerve:
- CN VI, innervated Lateral rectus. Function to abduct the eye.
- Lesion would cause medial deviation. Horizontal diplopia
71
What are the components of a maternal serum quadruple screen?
AFP, estriol, beta hCG, and inhibin A
72
What conditions cause an increase in Maternal serum AFP?
1. Open neural tube defects (eg, anencephaly, open spina bifida)
2. Ventral wall defects (eg, omphalocele, gastroschisis)
3. Multiple gestation
73
What conditions cause a decrease in Maternal serum AFP?
Aneuploidies (eg, trisomy 18 and 21)
74
Describe the features of fragile X syndrome:
- Pathogenesis: X-linked disorder caused by a trinucleotide (CGG) repeat expansion in the FMR1 gene (fragile X messenger ribonucleoprotein). Repeats with more that 200 causes hypermethylation, which silences the gene and prevents transcription of the associciated ribonucleoprotein.
- Physical features: Long, narrow face, a prominent forehead and chin; and large testes. Most apparent after puberty. Hyperlaxity of the joints in the hand can also occur.
- Cognitive and Developmental: Developmental delay (speech and motor) common in infancy. Intellectual disability can vary.
- Neuropsychiatric: features of ADHD (eg, inattention, impulsivity) and autism spectrum disorder (eg, poor eye contact, social deficits) are common.
75
Vignette mentions a skin nodule that stains dark-blue, basaloid keratinocytes in the dermis with peripheral palisading and cleft formation. Cells are crowded, have scan cytoplasm, and have a high N:C ratio. What is the Dx and what is the most likely outcome?
Dx: Basal cell carcinoma
Outcome: Local growth with progressive tissue destruction.
76
Neuroanatomy:
List the most common causes of Spinal stenosis: 3
- Intervertebral disc herniation
- Ligamentum flavum hypertrophy
- Osteophyte formation affecting the facet joints
77
Describe Holoprosencephaly:
- Embryology: Incomplete division of the forebrain (prosencephalon)
- Etiologies: Genetic: Trisomy 13, Sonic Hedgehog gene mutations;
Environmental: maternal alcohol use, retinoic acid deficiency
- Clinical features: CNS abnormalities: range from asymptomatic to seizures, severe intellectual disability, death.
Midface abnormalities: range from mild hypotelorism (distance between the eyes) and cleft lip/palate to cyclopean, primitive nose, facial cleft.
78
Describe Permissiveness:
Occurs when a hormone has no direct effect on a physiologic process but allows another hormone to exert its maximal effect on that process.
Example: Cortisol exerts a permissive effect on catecholamines to potentiate vasoconstriction and bronchodilation; it also has a permissive effect on glucagon to increase glucose release from the liver.
79
An increase in which of the following features best explains the presence of Target cells?
Increase in Surface area-to-volume ratio. Occurring from either a reduced erythrocyte cell volume from deficient hemoglobin synthesis (thalassemia, iron deficiency) or structural mutation to hemoglobin (eg, sickle cell)
Or excessive erythrocyte cellular membrane due to greater cholesterol-to-phospholipid ratios (eg, Obstructive liver disease) or splenectomy.
80
Describe Pappenheimer bodies:
Aggregated iron deposits in erythrocytes that are often seen in patients with sideroblastic anemia. They appear as dark blue inclusions.
81
Describe Howell-Jolly bodies:
Clusters of DNA remnants in erythrocytes due to hyposplenism or asplenism (the spleen usually removes the DNA remnants). They appear as peripheral, round, dark purple, blue, or red inclusions.
82
Describe Heinz bodies:
Aggregates of denatured hemoglobin that may be present in erythrocytes when patients have Glucose-6-phosphate DH deficiency or thalassemia. Cannot be seen on routine screening.
83
Describe Basophilic stippling:
Blue granules dispersed within the cytosol of erythrocytes due to precipitated ribosomes.
- thalassemias
- alcohol use disorder
- lead/heavy metal poisoning
84
Describe the immunosuppressants in transplant patients Cyclosporine and Tacrolimus:
Inhibit calcineurin activation. Calcineurin is an essential protein in the activation of IL-2, which promotes the growth and differentiation of T cells.
85
What medication is know to have a lower incidence of tornado de pointes than other QT-prolonging agents?
Amiodarone
86
Which cells control a Tuberculosis infection?
CD4 T lymphocytes and macrophages
87
ST elevations in (lateral) leads I and aVL, which cardiac artery is affected?
Left circumflex artery
88
Which leads have ST elevations when it affects the Left Anterior Descending Artery (LAD)?
Proximal: anterior leads V1-V4
Distal segment may spare V1-V2.
89
Which leads have ST elevations when the Left Main Coronary Artery is affected? (giving rise to the LAD and LCX)
Anterior V1-V4 and lateral V5-V6 and aVL leads.
90
What additional tests should be considered during a workup for acute pancreatitis?
Serum Triglycerides (more than 1000 mg/dL
91
Describe the three treatment of cyanide (CN-) toxicity:
1. Sodium thiosulfate: sulfur donor that facilitates CN- binding to form thiocyanate, which is excreted in the urine.
2. Hydroxocobalamin: Cobalt binds to CN- to form cyanocobalamin, which is excreted in the urine. Prevents cyanide binding to ferric ions.
3. Sodium Nitrite: Nitrites promote formation of methemoglobin, which binds CN- with greater affinity than cytochrome C oxidase, reducing CN- toxicity. Take with caution because Methemoglobinemia is toxic in excess.
92
Describe Campylobacter Jejuni:
- Epidemiology: Motile, curved, gram-negative rod, oxidase-positive.
Transmission: contaminated food (undercooked poultry) and pets (dogs).
Common cause of food borne gastroenteritis.
- Manifestations: Fever, abdominal pain, diarrhea w/ w/o blood/mucus. Usually self-limited (<7days)
- Complications: Guillain-Barré syndrome (cross-reacting antibody to myelin gangliosides)
Reactive arthritis.
93
What is impaired in Osteogenesis Imperfecta?
Osteoid production by osteoblasts.
94
Formula for Odds Ratio:
Odds of dx of cases/ odds of dx of control.
OR= (a/c)/(b/d) or (ad)/(bc)
95
Levels of which of the following substances will be higher in the pulmonary vein compared to the pulmonary artery in Decompensated heart failure? (exertion dyspnea, orthopnea, JVD, cardiac heave, and peripheral edema)
Angiotensin II
96
Describe Dysplasia type of congenital anomaly?
- Abnormal organization of cells within a tissue (often genetic)
- Ex: Skeletal dysplasia (eg, achondroplasia)
97
What is responsible for internuclear ophthalmoplegia (impaired adduction with CL eye gaze) and optic neuritis (transient blur in vision and eye pain with movement)? What is the dx?
Demyelination of CNS (reduced saltatory conduction) in AI-Multiple Sclerosis
98
Describe Intraductal Papilloma
Epithelial and myoepithelial cells lining fibrovascular cores in a cyst was or duct. Causes bloody nipple discharge and typically present without breast masses or skin changes.
99
What is the difference between factor X (hematin) and factor V (NAD+) in Haemophilus influenza?
- X factor Hematin responsible for beta-hemolysis-induced erythrocyte lysis
- V Factor (NAD+) is responsible for growth
100
Describe the Trochlear Nerve:
- CN IV, innervates the superior oblique Fx to abduct, internally rotate, depress the eye while adducted
- Lesion cause upward deviation, vertical and torsional diplopia
101
List the key features of congenital syphillis?
Rhinorrhea, Skeletal anomalies, Desquamating rash (palms/soles)
102
Which inhibitors block binding of platelet glycoprotein IIb/IIIa with fibrinogen and fibronectin?
- GpIIb/IIIa inhibitors: Abciximab, Eptifibatide, Tirofiban
*Useful in percutaneous intervention (PCI) in ACS
103
Formula for oral bioavailability:
AUC of PO dose/ AUC of IV dose
104
Describe E coli virulence factor Lipopolysaccharide:
How does it present?
- Mech: Activates macrophages -> widespread release of IL-1, IL-6 and TNF-alpha
- Presentation: Bacteremia and septic shock
105
Which nerve roots is responsible for perianal anesthesia?
- S2-S4, aka saddle anesthesia
106
What plays an important role in mRNA translation and mRNA degradation?
Cytoplasmic P bodies
107
Describe the effects of Phenylephrine:
- alpha 1
- BP: Increase
- HR: decrease
108
Describe Hep B marker: HBsAg
- Hep B virus surface glycoproteins
- Detectable during acute infection
- Persistence >6 mo = chronic infection
109
What would you expect with UV radiation damage?
Endonuclease nicking of the damaged DNA => Xeroderma pigmentosum
110
If the rectus abdomens muscle is incised laterally, what structure is at greater risk of injury?
Inferior epigastric artery
111
Describe the Hep B marker: HBeAg
- Hep B virus polypeptide
- Detectable during acute infection
- Indicates increase replication and infectivity
112
GI Pathology:
Elevated unconjugated bilirubin, intermittent scleral icterus, normal PE and vitals. What is Dx?
Gilbert Syndrome. Icterus upon a stressor.
Pathophysiology: Dec. activity of UDP Glucoronosyltransferase
113
The presence of a central vascular catheter and receipt of parenteral are risk factors for what?
Candida in the blood -> candademia
*Pseudohyphae with blastoconidia
114
Where is type 3 collagen found, and what is its association?
Location: Skin, lungs, intestines, blood vessels, bone marrow, lymphatics, and granulation tissue.
Associated with Vascular Ehlers-Danlos Syndrome type 4
115
Where is type 4 collagen found, and what is its association?
Location: Found in basement membrane
Associated with Alport Syndrome
116
Cannulation above the inguinal ligament can significantly increase the risk for what?
Retroperitoneal Hemorrhage
117
Lesion where in the brain would cause contralateral sensory deficits and cortical sensory signs?
The somatosensory cortex, located posterior to the central sulcus
118
Describe Persistent Vitelline Duct:
- Complete duct closure failure
- Results in a patient connection between intestinal line and the umbilicus.
- Causes meconium discharge from the umbilicus after birth
119
Describe Exudative Pleural Effusion:
Light Criteria:
- Pleural protein/serum protein > 0.5, or
- Pleural LDH/ serum LDH >0.6, or
- Pleural LDH >2/3 upper limit of normal
Pathophysiology: Inflammation increase in membrane permeability
Common Cause:
- Infection (eg, pneumonia, TB), malignancy, Rheumatologic disease
120
Describe Small Cell Carcinoma of the Lung:
Clinical features:
- Risks: Smoking, male> female. Highly aggressive, centrally located.
- Histology: sheets of small blue cells with scant cytoplasm.
- Neuroendocrine markers: neural cell adhesion molecule (NCAM), neuron-specific enolase, chromogranin, synaptophysin.
Associated Paraneoplastic Syndromes:
- SIADH
- Cushing Syndrome
- Lambert-Eaton Syndrome
121
Describe the Hep B marker: Anti-HBc IgG
Present in both acute and chronic infection. Not present after vaccination.
122
What is responsible for vaccine reactogenicity?
Macrophages and IL-6, and Mast cells and IL-1. Look for warmth, swelling, edema, fatigue. fever, and headache.
123
Gram negative bacilli, fast lactose fermenter, indole negative:
Klebsiella, Enterobacter
124
What would be contained in Meckel Diverticulum?
Heterotopic/Ectopic Gastric Mucosa
125
What nerve is in close proximity to the crust terminals of the right atrium?
Right Phrenic nerve -> elevation of right hemidiaphragm
126
Which cytokines are responsible for cachexia?
TNF-alpha, IL-1 beta, IL-6
127
Cardiovascular Pathology:
In Mitral Stenosis, how do the Left ventricular hemodynamics look during rest?
Normal Diastolic pressure, after load, and contractility
128
What nerve is responsible for adducting the thigh?
Obturator Nerve
129
Describe the effects of Dobutamine:
Beta 1 > Beta 2 receptor binding.
BP: -/decrease
HR: Increase
130
What are the complication of Hereditary Spherocytosis?
Pigmented gallstones, Aplastic crisis with Parvovirus B19 infection
131
Describe the effects of Isoproterenol:
Beta 1 = Beta 2 receptor binding
BP: -/decrease
HR: increase
132
Describe the 1st line Tx for Schizophrenia:
D2 receptor antagonists- antipsycotics
133
Where would suspect an ectopic foci in a patient with AFib?
Pulmonary Veins
134
List the key features for congenital Cytomegalovirus?
- Periventricular calcifications
- Microcephaly
- Sensorineural hearing loss
135
What is the effect of surfactant on Functional Residual Capacity?
Increase
136
What is released from mast cells and basophils during anaphylaxis?
Histamine and Tryptase respectively
137
Describe Hep B marker: Anti-HBs
Seen with cleared infection or vaccination. Confers long-term immunity
138
Which drugs inhibit ADP mediated platelet aggregation. Useful in PCI, tx in unstable angina, and non-Q wave MI?
Ticlodipine and Clopidogrel
139
What is deficient and what is accumulated in Tay-Sacks Disease?
Deficient in Beta-hexosamidase A
Accumulates GM2 ganglioside
140
Gram negative diplococci, aerobic, can utilize maltose?
N. Meningitidis
141
Which host factors are primarily responsible for mediating the response to Trastazumab?
Natural Killer cells and granzymes
142
Withdrawal of what substance causes anxiety, tremor, insomnia, and sympathetic hyperactivity (eg, diaphoresis, palpitations). Severe cases cause psychosis, seizures, and death?
Benzodiazepines eg, Lorazepam
143
What causes nonpitting edema in neonates with Turner Syndrome?
Lymphatic network dysgenesis
144
What causes cleft palate?
Palatine shelves fail to fuse
145
Describe Cryptosporidium parvum:
Pathogenesis:
- A parasite spread via fecal-oral transmission (eg, contaminated water, animal contact)
- Oocyte ingestion -> sporozoite attachment to intestinal epithelium -> intraluminal merino formation -> fecal oocyte shedding.
Clinical manifestations:
- immunocompetent: self-resolving, watery (noninflammatory) diarrhea < 2 weeks
- Immunosuppressed (eg, AIDS, transplant recipient): prolonged, severe diarrhea with weight loss/ malabsorption.
Dx:
- Stool PCR testing
- Stool microscopy: acid-fast staining oocytes or immunofluorescent assay.
Histology:
- basophilic Cryptosporidium organisms on intestinal brush border, small intestine villous blunting, lamina propria inflammation
146
What organism has a narrow zone of clear hemolysis with zone enhancement in the presence of Staph. Aureus?
Streptococcus agalactiae (GBS)
147
Describe a Glomangioma:
A benign tumor of the modified smooth muscle cells of a glomus body. Glomus bodies are numerous small, encapsulated neuromuscular organs found in the dermis of the nail bed, pads of the fingers and toes, and the ears. Rich vasculature shunts blood away as a form of thermoregulation.
148
Describe Pertussis:
Pathophysiology:
- Bordetella pertussis (gram-negative coccobacilli)
- Major virulence factors: pertussis toxin (AB toxin), adenylate cyclase toxin, tracheal cytotoxin
Clinical stages:
- Catarrhal (1-2 wks): mild cough, rhinitis
- Paroxysmal (2-6 wks): severe coughing spells with inspiratory whoop, posttussive emesis; w/ w/o apnea/cyanosis (infants)
- Convalescent (weeks to months): gradual resolution
Treatment:
- Macrolide antibiotic (eg, azithromycin) (50S, inhibits protein synthesis)
- Prevention: Acellular pertussis vaccine.
149
Describe the 6 Pharyngeal and Aortic arches with associations:
1. Trigeminal (CN V), Maxillary artery
2. Facial (CN VII), Stapedial artery (regresses)
3. Glossopharyngeal (CN IX), Common carotid artery and proximal internal carotid artery.
4. Superior laryngeal branch of vagus ( CN X), True aortic arch, subclavian arteries.
5. Obliterated
6. Recurrent laryngeal branch of CN X, Pulmonary arteries, ductus arteriosus
150
Describe the step involved in Base excision repair:
1. Glycosylase: Cleaves the altered base, leaving an AP site
2. Endonuclease: cleaves the 5' end
3. Lyase: Cleaves the 3' sugar phosphate
4. Polymerase: Fills the single nucleotide gap
5. Ligase: Seals the nick
151
What you expect to decrease in Wernicke encephalopathy?
Erythrocyte transketolase activity
152
Describe the clinical features of early congenital syphillis: 4 category involvement
Perinatal:
- Prematurity
- Intrauterine fetal demise
- low birth weight
- Focal necrosis of the umbilical cord
Mucocutaneous:
- Snuffles: copious rhinorrhea, often purulent or seroanguineous
- Desquamating, maculopapular rash involving palms/soles
- fissures near orifices (eg, anal, oral)
- jaundice
Musculoskeletal:
- Long bone abnormalities (eg, periosteal thickening, metaphyseal erosion)
Reticuloendothelial:
- Hepatomegaly w/ w/o splenomegaly
- Lymphadenopathy
- Anemia, thrombocytopenia, leukopenia/leukocytosis
153
Describe a patent ductus arteriosus:
- Allows blood from the aorta to flow directly into the pulmonary artery => decreasing the SVR.
- Increase in blood return to the LA and LV, LV compensates by increasing SV and CO.
154
Virology:
Describe Conjugation:
Form of horizontal gene transfer that involved the formation of the pilus and the direct passing of genetic material from one bacterium to another. Common source of antibiotic resistance and environmental adaptation. Particular about Shigella tx resistance.
155
Describe Hemophilia:
XLR Bleeding disorder due to decreased levels of factor VIII (Hemophilia A) or factor IX (hemophilia B). Decreased levels cause a failure to convert prothrombin into thrombin and deficient thrombus formation. Typically present as bleeding after a tooth extraction and a hx of hemarthrosis (bleeding into the joints).
156
What is the pathophysiology behind 3rd degree AV block?
Degenerative changes involving the atrioventricular node.
157
What organ like deep to the tip of the 12th rib?
Left Kidney
158
Describe the Glossopharyngeal nerve:
- Somatic motor: Stylopharyngeus muscle only (elevates larynx during swallowing)
- Parasympathetic: Inferior salivary nucleus -> CN IX -> otic ganglion
-> travels along auriculotemporal nerve (CN V3) -> parotid gland secretion.
- General sensory: Tympanic membrane (inner surface), Eustachian tube, posterior third of tongue, tonsillar region, upper pharynx (afferent portion of gag reflex), carotid body, and carotid sinus
- Special sensory (taste): posterior third of tongue
159
HML Pathology:
What normal value would you expect to see in a patient with Methemoglobinemia (Nitrites)?
PaO2
160
Microbiology:
Describe Ehrlichia chaffeensis:
Harbored in white-tailed deer and transmitted to humans by tick bite. It replicates in vacuoles within monocytes and forms mulberry-shaped, intraleukocytic inclusions (morale. Manifestations usually include nonspecific symptoms (eg, fever, chills, myalgia), maculopapular rash, and significant laboratory abnormalities, paricularly lymphopenia.
161
Describe Syndrome of inappropriate antidiuretic hormone (SIADH):
Pathophysiology:
- Uncontrolled secretion of ADH.
- Leads to water retention and impaired urinary water excretion
Causes:
- CNS disturbances (stroke, hemorrhage, trauma)
- Medications (eg, carbamazepine, SSRIs, NSAIDs)
- Lung disease (eg, pneumonia)
- Malignancy (eg, small-cell lung cancer)
Clinical findings:
- nausea, forgetfulness (mild hyponatremia)
- seizures, coma (severe hyponatremia)
- Euvolemia (eg, moist mucous membranes, no edema, no JVD)
Laboratory findings:
- hyponatremia, Low serum osmolality, High urine osmolality, high urine sodium
162
Patients with severe aortic stenosis are at high risk for mucocutaneous and colonic bleeding due to what?
Acquired von Willebrand deficiency
163
Pathway for Neisseria Meningitidis to reach the CNS:
Pharynx -> Blood -> choroid plexus -> meninges
164
Describe Meckel Diverticulum:
The most common vitelline duct anomaly, resulting from partial closure of the vitilline duct, with the patent portion attached to the ileum. A fibrous band may connect the tip of the diverticulum with the umbilicus. Patients classically have painless hematochezia due to intestinal ulceration from heterotopic gastric mucosa contained within the diverticulum.
165
Describe the findings of Opioid Intoxication:
- Pupillary constriction (ie, mitosis),
- depressed mental status
- Hypothermia
- Hypotension
- Decreased tidal volume
166
Describe the MOA of Digoxin on the heart:
Slows AV node conduction by increasing parasympathetic tone. Works to treat Afib at rest, not so much during exercise because of increased sympathetic tone.
167
What virulence factor of Staph. Aureus is responsible for necrotizing pneumonia (pulmonary cavitations/ abscesses)?
Panton- Valentine Leukocidin
168
How is gastric acid neutralized in the GI tract?
1. Bicarbonate from the submucosal (Brunner) glands of the 1 part of duodenum.
2. Pancreatic secretions emptied into the duodenum at ampulla.
169
Describe Hep B marker: Anti-HBcIgM
Detectable during acute infection. Present during window phase (between HBsAg and anti-HBs
170
Inhibition of Neprilysin and Angiotensin Receptor is important why?
Increase ANP and BNP --> vasodilation, diuresis --> increased urinary Na+ excretion
171
Gram negative bacilli, fast Lactose fermenter, indole positive
E. Coli
172
Which organisms are responsible for recurrent infections in patients with Chronic Granulomatous disease?
*Catalase positive organisms:
- Bacteria: Staph Aeureus, Barkholderia, Serratia, Nocardia
- Fungi: Aspergillus
173
Where is type 2 collagen found and what pathology is it associated with?
Found in carriage, vitreous humor, and nucleus pulposus.
Associated with skeletal dysplasias
174
How would you describe Aspergillous Fumigates?
Fungus found in decaying vegetables causing rhinosinusitus.
Septate Hyphae with acute 45 degree angle branching
More commonly effect immunocompromised individuals
175
Describe Chikunguny Virus infection
Epidemiology:
- Tropical/subtropical of Caribbean, Central/South America, Africa and Asia.
- Vector: Aedes mosquito (also transmits dengue, yellow fever, and Zika)
- Manifestations: Incubation: 3-7 days. High fever and severe polyarthralgia (almost always present), headache, myalgia, conjunctivitis, maculopapular rash. Lymphopenia, thrombocytopenia, transaminitis.
- Manage: Supportive (initial symptoms resolve 7-10 days), Chronic arthralgia/arthritis frequently occurs (may require Methotrexate)
176
Elevated AFP with ultrasound shows open neural tube defect, presented with a cystic lesion overlying the lumbosacral spine, ventriculomegaly, and hindbrain herniation), What is the defect?
Primary neurulation
177
What are the muscles of the quadriceps? Where do they insert? What is the pathologic association?
Muscles: Rectus femoris, Vastus intermedius, vastus medialis, vastus lateralis.
Inserts at the tibial tubercle.
Association: Osgood-Schlatter disease.
178
Describe Vitelline sinus
Results from partial closure of the vitelline duct, with the patent portion at the umbilicus; serous umbilical drainage may occur.
179
Describe the effects of Norepinephrine:
alpha 1 > beta 1 > beta 2
BP: increase
HR: - / reflexive bradycardia
180
Describe the different Adrenergic Agonists:
alpha 1: peripheral VC, increase SVR
beta 1: Increase HR and Contractility, increase CO
beta 2: peripheral VD, decrease SVR
D1: Renal arteriolar VD
181
Describe Vitellin Duct Cyst:
Forms when peripheral portions of the duct obliterate but the central part remains. Patients are asymptomatic.
182
Describe Trendelenburg Gait:
Injury to the superior gluteal nerve -> weakness in the gluteus medius.
Example: injection to superomedial quadrant.
Hip drop of the contralateral side of the lesion.
183
Describe the Hep B marker: Anti-HBe
Develops in cleared infection and later in chronic infection.
Indicated decrease viral replication and infectivity
184
Gram negative diplococci, aerobic, cannot utilize maltose?
N. Gonorrhoea, Moraxella
185
Which drugs inhibit platelet aggregation by inhibiting phosphodiesterase activity and increasing cAMP?
Dipyridamole and cilostazol. Cilostazol also acts as a direct arterial dilator.
186
Describe Androgen insensitivity syndrome:
- Dysfunctional androgen receptors
- Genotypical male: XY
- Testes present, absent external and internal genitalia
187
Describe Fludrocortisone:
Synthetic mineralcorticoid
1. Increase Na+ reabsorption in DCT and collecting duct -> fluid retention and circulation blood volume -> decrease urine sodium
2. Increase vascular sensitivity to multiple endogenous vasoconstrictors (eg, ATII, NE) causing a potentiation of their pressor effects
188
What is the inheritance pattern of Hemophilia A or B?
X-Linked Recessive
1/2 * 1/2 * 1/2 (for the chance of having a boy)
189
Describe Trisomy 18 (Edwards Syndrome)
- 47, XX, +18 (Meiotic Nondysjunction)
- Micrognathia (small mandible)
- Prominent occiput
- Low set ears
- Heart defects, kidney defects
- Limited hip abduction
- Rocker bottom feet
- Clenched hands either overlapping fingers
190
What are the primary mediators in COPD?
Neutrophils, macrophages, and CD8 T cells
191
Describe the muscarinic effects of Cholinergic Toxicity (Organophosphate poisoning) ?
DUMBELS
- Diarrhea/ diaphoresis
- Urination
- Miosis
- Bronchospasm, bronchorrhea (watery sputum), and Bradycardia
- emesis
- lacrimation
- salivation
Treat with Atropine
192
Describe the nicotinic effects of Cholinergic Toxicity (Organophosphate poisoning) ?
Muscle weakness, paralysis, fasciculation
Treat with Pralidoxime
193
Describe the E coli virulence factor: Shiga Toxin
Inactivated 60S ribosomal subunit, halting protein synthesis and causing cell death
Presentation: Blood gastroenteritis
Particular with E Coli 0157:H7
194
Cardiovascular Pathology:
Holosystolic murmer at the apex with radiation to the axilla with audible S3 to determine severity
Mitral regurgitation
195
Describe Cerebral Arteriovenous malformation
Vascular malformations histologically characterized by a tangle of abnormal vessels, including large veins with thickened walls and irregular arteries.
Intracranial hemorrhage, headache, +/- seizures
'Bag of worms' appearance and dark flow voids on radiograph. Refer to picture taken.
196
Microbiology:
List key feature of congenital Rubella:
Cataracts
Heart defects (eg, PDA)
Sensorineural hearing loss
197
Gram negative bacteria, cannot ferment lactose, but is oxidate positive?
Pseudomonas, common UTI cause with indwelling catheters
198
What is a consequence of chronic corticosteroid use applied topically?
Dermal/ Cutaneous Atrophy, as well as telengiectasias and acne.
199
What 2 main arteries supply the small and large intestines?
SMA and IMA
Connected by the marginal artery of Drummond.
200
Describe the E Coli virulence factor Heat-stable/ Heat labile enterotoxins:
Mechanism: Promotes fluid and electrolyte secretion from intestinal epithelium.
Presentation: watery gastroenteritis
201
HML: Pathology
Patient with pancytopenia, inappropriate low reticulocyte count, normal cell lines on PBS, no splenomegaly. What is the dx, how to dx?
Dx: Aplastic Anemia
Bx: hypocellular marrow with abundance of stratal and fat cells. 'Dry tap.'
202
Gram negative coccobacilli?
H. Influenzae
B. Pertussis
Pasteurelia
Brucella
F. Tularensis
203
What is the inheritance pattern for Phenylketonuria? Symptoms?
Autosomal Recessive
1/2 * 1/2
Symptoms: Intellectual disability, gait abnormality, musty body odor, Eczema
- Deficiency in phenylalanine hydroxylase (PAH)
204
What nerve is affected with a Fibular neck fracture, what are the deficits?
Common fibular nerve (perineal) -> loss of sensation of the dorsal of the foot.
Deep Fibular nerve: dorsiflexion weakness.
Superficial fibular nerve: eversion weakness
205
What drug inhibits inosine 5'-monophosphate dehydrogenase?
Mycophenolate: Inhibits IMP -> GMP conversion primarily in lymphocytes. Used to prevent rejection in transplants.
Process in denote purine synthesis. Prevents lymphocytes from proliferating.
206
Describe Arsenic poisoning
Mechanism:
- Binds to sulohydryl groups
- Disrupts cell respiration and glucogensis
Sources:
- Pesticides/insecticides
- contaminated water (wells mostly)
- Pressure treated wood
Manifest:
- Acute: Garlic breath, vomitting, watery diarrhea, QTc prolongation
- Chronic: Hyper/hypopigmentation, hyperkeratosis, stocking-glove neuropathy
Treatment:
- Dimercaprol and DMSA
207
Describe the 5 types of cell junctions?
Gap Junctions: Connexins, fx to communicate intercellular
Tight junctions: Claudin and Occludin, fx paracellular barrier
Adherens: Cadherins, fx to anchor cells
Desmosomes: Cadherins (desmogleins/plakins), fx to anchor cells
Hemidesmosomes: Integrins, fx to anchor cells
208
Describe Prevalence
existing cases/ population
Affected by immigration and emigration of both healthy and sick
209
What is tetrahydrobiopterin (BH4) an important cofactor for?
1. Phenylalanine hydrocylase: Phe-> Tyr; phenylketonuria (microcephaly, developmental delay, seizures). Hypopigmentation too via tyrosinase competitive inhibition
2. Tyrosine hydroxylate: catecholamine production
3. Tryptophan hydroxylate: Serotonin production
210
What is the risk taking Eculizumab, what is the prophylaxis?
Eculizumab target C5, an essential for the MAC complex. Treatment option for Paroxysmal Nocturnal hemoglobinuria.
Needs vaccination for encapsulated bacteria eg, Neisseria Meningitidis, Strep. Pneumonia, etc. Also PCN prophylaxis.
211
Abrupt-onset unilateral headache, eye pain with nausea and visual halos. What is the dx? Tx? Mechanism?
Dx: Angle-closure glaucoma: impaired drainage of aqueous humor.
Tx: Carbonic anhydrase inhibitor eg, Acetazolamide decreases pressure. Also affects the PCT of the kidney causing an increase in urine pH and mild metabolic acidosis.
212
List the causes of QT prolongation:
1. Acquired: Medications
Macrolides and Fluoroquinolones. Antiemetics (eg, ondansetron), Azoles (Fluconazol), Antipsychotics, TCAs, SSRIs, some opioids (eg, methadone, oxycodone), Class 1a antirrhythmics: eg, quinidine, Class III antirrhythmics eg dofetilide, sotalol.
2. Electrolyte Imbalance: Decrease Magnesium, Decrease Potassium, Decrease Calcium
3. Congenital: Romano-Ward syndrome (AD), Jerrell & Lange-Nielsen Syndrome (AR) associated with sensorineural hearing loss.
All have common Volted gated potassium channels
213
Describe the effects of Dopamine:
Low dose:
- D1 > beta 1 > alpha 1 receptor binding
- BP: - / decrease
- HR: increase
High Dose:
- alpha 1 > beta 1 > D1
- BP: increase
- HR: - / decrease (reflexive)
214
How is protein synthesis terminated?
Stop codons (UGA, UAA, UAG) are recognized by releasing factors that hydrolyze the bond between the polypeptide chain and the tRNA in the P site
215
Pt with ringed trophozoites traveled to an endemic area? What is the dx, what is the treatment?
Dx: Malaria, Plasmodium species. Giemsa staining positive
Tx:
- Non African origin -> Chloroquine
- Endemic Africa: Atovaquone & proguinal combo, or artemisinins.
- For Hypnozoites (Liver forms of P Vivax and P ovals) -> Primaquine
216
Explain the causes of Hypoxemia:
1. Reduced PiO2; High altitude; Normal A-a
2. Hypoventilation; CNS Depression, Morbid obesity; Normal A-a
3. Diffusion limitation; Emphysema, ILD; Increase A-a
4. V/Q mismatch; PE, Pneumonia; Increased A-a
217
Describe malformation type of congenital anomaly?
- Defect in organogenesis (eg, genetic or teratogenic)
- Ex: Spinal Bifida, Holoprosencephaly
218
Which medical conditions are considered polygenic inheritance?
Mneumonic AGE THIS
- Androgenetic alopecia
- Glaucoma
- Epilepsy
- T2DM
- HTN
- IHD
- Schizophrenia
219
Describe disruption as a congenital anomaly?
Destruction of a structure that was previously developing normally.
Ex: Amniotic bands, triggered by interuption of the blood supply, forms fibrous bands that encircle and contracts without external pressure
220
Describe the physiologic changes of pregnancy:
1. Cardiovascular: Increase blood volume (plasma > RBC mass), decrease SVR, increase HR and CO.
2. Pulmonary: Increase central respiratory drive (hyperpigmentation) decrease PaCO2 (resp. alk.), increase PaO2.
3. Renal: Increase in RBF, urine output, increase GFR, decrease in BUN and Serum creatinine. Increase HCO3- excretion (metabolic compensation). Decrease Na+ concentrate (Increase ADH)
4. Hematologic: Increase in prothrombotic coagulation factors, decrease concentrations (dilution anemia)
221
Phases of Acute Respiratory Distress syndrome:
1. Week 1: Exudative: hyaline membranes, acute inflammation.
2. Week 2: Proliferative: interstitial inflammation; proliferation of pneumocytes, endothelial cells, fibroblasts for collagen deposition. ***Prolonged period causes a reduced diffusion capacity resulting in an Increased A-a gradient.
3. Week 3: Fibrosis, not with all patients
222
Which part of the aorta is susceptible to injury in rapid decelerating injury?
Dx: Blunt aortic injury
Location: Aortic Isthmus
Symptoms: chest pain, SOB, widened mediastinum, pulse discrepancy between upper and lower extremities (similar to aortic coarctation) intrascapular murmur (aortic impingement).
223
Describe von Gierke Disease:
Type 1 GSD
- hepatomegaly and steatosis
- fasting hypoglycemia
- lactic acidosis
- hyperuricemia and hyperlipidemia
- deficiency in Glucose- 6- phosphatase
224
Describe Oculocutaneous Albinism:
Pathophysiology:
- AR Tyrosinase. mutation. Impaired melanin synthesis. Abnormal optic nerve and foveal development.
- Eye finding: Photophobia, reduced visual acuity, strabismus, Nystagmus, Light colored, translucent iris
- Skin findings: White.light skin and hair, Increase propensity for sunburn, increase risk of skin cancer
225
What respiratory pathologies can manifest from rheumatoid arthritis?
Pulmonary fibrosis (bilateral reticular modular opacities on CXR. PFTs show restrictive pattern. Can occur from the disease or meds -> interstitial lung disease
226
Dermatology Pathology:
What skin finding can you find after a bony fracture, ligamentous rupture, or muscular injury. Does not blanch under pressure as the RBCs are not in the vessel and undergoes a color change that can estimate the age of injury.
Ecchymoses
227
MSK Pathology:
Describe the features of Drug-induced lupus erythematosus:
Clinical features:
- Abrupt onset of symptoms: Fever/fatigue, arthralgias/arthritis, rash, serositis
- increase risk in slow acetylators
Laboratory findings:
- Antihistone antibodies present in >95% of patients
- Anti-dsDNA antibodies rarely seen (Specific for SLE)
Implicated drugs:
- Procainamide, Hydralazine, Isoniazid, Minocycline, TNF-alpha inhibitors (eg, etanercept)
228
What do you avoid in a patient with Aldolase B deficiency or hereditary fructose intolerance (AR)?
Fructose or sucrose
Aldolase B deficiency can result in fructose-1-phosphate accumulation; this toxic metabolite depletes intracellular phosphate and inhibits the activation of hepatic phosphorylase and gluconeogenesis.
229
List the major muscles responsible for flexion of the hip:
Iliopsoas, Rectus femoris, Tensor fascia lata
230
MSK Anatomy:
List the major muscles responsible for extension of the hip:
Gluteus maximus, Semitendinosus, Semimembranosus, Biceps femoris (long head)
231
MSK: Anatomy
List the major muscles responsible for abduction of the hip:
Gluteus medius, Gluteus minimus
232
List the major muscles responsible for adduction of the hip:
Adductor brevis, Adductor longus, Adductor Magnus
233
Describe Selective IgA deficiency:
Clinical features:
- usually asymptomatic
- recurrent sinopulmonary and GI infections
- autoimmune disease
- anaphylaxis during transfusions
Diagnosis:
- low or absent serum IgA levels
- Normal IgG and IgM levels
234
Psych Pharmacology:
What do you give a patient suffering alcohol withdrawal? Name 3 meds
Benzodiazepines: acts on GABA receptors, preventing alcohol withdrawal. Eg, lorazepam, diazepam, chlordiazepoxide.
235
Describe Sexual performance anxiety/psychogenic erectile dysfunction:
Causes and risk factors:
- marital/ relational stress, conflict
- major psychosocial trauma (loss of job or loved one)
- severe medical illness (stroke, myocardial infarction)
- mood, anxiety disorders
Features:
- abrupt onset, clear precipitating event or stressor
- situational ED (normal nocturnal/nonsexual erections)
- impaired or premature orgasm
Management:
- CBT, couples/relational therapy
236
What site is the primary infection in a patient with Cryptococcus neoformans?
Organism resides in cold contaminated by bird droppings, and Human exposure primarily occurs due to inhalation into the lungs.
237
List the common medication associated with constipation:
Opioids:
- Centrally acting (eg, oxycodone, morphine)
- Peripherally acting (eg, loperamide)
Anticholinergic agents:
- antihistamines (eg, diphenhydramine)
- Tricyclic antidepressants (eg, amitriptyline)
- antispasmodics (eg, dicyclomine)
- 1st generation antipsychotics (Eg, haloperidol)
Cation- containing agents
- iron tablets
- aluminum (eg, antacids)
Non-dihydropyridine CCBs:
- diltiazem, verapamil
5HT3 antagonists:
- Ondansetron, granisetron
238
What agent is responsible for Tinea corporis?
- Trichophyton rubrum
- most common cause and infects keratinized matter in the stratum corneum of the superficial epidermis but does not invade the dermis or subcutaneous tissues.
239
Describe the Plague:
Microbiology:
- Yersinia pestis
- gram negative coccobacillus
- Bipolar (safety-pin) appearance on Wright or Giemsa staining
Epidemiology:
- Zoonotic: transmitted primarily by rodent fleas
- endemic to South and North America, Africa, Asia, Russia
Manifestations:
- painful regional lymphadenopathy with overlying erythema (buboes)
- chills, fever, headache, weakness
- disseminated intravascular coagulation and death when not treated
240
Which common colonic polyps are neoplastic?
- Sessile serrated polyp
- Adenomatous (Villous > tubular)
241
Which common colonic polyps are nonneoplastic?
- Hyperplastic
- Inflammatory
- Hamartomatous
242
Describe Reye Syndrome:
Pathophysiology:
- ASA use in children during viral infection (eg, influenza, varicella)
- Mitochondrial toxicity -> impairs fat metabolism
- Microvesicular fat deposits in the lever (steatosis)
- Hepatic dysfunction 0> hyperammonemia
- Diffuse astrocyte swelling (ie, cerebral edema)
Clinical features:
- acute liver failure: hepatomegaly, elevated transaminases; coagulopathy.
- rapid progressive encephalopathy: vomitting, lethargy, seizures, coma
Rx: Supportive
243
Describe Cori disease:
Type 3 GSD
- deficiency in debranching enzyme
- hepatomegaly
- ketotic hypoglycemia
- hypotonia and weakness
- abnormal glycogen with very short outer chains
244
Describe Paranoid Personality Disorder:
Distrust and suspiciousness
- Believes being exploited and deceived by other
- interprets benign comments and events as threats; reacts angrily
- bears judgment
- questions loyal of partner without justification
245
During pregnancy what hormone contributes to insulin resistance?
Human Placental Lactogen (hPL)
- a peptide hormone released from syncytiotrophoblast during the 2nd and 3rd trimester
=> Increase maternal glucose levels, maternal proteolysis, and maternal lipolysis
- stimulated pancreatic beta-cell proliferation to increase insulin production, if cannot overcome -> gestational diabetes
246
Describe the features of MHC-I:
Structure:
- heathy chain and beta 2 micro globulin
Location:
- all nucleated cells
Function:
- present antigen to CD8+ cytotoxic T cells
Type of antigen
- viruses, tumor proteins, antigens are processed in the cytoplasm
Ag presentation results in apoptosis of the presenting cells
247
MSK Development
What causes cleft lip?
Failed fusion of the left or right maxillary prominence with the intermaxillary segment
248
Describe McArdle Disease:
Type 5 GSD
- muscle phosphorylase deficiency (glycogen phosphorylase
- weakness and fatigue with exercise
- no rise in lactate levels post exercise
249
Describe Vasospastic angina:
Pathogenesis:
- Hyperactivity of coronary smooth muscle due to endothelial dysfunction and autonomic imbalance
Clinical Presentation:
- <50 yo, minimal CAD risk factors other than smoking
- recurrent chest discomfort at rest or during sleep
- spontaneous resolution
Diagnosis:
- ECG: ST-elevation during episodes
250
Explain the antipsychotic effect: Extrapyramidal side effects
Acute dystonic reaction:
- sudden-onset, sustained muscle contractions
Akathisia:
- subjective restlessness with inability to sit still
Drug-induced Parkinsonism:
- tremor, rigidity, bradykinesia, masked facies
251
Explain the Warburg Effect:
A method to produce energy through anaerobic glycolysis in rapidly dividing cells ie stem cells and cancer cells. Produces lots of lactate.
252
Describe deformations a congenital anomaly:
Definition: mechanical forces alter shape/position of a structure that was previously developing was previously developing normally.
Ex: Clubfoot (Talipes equinovarus)
253
Explain the anti-psychotic side effect: Tardive dyskinesia
Involuntary movements after chronic use (eg, lip smacking, choreathetoid movements)
254
Patient with a Porcelain gallbladder is at increased risk of what? What precedes, and what is the association?
Gallbladder adenocarcinoma, Chronic cholecystitis precedes, associated with multiple gallstones. Refer to photo taken.
255
Failure of which of the embryologic processes is most like associated with Spina Bifida Occulta?
- Vertebral arch fusion, a closed neural tube defect
- Typically L5-S1
256
Describe Ankylosing Spondylitis:
- Inflammatory Back Pain: Chronic, insidious back and buttock pain. Onset at <40 yo. Worse with rest, relieved with warmth.
- Examination findings: Decreased motion of the torso. Stiff/stooped pasture, tenderness, Dactylics (swelling fingers/toes), Uveitis
- Pathophysiology: Increase osteoclast activation because of increased production of IL-17, TNF-alpha, and prostaglandins
- Labs: Elevated ESR and CRP, HLA-B27
- Imaging:
- Sacroiliitis: bone erosions, subchondral sclerosis, eventual bony fusion (ankylosis)
- Bridging syndesmophytes: ossification at vertebral body margins (bamboo spine)
257
What type of collagen is found in mature scars (eg, remote myocardial infarction)? What diagnosis is associated?
Type 1 collagen normally found in bones, tendons, ligaments, skin, and dentin (teeth). Associated with osteogenesis imperfecta
258
What structures are derive from neural crest cells- ectoderm?
- Neural ganglia, adrenal medulla
- Schwann cells, Pia and arachnoid matter
- Aorticopulmonary septum and endocardial cushions
- Brachial arches (bones and cartilage)
- Skull bones
- Melanocytes
259
CVS Pharmacology:
Describe the effects of sublingual nitroglycerin
Nitrates decrease the preload by causing venodilation, causing a decrease in LV EDV and wall stress, resulting in decreased myocardial oxygen demand
260
What muscle arises from the sacrum, passes through the greater sciatic foramen, and inserts on the greater trochanter.
The Piriformis muscle
- Acting to externally rotate the thigh when extended and adducts the thigh when flexed. Also causes compression to the sciatic nerve when hypertrophied.
261
Pain + limited hip extension and knee flexion + ischial avulsion fractures affects what group of muscles?
The hamstrings: composed of the biceps femoris (long and short heads), semitendinosus, and semimembranosus
262
What nerve is vulnerable to injury in a posterior hip dislocation causing the leg to be shortened and internally rotated, with the hip held in flexion and adduction?
The sciatic nerve
263
What can cause an anterior displacement of the vertebral body ie spondylolisthesis?
Fracture of the posterior vertebral arch often occurring at the pars interarticularis ie spondylolysis, mostly bilateral
264
Describe Greater trochanteric pain syndrome:
- Overuse tendinopathy of the gluteus medius and gluteus minimus at their insertion on the greater trochanter of the femur.
- Exam will show tenderness over the greater trochanter
- pain is reproduced by resisted hip abduction and internal rotation (when the hip is flexed)
265
What structure(s) are contained in the anterior compartment of the leg?
- Deep perineal nerve
- Anterior tibial artery and veins
266
What structure(s) are contained in the lateral compartment of the leg?
- Superficial peroneal nerve
267
What structure(s) are contained in the deep posterior compartment of the leg?
- Tibial nerve
- Posterior tibial artery and veins
- Peroneal artery and veins
268
What is the mnemonic for the bones of the wrist?
"Some Lovers Try Positions That They Can't Handle"
- Lower row starting from the thumb: Scaphoid, Lunate, Triquetrum, Pisiform
- Top row starting from the thumb: Trapezium, Trapezoid, Capitate, Hamate
269
What is the MOA of Zidovudine (ZDV)?
A nucleoside reverse transcriptase inhibitor used to prevent maternal to fetal transmission of HIV during labor (when the mother is not suppressed). It is a thymidine analogue without a hydroxyl group. Causes chain termination.
270
Describe the guidelines for Clozapine:
Indications:
- treatment-resistant schizophrenia
- Schizophrenia associated with suicide ideations
Adverse effects:
- agranulocytosis
- seizures
- myocarditis
- metabolic syndrome
271
Describe Clostridioides difficile colitis:
Risk factors:
- recent antibiotic use
- hospitalization
- gastric acid suppression (eg, PPI)
Pathogenesis:
- disruption of intestinal flora -> C difficile overgrowth
- Toxins A and B disrupt cytoskeleton integrity and stimulate inflammation
- Pseudomembrane formation
Clinical presentation:
- profuse watery diarrhea (most common)
- Leukocytosis (around 15k/mm^3)
- Fulminant colitis/toxic megacolon
Diagnosis:
- Stool PCR for C difficult genes (specific for toxigenic strains)
- Stool EIA for C diff. toxin and glutamate dehydrogenase antigen
Treatment:
- Oral fidaxomicin (inhibits the RNA polymerase sigma subunit) or oral vancomycin
- IV metronidazole added for fulminant (sudden and severe) disease
272
What antibiotic is effective in clostridial skin infections eg, Clostridium perfringens, Clostridium septicum?
Doxycycline: Binds to the 30S ribosomal subunit (tetracycline)
273
Describe Abruptio Placentae
Definition:
- premature placental separation from uterus
Risk factors:
- hypertension, preeclampsia
- abdominal trauma
- cocaine or tobacco use
- prior abruptio placentae
Clinical features:
- sudden-onset vaginal bleeding
- abdominal pain
- high-frequency contractions
- tender, firm uterus
274
Vignette mentions proximal stomach herniating through the esophageal hiatus, what's the defect, what's the dx?
Hiatal hernia, a common disorder where abdominal cavity herniate through the diaphragm into the thoracic cavity at the esophageal hiatus. Due to laxity (looseness) of the phrenoesophageal membrane, usually caused by stresses like coughing, vomiting.
275
What effect occurs when the tendency of study subjects to change their behavior as a result of their awareness. that they are being studied?
Hawthorned effect (observer effect)
276
What gene is inactivated in Hereditary Pulmonary Arterial hypertension?
What is the inheritance pattern?
- BMPR2
- Autosomal dominant
- predisposes for excessive endothelial injury and smooth muscle cell proliferation.
277
Which cells and mediators cause noncaseating granulomas in cases like Sarcoidosis?
APCs -> IL-12 -> Th1 (CD4) -> IL-2 and interferon gamma -> Th1 cells proliferate and macrophage activate respectively.
278
What is the significance of Malonyl-CoA?
- Product of rate limiting step in de novo fatty acid synthesis
- where Cystolic acetyl-CoA carboxylase converts acetyl-CoA to malonyl-CoA
- inhibits the action of mitochondrial carnitine acyltransferase, therefore inhibiting beta-oxidation of newly formed fatty acids.
279
Describe the Rotator cuff muscle: Supraspinatus
- Origin on scapula: supraspinous fossa
- attachment on humerus: superior aspect of greater tubercle
- function on arm: abduction (primarily <15 degree)
- innervation: suprascapular nerve
280
Describe the Rotator cuff muscle: Infraspinatus
- origin on scapula: infraspinous fossa
- Attachment on humerus: posterolateral aspect of greater tubercle
- function on arm: External rotation
- innervation: suprascapular nerve
281
MSK Anatomy:
Describe the Rotator cuff muscle: Teres minor
- origin on scapula: lateral border
- attachment on humerus: posterolateral aspect of greater tubercle
- function on arm: adduction and external rotation
- innervation: axillary nerve
282
Describe the Rotator cuff muscle: Subscapularis
- Origin on scapular: sub scapular fossa
- Attachment on humerus: lesser tubercle
- function on arm: adduction and internal rotation
- innervation: Upper and lower subscapular nerve
283
What affect does T3 have on bone?
Activate osteoclasts the bone resorption.
284
What infection is associated with gastric MALT lymphoma?
Helicobacter pylori.
285
Describe the 1st line drugs for neuropathic pain:
- First line: TCAs, SNRIs, and Anticonvulsants.
- TCAs (nortriptyline, amitriptyline) modulate pain transmission by inhibiting VG Na channels in sensory nerves and increasing NE signaling in CNS.
- SNRIs (duloxetine, venlafaxine) alter central transmission of pain by increasing NE in the central synapses.
- Anticonvulsants (gabapentin, pregabalin) inhibit the release of excitatory neurotransmitters by binding to VG Ca modulators on nerve terminals.
286
Describe the histopathologic examination of syphilitic lesions (at all stages):
Intense plasma cell-rich infiltrate with proliferative endarteritis (inflammation of the inner lining of an artery).
287
Describe the causes of Gout:
1. Increased urate production:
- Primary gout (idiopathic)
- Myeloproliferative/lymphoproliferative disorders
- tumor lysis syndrome
- Hypoxanthine-guanine phosphoribosyltransferase (HGPRT) deficiency
2. Decreased rate clearance:
- CKD, Thiazide/loop diuretics
288
What is the inheritance patter of Cystic Fibrosis:
Autosomal recessive
289
Compare HIV-1 and HIV-2 respectively:
Geographic location:
- Worldwide vs West africa
Viral load:
- high vs low
Progression to AIDS:
- 7-10 years vs 10-25 years
Intrinsic resistance:
- limited vs NNRTIs, fusion inhibitors
290
What are the causes of a Paradoxical embolism?
Abnormal connection between the right and left chambers eg patent foramen ovale, atrial septal defect, or ventricular septal defect.
291
How is it possible for the Hep D virus to infect hepatocytes and multiply?
The hepatitis B surface antigen of hep B virus must coat the hepatitis D antigen. Hep D itself is considered replicative defective.
292
Which occupations are associated with asbestos?
Insulation installation, shipbuilding, pipe work
293
What do you give to a premature baby (<32 wks) to prevent NRDS?
Corticosteroids to increase surfactant production by accelerating maturation of type II pneumocytes, eg betamethasone, dexamethasone.
294
Describe the pathogenesis of Acute Promyelocytic leukemia:
- t(15;17) involving PML and RARA -M PML-RAR alpha oncoprotein -> myeloid differentiation inhibited
- RAR alpha: nucelar receptor involved in myeloid differential
- PML: fusion forms receptor with dominant negative activity
295
HML Pathology:
Describe the pathogenesis Burkitt lymphoma:
- t(8;14) involving MYC and IGH -> MYC over expression
-> cell growth
- MYC: transcription factor regulating cell growth
- IGH: Immunoglobulin heavy chain (high expression in B cells)
296
Describe the pathogenesis Chronic myeloid leukemia:
- t(9;22) involving ABL1 and BCR -> BCR-ABL1 oncoprotein -> cell proliferation
- ABL1: non receptor tyrosin kinase
- BCR: fusion leads to activation
297
Describe the pathogenesis Follicular lymphoma:
- t(14;18) involving IGH and BCL2 -> BCL2 over expression -> apoptosis evasion
- BCL2: antiapoptotic protein
298
Describe the pathogenesis Mantle cell lymphoma:
- t(11;14) involving CCND1 and IGH -> cyclin D1 over expression -> cell cycle progression
- Cyclin D1: regulated cells cycle
299
Describe Internuclear ophthalmoplegia:
Disorder of impaired horizontal gaze caused by a lesion in the medial longitudinal fascicles (MLF). The affected ipsilateral eye is unable to adduct while the CL eye able to abduct (often associated with nystagmus). Convergence and pupillary light reflex are preserved because the pathways bypass the MLF.
300
What structure is at risk for damage if there a laceration at the posterior vaginal opening through the vaginal mucosa and submucosa?
Perineal body
301
Describe a Subgaleal hemorrhage:
A potentially fatal neonatal bleed that occurs during delivery when emissary veins between the dural sinuses and scalp are sheared. The accumulation of blood between the periosteum and galea aponeurosis present with a diffuse, fluctuant scalp and neck swelling; high risk for shock and death.
302
Lesion to what part of the brain results in contralateral hemiballism?
Subthalamic Nucleus
303
What can pregnant women with severe preeclampsia develop?
HELLP Syndrome:
- Hemolysis, elevated liver enzymes, low platelet count
- also at risk for seizure, renal insufficiency, disseminated intravascular coagulation (DIC) due to endothelial dysfunction
304
What does the Ulnar nerve innervate and what motions is it responsible for?
- Sensory for fifth digit, medial half of the fourth digit, and the hypothenar eminence
- responsible for wrist flexion and adduction
- injury leads to claw hand (ring and picky finger cannot extend with rest of the hand)
- Loss of MCP flexion and IP extension by lubrical III and IV
305
Describe wrist drop: what nerve is affected, what 3 muscles are effected?
- Injury to the radial nerve
- inability to extend the wrist
- Loss of wrist extension by ECRB, and ECRL, and ECU
306
Describe Median claw:
- Injured nerve: distal median
- Lateral 3.5 digits cannot extend
- Loss of MCP flexion and IP extension by lumbricals I and II
307
MSK Pathology:
Describe hand of benediction:
- injured nerve: Proximal median
- content: attempting to a fist
- Loss of DIP flexion by FDP to index and middle fingers
- Loss of PIP flexion and FDS
- Loss of IP flexion by FPL (flexor pollicus longus)
- Intact FDP to ring and little fingers preserves flexion
308
What transverses through the Cribriform plate of the anterior cranial fossa?
CN I olfactory bundles
309
What transverses through the optic canal of the middle cranial fossa?
CN II, Ophthalmic artery, central retinal vein
310
What transverses through the Superior orbital fissure of the middle cranial fossa?
CN III, IV, V1, VI, ophthalmic vein, sympathetic fibers
311
What transverses through the Foramen rotundum of the middle cranial fossa?
CN V2 (maxillary)
312
What transverses through the Foramen ovale of the middle cranial fossa?
CN V3 (mandibular)
313
What transverses through the internal acoustic meatus of the posterior cranial fossa?
CN VII (facial), VIII (vestibularcochlear)
314
What transverses through the Jugular foramen of the posterior cranial fossa?
CN IX, X, XI, jugular vein
315
What transverses through the hypoglossal canal of the posterior cranial fossa?
CN XII
316
Neuro Anatomy:
What transverses through the Foramen magnum of the posterior cranial fossa?
Spinal roots of CN XI, brain stem, vertebral arteries
317
MSK Pathology:
What surgical maneuver is needed to relieve the pressure in Carpal Tunnel syndrome?
Longitudinal incision of the transverse carpal ligament aka the flexor retinaculum
318
What can you expect in Brown-Séquard syndrome?
- IL paralysis due to corticospinal tract injury
- IL loss of vibratory, proprioceptive, and light touch sensation (dorsal columns)
- CL loss of pain, temperature, and crude touch sensation (spinothalamic tract) below the level of the injury
- results from hemisection of the spinal cord
319
Describe the musculocutaneous nerve:
- derived from the upper trunk of the brachial plexus (C5-C7)
- Innervates the coracobrachialis which flexes and adducts the arm
- innervated the major elbow flexors (eg, biceps brachia, brachial)
- provides sensory innervation to the lateral forearm
320
Describe the hypothalamic nuclei: Ventromedial
Signals satiety; destruction leads to hyperphagia
321
Describe the hypothalamic nuclei: Lateral
Signals hunger; destruction leads to anorexia
322
Describe the hypothalamic nuclei: Anterior
Mediates heat dissipation; destruction leads to hyperthermia
323
Describe the hypothalamic nuclei: Posterior
signals to conserve heat; destruction leads to hypothermia
324
Describe the hypothalamic nuclei: Arcuate
Secretion of Dopamine (inhibits prolactin), GHRH
325
Describe the hypothalamic nuclei: Medial preoptic
Secretion of GnRH, regulates sexual behavior
326
Describe the hypothalamic nuclei: Paraventricular
Secretion of oxytocin, CRH, TRH, and small amounts of ADH
327
Describe the hypothalamic nuclei: Supraoptic
Secretion of ADH and small amounts of oxytocin
328
Describe the hypothalamic nuclei: Suprachiasmatic
Circadian rhythm regulation and pineal gland function
329
What structure is twisted in an Ovarian torsion?
Infundibulopelvic ligament
330
What is muscle is involved in painful external rotation of the arm against resistance?
Infraspinatus
331
What is the relation between the femoral nerve, artery, vein?
Lateral to medial respectively
332
What is the importance of L2-L4 nerve roots?
- Patellar reflex
- lesion can cause sensory deficiency to anteromedial thigh and medial shin
- Lesion affects hip flexion (iliopsoas), hip adduction, knee extension (quadriceps)
333
What is the importance of the S1 nerve root?
- Achilles reflex
- lesion can cause sensory deficiency to posterior calf, sole and lateral part of the foot
- lesion can also affect hip extension (gluteus Maximus), knee flexion (hamstrings), and foot plantar flexion (gastrocnemius)
334
Describe lumbosacral radiculopathy of L5 nerve root:
- no reflex affected
- sensory loss of lateral shin and dorsal of the foot
- weakness in foot dorsiflexion and inversion (tibialis anterior), foot eversion (peroneus), and toe extension (extensor hallucis and digitorum)
335
Head and neck squamous cell carcinomas typically first spread where?
Anterior cervical/jugular lymph nodes via the lymphatics
336
If you had to anesthetize the nerves supplying the quadriceps, wha nerve is it, and where should you inject?
Femoral nerve, below the inguinal ligament ie in the inguinal crease
337
Which lymph nodes drain the testis?
Para-aortic
338
Which lymph nodes drain the scrotum?
Superficial inguinal
339
What is contained in the Kiesselbach plexus of the Nasal septum?
- septal branch of the anterior ethmoidal artery
- lateral nasal branch of the sphenopalatine artery
- septal branch of the superior labial artery (branch of the facial artery)
340
How can patients be at increased risk of recurrent encapsulated bacterial infection like Neisseria Meningitidis?
Terminal compliment deficiency C5-C9.
341
What risk is increased with coarctation of the aorta?
Cerebral Aneurysm which can rupture into a subarachnoid hemorrhage.
342
Explain the tubular fluid/plasma ultra filtrate graph:
- Upward (positive) slope indicated an increasing concentration of that substance as fluid moves toward distal parts of the tubule, results of secretion or non reabsorption
- A downward slope indicates active reabsorption of that substance in the proximal tubule
- Order: Top to bottom
Positive slope: 1. Creatinine, 2. Urea
No slope: 3. Sodium or Potassium
Negative slope: 4. Bicarbonate, 5. Glucose or Amino Acids
343
Describe Nocardiosis/Nocardia
Microbiology:
- Gram positive rod (beaded or branching)
- Partially acid- fast
- Aerobic
Epidemiology:
- Endemic in soil
- disease from spore inhalation or traumatic inoculation into skin
- Immunocompromised or elderly patients
Clinical features:
- Pneumonia: similar to TB
- CNS involvement: brain abscess
- Cutaneous involvement
Treatment:
- Trimethoprim-sulfamethoxazole
- Surgical drainage of abscesses
344
Describe the MOA of Echinocandins eg Caspofungin, Micafungin:
- blocks synthesis of 1,3-beta-D-glucan, suppressing fungal cell wall synthesis.
345
Describe a pericardial effusion:
- Enlarged, globular silhouette
- chest tightness or fullness an dyspnea on exertion (due to decreased diastolic ventricular filling that leads to decreased stroke volume
- Tachycardia to compensate for decreased ventricular filling
- Low voltage QRS and diminished heart sounds
- Electrical alternans dues to the swinging motion of the heart in the fluid-filled pericardial cavity, causing a beat-to-beat variation in the QRS axis
346
Describe Cataracts:
Pathogenesis:
- Oxidative damage and opacification of the lens
Risk factors:
- age >60
- Diabetes mellitus
- Chronic sunlight exposure
- tobacco use
- immunosuppression (eg, HIV, corticosteroids)
Clinical features:
- painless, progressive, bilateral vision loss
- difficulty with nighttime driving
- loss of red reflex
- opacified lens
Treatment:
- Artificial lens implantation
347
What site of the brain is responsible for vomiting?
Chemoreceptor trigger zone, aka the Area postrema. Located at the caudal end of the fourth ventricle.
348
What benign disorder is characterized by low total thyroxine (T4) and normal free T4 and TSH?
Thyroxine-binding globulin deficiency, patients are euthyroid and do not require treatment.
349
Describe the respiratory tract infections in children: Nasopharyngitis (common cold)
Presentation:
- nasal congestion and discharge, sneezing, cough and sore throat
Common etiologic agents:
- Rhinovirus, Influenza virus, coronavirus
350
Describe the respiratory tract infections in children: Laryngotracheitis (croup)
Presentation:
- Upper respiratory tract symptoms followed by hoarseness, barking cough, stridor, and respiratory distress
Common etiologic agents:
- Parainfluenza virus
351
Describe the respiratory tract infections in children: Diphtheria
Presentation:
- sore throat, cervical lymphadenopathy, coalescing pseudomembrane
Common etiologic agents:
- Corynebacterium diphtheriae (club shaped, gram positive baccilus)
352
Describe the respiratory tract infections in children: Epiglottitis
Presentation:
- sore throat, dysphagia, drooling, and respiratory distress
- thumb print sign on X-ray
Common etiologic agents:
- Haemophilus influenzae
353
Describe the respiratory tract infections in children: Bronchiolitis
Presentation:
- upper respiratory tract symptoms followed by wheezing, cough, and respiratory distress
Common etiologic agents:
- Respiratory syncytial virus
354
Describe Nontyphoidal Salmonella:
Epidemiology:
- Poultry/eggs, exotic pet contact
- industrialized regions
- S. Enteritidis, S. Newport, S. Typhumirium
Pathophysiology:
- invasion of enterocytes
- neutrophil-mediated inflammatory response localized to lamina propria/ Peyer patches
Manifestations:
- Gastroenteritis: Self-limited, watery diarrhea (can be bloody). Rarely invasive: osteomyelitis, endocarditis, mycotic aneurysm (a life-threatening condition that occurs when a blood vessel wall becomes infected and weakens, causing the vessel to swell or balloon)
355
Describe Typhoidal Salmonella:
Epidemiology:
- water/food contamination
- resource-limited regions
- S. Typhi, S Paratyphi
Pathophysiology:
- Invasion of enterocytes
- blunted neutrophil response due to capsular antigen Vi
- extensive intracellular replication in macrophages -> spread through lymphatics and RES
Manifestation:
- Typhoid fever: Progressive fever (pulse-temperature dissociation), Rose spots, abdominal pain, hepatosplenomegaly, GI bleeding, perforation
356
Describe the MOA Fibrates:
Lower triglyceride levels by activating peroxisome proliferator-activated receptor alpha (PPAR- alpha), which leads to decreased hepatic VLDL production and increased lipoprotein lipase activity.
357
Describe the effects of taking Omega-3 fatty acids:
Lower triglycerides by decreasing production of VLDL and apolipoprotein B
358
How can you localize the heterotopic gastric mucosa in Meckel diverticulum?
99mTc-pertechnetate
359
What can you expect damaging the anterior and posterior vagal trunks that pass through esophageal hiatus? eg, esophageal hiatal hernia repair aka fundoplication
-Delayed gastric emptying
- gastric hypochlorhydria
360
Where can you expect a neoplastic spinal cord compression to spread?
Epidural space causing severe back pain, motor weakness, and/or sensory deficits. Urinary and fecal retention or incontinence are common late-stage findings/
361
What is strong evidence of malignancy?
Monoclonal lymphocytic proliferation
362
Describe the characteristics of the left ventricle: 5 points
- High muscle mass
- High resting oxygen extraction
- Coronary perfusion during diastole only
- collateral circulation less developed
- Low ischemic preconditioning
363
Describe the characteristics of the right ventricle:
- Low muscle mass
- Low resting oxygen extraction
- Coronary perfusion throughout cardiac cycle
- Collateral circulation more developed
- High ischemic preconditioning (protective)
364
Describe Chédiak-Higashi Syndrome:
- Autosomal recessive
- affects lysosomal trafficking
- Immunodeficiency, albinism, neurological abnormalities (eg, nystagmus)
- Giant cytoplasmic granules are seen within neutrophils
365
Describe Myoglobin
- Monomeric containing only one globin therefor carries one oxygen molecule
- Graphically is hyperbolic
366
Where do internal hemorrhoids originate?
Above the pectinate line
Nonpainful
367
Where do external hemorrhoids originate?
Below the pectinate line
Painful
368
Where do internal hemorrhoids drain?
Superior rectal vein, which communicates with the inferior mesenteric vein.
369
MSK Anatomy:
Where do external hemorrhoids drain?
Drains via the inferior rectal vein into the internal pudendal vein, which communicates with the internal iliac veins.
370
What does the superior vesicle artery supply?
Bladder and ductus deferens
371
What does the left colic artery supply?
Branching off the inferior mesenteric artery. Supplying the transverse and descending colon.
372
What does the external iliac vein drain?
- inferior epigastric (anterior abdominal wall)
- deep circumflex iliac veins (iliac crest)
373
What does the external pudendal artery supply?
- Scrotum (male)
- Labia majora (females)
- Perineum
374
What labs consider polycythemia as a dx?
Hematocrit:
- >48% for females
- >52% males
375
What are the takeaways of Absolute Polycythemia?
Polycythemia Vera:
- true increase in RBC
- Polycythemia Vera cause all 3 cell lines increase
Secondary erythrocytosis:
- Only RBC increases
- Normal WBC and platelets
- Hypoxia, erythropoietin producing tumors
376
What are the takeaways of Relative Polycythemia?
- Relative has normal RBC mass
- Causes include dehydration and excessive diuresis
377
Describe Histoplasma Capsulatum:
Epidemiology:
- Dimorphic fungus - mold in environment, yeast at body temperature
- endemic to Ohio and Mississippi River Valleys
- Soil contaminated by bird or bat droppings
Pathophysiology:
- Inhaled -> phagocytosed by alveolar macrophages -> escapes lysosome destruction -> spreads to hilar/ mediastinal lymph nodes
- controlled by cell-mediated immune response (granulomas)
Disease course:
- Immunocompetent: asymptomatic (primarily) or self- limited pneumonia with mediastinal/hilar lymphadenopathy
- Immunocompromised: disseminated disease through liver, spleen, or bone marrow
Diagnosis:
- urine antigen testing
- Biopsy with histopathology- granulomas and macrophages with intracellular ovoid/round yeast
378
Pulmonary Pharmacology and Embryology:
What do you give to an infant suffering from NRDS?
Corticosteroids, infant is most like premature <32 weeks and has a surfactant deficiency.
379
Immunology:
How is serum sickness resolved?
Mononuclear phagocytes continue to remove the excess ICs.
380
GI Embryology:
What is the pathogenesis of a congenital diaphragmatic hernia?
Failure of the pleuropertinoneal folds to close
381
Behavioral science:
How long does it take for an adequate antidepressant response?
4-6 weeks
382
Biochemistry: Triglyceride metabolism
How are triglycerides converted into glucose?
Liver and kidney enzyme Glycerol kinase phosphorylates producing DHAP, further producing energy and Glucose
383
Cardiovascular Pharmacology:
Which drugs would most likely cause drug induce lupus erythematosus?
5 points
- Hydralazine
- Procainamide
- Isoniazid
- Minocycline
- Quinidine
384
Microbiology:
What drug is Mycobacterium Tuberculosis most likely resistant to if there are reductions in the catalase-peroxidase enzyme?
Isoniazid INH, an inhibitor of mycolic acid synthesis, a crucial component to the cell wall
385
Cardiovascular Pathology:
What hemodynamics measurements are you expected to see in a pt with Hypovolemic shock?
- CVP (Right-sided preload); Decrease
- PCWP (Left-sided preload: Descrease
- Cardiac index (LV output): decrease
- SVR: increase
- SvO2 (mixed venous oxygen saturation): Decrease
386
Cardiovascular Pathology:
What hemodynamics measurements are you expected to see in a pt with cardiogenic shock?
- CVP (Right-sided preload); increase
- PCWP (Left-sided preload: increase
- Cardiac index (LV output): decrease
- SVR: increase
- SvO2 (mixed venous oxygen saturation): Decrease
387
Cardiovascular Pathology:
What hemodynamics measurements are you expected to see in a pt with obstructive shock?
- CVP (Right-sided preload); increase
- PCWP (Left-sided preload: decrease (CTamp*)
- Cardiac index (LV output): decrease
- SVR: increase
- SvO2 (mixed venous oxygen saturation): Decrease
388
Cardiovascular Pathology:
What hemodynamics measurements are you expected to see in a pt with distributive shock?
- CVP (Right-sided preload): decrease
- PCWP (Left-sided preload: decrease
- Cardiac index (LV output): Increase
- SVR: decrease
- SvO2 (mixed venous oxygen saturation): Increase**
389
Subject Cards
flashcards
Decks in class (43)
# Cards
-
UWorld Incorrects389
-
Hematology446
-
Bootcamp Incorrects32
-
Immunology26
-
Cardiovascular310
-
MSK5
-
Epi/Biostats2
-
Microbiology22
-
Gastrointestinal and Nutrition39
-
Renal, Urinary Systems, and Electrolytes239
-
Pulmonary and Critical Care15
-
Reproductive System3
-
Endocrine, Diabetes and Metabolism4
-
Pregnancy, Childbirth and Puerperium2
-
Genetics8
-
Neurology2
-
Multisystem7
-
Form 25 Incorrects74
-
Biochemistry115
-
Sketchy Pharm: Autonomic Drugs129
-
Sketchy Micro: Fungi76
-
Form 26 Incorrects84
-
200 Concepts of Amboss92
-
HY Arrows133
-
Sketchy Viruses96
-
Form 27 Incorrects95
-
Sketchy Bacteria19
-
Sketchy Parasites38
-
Free 120 June 2022 Incorrects52
-
Form 28 Incorrects87
-
HY Images255
-
FA Rapid Review38
-
Form Incorrect Topics59
-
HyGuru Review354
-
FA Equations63
-
Psych Drugs14
-
Diabetic drugs15
-
Heart Murmurs14
-
Form 29 Incorrects71
-
Form 30 Incorrects66
-
Form 31 Incorrects70
-
Form 32 Incorrects77
-
Form 33 incorrects93
