UWORLD Notes by Subject (Main Division) (Usmle Grassroots)

Question
MainDivision
Id
SubDivision
Notes
654
Anatomy
Cardiovascular System
A laterally directed chest wall stab wound at the fifth intercostal

space along the midclavicular line. The structure injured would be
the *Left Lung*
1699
Anatomy
A puncture wound at the left sternal border in the fourth intercostal

space will injure the *Right Ventricle*
The aorta and superior mesenteric artery can compress the left
renal vein. The increase pressure in the left renal vein causes
retrograde blood flow to the testes and dialtion of the pampiniform
plexus ==> *VARICOCELE*
A skull fracture at the junction of the frontal, pariatal, temporal and

sphenoid bones (pterion) risks lacerating the middle meningeal
artery and causing epidural hematoma. The MMA is a branch of
*Maxillary Artery*
1805
1813
Anatomy
Anatomy
1871
Anatomy
In most poeple with right coronary dominance, Inducible ischemia

of the inferior surface of the heart would probably be due to
occlusion of *Right coronary artery*
1967
Anatomy
For graft purposes, the Great Saphenous Vein can accessed at a

site *Just inferolateral to the pubic tubercle*
2023
Anatomy
The Superior Venecava is derived from the common cardinal

veins.
2130
Anatomy
A high speed motor vehicle accident that leads to injury of aorta

would most liley ruptur that ismthus (just after subclavian artery) of
the aorta. Pt usually dies before reaching hospital. If they do reach
they present with non specific chest and abdominal pain.
7646
Anatomy
Left ventricular leads in biventricular pacemaker course through

the coronary sinus, which resides in the *Atrioventricular Groove*
on the post aspect of the heart.
8294
Anatomy
IV drug users can have righ sided endocarditis involving the

*TriCuspid Vavle* most often due Staph Aureus infection. This
often presents as an early systolic murmur best heard over the left
lower sternal border due to tricuspid regurgitation.
8332
Anatomy
Pt undergoes transesophageal echocardiography. The ultrasound

probe is placed in the mid-esophagus facing "anteriorly". The
cardiac chamber closest to the probe is *Left Atrium*
8333
Anatomy
Transesophageal echo probe facing posteriorly would interrogate

the *Descending Aorta*
11764
Anatomy
While cannulating the Right Common Femoral artery for cardiac

catherization, the physician penetrates the arterial wall above the
right ingiunal ligament. Soon after pt becomes cold, and
hypotensive. Bleeding is susupected. Most likely location is
*Retroperitoneal Space*
[CFA cannulation shud be below inguinal ligament]
11780
Anatomy
Pulmonary capillary wedge pressure (measured via a swan-ganz

catheter into the pulmonary artery) closely reflectsend-diastolic
pressure in *Left Atrium* and the Left Ventricle.
11956
Anatomy
Radiofreqyency ablation of the AV node in a pt with arrhythmia is

achieved at the *Interatrial septum near the opening of the
coronary sinus*
1106
Anatomy
Dermatology
Pt with inflamatory acne. The glands involved release secretions by

*Holocrine* manner.
[Sebacious glands]
1686
Anatomy
Ear, Nose & Throat (ENT)
The recurrent laryngeal nerve is in close proximity to the inferior

thyroid artery and can accidently damaged during inferior thyroid
artery ligation during a thyroidectomy.
1698
Anatomy
Blunt trauma to the globe can cause orbital blowout fractures.

These fractures most commonly involve the medial or inferior
orbital walls due to thin bone bordering the ethmoid and *Maxillart*
sinuses.
1814
Anatomy
Pt who faints after otoscope exam has experience vasovagal

syncope due to stimulation of post ext auditory canal. *Vagus
Nerve is affected*
11783
Anatomy
Pt with epistaxis. Silver nitrate cautery is performed and bleeding

stops. Cautery was most likely applied to *Nasal Septum*
[Most bleeds happen here in Kiesselback's plexus]
Anatomy
Endocrine, Diabetes &

Metabolism
A nerby nerve injury while ligating an artery entering the superior

pole of the thyroid lobe(superior thyroid artery) would most likely
deninnervate the *Cricothyroid Muscle* which is innevated by the
external branch of the superior laryngeal neerve.
1747
1632
Anatomy
FemaleReproductive
System & Breast
*The suspensory ligament of ovary* must be ligated during removal

of ovaries to prevent bleeding. It carries the ovarian artery. It also
known as the infundibulopelvic ligament. Note that the Cardinal
Ligament (transverse cervical ligament) holds the uterine artery
and needs to be ligated in a hysterectomy.
1739
Anatomy
FemaleReproductive
System & Breast
A *pudendal nerve* block is performed by injecting an anesthetic

intravaginally, medial to the ischial spine, through the sacrospinous
ligament. This provides anesthesia to most of the perineum.
8390
Anatomy
FemaleReproductive
System & Breast
16 year old female with pelvic pain every 28 days and resolves in a
day or two with fully developed 2ndry sexual characteristic. She
has a palpable mass anterior to the rectum. Serum Beta-hCG is
negative. Most likely Dx is *Imperforate hymen*
11781
Anatomy
FemaleReproductive
System & Breast
Pt with right sided back pain and voiding is normal after a

hysterectomy probably has an injured *Ureter* during the surgery.
Voiding is normal becuase other ureter is functionl.
11820
Anatomy
FemaleReproductive
System & Breast
Exercise to strengthen pelvic floor targets *Levantor Ani Muscle*
Anatomy
FemaleReproductive
System & Breast
To help with delivery, a vertica; midline incision is made at the post

vaginal opening through the vaginal and subvaginal mucosa. The
structure most likely involved in this incision is the *Perineal Body*
Anatomy
FemaleReproductive
System & Breast
Woman who delivers twins and has postpartum hemorrhage and

surgery is started. To control her bleeding, bilateral ligation of
*Internal Iliac* arteries is preformed and this would preserve her
fertility due to the dual supply of the uterus from the ovarian
arteries.
Anatomy
submucosal glands that have alkaline secretions in Gi endoscopy

probably are the Submucosal (Brunner) glands which can be
Gastrointestinal & Nutrition
found at the *First part Duodenum* (ampulla of vater) and the
Pylorus.
Anatomy
A peptic ulcer localized PROXimally on the lesser curvature

Gastrointestinal & Nutrition probably penetrated the *Left gastric Artery* which is a branch of
the celiac trunk.
303
Anatomy
Laparotomy shows decreased angle between superior mesenteric

artery and aorta. The structure most likley obstructed is
*Transverse portion of duodenum*
[Superior mesenteric artery syndrome]
838
Anatomy
Gastrointestinal & Nutrition Head and Body of Pancreas are Retroperitoneal.
11823
11908
129
292
Anatomy
A mass in the third portion of the duodenum that is infiltrating

Gastrointestinal & Nutrition beyond guy wall carrys the risk of compromising the *Superior
Mesenteric Artery*
Anatomy
Obese pt is interested in adjustable gastric band. In order to

encircle the stomach, the band must pass thru the *Lesser
Omentum*
(Hepatoduodenalligamnet+hepatogastricligament)
10583
Anatomy
Pt was stabbed in RUQ. He is bleeding. Brisk, n"onpulsatile"

bleeding is seen emanating from behind the lover. The surgeon
occludes the "hepatoduodenal ligament", but the pt continues to
Gastrointestinal & Nutrition hemorrhage. Most likley source of bleeding is *Inferior Vene cava*
[Pringle maneuver, hepatoduodenal ligament includes the portal
triad of hepatic artery, ven and comon bile duct][the nonpulsatile
nature of bleed make it not from an artery]
11771
Anatomy
External Hemorrhoids originate below the dentate the line. They

Gastrointestinal & Nutrition have cutanoeous (somatic) innervation from the inferior rectal
nerve which is a branch of the *Pudendal Nerve*
11775
Anatomy
11782
Anatomy
Gastrointestinal & Nutrition *Teniae coli* are used to locate the appendix.
Anatomy
Pt has mass in the middle third of the rectum extending to

rectosigmoid junction. It was resected. The lymph nodes that shud
be assessed are the *Internal Iliac lymph nodes*
(lymph drianage of rectum proximal to the anal dentate line occurs
via inferior mesenteric and internal iliac nodes, while distal to
dentate line drain into inguinal nodes)
Anatomy
Internal hemorhoids is characterized by painless bleeding,

mucosal lesnions above the dentate line on anoscopy. Constipation
can lead to it. The venous component is drained into Superior
rectal veins wich drian into The *Inferior Mesenteric Vein* which
drains into the splenic vein which drains into the hepatic portal
vein.
Anatomy
Pelvic fracture in a male can result in urethral injury leading to

inability to void despite full bladder sensation. The most commonly
MaleReproductiveSystem injured site is the *membraneous urthera* which is right after the
prostatic urethra. Both membranoeous and prostatic are part of the
post urethra.
1737
Anatomy
In a pt with BPH who is given Finasteride that acts on *The

MaleReproductiveSystem prostate* (below the bladder on CT)
(5-alpha reductase inhibitor)
8326
Anatomy
MaleReproductiveSystem The scrotum is drained by the superficial inguinal lymph nodes.
11658
Anatomy
MaleReproductiveSystem Gonadal arteries originate from the abdominal aorta!
11762
Anatomy
Undescended testes that can be felt medial to the mid-inguinal

MaleReproductiveSystem point have to only be passed through the Superficial inguinal ring
which is formed by the *External oblique muscle aponeurosis*
Anatomy
Pt that presents with amenorrhea and notes that her breasts have
become engorged. She is taking an antipyschotic drug. She
probably has galactorhea in which the dopaminergic athway
disturbance responsible is the the *Tuberoinfundibular*. It
connects the Hypothalamus to ant pit and is responsible for
dopamine-dependent prolactin tonic inhibition. The drug she is on
blocks dopain in that pathway.
1832
8587
11817
11840
839
513
Nervous System
The somatic pain in appendicitis that shifts from the umbilicus to

Mcbirney point is due to *Inflammation of parietal peritoneum*
566
635
1452
Anatomy
Anatomy
Anatomy
Nervous System
Pancoast tumors are non-small cell lung cancers that arise near
the superior sulcus. Pts may develop ipsilateral shoulder pain,
upper limb parethesias and areflexic arm weakness due to involv of
brachial plexus. Horner syndrome (ipsilateral partial ptosos, miosis,
anhydrosis) can occur due to invlove of cervical sympathetic
*Autnomic Ganglia*
Nervous System
Old pt with long standing HTN who presents for involuntary

movements, "Threw remote control across the room" P,E shows
Large amplitude flinging movements affecting proximal muscles of
upper extremity. Pt most likely has injury to *Subthalamic Nucleus*
Nervous System
Symptoms of hyeracusis (high sensitivity to everday sounds)

accompanied by ear pain and difficulty hearing is due to damage
to the stapedius muscle wich is innervated by the stapedius nerve
which a branch of the *Facial nerve*
1687
Anatomy
Nervous System
Pt with initial resistance to passive extension followed by sudden

release has Clasp-knife Spasticity which is seen in upper motor
neuron lesion due to lack of inhibition on spinal stretch reflex arch.
Pts with *INTERNAL CAPSULE* stroke have pure motor weakness
affecting contralateral limbs and lower face.
1696
Anatomy
Nervous System
Embolism to ACA would impared ability to *Climb stairs*
1741
Anatomy
Nervous System
Vomiting from sysetmic chemotherapy is triggered by

chemoreceptor trigger zone located on the *Dorsal surfce of
Medulla at the caudal end of 4th Ventricle* (Area postrema)
1742
Anatomy
Nervous System
Pt with nerve injury and prsents with foot slapping the ground with
each step (steppage gait) has *Common peroneal nerve injury*
1749
Anatomy
Nervous System
Injury to median nerve at the wrist is manfiested by diminished

sensation in first 3 digits with preserved sensation along the thenar
eminence. The median nerves courses between the *Flexor
digitorum superficialis and Flexor digitorum Profundus*
1815
Anatomy
Nervous System
CN IX resection would lead to loss of sensation over the *Tonsils*
1829
Anatomy
Nervous System
Pt who falls from tree and tries to break fall ny grabbing tree
branch will likely suffer from *Lower trunk injury of Brachial
Plexus*. He will be unable to perform fine finger movements with
hand (Lower trunk supplies median and ulnar)
1846
Anatomy
Nervous System
Occlusion to the *Middle cerebral Artery* can cause both

Wernicke and Broca's aphasia.
1933
Anatomy
Nervous System
Pt with diplopia and has problems walking down stairs and trouble
reading probably has a lesion to the trochlear nerve which is
responsible for depression of adducted eye.
2024
Anatomy
Nervous System
jaw deviation to right on opening mouth, difficulty chewing food

suggest CN V3 Injury (Mandibuar) It passes through *foramen
ovale*.
Nervous System
loss of touch, temperature, and vibratory sensations indiacte

damage to spinothalamic and dorsal column tracts. These two both
project into the Ventral Post. Lateral Nucleus of Thalamus. Also if
pt experiences diminished sensation over right side of face, then
his trigeminal pathway is damaged. The trigemical pathway is also
received by the thalamus at the Ventral Post. Medial Nucleus. So
damage to *Venral Post Thalamus* can trigger all above sensory
loss involving 3 paths.
2076
Anatomy
2077
Anatomy
Nervous System
fluid filled cavities in the deep structures of the brain arise from
lacune formation due to occlsuin of small penetrating arteries that
supply the structures. These lacunar infarcts are cause by
LIPOHYALINOSIS (hyaline thickening of vascular wall) &
Microatheromas (athersclerotic accumulation of lipid-laden
macrophages on intimal layer of penetrating arteries. These
predispose to *Small-Vesel Occlusion*
2127
Anatomy
Nervous System
The most common finding in *PCA* territory infarction is

Contralateral Hemianopia.
8522
Anatomy
Nervous System
The vagus and spinal accessory nerve exit through the *Jugular
Foramen*
8564
Anatomy
Nervous System
Premature neonate with decreased level of conscousnes and

hypotonia. She is weak, has prominent scalp veins and tense
fontanels. Ultrasound shows blood in the lateral ventricles. Source
of ventricles is *Germinal Matrix*
(This interventricular hemorrhage in a premature neonate)
8592
Anatomy
Nervous System
Pt with homonymous hemianopia with macular sparing could have

occlusion of *PCA*
8594
Anatomy
Nervous System
Injury to meyer's loop in the temporal lope results in contralateral

superiorquadantanopia.
Nervous System
Pt with right nasal hemianopsia who has an interal carotic artery

aneurysm. Most likely portion of visual pathway that is dirupted is
the *right peri chiasm*
[review optic lesions]
Nervous System
Orbital floor fractures can impair the infraorbital nerve which is a

continuation of the maxilaary nerve and result in numbness and
paresthesia in the uppercheeck, UPPER LIP, and upper gingiva.
This can also impair inferior rectus muscle amd impair superior
gaze
8636
11742
Anatomy
Anatomy
11744
Anatomy
Nervous System
The three trunks of the brachial plexus pass between the middle
and anterior scalene muscles (scalene triangle). Interscalene
nerve block (anesthesia) in this arrea would also affect the Phrenic
Nerve and hence affect the *Diaphragm* causing transient
ipsilateral diaphragmatic paralysis. (Phrenic nerve roots pass thru
the interscalene sheath)
11777
Anatomy
Nervous System
The Quadraceps tendon is supplied by the femoral nerve. The

femoral nerve can be blocked best in the *Inguinal Crease* at the
lateral borde of the femoral artery.
11952
Anatomy
Nervous System
Postpartumn fecal incontinence can be caused by injury to

*Pedundal Nerve*
1535
Anatomy
Pulmonary & Critical Care
The *Phrenic Nerve* carries paim fibers form the Diaphragmatic

and Mediastinal Pleura. Irritation of pleura at either area will
produce sharp pain worsened by "inspiration" that will be referred
to the c3-c5 distribution at the "base of the neck and over the
shoulder".
1695
Anatomy
Stab wound immediately above the clavicle and lateral to the

manubrium can puncture the *Pleura* and cause pneumothorax,
tensionpneumothoraxorhemothorax.
1745
Anatomy
Pts who is supine will aspirate into the *Post segment of the upper
lobe* and the Superior segment of the lower lobes of the right lung
8703
Anatomy
Pt with a fish bone lodged in the left piriform recess would impair
his internal laryngeal nerve which is a branch of superior laryngeal
nerve (CN X) and hence would impair his *Cough Reflex*
11845
Anatomy
In Obstructive Sleep Apnea. Electric stimulation of *Hypoglossal

nerve* help the pt
1680
Anatomy
Renal, Urinary Systems &

Electrolytes
The "proximal" part of the ureter is supplied by the *Renal Artery*.

The middle part is highly variable receiving supply from the
gonadal artery, the common iliac, and uterine arteries. The distal
part (close to bladder) is supplied by Superior Vesical artery,
which is a branch of the internal iliac.
1700
Anatomy

Electrolytes
A fracture of the elft 12th rib can cause laceration to *Left Kidney*
10962
Anatomy

Electrolytes
Pt leaking urine with coughing (stress incontinence) is due *to

Urethral sphincter dysfunction*
11708
Anatomy

Electrolytes
In suprapubic cystostomy, besides the bladder, the structure most

likely penetrated by the trocar and cannula is the *Anterior
AbdominalAponeurosis*
Anatomy
A gardner who comes in with knee pain with no visible erythema or

Rheumatology/Orthopedics abrasions. He spends hours on on his knees while working. The
bursae most likely affected in this pt is *Prepatellar*
& Sports
[Prepatellar Bursitis][a.ka "housemaids knee]
1634
Anatomy
Pt with sensory loss over the medial 1 and 1/2 digits and
Rheumatology/Orthopedics
hypothenar eminence indicate ulnar nerve injury which often
& Sports
occurs at *Hook of Hamate*
1697
Anatomy
Rheumatology/Orthopedics An anterior translation of the tibia relative to the femur on stability

& Sports
testing indicates an inury to the *Anterior Cruciate Ligament*
Anatomy
CHild Pt who falls on his outstretched arms and fractures his

clavicle. What causes the medial fragment of the fractured bone to
be displaced superiorly is the *Sternocleidomastoid muscle* while
& Sports
the lateral portion would be pulled inferiorly by the wieght of the
arm and the pectoralis major muscle.
1704
Anatomy
Pt who falls on his can hands and cant extend wrist. Mid humoral
Rheumatology/Orthopedics shaft fracture is detected. Artery is injured is *Deep Brachial
Artery (Profunda brachi)*
& Sports
(Runs along the radial nerve)
1730
Anatomy
Rheumatology/Orthopedics The most important structure in the Valsalva Meneuver is *Rectum

& Sports
Abdmonis Muscle* which can be seen anterioly on a CT scan.
1812
Anatomy
Mastectomy with axillary lymph node removal can injur the long
thoracic nerve and henc injury seratius anterior and lead to winged
& Sports
scapula.
1956
Anatomy
Rheumatology/Orthopedics In a pt with a femoral neck fracture. The injury that would lead to
& Sports
osteonecrosis most likley involves the *Medial Cicrumflex* Artery.
7621
Anatomy
Psoas major muscle contributes to hip flexion which is an action

taken when sitting up from a supine position without using the
& Sports
hand.
8671
Anatomy
Pt presents because of right lower abdominal and groin pain and

difficulty walking. He is on warfarin. His abdominal CT (image)
Rheumatology/Orthopedics shows retroperitoneal hematoma lying anterior to psoas muscle.
& Sports
Additional expected finding would be *Loss of sensation on the ant
aspect of right thigh*
[Femoral nerve compressed due to bleeding from warfarin use]
11659
Anatomy
Rheumatology/Orthopedics pt with a comminuted patella fracture would be unable to *Extend

the knee against gravity*
& Sports
11683
Anatomy
Rheumatology/Orthopedics In Carpal Tunnel Syndroem, Incicision of the *Transverse Carpal

& Sports
Ligament* (Flexor retinaculum) would improve symptoms.
11727
Anatomy
Rheumatology/Orthopedics The *Piriformis muscle* passes through the greater sicatic

& Sports
formaen and occupies most of its volume.
1491
1702
Anatomy
15 year old boy presents with right arm numbness. He plays

baseball. He has had fluctuating tingling and numbness involving
the right shoulder arm and hand. Also he felt dull pain in right little
finger and hand. He has a cervical rib. Exam shows decreased
& Sports
sensation over emdial 2 fingers and hypothenar eminence. The
structure contributing to this pts condition is *Scalene Muscle*
(Thoracid outlet syndrome, compression of brachial plexus)
11819
Anatomy
13 yr old boy comes with right knee pain. It started as a mild ache
in lower part of knee then worsened and now causes him to limp.
Pain is relieved with rest and reproduced when knee is
Rheumatology/Orthopedics straightened. Evaluation reveals avulsion of 2ndry ossification
center of tibia due to repetitive muscle contraction and traction of
& Sports
bone. Most likely insertion site of involved muscle tendon is *Tibial
Tuberosity*
[Osgood-Schiatter Disease]
11629
Behavioral
science
If a hypertensive and diabetic patient is using herbs to lose weight,

Gastrointestinal & Nutrition explain to them that these are poorly regulated and have potential
health risks.
8456
Behavioral
science
GeneralPrinciples
Providing care to all company employees in exchange for a set

monthly fee is *Capitation*
11534
Behavioral
science
Miscellaneous
(Multisystem)
Pt with many diseases including neurocognitive disorder, in order

to achieve drug adherence, you should *Involve a social worker in
discharge planning*
-Note: Checklist wont work since pt's cognition is impaired.
11550
Behavioral
science
Miscellaneous
(Multisystem)
Pt who is becoming an outpatient and has complex medication

regimens should be given a *Hospital discharge checklist*
247
Behavioral
science
Psychiatric/Behavioral &
Substance Abuse
Buspirone is an nonbenzodiazepine anxiolytic used to treat

Generalized Anxiety disorder. It has a SLOW ONSET. It lacks
muscle relaxant or anticonvulsant properyes and carries no risk of
dependence. It is a partial agonist of 5HT (1a)
248
Behavioral
science
Substance Abuse
SSRI's & SNRI's are first line medication in generalized anxiety

disorder. Benzos should be limited to short term use and for pts
who respond poorly to antidepressants.
Substance Abuse
Pt has been receiving treatment for mood swings and sleep

problems. Now the pt has constipation, dry skin, and hair loss.
Also she has weight gain despite regular diet. BP is 110/70. Pt
appears tired but exam is otherwise normal. Most likely responsible
drug is *Lithium*
[Hypothyroidism due to lithium used in bipolar disorder]
11778
520
Behavioral
science
574
Behavioral
science
Substance Abuse
Following amitriptyline overdose (TCA). There is QRS widening

and QTc prolongation. And Death occurs. Deat is related to
*Sodium Chanel inhibition*
[Fast Na chanel inhibition resulting in conduction defects and
arrythmias]
707
Behavioral
science
Substance Abuse
Pt with painful erection for more than 4 hours. Past med history is
sig for treatment-resistent depression, OCD, and insomnia. Drug
most likley used is *Trazadone*
[Priapism, rare side effect of trazadone]
Substance Abuse
Pt smoked unknown substance. He displays uncoordinated jerky

movements of extremities and assualts someone. He appears
immune to pain. In the ER he has visual hallucinations and
alternates between agitation and sedation. He is hyptertensive and
tachycardic and has vertical nystagmus. Later, he doesnt
remember anything that happened. MOA of drug is
*N-Methyl-D-aspartatereceptorAntagonism*(NMDAAntagonist)
[This is PCP]
1165
Behavioral
science
1287
Behavioral
science
Substance Abuse
Methadone which is used in Heroin Addicts (Opiate) during

withdrawal phase, it is beneficial due to *Long Half-Life* and can
therefore suppress cravings and withdrawal symptoms for >24 hrs.
It is a full Mu-opiod receptor agonist (not partial)
The partial agonist is "Buprenorphine" also used. (Usually alone
with Nalaxone which is an opoid anatagonist)
1288
Behavioral
science
Substance Abuse
PCP is a hallucinogen that causes agitation, halluciantions, violent

behavior. Distinguishing factors of abuse are are Ataxia,
Nystagmus, and Memory loss
1352
Behavioral
science
Substance Abuse
Pt who requires benzodiazepam with least imapaired judjement or

daytime fatigue should be given one with a short T1/2 and least
hepatic metabolismlike *Lorazepam*
[LOTbenzos,lorazepam,oxazepam,temazepam][Undergodirect
glucuronidation]
1429
Behavioral
science
Substance Abuse
Young man who says that his parents who are about to get a
divorce are angry at him. His defense mechanism is *Projection*
2047
Behavioral
science
Substance Abuse
Pt with mood symptoms and history of psychotic symptoms for

more than 4 weeks in absence of moods symptoms suggests
*Schizoaffective Disorder*
2049
Behavioral
science
Substance Abuse
Use SSRI'S to treat OCD.
2053
Behavioral
science
Substance Abuse
Shifting of emotions assciated with a significant person from the

past to a person in the presentis called *Transference*
7752
Behavioral
science
Substance Abuse
Patients with frontal lobe injury often experience executive

dysfunction and personality changes secondary to impairement of
the ogranizational, restraint, and motivational systems. Changes in
social behavior can manifest in variable ways with *Left* sided
lesions more often associated with "Apathy" and right-sided lesions
withdisinhibition.
8954
Behavioral
science
Substance Abuse
Majority of overdose deaths are related to *Opioids*
9814
Behavioral
science
Substance Abuse
Access to firearms increases risks for suicide.
10581
Behavioral
science
Substance Abuse
Pt with somatic symptom disorder should be *Scheduled regular

outpatient office visits*
10785
Behavioral
science
Substance Abuse
Stimulus conrtol therapy in Tx of insomnia involves leaving the

bedroom if unable to fall asleep within 20 minutes.
11594
Behavioral
science
Substance Abuse
Suspicion and distrust, feeling of being exploited, together with

histroy of repetitive conflict suggests *paranoid personality
disorder*
11603
Behavioral
science
Substance Abuse
Fear of Elevators is treated with *Behavioral Therapy*
11605
Behavioral
science
Substance Abuse
Pts who has pyschotic symptoms has been staying up late for
exams probably has *Substance Induced Psychotic disorder*
11743
Behavioral
science
Substance Abuse
Use clozapine in treatment resistent schizophrenia.

(Agranulocytosis, seizures and metabolic syndrome are side
effects)
11746
Behavioral
science
Substance Abuse
Depression, Fatigue, Hypersomnia, Hyperphagia, and Vivid

dreams are characteristic of *Cocaine Withdrawal*
Substance Abuse
Pt with recurrent episodes of chest ain, ,tachycardia, shortness of

breath, sweating, and tremulousness in a young otherwise healthy
pt with normal ECG. Best next step in management is
*Benzodiazepine*
[Panic Disorder]
11756
Behavioral
science
11807
Behavioral
science
Substance Abuse
Pts who is bulimic (bulimia nervosa) (Binging, exercise, normal

weight, self induced vomiting proven by pharyngeal erythema,
hypokalemia, and increased amylase)can be given an SSRI such
as*Fluoxetine*
11809
Behavioral
science
Substance Abuse
Methylphenidate used in ADHD has a side effect of *Decrease

Appetite and Weight loss*
11810
Behavioral
science
Substance Abuse
A child at age 2 with only 40 words of vocabularly should be

*Assessed further*
(Normal is 50-100 words at age 2)
11838
Behavioral
science
Substance Abuse
Use *SRRI's* in panic disoder in pt who presents camly and

normal vital signs.
11854
Behavioral
science
Substance Abuse
srri's used in depression *Block Serotonin Receptor*
11866
Behavioral
science
Substance Abuse
Dont confuse *Anxiety to due medical condition* as in

Hyperthyroidsim with generalized anxiety disorder. Weightloss,
tachycardia, warm moist skin, tremor along with anxiety suggest
hyperthyroidism.
11899
Behavioral
science
Substance Abuse
Delirium can be treated with first gen antipsychotic such as

*Haloperidol* in addition to treating the underlying cause.
2057
Behavioral
science
Social Sciences
A pregnant minor is entitled to consent to prenatal care. Not an
(Ethics/Legal/Professional) electiveterminationhowever.
10290
Behavioral
science
Social Sciences
The requirement for hospice care referal is *Prognosis of less or
(Ethics/Legal/Professional) equal to six months*
10399
Behavioral
science
Social Sciences
Physicians must report impaired collegues in a timely manner.
(Ethics/Legal/Professional)
11668
Behavioral
science
Social Sciences
a health insurance plan with low monthly premieums is *Health
(Ethics/Legal/Professional) MaintenanceOrganization*
1064
Biochemistry
Dermatology
Pallegra which is due to niacin (ViB3, precursor to NAD)

deficiency is characterized by Dermatitis (skin rash on sun
exposed), Diarrhea, and Dementia (irritable, hostile, dioriented).
Niacin is obtained from diet or synthesized in body from
*Tryptophan*. Therefore, Tryptophan is the precursor for the
compensatory pathway for NAD synthesis.
1244
Biochemistry
Dermatology
Ehlers Danlos Syndrome which presents with hyperextensible skin,

easy bruising, hypermobile joints is a defect in collagen synthesis.
1245
Biochemistry
Dermatology
Ehler-Danlos Synrome can be caused by procollagen peptidase

deficiency which results in impaired *cleavage of terminal
propeptides* Where? --> Extracellular space.
Dermatology
Signs of scurvy such as bleeding gums , ecchymoses and

corkscrew hairs implicate vit C deficiency. Vit C is required in
postranslational hydroxylation of proline and lysin residues by
hydroxylases in collagen synthesis. It happens in the Rough
Endoplasmic reticulum
Dermatology
12 yr old is evaluated for ataxia acompanied by episodic

erythematous and puritic skin lesions and loose stools. Lab shows
loss of neutral aromatic amino acids in urine. The pt symptoms
would most likley respond to to supplementation with *Niacin Vit B3*
[Hartnup dsiease, defective intestinal and renal absorption of
tryptophan. Ttryptophan is a precursor to Nicotinic acid, serotonin,
andmelatonin.]
[Tryptophan, phenylalanine and tyrosine are all aromatic
aa][note:Pallegra?]
1247
1334
Biochemistry
Biochemistry
2037
602
Biochemistry
Biochemistry
Dermatology
tRNA containts chemically modified bases such as dihydrouridine,

ribothymidine, and pseudouridine. It has a *CCA* sequence at the
its 3'-end that is used a recognition sequence by proteins. The 3'
terminal hydroxyl group of the CCA tail serves as the aa binding
site.

Metabolism
Pituitary resection decreases ACTH which decreases Cortisol,

decrease in cortisol decreases expression of
*PHENYLETHANOL-N-METHYLTRANSFERASE* which the
enzyme that converts Norepi into Epi. Therefore, putituwary
resection leads to decreased EPI production.
847
Biochemistry

Metabolism
Cells that express more glucose transporters as insulin levels

increase are *skeletal muscle cells* and adipocytes.
Cell that have constant glucose transporter expression even as
insulin level increases are *Renal tunular cells* also brain,
intestine, RBC, and Liver
934
Biochemistry

Metabolism
Sorbitol produced by aldolase reductase is normally metabolized to

*Fructose*
997
Biochemistry

Metabolism
Oxaloacetate-----> Phosphoenolpyruvate (catalyzed byPEP

carboxykinase) is the 2nd commited step in gluconeogenesis
which predominates in starvation states.
998
Biochemistry

Metabolism
Pts with pyruvate dehydrogenase deficiency should be on a

ketogenic diet. Soley Ketogenic aminoacids include *lysine* and
leucine.
1010
Biochemistry

Metabolism
Insuline resistance by the pancreatic cells i sstimulated by

increased ATP production. *Glucokinase* functions as a glucose
sensor in pancreatic beta cells by controlling the rate of glucose
entry into the glycolytic pathway. Mutations in the *glucokinase*
gene are a cause of maturity-onset diabetes of the young.
1019
Biochemistry

Metabolism
Pt has absent lactate dehydrogenase activity in muscles. In this pt,

strenuous exercise leads to inhibition of glycolysis in skeletal
muscles due to intracellular depletion of *NAD+*
1021
Biochemistry

Metabolism
Homeless pt with signs of wernicke encephalopathy after admin of

glucose without thiamine supplemenation would have an impaired
*Alpha ketoglutarate to Succinly CoA reaction*
[Thiamine is needed for alpha ketogluyerate dehydrogenase][Also
needed for other dehydrogenases and transketolase]
1022
Biochemistry

Metabolism
A direct source of energy in the TCA cycle is in the conversion of

succinylcoA into Succinate thus yeilding GTP.
Biochemistry

Metabolism
Increasing fructose-2,6-bisphosphate promotes glycoloysis (insulin

like effect) and inhibits Gluconeogensis. Inhibiting
Gluconeogenesis means less alanine and other glucuneogenic
substrates are converted to glucos.

Metabolism
During fasting, maintenance of pt blood glucise is facilitated by

hepatic conversion of pyruvate into glucose. The substance that is
an allosteric activator of the first step of this process is
*Acetyl-CoA*
[Gluconeogenesis]

Metabolism
Pt presents with myalgias, anorexia, and skin rash. He has been

consuming raw white eggs for several months. P.E shows macular
dermatitis of extremities. A water soluble vit def is suspected. The
biochemical conversions that most likely uses the def vit as a
cofactor are *Pyruvate to Oxaloacetate*
[Vit B7 (Biotin) needed as a cofactor for Carboxylases]
1031
1034
1063
Biochemistry
Biochemistry
Pt with hereditary defect in fructose metabolism. He is

asymtomatic however. This pt is still able to metabolize fructose
due to compensatory activity of *Hexokinase*
[Essential fructose uea]
1070
Biochemistry

Metabolism
1073
Biochemistry

Metabolism
In Aldolase deficiency, remove *Sucrose* from Diet.
1119
Biochemistry

Metabolism
Reactions of the pentos phosphate pathway (HMP shunt) occur in

the cytoplasm. Therefore this includes activity of enzyme
*Transketolase*
1121
Biochemistry

Metabolism
Insulin increases intracellular glycogen stores and decreases

hepatic glucose release into blood (gluconeogenesis), it does so
by activating *Protein Phosphatase-1*

Metabolism
*Orinithine Transcarbamoylase* deficiency is the mcc urea cycle

disorder. The high NH3 causes neurologic abnormalities. Typical
tell tale sign is high urine OROTIC ACID. becasue with no OTC,
carbamoyl phosphate is converted to orotic acid in pyrmidine
synthesis.

Metabolism
Pt with Phenylalanemia who is place on dietary requirements and

supplemented with tyrosine and presents with normal
phenylalanine levels but with axial hypotonia and microcephaly.
Also, prolactin is elevated. The enzyme missing in this pt
*Dihydrobiopterin reductase*
(Involved in converting tyrosine to DOPA, hence high prolacin)
1370
1501
Biochemistry
Biochemistry
1990
Biochemistry

Metabolism
An autosomal recessive diroder of Sphingomyelinase deficiency.

Most consistent with this condition is *Neurodegenration and
Hepatosplenomegaly*
[Neiman-Pick disease. aslo foamy macrophages and cherry-red
macular spot]
2066
Biochemistry

Metabolism
Pt with orotic acid urea and normal ammonia levels could have a
defect of UMP synthase (hereditary orotic aciduria)
Supplementation with *URIDINE* helps this pt.
11917
Biochemistry

Metabolism
*Hormone Sensitive Lipase* is found in adipose tissue, it catalyzes

the mobilization of stored triglycerides into free fatty acids and
glycerol. The liver can further oxidize FFA to acetyl-coA and then
further metabolized into Ketoen Bodies.
This can be seen during Starvation.
11918
Biochemistry

Metabolism
In an animal that well fed with CHD's. beta-oxidation of fatty acids

is inhibited via *Malonyl-coA* which inhibits carnitine
acyltransferase from shuttling acyl groups into the mitochondria.
11950
Biochemistry

Metabolism
Zinc finger mtoif are composed of chains of aminoacids bound

together around a zinc atom via linkage with cystein and histidine
residues. Intracellular receptors that bind steroids, *Thyroid
Hormones*, and fat-soluble vitamins act directly as transcription
factors and conatin zinc biding domains.
67
Biochemistry
Gallstones caused by the use of fibrates for dyslipidemia are

caasued by decreased activity of 7-lpha-hydroxylase.
790
Biochemistry
Under normal cirumstances the Ras protein is activated only when

boud to *GTP*
1068
Biochemistry
The substance with the fastest rate of metablosim in the glycotic

pathwayis*Fructose-1-phosphate*
1072
Biochemistry
Lactose intolerance is due to absence of enzyme lactase which

convertsGalactosyl-B-1,4-glucose(LACTOSE)intoGalactose.
Biochemistry
In the duodenum, Enteropeptidase convert Trypsinogen to the

Gastrointestinal & Nutrition active form trypisn. Pt with impaired enteropeptidase will fail to
form *Trypsin*
Biochemistry
Pt who presents with difficulty swallowing and is found to have an

mass in esophagus. He is a hunter and put sodium nitrite in his
meat. Analysis of biopsy sample show Cytosin Demaination. This
damage is usually repaired (Base Excision Repair) by this
enzymatic sequence; *Glycosylase, Endonuclease, Lyase,
Polymerase, Ligase*
1807
Biochemistry
Chronic alcoholic pt with angular stomatitis, cheilitis, glossitis and a

"low riboflavin" probably has riboflavin (B2) deficeincy. Riboflavin
can become FMN (flavin mononucleotide) then FAD (dinucleotide)
which act as coenzymes in reactions thru acceptance of electrons
(ETC (complex2)& Krebs). FAD is a component of *Succinate
Dehydrogenase*
8425
Biochemistry
Biochemistry
Pt with Abdominal pain who ingested mmushrooms, he is

jaundiced with tender palpable liver and elevated liver enzymes and
bilirubin most likey has Amatoxin that binds to DNA-dependent
RNA polymerase type 2 and halts *mRNA synthesis*
1251
1475
8482
Mutations in Leptin gene or receptor will lead to *Hyperphagia and

Obesity*
995
Biochemistry
GeneralPrinciples
After a ligand binds to a G protein-coupled receptor that activates

phopholipase C, membrane phospholipids are broken down to
DAG and IP3. *Protein Kinase C* is subsequently activated by
DAG and Ca.
996
Biochemistry
GeneralPrinciples
If lactic acid is accumulatimg that means there is increased activity

of Lactate dehydrogensae and DECREASED activity of *Pyruvate
Dehydrogensae*
1028
Biochemistry
GeneralPrinciples
The rate of glycogenolysis within myocytes increases several x100

during active skeletal muscle contraction. The substance that
synchronizes these two processes is *Ca2+*
1248
Biochemistry
GeneralPrinciples
Collagen made by fibroblasts has Glycine as every third amino

acid (GLY-X-Y) it is thefefore the most abundant.
GeneralPrinciples
Certain tRNA molecules can recognize multiple different codons

coding for the same amino acid, a phenomenon explained by the
*Wobble hypothesis*
{Genetic code is Degenerate]
1424
Biochemistry
1434
Biochemistry
GeneralPrinciples
E.coli with enzyme-mediated nucleotide removal in the " 5' to 3'

direction " is done by *DNA polymerase 1*
[Other 3 have 3' to 5' exonucelease activity][DNA p1 Removes the
RNA Primer]
1437
Biochemistry
GeneralPrinciples
The factor that makes eukayotic DNA replication quick and

effective despite large size and complexity of genome is *Multiple
origins of replication*
2035
Biochemistry
GeneralPrinciples
mRNA *Interaction with P bodies* occurs only in the CYtoplasm.
868
Biochemistry
Hematology & Oncology
A new born baby has fetal HB prdominantly (alpha 2 gamma 2)

which changes to adult Hb (alpha 2 Beta 2) within the next six
months.
1035
Biochemistry
Synthesis of ribose from fructose-6phosphate can be done using

*Transketolase*.
1036
Biochemistry
G6PDconvertsglucose-6-phosphateto6-phosphogluconate
1337
Biochemistry
Pt comes due to recurrent blistering on back of hands and

forearms for several years. P.E shows vesicles and erosion on the
dorsum of both hands. Most likely deficient enzyme in this pt is
*Uroporphyrinogen Decarboxylase*
[Porphria Cutaneo Tarda]
1338
Biochemistry
Pt with neurologic symptoms (tingling, difficulty concentrating) and

recurrent episodes of nonspecific abdominal pain likely has acute
intermitten porphyria. (PBG deaminase def) This attack is helped
with infusion of heme which downregulates hepatic *ALA synthase*
1386
Biochemistry
Oxygen binding to Hb involves the release of *Protons*

[H+ is released]
In an experiment where scientist were able to separate hemoglobin

tetramers into individual alpha and beta subunits. If a solution is
created that contains only monomeric beta-hemoglobin subunits
and the o2 dissociation curve is measure, it would be have a *very
high affinity (P50%=1)* The beta subunit is almost identical to
Myoglobin which has a stong affinity to O2 (p50%=1) vs p50%=26
of HbA.
1413
Biochemistry
1419
Biochemistry
Differences between synthesis of 2 daughter DNA strands include

*The joining of DNA fragments by ligase*
This is beacuse the leading strand is less affected by ligase
compared to the lagging strand which has okazaki fragments that
must be constantly ligated by ligase.
1456
Biochemistry
The change in color of a bruise from blue to green is explained by

activity of *Heme Oxygenase*
[Biliverdin is Green, Bilirubin is yellow]
1470
Biochemistry
Both HbS and HbC result from *Misense Mutations*
Duchenne Muscular Dystrophy can also results from None-sense

Mutations (premature stop codon)
[Usually from deletions (frameshift) thu]
1487
Biochemistry
1847
Biochemistry
In an experiment where folate is deprived. Provision of

*Thymidine* would reduce erythroid precuros cell apoptosis.
[Folate def inhibits formation of dTMP, Thymidine supplementation
can increase dTMP and hence reduce erythroid precursor cell
apotosis]
1471
Biochemistry
Infectious Diseases
Bacterial *DNA polymerase 1* removes RNA primers during DNA

replication.
Nervous System
Pt presents for exertional dysnpnea and fatigability. On P.E her

gait is unstable when her eyes are closed and tehre is impaired
vibratory sensation in the lower extremities. There is marked Pallor
in conjunctiva, nail beds, and palms. The lab test that would
confirm Dx is *Serum Methylmalonic acid*
[Vit B12 Def]
64
Biochemistry
598
Biochemistry
Nervous System
Wernicke syndrome manifests with opthalmoplegia, ataxia, &

confusion. There is foci of hemorrhage and necrosis in the
"mamillary bodies" and periaqueductal gray matter om autopsy.
Diagnosis involves measuring *Eythrocyte Transketolase activity* It
occurs due to chronic Thiamine (B1) def commonly in alcoholics.
1335
Biochemistry
Nervous System
Hypertonicity, muslce rigidity and sugar smelling diapers are signs

for maple syrup urine disease and branched chain amino acids
such as leucine, isoleucine and valine should be restricted.
1371
Biochemistry
Nervous System
Infant with lethargy vomiting and seizures. Lab shows high

ammonium levels. Liver biopsy suggest impaired formation of
N-acetylgutamate as the cause. The reaction impaired in this pt
would be *Conversion of CO2+NH3 into Carbamoyl-Phosphate*
{N-acetylglutamateactivatescarbamoylphosphatesynthase1
which is th enzyme that converts co2+NH3 into Carbamoyl
phosphate]
1372
Biochemistry
Nervous System
Pt with inherited condition wich imapirs transport of ornithine from

cytosol to mitochondria. Restric *proteins* from diet to improve
condition.
1480
Biochemistry
Nervous System
High Arginine in plasma and CNS suggest arginase deficiency

which works to convert arginine into *Urea* in the urea cycle.
Nervous System
Pt with imapaired Tetrahydrobiopetrin synthesis would have

phenylketonurea and would therefore have deificency of
*Serotonin*
Nervous System
Pt with mutation in Protein involved in the assembly of small

nuclear ribonucleoproteins (snRNP's) in motor neurons. Pt will
have impaired function of *Spliceosomes*
Nervous System
In lesch-Nyhan syndrome, there is increased activity of *PRPP

Amidotransferase* due to compensatory increase in Denovo
Purine Synthesis.
Biochemistry
Nervous System
Infant with normal development in first few month then progressive

neurologic deterioration. P.E shows macrocephaly and an
abnormal startle reflex with acoustic stimuli. Funduscopy shows a
bright red fovea centralis. (chery red macula spot)Pt most likley
has accumulation of *GM2 ganglioside*
[Tay-Sachs]
Biochemistry
Infant with language regression and anemia probably has lead

Poisoning&Environmental
posioning and probably has an inhoiibited *ALA Dehydratase
Exposure
enzyme* plus ferrochelatase inhibition.
1500
2036
2067
8524
1454
1249
Biochemistry
Biochemistry
Biochemistry
Biochemistry
The stretch and recoil property of elastin is mediated by

*Interchain cross-links involving lysine*
[involveslysyloxidase]
1989
Biochemistry

Electrolytes
18 year old male with progressive skin rash. He has long standing
history of intermittent burning sensation in his palms and soles that
is exacerbated bt stres and fatigue. Burning is severe after
exercise. He sweats very little. Lab test reveals undetectable levels
of alpha-galactosidase A. Pt is at greatest risk for *Renal Failure*
[Fabry Disease, X-linked alpha-galactosidase A def]
11939
Biochemistry

Electrolytes
Pt with anion ga metabolic acidosis would rewuire renal

metabolism of *Glutamine* for maximizing acid excretion pt.
361
Biochemistry
Rheumatology/Orthopedics SnRNA has the function of *removal of introns from RNA

& Sports
transcripts*
1250
Biochemistry
an elstin associated glycoprotein defecct that is abundant in the

Rheumatology/Orthopedics lens, periosteium, and aortic media refers to *Marfan Syndrome*
an autosomal dominant disease with a defect in FBN1 gene coding
& Sports
for fibrillin glycoproten that forms around elastin.
2090
Biochemistry
Mutation in PRPP synthetase (enzyme in purine denova synthesis)

can lead to hyperuricemia due increased production of purines.
& Sports
Thus increasing the risk for Gout Which affects *Joints*
2091
Biochemistry
Negatively Birefringent crystals under polarized light indicates

Gouty Arthritis, for which the inflamatory response is mediated by
& Sports
*NEUTROPHILS*
8802
Biochemistry
Pt with signs of RA. Serum autoantibodies with "high specificity"

Rheumatology/Orthopedics for this pt condition are most likely to react with *Citrullinated
peptides*
& Sports
[ant-CCP]
1175
Biostatistics
Biostatistics &
Epidemiology
Absolute risk reduction = Event rate in the control group - event

rate in the Tx group
1178
Biostatistics
Biostatistics &
Epidemiology
Check other calculations in choices.
1187
Biostatistics
Biostatistics &
Epidemiology
A trend in whoch there is a rising prevalence but stable incidence

is due to prolonged duration of disease (*IMPROVED QUALITY
OF CARE* for e.g)
1188
Biostatistics
Biostatistics &
Epidemiology
Disproportionate loss of follow up btw exposed and control leads to

attrition bias which is a form of *Selection Bias*
1189
Biostatistics
Biostatistics &
Epidemiology
Matching involves grouping patients with similar characteristics in

both the control and treaetment (case) group. It is done to control
confounding bias.
1272
Biostatistics
Biostatistics &
Epidemiology
Statistical power *1-Beta* represents a study's ability to detect a

difference when one exists. Basically the ability to reject the null
hypothesis when its truly false.
1303
Biostatistics
Biostatistics &
Epidemiology
A study's power increases as its *Sample Size* increase.

Therefore, the larger the sample size, the larger the ability of a
study to detect a difference when one truly exists.
10570
Biostatistics
Biostatistics &
Epidemiology
When the unit of analysis in a study is "Populations" and not

individuals, then it is an *Ecological Study*
1174
Biostatistics
Number Needed to Treat is 1/Absolute Risk Reduction.

(ARR is: conrol rate - Tx rate)
1301
Biostatistics
Blinding prevents observer bias.
1190
Biostatistics
GeneralPrinciples
*Negative Predictive Value* is the probability of being free of

disease. Answers the question: What are the chances that I really
do not have cancer?
1233
Biostatistics
Know how to calculate Sen, Spec, PPV, NPV (QUICKLY)
1208
Biostatistics
Rheumatology/Orthopedics Case-fatality rate is calculated by dividing the number of fatal

& Sports
cases by the total number of people with the disease.
35
Embryology
Cyanosis in transposition of the great vessels is classic. This

condition is due to failure of Septation. Failure of the
aorticopulmonary septum to spiral. It can be conducive to life only
if accomanied by another condition that allows mixing of blood. E.g
Patent ductus arteriosus which presents with machine like murmur.
202
Embryology
Pt with signs of a stroke and echocardiogram shows bubbles on

left heart when agitated saline is inserted has an Patent Foramen
Ovale due to *Incomplete fusion of atrial septum primum and
secundum*
1705
Embryology
Teratology of Fallor results from *Deviation of Infundibular Septum*
1750
Embryology
The common carotid artery which is palpatrd along the inner side
of the sternocleidomastoid muscle is derived from the 3rd
pharyngeal aortic arch.
1740
Embryology
a uni lateral cleft lip is caused bt failure of *Fusion on the maxillary

prominenceandintermaxillarysegment*
543
Embryology

Metabolism
Pt with absent thymic shadow and narrowing of aortic arch on xray

probably has DiFeorge syndrome and lacks a thymus due to
failure of *Third pharyngeal Pouch* to develop.
550
Embryology

Metabolism
*Cortisol* has the greatest effect on lecithin to sphingmyelin ratio

(greater than 1.9 indicates mature lung)
1809
Embryology
FemaleReproductive
System & Breast
*Vaginal Agenesis* is characterized by short vagina and

rudimentary uterus and Amenorrhea with normal 2ndry sex
characteristics and normal wieght and stature. It is a.k.a Mullerian
Aplasia or MRKH syndrome. It often presents with urologic issues
as as unilateral renal agensis.
320
Embryology
Pt with Imperforate Ausu often have *Urinary tract Abnormalities*

accompanying the condition.
321
Embryology
Gastrointestinal & Nutrition Meckels diverticulum is an example of ECTOPY.
330
Embryology
If neural crest migation to the intestine is interrupted by the final

week (12 week) of migration, The *Rectum* would be affected.
437
Embryology
The ventral pancreatic primordium gives rise to the *Main

ppancreatic duct*
11803
Embryology
New born Pt with down syndrome who has reducible midline

abdominal protrusion covered by skin probably has an
uncomplicated umblical hernia due to *Incomplete Closure of
Umbilical Ring*
419
Embryology
MaleReproductiveSystem
1449
Embryology
If Leydig cells are working in a male (46xy) and Sertoli cells are
not then the fetus will have female and male internal genitalia and
male external genitalia. Why? becuase sertoli cells produce MIF
which inhibits female internal gonad differentiation.
252
Embryology
Miscellaneous
(Multisystem)
Fetus that has closely set eyes, middline mass cosistent with a
proboscis, fused cerebral hemispheres, and an absent forebrain
fissure has Holoprosencephaly whicha type of *Malformation*
496
Embryology
Nervous System
Vitamine supplementation prevents neural tube defects in pregant

women. For exampel those defects involving the pos neural folds
such as meningocele and meningomyelocele.
502
Embryology
Nervous System
Acetylcholinestrase in the amniotic fluid indicates a neural tube

defect in which there is a *Failure of Fusion*
8702
Embryology
Nervous System
The anterior pituitary is derived from *Surface Ectoderm*

(Rathke's pouch)
-Check Table
337
Embryology
Pregnancy, Childbirth &

Puerperium
Pregnant pt on anti-convulsants who presents with

polyhydroamnios, fetus probably has *Anencephaly* due to
antiepileptic medication whic is a risk factor for neural tube
defects.
1833
Embryology
High blood oxygen in a fetus can be found in the inferior

venecava.
652
Embryology

Electrolytes
urine discharge from the umbilicus is caused by a persistent

allantois remnant.
837
Embryology

Electrolytes
The mcc of unilateral fetal hydronephrosis is inadequate

canalization of *UretroPelvic Junction*

Electrolytes
Neoborn who has tachypnea and hypoxia. He has a flattened nose

and bilateral club feet. He dies one hour later. To be found during
autopsy is *Renal Agenesis*
[Potter sequence of pulmonary hypoplasia, falttened facies, and
limb deformity due to Oligohydroamnios due urinary tract anomaly]

Electrolytes
Ultrasound of fetus with bilaterally enlarged fetal kidneys with

diffuse small cysts and oligohydroamnios has Autosomal recessive
polycystic kidney disease (ARPKD) and is the oligohydroamnios
can lead to Potters sequence which is Flattened facies, Limb
deformity, and "Pulmnary Hypoplasia" and therefore the baby can
be born with *Respiratory Disress*
1752
1915
Embryology
Embryology
A patent processus vaginalis causes a communicating hydrocele.

It can also cause an *Indirect Inguinal Hernia*
Embryology
Rheumatology/Orthopedics Both the thymus and *Inferior parathyroid* originate from the 3rd
& Sports
pharyngeal pouch.
1684
Embryology
Infant with flaccid lower extremity and absent ankle reflexes

Rheumatology/Orthopedics bilaterally and with poorly developed lumbar spine and sacrum
(agenesis) has Caudal Regression Syndrome which is related to
& Sports
mother *Uncontrolled Diabetes* during pregnancy.
11835
Genetics
Biostatistics &
Epidemiology
Good Question On Hardy Wieiberg analysis
756
882
Genetics
Majority of Down syndrome have trisomy 21 that happens as a

result of *Chromosomal nondisjunction* during the 1st meitic
division of the ovum. Incidence increases with maternal age. Only
about 4 percent of down syndroem is caused by Robertsonian
Translocation.
1476
Genetics
Dermatology
Pt with xeroderma pigmentosum have a defect in *Endonucelease*

enzyme.
256
Genetics
FemaleReproductive
System & Breast
Pt with signs of Turner Syndrome is likey to have *Bicuspid Aortic

Valve*
8556
Genetics
FemaleReproductive
System & Breast
Turner syndrome pt can become pregnant but with oocyte

donation.
8283
Genetics
Differences in halotype frequencies in a population can be as a

result of *Linkage Disequilibrium*
GeneralPrinciples
A protein that has reverse transcriptase activity that functions to

add TTAGGG repeat to the 3'end of chromosomes. The cell type
with this protein is most likely *Epidermal Basal cells*
[Temlomerase protein on stem cells]
1438
Genetics
1462
Genetics
GeneralPrinciples
The acqusition of a new viral surface rotein is often all that is

necessary for a virus to infect a new type of host cell. This is an
example of *Phenotype Mixing* Here there is no change in
parental genome and tehrefore, subsequent progeny will revert to
having only original host attacking properties.
1469
Genetics
GeneralPrinciples
Viruses with segmented genomes can undergo genetic shift

through reassortment. Such viruses inclide orthomyxoviruses
(influenza) and *RotaViruses*
1728
Genetics
GeneralPrinciples
*Classic Galactosemia* is autosomal recessive.
1970
Genetics
GeneralPrinciples
The occurence of multiple, seemingly unrelated phenotypic

manifestation, often in different organs system as a result of a
single genetic defect is termed *Pleiotropy*
[Vignette example is Homocysteinurea, manifesting with pitting
edema (from DVT), caved in chest wall (marfinoid habitus), DVT,
singlegene mut in cystathionine beeta-synthase enzyme]
2015
Genetics
GeneralPrinciples
The homeobox genes code for proteins that are *Transcription

regulators*
2025
Genetics
GeneralPrinciples
Enhancers can be *Located upstream, downstream or within

introns of the gene*
2029
Genetics
GeneralPrinciples
Releasing factor 1 recognizes stop codons.
2030
Genetics
GeneralPrinciples
Mutations in promotor regions such as TATA box can likely affect

*Transcription Initiation*
2033
Genetics
GeneralPrinciples
The poly A tail at the *3' end of RNA* is not transcriped from DNA
template and was a post transcription modification.
8328
Genetics
GeneralPrinciples
In Trisomy 21, chromosomal nondisjunction occurs in *Meiosis 1*
11904
Genetics
GeneralPrinciples
Spina Bifida has a *Multifactorial* Inheritance pattern
11913
Genetics
GeneralPrinciples
*Alternative Splicing* is a process by which a single gene can

code for various unique proteins by selectively including or
excluding different DNA coding regions (Exons) into mature mRNA.
1474
Genetics
External Beam Radio therapy kills cancer cells through

*Double-strand DNA breaks*
2087
Genetics
In beta thalassemia there is *Microcytosis*

Virus that develop a trait (due to culturing with another viruse) and
their subsequent progeny continue to have the trait. Mechanism
that explains this is *Reassortment*
(Recombination is if progency acquires completely new trait)
11907
Genetics
Infectious Diseases
807
Genetics
Recurrent pneumonia, Azoospermia, Digital clubbing, No vas

MaleReproductiveSystem deferens are signs of Cystic Fibrosis. It can be diagnosed with
measuring *Chloride level in the sweat*
701
591
Genetics
Genetics
Miscellaneous
(Multisystem)
Husband short with a large head and prominent forehead. Wife is

normal. They are concerned about unborn child's height. Best
response is *Rsik of short stature in child is 50%*
(Achondrolasia is autosomal dominant, father must heterozygous
(otherwise be dead), mom is unaffected therefore 50%)
Nervous System
Young man who is aysmptomatic and found to be homozygous for

the apolipoprotein E-4 allele. In the future he most likely to suffer
from*Alzheimer'sdementia*
[Late onset familial Alzheimer's disease]
[Eary onset is assoc with 1) Amyloid precursor protein on chrom
21. 2) Presenilin 1 gene on chrom 14. 3) Presenilin 2 gene on
chrom 1.]
1307
Genetics
Nervous System
Pt with Fleshy, dome shaped lesions plus cafe-au-lait spots

probably has cutaneous neurofibromas which is a hallmark of
NF-1 which exhibits an inheritance pattenr of *Single Gene
Autosomal Dominant*
-The NF-1 gene is on chromosome 17.
1421
Genetics
Nervous System
CGG Trinucleotid repeats is characteristic of Fragile X syndrome.

Symptoms results from *Gene methylation* of FMR1 gene.
955
Genetics

Puerperium
Pt with Clitromegally and High Androgen levels with Maternal

Virilization probably has *Aromatase Deficiency*
1688
Genetics

Puerperium
An ovulated oocyte is at *Metaphase of Meiosis 2*
1830
Genetics

Puerperium
A complete mole usually results when an empty ovum is fertilized

by a haploid sperm. Subsequent duplication of the paternal genetic
complement (23X) results in characteristic *46,XX* genotype
Genetics

Electrolytes
Pt with painless hematuria, right sided renal mass, cytoology of

malignant cells with chromosome 3p deletion. No significant family
history. Findings indicate Sporadic Renal cell carcinoma which is
due to deletion of VHL gene on chromosome 3.
1935
Genetics
Presence of ragged skeletal muscle fibers and lactic acidosis is

suugestive of mitochondrial myopathy. Heteoroplasmy is
Rheumatology/Orthopedics responsible for variable expressiion of mitochonndrial disease in
& Sports
those affected. Heteroplasmy is having both mutated and wild
mitochondrial Genomes in one individual, severity of disease
depends on ratio of these.
8711
Histology
Scar tissue in the heart is Type 1 Collagen, Just like tendons,

ligaments, bone and blood vessels are type 1.
8424
Histology

Metabolism
The adrenam medulla is demaracted from the cortex and is

composed of Chromaffin cells with a deeply basophilic (blue)
cytoplasm. The medulla is stimulated by Acetycholine.
904
Tumor of cells heavely loaded with mucus that has metastasized to

the ovaries suggests adenocarcinoma of the *Stomach* Classicly
they are mucin-producing signet-ring neoplastic cells in ovarian
stroma. (Krukenberg tumor)
127
Histology
FemaleReproductive
System & Breast
1957
Histology
FemaleReproductive
System & Breast
Pt with heavy and painful menstrual bleeding with uniformly

enlarged uterus has Adenomyosis, which is *Endometrial tissue in
theMyometrium*
11890
Histology
FemaleReproductive
System & Breast
Revisebreastneoplasia!
367
Histology
*Hep B* infection causes hepatocellular cytoplasm to to fill wih

surface hep b antigen. The inclusions are (finely
granular,homogenous, pale pink), dull eosnophilic,ground glass
apearance. Commonly transmitted sexually or in "IV drug users"
889
Histology
Hemolytic anemia signs with blood smear showing spherocytes (no

cetral pallor) indicates spherocytosis which is *RBC cell
memberanecytoskeletonabnormality*
483
Histology
Infectious Diseases
The *True vocal cords* have stratified squamous epithelium. These

can be affected by HPV which is a DNA virus casuing warty
growth (papillomas) on the true vocal cords.
20
Histology
Nervous System
Pt with 1 week history of hemiplegia, expressive ahagia and CT

that shows hypodensity in his brain probably had an ischemic
brain infarct. Histologic finding after stainling for lIPIDS would
produce cells marked densely for lipids which are the
*MICROGLIA* and the lipids are from breakdown prduucts that
werephagocytosed.
1536
Histology
Nervous System
The Blood brain barrier has Tight Junctions (Zonula Occludens)
1922
Histology
Nervous System
Kinesin & dynein are *Microtublar* motor proteins responsible for

rapid axonal transport.Kinesin acts in Anterograde transpor,
Dynein in Retrograde.
1936
Histology
Nervous System
A toxic insult that targets protein KInesin will affect *Secretory

vesicles in nerve terminals* and will make them absent from tissue
histological examination.
478
Histology
*Type 2 Pneumocytes* have the ability to proliferate in response to

cell injury. They can regenerate!
480
Histology
The epithelium of the bronchi is psuedostratified ciliated epithelium

with goblet cells and submucosal mucoserous glands and cartilage.
Bronchioles, terminal bronchiols and respiratory bronchioles lack
goblet cells, glands, & cartilage. The terminal brocnhioles have
ciliated simple cubioidal. So CILIA is last to disappear moving
distally.
488
Histology
smoking induced emphysema is contributed to by neutrophils.
524
Histology
Pt with tickened bronchial walls, lymphocytic infiltration, mucous

gland enlargement, and patchy squamous metaplasia of bronchial
wall mucosa are features of Chronic Bronchitis. Smoking is a
leading cause of that. Smoking is *Behavioral contributor*
Histology

Electrolytes
In PSGN there is deposition of IgG, IgM, an *C3*, thus producing

a star-sky appearance on immunolfourescent microscopy.
1159
Histology
Osteocytes are connected to each other by *Gap Junctions*
& Sports
1734
Histology
Rheumatology/Orthopedics Antibodeis against Actin would be against the Z-line since it

& Sports
contains only actin
556
Immunology
Allergy & Immunology
Pt stung by a bee displaying edematous and erythematous plaque

with evanescent borders and mild central pallor. This is a local
allergic reaction (type 1 hypersensitivity) leading to the release of
*HISTAMINE*, heparin, leukotrienes, and prostaglandins that are
responisble for the increased vascular permeability leading to the
presentation.
743
Immunology
The classic triad of Urethritis, Conjunctivitis, and Mono- or

Oligoarticular arthritis indicates "Reactive Arthritis" which is a
seronegative (RF -ve) spondyloarthropathy (HLA-B27). Symptoms
usually present 1-4 weeks after a primary infection causing
urethritis (dysurea). Skin finding include a vesicular rash on palms
& soles, circinate balanitis, and *SACROiLiiTiS* (inflammation of
sacroiliac joint)
965
Immunology
We conjugate the H. Influenza capsular polysaccharide together

with diptheria toxoid in the vaccine because this combination
*IncreasesImmunogenicity*.
2068
Immunology
Histamine and *Tryptase* are elevated in Anaphylaxis.
2069
Immunology
Mast cell degranulation is triggered by *Receptor aggregation*

during High affinity IgE receptor activation.
Dermatology
Pt presents with highly Pruritic (itchy) erythematous rash

consisting of papules, vesicle and bulla following exposure to
wilderness (Elctrician working in unmaintained woody area). Cells
responsible for tissue damage are *T cells*
[Poison IVY dermatitis, type 4 hypersen]
Dermatology
Symptoms of Maculopapular Rash (skin) and multiple intestinal

ulcers (GI) after Liver transplant (or bone marrow) suggest
Graft-versus-Host disease which is characterized by *Graft T cell
sensitization against Host MHC antigen.*
Immunology
Dermatology
Pts with history of otitis media, chronic diarhea who on on exa

have pneumocystis probably have SCID. (Otitis meedia is from
bacteria and that reuires Humoral immunity) (pneumocystits
requires t cells) Thefere *Combined Immune deficiency*
Immunology
Imigrant pt who is otherwise healthy and labfinding yiled Positive

Anti-Hepatiitis A IgG. He was never vaccinated against hep A.
Thi slab finidng suggest him having an *Anicteric viral infection as
a toddler*
589
Immunology
Secretory IgA exists as a dimer with J chain in the middle and a

secretory piece that kind of cross links the dimer, it functions to
Gastrointestinal & Nutrition prevent IgA dimer degradation in mucosal membranes. Secretory
IgA is present in mucus, tear, and *Colostrum*. (Note: the serum
form is a monomer)
745
Immunology
Gastrointestinal & Nutrition NK cells kill cells that do not express MHC class 1 antigen.
1467
Immunology
The live attenuated oral (Sabine) poliovirus vaccine produces

stronger mucosal sectretory igA immune resposne than Salk killed
Gastrointestinal & Nutrition vaccine. Secretory IgA maybe refered to as *Duodenal Luminal
IgA*. Remember the route of entry of the virus is thru the intestinal
epithelial cells.
1596
Immunology
Immunology
The molecule involved in mediating the accumulation of pus is

Gastrointestinal & Nutrition *IL-8*
[Neutrophil chemotaxis]
1133
1613
2078
373
8539
Immunology
Immunology
Immune mechanism against Giradia involves CD4+ T helper cells

and *Secretory IgA Production*
11674
537
545
Immunology
Immunology
Immunology
GeneralPrinciples
The ubiquitin proteasome pathway is essential for breakdown of

intracellualr proteins, both native and foreign. Ubiquitin works as a
tag for proteasome recognition. This is performed by *Ubiquitin
Ligase* that catalyzes ubiquitin attachment.
Male Infant with eczema, recuurent infections and

thrombocytopenia has *Wiskot-Aldrich Syndrome*
[X-linked][Combined B and T cell disorder][Tx with Bone marrow
transplant]
ErthroblastosisFetalis(Jaundice,hepatosplenomegaly,edema,
low Hb, nucleated erythrocytes, extramedullary hematopoiesis) is
caused by *RBC opsonization by maternal antibodies*
558
Immunology
During the process of T-lymphocyte maturation, T cell receptors of

many lymphocytes demonstrate a very high-affinity interaction with
MHC molecules expressed on thymic medullary epithelial and
dendritic cells. At this time, lymphocyte undergo *Negative
Selection*
953
Immunology
CCR5 protien plays a role in HIV entry into CD4+ Cells. Blocking
of CCR5 receptor blocks entry of HIV into cells.
1598
Immunology
The surface marker for the macrophages of TB is CD14
1614
Immunology
B cells undergo *ISOTYPE SWITCHING* in germinal centres

(round) of the cortex of lymph nodes.
8480
Immunology
PECAM-1 gene is involved in Transmigration during the

inflamatory process.
Infectious Diseases
Pt with HIV history whose "bood" cultures grow psuedohyphae

producing yeast species with ability to form germtubes. This pt
probably has "Cadidemia" (disseminated candida infection).
Development of Candidemia is directly contributed by a *Low
Neutrophil Count*
Note: Superificial Candida Infection is contributed to by a "Low
T-lymphocyte count"
112
Immunology
378
Immunology
Infectious Diseases
Presence of HBeAg (marker for viral replication and increased

infectivity) in pregnant women with hep B infection increases the
risk of vertical transmision to child.
379
Immunology
Infectious Diseases
If HBeAg persists for several months and host ant-HBeAg remain

at low or undetectable levels, suspect *Chronic Hep B with high
infectivity*
Infectious Diseases
Sexually active pt presents with fevers and arthralgias (arthritis).

She has several postules on her arm (Dematitis). Her wrist and
ankle are tender on palpation (Tensosynovitis). Pt blood shows
G-ve bacteria that produces an ezyme that splits IgA at the hinge
regions. Most imp role of this bacterial enzyme is *Mucosal
adherence of bacteria*
[Disseminated Gonorrheal Infection, produce IgA proteases]
560
Immunology
676
Immunology
Infectious Diseases
Symptoms of Fever, Vomiting, Diarrhea, Muscle pain, low BP and

Erthroderma Indicate Toxic shock syndrome mostly caused by
Staph Aureus toxic syndrome toxin which acts a superantigen that
activates many *T Cells & Macrophages*
leading to production of cytokins that cause capillary leakage,
circulatory collapse, hypotension, fever, shock, and multiorgan
failure.
1468
Immunology
Infectious Diseases
The antiviral action of interferon is *Decreased prtein synthesis by

infected cells*
673
Immunology
Nervous System
4 year old Pt with ataxia, repeated respiratory infections, and

cultured cells that show high rate of genetic mutations probably
has Ataxia-telangiectasia and has *Cerebellar Atrophy*
762
796
1466
1763
1995
2128
569
742
Pt wih T cells that lack IL-12 receptor would be unable to release

*IFN-Gamma* and supplementation would be needed to improve
pt's recurrent respiratory infections.
African American woman presents with exertional dyspnea and dry

cough. Chest xray shows bilateral hilar adenopathy and reticular
pulmonary infiltrates. Serum ACE & Ca levels are elevated. PPD
test is negative. Bronchoscopy is arranged. The cell type that is
most likely to predominate in the lavage is *CD4+ cells*
(Sarcoidosis)
Pt given an inactivated viral component vaccine. On exposure to

real virus, would result in *Inhibition of viral entry into cells*
(Humoral immunity and not cell mediated immunity since it is not a
live virus)
2 yr old boy Pt with sinopulmonary infections (otitis media &

pneumococal pneumonia for e.g) Together with G. lamblia
gastroenteritis, failure to thrive and low Serum Imunoglobulins.
Flow cytometry of pts peripheral blood would show def of cell
bearing *CD19* marker
[X-linedAgammaglobulinemia, Bcells]
Infant with recurrent otitis media and bronchiolitis. He has oral

candiasis. He has a Hx of chronic Diarrhea. Serum protein
electrophoresis shows very low gamma globulin level. X-ray shows
absent thymic shadow. Most likley Dx is *SCID*
[Recurrent viral infections, Oral thrush, Persistent Diarrhea.
Absent thymic shadow is due to severe T cell def.
Hypogammaglobulinema is due to low B cells. Both low humoral
and cell med immunity]
Immunology
*Anti IgE Antibodies* are effective add-on-therapy to severe

allergic asthma patients that are already on glucucorticoids and
beta-agonists.ExamplesincludeOmalizumab.
Immunology

Electrolytes
Hyperacute renal transplant recjection is an *Antibody-mediated

hypersensitivity*
(preformed Ab's against graft)

Electrolytes
Female Pt with glomerulinephritis, photosensitive skin rash and

arthralgias together witha positive trepnemal RPR but with -ve
T.pallidum enzyme ummunoassay and also prolonged aPTT
probably has SLE with Antiphospholiid antibody syndrome and is
therefor at risk of *Recurrent Miscarriages*
Immunology
Immunology
Immunology
Immunology
Immunology
Immunology
747
Immunology

Electrolytes
Pt who received emergency blood transfusion who quickly

develops dyspnea, chills, chest/back pain, and hemoglobinurea
probably has acute hemolytic transfusion reaction. This is a type 2
hypersensity and therefore can be due to *Complement mediated
cell lysis*
750
Immunology

Electrolytes
When it comes to handling parasites, eosinophile do it via the

*Antigen-Dependent-Cell-Mediated Cytotoxicity (ADCC)*
8530
Immunology

Electrolytes
Pt with renal cell carcinoma and given high dose IL-2. There is
reduction in tumor burden. Mechanism? -> *Enhanced Activity of
NK cells*
11786
Immunology

Electrolytes
An immuno suppressant that inhibits lymphocyte proliferation by

blocking interleukin-2-signal transduction is similar to *Sirolimus*
298
Immunology
& Sports
Pts with Lymphocytes with mutated Fas gene product (i.e Fas
receptor) would have an impaired *Activation-Induced T
Lymhocyte Death*
Fas ligand that binds to Fas receptor on t cells activates Fas assoc
death domian (FADD) which activates caspases leading to
Apoptosis.
Immunology
2 year old with recurrent skin and mucosal infections. Skin

infection drainage grows Staph aureus with no purulence. Lab test
reveals absent CD18 antigens on leukocytes. Pt is at greatest risk
& Sports
for *Persistent Leukocytosis*
(Leukocyte Adhesion Deficiency type 1)
Immunology
Pt who is given infliximab for Crohn Disease. Ten days later he

develops a pruritic skin rash. Skin biopsy shows scattered areas of
Rheumatology/Orthopedics Fibrinoid necrosis and neutrohil infiltration involving his small
vessels. The finding most likely to accompany this condition is
& Sports
*Decreased Serum C3 level*
(Serum Sickness, Type 3 (immune-complex) hypersensitivity)
754
Immunology
Pt with sign of RA. Pt serum most likely has IgM antibodies that
react with *Fc portion of Human IgG*
& Sports
(Rheumatoid Factor)
759
Immunology
IL-4 & 5 are respnsible for antibody class switching.
& Sports
538
741
1388
Microbiology
Immigrant 6 year old who presents with dyspnea. He has Fever.

Exam shows neck swelling, palatal paralysis and a gray
pharyngeal exudate. His vaccination history is unknown. The
intervention that will imrove his symptons is *Passive Immunization*
(C.Diptheria infection, exotoxin)
1389
Microbiology
Non pathogenic C. Diptheria become pathogenic thru *Phage

conversionpermitingexotoxinproduction*
645
Microbiology
Coagulase-negative streptococci such as staph epi are methicilin

reistant and should be treated with *Vancomysin*
679
Microbiology
Staph epi is differentiated from staph aureus by the coagulase

test. Staph epi is coagulase negative while staph aureus is positive.
733
Microbiology
Old pt presents with low-grade fever and fatigue. Exam shows a

diastolic murmur at left sternal border. He has nontender
erythematous macules on his hands and feet. Blood cultures grow
g+ve cocci that are catalase-ve and grow in hypertonic saline and
bile. Pt medical history is likley to inculde *Cytoscopy* within the
past month
[Entercoccal Endocarditis, colonizes genitourinary tract]
[Viridans are bile insoluble and dont grow on hypertonic saline]
1001
Microbiology
Pt with Strep Gallolytics (S.Bovis) infection. Additional workup

should focus on *Colonic Neoplasia*
Viridans Steptococci are normal inhabitants if the oral cavity and

are a cause of transient bactremia after dental procedures in
healthy and diseased individuals. In pts with pre-existing valvular
lesions, viridans streptococci can adhere to *Fibrin-Platelet
Aggregates* and establish infection that leads to endocarditis.
Emigrant child with unknown history of vaccination who presents

with fever, throat pain, an dyspnea. There is coalescing gray
pharyngeal exudate and cervical adenopathy. He later dies of
Myocarditis and HF. Pt most likely has Diptheria and could have
been prevented by DTP vaccine which has diptheria toxoid which
provides *IgG against circulating proteins*
1003
1092
Microbiology
Microbiology
8282
680
1313
Microbiology
Microbiology
Microbiology
The action that most likely prevents intravascular catheter-related

infections is *Alcohol-based hand scrub prior to beginning the
procedure*
Dermatology
Infant with diffuse skin erythema, and epidemris comes off easily
with gentle pressure. This is caused by *Exotoxin-mediated skin
damage*
(SSSS by staph exofoliatin exotoxin)
Dermatology
Pt presents with skin changes. Blotches of skin on her arms

appear to be of different color. She also has a tingling sensation in
her hands. Exam shows patchy area of skin anesthesia and
hypopigmentation on her upper extremities. Nerve biopsy shows
organisms invading Schwann cells. Hiv test is negative. Most likley
cause is *Myobacterium Leprae*
[Tubercolid Leprosy, TH1 response. mild form compared to
Lepromatousleprosy(TH20]
1316
Microbiology
Dermatology
When pt's serum is added to a mixure of cardiolipin, lecithin, and

cholestrol and extensive flocculation is observed, the next step is to
evaluate for *Spirochetal Antibodies*. This is a nonspecific
treponemal serologic test known as the rapid plasma reagin test.
1553
Microbiology
Dermatology
a unilateral vesicular rash involving a single dermatome is

Shingles. The pt would siffer from *Persistent local pain* in the
next 6 months
Dermatology
Child of immigrants with a rash that started in face and spread

rapidly down the body. Exam shows a generalized, fine pinkish,
maculopapular rash and tender lymphadenopathy bilateral behind
the ears. Most likely cause of this disease is a *Togavirus*
[Rubella is a togavirus]
[Rubeola by paramyxovirus which causes measles has no post
auricular lumphadenopathy usually assoc with it]
Dermatology
Pt with animal exposure and scratch marks together with tender

regional LYMPHADENOPATHY likely has Cat-Scratch Disease
caused by Bartonella Henselae, a g-ve organism that also causes
*Bacillary Angiomatosis* in immunocompromised pts
Dermatology
Burn patients are susceptibe to infection with pseudomonas

aeruginosa which a gram -ve rod that is oxidase positive and
non-lactos fermenting. Tx can be with 4th generation
cephalosporin *CeFePiMe*
ELderely diabetic with severe pain and discharge from ear.

Touching pinea causes extreme pain. Otoscopy shows granulation
tissue in left ear canal with scant amount of discharge. Tymapnic
membrane is clear, and no middle ear effusion. Cultures grow a
g-ve rod. Characteristic best describing infecting organism is
*Motile and Oxidase +ve*
[PsudemonasOtitisExterna]
Microbiology
FemaleReproductive
System & Breast
Pt presents to fertility clinic. Attempting to concieve for past year,

no success. She used OCP for 15 years. 7 years ago she got
ceftriaxone for fever, abdominal pain, and vaginal discharge. Major
contributing factor to her inability to conceive is *Insufficient
antibiotic use*
[PID was treated only for gonorhea, azithro was not used for
coverage of chlamidya, this led to subclinical continous infection
that led to scaring of fallopian tubes and subsequent infertility]
Microbiology
FemaleReproductive
System & Breast
Pt with gray white fishy vaginal discharge with no inflammation that

shows clue cells is characteristic of bacteril vaginosis caused by
Gardnerella vaginitis which an *Anaerobic gram variable organism*
1669
1898
8858
8342
1027
1929
Microbiology
Microbiology
Microbiology
Microbiology
FemaleReproductive
System & Breast
Pt with abdominal pain, bloody vaginal discharge, orthostatic HTN

and a positive preganancy test. Prior infection with
*N.Gonorrhoeae* is likely responsible for her current condition.
[Pt has a ruptured ectopic preganncy. Primary resik factor for
Ectopic preg is tubal scaring and prior infection with Chlamidya
and N. gonorrhea are major predisposing factors.]
Microbiology
FemaleReproductive
System & Breast
Septic Abortiontypically prsents with fever, abodominal pain,

uterine tenderness, and/or foul-semlling discharge after
preganancy termination. Common offending pathogens inculude
*Staph Aureus* and E. coil due to seeding of the uterine cavity
duringinstrumentation.
Microbiology
The prsence of a fluid-filled cavity in liver in conjuction with fever,

chills and RUQ pain. Microorganism/route combinations that is
most likely cause is *Staph Aureus via Hematogenous route*
[Hepatic Abscess caused by staph]
278
Microbiology
Dysphagia for liquids and difficulty belching in association with a

diated esophagus and absent peristalsis in the smooth portion is
diagnostic of Achalasia. If pt is from south america or central
america suspect *T. Cruzi*
976
Microbiology
V Cholera is oxidase positive, g-ve, commam shaped rod that can

Gastrointestinal & Nutrition grow on alkaline media. Stool microscopy reveals *Mucous and
some sloughed epithelial cells* with No fecal leukocytes or RBC's.
1100
Microbiology
1136
Microbiology
Depending on age and condition of host and the species of

Shigella, as few as 10-500 cells can cause infection. *Shigella
flexneru*
[others include Entamoeba Histolytica, Giardia and C. jejuni]
1397
Microbiology
Pt takes Clindamycin and develops C.diff Colitis. The causative

Gastrointestinal & Nutrition agent damages the *Cytoskeleton Integrity* of intestinal mucosal
cells.
1398
Microbiology
In the absence of normal intestinal microbial flora, C.difficile can

Gastrointestinal & Nutrition overgrow and produce toxins. Therefore, persons with a
*Preserved Intestinal MicroBiome* may not develop an infection.
Microbiology
Enteric pathogen causing diarhea that can be transmitted from

domestic animals to humans is *Campylobacter*
extra note:
-(Curved G-ve rod that moves in corkscrw fashion)
-MCC of acute gastroenteritis in kids and adults
-Assoc with GBS
Microbiology
Pt ingests solution containing 13C labeled urea. He then is aksed

to blow into a tube and labeled carbon is detected in his breath
Gastrointestinal & Nutrition samples. This is most likely part of the evaluation of *Duodenal
Ulcer*
(H.pylori is urease positive)
Microbiology
Culture of a "periappendiceal fluid collection" in the abdomen

could reveal the anaerobic *Bacteroides Fragilis* which express
surface polysaccharides that favor abscess formation. Others
could include E.coli, enterococci, & streptococci.
Microbiology
The finding most suggestive of Strongloides Stercoralis infection is

Gastrointestinal & Nutrition *Rhabditiform Larvae in Stool*
[Tx with Ivermectin]
1932
11961
62
1422
1602
7573
8873
Microbiology
The toxin of EHEC *Inactivates ribosomal subunits*

[Just like shigella toxin]
10401
1592
732
1097
Microbiology
Microbiology
Microbiology
Microbiology
C. Difficile Infection is treated with Metronidazole, Vanco or

*Fidaxomicin* The first two are first line treatments but
*Fidaxomicin* is used in recurrent CDI and is bacteriocidal with
minimalsystemicabsorption.
GeneralPrinciples
Pt with CMV postive antibody probably had a *Mononucleosis-like

illness* in the past due to CMV infection, symptoms include fever,
malaisse, myalgia, atypical lymphocytosis, and elevated
transaminases.
PT dies from Strep Pneumo infection. He has history of motor

vehicle accident that required laparatomy. The mechanism that
contributed to the severeity of this pt's infection is *Systemic
Bacterial Clearance*
[Pt most likely had part his spleen removed after accident and
became suscptible to encapsulated bacteria due to inability to
clear them]
Pt with somnolence, lethargy, and oliguria with bloody diarrhea. He

has high urea, BUN and creatinine. Blood smear reveals
fragmented erythrocytes, Pt has HUS which is related to the
consumption of *Undercooked Beef*
1374
Microbiology
Mother had still bith at 18 weeks. Autopsy shows pleural effusion,

pulmonary hypoplasia, and ascites. Infection with *Non-enveloped,
single stranded DNA virus* is most likely etiology.
[Parvovirus causing fetal hydrops]
1722
Microbiology
pt being Tx for HIV. Viral strains show significant increase in POL

gene. This is related to *Antiretroviral chemotherapy*
(Resistance to drugs)
45
Microbiology
Infectious Diseases
A population that is universally vaccinated with recombinent

HBsAg. The disease that would almost entirely disappear is *Delta
Agent Infection*
{Hep D causes infection only when encapsulated with HBsAg, it is
a replication-defective RNA virus]
48
Microbiology
Infectious Diseases
Hepatitis that causes high incidence of fulminant hepatitis in

pregnant women with high mortality (20%) is hep E which is an
*unenveloped RNA virus* spread thru fecal oral route.
Infectious Diseases
Mucormycosis is an opportunistic infection caused by Rhizopus,

Mucor, and Absidia. Clinical picture is paranasal involvememnt in
diabetic or immunocompromised patient. Fungi form broad
nonseptate hyphae at 90 degree angles!!
Infectious Diseases
Pt with signs of diabetic ketoacidosis together with Black Necrotic

Escha on nasal cavity examination, facial pain, & headache
probably has "Mucormycosis" and Diagnosis can be made with
*Mucosal Biopsy* to see borad-ribbon-like nonseptate hyphae with
right-angle branching.
Infectious Diseases
Oral thrush (can be scaped off) in an otherwise healthy pt is

suggestive of immunosuppression and HIV should be suspected.
Therefore, Medical history can be focused on *Sexual Practices*
Infectious Diseases
Pt has fever and joint pain. He has abnormal lynphocytes on blood

smear. Condition is caused by an enveloped virus containing
partially-double stranded circular DNA. An enzyme packed in its
virion has RNA-dependent DNA-polymerase activity. Pt is most
likely infected with *Hep B virus*
106
107
111
376
Microbiology
Microbiology
Microbiology
Microbiology
532
Microbiology
Infectious Diseases
Pt presents due to fever, night sweats, weight loss and productive

cough. He says his sputum is greenish and foul smelling. Chest
X-ray shows a cavitary lesion in the middle lobe of right lung with
air-fluid levels. Most likley cause of this cavitary lesion is
*Aspiration of oropharyngeal contents*
[Lung Abscess]
678
Microbiology
Infectious Diseases
Youn woman with UTI. Sexually active. Culture shows catalase

+ve, g+ve cocci. Organism responsible is *Novobiocin resistant*
[Staph Saprophyticus UTI]
722
Microbiology
Infectious Diseases
Strep pyogenes (Group A)(G+ve cocci)(Beta hemolytic) (Catalse

-ve) (can cuse PSGN, Acute rehumatic fever, scarlet fever,
pharyngitis, & impetigo) is *Pyrrolidony Arylamidase Positive (PYR
+)* and Also Bacitracin sensitive.
728
Microbiology
Infectious Diseases
*Intravascular devices* contriubute to increase in staph bactremia

thru the nation
Infectious Diseases
Signs of encephalities (fever, headache, aphasia, mental

alteration) with temporal lobe lesions indicate *HSV
ENCEPHALITIES*
Infectious Diseases
Neoborn presents with inability to open mouth and hands are

clenched all day. P.E shows increased muscle tone, arching of the
back, and dorsiflexed feet.
This could ve been prevented with *Vaccination of pregnant
woman*
(Neonatal tetanus)
Infectious Diseases
Ulcer with central black eschar surrounded by edema suggest

Bacillus Anthracis. Helping in making a diagnosis would be
*Occupation*
[exposure to animal or animal products, if no risk of occupational
exposure then there is potential of bioterrorism]
907
968
971
Microbiology
Microbiology
Microbiology
1007
Microbiology
Infectious Diseases
Pt with asymmetric polyarthritis (knee, elbow, wrist)with synovial

fluid analysis showing neutrophilic predominanc and intracellular
organisms most likey has "Neusseria Gonorrhoeae". *Condom use
could ve prevented it*
1026
Microbiology
Infectious Diseases
Tx of Neisseria Gonorrhea does not appear to provide lasting

protective immunity due to *High variability of microbial antigenic
structure* and hence recurrent infections occur.
Infectious Diseases
6 year old of recently immigrant family comes due to sore throat

and fever. Exam shows mild tonsilar erythema with exudates.
Microscopy shows clumped, gram +ve bacteria with polar granules
that stain deeply with aniline dyes. The pathogenicity of the
organism likely causing this condition is *Impairment of protein
Synthesis*
(Diptheia toxin, ADP-ribosylation of EF-2)
Infectious Diseases
6 yr old with fever and sore throat. Non immunized. P.E shows a
grey pharyngeal exudate and gram stains shows g+ve organisms.
The culture type that facilitate teh growth of this organism is
*Cystein-tellurite agar*
[C.DIPTHERIA]
[Bordet-Gengou medium is for pertusis, thayer martin for
gonorrhea, mcConkey is for enterics]
1093
1095
Microbiology
Microbiology
1137
Microbiology
Infectious Diseases
AfricAmer womann with fev, malaise, and intense pain over right
thigh. She has long history of frequent presentation to hospital with
painful crises that respond to supplemental O2 & IV narcotics. The
new episode is diff cuz is Febrile with exquisite thigh pain &
abnormal MRI finding. Blood grows nonlactose-ferment, oxidase
-ve, motile organism. Virulence mechanism is *Resistance to
Opsonization*
[Salmonella osteomyelitis in Sickle cell pt, encapsulated, functional
asplenia]
1139
Microbiology
Infectious Diseases
E.coli which shows green metalic sheen on EMB agar, hemolysis

on blood agar, and lactos fermentation (pink) on McKonkey agar
causes UTI's thru use of *Fimbrial antigen* which allows adhesion
toUrothelium
1309
Microbiology
Infectious Diseases
Isoniazid inhibits mycolic acid synthesis in the treatment of TB

thus making Tb cells less resistent to decoloration by acid-alcohol.
Infectious Diseases
Phospholipid composition of viral particle surface is highly similar

to that of cell nucelar membrane. This is most likely
*Cytomegalovirus*
(Herpes viruses bud thru and acquire the lipid bilayer envelope
from the host cell nuclear membrane)
1408
Microbiology
1498
Microbiology
Infectious Diseases
Symptoms of acute dysurea and heamturia in the setting of a day

care (mostly boys) is Hemorrhagic Cystis caused by the
*ADENOVIRUS* which its genomic fragments can be found in
urine.
1550
Microbiology
Infectious Diseases
Recurrence of genital hepres can be reduced by *Continous daily

valacyclovir*
Infectious Diseases
A virus that gives B lymphocytes the ability to proliferate

indefinitely and retain their bility to secrete immunoglobins is
diagnosed "in vivo" using *Heterophile Antibodies"
(EBV virus)
Infectious Diseases
An HIV protein that is Glycosylated then proetolytically cleaved in 2

smaller proteins. This protein is gp160 which is cleaved into gp120
and gp41 which help in *Virion attachment to the Target Cells*
1594
1672
Microbiology
Microbiology
1723
Microbiology
Infectious Diseases
Pt with HIV who presents due to several months of pain and itching
in perirectal area. He also has intermitten rectal bleeding. Exam
shows a visible ulcerative mass. Most likely responsible pathogen
is*HumanPapillomavirus*
[Anal squamous cell cacinoma]
[CMV causes retinits and colitis, not a mass]
1949
Microbiology
Infectious Diseases
N. Gonorrhea urethritis is treated treated with *Ceftriaxone (3rd

gen Ceph) and Azithromycin (Macrolide) *
8593
Microbiology
Infectious Diseases
Isopropanol has antiseptic properties through *Disruption of cell

membranes*
10168
Microbiology
Infectious Diseases
Scabies causes an intesnse pruritic (ITCHY) rash at the wrsit, later

surface of fingers and finger webs. Pts excoriate (ITCH) Caused
by Sarcoptes Scabiei. Diagnose under microscpe for egg and
mite itself.
11459
Microbiology
Infectious Diseases
Fever and Diarhea after Antibiotic adminstration suggest C. Diff

infection and precaution of wearing *Nonsterile gloves and Gown*
should done.
11524
11540
11547
11604
11670
11766
11812
11822
11859
113
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
Infectious Diseases
Pt with fever and malaise. He had fever and chills which later
became fatigue. He lives in easter Massachusetts. There are lung
crackles and palpable splenomegaly. Peripheral blood smear
shows Intraerythrocytic pleomorphic forms (Maltese Cross). Most
likely source of infection is *Ixodes Tick*
(Babesiosis)
Infectious Diseases
Pt who presents with febrile illness, bilateral infiltrates on x-ray,

abnormal liver funcion tests, anemia, and (most importantly)
*CROSS-SHAPED IntraErythrocytic Inclusions* has Babesiiosis
by the Babesia microto which is a TICK Borne infection by the
IXodes Tick which also transmits the organism *BORRELIA
BURGDORFERI* that causes Lyme disease.
Infectious Diseases
Pt bitten by his dog. Wound is warm, red and swollen after 24hrs.
Wound culture grows g-ve coccobacilli and culture has mouse-like
odor. Organism? => *Pasturella Multicoda*
Infectious Diseases
20 yr old woman comes due to vaginal pain with sex annd dysuria.
She has a new boyfriend. Exam shows multiple, painful, shallow
ulcers with an erythematous base on the left labia. There is no
vaginal discharge. And no cervical motion tenderness. She has
bilateral inguinal lymphadenopathy. Best diagnostic test for pts
condition is *PCR fro viral DNA*
[Genital Herpes, Tzanck smear is also possible][Syphilus is
painless chancre]
Infectious Diseases
Pt presents with tonic-clonic seizure. He grew in rural Guatemala

and immigrated to US 3 years ago. All other test are negative. MRI
of brain reveals 2.5-centimetre cyst within the left sylvian fissure
that has minimal enhancement and no associated edema. Most
likely means of acquisition of infection is *Exposure to infected
stool*
[Neurocysticercosis by Taenia solium]
Infectious Diseases
Old pt with fever and altered mental status whos urine culture grow
g-ve rods that are lactos fermenting and indole-postive probably
has *E. Coli*
(UTI) (Indole positivity distinguishes it from Enterobacter cloacea)
Infectious Diseases
Pt with UTI after recent cytoscopy in which urine culture shows

g+ve cocci in chains most likey has Enteroccocus which shows
*Gamma hemolysis on blood agar*
Infectious Diseases
Infant comes due to generalized seizure. She fever for past 12

hrs. Pt is discharged with no medication. Three days later, she has
no fever but develops a maculopapular rash on her trunk. She is
most likely infected with *Human Herpesvirus 6*
[Roseola infantum, the seizure can happen with any febrile illness]
Infectious Diseases
Pt presents with shortness of breath, myalgias and retroorbital

headaches. Pt was cleaning Animal waste at a farm. He is febrile,
bronchial breath sounds are hear in right lower lung. Chest xray
shows right lower and middle lobe consolidation. Lab shows
thrombocytopenia and elevated liver enzymes. HIV test is negative.
Most likley cause is *Coxiella Burnetii*
[Q fever, has headaches and pneumonia with thrombocytopenia
andelevatedthrombocytopenia]
Nervous System
HIV pt infected with organism stained with india ink in CSF

showing spherical yeast with thick capsules (C.neoformans). Most
likely primary foucs is *Lungs*
[found in pigeon droppings and soil, enters thru resp route]
116
118
735
737
Microbiology
Microbiology
Microbiology
Microbiology
Nervous System
Pts with headache and fever. CSF has low glucose and high
protein. Microscopy shows transparent capsules on india ink is
suggestive of Cryptococcal meningeoencephalitis. Tx with
Amphoterain B. `
Nervous System
Pt with Hx of viral encephalitis and pneumocystis pneumonia most

likey has HIV and if they present with signs of meningitis with latex
agglutination positive for soluble polysaccharide antigen probably
has Cryptococcal meningitis and you should expect *Budding
yeast* on light microscopy.
Nervous System
Adult pt with signs of meningitis. CSF analysis shows elevated

opening pressure, increased neutrophils (10%), decreased
glucose and elevated protein. Pt most likely has Strep Pneumo
Meningitis and gram stain of csf would reveal *Lancet-Shaped,
Gram positive cocci in pairs*
Nervous System
Pt with CSF sample with bean-shaped g-ve cocci in pairs probably

has Neisseria Meningitidis which reaches the meninges via
*Pharynx--> blood---> choroid plexus-->Meninges*
This means that neisseria meningitidis is transmitted via respiratory
droplets.
738
Microbiology
Nervous System
Autopsy of 14 yr old male died of septic shock. Shows extensive

hyperemia and infarcts of internal organs. Purpuric cutaneous
lesions and hemorrhagic destruction of both adrenals are also
present. The organism responsible for death more commonly
causes*Meningitis*
[N. Meningitidis]
1005
Microbiology
Nervous System
Neisseria meningitidis uses pilus roteins to attach to *Nasopharynx

epithelial cells*
Nervous System
Pt with signs of meningitis and blood culture showing g-ve kidney

bean-shaped diplococci, the microbial component causing
morbidity is *Outer membrane LipoOligosaccaride*
Nervous System
3 month old infant with Hydrocephalus, Intracranial Calcifications

and Chorioretinitis has "Congenital Toxoplasmosis" which is
tansmitted transplacentally and the cause is therefore
*In-Utero-Infection*
Nervous System
Infant with meningitis and culture grows gram -ve rods that form
pink colonies on McConkey agar has E.coli neonatal meningitis
and the bacterial virulence factor is *Capsule*
(K1 capsular polysaccharide)
Nervous System
A motile gram +ve rod that has a narrow zone of beta hemolysis,
and can grow well at refrigiration temp is likely Listeria which is an
Inracellular Organism and therefore requires *Cell Mediated
Immunity* to eliminate.
Nervous System
Bacterial product that when injected into muscles with relentless

focal dystonia produces dramatic but temporary relief of symptoms
is C. Botulinum toxin, The bacteria demonstrates *Subterminal
SporeFormation*
Nervous System
Pt with presenting to ER with seizures. On exam he has oral thrush

and lymphadenopathy and MRI shows multiple ring enhancing
lesions (shown) probably has HIV and has acquired
*Toxoplasmosis.* that explain his seizures.
Nervous System
Campylobacter Jejuni can lead to Guillain-Barre Syndrome. GBS

is a demyelinating syndrome of the peripheral nerves
characterized by ascending muscle weakness and paralysis. Pt
has history of self resolving diarhea. C. jejuni is a common cause
of infectious diarrhea.
1006
1038
1140
1391
1401
1573
1601
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
1853
Microbiology
Nervous System
Young college stduent with headache, fever, altered metal status,

nuchal rigidity, purpuric rash) has Meningococcal meningitis and
could have been prevented with *Capsular Polysacharide*
vaccine.
1906
Microbiology
Nervous System
An elderly person with Confusion and flaccid paralysis and CSF

PCR shows Viral RNA. Most likey it is West Nile Virus which is
transmitted by *An Insect Bite* of the Culex Mosquito.
1966
Microbiology
Nervous System
Child with fever, headaches, vomiting, mild pharyngeal erythema

and neck stiffness. CSF analysis shows normal glucose and mildly
elevated protein. Leukocyte count is 300 with lymphocytic
predominance. Most likely cause is *Entervirus*
(Viral meningitis (aseptic), entervirus include cosackie, polio,
echovirus)
2082
Microbiology
Nervous System
Toxoplasmosis is Tx with *Pyrimethamine and Sulfadiazine*

[If u see ring enhancing lesions in HIV , suspect toxo before
lymphoma]
8324
Microbiology
Nervous System
Agitation, disorienttion, Pharyngospasm, Photophobia, COMA and

Death strongly suggests Rabies Encephalitis which binds to
*ACETYLCHOLINERECEPTORS*(nicotinic)
Nervous System
Blood cultures that grow coagulase negative staph after a

ventriculoperitoneal shunt placement. The most imp virulence
mechanism of bacterium is *Synthesis of an extracullular
polysaccharide matrix*
[Staph Epidermidis releasing a biofilm]
Microbiology
Nervous System
Pt with "fever", "stiff neck", altered mentation, "severe headache

with photophobia" could have Bacterial Meningitis and there *CSF
should be analyzed* to confirm diagnosis. Note: Migrains don't
present with fever!
Microbiology

Puerperium
Infant Pt with White pupils (Cataracts), heaing loss, and Machine

like murmur (PDA) probably has congenital Rubella. This could
have been prevented by giving the mother the *Live attenuated*
Rubella virus vaccine.
8533
11862
1464
Microbiology
1575
Microbiology

Puerperium
Pregn pt who is a migrant and develops low grade fever and

maculopapular rash that spreads from face and chest to trunk and
extremities over next 48 hrs. P.E shows postauricular
lymphadenopathy. The mother is at immediate risk for
*Polyarthralgia* while the fetus at risk *Sensineuronal Deafnes*.
This pt has German measles (Rubella) and has not been
vaccinated with MMR
117
Microbiology
An organism's capsule that stains red on Mucicarmine staining is

the capusle of *Cryptococcus Neoformans*
Pt with flue like symptoms and lung symtoms of crackles and

pulmonary infiltrate who works a capenter and suptum KOH
preparation shows "Broad Based-Bud" most likey has
*Blastomyces Dermatitidis*
120
Microbiology
266
Microbiology
Pt returning from cave exploation i central USA develop fever,

cough and malaise. Pulmonary infiltrates and hilar adenopathy are
present on x-ray. Lung tissue specimen will show *Ovoid cells
withinMacrophages*
(Histoplasma Capsulatum)
267
Microbiology
Hiv pt with cough, fever, hepatosplenomegaly (sysetmic symptoms)

and a bone marrow aspirate that shows small ovoid bodues wuthun
a macrophage is caused by *HISTOPLASMA Capsulatum*
269
Microbiology
Exam of lung tissue that shows spherules oacked with endospores.

Pt history will most likely reveal *Recent travel to Arizona*
[Coccidoides Immitis][Southern and central California, Arizona,
New Mexico, & Western Texas]
665
Microbiology
Pt presents with recurrent transient pulmonary infiltrates. She has

a history of bronchial asthma. He takes albuterol and inhaled
glucocorticoids. CBC shows Eosinophilia. Chest CT shows
proximal bronchiectsais. This pt has colonization of *Aspergilus
Fumigatus*
730
Microbiology
Virulence factor of Strep Pneumoo (g+ve diplococci, alpha

hemolytic) is *Polysaccharide Capsule*
731
Microbiology
G+ve lancet shaped cocci in pairs is Strep Pneumo which is *Bile

Soluble*
Pt with persistent cough and pulmonary infiltrate. Pt's blood shows

clumping in ice but not in warm water. Organism causing
condition? => *Mycoplasma Pneumonia*
-(ColdAgglutinin)
Heavy smoker with fever, confusion, headache, watery diarrhea

and mildy productive cough. Sputum gram stain show numerous
neutrophils but no bacteria. Most likely cause is *Legionella
Pneumophila*
[Triad of atypical pneumonia, diarrhea, and hyponatremia][poor
gram stain][long smoking Hx]
Microogranism causing pneumonia is isolated and demonstrates

slow growth on Buffered Carcoal Yeast Extract that is
supplemented with L-cystein and Fe. It is visualized with a silver
stain. Most likely cause of increased incidence of nosocomial
punemonias in his hospital is *Colonization of the hospital water
sysetm*
(Legionella)
5 yr old boy has hugh serum level of antibodies against Polyribitol

ribose phosphate(PRP). The antibodies would most likely carry
protectionagainst*Epiglottitis*
[Anti H. Influenza capsule antibodies]
H. influenza requires a blood agar supplemented with hematic and

NAD+. Pathogenicity is related to *Capsule* Virulence factor
[H.INFLU type B (HiB)]
958
960
961
962
964
Microbiology
Microbiology
Microbiology
Microbiology
Microbiology
999
Microbiology
A newborn who develops lethargy and respiratory distress. Blood

cultures shows beta-hemolytic gram+ve cocci in chains that are
bacitracin-resistant. The measure that could have prevented this
patients condition is *Intrapartum ampicilin*
[Strep Agalactiae, ie. Group B strep]
1216
Microbiology
Pt with sign of Tb and the observed bacterial growth is

mycobacteria that grow in parallel chains (Serpentine cords). This
growth correlates with bacterial *Virulence*
If viral paricles lose their infectivity once exposed to ether. We can

conclude that the are *Enveloped*
[Ether and other organic solvents can inactivate the enveloped
virus]
Pts olde than 65 are particularly prone to developing secondary

bacterial pneumonia after influenza infection. In order, the
ppathogens often most responsible for 2ndry bacterial pneumonia
are Strep Pneumo, *Staph Aureus*, and H. Influenza.
1377
1666
Microbiology
Microbiology
Child with upper-respiratory tract symptoms "followed" by brassy

(barking) cough and difficulty breathing probbaly has
parainfluenza virus Croup which is a *Paramyxovirus*
Mycoplasma hominis is a genus that includes Ureaplasma

urealyticum and those have no cell walls. They are therefore
resistent to cell wall synthesis inhibitors. We tend to use
anti-ribosomal agents (macrolides, tetracyclies)
Pt with persistent coughm low-grade fever and malaise. Chest xray

shows pulmonary infiltrates more severe than would be expected
based on clinical status. Causative agent required cholestrol
enriched medium to grow. This is walking pneumonia caused by
*Mycoplasma Pneumonia*
Microbiology
*Klebsiella Pneumoniae* is a g -ve rod that grows pink-colored

(lactose fermenting) mucoid colonies on MacConkey agar. It is
encapsulated and casues community acquired pnemonia in
Alcholicpateints.
646
Microbiology
*Staph Aureus* is the most commin cause of Acute Hematogenous

Rheumatology/Orthopedics osteomeylitis in children (10 year old for eg) characterized by pain
over long bones (tibia, femur)with high fever and chills. Possible
& Sports
soft tissue swelling. Vague symptoms.
845
Microbiology
Rheumatology/Orthopedics rash with slapped cheek appearance is of Erythema infectiosum

& Sports
caused by parvo virus B19, disease is also called Fifth disease.
Microbiology
Pt who has recently been to a resort presents with ithcy rash.

Exam shows diffuse, pruritic, papuloppustular rash on trunk and
Rheumatology/Orthopedics extremities. Analysis of fluid shows oxidase +ve grame -ve rods
that prodcuces a pigment on culture medium. Most likely source of
& Sports
this infection is *Pool water*
(Psuedomonas hot tub folliculitis)
1101
Microbiology
Pt present with sore on his right hand. He is in Wool business.

Was recently in Asia. P.E shows an ulcer with black eschar and
siginificant surrounding edema. The toxin causing the edema
around the ulcer has a MOA similar to a toxin produced by
& Sports
*Bordetella Pertussis*
(Bacillus Anthracis, anthrax exotoxin edema factor similar to
adenylate cyclase toxin of bordetella pertusis)
1394
Microbiology
Crepitus on physical and radiographic visualization of gas in

tissues esuggests Gas gangrene by C. Perfringes which also
& Sports
causes Transient Watery Diarrhea and Abdominal Discomfort.
11868
Microbiology
Pt who acquire staph infection thru hemodialysis catheters and

present with backpain could have developed osteomyelitis which
& Sports
can be evaluated using *MRI of the spine*
1667
1677
1679
9989
974
458
459
Microbiology
Microbiology
Microbiology
Pathology
Pathology
Skin biopsy from thigh of a child shows vascular lesions with IgA
and C3 deposition. The most likely clinical presentation is *Skin
rash and abdominal pain*
[Henoch-Schonlein Purpura]
Pt is hospitalized with recent onset oliguria and a high serum

creatinine level. He has been seen in clinic several times for an
untranasal ulcer that has failed to heal. The pt's condition is most
likely assoc with antibodies against *Neutrophils*
[Wegner's Granulamatosis with polyangiitis, Cytoplasmic staining
Antinuetrohil cytoplasm antibodies (c-ANCA) is pathognomonic]
39
Pathology
Pt with chest pt shows near-toal-occlusion of LAD artery. The

absence of myocardial necrosis and scarring despite vessel
occlusion in this pt is explained by the *Slow Growth Rate* of the
occluding plaque.
(arterial collaterals have developed around point of occlusion)
41
Pathology
Light Microscopic changes of ischemic myocyte after 12 days is

*Granulationtissuewithneovascularization*
Pt with dyspnea and chronic exertional angina is evaluated for

coronary revascularization. His Echho shows Hypokinesia of the
anterior wall of the left ventricle and a left ventricular ejection
fraction (LVEF) of 35%. The pt undergoes coronary artery bypass
grafting. Repeat eccho 10 days later shows that hypokinesia is no
longer evident and LVEF increased to 50%. The best explanation
for the changes in cardiac contractility is *Hibernating
Myocardium*
[Due to chronic ischemia
MI in the setting of normal coronary arteries. Mitral valve

thickening with vegetations is noted. Pt cardiac condition is most
likely associated with *SLE*
(Libman-sacks endocarditis (verucous endocarditis) occurs in 25&
of sle pts. SlE may cause acute coronary syndrome at young age
even with normal coronary arteries)
43
73
Pathology
Pathology
74
Pathology
Pt comes in with fatigue and shortness of breat. Recently he

noticed bilateral leg swelling and abdominal distention. Pt dies
despite Tx. Autopsy shows significant endocardial thickening with
dense fibrous deposits around the tricuspid and pulmonary valves
as well as moderate pulmonary valve stenosis. The left sided
cardiac chambers and valves are normal. Measuring levels of
*Urinary 5-hydroxyindoleacetic acid* would ve helped in
diagnosing pt
[Carcinoid Sydnrome]
82
Pathology
MCC of sudden cardiac deaths in young persons is *Hypertrophic

cardiomyopathy*
Presentation of "Sudden Cardiac Death" in young pt with family

history of SCD and autopsy finding of septal hypertrophy suggest
Hypertrophic CardioMyopathy which is Autosomal Dominant in
whcih there are mutations in sarcomere genes. These include
*Beta-Myosin Heavy Chain* and Myosin-binding protein C.
83
Pathology
84
Pathology
Young pt with an episode of syncope that was not provoked by any

activity. No significant past medical history and no medications.
ECG shows QT-interval prolongation. Assuming this is an inherited
condition, the relevant mutations likely affects *Membrane
Potassiumchannelproteins*
[sudden cardiac arrhythmia, QT interval reflects cardiac myocyte
action potential duration which is determined in part by K+ current]
91
Pathology
6 year old pt with Long QT interval and with family histo of sudden
death probably has congenital long QT syndrome and can have an
associated*Neurosensorydeafness*
94
Pathology
Localized amyloid in the atria of heart is amyloid derived from

Naturiretic peptide.
Acute-onset, mid-chest pleuritic pain that decreases on sitting up

and leaning forward is characteristic of acute pericarditis.
Fibrinous or serofibrinous pericarditis is the most common form.
Pericardial *Friction Rub* is the most striking physical finding.
97
Pathology
98
Pathology
Pt died. Autopsy is done. Gross inspection of heart shows shows

dense thick fibrous tissue in the pericardial space between
bisceral and paretal pericardium. The most likely sign that would ve
been detected during physical exam is *Kussmaul Sign*
[Constrictive Pericarditis]
176
Pathology
*Mitochondrial Vacuolization* indicates irreversible cell injury.
181
Pathology
Pt wih increased thickness of left ventricular wall and decreased

left ventricular cavity size have concentric cardiac hypertrophy.
This is associated with *Long standing HTN*
185
Pathology
Pt with lungs that reveal macrophages containing golden

cytoplasmic granules that turn dark blue with Prussian blue
staining. Prussian blue detects intracellular Fe. This is consistent
with hemosiderin laden macrophages (heart failure cells). This
presenc indiacates chronic elevation of hydrostatic pressure most
commonly as a result of *Left Ventricular Dysfuction* (i.e left-sided
heart failure)
188
Pathology
ASD is assocated with *Down Syndrome*
Pt is fatigued. P.E shows lesions involving nail beds. Further

evaluation would reveal additional abnormality during *Cardiac
Auscultation*
[Infective endocarditis reveals a mitral regurg murmur]
Autopsy finding of platelet-rich thrombi attached to mitral valve

leaflet. Most likely associated condition is *Advanced Malignancy*
[nonbacterial thrombotic endocarditis, associated with advanced
malignancy, especially mucinous adenocarcinoma]
42 year old. Pt dies from stroke.SHe had history of diastolic

murmur. Autopsy of left atrium shows diffuse fibrous thickening
and distortion of the mitral valve laflets, commissural fusion at the
leaflet edges and narrowing of the mitral valve orifice. The finding
is most likely the restult of *Rheumatic fever*
228
231
232
Pathology
Pathology
Pathology
241
Pathology
10 yr old boy presents with restlessness and involuntary kerking of

face, arms & legs 3 months after a sore throat. Pt is at greatest
risk fro developing *Valvular Heart Disease*
[Sydenham chorea as part of Acute Rheumatic Fever after Group
A strep infection]
242
Pathology
*Calcific Degenration* of trileaflet aortic valve is the most common

cause of Aortic Stenosis in Developed Nations.
445
Pathology
An athersclerotic plaque is likely t occur at the *ABDOMINAL

AORTA*
Plaque stability is reduced by macrophage release of

*Metalloprotinases* that degrade collagen. likelihood of plaque
rupture (and hence casuing acute coronary syndrome) depends
on plaque stability not size.
447
Pathology
451
Pathology
30 year old asian male presents with exertional calf pain and
painful foot ulcers. He demonstrates hypersensitivity o
intradermally injected tobacco extract. The process responsible for
his condition is *Segmental vasculitis extending into contiguous
veins and nerves*
[Buerger's disease]
452
Pathology
The morphologic changes observed in the arteries of a pt with

Giant cell arteritis are most similar to *Takasu Arteritis*
453
Pathology
Old Pt with severe drug resistant HTN who dies and autopsy shows
shrunken right kidney probably has unilateral renal artey stenosis
due to atheromatous plaque at origin of renal artery. Stenosis
eventually leads to renal atrophy due to *O2 and nutrient
deprivation*
460
Pathology
In Polyarteritis Nodosa. The arteries spared are usually the

*Pulmonary* Arteries.
462
Pathology
Myxomatous degeneration with pooling of proteoglycans in the

media layer of arteries is associated with *Aortic Aneurysm*
[assoc w/ Marfan synd]
466
Pathology
Baby with strawberry-type hemangiomas (bening vascular tumor)

in his buttocks. These *First Increase in size then Regress*
Pt with recurent severe nosebleed and with pink spider-like lesions

on his oral and nasal mucosa, face and arms. This pt probably has
*Osler-Weber-Rendu Syndrome* also called hereditary
hemorrhagictelangiectasia.
469
Pathology
470
Pathology
Female with history of breast cancer treated by radical

mastectomy and radiation years ago. She now presents with
persistent right arm swelling. This pt is at increased risk of
developing*Lymphangiosarcoma*
[Persistent lymphedema predisposes to lymphangiosarcoma, a
rare malignant neoplasm of endothelial lining of lymphatic
channels]`
471
Pathology
A vascular tumor that is associated with Arsenic and

Polyvinylchloride. The tumor is also postive for CD31. This is
*LiverAngiosarcoma*
474
Pathology
Pt with dilated and tortuous superficial veins in her lower legs. Pts
condition is most likely to be complicated by *Skin Ulcerations*
[Varciose Veins][Rarely to they lead to pulmonary embolism since
they are superficial]
751
Pathology
A substance that is secreted by the vascular endothelium and

inhibits platelet aggregation is *Prostacyclin*
782
Pathology
Pt with reduced plasma lipoprotein activity. If condition is untreated

he may develop *Acute Pancreatitis*
(Familial chylomicronemia type1)
809
Pathology
Pt with flank pain, hemturia, elevated lactate dehydrogenase (cell

necrosis) and a wedge-shaped right kidney on CT likely has renal
infarction most commonly due to thromboembolism. Systemic
thromboembolism commonly is due to *Atrial Fibrillation*
939
Pathology
Most common cause of aortic stenosis in the elderly is *Valvular

Calcification*
Pt with midsystolic click followed by short late-systolic murmur at

apex. Murmur disappears with squating. Pt's condition is related to
*Connective Tissue*
[Pt has Mitral valve prolapse with mitral regurgitation]
Pt with chest pain that radiates to left shoulder. Pain increases with
inspiration and partially relieved by sitting up and leaning forward.
She was seen for a facial rash 6 month ago. She is also being
evaluated for proteinurea. Cause of this pt's chest pain is
*Pericardial Inflammation*
(Manifestation of SLE)
Pt with blunt chest and head trauma who has pulsus paradoxus (fall
in systolic BP greater than 10 on inspiration), Jugular venous
distention and tachy cardia. He probably has *CARDIAC
TAMPONADE*
947
1040
1439
Pathology
Pathology
Pathology
1875
Pathology
In the event of an interruption of blood flow secondary to arterial

occlusion of left atrium. The organ that would be least vulnerable to
infarction is the *LIVER*
[Has dual blood supply][The exception is during liver transplant and
there is hepatic artery thrombosis. This becuase during the
transplant the collateral supply is severed]
1882
Pathology
Transient myocardial ischemia causes myocardial hypertrophy is

due to *Inttracellular Ca2+ accumulation*
8296
Pathology
Pt complains of worsening dyspnea. Also low grade fever and

weight loss, also syncopal episodes when lying down. Auscultation
shows low-pitched mid-diastolic rumble at cardiac apex. ECG
shows left atrial enlargement and echo shows large pedunclated
mass attached to the left atrium. Histology of mass will likley show
*Scattered cell within a mucopolysaccharide strome*
[Atrial Myxoma]
8458
Pathology
Most common cause of death a lightening strike is *Cardiac

Arrythmia* and Respiratory failure.
Dermatology
Pt with skin rash. He noticed it while in beach resort. He is works

in hot humid areas. Skin finding is shown (image). Most likely
cause is *Malassezia globoss*
[Pityriasis versicolor]
Dermatology
Pt with small bluish lesion under the nail of her right index finger. It
is extremely tender to touch. If the lesion is a tumor, its cells of
origin are likely to have a function of *Thermoregulation*
[This could be a glomangioma or a melanoma, since pigmentation
is not in answer choice, it must be a glomangioma][A glomangioma
is a tumor of modified smooth muscle cells of a glomus body.
Glomus bodies are involved in thermoregulation]
Dermatology
3 year old presents with recurrent skin rashes. He develops

erythematous itching rash on his cheeks, trunk, and arms abut 5
or 6 times a year. Mother says eruptions seem to be related to
consumption of certain foods. The pt's condition is most likely
associated with *Astham*
[Atopic Dermatitis or Eczema]
Dermatology
In shingles, affected are would have *Multinucleated cells with

Intranuclear inclusions*
[VZV]
Dermatology
Pt comes for routine check up and you notice several

subcutaneous bumps attached to Achilles tendons. Best initial test
is *Blood Cholestrol*
Pt has tendinous xanthomas (yellow nodules composed of "lipid"
laiden histiocytes in the dermis)
-Associatedwith(FamilialHypercholestrolemia)
104
467
876
1042
1108
Pathology
Pathology
Pathology
Pathology
Pathology
1111
Pathology
Dermatology
Pt presents with pruritic skin rash over elbows and knees. He also
has prolonged abdominal discomfort, faltulence and voluminous
greasy stools. The finding most likely to be seen in this pt is
*IncreasedIntestinalintraepitheliallymphocytes*
[Pt has Dematitis Herpetiform which is associated with celiac
disease that has increased intraepithelial lymphocytes]
1113
Pathology
Dermatology
Highest risk of metastasis in a malignant melanoma is *Active

Vertical Growth*
1114
Pathology
Dermatology
Biopsy of Urticaria would show *Dermal Edema*
1117
Pathology
Dermatology
Pt with bilateral skin lesions over his elbows. Biopsy shows very
thing stratum granulosum and prominent parakeratoic startum
corneum with occasional foci of neutrophil accumulation. Most
likely Dx is *Psoriasis*.
1314
Pathology
Dermatology
Pt that was injected with heat killed M. Leprae and developed a

large indurated nodule demostrates *Increased IL-2 & IFN-gamma
in skin lesions*
1937
Pathology
Dermatology
54 yr old woman comes due to multiple firm violaceous nodules on

her right upper arm. She was diagnosed with breast cancer and
treated with radical mastectomy. And had axillary lymph node
disection that shows no metastases. Post-operatively developed
chronic lymphadema involving her right arm. Most likley etiology of
her current skin lesions is *Angiosarcoma*
[Chronic lymphedema is a risk factor for cutaneous
angiosarcoma][lymph node disect is classic predisposing
procedure]
11502
Pathology
Dermatology
*Compound Nevi* are benign proliferation of melanocytes that

involve both the dermis and epidermis. They have uniiform
pigmentation and symmetrical sharp borders.
11852
Pathology
Dermatology
Allergic reaction to Morphine is *IgE- Independent mass cell

Degranulation*
191
Pathology

Metabolism
Pt with xanthelsama (xanthomas on medial eyelids). Best next step

is *Serum lipids and glucose*
Pathology

Metabolism
Post delivery woman who presents with signs of

panhypopituitarism with failure of lactation, central hypothyroidism,
and adrenal insufficiency. Most likley represents *Ischemic
necrosis* of pituitray gland (Sheehan Syndrome).

Metabolism
50 yr old man with sudden, severe headache. He complains of

mild headaches and decreased libido. P.E shows bilateral deficits
involving temporal visual fields and impaired extraoccular eye
movements. Shortly after admittance he becomes hypotensive and
dies. Mostlikely finding in autopsy is *pituitary hemorrhage*
[Pituitart apoplexy]

Metabolism
Pt with a pianful rash involving groin and perineum, DM and exam

that shows coalescing erythematous lesions with crushing and
scaling and central areas of bronze-colored induration and biopsy
of lesions shows superifical necrosis has a GLUCAGONOMA, He
shouldhave*ElevetaedGlucagonLevels*
220
225
585
Pathology
Pathology
768
Pathology

Metabolism
Pt with signs hyperthyroid symptoms together with painful thyroid

enlargememt. Thyroid scan reveals decrease in radioactive iodine
uptake. ESR is elevated. Biopsy of thyroid will most likely reveal
*Mixed, cellular infiltration with occasional multinucelated giant
cells*
[Sabacutegranulomatousthyroiditis]
848
Pathology

Metabolism
Pt with Type 2 Diabetes. Most likely assoc with his condition is

*Pancreatic islet amyloid deposition*
986
Pathology

Metabolism
Pt with elevated serum gastrin levels. Multi organ disease is

suspected. Pt should be asked for a history of *MEN type 1*
(MEN Type 1 has primary hyperparathyroidism, pituitary tumors,
and pacnreatic tumors (esp "Gastrinomas"))
1659
Pathology

Metabolism
Medullary thyroid carcinoma would show *Nests of polygonal cells

with Congo-ed positive deposits*
[Amyloid stains with Congo red]
1660
Pathology

Metabolism
In Medullary Thyroid Cancer, the gene changes responsible is

*Activating mutation of RET proto-oncogene*
1844
333
Pathology
Pathology

Metabolism
Pt with history of thyroidectomy (Medullary thyroid Cancer), flesh

color nodule on lips and tongue (Mucosal Neuromas), & Marfinoid
Habitus (tall, long fingers etc) probably has *MEN 2B*
FemaleReproductive
System & Breast
Woman comes for infertility evaluation. She complains of

dyspareunia. Menstrual cycles are accompanied by moderate to
sevee lower abdominal pain. Pelvic exam shows a normal-sized,
retroverted uterus. The post vaginal fornix is very tender to
palpitation. Pt's condition most likely involves *Ectopic Endometrial
Tissue*
[Endometriosis][Adhesions interfere with
ovulation=infetolity][imaplantsandadhesionsinvolvinguterosacral
ligament result in retroverted uterus, ligament]
1057
Pathology
FemaleReproductive
System & Breast
Asymptomatic pt's mamogram reveals microcalcifications. Biopsy

shows ducts distended by pleomorphic cells with prominent central
necrosis. Origin of this lesion is the *Breast Duct*
[Ductal Ca in Situ]
1928
Pathology
FemaleReproductive
System & Breast
Pt's P.E reveals a large adnexal mass. Ultrasonography reveals a

large ovarian cyst. She has signs of virlization togther with
clitoromegaly. Most likely Dx is *Sertoli-Leydig tumor*
1992
Pathology
FemaleReproductive
System & Breast
Pt with HIV whose PAP semar shows high grae cervical dysplasia.
The strongest risk factor for cervical dysplasia in this pt is
*Immunosupression*
[Risk factors for cervical cancer]
2056
Pathology
FemaleReproductive
System & Breast
The female reproductive structure that contains simple cuboidal

epithelial cells is *Ovary*
11858
Pathology
FemaleReproductive
System & Breast
Histopathology of High-grade cervical intraepithelial neoplasia

(CIN) would show *Expansion of immature basal cells to the
epithelial surface*
54
Pathology
A cavernous Hemangioma is the MC benign liver tumor. Typically

in adults 30-50 years.
56
Pathology
Pt with chronic hepatitis C, a large hepatic mass and multiple

Gastrointestinal & Nutrition satelite lesions has hepatocellular carcinoma. The marker for
recurrenc is *ALPHA FETOPROTEIN*
57
Pathology
Moldy grains from asia that cause specific G-to-T mutation in gene
Gastrointestinal & Nutrition p53. This is aflatoxin exposure, the mutation of which can increase
risk for developing *Hepatocellular Carcinoma*
71
Pathology
Pathology
Pt with severe right upper quadrant tenderness and laprascopic

surgery that reveals an erythematous, distended gallbladder with
Gastrointestinal & Nutrition patchy necrosis probably has acute calculous cholecystitis which
usuallu results from a *Gallbladder outflow obstruction* due to
gallstone obstruction of cystic duct.
88
Pathology
Pt with a mass obstructing the iliocecal valve with a high cholestrol

content. A radiographic finding conistent with this presentation
would be *Air in the billary tree*
(Gallstone ileus, gallstone penetrated intestine and lodged)
125
Pathology
Pt who is in shock and Hb level drops from 14 to 12. Nasogastric

Gastrointestinal & Nutrition suctioning reveals bright red blood. Pt's bleeding is most likely a
result of *Physiologic strss*
79
Pt with slow and incomplete gallbladder emptying (gallbladder

hypomotility) is at risk of developing a *Billiary Sludge*
Pathology
Pt presents with abdominal discomfort, greasy stool, and weight

loss. He has been treated for joint pain with Ibupropfen. Intestinal
biopsy shows multiple macrophages loaded with PAS-positive
granules in the lamina propria. This pt shud be Tx with *Antibiotics*
[Wipple disease caused by g+ve actinomycete Tropheryma
whippelii]
132
Pathology
The *Glycoprotein* in cell walls of actinomycete Tropheryma

whippeli colors magenta with PAS and is diastase-resistant,
making this stain an excellent choice for evaluating tissue for
whippledisease.
135
Pathology
Gastrointestinal & Nutrition The NF-kB factor pathway stimulates *Cytokine Production*
255
Pathology
Pt with sharp pain and bright red rectal bleeding on defecation

Gastrointestinal & Nutrition suggest an Anal Fissure. Which is at the *Posterior midline Distal
to the Dentate line*
Pathology
65 yr old man with iron def anemia. He has weight loss and
anorexia. He has no change in bower habits. Rectal exam shows
guaiac-positive brown stool. A 3cm mass is found on colonoscopy.
Biopsy shows pleomorphic cells with large, dark nuclei forming
irregular, crowded glands, some of which contain mucus. Studis
show multiple mass lesions in the liver and lungs. Pt's neoplasm
most likely originated from *Ascending colon*
[Right sided colon Cancer]
Pathology
Alcoholic male presents with hematemesis. Endoscopy shows

longitudinal mucosal tears at the gastroesophageal junction. This pt
condition is most likely related to *Intraabdominal pressure*
[Mallory-Weiss syndrome]
284
Pathology
Pt presents with anatcid resistant severe Heart Burn. P.E shows

scattered Telangiectasias on face, several ulcers at tip of fingers,
and small Ca deposits on hands and elbows. Most likely cause of
pt heart burn is *Fibrous Replacement of the muscularis in the
Gastrointestinal & Nutrition loweresophagus*
[CREST syndrome, Calcinossi, Raynaud Phenomenon,
Esophagealdysmotility,Sclerodactly,Telangiectasia]
[Esophageal dysmoti is result of atrophy and "Fibrous
replacement" of muscularis in lower esoph]
290
Pathology
Pathology
Pt with paraital cell hyperplasia (Zollinger-Ellison) causing visible

Gastrointestinal & Nutrition enlargement of gastric folds. The stimuli that caused this probably
*Gastrin*
131
257
281
304
305
Pathology
Erosions are defined as mucosal defects that do not fully extend

thru the *Muscularis Mucosa*
A pt with distal ulcer and high-normal gastrin levels that rise in

response to secretin adminstration are suggestive of
Zollinger-Ellison Syndrome. The is caused by gastrin-secreting
tumors (Gastrinomas) which is a *Neoplasia*
Usually secretin inhibits gastrin production.
326
327
Pathology
Gastrointestinal & Nutrition Celiac disease is diagnosed with *Small intestine Biopsy*
Pathology
Infant with poor weight gain since birth. He has bulky and greasy
stools. Jejunal Biopsy (Image) shows foamy or clear cytoplasm of
enterocytes with normal mucosal structure. Dx is
*Abetalipoproteinemia*
Pathology
Pt who recently travelled to south america. His liver biopsy shows

spotty hepatocyte necrosis and inflammatory cell infiltration. Most
likely clinical presentation of this pt is *Fever, Anorexia, and
dar-colored urine*
[Acute Hep A infection]
[Dark color urine is due to increased conjugated bilirubin levels]
368
Pathology
Pt dies from profuse upper gastrointestinal hemorrhage and gross

examination of liver is shown after autopsy. This resulted from
Gastrointestinal & Nutrition *Fibrosis and Nodular parenchymal regenration* of the liver. Pt
probably died from Liver Cirhosis that led to portal HTN and
eventualGIhemorrhage.
370
Pathology
Pathology
55 yr old caucasian male who is recently diagnosed with cardiac

arrhythmias is found to have mild hepatomegaly. He also
complains of a dark tan despite avoiding sun exposure. Pt most
likely suffers from *Hemochromatosis*
[Bronze diabetes, the triad of skin hyperpigmentation, DM, and
pigmnet cirrhosis with hepatomegaly]
Pathology
*Primary Biliary Cirrhosis is a chronic liver disease characterized

by autoimmune destruction of the intrahepatic bile ducts and
Gastrointestinal & Nutrition cholestasis (elevated alkaline phosphatase). The condition is most
common in middle-aged women, with severe pruritis (especially at
night) one of the first symptoms reported.
403
Pathology
Liver biospy showing extensive lymphocyte infiltration and

granulamatous destruction of interlobular bile ductis. Biopsy was
Gastrointestinal & Nutrition most likely taken from a *45 yr old woman with a long history of
pruritis and fatigue who has pale stools and xanthelasma*
[Primary Billary Cirrhosis}
405
Pathology
Pt with abdominal pain, diarhea and heme-positive stools. Stool

Gastrointestinal & Nutrition cultures are negative. Biopsy of colonic mucosa reveals
non-caseating granuloma. Pt most likely has *Crohn's Disease*
406
Pathology
Pathology
A finding most suggestive of Ulcerative colitis is *Continous

Mucosalinvolvement*
[Transnural inflam, rectal sparing, perianal fistula and
noncaseating granuloma are all suggestive of crohn's disease]
Pathology
Pt with Ulcerative Colitis who comes due to worsening pain and

bloody diarrhea. He has been non compliant with his medication.
He has hypotension and tachycardia. Pt is lethargic and has dry
mucus membranes. There is marked abdominal distention and
tenderness without rebound or guarding. Rectal exam shows
guaiac-positive, maroon-colored, liquid stool. Best next step in pt's
workup is *Plain abdominal x-ray*
[Toxic Megacolon assoc with UC]
Pathology
A differenc bewteen sporadic colorectal carcinoma and

Gastrointestinal & Nutrition colitis-associated carcinoma is that colitis associated carcinoma is
*Multifical in Nature*
Pathology
Pt with abdominal pain and bloody diarrhea following a

complicated surgical procedure likely has acute nonocclusive
ischemic colitis. Primary areas affected are the Splenic flexure
and the *Rectosigmoid Junction*.
366
394
401
407
410
411
413
Alcohol induced hepatic steatosis is due to *Decreased Free fatty

acidOxidation*
inflamed and swollen terminal ilieum is probably crohns disease in

which there is involvement of TH1 helper t cells.
421
Pathology
In the Adenoma-to-Carcinoma sequence in colon cancer, The

increase in the size if the polyps that mediates the late adenoma
Gastrointestinal & Nutrition part of thes sequence is a result of mutation of *K-ras*
protooncogene.
[APC > K-ras > p53]
426
Pathology
Gastrointestinal & Nutrition The initiating factor in acute appendicitis is *Lumen Obstruction*
427
Pathology
A pathologic finding in a polp that is associated with greatest risk

Gastrointestinal & Nutrition of malignant transformation includes a *2-cm villous adenomatous
polyp*
Pathology
38 year old man with colonoscopy showing ulcerative colon mass

with no polyps and biopsy showing adenocarcnoma. Gene
mutation responsible is most likely *MSH2*
(Hereditary Nonpolyposis Colorectal Canceer HNPCC)
Pathology
Pt is found to have colon adenocarcinoma in the asceding colon.

Pt most likely initially presented wuth *Weight loss and progressive
fatigue*
[Ascedning colon is wide and would prevent obstruction, pt usually
develop anemia due to occult blood loss and non specific
symptoms also occur]
434
Pathology
Pt has acute pancreatitis with normal gallbladder and common bile

duct (hence due alcohol). He has a >2 AST:ALT ratio. An
additional lab finding that is likely to be associated with the
Gastrointestinal & Nutrition underlying cause of this pt's pancreatitis is *Mean Corpuscular
Volume of 108 fl*
[Alchol causes Macrocytosis (MCV >100)likely due to poor
nutrition (folate def))
435
Pathology
Pathology
65 yr old man comes due to weight loss, Jaundice and anorexia.

He notes his urine has been dark and his stools pale. P.E shows
enlarged but nontender gallbladder. Most important risk factor
Gastrointestinal & Nutrition predisposing of his condition is *Smoking*
[Adneocarcinoma of the head of pancreas, Palpable nontender
gall bladder + weight loss + obstructive jaubdice (assoc with
priritis, dark urine, and pale stools). Smoking doubles the risk.]
Pathology
23 year old is hospitalized with acute pancreatitis that resolves

rapidly with fasting. Pt does not consume alcohol. One of the tests
that sould be considered during the workup is *Serum
Triglycerides*
[Hypertriglyceridemia can cause acute pancreatitis]
[Two main causes however are gallstones and alcoholism]
881
Pathology
6 yr old is brough tdue to confusion and intractable vomiting.

Mother says he had a febrile illness two dasy ago and she gave
him "Some over-the-counter pills and it helped his fever. While you
Gastrointestinal & Nutrition talk to mother, the boy lapses into a coma. Light microscopy of his
liver will reval *Microvesicular steatosis*
[Rye Sydnrome, hepatic encephalopathy due to aspirin intake
after a viral illness in kids]
1143
Pathology
429
432
436
440
A pancreatic psuedocyst is lined by *Fibrous and Granulation

Tissue*
Infection with Shigella Sonnei though food. The cells primarily

responsible for uptake of bacteria are *Microfold (M) cells*
1396
Pathology
Pt presents with abdoinal pain and diarrhea. Recent trip to

mexico.He is febrile. Elevated leukocytes. Sigmoidoscopy shows
white/yellow plaques on colonic mucosa and biopsy shows that
Gastrointestinal & Nutrition plaque are composed of fibrin and inflammatory cells. Given pt'd
Dx, the element likely elicited on further Hx taking regarding
mexico trip is *hospitalization and antibiotics for pnemonia*
[C. Deficile Colitis]
1783
Pathology
Pt with abdominal pain, diarrhea, and tender abdomen without

Gastrointestinal & Nutrition guarding. There is a draining fistula near her coccyx. Most likley
Dx is *Crohn Disease*
Pathology
Pt recently went to mexico. He presents with low grade fever,

anorexia, dark colored urine and RUQ tenderness. Liver biopsy
Gastrointestinal & Nutrition most likely shows *Hepatocye Swelling*
[Acute viral hepatitis, most likely by Hep A virus]
[Hall mark is hepatocyte necrosis which characterized by swelling]
1927
Pathology
IV drug used wuth fever, jaundice and anorexia. Liver biopsy

shows mononuclear infiltrates, hepatocyte swelling and acidophilic
bodies. Formation of acidophilic bodies is the result of *Apoptosis*
[viralhepatitis]
7710
Pathology
Pathology
HIV pt with multople hemorrhagic polypoidal lesions on

colonoscopy. Biopsy reveals spindle cells with surrounding blood
vesselproliferation.
Most likely cause is *Kaposi's Sarcoma* [HHV-8]
Pathology
Infant with abdominal distention, vomiting and blood streaked

stools. She was born out of preterm delivery. Abdominal x-rays
shows curvilinear areas of lucency that parallel the bowel wall
lumen. Most likely Dx is *Necrotizing Enterocolitis*
Pathology
Renal transplant pt who presents with worsening retrosternal chest

pain, dysphagia, and odynophagia. An
esophagogastroduodenosopyshowslinearshallowulceraionon
lower esophagus. Likely finding on esophageal biopsy is *Enlarged
cells with Intranuclear inclusions*
(CMVesophagitis)
Pathology
Pt dies from liver disease. Both changed and unchanged

hepatocytes domonstrate foreign DNA Fragments integrated into
their genome. These fragments likely belong to *Hep B virus*
[Hep C is RNA virus and has no reverse transciptatse and does not
integrate into host genome]
Backpain that is constant (i.e not relieved by rest or positional

changes) and that is worst at night is suggestive of *Neoplasm* as
in spinal metastasis.
55 year caucasian male is found on colonoscopy to have a solitary

mass in his sigmoid colon. Biopsy shows colon cancer. The
feature that carries the worst prognosis is *Tumor Penetration into
the Muscularis Propria*
(Tumor staging, more imp than grade)
Child who presents with headaches and gait instability. MRI shows
tumor in the cerebellum wtih both cystic and solid components
(white and dark). Most likely Dx is *Pilocytic Astrocytoma*
(Medulloblastoma is only solid, ie dark)
1863
8290
9920
11548
58
341
423
615
Pathology
Pathology
Pathology
Pt with duodenal ulcer. H. Pylori can be found in *Prepyloric area*

[Antrum of stomach]
710
Pathology
Neoborn with no postnatal care or medication. He has Cystic

Fibrosis. He develops Intracranial Hemorrhage. Cause is *Impared
gammacarboxylation*
(Neonatal Vit K deficiency)
(CF more suscepptible due to fat (ADEK) malabsorption)
829
Pathology
Pt has had an aortic valve replacement. His peripheral bloods

smear shows fragmented RBC's (Shistocytes or helmet cells) will
have *Decreased Serum Haptogloboin*
873
Pathology
Alcoholic with hypersegmented neutrophils in blood smear likely

has *Folate Def*
894
Pathology
G6PD has an *X-linked recessive* mode of inheritance.
infant with Hb electrophoresis showing: HbF=70%, HbA=20% &

HbS=10%. Mother has sick cell trait. Pt hasn no pallor or
splenomegaly. Most likely true abt this pt is that *She has relative
protection from Plasmodium Falciparum*
[Sickle cell trait]
895
Pathology
896
Pathology
African Am woman with sickle cell disease is admitted cuz of fever,

chills, and malaise. She has a hight WBC count and neutrophilia.
She becomes hypotensive and dies. Her blood cultures are most
likely to grow *Step Pneumo*
[Sicle Cell pts eventually become "functionally asplenic" and at risk
with encapsulated bacteria infection. Strep Pneumo is the most
commob. H flu is the second]
[Salmonella is MMC of osteomyelitis in children]
1083
Pathology
BRCA1/2 (breats and ovarian cancer) is responsible for *DNA

repair*
1086
Pathology
Previously healthy woman comes due to fever and sore throat. P.E
shows tonsillar exudate and nontender cervical lymph nodes
measuring 3.5cn. Antibiotics are started. A week later, pt says
symptoms resolved but the cervical lymph decreased lil bit inside.
On follow ups, the node fluctuates in size but doesnt disappear.
Most likely seen on biposy is *Follicular Lymphoma]
1292
Pathology
Pt on Warfarin who develops warfarin-induced skin necrosis, most

likely had *Protein C deficiency*
Pt end-stage renal disease. Dialysis is to be given. Before that, he

develops bleeding around the catheter exit. Furtehr evaluation
would show *Normal PT, aPTT, Platelet count, But Prolonged
Bleeding time*
{Uremic platelet dysfunction due to accumulation of toxins in blood,
Bleeding time is an indication of platelet function]
RBC cell fragments, burr cells, and helmet cells are associated
with either microangipathic hemolytic anemia or mechanical cell
destruction.
In pts with prosthetic valves, red blood cells are exposed to
excessive shear and turbulence in the circulation, causing damage
from mechanical trauma.
1293
1297
Pathology
Pathology
1405
Pathology
The presence of rod-shaped intracytoplasmic inclusions known as

Auer rods is characteristic of many forms of acute myeloblastic
leukemia (AML). The M3 varian of AML, acute promyelocytic
leukemia, is associated with the cytogenic abnormality *t(15:17)*
1406
Pathology
Auer rods which are seeen in Acute Myelogenous Leukemia stain

positive for *Peroxidase*
1580
1630
1717
1754
Pathology
Pathology
Pathology
Pathology
Pancreatic calcification with abdominal pain and finding of low

hemoglobin and high MCV suggest Macrocytic anemia. The pts
probably has Chronic pancreatitis due to ethanol abuse. The
anemia is due to folic acid def or b12 def and is causing impaired
DNA synthesis leading to *diminished thymidine synthesis*
IV drug used with HIV infection. He comes due abdominal

distention and anorexia. CT scan shows ascites and large mass
surrounding small intestine. Biopsy of mass shows unifrom, round,
medium-sized tumor cells with basophilic cytoplasm and
proliferation fraction of >99%. Agent assoc is *EBV*
[Burkitt Lymphoma, t(8:14) involving c-myc]
[Kaposi sarcoma (hhv8) would shows large cells, big nuclei, and
prominent nucleoli]
Hypophosphorylated RB protein is likely to *Prevent G1/S cell

cycle Transition*
(hypophosphorylated is active, abnormal phosphorylation results in
inactivation and proceeding of cycle unchecked)
Benign lympph node enlargement in response to antigenic

stimulation is associated with a Polyclonal proliferation of
lymphocytes. A monoclonal lymphocytic proliferation of
lymphocytes. A *Monoclonal lymphocytic proliferation* is a strong
evidenc of malignancy.
1755
Pathology
8 year odl pt from east africa with Large tumor on Mandible with
palbable regional lymphadenopathy. Biopsy shows diffuse infiltrate
of lymphoid cells with numerous mitotic figures and interspersed
macrophages surrounded by clear spaces (star-sky app). The
gene translocated in these lymphoid cells produces a protein that
is most directly responsbile for *Transcription Activation*
-(Burkits lymphoma, C-myc gene, t(8:14))
1758
Pathology
bcl-2 gene normally inhibits *Cell death cascade*

(inhibits apoptosis)
An example of Anaplastic tumor cells is *Brain tumor cells forming

giant cells*
[No resemblence to tissue of origin. Composed of pleomorphic
cells with large, hyperchromatic nuclei that grow in disorganized
fashion. Anaplastic tumors may also contain numerous, abdnormal
mitoses and giant tumor cells]
Pt has cancer. Genetic study shows a single nucleotide

substitution causing an "activating mutation". Gene most likely
involved is *KRAS*
[Activating mutation indicates a proto-oncogene, like KRAS][APC,
BRCA, RB, & TP53 are tumor suppressors hence are
anti-oncogenes]
Pt presents with skin rash. He has history of pneumocystic

pneumonia and painful ulcers. He uses Ilicit drugs frequently. P.E
shows a widespread rash of lesions (image shown). Most likely
cause is *Human Herpes Virus 8*
[Kaposi Sarcoma]
1759
1760
1761
Pathology
Pathology
Pathology
1785
Pathology
Pt with anemia (manifesting as fatigue), thrombocytopenia (Easy

bruising), and neutropenia (recent respiratory infection), with
profound reticilocytopenia, morphologically normal cells line in
eriheral smear and no splenomegaly. Bone marrow biopsy would
most likely show *Hypocellular marrow filled with fat cells and
marrow stroma*
[Aplastic Anemia]
1786
Pathology
Calculate Corrected reticulocyte count or sth.
1793
1796
1797
Pathology
Pathology
Pathology
Pt with progressive fatigue and occasional palpitations. She is post

menopausal. Blood Hb level is 8.5. Peripheral blood smear shows
pale microcytes. WHat should be ruled out initially in this pt
*Occult blood loss*
[hypochromic, microcytic anemia in setting of iron deficiency]
[primary mechanism of iron def is blood loss and shud be
excluded first]
Pt with hypochromic microcytic anemia who is treated with Fe

supplementation. several week later her blood smear shows
numerous enlarged RBC that appear blue on Wright-Giemsa stain.
The bluish color on hese RBC is explained by the presence of
*rRNA*
[Enhance erythropoiesis and release of mature RBC's and
reticulocytes, reticulocyte lacks nucleus but retain basophilic
residual rRNA that appears blue on said stain)
Individuals who demonstrate increased ativity of a specific

intracellular enzyme are more susceptible to developing
benz(o)pyrene induced lung cancer. The enzyme that is most
likely overactive in these pts is *Microsomal Monooxygenase*
1848
Pathology
Pt with Atrophic Gastritis who is given cyanocobalmin (vit B12) to

treat his macrocytic anemia (penicious anemia) would have a
rapid rise then fall of his *Reticulocyte count*
His Hemoglobin would rise steadily but less rapidly.
1851
Pathology
In HUS thee is *Elevated seum indirect bilirubin*
1873
Pathology
Angiogenesis is predominantly driven by *Fibroblast Growth

Factor* and Vascular Endothelilal Growth Factor.
A pt with a single amino acid substitutiion near the protein C

cleavage sit in he coagulation factor V gene products. This pt is at
greatest risk for *Pulmonary thromnoembolism*
[Factor V leiden, predisposes to hypercoagable state and DVT]
Pt with chest tightness and dyspnea, with chest CT showing a

saddle pulmonary embolus. Pt has history of cancer, smoking and
age (70). This places him at risk of developing a vebous
thromboembolism. A factor that contrinutes to this a
*Hypercoagulable state*
(Virchow's triad: endothelial injury, venous stasis, and
hypercoagulable state)
Hemophilia is an X-linked cogulopathy that presents with

intramuscular hemorrhage, hemarthroses, delayed bleed after
procedure. Lab results show prolonged Partial Thromboplastin
Time.
Pt has epistaxis, ecchymoses, and marked thrombocytopenia.

SHe has a normal hematocrit, leukocyte count and differential,
frinogen and PT. She takes no medication, and there is no
hepatosplenomegaly on P.E. These findings suggest an isolated
acquired thrombocytopenia. Most likely mechanism in this pt is
*Immune destruction of platelets* like "Immune thrombocytopenic
purpura"
The finding of a high peak in gamma-globulin region on serum

protein electrophoresis (SPEP) usually represents an M protein
consisting of an overproduced monoclonal immunoglobin. Multiple
myeloma causes an M protein peak on SPEK as well as anemia
(weakness), lytic bone lesions (back pain, pathologic fractures)
and renal insufficiency (related to amyloid deposition and
hypercalcemia).
*Multiple myeloma is *Plasma cell neoplasm**
1879
1880
1953
1954
1964
Pathology
Pathology
Pathology
Pathology
Pathology
2084
Pathology
Pt with signs of sickle cell disease (african american, recurrent

back pain, bony tenderness, low Hb). Histopathologic evaluation of
his spleen would show *Fibrosis and Atrophy*
2093
Pathology
Breast cells that over express 185kD glycoprotein and that have
intracellular tyrosine kinase activity are probably the HER2/neu
oncogenes that *Accelerates Cell Proliferation*
11750
Pathology
55 yr old man with generalized weakness and easy fatigability. He

has abdominal discomfort. Exam shows abdominal distention, and
massive hepatomeglay with spleen crossing midline. Peripheral
blood smear shows pancytopenia.Bone marrow aspiration is
attempted but no marrow can be aspirated. Finding most likely to
be seen in this pt is *Lymphocytes with cytoplasmic prjections*
[Hairy cell luekemia, "Dry Tap" due to marrow infiltration.
Splenomegaly to infiltration of red pulp]
11754
Pathology
Bone Metastases that is Osteoblastic (Sclerotic) on imaging can be

related to *Prostate cancer*
[Also small cell lung Ca and Hodgkin Lymphoma]
11869
Pathology
Paroxysmal nocturnal hemoglobinuria is due to a gene defect that

leads to uncontrolled complement-mediated hemolysis. The classic
triad includes hemolytic anemoa (hemoglobinuria), pancytopenia,
and thrombosis at atypical sites. Chronic hemolysis can cause
deposition in the kidney(*Hemosiderosis*)
390
Pathology
Infectious Diseases
The most common outcome in HBV-Infected adults is acute

hepatitis with mild or subclinical symptoms that eventually
*completely resolve*
472
Pathology
Infectious Diseases
Pt with aortic regurg murmur (diastolic) in the presence of

mediastinal widening. FTA-ABS psotive (syphilus). The pathologic
process responsible starts at *Vasa Vasoum Obliteration*
[Teriary Syphilus causing aortic aneyrysm, which beigns with vasa
vasorum endarteritis and obliteration resulting in inflam, ischemia
and weakening of adventitia.]
651
Pathology
Infectious Diseases
Tertiary Syphilus genital lesions are called *Gummas*
Infectious Diseases
An unvaccinated infant is brought with a rash. Three days ago,

she developed fever, along with cough, congestion, and red eyes.
Rash appeared on face and spread to trunk and arms. The def
assoc with increased complications from this pt condition is *Vit A*
[Measles virus]
1045
Pathology
1138
Pathology
Infectious Diseases
Pt recently went to south america presents with fever, headache,

abdominal pain and 1 week history of watery diarrhea that has
recently become bloody. He is febrile and P.E shows
hepatosplenomegalyandseveralfainterythematousmaculopapular
lesions on chest and abdomen. Most likely cause is *Salmonella
Typhi*
[Typhoid Fever]
1958
Pathology
Infectious Diseases
Bacterial Vaginosis can be Tx with *Clindamycin* or

Metronidazole.
Pathology
Pt presents with a painless scrotal nass. He also has increased

sweating and heat intolerance. P.E shows an enlarged nontender
right testicle. Lab shows increased serum T4 and T3. The
constellation of findings seen in this pt most likley suggest an
elevation of serum *hCG*
[Testicular malignancy releases hCG which has a similar structure
to TSH and can bind and activate thyroid to produce
ParaneoplasticHyperthyroidism.]
624
Pathology
Male comes for infertility evaluation. Semen analysis shows normal

sperm count but completely immobile sperm due to abnormal tail
MaleReproductiveSystem function. The finding most likely associated with this condition is
*Persistent bronchial dilation*
[Primary cilary dyskinesia, auto recessive]
Pathology
In klinefelters syndrome there is *Increased FSH* due to loss of

feedback Inhibition due to decrease in Inhibin levels (from sertoli
cells. There is also decreased testestrone (damage to leydig cells)
that is from primary hypogonadism.
Pathology
Miscellaneous
(Multisystem)
A renal mass that is composed of fat, smooth musscle, and blood

vessels. The pt is most likely to have additional finidng of *brain
Hamartomas and ash-leaf skin pathches*
[Angiomyolipoma, associ with Tuberous Sclerosis]
14
Pathology
Nervous System
HIV pt with diffuse cortical atrophy and CT scan shows enlarged

ventricles. The Hydrocephalus is secondary to the cortical atrophy
and hence termed *Hydrocephlus Ex Vacuo*
63
Pathology
Nervous System
In Wernicke-Korsakoff syndrome, when thiamin infusion is started,

the nuerologic deficit that most likely to persist despite treatment is
*Memory Loss*
Nervous System
1 month old infant brought due to difficulty awakening. Mother says

he rolled off the bed. P.E shows lethargic biy with large full ant
fontanlle. Bilateral retinal hemorrhages are seen on funduscopic
exam. You should suspect *Abusive heard trauma*
[Shaken baby sybcrome]
Nervous System
21 yr old man comes with impared balance, tremor, and diffculty

speaking. Symptoms developed slowly over several months. Pt is
found to have elevated serum transaminases. Viral Hep serologies
are negative. His cousin was Dx at young age with progressive
neuro disease. The Dx study most beneficial during work up is *Slit
Lamp Exam*
[Wilson Diseae]{Tx with D-penicilamine]
664
1055
347
397
Pathology
Pathology
468
Pathology
Nervous System
MRI of head of young t shows an angiomatous lesion involving the

cerebellum. There is also a cystic mass in the right kideny on
abdominal ultrasound. The differentail Dx must include
*Von-Hippel-Lindau disease*
492
Pathology
Nervous System
Light microscopy of bran tissue that shows neurons with shrunken

nuclei, no detectable nissle substance and intensely eosinophilic
cytoplasm. These findings indicate *Irreversible cell injury*
494
Pathology
Nervous System
Cell body rounding, peripheral displacement of the nuclei and

dispersion of Nissl substance to the periphery of the cells. These
findings described indicate *Axonal Reaction*
495
Pathology
Nervous System
Pt (who is right handed) presents with acute onset headache and

difficulty with vision. She passes out en route to hospital. CT scan
shows an acute hemorrhage in left temporal lobe and compression
of the ant medial temporal against the free margin of the the
tentorium cerebelli. The CN most likely compromised is
*Oculomotor*
497
Pathology
Nervous System
Sudden onset severe headache with no other abnormalities with

subarachnoid hemorhhage on ct is likey caused by a *Saccular
Anyeurysm*
499
Pathology
Nervous System
Elderly with Lobar Hemorrhage in occipital and parietal areas with

history of frontal lobe hemorrhage. Probably he has *Cerebral
AmyloidAngioplasty*
504
Pathology
Nervous System
Youn woman who presents with episodic headaches, dizziness

and gait disturbance. MRI of brain shows low lying cerebellar
tonisls extending into vertebral canal. Cause of this is a
*CongenitalMalformation*
(Chiari type 1)
505
Pathology
Nervous System
Pt involved in motor vehicle accident who sustains fracture of

temporal bone. Bloody most likely accumulates between *Bone and
Dura Mater*
[Epidural Hematoma]
593
Pathology
Nervous System
In alzheimer's disease, there is *Decreased acetycholine activity

in the nucelus basalis*
597
Pathology
Nervous System
Homeless man who is hospitalized and then develops acute

confusion, nystagmus, abducens palsy and opthalmoplegia
probably has Chronic Thiamine Deficiency due to liver
dysfunction. Thiamine is needed for Glucose metabolism and
therefore *Glucose Infusion* can percipitate Wernicke
Encephalopathy.
636
Pathology
Nervous System
Friedreich ataxia is associated with *Cardiomyopathy*
Nervous System
Lung cancer irritating the phrenic nerve can cause dyspnea,

hiccups and referred ppain to shoulder. Phrenic Neve arise from
*C3-C4*
Nervous System
PT with gait instability, dysmetria, and dysarthria. MRI shows

degenration of Post columns and spinocerebellar tracts. The
condition that has clinical manifestation that closely resemble this
pt disease is *Vit E deficiency*
[this pt has Friederich's Ataxia][vit E defi results in oxidative
damage and mimic F ataxia]
647
671
Pathology
Pathology
674
Pathology
Nervous System
Pt with a lesion involving teh corticospinal tract would have an

additional finidng of *Hyperactive deep tendon reflex*
(Hyperreflexia in UMN signs)
794
Pathology
Nervous System
Atrophy in Alzheimer's disease involves the *Hippocampus*

[Identify on MRI]
871
Pathology
Nervous System
Ischemic injury to the brain results liquefactive necrosis in which

there *Lysosomal Digestion of (necrotic) Tissue*
Nervous System
Pt been acting strange, not seeming to care about family (flat

affect), aggressivness, periodic random jerky movements
(Choreiform). Pts probably has Huntington's disease. There is Def
of *GABA* neurotransmitter.
902
906
Pathology
Pathology
Nervous System
Sensory ataxia and argyll robertson pupils are characteristic of

tabes dorsalis which a manisfestation of tertiary syphils caused by
treponemapallidum*Spirochete*.
The argyll roberston pupils are casued by spirochete inavading the
midbrain tectum.
915
969
1058
Pathology
Pathology
Pathology
Nervous System
Rapid correction of Hyponatremia results in *Osmotic

Demyelination Syndrome*
Nervous System
Pt with suspected tetanus who sustained a minor lower extremity

wound 1 week ago should have *History and Physical exam* as
the most important in making a Dx.
Nervous System
Ascending paralysis after upper resp tract infection. Condition

most likely associated with *Endoneural inflammatory infiltration*
[GBS after C.jejuni infection]
1152
Pathology
Nervous System
A child with an intracranial calcified mass. On gross exam of mass

after removal, it shows cystic spaces with thick brownish-yellow
fluid that is rich in cholestrol. The mass is likely derived from cell
responsible for forming the *Ant pititary*
[Craniopharyngioma derived from Rathke's pouch]
1153
Pathology
Nervous System
Child with brain tumor comprised o spindle cells that have hair like
glial processes and are associated with microcysts. These cells
are mixed wuth Rosenthal fibers and granular eosinophilic bodies.
Most likely Dx is *Pilocytic astrocytoma*
1260
Pathology
Nervous System
Pt with HIV and has mass on temporal lobe and biopsy shows cells
with EBV probably has a *Primary CNS Lymphoma*
Nervous System
Pt undergoing hemodialysis who has dminished sensation over

thumb, first two fingers, and radial half of her thrid finger probably
has carpal tunnel syndrome. The underlying mechanism of which
is *Nerve compression within an anatomic compartment*
[Median nerve compression thru deposition of Beta2-microglobulin
in carpal tunnel (dialysis assocated amyloidosis)]
1264
Pathology
1268
Pathology
Nervous System
Myotonia dystrophy is an autosomal dominant disorder caused by

trinucleatide repeats of myotonia protein kinase (CTG). Sustained
contraction, frontal baldness and cataratcs along with weakness
and type one fiber muscle atrophy is commonly seen. Also
gonadalhypertrophy.
1304
Pathology
Nervous System
*Schwannoma* is S-100 positive. (indicates neural crest origin)
Nervous System
Pt with long history of parkinson disease who recently develops

freezing episodes could benefit from high frequency deep brain
stimulation of the *Subthalamic Nucelus* or the globus pallidus
internus.
Nervous System
HIV-Associated dementia should be suspected in AIDS pateients

with progressive cognitive decline. Characteristic histopathologic
finding is Microglial Nodules formed around areas of necrosis that
may fuse to form multinucleated giant cells.
11462
11568
Pathology
Pathology
11574
Pathology
Nervous System
Pt involved in a truama who is camatose and has a rigid extension

of the upper and lower extremities. Damage to the *Pons* could
explain his posturing.
[Decerebrate posture, damage to brainstem at/below level of red
nucleus (midbrain, tegmentum, pons). It is due to loss of
descending excitation to the upper limb flexors (via rubrospinal
tract) and predominance of extensors (via vestibulospinal tract)
11627
Pathology
Nervous System
Pt with cavernous hemangioma is at greatest risk of developing

*Intracerebral Hemorrhage*
11632
Pathology
Nervous System
The cerebellar Vermis modulates axial/truncal posture via

connections with the medial descending motor systems. Lesions
on the vermis will results in TRUNCAL ATAXIA. Characterized by
unsteady gait, vertigo, nystagmus. Also, HEADACHE, nausea.
863
Pathology
Ophthalmology
Infant with white pupillary reflex and father has had a retinal
neoplasm during childhood most likely has Familial Retinoblastoma.
He is at greastest risk for developing *Osteosarcoma*
Ophthalmology
Pt with pathcy vision loss and flame-shaped retinal hemorrhage on

fundoscopic exam probably is due to *HTN* Poorly controlled HTN
can cause acute retinal hemorrhage which presents as painless,
unilateral visual disturbances ranging from mild loss of visual acuity
topermanentblindnes.
11675
Pathology
8325
485
486
531
Pathology
Pathology
Pathology
Pathology

Puerperium
Neoborn with a palpable swelling of neck. He is comfortable only

when held sideways. The child favors looking toward right and
cries when his head is turned to left. Most likely condition present
prenatally is *Intrauterine Malposition*
[Congenital torticollis, sternocleidomastoid muscle injury and
fibrosis]
Pt hospitalized for abdominal pain. Lab show elevation of serum

amylase and lipase. He has Hx of alcohol abuse. His condition
worsens and develops severe resp distress. He dies to resp failure.
Most likely finding on autopsy is *Alveolar hyaline membrane*
[Pancreatitis led to ARDS][Enzymes and inflam cytokines leak into
cirulation leading to infiltration of neutrophils in lung interstitium
and alveolar space. Injury leads to edema & fibrin depos leading
hyalinized alveoli]
Pt who history of heavy alcohol use and was admitted before for
acute pancreatitis. He presents with nausea vomitting and severe
abdominal pain. On 2nd day he develops dyspnea, and
hypoxemia. The parameter that is most likely normal in this pt is
*Pulmonary Capillary Wedge pressure*
[signs suggest ARDS for whch pancreatitis is major risk factor,
pulmonary edema with normal PCWP]
t dies from pulmonary infection. Autopsy shows a right lower lung

lobe that is pale, firm and airless. Histologically, the alveoli are
filled with "exudate containing neutrophils, fibrin, and some
fragmented RBC's". This pt died during the *Grat Hepatization*
phase of his disease.
533
Pathology
Pt with Peptosreptococcus and Fusobacterium in his lung.

Predisposing factor to his condition is *Seizure disorder*
[Lung abscess, caused by Oropharyngeal aspiration which can
occur due to seizures (loss of consciousness)]
552
Pathology
Hamartomas are the most common benign lung tumors. They are
composed of disorganized *Cartilage, fibrous, and adipose tissue*
55 yr old woman present due to cough and recent weight loss. She
doesnt smoke. P.E shows decreased breath sounds and dullness
to percussion at the left lung base. Image studies show an irregular
mass in the lower lobe of her left lung and left-sides pleural
effusion. It malignancy is diagnosed it is most likley
*Adenocarcinoma*
[Most common lung cancer in general populattion]
65 yr old presents due to nonproductive cough with anorexia and

weight loss. He has a 50 pack year smoking history. Exam show
enlarged supraclavilcular lymph node. Imaging shows a large
mediastinalmasscausingtrachealdeviation.Immunohostochemical
staining of mass is positive for chromogranin. Pt most likely suffers
from *Small cell carcinoma*
Pt presents with cough and headaches and dyspnea. He

complains of a puffy face. P.E shows facial swelling and
conjunctival edema. Dilated vessels are seen over his neck and
upper trunk. The pts condition is most likely caused by a
*Mediastinal Mass*
[Superior Venecava syndrome]
Pt with shoulder pain (pain under scapula and in right arm). Pain
is associ with numbness on his right forearm and tips of fingers.
He has Hemoptysis. He smoked 2 packs/day for 40 years. Most
likey cause is *Superior Sulcus Tumor*
(Pancoast Tumor)
554
555
565
648
Pathology
Pathology
Pathology
Pathology
649
Pathology
Histopathology reveals lung tumor cells with numerous, long

slender microvilli and abudnant tonofilaments. This is
*MESOTHELIOMA*
668
Pathology
Bronchoscopy with transbronchial biopsy of a calcified node is

done. Polarized microscopy shows birefringent particles
surrounded by dense collagen fibers. Pt most likely had exposure
to *Silica*
795
Pathology
African american female with Dry cough, pulmonary infiltrates,

hilar adenopathy, biopsy shows Non-caseating granuloma ==>
*SARCOIDOSIS*
799
Pathology
Retinal vascularization in premature neonate was most likey due

*NeonatalO2supplementation*
Newborn with Abdominal distention with normal rectal tone. Pt has

severl episodes if green emesis (hence billous). Laparotomy
shows inspissated green fecal mass obstructing distal ileum. Most
likely cause of mortality for this pt will be *Pneumonia*
This pt has meconium ileus (inspissated meconium at "Ilius") due
to "Cystic Fibrosis" and hence at risk for Pneumonia.
803
Pathology
806
Pathology
Pancreatic squamous metaplasia of the pancreas in a pt with CF

(recurrent pulmonary infections, finger clubbing)is due to
deficiency in *Vit A*
[vit A is needed for maintenance of orderly differentiation of
specialized epithelia]
877
Pathology
Black woman Pt with malaise, cough and rash wityh X-ray

revealing bilateral hilar lymphadenopathy and transbronchial
autopsy showing non-caseating granuloma has *SARCOIDOSIS*
Finding of small fibrotic focus in lower lobe of right lung and a

calcified lymph node in the right lung hilus. This findings are most
consistent with *Primary exposure to M. tuberculosis*
[Ghon foucs and Ghon complex]
1221
Pathology
1579
Pathology
Pt with fevers, hemodynamic instability, tachypnea and evidence

of UTI has Urosepsis likely complicated by ARDS causing her
hypoxia. Her resp symptoms are most likely due to *Fluid
accummulation in alveolar spaces*
[increased recruitment of neutrohils causing capillary damage and
leakage*
1925
Pathology
*Animal Dander should be avoided by pts with Asthma.
Pt with long history of smoking who comes due to shortness of

breath and chonic mild cough. Lung x-ray shows hemithorax
opacification on the right and deviation of the trachea toward
opacified side. Most likely cause is *Righ mainstem bronchus
lesion*
[Collapsed lung due to bronchial obstruction]
2116
Pathology
Pathology

Electrolytes
Antibodies detected in the serum of a young male are found to

react with teh alpha3-chain of collagen type 4. The pt is most likely
to have *Hemoptyis and Oliguria*
[Goodpasture disease,Anti-GBM antibody]
10
Pathology

Electrolytes
Pt with recurrent, self-limited painless hematuria "within days" after

an upper respiratory infection has Ig A nephropathy. Kidney
biopsy will show *Mesangial Deposits of IgA*
11
Pathology

Electrolytes
PSGN:
1)Enlarged, hypercellular glomeruli on light microsc
2) Lumpy-Bumpy granular deposits of IgG & C3 on
immunofluorescence
3) Electron dense deposits (Humps)on epithelial side of the basal
membrane on electron micros
12
Pathology

Electrolytes
In post-strep Glomerular Nephritis there is *DECREASED SERUM

C3*
28
Pathology

Electrolytes
Pt with signs of Nephrotic syndrome would a seconday change of

*Increased Live Lipoprotein Synthesis*
Pathology

Electrolytes
Pt with colon cancer who has Nephrotic Syndrome

(edema+proteinurea)with biopsyshowingglomerular cappillarywall
thickening without increase in cellularity. When sample is stained
with silver, irregular spikes from the GBM are seen. Pt has
*MembranousGlomerulopathy*
Pathology

Electrolytes
Child with signs of nephrotic syndrome. Pathologic change that

causes protein loss is *Glomerular podocyte damage*
[Effacement of podyctes im Minimal Change Disease]
382
385
811
Pathology

Electrolytes
Pt with urgency, frquency, a weak urinary stream and straining on

micturition. He notes noturia, and Oliguri alternating with polyurea.
Pts kidneys most likely will demonstrate *Parenchymal pressure
atrophy*
(BPH)
814
Pathology

Electrolytes
Pt with hexagonal crystals on urinalysis has cystinuria which

*AMinoAcidUrea*
832
Pathology

Electrolytes
Pt with multiple risk factors for athersclerosis including age, HTN,

hyperlipidemia and smoking. He presents with post prandial
abdominal pain accompanied by weight loss. He has one large
kidney on CT. This characteristic of *Renal Artery Stenosis*
834
Pathology

Electrolytes
Acute onset Gross hamturia in an otherwise healthy pt with family

history of sickle cell disease suggests *Renal Papillary Necrosis*
and an underlyin sicke cell trait.
886
Pathology

Electrolytes
In acute Tubular necrosis. The most important complication during

the Recovery Phase is *Hypokalemia*
888
Pathology

Electrolytes
Pt with UTI. Most specific finding for a Dx of Pyelonephritis is

*White blood Cell casts*

Electrolytes
Hypovolemia reduces RPF and hence *GFR*. This activates a

compensatory mechanism that systemical vasocnstricts leading to
further *reduction in RPF*. However, another reflux is increased
angiotensin 2 release due to decreased GFR that would
vasoconstrct efferent arteriole and help maintain GFR. As *RPF is
lower than GFR*. *FF Rises*.

Electrolytes
Pt with chronic lower back pain who has been using over the
counter NSAIDS ever since pain started 8 years ago. He has
elevated BP, trace lower extremity edema. High BUN. High
Creatinine. 1+ protein and 3-4 WBC in urine. Renal ultra sound
shows bilateral shrunken and irregular kidneys with few papillary
calcifications. Most likley cause of renal dysfunction is *Crhonic
Interstitial Nephritis*
[NSAID associated chronic renal injury]
1016
1049
Pathology
Pathology
Pathology

Electrolytes
7 yr odl with two day history of colicky abdominal pain develops

bloody stools. His urine appeared red today. P.E shows palpable
skin lesions on his buttocks. An additional finding consistent with
his condition is *Joint Pain*
[Henoch-SchonleinPurpura][Mostcommonsmallvesselvasculitis
in children]
1862
Pathology

Electrolytes
Old pt with blood in urine. Renal biospy shows rouned/polygonal

cells with abundant cytoplasm. The process that acconts for
abnormal appearance of cells is *Glycogen and lipid accumulation*
[C lear cell Ca of Kidney]
1913
Pathology

Electrolytes
Screening for early-stage diabetic nephropathy is done by

measuring urinary concentration of *Albumin*
Pathology

Electrolytes
Proteinurea with serum containing IgG4 antobodies to

phospholipase A2 receptor (PLA2R) suggests idiopathic
*Membranious Nephropathy*
Pathology
Pt with recurrent nonpitting edema of hands, raynaud phen, and

retrosternal burning has CREST syndrome which would find
& Sports
*Anti-centromere* Antobodoes.
Pathology
Pt with multi system systems and history IV drug use. His muscle
biopsy shows transmural inflammation of mid-sized arteries with
areas of homogeneous, eosinophilic arterial wall necrosis (i.e
fibrinoid necrosis). Areas of internal elastic lamina disruption are
& Sports
also present. Most likely predisposing factor to this pt's current
condition is *Viral Hepatitis*
[Polyarteritis Nodosa]
Pathology
Pt with persistent headache and pain in the jaw when chewing

Rheumatology/Orthopedics food. Artery biopsy shows multinuclear giant cells and internal
elastuc membrane "fragmentation". Pt has Giant cell arteritis and
& Sports
treatment reduces risk of *Ischemic optic Neuropathy*
Pathology
Eosiniphilic granulomatosis with polyangiitis (Churg-Strauss) is a

small to medium vessel vasculitis characterized by late-onset
Rheumatology/Orthopedics asthma, rhinosinusitis, and eosinophilia. Mononueritis multiplex due
& Sports
to involvement of the epineural vessels of peripheral nerve is
common. The finidning of antibodies against neutrophil
myeloperoxidase is also common.
Pathology
Pt with blue sclera and easily fractured bones probably has

Rheumatology/Orthopedics osteogenesis imperfecta due to defect in type 1 collagen which is
& Sports
the primary collagen in bone. Therefore, the primary impairement
is *Bone Matrix Formation*
721
Pathology
Child with fever and malaise. He parents say he refrains from

using his right leg. Passive range of motion does not elicit pain and
Rheumatology/Orthopedics no joint effusion is seen. However, the pt refuses to bear weight
with his right lower extremity. Scintigraphy is most likely to reveal
& Sports
increased focal radiotracer uptake in the *Long Bone Metaphysis*
[Hematogenous Osteomyelitis]
820
Pathology
Rheumatology/Orthopedics Digital Clubbing can be caused by Lung Disease. E.g:

& Sports
Bronchiectasis
Pathology
Elderly woman with jaw pain during chewing (Jaw claudication),

Rheumatology/Orthopedics An episode of vision loss in one eye that resolved (amaurosis
fugax). Best initial test is *Erythrocyte Sed Rate*
& Sports
[Giant cell Arteritis][C-reactive protein is also indicated]
1850
2131
340
457
461
667
702
914
Pathology
Pt with non-caseating granuloma, lymphadenopathy, and

hypercalcemia could have sarcoidosis. The elevated Ca level is
Rheumatology/Orthopedics due to *Activated Macrophages* how? There is increased
expression of 1-alpha hydroxylase in activated macrophages which
& Sports
causes PTH-independent production of 1,25-dihydroxyvitD leading
to increase intest abs of ca and hence hypercalcemia.
Pathology
Pt presents with worsening scoliosis. Pt with mutation in dystrophin

Rheumatology/Orthopedics gene on x chromosome. Histopathology of pt's calf would reveal
*Fibrofattymusclereplacement*
& Sports
(Duchene Muscular dystrophy)
Pathology
pt comes with fever, right flank pain, and difficulty walking. He has
diabetes. The pt lies supine with his right knee flexed and externally
roatated. He resists extension of the leg and thigh, particularly at
the hip. The pathologic process occuring in this pt involves the
& Sports
*Psoas Major* Muscle.
[Psoas abscess associated with diabetes as a rsik factor][Psoas
sign is elicited on hip extension]
11653
Pathology
Pt with who presents with pelvic pain. She has fibrous Dysplasia
(multiple osteolytic-appearing lesions of the hip and pelvis),
enodocrine abnormalities (hyperthyroidism, percocious puberty)
& Sports
and cafe-au-lait spots. (Triad) suggest a Dx of *McCune-Albright
Syndrome*
11798
Pathology
Pt with sign of SLE would have *Low C3 and C4*
& Sports
11821
Pathology
Rheeumatoid arthritis most likely affects *Cervical Spine*
& Sports
984
1266
8710
761
PathophysiologyAllergy & Immunology
23 yr old Female with migratory arthritis and skin rash exacerbated

by skin exposure. Urinalysis shows moderate proteinuria and RBC
casts. Serum Ab with specificity for this pts condition react with
*Double stranded DNA*
[SLE]
33
PathophysiologyCardiovascular System
Bicsupid aortic valve can lead to *aortic stenosis by 50 years old. *
42
In myocardial ischemia, the depletion of ATP in critical cellular

areas results in loss of contractility within about *60 seconds* of
total myocardia ischemia.
96
Pt with Hypotension, tachycardia, Jugular venous distension with

clear lungs and Pulsus Paradoxus (loss of palpable pulse during
inspiration) is consistent with *Cardiac Tamponade*
186
In isolated diastolic heart failure there is *Increased LV

end-diastolic pressure, normal LV end-diastolic volume, and
Normal LV ejection fraction*
187
Pt with VSD would also have a *Holosystolic murmur over the left
sternal border*
PT dies due to MI. Autopsy show slit-like tear in infarcted

myocardoum. This *typically occurs within 5-14 days after an
acute MI*
[Free wall rupture]
12 year old with a wide, fixed splitting of second heart sound on

routine physical exam. The congenital heart disease in this pt may
require surgical repair to prevent irreversible changes in
*Pulmonary Vessels*
(ASD, Pulmonary artery develop laminated medial hypertrophy,
irreversible)
193
201
The best indicator for mitral stenosis severity is *A2-to-opening

snapp time interval*
(shorter when more severe) (atrial pressure builds up causing
more forceful opening of valve "snap")
Mitral valve stenosis with *Increased left ventricular diastolic

pressure* suggests that the mitral stenosis is acoompanied by an
aoirtic valve problem such as stenosis or regurgitation. Both of
which can increase LV diastolic press.
235
The opening snap in mitral stenosis occurs shortly after the mitral
valve opens when *the left ventricular pressure drops below the left
atrial pressure*
238
Head poudning and bobbing are associated with *Widening of

pulsepressure*
244
PT with aoric stenosis can develop pulmonary edema due to

*Sudden decrease in LV preload* due to loss of atrial contraction
that is due to atrial fib. `
446
In the pathogenesis of athersclerotic plaques, release of

platelet-derived growth factor (PDGF) by locally adherent
*PLATELETS*, endothelial cells, and macrophages promotes the
migration of smooth muscle cells (cellualr component of plaques)
from the media into the intima and their subsequent proliferation.
Platelets also release trnsforming growth factor Beta (TGF-Beta)
which is chemotactic for SMC'S
843
In CHF there is a compensatory *Increase in Arterial Resistance*
944
Presence of a holosystolic heart murmur indicates Mitral valve

Regurgitation. Its severity can be indicated by the presence of an
*S3 gallop* which indiactes severe disease and indicates rapid
ventricular filling due to large volume of regurgitant blood
re-entering the ventricle during mid-diastole.
1578
In signs for Cor Pulmonale due to COPD, moderate increase in

capillary fluid transudation can be ofset by a compensatory
increase in *Tissue Lymhatic Drainage*
1903
A normal bleeding time indicates adequate platelet function. A

normal Activated partial thromboplastic time (aPTT) indicates an
intact intrinisic coagulation system. A prolonged prothrombin time
in the setting of a normal aPTT indicates a defect in th extrinsic
coagulation systen (E.g *fACOTR 7*)
2099
Pulsus Paradoxus can be seen in *Pericardial Disease*
2100
Pt with dyspnea, tachypnea, prolonged expiration and bilateral

wheezing is suggestive of acute exacerbation of Obstructive
Pulmonary Disease. This is usually treated with beta agonists
which relax bronchial smooth muscles by stimulating
beta-2-adrenergic receptors. The receptor is Gs coupled and
activates adenylyl cyclase and *Increases intracellular cAMP
concentration*
2105
Pt presents with fatigue and dyspnea. An early diastolic murmur is

heard at the left sternal border. Pt most likey has *Aortic
Regurgitation*
2117
A low pitched holosystolic murmur heard best at the left sternal

border with accentuation during the handgrip exercise is
characteristic of *VSD*
1860
PathophysiologyDermatology
Wrincles are a result of *decreased collagen fibrils production*
233
234
8904
PathophysiologyDermatology
Young girl with a soft raise, hyperpigmented, 0.5cm nontender

lesion iinferior to the right breast. Most likely cause is *Failed
involution of the mammary ridge*
[Accessory Nipple]
308
PathophysiologyEar, Nose & Throat (ENT)
Symptoms of recurrent vertigo together with unilateral hearing loss

is characteristic of Meniere's disease which there is *Increased
pressure and volume of endolymph*
212
226
Pathophysiology
Pathophysiology

Metabolism
Primary (psychogenic) polydipsia is a psychological disorder

characterized by increased intake of free water leading to
hyponatremia and production of large volume of dilute urine.
*Water restriction* will correct the serum Na levels and leads to
increse in urine osmolality.

Metabolism
Signs of Hyponatremia (altered mental status, headache,

weakness, seizures) plus a lung mass suggest SIADH casued by
small cell carcinoma. An additional finding would be *normal
extraceullar fluid volume*. Regulatory mechanism in the body deal
with the hyponatremia resulting a Euvolemic hyponatremia.
454
Pathophysiology

Metabolism
Adrenal Tumor that is functionally similar to the outermost layer of

the adrenal cortex (Glomerulosa) would have primary
hyperaldostrnism due to Aldostrone-producing Adenoma (Conn
Syndrome)and would therefore have *Sweating & Tremulousness*
as an added symptom.
582
Pathophysiology

Metabolism
Pt with Klinefelters have azospermia. That mean sperm count is

*None*
Ofcourse together with low LH, FSH and Testestrone.
608
Pathophysiology

Metabolism
Adminstration of Metyrapone will cause a decrease in cortisol

synthesis via inhibition of 11-beta-hydroxylase. In pts with an intact
hypothalamic pituitary axis, this will cause a reactive increase in
ACTH, 11-Deoxycortisol, and "urinary 17-hydroxycorticosteroid
levels"
611
Pathophysiology

Metabolism
11-hydroxylase deficiency in congenitl adrenal hyperplasia causes

high PB and Hirstutism (Big clit)
623
Pathophysiology

Metabolism
Peritibial myxedema and exopthalmos are specific features of

hyperthyroidsim due to Grave's disease. Peritibial myxedema is
*Lower Leg Skin thickening and induration*
656
Pathophysiology

Metabolism
Oral conraceptives decrease hirsutism by suppressing LH

secretion and thereby *Decreasing ovarian androgen production*
764

Pathophysiology
Metabolism
Metabolism
Pt with fatigue, bradycardia, weight gain, constipation, and

delayed relaxation of deep tendon reflexes has Hypothyroidism,
the most sensitive marker for Dx is *Serum TSH*
Signs of fatigue, weight gain and lumps rising from surface of
skeletal muscle following percussion with reflex hammer
(MYOEDEMA) combined with Elevated CK level indicate
HYPOTHYROID MYOPATHY and *TSH levels* should be checked.
765
Pathophysiology
766

Pathophysiology
Metabolism
772
Pathophysiology

Metabolism
An increase in estrogen activity leads to an increase in levels of

thyroxine-binding globulin. This leads to an *Increased Total T4
pool*
921
Pathophysiology

Metabolism
To diagnose Type diabetes melitus use *Fasting blood glucose

level*, random glucose, or HbA1c.
Pt being scheduled to be treated for hyperthryoidism usning

radioactive iodine therapy. Pretreatment with *Potassium
perchlorate* would decrease the effects of radiotherapy thru
competitive inhibition of iodine transport.
922
Pathophysiology

Metabolism
A fetus born to a mother who had gestational diabetes would have

hypoglycemia due to *Beta cell hyperplasia*
[Pancreas is used to a lot of glucose from mother. After delivery,
glucose suddenly stops but beta cells are still high in number and
secreting insulin, resulting in hypoglycemia]
925
Pathophysiology

Metabolism
Amenorhea in pt involved in strenous excersie and low body wieght

is caused by *HYpothalamic Suppression*

Metabolism
Pt with history of SLE dies at home. At her last P.E, her BP was
150/90. Clinical records show progressive truncal obesity, facial
plethora, and proximal muscle weakness. Lab showed mild
hyperglycemia. Evaluation of her adrenal galnds will most likely
show *Bilateral cortical atrophy*
[Iatrogenic cushing syndrome due to prolonged glucucorticoid
use, leads to supression of of hypothalamic oituitary axis]

Metabolism
Pt with HTN at young age together with weakness and paresthesias

(electrolye or acid-base disturbance) and low Renin levels is
consisent with Primary Hyperaldostronism. His Serum level of *Na
is normal, K is low, HCO3 is High*
(Na is normal due to aldostrone escape)

Metabolism
An infant boy with recurrent vomitting (salt wasting) and poor

feeding and P.E shows dehydration (salt wasting) and hypotension
with labs showing low sodium (wasting) and hyperkalemia. Pt
probably has Congenital Adrenal Hyperplasia - 21-hyrdoxylase
deficiency. There would be low cortisol, low aldo, high ACTH, and
*High 17-hydroxyprogestrone* which is a precuror to cortisol
synthesis.
928
929
Pathophysiology
Pathophysiology
930
Pathophysiology
933

Pathophysiology
Metabolism
Symptoms of Headache, tachycardia, diaphoresis and severe

HTN. THese resolve before Tx is given. Same thing happened a
month ago. This is pheochromocytoma and there is *Elevated
catecholamine release*
981
Pathophysiology

Metabolism
Pt with celiac disease will also develop vit D deficiency due to

defective mucosal absorption, presenting as bone pain and
weakness (Adult). Lab test would reveal *low Ca, Low PO4-, High
PTH*
[No vit D decreases absorption of Ca AND PO4- from GI tract]
985
Pathophysiology

Metabolism
In DKA there is *Increased (or normal) extracell K & Decreased

Intracell K**
1326
Pathophysiology

Metabolism
Upregulation of *Serine Phosphorylation* decreases

insulin-mediated glucose uptake.
1327
Pathophysiology

Metabolism
Insulin Resistance correlates strongly with Ecxess Visceral Fat

which can be assessed using *Wasit Circumference* or waist-to
hip-ratio.
869
Pathophysiology
FemaleReproductive
System & Breast
Cervical Intraepithelial neoplasia can be caused by HPV infection

which can result from sexual infection due to *Lack of barrier
contraception*.
1549
Pathophysiology
FemaleReproductive
System & Breast
Symptoms of primary herpes infections include inguinal

lymphadenopathy, tender vesicular lesions covering both labia
majora and pernium with dysuria and itching. The infection
(probably hsv-2) can lead to *Recurrent Genital Ulcers* (less
sever) (HSV lies dormant in sacral dorsal root ganglia)
2094
Pathophysiology
FemaleReproductive
System & Breast
Pt with menstrual irregularities, who is obese and has acne and

hirsutism probably has Polycystic Ovarian Syndrome, and
therefore has *Enlarged Ovaries*
2095
Pathophysiology
FemaleReproductive
System & Breast
Pts with PCOD who desire fertility are treated with Clomiphene,
*An estrogen receptor Modulator*
78
PathophysiologyGastrointestinal & Nutrition
Pt with cholestrol gall stones would have *High cholestrol, low bile
salts and low Poshatidylcholine* in the gallbladder.
80
The diagnostic test most specific fro acute cholecystitis is *Failed

gallbladder visualization on radionuclide billary scan*
133
Lactase deficeiency causes osmotic diarhea and *Acidification of

stool*
279
PathophysiologyGastrointestinal & Nutrition Zenker Diverticulum is due to *Cricopharyngeal motor dysfunction*
306
Pt with systemic signs and rash with skin biopsy showing large
clusters of mast cells positive for KIT probably has Systemic
Mastocytosis and an additional finding will be *Gastric
Hypersecretion*
363
*Absent Liver Conjugation enzymes* as seen in Criggler-najjar

PathophysiologyGastrointestinal & Nutrition syndrome type 1 (UGT enzyme def) can cause Neurlogic
abnormalities due to accumulation of unconjugated billirubin.
369
Pt who presents with nausea, fatigue, anorexia who recently had

surgery. Pt is weak and incteric and later dies. Liver biopsy shows
PathophysiologyGastrointestinal & Nutrition shrunken liver. Pt probably had Anesthetic Induced Hepatotoxicity
due to Haloethane use during surgery. You would expect to also
find a *Prolonged Prothrombin Time*
391
63 yr old woman died of congestive heart failure. Autopsy shows a

dilated heart and brownish pigmentation of the myocardium. Light
microscopy of liver after prussian blue is shown. The pt's brother
PathophysiologyGastrointestinal & Nutrition died of upper GI beed at age 43. Assuming this pts condition is
hereditary, what contributed to her delayed onset of symptoms is
*Premenaupasual menstrual bleed*
[Hemochromatosis]
402
Pt with generalized pruritus and high alkaline phosphatase along

with high titers of Antimitochondrial antibodies have Primary Billary
Cirrhosis. Liver autopsy would morphologically resemble
*Graft-vs-host disease*
441
1581
Vit A deficiency is characterized by night blindess and dry skin

(hyperkeratosis). Deficiency of this fat soluble vitamin can result
from Billary disorders, exocrine pancreatic insuffciency, or
intestinalmalabsorption.
1907
Pt who has acute pancreatitis and has a malignant mass on

pancrease and undergoes subtotal pancreatectomy would have
PathophysiologyGastrointestinal & Nutrition normal *IntestinalD-xyloseAbsorptioon*
(xylose is simple sugar, doesnt need pancreatic enzymes for
absorption)
11860
Intestinal Bacteria can produce *Folate* and vit K.

PathophysiologyGastrointestinal & Nutrition (In gastric bypass surgey there is bacterial overgrowth leading to
increase in these two substances)
425
890
Acute pancreatitis is nitiated by the inappropriate activation of

*Trypsinogen*
PathophysiologyHematology & Oncology
Pt with skin flushing, diarhea and cramping. P.E shows purple

vascular lesions surrounding her nose (Telangiectasias). Urinary
excretion of 5-HIAA is increased over 24 hrs. Imagings shows
tumor in small intestine. Most likely resposnible for condition is
*Metastatic Carcinoid*
Pt with anemia, reticulocytosis and increased indirect bilirubin.

Blood smear shows RBC without central pallor. Pt is most likely to
have *Increased mean corpuscular Hb concentration*
{HereditarySpherocytosis]
Pt with sign of abdominal pain, ascites, anemia, thombocytopenia,

hypercoagulability (e.g hepatic vein thrombosis) and a flow
cytometry that shows CD55 & CD59 Deficiency has Paraoxysmal
nocturnal hemoglobinuria whcih results in a hemolytic anemia due
to*ComplementActivation*
1339
Pt with acute abdominal pain, nausea and confusion with reddish

urine that darkens after standing for 24 hrs and her symptoms are
releived by IV dextrose probably has *acute intermittent porphyria*
in which there is deficient PBG Deaminase. Symptoms are
exacerbated by CYP450 inducers including smoking and alcohol
and relieved by glucose and heme.
1855
Infant with hand and foot syndrome (Dactylitis) with family hsitory
of penumococcal sepsis (encapsulated) probably has sickle cell
disease and his *Serum Haptoglobin would be Reduced*
1877
Pea d'orange is an erythematous itchy breast rash with skin

texture changes analogous to an orange peel. This is the key
dermatologuc presentation of inflammatory breast cancer and is
caused by cancerous cells obstructing lymphatic drainage to the
dermal lymphatic spaces.
1940
Target cells are seen in Beta Thallesemia. Its a condition in hwich

there is impaired *mRNA formation*
2133
Antocoagulant that prolongs both PTT and PT with no effect on TT

is *Direct factor Xa Ihibitor*
11805
Pt with muscle weakness. P.E shows Gotrons papules. (image)

Further evaluation would likely reveal *Ovarian Adenocarcinoma*
[Dermatomyositis, perimysial infiltrates. It can occur alone or as a
paraneoplastic syndrome. Most commonly associated with
Ovarian, lung, colorectal and non-hodkins lymphoma]
822
PathophysiologyInfectious Diseases
In HBV caused hepatocellular carcinoma, the *Viral DNA

integration into Host Genome* us the cause of neoplastic change.
Pt with fever, skin flushing and altered level of consciousness. Low

BP and blood culture positive for E. coli. They most likey have
Septic shocks due to *Lipid A* which is part of E.Coli LPS which
is released during either bacteriolysis and/or cell division.
1390
Pts who are migrants (unknown vaccine status) who develop

severe pharyngitis with exudates and cervical lymphadenopathy
(neck swelling, dysphagia) and one them dies of heart failure.
These people probably has respiratory diptheria infection. The
diptheria toxin works like the Exotoxin A produced by
*Psuedomonas Aerugionsa*
966
PathophysiologyNervous System
In tetanus, release of *Glycine* neurotransmitter is inhibited.
Newborn that is crying, has tremors, tachynea, sneezing and

diarhhea and mother has history of mental illness and/or hep c
infection history probably has Neonatal Abstinence Syndrome and
should be treated with opoids such as *Methadone*
Hydrocephalus in infants presents with macrocephaly and poor

feeding. Imaging studies showing enlarged ventricles are
characteristic. Untreated hydrocephalus leads to spasticity due to
stretching of periventricular pyramidal tracts, developmental
delays, and seizures.
Pt presenting with weakness, dizziness and paraesthesias with

recent history of eating japanese food has probably a Tetrodotoxin
from eating Puffer fish. These toxins block Sodium channels
thereforepreventingmuscledepoolarization.
897
1141
1255
1854
8352
360
PathophysiologyOphthalmology
68
Pathophysiology
11919
Pathophysiology
Acute and painless monocular vision loss is characteristic of

*Central retinal artery occlusion* Fundoscopic findings include a
pale retina with a "Cherry-Red Macula".

Puerperium
Pregnant woman who develops Cholelithiasis is due to

*Estrogen-induced Cholestrol hypersecretion &
Progestrone-inducedgallbladderhypomotility*

Puerperium
Woman who has a complication after c-section delivery of

dyspnea, hypotension, bradycardia, hypoxia, and DIC (bleeding
from incisons) and later dies most likely has Amniotic Fluid
Emboism (amniotic fluid enters maternal circulation). Histology of
lungs reveals *Pulmonary artery branch with swirls of fetal
squmous tissue*
527
PathophysiologyPulmonary & Critical Care
Young pt with paroxysmal episdoes of breathlessness and

wheezing unrelated to anything. Sputum microscopy shows many
granule containing cells and crystalloid masses. The sputum
finding suggest the role of *IL-5* in this pts condition.
[granule containing cells are eosinophils and crystalloid bodies are
charocot-leyden crystalsl, a response to IL-5 released by allergen
activated TH2 cells]
528
Hypocapniaimplies*alveolahyperventilation*
661
Only *Leucotrienes* and acetycholine produce asthma that is

relieved by pharmacologic antagonists.
In pts with Cystic Fibrosis, nasal muccosal basleine potential

difference is more negative becuase of Increased Sodium
reabsorption due to blocked Chloride channels due to CFTR
protein defect. Therefore the respiratory mucosa of the pt
demonstrates*Increasedsodiumreabsorption*
1910
Middle aged man with new-onset fever, productive cough and a

dense lobar infiltrate likely has community acquired pneumonia.
Most commonly caused by Strep Pneumo. What accounts for the
green color of his sputum is *Myeloperoxidase* of the neutrophil.
1939
Pt with CF has Na loss in sweat.
Chronic smoker with chronic cough who has been hospitalized

before for respiratory infections and treated with antibiotics
probably has COPD and therefore hypoxia and an additional
finding would be *Increased Erythropoitin production* in repsonse
to the hypoxia.
1985
An obese man who has excessive daytime sleepiness and signs of

upper air way obstruction such as snoring has obstructive sleep
apnea which is associated with syestemic hypertension and can
also lead to Pulmonary HTN!
8262
Cheyne-stokes breathing (rapid breathing followed by apnea) is

associated with *Congestive Heart Failure*
11900
Obesity related restritive lung disease decreases *Expiratory

reserve volume, functional residual capacity, forced expiratory
volume, forced vital capacity and total lung volume, Residual
volume is unchanged however*
813

Pathophysiology
Electrolytes
Stones in the ureter suggests calcium stones. The most common

risk factor for calcium stone is *Hypercalciurea* that is usually
idiopathic. Patients however have *Normocalcemia* due to Ca
regulation by vitD.
817
Pathophysiology
804
1942

Electrolytes
*Increased citrate saturation* helps prevent claculi formation.
831
Pathophysiology

Electrolytes
*vesicouretral urine reflux* predisposes a woman who had frequent

bladder infections to pyelonephritis because the the vesicouretral
junction is weakened.
956

Pathophysiology
Electrolytes
Pt with Metablic Alkalosis (pH > 7.45 & pCO2 >24). Lab study most
useful in diagnosing pt is *Urine Chloride*
Note: Volume status and urine chloride are important in the workup
of metablic alkalosis.
1050
Pathophysiology
7569
11038
11040
Pathophysiology
Pathophysiology
Pathophysiology

Electrolytes
Uric acid would percipitates in *Collecting duct and distal tubule

due to low urine pH*

Electrolytes
Significant renal artery stenosis causes renal hypoperfusion and

activation of the RAAS system. This leads increased release of
renin by the JG cells.
These cells would undergo hyperplasia and hypertrophy and they
are *Modified smooth muscle cells of the afferent arteriole*

Electrolytes
Pt with MS who develops urge incontinence. Reason is

*Uninhibited bladder contraction*
[Loss of central nervous inhibition of detrusor contraction, as
disease progresses the bladder can become atonic and dilated
leading to overflow incontinence]

Electrolytes
Diabetic autonomic neuropathy is common in type 1 diabetes and

can cause overflow incontinence due to inability to sense a full
bladder and incomplete emmptying. *Postvoid Residual* testing
with ultrasound or catheterization can confirm inadequate bladder
emptying.
11464
Pathophysiology

Electrolytes
Pts with MS often develop a spastic bladder a few weeks after

developing an acute lesion of the spinal cord. These pt present
with increased urinary frequency and urge incontinence.
Urodynamic studies show the presence of *Bladder Hypertonia*
11516
Pathophysiology

Electrolytes
Preventing UTI's from catheter can be done with *Prompt removal

of catheter when no longer indicated*
753
34 yr old man comes due to lower bk pain for several years. He

has stiffness and pain that are worst in the morning but gradually
improve during the day. Ibuprofen provides some relief. Lab shows
a positive HLA-B27 antigen. X-ray shows fusion of sacroiliac
Pathophysiology
& Sports
joints. Most helpful in monitoring progression of pt's disease is
*ChestExpansion*
[Ankylosing Spondylitis]
867
Pt with persistent shoulder and back pain and easy fatigability.

She has pain and stiffness in all her muscles.She has difficulty
Pathophysiology
concentrating. There is normal range of motion and 5/5 muscle
& Sports
strength. Soft tissue tenderness is present at several locatons.
Most likely DX is *Fibromyalgia*
978
Pathophysiology
Pt with lung mass and Hypercalcemia but with no bone focal lytic
lesions probably has Malignancy-associated hypercalcemia that is
& Sports
characterized by elevated *Parathyroid hormone-related protein*
982
Pathophysiology
Rheumatology/Orthopedics In primary osteoporosis, serum Ca and PTH levels are typically

& Sports
*Normal in range*
1450
Pt with recurrent acute Monoarthitis (one knee) and a history of a

Rheumatology/Orthopedics myeloproliferative disorder (E.g Polycytemia Vera) has typical
Pathophysiology
features of "GOUT" and would therefore have *Needle Shaped,
& Sports
Negatively Birefringent Crystals* on needle aspiration of the joint.
1600
A young man with acute lower extremity artthritis and a sterile (no
bacteria) joint effusion following a GI infection (diarrheal illness)
has typical symtoms of "Reactive Arthritis". It is a associated with
Pathophysiology
& Sports
*HLA-B27*
[Sponduloarthropathy assoc with HLA-B27]
11646
Biopsy that shows Endomysial Mononuclear inflammatory

Infiltrates and Patchy Muscle Fiber Necrosis inidcates
Polymyositis which present with insidious proximal muscle
Pathophysiology
& Sports
weakness. Usually, Autoantibodies such as antinuclear antibodies
(ANA) and *Anti-histydle-tRNA-Synthetase (anti-Jo1)* are present.
11770
Pt with headaches, visual and muscular symptoms, an enlarged

Rheumatology/Orthopedics temporal artery, an elevated ESR has Giant cell Arteritis with
Pathophysiology
assoc. polymyalgia rheumatica. The most imp mediator of this
& Sports
conditon is *IL-6* (cell mediated immunity, vasculitis)
11818
Pathophysiology
1612
726
Pharmacology
Pharmacology
Acute joint pain, swelling, and erythema with restricted range of

motion is consistent with synovitis. Diagnosed with *Synovial Fluid
& Sports
Analysis*
Pt with decreased serum complement C4 and C1 esterase inhibitor

levels. Drug that is contraindicated is *Captopril*
[Hereditary angioedema][ ACE inhibitors make bradykinin
accumulate in addition to already high bradykinin due to loss of
inhibitory action of C1 esterase inhib on kalikrein which converts
kinogen into bradykinin]
Biostatistics &
Epidemiology
Early penicilin Tx of Group A strep pharyngitis is important 4

prevention of Acute Rheumatic Fever which a major cause of CVS
death in many developing nations. ARF affect mainly heart and
CNS. Chronic cardiac inflammation can progres sto rheumatic
heart disease, esp valvualr. (Mitral valve)and would need *Heart
Surgery* Therefore, early Tx lowers need 4 Heart surgey!!
38
Pharmacology
Pt with episodic and transient anginal chest pain, occuring during

night time hours and accompanied by temporary ST-segment
elevations. Pt chest pain would be provoked by *Ergonovine*
[Prinzmetal Angina]
[Ergonovine is an egot alkaloid that constricts vascular smooth
muscle by stimulating both adrenergic and serotonergic receptors,
low doses inudce coronary spasm in pts with prinzmetal angina]
136
Pharmacology
Nitrates activate guanyl cyclase and increase levels of intracellular

cGMP which leads to *dephosphorylation of myosin light chain*
leading to relaxaton and hence vasodilation of vessel.
137
Pharmacology
At low doses, Nitroglyerin acts as a VENO-DILATOR, *Large

Veins* are the most Susceptible. Vasodilation causes decreasd
preload becuase blood collects in the venous system.
138
Pharmacology
Sublingual nitreates *Decrease left Ventricular Volume*

[Thru venodilation and hence decreasing preload]
140
Pharmacology
Adverse affect of nitrates is *HEADACHE* !!
141
Pharmacology
Pt with signs of hypertrophic cardiomyopathy (family history of

premature sudden death, systolic mumur). Due to the left
ventricular outflow obstruction, avoid drugs that reduce ventricular
volume such as vasodilators and diuretics. An example of a
vasodilator is *Isosorbide dinitrate*
142
Pharmacology
Pts taking daily nitrates need to have a nitrate free period to

prevent tolerance to the drug
Pt with A fib and CHF that is on multiple medications and develops

nausea, decreased appetitte and "Vison difficulties" and lab finding
of "Hyperkalemia" probably is on *DIGOXIN*
147
Pharmacology
149
Pharmacology
Milrinone is a phosphodiesterase-3 inhibitor that leads to an

increase intracellular cAMP which promotes intracell Ca influx and
increase cardiac contractility. An increase in cAMP in vascular
smooth muscle cells cause systemic *Vasodilation*
156
Pharmacology
A major complication of digoxin tox is Life threatenig

*Arrhythmias*.
689
Pharmacology
*FENOLDOPAM* is a selective D1 agonist that is used in

hypertesnive emergencies.
711
Pharmacology
Tx with statins causes increased *LDL receptor density*
713
Pharmacology
Elderely pt that comes with sudden-onset right arm weakness and

difficulty speaking that resolve within 20 minutes, and who also has
a history of HTN and hypercholestrolimia most likely had a
Transient Ischemic Attack and Aspirin should be indiacted. Being
an NSAID aspirin can cause *GI BLEEDING*
780
Pharmacology
Before giving statins check *Liver transaminases*
823
Pharmacology
Pt wirg ST segemnt MI who is given a fibrinolytic and becomes

camatose with asymmetrical pupils and irregular breathing
probably has *Intracerebral Hemorrhage* as an adverse affect of
fibrinolytic therapy.
899
Pharmacology
Amiodarone (class 3 antarrythmic) tho it prolongs QT interval (like

other class 3's and 1A's) it does not increase risk of torsades.
900
Pharmacology
An antiarrhythmic agent that binds perferentially to rapidly

depolarizing and ischemic ventricular myocardial fibers and has
minimal effect on normal ventricular myocardium is *Lidocaine*
It is effective in inhibiting ischemia-induced ventricular
arrhythmias.
901
Pharmacology
Know that Dofetilide is a class 3 anti-arrhythmic medication (K

channel blocker)
949
Pharmacology
A side of ACE inhibitors is cough and Angioedema (elnlarged lip)

tat is caused by *Bradykinin accumulation*
The anthracyclines (daunorubicin, doxorubicin, epirubicin, and

idarubicin) are chemotherapeutic agents associated with severe
Cardiotoxiity thru generation of free radicals. They cause *Dilated
Cardiomyopathy*
A drug given in periheral artery disease that provides symptomatic

improvement due to direct dilation of arteries and inhibition of
platlet aggregation is *Cilostazol*
[Phosphodiesterase Inhibitor]
1014
1080
Pharmacology
Pharmacology
1118
Pharmacology
Phosphodiesterase inhibitors such as Sildenafil lead to rise in

intracellular cGMP and result in vasodilation. This signaling
pathway is most similar to *Brain (and Atrial) Natriuretic Peptide*
which bind to transmembrane receptors linked to guanyl cyclase
that increases cGMP which activates cGMP-dependent kinase
leadingtovasodilation.
1164
Pharmacology
Blanching of a vein into which NE is being infused together with

induration and pallor of surrounding tissue suggets NE
extravasation which is treated with *Phentolamine*
1194
Pharmacology
Pregnanct associated deep vein thrombosis is treated with

*Enoxaparin*
[Low molecular wieght heparin]
1252
Pharmacology
Medication that causes selective direct relaxation of smooth

muscles of arterioles but does not affect veins would have an
adverse effect of *Na and fluid retention*
1343
Pharmacology
A drug that is a pure adrenergic agonist that causes immediate

increase in BP and delayed decrease in heart rate. Admin of drug
to healthy individuals would most likely result in *Decreased
atrioventricular node conduction velocity*
[The delayed decrease in heart rate was a reflex bradycardia, the
drug affects alpha 1 receptors]
1344
Pharmacology
Dobutamine increases *myocardial oxygen consumption*
1365
Pharmacology
*Dopamine* at lower doses stimulates D1 receptors in the renal

vasculature and tubules therey inducing an increase in renal blood
flow. At somewhat higher doese, dopamine stimulates the
beta-1-adrenergic receptors in the heart thereby increasing
Cardiac Contractility. At still higher doess, dopamine stimulates
alpha-1-receptors in the systemic vasculature thereby causing
generalized systemic vasoconstriction and hence lower cardiac
output due to higher after load.
1367
Pharmacology
Noreepi therapy results in *cAMP increase in cardiace muscle

cells*
1507
Pharmacology
*Dofetilide* is a class 3 antiarrhythmic and blocks K channels,

Just like Sotalol and Amiodarone.
1509
Pharmacology
A drug that depresses phase 0 ventricular depolarization (Na) and

prolongs phase 3 (K) is probably a class 1A antiarrythmics which
include*Disopyramide*
1565
Pharmacology
In pts with HTN and chronic ischemic myocardial failure, ACE

inhibitors (*Lisinopril*)are considered most effective long term
treatment.
1828
Pharmacology
If pt cant handle aspirin and he has stable angina. Give him

*Clopidogrel*
1947
Pharmacology
Norepi is an agonist for alpha 1 and Beta 2 but significantly more

agonist effect for alpha1 and therefore causes vasoconstriction
(B2 causes dilation). Therefore, norepi increases vascular tension
(vasoconstriction). A drug that reduces this ability of norepi would
have to block its alpha 1 agonist effect Irrevesibly
(non-competitively), and therefore a nonselective, non-cmpetitive
alpha antagonist such as *Phenoxybenzamine* can do it.
1948
Pharmacology
Betal Blockers inhibit renin release.
2006
Pharmacology
Beta Blockers prolong *PR interval* by decreasing AV nodal

conduction.
8289
Pharmacology
Low dose Atenolol affects B1 adrenergic receptors on *cardiac

cells and JGP cells but not vascular smmoth muscle*
8869
Pharmacology
*Flacainide* reduces QRS interval.
11844
Pharmacology
Fenofibrate therapy *Rduces Hepatic VLDL production*
836
Pharmacology
Dermatology
Terbinafine*inhibitssqualeneepooxidase*
Dermatology
28 yr odl pt who has history of childhood dermatitis has been

routinely applying corticosteroid cream to the flexor area of his
skin for many years. A punch biopsy of area subjected to this
topical therapy would most likely show *Dermal Atrophy*
[corticosteroids in addition to anti-inflammatory effect, cause
decreased production of extracellular matrix collagen and GAGS]
Dermatology
Pt with hair loss at anterior scalp and vertex has typical features of
androgenetic alopecia.
5-alpha-redyctase inhibitors such as *Finasteride* help minimize
progression of this disease.
1214
1726
Pharmacology
Pharmacology
8569
Pharmacology
Dermatology
In Tx of psoriasis, we use Vit D analogs such as *Calcitriene*

which activates Vit D receptor, which is a *Nuclear Transcription
Factor*
166
Pharmacology

Metabolism
A drug that can massively decrease Triglycerides is *Fenobirate*
167
Pharmacology

Metabolism
Acute falre of gouty arthritis (-ve birefringent crystals) can be due

to Tx with *NIACIN*
209
Pharmacology

Metabolism
Leuprolide is GnRh Analog and can be used in treatment of

prostate cancer. (metastasizes to vertebrae)
On initial therapy with Leuprolide *Testestrone and DHT rise then
fall with continued use*
548
Pharmacology

Metabolism
Glucucorticoids such as Prednisone cause Increased LIVER

gluconeogenesis, therby activation *LIVER Protien Synthesis*
549
Pharmacology

Metabolism
High-dose Prednison (Corticosteroid) would elevate *Neutrophil*

levels.
584
Pharmacology

Metabolism
Anastrozole is used to treat estrogen receptor positive breast

tumors. It *Decreases Androgen Aromatization*
600
Pharmacology

Metabolism
Pt with diabetic ketoacidosis is treated with regular insulin that has

no aminoacid modification Regular insulin which has a short half
life ,longer than lispro however.
604
Pharmacology

Metabolism
You should monitor *BUN & Creatinine* when admistring

Canagliflozin which is a SGLT2 inhibitor that decreases renal
abasorption of glucose used in type 2 diabetes
605
Pharmacology

Metabolism
Pioglitazone which is Thiazolidinedione antidiabetic dryg targets

*intracellular nucelar receptor*
[Binds peroxisome proliferator activated receptor gamma]
606
Pharmacology

Metabolism
Meglitinides (repaglinide, nateglinide) are short acting glucose

lowering medications. They are functionally similar to sulfonylureas
and act by binding and closing ATP-dependent K+ chanel in
pancreatic beta cell membrane, inducing depolarization and L-type
Ca channel opening. The increased Ca2+ influx stimulates beta
cells insulin release. They therefore, *Target membrane ion
channels*
Check Table
622
Pharmacology

Metabolism
Pt with signs of Hyperthryroidism with eye involvement (bilateral

redness,proptosis(exopthalmos))wasgivenmedicationthat
reduced her proptosis. The drug did that by affecting
*Inflammatory infiltration*
[Glucorticoids to treat exopthalmos in Grave disease pts]
625
Pharmacology

Metabolism
*TSH levels* should be monitored in pts receiving Amiodorone

therapy!
626
Pharmacology

Metabolism
Methimazole inhibits *Coupling of iodotyrosines* in the thyroid

gland.
Pharmacology

Metabolism
Pt with difficulty urinating and dribbling affecting quality of life

probably has BPH, treatment with Finasteride can cause releif but
also cause increase hair growth over scalp. That's becuse
Finasteride is a *5-alpha-reductase inhibitor*. This is the enzyme
that converts testestrone into its active metaboloite DHT.
Pharmacology

Metabolism
A drug that activates peroxisome-proliferator activated receptor-y

(a nuclear receptor and transcription factor) (such drugs are the
-glitazones) results in *Decreased Insulin Resistance*
658
920
Pt with type 2 diabetes. Tx that would increase serum C-peptide

level include *Glyburide*
{Sulfonylureases like glyburide and Meglitinide increase
endogenous insulin producttion and henc c-peptide]
1655
Pharmacology

Metabolism
1673
Pharmacology

Metabolism
Pt with redistribution of fat from the extremities to the trunk. This is

a common adverse effect of *highly-active antiretroviral therapy
(HAART)*
1984
Pharmacology

Metabolism
In a non medical setting, severe hypoglycemia is treated wih *IM

Glucagon*
11565
Pharmacology

Metabolism
A diabetic drug that can cause hypoglycemia is *Glyburide*

[Sulfonlureas increase insulin secretion from pancrease. Glipizide
is also a sulfonylurea but it is short acting (unlike Glyburide) and
hence its risk of hypoglycemia is reduced]
11634
Pharmacology

Metabolism
An anti-hyperlipidemia drugs that inhibits cholestrol absorption at

the brush border of the small intestine is *Ezetimibe*
808
Pharmacology
Pt with cystic fibrosis can be helped with *Pancreatic enzyme

supplementation* to aid absorption.
Pharmacology
Pt who attempts suicide using an insecticide. She presents with

nausea, vomiting, abdominal pain and copious diarhea. Her breath
has a garlic odor. This most likely Arsenic Poisoning and
*Dimercaprol* should be adminstered immediately.
865
Pharmacology
Treatment with osmotic laxatives such as polyethylene glycol

represents the same mechanism of *lactase deficiency* in which
there is a nonabsorbable osmotic substance that causes increase
in water and electrolyte secretion leading to diarrhea.
1156
Pharmacology
Colichy abdominal pain, constipation, irritability and headaches,

Gastrointestinal & Nutrition and works at battery factor, history of iron def anemia --> Lead
posinong
Pharmacology
Pt is given an opioid analgesic and develops upper abdominal

pain. P.E shows tenderness over RUQ. An adverse drug effect
invlving *SMooth muscle cells* is responsible.
Gastrointestinal & Nutrition [Admin of mu opioid analgesics can cause contraction of smooth
muscle of the sphinctor of Oddi leading to spasm and increase in
common bile duct pressure which can lead to increase pressure in
gallbladder and billary colid formation leading to pain]
1290
Pharmacology
Pt with 4 week history of mucoid diarrhea with benign findings on

evaluation (intermitten mild heart burn, unpleasant tase with dairy
products).Pt is started on Diphenoxylate therapy. Primary target of
Gastrointestinal & Nutrition this drug is *Motility*
[Pt has uncomplicated diarrhea, diphenoxylate is an opoid
anti-diarrhea agent structurally related to meperidine, it binds to
mu opiate receptor in gi tracts and slows motility]
8455
Pharmacology
Ribavirin wich is used in Hep C infection works by *Interferring

with duplication of viral genetic material*
11661
Pharmacology
Rifaxim is given in hepatic encephalopathy. It works by

*Decreasingintraluminalammoniaproduction*
11739
Pharmacology
Pts with cholestrol gallstones who refuse cholecstectomy can be

treated with Hydrophilic bile acids (ursodeoxycholic acid) that
Gastrointestinal & Nutrition reduce billary cholestrol secretion and *Increase billary bile acid
concentration*, which promotes gallstones dissolution by improving
cholestrol solubility. Howver, gallstone recurrence may occur.
1710
Pharmacology
GeneralPrinciples
841
1258
low Vd (3-5L) indicates highly charged/ hydrophilic drug and that it

has a high molecular wieght thereby highly protein bound.
1712
Pharmacology
GeneralPrinciples
Graph that is bimodal in measuring the concentration of Isoniazid

in plasma suggest pharmacologic polymorphism in drug
metabolizing capacity. Isoniazid is metabolized by *Acetylation*
and therefore you have slow and fast acetylators.
2112
Pharmacology
GeneralPrinciples
During continous infusion of a drug metabolized by first order

kinetics, the "stead state" is reached in *4-5 half lives*
(calculate it)
219
Pharmacology
In
Dapsone when used as prophylactic Tx for pneumocystis jiroveci

in the setting of allergy to TMP-SMX (Drug of choice)in HIV
infected patients can trigger GDPD anemia, which is an *Ezyme
deficiency Anemia*. Symptoms include red cell fragments,
microspherocytes, and bite cells.
893
Pharmacology
1077
Pharmacology
A medication that is a low molecular weight fraction of a negatively

charged chemical stored in mast cell granules. Its mechanism of
action is *Binding to antithrombin 3*
[LMW Heparin]
1079
Pharmacology
A platelet surface glycoprotein receptor that normally binds

fibrinogen to support platelet agreggation is Gp2b/3a. This is
targeted by *Abciximab*
1087
Pharmacology
For Heparin Overdose give *Protamine*

(Not Fresh frozen plasma)
(For warfarin overdose give FFP before vitK, protamine ineffective
for warfarin overdose)
1628
Pharmacology
Monloclonal antibody against CD20 marker is *Rituximab*
1674
Pharmacology
An HIV antiviral drug that is structurally unrelated to nucleosides

and is not phosphorylated intracellularly. The drug acts within the
cytolplasm of infected cells to inhibit sunthesis of viral DNA from
RNA template. The drug is *Nevirapine*
[Non nucleaoside Reverse transcriptase Inhibitor, e.g nevirapine
and efavirenz]
1784
Pharmacology
Enoxaparin is a form of low molecular weight heparin and

therefore binds to *Antithrombin 3* which once activated binds
factor Xa and stops it from converting prothromin to thrombin.
Pt undergoing chemotherapy who presents with signs of

hemorrhagic cystitis. Pt is probably undergoing
Cyclophosphamide or ifosfamide. This could have been prevented
with giving *MESNA*
1816
Pharmacology
1819
Pharmacology
Tumor cells become resistant to anticancer agents through

expression of cell surface glycoprotein (P-glycoproetin, coded for
by the human multi-drug resistance gene MDR1) which functions
as an *ATP-dependent transporter*
1890
Pharmacology
6-mercaptopurine is inactivated by *Xanthine Oxidase*
1893
Pharmacology
Vincristine inhibits cell synthesis at the M phase. (Microtubules)
2018
Pharmacology
Etoposide is a chemotherapeutic agent that inhibits the sealing

activity of *Topoisomerase 2*
2132
Pharmacology
Unfractionated Heparin binds to thrombin and inactivates it better

than low molecular weight heparin.
8371
Pharmacology
The step that Raltegravir imapirs in viral replication is *mRNA

transcription*
8542
Pharmacology
Rasburicase converts uric acid into more soluble metabolites.
11585
Pharmacology
Pt with Human epidermal growth factor receptor 2 tumor positivity

(3+over expression). Adjuvant therapy of a monoclonal antibody is
started. Target of this therapy is *Tyrosine Kinase Receptor*
[Breat Ca, HER2-neu is a tyrosine kinase receptor, antibody is
TrasTUzumab]
11728
Pharmacology
A therapy for vomiting would involve blocking of *Neurokinin 1*

receptors.
[Part of 5 receptors involved in vomiting, others are 5-H3, H1, M1,
& D2]
271
Pharmacology
Infectious Diseases
*Nystatin* bind Ergosterol in fungal cell membranes
274
Pharmacology
Infectious Diseases
Adminstering Amphoteracin B (binds to ergosterol) has a risk of

Renal Toxicity that could result in Severe hypokalemia and
hypomagnesemia due to increased tubular permeability.
Therefore, *Serum K & Mg levels* should be monitored.
277
Pharmacology
Infectious Diseases
Fungus with mutations in genes coding for Cellwall enzyme would

be resistant to *Capsofungin*, an antifungal that targets cellwall
glucansynthesis.
819
Pharmacology
Infectious Diseases
An HIV drug that can cause Hyperglycemia is *Atazanavir*

{Protease Inhibitors cause hyperglycemia, lipodystrophy, and
dyslipidemia]
1000
Pharmacology
Infectious Diseases
Bcteria that produce an enzyme (Aminoglycoside-modifying

enzyme) transfer an acetyl group to exogenous substance can
gain resistanc to *Gentamicin*.
1004
Pharmacology
Infectious Diseases
Management of household contacts of Meningococcl infection sis

*Prophylactic Rifampin*
1104
Pharmacology
Infectious Diseases
Trimethoprim has the same inracellular target as *Methotrexate*
1198
Pharmacology
Infectious Diseases
A drug for Beta-lactamase producing Bacteroides species is

*Pipercillin-tazobactam*
1223
Pharmacology
Infectious Diseases
M. Tuberculosis with significantly decreaed activity of intracellular

catalse peroxidase exhibit resistance to *Isoniazid*
1228
Pharmacology
Infectious Diseases
Pt being treated with TB that develops blurry vison (bilateral central

scotomas). Likely responsible agent is *Ethambutol* (optic
neuropathy)
1488
Pharmacology
Infectious Diseases
Antibiotic that causes tinitis and hearing loss is most likey an

aminoglycoside which affects *mRNA genetic code reading*
(binds irreversibly to 30s ribosomes)
1644
Pharmacology
Infectious Diseases
Pt with HIV being treated for Colitis (most likely CMV) with IV agent
that does not require intracellular activation and is known to bind in
vitro with viral encoded enzymes such as DNA polymerase, RNa
polymerase, and reverse transcriptase is *FOSCARNET*
1648
Pharmacology
Infectious Diseases
Oseltamivir is a neuramidase inhibitor and is useful in treatment of

Influ A and B viruses. It inhibits *Virion Particle Release*
1952
Pharmacology
Infectious Diseases
Penicilins are structurally similar to *D-alanine-D-alanine* and they

inhibit transpeptidases by binding to its site.
1965
Pharmacology
Infectious Diseases
In treating Malaria by vivax (recurrent fever every 48 hrs).

Primaquine is added to chloroquine in order to *Prevent disease
Relapse*
Infectious Diseases
Antibiotic against MRSA (pt is allegric to vanco) that causes

increassed Creaatinine Kinase and causes muscle pain. The
agent used affects *Maintenance of membrane Potential* of
bacteria.
(Daptomycin, creates transmembrane channels that depolarize
cellular membrane)
8288
Pharmacology
8538
Pharmacology
Infectious Diseases
Tx of enterobius vermicularis is *Albendazole*

[Scotch tape test]
11590
Pharmacology
Infectious Diseases
Pt with HLA-B*57:01 positive results is associated with *Abacavir*
8930
Pharmacology
Pt with BPH and treated with drug that reduces prostate volume is
MaleReproductiveSystem probably beig treated with 5-alpha reductase inhibitors such as
*Finasteride*
264
Pharmacology
Nervous System
Long treatment of Parkinsons with Levidopa renders *DRUG

RESPONSEUNPREDICTABLE*
265
Pharmacology
Nervous System
Entacapone *Increases the quantity of levodopa entering the brain*

[It inhibits Catechol-O-Methly transferase, and hence prevents it
degradation]
348
Pharmacology
Nervous System
Elderly pt with insomnia should be given *Ramelteon* which is a

melatonin agonist. It is safe and effective. Avoid bezos,
antihistaminesandsedatingantidepressants
349
Pharmacology
Nervous System
Benzo for insomnia with a lower rsik of tolerance and dependence

is*Zolpidem*
351
Pharmacology
Nervous System
Phenytoin is metablized by the P45O oxidase liver sysetm and

therefore drugs that induce this sysetm will decrease levels of
phenytoin. Such drugs include: Barbiturates, *RIFAMPIN*,
carbamezapine, grieseifulvin, and chronic alcoho.
352
Pharmacology
Nervous System
Do not use DIazepam with CNS depressants such as

*Chlorpheniramine* which is a 1st gen anti-histamine.
Nervous System
Pt with sudden episodes of severe, right-sided (Unilateral)facial

pain (knife stabbing my face) that lasts several seconds (instigated
by a meal or teeth brushing) with no other symptoms probably has
Trigeminal Neuralgia. The DOC for Tx is *Carbamezapine*.Works
like phenytoin by inhibiting high frequency firing by reducing the
ability of Na channels to recover from inactivation. (Reduces pain).
Side effects: aplastic anemia (check cbc) and drug interactions
(p450 inducer)
Nervous System
Drug interaction 2-3 weeks after New medication (e.g

phenytoin)that presents with cutaneous and systemic symptoms
such as diffuse erythema, generalized lymphadenopathy and
facial swelling arise from DRESS (drug reaction with Eosinophila &
systemic Symptoms) as the name suggests, lab finding would be
*EOSINOPHILIA*
Nervous System
Inahled anesthetic with a vey large atriovenous conc gradient

shortly after begining inhalation would have a *Slow Onset of
Action*
(high atriovenous conc gradient means increased peripheral tissue
solubility which negatively affects brain saturation)
354
508
660
Pharmacology
Pharmacology
Pharmacology
774
Pharmacology
Nervous System
The agent that can perciptate opoid wthdrawal in an opioid tolerant

pt is *Buprenorphine*
[An opiod partial agonist that can act as antagonis in presence of
other opioid medications]
851
Pharmacology
Nervous System
The parameter that correlates to the potency of an inhaled

anesthetic is *Minimal Alveolar Concentration*
852
Pharmacology
Nervous System
Thioepntal is a short acting barbiturate used for anesthesia

induction. After equilibrium in the brain, rapidly redistributes into
SKELETAL MUSCLE and adipose tissue. It mechanism is
increasing the inhibitory effects of GABA receptors in the CNS.
854
Pharmacology
Nervous System
Anesthesia with isoflurane would increase *Cerebral blood flow*
855
Pharmacology
Nervous System
Pt with fever and muscle rigidity soon after surgey. He has high
BP and high HR. P.E shows muscle stiffness and cyanotic skin
mottling. Most approprate treatments affects *Intracell Ca release
in skeletal Muscles*
(Pt has Malignant Hyperthermia, Treated with Dantrolene, a muscle
relaxant that acts on ryandoine receptor and prevents further
release of Ca)
856
Pharmacology
Nervous System
The cause of rapid plasma decay of thiopental was not metabolism

of the drug but rather *redistribution of the drug to other tissues*
throughout the body.
866
Pharmacology
Nervous System
Child with High fever and seizures has febrile seizures and shud
be given *Acetominophen* (Antipyretic, never give aspirin to a
child)
1322
Pharmacology
Nervous System
ST-Segment elevation in inferior leads tells you its Inferior MI. Inf
MI is due to blockage of right coronary artery which supplies SA &
AV nodes. Thus, inf MI's Often present with bradycardia. Treating
bradycardia with ATROPINE thru blocking vagal influence on
nodes thus increasing HR. Side effect of Atropine in the eye is
GLAUCOMA. So pts complains of severe right sided eye pain.
1360
Pharmacology
Nervous System
Receptor that when stimulated causes immediate change in

transmembrane Ca, Na, and potassium secondary to opening of
receptor channel is *Nicotinic Cholinergic Receptor*
Nervous System
A drug that causes less uterine contractions (i.e uterine relaxation)

and Eye Midryasis is *Alpha and beta-adrenergic agonist*
[B2 stimulation in uterus causes relaxation while Alpha 1
stimulation in eyes causes mydriyasis (the basis of using
phenylephrine befor eye exams)]
Nervous System
If pt is on warfarin and a new drug was added and pt developed

thrombotic event, then the new drug lowered efficacy of
anticoagulation property of warfarin through the induction of
CYP450, which is how Warfarin is metablized. One such drug is
Phenobarbital.
Nervous System
Pt with a hand tremor. It is most prominent in activity such drinking

from a glass. She says alcohol improves the tremor. Family Hx is
significant for similar problems. Best Tx for this pt is *Propranolol*
[Essential Tremor, nonselective beta blockers lessens it via CNS
effects]
1368
1777
1946
Pharmacology
Pharmacology
Pharmacology
2000
Pharmacology
Nervous System
Pt that presents with chest pain and has history of HTN,

Diabetesm, and asthma. Tx is given and chest pain disappears but
he now develops dyspnea. Pt was most likey given beta blockers to
relieve chest pain (B-1 block) and develoved bronchoconstriction
(B-2 block) which caused the dyspnea. B-blockers work by
*Inhibiting the neurostransmitter-receptor interaction in adrenergic
synapses*
2089
Pharmacology
Nervous System
Treat serotonin syndrome with *Cyproheptadine* (a first gen.

antihistamine that has nonspecific 5-HT & 5-HT2 receptor
antagonism)
Nervous System
Woman who presents with a migrain who is given a medication to

be used immediately during an attack. Medication most likely affect
*Postsynaptic serotonin receptor stimulation*
(Triptans, e.g sumatriptan, serotonin agononist 5-HT 1B & 1D)
Nervous System
Pt with MS who has spastic paraparesis. Most effective

monotherapy for this pts spasms is *Baclofen*
(agaonist at GABA-B receptor)
(Tizanidine is also effective)
8476
11458
Pharmacology
Pharmacology
11680
Pharmacology
Nervous System
Topical Capsaicin in the non-systemic Tx of post herpetic

neuralgia depletes *Substance P* by over releasing it.
1363
Pharmacology
Ophthalmology
Timolol in Tx of Glaucoma targets *Ciliary epitheliium*

[Decreases aquoeus humor production]
Pt with decreased vision. Says its blurry and distorted. Exam
shows a grayish discoloration of the macula with area of adjacent
hemorrhage. In treatment of this condition, *Vacsular Endothelial
Growth Factor* should be specifically targeted.
(Age related Macular degeneration (AMD), Retinal
neovascularization due to VEGF)
[Txwithranibizumab,bevacizumab)
7721
Pharmacology
Ophthalmology
172
Pharmacology
Poisoning&Environmental
Theophylline toxicity leads to *Seizures and Tachyarrhythmias*
Exposure
507
Pharmacology

Puerperium
Valproate increases risk of neural tube defects in pregnant women

such as *Meningocele*
1568
Pharmacology

Puerperium
Pt who has severe acne with scarring and now is interested in

Isotretinoin treatmnet. Best next step in management is *Urine
Beta-hCG*
[ral isotrtinoin is Teratogenic]
1775
Pharmacology

Puerperium
Tetracyclines (Doxycycline) that are given to treat pregnant women

with Lyme disease can cause fetal *Teeth Staining*.
If pregnancy is known, give Penicillin instead.
222
Pharmacology
Substance Abuse
Antipsychotics such resperidone block dopamine and can

therefore allow prolactin release which can cause amenorrhea.
Therefore, persons on respiridone can develop *Drug Induced
Amenorrhea*. Breast tenderness is also seen here.
350
Pharmacology
Substance Abuse
First line therapy for pyschomotor agitation in Alcohol withdrawal is

*Chlordiazepoxide*
[Long acting benzo]
519
Pharmacology
Substance Abuse
Drug interactions with lithium include Thiazide diuretics. Symptoms

of toxicity include resting tremor, balance issues (ataxia).
704
Pharmacology
Substance Abuse
A side effect of Buprion (Norepi and Dop reup inhib) (used in

depression, no sex probs or weight gain) is Seizures.
706
Pharmacology
Substance Abuse
Pt on depression medication that is casuing him sexual

dysfunction (SSRI's) can be switched to BUPROPION which
doesnt cause sexual dysfunction.
937
Pharmacology
Substance Abuse
Pt that is Dx with panic disorder and is given a drug that relieves

symptoms within an hour. Drug is prbably Benzodiazepine which
*Binds Allosterically to GABA receptor*
Barbiturates work on a different allosteric site and prolong duration
of channel opening in response to GABA.
1868
Pharmacology
Substance Abuse
Signs of confusion, fever, flushing, dry mouth, mydriasis and

decreased bowel sounds indiacte an Anticholinergic crisis which
can be caused by Tricylic Antidepressants such as *Amitriptyline*
8259
Pharmacology
Substance Abuse
Tx Narcolepst with *Modanfil*
8327
Pharmacology
Substance Abuse
Treating pt already on SSRI such as paroxetine with antibiotic

Linezolid can ilicit Sertonin Syndrome characteized by tremor,
hyperflexia, clonus, confusion, agitaton, cramps and diarrhea.
11577
Pharmacology
Substance Abuse
A pharmcotherapeutic agent that "reduces craving" for alcohol

Naltrexons which *Blocks Mu-opoid Receptor*
168
Pharmacology
Pt on glucocorticoids for asthma should be advised to perform

*Oral Rinsing* to avoid side effects of medication.
(if drug lodges in oral mucosa, it can candiasis)
170
Pharmacology
Drug that revereses irritant induced brochoconstriction but does

not work in vagectomized animals (meaning drug has effect on
vagus nerve) is probably *IpraTROPium* which is a muscurinic
antagonist. It combats the release of Ach due to vagus nerve
stimulation.
171
Pharmacology
Inhaled Cromolyn is used in Asthma. It *Inhibits Mast cell

degranulation*
Pt presents with dyspnea and weakness. Mother had similar

symptoms and died at age 42. Lung biopsy shows medial
hypertrophy, intimal fibrosis and decreased intraluminal diameter if
small branches of pulmonary artery. Pt is scheduled for lung
transplantation. The medication indicated for management during
the waiting period is *Bosentan*
[Pt has idiopathic pulmonary a hypertension][Bosentan is
endothelin-receptor antagonist, it blocks vasoconstricting affects of
endothelin]
903
Pharmacology
1312
Pharmacology
Hiv Pt with CD4 Count of 40 and blood culture grow acid fast
bacteria that grow optimally at 41 C. This could have been
prevented by prophylaxis with *Azithromycin*
(MACComplex)
1446
Pharmacology
Alcoholic pt with poor dentition whose chest CT shows air fluid

microabscesses. best treatment option is *Clindamycin*
[Oral Anaerobic bacteria causing aspiration pneumonia]
*Vacrenicline* is a partial agonist of nicotinic acetycholine

receptors. It can assist pts with cessation of tobacco use by
reducing withdrawal cravings and attenuating teh rewarding effects
of nicotine.
Pharmacology

Electrolytes
With with Diabetes showing peripheral neuropathy and increased

urinary albumin excretion. He has high BP. Best Pharm therapy
for HTN for hypergylcemic pt with microalbuminurea is ACE and
Arbs. E.g: *Lisinopril*
Pharmacology

Electrolytes
The most dangerous adverse effect of Amhoteracin B is

Nephrotoxicity which can be called *Renal Tubular Dysfunction*
[pt presents with ECG finding of frequent premature ventricular
beats, a finding due to kidney damage induced hypokalemia]
681
Pharmacology

Electrolytes
Pt with dyspnea, orthopnea, elevated JVP, lower extrem edema,

and lung crackles have acute decomensated heart failure and
should be treated with IV loop diuretics. Which work on *Thick
ascending limb of loop of henle*
685
Pharmacology

Electrolytes
Loop diuretics such as *Furosemide* can cause Ototoxicity.
1425
Pharmacology

Electrolytes
Pt on Chlorthalidone that develops muscle weakness. It is due

*Hypokalemia*
Pharmacology

Electrolytes
Pt on Acyclovir who develops acute elevation of serum creatine

levels. This could have been prevented with *Agressive IV
Hydration*
(Acyclovir Nephrotox)
Pharmacology

Electrolytes
*Foscarnet* can be used in Ganciclovir resistent CMV. Being a Ca

chelator it can cause hypocalcemia. Also it induces renal wasting
of Mg causing hypomagnesemia. Also reduces production of PTH
further contributing to Hypocalcemia.
Pharmacology

Electrolytes
Thiazides prevent calcium loss in urine, Thiazides keep calcium in

the body. Thus, they are useful in Tx of nephrolithiasis due to
calcium oxalate stones. Loop diuretics on the other hand lose
calcium. Loops Lose Calcium.
8754
151
275
1642
1643
2003
Pharmacology
8249
Pharmacology

Electrolytes
Pharmacologic therapy of Urge incontinence involves

*Antimuscurinic Agents*
11945
Pharmacology

Electrolytes
Erythropoiesis-stimulating agents are associated with increased

risk for *hYPERTENSION* and thromboembolic events.
699
Pharmacology
Rheumatology/Orthopedics Bisphosphanates (e,g alendronate) have similar structure to

& Sports
*Pyrophosphate*
718
Pharmacology
Rheumatology/Orthopedics *Methotrexate* which is used in RA can cause GI ulcers such as

& Sports
"painful mouth ulcers*. It also causes Liver Tox (high liver enzymes)
Pharmacology
Etanercept is TNF-alpha inhibitor used in RA for failed

methotrexate therapy. It is not an Ab but a decoy receptor for
TNF-alpha. Inhibition of TNF-alpha leads to impaired cell-mediated
immunity particularly for control of mycobacteria within
& Sports
granulomas and therefore inhibition can result in reactivation of TB
and hence beofore adminstration a *Tuberculin Skin Test* should
be made.
Pharmacology
Colchicine has side effects of ABdominal pain, nausea and

diarhea. It binfs to tubulin and therefore affects the cell
& Sports
*Cytoskeleton*
Pharmacology
A gout drug that causes nausea, vomiting and diarhea after intake
is a drug that *Inhibits microtubule formation*
& Sports
[Colchicine]
Pharmacology
A muscle relaxant that shows initial equal reduction in response

followed by fading away unequal response in the TOF stimulation
& Sports
test is a depolarizing muscle blocker like *Succinycholine*
1773
Pharmacology
Prolonged use of glucocorticoids such as *Prednisone* in pts with

Rheumatoid A. can lead to osteoarthritis and cause fractures of
& Sports
vertebral bones for example.
7792
Pharmacology
Rheumatology/Orthopedics A medication that selectively binds to an IL-1 "inducible" enzyyme

& Sports
is probably a selective COX-2 inhibitor such as *Celecoxib*
8481
Pharmacology
Quadriplegic pt who is givena a skeletal muscle relaxant before

Rheumatology/Orthopedics intubation goes into cardiac arrest. He has V fib and massive
& Sports
Hyperkalemia. Admistration of *Succinylcholine* probably caused
hissymptoms*
144
Physiology
The reason why Verapamil has no effect on skeletal muscle

contractility is because skeletl muscle has *No dependence on
extracellular Ca influx*
183
Physiology
During Systole, there is decreased blood flow to the *Left

Ventricular Myocardium*
192
Physiology
Pt with occlusion of "right" coronary artery causes acute MI. This

could lead to Sudden Cardiac Death, the most common
mechanism of death here is *Ventricular Fibrillation*
Really old pt with BP 180/70 at one visit then 175/68. The age
related changes that best explains his BP reading are *Aortic
Stiffening*
[Isolated systolic HTN, Aortic stiffening decreases comppliance of
aorta and elevates pressure during systole]
The most significant factor limiting coronary blood supply during

an exercise test is *Duration of Diastole*
(Myocardial Perfusion happens during Diastole)
Rightward extension of ventricular filling portion of graph indicates

increase in ventricular preload. This can occur in any state of fluid
overload (renal failure, CHF) or after infusion of *NORMAL
SALINE*
720
859
1168
1212
456
951
1511
Physiology
Physiology
Physiology
1512
1513
Physiology
Physiology
Pt presents with sign of hypovolemic shock who is give Normal

Saline. This intervention increases *End-Diastolic Sarcomere
Lenght*
(Increase in preload stretches myocardium and hence the
sarcomere length)
Cardiac tissue conduction velocity is from fastest to slowest as:

Purkinje system-->Atrial muscle--->Ventricular muscle---> AV node
[Park AT VENTure AVenue]
1515
Physiology
Pt with sudden onset palpitation plus rapid regular tachycardia that

responds to carotid massage probbly has PSVT. Carotid massage
increases afferent firing which increases vagal parasympathetic
tone which slows conduction thru AV node and hence *Prolongs
AV node Refractory period*
1516
Physiology
Within the zone of autoregulation of coronary blood flow. The main

endogenous factor for control of coronary blood flow is *Nitric
oxide*
1528
Physiology
The *Blood Flow Per Minute* in the pulmonary circulation closely

matches the blood flow in the systemic circulation. This is true in
both exercise and rest.
1529
Physiology
Cardiac Output= Rate of O2 consumption/arteriovenous O2

content difference.
1557
Physiology
Pt that presents with with dyspnea, orthopnea, and fatigue and with
a history of MI that was not revascularized due to delya in Tx. The
fact that the pt also presents with a diastolic heart sound that is
best heard in the left decubitus position at the apex is consistent
with a decompensated HF. The physical exam finidng (i.e the heart
sound) can be accentuated when *Listening at the end of
expiration*
1589
Physiology
Increase in HR and cardiac output with no changes in PaO2 and

PaCO2 indicate *Exercise*
1609
Physiology
Pt with lightheadedness when pressure is placed on the carotid

sinus has carotid sinus hypersensitivity and the carotid sinus has
AFFERENT sensory fibers to the meduula via the hering nerve
which is a branch of the *Glossopharyngeal nerve*
1621
Physiology
Decrease flow by a factor of 16 decreases radium of lumen by a

factor of 2 meaning *50%*
Decreased Cardiac output with unchanged venous return suggests

a problem in the contractility of the heart either due to a negative
inotropic drug or due to an injury to the myocardium such as with
a myocardial infarction.
1624
Physiology
1625
Physiology
A Cardiac output and venous return curve shows the cardiac

output is increased and the venous return is increased as well with
a rightward shift in right atrial pressure (increased mean arterial
pressure). Most likely cause is *Chronic Atriovenous Fistula*
[High cardiac output with increased venous return indicates
lowering of TPR. The rightward shift of right atrial pressure in the
venous return curve indicates higher mean arterial pressure which
indicates a chronic fistula]
1653
Physiology
In heart catheterization. The structure the produces a pressure

changed of a max of 25 and a min of 2 is *Right Ventricle*
1661
Physiology
Pt with a cardiac murmur and P.E reveals bouding femoral pulses

and carotid pulsations that are accompanied by head-bobbing
most likely suffers from *Aortic Regurgitation*
1931
Physiology
Ca efflux prior to myocyte relaxation is caused by use of

Ca2+ATPase and *NA+/Ca+ Exchange Mechanisms*
1973
1977
Physiology
Physiology
Calcium channel blockers as as verapamil slow *diastolic

depolarization* in SA and AV node.
Pt with irregular beat rhythm, narrow QRS complexes and Absent

P waves has A fib. What determines his ventricular contraction
rate is the *AV node refractory period*
2009
Physiology
During a study, the blood oxygen content of the aorta and several
other vessels is measured at rest. The greatest difference in these
measurements will most likely be between the aorta and the
*Coronary Sinus*
[myocardial oxygen extraction is very high]
8546
Physiology
In pts with CHF, compensatory activation of of RAAS and

*Sympathetic Nervous System* results in increased afterload,
excess fluid retention and cardiac remodelling.
8563
Physiology
When you give Acetycholine to dilat blood vessles. The amino acid
resposnible for this vasodilation is *Arginine*
11513
Physiology
A drug that selectively decreases heart rate but has no effect on

myocardial contractility or relaxation. The ion transpoters that this
medication works on are *Funny Na channels during S4*
[Ivabradine]
770
Physiology

Metabolism
Thyroid peroxidase enzyme is involved in *Thyroglobin Iodination*

also in oxidation of iodide, and coupling of 2 iodized tyrosine
residues.
821
Physiology

Metabolism
tan-Fat containing tissue found around the kidneys and adrenals of

a newborn is Brown Fat that helps to prevent *Hypothermia* by
producig heat.
Physiology

Metabolism
Aching bones and insdeous pain in back, pelvis and lower

extremities, combined with reduced sunlight exposure suggests Vit
D deficiency. UV light from the sun converts
*7-dehydrocholesterol* into *Cholecalciferol (Vit D3)*. Vit D3 is
then converted into 25-hydroxycholecalciferol by 25-hydroxylase.
25-hydroxycholecalcifrol is then converted to
1,25-dihydroxycholecalciferol (active vitD) by 1-alpha-hydroxylase.
This is the enzyme in the kidney acted on by PTH (+) and Ca2+
(-).
Physiology

Metabolism
Pt with mild hypercalcemia, borderline high PTH levels and urinary

Ca that is very low and normal 25-hydroxyvit D pobably has a
mutation in *Membrane-bound receptor coupled with a G-protein*
990
992
1065
Physiology

Metabolism
Pt presents with progressve lethargy. For past 3 weeks she had

loss of appetite, constipation, muscle weakness, polyuria and
polydipsia. She has been taking large doses of vitamins. Exam
shows she is stuporous and has dry mucus membranes. The
metabolic abnormality in this pt can also be found in *Sarcoidosis*
[Hypercalcemia]
1615
Physiology

Metabolism
High T3 would have negative feedback effects reducing TSH, T4

and rT3.
1768
Physiology

Metabolism
Proinsuline is cleaved by beta peptidases into Insulin and

C-peptide, both of which are then *Packed in Secretory Granules*
11660
Physiology

Metabolism
Postoperative HypoParaThyroidism is common after

thyroidectomy. Symptoms include Tingling, Numbness, Muscle
Spasms, Seizure, Trousseau and Chvostek signs ( twitching of
lower face muscle on percusiion below zygomatic arch)
208
Physiology
FemaleReproductive
System & Breast
Pulsatile (every 90 mins 4e.g) adminstration of GnRh is indicated

in Infertility (e.g Anovulation)
299
Physiology
FemaleReproductive
System & Breast
Progestron withdrawal leads to menses (i.e bleeding) which is a

result of *Apoptosis*
1560
Physiology
FemaleReproductive
System & Breast
LH stimulates the theca interna cells of the ovarian follicle to

produce androgens. Aromatase within the follicle's *Granulosa*
cells subsequently converts these androgens to estradiol under
FSH stumulation. The theca externa cells serve as connective
tissue support structure for the follicle.
126
Physiology
*Intestinal Influences* help Down-Regulate gastric secretions after

a meal.
1018
Physiology
Gastrointestinal & Nutrition Lipid absorption occurs in the Jejunum.
1358
Physiology
A drug that inhibits primary active transports across cell

membranesis*Omeprazole*
1546
Physiology
Secetin, released by the *Duodenal S cells* stimulates release of

bicarbonate from the pancreas.
1938
Physiology
Pt with secretory diarhea. Her gastric cells lack gastric acid.

Somatostatin relieves her symptoms. An excess of *Vasoactive
Intestinal Peptide* is responsible.
[VIPoma, a pancreatic islet cell tumor results in watery diarhea,
hypokalemia and achlorhydria. Somatostatin decrease productuon
of GI hormones]
1971
Physiology
Secretin increases concentration of *Bicarbonate* released from

the pancreas.
1616
Physiology
GeneralPrinciples
Resistance in parallel is 1/T=1/R1+1/R2+1/R3+...etc

[Remeber to inverse the answer]
787
Physiology
*The Hepatic Parenchymal Cells* secrete Hepcidin which is a

substance that controls the storage and release of iron through its
binding to ferroportin. Once bound to ferroportin it inactivates it
thus prevents iron intestinal absorption into blood and also prevents
its release from macrophages.
1062
Physiology
Intracranial Hemorrhage and its associated signs without signs of

trauma in a newborn that didnt receive vaccines is most likely due
to *Impaired clotting facotor carboxylation* as in vit K deficiency.
1082
Physiology
Fibrinolytics are used in ST segment elevation MI. They may

cause reperfusion arrythmias on arterial re-opening. These are
usually benign. An example is *tPA* [Tissue plasminogen activator]
CO poisoning causes *Increased CarboxyHb together with

unchanged PaCo2, Methoglobin level is unchanged*
[In Co poisoning, O2 contect is decreased BUT not oxygen partial
pressure which is represented by PacO2]
Pt who wwas in motor vehicle accident and has received several

units of packed-red blood cells. He now complains of tingling
sensation in his toes and fingers. Ca level is 7.2. Most likely cause
of symptoms is *Ca chelation by a substancce in the transfused
blood*
(Citrate is added prior to storage, chelates Ca)
Nervous System
A pentapeptide with strong affinity to delta and mu receptors

produced after application of noxious stimuli. This substance most
likely has a common molecular origin with *ACTH*
(POMC us cleaved into beta endorphins, ACTH & MSH)
1545
1654
775
Physiology
Physiology
Physiology
776
Physiology
Nervous System
The most likely postsynaptic action of low-dose morphine on the

spinal level (epidural) of a pt who has severe back pain due to
metastatic Ca is *Increasing K efflux out of cells*
[Upon binding to Mu receptors, morphine causes G-protein
coupled activation of K channels to increase K efflux. Increase K
efflux leads to Hyperpolarization of postsynaptic neurons and
termination of pain transmission]
1318
Physiology
Nervous System
In MS, *Length Constant* is decreased.
1356
Physiology
Nervous System
Macular lesions can result in *Central Scotomas*
Nervous System
Pt with cerebral edema who is on a ventilator adjusted to achieve a

pCO2 level bwteen 26-30 mmHG. Most likley effect of this
intervention is *Increased cerebral vascular resistance*
[a dro in pCO2 causes vasoconstriction and increases resistance
and hence reduces cerebral blood flow]
1493
Physiology
1657
Physiology
Nervous System
A pt is being evaluated for hypoventilation. He is asked to take

several deep breathe in rapid succession. Physiograph shows
decreasing amplitude of cyclic intrapleural pressure changes
during deep rapid breathing. Most likely site of this pts disease is
*Neuromuscular Junction*
[Pleural pressure changes indicate diaphragmatic contraction.
Decreasing contraction with each breathe (weaker with repition)
This most likely involves NJM (e.g Myasthenia Gravis or restrictive
lung)
11682
Physiology
Nervous System
Gaba pentin Inhibits presynaptic voltage-gated Ca channels thus

preventingneurostransmittervesiclerelease.
1987
Physiology

Puerperium
Progestrone inhibits prolactin during getstation thereby preventing

lactation.
481
Physiology
The resistance in the airways starts high from the begining and
jumps up more at medium sized bronchioles due to highly turbulent
flow. The resistance then decreases going towards subsequent
generations till reaching the terminal bronchioles due increased
surface area allowing low resistance laminar flow.
536
Physiology
Dust particles smaller than 2 micrometres are eliminated by

macrophagesthroughphagocytosis.
1357
Physiology
Pt with acute metabolic acidosis (Normal HCO3 with low pH and

High Pco2)could most likely suffer from *Heroin Overdose*
[Heroin causes respiratory depression and hypoventilation]
1514
Physiology
The CFTR protein is a transmembrane *ATP-gated* Chloride

channel.
1521
Physiology
Pt with illness like with Obstructive Lung disease would have air
trapping in lungs and hence a high *RV/TLC ratio*
1522
Physiology
Pt with tracheal pO2 of 150, Alveolar pO2 of 145, and Alveolar

pCO2 of 5 has *Pulmonary alveolar perfusion*
note: tracheal pO2 is normal. Normal alveolar pO2 is 104.
1526
Physiology
P(A)O2(Alveolar)=150-(PaCO2(Arterial)/0.8)
The PO2 in the left atrium and ventricle is lower than that in the
pulmonary capillaries due to mixing of oxygenated blood from the
pulmonary veins with *Deoxygenated blood* arising from the
bronchil arteries and thebesian veins.
Sudden-onset tachypnea and chest pain in a hospitalized pt shud

raise suspicion for Pulmonary Embolism. Especially if pt is
immobilized or had recent surgery. Thrombotic occlusion of
pulmonary circulation leads to increased blood flow to remainder
of lung causing a *Ventilation-perfusion V/Q mismatch*
1542
1584
Physiology
Physiology
1586
Physiology
Increase in hemtocrit with normal red blood cell mass indicates

*RelativeErythrocytosis*
1587
Physiology
The tissue that would Increase vascular resistance due to low

Oxygen tissue content is the *Lungs*
1620
Physiology
Increased lung volume increases PVR in alveolar vessels and

decreases PVR in extra-alveolar vessels. *PVR is lowest near FRC*
In high altitudes Po2 decreases and body responds by

hyperventilation which hence decreases PCO2 causing a
respiratory alkalosis (low pH). After 2 days the kidney respond to
the alkalosis by excreting HCO3 and decreasing it in blood.
1980
Physiology
1981
Physiology
Obese truck driver with history of calf swelling who presenst to ER

with sudden onset dyspnea probably has PE lodged from DVT
(calf swelling). In PE there is *respiratory alkalosis, low CO2, Low
O2, and normal HCO3*
1161
Physiology

Electrolytes
ADH acts on *Medullary segment of collecting duct*
1559
Physiology

Electrolytes
In a study a volunteer is given a substance that that specifically

and complete inhibits glucose transport in the proximal renal
tubules. In this volunteer, glucose clearance will best approximate
the clearance of *Inulin*
[No tubular reabsorption or secretion, filtered amount equals
excreted amount]
[Note that PAH is secreted as well]
1588
Physiology

Electrolytes
The nephron segment that will have the lowest concentration of

PAH is *Bowman's capsule*
1607
Physiology

Electrolytes
In the setting of low ADH, the highest osmolality is at the *Bottom

of Loop of Henle*
1608
Physiology

Electrolytes
If animal is deprived of water, ADH will be high, high ADH

promotes water reabsorption. The place with the lowest urine
osmloarity (highest dilution) would be the distal convoluted tubule.
Why? because its impermeable to water but continues to reabsorb
electrolytes. Also, the fluid just came from the ascending limb
which is also impermeable to water but reabsorps electrolytes.
2012
Physiology

Electrolytes
After adminstration of Desmopressin, renal clearance of *Urea*

decreases.
8881
Physiology

Electrolytes
When GFR is normal, relative decease in GFR results in only a

small increase in serum creatinine. However, when GGFR is
significantly decreased, small decrements of GFR produce large
changes in serum creatinine.
638
Physiology
Rheumatology/Orthopedics The marker that reflects the activity of osteoblasts is *Serum Level
& Sports
of bone-specific Alkaline Phosphatase*
639
Physiology
Pt with pain and deformity of long bones with hearing loss (due to
bony deformity of the skull). The pathologists identifies
Rheumatology/Orthopedics multinuncleated cells containing over a 100 nuclei. The factor that
is essential for the differentiation of these cells is *Receptor
& Sports
Activator of Nuclear factor Kappa-B ligand (RANK-L)*
(Pagets disease of bone, Osteoclasts)
824
Physiology
Rheumatology/Orthopedics Lack of Tubules in muscle fibers will result in *Uncoordinated

& Sports
contraction of myofibrils*
Physiology
Biopsy of a pt shows haphazardly oriented segments of lamellar

Rheumatology/Orthopedics bone with prominent cement lines. The pathogenesis of the
condition initially involves increases activity of *Osteoclasts*
& Sports
(Osteolytic phase of paget disease of bone)
987
1665
8266
Physiology
ATP helps release *Myosin head from Actin binding site*, and thus
lack of ATP leads to persistance of myosin-actin cross bridge
& Sports
(Rigor mortis)
Physiology
Wieght lifter who raises wieght above head and then his arms
Rheumatology/Orthopedics suddenly and involuntarily give away and he drops the wieght to
ground. The structure that was most likley responsible for the
& Sports
suddent muscle relaxation is *Golgi tendon organ*

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UWORLD Notes by Subject (Main Division) (Usmle Grassroots)

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Question

A laterally directed chest wall stab wound at the fifth intercostal

A puncture wound at the left sternal border in the fourth intercostal

A skull fracture at the junction of the frontal, pariatal, temporal and

In most poeple with right coronary dominance, Inducible ischemia

For graft purposes, the Great Saphenous Vein can accessed at a

The Superior Venecava is derived from the common cardinal

A high speed motor vehicle accident that leads to injury of aorta

Left ventricular leads in biventricular pacemaker course through

IV drug users can have righ sided endocarditis involving the

Pt undergoes transesophageal echocardiography. The ultrasound

Transesophageal echo probe facing posteriorly would interrogate

While cannulating the Right Common Femoral artery for cardiac

Pulmonary capillary wedge pressure (measured via a swan-ganz

Radiofreqyency ablation of the AV node in a pt with arrhythmia is

Pt with inflamatory acne. The glands involved release secretions by

Ear, Nose & Throat (ENT)

The recurrent laryngeal nerve is in close proximity to the inferior

Ear, Nose & Throat (ENT)

Blunt trauma to the globe can cause orbital blowout fractures.

Ear, Nose & Throat (ENT)

Pt who faints after otoscope exam has experience vasovagal

Ear, Nose & Throat (ENT)

Pt with epistaxis. Silver nitrate cautery is performed and bleeding

Endocrine, Diabetes &

A nerby nerve injury while ligating an artery entering the superior

*The suspensory ligament of ovary* must be ligated during removal

A *pudendal nerve* block is performed by injecting an anesthetic

Pt with right sided back pain and voiding is normal after a

Exercise to strengthen pelvic floor targets *Levantor Ani Muscle*

To help with delivery, a vertica; midline incision is made at the post

Woman who delivers twins and has postpartum hemorrhage and

submucosal glands that have alkaline secretions in Gi endoscopy

A peptic ulcer localized PROXimally on the lesser curvature

Laparotomy shows decreased angle between superior mesenteric

Gastrointestinal & Nutrition Head and Body of Pancreas are Retroperitoneal.

A mass in the third portion of the duodenum that is infiltrating

Obese pt is interested in adjustable gastric band. In order to

Pt was stabbed in RUQ. He is bleeding. Brisk, n"onpulsatile"

External Hemorrhoids originate below the dentate the line. They

Gastrointestinal & Nutrition

Pt has mass in the middle third of the rectum extending to

Internal hemorhoids is characterized by painless bleeding,

Pelvic fracture in a male can result in urethral injury leading to

In a pt with BPH who is given Finasteride that acts on *The

MaleReproductiveSystem The scrotum is drained by the superficial inguinal lymph nodes.

MaleReproductiveSystem Gonadal arteries originate from the abdominal aorta!

Undescended testes that can be felt medial to the mid-inguinal

The somatic pain in appendicitis that shifts from the umbilicus to

Old pt with long standing HTN who presents for involuntary

Symptoms of hyeracusis (high sensitivity to everday sounds)

Pt with initial resistance to passive extension followed by sudden

Embolism to ACA would impared ability to *Climb stairs*

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Injury to median nerve at the wrist is manfiested by diminished

CN IX resection would lead to loss of sensation over the *Tonsils*

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jaw deviation to right on opening mouth, difficulty chewing food

loss of touch, temperature, and vibratory sensations indiacte

The most common finding in *PCA* territory infarction is

Premature neonate with decreased level of conscousnes and

Pt with homonymous hemianopia with macular sparing could have

Injury to meyer's loop in the temporal lope results in contralateral

The suspensory ligament of ovary must be ligated during removal

A pudendal nerve block is performed by injecting an anesthetic

Exercise to strengthen pelvic floor targets Levantor Ani Muscle

Embolism to ACA would impared ability to Climb stairs

CN IX resection would lead to loss of sensation over the Tonsils

Occlusion to the Middle cerebral Artery can cause both

The most common finding in PCA territory infarction is

The Phrenic Nerve carries paim fibers form the Diaphragmatic

The "proximal" part of the ureter is supplied by the Renal Artery.

Rheumatology/Orthopedics The Piriformis muscle passes through the greater sicatic

Majority of overdose deaths are related to Opioids

Fear of Elevators is treated with Behavioral Therapy

Use SRRI's in panic disoder in pt who presents camly and

srri's used in depression Block Serotonin Receptor

Dont confuse Anxiety to due medical condition as in