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NBME (all) Review

QuestionAnswer
Polio CSF=Lymphocytic Pleocytosis
MS oligonal bands on electophoresis
ALS (Lou Gherig's Disease) defect of superoxide dismutase 1
EBV china kissing monoclonal carcinoma of the nasopharynx
Internal Iliac branch ligation required to control heavy vaginal bleeding
Streptococcus Pneumoniae prophylaxis required if pt has a splenctomy
Locked-in Syndrome basilar artery
Inhaled glue "pt not themself" confusion, clumsiness, frequent falls ataxic gait
Xanthoma/ Achielles Tendon absence of functional LDL receptors in hepatocytes
Middle Meningeal Artery pupils 4 mm in diameter and not reactive to light; due to trauma in temporal area
Activation of Adenylyl Cyclase Toxin stool shows gram negative, comma-shaped bacteria (Vibrio Cholerae)
Alveolar Macrophage HALLMARK shipyard workers
NSAIDs use in hypertensive pt with bilateral renal artery stenosis vasodilating prostaglandins at the afferent arteriole
Calcitonin marker to monitor for thyroid neoplasm
Aortic Stenosis cardiac valve defect and concentric left ventricular hypertrophy (systolic murmur)
MS Charcot's Triad
Aldoesterone-secreting Adrenal Adenoma decreased plasma renin activity
Malignant Hyperthermia decreases release of Ca+ from the SR
9mo. old Baby pincer grasp finger feeding standing while holding onto a table playing peek-a-boo
Leptin suppresses appetite by its action in the CNS
21-Hydroxylase female; facial hair chest hair clitoromegaly normal uterus increased concentrations of 17-hydroxyprogesterone and androstenedione
Trypanosoma Cruzi brazil organism (think cruziero soccer)
Resolution of Pneumococcal Pneumonia metaplasia of mesenchymal cells to pneumocytes
Interstitial Pulmonary Fibrosis Increased radial traction on airways
Early Septic Shock Rx IV 1 liter of isotonic saline (clean the blood)
Dissecting Aneurysm X-ray widened aortic arch
Ascites Rx in addition to loop diuretics spironlactone
Randomized clinical trial subjects assigned by coin toss to one of two groups
Tumor Necrosis Factor antibodies directed against in monocolonal antibody preparation
Ezetimibe MOA cholesterol decreasing drug inhibiting the transport of cholesterol through the intestinal wall
DVT Rx potentiates the action of antithrombin III
First Degree Burn severe erythema of back and extremities NO BLISTERS
Osteomyelitis predominance of neutrophils persistent FOOT PAIN
Alendronate MOA inhibition of osteoclast-mediation bone resorption
Vagus Nerve protude the tongue and say "Ah"
GI Blood Loss labs Hemoglobin: 9.5g/dL Leukocyte: 5400 Platelets: 350,000
Left Achilles Tendon Reflex strong with lower extremity is immobilized in a cast
Loperamide opioid antidiarrheal agent with little CNS effect
IgM antibody isotype most likely causing agglutination; the isotype in anemia
Nephrolithiasis (Kidney Stones) can occur due to gout
Major Depressive Disorder low energy; irritability; crying spells; difficulty falling asleep; waking up frequently at night
Proliferative Endometrial Tissue seen in biopsy of ovarian cyst and/or peritoneal cyst
5a-reductase gene mutation labia majora would develop into scrotum
Parietal cell absence after gastrectomy
Rosacea erythema over nose, cheeks, and scattered telangiectasia and a few papules
Pelvic Splanchnic Nerve Dysfunction Sx constipation abdominal distension
Listeria MonOCYTOgenes gram positive rod fever, chills, and muscle aches can occur in pregnant women
Ultrasound shows bilateral hydronephrosis and dilated ureters increased hydrostatic pressure in bowman space leading to renal failure
AflAtoxin china peanut farmer
Delirium pt is confused by everything and is known to not behave in such a manner at home
Bronzing of Skin increased intestinal iron absorption
Inferior Rectal Artery 15-mm, blue-tinged, rounded mass at the anal margin
Newborn with absence of bowel gas in abdomen incomplete formation of pleuroperitoneal membrane
Dynein arms absent in epithelium in pts. with Kartagener Syndrome (Cystic Fibrosis)
Metastatic Tumor to Cerebellum ataxia of the left upper and lower extremities
Vitamin B12 Deficiency spasticity in arm and legs impaired proprioception in feet increased muscle stretch reflexes in arms and knees absence of muscle stretch reflexes in ankles bilateral extensor plantar responses
Farmer with 7-mm red scaly plaque on the helical rim of left ear actinic keratosis
Tick Bite in Farmer Rx doxycycline
Renal Cell Adenocarcinoma hypervascular mass 12-cm solid mass on kidney Sx include flank pain gross hemateuria
Physician response to pt.'s Rx noncompliance "using something twice daily can be difficult. I assume you are like most patients who miss at least 10% of treatments"
Sacroiliac Joint Inflammation sx lower back pain with stiffness stiffness when sat for prolonged periods of time pain radiates down to buttocks
Ringing of Ears sx salicylate/ asprin poisioning
Ulcers Rx sulfasalazine
Ubiquitin Ligase MOA promotes cell growth and malignancy by causing cellular p53 protein degradation
Trophoblastic tissue necrotic intrauterine mass and metastatic nodule in the lungs
Bilateral Bell's Palsy adverse effect of: Lyme Disease and Guillan-Barre
Nephroblastoma sx congenitial urethral obstruction; marked dilation of ureters and renal pelvis minimal renal function
Thyroidectomy Consequences decreased PTH decreased Calcium parenthesis of hands and feet
Pudendal Nerve Block Ischial spine injection with lidocaine alternative to epidural in labor
Increased JVP and mild ankle edema increased capillary hydrostatic pressure
Tricuspid Valve 2/6 holosystolic murmur, left fifth intercoastal space ajacent to sternum and increases with inspiration
Camping Trip results in itchy rash in arms and legs activation of T lymphocytes
CMV infevction sx petechial RASH, microcephaly, and HEPATOSPLENOMEGALY
Puberty begins when breast buds develop
Hyperthyroidism sx thyroid antibodies
HSV sx in Males broken blisters and open sores on penis
Beta-Thalassemia disruption of normal splicing by creation of a new 3' splice site mutation from G --> A at position 355
Post Par-tum Depression Rx SSRI
Fibrinous Pericarditis sx pericardial friction rub after acute myocardial infarction
Cervical Biopsy in Microinvasive Cervical Carcinoma neoplastic cells in sub-basement membrane connective tissue
Increased amniotic fluid volume tracheoesophageal atresia
IL-8 responsibility recruitment of neutrophils to inflammatory site
Warfarin MOA VII (proconvertin) clotting factor first to be decreased by 50% after initiation of therapy
Ectopic Pregnancy vaginal bleeding direct and rebound tenderness with guarding b-hCG elevated closed cervical os
Overdose of Triiodothyronine in Primary Hypothyroidism decreased TSH, Free Throyxine Increased Free Triiodothyronine
Cocaine Users predisposition to myocardial ischemia
The binding site and action of hCG that causes gynecomastia testicle; produces estradiol
Strings of Beads HALLMARK fibromuscular dysplasia
Bacterial sx are a result of systemic release of IL-1 and TNF-alpa
Clostridium Difficle toxin intestinal tract will contain pseudomembranes of fibrin and inflammatory debris
Lost in Menopause ovarian secretion of 17beta-estradiol
PTT prolongation defect in factor 8 (VIII) antihemophilic factor
Organs glucose produced in liver + kidney
Elderly pulmonary function increased residual volume and alveolar-arterial Po2 difference decreased arterial Po2
Methylamphetamine (street drug Meth) MOA increased release of dopamine and norepinephrine
Asthmatic Pt. with Pollen Allergy Rx Albuterol (acute resolution)
Ibutilide Adverse Effect Torsades de Pointes
Mallory Hyaline in biopsy seen in alcoholic hepatitis
The right eye does not adduct past the midline on horizontal gaze when looking to the left indicates a lesion involving abducens nerve
The persistence of leukocytosis in the absence of infection indicates impairment in leukocyte adhesion and transmigration
Urethral Prolapse seen in elderly women with vulvar itching that has not resolved with treatment physical examination with show atrophy and thinning of labia minora
Rx inhibiting 30s ribosome binding gentamicin (class of aminoglycoside)
H. Influenzae Type B Vaccine T-independent antigens to T-dependent forms to enhance protection
Condition causing ANEMIA and SPLEEN to increase 5x it's normal size Hereditary Spherocytosis
Antihypertensive causing descreased serum potassium concentration hydrocholorthiazide
1,25-Dihydroxycholecaciferol active form of vitamin D
Calcified 80% Stenois can occur in pts who smoke, are hypertensive and experience continued extertional chest pain that is relieved by rest
Sepsis Rx 0.9% Saline
Indication for a Pacemaker third-degree atrioventricular block, hypotension and variable intensity S1
Erectile dysfunction Rx MOA inhibition of phosphodiesterase (PDE5 inhibitor)
Autoantibody with affinity for acetylcholine receptor seen in myasthenia gravis
Physician answer to pt inquiry on whether weight gain is hereditary "Yes, your weight gain can be caused by genes and enviromental factors"
Alcoholic Liver Disease adverse effect gynecomastia
Surgical intervention shows half of the small intestine is found to have a dark purple-red hemorrhagic appearance Mesenteric venous thrombosis
Epinephrine stimulates hormone-sensitive lipase in adipocytes that resulted in the accumulation of metabolites
Systemic Amyloid renal biopsy will show beta-pleated sheet structure
Defective Heme Synthesis porphyria; ALA rate limiting enzyme
Rx for Urinary Urgency inhibit of muscarinic receptors
Naloxone antidote for NARCOTIC OVERDOSE in an emergency situation
Tardive Dyskinesia grimaces rigid jerking purposeless movements of fingers
Osteogenesis Imperfecta type 1 collagen
Cyclosporine MOA in transplant patients suppresses early response of T lymphocytes to activation
Schizoid Disorder condition in which pt. avoid interacting with others and social activities in addition to being cold and detached
First Generalized Tonic-Clonic Seizure occurs from abnormality in CalCium
Loraradine Rx used to treat allergies; runny nose, itchy and watery eyes
Physiological changes when in water of 60F for 20 mins increased ADH and ANP decreased central blood volume
Sepsis after abortion causation decreased plasma fibrinogen concentration
Physician response when pt claims diagnosis is bad news "Yes, it is"
Diagnosing possible defect in fatty acid oxidation measurement of serum amino acid concentrations
Myocardinal infarction (CK-MB; troponin) markers result from protease inactivation by cytoplasmic free calcium ions
Neurofibromatosis Type 1 autosomal dominant
Chandelier Sign (cervical motion tenderness) gonorrhea, PID, or ectopic pregnancy dx
Physician response to pt in denial "It must be difficult for you to ACCEPT this diagnosis when you feel healthy"
Criteria for informed consent family agreement, competence, and cost
Renal stone composition when urine analysis pH is 8 struvite
Cellular production in second-degree burn precipitated by which component C5a; produced increased fibroblast migration and proliferation, increased synthesis of collagen and fibronectin, and decreased degradation of extracellular matrix by metalloproteinases
Damage to right subthalamic Hemiballisum; uncontrollable irregular movements of the LEFT side of the body
Damage to posterior pituitary gland progressive thirst and urinary frequency
Abnormality in 6 week old baby vomitting a small amount of milk 2 to 3 times a day immature lower esophageal spinchter
Poxvirus sx firm, smooth, umbilicated papules 2 to 4 mm in diameter in clusters
Bullous Pemphigoid results from development of autoantibodies against desmosomal proteins
Bulimic patients will have enlargement of parotid gland
HCO3- levels in advanced phase of COPD increased urinary excretion
Most common benign tumor of connective tissue myoxma
Dysphagia causing difficulty swallowing solids, dilated cardiomyopathy would be as a result of enlargement where left atrium
Agent used to slow the DNA replication process of neoplastic cells in cancer patients cyclophosphamide
Weakness of grasp is indicative of rheumatoid arthritis
This casual virus replicates its genome within the cell's nucleus
Caspofungin MOA beta-glucan carbohydrates in the cell wall
Stool analysis showing increased fat concentration indicative of deficiency in Vitamin E
Physician response when pt. complains about tardiness "I'm sorry I got delayed. I hope I haven't made you late somewhere else"
L3 to L4 herinations causes pain down the distal anterior thigh knee medial leg and foot
Africa trip + Wright Stain dx Malaria
Subclavian Central Catheter bacterial infection Staph Aureus + Enterococcus Facalis
E-Coli Virulence Factor Mannose-binding (type 1) fimbria
Pellagra 3 D's: dermatitis, dementia, and diarrhea (confusion, rash, and diarrhea) lack of NICOTINIC ACID or its precursor, TRYPTOPHAN in their diet
Hypertensive patient already on hydrocholorthiazide if not responding to Rx should be put on this ACE inhibitor Lisinopril
Pt. experiencing proteinuria and elevated hemoglobin is likely to have which elevated marker? Creatine Kinase
Vertebra region in the lower right quadrant about 5 cm superomedial to the anterosuperior iliac spine? T10
Which area should be avoided during ablation to leave the sinoatrial (pacemaker) node intact in a pt.? the junction of the superior vena cava and the right atrium
Marked increase in dopamine concentration when rising from a supine position to standing marks a deficiency of? dopamine beta-hydroxylase
Most common bacterial infection from breast feeding staphylcoccus aureus
Embryology: Syncytiotrophoblast secretes which hormone hCG
Embryology: Trophoblast acquisitions energy from mother
Embryology: Inner Cell mass will establish order
Embryology: Progesterone maintains the endometrial lining to prevent menstration
Embryology: Neural Crest derived from ECTODERM, but which layers make this even happen notocord + mesoderm
Neural Crest derivatives PNS, ear, eye adrenal gland, mouth, heart, digestive system, thyroid, and skin
Embryology: Germ layers serving as secondary energy reservoire endodermal yolk sac
Embryology: Week 10 sex of fetus
Teratogenic Rx: Aminoglycosides Ototoxicity
Teratogenic Rx: ACE inhibitors renal malformations
Teratogenic Rx: Fluroquinolones cartilage damage
Teratogenic Rx: Tetracyclines discolored Teeth
Teratogenic Rx: Cyclophosphamide facial anomalies, limb hypoplasia, absence of digits
Teratogenic Rx: Methotrexate abortion, NTD
Teratogenic Rx: Carbamazipine NTD
Teratogenic Rx: Valporic Acid NTD
Teratogenic Rx: Phenytoin fetal hydration syndrome
Teratogenic Rx: Lithium ebsteins anomaly
Teratogenic Rx: Statins cns and limb anomalies
Teratogenic Rx: Wafarin facial/ limb/ CNS anomalies, spontaneous abortion
Teratogenic Rx: Diethylstilbestrol (DES) clear cell vaginal adenocarcinoma
Teratogenic Rx: Thalidomide phocomelia; rare congenital deformity in which the hands or feet are attached close to the trunk, the limbs being grossly underdeveloped or absent.
Teratogenic Rx: Isotretinoin spontaneous abortion
Holoprosencephaly Consequence from ethanol
Limb Hypoplasia Consequence from thalidomide; cyclophosphamide
Homebox (HOX) Genes blueprint for skeletal morphology (where things are supposed to go); code for transcription regulator
Mutation HOXD-13 genes will result in synpolydactyly (fused 3rd and 4th digit)
4 chamber heart begins to develop at week 4
Most common cause of NTD folate deficency
Most common cause of congenital malformations in the US alcohol use in pregnancy
Most common cause of congenital intellectual disability in the US fetal alcohol syndrome
Vitamin A excess during pregnancy will lead to a cleft palate
COP-II functions in the cell cycle to help move products from ER to cis-Golgi; anterograde trafficking
This helps transport hydrolase enzymes from trans-Golgi to lysosome clathrin
Mannose-6-phosphate deficency results in I-cell disease
Mitchondria acts as buffer to calcium
Intermediate Filament Structures: Vimenten Structural component of: connective tissue
Progeria (Advanced Aging) nuclear lamins mutation
Cholesterol makes up 50% of the plasma membrane
Membrane Bound Receptors Tyrosine Kinase G-Protein-coupled Steroid receptors
PDGF and IGF-1 receptors 2alpha bound by disulfide bonds bidning extracellular ligand
Main Role of Plasma Membrane keeps sodium out of the cell; potassium inside of the cell
Corticosteriods inhibits phopholipase A2
Zileuton inhibits lipoxygenase
Zafirlukast and Montelukast inhibits leukotrienes
Cyclooxygenase inhibited by NSAIDS, Acetomenaphin, COX-2
Cell membrane lipid converted to arachidonic acid by phospholipase A2 phosphatidylinositol
Which cells are constantly regenerating (stays in G1 phase and no G0 phase) skin, hair follicles, and bone marrow
In apoptosis, the plasma membrane is blebbing away via phagocytosis
Intrinsic pathway: bcl-2 is anti-apoptotic
Intrinsic pathway: BAX is pro-apoptotic; increase in mitochondrial permability
Extrinsic pathway: Death Receptor TNF + Fas
Extrinsic pathway: Killer T Cells use perforin
Result of Granzyme B entering cells activation of caspases
Intrinsic pathway: Increased Mitochondrial permeability releases Cytochrome C
Irreversible Cell Injuries nuclear pyknosis karyolysis karyorrhexis Ca2+ influx leading to caspase activation
Neutrophils found in acute inflammation
Collagen primarily needs vitamin C
Leukocyte Adhesion Syndrome delayed umbilicus seperate
Leukocyte Adhesion Syndrome abnormal integrin molecules
Granulomas are found in chronic inflammation
Collection of macrophages ultimately become granulomas
Receptor for Rolling (inflammation) E-Selection (endothelium)
Receptor(s) for tight binding (inflammation) LFA-1; ICAM-1
Metals known to facilitate production of oxygen free radicals iron and copper
Strong (I) Slippery (II) Bloody (III) BM (IV) collagen
Step 1 in the production of collagen precollagen sythesis alpha chains
Step 2 in the production of collagen hydroxylation of lysine and proline
Step 3 in the production of collagen glycosylation of hydroxylated lysine essentially making procollagen
Step 4 in the production of collagen exocytosis
Collagen construction taken place in fibroblasts
Step 5 in the production of collagen cleavage of terminal collagen tropocollagen
Step 6 in the production of collagen crosslink tropocollagen molecules to make collagen fibrils
Steroioids inhibit collagen synthesis
Osteogensis Imperfecta is an abnormal or defect in Type I collagen
Osteogensis Imperfecta Autosomal Dominant
Osteogensis Imperfecta Hallmark blue sclera
Ehlers Danlos Syndrome Hallmark hyperjointibility
Kidney disease + Deafness + Eye problems Alport Syndrome
Alport Syndrome defecent in type IV
Cant see, Cant pee, Cant hear high C Alport Syndrome
Marfan Syndrome hyperELASTICITY
Marfan Syndrome defect in fibrillin, which makes elastin
Marfan Syndrome Hallmark elasticity of skin
a-1 antitrypsin deficency defect elastin in alveoli
Hypothalamus: Nucleus Masterclock for Circadian Rhythm suprachiasmatic nucleus
Hypothalamus: Nucleus making oxytocin paraventricular nucleus
Hypothalamus: Nucleus secretes ADH supraoptic nucleus
Hypothalamus: Nucleus Dealing with Obesity + Savage behavior dorsomedial nucleus
Hypothalamus: Nucleus inhibited by leptin lateral nucleus
Hypothalamus: if Nucleus destructed leads to obesity ventromedial nucleus
Hypothalamus: Nucleus regulating dopamine and GHRH arcuate nucleus
Hypothalamus: Nucleus conserving heat producing shivering in cold enviroments posterior nucleus
Hypothalamus: destruction of this body will lead to wernicke's encephalopathy
Hypothalamus: Nucleus stimulating GI dorsomedial nucleus
Posterior Pituitary otherwise known as neurohyphysis
Posterior Pituitary is derived from which germ layer neuroectoderm
Hypothalamus: Nucleus receives input from retina suprachiasmatic nucleus
Hypothalamus: Savage behavior + obesity from stimulation dorsomedial nucleus
Hypothalamus: Savage behavior + obesity from destruction ventromedial nucleus
Hypothalamus: Stimulation leads to eating and destruction further leading to starvation lateral nucleus
Hypothalamus: Regulates release of LH and FSH preoptic nucleus
Hypothalamus: Destruction results in neurogenic diabetes inspidius supraoptic nucleus
Hypothalamus: releases hormones affecting the anterior pituitary arcuate nucleus
Hypothalamus: which nucleus regulates appetite lateral nucleus
Neuro: decreased GABA + serotonin BUT increased norepinephrine is seen in anxiety disorders
Sleep stages: Stage N1 theta waves
Sleep stages: Stage N2 bruxism (teeth grinding) sleep spindles and K complexes
Sleep stages: Stage N3 delta waves sleep walking bed wetting
Sleep stages: REM beta waves lose muscle tone
Sleep stages: Relaxation alpha waves
Sleep stages: Rx decreases bed wetting (nocturnal enuresis) imipramine
Sleep stages: Rx MOA of impramine TCA
Sleep stages: Desmopressin (DDAVP) can aslo be used as Rx for decreasing urination
Sleep stages: Rx indomethacin decreases renal blood floow
Sleep Rxs: this med gives vivid dreams and should not be used for more than 3 months melatonin
Sleep Rxs: herbal remedy found OTC valerian
Sleep Rxs: first-line treatment for difficulty sleeping anti-histamines
Sleep Rxs: this med increases risk of priaprism Trazodone
Sleep Rxs: this med increases REM sleep Trazodone
Sleep Rxs: TCAs such as amitriptyline, doxepin increases cardiac risk of arrhythmais (obtain EKG prior to use)
Sleep Rxs: ADDICTIVE med that should only be used short-term benzodiazepines
Sleep Rxs: Popular meds acting on benZo receptors zolpidem + zalepon
Sleep Rxs: only med per FDA approved for long term eszopiclone
Sleep Rxs: nonaddictive med because it works on melatonin receptors rather than GABA reeptors ramelteon
Narcolepsy Rxs: first-line treatment modafinil
Cataplexy Rx vanlafaxine, fluoxetine, or atomoxetine
Sleep Rxs: GHB can assist in sleep and reduce cataplexy
Brain embryology: Forebrain develops into telencephalon -> cerebral hemispheres + diencephalon ->thalamus
Brain embryology: Midbrain develops into mesencephalon -> midbrain
Brain embryology: Hindbrain develops into metencephalon + myelencephalon -> cerebellum, pons, and medulla
Brain embryology: NTD avoided with routine sonogram + quadruple screening
Brain embryology: NTD indicative when alpha fetoprotein levels are elevated
Neuro Embyology: NTD defect indicative with AFP levels are increased
Neuro Embyology: AFP levels when decreased are indicative of down's syndrome
Neuro Embyology: Meningcele is a herniation JUST of the meninges
Neuro Embyology: Myelomeningocele occurs with hernation of both spinal cord + meninges
Neuro Embyology: No brain tissue separating amniotic fluid in the brain is indicative of anencephaly
Neuro Embyology: Holoprosencephaly occurs when the hemispheres of the brain fail to separate
Neuro Embyology: Cleft palate together with cyclopia are indicative of holoprosencephaly
Neuro Embyology: Sonic Hedgehod Gene mutations will be seen in patients with holoprosencephaly
Neuro Embyology: Posterior fossa (hindbrain) abnormalities are seen in Chiari Malformations
Neuro Embyology: Chiari Malformations occurs when cerebellum herniates download through forman magnum
Neuro Embyology: Syringomyelia is an enlargement of the central canal in spinal cord
Neuro Embyology: Compression of the spinothalamic tract occurs and is referred to syringomyelia
Neuro Embyology: HALLMARK: Cape-like, bilateral loss of pain and temperature sensation are seen in upper extremities
Neuro Embyology: HALLMARK: Anterior horn damage produces weakness and atrophy of hands
Neuro Embyology: Spinal cord trauma over time can produce syringomyelia
Neuro Embyology: Herniation of cerebellar tonsils are seen in Chiari I Malformation
Neuro Embyology: BOTH herniation of cerebellar tonsils and vermis Chiari II Malformation
Neuro Embyology: Hydrocephalus can be seen in patients with Chiari II Malformation
Neuro Embyology: Stenosis of aqueduct caused by a Chiari II malformations along with which other abnormality hydrocephalus
Neuro Embyology: Thoracolumbar Myelomeningocele is associated with Chiari II Malformation
Neuro Embyology: Second Posterior Fossa malformation Dandy-Walker Syndrome
Neuro Embyology: enlarged posterior fossa is indicative of Dandy-Walker syndrome
Neuro Embyology: cerebellar vermis fails to develop is indicative of Dandy-Walker syndrome
Neuro Embyology: Dilation of the 4th ventricle is associated with hydrocephalus indicative of which diagnosis Dandy-Walker syndrome
Neuro Embyology: Brachial Apparatus is composed of how many tissues six; 6
Neuro Embyology: Bracial Apparatus arch is derived from Mesoderm
Neuro Embyology: Bracial Apparatus clef is derived from the Ectoderm
Neuro Embyology: Bracial Apparatus pouch is derived from the Endoderm
Neuro Embyology: Bracial Apparatus Pouch #1 will give rise to Middle ear cavity Eutachian tubes Mastoid air cells
Neuro Embyology: Bracial Apparatus Pouch #2 will give rise to epithelial lining of the tonsils
Neuro Embyology: Bracial Apparatus Pouch #3 will give rise to inferior parathyroid gland + thymus
Neuro Embyology: Bracial Apparatus Pouch #4 will give rise to superior parathyroid gland
Neuro Embyology: DiGeorge Syndrome occurs when abnormal development 3rd and 4th brachial pouches
Neuro Embyology: Pt. with absent thymus and parathyroid glands DiGeorge Syndrome
Neuro Embyology: Hallmark Triad in DiGeorge Syndrome Absent thymus + hypocalcemia + T-cell deficiency
Neuro Embyology: Brachial Arches are Mesoderm derivatives
Neuro Embyology: Bracial Arch #1 produces CMN, which are Cartilage + Muscle + Nerve
Neuro Embyology: Treacher Collins Syndrome Series of facial abnormalities
Neuro Embryology: HALLMARK of Treacher Collins Syndrome includes Abnormal mandible + malleus
Neuro Embryology: Brachial Arch #2 produces S structures such as Stapes + Styloid Process + Stylohyoid ligament + lesser horn of the hyoid
Neuro Embryology: Hemispatial neglect indicates a lesion in the Parietal lobe (non dominant)
Neuro Embryology: Pt. neglects half of a side of their body as nonexistent Hemispatial neglect
Medical Term used for Crossed-Eyed pt. Strabismus or tropia
Golgi Apparatus modifies with amino acids S.A.T. Serine, Asparagine, Theronine
Astrocyte foot processes, basement membrane, capillary lumen are the components of the basement membrane
Midbrain is composed of red nucleus, medial meniscus, superior colliculus, cerebral aqueduct, medical geniculate body, spinothalamic tract, corticobulbar tract, corticospinal tract, substantia nigra
Inferior Colliculus is located in the caudal midbrain
Superior Colliculus is located in the rostral midbrain
CN located in the midbrain Oculomotor and Trochlear Nerves
Pons contains the abducens (CNVI) nerve
MLF is found in the pons
Medial Lemnicus travels done the medial aspect of the pons
Corticospinal tract is located in the medial aspects of the pons
Lateral part of pons is supplied by AICA
Cranial nerves will __________ as you go down the brainstem increase in number
Medulla medial aspect contains hypoglossal nerve (CN XII), medial lemniscus, and meduallry pyramid
Anterior Spinal Artery supplies the medial aspect of the medulla
PICA supplies the lateral aspect of medulla
Lateral aspect of medulla is composed of vestibular (CN VIII) nuclei, inferior cerebellar peduncle, spinal trigeminal tract and nucleus and lateral spinothalamic tract
Spinal Tracts: Dorsal Columns are composed of fasiculus cutaneous and fasciculus gracilis
Spinal Tracts: Dorsal Columns decussate in the medulla to then ascend
Spinal Tracts: Dorsal Columns become what medial lemniscus
Spinal Tracts: Medial Lemniscus goes into the VPL of thalamus
Spinal Tracts: VPL is located in the thalamus
Spinal Tracts: Dorsal Columns work on which side contralateral
VPL is the _____ port of the thalamus sensory
Spinothalamic tract decussates at the anterior white commisure
Spinothalmic tract ascends contralateraly
Which tract travels contralaterally in the brainstem spinothalamic
Information to the Corticospinal Tract comes from internal capsule
Spinothalamic tract ascends as Corticospinal Tract desends
Norepinephrine is increase in anxiety and mania
Norepinephrine is decreased in depressionb
Raphe Nucleus is the center of serotonin
In depression, serotonin is decreased
The levels of serotonin are decreased in anxiety
CPK, Adolase,and Myoglobin are osteomarkers
This condition prevents thymidine repair dimers from UV damages xeroderma pigmentosa
Dexamethasone Suppression Test
Dopamine levels in Schizophrenia increased
Dopamine levels in Depression decreased
Dopamine levels in Parkinson's decreased
Microglia HALLMARK seen in HIV multi-nucleated giant cells
Bitemporal Temporal Lobe location of HSV encephalitis
Decreased levels of Vitamin B6 lead to seizures
GABA is decreased n conditions such as anxiety and huntington's
The nucleus acubens houses neuroinhibitors such as GABA
Injury to axillary nerve results for damaged to the surgical neck of the humerus
P. Circumflex Humeral Artery supplies the surgical neck of the humerus
Perforin + Granzyme B is released as a result of cytotoxic T cells and NK cells during bacterial infection
Clathrin works in the (hint: starts with a C) cytosol
Process of receptor mediated endocytosis clathrin is activated which activates adaptins
Center of Huntington's disease caudate + putamen
Receptor locations: Tyrosine Kinase plasma membrane
Receptor locations: G-protein coupled cytosol
Receptor locations: steroids cytoplasm
Retro peritoneal Organs S.A.D.P.U.C.K.E.R
Destruction of Alpha 3 chain of Type IV Collage results in Goodpasture Syndrome
Hypotension, Tachycardia, and Cool Extremities are sx of hypovolemic shock
How to diagnose lactose intolerance pH of stool
MOA inhibit substance flow across cell membranes thus inhibiting primary active transport PPI
Zileuton, Montelukast, Zafirlukast are agents used to treat asthma
Transplant rejections primarily occur due to preformed antibodies against antigens
Langerhans Histocytosis HALLMARK birbeck granules
Tennis racket shaped cytoplasmic organelles langerhans histocytosis
Encapsulated bacteria Even Some Pretty Nasty Killers Have Shiny Bodies
The most injure organ in blunt trauma (not a foregut structure) spleen
Bilateral temporal visual deficit seen in pituitary adenomas
Payer Patches seen in small intestine (ileum)
Rx producing antibody against CD20 rituximab
Causative agent of barking cough croup
Meningiomas found in parietal lobe
Meningiomas produce lower limb sensory loss and hemineglectp
PICA Disorder inability to consume food; pt consumes items that are non-food such as ice, hair, paper
Rx for phobia benzodiapine
Agents in innate immunty neutrophils, dendrites, macrophages, and complement
Hot T-Bone Steak IL-1 (fever), IL-2 (T-cells), IL-3 (bone marrow), IL-4 (IgE + IgG production), IL-5 (IgA + Eosinophils production)
Active Immunity involves b + t cells
IFNs released by virus infected cells IFN-alpha and IFN-beta
Rx immunosuppreant inhibiting calcineurin, production of IL-22, and T-Cell Cyclosporin
HALLMARK in Crohn's Disease transmural inflammation
HALLMARK Ground Glass Apperance of lungs NRDS (Neonatal Respiratory Distress Syndrome)
HALLMARK Air Space and interstitial opacities in lungs NRDS (Neonatal Respiratory Distress Syndrome)
Antidote for acetominophen overdose N-Acetylcystine
N-Acetylcystine leaves disulfide bonds within muscous glycoproteins
Extension seen in obstructive lung disease expiratory phase (FEV down)
Asthmatic antigen cross linking IgE on pre-sensitized mast cells
Levels in COPD FEV down; FVC same
Restrictive Lung Disease leads to decreased TLC; normal FEV1:FVC ratio
Side effect of Tamoxifen endometrial hyperplasia
Disorder in which pt. complains of symptoms that are not even there somatization
Thrombocytopenia can be caused by this agent (hint: thrombolytic) heparin
Thrombocytopenia can be caused by this agent (hint: antibiotic) beta lactam antibiotics
Thrombocytopenia can be caused by this agent (hint: anti bacterial) vancomycin
Splenomegaly seen in this kissing disease EBV
Thrombocytopenia can be caused by this agent (hint: used to treat gram + bacteria) linezolid
Rx used in treatment of CMV foscarnet
Foscarnet does not require intracelullar activation
Arsenie Poisioning is treated with this agent dimercaprol
Poision Ivy is mostly encountered in hikers, forests, and wooded areas
Neisseria Gonnorhea will elevate neutrophils (think N in neiserria)
Rx used treat general protozas metrodiazole
Rx used treat trophozoites metrodiazole + tinidazole
Rx used treat cysts iodoquinol + paromomycin
Rx swish and swallow method us used with nyacin to treat oral candidasis
Erythrocytosis in men should be <52%
Erythrocytosis in women should be <48%
Activation of Leukotriene C4 is found in asthma
HALLMARK for asthma histology charcot-leyden crystals
Pharm: direct acting is an agonist
Pharm: inhibition of action is a anatagonist
Organophosphate Poisioning is seen primarily in farmers
Adenosine Deaminase Deficency results in this condition SCID
A-1 Adrenergic causing adverse reaction of orthostatic hypotension terazosin + doxazosin
Raymonds phenomenon leads to cerebral edema
Asprin given to children younger than the age of 12 will results in raymond's phenomenon
Disease arsing from deficiency in mannose-6-phosphate i-cell
Sx clouded cornea, restruct joint movement, and course facial features seen in i-cell disease
This bacteria's polysaccharies capsule gives it it's virulence step. pneumo
DNA mismatch repair will cause hereditary nonpolyposis colorectal cancer
Rx agent used for motion sickness scopolamine
HALLMARK fishy odor with thin discharge indicative of bacterial vaginosis
HALLMARK frothy odor with green/white discharge indicative of trichamonasis
HALLMARK cottage cheese discharge indicative of candidasis vaginosis
Water Deprivation Test is done to pt. who is suspected to have diabetes insipidus
Desmopressin (ADH) Challenge will indicate whether the dx is central or nephrogenic
This syndrome's onset may be due to an adverse reaction to steroids cushings syndrome
Amyloidosis stains congo red
HALLMARK apple green bigeringate amyloidosis
HALLMARK histology showing rouleaux (poker chips like) multiple myeloma
Adverse Reactions: Anti-hypertensive Nifedipine reflex tachycardia; useful for pt. with bradycardia
Adverse Reactions: Anti-hypertensive Beta Blocker prolong PR interval
Olgiodendrocyte destruction seen in multiple sclerosis
Retro peritoneal organ most injured in car accidents pancreas
Abnormalty seen in hereditary spherocytosis RBC membrane cytoskeleton
HALLMARK Interstitial Fibrosis honeycomb lung on x-ray
Honeycomb lung on x-ray is indicative of intersistial fibrosis
Rx acetylcysteine decreases levels of mucous
1st line indicator in diabetic nephropathy albumin
Generalized Anxiety Disorders are treated with buspirone
Crackles on lung auscultation mostly heard when pt has pulmonary edema
HALLMARK Asbestosis dumb bells appearance
Asbestosis histology will show enlongated structures with clubbed ends
Myocardial Infarction will produce prostagladins
Prostaglandins produced in MI will inhibit platelet aggregation
Cytochrome oxidase inducers include
Rapid correction of HYPONATUREMIA will lead to this condition central pontine myelinolysis
MRI shows increased signal intensity to the pons indicating rapid correcton of hyponatermia
Sx of central pontine myelinolysis paralysis, dysarthria, dysphagia, diplopia, loss of consciousness
Low sodium levels need to be correct very slowly
Retinoic acid (vitmain A derivative) alters HOX gene expression
Which antibiotics are potentially teratogenic F.A.T.; Fluroquinolones, Aminoglycosides, and Tertatogens
Rx teratogenic in pregnant women MTX, Statins, Warfarin, Isorebinoin, DES, Thalidomide
Limb buds begin to form at week 21
Fetal movement begins at week 8
By which week does the mother begin to experience fetal movement 8
Which vitamin should not be supplemented in large amounts during pregnancy vitamin A; alters HOX gene expression
Nuclear Localization Signals: Amino acids rich in L.A.P: lysine, arginine and proline
Nuclear Localization Signals: Essential component of protein bound for or residing in the nucleus histones
Where are histones located nucleus
Nuclear Localization Signals: Nuclear pores recognize these signals and transport proteins into the nucleus via ATPase
ATPase is the signal of transportation of proteins and into the nucleus
A single AA mutation may prevent nuclear transport
A deficiency leading to I-Cell Disease mannose phophorylation
Mannose phosphorylation secretion out of cell instead of into lysosomes for degradation
I-Cell Disease leads to death by the childhood age of 8
Chaperones assist in folding and transport of polypeptides in the ER and Golgi, etc
Stress Chaperones rescue shock-stressed proteins from misfolding
If folding is not successful, the chaperones facilitate degradation of damaged protein
Degradation of damaged proteins involves ubiquitin
This is also known as a heat shock protein ubiquitin
Peroxisomes provide beta oxidation of very long chain fatty and branched chain fatty acids
Which cyclin-CDK complexes assist in the progression from G1 phase to S phase Cyclin D and Cycline E; CDK 4 + CDK 2, respectively
Which cyclin-CDK complexes assist in the progression from G2 phase to M phase Cycline A and Cycline B; CDK 2 + CDK 1, respectively
What molecule does the Golgi add to proteins in order to direct the proteins to the lysosomes
What are the different methods that a cell uses to break down proteins
What is the most common cause of intellectual disability in infants fetal alcohol syndrome
Structural component of connective tissue L.E.F. (leukocytes, endothelium, fibroblasts) Vimentin
Desmin is the intermediate filament of structural component muscle (smooth, skeletal, and heart)
Cytokeratin is the intermediate filament of structural component epithelial cells
Glial fibrillary acid proteins is the intermediate filament of structural component astrocytes, schwann cells, other neuroglia
Peripherin is the intermediate filament of structural component neurons
Neurofilaments is the intermediate filament of structural component axons within neurons
Nuclear lamins is the intermediate filament of structural component nuclear envelope and DNA within
Which drugs act on microtubules (the microtuble growth voiding pure chemicals) thiabendazole + mebendazole + griseofulvin + vincrestine + pacixtel + vinblastine
What are the defects in Kartagner Syndrome aka immotile ciliary syndrome primary ciliary dyskinesia
During what week of fetal development does organogensis take place
What molecule provide the structural framework for DNA and nuclear envelope nuclear lamins
The first step in the signaling cascade that it initiated by tyrosine kinase receptors is autophosphorylation
What type of protein is PDGF single-pass transmembrane protein
Insulin and Insulin Growth Factor-1 receptors 2 alpha subunits and 2b subunits
Which arachiodonic acid product causes: increased bronchial tone prostaglandins
Which arachiodonic acid product causes: decreased bronchial tone PGF-12
Which arachiodonic acid product causes: increased platelet aggregation thromboxane
Which arachiodonic acid product causes: decreased platelet aggregation PG-12
Which arachiodonic acid product causes: increased uterine tone prostaglandins
Which arachiodonic acid product causes: decreased uterine tone PG-12
Which arachiodonic acid product causes: increased vascular tone thromboxane
Which arachiodonic acid product causes: decreased vascular tone PG-12
What are the two most abundant substances in the plasma membrane phospholipids and cholesterol
What drugs act on the arachidonic acid pathway Cycloxygenase (NSAIDs)
What are the stages that an embroy goes through between conception and the development of an inner cell mass cleavage, blastula, and gastrulation stages
The blastula eventually organizes itself into two layers inner cell mass and outer trophoblast
Trophoblast will become the placenta
Which cell types are constantly regenerating themselves due to an absence of the G0 phase and a short G1 phase GI, bone marrow, hair follicles, nails
BCL-2 is major anti-apoptotic regulator of mitochondrial permeability
Any DNA damage or apoptotic sign will activate Bax (pro-apoptotic)
Bax creates channels in mitochondrial membrane
Cytochrome C moves from the mitochondria and into cytosol
Cytochrome C activates caspases
The primary initator of apoptosis caspases
Name death receptors TNF-a + Fas ligand
Cytotoxic T-Cells recognize foreign or infected cells
Cytotoxic T-Cells release which agents perforin and granenzyme B
Mechanism of Cell Injury: influx of calcium will increase mitochondrial permeability and activate phospholipases, proteases, endonucleases and ATPase
Mechanism of Cell Injury: accumulation of oxygen-derived free radicals cell damage through membrane lipid peroxidation, protein modification and DNA breakage
Radiation Exposure may cause cell injury; DNA breakage, protein modification
What histology features may be seen in apoptotic liver cells infiltrate only if cause is alcohol is steatohepatitis
Apoptotic liver cells under the microscope will show histologic changes including steatosis, inflammation, ballooned hepatocytes, Mallory–Denk bodies, apoptotic hepatocytes, and fibrosis or cirrhosis
What damaging events can cause irreversible cell injury mitochondria swell, lysosomes swell, damage to plasma membrane and lysosomal membranes leads to enzyme leakage
What substances do cytotoxic T cells and NK cells use to induce apoptosis in the cells infected with a virus perforin and granenzyme B
Redox reaction may cause cell injury; DNA breakage, protein modification
What cellular enzymes are responsible for handling oxygen free radicals superoxide dismutase
Transition metals may cause cell injury; DNA breakage, protein modification
Nitric Oxide may cause cell injury; DNA breakage, protein modification
Leukocyte Oxidative Burst may cause cell injury; DNA breakage, protein modification
Reperfusion injury may cause cell injury; DNA breakage, protein modification
Acute inflammation: release of mediators neutrophils, histamine, bradykinin, serotonin
Acute inflammation: mediators in vasodilation prostagladins and nitrix oxide
Tissue remodeling by metalloproteinses contains C5a
Polymyalgia rhematica laboratory indication elevated ESR
C-Reactive Protein in the acute phase is synthesized by the liver
Oposonization of bacteria and activation of complement is done by C-Reactive Protein
Temporal arteritis laboratory indication elevated ESR
Acute inflammation: mediators increased vascular permeability fluid exudation bradykinin, serotonin, histamin, C3a + C5a, Leukotrienes, PAF, oxygen free radicals
Can C-Reative Protein be lowered by smoking cessation yes
Maliganancy laboratory indication elevated ESR
Elevations in this marker is a strong predictor or MI, Stoke, PAD, and sudden cardiac death C-Reactive Protein
True o False: C-Reactive Protein can be lowered by exercise/weight loss true
Which metals are known to faciltate the generation of oxygen free radicals metallprotienases
Which tumor suppressor proteins prevent the progression of the cell in S phase p53 and Rb
Cutaneous wound healing: week-months collagen production (Type III and Type I)
Cutaneous wound healing: 0-3 hours hemorrhage and clotting
Cutaneous wound healing: 1-3 days macrophage infiltration, granulation tissue, epithelization
Cutaneous wound healing: 12-24 hours acute inflammation (PMNs)
Infection, inflammation (e.g. osteomyelitis) laboratory indication elevated ESR
Ehlers-Danlos Syndrome sx (3-D pneumonic) Type III collagen deficiency
Diseases activity in RA and SLE elevated ESR
Which AA are found in large concentrations in collagen proline + lysine
What is the role of Vitamin C in collagen hydroxylation of proline and lysine
Sx hyperflexible koints, archnodactyly, aortic dissection, lens dislocation are all indicative of ehlers danlos
Sx hereditary nephritis, cataracts, sensorineural hearing loss
What is the underlying dysfunction in Chediak-Higashi syndrome Defect in lysosomal trafficking regulator gene (LYST); Microtubule dysfunction in phagosome-lysosome fusion;
Chediak-Higashi Syndrome is an autosomal recessive
How does having a high cholesterol content in the plasma membrane affect its function separate the phospholipids so that the fatty acid chains can't come together and cyrstallize.
A man working out at the gym building muscle would be considered hypertrophy
What can happen to the cells of the lower espohagus in response to chronic acid reflux metaplasia of simple squamous to columnar epithelium leading to GERD or Barret's Esophagus
What is lipofuscin granule aging or "wear-and-tear" pigments, found in the liver, kidney, heart muscle, retina, adrenals, nerve cells, and ganglion cells
Four major dopaminergic pathways mesocortical pathway
Four major dopaminergic pathways mesolimbic pathway
Four major dopaminergic pathways nigrostriatial pathway
Four major dopaminergic pathways tuberoinfundibular pathway
Which nervous system cell matches the follow description: fried egg under histology staining olgiodendrites
Which nervous system cell matches the follow description: form multinucleated giant cells in the CNS when infected with HIV mircroglia
Which nervous system cell matches the follow description: myelinates mutiple CNS axons
Which nervous system cell matches the follow description: myelinates one PNS axon schwann cells
Which nervous system cell matches the follow description: damaged in Guillain-Barre syndrome schwann cells
Which nervous system cell matches the follow description: damaged in multiple sclerosis ogliodendrites
Which nervous system cell matches the follow description: macrophase of the CNS microglia
Which nervous system cell matches the follow description: cells of the blood-brain barrier
What is the main inhibitory neurotransmitter of the CNS GABA
In which diseases is GABA altered huntington's and anxiet
What organelle becomes hypertrophied in hepatocytes with chronic phenobarbital use? smooth endoplasmic reticulum (SER)
What enzyme mitigates the aging effects of cellular division by maintaining chromosomal right telomerase
What is currently known as the most effective way of prolonging life span
Which area of the hypothalamus regulate the autonomic nervous system paraventricular nucleus
Which neurotransmitter have altered levels in anxiety disorder GABA
Which collagen is typically deficient in Ehlers-Danlos syndrome Type III
Which collagen is typically deficient in osteogensis imperfecta Type I
Which drug is used to shorten Stage N3 sleep imipramine
What is the sleep pattern in a patient with narcolepsy
In what stage of sleep are night terrors found Stage N3
What arachidonic acid product has actions that oppose that of prostacyclin COX-1 + COX-2
What brain structure is responsible for extraocular movements during REM sleep paramedian pontine reticular formation/conjugate gaze center
What two nerves are tested with the gag reflax vagus + glossopharyngeal
Unilateral facial drooping involving the forehead bell's palsy; LMN facial nerve (CN VII) palsy; UMN lesions spare the forehead
What organelle and cytochrome are particularly important in intrinsic apoptosis mitochondria + cytochrome C
During what sleep stage would a man have variable blood pressure, penile/clitoral tumescence, and variable EEG REM
A 19-year-old patient presents with a furnuncle on his philtrum, and the cavernous sinus becomes infected. What neurological deficits might you see in this patient?
Which areas of the hypothalamus regulate the autonomic nervous system? Anterior hypothalamus : Parasympathetic Posterior: Sympathetic
Cranial nerve 1 (Olfactory) Site of exit from the skull? Function? Lesions? How to test the function? Cribiform Plate Smell Cribiform plate fracture or Kallmann syndrome Smell something
Cranial nerve 2 (Optic) Site of exit from the skull? Function? How to test the function? Optic canal; [Sight] [Smell] [Eye chart]
Cranial nerve 3 (Occulomotor) Site of exit from the skull? Function? Lesions? How to test the function? Superior orbital fissure Parasympathetic: Cillary and sphincter muscles Innv. MR, SR, IR, IO (Extraoccular m.) Transtentorial/Uncal Herniation, Diabetes, Weber syndrome Follow my finger, pupillary light reflex, and convergence
Describe Weger Syndrome Form of stroke that causes occlusion of PCA. Causes contralateral hemiparesis and CN 3 palsy
Cranial nerve 4 (Trochlear) Site of exit from the skull? Function? Lesions? How to test the function? Superior orbital fissure Innv. SO Head trauma Move eye by following finger
Cranial nerve 5 (Trigeminal)-V1 Site of exit from the skull? Function? Lesions? How to test the function? V1 (Opthalmic): Superior orbital fissure Sensory for Medial nose and forehead Path: Trigeminal neuralgia Test: Facial sensation
Cranial nerve 5-V3 (Mandibular) Site of exit from the skull? Function? Lesions? How to test the function? Foramen ovale Motor fxn. of muscle of mastication (open and close jaw) Sensory: lower lip, lateral face, lower border of mandible Lesion: Jaw will deviate towards the side of lesion when opening Test: facial sensation, open jaw
Which muscle opens the jaw Lateral Pterygoid
Which muscle closes the jaw Masseter, Temporalis, Medial pterygoi
Cranial nerve 6 (Abducens) Site of exit from the skull? Function? Lesions? How to test the function? Superior orbital fissure Innv. lateral rectus Medial inferior pontine syndrome (contralateral hemiparesis and loss of tactile and vibrations + lesion of CN 6) Test with follow my finger
Cranial nerve 7 (Facial) Site of exit from the skull? Function? Lesions? How to test the function? Internal acoustic meatus Parasymp: Lacrimal, submandibular, and sublingual glands Innv. Facial expression, stapedius, stylohyoid, posterior belly of digastric m. Taste anterior 2/3 of tongue Bells Palsy (includes muscle of forehead) Test:Wrink
Name the 5 branches of the Facial Nerve (CN VII) Temporal Zygomatic Buccal Marginal mandibular Cervical
Cranial nerve 8 (Vesitbulacocchlear) Site of exit from the skull? Function? Lesions? How to test the function? Internal acoustic meatus Equilibrium and Hearing Acoustic schwannoma (vertigo, nystagmus, nausea and vomiting) Hearing and nystagmus
Cranial nerve 9 (Glossopharynageal) Site of exit from the skull? Function? Lesions? How to test the function? Jugular foramen Parasym: Parotid gland, stylopharyngeus m Sensory: pharynx, middle ear, auditory tube, carotid body and sinus, external ear, posterior 1/3 of tongue Lesions: PICA infarct Test: Gag relfex
Cranial nerve 10 (Vagus) Site of exit from the skull? Function? Lesions? How to test the function? Jugular foramen Symp: body viscera, laryngeal & pharyngeal m. Sensory: Trachea, External ear, viscera of esophagus, epiglottis Lesion: Thyroidectomy, PICA infarct Test: Gag reflex and saying ahh (elevates palate) Uvula deviates away from lesion
Cranial nerve 11 (Accessory) Site of exit from the skull? Function? Lesions? How to test the function? Jugular foramen Innv. SCM and Trapezius M. Lesion: PICA infarct Test: Turn head and shrug shoulders
Cranial nerve 12 (Hypoglossal) Site of exit from the skull? Function? Lesions? How to test the function? Hypoglossal canal Intrinsic tongue muscles Lesions: Anterior spinal a. infarct Tongue protudes towards lesion Test: Lalalala
Corneal Reflex How to test? Normal reflex Afferent: Efferent: Touch cornea with cotton N: Blink Afferent: V1 (opthalmic) Efferent: CN 7 (temporal branch)-closes eye (orbicularis oculi m.)
Lacrimal Reflex How to test? Normal reflex Afferent: Efferent: Touch cornea with cotton N: Lacrimate Afferent: V1 (opthalmic) Efferent: CN 7 (temporal branch)
Jaw Jerk Reflex How to test? Normal reflex Afferent: Efferent: Tap on chin Normal (no response) Afferent: V3 (Mandibular) Efferent: V3 (Masseter) UMN lesion if different
Pupillary Reflex How to test? Normal reflex Afferent: Efferent: Shine light in eye Normal: Pupillary constriction Afferent: Optic nerve Efferent: Parasymp CN 3
Gag Reflex How to test? Normal reflex Afferent: Efferent: Stick tongue depressor in mouth and say ahhh Normal: Gags Afferent: CN 9 Efferent: CN 10
Midbrain contains which CN nuclei? CN 3 and 4
Pons contains which CN nuclei? CN 5-8
Medulla contains which CN nuclei CN 9, 10, 12
Spinal cord contains which CN nuclei? CN 11
What does the Pineal body contain melatonin secretion, circadian rhythm
What does the Superior colliculus contain conjugate vertical gaze center
What does the Inferior colliculus contain auditory information
What nerves run through Cavernous sinus CN 3, 4, 6, branches (V1 and V2) of CN 5
What are other structures that run through Cavernous Sinus Internal Carotid a optic chiasm pituitary gland sphenoidal sinuses
The reticular activating system include which areas Reticular formation Mesencephalic nucleus Thalamic intralaminar nucleus Dorsal hypothalamus Tegmentum
The reticular activating system function arousal and sleep awakening
The Vagal nuclei are nucleus solitarius nucleus ambiguus dorsal motor nucleus
Nucleus solitarius Nucleus solitarius Visceral sensory info: Taste Baroreceptors gut distension (CN 7,9,10)
Nucleus Ambiguus Motor innv. Pharynx Larynx Upper Esophagus (CN 9,10,11)
Dorsal Motor Nucleus Autonomic (Parasymp) info: Heart Lungs Upper GI (CN 10)
Which sympathetic chain starts from what spinal cord segment and ends at what segment T1-L3
Horner Syndrome will cause sympathetic denervation of the face
Describe Horner syndrome symptoms Ptosis (drooping of eyelid) Anhidrosis (absence of sweating) and flushing (rubor) of affected side Miosis (constriction of pupils)
What is caused by Horner syndrome Spinal cord lesion above T1 assc.(superior cervical ganglion). Pancoast tumor (pre-ganglionic) Brown-Sequard syndrome Late stage syringomyelia
What are the muscles of mastication Open Jaw: Temporalis, medial pterygoid cLose Jaw: Lateral pterygoid Masseter m.
Unilateral facial drooping involving the forehead Bell's Palsy
Sx Ptosis, miosis and anhidrosis are indicative of Horner Syndrome
What G protein classes do alpha receptors stimulate? • α1= Gq • α2 =Gi
What G protein classes do beta receptors stimulate? • β1 =Gs • β2 =Gs
What G protein classes do muscarinic receptors stimulate? • M1 =Gq • M2 =Gi • M3 =Gq
What G protein classes do dopaminergic receptors stimulate? D2= Gs
What is the treatment for choriocarcinoma methotrexate vincristine vinblastine
What is the treatment for AML cytarabine (arabinofuranosyl)
What is the treatment for CML imatinib
Which Rx prevents breast cancer tamoxifen
What is the treatment for breast cancer etopside, bleomycin, cisplatin, ifosfamide
What is the rate-limiting enzyme in purine synthesis? Purine: PPRP (phosphoribosyl pyrophosphate synthetase II)
What is the rate-limiting enzyme in pyrimidine synthesis? Pyrimidine: Carbamoyl phosphate synthetase II
Case-Control study Compares a group of people with the disease vs those without the disease Looks for prior exposure or risk factor Retrospective/Observational
Cohort Study Compares a group with a given exposure or risk factor to a group without such exposure Can be prospective/retrospective Relative risk
Cross-sectional study Collects data from a group of people to assess frequency of disease (and related risk factor) at a particular point in time Disease prevalence Can't estimate causality
Twin Concordance Study Compares the frequency with which both monozygotic twins or both dizygotic twins develop the same disease
In which phase of meiosis is a primary oocyte arrested until just prior to ovulation? Prior ovulation: Prophase of meiosis I
In performing a lumbar puncture to obtain a sample of CSF, what structures are pierced, starting with the most exterior? Skin Subcutaneous fat Supraspinal ligament Interspinal ligament Ligamentum flavum Epidural space Dura Matter Subdural space Arachnoid matter Subarachnoid space
What medications are used in the treatment of pulmonary hypertension Endothelin receptor antagonists (Bosetan) MOA: Competitive antagonize endothelin-1 receptor PDE-5 inhibitor (Sildenafil) MOA: Inhibit cGMP PDE5 and prolong vasodilatory effect of NO Prostacyclin analogs (epoprostenol & iloprost) MOA: Prostacyclin
Does the notochord become the neural tube No, Notochord is derived from mesoderm; Notochord becomes nucleus pulposus of IV disk
From where does the amygdala receive inputs Inputs: Limbic cortex Neocortex of parietal, temporal, and occipital lobe
To where does the amygdala send output Output: Hypothalamus, Thalamus, Septum, Hippocampus
Narcoleptic sleep episodes begin with what stage of sleep Narcolepsy sleep episodes start at REM sleep
What are the different stages of normal sleep Awake: Beta waves Awake but relaxed: alpha waves Stage 1: Light sleep (Theta waves) Stage 2: Deeper sleep, Bruxism (Sleep spindles and K complexes) Stage 3: Deepest non-REM sleep (delta-slow wave)
Which T cell type regulates the humoral response T-Helper Cells 2 -Augment humoral (Plasma cell) response Generate IL-4 and IL-5
What is a reason why a woman might have primary amenorrhea (hint: congential) turner syndrome
What is a syringomyelia Cystic cavity within spinal cord (C8-T1) Crossing anterior spinal commissural fibers are damaged
What symptoms are commonly seen in patients with syringomyelia Cape-like bilateral loss of pain and temp sensation in upper extremities (fine touch preserved)
What type of skin cancer is associated with arsenic exposure in coal miners Squamous cell carcinoma
Which one will be able to increase the blood pressure of a hypotensive patient Phenylephrine
What are the steps in the conversion of vitamin D to its active form in the body D3 from sun exposure in skin. D2 ingested from plants. Both converted to 25-OH in liver and to 1,25-(OH)2 (active form) in kidney
By what mechanism does vitamin D help prevent osteoporosis Increases absorption of dietary Ca2+ and Phosphate Increases bone resorption -> Increased Ca2+ and Phosphate
What landmarks are used when placing an internal jugular central venous catheter Between the medial and lateral heads of the sternocleidomastoid muscle and lateral to the carotid artery in most cases
What is a reason why a woman might have primary amenorrhea? (hint:hymen) imperfortate hymen
What is a reason why a woman might have primary amenorrhea? (hint: congential) mullerian delayed agenesis
What can occur if a MAO inhibitor (MAOI) is added to an SSRI Serotonin syndrome
Rx for Serotonin Syndrome Treatment: Stop serotonergic drugs Benzodiazepine Supportive care Cyproheptadine (5-HT2 receptor antagonist)
Clavulanic acid, sulbactam, and tazobactam aid penicillins in their activity against bacteria through what mechanism Beta-lactamase inhibitor
What is the most common benign tumor of the salivary gland? pleomorphic adenoma
What is a Warthin's tumor Warthin tumor: (papillary cystadenoma lymphomatosum) is a benign cystic tumor with germinal centers
What cranial nerve goes through the parotid gland CN VII goes through parotid gland
Membranous glomerular diseases involve thickening of what structure Basement membrane Membranous nephropathy
Which bacteria are most commonly responsible for sialadenitis Bacteria: Staph a. and Viridans strep
What condition most commonly predisposes a patient to sialadenitis Predisposes: sialolithiasis (stone obstruction of salivary gland)
What important secretory products are secreted from the following cells of the GI tract? (hint: G cells) Gastrin
What important secretory products are secreted from the following cells of the GI tract (hint: I cells) Cholecystokinin (CCK)
What important secretory products are secreted from the following cells of the GI tract? (hint: S cells) Secretin
What important secretory products are secreted from the following cells of the GI tract? (hint: D cells) Somatostatin
What important secretory products are secreted from the following cells of the GI tract (hint: pariteal cells) Gatric acid and IF
What important secretory products are secreted from the following cells of the GI tract (hint: chief cells) Pepsinogen
What is the antidote for warfarin anticoagulation or warfarin overdose Warfarin overdose: Vitamin K, plasma (if active bleeding)
What is the antidote for heparin overdose Heparin overdose: Protamine sulfate
Most common cause of neural tube defects Folate Deficiency
Most common cause of congenital malformations in the US Alcohol
Most common cause of congenital mental retardation in the US Fetal Alcohol Syndrome
Sx Hyperflexible joints, arachnodactyly, aortic dissection, lens dislocation Marfan's Syndrome
Sx Hereditary nephritis, cataracts, sensorineural hearing loss Alport Syndrome
Sx Ptosis, miosis, anhidrosis Horner's Syndrome
Amyloid deposits in gray matter of the brain Senile plaques in Alzheimer's Disease
HALLMARK Drooling farmer Organophosphate poisoning
Sx Inability to breastfeed, amenorrhea, cold intolerance Sheehan's Syndrome
Sx Infertility, galactorrhea, bitemporal hemianopsia. Prolactinoma
Most common causes of Cushing syndrome (4) 1) Exogenous Steroids 2) Ectopic ACTH--small cell lung cancer 3) Cushing Disease--pituitary tumor 4) Adrenal Adenoma
Most common tumor of the adrenal gland Adrenal Adenoma
Most common tumor of the adrenal medulla (in adults) Pheochromocytoma
Most common tumor of the adrenal medulla (in kids) Neuroblastoma
Most common cause of primary hyperaldosteronism Adrenal Adenoma
Medical treatment for hyperaldosteronism Spironolactone or Eplerenone
Pheochromocytoma, medullary thyroid cancer, and hyperparathyroidism MEN 2A
Pheochromocytoma, medullary thyroid cancer, and mucosal neuromas MEN 2B
Adrenal disease associated with skin hyperpigmentation Addison's Disease
HTN, hypokalemia, metabolic acidosis Conn Syndrome
Most common thyroid cancer Papillary Carcinoma
Cold intolerance Hypothyroidism
Enlarged thyroid cells with ground-glass nuclei Papillary Carcinoma of the thyroid
Most common infections seen in chronic granulomatous disease Bugs producing catalase: Candida Aspergillus Staph aureus Klebsiella E. coli
Eczema, recurrent URI, high serum IgE Hyper-IgE Syndrome aka Job's Syndrome
Large lysosomal vesicles in phagocytes Chediak-Higashi Syndrome
Dark purple nodules on the skin in an HIV infected patient Kaposi's Sarcoma
Large cells with owl's eye inclusions CMW
Treatment of CMV Ganciclovir
Most common opportunistic infection in HIV patients PCP
Drug used to prevent Pneumocystis pneumonia TMP-SMX
Dysphagia, glossitis, and Fe deficiency anemia Plummer-Vinson Syndrome
Hematemesis with retching Mallory-Weiss Tear
Specialized columnar epithelium seen in a biopsy from the distal esophagus Barrett Esophagus
Biopsy of a patient with esophagitis reveals large pink intranuclear inclusions and host cell chromatin that is pushed to the edge of the nucleus HSV
Biopsy of a patient with esophagitis reveals enlarged cells, intranuclear and cytoplasmy inclusions, and a clear perinuclear halo CMV
An esophageal biopsy reveals lack of ganglion cells between the inner and outer muscular layers Achalasia
Biopsy of a mass in the parotid gland reveals a double layer of columnar epithelial cells resting on a dense lymphoid stroma Warthin's Tumor
Protrusion of the mucosa in the upper esophagus Esophageal web
Outpouching of all layers of the esophagus found just above the LES Epiphrenic Diverticulum
Basal cell hyperplasia, eosinophilia, and elongation of the lamina propria papilla seen in biopsy of the esophagus Chronic GERD
Goblet cells seen in the distal esophagus Barrett Esophagus
A PAS stain on a biopsy obtained from a patient with esophagitis reveals hyphate organisms Candida
Esophageal pouch found in the upper esophagus Zenker Diverticulum
Stomach biopsy reveals neutrophils above the BM, loss of surface epithelium, and fibrin-containing purulent exudate Acute Gastritis
Stomach biopsy reveals lymphoid aggregates in the lamina propria, columnar absorptive cells, and atrophy of glandular structures Chronic Gastritis
Diffuse thickening of gastric folds, elevated serum gastrin levels, biopsy reveals glandular hyperplasia without foveolar hyperplasia Zollinger-Ellison Syndrome
Mucin-filled cell with a peripheral nucleus Signet Ring cells
Most common type of stomach cancer Adenocarcinoma
Ovarian metastases from gastric cancer Krukenberg tumor
Gastric ulcerations and high gastrin levels Zollinger-Ellison Syndrome
Acute gastric ulcer associated with elevated ICP or head trauma Cushing Ulcer
Acute gastritis ulcer associated with severe burns Curling Ulcer
Painless jaundice Pancreatic Cancer
Most common cause of acute pancreatitis Gallstones & alcohol
Most common cause of chronic pancreatitis Alcohol
Small intestinal mucosa laden with distended macrophages in the lamina propria that are filled with PAS+ granules and rod-shaped bacilli seen by electron microscopy Whipple's Disease
Gluten Sensitivity Celiac Sprue
Total or subtotal atrophy of the small bowel villi, plasma cells, and lymphocytic infiltration into the lamina propria and epithelium, and hyperplasea/elongation of the crypts Celiac Sprue
Weight loss, diarrhea, arthritis, fever, adenopathy and hyperpigmentation Whipple's Disease
Anti-transglutaminase/anti-gliadin/anti-endomysial antibodies Celiac Disease
Vitamin given to pregnant women to prevent NT defects Folate
Newborn with chronic diarrhea, failure to thrive, and chronic Candida SCID
TG accumulation in hepatocytes Fatty Liver
Eosinophillic inclusion in the cytoplasm of hepatocytes Mallory Bodies from Alcoholic Hepatitis
Cancer closely linked to cirrhosis Hepatocellular Carcinoma
Severe hyperbilirubinemia in a neonate Crigler-Nagir, Type I
Mild, benign hyperbilirubinemia Gilbert's or Crigler-Nagir, Type 2
Hepatomegaly, abdo pain, ascites Budd-Chiari Syndrome
Green/yellow corneal deposits Wilson's Disease
Low serum ceruloplasmin Wilson's Disease
Cirrhosis, diabetes, and hyperpigmentation Hemochromatosis
Preferred anticoagulant for immediate anticoagulation Heparin
Preferred anticoagulant for long-term anticoagulation Warfarin
Preferred antocoagulant during pregnancy Heparin
A boy with self-mutilating behavior, mental retardation, and gout Lesch-Nyan Syndrome
Elevated Uric Acid Levels (4) Gout Lesch-Nyhan Tumor Lysis Loop or Thiazide Diuretics
Bluish-colored lines on the gingivae Lead Poisoning: Berton's Lead Lines
Causes of hypochromic, microcytic anemia Fe Deficiency Thalassemia Lead Poisoning
Hypersegmented neutrophils Megaloblastic Anemia: B12 or Folate Deficiency
Skull x-ray shows a "hair-on-end" appearance Marrow hyperplasia: Sickle-Cell Anemia or B-Thalassemia
Basophilic Stippling of RBCs Lead Poisoning
Painful cyanosis of the fingers and toes, with hemolytic anemia Cold agglutinins
Red urine in the morning, and fragile RBCs Paroxysmal Nocturnal Hemoglobinuria
Basophilic nuclear remnants in RBCs Howell-Jowell Bodies
Autosplenectomy Sickle Cell Disease
Drug used to treat sickle cell disease Hydroxyurea (blocks ribonucleoside reductase stopping UDP->dUMP)
Antiplatelet Antibodies Immune Thrombocytopenic Purpura
Bleeding disorder with GpIb deficiency Bernard-Soulier
Most common inherited bleeding disorder von Willebrand Disease
Cancer most commonly associated with noninfectious fever Hodgkin Lymphoma-exhibits B symtpoms
HALLMARK "Smudge" Cells CLL
HALLMARK "Punched out" lytic lesions Multiple Myeloma
HALLMARK Sheets of lymphoid cells with a "starry sky" appearance Burkitt Lymphoma
HALLMARK RBCs clumped together like a stack of coins Rouleaux Formation-Multiple Myeloma
HALLMARK Monoclonal AB spike Multiple Myeloma MGUS Waldenstrom's Macroglobulinemia
HALLMARK Reddish-pink rods in the cytoplasm of leukemic blasts Auer Rods-AML
HALLMARK Large B Cells with bilobed nuclei and prominent "owl eye" inclusions Reed-Sternberg cells-Hodgkin Lymphoma
Most common leukemia in children ALL
Most common leukemia in adults CLL
HALLMARK Characteristic Auer Rods AML
Myelodysplastic syndromes have a tendency to progress to this AML
Myeloproliferative disorders may progress to this AML
More than 20% blasts in the marrow Acute Leukemia
Leukemia with more mature cells and <5% blasts Chronic Leukemia
HALLMARK PAS (+) acute leukemia ALL
HALLMARK Commonly presents with bone pain ALL
HALLMARK Numerous basophils, splenomegaly, and negative for leukocyte alkaline phosphatase CML
HALLMARK Always positive for the Philadelphia Chromosome CML
Acute leukemia positive for peroxidase AML
Solid sheets of lymphoblasts in marrow ALL
PAS (-) acute leukemia AML
Rx Treatment choice for Rickets or Osteomalacia Vit D
Swollen gums, poor wound healing, bleeding mucous membranes, and spots on the skin Scurvy- Vit C deficiency
Most common cancer of the appendix Carcinoid Tumor
Most common surgical emergency Appendicitis
GI hamartomas, hyperpigmentation of the mouth, hands and genitalia Peutz-Jegher's
Multiple colon polyps, osteomas, soft tissue tumors Gardner's Syndrome
Severe RLQ pain with rebound tenderness Appendicitis
HALLMARK Apple core" lesion on barium enema Colon Cancer
Most common cause of RLQ pain Appendicitis
Most common cause of LLQ pain Diverticulitis
Most common cause of RUQ pain Cholecystitis
Colonoscopsy reveals very friable mucosa extending from the rectum to the distal transverse colon Ulcerative Colitis
Most common site of colonic diverticula Sigmoid colon
HALLMARK "String sign" on contrast x-ray Crohn's Disease
HALLMARK "Lead pipe" appearance of colon on contrast x-ray Ulcerative Colitis
Food poisoning due to exotoxin B. cereus [rice]; S. aureus [all others]
Osteomyelitis in sickle cells disease Salmonella
Food poisoning as a result of mayonnaise sitting out too long S. aureus preformed toxin
Diarrhea caused by gram (-) nonmotile organism that does not ferment lactose Shigella
Rice-water stool Vibrio cholera
Diarrhea caused by an S-shaped organism Yersinea
Food poisoning from reheated rice B. cereus
Diarrhea caused by gram (-) motile organism that doesn't ferment lactose Salmonella
Most common cause of "traveler's" diarrhea ETEC
Diarrhea after a course of antibiotics C. difficile
Diarrhea caused by gram (-) lactose fermenting bacteria, no fever E. coli
Diarrhea caused by gram (-) comma-shaped organism, no fever Vibrio
Diarrhea + recent ingestion of water from a stream Giardia/Entamoeba histolytica
Food poisoning from undercooked hamburger meat O157:H7
Ring-enhancing brain lesion in an HIV-infected patient Toxoplasma
Treatment for Trichomonas vaginalis Metronidazole for patient & sex partner
Most common protozoal diarrhea Giardia Lamblia
Most common helminth infection in the US Enterobius vermicularis
Second most common helminth infection in the US Ascaris lumbricoides
Cause of malaria Cause of malaria Plasmodium
What enzyme catalyzes peptide bond formation during protein synthesis rRNA (ribozyme) Peptidyl transferase
What conditions are associated with target cells (HALT) HbC Thalassemia Aplenia Liver disease
What name is given to anemia resulting from mechanical destruction of erythrocytes due to aortic stenosis or prosthetic heart values Macroangiopathic hemolytic anemia
Where do platelets come from megakaryocytes
Primary hemostasis platelet plug
What is inside an endothelial cell vWF Factor VIII Thromboplastin tPA PGI2
What is vWF made up of Several subunits linked by disulfide bonds, synthesized by endothelial cells and megakaryocytes
Where are vWF specifically stored in the endothelial cells Weibel-palade bodies and alpha-granules of platelets
vWF function Complexes with factor VIII Platelet adhesion to vessel wall and other platelets (def > Increased bleeding time)
A deficiency of vWF would look like what coagulation cascade def Factor VIII (Increased PTT) Hemophilla A
vWF uses what glycoprotein to bind to platelets GpIb
Platelet content (10) vWF COX ADP, PDGF, serotonin, fibrinogen, lysosomal enzymes, thromboxane A2, calcium, thrombin
What does ADP do Helps platelets adhere to endothelium by realising GpIIb/IIIa
GpIIb/IIIa function Binds to fibrinogen and forms cross-links among platelets (aggregation)
Aspirin NSAID Inhibits COX 1 and 2 (permanently by covalent acetylation)
Aspirin Leads to inhibition of TXA2 (decreases platelet aggregation) and Prostaglandin
Aspirin Increases BT, no effect on PT or PTT
Aspirin indications Antipyretic (Reduce fever) Analgesic (reduce pain) Anti-inflammatory Antiplatelet Acute MI Acute coronary syndromes Acute thrombotic stroke MI prevention
Aspirin side effects Gastric ulceration Tinnitus Hyperventilation Respiratory alkalosis Chronic use: Acute renal failure, interstitial nephritis, Upper GI bleeding
Why should one not give children with a viral sickness aspirin Reye syndrome (Hepatic encephalopathy Liver problems Hypoglycemia Mitochondrial abnormalities
Ticlopidine, Clopidogrel, Ticagrelor, Prasugrel Blocks ADP receptors -Prevents expression of GpIIb/IIIa - Inhibits platelet aggregation
Why would you give an ADP receptor inhibitor instead of aspirin You give them these drugs in case of allergy to aspirin
ADP receptor inhibitor indications Acute MI Coronary stenting Decreased incidence or recurrence of thrombotic stroke (Post-MI) Aspirin allergy
ADP receptor inhibitor side effects Neutropenia (ticlopidine) TTP (ticlopidine)
Abciximab, eptifibatide, tirofiban Glycoprotein IIb/IIIa Inhibitors Inhibits Gp IIb/IIIa (directly) - Inhibits platelet aggregation
What is Abciximab made from Monoclonal antibody Fab fragments
What are Glycoprotein IIb/IIIa Inhibitors indications Unstable angina (NSTEMI) Percutaneous transluminal coronary angioplasty
Platelet disorder labs PT, PTT, INR= Normal Bleeding time = increased
Platelet disorder clinical presentation Bleeding from mucous membranes Epistaxis Petechiae (microhemorrhages) Purpura
Platelet disorders Immune thrombocytopenia purpura (ITP) Thrombotic thrombocytopenia purpura (TTP) Bernard-Souiler syndrome Glanzmann thrombashenia
ITP lab findings Low platelet count Increased bleeding time Increased megakaryocytes (biopsy)
ITP be either acute or chronic. Who is more prone to acute ITP and chronic ITP Acute= children Chronic= women of childbearing age
ITP can be associated with Viral sickness or Lupus
ITP treatment Steroids IV Ig Splenectomy
TTP lab findings Decreased platelet count Increased bleeding time Schistocytes Increased LDH
TTP is assc. with what other disorder HUS (Hemolytic Uremic syndrome)
What bacteria is HUS associated with; especially kids E. coli O157:H7
Bernard-Soulier disorder labs No change/decreased platelet count Increased Bleeding time Also no agglutination on ristocetin cofactor assay
Glanzmann thrombasthenia Defect in platelet plug formation Decreased GpIIb/IIIa (defect in platelet-platelet formation) Low aggregation
Glanzmann thrombasthenia labs Increased bleeding time Normal platelet count Agglutination with ristocetin cofactor assay
Thrombocytopenia caused by other factors (Low platelet count) Heparin induced Aplastic anemia
von Willebrand disease (AD) Defect in vWF > Increased PTT (similar to Factor 8 def) Defect in platelet plug formation: decreased vWF > defect platelet-vWF adhesion
von Willebrand disease lab findings No change in platelet count Increased bleeding time No change in PT Increased PTT
Mixed platelet and coagulation disorders von Willebrand disease DIC
von Willebrand disease diagnosis Ristocetin cofactor assay (Decreased agglutination= (+)
von Willebrand disease treatment (DDAVP) Desmopressin: releases vWF from Weibel-pallade bodies in endothelium
DIC (Disseminated Intravascular Coagulation) Widespread activation of clotting Consumes platelets and coagulations factors Hypercoagulable (Bleed time increased)
DIC (Disseminated Intravascular Coagulation) lab findings Low platelets Increased bleeding time Increased PT and PTT Schistocytes Increased fibrin split products (D-dimers) Decreased fibrinogen (consuming) Decreased factors V and VIII (consuming)
DIC (Disseminated Intravascular Coagulation) causes STOP Making New Thrombi Sepsis (Gm -) Trauma Obstetric complications acute Pancreatitis Malignancy Nephrotic syndrome Transfusion
What else can increase d-dimers (fibrin split products) Snake Venom
What cytokines are increased in DIC TNF and IL-1
Platelet Stimulation Activation - Secretion of ADP, PDGF, serotonin, fibrinogen, lysosomal enzymes, thromboxane A2, calcium, thrombin - Thrombin: fibrinogen → fibrin - Thromboxane A2 → vasoconstriction and platelet aggregation
What is the underlying pathophysiology in thrombotic throbocytopenic purpura (TTP) Deficiency of the metalloprotease ADAMTS 13
What is the cause of ITP Anti-GpIIb/IIIa antibodies binds to receptors on platelets and then immune systems removes platelets by splenic macrophages
What is the classic triad of HUS? Hemolysis Uremia Thrombocytopenia
What is the classic pentad of TTP Nasty Fever Torched His Kidneys
What is the defect in Bernard-Soulier disease Decreased GpIb = defect in platelet to vWF adhesion
What is the life span of a platelet (which is also the maximum life of platelets after a transfusion) 8-10 days
What molecule is expressed on the surface of a platelet after it becomes activated GpIIb/IIIa
NSAIDs inhibit the production of which substance important in platelet aggregation? Thromboxane A2
After a normal spontaneous vaginal delivery,the new mom bleeds profusely from her vagina and later from her gums. What abnormal lab values would you suspect DIC: Decreased platelets Increased bleeding time Increased PT and PTT Increased D-Dimer
What is the mechanism of action of each of the following drugs? Streptokinase Directly or Indirectly aid conversion of plasminogen to plasmin
What is the mechanism of action of each of the following drugs? Aspirin Inhibits COX 1 and 2
What is the mechanism of action of each of the following drugs? Clopidogrel ADP receptor inhibitor
What is the mechanism of action of each of the following drugs? Abciximab Glycoprotein IIb/IIIa Inhibitor
What is the mechanism of action of each of the following drugs? Tirofiban Glycoprotein IIb/IIIa Inhibitors
What is the mechanism of action of each of the following drugs? Ticlopedine ADP receptor inhibitor
What is the mechanism of action of each of the following drugs? Enoxaparin Low-molecular weight heparin Activatior of antithrombin (decreases thrombin and factor Xa)
What is the mechanism of action of each of the following drugs? Eptifibatide Glycoprotein IIb/IIIa Inhibitors
Antiplatelet antibodies ITP
Bleeding disorder with gpIb deficiency Bernard-Soulier syndrome
Most common inherited bleeding disorder vWF disease
What are the 3 different mechanisms cells employ to break down proteins Ubiquitin protein ligase Lysosomes Calcium-dependent enzymes
Which medication used in the treatment of HIV is known for causing bone marrow suppression NRTIs (Zidovudine)
What is the treatment for lead poisoning Adult vs Children Adult: EDTA and Succimer Children: Succimer, EDTA, Dimercaprol
Intravascular hemolysis is going show A decrease in serum haptoglobin Increase LDH (lactate dehydrogenase) Schistocytes Increased reticulocytes Hemoglobinuria/Hemosiderinuria Urobilinogen in urine
Intravascular hemolysis is going show a decrease in serum haptoglobin Increase LDH (lactate dehydrogenase) Schistocytes Increased reticulocytes Hemoglobinuria/Hemosiderinuria Urobilinogen in urine
Extravascular hemolysis is going show Macrophages in spleen clear RBCs Spherocytes in peripheral smear Increase LDH (lactate dehydrogenase) No hemoglobinuria/hemosiderinuria Increased unconjugated bilirubin (jaundice)
Intravascular hemolysis is caused by Mechanical hemolysis (Prosthetic valve) Paroxysmal nocturnal hemoglobinuria Microangiopathic hemolytic anemia
Extravascular hemolysis diseases (5) Hereditary spherocytosis G6PD deficiency Pyruvate Kinase Def HbC defect Sickle cell anemia
Intrinsic hemolytic normocytic anemia diseases (Problem within RBCS) Hereditary spherocytosis G6PD deficiency Pyruvate Kinase Def HbC defect Sickle cell anemia Paroxysmal nocturnal hemoglobinuria
Hereditary spherocytosis Defect in protein interacting with RBC membrane skeleton and plasma mem.
What is MCHC Mean corpuscular hemoglobin concentration
Hereditary spherocytosis clinical findings Splenomegaly Aplastic crisis (Parvovirus B19
Hereditary spherocytosis diagnostic test? Osmotic fragility test- Increase lysis
Hereditary spherocytosis treatment? Splenectomy (HOWELL-JOLLY bodies)
G6PD deficiency Most common enzymatic disorder of RBCs X-linked recessive Defect in G6PD > Decreased glutathione > increased RBC susceptibility to oxidant stress
Oxidative stress factors are Sulfa drugs, antimalarials, infections, fava beans
G6PD deficiency labs Blood smears shows RBCs with Heinz bodies (clumps of hemoglobin) and bite cells (macrophages cause this)
G6PD deficiency symptoms Back pain, hemoglobinuria a few days after oxidant stress
Pyruvate Kinase Deficiency AR Decreased ATP > rigid RBCs (swelling & hemolysis) Swelling due to defect in Na+/K+ ATPase Common in newborns
Paroxysmal nocturnal hemoglobinuria Characteristics What test would you use to test for it? Increased complement-mediated RBC lysis (impaired synthesis of GPI anchor for decay-accelerating factor that protects RBC membrane from complement) Missing CD55 and CD59 = flow cytometry (+) Ham's test=RBC lysis at low pH
Paroxysmal nocturnal hemoglobinuria triad Coomb (-) hemolytic anemia Pancytopenia Venous thrombosis
Sickle cell disease HbS point mutation causes a single amino acid replacement in Beta chain (Sub. glutamic acid with valine)
What factors cause sickling of RBCs Low O2 tension Dehydration High altitude Acidosis
What infectious disease are people with sickle cell anemia resistant to? What type of people are more prone to this trait? Heterozygous (sickle cell trait) = resistance to malaria 8% of African americans
Why are newborns at first asymptomatic to sickle cell disease Because of the increased HbF in and decreased HbS
Sickle cell complications Aplastic crisis (parvovirus B19) Autosplenectomy (howell-jolly bodies) and Infections from SHiNE SKiS Salmonella osteomyelitis Painful crises (vaso-oclusive) Renal papillary necrosis due to hypoxemia and microhematuria
What can be seen on skull x-ray in sickle cell patients "Crew cut" on skull due to marrow expansion from increased erythropoiesis
Sickle cell disease treatment Hydroxyurea (increased HbF) Hydration
HbC defect Common in newborn Heterozygous for hemoglobin C: Asymptomatic Homozygous for hemoglobin C: -Mild hemolysis and splenomegaly HbC point mutation causes a single amino acid replacement in Beta chain (Sub. glutamic acid with lysine)
Extrinsic hemolytic normocytic anemia diseases (Problem outside RBCS) Autoimmune hemolytic anemia Microangiopathic anemia Macroangiopathic anemia Infections
Autoimmune hemolytic anemia Warm agglutinin (IgG) Cold agglutinin (IgM) Coombs (+)
Microangiopathic anemia RBCs are damaged when passing through obstructed or narrow vessel lumina
Microangiopathic anemia can be caused by DIC, TTP/HUS, SLE, and Malignant HTN
Schistocytes "Helmet cells" Seen on blood smear due to mechanical destruction of RBCs
Macroangiopathic anemia Prosthetic heart valves and aortic stenosis may cause hemolytic anemia, secondary to mechanical destruction Present with schistocytes
Infections causing hemolytic anemia Malaria (Plasmodium spp.) Babesia
A child anemic since birth has now been cured with splenectomy. What is the disease Hereditary spherocytosis
What is the difference between the hemoglobin S defect and the hemoglobin C defect? HbS is a point mutation of B-globin (by sub. of glutamic acid for valine) HbC is a point mutation of B-globin (by sub. of glutamic acid for lysine)
Coombs' (+) RBC agglutination with the addition of antihuman antibody because RBCs are coated with immunoglobulin or complement proteins
Direct Coombs' (DAT) "Type and screen"
What is the difference between a warm agglutinin and a cold agglutinin Cold: Antibodies against RBCs that interact more strongly at low temps (4°C) than at body temp Warm: Antibodies that react against RBC protein antigens at body temperature
What are schistocytes Mechanically destructed RBCs
What are two protozoal diseases that can cause hemolytic anemia Plasmodium spp. Babesia
What findings are associated with hereditary spherocytosis Anemia Jaundice Pigmented gallstones Splenomegaly (+) osmotic fragility test Coomb (-) Spherocytes in peripheral smear
Cold Agglutinins Antibodies against RBCs that interact more strongly at low temps (4°C) than at body temp
Warm Agglutinins Antibodies that react against RBC protein antigens at body temperature = chronic anemia
HALLMARK Ham's test Paroxysmal nocturnal hemoglobinuria
HALLMARK Heinz bodies G6PD deifcency
HALLMARK DEB test Fanconi anemia
HALLMARK Osmotic fragility test Hereditary spherocytosis
HALLMARK Basophilic stippling Lead poisoning Thalassemia
Sx Painful cyanosis of the fingers and toes, with hemolytic anemia Cold agglutinins
Autosplenectomy Sickle cell disease
Drug used to treat sickle cell disease Hydroxurea
What is the target HgbA1C for every diabetic patient <7.0
What are the fiver hereditary thrombosis syndrome Antithrombin deficiency Factor V Leiden Protein S deficiency Protein C deficiency Prothrombin gene mutation
Which Mycobacterium spp. fits each of the following description? Causes leprosy Mycobacterium leprae
Which Mycobacterium spp. fits each of the following description? Causes pulmonary TB-like symptoms in COPD patients M. tuberculosis
Which Mycobacterium spp. fits each of the following description? Causes cervical lymphadenitis in children M. Scrofulaceum
Which Mycobacterium spp. fits each of the following description? Causes a disseminated disease in AIDS patients M. avium-intraceullulare
Which Mycobacterium spp. fits each of the following description? Hand infection in aquarium M. marinum
Atrial fibrillation What are some charcteristics? Irregularly spaced ORS complexes Irregular baseline No steady rhythm (SA node dysfunction) (Multiple SA nodes) No coordinated atrial contraction = no discrete P waves
Atrial fibrillation can cause Atrial stasis (pooling) and lead to thrombosis>emboli
Atrial fibrillation can also cause SVTs? What is an SVT? How is it caused? SVT= Supraventricular tachycardia It is caused by the increased signals by the multiple SA nodes to the AV node can cause frequent ventricular depolarization
Atrial fibrillation treatment? New vs Chronic New: <48 hrs = synchronized cardioversion
Rate control drugs? Rhythm control drugs? Chronic: Heparin, enoxaparin Coumadin Rate control (digoxin, Beta-blockers, CCBs) Rhythm control (sotalol, amiodarone)= Potassium channel blockers
Why do you not cardioverse a chronic atrial fib This can cause a thrombus to dislodge and form emboli, due to the heart resetting the contraction
HALLMARK Atrial flutter characteristics Sawtooth appearance on EKG
First Degree Heart Block PR interval prolonged (>200 msec or 5 little boxes) Asymptomatic
First Degree Heart Block can be caused by what drug CCBs (Toxicity= Increased PR interval)
What bacterial infection can cause an AV node block Borrelia burgdorgeri (Lyme disease)
Second degree (Mobitz 1) Heart Block (Wenckebach) What is the major fact about it? Unsteady rhythm PR intervals increase, until beat drop Every QRS complex is followed by a P-wave, but every P-wave doesn't followed by a QRS complex Benign
What type of pattern is seen in Second degree (Mobitz 1) Heart Block Regularly Irregular
Second degree (Mobitz 2) Heart Block Characteristics? What can is progress to? What is it treated with? Unsteady rhythm No increae in PR intervals except for DROP (abrupt) Can progress to 3rd degree block Treated with pacemaker
Third degree heart block Characteristics? What bacterial disease assc. with? Treatment? Steady rhythm Decreased HR Atria and Ventricular beat independently (SA no communicating with AV) Narrow QRS complex Ventricular rate is slower, atrial faster Treated with pacemaker Lyme disease
Wolf-Parkinson-White Syndrome Ventricular pre-excitation syndrome Accessory conduction pathway from atria to ventricle Bypass AV node (shortened PR interval) Goes through bundle of Kent Ventricles partially depolarize earlier
Ventricles partially depolarizing earlier brings about what characteristics Delta waves with widened QRS and shortened PR intervals
Wolf-Parkinson-White Syndrome can result it in Reentry ciruit > SVTs
Wolf-Parkinson-White Syndrome treat with Class IA (procainmide) and III (amiodarone)
Paroxysmal Supraventricular Tachycardia Caused by Originates above the AV node Can be caused by AV nodal reentrant tachycardia Narrow QRS
Junctional Escape Rhythm Delayed heartbeat no originating from SA node, signal is coming from AV junction Protective mechanism is SA node is dysfunctional, then another area of heart fires off heart beats P-wave location can change depending on where signal originated from
Ventricular premature beats or PVC (Premature ventricular contraction) Early occurring wide QRS complexes Microentery at Purkinje fibers No P waves, widened QRS
Ventricular bigeminy Occurs when a ventricular premature beat follows each sinus beat
Ventricular trigeminy 2 sinus beats followed by a ventricular premature beat
Ventricular Escape Rhythm Failure for SA and AV nodes So no P waves and get widened QRS complexes Longer than avg R to R intervals persistent rhythm leads to ventricular complexes Persistence can lower rate < sinus rhythm
Ventricular Tachycardia (VT) 3 or more successive ventricular complexes
Nonsustained vs Sustained Nonsustained VT: -Series of repetitive ventricular beats -Duration <30secs Sustained VT: Duration >30secs
Monomorphic VT Rhythm is normal Slight irregularity of R-R intervals QRS axis shifted to left Width of QRS >0.6 secs
What happens if Monomorphic VT is sustained? treat with? hemodynamic collapse; Treat: async defibrillation and CPR
Torsades de Pointes Polymorphic VT Shifting sinusoidal waveforms Progress to V. Fib Wide QRS and tachycardia Long QT interval predisposes
What causes Torsades de Pointes? Treatment? Hypokalemia Hypomagnesemia Drugs Treat: Magnesium sulfate
Ventricular Fibrillation A completely erratic rhythm with NO identifiable waves. Fatal w/o CPR or defib
What is the initial treatment for ventricular fibrillation Monomorphic: defibrillation and CPR
What is the hallmark of a third degree heart bloc independent beating of atrium and ventricle
What drugs are know to prolong QT interval, increasing the likelihood of torsades in those at risk Antibiotics (macrolide) Antiemetics (ondansetron) Antidepressants (TCA) Antiarrhythmics (Class 1A and 3) Antipsychotics (haloperidol)
What are the two different types of second degree AV block? How do they differ? Mobitz type 1: Increasing PR interval then drop Mobitz type 2: No warning, normal PR interval + drop
Why is warfarin anticoagulation important in patients with chronic atrial fibrillation? Prevents any thrombosis to form due to atrial stasis (pooling)
What is the fibrous band attached to the testis and scrotum that aids in normal testicular descent? What is this structure called in females? Gubernaculum Female Remnant: Ovarian ligament + Round ligament of uterus
What is Osler-Weber-Rendu syndrome? Hereditary hemorrhagic telangiectasia AD disorder of blood vessels. Findings: telangiectasia, recurrent epistaxis, skin discolorations, arteriovenous malformations (AVMs), GI bleeding, hematuria.
Which studies use odds ratios, and which use relative risks? Case-control uses Odds ratio Cohort uses Relative Risk
What are the effects of NSAIDs' inhibition of PGE2? Increased vascular tone-vasoconstriction Increased bronchial tone- bronchoconstriction
What role do prostaglandins and angiotensin II play on the renal arterioles? prostaglandins: Dilate afferent arteriole (Increases RPF, GFR, so FF remains constant) Angiotensin II: Constricts efferent arteriole Decreases RPF, Increases GFR, so FF increases)
What is the mechanism of action of the following antiemetics? Scopolamine Antimuscuranic (M1)
What is the mechanism of action of the following antiemetics? Promethazine Histamine antagonist D2 dopamine antagonist
What is the mechanism of action of the following antiemetics? Prochlorperazine D2 dopamine antagonist
What is the mechanism of action of the following antiemetics? Metoclopramide D2 receptor antagonist
What is the mechanism of action of the following antiemetics? Ondansetron 5-HT3 antagonist
What are the 3 endogenous androgens, in order from the most potent to the least potent DHT > testosterone > androstenedione
How does a decrease in renal artery pressure cause an increase in blood pressure JG cells secrete renin in response to decreased renal blood pressure, decreases NaCl delivery to distal tubule, and Increases sympathetic tone (β1). Angiotesinogen > Angiotensin I > Angiotensin II
What physiologically is taking place in decompression sickness Gases (especially nitrogen) that had dissolved in the blood at high pressures form gas bubbles that can occlude blood vessels
Is a 34-year-old schizophrenic patient having active hallucinations, who is not oriented to time, place, or person, able to legally agree to a plan of care? No
What factors must be in place in order for a patient to have the capacity to make a decision? Patient is ≥ 18 years old or otherwise legally emancipated Patient makes and communicates a choice Patient is informed (knows and understands) Decision remains stable over time Decision is consistent with patient's values and goals, not clouded by a m
The thalamus is a relay station that conducts signals to and from the brain. Which thalamic nuclei are the relay stations for each of the following body sensations/activities? Auditory sensation MGN (Medial Geniculate)
The thalamus is a relay station that conducts signals to and from the brain. Which thalamic nuclei are the relay stations for each of the following body sensations/activities? Visual sensation LGN (Lateral Geniculate)
The thalamus is a relay station that conducts signals to and from the brain. Which thalamic nuclei are the relay stations for each of the following body sensations/activities? Motor to the body VL (Ventral Lateral)
The thalamus is a relay station that conducts signals to and from the brain. Which thalamic nuclei are the relay stations for each of the following body sensations/activities? Facial sensation VPM (Ventral Posteromedial)
The thalamus is a relay station that conducts signals to and from the brain. Which thalamic nuclei are the relay stations for each of the following body sensations/activities? Body sensation VPL (Ventral Posterolateral)
What is PPAR-γ Peroxisome Proliferator-activated Receptor Gamma
How is it relevant to the treatment of diabetes mellitus? Plays a role in adipocyte differentiation Nuclear transcription regulator Through Glitazones/thiazolidinediones It increases the insulin sensitivity in peripheral tissue
A 23-year-old man recently finished treatment to eradicate the lice infestation that he acquired during a recent trip to Mexico. What organism might be responsible for this man's recurrent fever? Borrelia recurrentis
What germ layer gives rise to each of the following adult structures Retina Neuroectoderm
What germ layer gives rise to each of the following adult structures Salivary glands Surface ectoderm
What germ layer gives rise to each of the following adult structures Pancreas Endoderm
What germ layer gives rise to each of the following adult structures Muscle of Abdominal wall Mesoderm
What germ layer gives rise to each of the following adult structures Thymus Endoderm
What germ layer gives rise to each of the following adult structures Spleen Mesoderm
What germ layer gives rise to each of the following adult structures Aorticopulmonary septum Neural Crest
What germ layer gives rise to each of the following adult structures Anterior pituitary Surface ectoderm
What germ layer gives rise to each of the following adult structures Posterior pitutary Neuroectoderm
What germ layer gives rise to each of the following adult structures Bones of skull Neural Crest
What germ layer gives rise to each of the following adult structures Cranial nerves Neural Crest
Left to Right Shunts; what are they? (3) ASD, VSD, PDA
What are the clinical uses for 1st (PEcK), 2nd (HEN PEcKS), 3rd, and 4th generation cephalosporins 1st gen- Gm (+), Proteus m., E.coli, Klebsiella
What are the clinical uses for 2nd gen-cephalosporins Haemophilus influenzae, Enterobacter a., Neisseria spp., Gm (+), Proteus m., E.coli, Klebsiella, Serratia m.
What are the clinical uses for 3rd gen-cephalosporins Serious gram-negative infections resistant to other Beta-lactams, Pseudomonas, Neisseria gonorrhea
What are the clinical uses for 4th gen cephalosporins (Cefepime)- Gm (-), increase activity against Pseudomonas and Gm (+) organisms
What are the classic symptoms of carcinoid syndrome (BFDR) Brochospasm and wheezing cutaneous flushing Diarrhea Right-sided valvular disease
Atrial Septal Defect (ASD) is caused by Hole in the interatrial septum
What type of murmur do you hear in an ASD? Loud S1; wide fixed spilt S2
What can be seen on X-ray in ASD? RVH
Ventricular septal defect Most common congenital heart defect
Defect in intraventricular septum 40% close in first 6 months of life
Ventricular septal defect can cause what If lesion is too large it can cause LV overload or HF
Patent Ductus Arteriosus (PDA) is caused by Prostaglandin synthesis and low O2 tension f infant is born through C-section
What type of murmur do you hear in a Patent Ductus Arteriosus (PDA) Continuous, "machine-like" murmur Left upper sternal border of the newborn
Patent Ductus Arteriosus (PDA) treatment Indomethacin (blocks PGE synthesis)
When is PDA to remain open When a patient has Transposition of the great vessels, to allow some oxygenated blood to mix with the deoxygenated blood (systemic)
Eisenmenger Syndrome Severe long-standing L to R shunt Increased pulmonary flow> pathologic remodeling of vasculature > pulmonary arterial htn RVH occurs to compensate > shunt becomes right to left
Eisenmenger Syndrome symptoms Later cyanosis, clubbing, polycythemia, and SOB
Coarctation of the Aorta (infantile) Infantile: Aortic narrowing near intersection of ductus arteriosus ("juxtaductal") - only blood flowing to distal aorta is from PDA. (Req open PDA)...Assc. with Turner Syndrome
Coarctation of the Aorta (adult) Distal to ductus arteriosus, Once PDA is closed remnant = Ligamentum aretiosum
Once PDA is closed the remnant is Ligamentum aretiosum
Coarctation of the Aorta symptoms Hypertension in upper extremities and weak delayed in lower extremities (brachial-femoral delay) Rib notching on chest X-ray (Dilated intercostal arteries) Can also lead to aortic regurg.> HF
Right to Left shunts Early cyanosis- "blue babies" (bypass pulmonary circuit)
Requires surgery or an open PDA right to left shunts
Right to Left Shunt Diseases (5 Ts) (hint: TAPVR (5 letters in name) Truncus arteriosus (1 vessel) Transposition (2 switched vessels) Tricuspid atresia (3= Tri) Tetralogy of Fallot (4 =Tetra) TAPVR (5 letters in name)
Persistent truncus arteriosus Failure of truncus arteriosus to divide into pulmonary trunk and aorta Deoxy blood of RV mixes with Oxy blood of LV Cyanosis, Respiratory distress, HF May have VSD
D-transposition of Great Vessels (TGA) What does it req. to be compatible with life? What medication should be give to help shunts? Aorta and Pul. artery are switched so Aorta leaves RV and Pulmonary a. leaves LV. Separation of pulmonary and systemic circulation Cyanosis is significant Prostaglandins
Who are more prone to TGA? Infant Diabetic Mothers
LGA (Large for gestational age) Infants suffer from shoulder dystocia, clavicular fractures, brachial plexus injury (Erb or Duchenne's palsy) Increased C-section
Tricuspid atresia Absent tricuspid valve and hypoplastic RV Require ASD and VSD
Tetralogy of Fallot Caused by anterosuperior displacement of the infundibular septum (MC cause of early cyanosis)
4 components of Tetraology of Fallot Pulmonary infundibular stenosis RVH Overriding aorta VSD
What helps with the spells of cyanosis in Tetralogy of Fallot Squatting=Increase SVR, Decreases R>L shunt, improves cyanosis
Tetralogy of Fallot classic x-ray finding is RVH or Boot-shaped heart in infant
Total anomalous pulmonary venous return (TAPVR) Open or closed loop? What is needed to keep patient alive? Pulmonary veins drain into right atria circulation (SVC, Coronary sinus) Closed loop Without shunt patient will die
What is the most common congenital cardiac anomaly VSD
Ebstein anomaly Associated with Maternal Lithium use Physical exam: widely split S2, tricuspid regurgitation
Explain how the great vessels are attached in a transposition of the great vessels Aorta and Pul. artery are switched so Aorta leaves RV and Pulmonary trunk leaves LV. Separation of pulmonary and systemic circulation
What heart defect is associated with deletion of Chromosome 22q11 deletions Tetralogy of Fallot Persistent Truncus arteriosus
Describe blood flow through a PDA L > R shunt Aorta > Pulmonary artery
What heart defect is associated with Down syndrome Endocardial cushion defect; Can cause abnormal connection of all 4 chambers of the heart
A 45-year-old man presents with a BP of 160/90 on the right arm and 170/92 on the left arm.There are no palpable pulses in the feet/ankle. What problem does this patient most likely have? Coarctation of the Aorta
What heart defect is associated with each of the following disorders: Congenital rubella PDA Pulmonary artery stenosis
What heart defect is associated with each of the following disorders? Turner syndrome Infantile coarctation Bicuspid aortic valves Infective endocarditis
What heart defect is associated with each of the following disorders? Marfan syndrome Aortic insufficiency Continuous machinery-like heart murmur PDA
HALLMARK "Boot-shaped heart" RVH or Tetralogy of Fallot
HALLMARK Rib notching Coarctation of aorta
Most common congenital cause of early cyanosis Tetralogy of Fallot
Where does erythropoiesis take place in the fetus (4)? Fetus: Yolk Sac. Liver, spleen, bone marrow
Which bones in adults synthesize RBCs (7)? Adults:Vertebrae, Sternum, Pelvis, Ribs, cranial bones, and tibia & femur
Rx Next step in treatment of otitis media if resistant to amoxicillin Amoxicillin + Clavulanic acid (beta-lactamase inhibitor)
Rx Prophylaxis against bacterial endocarditis 1st gen cephalosporin, Aminopenicillins, and Penicillin V
Rx Increases the nephrotoxicity of aminoglycosides Cephalosporins
Rx Sufficient for the treatment of syphilis Penicillin G
Rx Single dose treatment for gonorrhea Ceftriaxone
What divides the right and left atria Septum primum and secundum
How is blood shunted from the right atrium to the left atrium in an embryo Foramen ovale and ostium secundum
What structure grows to close the opening/canal between the atrial chamber and ventricular chamber into two smaller openings Superior and Inferior endocardial cushion
What genetic abnormality is commonly associated with endocardial cushion defects Trisomy 21
Truncus arteriosus and Aorticopulmonary septum arises from what type of cells Neural crest cells
Which embryologic structure of the heart gives rise to each of the following adult structures? Ascending aorta and pulmonary trunk Truncus arteriosus
Which embryologic structure of the heart gives rise to each of the following adult structures? Smooth parts of the left and right ventricles Bulbis Cordis
Which embryologic structure of the heart gives rise to each of the following adult structures? Trabeculated parts of the left and right ventricles Primitive Ventricle
Which embryologic structure of the heart gives rise to each of the following adult structures? Trabeculated left and right atria Primitive Atrium
Which embryologic structure of the heart gives rise to each of the following adult structures? Coronary sinus Left horn of sinus venosus
Which embryologic structure of the heart gives rise to each of the following adult structures? Smooth part of the right atrium Right horn of sinus venosus
Which embryologic structure of the heart gives rise to each of the following adult structures? SVC R. common cardinal vein and right anterior cardinal vein
What vessel carries oxygenated blood from placenta to fetus Umbilical vein
Areas of shunting in fetal blood flow Ductus venosus Foramen Ovale Ductus arteriosus
What starts shutting down fetal circulation, and gives rise to adult circulation Breathing (respiration)
Common to hear what murmur in the first 24 hrs of life, and then it disappears PDA
Which fetal vessel has the highest oxygenation Umbilical Vein
What structure divides the truncus arteriosus into the aortic and pulmonary trunks? What is the cellular origin of this structure? Aorticopulmonary septum (Spiral) Neural Crest cells
What causes the ductus arteriosus to close Breathing Increased O2 and decreased prostaglandins [Indomethicin] (Drug to help close PDA)
What causes the foramen ovale to close Breathing Decrease resistance in pulmonary vasculature > increase in left atrial pressure vs. right atrial pressure
Order of oxygenation from highest to lowest (3) Umbilical Vein> Ductus venosus> IVC> R. atrium
What are some of the clinical uses for somatostatin Pituitary excess: Acromegaly, TSH-secreting tumor, ACTH-secreting tumor GI endocrine excess: Carcinoid syndrome, ZES syndrome, VIPoma, glucagonoma, insulinoma Diarrhea Reduce splanchnic blood circulation: Cirrhosis with bleeding esophageal varices
What is the name given to a thyroid hormone-secreting teratoma Mature teratoma (struma ovarii)
Hypothyroidism symptoms Constipation Lowering of the voice Menorrhagia Slowed mental and physical function Dry skin with coarse, brittle hair Reflexes showing slow return phase Myxedema (facial/periorbital) Weight gain Cold intolerance
Levothyroxine Synthetic analog of thyroxine (T4)
Why should you start Levothyroxine at a low does for elderly patients Can cause tachycardia, heat intolerance, arrythmias
Triiodothyronine Synthetic analog of T3
Cretinism findings? (6 P's) Poor brain development Pot-bellied Pale Puffy-faced Protuding umbilicus Protuberant tounge
Hashimoto thyroiditis Most common cause of hypothyroidism in the U.S. Autoimmune disorder Painless goiter (nontender)
Hashimoto thyroiditis diagnosis Antithyroglobulin and Antithyroid peroxidase antibodies Assc. with HLA-DR5 and HLA-B5
Hashimoto thyroiditis histology findings? What are these cells called? Dense infiltrates (germinal centers) of lymphocytes into thyroid. Hurthle cells
Hashimoto thyroiditis can cause an increased risk in what lymphoma? Non-Hodgikin lymphoma (Marginal Zone) (B-cell)
Hashimoto thyroiditis can start off as hyperthyroidism because? Thyrotoxicosis during follicular rupture
Hashimoto thyroiditis can also be assc. with what other diseases (3) Diabetes, Sjrojen syndrome, and Pernicious anemia
Subacute (de Quervain) Thyroiditis Hypothyroidism with a PAINFUL (tender) goiter Self-limited disease
Subacute (de Quervain) Thyroiditis can start off as what? Hyperthyroidism
Subacute (de Quervain) Thyroiditis causes what to the thyroid? Focal destruction with Granulomatous inflammation
Subacute (de Quervain) Thyroiditis has an increase or decrease of ESR? Increase
Subacute (de Quervain) Thyroiditis is associated with? HLA-B35, Effects Females (3:1)
Subacute (de Quervain) Thyroiditis often follows what? Viral infection (Flu-like) or URI
Riedel's thyroiditis caused by? Riedel's thyroiditis caused by? Chronic inflammation of thyroid > fibrous tissue (Hypothyroid or euthyroid)
Riedel's thyroiditis presents as? Histology? Fixed, hard, rock-like thyroid Painless goiter Histology: Macrophages and Eosinophils
Prolonged Riedel's thyroiditis in a younger patient can lead to? Mimics what cancer? Extension of fibrosis which may extend to airway or other structures. Anaplastic carcinoma
Radioiodine uptake scan increased Grave's disease or multinodular goiter , or even a single toxic adenoma
Radioiodine uptake scan decreased Adenoma or Carcinoma or thyroid
Papillary carcinoma Most common thyroid cancer Great prognosis Female predominance MC during 30s-50s
HALLMARK Papillary carcinoma "Orphan Annie" eyes or "Ground Glass" appearance or Psammoma bodies (concentric calcfications)
Papillary carcinoma risk factor Exposure to childhood irradiation Increased RET and BRAF mutation
Follicular carcinoma 2nd most common thyroid cancer Worse prognosis
Follicular carcinoma diagnosis Uniform cubodial cells lining the follicles Invade thyroid capsule
What differs follicular carcinoma and follicular adenoma Invasion of capsule occurs in carcinoma
How does Follicular carcinoma spread Hematogenously
Follicular adenoma of thyroid Benign tumor of thyroid Proliferation of follicles surrounded by capsule NO invasion
Medullary carcinoma of thyroid Proliferation of parafollicular "C" cells
Parafollicular "C" cells like to secrete Calcitonin
Medullary carcinoma of thyroid assc. with MEN 2A and 2B (RET mutations)
Anaplastic carcinoma of thyroid Anaplastic undifferentiated neoplasm Older patients
Thyroidectomy complications? (3) Hoarseness (Recurrent laryngeal nerve) Hypocalcemia (removal of parathyroid glands) Transection of recurrent and superior laryngeal nerves (during ligation of inferior thyroid artery and superior laryngeal artery)
What type of thyroid cancer matches each of the following statements? Most common type of thyroid cancer (70-75%) Papillary carcinoma
What type of thyroid cancer matches each of the following statements? Second most common type of thyroid cancer (10%) Follicular carcinoma
What type of thyroid cancer matches each of the following statements? Activation of receptor tyrosine kinases Papillary and Follicular carcinoma
What type of thyroid cancer matches each of the following statements? Hashimoto thyroiditis is a risk factor B-cell Lymphoma
What type of thyroid cancer matches each of the following statements? Cancer arising from parafollicular C cells Medullary carcinoma
What type of thyroid cancer matches each of the following statements? Commonly associated with either a RAS mutation or a PAX8-PPAR gamma 1 rearrangement (LY) Follicular carcinoma
What type of thyroid cancer matches each of the following statements? Commonly associated with rearrangements in RET oncogene or NTRK1 Papillary carcinoma
What type of thyroid cancer matches each of the following statements? Most common mutation in the BRAF GENE (serine/threonine kinase) Papillary carcinoma
Cold tolerance Hypothyroidism
Enlarged thyroid cells with ground-glass nuclei Papillary carcinoma
Hypothyroidism will cause elevation LDL and cholesterol. Why? (Hypercholesterolemia) Due to decreased LDL receptor expressio
What are the characteristics of narcolepsy Excessive daytime sleepiness Rapid progression from walking state to REM sleep Cataplexy (sudden muscular weakness) Hallucinations
What is the treatment for narcolepsy Daytime stimulants:(Amphetamines/Modafinil) and Nighttime sodium oxybate (GHB)
What is the first-line treatment for a patient with erectile dysfunction Phosphodiesterase inhibitors Sildenafil Vardenafil Tadalafil If hypogonadal: Testosterone replacement
What other drugs are used to treat Crohn disease that target TNF-α Infliximab and adlimumab
With what physical exam finding must you presume scaphoid fracture despite a normal initial x-ray Anatomical snuffbox tenderness = scaphoid fracture
What might result in a proximal fracture of the scaphoid if left untreated Avascular necrosis in the proximal fragment
During what week of fetal development will the fetus reach the following landmarks? Implantation Week 1
During what week of fetal development will the fetus reach the following landmarks? Organogensis Week 3-8
During what week of fetal development will the fetus reach the following landmarks? Heart begins to beat Week 4
During what week of fetal development will the fetus reach the following landmarks? can distinguish male or female genetalia Week 10
During what week of fetal development will the fetus reach the following landmarks? gastrulation Week 3
During what week of fetal development will the fetus reach the following landmarks? Formation of primitive streak and neural plate Week 3-4
What is a cholesteatoma, and how does it present Overgrowth of desquamated keratin debris within middle ear space May erode ossicles, mastoid air cells > conductive hearing loss and vertigo Grayish-white pearly lesion behind TM
What are the adverse reactions of exogenous testosterone in males Premature puberty in children Premature closure of epiphyseal plate Erythrocytosis Worsening of sleep apnea Suppression of spermatogenesis Increased LDL and Decreased HDL
What is the initial medical treatment for the arrhythmia known as torsades de pointes IV Magnesium sulfate
What structures give rise to the blood brain barrier Tight junctions between nonfenestrated capillary endothelial cells Basement membrane Astrocyte foot processes
Which diuretics are most appropriate for patients with hyperaldosteronism? What are their important side effects? K+-sparing diuretics Spironolactone, Amiloride, Triamterene, Eplerenone Competitive aldosterone receptor antagonist Hyperkalemia:SE
Diagram the pathway by which the cochlea communicates a signal to the primary auditory cortex. Cochlea > Cochlear nuclei > Contralateral superior olivary nucleus > Lateral lemniscus > Inferior colliculus > Medial geniculate body > Primary auditory cortex
What clinical presentation might lead you to suspect a patient may have lymphoma Weight loss, night sweats, fever, and painless lympadenopathy
Most common leukemia in children ALL
Most common leukemia in adults in US CLL
Characteristic Auer rods AML
Greater than 20% blasts in marrow Acute Leukemia
Leukemia with more mature cells and less than 5% blasts Chronic leukemia
PAS (+) acute leukemia ALL
Always positive for the Philadelphia chromosome (t 9;22) CML
Acute leukemia positive for PEROXIDASE AML
Solid sheets of lymphoblasts in marrow ALL
Always associated with the BCR-ABL genes CML
What histological change takes place in the trachea of a smoker Meteplasia (columnar to squamous)
Major Depressive Disorder Self-limited episode that must be present for atleast 2 weeks Decreased NE and Serotonin
Common Antidepressants SSRI- inhibits reuptake of serotonin SNRI- inhibits reuptake of serotonin and NE TCA- inhibits reuptake of serotonin and NE MAOI- monoamine oxidase inhibitor
Electroconvulsive therapy (ECT) Used for depression that isn't responding to any other treatments
Treatment for atypical depression First-line: SSRI
"Maternal (postpartum) blues" 50-85% incidence rate Depressed affect, tearfulness, and fatigue (2-3 days after delivery) Resolves in a week Support + follow-up= treatment
What is postpartum depression Postpartum depressive symptoms that persist for more than or equal to 2 weeks 10-15% incidence rate Depressed affect Anxiety Poor conc.
Postpartum psychosis 0.1-0.2% incidence rate Mood-congruent delusions Hallucinations Thoughts of harming baby/self Few days to few weeks Rx. Antipsychotics/Antidepressants
Dysthmia Persistent depressive disorder Often milder Lasts at least 2 years
Seasonal affective disorder Mild depression during winter months (due to decreased sunlight) Rx. Go outside or go on vacation
Risk factors for Suicide SAD PERSONS scale: Sex (male) Age (under 19 or over 45) Depression Previous attempts Ethanol (alcohol/drug use) loss of Rational thinking Sickness Organized plan No social support Stated future intent
Who tries to commit suicide more? Who succeeds? Women: try Men: succeed
What is atypical depression Hypersomnia Hyperphagia Mood reactivity Hypersensitivity to rejection Leaden paralysis Common subtype of Depression
A 28-year-old woman has symptoms of mild depression for 6 years. What's the diagnosis Dysthymia
A 55-year-old man who is a smoker and heavy drinker presents with a new cough and flu-like symptoms. Gram-stain shows no organisms; silver stain of sputum shows gram-negative rods. What is the diagnosis? Legionairres disease
What is the classic presentation of a patient with temporalis arteritis? What lab findings help diagnose temporalis arteritis Migranes (unilateral), loss of vision, pain when chewing Increased ESR and Biopsy (definitive)
SSRIs Used for Depression, Bulimia, general anxiety, and OCD, Premenstrual dysmorphic disorder Inhibit re-uptake of serotonin Takes weeks for it have any effect Less toxic
Side effects of SSRI Sexual dysfunction and Serotonin syndrome
Drugs associated with Serotonin Syndrome? (8) SSRIs SNRIs MAOIs St. Johns Wort Kava Kava Tryptophan Cocaine Amphetamines
Treatment for Serotonin Syndrome Cool patient down and provide benzodiazepine (first line) Or Cyproheptadine (5-HT2 receptor blockers)
Side effects of SNRIs Increased BP, sedation, nausea
TCAs (Tricyclic Antidepressants) Inhibit serotonin and NE re-uptake (Amitrptyline and Clomipramine-OCD) Older drug Depression Imipramine= bedwetting (enuresis)
Side effects of TCAs Sedation Alpha blocking effects Anticholinergic effects Decrease seizure threshold (desipramine and nortripyline not as much)
Rx Treatment for TCA overdose NaHCO3 to prevent arrhythmia (to alkalinized the urine)- excretes TCAs
Monoamine Oxidase Inhibitors (MAOI) Nonselective MAO inhibition which increases levels of amine neurotransmitter (NE, 5-HT, and Dopamine)
What is Selegiline used for Parkinsonism-like symptoms, so it increases dopamine
MAOI side effects? What is "wash-out" period Tachycardia and arrhythmia Must wait 2 weeks after stopping MAOI before starting new drug
Bupropion Used for smoking cessation Increases NE and dopamine by decreasing reuptake NDRI (NE and Dopamine reuptake inhibitor) Lowers seizure threshold NO sexual dysfunction
Mirtazapine Alpha-2 antagonist (pre-synaptic nerve terminals of adernergic neurons) Increase NE and 5-HT Also potent 5-HT2 & 5-HT3 receptor blockers Sedation, Increased appetite, weight gain
Trazodone Blocks 5-HT2 and alpha-1 receptors Good for Insomnia Side effect: priapism, sedation, postural hypotension
What is the MOA of each of the following medication classes? SSRI 5-HT inhibition re-uptake
What is the MOA of each of the following medication classes? SNRI Inhibit serotonin and NE re-uptake
What is the MOA of each of the following medication classes? TCA Inhibit serotonin and NE re-uptake (older)
What is the MOA of each of the following medication classes? MAOI Nonselective MAO inhibition which increases levels of amine neurotransmitter (NE, 5-HT, and Dopamine)
SSRI drugs (5) Fluoxetine, Sertraline, Paroxetine, Citalopram, Fluvoxamine
TCA drugs Notriptyline, Imipramine, Amitriptyline, Desipramine, Clomipramine, Doxepin
MAOI drugs (3) Selegiline, Tranylcypromine, Phenelzine
NDRI drugs Bupropion
SNRI drugs (3) Venlafaxine and Duloxetine, Milnacipran
Tetracyclic drugs (2) Mirtazapine and Trazodone
Which antidepressant matches each of the following statements? SE:priapism Trazodone
Which antidepressant matches each of the following statements? Lowers the seizure threshold Burpropion and TCAs
Which Rx matches each of the following statements? Works well with SSRIs and increases REM sleep Trazadone
What are the symptoms of serotonin syndrome? Hyperthermia Myoclonus Hyperreflexia Flushing and Diarrhea Autonomic instability (HTN and Increased HR) Mental status change Neuromuscular abnormalities
Which antidepressant matches each of the following statements? Appetite stimulant that is likely to result in weight gain Mirtazapine
Which antidepressant matches each of the following statements? Bedwetting in children TCAs (imipramine)
What are the symptoms of TCA overdose? Tri-Cs Convulsions Coma Cardiotoxicity (arrhythmias) Respiratory depression Confusion and hallucination Hyperpyrexia
Which antidepressant matches each of the following statements? Smoking cessation Bupropion
What happens if you ingest tyramine while on MAOIS? Hypertensive crisis Hemorrhagic stroke Cardiac arrythmias
What drug is associated with the following side effects? Dry mouth, tinnitus, blurred vision, mania Amitriptyline (due to anticholinergic effects)
Tendon xanthomas Familial hypercholesteremia
Café-au-lait spots NF-1 and Mccune albright
Tuft of hair on lower back Spina bifida occulta
What structures are at risk for injury with an anterior shoulder dislocation? Axillary nerve Posterior circumflex a. Supraspinatus tendon Anterior glenohumoral ligament Glenoid labrum Posterolateral humoral head
What are the layers of the epidermis Corneum Lucidum Granulosum Spinosum Basalis
Candida Albicans Thrush found in top of mouth and tongue Can be scraped off (leave bleeding mucosa) Common in immunocompromised (AIDS, diabetes, steroids, neonates)
Vulvovaginitis Caused by Candida albicans Severe itching Edema and discomfort Vaginal discharge Acidic env
Candida albicans deep infections? Cause what? Common in Drug users Endocarditis Dissemiated candidiasis Chronic mucocutaneous candidasis (immundef)
Candida albicans diagnosis When placed in serum: Develops germ tubes at 37 degrees Pseudohypahe and budding yeasts at 20 degrees
Candida albicans treatment Topical azloe- vaginal Nystatin, Fluconazole, or Caspofungin - oral/esophageal Caspofungin, Fluconazole, and amphotericin B- systemic
Cryptococcus neoformans How does it replicate? Where is it found? Cultured on? Heavily encapsulated Narrow based-budding- Rep. Found in soil and pigeon dropping Cultured on Sabouraud agar
Cryptococcus neoformans diagnosed using India Ink (stains polysaccharide capsule) Mucicarmine (stains red)
Cryptococcus neoformans antigen test used Latex agglutination test detects polysaccharide capsular antigen and is more specific
Cryptococcus neoformans lesions look like? What is the disease assc. Soap Bubble in brain (Cryptococcal meningoencephalitis)
Cryptococcal meningitis treatment Combo of Amphotericin B + Flucytosine and then followed by single-therapy Fluconazole
Pneumocystis jirovecii What disease does it cause? Who does it affect? Pneumocystis pneumonia (PCP) Diffuse intersitisl pneumonia Aytpical pneumonia (walking pneumonia) Asymptomatic normally Symptomatic for Immunosuppressed
Pneumocystis jirovecii diagnosis Identified in tissue or bronchial lavage using silver stain Chest imaging shows: Ground-glass opacities of interstital infiltrates
Pneumocystis jirovecii treatment TMP/SMX (Bactrim)
When do you start PCP prophylaxis on HIV patients? (TMP-SMX) Start when CD4+ count drops <200 cells/mm3
Aspergillus fumigatus (MOLD) Can cause: Allergic reactions (ABPA) Colonized = Aspergilloma (fungus ball) after Tb Invasive aspergillus (immunocompromised)
Aspergillus fumigatus diagnosis Narrow septate hyphae that branch at acute angles (less than 45 degrees)
Aspergillus fumigatus treatment Combo ("-Azole" + Amphotericin B)
Mucor and Rhizopus Cause mucormycosis Cause disease in severely immunocompromised
Mucor and Rhizopus diagnosis Broad Irregular shaped, nonseptate hyphae branching at WIDE angles (90 degrees) -Ribbon-like Penetrate cribiform plate to enter bloodstream
Patients with diabetic ketoacidosis or leukemia are prone to develop Rhinocerebral frontal lobe abcess: Facial pain and headache Black necrotic eschar on face Cranial nerve deficits and blindness
Mucor and Rhizopus treatment Surgical debriment and amphotericin B High mortality Progression rapid
Dermatophytes (diagnosis) Branching septate hyphae visible on KOH prep. with blue fungal stain
What are 4 molds that are considered dermatophytes (fungal species commonly found invading superficial layers of skin) Trichophytin Microsporum (most prevalent) Epidermophytin Malassezia furfur
What infections are commonly caused by dermatophytes Tina pedis- feet Tina cruis- groin Tinea corporis- body (ringworm) Tinea capitis- head (ringworm
Simple cutaneous dermatophytosis treatment Topical Terbinafine/Azoles Extensive infection or that involve scalp and hair require oral Terbinafine/Azoles
Tinea unguium-(onchomycosis)-nails Treatment Caused by Trichophyton rubrum Thickened discolored nails Terbinafine/Azoles (oral)
Tinea Vesicolor Caused by? Type of yeast? Causes? Occurrence? Caused by Malassezia furfur Lipophillic yeast Hypopigmented/hyperpigmented patches on body (back and shoulders) Effects trunk and proximal limbs Hot, humid weather
Tinea Vesicolor diagnosis and treatment KOH prep: spaghetti and meatballs look" Treat with topical azole (selenium sulfide)
Systemic MYCOSES Causes? Type of fungi? Pneumonia and disseminate Dimorphic fungi NO person to person transmission Granuloma formation (noncaseseating)
Systemic mycoses treatment? Local: Systemic: Local: Fluconazole/itraconazole Systemic: Amphotericin B
Histoplama capsulatum "Histo hides" Macrophages filled with Histoplasma (smaller than RBC) Hepatosplenomegaly
Blastomyces dermatitidis Inhaled Can disseminate to skin and bones Forms granulomatous nodules
Coccidioides immitis Exists as a spherule (filled with endospores) Arthroconidia (barrel shape) Bigger than RBC
Coccidioides immitis can cause if severe Desert bumps= erythema nodosum Desert rheumatism= arthralgias
Paracoccidioides brasiliensis Inhaled Disseminates widely Severe pneumonia, infection of mucus membranes and skin Captain Wheels formation
Sporothrix schenckii Can cause Sporotrichosis Dimorphic fungus Lives in soil and on vegetation Rose garderner's disease
Rose garderner's disease How is it caused? What forms Caused by pricks from thorns or sphagnum moss Small pustule/ulcers Nodules (painless) also form along draining lymphatics
Sporotrichosis treatment Itraconazole or Potassium iodide
Found in SW U.S. including West Texas and California Coccidiomyces
Found in Mississippi and Ohio River basins Histoplasma
Found in rural Latin America Paracoccidiomyces
Associated with plant thorns and cutaneous injury Sporothrix schenckii
Causes San Joaquin Valley fever Coccidiomyces
Found in states east of the Mississippi River (Central America-Canada) Blastomyces
Found in bird and bat droppings Histoplasma
Causes thrush in immunocompromised patients and vulvovaginitis in women Candida albicans
Mold form contains barrel-shaped arthroconidia Coccidiomyces
Multiple budding of yeast form Paracoccidiomyces b.
Opportunistic mold with septate hyphae that branch at a 45° angle Aspergillus fumigatus
Yeast known for causing meningitis in AIDS patients Cryptococcus meningitis
Opportunistic mold with irregular nonseptate hyphae that branch at wide angles (>90 degrees) Mucor and Rhizopus
Associated with dust storms and earthquakes Coccidiomyces
An HIV (+) patient with CSF showing 75/mm3 lymphocytes suddenly dies. Yeast is identified in the CSF. What is the most likely diagnosis? Cryptococcus neoformans
Broad-based budding of yeast Blastomyces
What infections are associated with birds Histoplasma capsulatum Cryptococcus neoformans Chlamydophila psittaci H5N1 Influenza (Bird Flu) West Nile Virus
Causes diaper rash Candida albicans Erythematous skin Satellite lesions
Known for causing pneumonia in AIDS patients start Bactrim prophylaxis when CD4 <200 Pneumocystis jirovecii
Most common opportunistic infection in HIV patients Pneumocystis jirovecii
Prophylaxis for Cryptococcus in AIDS patients Fluconazole
Prophylaxis for PCP in AIDS patients TMP-SMX
Treatment for oral candidiasis Nystatin/Fluconazole
Treatment for systemic candidiasis Amphotericin B
Opportunistic fungal infections Candida albicans Aspergillus Cryptococcus neoformans Mucor & Rhizopus spp.
What is the classic clinical presentation of a thyroglossal duct cyst Presents as anterior midline neck mass that moves with swallowing or protrusion of tongue (asymptomatic) <30 yrs Can become infected (abcess)
What conditions are associated with an elevated ESR (erythrocyte sedimentation rate) Most anemias Infections (osteomyletis) Polymyagia rheumatica Inflammation (Temporal arteritis) Cancer Pregnancy Autoimmune disorders (Rheumatoid)
What is the clinical use for tiotropium Anti-muscuranic Respiratory COPD, asthma Relax airway
1st order velocity/kinetics when reaction velocity is directly proportional to concentration of substrate
Zero order velocity/kinetics is when velocity is completely independent of concentration of substrate
Vmax maximum velocity the reaction can achieve Proportional to the amount of enzymes available
Km substrate concentration at 1/2 of Vmax Inversely related to the affinity of the enzyme for its substrate
Lineweaver-Burk plot x-axis: 1/S y-axis: 1/V Slope = Km/Vmax X-intercept: 1/-Km Y-intercept: 1/Vmax
Increased y-intercept does what to Vmax Decreases Vmax
A shift to the right on the x-intercept (closer to zero) does what to Km and affinity increases Km and Lowers affinity
Competitive inhibitor does what to Vmax it does nothing to Vmax and increases Km
Noncompetitive inhibitor does what to Vmax it decrease Vmax and does nothing to Km
What 4 pharmacokinetics equations are most important to know for Step 1 1) Volume of Distribution= Amt of drug in body/plasma drug conc 2)Clearance= Rate of elimin/plasma drug conc= (0.7 x Vd/half-life) 3) Loading Dose= Conc at steady state X Vd 4)Maintenance dose= Conc at steady state x Clearance
Half-life the time required to change the amount of drug in the by body HALF during elimination or constant infusion
94% steady state concentration can be achieved after how many half lives 4 Half-lives
Efficacy the maximal effect a drug can produce
Potency amount of drug needed for a given effect
Competitive anatagonist Shifts curve to right and lowers potency no change in efficacy Increased Km & same Vmax
Noncompetitive antagonist or Irreversible antagonist Shifts curve down (decrease efficacy) Decrease Vmax and same Km
Partial agonist Shifts curve down and left (decrease efficacy but increased potency) Decrease Vmax and Km
What variable can you not compare between Agonist and Partial agonist potency, because it is an independent variable
Therapeutic index (TI)= LD50= lethal dose to about 50% of people _____________________________________________ ED50= effective dose to about 50% of people
Safer drugs have a Higher therapeutic index (Increased LD50 or Decreased ED50)
Examples of drugs with low TI? (5) Digioxin Lithium Theophylline Warfarin Seziure drugs
Therapeutic window Measure of clinical drug effectiveness for a patient Higher therapeutic window= safer the drug
How do you decreased target concentration by 1/2 you stop infusion of drug for 1 half-life
If clearance is decreased, but Vd is unchanged, How does that effect loading dose and maintenance dose? loading Dose would remain unchanged, but Maintenance dose would decrease.
Where would you expect to find B cells in a lymph node B-Cells located in Follicle of lymph node
Where would you find T cell T-Cell located in Paracortex of lymph node macrophages located in Medullary Sinus of lymph node Plasma cells located in Medullary Cords of lymph node
Where would you find macrophages macrophages located in Medullary Sinus of lymph node
Where would you find plasma cells plasma cells located in Medullary Cords of lymph node
The protein derived from what gene serves as a transcription factor for the development and function of regulatory T cells FOXP3- Found on X chromosome Codes for Forkhead Box Protein P3 Important for self-tolerance Absence= autoimmune diseases
What is the female homologue to each of the following male structures? Corpus spongiosum Vestibular bulbs
What is the female homologue to each of the following male structures? Cowper's glands (bulbourethral glands) Greater vestibular glands of Bartholin
What is the female homologue to each of the following male structures? Prostate Urethral and paraurethral glands of Skene
What is the female homologue to each of the following male structures? Glans penis Glans clitoris
What is the female homologue to each of the following male structures? Ventral penile shaft Labia minora
What is the female homologue to each of the following male structures? Scrotum Labia majora
What important intracellular proteins are common to both the extrinsic and intrinsic apoptotic pathways? Cytosolic caspases
What ratio indicates fetal lung maturity? What is the proper name for the main component of pulmonary surfactant? Lecithin:sphingomyelin ratio (>2:1) Surfactant main component = lecthins (dipalmitoylphosphatidylcholine)
What amino acids are necessary for purine synthesis Glycine Aspartate Glutamine (GAG)
What nutrient deficiency is associated with spooning of the nails (koilonychia) iron
What is the equation for determining a drug's clearance CL= (0.7) x Vd ----------------- Half-Life
Which bacteria are well known for being obligate intracellular bacteria Rickettsia Chlamydia Coxiella
Why can't obligate intracellular bacteria replicate extracellularly because they rely on host ATP, can't make it on their own
What is compartment syndrome, and how is it treated Trauma/Burn/intense excercise to leg: Increased pressure within the fascial compartment Treatment: Fasciotomy
Separates the greater and lesser sacs Gastrohepatic ligament (right) Gastrosplenic ligament (left)
May be cut during surgery to access the lesser sac Gastrohepatic ligament
2 ligaments that connect the spleen to other structures Gastrosplenic and Splenorenal ligaments
Contains the portal triad Heaptoduodenal ligament
Connects liver to the anterior abdominal wall Falciform ligament
Where are neurotrasmitters made RER
infant with failure to thrive, hepatosplenomegally, neurodegeneration Neimann-Pick disease (genetic sphingomyelinase deficiency)
infant with hypoglycemia, failure to thrive, and hepatomegaly Cori's disease (debranching enzyme deficiency)
infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect Edward's syndrome (trisomy 18)
infant with failure to thrive, hepatosplenomegally, neurodegeneration Neimann-Pick disease (genetic sphingomyelinase deficiency)
infant with hypoglycemia, failure to thrive, and hepatomegaly Cori's disease (debranching enzyme deficiency)
infant with microcephaly, rocker-bottom feet, clenched hands, and structural heart defect Edward's syndrome (trisomy 18)
Jaundice, RUQ pain, fever Charcot's triad (ascending cholangitis)
Keratin pearls on a skin biopsy squamous cell carcinoma (lung and cervix)
large rash with bull's eye appearance erythema chronicum migrans from Ixodes tick bite (Lyme Disease: Borrelia)
Lucid interval after traumatic brain injury epidural hematoma (middle meningeal artery rupture)
male child, recurrent infections, no mature B cells Bruton's disease (X-linked agammaglobulinemia)
Mucosal bleeding and prolonged bleeding time Glanzmann's thrombasthenia (defect in platelet aggregation due to lack of GpIIb/IIIa)
Multiple colon polyps, osteomas/soft tissue tumors, impacted/supernumerary teeth Gardner's syndrome (subtype of FAP)
Necrotizing vasculitis (lungs) and necrotizing glomerulonephritis Wegener's (c-ANCA positive) and Goodpasture's syndromes (anti-basement membrane antibodies)
Neonate with arm paralysis following difficult birth or following clavicle fracture Erb-Duchenne palsy (superior trunk [C5-C6] brachial plexus injury: "waiter's tip")
no lactation postpartum, absent menstruation, cold intolerance Sheehan's syndrome (pituitary infarction)
Nystagmus, intention tremor, scanning speech, bilateral internuclear ophthalmoplegia Multiple Sclerosis (Charcot's triad)
Oscillating slow/fast breathing Cheyne-Stokes respirations (central apnea in CHF or increased intracranial pressure)
painful blue fingers/toes, hemolytic anemia cold agglutinin disease (autoimmune hemolytic anemia caused by Mycoplasma pneumoniae, infectious mononucleosis)
painful, pale, cold fingers/toes Raynaud's syndrome (vasospasm in extremities)
painful, raised red lesions on palms and soles Osler's node (infective endocarditis)
painless erythematous lesions on palms and soles Janeway lesions (infective endocarditis)
painless jaundice cancer of the head of the pancreas obstructing the bile duct
palpable purpura, joint pain, abdominal pain (child) Henoch-Schonlein purpura (IgA vasculitis affecting skin and kidneys)
pancreatic, pituitary, parathyroid tumors Wermer's syndrome (MEN I)
precocious puberty, cafe-au-lait spots, multiple unilateral bone lesions McCune-Albright syndrome (a form of Polyostotic fibrous dysplasia)
pink complexion, dyspnea, hyperventilation "pink puffer" (emphysema: centroacinar [smoking], panacinar [alpha1-antitrypsin deficiency])
polyuria, acidosis, growth failure, electrolyte imbalances Fanconi's Syndrome (proximal tubular reabsorption defect)
Positive anterior "drawer sign" Anterior cruciate ligament (ACL) injury
ptosis, miosis, anhidrosis Horner's Syndrome (sympathetic chain lesion)
pupil accommodates but doesn't react Argyll Robertson pupil (neurosyphilis)
Rapidly progressive leg weakness that ascends (following GI/upper respiratory infection) Guillain-Barre syndrome (autoimmune acute inflammatory demyelinating polyneuropathy)
Rash on palms and soles Secondary Syphilis, Rocky Mountain Spotted Fever, Coxsackie Virus
Recurrent colds, unusual eczema, high serum IgE Job's syndrome (hyper-IgE syndrome: neutrophil chemotaxis abnormality)
Red "currant jelly" sputum in alcoholic or diabetic patients Klebsiella pneumoniae
Red, itchy, swollen rash of nipple/areola Paget's disease of the breast (represents underlying neoplasm)
red urine in the morning, fragile RBCs paroxysmal nocturnal hemoglobinuria
renal cell carcinoma, hemangioblastomas, angiomatosis, pheochromocytoma von Hippel-Lindau disease (dominant tumor suppressor gene mutation)
resting tremor, rigidity, akinesia, postural instability Parkinson's disease (nigrostriatal dopamine depletion)
restrictive cardiomyopathy (juvenile form: cardiomegaly), exercise intolerance Pompe's disease (lysosomal glucosidase deficiency)
retinal hemorrhages with pale center Roth's spots (bacterial endocarditis)
severe jaundice in neonate Crigler-Najjar syndrome (congenital unconjugated hyperbilirubinemia) and lots of other causes
Severe RLQ pain with rebound tenderness McBurney's sign (appendicitis)
short stature, increased incidence of tumors/leukemia, aplastic anemia Fanconi's anemia (genetically inherited; often progresses to AML)
single palm crease Simian Crease (Down Syndrome)
Situs inversus, chronic sinusitis, bronchiectasis Kartagener's syndrome (dynein defect affecting cilia)
skin hyperpigmentation Addison's disease (primary adrenocortical insufficiency of autoimmune or infectious etiology)
Slow, progressive muscle weakness in boys Becker's muscular dystrophy (X-linked, defective dystophin; less sever than Duchenne's)
small, irregular red spots on buccal/lingual mucosa with blue-white centers Koplik spots (measles)
smooth, flat, moist white lesions on genitals condylomata lata (secondary syphilis)
splinter hemorrhages in fingernails bacterial endocarditis
"Strawberry tongue" Scarlet fever, Kawasaki disease, toxic shock syndrome=streak ovaries, congenital heart disease, horseshoe kidney=turner syndrome (XO, short stature, webbed neck, lymphedema)
sudden swollen/painful big toe joint, tophi gout/podagra (hyperuricemia)
swollen gums, mucous bleeding, poor wound healing, spots on skin scurvy (vitamin C deficiency: can't hydroxylate proline/lysine for collagen synthesis)
swollen, hard, painful finger joints osteoarthritis (osteophytes on PIP [Bouchard's nodes], DIP [Heberden's nodes])
systolic ejection murmur (crescendo-decrescendo) aortic valve stenosis
Thyroid and Parathyroid tumors, pheochromocytoma Sipple's Syndrome (MEN 2A)
Toe extension/fanning upon plantar scrape Babinski's sign (UMN lesion)
Unilateral facial drooping involving forehead Bell's palsy (LMN CN VII palsy)
Urethritis, conjunctivitis, arthritis in a male reiter's syndrome (reactive arthritis associated with HLA-B27)
Vascular birthmark (port-wine stain) Hemangioma (benign, but associated with Sturge-Weber syndrome)
Vasculitis from exposure to endotoxin causing glomerular thrombosis Shwartzman reaction (following second exposure to endotoxin)
Vomiting blood following esophagogastric lacerations Mallory-Weiss syndrome (alcoholic and bulimic patients)
"Waxy" casts with very low urine flow chronic end-stage renal disease
WBC casts in urine acute pyelonephritis
weight loss, diarrhea, arthritis, fever, adenopathy Whipple's disease (tropheryma whippelii)
"worst headache of my life" subarachnoid hemorrhage
WBCs in urine acute pyelonephritis and cystitis
Autosomal Chromosome 17 mutation in tumor suppressor gene that regulates "ras" signaling Neurofibromatosis type I
vitamin K dependent clotting factors II, VII, IX, and X as well as proteins C and S
anticentromere antibodies Scleroderma (CREST)
Antidesmoglein (epithelial) antibodies pemphigus vulgaris (blistering)
anti-glomerular basement membrane antibodies Goodpasture's syndrome (glomerulonephritis and hemoptysis)
antihistone antibodies Drug-induced SLE (hydralazine, isoniazid, phenytoin, procainamide)
anti-IgG antibodies (IgM) Rheumatoid arthritis (systemic inflammation, joint pannus, boutonniere deformity)
antimitochondrial antibodies (AMAs) Primary Biliary cirrhosis (female, cholestasis, portal hypertension) (also pANCA present)
antineutrophil cytoplasmic antibodies (ANCAs) vasculitis (c-ANCA: Wegener's; pANCA: microscopic polyangiitis, Churg-Strauss syndrome, Pauci-immune crescentic glomerulonephritis)
Antinuclear antibodies (ANAs: anti-Smith and anti-dsDNA) SLE (type III hypersensitivity)
Antiplatelet antibodies Idiopathic thrombocytopenic purpura (ITP) (bleeding diathesis)
Anti-topoisomerase antibodies diffuse systemic scleroderma (not CREST)
anti-transglutaminase antibodies Celiac disease (diarrhea, distention, weight loss)
antigliadin antibodies Celiac disease (diarrhea, distention, weight loss)
anti-endomysial antibodies celiac disease (diarrhea, distention, weight loss)
azurophilic granular needles in leukemic blasts auer rods (acute myelogenous leukemia: especially the promyelocytic type)
"Bamboo spine" on x-ray ankylosing spondylitis (chronic inflammatory arthritis: HLA-B27)
Basophilic nuclear remnants in RBCs Howell-Jolly bodies (due to splenectomy or nonfunctional spleen)
Basophilic stippling of RBCs Lead poisoning or siderblastic anemia
Bloody tap on LP Subarachnoid hemorrhage
"Boot-shaped" heart on x-ray Tetralogy of Fallot, RVH
Branching gram-positive rods with sulfur granules actinomyces israelii
bronchogenic apical lung tumor pancoast's tumor (can compress sympathetic ganglion and cause Horner's syndrome)
"Brown" tumor of bone Hemorrhage (hemosiderin) causes brown color of osteolytic cysts. Due to: 1. hyperparathydoidism 2. Osteitis fibrosa cystica
Cardiomegaly with apical atrophy Chagas' disease (typanosoma cruzi)
cellular crescents in Bowman's capsule rapidly progressive crescentic glomerulonephritis
"chocolate cyst" of ovary endometriosis (frequently involves both ovaries)
circular groupoing of dark tumor cells surrounding pale neurofibrils Homor Wright rosettes (neuroblastoma, medulloblastoma, Ewing Sarcoma)
Colonies of mucoid Pseudomonas in lungs Cystic fibrosis (CFTR mutation in Caucasians resulting in fat-soluble vitamin deficiency and mucous plugs)
abdominal pain, ascites, hepatomegaly Budd-Chiari syndrome (posthepatic venous thrombosis- no JVD)
Achilles tendon xanthoma familial hypercholesterolemia (increased LDL leads to deposits)
Adrenal hemorrhage, hypotension, DIC Waterhouse-Friderichsen syndrome (meningococcemia)
arachnodactyly, lens discoloration, aortic dissection, hyperflexible joints Marfan's syndrome (fibrillin defect)
athlete with polycythemia erythropoietin injection
back pain, fever, night sweats, weight loss Pott's disease (vertebral tuberculosis) with caseating granulomas
Bilateral hilar adenopathy, uveitis
blue sclera Osteogenesis imperfecta (type I collagen defect)
bluish line on gingiva Burton's line (lead poisoning)
bone pain, bone enlargement, arthritis, increased alk phos PAGET'S DISEASE of bone (increased osteoblastic and osteoclastic activity)
Bounding pulses, diastolic heart murmur, head bobbing aortic regurgitation
Cafe-au-lait spots, Lisch nodules (iris hamartoma) Neurofibromatosis type I (+pheochromocytoma, optic gliomas) Neurofibromatosis type II (+bilateral acousitc neuromas)
Cafe-au-lait spots, polyostotic fibrous dysplasia, precocious puberty McCune-Albright syndrome (mosaic G-protein signaling mutation)
Calf pseudohypertrophy muscular dystrophy (most commonly Duchenne's)
"Cherry-red spot" on macula Tay-Sachs (ganglioside accumulation) or Niemann-Pick (sphingomyelin accumulation), central retinal artery occlusion
Chest pain, pericardial effusion/friction rub, persistent fever following MI Dressler's syndrome (autoimmune-mediated post-MI fibrinous pericarditis, 1-12 weeks after acute episode)
Child uses arms to stand up from squat Gowers' sign (Duchenne muscular dystophy: X-linked recessive deleted dystrophin gene)
Child with fever develops red rash on face that spreads to body "Slapped cheeks" (erythema infectiosum/fifth disease: parvovirus B19)
chorea, demetnia, caudate degeneration Huntington's disease (autosomal-dominant CAG repeat expansion)
chronic exercise intolerance with myalgia, fatigue, painful cramps McArdle's disease (muscle phosphorylase deficiency)
Cold intolerance hypothyroidism
conjugate lateral gaze palsy, horizontal diplopia internuclear ophthalmoplegia (damage to MLF; bilateral [multiple sclerosis], unilateral [stroke])
continuous "machinery" heart murmur PDA (close with indomethacin; open with misoprostol)
cutaneous/dermal edema due to connective tissue deposition myxedema (hypothyroidism, Graves' disease)
Dark purple skin/mouth nodules Kaposi's sarcoma (usually AIDS patients [gay men]: associated with HHV-8)
Deep, labored breathing/hyperventilation Kussmaul breathing (diabetic ketoacidosis)
Dermatitis, dementia, diarrhea, death pellagra (niacin [vitamin B3] deficiency)
dilated cardiomyopathy, edema, polyneuropathy wet beriberi (thiamine [vitamin B1] deficiency) -> dry is without dilate cardiomyopathy and edema
dog or cat bite resulting in infection Pasteurella multocida (cellulitis at inoculation site)
dry eyes, dry mouth, arthritis Sjogren's syndrome (autoimmune destruction of exocrine glands)
Dysphagia (esophageal webs), glossitis, iron deficiency anemia Plummer-Vinson syndrome (may progress to esophageal squamous cell carcinoma)
elastic skin, hypermobility of joints Ehlers-Danlos Syndrome (collagen defect, usually type III)
enlarged, hard left supraclavicular node virchow's node (abdominal metastasis)
erythroderma, lymphadenopathy, hepatosplenomegaly, atypical T cells Sezary syndrome (cutaneous T-cell lymphoma) or mycosis fungoides
facial muscle spasm upon tapping Chvostek's sign (hypocalcemia)
fat, female, forty, and fertile Chvostek's sign (hypocalcemia)
fever, chills, headache, myalgia following antibiotic treatment for syphilis Jarisch-Herxheimer reaction (rapid lysis of spirochetes results in toxin release)
Fever, cough, conjunctivits, coryza, diffuse rash measles (morbillivirus)
fever, night sweats, weight loss B symptoms (lymphoma) or TB
Fibrous plaques in soft tissue of penis Peyronie's disease (connective tissue disorder)
gout, mental retardation, self-mutilating behavior in a boy Lesch-Nyhan syndrome (HGPRT deficiency, X-linked recessive)
Green-yellow rings around peripheral cornea Kayser-Fleischer rings (copper accumulation from Wilson's disease)
Hamartomatous GI polyps, hyperpigmentation of mouth/feet/hands) Peutz-Jeghers syndrome (genetic benign polyposis can cause bowel obstruction; increase cancer risk
Hepatosplenomegaly, osteopososis, neurologic symptoms Gaucher's disease (glucocerebrosidase deficiency)
Hereditary nephritis, sensorineural hearing loss, cataracts Alport's syndrome (type IV collagen mutation)
hypercoagulability (leading to migrating DVTs and vasculitis) Trousseau's sign (adenocarcinoma of pancreas or lung)
Hyperphagia, hypersexulaity, hyperorality, hyperdocility Kluber-Bucy syndrome (bilateral amygdala lesion)
Hypertension, hypokalemia, metabolic alkalosis Conn's syndrome (primary hyperaldosteronism)
hypoxemia, polycythemia, hypercapnia "blue bloater" (chronic bronchitis: hyperplasia of mucous cells)
indurated, ulcerated genital lesion NONPAINFUL: chancre (primary syphilis, Treponema pallidum); PAINFUL: painful, with exudate: chancroid (Haemophilus ducreyi)
Degeneration of dorsal column nerves tabes dorsalis dorsalis (tertiary syphilis)
Depigmentation of neurons in substantia nigra Parkinson's disease (basal ganglia disorder: rigidity, resting tremor, bradykinesia)
desquamated epithelium casts in sputum curschmann's spirals (bronchial asthma; can result in whorled mucous plugs)
disarrayed granulosa cells in eosinophilic fluid Call-Exner bodies (granulosa-theca cell tumor of the ovary)
back pain, fever, night sweats, weight loss Pott's disease (vertebral TB)
big toe extension/fanning upon plantar scrape Babinski's sign (UMN lesion --> spastic paralysis)
Bilateral hilar adenopathy, uveitis sarcoidosis (noncaseating granulomas)
elevated D-dimers can be due to... thrombosis, DIC, PE, DVTs, Budd Chiari
abdominal pain, ascites, hepatomegaly Budd-Chiari syndrome (posthepatic venous thrombosis - looks like CHF but no JVD)
Bilateral hilar adenopathy, uveitis sarcoidosis (noncaseating granulomas)
bluish line on gingiva Burton's line (lead poisoning)
What is deficient in I- cell disease? Phosphitransferase - tags enzymes with mannose 6 phosphate
what bacterial structure is the space between the inner and outer cell walls of gram negative bacteria periplasmic space
what bacterial form provides resistance to dehydration, heat, and chemicals (endo)spore
what bacterial structure forms attachment between two bacteria during conjugation (transfer of DNA material) (F or sex) pilus
what bacterial structure is genetic material within the bacteria that contains genes for antibiotic resistance plasmid
what stain is required to see chlamydia giemsa stain
which organisms are not well visualized with gram stain treponema (too thin), legionella (fatty acids), mycoplasma (no cell wall), mycobacteria (high lipid content) [also chlamydia and rickettsia]
By what method are plasmids exchanged between bacteria conjugation
which exotoxin inhibits acetylcholine release at the neuromuscular junction, resulting in flaccid paralysis botulinum toxin
which exotoxin is a phospholipase that causes gas gangrene alpha toxin of clostridium perfringens
which exotoxin inhibits the inhibitor of adenylyl cyclase, causing whooping cough pertussis toxin
which exotoxin stimulates adenylyl cyclase, resulting in chloride and water entering the intestinal lumen, causing diarrhea cholera toxin, heat labile ETEC toxin
Which exotoxin destroys leukocytes PV leukocidin and gamma-hemolysin of staph aureus
which exotoxin is composed of edema factor, lethal factor, and protective antigen anthrax toxin of bacillus anthracis
Myelodysplastic Syndrome A group of disorders caused when something disrupts the production of blood cells
70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the stool. Dx? tubular adenoma
38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical shows inflamed nasal mucosa. No congestion in lower lung. Pharmacotherapy? Loratidine
24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph shown. Causal agent? Herpes simplex virus type 2
42yo F with 3-year hx of an intermittent facial rash, including the forehead, eyelids, nose, and cheeks. Rash seems to be getting worse since she moved from New York to Florida last year. Spicy foods precipitate a flushing reaction that seems to exacerba Rosacea
53yo M returned from Africa, has fever, headache, and abdominal discomfort. Received appropriate vaccinations prior to the trip. T 39.4C. A wright-stained peripheral smear shown. Dx? Malaria
68yo F with T2DM and hypertension that has even poorly controlled despite hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration of 130 and proteinuria. In addition to current Rx, which is most appropriate pharmacotherapy? Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy with flourouracil, leucovorin, and irinotecan. perscribed opioid antidiarrheal agent with no CNS effects. Which med? Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery diarrhea for 8 hours despite a lack of oral intake. Recently returned from a medical relief trip to a remove village in Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry s Activation of adenylyl cyclase
59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia of left upper and lower extremities. Muscle strength, DTR, sensation, proprioception normal. Metastatic tumor Cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash, microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in newborn; IGM - in mother, + in newborn. Explanation? CMV
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE shows a bulging, fluod0filled mass approximately 5 cm in diameter in the midline over the lumbosacral region. No spontaneous movements of the lower extremities. Abnormality m 15 to 40
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous ibutilide is administered. Ten minutes later, ECG shows normal sinus rhythm. Risk for which drug Torsades de Pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating down the distal anterior thigh, knee, medial leg, and food. Bony outgrowth of vertebrae compressing one of the spinal nerves is suspected. Nerve root in which intervertebral for L-3 to 4
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is 10%. Physician recommends initiation of insulin injections. Responds, "I know that insulin would help control my blood suga Contemplation
24yo M with 2-day history of an itchy rash on his arms and legs. Returned from a camping trip in the woods 5 days ago. PE shows edematous, erythematous rash with linear vesicles. Cause is activation of which cell types? T lymphocytes
70yo M from china with poorly differentiated monoclonal carcinoma of the nasopharynx. DNA probes of neoplastic cells are most likely to detect genome of which virus? Epstein-Barr virus
24yo M with hx of IVDA could not be aroused. Friend reports that the patient injected himself with a drug 6 hours ago. Labs show drug concentration of 0.3. Assuming first-order one-compartment kinetics, has a half-life of 2 hours, and a volume of distribu 480
Compound is taken up by bacterial cells. No energy is necessary for uptake, and the compound is not concentrated in the cell. Which describes this mechanism of transport? Carrier-mediated diffusion
Newborn has male genital ducts but female external genitalia. Cytogenetic analysis shows a 46,XY karyotype, and genetic testing shows a mutation of the gene encoding 5alpha-reductase. In absence of this mutation, labia majora would have been? Scrotum
Study designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in patients with CHF. Sixty patients with CHF are recruited. Each assigned by coin toss to one of tw groups. Design? Randomized clinical trial
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes? Central blood volume DECREASED, ADH (vasopressin) INCREASED, Atrial Natriuretic Peptide INCREASED??
Tells patient he has lung cancer. The patient reponds, "How can this be happening to m? I eat right and exercise." Appropriate response? "It must be difficult for you to accept this diagnosis when you feel healthy."
18mo girl. Separation of the umbilical cord was delayed after birth. Has had four severe skin infections Staphylococcus aureus; No pus formation at infection sites. Persristent leukocytosis in absence of infection. Mechanisms impaired? Leukocyte adhesion and transmigration
32yo M with 6-month hx of low back pain and stiffness, worse in morning and improve during the day; the pain radiates to his buttocks but not down his legs. Back stiffness if he sits for prolonged periods. Which to confirm diagnosis? X-rays of the sacroiliac joints
17yo boy with 8-kg weight gain during the past year. No medical illness. BMI is 32. He asks, "Do you think that my weight gain is inherited from my father?" Appropriate response? "Yes, your weight gain can be caused by genes and environment combined."
52yo M neighbors have reported that he has been confused and not taking care of himself. 4-mo Hx of diarrhea. PE shows extreme muscle wasting, stomatitis, and a diffuse rash that is worse in sun-exposed areas. Diagnosis? Pellagra
80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest probability for TA is 50% in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and specificity of 60%. Based on the restults of the ESR testing, most appropriate next ste Additional testing to confirm the diagnosis of TA
Sequence surrounding the first two exons of the human beta-globin gene shown, with exons in bold. Translation start codon is underlined. A mutation from G-->A at position 355 is most likely to lead to beta-thalassemmia by which mechanism? Disruption of normal splicing by creation of a new 3' splice site??
42yo M in ED because of a 10-day history of progressive fever, SOB, and nonproductive cough. 20-kg weight loss. Immigrated to USA from the Ivory Coast 4 years ago. T 38C. Lungs clear, CXr shows diffuse interstitial infiltrate. Silver stain obtained via br Infection with HIV-2
27yo F with vaginal bleeding for 3 weeks. First pregnancy ended with a spontaneous abortion 8 months ago. No Rx since dilatation and curettage at that time. PE shows enlarged uterus, beta-hCG markedly increased. Ultrasonagraphy of pelvis shows material w Trophoblastic tissue
65yo M emigrated from Brazil with 8-month history of shortness of breath and fatigue, edema of lower ext. CXR shows cardiomegaly. endomyocardial biopsy specimen shows myofiber necrosis with a mixed inflammatory infiltrate of PMNs, T lymphos, m.phages, and Trypanosoma cruzi
40yo F with mole on her back that has increased in size during past 4 months. PE shows raised irregular lesion with variegated black-tan pigmentation and ill-defiined margins. Pleomorphic, hyperchromatic cells within clear islands that tend to collapse. E Melanoma
42yo farmer has a 7-mm red scaly plaque on helical rim of left ear. Photomicrograph shown. Dx? Actinic keratosis
30yo F training for a marathon, running 20 mild/day. Fasting glucose is 60. After her glucose stores have been depleted, which organ, in addition to liver, releases glucose? Kidney
Male newborn at 28 weeks'. Given ventilatory support with up to 80% oxygen for the next 72 hours, but dies of resp. failure. Cause is inadequate secretion from which labeled cell types? Not sure about this one. Looking for surfactant.
9yo girl with poor growth during the past year. < 3rd %ile for height and at 10th percentile for weight. PE normal. Visual field testing shows bitemporal hemianoia. Labs show GH deficiency. MRI shows calcified cystic mass in suprasellar region. Tumor deri Diverticulum of the roof of the embryonic oral cavity
28yo F G1P1 with 2-day history of a painful mass in her right breast. Delivered healthy female newborn 3 weeks ago, and been breast0-feeding since. T 37C, PE shows 3-cm tender mass surrounded by an area of erythema beneath the right areola. Causal org? Staphylococcus aureus
3yo boy with bacterial colitis caused by Salmonella enterica serovar arizonae. Which factor accounts for recruitment of PMNS to inflammatory site by intestinal epithelial cells? Interleukin-8 (IL-8)
27yo F with fever, malaise, abdominal pain, and vaginal d/c for 4 days. LMP 5 days ago. Had ectopic 1 year ago. T 38.3 C, bilateral lower quadrant tenderness with rebound and guarding. Pelvic exam with cervical motion tenderness and bilateral adnexal tend Gonorrhea
20M with 3-month hx of progressive thirst (drinking a lot of fluids) and urinary frequency during past 3 days. U/A shows specific gravity less than 1.006. Most likely has dysfunction of which endocrine structure? Posterior pituitary gland
21yo M in ED with excruciating anal pain for 4 hours. Exam shows 15-mm, blue tinged rounded mass at anal margin. Represents thrombus in a tributary of which blood vessel? Inferior rectal vein
6-week-old girl with 6-day hx of vomiting small amount of milk 2 to 3 times daily. 50 %ile for length and weight. Cause? Immature lower esophageal sphincter
37yo M with 4-day hx of diarrhea and abdominal pain, worse in past 24h, with watery-brown stools. Completed a 10-day course of amoxicillin for a sinus infection 5 days ago. Stool shows: Fecal fat negative; ova and parasites negative; Cx for infx negative; Pseudomemnbranes of fibrin and inflammatory debris
28yo M in ED 30 minutes after SOB. 3-year hx of cocaine abuse. T 38.1, P 100/min, BP 150/45. PE: diminished pulses in left upper extremity. Crackles heard over all lung fields. 2/6 diastolic murmur at left sternal border. CXr shows a widened aortic arch. Dissecting aneurysm
1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal. Next step? Measurement of serum acylcarnitine concentrations
79yoM 30 minutes after LOC for 30 seconds. Alert, but dizzy. No urinary or fecal incontinence. Pulse 40/min, BP 92/56. PE shows no tongue biting. Lungs clear, Variable intensity S1. Oriented X3. ECG shows a third-degree atrioventricular block. Next step? Insertion of transvenous pacemaker
55yo M with chronic bronchitis in ED after being unresponsive. Found bottles of albuterol, ampicillin, codeine, and theophylline bedside. T 37.2 C, p 112/min, respirations are 6/min, BP 95/60. Acute Rx should include? Naloxone
50yo man has persistent cough for 2 months. He has had a 5 kg (11 lb) weight loss. He is a farmer and on itraconazole 4 weeks for histoplasmosis from chicken coops. Medications: hydrochlorothiazide, enalapril, atenolol, omeprazole, and metoclopramide for Omeprazole
20yo man with 6-hour difficulty breathing and vomiting. 10-year history of type 1 diabetes on insulin. Pulse 90, respirations 30 and deep, bp 90/60. Physical shows dehydration. Labs: Na+ 130, K+ 6.5, HCO3 5, glucose 500, pH 7.2, pCO2 25 mm Hg. Which compo Epinephrine
Physician sad to inform patient of progression of carcinoma to the terminal phase. Physician's face makes patient cry and ask, "It's bad news, isn't it?" Which is best response? "Yes, it is."
75yo man 2-year history of decreased force of urinary stream, urinate several times throughout night. BUN 55, Cr 5.0. Ultrasound shows bilateral hydronephrosis and dilated ureter. Mechanism of renal failure? Increased hydrostatic pressure in Bowman space
4yo boy two bacterial urinary tract infections past year. Physical exam normal. Radiologic studies show dilation of left ureter and renal pelvis, minimal left-sided renal function. Left nephrectomy done. Photo: dilated renal pelvis and ureter. Which is ca Congenital ureteral obstruction
45yo man poorly controlled type 2 diabetes 1-month low-grade fever. Getting hemodialysis for end-stage renal disease. T 37 C (98.6 F), pulse 72, bp 144/92. Physical subclavian catheter below right clavicle. Lungs clear. Cardiac exam no murmurs. Blood cult Enterococcus faecalis
3yo boy sickle cell disease with fever and pain over left foot 3 weeks. Hematocrit stable. Leukocyte count 15,000 predominance of neutrophils. Which is most likely explanation for findings? Osteomyelitis
45yo woman follow-up exam after 8 weeks tamoxifen therapy for estrogen- and progesterone-positive invasive ductal carcinoma of breast. 50yo sister also hormone-sensitive breast cancer. Physical exam normal. Serum decreased concentrations of endoxifen, act 25%
60yo man progressive shortness of breath past 3 months. Worked in shipyard. Respirations 25. Bilateral basilar crepitant crackles. Xray chest reticulonodular pulmonary infiltrates consistent with interstitial fibrosis. Picture: sputum sample of elongate s Alveolar macrophage
30yo woman 20 weeks gestation, uncomplicated pregnancy. Fundal height is greater than expected for gestational age. Ultrasound shows increased amniotic fluid. Which abnormality is cause? Tracheoesophageal atresia
27yo woman 12-hour history of fever and abdominal pain. History of recurrent urinary tract infections. Temperature is 39 C (102.2 F). Physical exam tenderness of right flank. Abdominal xrays bilateral staghorn renal calculi. Urinalysis pH 8, many RBCs, WB Struvite
48yo nulligravid woman with excessive uterine bleeding for 3 months. Bleeding during menses and at irregular intervals. Menses were regular before. BMI 27. Pelvic exam: adnexae are nonpalpable. Endometrial curettage shows abundant tissue. Which is cause o Endometrial hyperplasia
55yo woman 6-week history low energy, irritability, crying spells, difficulty falling asleep, wakes up during night, cannot focus. Taking lorazepam for 15y for generalized anxiety disorder. Taking estrogen replacement therapy for postmenopausal symptoms. Major depressive disorder
Ten years after total gastrectomy, 60yo man difficulty walking. Diffuse spasticity in arms and legs, impaired proprioception in his feet, increased muscle stretch reflexes in arms and knees, absence of muscle stretch reflexes in ankles, bilateral extensor B12 (cobalamin)
80yo man type 2 diabetes 2-month history severe constipation. Laxatives haven't relieved symptoms. Abdominal exam shows distention. Colonoscopy shows no abnormalities. Patient has dysfunction of which nerve? Pelvic splanchnic
34yo man lightheaded after running 12 miles of marathon hot day. Pulse 130 bp 80/60. Which changes to autonomic nervous system occurred? Sympathetic efferent activity increased, parasympathetic efferent activity decreased
6-Mercaptopurine (6-MP) used to treat acute lymphoblastic leukemia (ALL). 6-MP acted on by enzymes to make 6-thioguanine nucleotides (6-TGN). Efficacy and toxicity of 6-MP correlated with 6-TGN. 6-MP acted on by xanthine oxidase (XO), thiopurine methyltra They may be given normal doses of 6-MP (?)
Ten human subjects given new oral drug to monitor drug effect and toxicity. Blood analyzed for human pharmacokinetics of drug for first time. Which trial type? Phase I
15yo girl health maintenance exam. Mother dx squamous cell carcinoma face, maternal grandfather died of metastatic melanoma. In patient this age, which factor most predicts compliance with photoprotection? Macrophages
44yo woman follow-up after two Pap smears showing atypical squamous cells of undetermined significant. Test shows viral E6 protein of human papillomavirus. This protein promotes cell growth and malignancy by causing cellular p53 protein degradation. This Ubiquitin ligase
40yo woman hx of 6 month episodic sinusitis with 2-week intermittent headaches, fatigue, and generalized joint pain, worsening cough productive of blood-tinged sputum. Failed antibiotics, decongestants and nasal corticosteroids. Physical exam: erythema na Wegener granulomatosis
25yo woman 6-month history of joint pain poorly responsive to aspirin. Physical exam: bilateral swelling of proximal interphalangeal joints, metacarpophalangeal joints, and wrists; weakness of grasp. Small nodules palpated beneath skin around joints of f Rheumatoid Arthritis
50yo woman 1-year hx of hot flashes and irregular menses. Decreased bone mineral density. Alendronate prescribed. Mechanism of drug? Inhibition of osteoclast-mediated bone resorption
Female newborn at 36 weeks gestation has respiratory distress. Apgar 3 and 5 at 1 and 5 minutes. Physical shows cyanosis. Endotracheal and NG tubes placed. Xray shows nasogastric tube in left hemithorax, mediastinum displacement to right, absence bowel ga Incomplete formation of pleuroperitoneal membrane
65yo women progressive vulvar itching past 2 months; miconazole for yeast infections ineffective. Exam: atrophy of labia minora and thin, parchment-like skin over vulva and anus. Dx? Lichen sclerosus
75yo man 2-day ear ringing, nausea, fatigue. Temp 37 C (98.6 F), pulse 100, respirations 24, bp 140/85. Physical: mild epigastic tenderness. ABG pH 7.42 pCO2 30 pO2 95 HCO3 19. Dx? Salicylate poisoning
15yo girl 1-day hx redness and painful skin following sunbathing. She used sunblock. No medications. Physical exam: severe erythema of back and extremities, no blisters. Dx? First-degree burn
58yo man supraventricular tachyarrhythmia refractory to pharmacotherapy gets ablation of accessory excitatory pathway in atrial endocardium. Which area should be avoided to leave sinoatrial (pacemaker) node intact? The junction of the superior vena cava and the right atrium
81yo woman massive pulmonary embolism from deep venous thrombosis. Platelet count 160,000. Appropriate pharmacotherapy is started. One week later, platelets 55,000. Thrombocytopenia most likely caused by a drug with which of the following mechanism of act Potentiates the action of antithrombin III
22yo woman, g1p1, 2-day hx of fever, severe vaginal bleeding. four days ago delivered healthy male newborn. Temp 38.1 C (100.6 F). Pelvic exam: open cervix, heavy vaginal bleeding. US shows uterus with no placental tissue or thrombi. If operation required Internal iliac
35yo woman abnormal Pap smear. Cervical biopsy shows microinvasive cervical carcinoma. Which microscopic features led to dx? Neoplastic cells in sub-basement membrane connective tissue
17yo girl 1-day shortness of breath, weakness and muscle tenderness. Did triathlon previous day. BMI 19. Temperature 38 C (100.4 F), respirations 20, bp 150/90. Physical bilateral crackles lower lobes, muscle tenderness. Creatinine 4. Urinalysis 3+ protei Myoglobin
16yo boy with no signs of puberty. Sex development Tanner stage 2. Physical exam: circumcised penis, soft small tests 5 mL, prostate firm, nontender, no discharge or lesions. Testosterone low. Which hormone is cause of decreased serum testosterone and lac Luteinizing hormone
28yo woman wants to lose weight. She binges on high-carbohydrate foods 2 to 3 times a week, forcing herself to vomit after. BMI 23. Which physical finding is likely? Parotid gland enlargement
15yo girl emigrated from India and with several lesions on neck for 2 weeks. Physical exam shows hypopigmented, hypoesthetic area on left side of forehead and 4-cm lesions on neck. Biopsy shows acid-fast bacilli. Best explanation why the organism results Temperature senisitivity
59yo man has total thyroidectomy for 4-cm follicular carcinoma of thyroid. Twelve hours after procedure, has paresthesias of hands and feet. Vitals stable, carpal spasm on inflammation of bp cuff. Lab findings? Decreased parathyroid hormone, decreased calcium
41yo man with asthma and allergy to grass pollen wheezes and difficulty breathing 10 min after mowing lawn. Drug for immediate relief of acute symptoms? Albuterol
14yo boy daily headaches for 2 months. Headaches are bilateral aching in temples. "Has not been himself" for months. Confused, forgetting names, dates, places, clumsy, frequent falls. School performance declined. Physical exam: broad-based ataxic gait. Sl Inhaled glue
40yo African American woman 2-week hx fever, malaise, dyspnea. Temperature 36.7 C (98 F), respirations 20. Physical exam: erythema nodosum, parotid enlargement, hepatosplenomegaly. Calcium 16. CT chest bilateral hilar adenopathy. Increased in which in ser 1,25-Dihydroxycholecalciferol
56yo woman with restrictive cardiomyopathy, proteinuria, renal failure. 35-year history of rheumatoid arthritis. Renal biopsy shows glomerular deposition of eosinophilic hyaline material. Congo red statin: birefringent pattern under polarized light. Struc beta-pleated sheet structure
63yo man 3-month hx difficulty sleeping. Sleeps better upright. HR 90, bp 110/60. Physical exam: increased jugular venous pressure, mild ankle edema. Cause of edema? Increased capillary hydrostatic pressure
14yo boy come to ER 1 hour after colliding with teammate playing soccer. Physical exam: edematous tissues of left eye, mild depression of left zygomatic bone. Skin between eye and upper lip numb. Double vision look upward. Nerve damaged causing sensory lo Maxillary division of trigeminal nerve
Maxillary division of trigeminal nerve Family history of a similar illness
18yo man Crohn disease 1-day hx severe abdominal pain and intermittent bloody diarrhea. Temperature 38 C (100.4 F), pulse 98, respirations 18. Physical exam: draining anal fisutla. Treatment with antibiotics and prednisone over next 3 weeks recovers. Mech T-lymphocyte function
34yo woman with pyelonephritis treated with bactericidal antibiotic 4 days no improvement. Antibiotic added that inhibits binding to 30S ribosome, blocking protein synthesis intracellularly. Antibiotic? Gentamicin
3yo boy and his 5yo brother with recurrent hemarthroses. Both parents healthy, but mother with two younger brothers with same sx and maternal uncle who died at 8 of mild head trauma. Partial thromboplastin time is prolonged. Defect? Factor VIII (antihemophilic factor)
6yo boy from Russia with unstable gait and incoordination for 2 weeks. Pale, bulky stools for 4 years and two episodes of bacterial pneumonia and chronic cough since age 1 year. 3%ile for height/weight. Neuro exam shows ataxia, no DTRs, loss of propriocep Vitamin E
54yo F 1 week after sudden loss of vision in left eye, returned within 1 day. 3-month hx of progressive SOB with exertion. Echocardiography shows mass in the left atrium of the heart. Lesion is resected, photomicrograph of it is shown. Which describes the Myoxma
27yo primigravid woman at 34 weeks' with nausea and vomiting, and abdominal pain for 12 hours. Everything's been normal. BP is now 164/102, and right upper quadrant tenderness. Labs show Hb 7.4, HCT 24%, Platelets 72k, Cr 1.2, total bili 2.3, AST 112, ALT Schistocytes
60yo F 3 hours after sudden onset ankle pain. 4-year Hx of increasing serum creatinine concentrations. Began furosemide 1 month ago, also takes glipizide. P 120/min, resp 25/min, BP 150/100. Joint fluid shows negatively birefringent crystals. Increased ri Nephrolithiasis
56yo F follow-up 8 weeks after recovering from pneumococcal pneumonia. Chest X-rays normal. Which allowed this resolution to occur? Metaplasia of mesenchymal cells to pneumocytes
29yo F with 5-week hx of fatigue and 4-day hx of heart palpitations and anxiety. Has primary hypothyroidism Rx with triiodothyronine, but she has doubled the dose because of fatigue. TFT will show which? TSH DECREASED, Free thyroxine DECREASED, Free triiodothyronine INCREASED
20yo F has multiple neurofibromas. Mom, uncle, and brothers with similar lesions. Mode of inheritance? Autosomal Dominant
45yo M with yellow skin. Drinks eight to ten 12-ounce cans of beers daily for 10 days. Liver is tender. Serum: total bili 5.9, Alk Phos 210, AST 110, ALT 69, gamma-glutamyltransferase 25 (n = 0-30). Liver biopsy will show? Mallory Hyaline
35yo M uses crack cocaine daily, with 2-hour Hx of substernal chest pain. T 37C, P 110/min, BP 160/100. Most appropriate next step? Admit the patient to the hospital for possible myocardial ischemia
54yo F with hypertension and bilateral renal artery stenosis starts taking NSAIDS for back pain. Her Cr concentration increases from 1.0 to 5.0. Cause is due to inhibiting which? Vasodilating prostaglandins at the afferent arteriole
83yo M brought to ED after being found at home bedridden and confused. No meds. P 100/min, BP 85/50. BP unchanged after 1L IV saline. Pulmonary artery catheter shows: Cardiac output high, PCWP low, systemic vascular resistance low. Cause of hypotension? Early septic shock
32yo M with 3-month hx of swelling and breast tenderness. Receiving thyroid hormone and steroid replacements since removal of pituitary adenoma 2 years ago. Began hCG injections 4 months ago. Most likely binding site of hCG causing gynecomastia? Tissue: Testicle; Effect: estradiol production
38yo F with 3-day hx of sore throat. Photo shown of throat. Which nerves is tested by saying "ah," elevating area at tip of the arrow? Vagus
8yo boy with disruptive behavior, interrupts, always moving, trouble completing tasks. Drug with which mechanism is appropriate? Increased release of dopamine and norepinephrine
62yo M with alcohol-induced liver disease develops ascites. Infection ruled out. Most appropriate diuretic, in addition to loops, is which? Spironolactone
17. 72yo M with weakness and fatigue. Hemogrlobin concentration is 9.2, WBC 5400, platelets 350k. Peripheral blood smear is shown. Cause? GI blood loss
65yo F with widely metastatic breast cancer unresponsive to chemo. No family. "close friend," at all her visits and now she is moved to inpatient hospice after she decides she wants no further curative therapy. Says, "We can't bear to be apart. It would "The two of you seem to have a very important relationship. Of course you may stay together."
46yo M treated with oral cyclosporine after cardiac transplant. Cyclosporine decreases likelihood of rejected by which actions? Suppressing the early response of T lymphocytes to activation
30yo M in ED 15 minutes after found unconscious. Comatose, pupils 4 mm in diameter, not reactive to light. CT head shown. Cause of coma is bleeding from which structures? Middle meningeal artery
68yo M with 6-month hx of erectile dysfunction. PE and labs normal. If pharmacotherapy is indicated, drug with which MOA? Inhibition of phophodiesterase
35yo M with recurrent sinusitis and bronchitis. Cardiac examination shows PMI at fourth intercostal space within the midclavicular line on the right. Hepatic margin is palpable on the left. Endoscopy shows nasal polyps. Biopsy shows thickened, ciliated, p Dynein arms
30yo primi at 22 weeks' gestation with 1-day hx of fever, chills, and muscle aches. T 39.4, P 114/min, resp 15/min, BP 104/72. PE shows uterus consistent with 22-week gestation. Fetahl heart sounds are heard. WBC 12K, Blood cultures grow gram-positive rod Listeria monocytogenes
42yo M with multiple lesions over his body. PE shows flaccid bullous erosions involving upper and lower extremities and torso. Biopsy shows extensive epidermal acantholysis resulting in the formation of intraepidermal blister. Intact basal layer of kerat Development of autoantibodies against desmosomal proteins
50yo M 3 days after his first generalized tonic-clonic seizure. 1-month hx of frequent episodes of pins-and-needles sensation around the mouth, hands, and feet, involuntary contraction of muscles. Neuro exam shows mild, diffuse hyperreflexia. Which serum Calcium
52yo F with hot flashes. Menses have been irregular for the past 6 months. Physiologic cause? Failure of the ovaries to secrete 17beta-estradiol
32yo F G2P1 at 7 weeks' gestation with vaginal bleeding for 3 days and increasingly severe left abdominal pain for 18 hours. Direct and rebound tenderness with guarding in left lower quadrant. Cervical os is closed. serum beta-hCG is 6000. U/S shows empty Ectopic pregnancy
26yo F 5 weeks after birth of first child. Worries constantly that the infant is ill and wakes up to make sure he is well. Washes her hands 30 times per day. Worried about people braking into her house, checks lock 3-4 times a night. Not breast feeding. R Sertraline
10yo boy has had anemia since birth. Spleen is five times normal. Splenectomy is indicated if anemia is caused by which? Hereditary spherocytosis
62yo F in ED for 2-day hx of fever, abdominal tenderness, and painful urination. Agitated. T 38.8C, Labs show WBC 14k. Admitted to hospital, nurses note she has torn up four breakfast menus because she is confused. Cause? Delirium
60yo F with 3-year Hx of hyperlipidemia. Low-cholesterol diet and exercise program ineffective after 1 year. Lovastatin initiated, but unable to tolerate greater than 20 mg daily. Additional drug is added that inhibits transport of cholesterol through int Ezetimibe
48yo M with bronzing of his skin, weakness, and fatigue during the past 3 months. PE shows hepatomegaly, and small testes. Serum: AST INCREASED, ALT INCREASED, iron INCREASED, transferrrin sat INCREASED, ferritin INCREASED, testosterone DECREASED, LH DECR Increased intestinal iron absorption
45yo M with intermittent bloody diarrhea and abd pain. Sigmoidoscopy and rectal biopsy show IBD. Monoclonal antibody is begun, which is directed against what components? Tumor necrosis factor
"string of beads" sign Dx? Fibromuscular dysplasia
55yo M with sepsis. Appears anxious and confused. Rx with vancomycin and ceftriaxone initiated in ED. T 39.8, P 132/min, BP 85/48. PE shows warm, flushed skin. No aedema. Administrer which solutions? 0.9% Saline
36yo M undergoes elective liposuction under general anesthesia. Operation is terminated when patient develops hyperthermia, tachycardia, and marked muscle rigidity. MOA of drug that should be administered? Decreases release of Ca from the sarcoplasmic reticulum
In a survey of 100 households (average three residents per household), 45 with asthma are detected. Prevalence? 15%
While lifting weights, 24yo M swelling in right inguinal region. Photograph shown of small intestine resected. Dx? Strangulation
24yo with second-degre burn. Two weeks after, tissue shows increased fibroblast migration and proliferatoin, increased collagen and fibronectin, and decreased metalloproteinases. Caused by production of which? Transorming growth factor-beta
Protein found in brown adipose tissue of mice causes leak of H ions inward across inner mitochondrial membrane. Effect of this protein on oxidative phosphorylation and energy metabolism? Increased ratio of oxygen consumption to ATP generation
57yo M with alcoholism has distended abdomen with shifting dullness, fluid wave, caput medusae, palmar erythema, spider angiomata. Additional finding? Gynecomastia
16yo girl with 2-year hx of fainting; increased in frequency during past 6 months. BP 110/80 supine and 60/40 standing. Neuro exam normal. Plasma shows undetectable noreipinephrine and marked increase in dopamine concentration when standing. Deficiency of Dopamine beta-hydroxylase
HALLMARK: Peanut Farmer from China Aflatoxin
42yo M in ED for 5-hour hx of fever, chills, and severe pain and swelling of his left arm. Scratched his arm on a nail yesterday. Appears confused, T 40C, BP 71/38. Labs show Hb 14, HCt 42%, WBC 15K (35% PMNs, 40% bands, 25% lymphos), Platelets 50K, Serum IL-1 and tumor necrosis factor (TNF)-alpha
62yo M dies suddenly while playing tennis. No cardiac risk factors, no hx of CAD. Autopsy, cardiac valve defect and concentric LVH. Which valve abrnomalities is most likely involved? Aortic stenosis
67yo M has urinary urgency after placement of urinary bladder catheter during transurethral resection of the prostate. Most appropriate Rx has which MOA? Inhibition of muscarinic receptors
Mouse embryos are produced with two pronuclei, both of same parental origin. When the pronuclei are maternal, produces have poorly developed extraembryonic structures. When both pronuclei are paternal, produces have poorly developed embryonic tissue. Whic Imprinting
18-yo F with sepsis after an abortion. Within 24 hours she becomes dyspneic, oliguric, and develops petechiae, ecchymoses, and bleeding from venipuncture sites. Which lab finding? Decreased plasma fibrinogen concentration
63yo M with 6-month hx of exertional chest pain relieved by rest. smoked for 45 years. Mild HTN, no meds. Which lesion in LAD is most likely cause? Calcified 80% stenosis
65yo F with ovarian cancer treated with cyclophosphamide and other chemotherapeutic agents. Cyclophosphamide affects which target? DNA replication
Pharm co trying to develop a long-acting weight-loss agent that mimics activity of a naturally occurring peptide originates in adipose tissue, signals brain about stored fat, and suppresses appetite by its action in the CNS. Which chemical mediator? Leptin
45yo F has thyroidectomy because of asymmetric enlargement of thyroid noticed 6 weeks ago. Underwent adrenalectomy for pheochromocytoma 3 years ago. Bilateral thyroid lesions with spindle cells arranged in small clusters. Amyloid deposits b/w neoplastic Calcitonin
45yo F intubated, mechanically ventilated with fungemia with Candida albicans. Rx with caspofungin is started. Feature of causal organism targeted by this drug? Beta-Glucan carbohydrates in the cell wall
56yo M 4 hours after sudden onset of uncontrollable irregular movements of the left side of the body. PE shows flailing movements of the proximal appendicular muscles on the left. Nuclei damaged? Right subthalamic
60yo M 1-month Hx of progressive SOB with exertion. Breath sounds: Dec on right lung base, normal on left lung base Percussion note dull on right lung base, nml on left lung base Tactile fremitus decreased on right lung base, nml on left lung base Adv Pleural effusion
68yo M with difficulty swallowing solids for 2 months. Hx of dilated cardiomyopathy. X-rays of esophagus w/ barium contrast show indentation and posterior displacement of the esophagus. Enlargement of what caused dysphagia? Left atrium
25yo F with 3-year hx of irregular menses. Menarche was at age of 14 years. BP 116/62. PE shows increased hair growth on the face and chest. Pelvic exam shows clitoromegaly and a normal-appearing uterus. Serum shows increased 17-hydroxyprogesterone and an 21-hydroxylase
60yo M in ED for sudden onset of acute abdominal pain and tenderness, nausea, vomiting, and bloody diarrhea 2 hours ago. He has a Hx of cirrhosis and hepatocellular carcinoma. BP 99/50. Loss of bowel sounds. Surgery shows small intestine with dark purple- Mesenteric venous thrombosis
38yo M in ED 30 min after unable to stand upright. Lethargic, pulse 110/min, BP 90/62. PE shows dry mucosa and poor skin turgor. Midepigastric tenderness. Labs show: Serum: Na 143, K 3.2, Cl 101, HCO3 11 ABG: pH 7.28, Pco2 23, Po2 98 Acid-base status Metabolic acidosis
2mo boy given vaccine to convert T-independent antigens to T-dependent forms to enhance protection in young children. Which vaccine given? Haemophilus influenzae type b
A study conducted to assess effectiveness of injections of lidocaine into "trigger points" of pain symptoms in patients with fibromyalgia. Fifty patients randomly assigned - 0.9% saline only or saline plus lidocaine. Graph shows self-reported pain scores. Placebo effect
In a clinical study, a polymorphic marker with three alleles, 1, 2, and 3, is found to be tightly linked to the gene for polycystic kidney disease. Pedigree shown. If III, 1 is unaffected by this disease, patient is most likely carrier of? 2,3
6yo girl with 4-day hx of round shiny bumps in areas where she has eczema. Her mother saw similar bumps on a playmate at pool party 3 weeks ago. No other Sx. PE shows firm, smooth, umbilicated papules 2 to 4 mm diameter in clusters. Causal organism? Poxvirus
80yo F in ED for 2-day hx of "feeling funny." "Lost my pep." Hx of poorly controlled hypertension. Just started medication 2 weeks ago. BP 130/85. Pe normal. Serum potassium is 3. Which drug? Hydrochlorothiazide
68yo M in for a hemiorrhaphy. Surgeon gives info of risks and benefits. Patient says that he understands what he has been told, and his family will be able to discuss later. In this patient, which combination of components fulfill the criteria for fully i Information, competence, voluntariness
47yo F with psoriasis for follow-up. Was given several topical creams, to be used in specified sequence twice daily. No improvements apparent at this appointment. How to begin discussion of compliance? "using something twice daily can be difficult. I assume you are like most patients who miss at least 10% of treatments."
Male newborn has macrocephaly with poor skull mineralization, shortened extremities with misshaped long bones, and several fx. Defect in which? Collagen
27yo F in ED 30 min after ejected through windshield during MVC. Unrestrained front-seat passenger. PE shws marked edema and tenderness of the jaw. Panorex x-ray of mouth shown. Which is injured? Levator labii superioris
Girl for well-child exam. Normal development includes pincer grasp, finger feeding, standing while holding onto a table, and playing peekaboo. Age (in months)? 9
18yo M with yellow nodules on achilles tendons of his feet and extensor tendons of his hands. Exam shows collection of foamy histiocytes within the dermis. Serum cholesterol is 980, and lipoprotein electrophoresis shows a selective increase in LDL. Underl Absence of functional LDL receptors in hepatocytes
35yo M with 4-day Hx of high-grade fever, sever muscle aches, malaise, loss of appetite, and a nonproductive cough. wife and kids had similar illness. Temp 39.2, PE normal. CBC and CXR normal. Causal virus replicates its genome within the cell's nucleus. Influenza virus
28yo F at 18 weeks' gestation has palpitations. Labs show increased serum total thyroxine (T4) concentration. Best test to confirm hyperthyroidism? Thyroid antibodies
21yo M in ED 45 minutes after sustaining multiple injuries in a MVC. His BP is 90/50, PE shows diffuse abdominal tenderness. Dx with laceration of the spleen and undergoes splenectomy. Predisposed to infection with? Streptococcus pneumoniae
70yo F in longitudinal study of effects of aging on pulmonary function tests. Which represents woman now compared with results at age of 20 years? Residual volume UP, Arterial Po2 DOWN, Alveolar-arterial Po2 difference UP
45yo F farmer in ED for 2-day hx of confusion, lethargy, fever, headache, muscle pain, vomiting, and a rash on her wrists and ankles. Bitten by a tick a few days ago. T 38.5 C, Red-purple papules on distal extremities progress to trunk. Rx? Doxycycline
Study of breast cancer in women. Hundred healthy women observed for 10 years. Goal is to determine if number of family members who previously received dx of breast cancer correlates with incidence of future development of cancer. Best design? Cohort
62yo F with recurrent pulmonary emboli comes for follow-up. PE normal. Labs show PT of 12 seconds. Warfarin begun. Which clotting factors is first to be decreased by 50% after initiation of Rx? VII (proconvertin)
48yo F with 2-month hx of fatigue and intermittent headaches. BP 180/110, PE normal. Serum show a decreased potassium concentration and increased aldosterone. CT abdomen shows tumor on adrenal gland. Which additional findings supports aldosterone-secretin Decreased plasma renin activity
20yo F with 1-day hx of increasing urinary frequency and a burning sensation with urination. One sexual partner, uses condoms. VSS. PE shows mild suprapubic tenderness to deep palpation. Urine shows rare epithelial cells and 10 WBC/hpf. Urine grows E. col Mannose-binding (type 1) fibria
6yo boy with 3 systemic infections with Neisseria meningitidis over the past 2 years. Healthy otherwise. Which lab test is most likely abnormal? Total hemolytic complement concentration
13yo girl 2/6, holosystolic murmur heard best over left fifth intercostal space adjacent to the sternum; it increases with inspiration. Abnormality of which valves? Tricuspid
55yo F with left flank pain and gross hematuria. Mass is palpable in LUQ of abdomen. Ultrasonography shows a 12-cm solid mass on lower pole of left kidney. Angiograms show hypervascular mass. Dx? Renal cell adenocarcinoma
19yo M in MVC. Penetrating wound to right cerebral cortex with paralysis of the left lower extremity, fracture of right mid humerus with severing of the radial nerve, and a fracture of right tibia. After 10 weeks, DTR strongest in which locations? Left Achilles tendon
40yo F with 1-year hx of episodes of crampy abdominal pain, intermittent diarrhea, and rectal bleeding with passage of mucus. BMI 18. Abdomal exam: diffuse tenderness with no rebound. Sigmoidoscopy shows diffuse ulcers. Initial Rx? Sulfasalazine
27yo M for employment exam. No Hx of major illness. Never been sexually active. Minimal contact with parents and siblings, no hobbies. Doesn't feel depressed. Shrugs in response to congratulations about his new job. Flat affect. Personality disorder? Schizoid
30yo F has ptosis, ophthalmoplegia, and diplopia. Serum shows autoantibody with affinity for acetylcholine receptor at the postsynaptic neuromuscular junction. Which neoplasm? Thymoma
Exam scaled so scores are normally distributed with mean of 500 and SD of 100. Which % are between 400 and 600? 67%
62yo M with pericardial friction rub 3 days after acute myocardial infarction. Cause of rub? Fibrinous pericarditis
42yo F with 1-mo Hx of abdominal pain, after eating fatty meals. BMI 31. PE shows jaundice and tenderness of RUQ. Increase of which liver function? Cholesterol synthesis
70yo M with recent loss of mental function. Hx of weight loss. No drugs. VSS, not dehydrates. Mild anemia. Labs show Na 110, Cl 85, K 4.4, BUN 15, Cr 15; Plasma osmolality 250; Urine osmolality 750. Dx? Pulmonary neoplasm
40yo M skin extremely sensitive to sunlight, which causes formation of vessicles and blisters on the skin which take weeks to heal. Diagnosed with disorder caused by increased synthesis of compounds in the skin that are subject to excitation by visible li Heme Synthesis
60yo M with 6-month hx of fatigue. Four years ago, had subtotal gastrectomy after gunshot wound. Drinks 6-8 beers daily. PE shows paresthesias of both hands. Labs show: Hb 8, HCT 24%, MCV 115, WBC 5k, Platelets 165k, RBC Folic acid 500 (N = 125-600), B12 Pariteal Cells
40yo M with interstitial pulmonary fibrosis has greater maximal expiratory flow rate than predicted. Which best explains this? Increased radial traction on airways
20-year-old F secretary with 8yr history of intermittent headaches. Flashing lights in her right visual field, followed 20 minutes later by a unilateral throbbing headache accompanied by nausea and vomiting. occur around time of menses. Dx? Migraine
70 yr old african american women come to physician after 1 day onset of back pain. She's a part time cashier, low income, and smoked 1/2 a pack for 50 years and drinks 3 caffeinated beverages a day. X-ray shows vertebral compression fracture of L3 and she Gender
5-year-old-boy with mental retardedation is grossly obese and has facial features of Prader-Willi syndrome. Karytoyping and flourescent in situ hybridization studies do not show deletion in the usual site. Which to confirm PWS? Maternal Origin of Chromosome 15
83yo M from Puerto Rico with weight loss and abdominal pain and blood in his stool for 1 month. Possible colon cancer. Poor english. Needs colonoscopy but family doesn't want to hear bad news and wants to make decision for about his treatment. Next step? Use a Spanish-speaking interpreter to determine how much the patient wishes to know about diagnosis and treatment
38-year-old F undergoes laparoscopic cholecystecomy with general anesthesia. Afetr she awakens postoperatively, she is nauseated and vomits threee times in 20 minutes. Treatment for N/V? Ondansetron
During an experimental study of oxygen consumption in the kidney, experiemtnal animals are ventillated with 100% nitrogen. Cells from which of the following areas of the kidney first show signs of anoxic injury? Distal convoluted tubule?
7-year-old girl 30 minutes after being hit in the mouth with basketball. Something stuck in her throat. Part of one tooth is missing. Lateral x-ray of the neck and chest is shown; arrow shows part of the tooth. Greatest risk for aspiration into which lobe Right Lower
Poliovirus mRNA lacks a 5' m7G cap but is translated efficiently by cellular ribosomes. Which of the following additional structural features of poliovirus mRNA is the most likely cause of its ability to be translated in the absence of a cap? Presence of an internal ribosome entry site
67-year-old F brother and mother have history of colon cancer. Physician recommends colonscopy, but patent only wants her stool to be tested for blood. Most likely concerned about which of the following regarding this test? Low specificity
69-year-old African American woman has moderate hypertension and type 2 DM. BMI 31. On hydrohlorothiazide. Labs show microalbuminuria. Most appropriate to add which drugs? Irbesartan
36-year-old man with 2-hour history of pain and swelling of his right calf. No shortness of breath or chest pain. 18-hour airplane trip 4 hours ago. Noninvasive vascular studies show an occlusion of right femoral vein. Immediate therapy has which mechanis Activation of antithrombin III
64 yr old alcoholic man with 1 day of confusion. Disoriented, disheveled. Dehydrated, jaundiced. and has spider angiomata over face and chest. Has flapping up and down of the hands when his arms are outstretched. Abdominal distention and bulging flanks. H Killing of bacteria in the gut that generate ammonia
1 year old boy is brought in. Has white, pale hair that hasn't changed color since birth. His eyes are blue. During opthalmic examination, the patient turns away from the flashlight and starts crying. Which of the following is the most likely cause of the Inability to make melanin
2-year-old boy with developmental delay. Hx of hearing loss in mother and delayed speech in older sister. Maternal uncle had stroke-like episodes at the age of 25 years. Physical shows ophthalmoplegia and hypotonia. Lactic acid concentration increased. E Heteroplasmy
Male newborn at 28 weeks' is tachypneic and hypoxemic. Which altered structure changes in the type II pneumocytes is the most likely cause? Decreased numbers of lamellar bodies
16-year-old girl with cystic fibrosis with 3-week history of generalized weakness, numbness and tingling of her arms and legs, and difficulty walking. Not adhered to medications. Bilateral weakness and decreased deep tendon reflexes in the upper and lowe Vitamin E
48-year-old woman with 6-month hx of irregular menstrual periods and hot flashes. LMP 35 days ago, and had scant blood flow. Menses had previously occurred at regular 28-day cycles. Mild thinning of the vaginal tissue. Labs most likely to show which of th Decreased follicle-stimulating hormone
62-year-old M with unstable angina pectoris undergoes coronary catheterization. To visualize the anterior interventricular (left anterior descending) artery, the tip of the catheter would need to be placed into the orifice of which arteries? Left coronary
35-year-old F with intermittent sharp chest pain exacerbated by deep breathing, and can be decreased by leaning forward. 2-month hx of pain and swelling in her hands and knees accompanied by morning stiffness that lasts 1 hour. Pulsus paradoxus less than Pericarditis
60-year-old M with a systolic murmur is a heard, which is loudest at the point indicated by the X in the diagram. Which cardiac abnormality is the cause? Aortic valve stenosis
31-year-oldwoman with invasive squamous cell carcinoma of the cervix. Biopsy shows tumor cells express human papillomavirus, type 16 antigens. Which cell types plays a role in recognizing and killing these virus-infected tumor cells? T lymphocytes
An 85-year-old woman is diagnosed with a fracture of the right femur and begins treatment with morphine by patient-controlled analgesic pump. Three days later, her respirations are 6/min. Physical examination shows pinpoint pupils. Her serum creatinine co Morphine is metabolized to active metabolites that accumulate
35 y/o man with 3 yr history of enlarging nose, coarse facies, muscle weakness, increased hand/foot size. Large fleshy nose and prognathism on exam. High IGF-1 in serum. MRI shows pituitary adenoma. Morphologic analysis of the tumor shows a densely granul Adenlyl cyclase
30-year-old woman with Li-Fraumeni syndrome found to have adenocarcinoma of the breast. Family history includes osteosarcoma. Which mechanisms underlies this condition? Impaired regulation of apoptosis
56-year-old with palpable hard nodule on prstate has increased serum prostate-specific antigen concentration. Fine-needle biopsy specimen shows adenocarcinoma. Patient undergoes radical prostatectomy. Which structure is at greatest risk for injury during Pelvic parasympathetic nerves
56-year-old woman frequently burned herself while cooking. Loss of pain and temperature sensation in both upper extremities and portion of her trunk from clavicles to just below the nipples. Touch, vibratory sensation, and proprioception normal. Findings Syrinx of the central region of the spinal cord from C-4 to T-5
25-year-old man comes to the physician 8 hours after the onset of severe pain of his low back that radiates down his left leg. He started a weight-lifting regimen earlier in the day during which he tried to lift a bar loaded with 91 kg (200 lb) from the g Rupture of an intervertebral disc
43-year-old man with 6-week hx of sharp, stabbing pain on the left side of his face that occurs when he touches it. Pain when shaving. Pain just lateral to the left nasal ala reproduces the pain. Nerve supplying this area exits the skull through which for Rotundum
33-year-old man with 3-month hx of muscle weakness and cramping, appears shortly after he begins exercising. Serum creatine kinase increased. Venous blood from antecubital vein show lactate concentrations do not increased compared with preexercise values. Glycogen phosphorylase
67-year-old man with 2-month hx of weight loss. Has type 1 DM, gallstone removal 12 years ago, smoked 1 pack daily for 45 years. BMI 34, Calcium concentration of 11 mg/dL. Abdominal CT shows a pancreatic mass, biopsy shows pancreatic adenocarcinoma. Stron Cigarette smoking
28-year-old woman with 1-week history of fever and chills. 4.5-kg weight loss, 5-year hx of chronic sinusitis. Mildly distressed. BMI 18. Temp is 39 C (102.2 F). Has markedly diminished nasal septa. Chest x-ray shows multiple pulmonary nodules. Serologic Wegener granulomatosis
52-year-old man with 3-week history of increased thirst and urinary frequency; 4.5-kg weight loss. Has hypertension and hyperlipidemia treated with pravastatin and metoprolol. BMI 34. Which is most likely to be increased? Fasting serum glucose concentration
48-year-old man with possible hypertension. On basis of ten measurements, the patient's average diastolic blood pressure is 113, and standard deviation is 8. If four rather than ten measurements are made, which is the expected impact on 95% confidence int Increase in width
66-year-old M with 6-month history of decreased exercise tolerance and shortness of breath with exertion. Vitals stable. Auscultation shows bilateral basilar crackles. Cardiac examination shows S3 gallop. Grade 2/6 holosystolic murmur heard best at the ap Dilated cardiomyopathy
29-year-old woman for advice on losing weight. Has been taking thyroxine for several months in attempt to lose weight. Her thyroid function is normal. Which findings is most likely on histopathologic eam of the thyroid gland? Follicular atrophy
44-year-old man with 2-month history of abdominal pain and diarrhea. Pain relieved after eating and antacids. EPigastric tenderness. Serum gastrin concentration of 500 pg/mL (N=50 - 100) and gastric acid secretion of 80 (N=6-40). Most definitive treatment Surgical removal of the suspected tumor
50-year-old man with progressive bulge in his abdomen during past 6 months. No changes in bowel habits. Midline hernia above umbilicus that cannot be reduced be gently pushing on it. Operative repair initiated. Which extracellular matrix components requir Collagen
50-year-old man with progressive bulge in his abdomen during past 6 months. No changes in bowel habits. Midline hernia above umbilicus that cannot be reduced be gently pushing on it. Operative repair initiated. Which extracellular matrix components requir Lysosomes
53-year-old man in ED 1 hour after right-sided weakness. Right perioral droop. Babinski sign present on the right. CT scan of the head shows no abnormalities. One week later, a repeat CT scan shows a small area of hypodensity involving the left internal c Microglial cells
38-year-old woman in for pre-employment exam. No illness. No meds. Labs show Hb 8.2, HCT 25%, MCV 69. WBC 5.9k, Retics 0.8%, platelets 350k. Dx? Iron deficiency anemia
27-year-old man with acute myelocytic leukemia receives high-dose cyclophosphamide in preparation for hematopoietic stem cell transplantation. Which will decrease toxicity from this chemotherapy regimen? Mesna
30-year-old man develops hemoptysis, dyspnea, weakness, and hematuria. Diffuse pulmonary hemorrhages bilaterally. Renal biopsy shows focal glomerular necrosis with crescent formation and linear deposition of IgG and C3 in glomerular capillary loops. Patho Autoantibodies against host cell basement membranes
21-year-old woman with 2-week hx of blood-tinged vomiting. 2-year hx of self-induced vomiting after gorging on food. BMI 24. Which drugs is most appropriate? Fluoxetine
56-year-old man scheduled for physical therapy 3 days following right shoulder operation. Therapy to strengthen the infraspinatus and teres minor muscles. Which should this patient perform against resistance? Lateral (external) rotation
cASPofungin cell wall inhibitor used in invasive aspergillosis
Rx to avoid in Pregnancy SAFE Moms Take Really Good Care Sulfonamides, Aminoglycosides, Fluoroquinolones, Erythromycin, Metro, Tetra, Ribavirin, Griseofulvin, Chloramphenicol
22q11 synd (DiGeorges) Truncus Arteriosus, TOF
Heart defects seen in Turner's Syndrome Preductal Coarctation
Heart defect seen in Congential Rubella Septal defects, PDA, Pulmonary Artery Stenosis
Problems seen in diabetic mother's children Transposition of great vessels hypoglycemia after birth clavical fractures and erb's palsy
Sx Hypochloremic metabolic alkalosis w hypoKalemia, nonbilious projectile vomiting Congenital Plyloric Stenosis
Thoracodorsal + pathology unable to wipe bottom
Suprascapular + pathology trouble initiating arm abduction
Nerve runs with lateral thoracic artery long thoracic nerve
Nerve runs with deep brachial artery radial nerve
Medial Nerve + pathology loss of forearm protonation
Hemochromatosis Gene HLA-A3
PAIR Ankylosing spondylitis gene HLA-B27
Graves' Dz Gene HLA-B8
Axillary lymph node location/drain upper limb lateral breast drains
What drains to Celiac lymph nodes stomach drains into
Sigmoid colon drains to colic --> inferior mesentary
What drains to the internal iliac rectum above pectinate
What drains to the superficial inguinal anal canal scrotu thigh
What drains to superficial/deep plexus -> paraaortic lymph node testes
What drains to thoracic duct drains to L subclavian & internal jugular
What drains to right lymphatics drains to brachiocephalic vein
IL-12, IFN b, IFN a --> enhances NK cells
T cells receptors TCR CD28 CD3
CD 21= EBV receptor on B cellls
Helper T cell receptors CD4 CD40L
B cell receptors CD19,20,21 CD40 MHCII B7
Macrophage receptors MHC II B7 CD40 CD14***(endotoxin receptor) receptor for Fc & C3b
NK cell receptors MHC I CD16 (binds IgG Fc) CD 56***
Protection from Complement CD55 CD59
IL1--> stimulates endothelium adhesion molecues
IL6--> fever acute phase proteins
IL8--> major neutrophil chemotaxis
Neutrophil chemotaxis--> IL8 Leukotriene B4 C5a
IL12--> T cells into Th1 cells activate NK cell secreted by B cells
Secreted by Macrophage--> IL 1,6,8,12 TNF a
TNF-alpha causes septic shock vascular leak, activate endothelium acute phase pro
Secreted by Th1 cells IL2 IFN y
Secreted by Th2 cells IL4 IL5 IL10
IL5--> stimulates eosinophils
Interferons a & b causes induce ribonucleases block viral pro synthesis
IFN y causes increase in MHC I and II
IL3 causes all T cells to secrete
Bacteria with Ag variation Salmonella (2 flagellar) Borrelia N gonorrhea (pilus)
IFN a & b does what? released by virally infected cells
IFN y does what? inhibits production of Th2 cells
Terminal deoxynucleotidyl transferase--> adds DNA during recombination of Ab diversity (B cells)
C3b & IgG primary opsinins
Preformed Ab= passive immunity conditions To Be Healed Rapid Tetanus, Botulinum, HBV, Rabies
Name all granulomatous conditions fungal (histo, blasto) syphilis (gummas) leprosy cat scratch fever (Bartonella henseliae) sarcoid crohn's berylliosis listeria foreign bodies wegeners (necrotizing granulomas) Chronic Granulomatous Dz
MOA of hypersensitivity type 1 IgE and histamine 15 min
MOA of hypersensitivity type 2 Ab mediated hypersensitivity IgM, IgG direct and indirect Coombs test
MOA of hypersensitivity type 3 Arthus reaction Ag-complement-IgG complex 5-12 hr
MOA of hypersensitivity type 4 T cell mediated 24-48 hr
B cell Conditions Bruton's CVID Hyper IgM Ig deficencies
T cell Conditions DiGeorges Job's synd (FATED) IL-12 r def chronic mucocutaneous candidiasis
B & T cell Conditions SCIDS Ataxia-Telangiectasia Wiskott-Aldrich
Phagocyte Conditions Chediak & Job Chronicallly Lack phagocytes (CGD and Leukocyte adhesion def)
DiGeorges Child HALLMARK young child w tetany from hypoCa++ and candidiasis
CGD Child HALLMARK young child with recurrent lung infxn and granulomatous lesions
Ectoderm missing in DiGeorges 2yo child multi viral and fungal infxn, hypoPTH, what germ layer gives rise to missing organ?
Jobs Syndrome Symptoms repeated Staph abcesses, neutrophils don't respond to stimuli
DiGeorge Symptoms heart defects and repeat viral infxn, low T cells
MOA in Bruton's no tyrosine kinase gene, low Ig of all classes
MOA in Hyper IgM defective CD40L severe pyogenic infxn high IgM, very low IgG
IgA Deficency Symptoms milk allergy repeated sinus infxn
CVID Symptoms defect in B cell maturation lymphomas low plasma cells
IL-12 receptor Deficency Symptoms disseminated mycobacterial infxn low IFN y
IL-2 r, ADA def, MHC II def= 3 types of SCID
SCID labs high adenine low IL-2r
Ataxia Telangiectasia Symptoms DNA repair enzyme defect IgA def
Wiskott-Aldrich Symptoms X-recessive Thrombocytopenic purpura Infxn Eczema Recurrent pyogenic infxn
Leukocyte Adhesion Deicency Symptoms defect in LFA-1 integrin delayed umbilicus separation
Chediak Higashi Symptoms partial albinism pyogenic infxn neuropathy
Deficency of MAC C5-9 Symptoms recurrent Neisseria infxn
EEG waveforms BATS Drink Blood Beta= eye open Alpha= awake, eyes closed Theta= light sleep Sigma= sleep spindles Delta= low freq, high amplitude REM= Beta= highest freq, low amplitude
SEM * 2 +_ mean how do you determine 95% confidence interval?
3rd gen cephalosporins uses serious gram - (Ceftriaxone= meningitis & gonorrhea)
4th gen cephalosporin uses pseudomonas & gram +
Aztrenonam USE binds PBP3 no penicillin allergy
How are aztreonam & aminoglycosides similar? serious gram - infxn (aztreonam= aminoglycoside pretender)
Imipenem & meropenem enterococci gram +/- anareobes (very broad)
Next step in TX of otitis if resistant to amoxicillin Augmentin
What increases nephrotoxicity of aminoglycosides? Cephalosporins
Symptoms of Haemophilus influenza MOPE Meningitis, Otitis media, Pneumonia, Epiglossitis
Symptoms of Pseudomonas PSEUDO Pneumonia, Sepsis, External otitis, Uti, Drug use, diabetic Osteomyelitis
Enterobacteriacae gut KEES PSS Klebsiella, E coli, Serratia, Proteus, Salmonella, Shigella
Most common cause of gram - sepsis Ecoli + Klebsiella
Symptoms of Protease carries urease cause staghorn calculi in renal
Symptoms of Klebsiella 4 A's Aspiration pneumonia, Abscess in lungs, Alcholics, diAbetics nosocomial UTI's
Urease + Bugs H. pylori Proteus
Cat scratch organism Bartonella Henselae transmission
Dog/cat bite organism Pasturella Multocida transmission
Cat feces organism Toxoplasmosis transmission
Puppy feces organism Yersinia enterocolitica transmission
Animal urine organism Leptospira transmission
Rat bites organism Spirillum Minus transmission
Spirochetes organism BLT Borrelia, Leptospira, Treponema
Reiter's Syndrome bug shigella flexneri C trachomonas D-K
Motile organism cause UTI Proteus
Uses for macrolides PUS Pneumonia (atypical- mycoplasma, chlamydia, legionella), UTI, STDs
Most common UTI bugs PEcK+ S. Saphrophyticus #1= Ecoli
Drugs for anaerobic infections Metro, clindamycin, imipenem
Conditions associated with Use of Metronidazole GET GAP on the metro Giardia, Entamoeba, Trichomonas, Gardnerella, Anaerobes, h Pylori
MOA of Metronidazole from free rads in bacteria- damage DNA
H pylori Triple Therapy PPI, clathromycin, amoxicillin/metro
Effective against Pseudomonas TCP Cefapime Aztreonam Fluoroquinolones Aminoglycosides Polymixins
What type of hallucinations causes what type of conditions ViAO = De Sc Ep tion Visual= Delirium Auditory= Schizo Olfactory= Epilepsy
Side Effects of TCA Tri=C's Convulsions, Coma, Cardiotox
Side Effects of High Potency Neuroleptics haloperidol, trifluoperazine, fluphenazine NMS & tardive dyskinesia
Side Effects of Low Potency Neuroleptics thioridazine, chlorpromazine anticholinergic, antihistamine, a block
Patient on diphenhydramine & dementia wants sleep meds, which Rx trazadone or high potency antipsychotics (b/c less anti-Ach SE)
MOA of benzos and barbituates increase in GABA (cl- channel vs duration)
SNRIs venlafaxine, duloxetine, nefanizone
MAOIs the MAOI PITS Phenelzine, Isocarboxazid, Tranylcypromine, Selegiline
NDRI Buproprion
Tetracyclics Mirtazapine= use for Depression w insomnia Trazadone= use for insomnia
Prevent relapse in alcoholics 1 AA 2 disulfram 3 naltrexone 4 topiramate 5 acamprosate
Unique properties of this Rickettsial organism Coxiella Burnetti neg Weil Felix from tick feces and cattle placenta - spores aerosilized sx w no rash
Zoonotic Bacteria Big Bad Bed Bugs From Your Pet (Ella) Bartonella spp, Borrelia burgdorferi, Borrelia recurrentis, Brucella spp, Francisella tularensis, Yersinia pestis/enterolytica, Pasturella multocida
Symptoms of Chlamydia Trachomatis 50% subclinical type D-K: urethritis, PID, ectopic preg, neonatal pneumonia type L1,2,3: lymphogranuloma venereum, lympadenitis, ulcers
Symptoms of C. Pneumoniae & Psittaci atypical pneumonia (aerosol)
Antibiotics contraindicated in hepatic insufficiency MCMCRT Metro, Chloramphenicol, Macrolides, Clindamycin, Rifampine, Tetracycline
Ghon focus Calcified Scar
Ghon complex Ghon focus + hilar nodes
Symptoms of Mycobacterium kensaii cause pulm TB-like sx in COPD pt
Symptoms of Mycobacterium kensaii in child cause cervical lymphadenitis in children
Impenem SE of Ethambutol red-green color blindness
Rifampin uses TB & leprosy meningococcal prophylaxis Hib
Macrolide drugs azithromycin class
Fetal Erythropoiesis Young Liver Syn Blood Yolk Sac-> Liver->Spleen->BM
Truncus Arteriosus ascend. Aorta/Pulm trunk embryol structure
Bulbis Cordis R ventr and smooth parts of L&R ventri embrol structure
Trabeculated parts of L&R ventricle L ventricle embryo structure
Pain radiating to back acute pancreatitis dissecting aortic anuersym diaphragm pain cholecystitis
Patent urachus urine discharge from umbilicus vesicourachal diverticulum (=lesser)
Vitelline duct fails to close meconium discharge from umbilicus meckel's diverticulum (=partial closure)
Primitive atria becomes trabeculated L&R atria embrological structure
A gardener presents with SOB, salivation, miosis, and diarrhea. What is the cause/ MOA? Organophosphate poison, anticholinesterase
Atropine is not effective in reversal of organophosphate poisoning. Why? What helps? No effect on cholinesterase, use Pralidoxime
What muscarnic agonist / antagonist is used in asthma / COPD? Ipratropium (an antagonist)
30 YO has urinary rentention due to neuroleptic, what do you treat with? Cholinergic Agonist (problem is anti cholinergic s/e's
In Dark both pupils dialate. In light one pupil is miotic while another, given drug X, is mydratic. What is X? Anticholinergic (atropine)
What drug is most apropriate in a pt with shock in order to maintain renal blood flow Dopamine (although clinically doesn't really work)
60 YO male. Has a hard time driving at night due to worsening vision and halos appearing around headlights. What is causing this? Cataracts
A gymnast sustains an anterior shoulder dislocation. What nerve is injured? Axillary n.
A kid falls while skateboarding and injures his elbow. He can't feel the medial part of his palm. What nerve is injured? What "sign"? Ulnar N. Ulnar Claw (can't extend 4/5 digits)
A highschool athlete falls on his arm. Radiograph shows midshaft break of humerous. Which nerve / artery are at risk? Radial n. Deep Brachial Art.
What patients are suseptible to Listeria? Immunocompromised, Neonates, Pregnant Women
What organisms are implicatd in subacute endocarditis? S. Veridians, Staph Epi, Enterococci. Staph Aure = Acute not subacute
A woman is breast feeding develops swelling and redness over her right breast. Exam reveals a warm, fluctuant mass. What is this? Acute Mastitis -> Staph Aures
Most common aerobic skin flora? Staph Epidermis
6 month old child is given HONEY for a cough and cold and becomes flaccid. What causes this? MOA? C. Botulinum (Gm + Rod) inhibits Ach release
One hour after eating a potato salad at a picnic. Whole family vomits. 10hrs later they are better. Whats the cause? Staph Aureus. Preformed toxin ingested (no infection)
Which complement is responsible for neutrophil chemotaxis? C5a (also leukotriene B4, IL8)
Child presents with TETANY from hypocalcemia and CANDIDASIS due to immune suppression. What is deficient? What is the condition? T cells, No Thymus = DiGeorges (22q11, "CATCH-22")
A young child has recurrent LUNG infection and granulomatous lesions. What defect in neutrophils causes this? Lack of NADPH oxidase = no respiratory Burst
Mother brings 2 y/o child w/ Hx of multiple viral, fungal infections and the child is HYPOCALCEMIC. Which Germ layer gives rise to the missing structure? (Endo, Ecto, Meso) No Thymus, DiGeorge Syndrome, Endoderm (from tongue)
A child with immune diorder w/ repeated Staph Abcesses. Neutrophils do not respond to chemotactic stimuli. What is the diag? Hyper IgE aka Job Syndrome
A patient suffers recurrent Neisseria Infections. What part of complement is defective? C5-C9, (LatE)
How does mechanism of Type 2 Hypersensitivity differ from Type 3? Type 2 = Ab against SELF antigens. Type 3 = Ab's against REAL antigens. Complexs get stuck places and cause problems.
45 y/o female, MALAR RASH and ARTHRITIS. Which Ab is specific for the condition? Anti dsDNA, Anti Smith. ANA is nonspecfic
After bone marrow transplant a patient suffers dermatitis, enteritis, and hepatitis? What is the condition? Graft vs Host Dz.
A physican is looking for a risk factor for Pancreatitis. He interviews 100 w/ and 100 w/o pancreatitis. What kind of study is this? Case Control
New glucose test arrives. You test it with a solution of 90mg of glucose. The test gives you the following readings: 54, 56, 55, 54, 53, 56, 55, 54. What is its presions and accuracy? High Precision; low accuracy (value stays in the 50s while not accurate which 50s value)
A group of ppl who smoke and do not smoke are followed over 10 years. Every two years they check who develops cancer. What kind of study is this? Cohort
A certain screening test has a 1% false negative rate. What is the sensitivity? 99%
Prevalence of Varicella in Pop A is 2x that of Pop B. It has the same incidence in both populations. Why is the prevalence different? Dz in Pop A has longer duration
State the diagnosis: Gm (-), OXIDASE (+), DIPLO COCCI Neisseria
22 y/o medical student. Burning feeling AFTER MEALS. EGD shows gm (-) RODS in gastric mucosa, what are they? H. Pylori
50 y/o male smoker with new cough and flu like symptoms. Gm stains shows nothing. SILVER STAINS shows rods. What is the diagnosis? Legionella (atypical pneumonia)
40 y/o female. Acute unilateral knee pain and bilateral BELLS PALSY. What organism? How is it transmitted? Lyme Disease via Burreli Burgdorferi via Tick
21 y/o male. 5 day hx for fever chills and enlarged painful knee. What organism? And what treatment? Gonorrhea -Ceftriaxone or Azithyromyocin if allergy
After taking a course of Amoxicillin, and adult pts develops toxic MEGACOLON and DIARRHEA. What caused this? C. Diff
25 y/o with mycoplasma atypical pneumonia, exhibits anemia due to cryoagglutinins. What type of Ig is responsible for anemia? IgM
Homeless alcoholic pt vomited while intoxicated. Develops FOUL smelling sputum. What organism? Klebsiella or anerobe
65 y/o asks husband to stay in hospital overnight b/c she is afraid of being alone. What defense mechanism is this? Regression
Which defense mechanism underlies all others? Repression
60 y/o man admitted for chest pain, jumps out of bed and does 50 push ups to show he has not had a heart attack. What is the defense mechanism? Denial
4 y/o girl complains of painful genitalia. On exam discharge with smear showing N. gonorrhoeae. What happened? Sexual Abuse
72 y/o patient is unable to recall 3 objects during mini mental status exam. When asked what he would do if he smelled smoke he says "yell fire". When asked what a table can chair have in common he says both are made of wood. Family reports he needs const Dementia
72 y/o brought to the clinic by family. Strange behaviors in last week. Very agitated, NAPS frequently during the day, URINATES on self, poor appetite. Unable to focus during exam. Diagnosis? Delerium
You are on call and receive a call from a nurse asking to give sleep medication (diphenhramine) to an ELDERLY pt. with DEMENTIA. What do you do? No diphenhydramine, no Benzos, use Trazadone or Haliperidol
A patient tries to commit suicide by cutting wrists. After beening cared for in the ER, what question would you ask to determine her level of commitment? What did she do after cutting her wrists? Call someone? Lie in a bathtub?
28 y/o female with mild depression for 2 yrs. What diagnosis? Dysthamia
2 months after losing her spouse a 42 YO female is having trouble eating, concentrating, and sleeping/ What do you do? This is still with in normal. But you can tx the insomnia and help with trazadone or something else
A patient on whom you want an MRI tells you they are claustophobic. What can you do? Give two Benzos prior to MRI
A young woman is anxious about her 1st pap smear and is told to realx and to imagine what the steps are. What is the process and example of? Systamatic Desensitization
A woman has flashbacks about her boy friends death one monnth ago in a hit and run accident. She often cries and wishes for justice. Diagnosis? Normal Greif
Nurse has hypoglycemia with no elevation of C-protein. Diagnosis? Malingering or Facistious depenidng on 2nd gain
40 YO female tells you she is in love with you. You refer her (which you should never do during USMLE) and she attempts suicide. What is this personality disorder? Splitting (Borderline )
30 Yo woman tells you that you are the best doctor and the nurses are very bad. On subsequent visit she threatens to change doctors because you do not feel a specific lab test is justified. You also notice several "scartches" on her left arm. What persona Splitting (Borderline )
55 YO female wearing all black with a black feather boa and excess lipstick. What type of personality disorder? Histrionic
A pt. demands only the best most famous doctor in town. What personality disorder? Narcissistic
A patient returns from a trip to New Mexico, now has pneumonitis. What is fungal cause? Coccidioidomycocces
A 30 Yo female has "cauliflower" skin lesion. Tissue biopsy shows broad based budding yeast. What is this organism? Blastomycoisis
An HIV (+) pt with CSF showing 75/mm3 lymphocytes suddenly dies. Yeast is identified in the CSF. What is the diag? Cryptococcus
A pt presents with a "rose garden scenario" (thorn prick with ulcers along lymphatic drainage). What is infection? Sporothrix
A Pt who visited Mexico presents with Bloody Diarrhea. What infection could be found in the stool? Cryptosporidium (usually filtered from city water supply....) more severe in AIDS
32 YO male went camping in N. California 2 wks ago. Pt had a 2 day stint of diarrhea and how has liver damage and Jaundice. What is the diagnosis? Entamoeba Histolytica (not Giardia b/c Jaundice is present)
Pt returns after 2 wk vacation in Africa. Typical malaria presentation and recurrent fever. What is the mechanism for the cyclic? Malaria cycle in RBS's causing lysis every 48-72 hrs
Which Fetal Vessel has the highest 02 concentration? Umbilical Vein (1 verin, 2 arteries)
45 YO male with BP 160/90 on right arm and 170/92 on the left arm. No pulse in feet or ankle. What is the diagnosis? Coarctation of the Aorta (adult type)
Describe blood flow through a PDA? Just for fun what keeps it open, what closes it? Left to right shunt. (during pregnancy not called "patent" so incorrect to say R-> L then becomes L-> R). Hear a continuous machine murmer. Open = PGE, close = indomethacin
Monozygotic twins are delivered. One is pale and has a hematocrit of 15% the other is flushed with hct of 55%. What caused this? who will do better? This is twin transfusion, mostly like due to monochorionic, mono amniotic pregnancy. Twin with lower hct will do better due to "sludging" in the one with high hct.
A child presents with Cleft lip. What process failed? Fusion of the maxillry process with the Medial Nasal Process. Cleft lip is mostly a aesthetic defect were cleft pallate has functional defiect as well
23 YO male presents with one testicle. what is he at risk for? Germ Cell tumor of teste
24 YO male develops testicular cancer. Mets spread where? via Inguinal canal to para-aortic LN's
16 YO female with amenorhea. Pt lacks uterus and uterine tubes. Has two round structures in midline just superior to labia majora. What is the diagnosis? Androgen Insensitive (46XY)
While on an ACE-i a pts develops a cough. Why? what is a replacement? No Ang II = build up of bradykinn = cough. Use AngioTensin II Receptor Blocker (ARB)
40 yo male on lipid lower meds. Develops rash, puritis and diarrhea. What drug? Is this a allergic rxn? what mediates this response? Niacin, not allergic due to prostaglandins (take asprin b4 hand to decrease) also dec with long term therapy)
What is mechanism of action of Cardiac Glycosides (Digoxin)? Blocks the Na/K atpase pump. Na leaves cell via Na/Ca counter transporter and increases intracellular Ca lvls = better contractility
An abdominal Aortic aneurysm is most likley due to? Atheroscerois
A pt with poorly controlled HTN has actue sharp substernal pain raidiating to the back. Death occurs within a few hours. Diagnosis? Dissecting Aorta
During a high school football game a young athlete collapses and dies immediately. What is the condition? Hypertrophic cardiomyopathy
What murmers are heard best in the Left Lateral Decubitous Position? Mitral Stenosis/ Regurg. And Left sided S3 / S4
80 YO male. systolic cresendo decresendo murmur. What is the condition? Aortic Stenosis (probabley due to calcified aorta)
IV drug user presents with Chest pain, dyspnea, tachycardia, tachypnea. What is the condition? Bacterial Endocardidits -> PE (remeber drug users get it on the right)
Pt brought to ER after MVA presents with chest pain, dyspnea, tachycardia, tachypnea. What is the condition? Tension Pneumothorax most likely, could be Cardiac Tamponade too
Post-op pt presents with Chest pain, dyspnea, tachycardia, tachypnea. What is the condition? PE
A young girl with a congeital valve dz is given penicillin prophylactically. In the ER bacterial endocarditis is diag. What is next? IV Vancomyocin and possible echo to check valves (might need replacement)
An adult pt with hx of HTN presents with sudden sharp, tearing pain, radiating to his back. What do you see on CXR? Widening of the mediastinum (Dissecting Aorta)
On auscultation of a patient you hear a pansystolic murmur at the apex with radiation to the axilla. Cause? Mitral Regurgitation (Aortic Stenosis is not PANsystolic)
A 25 YO pregnant woman in her 3rd trimester has normal BP when standing and sitting but drops to 90/50 when she lies supine. What is the condition? Compression of IVC, dont lie on your back.
45 YO male with squamous cell carcinoma of the penis. He had exposure to what Virus? HPV - 16 / 18
20 YO college student presents with LAD, fever, and hepatosplenmegaly. His serum agglutinates sheep RBC's. What cell is infected? B Cells - EBV mononucleosis (+) monospot. Cause of (-) monospot mononucleosis? CMV
How does rabies travel through the CNS to cause fatal encephalitis and seizures? Retrograde along neurons
What is the characteristic shape of rabies? Bullet Shaped
An adolescent presents with cough and rust colored sputum. What does gm stain show? Strep. Pneumo -> Gm (+) diplococci
HIV (+) pt with a CD4 count of 250 presents with signs of meningitis. CSF shows a heavily encapsulated organism. What is it? Cryptococcus Neoformans
An older patient has blood in his urine and renal stones. What organism? Proteus
A 50 YO pt is recovering from Abd surgery from 2 days ago. He has had an internal catheter in place since then. He now has a fever of 100F. Most likely organism? E-Coli (UTI)
Hemidesmisomes, cadherin, integrin, ICAM-1. Which joins only cells of teh same type and does not attach to the basement membrane? Cadherin
Where does new bone formation take place in growing long bones? Epipseal Plate
A football player was kick in the legs and suffered a damaged medial meniscus. What else is likely to have been damaged? ACL, MCL
A man presents with pain and swelling of the knees, subcutaneous nodules around the joints and achilles tendon, equisite pain in the metatarsophalangeal joint of his right big toe. Biopsy reveals needle like crystals. Most likely Gout
Treatment of Acute Gout exacerbation? NSAID, Colchicine
A patient has difficulty swallowing, distal cyanosis in cold temp, anti-centromere antibodies. What other S/S will you see? CREST: Calcinosis, Sclerodactyly, Telangiectasia
A patient presents with photosensitivity, arthritis, renal disease and recurrent oral ulcers. She is taking Primaquine and NSAIDS. What should be checked 2/yr? Renal Fxn (SLE)
30 yo woman presents with low grade fever, rash across her nose and gets worse in the sun and widespread edema. What blood test would you use to screen? ANA - SLE
A CT scan of the chest shows bilateral hilar LAD. What is the diagnosis? Sarcoidosis
A 75 yo male presents with acute knee pain and swelling. X ray reveals erosion of the joint space and calcium deposits in the menisci. What is Diag? What would be found on FNA of joint? PsuedoGout -> Calcium pyrophosphate
A 50 YO female complains of double vision, amenorrhea and headaches. What is likely diagnosis? Prolactinoma
A patients MRI shows replacment of tissue in the sella tursica with CSF. What is the presentation? Most likley asymptomatic or defieciency in Pituitary Hormones
What hormones come from the anterior pituitary? FSH, LH, ACTH, GH, prolactin, TSH
Which hormones share a common alpha unit? FSH, TSH, LH, bHCG
A young woman is found to have short stature and shortened 4th and 5th metacarpals. What endocrine disorder is this? Albrights osteodystrophy (Pseudohypoparathydroiism) aka body not responsive to PTH
35 yo female presents with diffuse goiter and hyperthyroidism. What is TSH / T3/ T4? Low TSH High T3,T4
48 YO female presents with progressive lethargy, and extreme cold sensitivity. What is Diag? Lab values? Hypothyroid / Hasimotos most likely (High TSH low T3/4)
An adult male with elevated serum cortisol and signs of cushing syndrome undergoes dexamethasone suppresion. 1mg does not decrease cortisol, 8mg does. What is diag? ACTH secreting pituitary adenoma
A very tan child with pale mother comes in and is found to be hypotensive. What is the condition? Addisons
28 YO male with normal well managed IDDM comes in with DKA hae had recently been taking OTC cold medicine. What caused his DKA? Infection
How is hemoglobin glycosylated in DM to make HA1c? Non enzymatically (slowly do to glucose build up)
What are the sources of Carbon for Purine formation? For pyrimidine? Co2, Glycine, tetrahydrofolate / CO2 and aspartate
How does UV light damage DNA? Causes Thymine Dimers to form
What ammino acid frequently has more coding sequences in mRNAt the represented in the peptide? AUG - methione
What happens to mRNA before it leaves the nucleus? Spliced (remove introns), Poly A tail, and 5' Cap
Two pts have the same mutation on chromosome 15. but they have different phenotypic expressions. One has a mutation from the father the other from the mother. What is this an example of? Genetic Imprinting
An obese woman presents with amenorrhea and increased serum testosterone. Diag? Polycystic Ovarian Syndrome (stein-leventhaul)
What type of cancer are patients with polycystic ovarian syndrome at risk for? Endometrial
Why is progesterone used in combo with estrogen in hormone replacement therapy? To protect Uterus / endometrium from unregulated hyperplasia / cancer
What circumstance would cause an elevated LH? Polycystic Ovarian Syndrome (stein-leventhaul), physiological LH surge, low estrogen lvls, Turner Syndrome
A pregnant woman with previous C section is at increased risk for what pregnancy complications? Placenta Accreta, Previa
A pregnant women at 16 weeks gestation presents with large abd and HTN. Diag? Lab values? Hydatifrom Mole, increased beta HCG
What substance is elevated in hydatifrom moles? beta HCG (Really high in complete, slightly elevated in partial)
15 YO pt who normally comes in with her parents presents alone. She states she is sexually active but knows she is not pregnant because she has never menstrated. What should you tell her? Check for delayed puberty, talk about how you can get pregant on your first time even before you menstrated, STDs and maybe contraceptives
23 YO female is on rifampin for TB and OCP. She gets pregnant. Why? Rifampin increase Cyp450 metabolism of OCP, decreasing their effectiveness
What is the best option of birth control of mental retarted pts? Medroxyprogesterone (injection q3 months)
A 58 YO post menopausal women is on Tamoxifen. What is she at risk of acquiring? Endometrial Carcinoma
What cells are responsible for maintaing a high testosterone concentration in the seminiferous tubules? Leydig - Secrete; Sertoli - release of ABG = holds testosterone in place
A 55 y/o man undergoing tx for BPH has increased testosterone and decreased DHT as well as gynecomastia and edema. What medication is he on? Finasteride - 5 alpha reductase inhibitor (also used to treat renal stones)
Where does testicular cancer first metastasize? Para Aorotic Lymph Nodes
What protein is involved in transporting an endocytosed vesicle from the plasma membrane to the endosome? Clatherin
A patient with a corticol lesion is UNAWARE of his neurologic deficiency. Where is the lesion? Located on non dominate parietal Lobe (usually right)
What are the findings of Brown Sequard Syndrome? Ipsilateral UMN lesion below the lesion | Ipsilateral loss of tactile, vibration and proprioception below lesion | Contralateral pain and temp loss below lesion | ipsilateral all sension for a few levels above lesion | LMN at level of lesion
A man in his 40s begins to develop early dementia and uncontrolable movements of his upper extremities. where in the brain do you expect to see atrophy? Caudate -> Huntingtons
A male presents with involuntary flailing of one arm. Where is the lesion? This is hemibalismus. Contral lateral thalamus
28 y/o chemist presents with MPTP exposure. What neurotransmitter is depleted? Dopamine
A patient cannot abduct her left eye on lateral gaze but convergence is normal. She also has difficulty smiling. Where in the CNS is the lesion? CN IV (MLF tract) + CN VII. Both are at level of Pontine
28 y/o woman in a MVA. Initally feels fine then loses consiousness. CT shows intracranial hemorrhage that does not cross suture lines. What bone and vessel were damaged? MMA, and temporal bone
85 y/o man with alzheimers falls at home and presents 3 days later with severe headache and vomiting. What is the diagnosis? What is damaged? Subdural hematoma bridging veins
A woman involved in a accident cannot turn her head to the left and has a right shoulder droop. What is damaged? CN XI - accessory
A 19 y/o pt presents with a furuncle on his philtrum and the cavernous sinous becomes infected. What might you see? defects in CN 3, 4, 6
A pt has a leftward deviation of the tongue on protusion and has a right sided spastic paralysis. Where is the lesion? Left Medulla + corticospinal tract (happens before the tract decusates)
Created by: Tsantos7