UWORLD Notes April 29 2016 (Usmle Grassroots)

Question
MainDivision SubDivision Notes

Id
A renal mass that is composed of fat, smooth musscle, and blood
Miscellaneous vessels. The pt is most likely to have additional finidng of *brain
6 Pathology
(Multisystem) Hamartomas and ash-leaf skin pathches*
[Angiomyolipoma, associ with Tuberous Sclerosis]
Antibodies detected in the serum of a young male are found to
Renal, Urinary Systems & react with teh alpha3-chain of collagen type 4. The pt is most likely
7 Pathology
Electrolytes to have *Hemoptyis and Oliguria*
[Goodpasture disease,Anti-GBM antibody]
Renal, Urinary Systems & In PSGN there is deposition of IgG, IgM, an *C3*, thus producing
8 Histology
Electrolytes a star-sky appearance on immunolfourescent microscopy.
Pt with recurrent, self-limited painless hematuria "within days" after
Renal, Urinary Systems &
10 Pathology an upper respiratory infection has Ig A nephropathy. Kidney
Electrolytes
biopsy will show *Mesangial Deposits of IgA*
PSGN:
1)Enlarged, hypercellular glomeruli on light microsc
Renal, Urinary Systems & 2) Lumpy-Bumpy granular deposits of IgG & C3 on
11 Pathology
Electrolytes immunofluorescence
3) Electron dense deposits (Humps)on epithelial side of the basal
membrane on electron micros
Renal, Urinary Systems & In post-strep Glomerular Nephritis there is *DECREASED SERUM
12 Pathology
Electrolytes C3*
HIV pt with diffuse cortical atrophy and CT scan shows enlarged
14 Pathology Nervous System ventricles. The Hydrocephalus is secondary to the cortical atrophy
and hence termed *Hydrocephlus Ex Vacuo*
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
20 Histology Nervous System
produce cells marked densely for lipids which are the
*MICROGLIA* and the lipids are from breakdown prduucts that
werephagocytosed.
Renal, Urinary Systems & Pt with signs of Nephrotic syndrome would a seconday change of
28 Pathology
Electrolytes *Increased Live Lipoprotein Synthesis*
33 PathophysiologyCardiovascular System Bicsupid aortic valve can lead to *aortic stenosis by 50 years old. *
Cyanosis in transposition of the great vessels is classic. This
condition is due to failure of Septation. Failure of the
35 Embryology Cardiovascular System 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.
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*
38 Pharmacology Cardiovascular System [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]
Pt with chest pt shows near-toal-occlusion of LAD artery. The
absence of myocardial necrosis and scarring despite vessel
39 Pathology Cardiovascular System occlusion in this pt is explained by the *Slow Growth Rate* of the
occluding plaque.
(arterial collaterals have developed around point of occlusion)
Light Microscopic changes of ischemic myocyte after 12 days is
41 Pathology Cardiovascular System
*Granulationtissuewithneovascularization*
In myocardial ischemia, the depletion of ATP in critical cellular
42 PathophysiologyCardiovascular System areas results in loss of contractility within about *60 seconds* of
total myocardia ischemia.
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
43 Pathology Cardiovascular System 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
A population that is universally vaccinated with recombinent
HBsAg. The disease that would almost entirely disappear is *Delta
45 Microbiology Infectious Diseases Agent Infection*
{Hep D causes infection only when encapsulated with HBsAg, it is
a replication-defective RNA virus]
Hepatitis that causes high incidence of fulminant hepatitis in
48 Microbiology Infectious Diseases pregnant women with high mortality (20%) is hep E which is an
*unenveloped RNA virus* spread thru fecal oral route.
A cavernous Hemangioma is the MC benign liver tumor. Typically
54 Pathology Gastrointestinal & Nutrition
in adults 30-50 years.
Pt with chronic hepatitis C, a large hepatic mass and multiple
56 Pathology Gastrointestinal & Nutrition satelite lesions has hepatocellular carcinoma. The marker for
recurrenc is *ALPHA FETOPROTEIN*
Moldy grains from asia that cause specific G-to-T mutation in gene
57 Pathology Gastrointestinal & Nutrition p53. This is aflatoxin exposure, the mutation of which can increase
risk for developing *Hepatocellular Carcinoma*
Pt dies from liver disease. Both changed and unchanged
hepatocytes domonstrate foreign DNA Fragments integrated into
58 Pathology Hematology & Oncology 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]
The prsence of a fluid-filled cavity in liver in conjuction with fever,
chills and RUQ pain. Microorganism/route combinations that is
62 Microbiology Gastrointestinal & Nutrition
most likely cause is *Staph Aureus via Hematogenous route*
[Hepatic Abscess caused by staph]
In Wernicke-Korsakoff syndrome, when thiamin infusion is started,
63 Pathology Nervous System the nuerologic deficit that most likely to persist despite treatment is
*Memory Loss*
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
64 Biochemistry Nervous System
in conjunctiva, nail beds, and palms. The lab test that would
confirm Dx is *Serum Methylmalonic acid*
[Vit B12 Def]
Gallstones caused by the use of fibrates for dyslipidemia are
67 Biochemistry Gastrointestinal & Nutrition
caasued by decreased activity of 7-lpha-hydroxylase.
Pregnant woman who develops Cholelithiasis is due to
Pregnancy, Childbirth &
68 Pathophysiology *Estrogen-induced Cholestrol hypersecretion &
Puerperium
Progestrone-inducedgallbladderhypomotility*
Pt with slow and incomplete gallbladder emptying (gallbladder
hypomotility) is at risk of developing a *Billiary Sludge*
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)
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
74 Pathology Cardiovascular System 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]
Pt with cholestrol gall stones would have *High cholestrol, low bile
78 PathophysiologyGastrointestinal & Nutrition
salts and low Poshatidylcholine* in the gallbladder.
Pt with severe right upper quadrant tenderness and laprascopic
surgery that reveals an erythematous, distended gallbladder with
79 Pathology Gastrointestinal & Nutrition patchy necrosis probably has acute calculous cholecystitis which
usuallu results from a *Gallbladder outflow obstruction* due to
gallstone obstruction of cystic duct.
The diagnostic test most specific fro acute cholecystitis is *Failed
gallbladder visualization on radionuclide billary scan*
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
83 Pathology Cardiovascular System 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.
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
84 Pathology Cardiovascular System 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]
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)
6 year old pt with Long QT interval and with family histo of sudden
91 Pathology Cardiovascular System death probably has congenital long QT syndrome and can have an
associated*Neurosensorydeafness*
Localized amyloid in the atria of heart is amyloid derived from
Naturiretic peptide.
Pt with Hypotension, tachycardia, Jugular venous distension with
96 PathophysiologyCardiovascular System clear lungs and Pulsus Paradoxus (loss of palpable pulse during
inspiration) is consistent with *Cardiac Tamponade*
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.
Pt died. Autopsy is done. Gross inspection of heart shows shows
dense thick fibrous tissue in the pericardial space between
98 Pathology Cardiovascular System bisceral and paretal pericardium. The most likely sign that would ve
been detected during physical exam is *Kussmaul Sign*
[Constrictive Pericarditis]
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
104 Pathology Dermatology
cause is *Malassezia globoss*
[Pityriasis versicolor]
Mucormycosis is an opportunistic infection caused by Rhizopus,
Mucor, and Absidia. Clinical picture is paranasal involvememnt in
106 Microbiology Infectious Diseases
diabetic or immunocompromised patient. Fungi form broad
nonseptate hyphae at 90 degree angles!!
Pt with signs of diabetic ketoacidosis together with Black Necrotic
Escha on nasal cavity examination, facial pain, & headache
107 Microbiology Infectious Diseases probably has "Mucormycosis" and Diagnosis can be made with
*Mucosal Biopsy* to see borad-ribbon-like nonseptate hyphae with
right-angle branching.
Oral thrush (can be scaped off) in an otherwise healthy pt is
111 Microbiology Infectious Diseases suggestive of immunosuppression and HIV should be suspected.
Therefore, Medical history can be focused on *Sexual Practices*
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).
112 Immunology Infectious Diseases Development of Candidemia is directly contributed by a *Low
Neutrophil Count*
Note: Superificial Candida Infection is contributed to by a "Low
T-lymphocyte count"
HIV pt infected with organism stained with india ink in CSF
showing spherical yeast with thick capsules (C.neoformans). Most
113 Microbiology Nervous System
likely primary foucs is *Lungs*
[found in pigeon droppings and soil, enters thru resp route]
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. `
An organism's capsule that stains red on Mucicarmine staining is
117 Microbiology Pulmonary & Critical Care
the capusle of *Cryptococcus Neoformans*
Pt with Hx of viral encephalitis and pneumocystis pneumonia most
likey has HIV and if they present with signs of meningitis with latex
118 Microbiology Nervous System agglutination positive for soluble polysaccharide antigen probably
has Cryptococcal meningitis and you should expect *Budding
yeast* on light microscopy.
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*
Pt who is in shock and Hb level drops from 14 to 12. Nasogastric
125 Pathology Gastrointestinal & Nutrition suctioning reveals bright red blood. Pt's bleeding is most likely a
result of *Physiologic strss*
*Intestinal Influences* help Down-Regulate gastric secretions after
126 Physiology Gastrointestinal & Nutrition
a meal.
Tumor of cells heavely loaded with mucus that has metastasized to
FemaleReproductive the ovaries suggests adenocarcinoma of the *Stomach* Classicly
127 Histology
System & Breast they are mucin-producing signet-ring neoplastic cells in ovarian
stroma. (Krukenberg tumor)
submucosal glands that have alkaline secretions in Gi endoscopy
probably are the Submucosal (Brunner) glands which can be
129 Anatomy Gastrointestinal & Nutrition
found at the *First part Duodenum* (ampulla of vater) and the
Pylorus.
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]
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.
Lactase deficeiency causes osmotic diarhea and *Acidification of
stool*
135 Pathology Gastrointestinal & Nutrition The NF-kB factor pathway stimulates *Cytokine Production*
Nitrates activate guanyl cyclase and increase levels of intracellular
136 Pharmacology Cardiovascular System cGMP which leads to *dephosphorylation of myosin light chain*
leading to relaxaton and hence vasodilation of vessel.
At low doses, Nitroglyerin acts as a VENO-DILATOR, *Large
137 Pharmacology Cardiovascular System Veins* are the most Susceptible. Vasodilation causes decreasd
preload becuase blood collects in the venous system.
Sublingual nitreates *Decrease left Ventricular Volume*
138 Pharmacology Cardiovascular System
[Thru venodilation and hence decreasing preload]
140 Pharmacology Cardiovascular System Adverse affect of nitrates is *HEADACHE* !!
Pt with signs of hypertrophic cardiomyopathy (family history of
premature sudden death, systolic mumur). Due to the left
141 Pharmacology Cardiovascular System ventricular outflow obstruction, avoid drugs that reduce ventricular
volume such as vasodilators and diuretics. An example of a
vasodilator is *Isosorbide dinitrate*
Pts taking daily nitrates need to have a nitrate free period to
prevent tolerance to the drug
The reason why Verapamil has no effect on skeletal muscle
144 Physiology Cardiovascular System contractility is because skeletl muscle has *No dependence on
extracellular Ca influx*
Pt with A fib and CHF that is on multiple medications and develops
147 Pharmacology Cardiovascular System nausea, decreased appetitte and "Vison difficulties" and lab finding
of "Hyperkalemia" probably is on *DIGOXIN*
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*
With with Diabetes showing peripheral neuropathy and increased
Renal, Urinary Systems & urinary albumin excretion. He has high BP. Best Pharm therapy
151 Pharmacology
Electrolytes for HTN for hypergylcemic pt with microalbuminurea is ACE and
Arbs. E.g: *Lisinopril*
A major complication of digoxin tox is Life threatenig
*Arrhythmias*.
Endocrine, Diabetes &
166 Pharmacology A drug that can massively decrease Triglycerides is *Fenobirate*
Metabolism
Endocrine, Diabetes & Acute falre of gouty arthritis (-ve birefringent crystals) can be due
167 Pharmacology
Metabolism to Tx with *NIACIN*
Pt on glucocorticoids for asthma should be advised to perform
168 Pharmacology Pulmonary & Critical Care *Oral Rinsing* to avoid side effects of medication.
(if drug lodges in oral mucosa, it can candiasis)
Drug that revereses irritant induced brochoconstriction but does
not work in vagectomized animals (meaning drug has effect on
170 Pharmacology Pulmonary & Critical Care vagus nerve) is probably *IpraTROPium* which is a muscurinic
antagonist. It combats the release of Ach due to vagus nerve
stimulation.
Inhaled Cromolyn is used in Asthma. It *Inhibits Mast cell
171 Pharmacology Pulmonary & Critical Care
degranulation*
Poisoning&Environmental
172 Pharmacology Theophylline toxicity leads to *Seizures and Tachyarrhythmias*
Exposure
176 Pathology Cardiovascular System *Mitochondrial Vacuolization* indicates irreversible cell injury.
Pt wih increased thickness of left ventricular wall and decreased
181 Pathology Cardiovascular System left ventricular cavity size have concentric cardiac hypertrophy.
This is associated with *Long standing HTN*
During Systole, there is decreased blood flow to the *Left
183 Physiology Cardiovascular System
Ventricular Myocardium*
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
185 Pathology Cardiovascular System 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)
In isolated diastolic heart failure there is *Increased LV
186 PathophysiologyCardiovascular System end-diastolic pressure, normal LV end-diastolic volume, and
Normal LV ejection fraction*
Pt with VSD would also have a *Holosystolic murmur over the left
187 PathophysiologyCardiovascular System
sternal border*
188 Pathology Cardiovascular System ASD is assocated with *Down Syndrome*
Endocrine, Diabetes & Pt with xanthelsama (xanthomas on medial eyelids). Best next step
191 Pathology
Metabolism is *Serum lipids and glucose*
Pt with occlusion of "right" coronary artery causes acute MI. This
192 Physiology Cardiovascular System could lead to Sudden Cardiac Death, the most common
mechanism of death here is *Ventricular Fibrillation*
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)
Pt with signs of a stroke and echocardiogram shows bubbles on
left heart when agitated saline is inserted has an Patent Foramen
202 Embryology Cardiovascular System
Ovale due to *Incomplete fusion of atrial septum primum and
secundum*
FemaleReproductive Pulsatile (every 90 mins 4e.g) adminstration of GnRh is indicated
208 Physiology
System & Breast in Infertility (e.g Anovulation)
Leuprolide is GnRh Analog and can be used in treatment of
Endocrine, Diabetes & prostate cancer. (metastasizes to vertebrae)
209 Pharmacology
Metabolism On initial therapy with Leuprolide *Testestrone and DHT rise then
fall with continued use*
Primary (psychogenic) polydipsia is a psychological disorder
characterized by increased intake of free water leading to
212 Pathophysiology hyponatremia and production of large volume of dilute urine.
Metabolism
*Water restriction* will correct the serum Na levels and leads to
increse in urine osmolality.
219 Pharmacology Hematology & Oncology In
Post delivery woman who presents with signs of
Endocrine, Diabetes & panhypopituitarism with failure of lactation, central hypothyroidism,
220 Pathology
Metabolism and adrenal insufficiency. Most likley represents *Ischemic
necrosis* of pituitray gland (Sheehan Syndrome).
Antipsychotics such resperidone block dopamine and can
Psychiatric/Behavioral & therefore allow prolactin release which can cause amenorrhea.
222 Pharmacology
Substance Abuse Therefore, persons on respiridone can develop *Drug Induced
Amenorrhea*. Breast tenderness is also seen here.
50 yr old man with sudden, severe headache. He complains of
mild headaches and decreased libido. P.E shows bilateral deficits
Endocrine, Diabetes & involving temporal visual fields and impaired extraoccular eye
225 Pathology
Metabolism movements. Shortly after admittance he becomes hypotensive and
dies. Mostlikely finding in autopsy is *pituitary hemorrhage*
[Pituitart apoplexy]
Signs of Hyponatremia (altered mental status, headache,
weakness, seizures) plus a lung mass suggest SIADH casued by
226 Pathophysiology small cell carcinoma. An additional finding would be *normal
Metabolism
extraceullar fluid volume*. Regulatory mechanism in the body deal
with the hyponatremia resulting a Euvolemic hyponatremia.
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
232 Pathology Cardiovascular System 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*
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.
The opening snap in mitral stenosis occurs shortly after the mitral
235 PathophysiologyCardiovascular System valve opens when *the left ventricular pressure drops below the left
atrial pressure*
Head poudning and bobbing are associated with *Widening of
pulsepressure*
10 yr old boy presents with restlessness and involuntary kerking of
face, arms & legs 3 months after a sore throat. Pt is at greatest
241 Pathology Cardiovascular System risk fro developing *Valvular Heart Disease*
[Sydenham chorea as part of Acute Rheumatic Fever after Group
A strep infection]
*Calcific Degenration* of trileaflet aortic valve is the most common
cause of Aortic Stenosis in Developed Nations.
PT with aoric stenosis can develop pulmonary edema due to
244 PathophysiologyCardiovascular System *Sudden decrease in LV preload* due to loss of atrial contraction
that is due to atrial fib. `
Buspirone is an nonbenzodiazepine anxiolytic used to treat
Behavioral Psychiatric/Behavioral & Generalized Anxiety disorder. It has a SLOW ONSET. It lacks
247
science Substance Abuse muscle relaxant or anticonvulsant properyes and carries no risk of
dependence. It is a partial agonist of 5HT (1a)
SSRI's & SNRI's are first line medication in generalized anxiety
Behavioral Psychiatric/Behavioral &
248 disorder. Benzos should be limited to short term use and for pts
science Substance Abuse
who respond poorly to antidepressants.
Fetus that has closely set eyes, middline mass cosistent with a
Miscellaneous
252 Embryology proboscis, fused cerebral hemispheres, and an absent forebrain
(Multisystem)
fissure has Holoprosencephaly whicha type of *Malformation*
Pt with sharp pain and bright red rectal bleeding on defecation
255 Pathology Gastrointestinal & Nutrition suggest an Anal Fissure. Which is at the *Posterior midline Distal
to the Dentate line*
FemaleReproductive Pt with signs of Turner Syndrome is likey to have *Bicuspid Aortic
256 Genetics
System & Breast Valve*
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]
Long treatment of Parkinsons with Levidopa renders *DRUG
264 Pharmacology Nervous System
RESPONSEUNPREDICTABLE*
Entacapone *Increases the quantity of levodopa entering the brain*
265 Pharmacology Nervous System [It inhibits Catechol-O-Methly transferase, and hence prevents it
degradation]
Pt returning from cave exploation i central USA develop fever,
cough and malaise. Pulmonary infiltrates and hilar adenopathy are
266 Microbiology Pulmonary & Critical Care present on x-ray. Lung tissue specimen will show *Ovoid cells
withinMacrophages*
(Histoplasma Capsulatum)
Hiv pt with cough, fever, hepatosplenomegaly (sysetmic symptoms)
267 Microbiology Pulmonary & Critical Care and a bone marrow aspirate that shows small ovoid bodues wuthun
a macrophage is caused by *HISTOPLASMA Capsulatum*
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]
271 Pharmacology Infectious Diseases *Nystatin* bind Ergosterol in fungal cell membranes
Adminstering Amphoteracin B (binds to ergosterol) has a risk of
Renal Toxicity that could result in Severe hypokalemia and
274 Pharmacology Infectious Diseases
hypomagnesemia due to increased tubular permeability.
Therefore, *Serum K & Mg levels* should be monitored.
The most dangerous adverse effect of Amhoteracin B is
Renal, Urinary Systems & Nephrotoxicity which can be called *Renal Tubular Dysfunction*
275 Pharmacology
Electrolytes [pt presents with ECG finding of frequent premature ventricular
beats, a finding due to kidney damage induced hypokalemia]
Fungus with mutations in genes coding for Cellwall enzyme would
277 Pharmacology Infectious Diseases be resistant to *Capsofungin*, an antifungal that targets cellwall
glucansynthesis.
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*
279 PathophysiologyGastrointestinal & Nutrition Zenker Diverticulum is due to *Cricopharyngeal motor dysfunction*
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]
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
284 Pathology 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]
Erosions are defined as mucosal defects that do not fully extend
thru the *Muscularis Mucosa*
A peptic ulcer localized PROXimally on the lesser curvature
292 Anatomy Gastrointestinal & Nutrition probably penetrated the *Left gastric Artery* which is a branch of
the celiac trunk.
Pts with Lymphocytes with mutated Fas gene product (i.e Fas
receptor) would have an impaired *Activation-Induced T
Lymhocyte Death*
Rheumatology/Orthopedics
298 Immunology
& Sports
Fas ligand that binds to Fas receptor on t cells activates Fas assoc
death domian (FADD) which activates caspases leading to
Apoptosis.
FemaleReproductive Progestron withdrawal leads to menses (i.e bleeding) which is a
299 Physiology
System & Breast result of *Apoptosis*
Laparotomy shows decreased angle between superior mesenteric
artery and aorta. The structure most likley obstructed is
*Transverse portion of duodenum*
[Superior mesenteric artery syndrome]
Pt with paraital cell hyperplasia (Zollinger-Ellison) causing visible
304 Pathology Gastrointestinal & Nutrition enlargement of gastric folds. The stimuli that caused this probably
*Gastrin*
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.

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*
Symptoms of recurrent vertigo together with unilateral hearing loss
308 PathophysiologyEar, Nose & Throat (ENT) is characteristic of Meniere's disease which there is *Increased
pressure and volume of endolymph*
Pt with Imperforate Ausu often have *Urinary tract Abnormalities*
320 Embryology Gastrointestinal & Nutrition
accompanying the condition.
321 Embryology Gastrointestinal & Nutrition Meckels diverticulum is an example of ECTOPY.
326 Pathology Gastrointestinal & Nutrition Celiac disease is diagnosed with *Small intestine Biopsy*
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*
If neural crest migation to the intestine is interrupted by the final
week (12 week) of migration, The *Rectum* would be affected.
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
FemaleReproductive
333 Pathology palpitation. Pt's condition most likely involves *Ectopic Endometrial
System & Breast
Tissue*
[Endometriosis][Adhesions interfere with
ovulation=infetolity][imaplantsandadhesionsinvolvinguterosacral
ligament result in retroverted uterus, ligament]
Pregnant pt on anti-convulsants who presents with
Pregnancy, Childbirth & polyhydroamnios, fetus probably has *Anencephaly* due to
337 Embryology
Puerperium antiepileptic medication whic is a risk factor for neural tube
defects.
Pt with recurrent nonpitting edema of hands, raynaud phen, and
340 Pathology retrosternal burning has CREST syndrome which would find
& Sports
*Anti-centromere* Antobodoes.
Backpain that is constant (i.e not relieved by rest or positional
341 Pathology Hematology & Oncology changes) and that is worst at night is suggestive of *Neoplasm* as
in spinal metastasis.
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
347 Pathology Nervous System fontanlle. Bilateral retinal hemorrhages are seen on funduscopic
exam. You should suspect *Abusive heard trauma*
[Shaken baby sybcrome]
Elderly pt with insomnia should be given *Ramelteon* which is a
348 Pharmacology Nervous System melatonin agonist. It is safe and effective. Avoid bezos,
antihistaminesandsedatingantidepressants
Benzo for insomnia with a lower rsik of tolerance and dependence
is*Zolpidem*
First line therapy for pyschomotor agitation in Alcohol withdrawal is
Psychiatric/Behavioral &
350 Pharmacology *Chlordiazepoxide*
Substance Abuse
[Long acting benzo]
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.
Do not use DIazepam with CNS depressants such as
*Chlorpheniramine* which is a 1st gen anti-histamine.
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)
Acute and painless monocular vision loss is characteristic of
360 PathophysiologyOphthalmology *Central retinal artery occlusion* Fundoscopic findings include a
pale retina with a "Cherry-Red Macula".
Rheumatology/Orthopedics SnRNA has the function of *removal of introns from RNA
361 Biochemistry
& Sports transcripts*
*Absent Liver Conjugation enzymes* as seen in Criggler-najjar
363 PathophysiologyGastrointestinal & Nutrition syndrome type 1 (UGT enzyme def) can cause Neurlogic
abnormalities due to accumulation of unconjugated billirubin.
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]
*Hep B* infection causes hepatocellular cytoplasm to to fill wih
surface hep b antigen. The inclusions are (finely
367 Histology Gastrointestinal & Nutrition
granular,homogenous, pale pink), dull eosnophilic,ground glass
apearance. Commonly transmitted sexually or in "IV drug users"
Pt dies from profuse upper gastrointestinal hemorrhage and gross
examination of liver is shown after autopsy. This resulted from
368 Pathology Gastrointestinal & Nutrition *Fibrosis and Nodular parenchymal regenration* of the liver. Pt
probably died from Liver Cirhosis that led to portal HTN and
eventualGIhemorrhage.
Pt who presents with nausea, fatigue, anorexia who recently had
surgery. Pt is weak and incteric and later dies. Liver biopsy shows
369 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*
Alcohol induced hepatic steatosis is due to *Decreased Free fatty
acidOxidation*
Imigrant pt who is otherwise healthy and labfinding yiled Positive
Anti-Hepatiitis A IgG. He was never vaccinated against hep A.
373 Immunology Gastrointestinal & Nutrition
Thi slab finidng suggest him having an *Anicteric viral infection as
a toddler*
Pt has fever and joint pain. He has abnormal lynphocytes on blood
smear. Condition is caused by an enveloped virus containing
376 Microbiology Infectious Diseases 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*
Presence of HBeAg (marker for viral replication and increased
378 Immunology Infectious Diseases infectivity) in pregnant women with hep B infection increases the
risk of vertical transmision to child.
If HBeAg persists for several months and host ant-HBeAg remain
379 Immunology Infectious Diseases at low or undetectable levels, suspect *Chronic Hep B with high
infectivity*
Pt with colon cancer who has Nephrotic Syndrome
(edema+proteinurea)with biopsyshowingglomerular cappillarywall
382 Pathology thickening without increase in cellularity. When sample is stained
Electrolytes
with silver, irregular spikes from the GBM are seen. Pt has
*MembranousGlomerulopathy*
Child with signs of nephrotic syndrome. Pathologic change that
385 Pathology causes protein loss is *Glomerular podocyte damage*
Electrolytes
[Effacement of podyctes im Minimal Change Disease]
The most common outcome in HBV-Infected adults is acute
390 Pathology Infectious Diseases hepatitis with mild or subclinical symptoms that eventually
*completely resolve*
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
391 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]
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]
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
397 Pathology Nervous System 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]
*Primary Biliary Cirrhosis is a chronic liver disease characterized
by autoimmune destruction of the intrahepatic bile ducts and
401 Pathology 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.
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*
Liver biospy showing extensive lymphocyte infiltration and
granulamatous destruction of interlobular bile ductis. Biopsy was
403 Pathology 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}
Pt with abdominal pain, diarhea and heme-positive stools. Stool
405 Pathology Gastrointestinal & Nutrition cultures are negative. Biopsy of colonic mucosa reveals
non-caseating granuloma. Pt most likely has *Crohn's Disease*
inflamed and swollen terminal ilieum is probably crohns disease in
which there is involvement of TH1 helper t cells.
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]
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]
A differenc bewteen sporadic colorectal carcinoma and
411 Pathology Gastrointestinal & Nutrition colitis-associated carcinoma is that colitis associated carcinoma is
*Multifical in Nature*
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*.
A patent processus vaginalis causes a communicating hydrocele.
419 Embryology MaleReproductiveSystem
It can also cause an *Indirect Inguinal Hernia*
In the Adenoma-to-Carcinoma sequence in colon cancer, The
increase in the size if the polyps that mediates the late adenoma
421 Pathology Gastrointestinal & Nutrition part of thes sequence is a result of mutation of *K-ras*
protooncogene.
[APC > K-ras > p53]
55 year caucasian male is found on colonoscopy to have a solitary
mass in his sigmoid colon. Biopsy shows colon cancer. The
423 Pathology Hematology & Oncology feature that carries the worst prognosis is *Tumor Penetration into
the Muscularis Propria*
(Tumor staging, more imp than grade)
Pt with skin flushing, diarhea and cramping. P.E shows purple
vascular lesions surrounding her nose (Telangiectasias). Urinary
425 PathophysiologyHematology & Oncology excretion of 5-HIAA is increased over 24 hrs. Imagings shows
tumor in small intestine. Most likely resposnible for condition is
*Metastatic Carcinoid*
426 Pathology Gastrointestinal & Nutrition The initiating factor in acute appendicitis is *Lumen Obstruction*
A pathologic finding in a polp that is associated with greatest risk
427 Pathology Gastrointestinal & Nutrition of malignant transformation includes a *2-cm villous adenomatous
polyp*
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)
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]
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
434 Pathology 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))
A pancreatic psuedocyst is lined by *Fibrous and Granulation
Tissue*
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
436 Pathology 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.]
The ventral pancreatic primordium gives rise to the *Main
ppancreatic duct*
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]
Acute pancreatitis is nitiated by the inappropriate activation of
*Trypsinogen*
An athersclerotic plaque is likely t occur at the *ABDOMINAL
AORTA*
In the pathogenesis of athersclerotic plaques, release of
platelet-derived growth factor (PDGF) by locally adherent
*PLATELETS*, endothelial cells, and macrophages promotes the
446 PathophysiologyCardiovascular System 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
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.
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]
The morphologic changes observed in the arteries of a pt with
Giant cell arteritis are most similar to *Takasu Arteritis*
Old Pt with severe drug resistant HTN who dies and autopsy shows
shrunken right kidney probably has unilateral renal artey stenosis
453 Pathology Cardiovascular System due to atheromatous plaque at origin of renal artery. Stenosis
eventually leads to renal atrophy due to *O2 and nutrient
deprivation*
Adrenal Tumor that is functionally similar to the outermost layer of
the adrenal cortex (Glomerulosa) would have primary
454 Pathophysiology hyperaldostrnism due to Aldostrone-producing Adenoma (Conn
Metabolism
Syndrome)and would therefore have *Sweating & Tremulousness*
as an added symptom.
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
456 Physiology Cardiovascular System Stiffening*
[Isolated systolic HTN, Aortic stiffening decreases comppliance of
aorta and elevates pressure during systole]
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
457 Pathology 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]
Skin biopsy from thigh of a child shows vascular lesions with IgA
and C3 deposition. The most likely clinical presentation is *Skin
458 Pathology Allergy & Immunology
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
459 Pathology Allergy & Immunology
likely assoc with antibodies against *Neutrophils*
[Wegner's Granulamatosis with polyangiitis, Cytoplasmic staining
Antinuetrohil cytoplasm antibodies (c-ANCA) is pathognomonic]
In Polyarteritis Nodosa. The arteries spared are usually the
*Pulmonary* Arteries.
Pt with persistent headache and pain in the jaw when chewing
Rheumatology/Orthopedics food. Artery biopsy shows multinuclear giant cells and internal
461 Pathology
& Sports elastuc membrane "fragmentation". Pt has Giant cell arteritis and
treatment reduces risk of *Ischemic optic Neuropathy*
Myxomatous degeneration with pooling of proteoglycans in the
462 Pathology Cardiovascular System media layer of arteries is associated with *Aortic Aneurysm*
[assoc w/ Marfan synd]
Baby with strawberry-type hemangiomas (bening vascular tumor)
in his buttocks. These *First Increase in size then Regress*
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*
467 Pathology Dermatology [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]
MRI of head of young t shows an angiomatous lesion involving the
cerebellum. There is also a cystic mass in the right kideny on
468 Pathology Nervous System
abdominal ultrasound. The differentail Dx must include
*Von-Hippel-Lindau disease*
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.
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
470 Pathology Cardiovascular System developing*Lymphangiosarcoma*
[Persistent lymphedema predisposes to lymphangiosarcoma, a
rare malignant neoplasm of endothelial lining of lymphatic
channels]`
A vascular tumor that is associated with Arsenic and
471 Pathology Cardiovascular System Polyvinylchloride. The tumor is also postive for CD31. This is
*LiverAngiosarcoma*
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*
472 Pathology Infectious Diseases
[Teriary Syphilus causing aortic aneyrysm, which beigns with vasa
vasorum endarteritis and obliteration resulting in inflam, ischemia
and weakening of adventitia.]
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]
*Type 2 Pneumocytes* have the ability to proliferate in response to
478 Histology Pulmonary & Critical Care
cell injury. They can regenerate!
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.
The resistance in the airways starts high from the begining and
jumps up more at medium sized bronchioles due to highly turbulent
481 Physiology Pulmonary & Critical Care flow. The resistance then decreases going towards subsequent
generations till reaching the terminal bronchioles due increased
surface area allowing low resistance laminar flow.
The *True vocal cords* have stratified squamous epithelium. These
483 Histology Infectious Diseases can be affected by HPV which is a DNA virus casuing warty
growth (papillomas) on the true vocal cords.
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*
485 Pathology Pulmonary & Critical Care
[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
486 Pathology Pulmonary & Critical Care 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]
488 Histology Pulmonary & Critical Care smoking induced emphysema is contributed to by neutrophils.
Light microscopy of bran tissue that shows neurons with shrunken
492 Pathology Nervous System nuclei, no detectable nissle substance and intensely eosinophilic
cytoplasm. These findings indicate *Irreversible cell injury*
Cell body rounding, peripheral displacement of the nuclei and
494 Pathology Nervous System dispersion of Nissl substance to the periphery of the cells. These
findings described indicate *Axonal Reaction*
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*
Vitamine supplementation prevents neural tube defects in pregant
496 Embryology Nervous System women. For exampel those defects involving the pos neural folds
such as meningocele and meningomyelocele.
Sudden onset severe headache with no other abnormalities with
497 Pathology Nervous System subarachnoid hemorhhage on ct is likey caused by a *Saccular
Anyeurysm*
Elderly with Lobar Hemorrhage in occipital and parietal areas with
499 Pathology Nervous System history of frontal lobe hemorrhage. Probably he has *Cerebral
AmyloidAngioplasty*
Acetylcholinestrase in the amniotic fluid indicates a neural tube
502 Embryology Nervous System
defect in which there is a *Failure of Fusion*
Youn woman who presents with episodic headaches, dizziness
and gait disturbance. MRI of brain shows low lying cerebellar
504 Pathology Nervous System tonisls extending into vertebral canal. Cause of this is a
*CongenitalMalformation*
(Chiari type 1)
Pt involved in motor vehicle accident who sustains fracture of
temporal bone. Bloody most likely accumulates between *Bone and
Dura Mater*
[Epidural Hematoma]
Pregnancy, Childbirth & Valproate increases risk of neural tube defects in pregnant women
507 Pharmacology
Puerperium such as *Meningocele*
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*
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
513 Anatomy Nervous System 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.
Psychiatric/Behavioral & Drug interactions with lithium include Thiazide diuretics. Symptoms
519 Pharmacology
Substance Abuse of toxicity include resting tremor, balance issues (ataxia).
Pt has been receiving treatment for mood swings and sleep
problems. Now the pt has constipation, dry skin, and hair loss.
Behavioral Psychiatric/Behavioral & Also she has weight gain despite regular diet. BP is 110/70. Pt
520
science Substance Abuse appears tired but exam is otherwise normal. Most likely responsible
drug is *Lithium*
[Hypothyroidism due to lithium used in bipolar disorder]
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*
Young pt with paroxysmal episdoes of breathlessness and
wheezing unrelated to anything. Sputum microscopy shows many
granule containing cells and crystalloid masses. The sputum
527 PathophysiologyPulmonary & Critical Care 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 PathophysiologyPulmonary & Critical Care Hypocapniaimplies*alveolahyperventilation*
t dies from pulmonary infection. Autopsy shows a right lower lung
lobe that is pale, firm and airless. Histologically, the alveoli are
531 Pathology Pulmonary & Critical Care filled with "exudate containing neutrophils, fibrin, and some
fragmented RBC's". This pt died during the *Grat Hepatization*
phase of his disease.
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]
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)]
Dust particles smaller than 2 micrometres are eliminated by
536 Physiology Pulmonary & Critical Care
macrophagesthroughphagocytosis.
Male Infant with eczema, recuurent infections and
thrombocytopenia has *Wiskot-Aldrich Syndrome*
537 Immunology Hematology & Oncology
[X-linked][Combined B and T cell disorder][Tx with Bone marrow
transplant]
2 year old with recurrent skin and mucosal infections. Skin
infection drainage grows Staph aureus with no purulence. Lab test
538 Immunology reveals absent CD18 antigens on leukocytes. Pt is at greatest risk
& Sports
for *Persistent Leukocytosis*
(Leukocyte Adhesion Deficiency type 1)
Pt with absent thymic shadow and narrowing of aortic arch on xray
543 Embryology probably has DiFeorge syndrome and lacks a thymus due to
Metabolism
failure of *Third pharyngeal Pouch* to develop.
ErthroblastosisFetalis(Jaundice,hepatosplenomegaly,edema,
545 Immunology Hematology & Oncology low Hb, nucleated erythrocytes, extramedullary hematopoiesis) is
caused by *RBC opsonization by maternal antibodies*
Endocrine, Diabetes & Glucucorticoids such as Prednisone cause Increased LIVER
548 Pharmacology
Metabolism gluconeogenesis, therby activation *LIVER Protien Synthesis*
Endocrine, Diabetes & High-dose Prednison (Corticosteroid) would elevate *Neutrophil*
549 Pharmacology
Metabolism levels.
Endocrine, Diabetes & *Cortisol* has the greatest effect on lecithin to sphingmyelin ratio
550 Embryology
Metabolism (greater than 1.9 indicates mature lung)
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
554 Pathology Pulmonary & Critical Care 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 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
556 Immunology Allergy & Immunology
*HISTAMINE*, heparin, leukotrienes, and prostaglandins that are
responisble for the increased vascular permeability leading to the
presentation.
During the process of T-lymphocyte maturation, T cell receptors of
many lymphocytes demonstrate a very high-affinity interaction with
558 Immunology Hematology & Oncology MHC molecules expressed on thymic medullary epithelial and
dendritic cells. At this time, lymphocyte undergo *Negative
Selection*
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
560 Immunology Infectious Diseases 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]
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]
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
566 Anatomy Nervous System
brachial plexus. Horner syndrome (ipsilateral partial ptosos, miosis,
anhydrosis) can occur due to invlove of cervical sympathetic
*Autnomic Ganglia*
Hyperacute renal transplant recjection is an *Antibody-mediated
569 Immunology hypersensitivity*
Electrolytes
(preformed Ab's against graft)
Following amitriptyline overdose (TCA). There is QRS widening
and QTc prolongation. And Death occurs. Deat is related to
574 *Sodium Chanel inhibition*
[Fast Na chanel inhibition resulting in conduction defects and
arrythmias]
Pt with Klinefelters have azospermia. That mean sperm count is
582 Pathophysiology *None*
Metabolism
Ofcourse together with low LH, FSH and Testestrone.
Endocrine, Diabetes & Anastrozole is used to treat estrogen receptor positive breast
584 Pharmacology
Metabolism tumors. It *Decreases Androgen Aromatization*
Pt with a pianful rash involving groin and perineum, DM and exam
that shows coalescing erythematous lesions with crushing and
585 Pathology scaling and central areas of bronze-colored induration and biopsy
Metabolism
of lesions shows superifical necrosis has a GLUCAGONOMA, He
shouldhave*ElevetaedGlucagonLevels*
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
589 Immunology 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)
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*
591 Genetics Nervous System [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.]
In alzheimer's disease, there is *Decreased acetycholine activity
in the nucelus basalis*
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.
Wernicke syndrome manifests with opthalmoplegia, ataxia, &
confusion. There is foci of hemorrhage and necrosis in the
598 Biochemistry Nervous System "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.
Pt with diabetic ketoacidosis is treated with regular insulin that has
600 Pharmacology no aminoacid modification Regular insulin which has a short half
Metabolism
life ,longer than lispro however.
Pituitary resection decreases ACTH which decreases Cortisol,
decrease in cortisol decreases expression of
602 Biochemistry *PHENYLETHANOL-N-METHYLTRANSFERASE* which the
Metabolism
enzyme that converts Norepi into Epi. Therefore, putituwary
resection leads to decreased EPI production.
You should monitor *BUN & Creatinine* when admistring
604 Pharmacology Canagliflozin which is a SGLT2 inhibitor that decreases renal
Metabolism
abasorption of glucose used in type 2 diabetes
Pioglitazone which is Thiazolidinedione antidiabetic dryg targets
605 Pharmacology *intracellular nucelar receptor*
Metabolism
[Binds peroxisome proliferator activated receptor gamma]
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
606 Pharmacology Ca channel opening. The increased Ca2+ influx stimulates beta
Metabolism
cells insulin release. They therefore, *Target membrane ion
channels*
Check Table
Adminstration of Metyrapone will cause a decrease in cortisol
synthesis via inhibition of 11-beta-hydroxylase. In pts with an intact
608 Pathophysiology hypothalamic pituitary axis, this will cause a reactive increase in
Metabolism
ACTH, 11-Deoxycortisol, and "urinary 17-hydroxycorticosteroid
levels"
Endocrine, Diabetes & 11-hydroxylase deficiency in congenitl adrenal hyperplasia causes
611 Pathophysiology
Metabolism high PB and Hirstutism (Big clit)
Child who presents with headaches and gait instability. MRI shows
tumor in the cerebellum wtih both cystic and solid components
615 Pathology Hematology & Oncology
(white and dark). Most likely Dx is *Pilocytic Astrocytoma*
(Medulloblastoma is only solid, ie dark)
Pt with signs of Hyperthryroidism with eye involvement (bilateral
redness,proptosis(exopthalmos))wasgivenmedicationthat
622 Pharmacology reduced her proptosis. The drug did that by affecting
Metabolism
*Inflammatory infiltration*
[Glucorticoids to treat exopthalmos in Grave disease pts]
Peritibial myxedema and exopthalmos are specific features of
623 Pathophysiology hyperthyroidsim due to Grave's disease. Peritibial myxedema is
Metabolism
*Lower Leg Skin thickening and induration*
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
624 Pathology MaleReproductiveSystem
elevation of serum *hCG*
[Testicular malignancy releases hCG which has a similar structure
to TSH and can bind and activate thyroid to produce
ParaneoplasticHyperthyroidism.]
Endocrine, Diabetes & *TSH levels* should be monitored in pts receiving Amiodorone
625 Pharmacology
Metabolism therapy!
Endocrine, Diabetes & Methimazole inhibits *Coupling of iodotyrosines* in the thyroid
626 Pharmacology
Metabolism gland.
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*
636 Pathology Nervous System Friedreich ataxia is associated with *Cardiomyopathy*
Rheumatology/Orthopedics The marker that reflects the activity of osteoblasts is *Serum Level
638 Physiology
& Sports of bone-specific Alkaline Phosphatase*
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
639 Physiology
& Sports is essential for the differentiation of these cells is *Receptor
Activator of Nuclear factor Kappa-B ligand (RANK-L)*
(Pagets disease of bone, Osteoclasts)
Coagulase-negative streptococci such as staph epi are methicilin
645 Microbiology Cardiovascular System
reistant and should be treated with *Vancomysin*
*Staph Aureus* is the most commin cause of Acute Hematogenous
Rheumatology/Orthopedics osteomeylitis in children (10 year old for eg) characterized by pain
646 Microbiology
& Sports over long bones (tibia, femur)with high fever and chills. Possible
soft tissue swelling. Vague symptoms.
Lung cancer irritating the phrenic nerve can cause dyspnea,
647 Pathology Nervous System hiccups and referred ppain to shoulder. Phrenic Neve arise from
*C3-C4*
Pt with shoulder pain (pain under scapula and in right arm). Pain
is associ with numbness on his right forearm and tips of fingers.
648 Pathology Pulmonary & Critical Care He has Hemoptysis. He smoked 2 packs/day for 40 years. Most
likey cause is *Superior Sulcus Tumor*
(Pancoast Tumor)
Histopathology reveals lung tumor cells with numerous, long
649 Pathology Pulmonary & Critical Care slender microvilli and abudnant tonofilaments. This is
*MESOTHELIOMA*
651 Pathology Infectious Diseases Tertiary Syphilus genital lesions are called *Gummas*
Renal, Urinary Systems & urine discharge from the umbilicus is caused by a persistent
652 Embryology
Electrolytes allantois remnant.
A laterally directed chest wall stab wound at the fifth intercostal
654 Anatomy Cardiovascular System space along the midclavicular line. The structure injured would be
the *Left Lung*
Endocrine, Diabetes & Oral conraceptives decrease hirsutism by suppressing LH
656 Pathophysiology
Metabolism secretion and thereby *Decreasing ovarian androgen production*
Pt with difficulty urinating and dribbling affecting quality of life
probably has BPH, treatment with Finasteride can cause releif but
658 Pharmacology also cause increase hair growth over scalp. That's becuse
Metabolism
Finasteride is a *5-alpha-reductase inhibitor*. This is the enzyme
that converts testestrone into its active metaboloite DHT.
Inahled anesthetic with a vey large atriovenous conc gradient
shortly after begining inhalation would have a *Slow Onset of
660 Pharmacology Nervous System Action*
(high atriovenous conc gradient means increased peripheral tissue
solubility which negatively affects brain saturation)
Only *Leucotrienes* and acetycholine produce asthma that is
661 PathophysiologyPulmonary & Critical Care
relieved by pharmacologic antagonists.
Male comes for infertility evaluation. Semen analysis shows normal
sperm count but completely immobile sperm due to abnormal tail
664 Pathology MaleReproductiveSystem function. The finding most likely associated with this condition is
*Persistent bronchial dilation*
[Primary cilary dyskinesia, auto recessive]
Pt presents with recurrent transient pulmonary infiltrates. She has
a history of bronchial asthma. He takes albuterol and inhaled
665 Microbiology Pulmonary & Critical Care glucocorticoids. CBC shows Eosinophilia. Chest CT shows
proximal bronchiectsais. This pt has colonization of *Aspergilus
Fumigatus*
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
667 Pathology
& Sports to involvement of the epineural vessels of peripheral nerve is
common. The finidning of antibodies against neutrophil
myeloperoxidase is also common.
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*
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]
4 year old Pt with ataxia, repeated respiratory infections, and
673 Immunology Nervous System cultured cells that show high rate of genetic mutations probably
has Ataxia-telangiectasia and has *Cerebellar Atrophy*
Pt with a lesion involving teh corticospinal tract would have an
674 Pathology Nervous System additional finidng of *Hyperactive deep tendon reflex*
(Hyperreflexia in UMN signs)
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
676 Immunology Infectious Diseases activates many *T Cells & Macrophages*
leading to production of cytokins that cause capillary leakage,
circulatory collapse, hypotension, fever, shock, and multiorgan
failure.
Youn woman with UTI. Sexually active. Culture shows catalase
678 Microbiology Infectious Diseases +ve, g+ve cocci. Organism responsible is *Novobiocin resistant*
[Staph Saprophyticus UTI]
Staph epi is differentiated from staph aureus by the coagulase
test. Staph epi is coagulase negative while staph aureus is positive.
Infant with diffuse skin erythema, and epidemris comes off easily
with gentle pressure. This is caused by *Exotoxin-mediated skin
680 Microbiology Dermatology
damage*
(SSSS by staph exofoliatin exotoxin)
Pt with dyspnea, orthopnea, elevated JVP, lower extrem edema,
Renal, Urinary Systems & and lung crackles have acute decomensated heart failure and
681 Pharmacology
Electrolytes should be treated with IV loop diuretics. Which work on *Thick
ascending limb of loop of henle*
685 Pharmacology Loop diuretics such as *Furosemide* can cause Ototoxicity.
Electrolytes
*FENOLDOPAM* is a selective D1 agonist that is used in
hypertesnive emergencies.
Rheumatology/Orthopedics Bisphosphanates (e,g alendronate) have similar structure to
699 Pharmacology
& Sports *Pyrophosphate*
Husband short with a large head and prominent forehead. Wife is
normal. They are concerned about unborn child's height. Best
Miscellaneous
701 Genetics response is *Rsik of short stature in child is 50%*
(Multisystem)
(Achondrolasia is autosomal dominant, father must heterozygous
(otherwise be dead), mom is unaffected therefore 50%)
Pt with blue sclera and easily fractured bones probably has
Rheumatology/Orthopedics osteogenesis imperfecta due to defect in type 1 collagen which is
702 Pathology
& Sports the primary collagen in bone. Therefore, the primary impairement
is *Bone Matrix Formation*
Psychiatric/Behavioral & A side effect of Buprion (Norepi and Dop reup inhib) (used in
704 Pharmacology
Substance Abuse depression, no sex probs or weight gain) is Seizures.
Pt on depression medication that is casuing him sexual
706 Pharmacology dysfunction (SSRI's) can be switched to BUPROPION which
Substance Abuse
doesnt cause sexual dysfunction.
Pt with painful erection for more than 4 hours. Past med history is
Behavioral Psychiatric/Behavioral & sig for treatment-resistent depression, OCD, and insomnia. Drug
707
science Substance Abuse most likley used is *Trazadone*
[Priapism, rare side effect of trazadone]
Neoborn with no postnatal care or medication. He has Cystic
Fibrosis. He develops Intracranial Hemorrhage. Cause is *Impared
710 Pathology Hematology & Oncology gammacarboxylation*
(Neonatal Vit K deficiency)
(CF more suscepptible due to fat (ADEK) malabsorption)
711 Pharmacology Cardiovascular System Tx with statins causes increased *LDL receptor density*
Elderely pt that comes with sudden-onset right arm weakness and
difficulty speaking that resolve within 20 minutes, and who also has
713 Pharmacology Cardiovascular System 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*
Rheumatology/Orthopedics *Methotrexate* which is used in RA can cause GI ulcers such as
718 Pharmacology
& Sports "painful mouth ulcers*. It also causes Liver Tox (high liver enzymes)
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
720 Pharmacology 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.
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
721 Pathology
& Sports with his right lower extremity. Scintigraphy is most likely to reveal
increased focal radiotracer uptake in the *Long Bone Metaphysis*
[Hematogenous Osteomyelitis]
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.
Early penicilin Tx of Group A strep pharyngitis is important 4
prevention of Acute Rheumatic Fever which a major cause of CVS
Biostatistics & death in many developing nations. ARF affect mainly heart and
726 Pharmacology
Epidemiology 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!!
*Intravascular devices* contriubute to increase in staph bactremia
thru the nation
Virulence factor of Strep Pneumoo (g+ve diplococci, alpha
hemolytic) is *Polysaccharide Capsule*
G+ve lancet shaped cocci in pairs is Strep Pneumo which is *Bile
Soluble*
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
732 Microbiology Hematology & Oncology Bacterial Clearance*
[Pt most likely had part his spleen removed after accident and
became suscptible to encapsulated bacteria due to inability to
clear them]
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]
Adult pt with signs of meningitis. CSF analysis shows elevated
opening pressure, increased neutrophils (10%), decreased
735 Microbiology Nervous System 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*
Pt with CSF sample with bean-shaped g-ve cocci in pairs probably
has Neisseria Meningitidis which reaches the meninges via
737 Microbiology Nervous System *Pharynx--> blood---> choroid plexus-->Meninges*
This means that neisseria meningitidis is transmitted via respiratory
droplets.
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]
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
741 Immunology
& Sports vessels. The finding most likely to accompany this condition is
*Decreased Serum C3 level*
(Serum Sickness, Type 3 (immune-complex) hypersensitivity)
Female Pt with glomerulinephritis, photosensitive skin rash and
arthralgias together witha positive trepnemal RPR but with -ve
742 Immunology T.pallidum enzyme ummunoassay and also prolonged aPTT
Electrolytes
probably has SLE with Antiphospholiid antibody syndrome and is
therefor at risk of *Recurrent Miscarriages*
The classic triad of Urethritis, Conjunctivitis, and Mono- or
Oligoarticular arthritis indicates "Reactive Arthritis" which is a
seronegative (RF -ve) spondyloarthropathy (HLA-B27). Symptoms
743 Immunology Allergy & Immunology 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)
745 Immunology Gastrointestinal & Nutrition NK cells kill cells that do not express MHC class 1 antigen.
Pt who received emergency blood transfusion who quickly
develops dyspnea, chills, chest/back pain, and hemoglobinurea
747 Immunology probably has acute hemolytic transfusion reaction. This is a type 2
Electrolytes
hypersensity and therefore can be due to *Complement mediated
cell lysis*
Renal, Urinary Systems & When it comes to handling parasites, eosinophile do it via the
750 Immunology
Electrolytes *Antigen-Dependent-Cell-Mediated Cytotoxicity (ADCC)*
A substance that is secreted by the vascular endothelium and
inhibits platelet aggregation is *Prostacyclin*
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
753 Pathophysiology a positive HLA-B27 antigen. X-ray shows fusion of sacroiliac
& Sports
joints. Most helpful in monitoring progression of pt's disease is
*ChestExpansion*
[Ankylosing Spondylitis]
Pt with sign of RA. Pt serum most likely has IgM antibodies that
754 Immunology react with *Fc portion of Human IgG*
& Sports
(Rheumatoid Factor)
Rheumatology/Orthopedics Both the thymus and *Inferior parathyroid* originate from the 3rd
756 Embryology
& Sports pharyngeal pouch.
759 Immunology IL-4 & 5 are respnsible for antibody class switching.
& Sports
23 yr old Female with migratory arthritis and skin rash exacerbated
by skin exposure. Urinalysis shows moderate proteinuria and RBC
761 PathophysiologyAllergy & Immunology casts. Serum Ab with specificity for this pts condition react with
*Double stranded DNA*
[SLE]
Pt wih T cells that lack IL-12 receptor would be unable to release
762 Immunology Pulmonary & Critical Care *IFN-Gamma* and supplementation would be needed to improve
pt's recurrent respiratory infections.
Pt with fatigue, bradycardia, weight gain, constipation, and
764 Pathophysiology delayed relaxation of deep tendon reflexes has Hypothyroidism,
Metabolism
the most sensitive marker for Dx is *Serum TSH*
Signs of fatigue, weight gain and lumps rising from surface of
Endocrine, Diabetes & skeletal muscle following percussion with reflex hammer
765 Pathophysiology
Metabolism (MYOEDEMA) combined with Elevated CK level indicate
HYPOTHYROID MYOPATHY and *TSH levels* should be checked.
Pt being scheduled to be treated for hyperthryoidism usning
Endocrine, Diabetes & radioactive iodine therapy. Pretreatment with *Potassium
766 Pathophysiology
Metabolism perchlorate* would decrease the effects of radiotherapy thru
competitive inhibition of iodine transport.
Pt with signs hyperthyroid symptoms together with painful thyroid
enlargememt. Thyroid scan reveals decrease in radioactive iodine
Endocrine, Diabetes & uptake. ESR is elevated. Biopsy of thyroid will most likely reveal
768 Pathology
Metabolism *Mixed, cellular infiltration with occasional multinucelated giant
cells*
[Sabacutegranulomatousthyroiditis]
Thyroid peroxidase enzyme is involved in *Thyroglobin Iodination*
770 Physiology also in oxidation of iodide, and coupling of 2 iodized tyrosine
Metabolism
residues.
An increase in estrogen activity leads to an increase in levels of
772 Pathophysiology thyroxine-binding globulin. This leads to an *Increased Total T4
Metabolism
pool*
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]
A pentapeptide with strong affinity to delta and mu receptors
produced after application of noxious stimuli. This substance most
775 Physiology Nervous System
likely has a common molecular origin with *ACTH*
(POMC us cleaved into beta endorphins, ACTH & MSH)
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*
776 Physiology Nervous System [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]
780 Pharmacology Cardiovascular System Before giving statins check *Liver transaminases*
Pt with reduced plasma lipoprotein activity. If condition is untreated
782 Pathology Cardiovascular System he may develop *Acute Pancreatitis*
(Familial chylomicronemia type1)
*The Hepatic Parenchymal Cells* secrete Hepcidin which is a
substance that controls the storage and release of iron through its
787 Physiology Hematology & Oncology binding to ferroportin. Once bound to ferroportin it inactivates it
thus prevents iron intestinal absorption into blood and also prevents
its release from macrophages.
Under normal cirumstances the Ras protein is activated only when
boud to *GTP*
Atrophy in Alzheimer's disease involves the *Hippocampus*
[Identify on MRI]
African american female with Dry cough, pulmonary infiltrates,
795 Pathology Pulmonary & Critical Care hilar adenopathy, biopsy shows Non-caseating granuloma ==>
*SARCOIDOSIS*
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
796 Immunology Pulmonary & Critical Care
test is negative. Bronchoscopy is arranged. The cell type that is
most likely to predominate in the lavage is *CD4+ cells*
(Sarcoidosis)
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.
In pts with Cystic Fibrosis, nasal muccosal basleine potential
difference is more negative becuase of Increased Sodium
804 PathophysiologyPulmonary & Critical Care reabsorption due to blocked Chloride channels due to CFTR
protein defect. Therefore the respiratory mucosa of the pt
demonstrates*Increasedsodiumreabsorption*
Pancreatic squamous metaplasia of the pancreas in a pt with CF
(recurrent pulmonary infections, finger clubbing)is due to
806 Pathology Pulmonary & Critical Care deficiency in *Vit A*
[vit A is needed for maintenance of orderly differentiation of
specialized epithelia]
Recurrent pneumonia, Azoospermia, Digital clubbing, No vas
807 Genetics MaleReproductiveSystem deferens are signs of Cystic Fibrosis. It can be diagnosed with
measuring *Chloride level in the sweat*
Pt with cystic fibrosis can be helped with *Pancreatic enzyme
808 Pharmacology Gastrointestinal & Nutrition
supplementation* to aid absorption.
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*
Pt with urgency, frquency, a weak urinary stream and straining on
micturition. He notes noturia, and Oliguri alternating with polyurea.
811 Pathology Pts kidneys most likely will demonstrate *Parenchymal pressure
Electrolytes
atrophy*
(BPH)
Stones in the ureter suggests calcium stones. The most common
Renal, Urinary Systems & risk factor for calcium stone is *Hypercalciurea* that is usually
813 Pathophysiology
Electrolytes idiopathic. Patients however have *Normocalcemia* due to Ca
regulation by vitD.
Renal, Urinary Systems & Pt with hexagonal crystals on urinalysis has cystinuria which
814 Pathology
Electrolytes *AMinoAcidUrea*
817 Pathophysiology *Increased citrate saturation* helps prevent claculi formation.
Electrolytes
An HIV drug that can cause Hyperglycemia is *Atazanavir*
819 Pharmacology Infectious Diseases {Protease Inhibitors cause hyperglycemia, lipodystrophy, and
dyslipidemia]
Rheumatology/Orthopedics Digital Clubbing can be caused by Lung Disease. E.g:
820 Pathology
& Sports Bronchiectasis
tan-Fat containing tissue found around the kidneys and adrenals of
821 Physiology a newborn is Brown Fat that helps to prevent *Hypothermia* by
Metabolism
producig heat.
In HBV caused hepatocellular carcinoma, the *Viral DNA
822 PathophysiologyInfectious Diseases
integration into Host Genome* us the cause of neoplastic change.
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.
Rheumatology/Orthopedics Lack of Tubules in muscle fibers will result in *Uncoordinated
824 Physiology
& Sports contraction of myofibrils*
Pt has had an aortic valve replacement. His peripheral bloods
829 Pathology Hematology & Oncology smear shows fragmented RBC's (Shistocytes or helmet cells) will
have *Decreased Serum Haptogloboin*
*vesicouretral urine reflux* predisposes a woman who had frequent
831 Pathophysiology bladder infections to pyelonephritis because the the vesicouretral
Electrolytes
junction is weakened.
Pt with multiple risk factors for athersclerosis including age, HTN,
Renal, Urinary Systems & hyperlipidemia and smoking. He presents with post prandial
832 Pathology
Electrolytes abdominal pain accompanied by weight loss. He has one large
kidney on CT. This characteristic of *Renal Artery Stenosis*
Acute onset Gross hamturia in an otherwise healthy pt with family
834 Pathology history of sickle cell disease suggests *Renal Papillary Necrosis*
Electrolytes
and an underlyin sicke cell trait.
836 Pharmacology Dermatology Terbinafine*inhibitssqualeneepooxidase*
Renal, Urinary Systems & The mcc of unilateral fetal hydronephrosis is inadequate
837 Embryology
Electrolytes canalization of *UretroPelvic Junction*
838 Anatomy Gastrointestinal & Nutrition Head and Body of Pancreas are Retroperitoneal.
Pelvic fracture in a male can result in urethral injury leading to
inability to void despite full bladder sensation. The most commonly
839 Anatomy MaleReproductiveSystem injured site is the *membraneous urthera* which is right after the
prostatic urethra. Both membranoeous and prostatic are part of the
post urethra.
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.
843 PathophysiologyCardiovascular System In CHF there is a compensatory *Increase in Arterial Resistance*
Rheumatology/Orthopedics rash with slapped cheek appearance is of Erythema infectiosum
845 Microbiology
& Sports caused by parvo virus B19, disease is also called Fifth disease.
Cells that express more glucose transporters as insulin levels
increase are *skeletal muscle cells* and adipocytes.
847 Biochemistry Cell that have constant glucose transporter expression even as
Metabolism
insulin level increases are *Renal tunular cells* also brain,
intestine, RBC, and Liver
Endocrine, Diabetes & Pt with Type 2 Diabetes. Most likely assoc with his condition is
848 Pathology
Metabolism *Pancreatic islet amyloid deposition*
The parameter that correlates to the potency of an inhaled
anesthetic is *Minimal Alveolar Concentration*
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*
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
855 Pharmacology Nervous System in skeletal Muscles*
(Pt has Malignant Hyperthermia, Treated with Dantrolene, a muscle
relaxant that acts on ryandoine receptor and prevents further
release of Ca)
The cause of rapid plasma decay of thiopental was not metabolism
856 Pharmacology Nervous System of the drug but rather *redistribution of the drug to other tissues*
throughout the body.
Colchicine has side effects of ABdominal pain, nausea and
859 Pharmacology diarhea. It binfs to tubulin and therefore affects the cell
& Sports
*Cytoskeleton*
Infant with white pupillary reflex and father has had a retinal
863 Pathology Ophthalmology neoplasm during childhood most likely has Familial Retinoblastoma.
He is at greastest risk for developing *Osteosarcoma*
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.
Child with High fever and seizures has febrile seizures and shud
866 Pharmacology Nervous System be given *Acetominophen* (Antipyretic, never give aspirin to a
child)
Pt with persistent shoulder and back pain and easy fatigability.
She has pain and stiffness in all her muscles.She has difficulty
867 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*
A new born baby has fetal HB prdominantly (alpha 2 gamma 2)
868 Biochemistry Hematology & Oncology which changes to adult Hb (alpha 2 Beta 2) within the next six
months.
Cervical Intraepithelial neoplasia can be caused by HPV infection
FemaleReproductive
869 Pathophysiology which can result from sexual infection due to *Lack of barrier
System & Breast
contraception*.
Ischemic injury to the brain results liquefactive necrosis in which
there *Lysosomal Digestion of (necrotic) Tissue*
Alcoholic with hypersegmented neutrophils in blood smear likely
has *Folate Def*
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]
Black woman Pt with malaise, cough and rash wityh X-ray
877 Pathology Pulmonary & Critical Care revealing bilateral hilar lymphadenopathy and transbronchial
autopsy showing non-caseating granuloma has *SARCOIDOSIS*
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
881 Pathology 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]
Majority of Down syndrome have trisomy 21 that happens as a
result of *Chromosomal nondisjunction* during the 1st meitic
882 Genetics Cardiovascular System division of the ovum. Incidence increases with maternal age. Only
about 4 percent of down syndroem is caused by Robertsonian
Translocation.
Renal, Urinary Systems & In acute Tubular necrosis. The most important complication during
886 Pathology
Electrolytes the Recovery Phase is *Hypokalemia*
Renal, Urinary Systems & Pt with UTI. Most specific finding for a Dx of Pyelonephritis is
888 Pathology
Electrolytes *White blood Cell casts*
Hemolytic anemia signs with blood smear showing spherocytes (no
889 Histology Hematology & Oncology cetral pallor) indicates spherocytosis which is *RBC cell
memberanecytoskeletonabnormality*
Pt with anemia, reticulocytosis and increased indirect bilirubin.
Blood smear shows RBC without central pallor. Pt is most likely to
890 PathophysiologyHematology & Oncology
have *Increased mean corpuscular Hb concentration*
{HereditarySpherocytosis]
Dapsone when used as prophylactic Tx for pneumocystis jiroveci
in the setting of allergy to TMP-SMX (Drug of choice)in HIV
893 Pharmacology Hematology & Oncology infected patients can trigger GDPD anemia, which is an *Ezyme
deficiency Anemia*. Symptoms include red cell fragments,
microspherocytes, and bite cells.
894 Pathology Hematology & Oncology 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
895 Pathology Hematology & Oncology splenomegaly. Most likely true abt this pt is that *She has relative
protection from Plasmodium Falciparum*
[Sickle cell trait]
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]
Pt with sign of abdominal pain, ascites, anemia, thombocytopenia,
hypercoagulability (e.g hepatic vein thrombosis) and a flow
897 PathophysiologyHematology & Oncology cytometry that shows CD55 & CD59 Deficiency has Paraoxysmal
nocturnal hemoglobinuria whcih results in a hemolytic anemia due
to*ComplementActivation*
Amiodarone (class 3 antarrythmic) tho it prolongs QT interval (like
other class 3's and 1A's) it does not increase risk of torsades.
An antiarrhythmic agent that binds perferentially to rapidly
depolarizing and ischemic ventricular myocardial fibers and has
900 Pharmacology Cardiovascular System minimal effect on normal ventricular myocardium is *Lidocaine*
It is effective in inhibiting ischemia-induced ventricular
arrhythmias.
Know that Dofetilide is a class 3 anti-arrhythmic medication (K
channel blocker)
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.
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
903 Pharmacology Pulmonary & Critical Care 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]
Pt with painless hematuria, right sided renal mass, cytoology of
Renal, Urinary Systems & malignant cells with chromosome 3p deletion. No significant family
904 Genetics
Electrolytes history. Findings indicate Sporadic Renal cell carcinoma which is
due to deletion of VHL gene on chromosome 3.
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.
Signs of encephalities (fever, headache, aphasia, mental
907 Microbiology Infectious Diseases alteration) with temporal lobe lesions indicate *HSV
ENCEPHALITIES*
Elderly woman with jaw pain during chewing (Jaw claudication),
Rheumatology/Orthopedics An episode of vision loss in one eye that resolved (amaurosis
914 Pathology
& Sports fugax). Best initial test is *Erythrocyte Sed Rate*
[Giant cell Arteritis][C-reactive protein is also indicated]
Rapid correction of Hyponatremia results in *Osmotic
Demyelination Syndrome*
A drug that activates peroxisome-proliferator activated receptor-y
920 Pharmacology (a nuclear receptor and transcription factor) (such drugs are the
Metabolism
-glitazones) results in *Decreased Insulin Resistance*
Endocrine, Diabetes & To diagnose Type diabetes melitus use *Fasting blood glucose
921 Pathophysiology
Metabolism level*, random glucose, or HbA1c.
A fetus born to a mother who had gestational diabetes would have
hypoglycemia due to *Beta cell hyperplasia*
922 Pathophysiology [Pancreas is used to a lot of glucose from mother. After delivery,
Metabolism
glucose suddenly stops but beta cells are still high in number and
secreting insulin, resulting in hypoglycemia]
Endocrine, Diabetes & Amenorhea in pt involved in strenous excersie and low body wieght
925 Pathophysiology
Metabolism is caused by *HYpothalamic Suppression*
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
928 Pathophysiology hyperglycemia. Evaluation of her adrenal galnds will most likely
Metabolism
show *Bilateral cortical atrophy*
[Iatrogenic cushing syndrome due to prolonged glucucorticoid
use, leads to supression of of hypothalamic oituitary axis]
Pt with HTN at young age together with weakness and paresthesias
(electrolye or acid-base disturbance) and low Renin levels is
929 Pathophysiology consisent with Primary Hyperaldostronism. His Serum level of *Na
Metabolism
is normal, K is low, HCO3 is High*
(Na is normal due to aldostrone escape)
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
930 Pathophysiology probably has Congenital Adrenal Hyperplasia - 21-hyrdoxylase
Metabolism
deficiency. There would be low cortisol, low aldo, high ACTH, and
*High 17-hydroxyprogestrone* which is a precuror to cortisol
synthesis.
Symptoms of Headache, tachycardia, diaphoresis and severe
Endocrine, Diabetes & HTN. THese resolve before Tx is given. Same thing happened a
933 Pathophysiology
Metabolism month ago. This is pheochromocytoma and there is *Elevated
catecholamine release*
Endocrine, Diabetes & Sorbitol produced by aldolase reductase is normally metabolized to
934 Biochemistry
Metabolism *Fructose*
Pt that is Dx with panic disorder and is given a drug that relieves
symptoms within an hour. Drug is prbably Benzodiazepine which
937 Pharmacology *Binds Allosterically to GABA receptor*
Substance Abuse
Barbiturates work on a different allosteric site and prolong duration
of channel opening in response to GABA.
Most common cause of aortic stenosis in the elderly is *Valvular
Calcification*
Presence of a holosystolic heart murmur indicates Mitral valve
Regurgitation. Its severity can be indicated by the presence of an
944 PathophysiologyCardiovascular System *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.
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]
A side of ACE inhibitors is cough and Angioedema (elnlarged lip)
tat is caused by *Bradykinin accumulation*
The most significant factor limiting coronary blood supply during
951 Physiology Cardiovascular System an exercise test is *Duration of Diastole*
(Myocardial Perfusion happens during Diastole)
CCR5 protien plays a role in HIV entry into CD4+ Cells. Blocking
of CCR5 receptor blocks entry of HIV into cells.
Pregnancy, Childbirth & Pt with Clitromegally and High Androgen levels with Maternal
955 Genetics
Puerperium Virilization probably has *Aromatase Deficiency*
Pt with Metablic Alkalosis (pH > 7.45 & pCO2 >24). Lab study most
Renal, Urinary Systems & useful in diagnosing pt is *Urine Chloride*
956 Pathophysiology
Electrolytes Note: Volume status and urine chloride are important in the workup
of metablic alkalosis.
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
961 Microbiology Pulmonary & Critical Care 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
964 Microbiology Pulmonary & Critical Care NAD+. Pathogenicity is related to *Capsule* Virulence factor
[H.INFLU type B (HiB)]
We conjugate the H. Influenza capsular polysaccharide together
965 Immunology Allergy & Immunology with diptheria toxoid in the vaccine because this combination
*IncreasesImmunogenicity*.
966 PathophysiologyNervous System In tetanus, release of *Glycine* neurotransmitter is inhibited.
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)
Pt with suspected tetanus who sustained a minor lower extremity
969 Pathology Nervous System wound 1 week ago should have *History and Physical exam* as
the most important in making a Dx.
Ulcer with central black eschar surrounded by edema suggest
Bacillus Anthracis. Helping in making a diagnosis would be
971 Microbiology Infectious Diseases *Occupation*
[exposure to animal or animal products, if no risk of occupational
exposure then there is potential of bioterrorism]
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
974 Microbiology
& Sports that prodcuces a pigment on culture medium. Most likely source of
this infection is *Pool water*
(Psuedomonas hot tub folliculitis)
V Cholera is oxidase positive, g-ve, commam shaped rod that can
976 Microbiology Gastrointestinal & Nutrition grow on alkaline media. Stool microscopy reveals *Mucous and
some sloughed epithelial cells* with No fecal leukocytes or RBC's.
Pt with lung mass and Hypercalcemia but with no bone focal lytic
978 Pathophysiology lesions probably has Malignancy-associated hypercalcemia that is
& Sports
characterized by elevated *Parathyroid hormone-related protein*
Pt with celiac disease will also develop vit D deficiency due to
defective mucosal absorption, presenting as bone pain and
981 Pathophysiology weakness (Adult). Lab test would reveal *low Ca, Low PO4-, High
Metabolism
PTH*
[No vit D decreases absorption of Ca AND PO4- from GI tract]
Rheumatology/Orthopedics In primary osteoporosis, serum Ca and PTH levels are typically
982 Pathophysiology
& Sports *Normal in range*
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
984 Pathology
& Sports expression of 1-alpha hydroxylase in activated macrophages which
causes PTH-independent production of 1,25-dihydroxyvitD leading
to increase intest abs of ca and hence hypercalcemia.
Endocrine, Diabetes & In DKA there is *Increased (or normal) extracell K & Decreased
985 Pathophysiology
Metabolism Intracell K**
Pt with elevated serum gastrin levels. Multi organ disease is
Endocrine, Diabetes & suspected. Pt should be asked for a history of *MEN type 1*
986 Pathology
Metabolism (MEN Type 1 has primary hyperparathyroidism, pituitary tumors,
and pacnreatic tumors (esp "Gastrinomas"))
Biopsy of a pt shows haphazardly oriented segments of lamellar
Rheumatology/Orthopedics bone with prominent cement lines. The pathogenesis of the
987 Physiology
& Sports condition initially involves increases activity of *Osteoclasts*
(Osteolytic phase of paget disease of bone)
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
990 Physiology then converted into 25-hydroxycholecalciferol by 25-hydroxylase.
Metabolism
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+
(-).
Pt with mild hypercalcemia, borderline high PTH levels and urinary
992 Physiology Ca that is very low and normal 25-hydroxyvit D pobably has a
Metabolism
mutation in *Membrane-bound receptor coupled with a G-protein*
After a ligand binds to a G protein-coupled receptor that activates
phopholipase C, membrane phospholipids are broken down to
995 Biochemistry GeneralPrinciples
DAG and IP3. *Protein Kinase C* is subsequently activated by
DAG and Ca.
If lactic acid is accumulatimg that means there is increased activity
996 Biochemistry GeneralPrinciples of Lactate dehydrogensae and DECREASED activity of *Pyruvate
Dehydrogensae*
Oxaloacetate-----> Phosphoenolpyruvate (catalyzed byPEP
997 Biochemistry carboxykinase) is the 2nd commited step in gluconeogenesis
Metabolism
which predominates in starvation states.
Pts with pyruvate dehydrogenase deficiency should be on a
998 Biochemistry ketogenic diet. Soley Ketogenic aminoacids include *lysine* and
Metabolism
leucine.
A newborn who develops lethargy and respiratory distress. Blood
cultures shows beta-hemolytic gram+ve cocci in chains that are
999 Microbiology Pulmonary & Critical Care bacitracin-resistant. The measure that could have prevented this
patients condition is *Intrapartum ampicilin*
[Strep Agalactiae, ie. Group B strep]
Bcteria that produce an enzyme (Aminoglycoside-modifying
1000 Pharmacology Infectious Diseases enzyme) transfer an acetyl group to exogenous substance can
gain resistanc to *Gentamicin*.
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
1003 Microbiology Cardiovascular System 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.
Management of household contacts of Meningococcl infection sis
*Prophylactic Rifampin*
Neisseria meningitidis uses pilus roteins to attach to *Nasopharynx
epithelial cells*
Pt with signs of meningitis and blood culture showing g-ve kidney
1006 Microbiology Nervous System bean-shaped diplococci, the microbial component causing
morbidity is *Outer membrane LipoOligosaccaride*
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*
Insuline resistance by the pancreatic cells i sstimulated by
increased ATP production. *Glucokinase* functions as a glucose
1010 Biochemistry sensor in pancreatic beta cells by controlling the rate of glucose
Metabolism
entry into the glycolytic pathway. Mutations in the *glucokinase*
gene are a cause of maturity-onset diabetes of the young.
The anthracyclines (daunorubicin, doxorubicin, epirubicin, and
idarubicin) are chemotherapeutic agents associated with severe
Cardiotoxiity thru generation of free radicals. They cause *Dilated
Cardiomyopathy*
Hypovolemia reduces RPF and hence *GFR*. This activates a
compensatory mechanism that systemical vasocnstricts leading to
Renal, Urinary Systems & further *reduction in RPF*. However, another reflux is increased
1016 Pathology
Electrolytes angiotensin 2 release due to decreased GFR that would
vasoconstrct efferent arteriole and help maintain GFR. As *RPF is
lower than GFR*. *FF Rises*.
1018 Physiology Gastrointestinal & Nutrition Lipid absorption occurs in the Jejunum.
Pt has absent lactate dehydrogenase activity in muscles. In this pt,
1019 Biochemistry strenuous exercise leads to inhibition of glycolysis in skeletal
Metabolism
muscles due to intracellular depletion of *NAD+*
Homeless pt with signs of wernicke encephalopathy after admin of
glucose without thiamine supplemenation would have an impaired
1021 Biochemistry *Alpha ketoglutarate to Succinly CoA reaction*
Metabolism
[Thiamine is needed for alpha ketogluyerate dehydrogenase][Also
needed for other dehydrogenases and transketolase]
Endocrine, Diabetes & A direct source of energy in the TCA cycle is in the conversion of
1022 Biochemistry
Metabolism succinylcoA into Succinate thus yeilding GTP.
Tx of Neisseria Gonorrhea does not appear to provide lasting
1026 Microbiology Infectious Diseases protective immunity due to *High variability of microbial antigenic
structure* and hence recurrent infections occur.
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
FemaleReproductive contributing factor to her inability to conceive is *Insufficient
1027 Microbiology
System & Breast 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]
The rate of glycogenolysis within myocytes increases several x100
1028 Biochemistry GeneralPrinciples during active skeletal muscle contraction. The substance that
synchronizes these two processes is *Ca2+*
Increasing fructose-2,6-bisphosphate promotes glycoloysis (insulin
Endocrine, Diabetes & like effect) and inhibits Gluconeogensis. Inhibiting
1031 Biochemistry
Metabolism Gluconeogenesis means less alanine and other glucuneogenic
substrates are converted to glucos.
During fasting, maintenance of pt blood glucise is facilitated by
hepatic conversion of pyruvate into glucose. The substance that is
1034 Biochemistry an allosteric activator of the first step of this process is
Metabolism
*Acetyl-CoA*
[Gluconeogenesis]
Synthesis of ribose from fructose-6phosphate can be done using
1035 Biochemistry Hematology & Oncology
*Transketolase*.
1036 Biochemistry Hematology & Oncology G6PDconvertsglucose-6-phosphateto6-phosphogluconate
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*
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)
In shingles, affected are would have *Multinucleated cells with
1042 Pathology Dermatology Intranuclear inclusions*
[VZV]
An unvaccinated infant is brought with a rash. Three days ago,
she developed fever, along with cough, congestion, and red eyes.
1045 Pathology Infectious Diseases 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]
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
Renal, Urinary Systems & Creatinine. 1+ protein and 3-4 WBC in urine. Renal ultra sound
1049 Pathology
Electrolytes 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]
Renal, Urinary Systems & Uric acid would percipitates in *Collecting duct and distal tubule
1050 Pathophysiology
Electrolytes due to low urine pH*
In klinefelters syndrome there is *Increased FSH* due to loss of
feedback Inhibition due to decrease in Inhibin levels (from sertoli
1055 Pathology MaleReproductiveSystem
cells. There is also decreased testestrone (damage to leydig cells)
that is from primary hypogonadism.
Asymptomatic pt's mamogram reveals microcalcifications. Biopsy
FemaleReproductive shows ducts distended by pleomorphic cells with prominent central
1057 Pathology
System & Breast necrosis. Origin of this lesion is the *Breast Duct*
[Ductal Ca in Situ]
Ascending paralysis after upper resp tract infection. Condition
1058 Pathology Nervous System most likely associated with *Endoneural inflammatory infiltration*
[GBS after C.jejuni infection]
Intracranial Hemorrhage and its associated signs without signs of
1062 Physiology Hematology & Oncology trauma in a newborn that didnt receive vaccines is most likely due
to *Impaired clotting facotor carboxylation* as in vit K deficiency.
Pt presents with myalgias, anorexia, and skin rash. He has been
consuming raw white eggs for several months. P.E shows macular
Endocrine, Diabetes & dermatitis of extremities. A water soluble vit def is suspected. The
1063 Biochemistry
Metabolism 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]
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).
1064 Biochemistry Dermatology
Niacin is obtained from diet or synthesized in body from
*Tryptophan*. Therefore, Tryptophan is the precursor for the
compensatory pathway for NAD synthesis.
Pt presents with progressve lethargy. For past 3 weeks she had
loss of appetite, constipation, muscle weakness, polyuria and
Endocrine, Diabetes & polydipsia. She has been taking large doses of vitamins. Exam
1065 Physiology
Metabolism shows she is stuporous and has dry mucus membranes. The
metabolic abnormality in this pt can also be found in *Sarcoidosis*
[Hypercalcemia]
The substance with the fastest rate of metablosim in the glycotic
pathwayis*Fructose-1-phosphate*
Pt with hereditary defect in fructose metabolism. He is
Endocrine, Diabetes & asymtomatic however. This pt is still able to metabolize fructose
1070 Biochemistry
Metabolism due to compensatory activity of *Hexokinase*
[Essential fructose uea]
Lactose intolerance is due to absence of enzyme lactase which
convertsGalactosyl-B-1,4-glucose(LACTOSE)intoGalactose.
1073 Biochemistry In Aldolase deficiency, remove *Sucrose* from Diet.
Metabolism
A medication that is a low molecular weight fraction of a negatively
charged chemical stored in mast cell granules. Its mechanism of
1077 Pharmacology Hematology & Oncology
action is *Binding to antithrombin 3*
[LMW Heparin]
A platelet surface glycoprotein receptor that normally binds
1079 Pharmacology Hematology & Oncology fibrinogen to support platelet agreggation is Gp2b/3a. This is
targeted by *Abciximab*
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]
Fibrinolytics are used in ST segment elevation MI. They may
1082 Physiology Hematology & Oncology cause reperfusion arrythmias on arterial re-opening. These are
usually benign. An example is *tPA* [Tissue plasminogen activator]
BRCA1/2 (breats and ovarian cancer) is responsible for *DNA
repair*
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]
For Heparin Overdose give *Protamine*
(Not Fresh frozen plasma)
(For warfarin overdose give FFP before vitK, protamine ineffective
for warfarin overdose)
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*
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
1093 Microbiology Infectious Diseases 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)
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
1095 Microbiology Infectious Diseases *Cystein-tellurite agar*
[C.DIPTHERIA]
[Bordet-Gengou medium is for pertusis, thayer martin for
gonorrhea, mcConkey is for enterics]
Pt with somnolence, lethargy, and oliguria with bloody diarrhea. He
has high urea, BUN and creatinine. Blood smear reveals
1097 Microbiology Hematology & Oncology
fragmented erythrocytes, Pt has HUS which is related to the
consumption of *Undercooked Beef*
The toxin of EHEC *Inactivates ribosomal subunits*
[Just like shigella toxin]
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
1101 Microbiology 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)
1104 Pharmacology Infectious Diseases Trimethoprim has the same inracellular target as *Methotrexate*
Pt with inflamatory acne. The glands involved release secretions by
1106 Anatomy Dermatology *Holocrine* manner.
[Sebacious glands]
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)
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]
Highest risk of metastasis in a malignant melanoma is *Active
Vertical Growth*
1114 Pathology Dermatology Biopsy of Urticaria would show *Dermal Edema*
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*.
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.
Reactions of the pentos phosphate pathway (HMP shunt) occur in
1119 Biochemistry the cytoplasm. Therefore this includes activity of enzyme
Metabolism
*Transketolase*
Insulin increases intracellular glycogen stores and decreases
1121 Biochemistry hepatic glucose release into blood (gluconeogenesis), it does so
Metabolism
by activating *Protein Phosphatase-1*
Pt presents with highly Pruritic (itchy) erythematous rash
consisting of papules, vesicle and bulla following exposure to
1133 Immunology Dermatology wilderness (Elctrician working in unmaintained woody area). Cells
responsible for tissue damage are *T cells*
[Poison IVY dermatitis, type 4 hypersen]
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]
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 &
1137 Microbiology Infectious Diseases 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]
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
1138 Pathology Infectious Diseases hepatosplenomegalyandseveralfainterythematousmaculopapular
lesions on chest and abdomen. Most likely cause is *Salmonella
Typhi*
[Typhoid Fever]
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
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)
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.
Infection with Shigella Sonnei though food. The cells primarily
responsible for uptake of bacteria are *Microfold (M) cells*
A child with an intracranial calcified mass. On gross exam of mass
after removal, it shows cystic spaces with thick brownish-yellow
1152 Pathology Nervous System 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]
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*
Colichy abdominal pain, constipation, irritability and headaches,
1156 Pharmacology Gastrointestinal & Nutrition and works at battery factor, history of iron def anemia --> Lead
posinong
1159 Histology Osteocytes are connected to each other by *Gap Junctions*
& Sports
1161 Physiology ADH acts on *Medullary segment of collecting duct*
Electrolytes
Blanching of a vein into which NE is being infused together with
1164 Pharmacology Cardiovascular System induration and pallor of surrounding tissue suggets NE
extravasation which is treated with *Phentolamine*
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
Behavioral Psychiatric/Behavioral & alternates between agitation and sedation. He is hyptertensive and
1165
science Substance Abuse tachycardic and has vertical nystagmus. Later, he doesnt
remember anything that happened. MOA of drug is
*N-Methyl-D-aspartatereceptorAntagonism*(NMDAAntagonist)
[This is PCP]
A gout drug that causes nausea, vomiting and diarhea after intake
1168 Pharmacology is a drug that *Inhibits microtubule formation*
& Sports
[Colchicine]
Number Needed to Treat is 1/Absolute Risk Reduction.
1174 Biostatistics Cardiovascular System
(ARR is: conrol rate - Tx rate)
Biostatistics & Absolute risk reduction = Event rate in the control group - event
1175 Biostatistics
Epidemiology rate in the Tx group
Biostatistics &
1178 Biostatistics Check other calculations in choices.
Epidemiology
A trend in whoch there is a rising prevalence but stable incidence
Biostatistics &
1187 Biostatistics is due to prolonged duration of disease (*IMPROVED QUALITY
Epidemiology
OF CARE* for e.g)
Biostatistics & Disproportionate loss of follow up btw exposed and control leads to
1188 Biostatistics
Epidemiology attrition bias which is a form of *Selection Bias*
Matching involves grouping patients with similar characteristics in
Biostatistics &
1189 Biostatistics both the control and treaetment (case) group. It is done to control
Epidemiology
confounding bias.
*Negative Predictive Value* is the probability of being free of
1190 Biostatistics GeneralPrinciples disease. Answers the question: What are the chances that I really
do not have cancer?
Pregnanct associated deep vein thrombosis is treated with
1194 Pharmacology Cardiovascular System *Enoxaparin*
[Low molecular wieght heparin]
A drug for Beta-lactamase producing Bacteroides species is
*Pipercillin-tazobactam*
Rheumatology/Orthopedics Case-fatality rate is calculated by dividing the number of fatal
1208 Biostatistics
& Sports cases by the total number of people with the disease.
A muscle relaxant that shows initial equal reduction in response
1212 Pharmacology followed by fading away unequal response in the TOF stimulation
& Sports
test is a depolarizing muscle blocker like *Succinycholine*
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
1214 Pharmacology Dermatology
topical therapy would most likely show *Dermal Atrophy*
[corticosteroids in addition to anti-inflammatory effect, cause
decreased production of extracellular matrix collagen and GAGS]
Pt with sign of Tb and the observed bacterial growth is
1216 Microbiology Pulmonary & Critical Care mycobacteria that grow in parallel chains (Serpentine cords). This
growth correlates with bacterial *Virulence*
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]
M. Tuberculosis with significantly decreaed activity of intracellular
catalse peroxidase exhibit resistance to *Isoniazid*
Pt being treated with TB that develops blurry vison (bilateral central
1228 Pharmacology Infectious Diseases scotomas). Likely responsible agent is *Ethambutol* (optic
neuropathy)
1233 Biostatistics Pulmonary & Critical Care Know how to calculate Sen, Spec, PPV, NPV (QUICKLY)
Ehlers Danlos Syndrome which presents with hyperextensible skin,
1244 Biochemistry Dermatology
easy bruising, hypermobile joints is a defect in collagen synthesis.
Ehler-Danlos Synrome can be caused by procollagen peptidase
1245 Biochemistry Dermatology deficiency which results in impaired *cleavage of terminal
propeptides* Where? --> Extracellular space.
Signs of scurvy such as bleeding gums , ecchymoses and
corkscrew hairs implicate vit C deficiency. Vit C is required in
1247 Biochemistry Dermatology postranslational hydroxylation of proline and lysin residues by
hydroxylases in collagen synthesis. It happens in the Rough
Endoplasmic reticulum
Collagen made by fibroblasts has Glycine as every third amino
acid (GLY-X-Y) it is thefefore the most abundant.
The stretch and recoil property of elastin is mediated by
1249 Biochemistry Pulmonary & Critical Care *Interchain cross-links involving lysine*
[involveslysyloxidase]
an elstin associated glycoprotein defecct that is abundant in the
Rheumatology/Orthopedics lens, periosteium, and aortic media refers to *Marfan Syndrome*
1250 Biochemistry
& Sports an autosomal dominant disease with a defect in FBN1 gene coding
for fibrillin glycoproten that forms around elastin.
In the duodenum, Enteropeptidase convert Trypsinogen to the
1251 Biochemistry Gastrointestinal & Nutrition active form trypisn. Pt with impaired enteropeptidase will fail to
form *Trypsin*
Medication that causes selective direct relaxation of smooth
1252 Pharmacology Cardiovascular System muscles of arterioles but does not affect veins would have an
adverse effect of *Na and fluid retention*
Newborn that is crying, has tremors, tachynea, sneezing and
diarhhea and mother has history of mental illness and/or hep c
1255 PathophysiologyNervous System
infection history probably has Neonatal Abstinence Syndrome and
should be treated with opoids such as *Methadone*
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.
1258 Pharmacology 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]
Pt with HIV and has mass on temporal lobe and biopsy shows cells
with EBV probably has a *Primary CNS Lymphoma*
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)]
Pt presents with worsening scoliosis. Pt with mutation in dystrophin
Rheumatology/Orthopedics gene on x chromosome. Histopathology of pt's calf would reveal
1266 Pathology
& Sports *Fibrofattymusclereplacement*
(Duchene Muscular dystrophy)
Myotonia dystrophy is an autosomal dominant disorder caused by
trinucleatide repeats of myotonia protein kinase (CTG). Sustained
1268 Pathology Nervous System contraction, frontal baldness and cataratcs along with weakness
and type one fiber muscle atrophy is commonly seen. Also
gonadalhypertrophy.
Statistical power *1-Beta* represents a study's ability to detect a
Biostatistics &
1272 Biostatistics difference when one exists. Basically the ability to reject the null
Epidemiology
hypothesis when its truly false.
Methadone which is used in Heroin Addicts (Opiate) during
withdrawal phase, it is beneficial due to *Long Half-Life* and can
Behavioral Psychiatric/Behavioral & therefore suppress cravings and withdrawal symptoms for >24 hrs.
1287
science Substance Abuse 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)
PCP is a hallucinogen that causes agitation, halluciantions, violent
1288 behavior. Distinguishing factors of abuse are are Ataxia,
Nystagmus, and Memory loss
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
1290 Pharmacology 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]
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.
1301 Biostatistics Cardiovascular System Blinding prevents observer bias.
A study's power increases as its *Sample Size* increase.
Biostatistics &
1303 Biostatistics Therefore, the larger the sample size, the larger the ability of a
Epidemiology
study to detect a difference when one truly exists.
1304 Pathology Nervous System *Schwannoma* is S-100 positive. (indicates neural crest origin)
Pt with Fleshy, dome shaped lesions plus cafe-au-lait spots
probably has cutaneous neurofibromas which is a hallmark of
1307 Genetics Nervous System NF-1 which exhibits an inheritance pattenr of *Single Gene
Autosomal Dominant*
-The NF-1 gene is on chromosome 17.
Isoniazid inhibits mycolic acid synthesis in the treatment of TB
thus making Tb cells less resistent to decoloration by acid-alcohol.
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)
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]
Pt that was injected with heat killed M. Leprae and developed a
1314 Pathology Dermatology large indurated nodule demostrates *Increased IL-2 & IFN-gamma
in skin lesions*
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.
1318 Physiology Nervous System In MS, *Length Constant* is decreased.
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.
Endocrine, Diabetes & Upregulation of *Serine Phosphorylation* decreases
Metabolism insulin-mediated glucose uptake.
Insulin Resistance correlates strongly with Ecxess Visceral Fat
1327 Pathophysiology which can be assessed using *Wasit Circumference* or waist-to
Metabolism
hip-ratio.
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*
1334 Biochemistry Dermatology [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?]
Hypertonicity, muslce rigidity and sugar smelling diapers are signs
1335 Biochemistry Nervous System for maple syrup urine disease and branched chain amino acids
such as leucine, isoleucine and valine should be restricted.
Pt comes due to recurrent blistering on back of hands and
forearms for several years. P.E shows vesicles and erosion on the
1337 Biochemistry Hematology & Oncology dorsum of both hands. Most likely deficient enzyme in this pt is
*Uroporphyrinogen Decarboxylase*
[Porphria Cutaneo Tarda]
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*
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.
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 Cardiovascular System Dobutamine increases *myocardial oxygen consumption*
Pt who requires benzodiazepam with least imapaired judjement or
daytime fatigue should be given one with a short T1/2 and least
1352 hepatic metabolismlike *Lorazepam*
[LOTbenzos,lorazepam,oxazepam,temazepam][Undergodirect
glucuronidation]
1356 Physiology Nervous System Macular lesions can result in *Central Scotomas*
Pt with acute metabolic acidosis (Normal HCO3 with low pH and
1357 Physiology Pulmonary & Critical Care High Pco2)could most likely suffer from *Heroin Overdose*
[Heroin causes respiratory depression and hypoventilation]
A drug that inhibits primary active transports across cell
membranesis*Omeprazole*
Receptor that when stimulated causes immediate change in
1360 Pharmacology Nervous System transmembrane Ca, Na, and potassium secondary to opening of
receptor channel is *Nicotinic Cholinergic Receptor*
Timolol in Tx of Glaucoma targets *Ciliary epitheliium*
1363 Pharmacology Ophthalmology
[Decreases aquoeus humor production]
*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.
Noreepi therapy results in *cAMP increase in cardiace muscle
cells*
A drug that causes less uterine contractions (i.e uterine relaxation)
and Eye Midryasis is *Alpha and beta-adrenergic agonist*
1368 Pharmacology Nervous System [B2 stimulation in uterus causes relaxation while Alpha 1
stimulation in eyes causes mydriyasis (the basis of using
phenylephrine befor eye exams)]
*Orinithine Transcarbamoylase* deficiency is the mcc urea cycle
disorder. The high NH3 causes neurologic abnormalities. Typical
1370 Biochemistry tell tale sign is high urine OROTIC ACID. becasue with no OTC,
Metabolism
carbamoyl phosphate is converted to orotic acid in pyrmidine
synthesis.
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
1371 Biochemistry Nervous System would be *Conversion of CO2+NH3 into Carbamoyl-Phosphate*
{N-acetylglutamateactivatescarbamoylphosphatesynthase1
which is th enzyme that converts co2+NH3 into Carbamoyl
phosphate]
Pt with inherited condition wich imapirs transport of ornithine from
1372 Biochemistry Nervous System cytosol to mitochondria. Restric *proteins* from diet to improve
condition.
Mother had still bith at 18 weeks. Autopsy shows pleural effusion,
pulmonary hypoplasia, and ascites. Infection with *Non-enveloped,
1374 Microbiology Hematology & Oncology
single stranded DNA virus* is most likely etiology.
[Parvovirus causing fetal hydrops]
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]
Oxygen binding to Hb involves the release of *Protons*
[H+ is released]
Immigrant 6 year old who presents with dyspnea. He has Fever.
Exam shows neck swelling, palatal paralysis and a gray
1388 Microbiology Allergy & Immunology pharyngeal exudate. His vaccination history is unknown. The
intervention that will imrove his symptons is *Passive Immunization*
(C.Diptheria infection, exotoxin)
Non pathogenic C. Diptheria become pathogenic thru *Phage
1389 Microbiology Allergy & Immunology
conversionpermitingexotoxinproduction*
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*
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.
Crepitus on physical and radiographic visualization of gas in
1394 Microbiology tissues esuggests Gas gangrene by C. Perfringes which also
& Sports
causes Transient Watery Diarrhea and Abdominal Discomfort.
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
1396 Pathology 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]
Pt takes Clindamycin and develops C.diff Colitis. The causative
1397 Microbiology Gastrointestinal & Nutrition agent damages the *Cytoskeleton Integrity* of intestinal mucosal
cells.
In the absence of normal intestinal microbial flora, C.difficile can
1398 Microbiology Gastrointestinal & Nutrition overgrow and produce toxins. Therefore, persons with a
*Preserved Intestinal MicroBiome* may not develop an infection.
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*
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)*
Auer rods which are seeen in Acute Myelogenous Leukemia stain
positive for *Peroxidase*
Phospholipid composition of viral particle surface is highly similar
to that of cell nucelar membrane. This is most likely
1408 Microbiology Infectious Diseases *Cytomegalovirus*
(Herpes viruses bud thru and acquire the lipid bilayer envelope
from the host cell nuclear membrane)
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
1413 Biochemistry Hematology & Oncology 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.
Differences between synthesis of 2 daughter DNA strands include
*The joining of DNA fragments by ligase*
1419 Biochemistry Hematology & Oncology 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.
CGG Trinucleotid repeats is characteristic of Fragile X syndrome.
1421 Genetics Nervous System
Symptoms results from *Gene methylation* of FMR1 gene.
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
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]
Renal, Urinary Systems & Pt on Chlorthalidone that develops muscle weakness. It is due
1425 Pharmacology
Electrolytes *Hypokalemia*
Behavioral Psychiatric/Behavioral & Young man who says that his parents who are about to get a
1429
science Substance Abuse divorce are angry at him. His defense mechanism is *Projection*
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]
The factor that makes eukayotic DNA replication quick and
1437 Biochemistry GeneralPrinciples effective despite large size and complexity of genome is *Multiple
origins of replication*
A protein that has reverse transcriptase activity that functions to
add TTAGGG repeat to the 3'end of chromosomes. The cell type
1438 Genetics GeneralPrinciples
with this protein is most likely *Epidermal Basal cells*
[Temlomerase protein on stem cells]
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*
Alcoholic pt with poor dentition whose chest CT shows air fluid
1446 Pharmacology Pulmonary & Critical Care microabscesses. best treatment option is *Clindamycin*
[Oral Anaerobic bacteria causing aspiration pneumonia]
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
1449 Embryology MaleReproductiveSystem
male external genitalia. Why? becuase sertoli cells produce MIF
which inhibits female internal gonad differentiation.
Pt with recurrent acute Monoarthitis (one knee) and a history of a
Rheumatology/Orthopedics myeloproliferative disorder (E.g Polycytemia Vera) has typical
& Sports features of "GOUT" and would therefore have *Needle Shaped,
Negatively Birefringent Crystals* on needle aspiration of the joint.
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*
Infant with language regression and anemia probably has lead
Poisoning&Environmental
1454 Biochemistry posioning and probably has an inhoiibited *ALA Dehydratase
Exposure
enzyme* plus ferrochelatase inhibition.
The change in color of a bruise from blue to green is explained by
1456 Biochemistry Hematology & Oncology activity of *Heme Oxygenase*
[Biliverdin is Green, Bilirubin is yellow]
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
1462 Genetics GeneralPrinciples 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.
Infant Pt with White pupils (Cataracts), heaing loss, and Machine
Pregnancy, Childbirth & like murmur (PDA) probably has congenital Rubella. This could
1464 Microbiology
Puerperium have been prevented by giving the mother the *Live attenuated*
Rubella virus vaccine.
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)
The live attenuated oral (Sabine) poliovirus vaccine produces
stronger mucosal sectretory igA immune resposne than Salk killed
1467 Immunology 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.
The antiviral action of interferon is *Decreased prtein synthesis by
1468 Immunology Infectious Diseases
infected cells*
Viruses with segmented genomes can undergo genetic shift
1469 Genetics GeneralPrinciples through reassortment. Such viruses inclide orthomyxoviruses
(influenza) and *RotaViruses*
1470 Biochemistry Hematology & Oncology Both HbS and HbC result from *Misense Mutations*
Bacterial *DNA polymerase 1* removes RNA primers during DNA
1471 Biochemistry Infectious Diseases
replication.
External Beam Radio therapy kills cancer cells through
1474 Genetics Hematology & Oncology
*Double-strand DNA breaks*
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*
Pt with xeroderma pigmentosum have a defect in *Endonucelease*
1476 Genetics Dermatology
enzyme.
High Arginine in plasma and CNS suggest arginase deficiency
which works to convert arginine into *Urea* in the urea cycle.
Duchenne Muscular Dystrophy can also results from None-sense
1487 Biochemistry Hematology & Oncology Mutations (premature stop codon)
[Usually from deletions (frameshift) thu]
Antibiotic that causes tinitis and hearing loss is most likey an
1488 Pharmacology Infectious Diseases aminoglycoside which affects *mRNA genetic code reading*
(binds irreversibly to 30s ribosomes)
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
1491 Anatomy
& Sports bursae most likely affected in this pt is *Prepatellar*
[Prepatellar Bursitis][a.ka "housemaids knee]
Pt with cerebral edema who is on a ventilator adjusted to achieve a
pCO2 level bwteen 26-30 mmHG. Most likley effect of this
1493 Physiology Nervous System intervention is *Increased cerebral vascular resistance*
[a dro in pCO2 causes vasoconstriction and increases resistance
and hence reduces cerebral blood flow]
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.
Pt with imapaired Tetrahydrobiopetrin synthesis would have
1500 Biochemistry Nervous System phenylketonurea and would therefore have deificency of
*Serotonin*
Pt with Phenylalanemia who is place on dietary requirements and
supplemented with tyrosine and presents with normal
Endocrine, Diabetes & phenylalanine levels but with axial hypotonia and microcephaly.
1501 Biochemistry
Metabolism Also, prolactin is elevated. The enzyme missing in this pt
*Dihydrobiopterin reductase*
(Involved in converting tyrosine to DOPA, hence high prolacin)
*Dofetilide* is a class 3 antiarrhythmic and blocks K channels,
Just like Sotalol and Amiodarone.
A drug that depresses phase 0 ventricular depolarization (Na) and
1509 Pharmacology Cardiovascular System prolongs phase 3 (K) is probably a class 1A antiarrythmics which
include*Disopyramide*
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*
Pt presents with sign of hypovolemic shock who is give Normal
Saline. This intervention increases *End-Diastolic Sarcomere
1512 Physiology Cardiovascular System Lenght*
(Increase in preload stretches myocardium and hence the
sarcomere length)
Cardiac tissue conduction velocity is from fastest to slowest as:
1513 Physiology Cardiovascular System Purkinje system-->Atrial muscle--->Ventricular muscle---> AV node
[Park AT VENTure AVenue]
The CFTR protein is a transmembrane *ATP-gated* Chloride
channel.
Pt with sudden onset palpitation plus rapid regular tachycardia that
responds to carotid massage probbly has PSVT. Carotid massage
1515 Physiology Cardiovascular System increases afferent firing which increases vagal parasympathetic
tone which slows conduction thru AV node and hence *Prolongs
AV node Refractory period*
Within the zone of autoregulation of coronary blood flow. The main
1516 Physiology Cardiovascular System endogenous factor for control of coronary blood flow is *Nitric
oxide*
Pt with illness like with Obstructive Lung disease would have air
trapping in lungs and hence a high *RV/TLC ratio*
Pt with tracheal pO2 of 150, Alveolar pO2 of 145, and Alveolar
1522 Physiology Pulmonary & Critical Care pCO2 of 5 has *Pulmonary alveolar perfusion*
note: tracheal pO2 is normal. Normal alveolar pO2 is 104.
1526 Physiology Pulmonary & Critical Care P(A)O2(Alveolar)=150-(PaCO2(Arterial)/0.8)
The *Blood Flow Per Minute* in the pulmonary circulation closely
1528 Physiology Cardiovascular System matches the blood flow in the systemic circulation. This is true in
both exercise and rest.
Cardiac Output= Rate of O2 consumption/arteriovenous O2
content difference.
The *Phrenic Nerve* carries paim fibers form the Diaphragmatic
and Mediastinal Pleura. Irritation of pleura at either area will
1535 Anatomy Pulmonary & Critical Care 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".
1536 Histology Nervous System The Blood brain barrier has Tight Junctions (Zonula Occludens)
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.
CO poisoning causes *Increased CarboxyHb together with
unchanged PaCo2, Methoglobin level is unchanged*
1545 Physiology Hematology & Oncology
[In Co poisoning, O2 contect is decreased BUT not oxygen partial
pressure which is represented by PacO2]
Secetin, released by the *Duodenal S cells* stimulates release of
bicarbonate from the pancreas.
Symptoms of primary herpes infections include inguinal
lymphadenopathy, tender vesicular lesions covering both labia
FemaleReproductive
1549 Pathophysiology majora and pernium with dysuria and itching. The infection
System & Breast
(probably hsv-2) can lead to *Recurrent Genital Ulcers* (less
sever) (HSV lies dormant in sacral dorsal root ganglia)
Recurrence of genital hepres can be reduced by *Continous daily
valacyclovir*
a unilateral vesicular rash involving a single dermatome is
1553 Microbiology Dermatology Shingles. The pt would siffer from *Persistent local pain* in the
next 6 months
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
1557 Physiology Cardiovascular System 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*
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
1559 Physiology the clearance of *Inulin*
Electrolytes
[No tubular reabsorption or secretion, filtered amount equals
excreted amount]
[Note that PAH is secreted as well]
LH stimulates the theca interna cells of the ovarian follicle to
produce androgens. Aromatase within the follicle's *Granulosa*
FemaleReproductive
1560 Physiology cells subsequently converts these androgens to estradiol under
System & Breast
FSH stumulation. The theca externa cells serve as connective
tissue support structure for the follicle.
In pts with HTN and chronic ischemic myocardial failure, ACE
1565 Pharmacology Cardiovascular System inhibitors (*Lisinopril*)are considered most effective long term
treatment.
Pt who has severe acne with scarring and now is interested in
Pregnancy, Childbirth & Isotretinoin treatmnet. Best next step in management is *Urine
1568 Pharmacology
Puerperium Beta-hCG*
[ral isotrtinoin is Teratogenic]
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.
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
1575 Microbiology lymphadenopathy. The mother is at immediate risk for
Puerperium
*Polyarthralgia* while the fetus at risk *Sensineuronal Deafnes*.
This pt has German measles (Rubella) and has not been
vaccinated with MMR
In signs for Cor Pulmonale due to COPD, moderate increase in
1578 PathophysiologyCardiovascular System capillary fluid transudation can be ofset by a compensatory
increase in *Tissue Lymhatic Drainage*
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*
Pancreatic calcification with abdominal pain and finding of low
hemoglobin and high MCV suggest Macrocytic anemia. The pts
1580 Pathology Hematology & Oncology 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*
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.
Sudden-onset tachypnea and chest pain in a hospitalized pt shud
raise suspicion for Pulmonary Embolism. Especially if pt is
1584 Physiology Pulmonary & Critical Care 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*
Increase in hemtocrit with normal red blood cell mass indicates
*RelativeErythrocytosis*
The tissue that would Increase vascular resistance due to low
Oxygen tissue content is the *Lungs*
Renal, Urinary Systems & The nephron segment that will have the lowest concentration of
1588 Physiology
Electrolytes PAH is *Bowman's capsule*
Increase in HR and cardiac output with no changes in PaO2 and
PaCO2 indicate *Exercise*
Pt with CMV postive antibody probably had a *Mononucleosis-like
illness* in the past due to CMV infection, symptoms include fever,
1592 Microbiology GeneralPrinciples
malaisse, myalgia, atypical lymphocytosis, and elevated
transaminases.
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)
Immune mechanism against Giradia involves CD4+ T helper cells
1596 Immunology Gastrointestinal & Nutrition
and *Secretory IgA Production*
1598 Immunology Hematology & Oncology The surface marker for the macrophages of TB is CD14
A young man with acute lower extremity artthritis and a sterile (no
bacteria) joint effusion following a GI infection (diarrheal illness)
1600 Pathophysiology has typical symtoms of "Reactive Arthritis". It is a associated with
& Sports
*HLA-B27*
[Sponduloarthropathy assoc with HLA-B27]
Campylobacter Jejuni can lead to Guillain-Barre Syndrome. GBS
is a demyelinating syndrome of the peripheral nerves
1601 Microbiology Nervous System characterized by ascending muscle weakness and paralysis. Pt
has history of self resolving diarhea. C. jejuni is a common cause
of infectious diarrhea.
Pt ingests solution containing 13C labeled urea. He then is aksed
to blow into a tube and labeled carbon is detected in his breath
1602 Microbiology Gastrointestinal & Nutrition samples. This is most likely part of the evaluation of *Duodenal
Ulcer*
(H.pylori is urease positive)
Renal, Urinary Systems & In the setting of low ADH, the highest osmolality is at the *Bottom
1607 Physiology
Electrolytes of Loop of Henle*
If animal is deprived of water, ADH will be high, high ADH
promotes water reabsorption. The place with the lowest urine
Renal, Urinary Systems & osmloarity (highest dilution) would be the distal convoluted tubule.
1608 Physiology
Electrolytes 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.
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*
Pt with decreased serum complement C4 and C1 esterase inhibitor
levels. Drug that is contraindicated is *Captopril*
[Hereditary angioedema][ ACE inhibitors make bradykinin
1612 Pharmacology Allergy & Immunology
accumulate in addition to already high bradykinin due to loss of
inhibitory action of C1 esterase inhib on kalikrein which converts
kinogen into bradykinin]
Symptoms of Maculopapular Rash (skin) and multiple intestinal
ulcers (GI) after Liver transplant (or bone marrow) suggest
1613 Immunology Dermatology
Graft-versus-Host disease which is characterized by *Graft T cell
sensitization against Host MHC antigen.*
B cells undergo *ISOTYPE SWITCHING* in germinal centres
(round) of the cortex of lymph nodes.
Endocrine, Diabetes & High T3 would have negative feedback effects reducing TSH, T4
1615 Physiology
Metabolism and rT3.
Resistance in parallel is 1/T=1/R1+1/R2+1/R3+...etc
1616 Physiology GeneralPrinciples
[Remeber to inverse the answer]
Increased lung volume increases PVR in alveolar vessels and
decreases PVR in extra-alveolar vessels. *PVR is lowest near FRC*
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.
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]
1628 Pharmacology Hematology & Oncology Monloclonal antibody against CD20 marker is *Rituximab*
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]
*The suspensory ligament of ovary* must be ligated during removal
of ovaries to prevent bleeding. It carries the ovarian artery. It also
FemaleReproductive
1632 Anatomy known as the infundibulopelvic ligament. Note that the Cardinal
System & Breast
Ligament (transverse cervical ligament) holds the uterine artery
and needs to be ligated in a hysterectomy.
Pt with sensory loss over the medial 1 and 1/2 digits and
1634 Anatomy hypothenar eminence indicate ulnar nerve injury which often
& Sports
occurs at *Hook of Hamate*
Pt on Acyclovir who develops acute elevation of serum creatine
Renal, Urinary Systems & levels. This could have been prevented with *Agressive IV
1642 Pharmacology
Electrolytes Hydration*
(Acyclovir Nephrotox)
*Foscarnet* can be used in Ganciclovir resistent CMV. Being a Ca
Renal, Urinary Systems & chelator it can cause hypocalcemia. Also it induces renal wasting
1643 Pharmacology
Electrolytes of Mg causing hypomagnesemia. Also reduces production of PTH
further contributing to Hypocalcemia.
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*
Oseltamivir is a neuramidase inhibitor and is useful in treatment of
Influ A and B viruses. It inhibits *Virion Particle Release*
In heart catheterization. The structure the produces a pressure
changed of a max of 25 and a min of 2 is *Right Ventricle*
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
1654 Physiology Hematology & Oncology
of symptoms is *Ca chelation by a substancce in the transfused
blood*
(Citrate is added prior to storage, chelates Ca)
Pt with type 2 diabetes. Tx that would increase serum C-peptide
Endocrine, Diabetes & level include *Glyburide*
1655 Pharmacology
Metabolism {Sulfonylureases like glyburide and Meglitinide increase
endogenous insulin producttion and henc c-peptide]
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
1657 Physiology Nervous System *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)
Medullary thyroid carcinoma would show *Nests of polygonal cells
1659 Pathology with Congo-ed positive deposits*
Metabolism
[Amyloid stains with Congo red]
Endocrine, Diabetes & In Medullary Thyroid Cancer, the gene changes responsible is
1660 Pathology
Metabolism *Activating mutation of RET proto-oncogene*
Pt with a cardiac murmur and P.E reveals bouding femoral pulses
1661 Physiology Cardiovascular System and carotid pulsations that are accompanied by head-bobbing
most likely suffers from *Aortic Regurgitation*
ATP helps release *Myosin head from Actin binding site*, and thus
1665 Physiology lack of ATP leads to persistance of myosin-actin cross bridge
& Sports
(Rigor mortis)
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.
Child with upper-respiratory tract symptoms "followed" by brassy
1667 Microbiology Pulmonary & Critical Care (barking) cough and difficulty breathing probbaly has
parainfluenza virus Croup which is a *Paramyxovirus*
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
1669 Microbiology Dermatology 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]
An HIV protein that is Glycosylated then proetolytically cleaved in 2
1672 Microbiology Infectious Diseases smaller proteins. This protein is gp160 which is cleaved into gp120
and gp41 which help in *Virion attachment to the Target Cells*
Pt with redistribution of fat from the extremities to the trunk. This is
1673 Pharmacology a common adverse effect of *highly-active antiretroviral therapy
Metabolism
(HAART)*
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]
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
1679 Microbiology Pulmonary & Critical Care based on clinical status. Causative agent required cholestrol
enriched medium to grow. This is walking pneumonia caused by
*Mycoplasma Pneumonia*
The "proximal" part of the ureter is supplied by the *Renal Artery*.
The middle part is highly variable receiving supply from the
1680 Anatomy gonadal artery, the common iliac, and uterine arteries. The distal
Electrolytes
part (close to bladder) is supplied by Superior Vesical artery,
which is a branch of the internal iliac.
Infant with flaccid lower extremity and absent ankle reflexes
Rheumatology/Orthopedics bilaterally and with poorly developed lumbar spine and sacrum
1684 Embryology
& Sports (agenesis) has Caudal Regression Syndrome which is related to
mother *Uncontrolled Diabetes* during pregnancy.
The recurrent laryngeal nerve is in close proximity to the inferior
1686 Anatomy Ear, Nose & Throat (ENT) thyroid artery and can accidently damaged during inferior thyroid
artery ligation during a thyroidectomy.
Pt with initial resistance to passive extension followed by sudden
release has Clasp-knife Spasticity which is seen in upper motor
1687 Anatomy Nervous System 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.
1688 Genetics An ovulated oocyte is at *Metaphase of Meiosis 2*
Puerperium
Stab wound immediately above the clavicle and lateral to the
1695 Anatomy Pulmonary & Critical Care manubrium can puncture the *Pleura* and cause pneumothorax,
tensionpneumothoraxorhemothorax.
1696 Anatomy Nervous System Embolism to ACA would impared ability to *Climb stairs*
Rheumatology/Orthopedics An anterior translation of the tibia relative to the femur on stability
1697 Anatomy
& Sports testing indicates an inury to the *Anterior Cruciate Ligament*
Blunt trauma to the globe can cause orbital blowout fractures.
These fractures most commonly involve the medial or inferior
1698 Anatomy Ear, Nose & Throat (ENT)
orbital walls due to thin bone bordering the ethmoid and *Maxillart*
sinuses.
A puncture wound at the left sternal border in the fourth intercostal
1699 Anatomy Cardiovascular System
space will injure the *Right Ventricle*
1700 Anatomy A fracture of the elft 12th rib can cause laceration to *Left Kidney*
Electrolytes
CHild Pt who falls on his outstretched arms and fractures his
clavicle. What causes the medial fragment of the fractured bone to
1702 Anatomy 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.
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
1704 Anatomy
& Sports Artery (Profunda brachi)*
(Runs along the radial nerve)
1705 Embryology Cardiovascular System Teratology of Fallor results from *Deviation of Infundibular Septum*
low Vd (3-5L) indicates highly charged/ hydrophilic drug and that it
1710 Pharmacology GeneralPrinciples
has a high molecular wieght thereby highly protein bound.
Graph that is bimodal in measuring the concentration of Isoniazid
in plasma suggest pharmacologic polymorphism in drug
1712 Pharmacology GeneralPrinciples
metabolizing capacity. Isoniazid is metabolized by *Acetylation*
and therefore you have slow and fast acetylators.
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)
pt being Tx for HIV. Viral strains show significant increase in POL
1722 Microbiology Hematology & Oncology gene. This is related to *Antiretroviral chemotherapy*
(Resistance to drugs)
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]
Pt with hair loss at anterior scalp and vertex has typical features of
androgenetic alopecia.
1726 Pharmacology Dermatology
5-alpha-redyctase inhibitors such as *Finasteride* help minimize
progression of this disease.
1728 Genetics GeneralPrinciples *Classic Galactosemia* is autosomal recessive.
Rheumatology/Orthopedics The most important structure in the Valsalva Meneuver is *Rectum
1730 Anatomy
& Sports Abdmonis Muscle* which can be seen anterioly on a CT scan.
Rheumatology/Orthopedics Antibodeis against Actin would be against the Z-line since it
1734 Histology
& Sports contains only actin
In a pt with BPH who is given Finasteride that acts on *The
1737 Anatomy MaleReproductiveSystem prostate* (below the bladder on CT)
(5-alpha reductase inhibitor)
A *pudendal nerve* block is performed by injecting an anesthetic
FemaleReproductive
1739 Anatomy intravaginally, medial to the ischial spine, through the sacrospinous
System & Breast
ligament. This provides anesthesia to most of the perineum.
a uni lateral cleft lip is caused bt failure of *Fusion on the maxillary
1740 Embryology Ear, Nose & Throat (ENT)
prominenceandintermaxillarysegment*
Vomiting from sysetmic chemotherapy is triggered by
1741 Anatomy Nervous System chemoreceptor trigger zone located on the *Dorsal surfce of
Medulla at the caudal end of 4th Ventricle* (Area postrema)
Pt with nerve injury and prsents with foot slapping the ground with
each step (steppage gait) has *Common peroneal nerve injury*
Pts who is supine will aspirate into the *Post segment of the upper
1745 Anatomy Pulmonary & Critical Care
lobe* and the Superior segment of the lower lobes of the right lung
A nerby nerve injury while ligating an artery entering the superior
Endocrine, Diabetes & pole of the thyroid lobe(superior thyroid artery) would most likely
1747 Anatomy
Metabolism deninnervate the *Cricothyroid Muscle* which is innevated by the
external branch of the superior laryngeal neerve.
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*
The common carotid artery which is palpatrd along the inner side
1750 Embryology Cardiovascular System of the sternocleidomastoid muscle is derived from the 3rd
pharyngeal aortic arch.
Neoborn who has tachypnea and hypoxia. He has a flattened nose
and bilateral club feet. He dies one hour later. To be found during
1752 Embryology autopsy is *Renal Agenesis*
Electrolytes
[Potter sequence of pulmonary hypoplasia, falttened facies, and
limb deformity due to Oligohydroamnios due urinary tract anomaly]
Benign lympph node enlargement in response to antigenic
stimulation is associated with a Polyclonal proliferation of
1754 Pathology Hematology & Oncology lymphocytes. A monoclonal lymphocytic proliferation of
lymphocytes. A *Monoclonal lymphocytic proliferation* is a strong
evidenc of malignancy.
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
1755 Pathology Hematology & Oncology 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))
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
1761 Pathology Hematology & Oncology shows a widespread rash of lesions (image shown). Most likely
cause is *Human Herpes Virus 8*
[Kaposi Sarcoma]
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]
Endocrine, Diabetes & Proinsuline is cleaved by beta peptidases into Insulin and
1768 Physiology
Metabolism C-peptide, both of which are then *Packed in Secretory Granules*
Prolonged use of glucocorticoids such as *Prednisone* in pts with
1773 Pharmacology Rheumatoid A. can lead to osteoarthritis and cause fractures of
& Sports
vertebral bones for example.
Tetracyclines (Doxycycline) that are given to treat pregnant women
1775 Pharmacology with Lyme disease can cause fetal *Teeth Staining*.
Puerperium
If pregnancy is known, give Penicillin instead.
If pt is on warfarin and a new drug was added and pt developed
thrombotic event, then the new drug lowered efficacy of
1777 Pharmacology Nervous System anticoagulation property of warfarin through the induction of
CYP450, which is how Warfarin is metablized. One such drug is
Phenobarbital.
Pt with abdominal pain, diarrhea, and tender abdomen without
1783 Pathology Gastrointestinal & Nutrition guarding. There is a draining fistula near her coccyx. Most likley
Dx is *Crohn Disease*
Enoxaparin is a form of low molecular weight heparin and
1784 Pharmacology Hematology & Oncology therefore binds to *Antithrombin 3* which once activated binds
factor Xa and stops it from converting prothromin to thrombin.
Pt with anemia (manifesting as fatigue), thrombocytopenia (Easy
bruising), and neutropenia (recent respiratory infection), with
profound reticilocytopenia, morphologically normal cells line in
1785 Pathology Hematology & Oncology 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 Hematology & Oncology Calculate Corrected reticulocyte count or sth.
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
1793 Pathology Hematology & Oncology *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*
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*
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*
*Vaginal Agenesis* is characterized by short vagina and
rudimentary uterus and Amenorrhea with normal 2ndry sex
FemaleReproductive
1809 Embryology characteristics and normal wieght and stature. It is a.k.a Mullerian
System & Breast
Aplasia or MRKH syndrome. It often presents with urologic issues
as as unilateral renal agensis.
Mastectomy with axillary lymph node removal can injur the long
1812 Anatomy thoracic nerve and henc injury seratius anterior and lead to winged
& Sports
scapula.
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*
Pt who faints after otoscope exam has experience vasovagal
1814 Anatomy Ear, Nose & Throat (ENT) syncope due to stimulation of post ext auditory canal. *Vagus
Nerve is affected*
1815 Anatomy Nervous System CN IX resection would lead to loss of sensation over the *Tonsils*
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*
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*
If pt cant handle aspirin and he has stable angina. Give him
*Clopidogrel*
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)
A complete mole usually results when an empty ovum is fertilized
1830 Genetics by a haploid sperm. Subsequent duplication of the paternal genetic
Puerperium
complement (23X) results in characteristic *46,XX* genotype
A mass in the third portion of the duodenum that is infiltrating
1832 Anatomy Gastrointestinal & Nutrition beyond guy wall carrys the risk of compromising the *Superior
Mesenteric Artery*
High blood oxygen in a fetus can be found in the inferior
1833 Embryology Pulmonary & Critical Care
venecava.
Pt with history of thyroidectomy (Medullary thyroid Cancer), flesh
1844 Pathology color nodule on lips and tongue (Mucosal Neuromas), & Marfinoid
Metabolism
Habitus (tall, long fingers etc) probably has *MEN 2B*
Occlusion to the *Middle cerebral Artery* can cause both
Wernicke and Broca's aphasia.
In an experiment where folate is deprived. Provision of
*Thymidine* would reduce erythroid precuros cell apoptosis.
1847 Biochemistry Hematology & Oncology [Folate def inhibits formation of dTMP, Thymidine supplementation
can increase dTMP and hence reduce erythroid precursor cell
apotosis]
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.
7 yr odl with two day history of colicky abdominal pain develops
bloody stools. His urine appeared red today. P.E shows palpable
Renal, Urinary Systems & skin lesions on his buttocks. An additional finding consistent with
1850 Pathology
Electrolytes his condition is *Joint Pain*
[Henoch-SchonleinPurpura][Mostcommonsmallvesselvasculitis
in children]
1851 Pathology Hematology & Oncology In HUS thee is *Elevated seum indirect bilirubin*
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.
Hydrocephalus in infants presents with macrocephaly and poor
feeding. Imaging studies showing enlarged ventricles are
1854 PathophysiologyNervous System characteristic. Untreated hydrocephalus leads to spasticity due to
stretching of periventricular pyramidal tracts, developmental
delays, and seizures.
Infant with hand and foot syndrome (Dactylitis) with family hsitory
1855 PathophysiologyHematology & Oncology of penumococcal sepsis (encapsulated) probably has sickle cell
disease and his *Serum Haptoglobin would be Reduced*
1860 PathophysiologyDermatology Wrincles are a result of *decreased collagen fibrils production*
Old pt with blood in urine. Renal biospy shows rouned/polygonal
Renal, Urinary Systems & cells with abundant cytoplasm. The process that acconts for
1862 Pathology
Electrolytes abnormal appearance of cells is *Glycogen and lipid accumulation*
[C lear cell Ca of Kidney]
Pt recently went to mexico. He presents with low grade fever,
anorexia, dark colored urine and RUQ tenderness. Liver biopsy
1863 Pathology 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]
Signs of confusion, fever, flushing, dry mouth, mydriasis and
1868 Pharmacology decreased bowel sounds indiacte an Anticholinergic crisis which
Substance Abuse
can be caused by Tricylic Antidepressants such as *Amitriptyline*
In most poeple with right coronary dominance, Inducible ischemia
1871 Anatomy Cardiovascular System of the inferior surface of the heart would probably be due to
occlusion of *Right coronary artery*
Angiogenesis is predominantly driven by *Fibroblast Growth
Factor* and Vascular Endothelilal Growth Factor.
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]
Pea d'orange is an erythematous itchy breast rash with skin
texture changes analogous to an orange peel. This is the key
1877 PathophysiologyHematology & Oncology dermatologuc presentation of inflammatory breast cancer and is
caused by cancerous cells obstructing lymphatic drainage to the
dermal lymphatic spaces.
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
1880 Pathology Hematology & Oncology thromboembolism. A factor that contrinutes to this a
*Hypercoagulable state*
(Virchow's triad: endothelial injury, venous stasis, and
hypercoagulable state)
Transient myocardial ischemia causes myocardial hypertrophy is
due to *Inttracellular Ca2+ accumulation*
1890 Pharmacology Hematology & Oncology 6-mercaptopurine is inactivated by *Xanthine Oxidase*
1893 Pharmacology Hematology & Oncology Vincristine inhibits cell synthesis at the M phase. (Microtubules)
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
A normal bleeding time indicates adequate platelet function. A
normal Activated partial thromboplastic time (aPTT) indicates an
1903 PathophysiologyCardiovascular System 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*)
An elderly person with Confusion and flaccid paralysis and CSF
1906 Microbiology Nervous System PCR shows Viral RNA. Most likey it is West Nile Virus which is
transmitted by *An Insect Bite* of the Culex Mosquito.
Pt who has acute pancreatitis and has a malignant mass on
pancrease and undergoes subtotal pancreatectomy would have
1907 PathophysiologyGastrointestinal & Nutrition normal *IntestinalD-xyloseAbsorptioon*
(xylose is simple sugar, doesnt need pancreatic enzymes for
absorption)
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.
Renal, Urinary Systems & Screening for early-stage diabetic nephropathy is done by
1913 Pathology
Electrolytes measuring urinary concentration of *Albumin*
Ultrasound of fetus with bilaterally enlarged fetal kidneys with
diffuse small cysts and oligohydroamnios has Autosomal recessive
Renal, Urinary Systems & polycystic kidney disease (ARPKD) and is the oligohydroamnios
1915 Embryology
Electrolytes can lead to Potters sequence which is Flattened facies, Limb
deformity, and "Pulmnary Hypoplasia" and therefore the baby can
be born with *Respiratory Disress*
Kinesin & dynein are *Microtublar* motor proteins responsible for
1922 Histology Nervous System rapid axonal transport.Kinesin acts in Anterograde transpor,
Dynein in Retrograde.
1925 Pathology Pulmonary & Critical Care *Animal Dander should be avoided by pts with Asthma.
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]
Pt's P.E reveals a large adnexal mass. Ultrasonography reveals a
FemaleReproductive
1928 Pathology large ovarian cyst. She has signs of virlization togther with
System & Breast
clitoromegaly. Most likely Dx is *Sertoli-Leydig tumor*
Pt with gray white fishy vaginal discharge with no inflammation that
FemaleReproductive
1929 Microbiology shows clue cells is characteristic of bacteril vaginosis caused by
System & Breast
Gardnerella vaginitis which an *Anaerobic gram variable organism*
Ca efflux prior to myocyte relaxation is caused by use of
Ca2+ATPase and *NA+/Ca+ Exchange Mechanisms*
Pt with abdominal pain, bloody vaginal discharge, orthostatic HTN
and a positive preganancy test. Prior infection with
FemaleReproductive *N.Gonorrhoeae* is likely responsible for her current condition.
1932 Microbiology
System & Breast [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.]
Pt with diplopia and has problems walking down stairs and trouble
1933 Anatomy Nervous System reading probably has a lesion to the trochlear nerve which is
responsible for depression of adducted eye.
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
1935 Genetics
& Sports those affected. Heteroplasmy is having both mutated and wild
mitochondrial Genomes in one individual, severity of disease
depends on ratio of these.
A toxic insult that targets protein KInesin will affect *Secretory
1936 Histology Nervous System vesicles in nerve terminals* and will make them absent from tissue
histological examination.
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
1937 Pathology Dermatology 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]
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]
1939 PathophysiologyPulmonary & Critical Care Pt with CF has Na loss in sweat.
Target cells are seen in Beta Thallesemia. Its a condition in hwich
there is impaired *mRNA formation*
Chronic smoker with chronic cough who has been hospitalized
before for respiratory infections and treated with antibiotics
1942 PathophysiologyPulmonary & Critical Care probably has COPD and therefore hypoxia and an additional
finding would be *Increased Erythropoitin production* in repsonse
to the hypoxia.
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
1946 Pharmacology Nervous System significant for similar problems. Best Tx for this pt is *Propranolol*
[Essential Tremor, nonselective beta blockers lessens it via CNS
effects]
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
1947 Pharmacology Cardiovascular System (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 Cardiovascular System Betal Blockers inhibit renin release.
N. Gonorrhea urethritis is treated treated with *Ceftriaxone (3rd
gen Ceph) and Azithromycin (Macrolide) *
Penicilins are structurally similar to *D-alanine-D-alanine* and they
inhibit transpeptidases by binding to its site.
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
1954 Pathology Hematology & Oncology 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"
Rheumatology/Orthopedics In a pt with a femoral neck fracture. The injury that would lead to
1956 Anatomy
& Sports osteonecrosis most likley involves the *Medial Cicrumflex* Artery.
Pt with heavy and painful menstrual bleeding with uniformly
FemaleReproductive
1957 Histology enlarged uterus has Adenomyosis, which is *Endometrial tissue in
System & Breast
theMyometrium*
Bacterial Vaginosis can be Tx with *Clindamycin* or
1958 Pathology Infectious Diseases
Metronidazole.
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**
In treating Malaria by vivax (recurrent fever every 48 hrs).
1965 Pharmacology Infectious Diseases Primaquine is added to chloroquine in order to *Prevent disease
Relapse*
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)
For graft purposes, the Great Saphenous Vein can accessed at a
site *Just inferolateral to the pubic tubercle*
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]
Secretin increases concentration of *Bicarbonate* released from
the pancreas.
Calcium channel blockers as as verapamil slow *diastolic
depolarization* in SA and AV node.
Pt with irregular beat rhythm, narrow QRS complexes and Absent
1977 Physiology Cardiovascular System P waves has A fib. What determines his ventricular contraction
rate is the *AV node refractory period*
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.
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*
Endocrine, Diabetes & In a non medical setting, severe hypoglycemia is treated wih *IM
1984 Pharmacology
Metabolism Glucagon*
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!
Pregnancy, Childbirth & Progestrone inhibits prolactin during getstation thereby preventing
1987 Physiology
Puerperium lactation.
18 year old male with progressive skin rash. He has long standing
history of intermittent burning sensation in his palms and soles that
Renal, Urinary Systems & is exacerbated bt stres and fatigue. Burning is severe after
1989 Biochemistry
Electrolytes 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]
An autosomal recessive diroder of Sphingomyelinase deficiency.
Most consistent with this condition is *Neurodegenration and
1990 Biochemistry Hepatosplenomegaly*
Metabolism
[Neiman-Pick disease. aslo foamy macrophages and cherry-red
macular spot]
Pt with HIV whose PAP semar shows high grae cervical dysplasia.
FemaleReproductive The strongest risk factor for cervical dysplasia in this pt is
1992 Pathology
System & Breast *Immunosupression*
[Risk factors for cervical cancer]
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]
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
2000 Pharmacology Nervous System 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*
Thiazides prevent calcium loss in urine, Thiazides keep calcium in
Renal, Urinary Systems & the body. Thus, they are useful in Tx of nephrolithiasis due to
2003 Pharmacology
Electrolytes calcium oxalate stones. Loop diuretics on the other hand lose
calcium. Loops Lose Calcium.
Beta Blockers prolong *PR interval* by decreasing AV nodal
conduction.
During a study, the blood oxygen content of the aorta and several
other vessels is measured at rest. The greatest difference in these
2009 Physiology Cardiovascular System measurements will most likely be between the aorta and the
*Coronary Sinus*
[myocardial oxygen extraction is very high]
Renal, Urinary Systems & After adminstration of Desmopressin, renal clearance of *Urea*
2012 Physiology
Electrolytes decreases.
The homeobox genes code for proteins that are *Transcription
regulators*
Etoposide is a chemotherapeutic agent that inhibits the sealing
activity of *Topoisomerase 2*
The Superior Venecava is derived from the common cardinal
veins.
jaw deviation to right on opening mouth, difficulty chewing food
2024 Anatomy Nervous System suggest CN V3 Injury (Mandibuar) It passes through *foramen
ovale*.
Enhancers can be *Located upstream, downstream or within
introns of the gene*
2029 Genetics GeneralPrinciples Releasing factor 1 recognizes stop codons.
Mutations in promotor regions such as TATA box can likely affect
*Transcription Initiation*
The poly A tail at the *3' end of RNA* is not transcriped from DNA
template and was a post transcription modification.
2035 Biochemistry GeneralPrinciples mRNA *Interaction with P bodies* occurs only in the CYtoplasm.
Pt with mutation in Protein involved in the assembly of small
2036 Biochemistry Nervous System nuclear ribonucleoproteins (snRNP's) in motor neurons. Pt will
have impaired function of *Spliceosomes*
tRNA containts chemically modified bases such as dihydrouridine,
ribothymidine, and pseudouridine. It has a *CCA* sequence at the
2037 Biochemistry Dermatology 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.
Pt with mood symptoms and history of psychotic symptoms for
2047 more than 4 weeks in absence of moods symptoms suggests
*Schizoaffective Disorder*
2049 Use SSRI'S to treat OCD.
Behavioral Psychiatric/Behavioral & Shifting of emotions assciated with a significant person from the
2053
science Substance Abuse past to a person in the presentis called *Transference*
FemaleReproductive The female reproductive structure that contains simple cuboidal
2056 Pathology
System & Breast epithelial cells is *Ovary*
Behavioral Social Sciences A pregnant minor is entitled to consent to prenatal care. Not an
2057
science (Ethics/Legal/Professional) electiveterminationhowever.
Pt with orotic acid urea and normal ammonia levels could have a
2066 Biochemistry defect of UMP synthase (hereditary orotic aciduria)
Metabolism
Supplementation with *URIDINE* helps this pt.
In lesch-Nyhan syndrome, there is increased activity of *PRPP
2067 Biochemistry Nervous System Amidotransferase* due to compensatory increase in Denovo
Purine Synthesis.
2068 Immunology Allergy & Immunology Histamine and *Tryptase* are elevated in Anaphylaxis.
Mast cell degranulation is triggered by *Receptor aggregation*
2069 Immunology Allergy & Immunology
during High affinity IgE receptor activation.
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.
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
2077 Anatomy Nervous System 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*
Pts with history of otitis media, chronic diarhea who on on exa
have pneumocystis probably have SCID. (Otitis meedia is from
2078 Immunology Dermatology
bacteria and that reuires Humoral immunity) (pneumocystits
requires t cells) Thefere *Combined Immune deficiency*
Toxoplasmosis is Tx with *Pyrimethamine and Sulfadiazine*
2082 Microbiology Nervous System [If u see ring enhancing lesions in HIV , suspect toxo before
lymphoma]
Pt with signs of sickle cell disease (african american, recurrent
2084 Pathology Hematology & Oncology back pain, bony tenderness, low Hb). Histopathologic evaluation of
his spleen would show *Fibrosis and Atrophy*
2087 Genetics Hematology & Oncology In beta thalassemia there is *Microcytosis*
Treat serotonin syndrome with *Cyproheptadine* (a first gen.
2089 Pharmacology Nervous System antihistamine that has nonspecific 5-HT & 5-HT2 receptor
antagonism)
Mutation in PRPP synthetase (enzyme in purine denova synthesis)
2090 Biochemistry can lead to hyperuricemia due increased production of purines.
& Sports
Thus increasing the risk for Gout Which affects *Joints*
Negatively Birefringent crystals under polarized light indicates
2091 Biochemistry Gouty Arthritis, for which the inflamatory response is mediated by
& Sports
*NEUTROPHILS*
Breast cells that over express 185kD glycoprotein and that have
2093 Pathology Hematology & Oncology intracellular tyrosine kinase activity are probably the HER2/neu
oncogenes that *Accelerates Cell Proliferation*
Pt with menstrual irregularities, who is obese and has acne and
FemaleReproductive
2094 Pathophysiology hirsutism probably has Polycystic Ovarian Syndrome, and
System & Breast
therefore has *Enlarged Ovaries*
FemaleReproductive Pts with PCOD who desire fertility are treated with Clomiphene,
System & Breast *An estrogen receptor Modulator*
2099 PathophysiologyCardiovascular System Pulsus Paradoxus can be seen in *Pericardial Disease*
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
2100 PathophysiologyCardiovascular System 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*
Pt presents with fatigue and dyspnea. An early diastolic murmur is
2105 PathophysiologyCardiovascular System heard at the left sternal border. Pt most likey has *Aortic
Regurgitation*
During continous infusion of a drug metabolized by first order
2112 Pharmacology GeneralPrinciples kinetics, the "stead state" is reached in *4-5 half lives*
(calculate it)
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]
A low pitched holosystolic murmur heard best at the left sternal
2117 PathophysiologyCardiovascular System border with accentuation during the handgrip exercise is
characteristic of *VSD*
The most common finding in *PCA* territory infarction is
Contralateral Hemianopia.
*Anti IgE Antibodies* are effective add-on-therapy to severe
2128 Immunology Pulmonary & Critical Care allergic asthma patients that are already on glucucorticoids and
beta-agonists.ExamplesincludeOmalizumab.
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.
Proteinurea with serum containing IgG4 antobodies to
2131 Pathology phospholipase A2 receptor (PLA2R) suggests idiopathic
Electrolytes
*Membranious Nephropathy*
Unfractionated Heparin binds to thrombin and inactivates it better
than low molecular weight heparin.
Antocoagulant that prolongs both PTT and PT with no effect on TT
is *Direct factor Xa Ihibitor*
Significant renal artery stenosis causes renal hypoperfusion and
activation of the RAAS system. This leads increased release of
7569 Pathophysiology renin by the JG cells.
Electrolytes
These cells would undergo hyperplasia and hypertrophy and they
are *Modified smooth muscle cells of the afferent arteriole*
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.
Psoas major muscle contributes to hip flexion which is an action
7621 Anatomy taken when sitting up from a supine position without using the
& Sports
hand.
Left ventricular leads in biventricular pacemaker course through
7646 Anatomy Cardiovascular System the coronary sinus, which resides in the *Atrioventricular Groove*
on the post aspect of the heart.
Pt with duodenal ulcer. H. Pylori can be found in *Prepyloric area*
[Antrum of stomach]
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
7721 Pharmacology Ophthalmology Growth Factor* should be specifically targeted.
(Age related Macular degeneration (AMD), Retinal
neovascularization due to VEGF)
[Txwithranibizumab,bevacizumab)
Patients with frontal lobe injury often experience executive
dysfunction and personality changes secondary to impairement of
Behavioral Psychiatric/Behavioral & the ogranizational, restraint, and motivational systems. Changes in
7752
science Substance Abuse social behavior can manifest in variable ways with *Left* sided
lesions more often associated with "Apathy" and right-sided lesions
withdisinhibition.
Rheumatology/Orthopedics A medication that selectively binds to an IL-1 "inducible" enzyyme
7792 Pharmacology
& Sports is probably a selective COX-2 inhibitor such as *Celecoxib*
Renal, Urinary Systems & Pharmacologic therapy of Urge incontinence involves
8249 Pharmacology
Electrolytes *Antimuscurinic Agents*
8259 Pharmacology Tx Narcolepst with *Modanfil*
Substance Abuse
Cheyne-stokes breathing (rapid breathing followed by apnea) is
associated with *Congestive Heart Failure*
Wieght lifter who raises wieght above head and then his arms
Rheumatology/Orthopedics suddenly and involuntarily give away and he drops the wieght to
8266 Physiology
& Sports ground. The structure that was most likley responsible for the
suddent muscle relaxation is *Golgi tendon organ*
The action that most likely prevents intravascular catheter-related
8282 Microbiology Cardiovascular System infections is *Alcohol-based hand scrub prior to beginning the
procedure*
Differences in halotype frequencies in a population can be as a
8283 Genetics Gastrointestinal & Nutrition
result of *Linkage Disequilibrium*
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)
Low dose Atenolol affects B1 adrenergic receptors on *cardiac
cells and JGP cells but not vascular smmoth muscle*
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]
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.
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
8296 Pathology Cardiovascular System 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]
Agitation, disorienttion, Pharyngospasm, Photophobia, COMA and
8324 Microbiology Nervous System Death strongly suggests Rabies Encephalitis which binds to
*ACETYLCHOLINERECEPTORS*(nicotinic)
Neoborn with a palpable swelling of neck. He is comfortable only
when held sideways. The child favors looking toward right and
Pregnancy, Childbirth & cries when his head is turned to left. Most likely condition present
8325 Pathology
Puerperium prenatally is *Intrauterine Malposition*
[Congenital torticollis, sternocleidomastoid muscle injury and
fibrosis]
8326 Anatomy MaleReproductiveSystem The scrotum is drained by the superficial inguinal lymph nodes.
Treating pt already on SSRI such as paroxetine with antibiotic
8327 Pharmacology Linezolid can ilicit Sertonin Syndrome characteized by tremor,
Substance Abuse
hyperflexia, clonus, confusion, agitaton, cramps and diarrhea.
8328 Genetics GeneralPrinciples In Trisomy 21, chromosomal nondisjunction occurs in *Meiosis 1*
Pt undergoes transesophageal echocardiography. The ultrasound
8332 Anatomy Cardiovascular System probe is placed in the mid-esophagus facing "anteriorly". The
cardiac chamber closest to the probe is *Left Atrium*
Transesophageal echo probe facing posteriorly would interrogate
the *Descending Aorta*
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
8342 Microbiology Ear, Nose & Throat (ENT) 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]
Pt presenting with weakness, dizziness and paraesthesias with
recent history of eating japanese food has probably a Tetrodotoxin
8352 PathophysiologyNervous System
from eating Puffer fish. These toxins block Sodium channels
thereforepreventingmuscledepoolarization.
The step that Raltegravir imapirs in viral replication is *mRNA
transcription*
16 year old female with pelvic pain every 28 days and resolves in a
FemaleReproductive day or two with fully developed 2ndry sexual characteristic. She
8390 Anatomy
System & Breast has a palpable mass anterior to the rectum. Serum Beta-hCG is
negative. Most likely Dx is *Imperforate hymen*
The adrenam medulla is demaracted from the cortex and is
8424 Histology composed of Chromaffin cells with a deeply basophilic (blue)
Metabolism
cytoplasm. The medulla is stimulated by Acetycholine.
Mutations in Leptin gene or receptor will lead to *Hyperphagia and
Obesity*
Ribavirin wich is used in Hep C infection works by *Interferring
with duplication of viral genetic material*
Behavioral Providing care to all company employees in exchange for a set
8456 GeneralPrinciples
science monthly fee is *Capitation*
Most common cause of death a lightening strike is *Cardiac
Arrythmia* and Respiratory failure.
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)
PECAM-1 gene is involved in Transmigration during the
inflamatory process.
Quadriplegic pt who is givena a skeletal muscle relaxant before
Rheumatology/Orthopedics intubation goes into cardiac arrest. He has V fib and massive
8481 Pharmacology
& Sports Hyperkalemia. Admistration of *Succinylcholine* probably caused
hissymptoms*
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*
The vagus and spinal accessory nerve exit through the *Jugular
Foramen*
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]
Pt with renal cell carcinoma and given high dose IL-2. There is
8530 Immunology reduction in tumor burden. Mechanism? -> *Enhanced Activity of
Electrolytes
NK cells*
Blood cultures that grow coagulase negative staph after a
ventriculoperitoneal shunt placement. The most imp virulence
8533 Microbiology Nervous System mechanism of bacterium is *Synthesis of an extracullular
polysaccharide matrix*
[Staph Epidermidis releasing a biofilm]
Tx of enterobius vermicularis is *Albendazole*
[Scotch tape test]
The molecule involved in mediating the accumulation of pus is
8539 Immunology Gastrointestinal & Nutrition *IL-8*
[Neutrophil chemotaxis]
8542 Pharmacology Hematology & Oncology Rasburicase converts uric acid into more soluble metabolites.
In pts with CHF, compensatory activation of of RAAS and
8546 Physiology Cardiovascular System *Sympathetic Nervous System* results in increased afterload,
excess fluid retention and cardiac remodelling.
FemaleReproductive Turner syndrome pt can become pregnant but with oocyte
8556 Genetics
System & Breast donation.
When you give Acetycholine to dilat blood vessles. The amino acid
resposnible for this vasodilation is *Arginine*
Premature neonate with decreased level of conscousnes and
hypotonia. She is weak, has prominent scalp veins and tense
8564 Anatomy Nervous System fontanels. Ultrasound shows blood in the lateral ventricles. Source
of ventricles is *Germinal Matrix*
(This interventricular hemorrhage in a premature neonate)
In Tx of psoriasis, we use Vit D analogs such as *Calcitriene*
8569 Pharmacology Dermatology which activates Vit D receptor, which is a *Nuclear Transcription
Factor*
Obese pt is interested in adjustable gastric band. In order to
encircle the stomach, the band must pass thru the *Lesser
Omentum*
(Hepatoduodenalligamnet+hepatogastricligament)
Pt with homonymous hemianopia with macular sparing could have
occlusion of *PCA*
Isopropanol has antiseptic properties through *Disruption of cell
membranes*
Injury to meyer's loop in the temporal lope results in contralateral
superiorquadantanopia.
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]
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.
8671 Anatomy
& 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]
The anterior pituitary is derived from *Surface Ectoderm*
8702 Embryology Nervous System (Rathke's pouch)
-Check Table
Pt with a fish bone lodged in the left piriform recess would impair
8703 Anatomy Pulmonary & Critical Care his internal laryngeal nerve which is a branch of superior laryngeal
nerve (CN X) and hence would impair his *Cough Reflex*
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
8710 Pathology 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]
Scar tissue in the heart is Type 1 Collagen, Just like tendons,
8711 Histology Cardiovascular System
ligaments, bone and blood vessels are type 1.
*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.
Pt with signs of RA. Serum autoantibodies with "high specificity"
Rheumatology/Orthopedics for this pt condition are most likely to react with *Citrullinated
8802 Biochemistry
& Sports peptides*
[ant-CCP]
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*
8869 Pharmacology Cardiovascular System *Flacainide* reduces QRS interval.
The finding most suggestive of Strongloides Stercoralis infection is
8873 Microbiology Gastrointestinal & Nutrition *Rhabditiform Larvae in Stool*
[Tx with Ivermectin]
When GFR is normal, relative decease in GFR results in only a
Renal, Urinary Systems & small increase in serum creatinine. However, when GGFR is
8881 Physiology
Electrolytes significantly decreased, small decrements of GFR produce large
changes in serum creatinine.
Young girl with a soft raise, hyperpigmented, 0.5cm nontender
lesion iinferior to the right breast. Most likely cause is *Failed
8904 PathophysiologyDermatology
involution of the mammary ridge*
[Accessory Nipple]
Pt with BPH and treated with drug that reduces prostate volume is
8930 Pharmacology MaleReproductiveSystem probably beig treated with 5-alpha reductase inhibitors such as
*Finasteride*
8954 Majority of overdose deaths are related to *Opioids*
9814 Access to firearms increases risks for suicide.
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*
*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.
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.
Behavioral Social Sciences The requirement for hospice care referal is *Prognosis of less or
10290
science (Ethics/Legal/Professional) equal to six months*
Behavioral Social Sciences
10399 Physicians must report impaired collegues in a timely manner.
science (Ethics/Legal/Professional)
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.
Biostatistics & When the unit of analysis in a study is "Populations" and not
10570 Biostatistics
Epidemiology individuals, then it is an *Ecological Study*
Behavioral Psychiatric/Behavioral & Pt with somatic symptom disorder should be *Scheduled regular
10581
science Substance Abuse outpatient office visits*
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
10583 Anatomy 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]
Behavioral Psychiatric/Behavioral & Stimulus conrtol therapy in Tx of insomnia involves leaving the
10785
science Substance Abuse bedroom if unable to fall asleep within 20 minutes.
Renal, Urinary Systems & Pt leaking urine with coughing (stress incontinence) is due *to
10962 Anatomy
Electrolytes Urethral sphincter dysfunction*
Pt with MS who develops urge incontinence. Reason is
*Uninhibited bladder contraction*
11038 Pathophysiology [Loss of central nervous inhibition of detrusor contraction, as
Electrolytes
disease progresses the bladder can become atonic and dilated
leading to overflow incontinence]
Diabetic autonomic neuropathy is common in type 1 diabetes and
can cause overflow incontinence due to inability to sense a full
11040 Pathophysiology bladder and incomplete emmptying. *Postvoid Residual* testing
Electrolytes
with ultrasound or catheterization can confirm inadequate bladder
emptying.
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)
Fever and Diarhea after Antibiotic adminstration suggest C. Diff
11459 Microbiology Infectious Diseases infection and precaution of wearing *Nonsterile gloves and Gown*
should done.
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.
Pts with MS often develop a spastic bladder a few weeks after
Renal, Urinary Systems & developing an acute lesion of the spinal cord. These pt present
Electrolytes with increased urinary frequency and urge incontinence.
Urodynamic studies show the presence of *Bladder Hypertonia*
*Compound Nevi* are benign proliferation of melanocytes that
11502 Pathology Dermatology involve both the dermis and epidermis. They have uniiform
pigmentation and symmetrical sharp borders.
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]
Renal, Urinary Systems & Preventing UTI's from catheter can be done with *Prompt removal
Electrolytes of catheter when no longer indicated*
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)
Pt with many diseases including neurocognitive disorder, in order
Behavioral Miscellaneous to achieve drug adherence, you should *Involve a social worker in
11534
science (Multisystem) discharge planning*
-Note: Checklist wont work since pt's cognition is impaired.
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.
Pt bitten by his dog. Wound is warm, red and swollen after 24hrs.
11547 Microbiology Infectious Diseases Wound culture grows g-ve coccobacilli and culture has mouse-like
odor. Organism? => *Pasturella Multicoda*
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)
Behavioral Miscellaneous Pt who is becoming an outpatient and has complex medication
11550
science (Multisystem) regimens should be given a *Hospital discharge checklist*
A diabetic drug that can cause hypoglycemia is *Glyburide*
Endocrine, Diabetes & [Sulfonlureas increase insulin secretion from pancrease. Glipizide
11565 Pharmacology
Metabolism is also a sulfonylurea but it is short acting (unlike Glyburide) and
hence its risk of hypoglycemia is reduced]
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.
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.
11574 Pathology Nervous System [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)
Psychiatric/Behavioral & A pharmcotherapeutic agent that "reduces craving" for alcohol
11577 Pharmacology
Substance Abuse Naltrexons which *Blocks Mu-opoid Receptor*
Pt with Human epidermal growth factor receptor 2 tumor positivity
(3+over expression). Adjuvant therapy of a monoclonal antibody is
11585 Pharmacology Hematology & Oncology started. Target of this therapy is *Tyrosine Kinase Receptor*
[Breat Ca, HER2-neu is a tyrosine kinase receptor, antibody is
TrasTUzumab]
11590 Pharmacology Infectious Diseases Pt with HLA-B*57:01 positive results is associated with *Abacavir*
Suspicion and distrust, feeling of being exploited, together with
11594 histroy of repetitive conflict suggests *paranoid personality
disorder*
11603 Fear of Elevators is treated with *Behavioral Therapy*
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]
Behavioral Psychiatric/Behavioral & Pts who has pyschotic symptoms has been staying up late for
11605
science Substance Abuse exams probably has *Substance Induced Psychotic disorder*
Pt with cavernous hemangioma is at greatest risk of developing
*Intracerebral Hemorrhage*
If a hypertensive and diabetic patient is using herbs to lose weight,
Behavioral
11629 Gastrointestinal & Nutrition explain to them that these are poorly regulated and have potential
science
health risks.
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.
Endocrine, Diabetes & An anti-hyperlipidemia drugs that inhibits cholestrol absorption at
11634 Pharmacology
Metabolism the brush border of the small intestine is *Ezetimibe*
Biopsy that shows Endomysial Mononuclear inflammatory
Infiltrates and Patchy Muscle Fiber Necrosis inidcates
11646 Pathophysiology Polymyositis which present with insidious proximal muscle
& Sports
weakness. Usually, Autoantibodies such as antinuclear antibodies
(ANA) and *Anti-histydle-tRNA-Synthetase (anti-Jo1)* are present.
Pt with who presents with pelvic pain. She has fibrous Dysplasia
(multiple osteolytic-appearing lesions of the hip and pelvis),
11653 Pathology enodocrine abnormalities (hyperthyroidism, percocious puberty)
& Sports
and cafe-au-lait spots. (Triad) suggest a Dx of *McCune-Albright
Syndrome*
11658 Anatomy MaleReproductiveSystem Gonadal arteries originate from the abdominal aorta!
Rheumatology/Orthopedics pt with a comminuted patella fracture would be unable to *Extend
11659 Anatomy
& Sports the knee against gravity*
Postoperative HypoParaThyroidism is common after
Endocrine, Diabetes & thyroidectomy. Symptoms include Tingling, Numbness, Muscle
11660 Physiology
Metabolism Spasms, Seizure, Trousseau and Chvostek signs ( twitching of
lower face muscle on percusiion below zygomatic arch)
Rifaxim is given in hepatic encephalopathy. It works by
*Decreasingintraluminalammoniaproduction*
Behavioral Social Sciences a health insurance plan with low monthly premieums is *Health
11668
science (Ethics/Legal/Professional) MaintenanceOrganization*
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
11670 Microbiology Infectious Diseases that has minimal enhancement and no associated edema. Most
likely means of acquisition of infection is *Exposure to infected
stool*
[Neurocysticercosis by Taenia solium]
The ubiquitin proteasome pathway is essential for breakdown of
intracellualr proteins, both native and foreign. Ubiquitin works as a
11674 Immunology GeneralPrinciples
tag for proteasome recognition. This is performed by *Ubiquitin
Ligase* that catalyzes ubiquitin attachment.
Pt with pathcy vision loss and flame-shaped retinal hemorrhage on
fundoscopic exam probably is due to *HTN* Poorly controlled HTN
11675 Pathology Ophthalmology can cause acute retinal hemorrhage which presents as painless,
unilateral visual disturbances ranging from mild loss of visual acuity
topermanentblindnes.
Topical Capsaicin in the non-systemic Tx of post herpetic
neuralgia depletes *Substance P* by over releasing it.
Gaba pentin Inhibits presynaptic voltage-gated Ca channels thus
11682 Physiology Nervous System
preventingneurostransmittervesiclerelease.
Rheumatology/Orthopedics In Carpal Tunnel Syndroem, Incicision of the *Transverse Carpal
11683 Anatomy
& Sports Ligament* (Flexor retinaculum) would improve symptoms.
In suprapubic cystostomy, besides the bladder, the structure most
11708 Anatomy likely penetrated by the trocar and cannula is the *Anterior
Electrolytes
AbdominalAponeurosis*
Rheumatology/Orthopedics The *Piriformis muscle* passes through the greater sicatic
11727 Anatomy
& Sports formaen and occupies most of its volume.
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]
Pts with cholestrol gallstones who refuse cholecstectomy can be
treated with Hydrophilic bile acids (ursodeoxycholic acid) that
11739 Pharmacology 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.
Orbital floor fractures can impair the infraorbital nerve which is a
continuation of the maxilaary nerve and result in numbness and
11742 Anatomy Nervous System paresthesia in the uppercheeck, UPPER LIP, and upper gingiva.
This can also impair inferior rectus muscle amd impair superior
gaze
Use clozapine in treatment resistent schizophrenia.
11743 (Agranulocytosis, seizures and metabolic syndrome are side
effects)
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)
Behavioral Psychiatric/Behavioral & Depression, Fatigue, Hypersomnia, Hyperphagia, and Vivid
11746
science Substance Abuse dreams are characteristic of *Cocaine Withdrawal*
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]
Bone Metastases that is Osteoblastic (Sclerotic) on imaging can be
11754 Pathology Hematology & Oncology related to *Prostate cancer*
[Also small cell lung Ca and Hodgkin Lymphoma]
Pt with recurrent episodes of chest ain, ,tachycardia, shortness of
breath, sweating, and tremulousness in a young otherwise healthy
11756 pt with normal ECG. Best next step in management is
*Benzodiazepine*
[Panic Disorder]
Undescended testes that can be felt medial to the mid-inguinal
11762 Anatomy MaleReproductiveSystem point have to only be passed through the Superficial inguinal ring
which is formed by the *External oblique muscle aponeurosis*
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]
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)
Pt with headaches, visual and muscular symptoms, an enlarged
Rheumatology/Orthopedics temporal artery, an elevated ESR has Giant cell Arteritis with
& Sports assoc. polymyalgia rheumatica. The most imp mediator of this
conditon is *IL-6* (cell mediated immunity, vasculitis)
External Hemorrhoids originate below the dentate the line. They
11771 Anatomy Gastrointestinal & Nutrition have cutanoeous (somatic) innervation from the inferior rectal
nerve which is a branch of the *Pudendal Nerve*
The somatic pain in appendicitis that shifts from the umbilicus to
Mcbirney point is due to *Inflammation of parietal peritoneum*
The Quadraceps tendon is supplied by the femoral nerve. The
11777 Anatomy Nervous System femoral nerve can be blocked best in the *Inguinal Crease* at the
lateral borde of the femoral artery.
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
11778 Anatomy 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)
Pulmonary capillary wedge pressure (measured via a swan-ganz
11780 Anatomy Cardiovascular System catheter into the pulmonary artery) closely reflectsend-diastolic
pressure in *Left Atrium* and the Left Ventricle.
Pt with right sided back pain and voiding is normal after a
FemaleReproductive
11781 Anatomy hysterectomy probably has an injured *Ureter* during the surgery.
System & Breast
Voiding is normal becuase other ureter is functionl.
11782 Anatomy Gastrointestinal & Nutrition *Teniae coli* are used to locate the appendix.
Pt with epistaxis. Silver nitrate cautery is performed and bleeding
11783 Anatomy Ear, Nose & Throat (ENT) stops. Cautery was most likely applied to *Nasal Septum*
[Most bleeds happen here in Kiesselback's plexus]
Renal, Urinary Systems & An immuno suppressant that inhibits lymphocyte proliferation by
11786 Immunology
Electrolytes blocking interleukin-2-signal transduction is similar to *Sirolimus*
11798 Pathology Pt with sign of SLE would have *Low C3 and C4*
& Sports
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*
Pt with muscle weakness. P.E shows Gotrons papules. (image)
Further evaluation would likely reveal *Ovarian Adenocarcinoma*
11805 PathophysiologyHematology & Oncology [Dermatomyositis, perimysial infiltrates. It can occur alone or as a
paraneoplastic syndrome. Most commonly associated with
Ovarian, lung, colorectal and non-hodkins lymphoma]
Pts who is bulimic (bulimia nervosa) (Binging, exercise, normal
Behavioral Psychiatric/Behavioral & weight, self induced vomiting proven by pharyngeal erythema,
11807
science Substance Abuse hypokalemia, and increased amylase)can be given an SSRI such
as*Fluoxetine*
Behavioral Psychiatric/Behavioral & Methylphenidate used in ADHD has a side effect of *Decrease
11809
science Substance Abuse Appetite and Weight loss*
A child at age 2 with only 40 words of vocabularly should be
11810 *Assessed further*
(Normal is 50-100 words at age 2)
Pt with UTI after recent cytoscopy in which urine culture shows
11812 Microbiology Infectious Diseases g+ve cocci in chains most likey has Enteroccocus which shows
*Gamma hemolysis on blood agar*
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)
Acute joint pain, swelling, and erythema with restricted range of
11818 Pathophysiology motion is consistent with synovitis. Diagnosed with *Synovial Fluid
& Sports
Analysis*
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
11819 Anatomy
& Sports center of tibia due to repetitive muscle contraction and traction of
bone. Most likely insertion site of involved muscle tendon is *Tibial
Tuberosity*
[Osgood-Schiatter Disease]
FemaleReproductive
11820 Anatomy Exercise to strengthen pelvic floor targets *Levantor Ani Muscle*
System & Breast
11821 Pathology Rheeumatoid arthritis most likely affects *Cervical Spine*
& Sports
Infant comes due to generalized seizure. She fever for past 12
hrs. Pt is discharged with no medication. Three days later, she has
11822 Microbiology Infectious Diseases 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]
To help with delivery, a vertica; midline incision is made at the post
FemaleReproductive
11823 Anatomy vaginal opening through the vaginal and subvaginal mucosa. The
System & Breast
structure most likely involved in this incision is the *Perineal Body*
Biostatistics &
11835 Genetics Good Question On Hardy Wieiberg analysis
Epidemiology
Behavioral Psychiatric/Behavioral & Use *SRRI's* in panic disoder in pt who presents camly and
11838
science Substance Abuse normal vital signs.
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.
11844 Pharmacology Cardiovascular System Fenofibrate therapy *Rduces Hepatic VLDL production*
In Obstructive Sleep Apnea. Electric stimulation of *Hypoglossal
11845 Anatomy Pulmonary & Critical Care
nerve* help the pt
Allergic reaction to Morphine is *IgE- Independent mass cell
Degranulation*
11854 srri's used in depression *Block Serotonin Receptor*
Histopathology of High-grade cervical intraepithelial neoplasia
FemaleReproductive
11858 Pathology (CIN) would show *Expansion of immature basal cells to the
System & Breast
epithelial surface*
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]
Intestinal Bacteria can produce *Folate* and vit K.
11860 PathophysiologyGastrointestinal & Nutrition (In gastric bypass surgey there is bacterial overgrowth leading to
increase in these two substances)
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!
Dont confuse *Anxiety to due medical condition* as in
Behavioral Psychiatric/Behavioral & Hyperthyroidsim with generalized anxiety disorder. Weightloss,
11866
science Substance Abuse tachycardia, warm moist skin, tremor along with anxiety suggest
hyperthyroidism.
Pt who acquire staph infection thru hemodialysis catheters and
11868 Microbiology present with backpain could have developed osteomyelitis which
& Sports
can be evaluated using *MRI of the spine*
Paroxysmal nocturnal hemoglobinuria is due to a gene defect that
leads to uncontrolled complement-mediated hemolysis. The classic
11869 Pathology Hematology & Oncology triad includes hemolytic anemoa (hemoglobinuria), pancytopenia,
and thrombosis at atypical sites. Chronic hemolysis can cause
deposition in the kidney(*Hemosiderosis*)
FemaleReproductive
11890 Histology Revisebreastneoplasia!
System & Breast
Behavioral Psychiatric/Behavioral & Delirium can be treated with first gen antipsychotic such as
11899
science Substance Abuse *Haloperidol* in addition to treating the underlying cause.
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*
11904 Genetics GeneralPrinciples Spina Bifida has a *Multifactorial* Inheritance pattern
Virus that develop a trait (due to culturing with another viruse) and
their subsequent progeny continue to have the trait. Mechanism
11907 Genetics Infectious Diseases
that explains this is *Reassortment*
(Recombination is if progency acquires completely new trait)
Woman who delivers twins and has postpartum hemorrhage and
surgery is started. To control her bleeding, bilateral ligation of
FemaleReproductive
11908 Anatomy *Internal Iliac* arteries is preformed and this would preserve her
System & Breast
fertility due to the dual supply of the uterus from the ovarian
arteries.
*Alternative Splicing* is a process by which a single gene can
11913 Genetics GeneralPrinciples code for various unique proteins by selectively including or
excluding different DNA coding regions (Exons) into mature mRNA.
*Hormone Sensitive Lipase* is found in adipose tissue, it catalyzes
the mobilization of stored triglycerides into free fatty acids and
11917 Biochemistry glycerol. The liver can further oxidize FFA to acetyl-coA and then
Metabolism
further metabolized into Ketoen Bodies.
This can be seen during Starvation.
In an animal that well fed with CHD's. beta-oxidation of fatty acids
11918 Biochemistry is inhibited via *Malonyl-coA* which inhibits carnitine
Metabolism
acyltransferase from shuttling acyl groups into the mitochondria.
Woman who has a complication after c-section delivery of
dyspnea, hypotension, bradycardia, hypoxia, and DIC (bleeding
Pregnancy, Childbirth & from incisons) and later dies most likely has Amniotic Fluid
Puerperium Emboism (amniotic fluid enters maternal circulation). Histology of
lungs reveals *Pulmonary artery branch with swirls of fetal
squmous tissue*
Renal, Urinary Systems & Pt with anion ga metabolic acidosis would rewuire renal
11939 Biochemistry
Electrolytes metabolism of *Glutamine* for maximizing acid excretion pt.
Renal, Urinary Systems & Erythropoiesis-stimulating agents are associated with increased
11945 Pharmacology
Electrolytes risk for *hYPERTENSION* and thromboembolic events.
Zinc finger mtoif are composed of chains of aminoacids bound
together around a zinc atom via linkage with cystein and histidine
11950 Biochemistry residues. Intracellular receptors that bind steroids, *Thyroid
Metabolism
Hormones*, and fat-soluble vitamins act directly as transcription
factors and conatin zinc biding domains.
Postpartumn fecal incontinence can be caused by injury to
*Pedundal Nerve*
Radiofreqyency ablation of the AV node in a pt with arrhythmia is
11956 Anatomy Cardiovascular System achieved at the *Interatrial septum near the opening of the
coronary sinus*
Septic Abortiontypically prsents with fever, abodominal pain,
uterine tenderness, and/or foul-semlling discharge after
FemaleReproductive
11961 Microbiology preganancy termination. Common offending pathogens inculude
System & Breast
*Staph Aureus* and E. coil due to seeding of the uterine cavity
duringinstrumentation.

UWORLD Notes April 29 2016 (Usmle Grassroots)

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Usually secretin inhibits gastrin production.

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